School-based Mental Health Programs Research Articles

32.4 Vulnerable Voices: Utilizing Community-Engagement and Advocacy to Promote School-Based Suicide Prevention Programs

The participant will discuss the impact of school-based suicide prevention programs on suicide rates among adolescents, and the participant will learn practical ways to advocate for suicide prevention programs within their community. The increasing rates of suicide among adolescents has become a major public health concern. In 2019, suicide was the second leading cause of death for individuals aged 10 to 24 years old. Adolescents in this age range spend a significant amount of time in school. As a result, school-based mental health programs have become an avenue for addressing suicidality, and districts that have incorporated suicide prevention programs have reduced suicidality among their students.

A systematic review of the long-term benefits of school mental health and wellbeing interventions for students in Australia

BackgroundOver the last decade there has been increased recognition about the role of school staff in preventing mental ill health and promoting wellbeing in young people. Despite this, information regarding the long-term benefits of school mental health programs is not widely available.AimsThe aim of this systematic review was to synthesize the evidence for school-based mental health and wellbeing programs which are available in Australia and have been shown to have long-term benefits for children and adolescents.ResultsThis systematic review of the literature identified 74 articles reporting long-term outcomes for student mental health and wellbeing, distributed across 29 unique programs. Common features of efficacious programs included cognitive behavioral interventions, mental health literacy, and social-emotional skills programs.ConclusionsSome of the identified school-based interventions for student mental health and wellbeing demonstrated long-term positive impacts on students' physical and psychological health and wellbeing.

Implementation and Outcomes of a National School-Based Mental Health Program for Middle School Students in Chile.

BackgroundChile’s national school-based mental health program, Skills for Life (SFL), has demonstrated effectiveness in improving behavioral and academic outcomes in first- through third-grade students. The current study assessed the feasibility and outcomes of SFL’s program for sixth- through eighth-grade students.MethodsWe assessed the percentage of students who participated in the program and longitudinal changes on teacher-reported Teacher Observation of Classroom Adaptation Re-Revised (TOCA-RR) scores, youth-reported Pediatric Symptom Checklist-Chile (PSC-Y-CL) scores, grade-point average, and school attendance from sixth to eighth grade (2016–2018) for SFL’s workshop intervention. Linear mixed effects models analyzed the association between outcome variables and workshop attendance.ResultsOf the 30,649 sixth graders who attended the 754 participating schools in 2016, 28,204 (92.0%) were screened with the TOCA-RR. Of the 1829 students who screened at risk, 1344 had available workshop data for seventh grade, with 86.9% of them participating in most (≥ 7) workshop sessions. Workshop attendance was significantly associated with improvements in school attendance and peer relationships (a TOCA-RR subscale) in eighth grade.ConclusionsWith high rates of behavioral health screening and workshop attendance, this study demonstrated the feasibility of implementing SFL’s middle school program on a national scale. Higher workshop attendance by at-risk students was associated with better school attendance and peer relationships in eighth grade, as well as better but not significantly different outcomes on other measures (e.g., teacher-rated school performance and aggressive behavior in the classroom). Overall, these findings provide preliminary evidence of the feasibility and benefits of SFL’s middle school program.

Strategies for Enhancing the Implementation of Universal Mental Health Prevention Programs in Schools: A Systematic Review

A number of school-based mental health prevention programs have been found to be effective in research trials, but little is known about how to support implementation in real-life settings. To address this translational problem, this systematic review aims to identify effective strategies for enhancing the implementation of mental health prevention programs for children in schools. Four electronic databases were searched for empirical, peer-reviewed articles in English from January 2000 to October 2021 reporting the effects of implementation strategies for school-based universal mental health programs. Twenty-one articles were included in the narrative synthesis and assessed for quality using the Mixed Methods Appraisal Tool. Twenty-two strategies were found to be effective at improving program fidelity or adoption. The strategies with the strongest positive evidence base were those that involved monitoring and provision of feedback, engaging principals as program leaders, improving teachers’ buy-in and organising school personnel implementation meetings. We recommend school-based practitioners trial strategies with positive findings from this review as part of their continuous quality improvement. This review highlights the pressing need for large-scale, randomised controlled trials to develop and trial more robust strategies to enhance adoption, as the five implementation studies found to measure adoption used qualitative methods limited by small samples sizes and case study designs.

