Summary of significant findings in studies.

<p>Italicized studies indicate those conducted in refugee and IDP camps.</p><p>CAPS: Clinical-Administered PTSD Scale; CBT: Cognitive Behaviour Therapy; CCPT: Child-Centered Play Therapy; IPT: Interpersonal therapy; KIDNET: Narrative Exposure Therapy adapted for children; NET: Narrative Exposure Therapy; PSSA: Psychosocial Structured Activities program; PTSD-RI: PTSD Reaction Index; RCMAS: Revised Children's Manifest Anxiety Scale; SDQ: Strengths and Difficulties Questionnaire; TF-CBT: Trauma-Focused Cognitive Behaviour Therapy; TGIC: Trauma Grief Inventory for Recovery; TSCC: Trauma Symptom Checklist for Children; TST: Trauma Systems Therapy.</p

Diagram to show the range of mental health interventions included in the selected studies.

<p>Diagram to show the range of mental health interventions included in the selected studies.</p

Flow Diagram to show the process of Study Selection.

<p>Flow Diagram to show the process of Study Selection.</p

Summary of included studies.

<p>*Sample size calculated excluding non-active controls; brackets indicate final number used in evaluation, if reported.</p><p>APAI: Acholi Psychosocial Assessment Instrument; BASC: Behaviour Assessment System for Children; BEI: Brief Ethnographic Interviewing; BHS: Beck Hopelessness Scale; CAFAS: Child and Adolescent Functional Assessment Scale; CAPS: Clinical-Administered PTSD Scale; CATS: Cultural Adjustment and Trauma Services; CBT: Cognitive Behaviour Therapy; CCPT: Child-Centered Play Therapy; CCT: Controlled Clinical Trial; CDI: Children's Depression Inventory; CEW: Creative Expression Workshops; CGAS: Child Global Assessment Scale; CIDI: Composite International Diagnostic Interview; CISM: Critical Incident Stress Management; CP: Creative Play as developed by War Child Holland; CPTSD-RI: Child Post Traumatic Stress Reaction Index; CSCS: Piers-Harris Children's Self-Concept Scale; DSRS: Depression Self-Rating Scale; DYSIPS: Diagnostic Symptom for Psychological Disorders; ESL: English as a Second Language; FACES: Family, Adult and Child Enhancement Services; HSCL: Hopkins Symptom Checklist-25;HTQ: Harvard Trauma Questionnaire; IDP: Internally displaced person; IES: Impact of Events Scale; IPT: Interpersonal therapy; KHS: Kazdin Hopelessness Scale; KIDNET: Narrative Exposure Therapy adapted for children; K-SADS: Kids Schedule for Affective Disorders and Schizophrenia; MINI: Mini International Neuropsychiatric Interview; NET: Narrative Exposure Therapy; PDS: Posttraumatic Diagnostic Scale; PRPS: Parent Report of Posttraumatic Symptoms; PSSA: Psychosocial Structured Activities Program; PTSD-RI: PTSD Reaction Index; PWA: Adolescent Post-War Adversities Scale-Somali Version; RCMAS: Revised Children's Manifest Anxiety Scale; RCT: Randomised Clinical Trial; R-IES: Revised Impact of Events Scale; RSET: Rosenberg Self-Esteem Scale; SEI: Self-Esteem Inventory; SDQ: Strengths and Difficulties Questionnaire; TF-CBT: Trauma-Focused Cognitive Behaviour Therapy; TGIC: Trauma Grief Inventory for Children; TRF: Achenbach's Teacher's Report Form; TSCC: Trauma Symptom Checklist for Children; TSCL: Trauma Symptom Checklist for Children; TST: Trauma Systems Therapy; UPID: UCLA PTSD Index for DSM-IV;WTQ: VWAES: Violence, War and Abduction Exposure Scale; War Trauma Questionnaire; WTSS: War Trauma Screening Scale.</p

Relationship between negative cognitive style and the risk of a person with RAP developing depression/ anxiety.

<p>Relationship between negative cognitive style and the risk of a person with RAP developing depression/ anxiety.</p

The cognitive style groups (high versus low) and the <i>relative risk</i> of depression/ anxiety in those with RAP.

<p>The cognitive style groups (high versus low) and the <i>relative risk</i> of depression/ anxiety in those with RAP.</p

Odds ratios for recurrent abdominal pain (RAP) at 3, 4, 7 & 9 years as a predictor of depression &/ anxiety at 18.

<p>Odds ratios for recurrent abdominal pain (RAP) at 3, 4, 7 & 9 years as a predictor of depression &/ anxiety at 18.</p

Graph depicting that a negative cognitive style amplifies the potential for emotional distress disorders in early adulthood after childhood RAP.

<p>Graph depicting that a negative cognitive style amplifies the potential for emotional distress disorders in early adulthood after childhood RAP.</p

The percentage (and odds ratios) of participants who go on to become clinically depressed/ anxious with each increased time point of RAP.

<p>The percentage (and odds ratios) of participants who go on to become clinically depressed/ anxious with each increased time point of RAP.</p

Empowering school staff to support pupil mental health through a brief, interactive web-based training program: mixed methods study

Background: Schools in the United Kingdom and elsewhere are expected to protect and promote pupil mental health. However, many school staff members do not feel confident in identifying and responding to pupil mental health difficulties and report wanting additional training in this area. Objective: We aimed to explore the feasibility of Kognito’s At-Risk for Elementary School Educators, a brief, interactive web-based training program that uses a simulation-based approach to improve school staff’s knowledge and skills in supporting pupil mental health. Methods: We conducted a mixed methods, nonrandomized feasibility study of At-Risk for Elementary School Educators in 6 UK primary schools. Our outcomes were (1) school staff’s self-efficacy and preparedness to identify and respond to pupil mental health difficulties, (2) school staff’s identification of mental health difficulties and increased risk of mental health difficulties, (3) mental health support for identified pupils (including conversations about concerns, documentation of concerns, in-class and in-school support, and referral and access to specialist mental health services), and (4) the acceptability and practicality of the training. We assessed these outcomes using a series of questionnaires completed at baseline (T1), 1 week after the training (T2), and 3 months after the training (T3), as well as semistructured qualitative interviews. Following guidance for feasibility studies, we assessed quantitative outcomes across time points by comparing medians and IQRs and analyzed qualitative data using reflexive thematic analysis. Results: A total of 108 teachers and teaching assistants (TAs) completed T1 questionnaires, 89 (82.4%) completed T2 questionnaires, and 70 (64.8%) completed T3 questionnaires; 54 (50%) completed all 3. Eight school staff members, including teachers, TAs, mental health leads, and senior leaders, participated in the interviews. School staff reported greater confidence and preparedness in identifying and responding to mental health difficulties after completing the training. The proportion of pupils whom they identified as having mental health difficulties or increased risk declined slightly over time (medianT1=10%; medianT2=10%; medianT3=7.4%), but findings suggested a slight increase in accuracy compared with a validated screening measure (the Strengths and Difficulties Questionnaire). In-school mental health support outcomes for identified pupils improved after the training, with increases in formal documentation and communication of concerns as well as provision of in-class and in-school support. Referrals and access to external mental health services remained constant. The qualitative findings indicated that school staff perceived the training as useful, practical, and acceptable. Conclusions: The findings suggest that brief, interactive web-based training programs such as At-Risk for Elementary School Educators are a feasible means to improve the identification of and response to mental health difficulties in UK primary schools. Such training may help address the high prevalence of mental health difficulties in this age group by helping facilitate access to care and support.</p