Volume 12, Number 1, April 2020 pp 65 - 82

www.um.edu.mt/ijee

Mental health promotion in schools: A comprehensive theoretical

framework
1

Valeria Cavioni , Ilaria Grazzani and Veronica Ornaghi

University of Milano-Bicocca, Milan, Italy

Recent decades have seen a rise in mental health problems among children and
adolescents. Despite a proliferation of studies describing effective school-based mental
health programs, reviews of current research in this field suggest a strong lack of
consensus concerning the definition of school mental health and its constructs. In the
present paper, we set out to fill this gap via a two-step process: first, we offer a critical
overview of recent research around the concept of school mental health; second, we
propose a comprehensive theoretical framework for researchers, practitioners, and
policy-makers involved in mental health promotion and school prevention programs. The
proposed framework comprises three key domains: the first two, cover the promotion of
social and emotional learning and resilience, while the third concerns the prevention of
behavioural problems.
Keywords: school mental health; social and emotional learning; resilience; social,
emotional, and behavioural problems, theoretical framework

First submission 30th December 2019; Accepted for publication 31st March 2020.

Introduction
Background
Mental health is defined as a “state of well-being in which every individual realizes his or her own potential,
copes with the normal stresses of life, works productively and fruitfully, and is able to make a contribution to
her or his community” (WHO, 2005, p.12). It is viewed as a dimension of overall health that spans a continuum
from high-level wellness to severe illness (WHO, 2013). The promotion of mental health consists of any action
taken to create living conditions and environments that support mental wellness and allow individuals,

1
Corresponding author. Email address: valeria.cavioni@unimib.it

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families, groups or communities to adopt and maintain healthy lifestyles fostering optimal emotional
functioning and social inclusion (O’Reilly et al., 2018).
Over the past twenty years, mental health difficulties among children and adolescents have been on
the increase worldwide, becoming a leading cause of disability (WHO, 2003). The incidence of diagnosable
mental, emotional, or behavioural disorders is now estimated at between 10% and 20% among school children
(Erskine et al., 2015; Ford et al., 2003; Gore et al., 2011; WHO, 2015). Mental health difficulties can manifest
as either externalizing or internalizing problems (Boylan et al., 2012; Stone et al., 2015). The most common
externalizing problems, from preschool age onwards, include disruptive behaviour issues, attention deficit
hyperactivity disorders (ADHD), oppositional defiant disorders, and conduct disorders (Tremblay et al., 2004).
The predominant internalizing disorders include depression, anxiety, panic disorder, mood disorders, social
phobia, specific phobias, and obsessive-compulsive disorder (Baranne & Falissard, 2018; Ogundele, 2018).
Data collected over the last decade indicate that self-harm, suicidal attempts, eating disorders, depression, and
addictive disorders are growing problems among young people (Burstein et al., 2019; Keyes et al., 2019;
Twenge, 2020; Twenge et al., 2018). Depression is the third leading cause of death among adolescents in the
USA and Europe (WHO, 2018).
Mental health difficulties have a significant adverse impact on different aspects of children’s and
young people’s development, contributing to poor school adjustment, reduced concentration, and problems in
achievement and social relationships (Cavioni & Zanetti, 2015; Cefai et al., 2014; Cullinan & Sabornie, 2004;
Macklem, 2011; Ornaghi et al., 2016; Tempelaar et al., 2014; Thorlacius & Gudmundsson, 2019). Mental
health issues are also associated with poor school attendance, suspension, and early school dropout (DeSocio
& Hootman, 2004).
Given these alarming statistics, for three decades now, the mental health of children and adolescents
has been assigned priority status within the global child health agenda (Palfrey et al., 2005; Patton et al., 2012).
As early as 1986, in the Ottawa Charter for Health Promotion, the WHO (1986) identified children’s and
adolescents’ mental health as a key area of public concern, towards which policy-makers needed to target their
actions. Based on this, subsequent WHO policy documents (e.g., 1996; 2001; 2003; 2005) flagged the key role
of the education sector in addressing children’s and young people’s mental health needs. WHO recommends
that schools function as one of the primary mental health support systems for students, enabling the planning
and implementation of a broad spectrum of mental health actions that encompass promotion, prevention,
intervention, and rehabilitation (WHO, 2000; 2005; 2007). In 1995, the WHO's Global School Health Initiative
(WHO, 2000) emphasized the importance of focusing on and enhancing the psychosocial environment in
schools with a view to fostering emotional and social well-being.
The following sections review the recent research on the promotion of mental health in schools,
formulating an innovative school mental health framework that is intended to offer a comprehensive and
conceptually broad guide to researchers, practitioners, and policy-makers involved in planning and evaluating
sustainable school mental health programs for students and teachers.

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School mental health: terms and approaches
Although the concept of school mental health dates back to the early 1900s, as reflected in the publication of
the first recorded scientific paper on the topic, entitled “Mental Health of School Children” (Anonymous,
1906), efforts to define mental health in schools continue to be hampered by a lack of precise terminology and
the absence of universal agreement on the meaning of school mental health.
One explanation for this phenomenon is that a number of related terms – such as “social and emotional
learning”, “social and emotional education”, “moral education”, “life skills”, “emotional literacy”, “emotional
intelligence”, or “character education” – are used alternatively to “mental health” in educational contexts
(Cavioni et al., 2017; Cefai et al., 2018b; Cefai & Cavioni, 2014; Elias et al., 2008; O’Reilly et al., 2018;
Weare, 2004; 2010; Weare & Nind, 2011). This makes it all the more important to define what is specifically
understood by school mental health. The Wisconsin Department of Public Instruction has proposed that mental
health in school includes “practices to address the continuum from high-level emotional wellbeing to
significant student mental health challenges. School mental health addresses all aspects of social-emotional
development of school-age children including wellness, mental illness, substance abuse, and effects of adverse
childhood experiences” (2015, p.3). Similarly, for Cefai and Cooper (2017), mental health promotion in
schools “is related to positive mental health and reduced internalized and externalized conditions, such as
anxiety, depression, substance use, violence, and antisocial behaviour” (p. 3).
Another reason for the lack of shared terminology is that researchers have tended both to emphasize
the multi-dimensional nature of school mental health, which encompasses a range of approaches and
developmental contexts, and to adopt a holistic view of schools themselves (Weare, 2004). For example, the
so-called “whole-school approach” acknowledges that all aspects of the school community have an impact on
students’ mental health and recognizes the importance of engaging the collaboration of students, families,
school staff, community, and stakeholders (Graetz et al., 2012; Weist, & Murray; 2008).

