School-based MHPSS interventions in humanitarian contexts: a realist review

Area of Science:

• Public Health
• Psychology
• Education

Background:

• Humanitarian crises significantly disrupt children's well-being and education.
• School-based mental health and psychosocial support (MHPSS) interventions are crucial in these contexts.
• Understanding the mechanisms of MHPSS effectiveness is vital for optimizing interventions.

Purpose of the Study:

• To elucidate the characteristics of school-based MHPSS interventions in humanitarian settings.
• To identify the hypothesized mechanisms through which these interventions influence child well-being and learning outcomes.
• To develop evidence-informed programme theories for MHPSS in educational contexts.

Main Methods:

• A realist review methodology was employed, searching multiple databases and grey literature up to January 2022.
• Included studies focused on universal MHPSS prevention for children aged 6-12 in humanitarian, low- and middle-income country educational settings.
• Data analysis involved narrative synthesis and realist techniques to develop context-mechanism-outcome configurations.

Main Results:

• Eleven evidenced-informed programme theories were developed across child, teacher, caregiver, and school environment levels.
• Child-level mechanisms include enhanced coping skills, emotion regulation, and interpersonal relationships.
• Teacher support, caregiver bonds, and a secure school environment were linked to improved psychosocial well-being and learning outcomes.

Conclusions:

• Developed programme theories offer a promising framework for enhancing school-based MHPSS in humanitarian contexts.
• Further research is necessary to substantiate these theories and strengthen the evidence base for MHPSS interventions.
• Focusing on child, teacher, and caregiver levels, along with the school environment, is key to improving outcomes.