Mapping community-sensitive interventions for promoting mental health in high schools: a scoping review¹

Mapeamento de intervenções sensíveis à comunidade para a promoção da saúde mental no ensino médio: uma revisão de escopo

Cartographie des interventions sensibles à la communauté pour la promotion de la santé mentale dans les écoles secondaires: une examen de la portée

Mapeo de intervenciones sensibles a la comunidad para promover la salud mental en la secundaria: una revisión del alcance

Abstracts

This scoping review evaluated community-sensitive mental health promotion projects in high schools. In total, 15 papers were selected from six major bibliographic databases. Results showed that these programs conceptualize mental health as socially constructed projects, highlighting the need for interventions that are tailored to specific communities in school settings. Challenges included forming partnerships within school communities, responding to unforeseen demands, obtaining funding in contexts that favor universal approaches and prioritize individualized focus, and linking academic and community knowledge. Incorporating human rights-based approaches involves addressing social inequalities and human rights in school mental health interventions. Addressing the social determinants of mental health in school-based programs requires innovative theoretical and methodological intervention models.

Keywords:
Mental health; health promotion; youths; high school

Uma revisão do escopo de projetos de promoção de saúde mental sensíveis à comunidade em escolas de ensino médios é apresentada, a partir de 15 artigos, selecionados de seis grandes bases de dados. Os projetos conceituam a saúde mental como socialmente construída e destacam a necessidade de intervenções adaptadas a cada comunidade. Os desafios incluíram a formação de parcerias dentro das comunidades escolares, a resposta a exigências imprevistas, a obtenção de financiamento em contextos que favorecem abordagens universais individualizantes, e a conexão entre o conhecimento acadêmico e comunitário. A incorporação de abordagens baseadas nos direitos humanos implica o debate sobre as desigualdades sociais nas intervenções escolares. Modelos de intervenção teóricos e metodológicos inovadores são necessários para abordar os determinantes sociais da saúde mental em programas escolares.

Palavras-chave:
Saúde mental; promoção de saúde; jovens; ensino médio

Cet article présente un examen de la portée des projets communautaires de promotion de la santé mentale dans les écoles secondaires, basé sur 15 études sélectionnées dans six grandes bases de données. Les projets conceptualisent la santé mentale comme une construction sociale et soulignent la nécessité d’interventions adaptées à chaque communauté. Les défis comprenaient la formation de partenariats au sein des communautés scolaires, la réponse à des demandes imprévues, l’obtention de financements dans des contextes favorisant des approches universelles donnant la priorité à l’individu et la connexion des connaissances académiques et communautaires. L’intégration d’approches basées sur les droits de l’homme implique le débat sur les inégalités sociales dans les interventions scolaires. Des modèles d’intervention théoriques et méthodologiques innovants sont nécessaires pour aborder les déterminants sociaux de la santé mentale dans les programmes scolaires.

Mots-clés:
Santé; mentale; promotion de la santé; jeunes; lycée

Se presenta una revisión del alcance de los proyectos de promoción de la salud mental sensibles a la comunidad en la secundaria a partir de 15 artículos seleccionados en seis grandes bases de datos. Los proyectos conceptualizan la salud mental como una construcción social y resaltan la necesidad de intervenciones adaptadas a cada comunidad. Los desafíos incluyeron formar alianzas dentro de las comunidades escolares, responder a demandas imprevistas, obtener financiamiento en contextos que favorezcan enfoques universales que prioricen al individuo y conectar el conocimiento académico y comunitario. La incorporación de enfoques basados en los derechos humanos implica el debate sobre las desigualdades sociales en las intervenciones escolares. Se necesitan modelos de intervención teóricos y metodológicos innovadores para abordar los determinantes sociales de la salud mental en los programas escolares.

Palabras-clave:
Salud mental; promoción de la salud; jóvenes; escuela secundaria

Introduction

This paper presents a scoping review of community-sensitive interventions in high schools, analyzing to what extent they consider the social determinants of mental distress and promote collaborative strategies with the school communities. It was developed as part of an intervention project focusing on eight public Brazilian high schools. The general project’s central axis is based primarily on human rights when dealing with the health demands surrounding youth. It seeks to facilitate young people’s access to health and reduce violence between peers through an alliance between high school territory and basic health units close to these schools (Paiva et al., 2021).

Since the beginning of this project, the research team has been asked to develop projects concerning mental health issues in schools since they were considered a significant issue by the school communities. In a study with students from the same schools, based on quantitative research carried out in the end of 2019, about the social determinants of suicidal ideation among them, we observed that being a woman, being LGBT+, and having previous experience of discrimination at school or on the internet proved to be factors associated with a higher prevalence of mental suffering among these young people (Vieira Garcia et al., 2022).