The need for a comprehensive framework

Missing, however, is a comprehensive theoretical framework that clearly delineates the concept of school
mental health, while addressing the following two key aspects. First, research in the field has identified two
complementary lines of intervention in school-based mental health initiatives: programs aimed at enhancing
mental health and well-being by fostering social and emotional competencies and resilience skills, and schemes
targeting the prevention and relief of mental health difficulties, behavioural issues, and at-risk behaviours
(Weare, 2010). Although systematic reviews of intervention suggest that, for maximum efficacy, programs
need both to support universal mental health promotion and to address social, emotional, and behavioural
problems (Cefai & Cooper, 2017; Weare & Nind, 2011), a comprehensive framework that outlines in detail
the specific competences and behaviours targeted by school mental health interventions is still needed.
Secondly, existing definitions of school mental health tend to mainly focus on students’ mental health
without recognizing the importance of also sustaining the well-being of teachers. Indeed, teachers’ own

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emotional health needs are neglected or inadequately addressed by the majority of mental health programs
(Shelemy, Harvey, & Waite, 2019). Hence, a further aim of the present framework is to specifically include
teacher mental health as a key component of a whole-school approach to mental health promotion.

Overview of the theoretical framework

Effective school mental health programs mainly target the promotion of social and emotional learning (SEL)
and resilience as well as the prevention of social, emotional, and behavioural difficulties, including risk
behaviours (Browne et al., 2004; Cefai et al., 2018a; O’Reilly et al., 2018; Weare, 2010). Therefore, the
proposed framework, which is based on existing research on mental health promotion and prevention,
represents school mental health as encompassing three major domains. The first two concern the promotion of
protective factors in mental health, specifically, social and emotional learning (SEL) and resilience, while the
third is the prevention of social, emotional, and behavioural problems.
Figure 1 provides a graphic summary of the theoretical framework, representing the three domains of
school mental health, the associated developmental settings (family and community), and the overarching role
of policy-making. In the next sections of the paper, we more fully describe the framework by discussing the
three major domains in relation to mental health outcomes and the different developmental systems. For each
of the domains, we also summarize the main theoretical constructs reviewed, together with a list of key target
skills and behaviours for both students and teachers (Table I, Appendix).

Figure 1. School Mental Health Theoretical Framework

(Cavioni, Ornaghi, & Grazzani)

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Promotion of social and emotional learning
Numerous large-scale reviews and meta-analyses on the impact of SEL programs carried out in United States
and in Europe and mainly delivered by trained teachers in partnership with mental health professionals
(Franklin et al., 2012) have pointed up the twofold benefits of intervention: students participating in such
programs display enhanced social and emotional competencies (e.g., social skills, positive attitudes towards
self and others, positive social behaviours) and reduced internalizing and externalizing problems compared to
control groups of peers (Cefai et al., 2018a; Corcoran et al., 2018; Durlak et al., 2011; Payton et al., 2008; Zins
& Elias, 2007).
More specifically, research has documented a significant positive impact of SEL programs on
students’ behaviour from kindergarten up to high school including improved social-emotional competences
across the five SEL competencies (CASEL, 2013), enhanced self-esteem and connection to school, better
classroom behaviour, improved academic motivation and performance, as well reduced conduct problems,
bullying and aggression and less emotional distress such as stress, anxiety and depression, (Catalano et al.,
2002; Conley et al., 2015; Durlak & Wells, 1997; Sklad et al., 2012; Taylor et al., 2017; Tobler et al., 2000;
Wiglesworth et al., 2016; Ura et al., 2019).
While the impact of SEL programs on students has been well documented (Weare, 2004; 2010; Weare
& Nind; 2011), little attention has been paid to the impact of SEL on enhancing teachers’ social and emotional
skills. Research by Jennings & Greenberg (2009), who applied the CASEL competencies model (Durlak et al.,
2015), suggested that socially and emotionally competent teachers are better at understanding and managing
their own and others’ emotions, display stronger relationship-building capability, and report higher self-
efficacy in teaching. These competencies are in turn positively associated with greater work satisfaction and
reduced stress and burnout (Jennings et al., 2017; Jennings & Greenberg; 2009).

Promotion of resilience
Research has identified resilience as a complex construct resulting from a dynamic relationship between risk
and protection factors (Benard, 2004; Luthar & Cicchetti, 2000; Ungar, 2012; 2018). Studies conducted in
educational contexts have been focused on how personal and social protective factors can help the mental
health of both students and teachers (Cowen et al., 1997). Among such factors, resilience is a key protective
capacity that contributes to maintaining positive mental health and preventing and mitigating mental health
problems during childhood and adolescence (Dray et al., 2015; Kessler et al., 2008). Children with higher
levels of resilience are less prone to mental health problems such as depression and anxiety disorders (Hjemdal
et al., 2007; Hjemdal et al., 2011).
Studies on the effectiveness of resilience-enhancing school-based programs and interventions have
reported various positive outcomes in children and young people such as improved resilience outcomes, stress
management, coping skills, social and emotional competence and learning interest and decreased anxiety,

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depression and risk-taking behaviour (Cefai et al., 2018b; Fenwick-Smith et al., 2018; Meschke & Patterson,
2003; Twum-Antwi et al., 2019, Ungar, 2018).
Only in recent years have researchers investigated teachers’ resilience with a view to identifying the
factors that enable them to achieve school goals and maintain well-being, despite environmental stressors and
recurring challenges and setbacks at work (Brunetti, 2006; Patterson et al., 2004). This has led to the
identification of a range of individual characteristics (such as self-efficacy, strong intrinsic motivation to teach,
and coping strategies) and contextual protective factors (including receiving support from colleagues and
school administrative staff) that help teachers to deal with challenging situations and successfully maintain job
satisfaction and commitment to their profession (Beltman et al., 2011; Cefai & Cavioni, 2014).

