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Abstract Background The acceptability of teachers delivering task-shifted mental health care to their school-aged students is understudied. Here, we evaluate teachers’, students’, and caregivers’ acceptability of Tealeaf (Teachers Leading the Frontlines), an alternative system of care in which teachers are trained and supervised to deliver transdiagnostic, non-manualized task-shifted care to their students. Methods In a 2019 single-arm, mixed methods, pragmatic acceptability pilot study in Darjeeling, India, 13 teachers delivered task-shifted child mental health care to 26 students in need. Teachers delivered care through using a transdiagnostic, non-manualized therapy modality, “education as mental health therapy” (Ed-MH). Measured with validated scales, teachers’ and students’ acceptability were compared after teacher training (PRE) and at the end of intervention (POST) using paired t tests. Teachers (n = 7), students (n = 7), and caregivers (n = 7) completed semi-structured interviews POST. Results Teachers’ quantitative measures indicated moderate acceptability PRE and POST and did not change PRE to POST. Children’s measures showed acceptability PRE and POST but decreased PRE to POST. Teachers and caregivers universally expressed acceptability in interviews. Facilitators of acceptability included impact, trust of teachers, and teachers’ ability to make adaptations. Conditions required for acceptability included supervision and teachers emphasizing academics benefits over mental health benefits to caregivers. Barriers to acceptability included a lack of teacher time and stigma. Interviewed students universally were unaware of receiving care; teachers intentionally avoided singling them out. Conclusion Teachers, caregivers, and children found teacher delivering task-shifted care acceptable, a key factor in care adoption and sustainability, though interviewed children were unaware of receiving care. Trial registration The trial was registered on January 01, 2018 with Clinical Trials Registry—India (CTRI), Reg. No. CTRI/2018/01/011471, Ref. No. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27

With growing diversity within the U.S. population and notable barriers to accessing behavioral health care, marginalized youth are placed at risk for developing psychosocial and mental health problems. Promoting evidence-based interventions (EBIs) through school-based mental health services may improve accessibility and quality of care for marginalized youth facing mental health disparities. Culturally sensitive interventions (CSIs) may further improve engagement with and effectiveness of EBIs with marginalized youth. In this article, we provide guidelines for advancing CSIs when implementing and adapting EBIs with marginalized youth in schools. First, we emphasize inclusive strategies for advancing CSIs with marginalized youth in schools, focusing on antiracist adaptations to interventions and using a community-based participatory research approach when implementing EBIs. Following, we discuss techniques for tailoring CSIs to more effectively support marginalized youth and their families with school-based prevention and treatment. Specifically, we recommend using the Adapting Strategies for Promoting Implementation Reach and Equity framework as a guide to promote equitable implementation as well as key strategies for engaging marginalized youth and their families with school-based EBIs. Ultimately, we offer these guidelines to address disparities and inform more equitable practice in youth mental health care—and to motivate future studies advancing culturally responsive services with marginalized youth in schools. Public Policy Relevance Statement: Promoting evidence-based interventions (EBIs) through school-based mental health services may improve accessibility and quality of care for marginalized youth facing mental health disparities. Inclusive and culturally sensitive EBIs may be especially useful for addressing inequities in marginalized youths' mental health outcomes. We provide guidelines and practical recommendations for implementing and adapting inclusive and culturally sensitive EBIs with marginalized youth in schools. [ABSTRACT FROM AUTHOR]

Schools offer an advantageous setting for the prevention, early identification, and treatment of mental health problems for youth. However, school mental health (SMH) services are typically not based on evidence for effectiveness, nor are they efficiently delivered, with SMH practitioners (SMHPs) able to only treat a small number of students in need. The current study evaluated the feasibility, acceptability, efficiency, and outcomes of a four-session assessment, engagement, problem-solving, and triage strategy for SMHPs that aimed to improve efficiency while being based on elements of evidence-based care. The study, conducted in 15 US school districts in three states, used stratified random assignment to assign 49 high schools and their participating SMHP(s) to either the Brief Intervention for School Clinicians (BRISC; N = 259 students) or services as usual (SAU; N = 198 students). SMHPs implemented BRISC elements with adequate to excellent fidelity and reported the strategy was feasible and well-aligned with presenting problems. Students assigned to BRISC reported significantly greater engagement in SMH at 2 months and completion of SMH treatment by 6 months. BRISC-assigned SMHPs reported significantly greater treatment completion after four sessions (53.4%) compared to SAU (15.4%). Students in the BRISC condition also reported significantly greater reduction in problem severity as evaluated by the Youth Top Problems Assessment. No differences were found for anxiety or depression symptoms or overall functioning. Results indicate that BRISC is a feasible early intervention and triage strategy that may aid in more efficient provision of SMH services with no compromise to SMH effectiveness. [ABSTRACT FROM AUTHOR]