The primary research team identified the need for a comprehensive study of intervention projects that focused on the mental health of high school students. Since the significant project’s background was based on participative research and a human-rights framework, proposals with similar characteristics must be considered.

The debate on the social determinants of mental health and the growing influence of social sciences and the humanities strengthens the critical assessment of the psychiatric explanations for mental distress origins (Rose, 2019). Psychological and psychiatric realities should not be understood outside of their social context (Orford, 2008). Unfortunately, though, interventions for mental health promotion overwhelmingly focus on treating existing mental illnesses detected in previous screening while leaving aside community and societal levels or creating supportive environments for mental health (Enns et al., 2016).

The decline in adolescent and youth mental health indicators worldwide (WHO, 2014) was exacerbated by the SARS-COV-2/COVID-19 pandemic, highlighting the need for long-term innovative interventions to mitigate distress in this population (Ford et al., 2021).

If we aim to reduce the consequences on the mental health of children and adolescents of rights neglect and violation, as proposed by the UN Special Rapporteur on the right to health (Pūras, 2019), the programs that consider the social determinants of mental distress are relevant. Furthermore, when such distress in children and adolescents occurs in institutions, critical approaches should highlight inequalities, social justice, and a distinctly educational vision for change (O’Toole, 2017).

Schools are recognized as essential places for mental health promotion among adolescents and young people (WHO, 2014). However, the interventions commonly directed to schools usually do not consider specificities regarding the school’s agents, including students, teachers, and other workers. They often prioritize universal “packages” of activities, with little dialogue with schools’ realities. When considering the social determinants of mental health, this universal approach may be challenging, as class, race, gender, sexual diversity, and other social determinants impact school communities differently. Because of this, there is a need for community-sensitive research that involves an active partnership with community members and for culturally appropriate methods to conduct this research (Macaulay, Commanda, Freeman et al., 1999).

Community-sensitive interventions in schools refer to strategies and practices designed to address diverse communities’ unique needs, strengths, and cultural contexts within educational settings. These interventions prioritize collaboration with community stakeholders, including students, families, local organizations, and cultural groups, to develop inclusive and culturally responsive programs that promote positive outcomes for all learners (Greenberg et al., 2001). The necessity of community-sensitive interventions in schools, particularly considering race, class, gender, and sexual diversity as critical social determinants of mental health, is crucial for fostering inclusive and supportive learning environments that promote the well-being of all students. Research has highlighted the profound impact of these intersecting social identities on mental health outcomes, emphasizing the need for tailored interventions that address the unique challenges and experiences faced by diverse student populations. A common strategy in these interventions is adopting a culturally relevant curriculum, when schools incorporate diverse perspectives, histories, and experiences to promote students’ sense of identity and belonging (Nieto, 2017).

We consider community-sensitive interventions in schools to be integral to health promotion efforts by addressing social determinants of health, promoting healthy behaviors, creating supportive environments, collaborating with community partners, empowering students and families, and advocating for policy change, in line with the WHO (2014) document that settles that” health promotion has been seen to ask for peace, social justice, decent housing, education, and employment.” However, scientific literature needs to be more comprehensive literature that analyses specific projects in this field. Although many research reviews focused on mental health improvement in school settings, we could not find any focusing specifically on community-sensitive interventions. For this reason, we decided to design a scoping review regarding this theme. In this paper, we present the results and discussion of this review, where we map out mental health promotion projects that adopt a community-sensitive intervention in high schools, analyzing to what extent they manage to consider the social determinants of mental distress and promote collaborative strategies with the school communities.

Method

We conducted a “scoping review” (Arksey & O’Malley, 2005). This systematic review process allows mapping the relevant scientific literature on a given topic, clarifying complex concepts, systematizing the existing knowledge in this field, and identifying gaps in learning through a research agenda.

Our search strategy involved articles published in the ERIC, MEDLINE, PsycINFO, Scopus, Sociological Abstracts, and Web of Science databases up to 2020. These databases were selected after consderations of the major ones that discusses the themes of social determinants, education, and mental health related topic.

After an exploratory test, directed to look after whats search terms fitted better to capture the objectives of the present research, we chose the following search terms appearing in abstracts and titles to address the objectives of our review: “mental health” AND “school-based” AND “intervention” AND (“adolescents” OR “youths”).

