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Background: Low and middle-income countries (LMICs) lack trained child mental health professionals. While teachers' child development experience potentially positions them to fill the gap as lay mental health counselors, they have rarely delivered indicated child mental health care in LMICs. As part of assessing the feasibility of teachers serving as lay counselors, we explored teachers' perceptions of serving as lay counselors and their mental health attitudes and knowledge. Methods: In 2018, with training and supervision, 19 primary school teachers from five rural, low cost private schools in Darjeeling, India, served as lay counselors in their classrooms. Using mixed methods, we examined teacher perceptions of serving as lay counselor and mental health attitudes and knowledge through a survey (n = 15), a summative assessment (n = 14), and semi-structured interviews (n = 17). For the survey and summative assessment, pre-training, post-training, and post-intervention mean scores were compared using paired t tests. Post-intervention interviews were coded for teachers' perceptions of serving as lay counselor and mental health attitudes and knowledge. Results: Qualitatively, teachers expressed being willing to serve as lay counselor, having more inclusive mental health attitudes, and retaining mental health knowledge as applicable to use during instructional time or incorporation into the knowledge transfer process, their primary duty. By contrast, quantitatively, teachers' attitudes appeared to become more inclusive on the study-specific survey pre versus post-training, but reverted to pre-training levels post-intervention. Teachers' mental health knowledge on the summative assessment did not change pre-training versus post-training versus post-intervention. Conclusions: Training, supervision, and serving as lay counselors led to teachers' willingness to serve as lay counselors. Teachers served as lay counselors by utilizing therapeutic techniques during class time and incorporating them into their typical instruction, not through delivering traditional office-like care. Teacher practices may be pointing to the potential emergence of an "education as mental health therapy" system of care. Their changes in attitudes and knowledge reflected their emerging practices. Quantitative measures of knowledge and attitude changes did not capture these nuanced changes. Trial Registration The parent feasibility trial was registered on January 01, 2018 with Clinical Trials Registry – India (CTRI), reg. no. CTRI/2018/01/011471, ref. no. REF/2017/11/015895. http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=21129&EncHid=&modid=&compid=%27,%2721129det%27.. [ABSTRACT FROM AUTHOR]

Background: Knowledgeable in child development, primary school teachers in low- and middle-income countries (LMICs) have the potential to identify their students needing mental health care. Objective: We evaluated whether teachers in Darjeeling, India can accurately nominate school-aged children for mental health services after training and aided by a novel tool. Methods: In 2018, 19 primary school teachers from five low-cost private (LCP) schools in rural Darjeeling were trained to nominate children needing care. Teachers evaluated all of their students aided by a novel tool, 'Behavior Type and Severity Tool' (BTST), completed the Achenbach Teacher Report Form (TRF) as a mental health status reference standard, and nominated two students for care. Sensitivity and specificity of being nominated compared to TRF overall and subdomain scores were calculated. BTST performance was determined by comparing BTST and TRF scores and creating Receiver Operating Characteristic curves to determine optimal cutoffs. Multivariable regression models were used to identify demographic predictors of teacher accuracy using the BTST. Results: For students demonstrating a clinical or borderline score in at least one TRF subdomain, the sensitivity (72%) and specificity (62%) of teacher nomination were moderately high. BTST overall scores and TRF Total Problem scores were correlated (Spearman's ρ = 0.34, p < 0.0001), as were all subdomains. For the TRF Total Problem score, a maximum Youden's J of 0.39 occurred at BTST cutoff >4 for borderline struggles and 0.54 at the BTST cutoff >6 for clinical struggles. Younger teacher age, less education, less formal education training, and more years of experience were positively associated with teacher accuracy. Conclusions: With training and a simple decision support tool, primary school teachers in an LMIC nominated students for mental health services with moderate accuracy. With the BTST being weakly accurate, teachers' judgment largely accounted for the moderate accuracy of nominations. [ABSTRACT FROM AUTHOR]

Background: Task‐shifted, teacher‐led care may begin to bridge the child mental health care gap in low‐ and middle‐income countries by improving mental health literacy. We explore the perceived impact of RESEED (Responding to Students' Emotions through Education), an abbreviated version of Tealeaf (Teachers Leading the Frontlines). Methods: After classroom implementation of tools from a 3‐day training on child mental health and cognitive behavioral techniques in Darjeeling, India, 29 teachers participated in focus group discussions (FGDs). Results: Inductive content analyses of FGDs demonstrated RESEED's acceptability, positive overall impact, and barriers. Conclusions: Stepped levels of teacher‐led care may support child mental health in resource‐limited settings through mental reframing. [ABSTRACT FROM AUTHOR]

The mental health needs of children in low-and-middle income countries (LMICs) often go unmet due to a lack of qualified mental health professionals. Task-shifting the provision of mental health services to teachers may facilitate access to care. Family engagement in task-shifting may support mental health outcomes but is understudied in this context. The current study explored teacher and caregiver perceptions of family engagement within a teacher-led, task-shifted mental health intervention in an LMIC. Primary school teachers from five schools in Darjeeling, India delivered evidence-based, indicated mental health care to children with mental health needs throughout the school day. We conducted semi-structured interviews (SSIs) with teachers (n=17) and caregivers (n=21). SSIs were coded for themes related to family engagement. Teachers and caregivers were compared based on perceived levels of engagement. Participants reported three patterns of engagement: families who fully engaged; families who felt positively about teachers but displayed little engagement; and families with limited engagement. Barriers included logistical challenges and misconceptions about the programme. Many teachers implicated family engagement as a facilitator of the programme, suggesting that family involvement may support intervention outcomes. Future work could involve the development of an intervention component to better facilitate engagement in this context. Trial registration: Clinical Trials Registry India identifier: CTRI/2018/01/011471. [ABSTRACT FROM AUTHOR]