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Christina Cruz, MD, assistant professor in the UNC Department of Psychiatry, is the first author of a study published in Frontiers in Psychiatry that shows how teachers can successfully deliver child mental health care in a low and middle income country.

CHAPEL HILL, NC – A study published in Frontiers in Psychiatry looks at how teachers in low and middle income countries are uniquely positioned to deliver mental health care to their students, and how utilizing teachers in this way can potentially improve access to child mental health care.

Christina Cruz, MD, assistant professor in the UNC Department of Psychiatry, led the year-long study that took place in Darjeeling, India with 19 teachers and 36 elementary-aged children in five rural primary schools. Cruz’s previous research on the subject has shown that teachers are professionals with proficiency in child development who have the potential to impact child behavior through daily, consistent contact with children, and the ability to address the mental health needs of children in real time.

“Our work and these recent findings are novel in that they show a potentially viable way for teachers to deliver care by tweaking the interactions they already have with students, making the demands on the teachers’ time much lower as compared with typical, lay counselor duties,” said Cruz.

Through this process Cruz’s team developed Teachers Leading the Frontlines (Tealeaf), a new intervention in which teachers deliver evidence-based, indicated psychological care to their students in need in rural primary schools. Teachers in the study completed a 10-day training program on Tealeaf, in which they learned to use an approach that they could customize, including using both one-on-one sessions and care tasks fitted into their primary teaching duties.

“With education as mental health therapy (Ed-MH), the ‘dose’ of care is each interaction teachers have with their students, tweaked to be therapeutic,” Cruz said. “Teachers already spend time with students who have mental health struggles and often feel ill-equipped to work with these students. With this training, we found that having these skills improved teachers’ sense of self-efficacy, and that it helped them do their job better.”

The study found that participation rates for intervention activities were more than 80%. A majority of teachers met or exceeded quality benchmarks for all intervention activities. A majority of the time teachers chose to deliver teacher-centric techniques that only teachers could deliver given their role in the child’s life. Children improved in mental health score percentiles on the Achenbach Teacher Report Form.

“We hope Tealeaf will become a system of care used globally to improve high quality child mental health care,” Cruz said. “We believe that Tealeaf and Ed-MH together are viable ways to improve access to child mental health care as they can be implemented anywhere teachers teach.”

Cruz and her team also hope to make Tealeaf widespread in Darjeeling. They are currently in the process of expanding Tealeaf to adolescents, as well as creating a formal family engagement component to help bolster teachers’ efforts and increase community engagement in Tealeaf.