Towards school-based mental health programs in Nigeria: the immediate impact of a depression-literacy program among school-going adolescents and their teachers

BackgroundDepression-literacy, which is the foundational requirement for symptom recognition, positive attitude and help-seeking, is poor among adolescents in Nigeria. This study, therefore, aims to determine the impact of a school-based training program on depression-literacy among a cohort of high-school students and their teachers in South-West Nigeria.MethodsAn adapted version of the Break Free from Depression, a 4-module depression awareness curriculum for staff and students, was implemented among students and their teachers. Paired-sample T-test was used to assess the domain-specific (knowledge, attitude, and confidence) impact of the training by comparing the baseline and immediate (within the week of the training) post-scores.ResultsA total of 3098 students and 294 teachers from 21 schools across three states in South-West Nigeria successfully completed the training. There was a significant positive difference (p < 0.05), at post-test, in the knowledge, attitude, and confidence among the students. The same was observed among teachers except for attitude where positive change did not reach significant level (p = 0.06). When statistically significant, the calculated effect size (eta squared) was highest for knowledge (students: 0.07, p = 0.001; teachers: 0.08, p < 0.000) and least for attitude (students: 0.003, p = 0.002 teachers: 0.085, p = 0.06). Multiple regression analyses result showed that the level of pre-scores predicted the magnitude of change in all domains of depression-literacy (p < 0.05) after controlling for age, gender, and type of school among the students, but not for teachers.ConclusionsSchool-based depression-literacy programs can lead to significant positive change in knowledge, attitude, and confidence of students and teachers.

Adaptation of a school-based mental health program for adolescents in Vietnam.

Cultural adaptation of a school-based mental health intervention developed in a high-income country is a cost-effective method to address the mental health needs of adolescents in resource-constrained settings. The aim of this study was to translate and culturally adapt the Resourceful Adolescent Program for Adolescents (RAP-A) for adolescents attending high school in Vietnam. The translation and adaptation were conducted using a five-step process including (1) initial stakeholder consultation, (2) forward translation, (3) backward translation, (4) adaptation, and (5) finalising the adapted version. An adaptation panel was established, including the RAP-A authors and mental health and public health experts from Australia, and psychology and public health experts from Vietnam. The panel collaborated closely with a group of stakeholders, including bilingual psychologists and psychiatrists, high school (grades 10-12) students and teachers throughout the adaptation process. The adapted version of RAP-A was named 'Happy House'. Happy House was adapted to be delivered in larger groups and in longer sessions than the RAP-A. The 11 sessions in RAP-A were restructured to 6 sessions in Happy House. Major changes were not required for any of the materials. However, some content, illustrations and videos were adapted to be more feasible for the school context and to enhance the comprehensibility, acceptability and appropriateness. Happy House has great potential to be relevant, comprehensible and acceptable for Vietnamese adolescents. Further research is warranted to examine the relevance, comprehensibility, acceptability, and effectiveness of this program on adolescents' mental health before advocating for scaling up program delivery in high schools throughout Vietnam.

The combination of user experience evaluation method in asessing the application of suicide risk idea identification

The global pandemic COVID-19 has led to extreme loss of human life worldwide. &lt;span lang="EN-US"&gt;The pandemic has made a profound impact on the psyche of some people, and it has led to suicide. The need for confident handling of specific risk factors for suicide is needed. Therefore, to support Indonesian governments to control the increment of suicidal ideas for adolescents using a combination of unmoderated remote usability testing (URUT) and usability metric for user experience (UMUX)-Lite. Then we adopted the school-based mental health program to make a prototype mobile application using the risk factor for suicidal ideation (RFSI) instrument to identify suicidal ideas in adolescents. Participants’ characteristics included late adolescents aged 19-22 years, male and female. The results show that the time-based efficiency on the registered task obtained from the calculation is 0.025 goals/sec. In one second, participants could complete a 0.025 of the job; although all participants could complete all tasks well and quickly, they provided good satisfaction scores. Some design improvements are needed on the prototype by considering user input&lt;/span&gt;.

