Innovation summary

It is estimated that up to 23% of Ethiopian children have mental health problems and while there are scarce mental health services for adults in Ethiopia, such services for children are almost non-existent. The goal of the innovation is to create a situation where all persons with mental health and/or behaviour problems in the target population are identified and receive appropriate, timely care.

The innovation, initiated by the Ethiopian School Readiness Initiative (SRI), uses task shifting by enabling teachers and primary caregivers to identify and manage mental and/or behavioural problems, or refer such cases for professional care. 

Impact summary

  • 1000 beneficiaries will be provided with mental health services
  • Anticipated 50% improvement in SDQ total problem scores of children that receive treatment
  • $205,000 USD funded over two years

School-based mental health services also have the potential for bridging the gap between need and utilization by reaching disadvantaged children who would otherwise not have access to these services. 

[Armbruster, Gerstein, & Fallon, 1997]1

This innovation is funded by Grand Challenges Canada.


Main photo taken by Fred Seligman MD

Innovation details

This innovation has the following main objectives: 

To enable teachers and parents to enhance children's social and emotional development, to understand signs and symptoms of common mental disorders and to replace the traditional harsh discipline of children with positive practices through the development of training manuals

To train teachers and parents, training manuals on child development and on mental disorders were prepared and validated. The manuals give guidelines to trainers on how to run participatory sessions. All manuals provide detailed but simple information to trainers on relevant issues. The manuals serve as a resource for trainers to provide answers to expected questions from parents. All trainings are accompanied by fliers on specific issues that parents take home after each training. The leaflets are assumed to be used by parents as quick reminders and to discuss with family members and neighbours.

Ten parent training manuals, in Amharic, were developed on the issues listed below. Lectures, group discussions and role playing scenarios were used to train 370 preschool teachers. The parental training is ongoing using similar methods.5,000 caretakers will be trained

Nine manuals were developed on how to enhance child development 

  • Physical, language, social and emotional, intellectual development (4 manuals)
  • Child health and nutrition
  • Enhancing sensory development and creativity through play
  • Protecting children
  • Optimizing interpersonal relationships
  • Challenges of parenting in Ethiopia

One manual was developed on how to identify signs and symptoms of mental disorders. It included:

  • List of common mental disorders
  • Description of specific conditions 
  • Local views regarding attributions and remedies for specific conditions
  • Available evidence based solutions (suggestions on how to prevent stressful situations for family members, to support persons with various types of mental problems and when help should be sought).  

An educator’s manual was produced and validated on how to train parents on positive disciplining of children. It included: 

  • The definition of discipline (global and local traditional) 
  • Various situations for traditionally recommended disciplinary actions 
  • Types of disciplinary methods employed by Ethiopian parents
  • Differences between positive disciplining and punishment and their expected outcomes 
  • Positives and negatives of positive discipline and corporal punishment based on evidence from literature and empirical findings in the local communities 

The trainings on mental health and on child discipline have been given to over 300 teachers using group discussions, role play scenarios and lectures. The teachers have been training the parents of children in their respective schools.

To provide mental health services to children and their primary caretakers 

The innovation also involves the provision of treatment and follow up for children and adults in the target group with behaviour/mental problems. SRI has partnered with two government clinics to allow referred cases to get mostly free treatment. SRI covers the costs to buy medications from the private vendors when free medications are unavailable in the government hospitals. Treatment for children consists of behaviour therapy, family therapy and parental training while treatment for adults involves psychotherapy and drug treatment.  So far the over 60 children and over 40 adults have been treated after being referred from schools.

Key drivers

Partnerships with the Education and Health Bureaus

The partnership with the Addis Ababa City Administration Education Bureau ensures access to the preschools that the Bureau regulates. These preschools are targeted towards low-income children and their families, providing easy access to the target population.

The Addis Ababa City Administration Health Bureau has partnered with SRI to allow mental health professionals to provide free services to children from poorer homes. This partnership is essential in ensuring sustainability of services.

Tools Developed with Local Stakeholders

The tools used in the program have been developed with local stakeholders, taking local context into consideration.

Challenges

Staff Turnover

Gradual decrease of teachers catered to additional work on SRI to train newly employed teachers

Lack of Funds to Provide Nutrition for Deprived Children

Some hungry children often would not come to school or would abscond from school which reduced the contact between their parents and teachers and prevented opportunities for update discussions with parents

Continuation

Local stakeholders are fully supportive of the tools used in this program and are open to continued use. The evaluator of the project, Addis Ababa City Administration Education Bureau, would like this program to be scaled up to 140 preschools, recently opened for children from poorer inner city homes.

SRI plans to scale up this program if funding is attained. Potential donors will be approached to assist with scale up to other parts of the country, particularly outside of the capital. 

Partners

Funder

Evaluation methods

The project will embed a randomized controlled study to evaluate the knowledge and skills the teachers have gained and to identify and manage common mental disorders in children. 

The intervention is evaluated by the Addis Ababa City Administration Education Bureau on a quarterly basis. 

Cost of implementation

The cost of implementing the innovation is approximately $205,000 USD. The cost effectiveness analysis is yet to be done, however the research team expects the innovation to be highly cost-effective as the program is based on the concept of task shifting without any additional salaries.

Impact details

The project target is to have 50% symptom reduction following treatment in cases identified as suffering from mental illness. In addition, the majority of the trained teachers will be able to correctly identify signs and symptoms of common mental disorders and corporal punishment should be abolished in all the project schools. 

References

  1. Armbruster et al. (1997) Bridging the gap between service need and service utilization: a school-based mental health program. Community Mental Health Journal. 33(3):199-211

Comments

Somalia was the first country in East Africa to have school mental health innovating this practice in Africa. Handuleh, J, Whitwell S, Fekadu, D, School Mental health project in Somalia, The Arab Journal of Psychiatry (2013) Vol. 24 No. 1 Page (46 - 51) (doi: 10.12816/0000098)

A nice project which i hope to replicate in my locality

Hi Dr. Handuleh, It would be great to feature the mentioned project on MHIN as a case study. Could you please either submit a short description for this through this link: http://mhinnovation.net/community/contribution or email us at mhin@lshtm.ac.uk? Looking forward to hearing from you! -Shamaila

Great project! Nice to hear about this thank you for sharing the useful information. I came to know about this through an <a href="http://essaymama.org/">paper writing service</a>. This helps many parents and children to learn.
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