The research team examined the project scope statement, requirements documentation, and related project documents to identify any inconsistencies or gaps. The abstracts we selected through this process were read by two independent researchers both authors of this article), and a third researcher, who acted as a referee in any cases of disagreement. The inclusion criteria of elegibility for papers were the ones that: (1) described community-sensitive intervention program aimed at promoting mental health; (2) focused on high-schools students, or young people of the same age; (3) were Published in English, French, Spanish, or Portuguese, and (4) had full-text available on the journal’s database of the Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil

The exclusion criteria of elegibility were of papers that: (1) did not have mental health as a central theme; (2) described only previously planned models of interventions (developed without the participation of the school community); (3) focused on age groups of students different from our proposal; (4) had only a theoretical approach, without describing any specific program; (5) described interventions that started from a medicalized view of the students (for example, by carrying out screenings of alleged disorders for later treatment)

Table 1
Eligibility for inclusion

Inclusion criteria

Exclusion criteria

- Papers that: described community-sensitive intervention program aimed at promoting mental health focus on high-schools students (or of equivalent age) were Published in English, French, Spanish, or Portuguese had full-text available on the journal’s database of the Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil

- Papers that did not have mental health as a central theme described only previously planned models of in-terventions (developed without the participation of the school community) that focused on age groups of students different from our proposal. had only a theoretical approach, without descri-bing any specific program described interventions that started from a medicalized view of the students (for example, by carrying out screenings of alleged disorders for later treatment)

The search on the datases identified 3235 papers through, after duplicates removed. These papers were subsequently screened by title and abstract. by two independent researchers and a third researcher, who acted as a referee in any cases of disagreement, as pointed out before. After this screrening. 69 papers were selected, and 59 of them (with full-text available) were screened in a second round, regarding the whole paper. By the end of this final screening, 15 papers were selected and are presented and analysed in the results.

Figure 1
Article selection

Results and discussion

The final screen selected 15 intervention projects, that are summarized in table 2. This item is divided in 5 sections: (1) general results; (2) major theoretical references of the interventions; (3) how papers conceive community and singular practices; (4) how is the construction of the relationship in the interventions projects with the school community and its challenges; (5) what are the challenges concerning local knowledge