School-Based Mental Health Programs for Preadolescent Girls: Mitigating Social Contagion of Non-Suicidal Self-Injury

Current mental health disorder rates for preadolescent and adolescent girls demonstrate a disturbing trend, most notably a drastic increase in reports of non-suicidal self-injury (NSSI), especially in the age category of 10- to 14-year-olds. NSSI has become normalized in the adolescent population, and social contagion—the spreading of NSSI through peer and media influence—has become a significant concern. This article defines and discusses NSSI and social contagion and explores why preadolescent and adolescent girls may be particularly vulnerable to it. Further, current Canadian approaches to mental health promotion and primary prevention are reviewed, and an argument is made for the development and implementation of elementary school–based, gender-specific, comprehensive mental health programs. Incorporating interconnected evidence-based protective factors such as self-worth, self-compassion, emotion regulation, healthy relationships, communication, and family and school systems will provide young girls with valuable skills and knowledge to mitigate their engagement with NSSI and to resist social contagion.

4 Steps To My Future (4STMF): protocol for a universal school-based pilot and feasibility study of a CBT-based psychoeducational intervention to support psychological well-being amongst young adolescents in the Western Cape, South Africa.

BackgroundMental health problems often emerge during middle childhood and adolescence. In South Africa, and in the context of high rates of poverty, violence, and adversity, many children are at a considerable risk for developing mental health problems. Access to and costs of mental health services preclude treatment for most. There is evidence that universal school-based prevention programmes are effective in well-resourced settings. However, little is known about the feasibility and acceptability of such programmes in low- and middle-income countries (LMICs), including South Africa.MethodsThis is a feasibility pilot study of 4 Steps To My Future (4STMF), a Cognitive Behaviour Therapy (CBT) school-based programme for young adolescents in the Western Cape, South Africa. This eight-session intervention will be delivered to children in grade 5 (aged 10–13 years approximately) attending two public government-run schools in the Western Cape, South Africa. We aim to enrol approximately 224 children in grade 5. We will randomise which school receives the intervention first and the other will be a delayed intervention group. We will train individuals with a post-graduate degree in psychology to facilitate the programme. We will collect demographic data on participants as well as data on primary (feasibility measures) and secondary outcomes (mental health and well-being measures). We will collect data at baseline, post-intervention, and at 1-month follow-up.DiscussionThis pilot study will provide data on the acceptability and feasibility of delivering a universal school-based prevention programme in South African schools. The study will provide preliminary data to inform the design of a full-scale randomised controlled trial (RCT) of a universal school-based mental health programme aimed at preventing mental health problems.Trial registrationThis trial is registered with the Pan African Clinical Trial Registry (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=10881) database, with unique identification number for the registry: PACTR202004803366609. Registered on 24 April 2020.

A quasi-experimental controlled study of a school-based mental health programme to improve the self-esteem of primary school children

Children’s mental health problems are associated with a low self-esteem. Harter has proposed that recognising competence in personal importance and social support would improve students’ self-esteem. However, to the best of our knowledge, no study has examined Harter’s theory for primary school children. This study aimed to test the effectiveness of the Treasure File Programme for improving primary school children’s self-esteem. The programme’s effectiveness was evaluated regarding the students’ self-esteem, physical well-being, emotional well-being, family relationships, friendships, and school performance. A total of 794 primary school students (aged 7–11 years) in the intervention group and 592 in the control group were recruited in a quasi-experimental study design. The intervention group indicated significant improvement in the self-esteem domain compared to the control group. However, no intervention effects were observed on physical well-being, emotional well-being, family, friends, and school. These findings indicate that this programme is effective in improving self-esteem in primary school students. Given the importance of self-esteem in children’s mental health, this programme may be helpful as a primarily educational programme option to address mental health problems in primary school children.

Earthquake exposure, adverse childhood experiences, and psychosocial functioning in Chilean children: A longitudinal study.

