Universal School-based Intervention Research Articles

Development of a school-based programme for mental health promotion and prevention among adolescents in Nepal and South Africa

IntroductionAdolescence is a critical time for mental health promotion and prevention and establishing healthy behaviours. Implementing universal, school-based psychosocial interventions can improve short- and long-term health trajectories for adolescents. While these interventions may offer important opportunities for fostering skills and relationships, few school-based interventions have been developed for and tested in low- and middle-income countries (LMICs) where adolescent mental health needs may be significant and under-served. This manuscript details the development of a multi-component, universal school-based intervention, Health Action in ScHools for a Thriving Adolescent Generation (HASHTAG), for adolescents aged 12–15 years in Nepal and South Africa. Methods and resultsWe describe HASHTAG's development over four phases, combining methods and results as each phase was iteratively conducted between 2018 and 2021. Phase 1 included a systematic review and components analysis, building from WHO guidelines for adolescent mental health. Seven components were strongly supported by the evidence: emotional regulation, stress management, mindfulness, problem-solving, interpersonal skills, assertiveness training, and alcohol and drug education. Phase 2 encompassed site selection, theory of change development, and formative research engagements; research teams in each site engaged adolescents and key adult stakeholders to identify priorities for intervention. Stakeholders voiced preferences for external facilitators and key content and delivery for intervention sessions. These findings informed Phase 3, a draft manual of HASHTAG, including a whole-school component, called Thriving Environment in Schools, and a classroom-based, six-session component, Thrive Together. In Phase 4, participants engaged in consultative workshops to review and contextualise content by country, preparing HASHTAG for implementation in a feasibility trial. Minor adaptations were made in Nepal, including using school nurses and adjusting take-home materials; both country's workshops identified practical considerations for implementing activities. ConclusionsHASHTAG was designed around core evidence-based components to increase translatability across LMICs, while enabling country-specific tailoring to enhance feasibility. Future research will test whether this multi-component, whole-school approach can improve adolescent mental health.

The Impact of Wellbeing Interventions on the Anxiety Levels of Children Attending Low-Income Schools: A Systematic Literature Review

This systematic review examined the impact of wellbeing interventions on the anxiety levels of children attending low-income schools. Studies, published between January 2000 and April 2022, were included if they had samples of school aged children attending low-income schools who were given a universal school-based wellbeing intervention. Ten databases were searched systematically to identify 542 records. After title and abstract screening, 43 records remained for full text screening, and of these studies, 10 met inclusion criteria. Quantitative data were extracted and were analysed narratively. The review found that in 50% of studies, wellbeing interventions were effective for reducing anxiety and that the impacts were maintained longer-term. The effects were stronger for girls when measured using self-report and were stronger for boys when measured using parental report.

Effectiveness of a universal school-based intervention for reducing internalizing problems in irish primary school children: A cluster randomized control trial

Effectiveness of a universal school-based intervention for reducing internalizing problems in irish primary school children: A cluster randomized control trial

A mixed methods partner-focused cost and budget impact analysis to deploy implementation strategies for school-based prevention

BackgroundObtaining information on implementation strategy costs and local budget impacts from multiple perspectives is essential to data-driven decision-making about resource allocation for successful evidence-based intervention delivery. This mixed methods study determines the costs and priorities of deploying Enhanced Replicating Effective Programs (REP) to implement the Michigan Model for Health™, a universal school-based prevention intervention, from key shareholder perspectives.MethodsOur study included teachers in 8 high schools across 3 Michigan counties as part of a pilot cluster randomized trial. We used activity-based costing, mapping key Enhanced REP activities across implementation phases. We included multiple perspectives, including state agencies, regional education service agencies, lead organization, and implementers. We also conducted a budget impact analysis (BIA, assessing the potential financial impact of adopting Enhanced REP) and a scenario analysis to estimate replication and account for cost variability. We used an experimental embedded mixed methods approach, conducting semi-structured interviews and collecting field notes during the trial to expand and explain the cost data and the implications of costs across relevant perspectives.ResultsBased on trial results, we estimate costs for deploying Enhanced REP are $11,903/school, with an estimated range between $8263/school and $15,201/school. We estimate that adding four additional schools, consistent with the pilot, would cost $8659/school. Qualitative results indicated misalignment in school and teacher priorities in some cases. Implementation activities, including training and implementation facilitation with the health coordinator, were sometimes in addition to regular teaching responsibilities. The extent to which this occurred was partly due to leadership priorities (e.g., sticking to the district PD schedule) and organizational priorities (e.g., budget).ConclusionsPrevious research findings indicate that, from a societal perspective, universal prevention is an excellent return on investment. However, notable misalignment in cost burden and priorities exists across shareholder groups. Our results indicate significant personal time costs by teachers when engaging in implementation strategy activities that impose an opportunity cost. Additional strategies are needed to improve the alignment of costs and benefits to enhance the success and sustainability of implementation. We focus on those perspectives informed by the analysis and discuss opportunities to expand a multi-level focus and create greater alignment across perspectives.Trial registrationClinicalTrials.gov NCT04752189. Registered on 12 February 2021.

