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Table 2 Summary of adaptations to school mental health program

From: Scaling‐up school mental health services in low resource public schools of rural Pakistan: the Theory of Change (ToC) approach

Components of school mental health program Conventional Suggested adaptations
Knowledge about child development Theoretical descriptions of each developmental stage through lectures Use of pictures and narratives through electronic medium to demonstrate different stages and domains of child development
Universal strategies
 Counselling skills Good communication skills listed in written materials, with limited practice through role play during training Good communication skills to be integrated throughout the entire training; teachers to be provided examples of good practices through electronic medium
 Role of parents/primary caregivers Brief narrative to explain the role of parents/primary caregivers in child’s education covered in lecture A collaborative care model to promote parent-teacher collaboration to be added.
Detailed guidelines to conduct effective parent teacher meetings to be provided as supplementary material
 Promoting life skills–use of circle time A list of potential life skills which can be implemented in school settings is provided.
A brief narrative on what is circle time activity in school settings is provided
Detailed guidelines for teachers on how to impart life skills training in school settings to be incorporated in circle time activities
Structured guidelines on how to conduct circle time activities in schools to be developed and incorporated in the intervention
 Teachers’ wellness Brief description in manual and reference to additional reading material as supplementary A new module to promote teacher`s wellness incorporating evidence-based strategies for stress management to be developed
 Targeted strategies Case studies on anxiety, separation anxiety/school refusal, post-trauma, depression, suicide, ADHD, autism, psychosis, conduct problems, substance use problems to demonstrate what strategy a teacher can implement in classroom settings A trans-diagnostic approach was recommended to avoid diagnostic labels and to prevent labelling/stigmatization of children in school settings
To facilitate teacher’s understanding of the conditions depression, anxiety and PTSD case studies to be combined as internalizing problems case study.
Case studies on ADHD and conduct problems to be combined as externalizing problems case study
A case study on child with learning difficulties has to be added
Case studies not to just demonstrate what to do but also to emphasize how to implement intervention strategies in a classroom setting
 Training A one-off training consisting of didactic lectures to a few nominated teachers on designated dates and venues
The content is delivered in the form of didactic lectures
A self-paced, open access, online teachers training course, comprising of interactive videos and role plays to be developed and delivered using a cascade model of training whereby champion teachers cascade down training to all teachers in their respective schools
 Supervision Monthly face to face supervision A cascade model of monthly face to face supervision meetings whereby trainers supervise the champion teachers who will supervise the school teachers in their respective schools