Implementing a School-Based Risk Management Protocol in a Task-Shifted Mental Health Model: An Implementation Science Evaluation

Adolescent mental health challenges are increasingly prevalent in low- and middle-incomecountries (LMICs), where access to evidence-based care remains critically limited. Task-shifted,school-based interventions offer a scalable solution but often lack structured protocols formanaging elevated risk, such as suicidality or abuse. The Shamiri Risk Management Protocol(Shamiri-RMP) was developed to address this gap by providing a tiered system for screening,classifying, and responding to student risk within a broader stepped-care mental health model. Weconducted a mixed-methods implementation study across 149 public high schools in Kenya.Caseworker fidelity and risk classification accuracy were quantitatively evaluated through aclinical review of 222 student cases. The Consolidated Framework for Implementation Research(CFIR) guided qualitative analysis of caseworker surveys to identify implementation barriers andfacilitators. Of 76,855 students enrolled in the broader Shamiri program, 977 were referred forfurther risk assessment, and 222 were enrolled in the Shamiri-RMP . Among these, 42.7% werelow-risk, 35.7% moderate-risk, and 21.6% high-risk. Risk reductions occurred in over half of allcases, and protocol fidelity was high. Implementation facilitators included supervisory support andprotocol clarity, while key barriers included referral gaps and confidentiality concerns. Findingssupport the feasibility and scalability of the Shamiri-RMP in LMIC school settings.Key-words: Risk management protocols, school-based mental health, implementation science,task-shifted stepped care Funding Acknowledgment: This study was funded by the Fund for Innovation inDevelopment (FID).