Mental health is an immediate concern for public health and government officials due to the increase in mental ill health issues among young people and adults. School-based mental health services (SBMHSs) have grown rapidly in recent years, in response to this, as policy debates focus on the health and economic implications of mental for individuals and society. School-based mental health programs are focused on identifying, intervening, and providing mental health support to children and young people through the promotion of mental health and well-being within schools. With their increased presence and funding in both high- and low-income countries, concerns have been raised regarding their effectiveness, implementation, and sustainability as a means of early intervention and reducing adult mental health issues. While there are some promising results on the effectiveness of SBMHS, many barriers have been identified which hinder the implementation and sustainability of these services. Barriers include cultural and contextual factors for local adaptation; the specifics of intervention delivery; school capacity, leadership, and commitment; and system-level factors such as frameworks, policies, and government support. The research findings highlight that barriers and facilitators for the implementation and sustainability of school-based mental health interventions are not dissimilar to those observed in health, improvement, and educational interventions. As such, further research is needed to provide clarity on the principles needed to implement and sustain school-based mental services which effectively provide relevant and timely access to mental health support and services to children and young people. [ABSTRACT FROM AUTHOR]

Multidisciplinary teams of school- and community-employed mental health, health, and educational staff work together in schools to offer a full continuum of mental health promotion, prevention, early intervention, and treatment services and supports. Intentional teaming structures and practices are essential to ensure teams deliver effective, coordinated services and supports. The current study investigated the extent to which continuous quality improvement strategies improved school mental health team performance during a 15-month national learning collaborative for 24 school district teams. All teams significantly improved their average teaming performance from baseline to the end of the collaborative (t(20) = −5.20, p <.001). Plan-Do-Study-Act (PDSA) cycles allowed teams to rapidly evaluate specific quality improvement changes to improve their performance. Teams with the most improvement focused on increasing multidisciplinary team membership, avoiding duplication and promoting efficiency, and connecting to community mental health providers/resources. [ABSTRACT FROM AUTHOR]

Telementoring is a low-cost, flexible way for school mental health professionals to access professional learning. Using a mixed-methods intervention design, we examined the impact of prolonged telementoring on school mental health professionals' (school counselors, psychologists, social workers, and others) understanding and application of evidence-based school counseling, including associations between their use of evidence-based, culturally responsive, and collaborative practices to support student mental health. Our findings demonstrate support for the use of telementoring to improve school mental health professionals' understanding and application of the evidence-based school counseling model. We provide specific considerations for school counseling professionals. [ABSTRACT FROM AUTHOR]

This paper supports that social-emotional learning (SEL) programs are used as a method to increase resiliency and promote positive mental health in youth and will focus on one program, Positive Action (PA). This paper engages in a review of the literature that utilized the program to increase resiliency and address the mental health needs of students in school settings. PA is a program that is aimed at character development and decreasing problem behaviors. Several studies have been conducted with diverse populations and they found that this program does improve character development, decreases problem behaviors, and promotes resiliency. This review encourages practitioners to utilize evidence-based SEL programs to promote resiliency and increase positive mental health in the students that they work with. To my knowledge, this is the first article of its kind, making the necessary connection between already created and developed social-emotional learning programs and explicitly connecting the programs to building resilience among students. This analysis draws the connection between SEL programs and the promotion of student resiliency. SEL programs are designed to improve student outcomes that can include student achievement and reduce problem behaviors. These programs already have the theoretical foundation to increase resiliency; this analysis explicitly connects the SEL program to promote resiliency among students. [ABSTRACT FROM AUTHOR]

Building dynamic partnerships between communities and academic institutions, via knowledge exchange, plays a vital role in generating research with mutual benefits for research partners and wider communities. Knowledge exchange between universities and schools has recently received particular interest in child and adolescent mental health research. This article outlines a knowledge exchange programme that involved children, primarily, and teachers and parents/carers in dialogues around school well-being. Using a series of co-created and multimodal creative activities, we: (1) worked closely with 25 students of an inclusive and multicultural primary school (aged 9 to 10 years old) to understand their school well-being experiences, and to co-create a school blog to communicate key messages with local communities; and (2) initiated a discussion around child and school well-being with a group of parents/carers and teachers through expanding on the children’s blog. In this article, we outline our methodology to facilitate children’s involvement with the project well-being activities. We explore key methodological strengths and challenges, and highlight lessons we learned and how these stress the significance of seeking young people’s points of view when designing school well-being initiatives.

Abstract Background Child and adolescent mental health problems are a global public mental health priority. However, there is a lack of evidence-based scalable psychological interventions for adolescents living in low resource settings. This trial was designed to evaluate the feasibility and acceptability of delivering the World Health Organization’s Early Adolescent Skills for Emotions (EASE) intervention at public schools in a rural sub-district in Rawalpindi, Pakistan. Methods A two arm, single blinded, feasibility cluster randomized controlled trial with mixed-methods evaluation was conducted with 59 adolescents and their caregivers from 8 public schools. In the 4 intervention arm schools, 6 non-specialist facilitators delivered the culturally-adapted EASE group sessions to the adolescents (n = 29) and their caregivers with desired fidelity under the supervision of in-country supervisors. Results The participation rate of adolescents in the intervention sessions was 83%. The intervention strategies were implemented by the adolescents. However, attending biweekly sessions at schools was challenging for caregivers with only 50% caregivers attending the sessions. Conclusions The results of this study support the feasibility and acceptability of delivering this culturally adapted intervention through non-specialist facilitators in school settings in Pakistan and pave the way to conduct a fully powered cluster randomized controlled trial to test the effectiveness of intervention to improve psychological outcomes in adolescents. Trial registration Trial registered with Clinicaltrials.gov prospectively; NCT04254393.

