Original Article

Barriers to Mental and Social Health Programs in Schools: A Qualitative Study in Iran

Abstract

Objective: In order to achieve development goals, in addition to providing students with physical health, their mental and social health should be considered as a necessity and priority in development programs. This program, called the Nemad Project in Iran was formally established in 2015. This study aims to explore the challenges of the Nemad project in Iranian schools based on stakeholders' views.

Method: The present qualitative study, with a contractual content analysis approach, was conducted on 21 experts in the field of social harm prevention and mental health promotion at the senior, intermediate, and operational levels in educational institutions and schools, Ministry of Health, the Judiciary and the Planning and Budget Organization. These experts also included project technical officers. Participants were selected using snowball and purposeful sampling methods. Data were collected through semi-structured interviews and analyzed by coding, classification, and extraction of the main themes.

Results: Six main themes were derived that included inefficiency in resource management (with subcategories of inadequate facilities and equipment, inadequate human resource management, and information management system deficiencies), weakness in program organization (with subcategories of poor cross-sectoral and weak inter-sectoral subgroups), challenges of laws/regulations/policies (with sub-categories of defective protocols and guidelines and lack of specific task descriptions), barriers and challenges to implementation of policies (with macro and school policy implementation subcategories), structural factors (with subcategories of financial resources allocation problems, inconsistency in managerial levels, and deficiencies in decision-making principles), weaknesses in educational processes (with subcategories of inadequate teacher education, weaknesses in parenting courses, and weaknesses in student education), and ultimately, weaknesses in monitoring and evaluation (with the subcategory of lack of a monitoring and evaluation system).

Conclusion: According to experts, implementation of mental and social programs in schools is not in a desirable situation and is faced with certain challenges. To enhance the management of the Nemad project in Iranian schools, it is necessary to compile flowcharts of service delivery and inter-device communication, allocate resources to meet the expectations of each organization, do performance-based budgeting, take a comprehensive look at parental issues, and design a system of monitoring and evaluating the requirements.