Table 2
Interventions to promote mental health

Authors	Brief Program Summary	Participants	Metodology	Main results
Alicia et al. (2012)	High school-based mental health service delivery model, designed to promote positive youth development, identify and address individual student needs. It included youth group board meetings centered around a life skills curriculum; individual meetings between staff and youths; academic incentives; rips and retreats; and summer internships. Engagement and mental health support occurred in hallways, lunchrooms, classrooms, after school, in the community, at home, or online.	African American and Latino youths, from 14-18 years old, in New York City, USA	The article describes the program's clinical goals, theoretical influences, components, and critical features and presents preliminary data on youth engagement for two cohorts of students.	One of the key strategies from this framework is to involve youth and families as active partners in their care from the very beginning, allowing them to develop their own service plan. This approach not only empowers them but also enhances their engagement with the services. The flexibility of having both formal and informal positive contact with youth and families further normalizes the idea of seeking support.
Balaji et al. (2011)	A population-based intervention aimed to promote the health of youth in the domains of reproductive and sexual health, violence, mental health, substance use, and help-seeking for health concerns. The intervention comprised educational institution-based peer education and teacher training (in the urban community), community peer education, and health information materials.	98 youths and 13 teachers in Goa, India	Exploratory controlled evaluation of an intervention in which two pairs of urban and rural communities; each was randomly assigned to receive a multi-component intervention, and the other was wait-listed.	In both intervention communities, the prevalence of violence perpetrated and probable depression was significantly lower, and knowledge and attitudes toward reproductive and sexual health were substantially higher. The urban sample reported significantly lower levels of substance use, suicidal behavior, sexual abuse, and reproductive and sexual health complaints.
Bradshaw et al. (2012)	Community-based participatory research on the three-tiered Positive Behavioral Interventions and Supports model aimed to support school-based prevention and implementation of evidence-based programs. This non-curricular, universal prevention strategy sought to alter the school environment by creating improved systems and procedures to promote positive change in staff and student behaviors.	Students from 1465 public schools in the State of Maryland,, one fourth of them at high-school	The paper proposes a qualitative analysis of the implementation of the program em the State of Mzryland	Forming and sustaining authentic relationships in supporting school-based prevention research and the implementation of evidence-based programs was crucial. sSchools that implement the program typically secure support from at least 80% of the school staff before adopting it. However, schools that are mandated to adopt this or a similar program may face more resistance, potentially leading to less favorable outcomes than schools that voluntarily implement it.
Ford- Paz et al. (2019)	A community-developed school-based intervention primarily directed at ethnic minority girls living in underserved urban communities. The program was designed to provide group counseling sessions (50 min), delivered weekly during the school day, with groups of 10-12 students. Lessons included exploring aspects of identity, culture, and values, learning to label emotions and use coping skills to manage stress, and learning about aspects of healthy and unhealthy relationships, empathy, and communication skills. Each lesson contains psychoeducation, group activity, journaling, and a “committed action” assignment to allow for skill practice and generalization.	960 black and Latino girls from 21 public schools (77% of them in high school) in the Chicago metropolitan region , USA	Qualitative and quantitative data were collected from all the participants 960 and the projects's counselors, parents, and school staff over one academic year.	The results demonstrated the program's acceptability and noteworthy improvements for participants in targeted outcomes, including mental health, emotion regulation, and academic engagement. Findings also indicated several challenges to implementation feasibility and acceptability, including screening and enrollment processes and curriculum length.
Garcia et al. (2013)	School-based mental health promotion program designed to improve well-being in Latina adolescents. The project consisted of a 16-session facilitated curriculum, including sharing circles, mind-body exercises,	42 Latina youths from two public high-schools in a city in the Midwest, USA	A pilot randomized controlled trial compared outcomes over nine months postintervention of the program	Findings showed that the program might aid Latina girls in reducing their perceived stress and depressive symptoms and in building meaningful connections. The school-based nature of the program promises potential sustainability and
	and coping skills building or attention control.			continuity, and for some girls, it offers a primary reason to stay connected to school. The trial demonstrated findings in the expected direction, including reduced perceived stress and increased connectedness.
Lafromboise and Lewis (2008)	Community high-school suicide prevention program designed to provide intervention strategies consistent with cultural and community values and strengths in an Indian reservation. The interventions involved a skills-training approach to reduce the risk factors of substance and tobacco use among adolescents and a life skills development curriculum endorsed by the tribe to address essential risk factors associated with adolescent suicide (e.g., hopelessness, depression, anger). The intervention was offered three days a week in language arts classes during the first year of the intervention, followed by booster sessions on suicide prevention during the third year.	One high-school in an New Mexico's Indian reservation, USA	Qualitative analysis of the intervention, based on ethnographic research	The paper shows that interventions within tribal communities must include necessary protocols associated with cultural resources, indigenous values, and healing practices. The reliance on evidence-based practices to address tribal youth suicide needs may narrow family and community options and neglect valuable cultural resources found within tribal communities, particularly in those that still maintain a solid artistic and traditional base.
Mayberry (2013)	An intervention designed to disrupt the stigma LGBT youth often experience in high school settings through school clubs created to “support” LGBT youth and their allies (GSAs). Meetings provide members with an organizational environment in which they develop a sense of social support, community, and social identity.	4 support groups from public high-schools in a city in the Southeast, USA	Qualitative analysis of interviews with members that participate for at least nine month of the intervention	GSAs successfully empowered their members on a psychological level to "speak out" against antigay senti-ments and behaviors but are limited by the fear of parental and communi-ty resistance in their ability to devel-op into fully empowered organiza-tions or to strategically build substan-tive coalitions with community or-ganizations beyond school setting.