It is imperative that educators take a positive and preventive approach to support students and promote school safety. This article addresses the importance of identifying students who need additional mental health support and providing the highest quality support. These include best practices of emphasizing strength-based approaches, working with students and families as collaborators, integrating strategies into schools' multi-tiered systems of support, using data for decision making, implementing and refining evidence-based practices, and conducting ongoing evaluation. This article reviews specific examples of positive approaches to promoting student mental health funded by the National Institute of Justice Comprehensive School Safety Initiative. These real-world research initiatives provide examples of how multi-tiered systems of support for student mental health can serve as a mechanism to promote school safety. [ABSTRACT FROM AUTHOR]

In this article, we present an introduction to the second part of a two‐part special series focused on embedding equity into school mental health. In the previous part, we focused on measurement and practice, and in this second part, we focus on theory. Practitioner points: Explicitly addressing equity in school mental health research and practice is important for ensuring that services are accessible, appropriate, and effective for all students, especially those who face marginalization within schools. This special issue includes eight articles focused on integrating equity into school mental health theory. An appendix is also included outlining recommendations for research and practice compile across the two issues of the special series. [ABSTRACT FROM AUTHOR]

Ample evidence suggests that PK‐12 students experience racism and other forms of discrimination in school and that these experiences have a deleterious impact on their mental health. Several studies have shown a consistent and strong relationship between racism and negative mental health outcomes including increased depression and anxiety, decreased self‐worth and self‐esteem, as well as psychological maladjustment. School‐based mental health services can ensure that racial and ethnic minoritized (REM) students gain access to mental health services. Because schools are one place where REM students experience structural and individual discrimination, it is critical that school‐based mental health providers utilize strategies to promote school climates that are safe and affirming for these students. Using a multitiered system of support framework, we describe the tier 1 interventions to promote positive school racial climate and the elements of culturally responsive practices to be integrated into tier 2 and tier 3 interventions to improve mental health outcomes for REM youth. [ABSTRACT FROM AUTHOR]

Despite evidence that school mental health can enhance access to care for students from marginalized racial/ethnic groups, disparities remain in the appropriateness, quality, effectiveness, and outcomes of school mental health services. Implementation strategies hold some promise for addressing the disparities that emerge as result of inequitable implementation of mental health services. However, without explicitly examining implementation strategies through an equity lens, it is unclear the extent to which they will promote equitable implementation or student outcomes. Thus, the goal of the current paper is to describe the Adapting Strategies to Promote Implementation Reach and Equity framework, a generalizable process for adapting implementation strategies to explicitly center the goal of reducing disparities in implementation and service recipient outcomes. We outline a three‐step process for incorporating an equity lens into implementation strategies and provide examples of how this framework can be applied to implementation strategies in school mental health. We also discuss examples of projects where implementation strategies were intentionally paired with school mental health programs to enhance racial equity. Implications and recommendations for school mental health and implementation research and practice are discussed. [ABSTRACT FROM AUTHOR]

This study aimed to examine the mediating role of happiness at school in the relationship between secondary school students’ school satisfaction and psychological well-being. A total of 367 secondary school students, including 204 girls (55.6%) and 163 boys (44.4%), participated in the study. While collecting the data for the study, Personal Information Form, Overall School Satisfaction Scale for Children, Stirling Children’s WellBeing Scale, and School Children’s Happiness Inventory were used. First, descriptive statistics of the collected data were calculated and the relationships between the variables were determined by the correlation coefficient. Mediation analysis in the research was made using structural equation modeling. As a result of the analysis, it was seen that the school satisfaction of secondary school students positively predicted both their psychological well-being and their happiness at school. Similarly, secondary school students’ happiness at school positively predicted their psychological well-being. In addition, as a result of the structural equation analysis, it was seen that happiness at school has a partial mediator role in the relationship between school satisfaction and the psychological well-being of secondary school students. Bootstrap confidence intervals (%95) were calculated to see if the mediation effect was significant, and it was determined that the results did not include zero and therefore the mediation result was significant. This result can be interpreted as secondary school students’ school satisfaction increases their happiness levels at school, and their psychological well-being increases with the increase in their happiness at school. All these results reached in the research draw attention to how important school-based experiences are for the mental health of school-age children. [ABSTRACT FROM AUTHOR]

The mental health needs of youth are both significant and increasing. Recent advancements have highlighted the need to reduce psychological distress while promoting the development of important social and emotional competencies. Current social and emotional assessment tools are limited in important ways that preclude their widespread use. In the current article, these limitations are discussed. A novel social and emotional learning assessment framework guided by methodological and theoretical innovations is presented. Future research directions and opportunities are discussed.

Clinician bias is a contributor to health care inequities, but research on racial-ethnic bias among mental health professionals, especially toward minoritized youths, is limited. This column describes two studies involving mental health clinicians in schools, where most youths access mental health services. Study 1 used a mixed-methods approach to identify stereotypes about Black and Latinx youths salient to clinicians (e.g., academic failure; anger and aggression). In study 2, the authors developed four Implicit Association Tests to assess clinicians' implicit prejudice and stereotyping of Black and Latinx youths and found pro-White and anti-Black/Latinx bias at levels similar to those of other health care providers and the general population. [ABSTRACT FROM AUTHOR]