The impact of an 8.8 magnitude Chilean earthquake on elementary school students' psychosocial functioning was assessed along with exposure to adverse childhood experiences (ACEs). Skills for Life,a national school-based mental health program in Chile, routinely assesses first- and third-grade students' psychosocial functioning and classroom adaptation. Students (N = 19,627) were screened before (2009) and after (2011) the 2010 earthquake with parent- and teacher-report measures and with a parent-report of four ACEs (family psychopathology, child chronic illness, family social isolation, father absence). Earthquake exposure was categorized as mild, moderate, or severe for Chile's 15 regions. Multilevel models analyzed the unadjusted and adjusted impacts of earthquake exposure and ACEs on functioning while clustering for school- and district-level effects. In covariate-adjusted models, earthquake exposure and three ACEs were significantly associated with worsened psychosocial functioning; earthquake exposure and all four ACEs were significantly associated with worsened classroom adaptation. New family psychopathology, B = 1.90, p < .001; chronic illness, B = 2.25, p < .001; and severe earthquake impact, B = 1.29, p < .001, held the strongest negative effects on psychosocial well-being. Moderate, B = 3.04, p = .011, and severe earthquake exposure, B = 2.53, p = .047, and new family psychopathology, B = 1.99, p < .001, were associated with the worst classroom functioning 1-year postdisaster. Findings suggest that both exogenous and home-based stressors can have significant consequences for children's psychosocial functioning and classroom adaptation, and routine screening helps quantify how individual students are affected by chronic versus acute stressors.

Exploring the acceptability of a WHO school-based mental health program in Egypt: A qualitative study

Mental health interventions should target critical developmental stages, such as childhood and adolescence; and be embedded into cross-sectoral settings including education. The World Health Organization, Eastern Mediterranean Regional office has developed a school-based mental health program (SMHP), encouraging implementation research to inform its scale-up. We contribute to this by exploring stakeholder acceptability of the SMHP as a key assumption underpinning successful program implementation.This qualitative study, conducted January to July 2019 in Al Obour, Egypt, explores stakeholder views of SMHP acceptability, the roles of teachers and school psychologists in supporting child mental health, and barriers to SMHP implementation and scale-up. Focus group discussions (n ​= ​4) and individual in-depth interviews (n ​= ​7) were conducted with 30 stakeholders (parents, teachers, psychologists, and support centre managers). Data were analysed thematically against the theoretical framework of acceptability.Our results indicate that the SMHP is highly acceptable to teachers, psychologists, parents, and other education professionals. Key findings indicate the SMHP fits with teachers' and school psychologists' values, and highlight the importance of collaboration among these stakeholders for program effectiveness. Program features such as a community-based centre and respect for privacy and confidentiality are recognised to reduce parents’ opportunity costs, and influence their affective attitudes, leading to increased engagement. Factors such as teacher burden require additional exploration and strategies to address them as potential impediments to successful SMHP implementation. This qualitative study yields important insights from multiple stakeholders into the acceptability of a school-based mental health intervention, providing support for scale-up of the SMHP in Egypt and the Region.

Feasibility of a school-based mental health program implementation to improve the status of depression and quality of life of mothers of children with autism spectrum disorders in urban Bangladesh: MENTHOL study.

We assessed the feasibility of implementing psychological counseling services (PCS) for mothers of children with autism spectrum disorders (ASD) integrated within special education settings in urban Bangladesh. In two special education schools for ASD in Dhaka City, trained female psychologists screened mothers using the Patient Health Questionnaire (PHQ-9). PCS was administered to all the mothers irrespective of a diagnosis of depression. Mothers with a PHQ-9 score >4 who met criteria for a major depressive episode (MDE) based on the DSM-IV Structured Interview Axis I Disorders (SCID-I) were also administered skill-building training through monthly home visits to support ASD care. The level of depression was assessed by the Depression Measurement Scale (DMS), and quality of life (QoL) was measured by Visual Analogue Scale (VAS) of EQ5D5L scale before and after PCS. Among 188 mothers enrolled in the study, 81 (43%) received PCS, and 27.1% (22) had MDE. In the first month, 73 sessions were scheduled and 60 completed (85%). In the last month, 53 sessions were scheduled and 52 completed (98%). The mean DMS score decreased from 79.5 ± 23 to 60 ± 20 (p = 0.004), and DMS scores were significantly higher among mothers with MDE (97.8 ± 12.1 v. 69.9 ± 22.1; p < 0.001) compared to those without MDE (72.7 ± 22.6 v. 56.1 ± 18.1; p = 0.003). The mean VAS score improved from 70.3 ± 14.1 to 80.2 ± 13.3 (p = 0.001) between the first and the last session. Changes in DMS were negatively correlated with changes in VAS scores (β: -0.213, 95% CI 0.370 to -0.056). Within special education schools for ASD in urban Bangladesh, it was feasible to administer an integrated program of PCS for mothers of children with ASD by trained psychologists who were able to screen and intervene to reduce their level of depression and improve their quality of life.

