Cultural adaptation, content, and protocol of a feasibility study of school-based “Let’s learn about emotions” intervention for Finnish primary school children

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.

1 Introduction

Emotional awareness and emotion regulation contribute to cognitive and socio-emotional development and are strongly related to emotional and behavioral difficulties (1). Behavioral problems serve as risk factors for later adverse outcomes, including school disengagement (2, 3). Pupils’ behavioral problems are associated with classroom climate (4), and teachers’ stress (5). School-based interventions aiming to prevent emotional and behavioral problems can be beneficial not only for children and their families but also for schools and teachers. Additionally, cost-effective prevention programs are beneficial at societal levels (6).

Schools are optimal for delivering interventions as they can reach practically all children during a critical period in their cognitive and socio-emotional development. Preventive programs executed in schools follow the ecological theory, which regards different environments as interconnective systems influencing child development (7, 8). Child’s difficulties reflect the contradiction between child’s skills and the environmental demands, and therefore preventive actions should target the entire system (9). Among the theoretical foundations of numerous school-based interventions, the ‘Social Learning Theory’ developed primarily by Bandura and Walters (10), is a key framework. This principle has served as the foundation for numerous interventions designed to shape student behaviors, attitudes, and reactions using well-planned environments and role modeling. Preventive interventions can be universal (primary), selected (secondary) and indicated (tertiary) (11). The aim should not only be the prevention of problems, but the promotion of well-being and acknowledgement of protective factors, as these contribute to building resilience (12). Teaching these skills enhances children’s potential for success socially, academically and in overall in modern life (13). The Finnish government emphasizes the emerging need for preventive measures to support the well-being of children in schools (14).

Children’s learning occurs alongside with peers and teachers. Teacher’s role is crucial when implementing school-based interventions. It has been observed that teacher-delivered preventive interventions are comparable to those which have been additionally delivered by professionals (15). However, teacher education and support need to be sufficient (16). The success of the interventions relies heavily on the implementation (17). The implementation is a multistep process, and several factors impact on these phases: individual and school-level factors such as knowledge and attitudes of the principals and teachers, student material and classroom atmosphere, as well as macro-level factors such as policies, finance, and leadership. The core is however based on the intervention itself, the delivery of the intervention, and the support for the deliverers, often referring to teachers (8).

1.1 Previous studies on school-based interventions for mental health and emotional well-being

Multiple school-based universal intervention programs have been developed to promote mental health and emotional well-being of young children. The majority of interventions designed to prevent common mental health difficulties are based on cognitive behavioral therapy (CBT) (18). Studies that focus on the reduction or prevention of mental health problems and disorders, have shown inconsistent results with only a few studies with strong evidence, most studies with weak evidence, and some with no effect at all (18, 19). Mental health promotion programs, such as social and emotional learning (SEL) Greenberg (20) and positive psychological interventions (PPIs) (21) are shown to be effective in improving social skills, coping skills, help-seeking skills, psychological well-being, emotional regulation, and academic performance, and reduction of emotional problems according to reviews and meta-analyses (22–25). Evidence-based interventions enable the delivery of the highest quality practices to individuals. The importance of good design and execution of interventions has been highlighted (17).

1.2 The original intervention Up2-D2

Many of the previous school interventions have specifically targeted anxiety, depressive symptoms, or behavioral problems (26). However, a Japanese school-based program utilized a transdiagnostic approach targeting both internalizing and externalizing problems at the same time, within the same program. This program, called the Universal Unified Prevention Program for Diverse Disorders (Up2-D2) was developed in Kyoto, Japan (27) by an interdisciplinary team consisting clinical psychologists, developmental psychologists and consulting teachers. There are several features to be noted regarding the development and feasibility studies of the program. The Up2-D2, as a universal unified school-based prevention program, consists of components mainly from CBT, but also from SEL and positive psychology. To address transdiagnostic mental health problems, the program applied a common elements approach, which involves compiling common components derived from evidence-based treatments for diverse disorders. The approach is applicable when the components are separable, independent, and structured (28). Clearly the approach is advantageous when teachers implement the program in their classroom since every class is separated by school timetable and each lesson is organized based on the predetermined curriculum. The Up2-D2 was developed based on accumulated experiences from the previous studies which were implemented by schoolteachers rather than mental health professionals (e.g., clinical psychologists, psychiatrists) for more than two decades [see Ishikawa et al. (29)].