In this article, we present an introduction and overview for a two‐part special issue series focused on embedding equity into school mental health through theory, research, and practice. The papers in Part 1 of the special issue series cover critical topics for advancing equitable school mental health, including the centering of community and youth perspectives; a focus on reducing disproportionality in discipline practices; and details on equity‐focused interventions. In Part 2, papers focus on integrating race and racial equity into school mental health frameworks; integrating a racial equity lens into trauma‐informed school practices; addressing outcomes that have disproportionate impacts on youth of color; and exploring domains of injustice and oppression beyond racial inequity. We hope that the topics discussed in this special issue series move us towards providing equitable and just school mental health services for all children and youth. [ABSTRACT FROM AUTHOR]

Tier 1 school mental health programs for middle school youth often focus on healthy relationships promotion. However, the vast majority of these programs take a gender‐ and race‐neutral approach (i.e., content that does not focus on the way that gender, race, and ethnicity intersect to shape relationships and mental health). Embedding these intersections into Tier 1 programs is critical to equitably advancing mental health for middle school youth. This article specifically explores associations between participation in a Tier 1 gender‐transformative healthy relationships program and friendship quality for Ethnocultural boys. Data were drawn from 278 White and Ethnocultural boys who participated in the program in 2016–2017 or 2017–2018 in a Western Canadian province. Data were analyzed using three‐level multilevel models. In these data, we found that Ethnocultural boys who participated in WiseGuyz reported improved friendship quality with their closest same‐sex friend following the end of the program. We also found that Ethnocultural boys who reported a positive change in male role norms related to emotional restriction reported significant improvements to friendship quality from pre‐ to post‐test. Findings suggest the importance of embedding equity into Tier 1 school mental health programming through a specific focus on intersections between gender, race, and ethnicity. [ABSTRACT FROM AUTHOR]

Children's mental health is deteriorating while access to child and adolescent mental health services is decreasing. Recent UK policy has focused on schools as a setting for the provision of mental health services, and counselling is the most common type of school-based mental health provision. This study examined the longer-term effectiveness of one-to-one school-based counselling delivered to children in UK primary schools. Data were drawn from a sample of children who received school-based counselling in the UK in the 2015/16 academic year, delivered by a national charitable organisation. Mental health was assessed at baseline, immediately post-intervention, and approximately 1 year post-intervention, using the Strengths and Difficulties Questionnaire (SDQ) completed by teachers and parents. Paired t tests compared post-intervention and follow-up SDQ total difficulties scores with baseline values. Propensity score matching was then used to identify a comparator group of children from a national population survey, and linear mixed effects models compared trajectories of SDQ scores in the two groups. In the intervention group, teacher and parent SDQ total difficulties scores were lower at post-intervention and longer-term follow-up compared to baseline (teacher: baseline 14.42 (SD 7.18); post-intervention 11.09 (6.93), t(739) = 13.78, p < 0.001; follow-up 11.27 (7.27), t(739) = 11.92, p < 0.001; parent: baseline 15.64 (6.49); post-intervention 11.90 (6.78), t(361 = 11.29, p < 0.001); follow-up 11.32 (7.19), t(361) = 11.29, p < 0.001). The reduction in SDQ scores was greater in the intervention compared to the comparator group (likelihood ratio test comparing models with time only versus time plus group-by-time interaction: χ2 (3) = 24.09, p < 0.001), and model-predicted SDQ scores were lower in the intervention than comparator group for 2 years post-baseline. A one-to-one counselling intervention delivered to children in UK primary schools predicted improvements in mental health that were maintained over a 2 year follow-up period. [ABSTRACT FROM AUTHOR]

This study reviews findings for the first randomized controlled trial (RCT) on the Interconnected Systems Framework (ISF) for school mental health (SMH) and Positive Behavioral Interventions and Supports (PBIS). Since its development in the late 2000s, the ISF has been supported by federally funded centers for SMH and PBIS, and, guided by a national workgroup, is being implemented in >50 communities in the United States. This experimental evaluation of the ISF involved an RCT implemented in 24 schools in two southeastern states, with the ISF implemented in eight schools, PBIS alone implemented in eight schools, and typically co-located PBIS+SMH implemented in eight schools. Related to very poor implementation, documented by two sources of fidelity data, two ISF schools were dropped from major analyses; hence, the study used a treatment on the treated (ToT; Rubin, 1974) as compared to a more traditional Intent-to-Treat approach (ITT; Lachin, 2000). This is the first paper from this large study, with emphasis here on proximal variables and school discipline. Within schools' multi-tiered systems of support (MTSS), ISF schools delivered more Tier 2 (early intervention) and Tier 3 (treatment) interventions to a greater proportion of students than the other two conditions by the second year of the intervention. There was also a dramatic difference in the provision of interventions by community mental health clinicians in ISF schools (almost half of interventions delivered) as compared to PBIS+SMH schools (around 3% of interventions delivered), underscoring the critical role of the ISF in integrating clinicians into MTSS teams and core school functions in SMH. As compared to the other two conditions, ISF schools also had reduced office discipline referrals (ODRs) and in-school suspensions, as well as reduced ODRs and out-of-school suspensions for African American students. Findings are discussed in relation to future directions of education-mental health system partnerships in improving the delivery and impact of SMH programs and services, demonstrated in the ISF. [ABSTRACT FROM AUTHOR]