Pilot feasibility and acceptability trial of BE REAL’s BodyKind: A universal school-based body image intervention for adolescents

Body dissatisfaction is prevalent among adolescents and a primary risk factor for eating disorders, yet there are few body image interventions for older adolescents that support development of positive body image. Therefore, we assessed the feasibility, acceptability and preliminary effectiveness of BodyKind, a four-lesson, mixed gender, teacher-led, school-based curriculum for older adolescents, that combines principles of self-compassion, compassion for others, cognitive dissonance, and social activism to address contemporary adolescent body image concerns (i.e., appearance bias, comparisons on social media) and strengthen positive body image development. The sample contained 147 adolescents, predominantly racial/ethnic minorities (>95%), 54.8% male, 41.5% female and 4.1% gender-minority students aged 15–18 years (M=16.24, SD=.96) from a low-income, inner-city high school in the Midwestern US. Two teachers received training and delivered the curriculum to students. This single arm, mixed methods trial assessed student and teacher acceptability, teacher fidelity and student intervention outcomes. Despite reasonable teacher fidelity, recruitment/attendance rates, post-intervention data loss (35% attrition) limited evaluations of program effectiveness and study feasibility. Important learnings regarding study feasibility will inform optimisation for future school-based trials. Findings demonstrate high acceptability of BodyKind among teachers and adolescents in a lower socioeconomic school setting, and further randomized controlled effectiveness trials are required.

Assessing the effectiveness and the mechanisms of the Social-Emotional Prevention Program for Preschoolers: Findings from a universal school-based intervention

The Social-Emotional Prevention Program (SEP) encompasses a multifaceted approach (classroom curriculum, with teacher and parent training) intended to increase preschool children's social adjustment, as well as to reduce risk of emotional and behavioral problems. The present study's focus was on implementing the technology-assisted SEP version and was aimed at (a) investigating the program's effectiveness on children's social-emotional competencies and parental practices, as well as (b) testing the program's conceptual framework, with an emphasis on children's emotion regulation (ER) skills and parental emotion socialization practices as explanatory intervention mechanisms. A randomized-controlled trial (RCT) was conducted with five schools assigned to either the intervention or to a comparison condition (wait-list control). Structural equation models (SEM) and complier average causal effects (CACE) were conducted to evaluate SEP effectiveness on teacher- and parent-rated child outcomes (primary outcomes) and parenting behaviors (secondary outcomes). Findings from the present study indicated that (a) SEP fosters increased social-emotional competencies and increased use of adaptive ER strategies, with teacher and parent ratings converging to support these outcomes; (b) parental participation in the program increased the use of reappraisal and emotion coaching strategies; and (c) children's ER mediated the intervention's effect on social competence, whereas parental coaching and parental ER mediated SEP effects on children's ER. This study's findings suggest that the SEP may be an effective universal intervention for promoting preschoolers' social-emotional competence and may provide emerging evidence to support the program's hypothesized mechanisms of change.

Understanding unusual sensory experiences: a randomised experimental study of a school-based intervention for adolescents.

