Evaluating the effectiveness of facilitator-led mental health education program interventions to improve adolescent mental wellbeing

Background

In the last decade, youth mental wellbeing has plummeted across the nation as 1 in 5 high schoolers have seriously considered suicide, while the suicide rate increased by nearly 40%. Especially in the wake of COVID-19, a loss of independence and increased social isolation contributed to 70% of young people reporting worsening mental health coupled with a significant rise in hospitalization due to self-injury. Tele-mentoring and train the trainer approaches to train school mental health educators are increasingly popular interventions to target preventive wellbeing education to combat conditions such as anxiety, depression, emotional regulation and stress. In particular, the Project Evaluation of Community Healthcare Outcomes (ECHO) uses an evidence-based model to support providing mental health services in its hub-and-spoke model using didactic and case-based module learning.

Objective

The purpose of this systematic review is to evaluate the effectiveness of mental health educational interventions led by providers/educators, which use tele-mentoring and other community learning models (e.g., the ECHO model). Furthermore, we evaluated whether there is improvement in mental wellbeing and/or an increase in subject knowledge, self-efficacy, satisfaction, community building, and acceptability.

Methods

A systematic review was performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic REVIEW) guidelines. We searched for key words using PubMed, Embase, Web of Science, Ovid, and PsycINFO in September 2024. Interventions were included if the study was published from 2000 until the present, conducted within the United States, reached a population of school or non-school-based educators teaching adolescents ages 10-18, and reported on general mental wellbeing (i.e., anxiety, depression, suicidal ideation, stress, mindfulness, and emotional regulation).

Results

After retrieving a total of 2603 articles from database searching, further screening reduced the number of articles that met the inclusion criteria to 12. All articles used a train the trainer approach where facilitators educated a teacher population; 6 articles went further to examine outcomes from teachers educating an adolescent population.

Among the articles which only educated a teacher population, program satisfaction, fidelity, engagement, and curriculum literacy reached highs of 100%, 83.3%, 100%, and 66.7%, respectively. Qualitative responses show that adolescents who participated had positive self-reported effects on social resilience and emotional regulation through a greater understanding of dialectical behavior therapy. These findings suggest that teachers found the training applicable to their own teaching environments, and the material both adaptable and conducive to fostering a positive and emotionally healthy classroom environment. However, measured impact among adolescents still remains unclear without direct outcomes responded by the adolescents themselves. In the teacher and adolescent training programs, there were more revealing with specific outcomes better tailored to the program and response for adolescents. Among the articles which also educated an adolescent population,100% reported high curriculum program knowledge retention rate in literacy for either their adult educator or adolescent cohorts. Therefore, these varying and nuanced findings show the need for further research in individual engagement and pre-existing risk factors in determining program success.

Conclusions

Interventions enhancing school mental health professional or general school educator mental health literacy through an ECHO-like model could potentially lay the groundwork for improved youth wellbeing and engagement, underscoring the importance in fostering resilience among community wide evidence-based practices. These interventions demonstrated most notably improved satisfaction and curriculum understanding levels as compared to their control group baseline scores, although the success of which may be limited to the number of studies implemented, the role of student engagement, and the mode of measuring outcomes.