Lay Field-worker–Led School Health Program for Primary Schools in Low- and Middle-Income Countries

Matergia, Michael; Ferrarone, Peter; Khan, Yasín A.; Matergia, Denna Weiss; Giri, Priscilla; Thapa, Sanjeeta; Simões, Eric A F

doi:10.1542/peds.2018-0975

Cited by 9 publications

(15 citation statements)

References 38 publications

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“…Due to a perception of higher quality education and preference for English education, many families in rural Darjeeling send their children to low-cost private (LCP) schools ( 19 ). While Darjeeling estimates of LCP enrollment are not available, LCP enrollment is estimated at 30–50% of primary school students across India ( 18 ).…”

Section: Methodsmentioning

confidence: 99%

The Potential Emergence of “Education as Mental Health Therapy” as a Feasible Form of Teacher-Delivered Child Mental Health Care in a Low and Middle Income Country: A Mixed Methods Pragmatic Pilot Study

Cruz

Giri²,

Vanderburg

et al. 2021

Front. Psychiatry

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Objective: We assessed task-shifting children's mental health care to teachers as a potential approach to improving access to child mental health care.Methods: In Darjeeling, India, we conducted a single-arm, mixed-methods feasibility study with 19 teachers and 36 children in five rural primary schools to determine whether teachers can deliver transdiagnostic mental health care to select children-in-need with fidelity to protocol, to assess which therapeutic options teachers chose to use within the protocol, and to evaluate for a potential signal of efficacy.Results: Participation rates for intervention activities were >80%. A majority of teachers met or exceeded quality benchmarks for all intervention activities. Teachers chose to deliver teacher-centric techniques, i.e., techniques that only teachers could deliver given their role in the child's life, 80% of the time. Children improved in mental health score percentiles on the Achenbach Teacher Report Form. Key facilitators included the flexibility to adapt intervention activities to their needs, while identified barriers included limited time for care delivery.Conclusion: Findings support the feasibility of task-shifting children's mental health care to classroom teachers in resource-limited schools. Fidelity to protocol appeared feasible, though the freedom to choose and adapt therapeutic techniques may also have enhanced feasibility. Surprisingly, teachers consistently chose to deliver teacher-centric therapeutic techniques that resulted in a potential signal of efficacy. This finding supports the potential emergence of “education as mental health therapy” (Ed-MH) as a new therapy modality. Continued investigation is required to test and refine strategies for involving teachers in the delivery of transdiagnostic mental health care.

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Section: Methodsmentioning

confidence: 99%

The Potential Emergence of “Education as Mental Health Therapy” as a Feasible Form of Teacher-Delivered Child Mental Health Care in a Low and Middle Income Country: A Mixed Methods Pragmatic Pilot Study

Cruz

Giri²,

Vanderburg

et al. 2021

Front. Psychiatry

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“…Schools promote learning and children spend a significant amount of time there. 34 , 36 , 42 , 45 Schools also have the potential to reach many children in the population irrespective of external factors such as socioeconomic status. 61 , 71 This promotes an equitable and universal approach to facilitating HL development.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the interventions that relied on an external provider to come in and act as the HLM found it challenging and time-consuming to form these relationships with staff and students. 34 , 45 , 50 However, it was recognized that these relationships were important for continuing success. Given the ongoing relationship between students, teachers, parents, and community members in schools, the school setting is ideally suited for a HLM to be positioned.…”

Section: Discussionmentioning

confidence: 99%

An International Review to Characterize the Role, Responsibilities, and Optimal Setting for Health Literacy Mediators

Spencer

Kemp

Cruickshank

et al. 2021

Global Pediatric Health

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Health literacy is a critically important determinant of health and is influenced by access to supportive social networks and services. Global investment in education throughout the life course is required to support health literacy development. The aim of this review is to characterize the role, responsibilities, and the optimal setting for the emergent role of a Health Literacy Mediator (HLM). A scoping review of recent literature was conducted. The review revealed a lack of consensus on who should be teaching health literacy, and variability in confidence when teaching health literacy. Professionals reported facing barriers such as a lack of time, a lack of knowledge, and recognized that the health literacy needs of children worldwide are not being met. Further research into the role of HLM is required to determine who is best suited to this role and what their responsibilities will be to ensure consistent health literacy education.

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“…The majority of residents are ethnically Nepali, a minority group within the State of West Bengal [22]. Daily wages are 120 Indian rupees (INR) (approximately $1.68 United States dollars (USD)) for tea plantation laborers, who make up the majority of workers (77%) [23,24]. While a Darjeeling-specific prevalence of child mental illness has not been published, prevalence rates in a nearby rural area, also in West Bengal, estimated child psychiatric morbidity at 33% [2].…”

Section: Settingmentioning

confidence: 99%

“…To target schools enrolling children with poor access to care, LCP schools were considered eligible if they were located in rural Darjeeling, did not receive aid from the government, enrolled students from families with average daily incomes of $10 USD or less, and had total annual fees of $180 USD or less [24]. Of the 17 eligible schools contacted, 11 agreed to participate and 5 were chosen based on further inclusion criteria of having a population of 50 or more students to more accurately approximate prevalence rates of the general population.…”

Section: Participantsmentioning

confidence: 99%

Perceptions, attitudes, and knowledge of teachers serving as mental health lay counselors in a low and middle income country: a mixed methods pragmatic pilot study

Cruz

Lamb

Giri³

et al. 2021

Int J Ment Health Syst

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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..

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Lay Field-worker–Led School Health Program for Primary Schools in Low- and Middle-Income Countries

Cited by 9 publications

References 38 publications

The Potential Emergence of “Education as Mental Health Therapy” as a Feasible Form of Teacher-Delivered Child Mental Health Care in a Low and Middle Income Country: A Mixed Methods Pragmatic Pilot Study

The Potential Emergence of “Education as Mental Health Therapy” as a Feasible Form of Teacher-Delivered Child Mental Health Care in a Low and Middle Income Country: A Mixed Methods Pragmatic Pilot Study

An International Review to Characterize the Role, Responsibilities, and Optimal Setting for Health Literacy Mediators

Perceptions, attitudes, and knowledge of teachers serving as mental health lay counselors in a low and middle income country: a mixed methods pragmatic pilot study

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