The Up-D2 was developed based on the user-centered design (UCD) for psychosocial interventions (30). Although most previous school-based preventive interventions have focused on a single type of psychopathology, CBT approaches originally share the components between internalizing and externalizing disorders [see Society of Clinical Child and Adolescent Psychology (31)] and theoretically produce a broad paradigm treating gain [e.g. (32)]. To make the most of its gains, the Up2-D2 includes UCD concept during the development phase, in contrast to ordinary adaptation and implementation which are usually addressed after completion of efficacy studies (27). For example, it includes manga for the children to get excited and adhere to the materials to increase its learnability. The program is based on a story-like approach, by presenting and guiding three children who experience different kind of difficulties in their daily lives (i.e., anxiety, depression, and anger), and pupils can learn about different social and emotional skills through the material. Each lesson starts with an introductory manga that provides a preview of the difficulties that the characters encounter. A new skill is taught in every lesson as an “invention” (magic tools) from a “sensei” (master) of emotions, and children can learn each skill collecting all the inventions through the lessons. The program was developed to have a positive orientation, which makes the program more likely to be well-received, for both teachers and students, compared to a program targeted only at-risk students. The program also includes lower cognitive load when compared to targeted CBT-based interventions.

Feasibility studies have shown promising results in actual school settings in Japan, such as significant decreases in pupil and parent-reported mental health symptoms measured by Strengths and Difficulties Questionnaire (SDQ) (33–35). There was improvement in pupil-reported self-efficacy and teacher-reported pupils’ social skills in pre-post assessment before and immediately or 3 months after the program (35). In addition, the Up2-D2 decreased anxiety symptoms in students in 7th grade immediately after the nation-wide school closure due to COVID-19 pandemic (36). Moreover, high satisfaction, understanding, and usability of the Up2-D2 from teachers in elementary schools was obtained compared with that in secondary schools (37).

1.3 Cultural adaptation

The aim of cultural adaptation is to increase the adaptability and feasibility of an intervention (38). This paper indicates what adaptations are essential in the context of universal prevention programs implemented by school teachers in elementary school. Cultural adaptation can be divided into different stages: before the intervention trial, the program should be carefully planned, tested, and enhanced by the piloting results (39). Adapting a CBT-based intervention from East Asian cultural context to Western context is not common and that is the originality in this study. This is because most evidence-based psychosocial interventions for children and adolescents including CBT-based interventions originated in a Western context. Interestingly, the Up2-D2 was developed in East Asian cultural context after importing evidence-based practice from Western countries. This effort could shed light on commonalities and differences in school-based CBT-interventions between East and West. Previously fluent East–West transmission has been experienced with mindfulness-based practices (40).

The aim of this article is to (1) describe the cultural adaptation process and the content of the program as the Japanese school-based program Up2-D2 was adapted to Finnish context; (2) describe the teacher training model based on Japanese experiences but further developed to fit Finnish context; (3) provide information about a feasibility study among Finnish 4th graders (10- to 11-years-old).

2 Methods

2.1 Description of the cultural adaptation process

Bernal et al.’s (41) ecological validity model was used as a guideline in the cultural adaptation process of the intervention. The process of adaptation was as follows (Figure 1): first, all materials from the original Japanese program (27) were translated into Finnish by two translators proficient in both Japanese and Finnish. The Finnish research team consisted of one linguist, mental health professionals (cognitive behavioral therapists, child and adolescent psychiatrists) and educational professionals. After translation, the Finnish research team modified the language to suit the target age group and CBT, and carried out cultural adaptation to ensure the content’s appropriateness for Finnish pupils and teachers. Some cultural differences were detected, such as the emphasis on politeness in the Japanese version, contrasting with the desired assertiveness in the Finnish context. Consultations with teachers and educators were conducted throughout the process. Finally, a one-lesson pilot study was conducted in two classes of 4^th graders (aged 10–11 years) in Turku, Finland, in May 2022. Modifications were made according to the feedback we received from pupils and teachers.

FIGURE 1

Figure 1. The flow diagram of the adaptation process.

2.2 Content of the intervention

“Let’s learn about emotions” (Finnish name “Opitaan tunteista”) is a school-based, teacher-delivered universal program, based mainly on CBT, but also on SEL and positive psychology theories. In each lesson, evidence-based skills representing interventions (Table 1) are taught to pupils. These skills aim to enhance the emotional and behavioral regulation of the pupils and impact positively on their social skills and peer relations. The theoretical background of each lesson has been described in Table 1. Strategies include psychoeducation, behavioral activation, social skills, stress management, cognitive restructuring, gradual exposure, and problem-solving.

TABLE 1

Table 1. Aims and theoretical background for each lesson.