One in ten young people experience unusual sensory experiences (USE), such as hallucinations. From a cognitive perspective, the appraisal of USE determines the impact of these experiences. Negative appraisal, as well as other psychological processes (e.g. thinking flexibility, maladaptive schemas, anxiety/depression), is associated with more distress. Our aim was to (a) develop a universal single-session school-based intervention on USE for adolescents and (b) evaluate the effect of the intervention on appraisals of and help seeking intentions for USE. A randomised controlled experimental design with a one-month follow-up was used to test the effectiveness of the intervention in one school. Students (n=223) aged 12-13 were randomised by class to a single-session intervention on USE or a control intervention (generic mental wellbeing). Participants completed measures of appraisals of and help-seeking intentions for USE at pre- and postintervention and at one-month follow-up. They also completed measures of schemas, thinking flexibility and anxiety/depression at preintervention. Overall, 190 adolescents completed the main outcome measures at all three points. The intervention on USE led to a significant (p < .05) increase of positive appraisals of USE compared with the control, with effects sustained at one-month follow-up. The intervention on USE did not lead to significantly greater help-seeking intentions for USE (p=.26). Adolescents' schemas were associated with appraisals and slow thinking and anxiety/depressive symptoms with help-seeking behaviour for USE. A single-session universal school-based intervention shows promise by improving appraisals of USE. Further research is required across different school populations.

Economic evidence of preventive interventions for anxiety disorders in children and adolescents – a systematic review

IntroductionAnxiety disorders are common in children and youth. Also, in prevention, be it universal, selective or indicated, economic evaluation supports decision-making in the allocation of scarce resources.ObjectivesThis review identified and summarised the existing evidence of economic evaluations for the prevention of anxiety disorders in children and adolescents.MethodsA systematic search was conducted on the EBSCO, Scopus, Web of Science, ProQuest, Cochrane and PubMed databases. We included studies that focused on children and adolescents under 18 years of age, aimed to prevent anxiety disorders, and presented an incremental analysis of costs and effectiveness. A registered checklist was used that assessed the quality of the included articles.ResultsThe search yielded 1,697 articles. Five articles were included in this review. Three were RCT-based and two were model-based studies. Out of five included interventions, one was a universal school-based intervention, two selective interventions and two indicated interventions. Universal school-based prevention of anxiety was not cost-effective compared to usual teaching. Selective parent training and indicative child- and parent-focused CBT prevention were likely cost-effective compared to usual care or doing nothing.ConclusionsParent education and cognitive behaviour therapy interventions can be cautiously interpreted as being a cost-effective way of preventing anxiety in children and adolescents. However, the evidence is weak related to cost-effectiveness as there are only a few studies, with relatively small sample sizes and short follow-ups.DisclosureNo significant relationships.

Study protocol for a cluster randomized trial of a school, family, and community intervention for preventing drug misuse among older adolescents in the Cherokee Nation

BackgroundThe national opioid crisis has disproportionately burdened rural White populations and American Indian/Alaska Native (AI/AN) populations. Therefore, Cherokee Nation and Emory University public health scientists have designed an opioid prevention trial to be conducted in rural communities in the Cherokee Nation (northeast Oklahoma) with AI and other (mostly White) adolescents and young adults. Our goal is to implement and evaluate a theory-based, integrated multi-level community intervention designed to prevent the onset and escalation of opioid and other drug misuse. Two distinct intervention approaches—community organizing, as implemented in our established Communities Mobilizing for Change and Action (CMCA) intervention protocol, and universal school-based brief intervention and referral, as implemented in our established Connect intervention protocol—will be integrated with skill-based training for adults to strengthen social support for youth and also with strategic media. Furthermore, we will test systems for sustained implementation within existing organizational structures of the Cherokee Nation and local schools and communities. This study protocol describes the cluster randomized trial, designed to measure implementation and evaluate the effectiveness on primary and secondary outcomes.MethodsUsing a cluster randomized controlled design and constrained randomization, this trial will allocate 20 high schools and surrounding communities to either an intervention or delayed-intervention comparison condition. With a proposed sample of 20 high schools, all enrolled 10th grade students in fall 2021 (ages 15 to 17) will be eligible for participation. During the trial, we will (1) implement interventions through the Cherokee Nation and measure implementation processes and fidelity, (2) measure opioid and other drug use and secondary outcomes every 6 months among a cohort of high school students followed over 3 years through their transition out of high school, (3) test via a cluster randomized trial the effect of the integrated CMCA-Connect intervention, and (4) analyze implementation costs. Primary outcomes include the number of days during the past 30 days of (1) any alcohol use, (2) heavy alcohol use (defined as having at least four, among young women, or five, among young men, standard alcoholic drinks within a couple of hours), (3) any marijuana use, and (4) prescription opioid misuse (defined as “without a doctor’s prescription or differently than how a doctor or medical provider told you to use it”).DiscussionThis trial will expand upon previous research advancing the scientific evidence regarding prevention of opioid and other drug misuse during the critical developmental period of late adolescent transition to young adulthood among a sample of American Indian and other youth living within the Cherokee Nation reservation.Trial registrationClinicalTrials.gov NCT04839978. Registered on April 9, 2021. Version 4, January 26, 2022

Review: Economic evidence of preventive interventions for anxiety disorders in children and adolescents - a systematic review.

