Analysis of real-world scale-up processes for school-based mental health interventions

The global rise in adolescent anxiety, depression, and suicidality has intensified calls for large-scale implementation of effective school-based interventions. This study examined determinants and strategies for scaling up school-based interventions targeting these mental health concerns. A mixed-methods approach was used, involving authors of published school-based mental health intervention trials. Of these, 45 authors completed a survey on scale-up decisions, intentions, and strategies. Determinants and strategies were further explored through 12 in-depth interviews. In our analysis of survey data, we identified interventions that were implemented on a small- or large-scale. In our analysis of interview data, we identified discontinued-, in the process of being scaled-up-, and scaled-up interventions. Half of the interventions surveyed reported intentions to scale up. Determinants for scale-up according to participants fell into three themes: (1) intervention characteristics (e.g., evidence base), (2) resources and support (e.g., availability of financial resources), and (3) school context (e.g., alignment with school curricula). The most relevant strategies for scaling up the included interventions were intervention registries for dissemination, adapting interventions to new settings, establishing organizational structures, and assessing/reducing costs. Our findings highlight strategies that potentially contribute to successfully scale-up of school-based mental health interventions. To enhance impact, we recommend applying such strategies – such as leveraging intervention registries and creating organizational support. More and more teenagers worldwide struggle with anxiety, depression, or suicidal thoughts. Schools can help by offering mental health programs, but these programs aren’t always available everywhere. This study looked at what it takes to successfully expand these programs to more schools. We asked researchers who had tested school mental health programs about their experiences. First, 45 researchers filled out a survey about their plans to expand (i.e., ‘scale’) their programs to other settings. Then, we interviewed 12 of them to learn what helps, or makes it harder, to scale these programs up. We found that for half of the programs, researchers planned to expand them and three things mattered most for success: 1) The program itself – it must work well and be easy to adapt; 2) Money and support – schools need funding and training; and, 3) School fit – the program should match the school’s needs and context. Helpful strategies for scaling up included: 1) adding the program to existing lists of proven interventions that schools and policy makers use when choosing interventions, 2) adapting the program for different school contexts, 3) having a team to help schools run the program; and, 4) keeping costs low. These findings are relevant to help reduce the number of teens with mental health problems. By looking at scaled-up programs, we were able to provide insight into what could help to expand effective programs across schools.