Mental Health Literacy, School Mental Health Training of Teachers
Conditions
Keywords
School Mental Health, Psychosocial Support, Cluster Randomized Controlled Trial, Teacher Professional Development, Mental Health Promotion, Education Policy
Brief summary
The goal of this clinical trial is to learn if different formats of a school-based psychosocial support training program can improve teachers' ability to recognize and respond to students' mental health needs. The study will include teachers working in public schools in Brazil. The main questions it aims to answer are: 1. Do teachers who receive the training improve their knowledge on how to better to identify and support students with mental health difficulties? 2. Do different formats of training (synchronous online or self-paced) and the presence of supervision lead to different levels of improvement in this knowledge, in attitudes related to mental health, and helping behaviors? Researchers will compare three versions of the program (synchronous online with supervision sessions, synchronous online without supervision sessions, and asynchronous format) to see which approach is more effective, acceptable, and feasible. Participants will: 1. Take part in a training program delivered online or through self-paced materials; 2. In some groups, attend additional supervision sessions to discuss real-life cases; 3. Receive brief follow-up materials through mobile messages after the training 4. Complete online questionnaires at multiple time points (before the training, during the program, after completion, and at follow-up). The study will measure changes in teachers' knowledge, attitudes, and behaviors related to supporting students' mental health, as well as satisfaction with the program and its feasibility for large-scale implementation.
Interventions
BEHAVIORALOnline School-Based Psychosocial Support Training
A structured training program designed to improve teachers' ability to recognize and respond to students' mental health needs. The intervention includes evidence-based content on mental health literacy, identification of emotional and behavioral difficulties, and appropriate support and referral strategies. The training is delivered trough synchronous videoconference in two weekly sessions.
BEHAVIORALAsynchronous School-Based Psychosocial Support Training
A structured training program designed to improve teachers' ability to recognize and respond to students' mental health needs. The intervention includes evidence-based content on mental health literacy, identification of emotional and behavioral difficulties, and appropriate support and referral strategies. The training is delivered through an asynchronous self-paced course in a digital platform.
BEHAVIORALSupervision Sessions
Structured small-group supervision sessions conducted via audio calls, focused on discussion of real-life cases, clarification of concepts, and support for practical application of the training content.
BEHAVIORALMobile-Based Reinforcement Materials
Brief follow-up materials delivered via mobile messaging to reinforce key concepts covered in the training sessions.
Sponsors
Hospital de Clinicas de Porto Alegre
Child Mind Institute
Secretaria da Educação do Estado do Rio Grande do Sul (SEDUC-RS)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
This is a three-arm, parallel-group, cluster-randomized trial. Schools are the unit of randomization, with one to nine school staff members per school participating in the trial, including teachers and school management personnel. The three arms differ based on delivery format (synchronous online, or asynchronous) and the presence or absence of supervision. Two groups receive synchronous online training, with or without additional supervision sessions, while one group receives the same content delivered in an asynchronous format only. The intervention duration ranges from 2 to 4 weeks depending on the assigned condition. Outcomes are assessed at baseline, during the intervention, post-intervention, and follow-up (1 month after post-intervention assessment). The study is designed to compare the effectiveness, acceptability, and feasibility of different delivery formats and supervision components.