The intervention is aimed to 8- to 12-year-old pupils. The program consists of 12 sessions of 45 min, preferably delivered once a week. The program features three children: Fire heart (Tulisydän), Water heart (Vesisydän), and Earth heart (Maasydän) who are 5th graders with their own characteristics and weaknesses, and a sensei/master character: Great master (Ikivanha) (Figure 2). In each lesson, the children will encounter common problems or difficulties in their lives. Guided by these examples, the topics are introduced to the pupils. The sensei will offer them “magic tools” (inventions) (Table 1), which represent new socio-emotional skills for managing difficult situations. Pupils will participate in individual and group-level writing tasks in every lesson. In addition, they will receive homework designed to help them integrate the learned content into their daily lives (e.g., Lesson 1: “Write down some situation during your week and the emotion you experienced in that situation. Rate how strong that emotion was”). A book was produced for the pupils, providing an interesting and intriguing way to study emotional skills, Figure 2.

FIGURE 2

Figure 2. “Opitaan tunteista – tunnetaitoja koululaisille” (English: Let’s learn about emotions – emotional skills for school children): the Finnish book cover shows the three child manga characters and the master of emotions, as well as the Sensei’s first invention: emotion sensor.

2.3 Teacher training

Teachers’ education was planned to serve the needs of Finnish teachers, including a 2.5-h workshop before the intervention, a teachers’ manual, introductory videos for each lesson and four online support sessions during the spring 2023. The educational workshop contained general information of the intervention and the study, an example lesson (Lesson 1), and introduction of teachers’ manual and videos. Teachers’ manual was created based on the teachers’ materials used in Japan. The manual includes a brief theoretical description of each lesson and the aim of the lesson. Following that, the manual aligns with the pupils’ material providing practical, step-by-step instructions for each lesson. The introductory videos summarize the idea and the content of each lesson in a short and compact way. The length of each video is 1.5–2 min. Online meetings were planned to support teachers’ needs, answer questions, provide peer support comments, and summarize the following lessons. To provide comprehensive assistance to teachers, they have the option to contact the researchers via email, and if necessary, they can also access child psychiatry consultations during the entire intervention.

The aim was to design a comprehensive education and support system for teachers, providing them with sufficient materials while avoiding overburdening them. Teachers’ needs may differ between cultures and countries. Respecting teachers’ competence and autonomy are considered important in Finland. A balance between program fidelity and Finnish teachers’ autonomy was considered when planning their education.

2.4 Methods of the feasibility study

A single-group pretest-posttest design is used in the large ongoing feasibility study with three respondents: pupils, parents, and teachers. There are three repeated measurements, assessments are T0 at baseline, prior to the intervention; T1 immediately after the intervention; and T2 3 to 4 months after the intervention.

2.4.1 Study sample and recruitment

The study was done in the City of Hyvinkää, South of Finland, to pilot the intervention for all the pupils in 4^th grades (aged 10–11 years) in the public elementary schools of Hyvinkää, Finland. In total 36 classes in 14 schools, total 512 4^th graders received the intervention implemented in their normal curriculum in spring semester 2023. All these pupils, their parents and teachers were approached with written information letter regarding the program and the study. Consent forms were administered to parents and teachers. Active assent was observed from the pupils by clearly informing them of the study and voluntary nature of the questionnaires. Each pupil was given the same education regardless of their participation in the study, but only those pupils with a parental consent were able to fill the questionnaires.

2.4.2 Inclusion and exclusion criteria

Inclusion criteria were as follows: (1) pupils who currently enrolled in primary education in a public school located in Hyvinkää, Finland; (2) pupils whose parents granted active consent; (3) pupils who provided assent to participate in the study. Exclusion criteria were as follows: (1) pupils with severe intellectual disabilities; (2) pupils, whose teachers are unable to teach in Finnish and (3) pupils with a very limited understanding of Finnish.

2.4.3 Data collection

Questionnaires for pupils and teachers were self-administered paper questionnaires that were filled in at schools during lessons. Teachers sent an electronic message to each parent, containing a link to university’s secure website. This website contains the information letter, consent form, and the questionnaires.

2.4.4 Outcome assessments

Table 2 presents a detailed overview of the measures used at each assessment point, T0, T1 and T2. Sociodemographic information was collected from pupils (first name, birth month, school, class, gender, and first language), teachers (name, age, gender, class and school), and parents (child’s first name, birth month, class and school).

TABLE 2

Table 2. Overview of measures.