M cLeode et al. (2015)	School-based, peerfacilitated healthy relationships program focused on academically at-risk students. The five weekly 50-60 minutes sessions discussed relationship violence, ways to protect oneself and help friends, and decision-making, using multimodal strategies that included lectures, skits, activities, and self-assessments.	291 students from 3 public high-school in a city in the State of Virginia, USA	The paper evaluates findings from a secondary data analysis of records, gathered by prevention program staff, to assess its effectiveness of the program.	Findings showed that program participants made statistically significant improvements from pretest to posttest across demographics of race and gender. Results support the value of developing culturally responsive curricula and using peer-facilitated programming to address teenage dating violence in school-based healthy relationship programs.
Mevissen et al. (2018)	Theoryand evidence-based sexual prejudice reduction program that was co-developed with teachers. The program included a website and a teacher manual with a stepwise description of the exercises, such as a proposed timetable, and suggestions for homework assignments, to reduce the sexual stigma against students.	One public high-school in a city in the Netherlands	A qualitative study that aimed the feasibility of developing a sexual prejudice reduction program for schools	The multidisciplinary linkage group was vital to the development of the programThe input from the teachers was highly influential in shaping the final intervention into a program that would be feasible for them to implement, i.e., a program that is flexible in use, can be adjusted to suit different school contexts and class dynamics, and, importantly, is not too time-consuming.
Motes et al. (1999)	Integrated school-based mental health services model established in rural and under-served communities, based on implementing an ecological or systemsbased treatment approach for children, youth, and their families receiving clinical intervention within school-based programs. Different treatment options were available within the framework, such as	20 rural public schools in South Carolina State, USA	The paper evaluates findings and implications from the model, established for three years in the state, for service system reform.	The project was welcomed in school districts across the state. All community mental health centers continued involvement with the project throughout the three years and afterward. The school-based programs were perceived as an essential and integral part of the school community. In several project sites, fiscal support from school districts has been put in place to ensure the continuation.
Mulvane y-Day et al. (2006)	Intervention using community-based participatory research to improve the social and academic functioning of children from ethnic minority populations in a public school district. The group engaged in (1) developing strategies for the identified problems at a system school level; (2) developing an intervention to improve the functioning of school-based teacher-support teams (which are the first common point of entry for many minority children ); and (3) conducting several workshops with the multiple stakeholders participating in the project.	One high-school and twelve elementary public schools in as undisclosed city, USA	The study used qualitative methods in problem definition and intervention planning, including in-depth qualitative interviews and stakeholder dialogue groups in two schools	The project led to system interventions at both schools, clarity about the policy constraints to effective collaboration, and increased awareness regarding the behavioral and academic needs of minority children in the schools. The process produced a series of questions to use as a framework in community-based participatory research partnership development.
Murugap pan and Vanishree (2019)	A school-based model for mental health promotion among urban adolescents (SPEAR), emphasizing the need to focus on the individual and intuition. The program was developed in six days of meetings with students. Facts and critical points for discussion were presented through activities supplemented with fables, stories from epics, anecdotes, video clips, news snippets, and fact sheets. It included a facilitator manual and a student workbook.	95 students from one private high-school in Bangalore, India	Qualitative analysis based on participant observation of the intervention	One of the significant challen-ges in scaling up the interven-tion is clarity on one's position on whether adults would be more useful to adolescents as facilitators rather than didactic instructors. Identifying time, human resources, and financial support to offer sessions to teachers and students over three years of schooling would be other major challenges in the sustainability of such an intervention.
Thomas et al. (2008)	School-based intervention that focused on ethnic identity, collectivist orientation, racism awareness, and libratory youth activism in a group of African American adolescent girls. The intervention groups met 1.5 hours two times per week over ten weeks and included cultural	74 African American girls from one public high school in a city in the Midwest, USA	The paper presents a study with African American girls, 36 were in the intervention group and 38 in the control group, with, preand post-tests to assess	Overall findings reveal that the intervention had significant and positive effects on ethnic identity, racism awareness, collectivism, and liberatory youthactivism. Implications for risk prevention and promotion of psychosocial functioning among African American youth are discussed.
	values, African American history, and contemporary culture. Participants also engaged in group projects to facilitate collective responsibility and shared personal experiences.		intervention effects.
Varjas et al. (2005)	School-based mental health promotion intervention program that consisted of eighteen 90-minute after-school sessions conducted in a small-group format. A narrative, story-based approach was used to (1) provide students with both individual and group opportunities to define stressful and supportive relationships through the use of graphic depictions of themselves; (2) describe stressful situations and associated feelings, thoughts, and behaviors; and (3) develop and enact (role play) scenarios for coping with stressful situations.	1200 7° to 12° grade public school students in Kandy, Sri Lanka	Qualitative study based on ethnography of the intervention	The findings suggest an expanded definition of culture that reflects an integrated eticemic perspective, and illustrate how universally accepted concepts can incorporate the unique experiences and perspectives of specific cultural groups. The operational definition of culture is critical to the development of data collection instruments for identifying and assessing cultural factors across multiple settings, determining cultural influences on individuals and groups, and evaluating interventions for diverse populations.
Wright- Berryman et al. (2019)	School-based peer suicide prevention program (Hope Squad) with 8 to 10 students per grade, selected through a peer nomination process, trained to improve self-efficacy, knowledge, and skills in helping peers in distress access help more quickly, which can minimize the damage of the crisis. The members are mentored by adult advisers.	Almost 300 high and elementary schools in the State of Utah. USA	Quantitative analysis of suicide concern contact data from school counseling centers that were collected for five years	The descriptive data provide a general overview of the types and frequencies of Hope Squad concerns The highest rates of all suicide-related contacts were among girls and students in the eighth and ninth grades. Reported attempts peaked in the 9th and 10th grades, reducimg through the 12th grade

