Case Study: A Systemic, Proactive Approach to Youth Mental Wellbeing in Rural Ugandan Schools

Case Study

Nov 4

A Partnership Between Mind the Class (MTC) [Now MindArch Health] and Plan for the Villages Organization (PLAVIO Uganda)

Author Note: This case study was compiled from internal program documents, including needs assessments, implementation plans, workroom analyses, and evaluation data from a 2022 pilot project.

Abstract

This case study documents a 2022 pilot program aimed at improving youth mental health and wellbeing in a high-risk, resource-limited community in Adekokwok County, Lira, Uganda. The project, a collaboration between Mind the Class (MTC) and Plan for the Villages Organization (PLAVIO Uganda), shifted from a traditional reactive crisis-response model to a proactive, systemic, and integrative prevention framework. The intervention was implemented across 12 schools, impacting an estimated 1,200 students. The methodology utilized MTC’s "5-Elements of Mental Wellbeing" model (Security, Regulation, Value, Decision-Making, Relatability) as a core framework for assessment, training, and implementation. A mixed-methods approach involving qualitative needs assessments with a multi-stakeholder Task Force and quantitative pre-intervention surveys established a baseline community wellbeing score of 3 out of 10. Key community concerns included school violence, gender-based violence, substance use, and school dropout, exacerbated by the COVID-19 pandemic. The intervention involved a train-the-trainer model, establishing school-based Psychological Safety Teams and student-led Peace Clubs, and integrating trauma-informed, culturally responsive practices. Post-intervention projections and initial outcomes indicated a potential rise in wellbeing to 7.5/10, with final analysis showing a 20% overall increase in wellbeing. The study highlights the efficacy of a systemic, assets-based approach in building psychological safety and resilience. Key limitations, including technological and linguistic barriers, are also discussed. The findings suggest that proactive, community-integrated mental health prevention models are a viable and effective strategy for improving youth outcomes in settings with significant trauma and limited resources.

Keywords: youth mental health, primary prevention, school-based intervention, psychological safety, systemic change, Uganda, community wellbeing, 5-Elements model

1. Introduction

The global crisis in youth mental health represents a significant challenge to public health, education, and sustainable development. Suicide is the fourth leading cause of death among 15-19-year-olds worldwide (World Health Organization [WHO], 2021). These challenges are often magnified in developing nations and post-conflict regions, where community-wide trauma, poverty, and limited access to care create a complex web of risk factors. In Uganda, communities grapple with the long-term effects of war, poverty, and gender-based violence, alongside systemic barriers such as funding inequities and a Western-centric understanding of mental pathology that may not align with local contexts (Kopinak, 2015).

Traditional mental health support in school settings often relies on a reactive, problem-focused model. This approach typically intervenes only after a student exhibits significant behavioral or emotional distress, leading to a cycle of crisis management, stigma, and limited long-term impact. Recognizing this gap, Mind the Class (MTC), in partnership with Plan for the Villages Organization (PLAVIO Uganda), initiated a pilot program in 2022 in Adekokwok County, Lira, Uganda. The project aimed to replace the reactive paradigm with a proactive, systemic primary prevention plan designed to build resilience and promote wellbeing before significant mental health challenges emerge.

This case study details the methodology, implementation, and outcomes of this pilot program. It examines the efficacy of a multi-faceted framework, the "5-Elements of Mental Wellbeing," in identifying needs, building local capacity, and fostering a culture of psychological safety within the school community.

2. Program Background and Theoretical Framework

The intervention was grounded in several core theories, including Systems Theory, Social Learning Theory, and Conflict Theory, to create a holistic and integrative model. The program recognized that a child’s wellbeing is not an isolated phenomenon but is deeply interconnected with the health of their environment, including family, school, and community systems (Bronfenbrenner, 1979). The core of the intervention was MTC’s proprietary 5-Elements of Mental Wellbeing, a framework designed to assess and address key factors of psychological health.

The 5-Elements are:

Secure (Anchor): Fostering internal and external safety. This includes feeling protected from harm, experiencing equitable treatment, and cultivating a sense of belonging and connection (Baeva & Bordovskaia, 2015).
Regulated (Vessel): The ability to manage internal physiological and emotional states. This involves developing self-control, healthy routines, and the capacity to co-regulate with others (Tangney et al., 2004).
Valued (Currency): Cultivating a sense of self-worth and purpose. This is achieved by engaging in meaningful activities and receiving positive feedback, leading to higher self-acceptance and awareness (Huo et al., 2020).
Decided (Compass): The capacity to make value-based choices. This element focuses on building self-efficacy, which acts as a buffer against stress and is a key predictor of academic success (Ackerman, 2018; Zajacova et al., 2004).
Related (Telescope): The ability to form healthy, collaborative relationships. This involves understanding social dynamics, practicing empathy, and communicating effectively (Arslan et al., 2010).