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
School-level inclusion criteria: * Public schools from the state education system of Rio Grande do Sul, Brazil, serving students in "Ensino Fundamental" and "Ensino Médio" (equivalent to grades 1-12), and belonging to "Polo 1" or "Polo 2", administrative groupings defined by the Rio Grande do Sul State Department of Education that includes the following Regional Education Coordinators (Coordenadorias Regionais de Educação \[CREs\]): 1st, 2nd, 11th, 12th, 27th, and 28th CREs (Polo 1) and the 4th, 7th, 15th, 16th, 23rd, 25th, 39th CREs (Polo 2); * Schools with 10 or more teachers on staff; Participant-level inclusion criteria (staff level) Participating teachers must meet all of the following criteria: * School staff currently working in participating public schools; * Able and willing to participate in all stages of the intervention and scheduled assessments; * Provide informed consent prior to participation
Exclusion criteria
School-level
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in the score in the Mental health Knowledge & Attitudes Questionnaire | Baseline (T0) to post-intervention at 2-4 weeks (T2) | Psychosocial support skills knowledge and attitudes will be assessed using a multiple choice instrument (Mental health Knowledge \& Attitudes Questionnaire) developed for this study and previously piloted in a sample of teachers. Scores will range from 0 to 100%, reflecting the percentage of correct responses. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Early and Sustained change in the score in the Mental health Knowledge & Attitudes Questionnaire | Baseline (T0) to after the second training session (approximately 1 week after baseline)/after ending of the asynchronous training (T1); Baseline (T0) to 1-month follow-up (T3) | Same instrument used in the primary outcome |
| Appropriate Response to a Student Mental Health Concern: Open-Ended Classroom Scenario | after the second training session (approximately 1 week after baseline)/after ending of the asynchronous training (T1); post-intervention at 2-4 weeks (T2); 1-month follow-up (T3) | Participants are asked to recall a recent situation in their classroom in which they noticed behaviors in a student that raised a possible concern about the student's mental health or psychosocial well-being. Participants provide an open-ended description of the situation and the behaviors they observed and describe what, if anything, they did to support the student. Responses will be evaluated to determine whether the actions described by the participant are considered appropriate (1) or not (0) based on the principles taught in the training. This assessment will be blind to the allocation group. The percentage of responses classified as appropriate will be calculated and compared across the three intervention arms. The recall period varies by assessment time point: at T1 and T2, situations occurring during the past week; and at T3, situations occurring during the past month. |
| Self-rated knowledge | baseline (T0); after the second training session (approximately 1 week after baseline)/after ending of the asynchronous training (T1); post-intervention at 2-4 weeks (T2); 1-month follow-up (T3) | Assessed using two self-report items developed for this study. One item assesses participants' perceived knowledge of mental health, rated on a five-point scale from very poor to excellent. A second item assesses participants' confidence in their ability to identify students with psychosocial or mental health difficulties, rated on a five-point scale from not at all confident to extremely confident. Higher scores indicate greater self-rated knowledge and confidence. Participants may also select prefer not to answer. |
| Changes in helping behaviors toward students | Baseline (T0) to after the second training session (approximately 1 week after baseline)/after ending of the asynchronous training (T1); Baseline (T0) to post-intervention at 2-4 weeks (T2); Baseline (T0) to 1-month follow-up (T3) | Assessed using a retrospective self-report scale developed to capture mental health-related helping behaviors toward students ("Helping Behaviors Scale"), including identifying emotional distress, providing support, and facilitating referral to appropriate services. The scale includes five items describing specific helping behaviors. Each item is rated as yes, no, or does not apply. Higher endorsement indicates a greater number of supportive actions taken by the respondent in the past week. |
| Change in the levels of teacher burnout | Baseline (T0); after the second training session (approximately 1 week after baseline)/after ending of the asynchronous training (T1); post-intervention at 2-4 weeks (T2); 1-month follow-up (T3) | Teacher burnout will be assessed using the 12-item version of the Burnout Assessment Tool (BAT-12), a self-report questionnaire developed to assess burnout as a multidimensional psychological syndrome. It evaluates four core dimensions of burnout: exhaustion, mental distance, cognitive impairment, and emotional impairment. Each item is rated on a five-point frequency scale ranging from 1 (never) to 5 (always). A total burnout score will be calculated as the mean of the 12 items, with higher scores indicating greater burnout symptoms. |
| Training acceptability & satisfaction | Post-intervention at 2-4 weeks (T2) | Assessed using a post-training self-report questionnaire developed for this study. The questionnaire includes one item assessing perceived adequacy of training length, rated as too short, about right, or too long; one item assessing whether the training included sufficient practice of the skills taught, rated on a five-point Likert scale ranging from strongly disagree to strongly agree. Higher ratings indicate greater satisfaction with the training components. An optional open-ended item collects additional qualitative feedback about the training. |
| Cost-effectiveness of the intervention | Baseline (T0) to post-intervention at 2-4 weeks (T2) | Cost-effectiveness will be calculated as the cost per improvement unit in the Mental health Knowledge \& Attitudes Questionnaire described previously |
Contacts
CONTACTGiovanni A. Salum, MD, PhD
PRINCIPAL_INVESTIGATORGiovanni A. Salum, MD, PhD
Child Mind Institute
Outcome results
None listed