General results

Publication years ranged from 1999 to 2019, with the predominance of papers from the last decade (10 out of 15) showing a growing interest in the theme.

There were differences in the scale of interventions - some included hundreds of high schools (Bradshaw et al., 2012; McLeod et al., 2015; Wright-Berryman et al., 2019), others just one (Lafromboise & Lewis, 2008; McLeod et al., 2015; Mevissen et al., 2018; Mulvaney-Day et al., 2006; Murugappan & Vanishree., 2019; Thomas et al., 2008). The project aims, designs, target populations, and methodologies were also quite different.

There were eleven projects in the USA, three in the Indian subcontinent, and one in Europe. The majority of interventions developed in the USA (6 out of 11) exclusively focused on Afro-American, Latino, and Native-American youths (Alicea et al., 2012; Ford-Paz et al., 2019; Garcia et al., 2013; Lafromboise & Lewis, 2008; Mulvaney-Day et al., 2006; Thomas et al., 2008). The scarcity of studies from other continents is noteworthy. The concentration of articles in the USA and english-speaking countries reflects the inequality of scientific production, due, among other factors, to the use of english as a “universal” language in Science. The absence of articles on mental health describing school-based projects in Latin America is notable, especially considering that community health promotion is exceptionally valued in these countries.

Major theoretical references

The studies reviewed are often defined as “participatory research” or “community-based research”. “Ecological”, “systemic”, and “holistic” were the most common terms to define their approach. With different nuances, those approaches assume that each school is a single “community,” “system,” or “ecosystem”, and any intervention requires prior knowledge of its characteristics and involvement with school agents and actors in the project.

Although schools are understood as “communities” or “systems,” the individualizing bias occasionally remained in at least three of the analyzed projects. Mental distress was considered the result of supposed mental disorders in Garcia et al. (2013), as can be seen in their objective defined by to reduce depressive symptoms and perceived stress among girls and to increase healthy coping through individual improvement and social protection resources. The intervention proposed by Balaji et al. (2011) focused mainly on individual outcomes: more effective anger management; better communication skills, self-confidence, and public-speaking skills; reduced smoking; and greater comfort in discussing sexual health issues with friends. Better emotional regulation and academic involvement were the major mental health improvements among the participants in the project conducted by Ford-Paz et al. (2019). The use of validated instruments for measuring the effectiveness of projects - based on responses to individual questionnaires - may have contributed to a more individualized view of mental distress, both regarding psychiatric outcomes, such as the presence (or not) of disturbs, or psychological ones, such as the presence (or not) of social skills

The interventions aiming at the schools as “communities” in two papers did not discuss the broader social context that permeates schools and students. Bradshaw et al. (2012) described prevention strategies aiming at changes in the school environment, improving the school’s organizational climate, and creating systems and procedures for promoting positive changes in the team and, consequently, in the students’ behavior. Likewise, Mulvaney-Day et al. (2006) aimed to improve the school’s organizational climate and reduce the risk of problematic behavior among all the school’s students.

The limited possibility of reaching the “structural” sphere of oppression was a theme of reflection. Mayberry (2013) noted that support groups for LGBT students in schools did not evolve into organizations capable of influencing school policies or that were directly involved in political decision-making processes at school or the state level. The resistance from parents and the fear of conservative reactions among the school management and teachers restricted the development of affirmative actions in the community.

Perhaps the best example of engagement towards structural changes in response to processes causing mental distress in this review was the one described by Thomas et al. (2008). In a project focusing on combating racism, based on an emancipatory perspective, they aimed to encourage young women to engage in actions, such as doing voluntary work in the community and effecting social changes at school. In doing so, students could think about social justice and protest against discrimination by teachers. The emphasis on youth activism was associated with adopting Freire’s critical pedagogy as a theoretical-methodological basis for the project (Thomas et al., 2008).

Conceiving community and singular practices

Universal evidence-based interventions were considered as rarely transferable to the interventions’ environments (Varjas et al., 2005). Effective local adaptation of practices in mental health interventions required modifications to protocols involving a high level of participation, collaboration, and problem-solving to achieve successful implementation (Mulvaney-Day et al., 2006). One alternative was to test the effectiveness of promising interventions, modify them according to the community context, and disseminate them afterward (Ford-Paz et al., 2019).

Focusing on the context within which young people live was considered necessary in the analyzed projects since mental health and mental distress depend on their interaction with the social environment. Bradshaw et al. (2012) advocated the involvement of communities as researchers’ partners in their community-based participatory research. They recognized each collaborator’s unique role in the process, thus increasing the possibility of reaching positive results and sustainable changes.

