TEALEAF OUTCOMES
- Christina M. Cruz^, Venessa C. Fuentes, Abhishek K. Rauniyar, Priscilla Giri, Choden Dukpa, Surekha Bhattarai, Arpana Thapa, Catherine C. Shrestha, Molly M. Lamb, Michael Matergia. 3.60 Comparative Preliminary Child Mental Health and Academic Outcomes After Elementary School Teachers Deliver Task-Shifted Mental Health Care in India. Journal of the American Academy of Child & Adolescent Psychiatry. 2023 Oct 1;62(10):S226.
Summary: Versus a comparator, teachers in Tealeaf delivering mental health care using our novel therapy, Ed-MH, improved mental health symptoms with medium effect (0.699) and academic achievement with medium to large effect (0.790 in math & 0.844 in reading English) of elementary school students in Darjeeling, India.
- Juliana L. Vanderburg, Choden Dukpa, Abhishek K. Rauniyar, Priscilla Giri , Surekha Bhattarai, Arpana Thapa, Bradley N. Gaynes, Karen Hampanda, Molly M. Lamb, Michael Matergia*, & Christina M. Cruz*. Exploring Mental Health and Academic Outcomes of Children Receiving Non-manualized, Transdiagnostic, Task-Shifted Mental Health Care From Their Teachers in a Low-and-Middle Income Country. Frontiers in pediatrics. 2022:160. https://doi.org/10.3389/fped.2022.807178
Summary: Primary teacher raters observed significant improvements in child mental health symptoms overall, with a gold standard measure scores moving from ‘borderline’ (needs clinical care) to ‘normal’ (no longer needs clinical care). Families observed on average a decreased impact of their children’s mental health symptoms on their children’s lives. Academically, math scores significantly improved while reading trended toward significance.
- Christina M. Cruz*“, Priscilla Giri“, Juliana L. Vanderburg, Peter Ferrarone, Surekha Bhattarai, Aileen A. Giardina, Bradley N. Gaynes, Karen Hampanda, Molly M. Lamb“, & Michael Matergia*“ (2021). 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. Front. Psychiatry 12:790536. doi: 10.3389/fpsyt.2021.790536
Summary: Teachers delivered Tealeaf care with at least 60% fidelity across care components, meeting or exceeding benchmarks per the literature. In studying fidelity, where teachers are allowed to choose therapeutic techniques to deliver, teachers chose to use techniques only they could use for 80% of the 536 techniques used across 23 teachers (such as reducing homework before gradually increasing it as a form of exposure therapy). This provided evidence for a new therapy that emerged through teachers’ choices, “education as mental health therapy” (Ed-MH), a kind of care only they as teachers can deliver. Additionally, teachers delivering care rated children on average as increasing in normalcy in mental health symptoms on a gold standard measure. Secondary observers (teachers with Tealeaf training but not caring for the rated child) rated children on average as improving from borderline to normal.
- Christina M. Cruz*, Choden Dukpa, Juliana L. Vanderburg, Abhishek K. Rauniyar, Priscilla Giri, Surekha Bhattarai, Arpana Thapa, Karen Hampanda, Bradley N. Gaynes, Molly M. Lamb & Michael Matergia*. Teacher, caregiver, and student acceptability of teachers delivering task-shifted mental health care to students in Darjeeling, India: a mixed methods pilot study. Discov Ment Health 2, 21 (2022). https://doi.org/10.1007/s44192-022-00024-z
Summary: “Teachers and caregivers universally expressed acceptability in interviews. Facilitators of acceptability included impact, trust of teachers, and teachers’ ability to make adaptations. Conditions required for acceptability included supervision and teachers emphasizing academics benefits over mental health benefits to caregivers. Barriers to acceptability included a lack of teacher time and stigma. Interviewed students universally were unaware of receiving care; teachers intentionally avoided singling them out.”
- Christina M. Cruz^, Molly M. Lamb , Karen Hampanda , Priscilla Giri , Matthew Campbell , Bijita Chowdhury , Aileen A. Giardina , Bradley N. Gaynes & Michael Matergia. (2021) Teacher Nomination of School-aged Children for Mental Health Services in a Low and Middle Income Country. Global Health Action, 14:1, 1861921, DOI: 10.1080/16549716.2020.1861921
Summary: “With training and a simple decision support tool, primary school teachers in Darjeeling nominated students for mental health services with moderate accuracy.”
PERCEPTIONS OF TEALEAF BY PARTICIPANTS
- Christina M. Cruz*, Molly M. Lamb, Priscilla Giri, Juliana Vanderburg, Peter Ferrarone, Surekha Bhattarai, Aileen A. Giardina, Karen Hampanda, Bradley N. Gaynes, & Michael Matergia*. 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. Int J Ment Health Syst 15, 40 (2021). https://doi.org/10.1186/s13033-021-00453-3
Summary: “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.”