Anxiety disorders are common in children and youth. Also, in prevention, be it universal, selective or indicated, economic evaluation supports decision-making in the allocation of scarce resources. This review identified and summarised the existing evidence of economic evaluations for the prevention of anxiety disorders in children and adolescents. A systematic search was conducted on the EBSCO, Scopus, Web of Science, ProQuest, Cochrane and PubMed databases. We included studies that focused on children and adolescents under 18 years of age, aimed to prevent anxiety disorders and presented an incremental analysis of costs and effectiveness. A registered checklist was used that assessed the quality of the included articles. The search yielded 1697 articles. Five articles were included in this review. Three were RCT-based, and two were model-based studies. Out of five included interventions, one was a universal school-based intervention, two selective interventions and two indicated interventions. Universal school-based prevention of anxiety was not cost-effective compared with usual teaching. Selective parent training and indicative child- and parent-focused CBT prevention were likely cost-effective compared with usual care or doing nothing. Parenteducation and cognitive behaviour therapy interventions can be cautiously interpreted as being a cost-effective way of preventing anxiety in children and adolescents. However, the evidence is weakly related to cost-effectiveness as there are only a few studies, with relatively small sample sizes and short follow-ups.

Contextual Moderators of a School-Based Ethnic-Racial Identity Intervention: The Roles of Family Ethnic Socialization and Ethnic-Racial Background.

Ethnic-racial identity (ERI) formation is a key developmental competency that contributes to adolescents' sense of self and psychosocial adjustment. A randomized controlled trial (RCT) has demonstrated the efficacy of a universal school-based health promotion intervention program to positively influence adolescents' ERI exploration and ERI resolution, compared to an attention control curriculum that was delivered by the same facilitators, had equivalent contact hours, and focused on post-secondary career and educational options. The current study extended prior tests of the RCT to better understand (a) how intervention-based ERI changes unfolded over two phases-temporally proximal pre- to post-test effects and long-term post-test effects across a 1-year follow-up period, and (b) identify for whom the intervention was more effective by testing theorized contextual moderators-baseline family ethnic socialization practices and youth ethnic-racial background (i.e., White majority vs. ethnic-racial minority). Bilinear spline growth models were used to examine longitudinal ERI trajectories in intervention and control groups across four survey assessments (baseline, 12weeks, 18weeks, 67weeks; N = 215; Mage = 15.02; 49.1% female; 62.6% ethnic-racial minority). In support of an additive effect for the role of families in school-based interventions, post-test ERI exploration significantly increased (relative to thecontrol group) to a greater extent for youth with higher (compared to lower) baseline levels of family ethnic socialization. ERI resolution significantly increased from pre- to post-test for ethnic-racial minority youth and also increased across the 1-year follow-up period for White youthin the intervention. These results highlight family ethnic socialization as a developmental asset for school-based ERI interventions and demonstrate differential pathways by which such interventions support ERI development for ethnic-racial minority and majority adolescents.

Universal school-based intervention for increasing resilience, and its effect on substance use

Abstract Introduction Universal interventions for preventing substance use are important priorities for schools. The present study aimed to evaluate the effect of a school-based educational intervention on the prevention or reduction of substance use among high school students. Methods This quasi-experimental study was conducted on 608 grade 10 high school students in Kerman, Iran. The intervention group consisted of 310 students (134 females and 176 males) and their parents, and the control group consisted of 298 students (120 females and 178 males). Students were recruited from September 2018 to February 2019 using a multistage sampling method. The Connor-Davidson Resilience Scale (CD-RIS) and a drug use tendency tool were the instruments used to measure the effect of the intervention. The universal educational intervention, which was based on life skills training, was performed by an experienced clinical psychologist over eleven sessions for students and five sessions for their parents. The postintervention evaluation was performed 3 months later. Results The intervention decreased students’ drug use tendency (p 0.05). Conclusion The universal resilience-enhancing secondary school-based educational intervention had no protective effect against substance use among Iranian adolescents. This finding may warrant future investigation of primary school students.