As we pointed out before, the majority of projects developed in the USA focused on the social and ethnic identity of the minority groups - blacks, Latinos, and indigenous. The emphatic defense of the “cultural” specificity of these groups demanded projects different from the ones initially designed for white students, i.e., projects considered neutral or universal. Thomas et al. (2008) discussed how approaches with “universal” ambitions historically expressed middle-class white values and how these strategies and materials were not applicable or practical for young black people who accumulate other experiences.

Demographic shifts in the United States have driven efforts to revise school curricula. For example, McLeod et al. (2015) highlighted the changes they had made for their intervention to be culturally more sensitive after young people (especially young blacks and Latinos) had assessed the original curriculum as inappropriate to their reality. This demanded a process of recreation of the program’s scenarios, activities, and language.

Three culturally specific projects focused on minority girls considering that activities were more effective if the gender and race/ethnicity of the participants were simultaneously considered (Ford-Paz et al., 2019; Garcia et al., 2013; Thomas et al., 2008). In two other projects, interventions were drawn on sexual orientation and gender identity (Mayberry, 2013; Mevissen et al., 2018). These studies supported the need for specific attention to this population segment, which is often a target for bullying, as described in the extensive literature on this matter (Espelage et al., 2019).

On the other hand, projects on the Indian subcontinent discussed that programs considered effective express “Western universal” values. Varjas et al. (2005) highlighted that interventions within school psychology had little cultural specificity while emphasizing that considering local characteristics could increase interventions’ acceptability, validity, and sustainability. Balaji et al. (2011) highlighted the diversity of Indian regional contexts and the different modes of sociability among young people between cities and the countryside. Motes et al. (1999) also advocated specific strategies for urban or rural schools in the United States.

The articles reviewed here highlighted the importance of teams that included researchers who shared the exact ethnic/racial origin and expressed diverse gender and sexual identities. Two papers described that “native” languages were used in the intervention (Garcia et al., 2013; Lafromboise & Lewis, 2008).

Construction of the relationship with the school community and its challenges

Partnerships with school communities were established in unique ways. The projects also differed in the degree of community involvement in the construction and implementation of the interventions. Addressing the most pressing needs of educators and policymakers facilitated relationship-building with the school community (Bradshaw et al., 2012). Although short-term actions were necessary to solve minor and immediate demands from the school community, more significant or “systemic” problems required a prolonged approach. For Mulvaney-Day et al. (2006), “small victories” in limited issues are part of building partnerships with the school community.

At least in two projects, school-focused interventions expanded to improve schools’ relationships with external agents. Motes et al. emphasized that systemic change required school teams to communicate frequently with community representatives, such as the police, judiciary, and social services, to improve the connections between individual services and systemic changes, even when working with a single young person (Motes et al., 1999). This ecological approach also was thought to alter school system processes and involved various agents of change: young people, teachers, parents, classmates, and school staff. Alicea et al. (2012), whose project focused on young people’s adherence to mental health services, strongly emphasized the interventions needed to improve their interface with schools. Motes et al. 1999) cited one program was set up to meet the needs of young people and families of Hispanic migrant workers in the community where the school was located. Another program in a different neighborhood led to the formation of a club for African-American youth to voice their concerns and serve as a support organization. Finally, a third program involved joining a community task force that addressed the theme of violence in the community (Motes et al. 1999).

Unplanned demands that result from the intervention itself or situations relating to the social context were identified as significant challenges. However, such requests could not always be met due to limitations on the researchers’ time, financial resources, and human resources. For instance, the intervention project could become unexpectedly complex, requiring additional resources and extended timelines (Mulvaney-Day et al., 2006). In addition, the demand for addressing traumatic situations experienced by the students being followed through the project, as described by Ford-Paz et al. (2019), showed a similar challenge.

Garcia et al. (2013) and Lafromboise and Lewis (2008) described strategies for collective listening in the community context before designing the intervention. In the later one, they had a three-year involvement process with an indigenous community before the intervention project.

Including people from the community as active agents in the intervention process (“peers”) was an auxiliary strategy for disseminating the project across schools. In threee cases, it was the primary strategy (Mayberry, 2013; McLeod et al., 2015; Wright-Berryman et al., 2019). These papers describe that the peer students underwent some training and could count on supervision by the research team. The other students often indicated these peer students by their capacity to communicate and receive the others’ emotional problems. For this to happen, permission from the families was needed.

Although the experiences of participant adherence were generally positive, effective participation by people in the school community as part of the process was not achieved in at least two interventions. Mevissen et al. (2018) highlight teachers’ difficulty to co-produce a manual on sexual diversity, which they attribute to excessive activities. In addition, Balaji et al. (2011) report weak interaction between teachers and peer students, making it challenging to integrate the “emotional education” program into schools.