3. Methodology

A six-phase systemic change approach was utilized: (1) Assessment, (2) Discovery, (3) Training, (4) Reflection, (5) Planning, and (6) Sustaining.

3.1 Setting and Participants
The pilot was conducted in Adekokwok County, Lira, Uganda, encompassing 12 schools and an estimated 1,200 students. The community includes South Sudanese refugee populations and faces significant socioeconomic challenges and high levels of trauma. A multi-stakeholder Task Force was established for each school, comprising diverse members including teachers, students, parents, community and religious leaders, and school administrators (principals/head of school).

3.2 Data Collection and Assessment
A mixed-methods approach was used to establish a baseline.

School Task Force Needs Assessment: A qualitative instrument administered to Task Force members to identify perceived problems, strengths, and important historical factors.
Student Wellbeing Survey: A quantitative tool administered to a sample of students to generate a baseline wellbeing score (rated 1-10) and gather data on social-emotional health.
Community Concerns Analysis: Key issues impacting student mental health were identified and prioritized by the community. The most pressing concerns were School Violence (30%), Gender-Based Violence (30%), and Substance Use (30%), followed by Bullying (20%) and Economic Recovery from COVID-19 (20%).

The initial assessment revealed a stark baseline wellbeing score of 3/10 across the student sample. Qualitative data from needs assessments corroborated this, with stakeholders reporting widespread financial crisis due to COVID-19, teenage pregnancy, high rates of school dropout, and emotional distress. Identified strengths included the presence of school counselors, a successful PTA focused on female education, and the fact that all surveyed students could identify at least one adult they felt safe speaking with.

4. Program Implementation

The program was rolled out in three main phases, designed to ground the community in new concepts, provide relief through actionable strategies, and shift the culture toward sustained practice.

4.1 Grounding Phase: Team Creation
PLAVIO Uganda leaders worked with school leadership to establish two key groups:

Psychological Safety Teams: Composed of diverse staff members (teachers, counselors) trained to lead mental health initiatives.
Peace Clubs: Peer-led student groups trained by the Psychological Safety Teams to identify at-risk students, promote peaceful communication, and serve as a secure first point of contact for peers in distress.

4.2 Relief Phase: Training and Co-Design
A "train the trainer" model was employed. MTC provided comprehensive training to the Program Ambassador and Task Force on the 5-Elements framework, secondary prevention (i.e., identifying warning signs), and tertiary prevention (i.e., referral pathways). This training was then adapted and delivered by local leaders. Key activities included:

Mentally Healthy Classroom Activities: A workbook with practical exercises for teachers to integrate into daily lessons, focusing on active listening, receiving feedback, and building trust.
Co-designed Protocols: School-to-parent and school-to-community communication and support protocols were developed collaboratively to ensure they were culturally relevant and utilized available resources.

4.3 Shift Phase: Maintenance and Iteration
This phase focused on sustainability through continuous improvement. It involved regular check-in meetings for feedback, analysis of referral data, and ongoing reflection to adapt strategies. The process integrated specific lenses for Neurodiversity (e.g., home-visit strategies for students with disabilities), Trauma (e.g., leveraging local social workers with experience in refugee camps), and Cultural Diversity (e.g., psychoeducation on war-related trauma triggers for refugee students).

5. Results and Outcomes

The program yielded both quantitative and qualitative evidence of positive change, with a projected post-intervention wellbeing score of 7.5/10.

5.1 Quantitative Outcomes
Initial analysis indicated an overall 20% increase in wellbeing. The "Discovery" phase, which involved qualitative interviews to map goal-setting roadmaps, produced scores indicating the community's perceived strengths and weaknesses across the 5-Elements (See Table 1).

The extremely low score in Relatability (25%) became a critical finding, highlighting a deep-seated lack of connection, rapport, and understanding of roles within the school and community ecosystem. This data point directly correlated with qualitative findings about teacher-student discipline gaps and parent detachment.

5.2 Qualitative Outcomes
The program successfully established a framework for systemic change.

Desired Changes Identified: The Task Force articulated clear goals, including "avoid shock and provide a strong sense of coping to prevent mental suffering," "increase a sense of collective responsibility," and "prevention of school drop out."
Creation of a Shared Language: The 5-Elements provided a non-pathologizing vocabulary for discussing complex issues like trauma and psychological safety.
Empowerment of Local Leaders: The train-the-trainer model successfully built capacity within the school, with Psychological Safety Officers and Peace Clubs becoming institutionalized assets.