Public alternative schools in the United States are multifaceted educational entities that often serve students marginalized from traditional spaces, yet little research exists highlighting the perceptions of alternative school students regarding mental health–promoting school practices. In this qualitative study, the voices of seven alternative high school students (four female and three male) are presented through the use of a targeted focus group. The following two research questions guided this study: What aspects of the public alternative school environment do students perceive to facilitate their mental health? What aspects of public alternative school environments do students perceive as barriers to mental health? Using qualitative descriptive methods, findings suggested that for these students the alternative school is a unique institution, designed for them, in which they can thrive due to the caring nature of the professionals they encounter. Implications for practitioners dedicated to producing mental health–promoting, inclusive school spaces for marginalized youth are presented. [ABSTRACT FROM AUTHOR]

Although many discuss the importance of early screening, few children and adolescents with mental health treatment needs are identified. The Mental Illness Needs Detection (MIND) Screener, a computer-based self-report measure of mental health treatment needs was developed to identify and assess for these needs efficiently in schools and other community-based settings. In this study, 394 students in a North Florida school district completed screening measures. Principals and local mental health treatment providers completed surveys regarding current identification processes for children in this community. The internal consistency of the MIND was supported with reliability analyses (α =.88) and the good-fit of a one-factor confirmatory factor analysis (CFI =.91, TLI =.90). The MIND scales moderately to highly correlated with another commonly used measure, supporting its validity (r values of.51 to.80). The MIND demonstrated precision through its sensitivity (83%), specificity (63%), and AUC values (.70). Utility of the MIND was also supported with school leadership reporting more satisfaction with the MIND than other previous methods in place. Overall, findings indicate promise for using the MIND in schools to screen children early for mental health treatment needs. It addressed many of the shortcomings of other measures and methods of screenings by assessing for a variety of symptoms, being immediately computer scored, and utilizing self-report. [ABSTRACT FROM AUTHOR]

Schools are the most common venue in which children and youth receive mental health services. To organize delivery of mental health care to such a large number of children, use of school teams is often recommended. Yet, there is limited empirical literature about the composition of school mental health teams or teams' relations to service provision. This study investigated team composition, including team multidisciplinarity (number of different types of professionals) and the presence of a community provider, and the relations of these two variables to service provision at Tier 1 (mental health promotion), Tier 2 (early intervention) and Tier 3 (intensive treatment) for 386 schools representing different school sizes, locations, and urbanicity. Results suggested team multidisciplinarity and the presence of a community provider were related to more frequent endorsement of service provision at schools. Practice and research implications are discussed including possible application to hiring decisions and further research with longitudinal data and information on service quality. [ABSTRACT FROM AUTHOR]

Amidst a national youth mental health crisis, comprehensive school mental health systems offer an opportunity to promote positive mental health for all students. To advance health equity, schools benefit from a culturally responsive, antiracist, and equitable (CARE) framework to address the youth mental health crisis. This article describes how to integrate CARE practices within a multi-tiered system of support for mental health in schools. The strategies align with a trauma-informed approach and aim to enhance the capacity of comprehensive school mental health systems to promote positive mental health and well-being for all students., Competing Interests: Disclosure There are no conflicts of interest to report and no funding related to this article., (Published by Elsevier Inc.)

Abstract Background There is an increasing need for Mental Health Promotion (MHP) among adolescents, especially in developing countries with limited resources and rapid socio-demographic transition. With the growing burden of mental health problems among adolescents (suicide, depression) and their preferences to seek help from their peers, improving Mental Health Literacy (MHL) and behaviours for First Aid in Mental Health (MH-FA) becomes crucial to promote their mental health. Methods Schools are ideal settings for reaching the vulnerable adolescents. The proposed study evaluates the effectiveness of a classroom-based teacher-led integrated school mental health intervention called SUMS (MHP + MHL + MH-FA). The study will involve a pragmatic, cluster-randomised waitlist-controlled design to evaluate the effectiveness of SUMS intervention using schools as unit-of-randomisation. The study will be conducted in Srinivaspura taluka (Sub-district) of Kolar district (administrative unit of health) of Karnataka in collaboration with a multi-disciplinary expert team from NIMHANS (National Institute of Mental Health And Neuro Sciences), Bangalore-India and Department of Education, Government of Karnataka, India. A total of 8 schools (400 students studying in 6–8 grade) from Srinivaspura taluka will be randomised into intervention and waitlist control group. The intervention group will receive SUMS intervention through 10–15 h of classroom sessions. The primary outcome is the improvement in positive mental health literacy, as measured by the Mental Health-Promoting Knowledge (MHPK-10) scale. Changes in MH-FA knowledge and intentions, Mental health stigma, help-seeking and resilience are assessed as secondary outcomes. Data will be collected at baseline, 6-weeks, 6-months and 12-months post-intervention. The waitlist-control schools will receive the interventions at the end of the 12-month follow-up assessment in intervention-schools. Discussion This is the first study to integrate Mental Health Literacy with Mental Health Promotion and behaviours for First Aid in Mental Health to promote mental health well-being among adolescent school children in India. With a need to build a more substantial evidence base on School Mental Health Promotion approaches in developing countries, the study findings will have implications for implementing and operationalising Health and Wellness Ambassador initiative in India. Trial registration Clinical Trials Registry - India, CTRI/2019/07/020394. Registered prospectively on 29 July 2019. ( ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=35724&EncHid=&userName=sums ).

