Analysis of real-world scale-up processes for school-based mental health interventions.

The global rise in adolescent anxiety, depression, and suicidality has intensified calls for large-scale implementation of effective school-based interventions. This study examined determinants and strategies for scaling up school-based interventions targeting these mental health concerns. A mixed-methods approach was used, involving authors of published school-based mental health intervention trials. Of these, 45 authors completed a survey on scale-up decisions, intentions, and strategies. Determinants and strategies were further explored through 12 in-depth interviews. In our analysis of survey data, we identified interventions that were implemented on a small- or large-scale. In our analysis of interview data, we identified discontinued-, in the process of being scaled-up-, and scaled-up interventions. Half of the interventions surveyed reported intentions to scale up. Determinants for scale-up according to participants fell into three themes: (1) intervention characteristics (e.g., evidence base), (2) resources and support (e.g., availability of financial resources), and (3) school context (e.g., alignment with school curricula). The most relevant strategies for scaling up the included interventions were intervention registries for dissemination, adapting interventions to new settings, establishing organizational structures, and assessing/reducing costs. Our findings highlight strategies that potentially contribute to successfully scale-up of school-based mental health interventions. To enhance impact, we recommend applying such strategies – such as leveraging intervention registries and creating organizational support.