Using Stakeholder Input to Guide Cultural and Contextual Adaptations for a Universal School-Based Intervention

Strong student–teacher relationships foster students’ social, emotional, and academic development, particularly for students from marginalized racial/ethnic groups. The current study gathered input from teachers, school and district administrators, and education researchers (N = 22) regarding strategies that can help teachers build relationships with high school students and to build such relationships in an equitable manner. Participants completed quantitative ratings, open-ended survey questions, and then participated in a series of focus groups. Descriptive analyses of quantitative ratings and content analysis of qualitative data examined teachers’ perceptions of the value of relationships generally and equity in relationships in particular. Analyses also examined barriers to relationship building and potential strategies to address barriers. Results suggest that teachers see relationships with students as important, but they vary in the amount of time and effort they invest in relationships. Teachers may not have the requisite training or skills, particularly when dealing with students with behavioral difficulties and/or individualized needs. Some teachers have professional identities that center around their content area and may not conceptualize building relationships with students as part of their role. Finally, structural features of secondary schools and a lack of leadership support were seen as barriers to relationship building. Participants had a number of concrete suggestions for successful school-wide efforts to enhance student–teacher relationships. With regard to equity, participants did not perceive that teachers take an equity lens to relationship building. Attitudinal, systemic, and skills-related barriers to relationships with racial/ethnic minority students were named, and strategies suggested included elevating student voice. The paper concludes with a discussion of implications for future research and practice.

Combined prevention for substance use, depression, and anxiety in adolescence: a cluster-randomised controlled trial of a digital online intervention

Substance use, depression, and anxiety in adolescence are major public health problems requiring new scalable prevention strategies. We aimed to assess the effectiveness of a combined online universal (ie, delivered to all pupils) school-based preventive intervention targeting substance use, depression, and anxiety in adolescence. We did a multicentre, cluster-randomised controlled trial in secondary schools in Australia, with pupils in year 8 or 9 (aged 13-14 years). Participating schools were randomly assigned (1:1:1:1) to one of four intervention conditions: (1) Climate Schools-Substance Use, focusing on substance use only; (2) Climate Schools-Mental Health, focusing on depression and anxiety only; (3) Climate Schools-Combined, focusing on the prevention of substance use, depression, and anxiety; or (4) active control. The interventions were delivered in school classrooms in an online delivery format and used a mixture of peer cartoon storyboards and classroom activities that were focused on alcohol, cannabis, anxiety, and depression. The interventions were delivered for 2 years and primary outcomes were knowledge related to alcohol, cannabis, and mental health; alcohol use, including heavy episodic drinking; and depression and anxiety symptoms at 12, 24, and 30 months after baseline. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613000723785) and an extended follow-up is underway. Between Sept 1, 2013, and Feb 28, 2014, we recruited 88 schools (12 391 pupils), of whom 71 schools and 6386 (51·5%) pupils were analysed (17 schools dropped out and 1308 pupils declined to participate). We allocated 18 schools (1739 [27·25%] pupils; 1690 [97·2%] completed at least one follow-up) to the substance use condition, 18 schools (1594 [25·0%] pupils; 1560 [97·9%] completed at least one follow-up) to the mental health condition, 16 schools (1497 [23·4%] pupils; 1443 [96·4%] completed at least one follow-up) to the combined condition, and 19 schools (1556 [23·4%] pupils; 1513 [97·2%] completed at least one follow-up) to the control condition. Compared with controls, the combined intervention group had increased knowledge related to alcohol and cannabis at 12, 24, and 30 months (standardised mean difference [SMD] for alcohol 0·26 [95% CI 0·14 to 0·39] and for cannabis 0·17 [0·06 to 0·28] at 30 months), increased knowledge related to mental health at 24 months (0·17 [0·08 to 0·27]), reduced growth in their odds of drinking and heavy episodic drinking at 12, 24, and 30 months (odds ratio for drinking 0·25 [95% CI 0·12 to 0·51], and for heavy episodic drinking 0·15 [0·04 to 0·58] at 30 months), and reduced increases in anxiety symptoms at 12 and 30 months (SMD -0·12 [95% CI -0·22 to -0·01] at 30 months). We found no difference in symptoms or probable diagnosis of depression. The combined intervention group also showed improvement in alcohol use outcomes compared with the substance use and mental health interventions and improvements in anxiety outcomes when compared with the mental health intervention only. Combined online prevention of substance use, depression, and anxiety led to increased knowledge of alcohol, cannabis, and mental health, reduced increase in the odds of any drinking and heavy episodic drinking, and reduced symptoms of anxiety over a 30-month period. These findings provide the first evidence of the effectiveness of an online universal school-based preventive intervention targeting substance use, depression, and anxiety in adolescence. Australian National Health and Medical Research Council.

