Building capacity to adapt the School Mental Health for implementation at scale in the Eastern Mediterranean Region

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Project summary: An estimated 10-20% of children globally are affected by a mental health problem. Child mental health has been identified as a priority within the WHO’s Eastern Mediterranean Region (WHO EMRO). Following consultations with international and regional experts and stakeholders, WHO EMRO developed an evidence-based manualised School Mental Health Intervention (EMRO SMHI), endorsed by all member countries, including Pakistan, where the federal and provincial health departments have made plans for phased national implementation at scale. A number of implementation challenges identified by stakeholders at a WHO EMRO consultation have to be addressed to achieve these plans, including sustainable delivery of quality training and supervision at scale; routine monitoring of outcomes; mechanisms for ensuring programme quality; and intervention adaptation for delivery in diverse regional settings. We will conduct research in Pakistan embedded within national implementation of the EMRO SMHI to address these challenges, applying scalable technological and social innovations developed and feasibility-tested in Pakistan. This builds upon many years’ experience of successfully delivering similar programs in resource- poor and challenging community-based settings in this region of Pakistan. Capacity building will be embedded within the project with focus on child mental health. This will involve strengthening the capacity of targeted cohorts of researchers and policy makers in 4 EMRO countries (Pakistan, Iran, Jordan, and Egypt) to: 1) Develop skills in generating, applying and effectively disseminating research to aid implementation of school-based interventions for child mental health; and 2) To understand, interpret and apply science-based methods and information to develop child mental health policies and plans; 3) Use their skills to build the child mental health research and policy capacity of their countries and the region as a whole. The research component, consisting of two stages, will be embedded within Pakistan’s phased scale-up implementation of the EMRO SMHI. Research will be conducted in Pakistan, in sites with an established research infrastructure, sub-districts Kallar Syedan and Gujar Khan, in the Province of Punjab. The research team will partner with the Pakistan Health Ministry and the WCC-IoP to both study and assist its scale-up plans by integrating our technological and social innovation. We will begin our work by engaging stakeholders to develop a comprehensive “theory of change” to both guide scale-up and support testable hypotheses about the structures, collaborations, and knowledge most important to the process of scaling innovations. In the next stage the research team will work with the WCC-IoP to conduct hybrid effectiveness-implementation research comparing two methods of implementing the EMRO SMHI. Using mixed methods, we will compare conventional training, supervision, service delivery and program monitoring with the use of a tablet-based technology-assisted platform that integrates these essential functions. The platform uses readily-adaptable video and audio modules to provide a structure for cascading personalised knowledge and skill instruction to teachers, so they can in turn apply universal and targeted strategies to address mental health problems with children and their families. We hypothesise that use of the platform will lead to improvements in both clinical and implementation outcomes.