Prevention of behavioural, emotional, and social problems

Social, emotional, and behavioural difficulties comprise a broad spectrum of behaviours that school children
can develop to varying degrees, and that may be either internalizing (directed at the self), or externalizing
(directed at the external environment) (Achenbach et al., 2017; Cooper, 2017). In schools, interventions to
prevent behavioural, emotional, and social problems usually target such conditions as depression, anxiety,
social withdrawal, substance use, self-harm, rule-breaking, delinquency and aggressive behaviour (Anderson
et al., 2018; Cooper & Jacobs, 2011).
Interventions may be implemented at the universal level, that is to say, with all students, or at the
targeted level, with students at particular risk of developing, or already manifesting, mild mental health
difficulties (Weare, 2010). Recent studies suggest that universal preventive programs are perceived as less
stigmatizing (Fisak et al., 2011). Furthermore, similar effect sizes have been observed for both universal and
targeted prevention programs, indicating that there is a need for both universal preventive interventions
complemented with targeted interventions (Ahlen et al., 2015; Waldron et al., 2018; Weare & Nind, 2011). In
particular, systematic reviews of universal programs in children and adolescents demonstrated significant
reductions in internalizing mental health problems such as stress, anxiety and depression symptoms (Feiss et
al., 2019; Lowry-Webster et al., 2001; Lowry-Webster et al., 2003; Waddell et al., 2007). Similarity, studies
on the effectiveness of prevention programs for externalizing problems documented significant reductions in
targeted behavioural issues, with effects lasting through one-year follow-up (Durlak & Wells, 1997; Greenberg
et al., 2001; Waddell et al., 2007; Wilson, et al., 2003).
Despite the increasing number of preventive programs for students, few intervention studies have
specifically targeted teachers’ mental health difficulties. Most of those that did were designed to reduce stress
and risk of burnout by introducing cognitive-behavioural techniques or relaxation strategies. For instance,
Leung and colleagues (2011) found that a brief cognitive-behavioural training program significantly relieved
stress and strain amongst the participating teachers. In another more recent study, lower anxiety and stress and
increased overall mental well-being were observed in a group of teachers who practiced yoga, as compared to
a control group (Telles et al., 2018).

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Developmental systems: family, community, policy
This framework acknowledges the importance of collaboration between the developmental systems
(Bronfenbrenner, 1979) – namely family and community – that play an active role in fostering school mental
health It also emphasizes the need for strong cooperation with a wide range of policy-makers to guarantee the
sustainability of mental health promotion in schools. Research has documented the limited effects of
intervention at follow-up when no provision is made for long-term sustainability after initial investment and
rollout (Askell-Williams, 2017; Askell-Williams et al., 2013). Sustainability over the longer term is best
accomplished via strategic collaboration with policy-makers to upscale mental health programs to wider
contexts. Programs need to be linked to existing mental health education policy and supported by local,
national, or international policymakers to have the best likelihood of producing lasting results.

Conclusion
The aims of this paper were to examine the existing research on school mental health with a view to
contributing to conceptual understanding of this construct, and to present a comprehensive theoretical
framework for mental health promotion in schools that takes the needs of both students and teachers into
account. The proposed framework, which is evidence-informed and comprises three key domains, is based on
the existing literature on mental health promotion and prevention among school children and teachers referring
to the literature on social and emotional learning, resilience and prevention of social, emotional and behaviour
difficulties (e.g., Adelman & Taylor, 2000; Cefai et al., 2018a; Cooper, 2017; Durlak et al., 2015; O’Reilly et
al. 2018; Taylor et al., 2017; Ungar, 2012; Weare & Nind, 2011), It identified a set of key skills and behaviours
that need to be targeted, for both students and teachers in mental health promotion in school. The framework
also advocates for the promotion of teacher wellbeing as a vital component of effective school mental health
strategies (Cavioni et al., 2018; Cefai et al., 2015).
Finally, the authors make the case that school mental health programs should involve the family and
community as well as policymakers, with a view to building a comprehensive care system in which mental
health promotion and prevention strategies are integrated with one another and delivered as a key component
of the school curriculum (Cefai et al., 2018a). In many instances, schools have largely been invited to
participate in fragmented programs, without being offered an adequate grounding in how these programs might
be incorporated into overall school organization (Adelman & Taylor, 2000).
The framework presented here has been devised to encourage researchers, practitioners, and policy-
makers to design evaluate comprehensive school mental health programs that simultaneously promote both
SEL and resilience, as well as targeting the prevention of behavioural issues in both students and teachers,
within a whole school approach to mental health promotion.