School-Based Mental Health Promotion and Early Intervention Programs in New South Wales, Australia: Mapping Practice to Policy and Evidence

Limited empirical evidence is available regarding the uptake and effectiveness of school-based mental health and wellbeing programs implemented in Australian schools. This study aimed to characterise the delivery of programs in primary (elementary) schools across New South Wales, Australia, and to assess this information against published ratings of program effectiveness. Delivery of programs in four health-promoting domains—creating a positive school community; teaching social and emotional skills; engaging the parent community; and supporting students experiencing mental health difficulties—were reported by 597 school principals/leaders via online survey. Although three quarters of principals reported implementing at least one program, many of these programs were supported by little or no evidence of effectiveness. There was also variability in the use of evidence-based programs across the four domains. Findings indicate a need to provide educators with improved support to identify, implement, and evaluate effective evidenced-based programs that promote student mental health.

What should a Universal School-Based Psychoeducational Programme to Support Psychological Well-Being amongst Children and Young People in South Africa Focus on and how should it be Delivered? A Multi-Stakeholder Perspective

Children and young people are vulnerable to developing mental health problems. In South Africa, this vulnerability is compounded by contextual risk factors such as community violence and poverty. However, mental health services are scarce and costly, which precludes access for many. Universal school-based mental health programmes can prevent the onset of mental health problems in children and young people and have been implemented to good effect in high-income settings. We sought to understand stakeholder perspectives on what such a programme should focus on and how it could be implemented in practice within the South African context. We interviewed children and young people (n = 22), parents (n = 21), teachers (n = 17), and school mental health counsellors (n = 6) recruited from two schools in the Western Cape, South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. We generated three overarching themes: ‘the value of a mental health and well-being programme’, ‘content and delivery’, and ‘practicalities and logistics’. Participants were optimistic about the potential value of such a programme. Developing content that was appropriate for group delivery, flexible and timed to fit within the school schedule was important. Finding ways to make activities meaningful for large classes was important logistically, as was determining to what extent leaners would feel comfortable participating alongside their peers. Participants felt that outsiders, as opposed to school staff, should deliver the programme and that parents should be involved where possible. Developing a mental health programme for children and young people in the South African context requires careful understanding of who the key role players in such an intervention will be and how exactly they want to be involved and, how the challenges associated with practicalities and logistics can be overcome.

A Local Review on the Use of a Bio-Psycho-Social Model in School-Based Mental Health Promotion.

Background: Schools are a key setting for student well-being promotion. Various school-based mental health programs have been implemented worldwide, with greater emphasis placed on psychological and social aspects. The bio-psycho-social model provides a holistic and integrated view of mental health based on theory and research evidence. Given the importance of considering all three dimensions in mental health promotion, this study explored reasons for the relative neglect of this approach by studying the early phase of school well-being program development and implementation.Method: In total, 77 Hong Kong government-funded student well-being programs implemented in 2000–2009 were reviewed for the use of biological, psychological, and social interventions. Questionnaires and interviews were conducted to explore program leaders' usage and views regarding theoretical frameworks and evidence-based practice and program evaluation. Challenges encountered in the initial stage of school well-being program development and implementation were identified and analyzed.Results: Of the 77 programs reviewed, only 5 addressed all three bio-psycho-social factors of mental health. A significantly greater number of programs addressed psychological (n = 63) and social (n = 40) factors compared to those that covered biological factors of mental health (n = 13). Of 24 program implementers who responded to the online survey, 75% claimed to have studied or applied a theoretical framework yet only 41.7% considered evidence-based practices to be important. The majority of interviewed participants valued their own practical experience over theory and research evidence. Many programs lacked rigorous evaluation of clear objectives and measurable outcomes, thus the mechanisms of change and program effectiveness were uncertain. Perceived barriers to program adoption and continuation were identified.Conclusion: This study highlighted a neglect of the biological contribution to mental health in school well-being promotion initiatives, possibly due to lack of theoretical knowledge and evidence-based practice among program leaders and implementers in the early phase of school mental health promotion. The bio-psycho-social model should therefore be recommended for student well-being programs as a holistic and integrated theory of mental health underpinning program objectives, mechanisms of change, and measurable outcomes. To develop effective practices in student well-being promotion, more thorough documentation, a rigorous evaluation framework, and support for frontline educators to evaluate their practices were recommended.