6. Discussion

The success of this pilot program lies in its systemic, proactive, and integrative design. By moving beyond an individual, reactive model, the intervention addressed the interplay between the individual and their environment, consistent with Systems Theory (Bronfenbrenner, 1979). The 20% increase in wellbeing, while preliminary, is a strong indicator that equipping a community with preventive tools and a shared framework can produce measurable positive outcomes.

The quantitative data from the 5-Elements assessment proved invaluable. The identification of Relatability as the most significant deficit allowed the intervention to focus resources on building connection, communication, and trust—factors directly linked to preventing the community's primary concerns of violence and dropout. This data-informed approach ensured that the solutions were targeted and relevant.

Furthermore, the program's explicit integration of trauma-informed and culturally responsive practices was crucial. Acknowledging the history of war trauma among refugee populations and co-designing solutions with local experts (e.g., social workers) ensured that the intervention was not merely a transplant of Western models but was adapted to the unique needs of the community (Kopinak, 2015). The establishment of Peace Clubs and Psychological Safety teams exemplifies Social Learning Theory (Bandura, 1977), where positive behaviors and coping mechanisms are modeled and reinforced by trusted peers and adults.

7. Limitations

The pilot program faced several limitations that should be addressed in future iterations:

Technological and Infrastructural Barriers: Intermittent internet access and technology issues complicated workroom calls and data collection.
Linguistic and Cultural Barriers: The primary language of the surveys and materials was English, which is not the native language for all participants, potentially affecting the nuance of responses.
Lack of a Control Group: As a pilot study, a control group was not used, which limits the ability to attribute all observed changes directly to the intervention.
Reliance on Self-Reported Data: The primary outcomes were based on self-reported surveys, which can be subject to social desirability and other biases.
Limited Access for Surveying: Logistical challenges restricted the scope of data collection with the Task Force and the broader student population.

8. Conclusion and Recommendations

The PLAVIO Uganda-MTC pilot program demonstrates that a systemic, proactive mental health prevention framework can be successfully implemented in a resource-limited, high-trauma school community. The 5-Elements model proved to be an effective tool for both needs assessment and for structuring a multi-level intervention that builds capacity, fosters psychological safety, and improves student wellbeing.

Based on these findings, the following recommendations are proposed:

Scale and Replicate: The model should be scaled to additional schools, incorporating lessons learned from the pilot.
Address Limitations: Future iterations should include professionally translated materials, explore offline or low-bandwidth data collection methods, and seek to establish a quasi-experimental design with a comparison group.
Strengthen Relatability: Targeted interventions focusing on building rapport, trust, and connection between students, teachers, parents, and the community should be a central focus.
Sustain Local Partnerships: Continued investment in local partnerships is essential for long-term success and sustainability, ensuring that the program remains community-owned and culturally congruent.

This case study provides a hopeful and evidence-based roadmap for how communities can move from a state of reaction to one of resilience, truly equipping their youth with the resources they need to thrive.

References

Ackerman, C. E. (2018, May 29). What is self-efficacy theory? (incl. 8 examples & scales). PositivePsychology.com.

Arslan, C., Hamarta, E., & Uslu, M. (2010). The relationship between confrontation, self-esteem and life satisfaction in a sample of Turkish university students. Educational Research and Reviews, 5(1), 31-34.

Baeva, I., & Bordovskaia, N. (2015). [Title of work, if available]. Herzen State Pedagogical University of Russia & St. Petersburg State University. (Note: Specific publication details were not provided in the source material, but the authors and institutions are cited as per the presentation slide).

Bandura, A. (1977). Social learning theory. Prentice Hall.

Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Harvard University Press.

Huo, J.-Y., Wang, X.-Q., Steger, M. F., Ge, Y., Wang, Y.-C., Liu, M.-F., & Ye, B.-J. (2020). Implicit meaning in life: The assessment and construct validity of implicit meaning in life and relations with explicit meaning in life and depression. The Journal of Positive Psychology, 15(4), 500-518. https://doi.org/10.1080/17439760.2019.1639793

Kopinak, J. K. (2015). Mental health in developing countries: Challenges and opportunities in introducing Western mental health system in Uganda. International Journal of MCH and AIDS, 3(1), 22–30.

Tangney, J. P., Baumeister, R. F., & Boone, A. L. (2004). High self-control predicts good adjustment, less pathology, better grades, and interpersonal success. Journal of Personality, 72(2), 271–324. https://doi.org/10.1111/j.0022-3506.2004.00263.x

World Health Organization. (2021, November 17). Adolescent mental health. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health

Zajacova, A., Lynch, S. M., & Espenshade, T. J. (2004). Self-efficacy, stress, and academic success in college. Research in Higher Education, 46(6), 677–706.