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References
Achenbach, T. M., Ivanova, M. Y., & Rescorla, L. A. (2017). Empirically based assessment and taxonomy
of psychopathology for ages 1½ - 90+ years: Developmental, multi-informant, and multicultural
findings. Comprehensive Psychiatry, 79, 4-18. https://doi.org/10.1016/j.comppsych.2017.03.006
Adelman, H. S., & Taylor, L. (2000). Shaping the future of mental health in schools. Psychology in the
Schools, 37(1), 49-60. https://doi.org/10.1002/(SICI)1520-6807(200001)37:1<49::AID-
PITS6>3.0.CO;2-0
Ahlen, J., Lenhard, F., & Ghaderi, A. (2015). Universal prevention for anxiety and depressive symptoms in
Children: A meta-analysis of randomized and cluster-randomized trials. The Journal of Primary
Prevention, 36(6), 887-403. https://doi.org/10.1007/s10935-015-0405-4
Anderson, J. K., Ford, T., Soneson, E., Thompson Coon, J., Humphrey, A., Rogers, M., . . . Howarth, E.
(2018). A systematic review of effectiveness and cost-effectiveness of school-based identification of
children and young people at risk of, or currently experiencing mental health difficulties.
Psychological Medicine, 49(1), 9-19.
Anonymous. (1906). Mental health of school children. Journal of the American Medical Association,
XLVII(1), 39-40.
Askell-Williams, H. (2017). Perspectives from teachers and school leaders about long-term sustainability. In
C. Cefai, & P. Cooper (Eds.), Perspectives, Mental Health Promotion in Schools. Cross-Cultural
Narratives and Perspectives (pp. 141-155). Sense Publishers.
Askell-Williams, H., Slee, P. T., & Van Deur, P. (2013). Social and emotional wellbeing programs: The
nexus between sustainability and quality assurance. The Psychology of Education Review, 37(2), 48-
56.
Baranne, M. L., & Falissard, B. (2018). Global burden of mental disorders among children aged 5-14 years.
Child and adolescent psychiatry and mental health, 12(19), https://doi.org/10.1186/s13034-018-
0225-4
Beltman, S., Mansfield, C., & Price, A. (2011). Thriving not just surviving: A review of research on teacher
resilience. Educational Research Review, 6(3), 185-207.
https://doi.org/10.1016/j.edurev.2011.09.001
Benard, B. (2004). Resiliency: What have we learned? WestEd.
Boylan, K., Vaillancourt, T., & Szatmari, P. (2012). Linking oppositional behaviour trajectories to the
development of depressive symptoms in childhood. Child Psychiatry & Human Development, 43(3),
484-497. https://doi.org/10.1007/s10578-011-0277-7
Bronfenbrenner, U. (1979). The ecology of human development. Experiments by nature and design. Harvard
University Press.

ISSN: 2073 7629

© 2020 CRES Volume 12, Number 1, April 2020 pp 72
Browne, G., Gafni, A., Roberts, J., Byrne, C., & Majumdar, B. (2004). Effective/efficient mental health
programs for school-age children: a synthesis of reviews. Social Science & Medicine, 58(7), 1367-
1384. http://dx.doi.org/10.1016/S0277-9536(03)00332-0
Brunetti, G. J. (2006). Resilience under fire: Perspectives on the work of experienced, inner city high school
teachers in the United States. Teaching and Teacher Education, 22(7), 812–825.
https://doi.org/10.1016/j.tate.2006.04.027
Burstein, B., Agostino, H., & Greenfield, B. (2019). Suicidal attempts and ideation among children and
adolescents in US emergency departments, 2007-2015. JAMA Pediatrics, 173(6), 598-600.
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2730063
CASEL - Collaborative for Academic, Social, and Emotional Learning (2013). 2013 CASEL Guide. Effective
social and emotional learning programs. Preschool and elementary school edition. CASEL.
Catalano, R. F., Berglund, M. L., Ryan, J. A., Lonczak, H. S., & Hawkins, J. D. (2002). Positive youth
development in the United States: Research findings on evaluations of positive youth development
programs. Prevention & Treatment, 5(1), Article ID 15. https://doi.org/10.1037/1522-3736.5.1.515°
Cavioni, V., Grazzani, I., & Ornaghi, V. (2017). Social and emotional learning for children with Learning
Disability: Implications for inclusion. International Journal of Emotional Education, 9(2), 100-109.
Cavioni, V. & Zanetti, M.A. (2015). Social-emotional learning and students' transition from kindergarten to
primary school in Italy. In H. Askell-Williams (Ed.), Transforming the Future of Learning with
Educational Research (pp. 241-258). IGI Global.
Cavioni, V., Zanetti, M. A., Beddia, G., & Lupica Spagnolo, M. (2018). Promoting resilience: A European
curriculum for students, teachers and families. In M. Wosnitza, F. Peixoto, S. Beltman, & C. F.
Mansfield (Eds.), Resilience in Education. Concepts, Contexts and Connections (pp. 313-332).
Springer.
Cefai, C. (2008). Promoting resilience in the classroom. A guide to developing pupils’ emotional and
cognitive skills. Jessica Kingsley Publishers.
Cefai, C., Arlove, A., Duca, M., Galea, N., Muscat, M., & Cavioni, V. (2018a). RESCUR Surfing the
Waves: an evaluation of a resilience programme in the early years. Pastoral Care in Education,
36(3), 189-204. https://doi.org/10.1080/02643944.2018.1479224
Cefai, C., Bartolo, P. A., Cavioni, V., & Downes, P. (2018b). Strengthening social and emotional education
as a core curricular area across the EU. A review of the international evidence. NESET II report.
Publications Office of the European Union.
Cefai, C., & Cavioni, V. (2014). Social and emotional education in primary school. Integrating Theory and
Research into Practice. Springer.
Cefai, C., & Cooper, P. (2017). Mental health promotion in schools. Cross-cultural narratives and
perspectives. Sense Publishers.