2.4.5 Primary outcome

The primary outcome of this study is pupils’ emotional and behavioral problems following the original study of the Japanese version of this intervention conducted by Oka et al. (35). These emotional and behavioral difficulties were assessed by the self-report, and parent-report version of the Strengths and Difficulties Questionnaire (SDQ) (33). The SDQ is one of the most widely used screening instruments for identifying these difficulties in children and adolescents, with good internal consistency, reliability, and inter-rater agreement in school-aged children (43, 44). The Finnish version of SDQ has also been found to be reasonably reliable among school-aged children, Cronbach’s alfa being 0.71 for total score (45). The SDQ consists of five subscales measuring emotional symptoms, conduct problems, hyperactivity, peer problems and prosocial behavior. The subscales have Cronbach’s alfas varying from 0.57 for conduct disorders to 0.69 for emotional symptoms and prosocial scale among Finnish children (45). Each subscale has five items, each of which is rated 0, 1 or 2 points in accordance with being “absolutely true,” “somewhat true” or “not true.” The total difficulties score ranges from 0 to 40 (excluding prosocial scale which is scored inversely).

2.4.6 Secondary outcomes

To assess the classroom behavioral climate (CBC), we use a shortened version of a Finnish instrument, CBC, which has adequate reliability (46, 47). Pupil and teacher reports of CBC were used in this study. Traditional and cyber bullying and victimization were assessed by pupils (48). Seven questions assessed children’s perception about the school environment (48). Children’s loneliness questions for pupils and parents and Friendships questions for parents have been modified from the Children’s Depression Inventory (CDI) scale (49, 50). Children’s self-reported knowledge of emotional awareness was assessed after 12^th lesson by using a questionnaire created for the purposes of this research by the Finnish research team. The questions test children’s learning and comprehension of the main points of the intervention. Symptoms of depression, anxiety, or conduct problems were not measured separately. Since the intervention is universal, we aimed to measure general outcomes across the whole sample rather than focusing on psychiatric symptoms, which would only have been present in some pupils. SDQ was considered to capture both internalizing and externalizing problems sufficiently.

Acceptability and satisfaction of the intervention were measured post-test (T1) from pupils and teachers using a short questionnaire specially developed for this study, based on the questionnaire used in the Japanese study (35) and Client Satisfaction Questionnaire by Attkisson (51).

Fidelity was assessed with questions for the teachers after each lesson by anonymous fidelity and satisfaction questionnaires, with six questions at T1 as well as through the observation of random lessons on-site. Members of the study group will observe the teaching passively, filling a fidelity checklist. Feasibility is measured based on the proportion of eligible participants who are approached and provide consent to enter the study, the number of dropouts at each assessment point, and the presence of missing items on outcome measures.

2.4.7 Data management

Microsoft Access input forms were used in the data entry process of the children’s and teachers paper questionnaires. Parental reports were filled online on a secure site. All data is stored in protected fileservers of Turku University. These files are secured by daily backups and limited access. The access will be granted for researchers, statisticians, and data managers. After the data collection and entry phase, the data will be anonymized, validated, linked and imported to SAS datasets for statistical analyses.

2.4.8 Statistical analyses

Demographic data will be presented for pupils, parents and teachers separately. Categorical variables will be presented as counts and percentages and continuous variables as means and standard deviations (SD). Outcome variables will be analyzed with linear mixed-effects models with repeated measurements. The respondents (pupil, teacher, parent) will be included in the model as a random effect, if feasible. Changes will be examined for each respondent, for each class, as well as for the total population. Linear contrasts will be used to estimate the changes of each outcome variable from baseline. The five subscales of SDQ will be analyzed separately, and each item the secondary outcome measures will be observed separately. A two-sided value of p of <0.05 will be considered significant.

2.5 Schedule of the study

The intervention was carried out in spring semester 2023. Collection of T0 data was conducted in February 2023, T1 in May and T2 in September 2023.

3 Discussion

This paper details the cultural adaptation and content formulation of a universal school-based intervention centered on socio-emotional skills. The challenge was in adapting the intervention from an Eastern context to suit a Western one. Notably, while the content was tailored to serve Finnish pupils, the distinctive Japanese visual features, which garnered admiration, were preserved.

Within the broader discourse on cognitive-behavioral therapeutic interventions, an atypical trajectory surfaces in this study: the adaptation of a framework that was developed in East Asian culture to fit a Western school environment. Typically, evidence-based psychosocial strategies, particularly those devised for children and adolescents, develop from Western paradigms. This paper describes a reversal from traditional cultural adaptation approaches and provides a way for evaluating school-based CBT methods across both Eastern and Western contexts.

