School-Based MHPSS Interventions in Humanitarian Contexts Realist Review

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Conducted by a team of researchers and advisors, the realist review focuses on understanding the characteristics, mechanisms, and outcomes of school-based Mental Health and Psychosocial Support (MHPSS) interventions in humanitarian settings. The study aims to uncover how these interventions impact the wellbeing and learning outcomes of children affected by conflict and violence in various contexts.

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School-based MHPSS Interventions in Humanitarian Contexts Jennifer Flemming, Lead Researcher, The MHPSS Collaborative Ashley Nemiro, Senior MHPSS Advisor, The MHPSS Collaborative Jackline Oduor, Education Officer, Norwegian Refugee Council Molly Lasater, Associate, Johns Hopkins Bloomberg School of Public Health

Webinar Housekeeping Participant audio and video are disabled. Post questions using the Q&A function at any time. This session is being recorded. Closed captioning available in En The recording and presentations will be shared on the INEE website inee.org

The MHPSS Collaborative Who we are and what we do

MHPSS in Action Project Origins To generate high-quality evidence focused on the overall question, What are the linkages between MHPSS and SEL programming in schools and well-being outcomes for children affected by conflict and violence in three humanitarian contexts?

School-based MHPSS Interventions in Humanitarian Contexts: A Realist Review Dr. Molly Lasater, Department of International Health, Johns Hopkins Bloomberg School of Public Health Dr. Jennifer Flemming, Lead Researcher, The MHPSS Collaborative Christine Bourey, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health Dr. Ashley Nemiro, Senior Technical Specialist, The MHPSS Collaborative Dr. Sarah Meyer, The MHPSS Collaborative; Department of Population and Family Health, Mailman School of Public Health, Columbia University

Study Overview OBJECTIVE Conduct a realist review to elucidate the characteristics of school-based MHPSS interventions in humanitarian settings and the mechanisms by which they are hypothesized to influence wellbeing or learning outcomes School School- -based MHPSS MHPSS interventions interventions based MHPSS Outcomes Learning Outcomes RESEARCH QUESTION What are the characteristics, key outcome measures, and mechanisms through which school-based MHPSS interventions in humanitarian settings work (or are hypothesized to work)?

Methods Methods 2. Conduct searches, review, and data extraction 1. Develop Initial Programme Theories (IPTs) 3. Link CMOCs to IPTs 4. Programme Theories

Findings Overall, limited evidence of positive impacts of the included interventions Study characteristics Intervention modalities Psychoeducation, CBT techniques, coping skills, social support, arts and play, music Outcome measures Psychological symptoms of distress, wellbeing, literacy and math skills Intervention implementation Teacher/ school staff, mental health professionals, community health workers

Findings Established 11 programme theories from the review, across 5 levels Levels: child (n=4), teacher (n=3), caregiver (n=2), school environment (n=1), and school managers/ administrators (n=1). No evidence to support Programme Theory 3.2 (caregiver) or Programme Theory 5 (school managers/ administrators)

Programme Theories Child Level 1.1 Develop and strengthen coping skills When MHPSS prevention and promotion interventions are integrated into learning spaces, children are better able to Understand and manage their emotions and develop a greater sense of self Improved psychosocial wellbeing 1.2 Strengthen interpersonal relationships with peers, instructors, and caregivers 1.3 Improved learning outcomes 1.4 Have improved psychosocial wellbeing

Programme Theories Teacher / educator / facilitator level Improved teacher psychosocial wellbeing When teachers/ educators/ facilitators in learning spaces actively engage in training and receive supportive supervision to increase their mental health literacy, they are better able to Develop positive coping skills 2.1 Improved student psychosocial wellbeing Support their students' mental health, allowing children to strengthen self- esteem, process their emotions and develop new coping skills 2.2 Improved student learning outcomes Support their students mental health 2.3

Programme Theories Caregiver level When caregivers are engaged in their children s learning and wellbeing Improved psychosocial wellbeing Interpersonal and family bonds are strengthened 3.1

Programme Theories School environment level When school environments are created to be safe, supportive, and child-centered Improved psychosocial wellbeing and learning outcomes Children will feel secure, relaxed, and less stressed 4.1

IMPLICATIONS FOR MHPSS PROGRAMMING Safe learning environments and MHPSS in education Whole of school approaches vs. single component interventions

IMPLICATIONS FOR IMPLICATIONS FOR MHPSS RESEARCH MHPSS RESEARCH Selection of outcome measures Develop theories of change Implementation of interventions Whom interventions work for: gender, age, and risk profiles

= Phase II: Examining enabling environments for MHPSS programming in education settings in humanitarian contexts: Perceptions of children, teachers, and caregivers across different contexts January 2022 December 2023

Primary Research Questions 1. What do children, teachers and caregivers perceive to be the role of classroom-based MHPSS interventions in humanitarian contexts? 2 What are students , teachers and caregivers perspectives on what constitutes an enabling environment for MHPSS interventions in education in humanitarian contexts, and particularly in their context? 3. What are the key elements of different domains of an enabling environment, as assessed across different contexts, and how do they relate to each other? 4. What roles do classroom-based MHPSS interventions play in return and/ or re-entry to school during COVID-19 school closures in humanitarian contexts? 5. What is the perspective of implementing staff, local stakeholders, and other relevant actors regarding change processes within a specific MHPSS intervention?