Development of School-based Mental Health Program

BACKGROUND: Mental health services for school-aged children can help prevent the emergence of more severe problems. AIM: This study aims to create a mental health program for school-aged children. METHODS: An action design was used, and the implementation procedure consisted of four stages, namely reconnaissance, planning, acting, and reflecting. Furthermore, the respondents were 12 teachers, and the samples for the program were 73 students. In the reconnaissance stage, data were recorded and documented in transcript form. RESULT: At the planning stage, the instrument of mental health status, workbooks, and modules were developed. Meanwhile, in the acting stage, psychosocial intervention was conducted, and in the reflecting stage, the child mental health status before and after were measured using a dependent t-test. Furthermore, Focus Group Discussion activity in the Development of School-based Mental Health Program has 6 themes. The analysis results showed significant changes, meaning that there was a change in mental health status in school-aged children (p = 0,000; alpha 0.05). This showed that there was a significant influence of the program implementation on mental health status. CONCLUSION: The programs include identification, assessment, intervention, and mental health facilitation in school-aged children. Therefore, it is recommended for health service and education office to synergize in developing the program to improve achievement.

Predictors of Depression and Suicidal Ideation of Filipino College Freshmen in a Philippine State College

This study described the prevalence and predictors of depression and suicidal ideation of 365 Filipino college freshmen in a Philippine State College during the academic year 2019–2020. Utilizing a descriptive correlational design, psychosocial predictors were measured using the Bar-On EQ Inventory and participants' socio-demographic profile respectively. Depression and suicidal ideation were measured using Depression, Anxiety, and Stress Scale-21 and Columbia-Suicide Severity Rating Scale respectively. Emotional intelligence and family structure were inversely associated with depression and suicidal ideation while sex was associated with suicidal ideation. Parents/guardian's educational attainment was associated with depression and suicidal ideation. EQ and family structure were predictors of depression and suicidal ideation, while sex predicted suicidal ideation. Prevalent depression, higher suicidal tendencies among female students, and those living alone, and students' underdeveloped EQ point towards an urgency for gender-specific, psycho-socially oriented, and strategic school-based mental health program.

Multilevel Barriers and Facilitators to Sustainability of a Universal Trauma-Informed School-Based Mental Health Intervention Following an Efficacy Trial: A Qualitative Study

Limited research exists about factors that influence the sustainability of preventive school mental health interventions when research support ends. This study assessed barriers and facilitators to sustaining RAP (Relax, be Aware, do a Personal rating) Club, a trauma-informed universal mental health intervention, in urban schools following efficacy trial implementation. Between 2016-2018, 13 Baltimore City schools implemented RAP Club. We evaluated RAP Club sustainability using semi-structured interviews with administrators (n=10) and school staff trained to deliver the intervention (n=11), as well as review of intervention fidelity logs (n=137) and notes from supervision calls (n=10) with school staff and research team members who implemented the program. Although most school staff described RAP Club as acceptable and beneficial, none of the 13 schools sustained the intervention. Barriers to sustainability included low self-efficacy among school staff trained to deliver the intervention, school staff turnover, logistical challenges with space and time in the regular school calendar to deliver the program, insufficient funding to sustain the program outside of the research context, and limited planning and ongoing communication between school personnel and researchers about sustainability. Recommendations for increasing post-trial program sustainability include developing sustainability plans with schools during the pre-implementation phase, enhancing ongoing support for school staff during the implementation phase, and using academic-community partnerships to facilitate sustainability and intervention scale-up during the post-implementation phase. Increasing sustainability of beneficial school-based mental health programs has the potential to reduce mental health disparities and promote health equity.

School-Based Mental Health Programs for Improving Psychosocial Well-Being in Children and Adolescents: Systematic Review

School-Based Mental Health Programs for Improving Psychosocial Well-Being in Children and Adolescents: Systematic Review