ISSN: 2073 7629

© 2020 CRES Volume 12, Number 1, April 2020 pp 73
Cefai, C., Cavioni, V., Bartolo, B., Simoes, C., Ridicki Miljevic, R., Bouillet, D., . . . Eriksson, C. (2015).
Social inclusion and social justice: resilience curriculum for early years and elementary schools in
Europe. Journal of Multicultural Education, 9(3), 122-139.
Cefai, C., Clouder, C., Antognazza, D., Cavioni, Cavioni, V., Heys, B., . . . Solborg, C. (2014). From Pisa to
Santander: A statement on children’s growth and wellbeing. The International Journal of Emotional
Education, 6(2), 86-89.
Conley, C. S., Durlak, J. A., & Kirsch, A. C. (2015). Meta-analysis of universal mental health prevention
programs for higher education students. Prevention Science, 587–507.
https://doi.org/10.1007/s11121-015-0543-1
Cooper, P. (1999). Understanding and supporting children with emotional and Behavioural Difficulties.
Jessica Kingsley Publishers.
Cooper, P. (2017). Evidence based approaches to mental health issues in schools. Effective strategies for the
classroom practitioner. In C. Cefai & P. Cooper (Eds.), Mental Health Promotion in Schools. Cross-
Cultural Narratives and Perspectives (pp. 11-21). Sense Publishers.
Cooper, P. & Jacobs, B. (2011). From Inclusion to Engagement: Helping Students Engage with Schooling
through Policy and Practice. John Wiley.
Corcoran, R. P., Cheung, A. C., Kim, E., & Xie, C. (2018). Effective universal school-based social and
emotional learning programs for improving academic achievement: A systematic review and meta-
analysis of 50 years of research. Educational Research Review, 25, 56-72:
https://doi.org/10.1016/j.edurev.2017.12.001
Cowen, E. L., Wyman, P. A., Work, W. C., Kim, J. Y., Fagen, D. B., & Magnus, K. B. (1997). Follow-up
study of young stress affected & stress-resilient urban children. Development and Psychopathology,
9(3), 564-577.
Cullinan, D., & Sabornie, E. J. (2004). Characteristics of emotional disturbance in middle and high school
students. Journal of Emotional and Behavioral Disorders, 12(3), 157-167.
https://doi.org/10.1177/10634266040120030301
DeSocio, J., & Hootman, J. (2004). Children's mental health and school success. The Journal of School
Nursing, 20(4), 189-196. https://doi.org/10.1177/10598405040200040201
Dray, J., Bowman, J., Wolfenden, L., Campbell, E., & Freund, M. (2015). Systematic review of universal
resilience interventions targeting child and adolescent mental health in the school setting: review
protocol. Systematic Reviews, 4(186).
Durlak, J. A., & Wells, A. M. (1997). Primary prevention mental health programs for children and
adolescents: a meta-analytic review. American Journal of Community Psychology, 25(2), 115-152.
https://doi.org/10.1023/A:1024654026646
Durlak, J. A., Domitrovich, C. E., Weissberg, R. P., & Gullotta, T. P. (2015). Handbook of Social and
Emotional Learning. Research and Practice. The Guilford Press.

ISSN: 2073 7629

© 2020 CRES Volume 12, Number 1, April 2020 pp 74
Durlak, J. A., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. (2011). The Impact of Enhancing
Students' Social and Emotional Learning: A Meta-Analysis of School-Based Universal
Interventions. Child Development, 82(1), 405-432. https://doi.org/10.1111/j.1467-
8624.2010.01564.x
Elias, M. J., Parker, S. J., & Kash, V. M. (2008). Social and emotional learning, moral education, and
character education: A comparative analysis and a view toward convergence. In L. Nucci, & D.
Narvaez (Eds.), Handbook of Moral and Character Education (pp. 248-266). Routledge.
Elias, M. J., Zins, J. E., Weissberg, R. P., Frey, K. S., Greenberg, M. T., & Haynes, N. M. (1997). Promoting
social and emotional learning: Guidelines for educators. ASCD.
Erskine, H., Moffitt, T., Copeland, W., Costello, E., Ferrari, A., Patton, G., . . . Scott, G. (2015). A heavy
burden on young minds: The global burden of mental and substance use disorders in children and
youth. Psychological Medicine, 45(7), 1551-1563. https://doi.org/10.1017/S0033291714002888
Feiss, R., Dolinger, S.B., Merritt, M., Reiche, E., Martin, K., Yanes, J. A., Thomas, C. M., & Pangelinan,
M. (2019). Systematic Review and Meta-Analysis of School-Based Stress, Anxiety, and Depression
Prevention Programs for Adolescents. Journal of Youth and Adolescence, 48(9), 1668–1685.
https://doi.org/10.1007/s10964-019-01085-0
Fenwick-Smith, A., Dahlberg, E. E., & Thompson; S. C. (2018). Systematic review of resilience-enhancing,
universal, primary school-based mental health promotion programs. BMC Psychology, 6(1).
https://doi.org/10.1186/s40359-018-0242-3
Fisak, B. J., Richard, D., & Mann, A. (2011). The prevention of child and adolescent anxiety: A meta-
analytic review. Prevention Science, 12(3), 255–268. https://doi.org/10.1007/s11121-011-0210-0
Ford, T., Goodman, R., & Meltzer, H. (2003). The British child and adolescent mental health survey 1999:
The prevalence of DSM‐IV disorders. Journal of the American Academy of Child and Adolescent
Psychiatry, 1203-1211. https://doi.org/10.1097/00004583-200310000-00011
Franklin, C. G. S., Kim, J. S., Ryan, T. N., Kelly, M. S., & Montgomery, K. L. (2012). Teacher involvement
in school mental health interventions: A systematic review. Children and Youth Services Review,
Children and Youth Services Review, 34(5), 973–982.
https://doi.org/10.1016/j.childyouth.2012.01.027
Gore, F. M., Bloem, P., Patton, G. C., Ferguson, J., Joseph, V., Coffey, C., . . . Mathers, C. D. (2011). Global
burden of disease in young people aged 10–24 years: a systematic analysis. Lancet, 377, 2093-2102.
http://dx.doi.org/10.1016/S0140-6736(11)60512-6
Graetz, B., Littlefield, L., Trinder, M., Dobia, B., Souter, M., Champion, C., . . . Cummins, R. (2012).
KidsMatter: A population health model to support student mental health and well-being in primary
schools. International Journal of Mental Health Promotion, 10(4), 13-20.
https://doi.org/10.1080/14623730.2008.9721772

