Mental health and wellbeing in community sport: The Ahead of the Game program

Participants (which include adolescent males, their parents, and their coaches) will be exposed to at least one program from a choice of four which will determined by their sporting club. Adolescents will be exposed to: 1. A brief (45 minute) mental health literacy program delivered face-to-face at a sporting club (called Help Out a Mate). Using the concept of mental health literacy, this program aims to increase mental health literacy among adolescent males (specifically in regard to depression and anxiety), increase their skills and confidence to help a peer showing signs of a mental health problem, increase helping behaviour and supportive actions, increase appropriate help-seeking among young males at risk of mental health problems, and decrease stigmatising attitudes. Specifically, the intervention involves the following components which are delivered with the aid of a powerpoint presentation; (i) what is mental health and mental illness; (ii) myths about mental illness; (iii) what is depression?; (iv) what is anxiety?; (v) how to help; and, (vi) where to get information. The program focuses on helping adolescents to recognise the signs of depression and anxiety, approach a friend confidently, encouraging help-seeking, make an adult aware of potential mental health problems, and understand self-help behaviours. Additionally, the program teaches adolescents how to ask for help if they feel that they need it. In line with the overall program, additional resources are provided to the adolescents, including a ‘Man Card’ (business card) which includes the main steps on how to help their friend as presented in the intervention, and referral information to other mental health resources. The intervention also includes two ‘role play’ scenarios for participants to practice providing and asking for help. The program is delivered face-to-face, and is usually conducted in a room at the athlete’s sports clubs to groups of approximately 5-20 adolescents. The program is usually conducted by young adult volunteers with lived experience of mental health problems, as it has been found that a mixture of education and exposure to someone with a mental illness can effectively reduce stigma. The volunteers are all trained in Mental Health First Aid. The program is designed to be brief (approx. 45 minutes) so that it could conveniently be placed in or around a typical training session. In addition, the key messages of the program are reinforced with materials given to all adolescent participants. Specifically, each adolescent is provided with a boot bag (printed with ‘Help Out a Mate), drink bottle (printed with a list of healthy behaviours), z-card (with information on symptom recognition and help-seeking options), and stress ball (printed with the Ahead of the Game logo). 2. A brief (1 hour) resilience program delivered face-to-face at a sporting club and supplemented by 6 online/app modules (called Your Path to Success in Sport). The program aims to provide adolescent males with mental skills for coping with adversity and building resilience through sport. This sport psychology program consists of one face-to-face workshop (approximately one hour) supported by six 10 minute modules delivered online/via app. The workshop is delivered by a trained facilitator and involves interactive tasks to establish the need and context for subsequent engagement with the online/app-based resources. For example, this session considers the need for resilience in sport and other domains of life through videos, stories from elite athletes, and identifying challenges and obstacles that adolescents are likely to face. The adolescents are then provided with access to the supplementary modules to complete on their own. These resources are accessed through the Ahead of the Game website or by downloading the Ahead of the Game app. Each module consists of instructional videos, stories from elite athletes and adolescents in sport, as well as reflective activities and exercises to try in their own game. These modules take approximately 10 minutes to complete, and address 6 topics in order: (1) problem-solving; (2) controlling the controllables; (3) managing your thoughts; (4) keeping your cool; (5) playing to your strengths; and (6) appreciating your team. Together, this program aims to provide adolescent males with skills and strategies for building resilience which can be applied to their own performance in sport (e.g., dealing with injury), as well as helping them cope with adversity in other domains of life (e.g., school, work). 3. The parents of adolescent males will be exposed to a brief (1 hour) mental health literacy program delivered face-to-face at a sporting club. Parents are the primary source of support for adolescents and the likely first observers of mental health disorder symptoms in their children. Therefore, parents need to be able to provide adequate support and assistance when their child or adolescent shows symptoms of a mental health disorder. Research, however, suggests that the mental health literacy of parents (in terms of their children’s mental health) is limited and parents are not adequately prepared or confident to assist children who experience a mental health disorder. The parent program is designed to increase parent mental health literacy through a one hour, face-to-face workshop delivered through community sport clubs. Specifically, the workshop aims to raise awareness of parents’ role in promoting and supporting positive adolescent mental health, and to increase knowledge of common youth mental health disorders, mentally healthy behaviours, and help-seeking options. It also aims to reduce stigma, promote constructive communication about mental health, and increase parental confidence and self-efficacy in supporting optimal adolescent mental health. Intervention content is guided by the mental health literacy framework and is designed to be engaging through a mix of parent reflection, discussion, presentation, and videos. Materials were developed and adapted from Mental Health First Aid guidelines, or used with permission from mental health organisations and parenting organisations (e.g., ReachOut, Raising Children Network). The content of the intervention workshop has been assessed for relevance and accuracy by a Mental Health First Aid trainer. The workshop is kept intentionally brief to combat parents’ reported time constraints, and capitalises on the close social support networks among parents in the youth sport club environment. The information presented is set at an introductory level and is aided by the use of a powerpoint presentation. Specifically, the content includes: Awareness raising of the role of parents in adolescent mental health; how to recognise the signs of a mental health problem and how to tell the difference from normal teenage behaviour; professional help-seeking options; skills to start a conversation; positive preventative behaviours for adolescent mental health. The program is delivered by one of two presenters who each have a Masters degree in Sport Psychology. 4. The coaches of adolescent male participants will be exposed to a coach training program which includes: two face-to-face workshops of 2 hours in duration; 2 mentoring sessions with a coach educator of 1 hour in duration; and 12 online modules of approximately 20 minutes in duration. This primary aim of the coach program is to help coaches develop the skills to facilitate intrinsic motivation among their players. Based on self-determination theory, the coach program is specifically targeted at helping coaches to support athletes’ autonomy, competence, and relatedness. The program involves a combination of face to face workshop and online materials. There are two face-to-face workshops which last 2 hours each. The workshops introduce the coaches to the online materials, where they begin working through activities and various video examples. In total, there are 12 online modules of approximately 20 minutes in duration each. Each module follows the same format: An introductory video about the principle being taught (approximately 2 minutes); Example videos of good and poor coaching practice relevant to the principle being taught (approximately 5 minutes); reflection on the good and poor practice videos (determined by the participant); and, goal setting relevant to the principle being taught (approximately 5 minutes). Workshops and online modules are supplemented by two 1-hour mentoring sessions, which take place either face-to-face or online via Skype (or similar application). Mentor sessions are coach-directed, but are usually used to answer questions that coaches have, explain principles in more detail if needed, and to provide ongoing support to the coach. The program is typically run as follows: Face to face workshop 1 (week 1); 6 online modules (weeks 2-5); mentoring session (week 6); face-to-face workshop 2 (week 7); 6 online modules (weeks 8-11); and a final mentoring session (week 12). All workshops and mentoring sessions are facilitated by a sports psychologist with a minimum of 2 years experience in the face-to-face delivery of interventions. Each facilitator received extensive (12 hours) training in the content and online system. All participants will be drawn from organised sporting clubs in the Illawarra and Southern Sydney region of New South Wales, Australia. Given the bottom-up approach used within the trial, all participants are free to choose what programs they will attend. In total, the program is designed to last for up to 12 weeks, but the scheduling of programs is at the sporting club’s discretion. Fidelity of program delivery is monitored via checklists which are completed by each presenter following each workshop. Fidelity to protocol of online components for the adolescent resilience program and the coach program are monitored by completion of the modules online or via the Ahead of the Game app. Parental and adolescent attendance at workshops is monitored by the facilitator.