Noriko HIDA

Background/Objectives: School-based universal mental health interventions offer an inclusive and scalable approach to promote mental health and well-being among children. This study evaluates the Let’s Learn About Emotions (Opitaan tunteista in Finnish) program, an evidence-based, teacher-led universal school-based intervention originally developed in Japan and culturally adapted for Finnish primary schools. Methods: A total of 512 fourth-grade students from 14 schools participated in the 12-week program during spring 2023. Using a mixed-methods design, we assessed (1) the program’s acceptability among students, parents, teachers, and school principals, (2) fidelity of implementation, and (3) changes in students’ mental well-being pre- to post-intervention. Quantitative data included standardized questionnaires with valid responses collected from 233 students at baseline and 209 students at post-intervention, as well as parents and teachers. Qualitative data were collected through focus group discussions involving parents, teachers, and school principals during spring 2024. Results: Acceptability was high across all respondent groups. Teachers adhered closely to the teaching manual, as confirmed by self-reports and direct classroom observations. Statistically significant improvements were observed in parent-reported conduct problems, hyperactivity, and peer problems, though student self-reports did not show similar benefits. Conclusions: The program was found to be both acceptable and culturally appropriate in the Finnish context. Findings from this study provide valuable insights for refining and improving the program for future implementation. To more rigorously examine its effectiveness, future studies should employ a randomized controlled trial design.

Introduction Emotional awareness and emotion regulation are crucial for cognitive and socio-emotional development in children. School-based interventions on socio-emotional skills have the potential to prevent these problems and promote well-being of children. The Japanese school-based program, Universal Unified Prevention Program for Diverse Disorders (Up2-D2), has shown preventive effects on mental health of children in Japan. The aims of this protocol paper are to describe the unique process of adapting the Up2-D2 from Eastern to Western context, and to present a feasibility study of the intervention, conducted in Finland. Methods The cultural adaptation process started with the linguistic translation of materials, followed by the modification of language to fit the Finnish context. While the Japanese ideology was saved, some content was adapted to fit Finnish school children. Further modifications were made based on feedback from pupils and teachers. The Finnish version of the program was named “Let’s learn about emotions” and consisted of 12 sessions and targeted 8- to 12-year-old pupils. A teacher education plan was established to assist Finnish teachers with the intervention, including a workshop, teachers’ manual, brief introductory videos, and online support sessions. A feasibility study involving 512 4th graders in the City of Hyvinkää, South of Finland, was conducted. It assessed emotional and behavioral problems, classroom climate, bullying, loneliness, perception of school environment, knowledge of emotional awareness, and program acceptability. Discussion The originality of this study underlies in the East–West adaptation of a cognitive behavioral therapy-based program. If promising feasibility findings are replicated in Finland, it could pave the way for further research on implementing such programs in diverse contexts and cultures, promoting coping skills, awareness, social skills and early prevention of child mental health problems. Ethics The ethical board of the University of Turku gave ethics approval for this research. The educational board of the City of Hyvinkää accepted this study.

This study examined the applicability and preliminary effects of the Universal Unified Program for Diverse Disorders (Up2-D2; Ishikawa et al., 2019) when adapted for adolescents with intellectual disabilities (ID). Modifications included unit division, extended review periods, and the incorporation of peer idea-sharing. Eight students with mild to moderate ID participated in a special needs education high school. Two teachers administered the program as self-supporting activity curricula from April to March. After the participants received the 30 sessions of the Up2-D2, their depression significantly decreased. While there were no clear effects on anxiety, aggression, self-effectiveness and total difficulties, variability was observed in individual changes. This study suggested that the Up2-D2 with adaption for students with ID is feasible in a school for special needs education. Further, it partially improves the mental health problems of the students. In the future implementation of the program, the development of supplemental teaching materials and adding sessions to learn experimentally are needed.

Preventive interventions before the problems occur are not to be implemented, as its effects are less visible than those of treatment to solve existing problems. However, given the deterioration of children’s mental health in school settings and the negative impact of the COVID-19 pandemic, it is an impending issue to promote and implement preventive intervention in school. This review described the current research trends and challenges of mental health prevention education in school through the social implementation of the Universal Unified Prevention Program for Diverse Disorders (Up2-D2). In this review, we discussed research issues in social implementation, such as examining efficacy, selecting measurements, expanding targeted population, sophisticating and shortening of components, selecting from existing programs, and training young researchers. In addition, challenges on the practical side, such as finding key persons, creating class time, training implementers, obtaining funds for management, and doing public relations were also discussed.