ISSN: 2073 7629

© 2020 CRES Volume 12, Number 1, April 2020 pp 75
Greenberg, M. T., Domitrovich, C., & Bumbarger, B. (2001). The prevention of mental disorders in school-
aged children: Current state of the field. Prevention and Treatment, 4(1), Article 1a.
https://doi.org/10.1037/1522-3736.4.1.41a
Hjemdal, O., Aune, T., Reinfjell, T., & Stiles, T. C. (2007). Resilience as a predictor of depressive
symptoms: a correlational study with young adolescents. Clinical Child Psychology and Psychiatry,
12(1), 91-104. https://doi.org/10.1177/1359104507071062
Hjemdal, O., Vogel, P. A., Solem, S., Hagen, K., & Stiles, T. C. (2011). The relationship between resilience
and levels of anxiety, depression, and obsessive–compulsive symptoms in adolescents. Clinical
Psychology and Psychotherapy, 18(4), 214-321. https://doi.org/10.1002/cpp.719.
Jennings, P. A., & Greenberg, M. T. (2009). The prosocial classroom: teacher social and emotional
competence in relation to student and classroom outcomes. Review of Educational Research, 79(1),
491-525. https://doi.org/10.3102/0034654308325693
Jennings, P. A., Brown, J. L., Frank, J. L., Doyle, S., Oh, Y., Davis, R., . . . Greenberg, M. T. (2017).
Impacts of the CARE for Teachers program on teachers’ social and emotional competence and
classroom interactions. Journal of Educational Psychology, 109(7), 1010–1028.
http://dx.doi.org/10.1037/edu0000187
Kessler, R., Angermeyer, M., Anthony, J. C., Graaf, R. D., Demyttenaere, K., Gasquet, I., . . . Tsang, C. A.
(2008). Lifetime prevalence and age-of-onset distributions of mental disorders in the world health
organization’s world mental health survey initiative. In R. C. Kessler, & T. B. Ustan (Eds.), The
WHO World Mental Health Surveys: Global Perspectives on the Epidemiology of Mental Disorders.
Cambridge University Press Published in collaboration with the World Health Organization.
Keyes, K. M., Gary, D., O’Malley, P. M., Hamilton, A., & Schulenber, J. (2019). Recent increases in
depressive symptoms among U.S. adolescents: trends from 1991 to 2018. Social Psychiatry and
Psychiatric Epidemiology, 54(8), 987-996. http://dx.doi.org/10.1007/s00127-019-01697-8
Leung, S. S., Chiang, V. C., Chui, Y. Y., Mak, Y. W., & Wong, D. F. (2011). A brief cognitive-behavioral
stress management program for secondary school teachers. Journal of Occupational Health, 53(1),
23-35. https://doi.org/10.1539/joh.L10037
Lowry-Webster, H. M., Barrett, P. M., & Dadds, M. R. (2001). A universal prevention trial of anxiety and
depressive symptomatology in childhood: Preliminary data from an Australian study. Behaviour
Change, 18(1), 36-50. https://doi.org/10.1375/bech.18.1.36
Lowry-Webster, H., Barrett, P. M., & Lock, S. (2003). A universal prevention trial of anxiety symptomology
during childhood: Results at 1-year follow-up. Behaviour Change, 20(1), 25-43.
https://doi.org/10.1375/bech.20.1.25.24843
Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and
guidelines. Child Development, 71(3), 543–562. https://doi.org/10.1111/1467-8624.00164

ISSN: 2073 7629

© 2020 CRES Volume 12, Number 1, April 2020 pp 76
Macklem, G. L. (2011). Evidence-based school mental health services. Affect education, emotion regulation
training, and cognitive behavioral therapy. Springer.
Mansfield, C. F., Beltman, S., Price, A., & McConney, A. (2012). “Don’t sweat the small stuff:”
Understanding teacher resilience at the chalkface". Teaching and Teacher Education, 28(3), 357-
367. doi:10.1016/j.tate.2011.11.001.
Masten, A. S. (1994). Resilience in individual development: Successful adaptation despite risk and adversity.
In M. C. Wang, & E. W. Gordon (Eds.), Educational resilience in inner-city America: Challenges
and prospects (pp. 3-25). Erlbaum.
Masten, A. S. (2011). Resilience in children threatened by extreme adversity: frameworks for research,
practice, and translational synergy. Development and Psychopathology, 23(2), 493-506.
https://doi.org/10.1017/S0954579411000198
Meschke, L. L. &. Patterson, J. M. (2003). Resilience as a Theoretical Basis for Substance Abuse
Prevention. The Journal of Primary Prevention, 23(4), 483–514.
https://doi.org/10.1023/A:1022276511537
O’Reilly, M., Svirydzenka, N., Adams, S., & Dogra, N. (2018). Review of mental health promotion
interventions in schools. Social Psychiatry and Psychiatric Epidemiology, 53, 647-662.
https://doi.org/10.1007/s00127-018-1530-1
Ogundele, M. O. (2018). Behavioural and emotional disorders in childhood: A brief overview for
paediatricians. World journal of clinical pediatrics, 7(1), 9-26.
http://dx.doi.org/10.5409/wjcp.v7.i1.9
Ornaghi, V., Pepe, A., & Grazzani, I. (2016). False-belief understanding and language ability mediate the
relationship between emotion comprehension and prosocial orientation in preschoolers. Frontiers in
Psychology, 7, 1534. https://doi.org/10.3389/fpsyg.2016.01534
Palfrey, J., Tonniges, T., Green, M., & Richmond, J. (2005). Introduction: Addressing the millennial
morbidity - The context of community pediatrics. Pediatrics, 115(3), 1121-1123.
https://doi.org/10.1542/peds.2004-2825B.
Patterson, J. H., Collins, L., & Abbott, G. (2004). A study of teacher resilience in urban schools. Journal of
Instructional Psychology, 31(1), 3-11.
Patton, G. C., Coffey, C., Cappa, C., Currie, D., & Riley, L. (2012). Health of the world's adolescents: a
synthesis of internationally comparable data. The Lancet, 379(9826), 1665-1675.
https://doi.org/10.1016/s0140-6736(12)60203-7
Payton, J., Weissberg, R. P., Durlak, J. A., Dymnicki, A. B., & Pachan, M. (2008). The positive impact of
social and emotional learning for Kindergarten to eighth-grade students. Findings from three
scientific reviews. CASEL.
Rutter, M. (1999). Resilience concepts and findings: Implications for family therapy. Journal of Family
Therapy, 21(2), 119-144. https://doi.org/10.1111/1467-6427.00108