There is compelling evidence that early school intervention programs enhance children’s development of life skills, with a positive knock-on effect on their behaviors and academic outcomes. To date, most universal interventions have displayed gains in children’s social-emotional competencies with a limited reduction in problem behaviors. This may depend on programs’ curricula focused to a greater extent on preschoolers’ social-emotional competencies rather than problem behaviors. Promoting Mental Health at Schools (PROMEHS) is a European, school-based, universal mental health program explicitly focused on both promoting students’ mental health and preventing negative conduct by adopting a whole-school approach. In this study, we set out to evaluate the effectiveness of the program for Italian and Portuguese preschoolers. We recruited 784 children (age range = 4–5 years), assigning them to either an experimental group (six months’ participation in the PROMEHS program under the guidance of their teachers, who had received ad hoc training) or a waiting list group (no intervention). We found that PROMEHS improved preschoolers’ social-emotional learning (SEL) competencies, prosocial behavior, and academic outcomes. The more practical activities were carried out at school, the more children’s SEL competencies increased, and the more their internalizing and externalizing behaviors decreased. Furthermore, marginalized and disadvantaged children were those who benefited most from the program, displaying both greater improvements in SEL and more marked decreases in internalizing problems compared to the rest of the sample.

Youth suicide continues to be a significant public health issue, with especially elevated levels of suicide thoughts and behaviors experienced by marginalized students across race/ethnicity, gender, sexual orientation, and age demographics. This article highlights the importance of contemporary research informing and advancing professional efforts and also introduces a special topic section including eight articles that focus on key gaps in the literature related to mitigating suicide risk among youth in schools. Four survey studies and one systematic review aim to identify risk and protective factors for marginalized and understudied populations, with strong emphasis on cultural considerations around youth suicide; two studies center on the development and evaluation of school-based suicide prevention programs, with a focus on warning signs, professional development, and social validity; and the final paper focuses on learning from student perspectives to improve postvention. This special topic section represents the complexity of youth suicide prevention and postvention and offers school psychologists knowledge and strategies to prevent and intervene to reduce youth suicide. The introduction closes with several recommendations for further advancing science, practice, and policy related to mitigating suicide risk among youth in schools. IMPACT STATEMENT Prevention of youth suicide requires contemporary research and program development. School psychologists can play a critical role in preventing youth suicide through culturally relevant studies, evidence-based training and curriculum, and postvention strategies. Collectively, articles in this special series strengthen the literature for guiding school psychologists in mitigating suicide risk among youth in schools. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The purpose of this systematic review was to assess the current literature on mindfulness-based school interventions (MBSIs) by evaluating evidence across specific outcomes for youth. Methods: We evaluated 77 studies with a total sample of 12,358 students across five continents, assessing the quality of each study through a robust coding system for evidence-based guidelines. Coders rated each study numerically per study design as 1 + + (RCT with a very low risk of bias) to 4 (expert opinion) and across studies for the corresponding evidence letter grade, from highest quality ("A Grade") to lowest quality ("D Grade") evidence. Results: The highest quality evidence ("A Grade") across outcomes indicated that MBSIs increased prosocial behavior, resilience, executive function, attention, and mindfulness, and decreased anxiety, attention problems/ADHD behaviors, and conduct behaviors. The highest quality evidence for well-being was split, with some studies showing increased well-being and some showing no improvements. The highest quality evidence suggests MBSIs have a null effect on depression symptoms. Conclusions: This review demonstrates the promise of incorporating mindfulness interventions in school settings for improving certain youth outcomes. We urge researchers interested in MBSIs to study their effectiveness using more rigorous designs (e.g., RCTs with active control groups, multi-method outcome assessment, and follow-up evaluation), to minimize bias and promote higher quality—not just increased quantity—evidence that can be relied upon to guide school-based practice. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Psicología (Santiago) is the property of Universidad de Chile and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Child and adolescent mental health problems are a global public mental health priority. However, there is a lack of evidence-based scalable psychological interventions for adolescents living in low resource settings. This trial was designed to evaluate the feasibility and acceptability of delivering the World Health Organization's Early Adolescent Skills for Emotions (EASE) intervention at public schools in a rural sub-district in Rawalpindi, Pakistan. Methods: A two arm, single blinded, feasibility cluster randomized controlled trial with mixed-methods evaluation was conducted with 59 adolescents and their caregivers from 8 public schools. In the 4 intervention arm schools, 6 non-specialist facilitators delivered the culturally-adapted EASE group sessions to the adolescents (n = 29) and their caregivers with desired fidelity under the supervision of in-country supervisors. Results: The participation rate of adolescents in the intervention sessions was 83%. The intervention strategies were implemented by the adolescents. However, attending biweekly sessions at schools was challenging for caregivers with only 50% caregivers attending the sessions. Conclusions: The results of this study support the feasibility and acceptability of delivering this culturally adapted intervention through non-specialist facilitators in school settings in Pakistan and pave the way to conduct a fully powered cluster randomized controlled trial to test the effectiveness of intervention to improve psychological outcomes in adolescents. Trial registration Trial registered with Clinicaltrials.gov prospectively; NCT04254393. [ABSTRACT FROM AUTHOR]

