Brief Summary

This is an observational study with the aim of SWELE Programme is to raise mental health knowledge and awareness by implementing a play-based approach on Supporting Wellness in E-Child Learning Environments (SWELE) programme combining unstructured outdoor play activities with mindfulness-based interventions to promote mental health in children and adolescents with special education needs (SEN), in the context of the COVID-19 pandemic.

This is a 16-week SWELE programme and it will be conducted in two batches. Each batch has three special schools. The main activities include: One training workshop for three groups in each special school: 1) Scout Leaders (special schools' teachers), 2) SEN students (scouts in the school) to become Youth Mental Health Ambassadors and 3) for parents, school social workers, school nurses, schoolteachers and stakeholders; 30 minutes unstructured outdoor play with mindfulness activities 2 times per week for 16 weeks

After participated the SWELE programme, the primary outcomes include reducing anxiety symptoms, reducing negative emotions, improving social skills in peer relationships; and changing in playfulness level among SEN children and adolescents.

Main activities of SWELE programme:

* Unstructured outdoor free play integrated into the school's extra-curricular activities (Youth Mental Health Ambassadors) to promote SEN students' mental health for objectives 1-4.
* Use mindfulness-based podcasts, mindfulness games, mindfulness art for objectives 1-2.
* Through meditation and deep breathing technique, storytelling with relaxing waves piano music, yoga and mindful art for objectives 1-2.
* Training Workshops (Training of trainers) for Scout Leaders who will implement SWELE program in each special school.
* Youth Mental Health Ambassador Program for SEN students who are enrolled in Scout Club in each special school; SWELE training workshops for parents and schoolteachers will also be held in each special school for objectives 1-4.
* Examples of unstructured play might be creative play alone or with others, including artistic or musical games. imaginative games - for example, making cubbyhouses with boxes or blankets, dressing up or playing make-believe, exploring new or favorite spaces like school backyards, parks, playgrounds and so on.

Conditions

• Specific Learning Disorder
• Intellectual Disability, Mild to Moderate
• Autism Spectrum Disorder
• Attention Deficit Hyperactivity Disorder
• Physical Disability

Intervention / Treatment

• Behavioral: SWELE Programme

Primary Outcome Measures

• Change scores from baseline to 16 weeks in SEN students' mood using the Mood Scale (16 weeks)
  To reduce over 80% of SEN students' low mood after participated the 16-week SWELE programme. The Mood Scale includes five different emoji with a 5-points response scale of mood ranging from 1-5: 1-Very bad; 2-bad, 3-so-so, 4-good; to 5-very good. The range of scale score can be from 1 to 5 where higher scores represented very good mood and emotion.
• Change scores from baseline to 16 weeks in SEN students' anxiety symptoms using the Chinese version of the short-form State-Trait Anxiety Inventory (STAI-S-6 & STAI-T-7) (16 weeks)
  To reduce over 80% of SEN students' anxiety symptoms after participated the 16-week SWELE programme. The Chinese version of short-form of State-Trait Anxiety Inventory (STAI-S-6 \& STAI-T-7) demonstrates sound psychometric properties to evaluate the anxiety level. Observers will be asked to rate each item using the following scale (Scale of 1-4; 1 = not at all, 2 = a little, 3 = moderate, 4 = extremely). The range of score from 13 to 52. The mean of the Inventory will be calculated and the mean difference will be compared between the baseline and at 16 weeks. The higher score shows a higher level of anxiety.
• Change scores from baseline to 16 weeks in SEN students' behavior regulations (classroom self-regulation and social skills) using the Child Behavior Rating Scale (CBRS) (16 weeks)
  To increase over 70% of SEN Students' self-regulation and social skills after participated the 16-week SWELE programme. The Child Behavior Rating Scale (CBRS) consists of 17 items that measure children's behavioral regulation as illustrated by two subscales: the Classroom Self-Regulation subscale (10 items) and Social Skills subscale (7 items) that assess teachers' perceptions of children's behavioral regulation in social situations. Observers/teachers will be asked to rate each item using the following scale (Scale of 1-5; 1 = not at all, 2 = a little, 3 = sometimes, 4= always, 5 = often). The range of score from 17 to 85. Scores The mean of the scale will be calculated with the mean difference will be compared between the baseline and at 16 weeks. The higher score shows a high anxiety level of individual.
• Change scores from baseline to 16 weeks in SEN students' playfulness using the Children's Playfulness Scale (CPS) (16 weeks)
  To increase 70% of SEN students' playfulness after participated the 16-week SWELE programme. Children's Playfulness Scale (CPS) is a 23-item, and it was used by teachers evaluate the children's behavior. This 5-point Likert scale is designed to assess children's playfulness based on five dimensions: physical spontaneity, social spontaneity, cognitive spontaneity, manifest joy, and sense of humor. Each item poses a statement such as "the child uses unconventional objects in play," which is scored on a 5-point Likert-type scale with responses ranging from "sounds exactly like the child" to "doesn't sound at all like the child".

Study Officials

• Regina Lee, PhD (Principal Investigator) — Chinese University of Hong Kong