Child mental health problems are one of the key challenges in public health. Providing children with evidence-based early interventions to tackle these challenges has uttermost significance for society. The possibility of the school environment in providing skills training for children on how to cope with and manage emotional and behavioral problems has not been thoroughly studied. Most school programs focused on some specific problem such as bullying. The “Lets Learn about Emotions” program is universal and transdiagnostic, covering a wide range of mental health problems. The program is based on solid theoretical bases, including CBT and positive psychology theories. Evidence-based skills are taught during 12-week curriculum-based intervention. These skills enhance emotional and behavioral regulation in pupils and impact positively on their social skills and peer relations. Teachers play a key role in skills training, providing strong face-to-safe and remote support using workshops, consultations and different types of materials.

There are several limitations to be discussed in the study. Although the program consists of SEL components, it is not a comprehensive SEL program. Participation of parents and community in this intervention was limited. This could be addressed in the future by providing more information and involvement for parents, entire schools and community. Another limitation concerns fidelity. Whereas we examined fidelity by teacher reports and observation, we did not include pupil’s perspective. Fidelity comprises also the attitudes and how teachers model the skills from the program in their own behavior. These limitations can be exploited in the future research. Fidelity checks could also be built in the program itself in the future.

Teaching emotional and social skills is educating the children for life, rather than aiming only for academic achievements. Schools offer an ideal place to provide a universal program aiming at improving these skills. The present study provides information about the feasibility of teaching emotional and social skills in elementary school settings. This implicitly challenges the current role of school system, which primarily aims to teach academic skills, by additionally educating children to cope with emotional and behavioral problems. If the promising feasibility findings reported in the original Japanese study are replicated in Finland, this will give strong reasoning for further efficacy and implementation research both in Western and non-Western societies, aiming to enhance coping skills, awareness, and early prevention of child mental health problems in a real-world context.

Ethics statement

The studies involving humans were approved by the Ethics Committee for Human Sciences at the University of Turku. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.

Author contributions

AS: Conceptualization, Funding acquisition, Methodology, Project administration, Resources, Supervision, Writing – original draft, Writing – review & editing, Validation. SI: Conceptualization, Methodology, Project administration, Resources, Supervision, Writing – original draft, Writing – review & editing, Validation. TS: Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing, Validation. KK: Resources, Writing – review & editing, Validation. YM: Methodology, Project administration, Validation, Writing – original draft, Writing – review & editing. KM: Resources, Validation, Writing – review & editing. XZ: Writing – review & editing NH: Resources, Validation, Writing – review & editing. TK-L: Methodology, Validation, Writing – review & editing. TR: Methodology, Validation, Writing – review & editing. ST: Validation, Writing – review & editing. SG: Methodology, Writing – review & editing. SH-Y-S: Data curation, Methodology, Resources, Writing – review & editing. HS: Methodology, Supervision, Writing – review & editing. VN: Methodology, Supervision, Writing – review & editing.

Funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The study is funded by the Academy of Finland and Invest Flagship program.

Acknowledgments

We would like to thank the schools of Hyvinkää for everyone’s valuable participation in the study. We would also like to thank all the members of the research group, both in Japan and in Finland.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

1. Compas, BE , Jaser, SS , Bettis, AH , Watson, KH , Gruhn, MA , Dunbar, JP, et al. Coping, emotion regulation, and psychopathology in childhood and adolescence: a meta-analysis and narrative review. Psychol Bull. (2017) 143:939–91. doi: 10.1037/bul0000110

PubMed Abstract | CrossRef Full Text | Google Scholar

2. Olivier, E , Morin, AJ , Langlois, J , Tardif-Grenier, K , and Archambault, I . Internalizing and externalizing behavior problems and student engagement in elementary and secondary school students. J Youth Adolesc. (2020) 49:2327–46. doi: 10.1007/s10964-020-01295-x

PubMed Abstract | CrossRef Full Text | Google Scholar

3. Sourander, A , Jensen, P , Davies, M , Niemelä, S , Elonheimo, H , Ristkari, T, et al. Who is at greatest risk of adverse long-term outcomes? The Finnish from a boy to a man study. J Am Acad Child Adolesc Psychiatry. (2007) 46:1148–61. doi: 10.1097/chi.0b013e31809861e9

PubMed Abstract | CrossRef Full Text | Google Scholar

4. Wang, MT , Degol, JL , Amemiya, J , Parr, A , and Guo, J . Classroom climate and children’s academic and psychological wellbeing: a systematic review and meta-analysis. Dev Rev. (2020) 57:100912. doi: 10.1016/j.dr.2020.100912

CrossRef Full Text | Google Scholar

5. Friedman-Krauss, AH , Raver, CC , Neuspiel, JM , and Kinsel, J . Child behavior problems, teacher executive functions, and teacher stress in head start classrooms. Early Educ Dev. (2014) 25:681–702. doi: 10.1080/10409289.2013.825190