Universal School-Based Intervention Does Not Reduce Socioeconomic Inequalities in Weight Status among Adolescents.

Background: Differences in weight status by socioeconomic position occur during adolescence and is known as weight social gradient (WSG). The PRALIMAP (Promotion de l'ALIMentation et de l'Activité Physique) trial highlighted that a universal intervention was effective in reducing overweight and obesity prevalence among adolescents. However, its ability to reduce the WSG is unclear. This study aimed to evaluate the impact of the PRALIMAP intervention on the WSG among adolescents. Methods: Data were obtained from 3504 adolescents who participated in the school-based PRALIMAP trial between 2006 and 2009. The PRALIMAP study consisted of three interventional strategies: educational, environmental, screening and care. Weight status was assessed by body mass index (BMI) z-score and overweight and obesity prevalence. The "indice de position sociale des élèves" was used to measure adolescents' socioeconomic status. Linear regression and hierarchical models were used to assess the WSG and its evolution, respectively. Results: Among all adolescents (14-18 years old), significant WSG was identified at baseline: BMI z-score (β = -0.06; p < 0.0001), overweight and obesity prevalence (β = -2.86; p < 0.0001). Overall, the intervention conferred no significant reduction in the WSG: BMI z-score (β = -0.01 [-0.02 to 0.01], p = 0.48), overweight and obesity prevalence (β = -0.01 [-0.07 to 0.05], p = 0.73). Similar results were observed for adolescents whatever the interventional strategy they benefited from in the PRALIMAP trial. Conclusions: This study provided no evidence that the PRALIMAP universal intervention was effective in reducing the socioeconomic inequalities in weight status among adolescents. Different interventions that account for social differences should be considered to tackle these inequalities.

Additive effectiveness of mindfulness meditation to a school-based brief cognitive-behavioral alcohol intervention for adolescents.

This randomized controlled trial is the 1st study to evaluate the additive efficacy of mindfulness meditation to brief school-based universal cognitive behavior therapy (CBT + MM) for adolescent alcohol consumption. Previous studies have lacked strong controls for nonspecific effects, and treatment mechanisms remain unclear. The present study compared a CBT + MM condition to an active control CBT intervention with progressive muscle relaxation (CBT + PMR) for nonspecific effects and an assessment-only control (AoC). Cluster sampling was used to recruit Australian adolescents (N = 404; 62% female) ages 13-17 years (M = 14.99, SD = .66) of mostly Australian-New Zealand or European descent. School classes were randomized to 3 intervention conditions (CBT + PMR = 8 classes, CBT + MM = 7 classes, AoC = 7 classes), and adolescents completed preintervention, postintervention, and 3- and 6-month follow-up assessments, including measures of alcohol consumption, mindfulness, impulsivity, and the alcohol-related cognitions of alcohol expectancies and drinking refusal self-efficacy. Multilevel modeling analyses revealed that both intervention conditions reduced the growth of alcohol consumption compared to the AoC (b = -.18, p = .014), although CBT + MM was no more effective than was CBT + PMR (b = -.06, p = .484). Negative alcohol expectancies increased for adolescents in the intervention conditions compared to the AoC (b = 1.09, p = .012), as did positive alcohol expectancies (b = 1.30, p = .008). There was no effect of interventions on mindfulness, drinking refusal self-efficacy, or impulsivity. There was no evidence of mindfulness-specific effects beyond existing effects of CBT within a brief universal school-based CBT intervention. Hypothesized mechanisms of change were largely unsupported. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An Analysis of Response Shifts in Teacher Reports Associated with the Use of a Universal School-Based Intervention to Reduce Externalising Behaviour