1. Jenkins R, Baingana F, Ahmad R, McDaid D, Atun R. Mental health and the global agenda: core conceptual issues. Ment Health Fam Med. 2011;8(2):69-82.
2. Engel GL. The need for a new medical model: a challenge for biomedicine. Psychodyn Psychiatry. 2012;40(3):377-96.
3. Wilkinson R, Pickett K. And another thing…: Towards a more equal society. Politics UK: Routledge; 2018. p. 70-4.
4. Fusar-Poli P. Integrated Mental Health Services for the Developmental Period (0 to 25 Years): A Critical Review of the Evidence. Front Psychiatry. 2019; 10:355.
5. Askell-Williams H, Dix KL, Lawson MJ, Slee PT. Quality of implementation of a school mental health initiative and changes over time in students’ social and emotional competencies. Sch Eff Sch Improv. 2013; 24(3) :357-81.
6. Jones SM, Kahn J. The evidence base for how we learn: Supporting students’ social, emotional, and academic development. WEJ. 2017;10(1) :5-20.
7. Dix KL, Shearer J, Slee PT, Butcher C. KidsMatter and Young Children with Disability: Evaluation Report. Adelaide, Australia: MAC: SWD; 2010.
8. Fenwick-Smith, A., Dahlberg, E.E. & Thompson, S.C. Systematic review of resilience-enhancing, universal, primary school-based mental health promotion programs. BMC Psychol. 2018: 6(1):30-47. doi:10.1186/s40359-018-0242-3.
9. Ashdown, D. M., & Bernard, M. E. Can explicit instruction in social and emotional learning skills benefit the social-emotional development, well-being, and academic achievement of young children? Early Child Dev Care. 2012; 39(6): 397–405.
10. Barry MM, Clarke AM, Morreale SE, Field CA. A review of the evidence on the effects of community-based programs on young people’s social and emotional skills development. Adolesc. Res. Rev. 2018;3(1) :13-27.doi: 10.1007/s40894-017-0055-2.
11. Duque E, Gairal R, Molina S and Roca E. How the Psychology of Education Contributes to Research With a Social Impact on the Education of Students With Special Needs: The Case of Successful Educational Actions. Front. Psychol.2020; 11(1): 439. doi: 10.3389/fpsyg.2020.00439 .
12. Weare K, Nind M. Mental health promotion and problem prevention in schools: what does the evidence say? Health Promot Int. 2011;26 Suppl 1:i29-69.
13. Yoshikawa H, Leyva D, Snow CE, Treviño E, Barata MC, Weiland C, et al. Experimental impacts of a teacher professional development program in Chile on preschool classroom quality and child outcomes. Dev Psychol. 2015;51(3):309-22.
14. Sharifi V, Amin-Esmaeili M, Hajebi A, Motevalian A, Radgoodarzi R, Hefazi M, et al. Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011. Arch Iran Med. 2015;18(2):76-84.
15. Rahimi-Movaghar A, Amin-Esmaeili M, Sharifi V, Hajebi A, Radgoodarzi R, Hefazi M, et al. Iranian mental health survey: design and field proced. Iran J Psychiatry. 2014;9(2):96-109.
16. National Coalition Document "Student Social Care System. High Council for Welfare and Social Security; 2016.
17. Baghian N, Sari AA, Shati M, Fallahzadeh H, Ahmadi B. Evaluation of students' mental and social health promotion educational programs: A systematic review. J Educ Health Promot. 2019;8(1):258. doi: 10.4103/jehp.jehp_416_19.
18. Demyttenaere K, Bruffaerts R, Posada‐Villa J et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA. 2004; 291(1): 2581‐90.
19. Elo S, Kääriäinen M, Kanste O, Pölkki T, Utriainen K, Kyngäs H. Qualitative content analysis: A focus on trustworthiness. SAGE open. 2014;4(1) :1-10. doi:.1177/2158244014522633.
20. Polit D, Hungler B. Essentials of nursing research: Methods, appraisal, asid utilization. Nurse Res. 2006; 13(4) :91-2.doi: 10.7748/nr.13.4.91.s11.
21. Davis-Kean PE. The influence of parent education and family income on child achievement: the indirect role of parental expectations and the home environment. J Fam Psychol. 2005;19(2):294-304.
22. Balsam SJ. Program evaluation of a school-based mental health center: implications for community needs and connection: Rutgers University-Graduate School of Applied and Professional Psychology.; 2018. https://doi.org/doi:10.7282/T3M048XM.
23. Fixsen DL, Blase KA, Naoom SF, Wallace F. Core implementation components. Res Soc Work Pract 2009;19(5) :531-40. doi:10.1177/1049731509335549
24. Fallahi A, Ebtekar F, Nemat-Shahrbabaki B, Moradi L. Barriers of Health Education from the Perspective of School Health Trainers: A Qualitative Study. JEHP. 2019;7(1) :41-8.
25. Zarezadeh Y, Fallahi A, Shahrbabaki BN, Hashemian M, Ghalvazi R. Perspective of health care providers about barriers of instructional programs: a qualitative study. Health. Scope. 2017;6(3) :1-9. doi: 10.5812/jhealthscope.15116.
26. Wanless SB, Domitrovich CE. Readiness to Implement School-Based Social-Emotional Learning Interventions: Using Research on Factors Related to Implementation to Maximize Quality. Prev Sci. 2015;16(8):1037-43.
27. Auschra C. Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review. Int J Integr Care. 2018;18(1):5.
28. Adelman HS, Taylor L. Involving teachers in collaborative efforts to better address the barriers to student learning. Prev. Sch. Fail. 1998;42(2) :55-60.
29. Oberle E, Domitrovich CE, Meyers DC, Weissberg RP. Establishing systemic social and emotional learning approaches in schools: A framework for schoolwide implementation. Cambridge J. Educ. 2016;46(3) :277-97.
30. Fathi B, Allahverdipour H, Shaghaghi A, Kousha A, Jannati A. Challenges in developing health promoting schools' project: application of global traits in local realm. Health Promot Perspect. 2014;4(1):9-17.
31. Inchley J, Muldoon J, Currie C. Becoming a health promoting school: evaluating the process of effective implementation in Scotland. Health Promot Int. 2007;22(1):65-71.
32. Greenberg MT, Domitrovich, C. E., Graczyk, P. A., Zins, J. E.. The Study of Implementation in School-Based Preventive Interventions: Theory, Research, and Practice. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration; 2005.
33. Weist MD, Mellin EA, Chambers KL, Lever NA, Haber D, Blaber C. Challenges to collaboration in school mental health and strategies for overcoming them. J Sch Health. 2012;82(2):97-105.
34. Evans SW, Glass-Siegel M, Frank A, Van Treuren R, Lever NA, Weist MD. Overcoming the challenges of funding school mental health programs. Handbook of School Mental Health Advancing Practice and Research: Springer; 2003.
35. Mellin EA, Taylor L, Weist MD. The Expanded School Mental Health Collaboration Instrument [School Version]: Development and Initial Psychometrics. School Mental Health. 2014;6(3):151-62.
36. Cammack NL, Brandt NE, Slade E, Lever NA, Stephan S. Funding expanded school mental health programs. In: Weist MD, et al., editors. Handbook of School Mental Health Research, Training, Practice, and Policy. Springer; New York City; 2014.
37. LeVesseur, Cheyne A. Implementing Universal Social and Emotional Learning Programs: The Development, Validation, And Inferential Findings from The Schoolwide SEL Capacity Assessment. Doctoral Dissertations; 2015.
38. Rothì, D. M., G. Leavey, and R. Best. Recognising and Managing Pupils with Mental Health Difficulties: Teachers’ Views and Experiences on Working with Educational Psychologists in Schools. Pastor Care Educ.2008; 26 (3): 127–142.
39. Yazdi-Feyzabadi V, Rashidian A, Keshavarz Mohammadi N, Omidvar N, Nedjat S, Karimi-Shahanjarini A. Analysis of Formation and Implementation of Health Promoter Schools Program in the Country and Relationship between School Nutrition Environment and Student Nutrition Behavior: Tehran University of Medical Sciences. Doctoral Dissertations :2015.
40. Minas H, Colucci E, Jorm AF. Evaluation of mental health first aid training with members of the Vietnamese community in Melbourne, Australia. Int J Ment Health Syst. 2009;3(1):19.
41. Thomas W, Bellefeuille G. An evidence-based formative evaluation of a cross cultural Aboriginal mental health program in Canada. AeJAMH. 2006;5(3) :202-15. https://doi.org/10.5172/jamh.5.3.202.
Files
IssueVol 18 No 2 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v18i2.12360
Keywords
Mental health social health schools

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Baghian N, Shati M, Akbari Sari A, Eftekhari A, Rasolnezhad A, Nanaei F, Ahmadi B. Barriers to Mental and Social Health Programs in Schools: A Qualitative Study in Iran. Iran J Psychiatry. 2023;18(2):97-107.