PubMed Abstract | CrossRef Full Text | Google Scholar

6. Bodden, DH , van den Heuvel, MW , Engels, RC , and Dirksen, CD . Societal costs of subclinical depressive symptoms in Dutch adolescents: a cost-of-illness study. J Child Psychol Psychiatry. (2022) 63:771–80. doi: 10.1111/jcpp.13517

PubMed Abstract | CrossRef Full Text | Google Scholar

7. Bronfenbrenner, U . Toward and experimental ecology of human development. Am Psychol. (1977) 32:513–31. doi: 10.1037/0003-066X.32.7.513

CrossRef Full Text | Google Scholar

8. Domitrovich, CE , Bradshaw, CP , Poduska, JM , Hoagwood, K , Buckley, JA , Olin, S, et al. Maximizing the implementation quality of evidence-based preventive interventions in schools: a conceptual framework. Adv School Ment Health Promot. (2008) 1:6–28. doi: 10.1080/1754730X.2008.9715730

PubMed Abstract | CrossRef Full Text | Google Scholar

9. Apter, SJ , and Conoley, JC . Childhood behavior disorders and emotional disturbance: an introduction to teaching troubled children. Englewood Cliffs, NJ: Prentice-Hall (1984).

Google Scholar

10. Bandura, A , and Walters, RH . Social learning theory. Englewood cliffs, NJ: Prentice-Hall (1977).

Google Scholar

11. Mrazek, PJ , and Haggerty, RJ . Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington, D.C: National Academy Press (1994).

Google Scholar

12. Powers, JD . Ecological risk and resilience perspective: a theoretical framework supporting evidence-based practice in schools. J Evid Based Soc Work. (2010) 7:443–51. doi: 10.1080/15433714.2010.509216

PubMed Abstract | CrossRef Full Text | Google Scholar

13. OECD . (2015). Skills for social progress: the power of social and emotional skills. OECD Skills studies.

Google Scholar

14. Finnish Government (2021). Education policy report of the Finnish government.

Google Scholar

15. Sklad, M , Diekstra, R , Ritter, MD , Ben, J , and Gravesteijn, C . Effectiveness of school-based universal social, emotional, and behavioral programs: do they enhance students’ development in the area of skill, behavior, and adjustment? Psychol Sch. (2012) 49:892–909. doi: 10.1002/pits.21641

CrossRef Full Text | Google Scholar

16. Shelemy, L , Harvey, K , and Waite, P . Meta-analysis and systematic review of teacher-delivered mental health interventions for internalizing disorders in adolescents. Ment Health Prev. (2020) 19:200182. doi: 10.1016/j.mhp.2020.200182

CrossRef Full Text | Google Scholar

17. Durlak, JA , Weissberg, RP , Dymnicki, AB , Taylor, RD , and Schellinger, KB . The impact of enhancing students’ social and emotional learning: a meta-analysis of school-based universal interventions [article]. Child Dev. (2011) 82:405–32. doi: 10.1111/j.1467-8624.2010.01564.x

PubMed Abstract | CrossRef Full Text | Google Scholar

18. Caldwell, DM , Davies, SR , Hetrick, SE , Palmer, JC , Caro, P , López-López, JA, et al. School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis [article]. Lancet Psychiatry. (2019) 6:1011–20. doi: 10.1016/S2215-0366(19)30403-1

PubMed Abstract | CrossRef Full Text | Google Scholar

19. O’Connor, CA , Dyson, J , Cowdell, F , and Watson, R . Do universal school-based mental health promotion programmes improve the mental health and emotional wellbeing of young people? A literature review [article]. J Clin Nurs. (2018) 27:e412–26. doi: 10.1111/jocn.14078

PubMed Abstract | CrossRef Full Text | Google Scholar

20. Greenberg . (2023). Evidence for social and emotional learning in schools. Available at: banksiagardens.org.au

Google Scholar

21. Seligman, MEP , and Csikszentmihalyi, M . Positive psychology [article]. Am Psychol. (2000) 55:5–14. doi: 10.1037/0003-066X.55.1.5

CrossRef Full Text | Google Scholar

22. Bolier, L , Haverman, M , Westerhof, GJ , Riper, H , Smit, F , and Bohlmeijer, E . Positive psychology interventions: a meta-analysis of randomized controlled studies [article]. BMC Public Health. (2013) 13:119–9. doi: 10.1186/1471-2458-13-119

