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

Abstract

ObjectiveThe aim of this review is to elucidate the characteristics of school-based mental health and psychosocial support (MHPSS) interventions in humanitarian contexts and the hypothesised mechanisms by which they influence well-being or learning outcomes.MethodsWe conducted a realist review and searched PubMed, Embase, Global Health, CINAHL, PsychInfo, PILOTS and grey literature through January 2022. Eligible studies included children age 6–12 years, were conducted in humanitarian contexts in low-income or middle-income countries, and focused on universal MPHSS prevention in an educational setting, using any study design. Data were extracted and analysed using narrative synthesis and realist analysis techniques to create ‘context–mechanism–outcome’ configurations that were iteratively developed to modify, refine and substantiate programme theories.ResultsTwenty-seven articles, representing 19 studies, were included in the review. We analysed data from 26 articles. Eleven evidenced-informed programme theories were developed at the levels of the child (n=4), teacher (n=3), caregiver (n=2), school environment (n=1) and school managers/administrators (n=1). At the child level, mechanisms related to strengthening coping skills, emotion regulation, interpersonal relationships led to improved psychosocial well-being or learning outcomes. At the teacher level, coping skills and the provision of support to students were linked to psychosocial well-being and learning outcomes. At the caregiver level, strengthening interpersonal bonds trigger improved psychosocial well-being, and at the school environment level, fostering feelings of security was linked to psychosocial well-being and learning outcomes. We did not find any evidence supporting the programme theory at the school managers/administrators level. We found limited evidence of positive impacts of the included interventions to support these programme theories.ConclusionsThese programme theories are a promising start towards ensuring school-based MHPSS interventions in humanitarian contexts better address the well-being and learning needs of children. Future research is needed to support these programme theories and enhance the evidence base.

Evaluating the implementation quality of a vocational education intervention for youth in Dadaab refugee camp in Kenya: Evidence of discrimination

“…Such conditions may have far-reaching adverse effects on the wellbeing of both teachers and students over time, and more so on the quality of teaching (Oh and van der Stouwe, 2008;Dryden-Peterson, 2015;Burde et al, 2017;DeJong et al, 2017). There is a need for more funding to support the in-service teacher training and development that should focus on increasing their capacity in terms of resilience, competency, and psychosocial support skills for their personal growth and that of their students (Taylor and Sidhu, 2012;Mendenhall et al, 2015;Soares et al, 2021;Lasater et al, 2022). Further, support for further education of resourceful refugee teachers to qualify as full-fledged teachers would offer secure and long-term solutions.…”

“…These efforts have been reinforced by conventions such as the 1989 Convention on the Right of the Child which emphasised protecting the rights of all children, including educational rights. Besides offering a return to familiar routines, especially for children and youth, education interventions in humanitarian contexts mitigate the psychosocial impact of violence and displacement (Bernhardt et al, 2014;Burde et al, 2017;Versmesse et al, 2017;Lasater et al, 2022).…”

“…The host country's education curriculum should be relevant and adaptable to all learners and have the capacity to respond to refugee learners' social, cultural, and linguistic formal and nonformal educational needs (Rutter, 2003;INEE, 2010;UNHCR, 2012;Cohen, 2020). Besides ensuring that classroom instruction and learning processes are both inclusive and student-centred, continuous training and developmental support should be accessible to both teaching and non-teaching staff (Crisp et al, 2001;Taylor and Sidhu, 2012;Lasater et al, 2022), in addition to embracing proper and suitable methods for assessing learning outcomes (INEE, 2010).…”

“…The United Nations High Commissioner for Refugees (UNHCR) reported that by the end of the year 2020, 82.4 million people were displaced around the globe, of which 32 per cent were refugees, and about 24 per cent were children under 18 years of age (UNHCR, 2021a). Prolonged wars, conflicts, and extreme violence are among the factors that have contributed to the adverse interruption of the educational and developmental processes of the school-age group of refugees (OECD, 2019;Kim et al, 2020;Lasater et al, 2022). Consequently, many have lost essential formal schooling during the conflicts (Milner and Loescher, 2011;Deane, 2016;Flemming, 2017), including lower literacy rates and widened gaps in knowledge across academic subjects (Birman and Tran, 2017).…”

“…Education interventions in humanitarian settings, on the one hand, are vital tools that protect learners from physical harm and provide opportunities for their cognitive, emotional, and social development. School attendance helps to restore a sense of normalcy and creates an environment for positive interactions amongst peers and with educators and creates opportunities for developing important life skills (Taylor and Sidhu, 2012;MacKinnon, 2014;Lasater et al, 2022). For over-age refugee youth, interventions accelerate their learning and building of skills and enable them to recover the lost school years (Shah, 2015;Deane, 2016;Birman and Tran, 2017;Flemming, 2017).…”