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Scaling‐up school mental health services in low resource public schools of rural Pakistan: the Theory of Change (ToC) approach
BACKGROUND: Ninety percent of children with mental health problems live in low or middle-income countries (LMICs). School-based programs offer opportunities for early identification and intervention, however implementation requires cross-sector collaboration to assure sustainable delivery of quality...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802314/ https://www.ncbi.nlm.nih.gov/pubmed/33436049 http://dx.doi.org/10.1186/s13033-021-00435-5 |
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author | Hamdani, Syed Usman Huma, Zill-e- Suleman, Nadia Warraitch, Azza Muzzafar, Naila Farzeen, Midhat Minhas, Fareed Aslam Rahman, Atif Wissow, Lawrence S. |
author_facet | Hamdani, Syed Usman Huma, Zill-e- Suleman, Nadia Warraitch, Azza Muzzafar, Naila Farzeen, Midhat Minhas, Fareed Aslam Rahman, Atif Wissow, Lawrence S. |
author_sort | Hamdani, Syed Usman |
collection | PubMed |
description | BACKGROUND: Ninety percent of children with mental health problems live in low or middle-income countries (LMICs). School-based programs offer opportunities for early identification and intervention, however implementation requires cross-sector collaboration to assure sustainable delivery of quality training, ongoing supervision, and outcomes monitoring at scale. In Pakistan, 35% of school-aged children are reported to have emotional and behavioral problems. As in many other LMICs, the government agencies who must work together to mount school-based programs have limited resources and a limited history of collaboration. The “Theory of Change” (ToC) process offers a way for new partners to efficiently develop mutual goals and long-term prospects for sustainable collaboration. OBJECTIVE: Develop a model for scale-up of school based mental health services in public schools of Pakistan. METHODS: We used ToC workshops to develop an empirically supported, ‘hypothesized pathway’ for the implementation of WHO’s School Mental Health Program in the public schools of rural Pakistan. Three workshops included 90 stakeholders such as policy makers from education and health departments, mental health specialists, researchers, head teachers, teachers and other community stakeholders including non-governmental organizations. RESULTS: The ToC process linked implementers, organizations, providers and consumers of school mental health services to develop common goals and relate them (improved child socioemotional wellbeing, grades and participation in activities) to interventions (training, monitoring and supervision of teachers; collaboration with parents, teachers and primary health care facilities and schools). Key testable assumptions developed in the process included buy-in from health care providers, education officials and professionals, community-based organizations and families. For example, teachers needed skills for managing children’s problems, but their motivation might come from seeking improved school performance and working conditions. Poverty, stigma and lack of child mental health literacy among teachers, administration, and parents were identified as key hypothesized barriers. Children and their families were identified as key stakeholders to make such a program successful. DISCUSSION: ToC workshops assisted in team building and served as a stakeholders’ engagement tool. They helped to develop and support testable hypotheses about the structures, collaborations, and knowledge most important to scaling-up school based mental health services in Pakistan. |
format | Online Article Text |
id | pubmed-7802314 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-78023142021-01-13 Scaling‐up school mental health services in low resource public schools of rural Pakistan: the Theory of Change (ToC) approach Hamdani, Syed Usman Huma, Zill-e- Suleman, Nadia Warraitch, Azza Muzzafar, Naila Farzeen, Midhat Minhas, Fareed Aslam Rahman, Atif Wissow, Lawrence S. Int J Ment Health Syst Research BACKGROUND: Ninety percent of children with mental health problems live in low or middle-income countries (LMICs). School-based programs offer opportunities for early identification and intervention, however implementation requires cross-sector collaboration to assure sustainable delivery of quality training, ongoing supervision, and outcomes monitoring at scale. In Pakistan, 35% of school-aged children are reported to have emotional and behavioral problems. As in many other LMICs, the government agencies who must work together to mount school-based programs have limited resources and a limited history of collaboration. The “Theory of Change” (ToC) process offers a way for new partners to efficiently develop mutual goals and long-term prospects for sustainable collaboration. OBJECTIVE: Develop a model for scale-up of school based mental health services in public schools of Pakistan. METHODS: We used ToC workshops to develop an empirically supported, ‘hypothesized pathway’ for the implementation of WHO’s School Mental Health Program in the public schools of rural Pakistan. Three workshops included 90 stakeholders such as policy makers from education and health departments, mental health specialists, researchers, head teachers, teachers and other community stakeholders including non-governmental organizations. RESULTS: The ToC process linked implementers, organizations, providers and consumers of school mental health services to develop common goals and relate them (improved child socioemotional wellbeing, grades and participation in activities) to interventions (training, monitoring and supervision of teachers; collaboration with parents, teachers and primary health care facilities and schools). Key testable assumptions developed in the process included buy-in from health care providers, education officials and professionals, community-based organizations and families. For example, teachers needed skills for managing children’s problems, but their motivation might come from seeking improved school performance and working conditions. Poverty, stigma and lack of child mental health literacy among teachers, administration, and parents were identified as key hypothesized barriers. Children and their families were identified as key stakeholders to make such a program successful. DISCUSSION: ToC workshops assisted in team building and served as a stakeholders’ engagement tool. They helped to develop and support testable hypotheses about the structures, collaborations, and knowledge most important to scaling-up school based mental health services in Pakistan. BioMed Central 2021-01-12 /pmc/articles/PMC7802314/ /pubmed/33436049 http://dx.doi.org/10.1186/s13033-021-00435-5 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Hamdani, Syed Usman Huma, Zill-e- Suleman, Nadia Warraitch, Azza Muzzafar, Naila Farzeen, Midhat Minhas, Fareed Aslam Rahman, Atif Wissow, Lawrence S. Scaling‐up school mental health services in low resource public schools of rural Pakistan: the Theory of Change (ToC) approach |
title | Scaling‐up school mental health services in low resource public schools of rural Pakistan: the Theory of Change (ToC) approach |
title_full | Scaling‐up school mental health services in low resource public schools of rural Pakistan: the Theory of Change (ToC) approach |
title_fullStr | Scaling‐up school mental health services in low resource public schools of rural Pakistan: the Theory of Change (ToC) approach |
title_full_unstemmed | Scaling‐up school mental health services in low resource public schools of rural Pakistan: the Theory of Change (ToC) approach |
title_short | Scaling‐up school mental health services in low resource public schools of rural Pakistan: the Theory of Change (ToC) approach |
title_sort | scaling‐up school mental health services in low resource public schools of rural pakistan: the theory of change (toc) approach |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802314/ https://www.ncbi.nlm.nih.gov/pubmed/33436049 http://dx.doi.org/10.1186/s13033-021-00435-5 |
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