PubMed Abstract | CrossRef Full Text | Google Scholar

23. Corcoran, RP , Cheung, ACK , Kim, E , and Xie, C . Effective universal school-based social and emotional learning programs for improving academic achievement: a systematic review and meta-analysis of 50 years of research [article]. Educ Res Rev. (2018) 25:56–72. doi: 10.1016/j.edurev.2017.12.001

CrossRef Full Text | Google Scholar

24. Goldberg, JM , Sklad, M , Elfrink, TR , Schreurs, KMG , Bohlmeijer, ET , and Clarke, AM . Effectiveness of interventions adopting a whole school approach to enhancing social and emotional development [article]. Eur J Psychol Educ. (2019) 34:755–82. doi: 10.1007/s10212-018-0406-9

CrossRef Full Text | Google Scholar

25. Payton, J. , Weissberg, R. P. , Durlak, J. A. , Dymnicki, A. B. , Taylor, R. D. , Schellinger, K. B., et al. (2008). The positive impact of social and emotional learning for kindergarten to eighth-grade students: findings from three scientific reviews. Technical report. In Collaborative for academic, social, and emotional learning [report].

Google Scholar

26. Caldwell, DM , Davies, SR , Thorn, JC , Palmer, JC , Caro, P , Hetrick, SE, et al. School-based interventions to prevent anxiety, depression and conduct disorder in children and young people: a systematic review and network meta-analysis. Public Health Res. (2021) 9:1–284. doi: 10.3310/phr09080

CrossRef Full Text | Google Scholar

27. Ishikawa, SI , Kishida, K , Oka, T , Saito, A , Shimotsu, S , Watanabe, N, et al. Developing the universal unified prevention program for diverse disorders for school-aged children. Child Adolesc Psychiatry Ment Health. (2019) 13:44–15. doi: 10.1186/s13034-019-0303-2

PubMed Abstract | CrossRef Full Text | Google Scholar

28. Marchette, LK , and Weisz, JR . Practitioner review: empirical evolution of youth psychotherapy toward transdiagnostic approaches. J Child Psychol Psychiatry. (2017) 58:970–84. doi: 10.1111/jcpp.12747

PubMed Abstract | CrossRef Full Text | Google Scholar

29. Ishikawa, S , Kishida, K , Takahashi, T , Fujisato, H , Urao, Y , Matsubara, K, et al. Cultural adaptation and implementation of cognitive-behavioral psychosocial interventions for anxiety and depression in Japanese youth. Clin Child Fam Psychol Rev. (2023) 26:727–50. doi: 10.1007/s10567-023-00446-3

PubMed Abstract | CrossRef Full Text | Google Scholar

30. Lyon, AR , and Koerner, K . User‐centered design for psychosocial intervention development and implementation. Clin. Psychol.: Sci. Pract. (2016) 23:180. doi: 10.1111/cpsp.12154

CrossRef Full Text | Google Scholar

31. Society of Clinical Child and Adolescent Psychology (2017). Effective child therapy: evidence-based mental health treatment for children and adolescents. Available at: https://effectivechildtherapy.org/ (Accessed 22 July 2023)

Google Scholar

32. Kendall, PC , O’Neil Rodriguez, KA , Villabø, MA , Martinsen, KD , Stark, KD , and Banneyer, K . Cognitive-behavioral therapy with children and adolescents In: J Ehrenreich-May and BC Chu, editors. Transdiagnostic treatments for children and adolescents: principles and practice. New York: Guilford (2012). 161–82.

Google Scholar

33. Goodman, R . The strengths and difficulties questionnaire: a research note [article]. J Child Psychol Psychiatry. (1997) 38:581–6. doi: 10.1111/j.1469-7610.1997.tb01545.x

CrossRef Full Text | Google Scholar

34. Kishida, K , Hida, N , and Ishikawa, SI . Evaluating the effectiveness of a transdiagnostic universal prevention program for both internalizing and externalizing problems in children: two feasibility studies. Child Adolesc Psychiatry Ment Health. (2022) 16:9. doi: 10.1186/s13034-022-00445-2

PubMed Abstract | CrossRef Full Text | Google Scholar

35. Oka, T , Ishikawa, SI , Saito, A , Maruo, K , Stickley, A , Watanabe, N, et al. Changes in self-efficacy in Japanese school-age children with and without high autistic traits after the universal unified prevention program: a single-group pilot study. Child Adolesc Psychiatry Ment Health. (2021) 15:42–11. doi: 10.1186/s13034-021-00398-y

PubMed Abstract | CrossRef Full Text | Google Scholar

36. Kishida, K , Hida, N , Matsubara, K , Oguni, M , and Ishikawa, S . Implementation of a transdiagnostic universal prevention program on anxiety in junior high school students after school closure during the COVID-19 pandemic. J Prev. (2023) 44:69–84. doi: 10.1007/s10935-022-00709-9