ISSN: 2073 7629

© 2020 CRES Volume 12, Number 1, April 2020 pp 77
Shelemy, L., Harvey, K., & Waite, P. (2019). Supporting students’ mental health in schools: what do
teachers want and need? Emotional and Behavioural Difficulties, 24(1), 100-116.
https://doi.org/10.1080/13632752.2019.1582742.
Sklad, M., Diekstra, R., De Ritter, M., & Ben, J. (2012). Effectiveness of school-based universal social,
emotional, and behavioral programs: Do they enhance students’ development in the area of skill,
behavior, and adjustment? Psychology in the Schools, 49(9), 892–909.
https://doi.org/10.1002/pits.21641
Stone, L. L., Otten, R., Engels, R. C., Kuijpers, R. C., & Janssens, J. M. (2015). Relations between
internalizing and externalizing problems in early childhood. Child & Youth Care Forum, 44(5), 635-
653. https://doi.org/10.1007/s10566-014-9296-4
Taylor, R., Oberle, E., Durlak, J. A., & Weissberg, R. P. (2017). Promoting positive youth development
through school-based social and emotional learning interventions: A meta-analysis of follow-up
effects. Child Development, 88(4), 1156-1171. https://doi.org/10.1111/cdev.12864.
Telles, S., Gupta, R. K., Bhardwaj, A. K., Singh, N., Mishra, P., Pal, D. K., & Balkrishna, A. (2018).
Increased mental well-being and reduced state anxiety in teachers after participation in a residential
yoga program. Medical Science Monitor Basic Research, 31(24), 105-112.
https://doi.org/10.12659/MSMBR.909200
Tempelaar, W. M., Otjes, C. P., Bun, C. J., Plevier, C. M., van Gastel, W. A., MacCabe, J. H., . . . Boks, M.
P. (2014). Delayed school progression and mental health problems in adolescence: a population-
based study in 10,803 adolescents. BMC Psychiatry, 14(244). https://doi.org/10.1186/s12888-014-
0244-5
Thorlacius, O., & Gudmundsson, E. (2019). The effectiveness of the children’s emotional adjustment scale
(ceas) in screening for mental health problems in middle childhood. School Mental Health, 11(3),
400-412.
Tobler, N. S., Roona, M. R., Ochshorn, P., Marshall, D. G., Streke, A. V., & Stackpole, K. M. (2000).
School-based adolescent drug prevention programs: 1998 meta-analysis. Journal of Primary
Prevention, 20(4), 275-337. https://doi.org/10.1023/A:1021314704811
Tremblay, R. E., Nagin, D. S., Séguin, J. R., Zoccolillo, M., Zelazo, P. D., Boivin, M., . . . Japel, C. (2004).
Physical Aggression during early childhood: trajectories and predictors. Pediatrics, 114(1), e43-e50.
https://doi.org/10.1542/peds.114.1.e43.
Twenge, J. M. (2020). Why increases in adolescent depression may be linked to the technological
environment. Current Opinion in Psychology, 32, 89-94.
http://dx.doi.org/10.1016/j.copsyc.2019.06.036
Twenge, J., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive symptoms, suicide-
related outcomes, and suicide rates among u.s. adolescents after 2010 and links to increased new

ISSN: 2073 7629

© 2020 CRES Volume 12, Number 1, April 2020 pp 78
 media screen time. Clinical Psychological Science, 6(1), 3-17.
https://doi.org/10.1177/2167702617723376
Twum-Antwi, A., Jefferies, P. & Ungar, M. (2019): Promoting child and youth resilience by strengthening
home and school environments: A literature review. International Journal of School & Educational
Psychology, 8(2), 78-89. https://doi.org/10.1080/21683603.2019.1660284
Ungar, M. (2012). Researching and theorizing resilience across cultures and contexts. Preventive Medicine,
55(5), 387-389. https://doi.org/10.1016/j.ypmed.2012.07.021
Ungar, M. (2018). Systemic resilience: principles and processes for a science of change in contexts of
adversity. Ecology and Society, 23(4),34. https://doi.org/10.5751/ES-10385-230434
Ura, S. K., Castro-Olivo, S. M., & d’Abreu, A. (2019). Outcome measurement of school-based sel
intervention follow-up studies. Assessment for Effective Intervention, 1-6.
https://doi.org/10.1177/1534508419862619.
Waddell, C., Hua, J. M., Garland, O. M., Peters, R. D., & McEwan, K. (2007). Preventing mental disorders
in children: a systematic review to inform policy-making. Canadian Journal of Public Health, 98(3),
166-173.
Waldron, S. M., Stallard, P., Grist, R., & Hamilton-Giachritsis, C. (2018). The ‘long-term’ effects of
universal school-based anxiety prevention trials: A systematic review. Mental Health & Prevention,
11, 8-15. https://doi.org/10.1016/j.mhp.2018.04.003
Weare, K. (2004). Developing the emotionally literate school. Sage.
Weare, K. (2010). Mental health and social and emotional learning: Evidence, principles, tensions, balances.
Advances in school mental health promotion, 3(1), 5–17.
https://doi.org/10.1080/1754730X.2010.9715670
Weare, K., & Nind, M. (2011). Mental health promotion and problem prevention in schools: What does the
evidence say? Health Promotion International, 26(S1), i29-i69.
Weist, M. D., & Murray, M. (2008). Advancing school mental health promotion globally. Advances in
School Mental Health Promotion, 1(sup1), 2-12. https://doi.org/10.1080/1754730X.2008.9715740
Wiglesworth, M., Lendrum, A., Oldfield, J., Scott, A., ten Bokkel, I., Tate, K., & Emery, C. (2016). The
impact of trial stage, developer involvement and international transferability on universal social and
emotional learning programme outcomes: A meta-analysis. Cambridge Journal of Education, 46(3),
347-376. https://doi.org/10.1080/0305764X.2016.1195791
Wilson, S., & Lipsey, M., & Derzon, J. (2003). The Effects of School-Based Intervention Programs on
Aggressive Behavior: A Meta-Analysis. Journal of Consulting and Clinical Psychology. 71, 136-49.
https://doi.org/10.1037/0022-006X.71.1.136.
Wisconsin Department of Public Instruction. (2015). The Wisconsin School Mental Health Framework.
Integrating School Mental Health with Positive Behavioral Interventions & Supports.
https://dpi.wi.gov/sites/default/files/imce/sspw/pdf/mhframework.pdf

