Publications

TEALEAF OUTCOMES

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.

 

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.

 

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.

 

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.”

 

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

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.”

 

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.

 

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.”

 

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

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

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.”

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.”

===========================

* co-corresponding authors

^corresponding author

“ equal contribution