Reversing Youth Mental Health Outcomes - Observatory of Public Sector Innovation

Mental Health System-wide Prevention

Mind the Class, a mental health prevention organization, is partnering with school systems to reduce the risks and reverse the rates of mental and behavioral health disorders by creating a community ecosystem. This full year project collaboratively designs a preventive implementation plan using proven wellbeing research and data-driven solutions in collaboration with our University of Warsaw partners and through local public and private partners support sustainable development.

Innovation Summary

Innovation Overview

Mind the Class has developed a new public health discipline to prevent risks and reverse outcomes of mental and behavioral disorders, leveraging a community ecosystem with proven preventive research. Our evidence-based framework defines wellbeing factors that promote good coping, stress reduction and resiliency among youth and their communities. The framework was put into practice as a strategic and operational consultative model to support school systems build a community system of support.

Psychological approaches to mental health have long used a medical model of assessment, diagnosis and treatment. Treatment approaches focus on reducing symptoms and behaviors outside the context of their environment. This approach is limited in that it cannot reduce the rates of mental illness nor prevent future mental health problems in those previously treated. There's an 11 year gap between the onset of symptoms and reactive mental and behavioral health interventions leading to a drastic rise in suicides, high school and medical costs, professional burnout, and a serious shortage in trained professionals. 1 in 5 children will become mentally ill adults leading to an increase in chronic problems by the time people are served, requiring more complex, longer term care and limited solutions. This validates the need for a systemic public health model for prevention to close the gap, as mental illness is a universal risk.

"In itself mental health is a prerequisite for physical health, and is strongly interlinked with other development factors such as poverty, work and economic growth or peace and justice. Mental health plays a key role in efforts to achieve social inclusion and equity, universal health coverage, access to justice and human rights, and sustainable economic development (World Health Organization, 2011)." (source)

We envision a world that focuses on prevention by creating a supportive environment around children early to foster emotional wellbeing and mitigate risks of mental illness. By working to equip school systems, communities and families before youth experience a triggering life event, we can improve their overall mental and physical health. In close examination of the research through a thematic analysis, we found the areas of wellbeing that support good mental and physical health were related to 5 areas, which we have labeled as the 5-Elements. We further broke down the elements into 60 key factors including 30 internal and 30 external variables. By categorizing the supportive practices, we now have a way to focus forward when we experience a barrier, rather than using past problems and fears to predict and avoid future problems and fears. This gives us a clear path to aim for which places us on a path around the barriers, thereby eliminating the barriers to achievement. This is the basis of our model.

We have designed an evidence-based public health capacity building approach to preventive mental health best-practices at the system-level that guides a cohort of social service teams from assessment to implementation. We provide strategic and operational consultation, professional development and community partnership development for 30 weeks. We measure wellbeing needs defined from our evidence-based framework, population factors, and risk factors through public health data to discover evidence-informed preventive solutions. We provide training to a trainer who coordinates a task force (including youth, school leaders, key community members, parents, and educators) for planning and scaffolding implementation. We create local public and private partnerships, secure resources and connect technology partners to fill need gaps and build capacity in teams for self-sustaining programs. This provides teams with a preventive implementation plan and a replicable model with a supportive ecosystem within their communities.

As this program is implemented in more school communities, we are building an artificial intelligence software solution that will be predictive of the most effective preventive strategies that match their unique population, risks and wellbeing needs to advance public mental health prevention globally and exponentially scale our impact. Furthermore this data allows researchers, public sector institutions and other innovative groups to benefit from the advances to unify our collective missions toward the reduction of mental and behavioral health risks and reversal of critical outcomes. System-wide prevention creates a supportive environment, reduces risk of mental health problems, reduce counseling referrals and behavioral incidents, is more cost effective, and creates a calmer more supportive culture and climate. When we architect proactively to improve wellbeing, people feel better equipped to manage uncertainty and change through capacity building, empowerment and connection, improving achievement and retention.

Innovation Description

What Makes Your Project Innovative?

The Mind the Class Program is Innovative as it:

Proactively addresses the core mental health needs of youth that are known to reduce risk factors for developing disease and disorders, rather than slower, costly, reactive solutions.
Systemically builds capacity in school communities for sustainable preventive solutions to a global problem allowing for a wider impact more quickly, rather than addressing each individual situationally.
Integrates cross-disciplinary approaches and resources to increase awareness, access, equity and address the complexity of wellbeing and shared burden of responsibility, rather than siloed innovation and implementation.

What is the current status of your innovation?

Mind the Class with University support and our local public sector partners are rounding out our first Pilot with 12 schools to reduce risks and have tested the framework in the clinical setting, established partnerships for data sharing and solution partnerships. We are entering into Phase 2 in which we will be working with 36 schools and 3-6 communities within those service areas. We are currently seeking funding to develop our software solution that will advance our data-driven solutions through artificial intelligence software.