Challenges concerning local knowledge

Developing intervention proposals that are simultaneously “scientifically valid” - especially those that incorporate strategies that have already been studied through randomized controlled trials (RCT) - and that sustain a dialogue with the school community was considered a challenge. This tension may be caused by the emphasis in health-related research on using randomized clinical trials as the “gold standard,” strengthening the focus on individual risk factors rather than social or environmental factors (Israel et al., 1998, pp. 173-174). In response, there was partial incorporation of proposed intervention “packages,” especially models derived from cognitive-behavioral and sociocognitive approaches. Bradshaw et al. (2012), for example, used the principles of social, behavioral learning, and organizational behavior typical in individual policies. They extended them to the entire student body in the various schools where their intervention occurred.

On the other hand, three papers suggested that there were deeper links between local and traditional knowledge. In these cases, local knowledge gained the “status” of a theoretical as a co-basis of the project. The project of Thomas et al. (2008) used the “Nguzo Saba” principles to mitigate the consequences of racism among students. These principles of African culture contribute to constructing the notions of family, community, and culture among Afro-descendants as a means of working towards the ideal of communitarianism, as opposed to Western individualism. Murugappan and Vanishree (2019) actively included appreciation of the “swabhava” of the participants. This Indian concept refers to the intrinsic nature of each person to seek to value intuition and wisdom in understanding their mental health. The intervention carried out by Lafromboise and Lewis (2008) began with an open invocation from a Zuni leader, asking students to remember that the life given to them is their greatest gift, which is an essential element of the tradition of this indigenous group.

Thomas et al. (2008) incorporated Freire’s critical pedagogy to involve students in discussions about racism. As a result, the students reflected on concrete experiences and dialogued about their meaning and understanding. From this, their awareness of their sociopolitical environment could be broadened, thus enabling their engagement in activism for social change.

Conclusion

The findings from this scoping study underscore the significant importance of community-sensitive programs, which actively engage with local contexts and challenge conventional models of standardized intervention units. These programs reconceptualize mental health issues as socially constructed phenomena, emphasizing the relevance of community-sensitive interventions for promoting mental health within school settings.

The literature reviewed examines social determinants of mental health, with many papers highlighting the potential impacts of various forms of oppression, such as racism, class inequality, sexism, and homophobia. However, subsequent interventions often focused primarily on individual responses to these forms of oppression (such as skills development and empowerment) rather than addressing structural factors. Some initiatives sought to extend beyond the school environment to engage with broader social contexts.

The geographical distribution of projects, with a concentration in the USA and English-speaking countries, reflects the dominance of English as a “universal” scientific language, even in databases that include other languages. Within the USA, interventions primarily targeted minority segments of school communities, including Black, Latino, and LGBT+ populations, which is also related to the critics or universal models of interventions.

Several challenges were identified in establishing partnerships within school communities, responding to unforeseen demands, and securing project approval within prevailing research and intervention funding contexts prioritizing universal approaches. Some projects retained an individualized perspective on mental distress, potentially due to validation requirements from the scientific community, which often rely on individual questionnaire responses to measure project effectiveness.

The pressure to demonstrate healthcare effectiveness may have led some researchers to focus on individual risk factors, potentially hindering integration between academic and community knowledge within these projects. The absence of strategies linking academic and community knowledge poses a theoretical and methodological challenge, suggesting the need for a deeper examination of researchers’ roles in intervention projects.

In light of human rights-based approaches, overcoming the limitations of individualizing methods requires profound reflection on the role of researchers in intervention contexts, which includes moving beyond supporting individuals who embody differences shaped by social inequalities and instead incorporating inequality analysis and human rights discourse to inform community-sensitive understandings of mental health distress within schools.

Some interventions focused solely on building individual resilience to oppression without creating collective spaces for reflection and social action. However, addressing social change processes can mitigate mental distress by acknowledging its social production and collective dynamics, particularly in school environments.

Innovative theoretical and methodological intervention models are needed to address the social construction of mental distress, particularly within academic spaces. Understanding how youth human rights violations contribute to psychosocial suffering at the school and community levels is crucial for promoting the mental well-being of future generations.

• 1
  This paper is part of the project “Youth vulnerabilities to STIs/HIV and to dating violence: evaluating a human rights-based psychosocial intervention”, financed by the São Paulo Resarch Foundation - Fapesp [FAPESP # 2017_25950-2]

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Publication Dates

• Publication in this collection
  13 June 2025
• Date of issue
  2025

History

• Received
  17 Apr 2024
• Accepted
  03 Nov 2024