Investing in school mental health programs has the potential to improve youths' access to mental health services. Barriers to the implementation of school mental health programs include limited workforce capacity, competing priorities, and lack of coordinated care. The current paper describes the history, development, and key components of the Behavioral Health Team (BHT) model that was established to promote implementation of school mental health programming. The BHT is a multi‐disciplinary team designed to maximize resources and collaboration, provide early identification of students with behavioral health needs, and match and connect students to the indicated interventions using data‐informed decision making. BHTs are tasked with selecting appropriate interventions, assuring fidelity of implementation, monitoring student progress and making adjustments based on data to enhance the sustainability and dissemination of evidence‐based prevention and intervention in schools. The paper reviews two case examples to illustrate how this model has been applied both within a large urban school district and a medium‐sized suburban school district. Results demonstrate that district support facilitates sustainability and expansion of the BHT model over time. Schools implementing this model demonstrate improvement in implementation of the BHT key components. Highlights: (1)Multi‐disciplinary school‐community teams can improve implementation of comprehensive school mental health programs and increase student access to services, yet many schools lack guidance on how to establish and sustain them.(2)The Behavioral Health Team (BHT) Model provides guidance on the implementation and key components of effective school‐community mental health teaming structures and is a promising approach to enhance the sustainability and dissemination of evidence‐based prevention and intervention in schools.(3)District support and school leadership can facilitate continuous quality improvement, sustainability, and dissemination of the BHT model. [ABSTRACT FROM AUTHOR]

Given the prevalence and negative outcomes associated with untreated mental health concerns, there is an urgent need for schools to enhance their capacity to prevent, identify, and address these needs. This is particularly important for students from culturally and linguistically diverse backgrounds, who are more likely to be underserved and face barriers to mental health treatment. Current methods of addressing mental health at school are reactive and insufficient, failing to address the needs of all students. Without an explicit focus on dismantling systemic racism and inequity within schools, our society will continue to underserve those already disenfranchised. As such, this paper outlines the challenges as well as the importance of incorporating culture into a conceptualization of universal mental health in schools. We include state‐, district‐, and school‐level solutions in this conceptualization. Specifically, we propose sample solutions to the implementation of equity‐focused, comprehensive mental health practices within a multitiered system of support, focusing predominantly on universal (i.e., tier 1 level) practices. HIGHLIGHTS: 1.Schools must enhance their capacity to prevent, identify, and address mental health concerns for all students. This cannot be effectively addressed without an explicit focus on dismantling systemic racism and inequity within the school system.2.This paper provides several specific recommendations for the implementation of culturally responsive school mental health practices. These recommendations were organized into three overarching themes: cultivating cultural humility, developing a culturally responsive school climate, and conducting culturally responsive assessment.3.These recommendations are not intended to be exhaustive; rather, the recommendations are intended to be critiqued, amended, and expanded upon by future researchers and stakeholders invested in the implementation of equitable school mental health services. [ABSTRACT FROM AUTHOR]

Trauma-informed care (TIC), a system of behavioral treatment practices that focuses on understanding and responding to the effects of adverse experiences via empathic and non-punitive interactions, is a promising intervention for the treatment of academic and mental health problems among youth. However, the effect of TIC on caregivers themselves is uncertain. Even less is known about the relationship between TIC and the well-being of teachers and school staff. In the current study, we investigated the relationship between exposure to criminal victimization (a known predictor of stress), attitudes toward TIC, and perceived stress among a sample of public school teachers and staff members (N = 396). In line with our predictions, increased victimization was associated with increased perceived stress whereas TIC-favorable attitudes were associated with decreased perceived stress. In addition, older participants exhibited lower perceived stress than younger participants. We discuss the current study's limitations and the implications of the current findings for future research and mental health practice in schools. [ABSTRACT FROM AUTHOR]

The Great East Japan Earthquake and Tsunami struck Japan on 11 March 2011 leaving more than 400,000 people, including 100,000 children, homeless. These displaced children lived in temporary housing and 'temporarily' attended schools, which provided them with professional mental health support after the disaster. This paper highlights the role of disaster mental health support teams from Miyagi Prefecture through a problem reported by one of the schools – the excessive feeding of fish by children who narrowly escaped the tsunami. The support team helped schoolteachers understand the perspective of survivor guilt by facilitating a group discussion among the children and exploring their feelings about the disaster, with a focus on the guilt of leaving their pets behind. The authors demonstrate the role of mental health professionals working with schools to help children resolve negative thoughts and feelings during disaster recovery, including the often-overlooked survivor guilt caused by life-threatening events. [ABSTRACT FROM AUTHOR]

Perceived social support is an important predictor of school mental health outcomes of students. However, more research is needed on the indirect effects in this association. The present study aimed to investigate the direct and indirect effects (via mental toughness) of parent-classmate-teacher support on early adolescents' school mental health. A total of 359 early adolescents (Mage = 12.77, SD = 0.91) from grades 6 to 8 participated in the research. The child and adolescent support scale, mental toughness scale for adolescents, and psychological wellbeing and distress screener were used as measuring instruments. The results suggest the importance of perceived social support from parents and classmates for school well-being, as well as the importance of mediating role of mental toughness. The present results extend our insight into the mechanism underlying the links between perceived social support and school mental health outcomes. Implications and limitations are discussed, and suggestions for future research are provided. [ABSTRACT FROM AUTHOR]