Abstract Background The present study examined the effectiveness of the Universal Unified Prevention Program for Diverse Disorders (Up2-D2) for internalizing and externalizing problems for children aged 9–11 years. Methods We used two feasibility studies. The Up2-D2 entailed 12 sessions delivered by teachers; each session was developed based on cognitive-behavioral and positive psychological interventions. In Studies 1 and 2, 58 elementary school children aged 9–11 and 73 elementary school children aged 10–11 attended the Up2-D2. The teachers in Study 1 received 1.5 h of on-site teacher training for learning rationales for interventions, how to run the program, and received ongoing supervision by professionals with mental health expertise. In contrast, the teachers in Study 2 were given self-learning DVD materials in place of on-site training and ongoing supervision. Results Mixed models revealed that general difficulties, which is total score of both internalizing and externalizing problems, decreased in Study 1 but not in Study 2. Additional analyses for children with subclinical general difficulties revealed that general difficulties, internalizing problems, and externalizing problems decreased in Study 1, whereas in Study 2, general difficulties and internalizing problems decreased, except for externalizing problems. Conclusions These results suggest that on-site teacher training and ongoing supervision are imperative for improving general difficulties in children at a universal level. In addition, universal preventive interventions by classroom teachers without on-site training and continuous supervision might be efficacious for reducing general difficulties and internalizing problems for children with subclinical difficulties.

<title>Abstract</title> School closures due to the coronavirus disease 2019 (COVID-19) pandemic have worsened mental health problems for children and adolescents worldwide. We aimed to examine the effectiveness of a transdiagnostic universal prevention program for the mental health of junior high school students after a nationwide school closure during the COVID-19 outbreak in Japan. A total of 117 junior high school students were included in the analysis. We used the Unified Universal Prevention Program for Diverse Disorders (Up2-D2) program; the Up2-D2 comprises cognitive-behavioral and positive psychological interventions provided over twelve 45-minute sessions. The program was originally implemented between June and July 2020, immediately after pandemic-related school closures had ended in Japan. The program assessments were based on students’ responses to a questionnaire incorporating five scales to measure indicators of internalizing and externalizing problems. Assessments were carried out before, immediately after, two-month, and six-month after implementing the program using student-reported questionnaires. Mixed models for the whole sample showed small anxiety improvement effects immediately post-intervention and two-month, and six-month assessments (<italic>g</italic> = -0.25, <italic>g</italic> = -0.44, and <italic>g</italic> = -0.30, respectively). The anxiety reducing effects were even greater for the higher-anxiety group at the post-, 2-month, and 6-month assessments (<italic>g</italic> = -1.48; <italic>g</italic> = -1.59; <italic>g</italic> = -1.06, respectively). These results indicate that the transdiagnostic universal prevention intervention effectively reduced anxiety for junior high students returning to school following school closures related to the COVID-19 pandemic in Japan.

研究論文本研究は，心の不調に関する心理教育がメンタルヘルスリテラシーの向上におよぼす効果について検討することを目的として行われた。本研究では，中学１年生99名を対象に，研究実施協力校に所属するスクールカウンセラーによって，宿泊研修の機会を利用した120分間の介入プログラムが行われた。介入プログラム「心の不調と対処法」では，心の不調の受容，自分自身で実行できる対処法についての検討（グループワーク），学内での相談先の紹介，そして大人へ相談することでの早期対応の必要性を扱った。他者に援助を求めるかどうかの態度の測定は被援助志向性尺度を用いた。また，メンタルヘルスリテラシーの測定は，不安症を呈する中学生の架空事例を作成した上で，それに対する回答から測定した。介入の結果，分析対象となった82名の内，不安症の症例が「心の不調である」と認識する者の人数が減少し，「心が弱い」「特別な問題である」という偏見や差別の意識が改善された。実験デザインや測度，そして介入プログラムの内容の改善が，今後の課題として挙げられた。