Innovation Development

Collaborations & Partnerships

Mind the Class partners with the University of Warsaw to support research, evaluation, and data analysis. Our local public health partners, like victim services, police departments and mental health social services provide risk factor data and representatives who will have a role on the community task force for each community served and contribute to the development of preventive solutions given qualitative and quantitative insights.

Users, Stakeholders & Beneficiaries

Students benefit from improved psychological safety, emotional and physical regulation, self-worth, feel more resolute and better related to others. School leaders and educators feel more connected and a shared community responsibility while retaining more qualified professionals. School social work teams have a full ecosystem for promoting mental wellness and report reduction in counseling referrals. Community members and parents feel more involved in the protection of youth wellbeing.

Innovation Reflections

Results, Outcomes & Impacts

In the first Pilot, life-cycle modeling and evaluation planning was conducted with the support of University researchers as consultants. Use of the model and approach was recorded, task force members were surveyed using a needs assessment and a wellbeing questionnaire was used with a sample of students. The benefits reached 1200 students in 12 schools. Psychological safety teams and a peace club was created, specialized trainings were conducted on high risk factors and community partnerships were made. The evaluation plan will scale with our phase 2 cohort impacting 36 schools with pre and post assessments with local public risk factor data stored on our software solution to initiate predictive preventive solution insights.

Challenges and Failures

In the Pilot, access to reliable technology limited meeting time and place. The Ambassador's local responsibilities to other high need areas such as menstrual hygiene, surgical access for youth, community funerals and personal and family illnesses such as malaria, at times interrupted the initial timeline of the project and as such, the project timeline was extended to support their availability. Limited transportation in the area creates some roadblocks for supportive interventions for more rural households to access community interventions and preventive programming. As such, partnerships continue to be explored who have knowledge and access to the area and solutions for hard-to -reach families. Multiple languages in the community brought up an important oversight in the inclusive evaluation and were addressed with specific solutions to this community. In the future, partnerships in translation will be explored.

Conditions for Success

Our four core values guide our vision for success: curiosity, inclusivity, collaboration and ingenuity. The youth lived experiences have guided our program development from the start. We have 13 members on our Advisory Board that have helped us prepare to launch the program model through networking and coaching. Those include consultancy advisors, psychiatry, behavioral health, legal, financial and university researchers on failure, social emotional learning and public health. We have spoken to a number of professionals in institutions and non-governmental organizations as well as public companies who have provided key context within their expertise and multiple perspectives that now remain as referral partners. Further, we have technical partnerships that use advancements in computer software to support preventive solutions as well as to provide key guidance on the development of our software solution. We have most recently grown our team by 5 key members.

Replication

Several conceptual discussions have been initiated for replication in other communities across the globe. The researched elements of wellbeing are inclusive of human needs, and both global studies and integrative psychological and sociological studies were evaluated and represented in the approach. The systemic change approach was designed specifically to understand the unique population, cultural and risk factors of each community and build self-sustaining capacity within the community by partnering to design an eco-system using local resources as measurable preventive solutions addressing wellbeing gaps and supporting strengths.

The factors for readiness in a community may include:

An open-minded program ambassador with at least 5 hours per week of time to dedicate to this project.
Secured funding for the project size and length.
Internet access at least 1 hour weekly for 30 weeks.

Lessons Learned

The initial pilot primarily provided a lot of hope and inspiration as our partners in Uganda have been immensely supportive, curious, openminded, transparent and motivated to make positive change. It was particularly helpful to have a partner with strong relationships in their community with pre-established expertise and credibility. The notion of a task force with diverse perspectives produced the desired "shared responsibility" and diffused fears for the school in taking on a new project by limiting the burden and building support. A train the trainer model was successful in eliminating the risk of dependency on the model, program and eliminated risk of rejection from outside influencers who haven't lived in the community. The resulting experience of the consultant was somewhat removed and relied heavily on the feedback of the Ambassador partners.

Anything Else?

Local partnerships will vary depending on the community served. For example, governing bodies that can provide mental health risk factor data are unique to each community. High risk factors are also unique variables and public partnerships would be sought after to best understand the community conditions, history, resources and support specific to those areas of need to reduce the likelihood of youth experiencing those factors and developing illness if they're exposed to those factors. We have identified 10 risk factors for mental and behavioral disorders that we evaluate within each community before conducting our wellbeing needs assessment. Other task force members who provide perspective and influence on the preventive plan, might include, representatives from local police, local government, spiritual and religious leaders, medical programs, mental health programs, public health programs in addition to a sample of youth, teachers, school counselors, and parents.