Student anxiety is less frequently identified and treated in school settings relative to other mental health concerns (e.g., externalizing behavior problems). Considering the perspectives of school-based mental health providers is critical for improving supports for students with anxiety in schools. The present study examined patterns and predictors of school-based provider perceptions of student anxiety, as well as factors influencing provider self-efficacy when addressing student anxiety concerns. Participants (N = 87) were providers working in a very large school district serving students from highly diverse socioeconomic and racial/ethnic backgrounds. Providers reported on their perceptions of the top-ranking student mental health concerns, as well as their own emotional exhaustion, beliefs about accommodating students who experience anxiety, and perceived self-efficacy responding to student anxiety. 71.3% of providers identified student anxiety within their top five student mental health concerns. Providers in schools with higher proportions of economically disadvantaged students were significantly less likely to consider anxiety a top five concern. On average, providers reported feeling somewhat confident addressing anxiety. Greater emotional exhaustion predicted poorer self-efficacy, whereas prior training in anxiety predicted higher self-efficacy. Beliefs about accommodating anxious students in ways that run counter to anxiety guidelines was not significantly associated with provider self-efficacy. Although anxiety is a well-recognized student mental health concern among school providers, student anxiety is less commonly perceived as a top five concern by providers working with economically disadvantaged students, which may underscore the importance of addressing acute stressors and trauma exposure in such populations. Offering more anxiety-specific training and efforts to reduce emotional exhaustion may improve provider self-efficacy for addressing anxiety. To provide more equitable mental health services and supports for anxiety in school settings, more work is needed to improve identification of student anxiety as well as provider self-efficacy for addressing it within districts serving predominately racial and ethnic minority students. [ABSTRACT FROM AUTHOR]

Abstract Background Low and middle-income countries (LMICs) lack trained child mental health professionals. While teachers’ child development experience potentially positions them to fill the gap as lay mental health counselors, they have rarely delivered indicated child mental health care in LMICs. As part of assessing the feasibility of teachers serving as lay counselors, we explored teachers’ perceptions of serving as lay counselors and their mental health attitudes and knowledge. Methods In 2018, with training and supervision, 19 primary school teachers from five rural, low cost private schools in Darjeeling, India, served as lay counselors in their classrooms. Using mixed methods, we examined teacher perceptions of serving as lay counselor and mental health attitudes and knowledge through a survey (n = 15), a summative assessment (n = 14), and semi-structured interviews (n = 17). For the survey and summative assessment, pre-training, post-training, and post-intervention mean scores were compared using paired t tests. Post-intervention interviews were coded for teachers’ perceptions of serving as lay counselor and mental health attitudes and knowledge. Results Qualitatively, teachers expressed being willing to serve as lay counselor, having more inclusive mental health attitudes, and retaining mental health knowledge as applicable to use during instructional time or incorporation into the knowledge transfer process, their primary duty. By contrast, quantitatively, teachers’ attitudes appeared to become more inclusive on the study-specific survey pre versus post-training, but reverted to pre-training levels post-intervention. Teachers’ mental health knowledge on the summative assessment did not change pre-training versus post-training versus post-intervention. Conclusions Training, supervision, and serving as lay counselors led to teachers’ willingness to serve as lay counselors. Teachers served as lay counselors by utilizing therapeutic techniques during class time and incorporating them into their typical instruction, not through delivering traditional office-like care. Teacher practices may be pointing to the potential emergence of an “education as mental health therapy” system of care. Their changes in attitudes and knowledge reflected their emerging practices. Quantitative measures of knowledge and attitude changes did not capture these nuanced changes. Trial Registration The parent feasibility trial was registered on January 01, 2018 with Clinical Trials Registry – India (CTRI), reg. no. CTRI/2018/01/011471, ref. no. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27. .

Approximately 50% of UK dramatherapists deliver their work in schools. Despite this, little is currently known about the way in which school settings affect the dramatherapy that is delivered within them. This qualitative investigation utilised semi-structured interviews (N = 12) and reflexive thematic analysis to identify the facilitators and barriers of providing dramatherapy in school settings. In addition, the unique experiences of working as a dramatherapist in a school setting were also investigated. Amongst others, the facilitators identified included school as an accessible and safe place for therapy to occur. In addition, the structure provided by the school's daily and annual timetable, and the support of other school-based professionals and organisations were also identified. The barriers identified related to funding challenges, inappropriate referrals, schools seeking quick results and a lack of access to suitable spaces for therapy to occur. Regarding their experiences of employment, many dramatherapists spoke of working in multiple schools and, whilst some enjoyed the flexibility this offered, many found it challenging to become part of the school community and experienced a sense of isolation whilst working. Feeling like they are lower paid than clinical counterparts, such as colleagues in Child and Adolescent Mental Health Services (CAMHS), was also raised by those interviewed. These findings suggest that resource investment and investment into teachers' and other school-based professionals' knowledge of dramatherapy is warranted. In addition, dramatherapists who work in schools may benefit from community building. Future research, which explores the experience of dramatherapists in other settings is also encouraged. • The facilitators and barriers of UK school-based dramatherapy are, largely, unknown. • School is typically an accessible and safe place for dramatherapy to occur. • Challenges in relation to space, funding, referrals and employment are noted. • Some school-based dramatherapists feel isolated and under-paid. • Investment into school-based dramatherapy is recommended. [ABSTRACT FROM AUTHOR]

Advancing equity and justice in school mental health can address inequities in school-based services and outcome disparities. The purpose of this special issue is to promote equitable and just systems and practices in school mental health to promote change in institutional practices that have produced and reproduced inequities over time. The four articles in this special issue clarify a process for advancing equity in school mental health by addressing justice-centered variables to promote connections across and within systems to realize a vision of comprehensive and integrated school mental health. [ABSTRACT FROM AUTHOR]