- Setareh Ekhteraei, Juliana Vanderburg, Choden Dukpa, Priscilla Giri, Surekha Bhattarai, Arpana Thapa, Catherine C. Shrestha, Bradley N. Gaynes, Molly M. Lamb, Michael Matergia*, & Christina M. Cruz* (2023), Short Research Article: RESEED – the perceived impact of an enhanced usual care model of a novel, teacher-led, task-shifting initiative for child mental health. Child Adolesc Ment Health. https://doi.org/10.1111/camh.12673
Summary: RESEED (Responding to Students’ Emotions through Education) is the first step of stepped levels of teachers delivered care. Teachers found RESEED to be acceptable and perceived it had an impact on children’s mental health and academics. They found barriers of time needed to deliver care.
- Juliana L. Vanderburg, Surekha Bhattarai, Peter Ferrarone, Priscilla Giri, Molly M. Lamb, Aileen A. Giardina, Karen Hampanda, Bradley N. Gaynes, Michael Matergia* & Christina M. Cruz* (2021). Teacher and caregiver perceptions of family engagement in teacher-led task shifted child mental health care in a low-and-middle-income country. Global Public Health, DOI: 10.1080/17441692.2021.2002924
Summary: “Participants reported three patterns of engagement: families who fully engaged; families who felt positively about teachers but displayed little engagement; and families with limited engagement. Barriers included logistical challenges and misconceptions about the program. Many teachers implicated family engagement as a facilitator of the program, suggesting that family involvement may support intervention outcomes.”
- Emma O’Brien, Choden Dukpa, Juliana Vanderburg, and The Tealeaf Team. (2020) Teachers As Agents of Change. ReFrame 2020: Beyond Clinical Contexts, 3, 67-71.
- Download Teachers As Agents of Change
Summary: Teachers serve many roles in the community beyond teaching. In Darjeeling, we find they are able to effectively address student mental health.
REVIEWS OF PSYCHOSOCIAL INTERVENTIONS FOR YOUTH IN LOW- AND MIDDLE- INCOME COUNTRIES
- Megan Cherewick^, Christina Daniel, Christina M. Cruz, Michael Matergia. Psychosocial interventions for autistic children and adolescents delivered by non-specialists in low-and middle-income countries: a scoping review. Frontiers in Psychology. 2023 Aug 7;14:1181976.
Summary: “Non-specialist mediated interventions for autistic children and adolescents are well suited for resource poor-environments. Studies included in this review demonstrated non-specialist delivered interventions in LMIC had positive effects in communication/language, social skills, motor skills, adaptive behaviors, and improved mental wellbeing. Moreover, synergies between non-specialist mediated intervention approaches across development should be matched and sequenced to developmental periods. An approach that engages multiple non-specialists in a child’s social ecological environment can be particularly beneficial to allow autistic children and adolescents to practice and master learning in different settings. Multi-level intervention approaches can also effect change in the individuals’ delivering interventions, leading to enhanced autism advocacy efforts to reduce stigma and celebrate the unique strengths of autistic individuals.”
SCHOOL RE-ENTRY FOR ADOLESCENTS AFTER A PSYCHIATRIC HOSPITAL STAY
- Juliana Vanderburg, Amanda C. Tow, Marisa E, Marraccini, Cari Pittleman, & Christina M. Cruz^. Caregiver experiences of adolescent school reentry after adolescent hospitalization due to suicidal thoughts and behaviors: Recommendations to improve reentry practices. 2023; Journal of School Health, 93: 206-218. DOI: 10.1111/josh.13291
Summary: “Themes emerged regarding academic difficulties during hospitalization; breakdowns in communication between schools, families, and hospitals; logistical challenges during the school reentry planning process; and challenges navigating peer relationships and academics following school reentry. Few reentry recommendations account for the specific challenges faced by families. Recommendations informed by caregiver experiences are needed to ensure that families can effectively support the recoveries of their children.”
- Marisa E. Marraccini, Cari Pittleman, Megan Griffard, Amanda C. Tow, Juliana L. Vanderburg, & Christina M. Cruz. Adolescent, parent, and provider perspectives on school-related influences of mental health in adolescents with suicide-related thoughts and behaviors. Journal of School Psychology,
Volume 93, 2022, Pages 98-118, https://doi.org/10.1016/j.jsp.2022.07.001.
Summary: “Data were analyzed using applied thematic analysis revealing three main themes related to perceptions of how school experiences can positively or negatively impact mental health, including (a) school activities, (b) school social experiences, and (c) school interventions. An emergent theme related to the complexity of suicide-related risk identified the ways in which school experiences may intersect with other environmental, biological, and psychological factors. Findings underscore the need for school-based approaches to address the unique academic, social, and emotional needs of students with suicide-related risk that complement the supports and services provided in their home and community.”
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* co-corresponding authors
^corresponding author
“ equal contribution