ISSN: 2073 7629

© 2020 CRES Volume 12, Number 1, April 2020 pp 79
World Health Organization (WHO). (1986). Ottawa Charter for Health Promotion. World Health
Organization.
World Health Organization (WHO). (1996). Public mental health: guidelines for the elaboration and
management of national mental health programmes. World Health Organization, Division of Mental
Health and Prevention of Substance Abuse.
World Health Organization (WHO). (2000). Local action: Creating health promoting schools. World Health
Organization.
World Health Organization (WHO). (2001). Mental health: new understanding, new hope. World Health
Organization.
World Health Organization (WHO). (2003). Creating an environment for emotional and social well-Being.
An important responsibility of a health-promoting and child friendly school. World Health
Organization.
World Health Organization (WHO). (2005). Promoting mental health: Concepts, emerging evidence,
practice. World Health Organization.
World Health Organisation (WHO). (2007). What is a health promoting school?
http://www.who.int/chool_youth_health/gshi/hps/en/index.html
World Health Organisation (WHO). (2013). Mental health: A state of well-being. 10 FACTS ON MENTAL
HEALTH. http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/
World Health Organization (WHO). (2015). First WHO report on suicide prevention.
http://www.who.int/mediacentre/news/releases/2014/suicide-prevention-report/en/
World Health Organization (WHO). (2018). Adolescent mental health. Key Facts.
https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
Zins, J. E., & Elias, M. J. (2007).Social and emotional learning: Promoting the development of all students.
Journal of Educational and Psychological Consultation, 17(2-3), 233-255.
https://doi.org/10.1080/10474410701413152
Zins, J. E., Weissberg, R. P., Wang, M. C., & Walberg, H. J. (2004). Building academic success through
social and emotional learning: What does the research say. Teachers College Press.

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 Appendix

Table I - Framework for school mental health: Constructs, domains, targeted skills and behaviours
Target skills and behaviours
Constructs and theorists Domains Students Teachers
Social and emotional learning (SEL) Promotion of  Self-awareness: identifying and labelling  Self-awareness: valuing own strengths, self-
social and emotions, self-esteem, self-efficacy, self- confidence, and self-belief
SEL is the process through which emotional confidence  Self-management: emotion regulation and
children and adults understand and learning  Self-management: emotion regulation, stress management, motivation, enthusiasm,
manage emotions, set and achieve motivation, goal setting, optimism optimism, motivation, goal setting
positive goals, feel and show empathy  Social awareness: perspective-taking, empathy,  Social awareness: perspective-taking,
for others, establish and maintain valuing diversity empathy, valuing diversity.
positive relationships, and make  Relationship skills: communication, conflict  Relationship skills: building support and
responsible decisions. SEL includes five management, social engagement, relationship relationships, communication, conflict
core competencies: self-management, building, cooperation, teamwork, prosocial management, social engagement, teamwork,
self-awareness, self-management, social behaviour, asking for help prosocial behaviour, asking for help.
awareness and responsible decision-  Responsible decision-making: identifying,  Responsible decision-making: identifying,
making (Elias et al., 1997; Durlak et al., analysing, and evaluating problems, assuming analysing, and evaluating problems,
2015). ethical responsibility, complying with rules assuming ethical responsibility

(Durlak et al., 2015; Payton et al., 2008; Zins, et (Beltman et al. 2011; Jennings et al., 2017;
al., 2004) Jennings & Greenberg; 2009).
Resilience Promotion of  Dealing with personal, familial, or social  Tenacity, perseverance, persistence
Resilience transitions and changes  Sense of humour
Resilience is the dynamic “capacity,  Dealing with bullying and cyberbullying  Flexibility
processes, or outcomes of successful  Dealing with academic difficulties  Willingness to take risks and to accept
adaptation in the context of significant  Dealing with negative peer pressure failure
threats to function or development”  Dealing with loss and bereavement  Coping skills
(Masten, 1994; 2011; Rutter, 1999)  Dealing with chronic diseases and disabilities  Self-care skills
In children, it includes the ability to deal  Stress and frustration management
with adversity and setbacks, rejection, (Cavioni et al., 2018; Cefai, 2008; Cefai et al.,
family conflict, loss, bullying and 2015). (Beltman et al., 2011; Mansfield et al., 2012).

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71
conflicts, life changes and transitions
(Cefai et al., 2015).
Social, emotional, and behavioural Prevention of  Disruptive behaviour, violence, and delinquency  Depression
problems social, emotional,  Oppositional behaviour  Anxiety
and behavioural  Impulsivity  Stress
This category includes different types of problems  Hyperactivity  Emotional exhaustion
challenging conduct that fall outside  Depression  Physical distress
behavioural norms (Achenbach et al.,  Anxiety 
2017; Cooper, 1999; 2017)
 Social withdrawal
 Self-harm and suicide risk (Jennings et al., 2017; Telles et al., 2018)
 Eating disorders and unhealthy diet
 Addictions and gambling
 Substance use
 Risky sexual behaviours
 Driving-related risks

(Anderson et al., 2018; Browne et al., 2004,

Greenberg et al., 2001; Lowry-Webster et al.,
2001; Lowry-Webster et al., 2003; O’Reilly et al.,
2018)

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