School-based psychosocial interventions are a widely used approach to prevent or reduce externalising behaviour. However, evaluating the effects of such interventions is complicated by the fact that the interventions may not only change the target behaviour, but also the way that informants report on that behaviour. For example, teachers may become more aware of bullying behaviour after delivering lessons on the topic, resulting in increased teacher reports of the behaviour. In this study, we used multi-group confirmatory factor analysis to evaluate whether teachers exposed to the Promoting Alternative Thinking Strategies (PATHS) intervention changed the way they reported on child externalising behaviour. Using data from the z-proso study (802 participants; 51% male; 69 teachers), teacher reports of aggressive behaviour, attention deficit hyperactivity disorder and non-aggressive conduct disorder symptoms were compared pre- and post- intervention and across the intervention and control conditions. There was no evidence that teacher reporting was affected by exposure to the intervention. This helps bolster the interpretation of intervention effects as reflecting changes in child behaviour, rather than in the manner of informant reporting.

Enhancing resiliency and promoting prosocial behavior among Tanzanian primary-school students: A school-based intervention.

Children in Sub-Saharan Africa are living under chronic adversity due to poverty, serious health issues, physical and sexual abuse, and armed conflicts. These highly stressful conditions have deleterious effects on their mental health and socio-emotional adjustment. Since many children lack adequate access to mental health care, culturally adapted school-based resiliency programs could provide a resource to scaffold their development and promote their mental health. This study evaluated the efficacy of a universal school-based intervention in enhancing the resiliency of Tanzanian primary school children and cultivating prosocial behaviors. A total of 183 students from grades 4 to 6 were randomly assigned to either the 16-session "ERSAE-Stress-Prosocial (ESPS)" structured intervention or to a Social Study curriculum (SS) active control group. The original ESPS program was adapted by Tanzanians mental health professionals who modified the program based on local idioms of distress and indigenous practices. Students' resilience was evaluated before, after and 8 months following the intervention by assessing social difficulties, hyperactivity, somatization, level of anxiety, prosocial behaviors and school functioning as well as academic achievements and disciplinary problems. There was significant improvement on all outcome measures for the ESPS group compared to the control group post-intervention and at the 8-month follow up. The ESPS intervention was equally effective on most measures for students experiencing different adversity levels. The results indicate that a culturally adapted universal school-based intervention can be effective in enhancing Tanzanian students' resiliency and promoting prosocial behaviors. Should these results be replicated and found enduring, the modified ESPS could be a valuable mental health-promoting intervention in other low-income countries.

Differential intervention effectiveness of a universal school-based resilience intervention in reducing adolescent substance use within student subgroups: exploratory assessment within a cluster-randomised controlled trial

ObjectivesInterventions addressing the individual and environmental protective factors of adolescents are suggested to have potential for reducing adolescent substance use. While universally delivered school-based substance use prevention interventions are common,...

A pilot study on the effectiveness of a school-based cognitive-behavioral anxiety intervention for 8- and 9-year-old children: A controlled trial in Japan

IntroductionMany universal school-based preventative intervention trials for anxiety have been conducted in Western countries. This pilot study examined the efficacy and acceptability of a school-based, universal preventative program for anxiety among children aged 8–9 years in Japan. The program was based on cognitive-behavioral therapy (CBT) and was informed by similar universal programs (i.e., the Fun FRIENDS program; Barrett, 2007a, 2007b). MethodsSeventy-four children from a single school were allocated to an intervention or control group. The intervention comprised 10 CBT sessions, and assessments were conducted before and after the program. The primary outcome measure was the Spence Children's Anxiety Scale (SCAS) as children's self-report. Secondary outcome measures were the Depression Self-Rating Scale for Children (DSRS-C), Children's Hope Scale (Hope), Spence Children's Anxiety Scale-Parent Version (SCAS-P), and Strengths and Difficulties Questionnaire-Parent Version (SDQ-P). ResultsThe SCAS as the primary outcome showed no significant differences between the two groups. In addition, DSRS-C, Hope and SDQ-P also showed no significant differences. SCAS-P in the intervention group showed significant decrease compared to those in the control group. ConclusionThe results of this trial study suggest that a school-based universal preventative program for anxiety may have no significant effects on 8–9-year-old children. Trial registrationUMIN-CTR Identifier UMIN000008798.