PubMed Abstract | CrossRef Full Text | Google Scholar

37. Kishida, K , Hida, N , Matsubara, K , Abe, N , Kira, Y , Takebe, M, et al. Development of a teacher-delivered transdiagnostic universal prevention program for adolescents and examining its usability by teachers. Ment Health Prev. (2022) 28:200252. doi: 10.1016/j.mhp.2022.200252

CrossRef Full Text | Google Scholar

38. Bernal, G , Jiménez-Chafey, MI , and Domenech Rodríguez, MM . Cultural adaptation of treatments: a resource for considering culture in evidence-based practice. Prof Psychol Res Pract. (2009) 40:361–8. doi: 10.1037/a0016401

CrossRef Full Text | Google Scholar

39. Barrera, M Jr, Castro, FG , Strycker, LA , and Toobert, DJ . Cultural adaptations of behavioral health interventions: a progress report. J Consult Clin Psychol. (2013) 81:196–205. doi: 10.1037/a0027085

PubMed Abstract | CrossRef Full Text | Google Scholar

40. Kirmayer, LJ . Mindfulness in cultural context. Transcult Psychiatry. (2015) 52:447–69. doi: 10.1177/1363461515598949

CrossRef Full Text | Google Scholar

41. Bernal, G , Bonilla, J , and Bellido, C . Ecological validity and cultural sensitivity for outcome research: issues for the cultural adaptation and development of psychosocial treatments with Hispanics. J Abnorm Child Psychol. (1995) 23:67–82. doi: 10.1007/BF01447045

PubMed Abstract | CrossRef Full Text | Google Scholar

42. Ishikawa, S-i, Kamio, Y. Universal Unified Prevention Program for Diverse Disorders (Up2-D2): Worksheets for students and manual for teachers [Unpublished manuscript]. Doshisha University: Kyoto, Japan.

Google Scholar

43. Muris, P , Meesters, C , Eijkelenboom, A , and Vincken, M . The self-report version of the strengths and difficulties questionnaire: its psychometric properties in 8- to 13-year-old non-clinical children [article]. Br J Clin Psychol. (2004) 43:437–48. doi: 10.1348/0144665042388982

PubMed Abstract | CrossRef Full Text | Google Scholar

44. Stone, LL , Otten, R , Engels, RCME , Vermulst, AA , and Janssens, JMAM . Psychometric properties of the parent and teacher versions of the strengths and difficulties questionnaire for 4- to 12-year-olds: a review [article]. Clin Child Fam Psychol Rev. (2010) 13:254–74. doi: 10.1007/s10567-010-0071-2

PubMed Abstract | CrossRef Full Text | Google Scholar

45. Koskelainen, M , Sourander, A , and Kaljonen, A . The strengths and difficulties questionnaire among Finnish school-aged children and adolescents. Eur Child Adolesc Psychiatry. (2000) 9:277–84. doi: 10.1007/s007870070031

PubMed Abstract | CrossRef Full Text | Google Scholar

46. Hoffmann, L , Närhi, V , Savolainen, H , and Schwab, S . Classroom behavioural climate in inclusive education – a study on secondary students’ perceptions [article]. J Res Spec Educ Needs. (2021) 21:312–22. doi: 10.1111/1471-3802.12529

CrossRef Full Text | Google Scholar

47. Närhi, V , Kiiski, T , and Savolainen, H . Reducing disruptive behaviours and improving classroom behavioural climate with class-wide positive behaviour support in middle schools [article]. Br Educ Res J. (2017) 43:1186–205. doi: 10.1002/berj.3305

CrossRef Full Text | Google Scholar

48. Sourander, A , Klomek, AB , Ikonen, M , Lindroos, J , Luntamo, T , Koskelainen, M, et al. Psychosocial risk factors associated with cyberbullying among adolescents: a population-based study. Arch Gen Psychiatry. (2010) 67:720–8. doi: 10.1001/archgenpsychiatry.2010.79

CrossRef Full Text | Google Scholar

49. Kovacs, M . Rating scales to assess depression in school-aged children. Acta Paedopsychiatr. (1981) 46:305–15.

PubMed Abstract | Google Scholar

50. Lempinen, L , Junttila, N , and Sourander, A . Loneliness and friendships among eight-year-old children: time-trends over a 24-year period. J Child Psychol Psychiatry. (2018) 59:171–9. doi: 10.1111/jcpp.12807

CrossRef Full Text | Google Scholar

51. Attkisson, CC . The Client Satisfaction Questionnaire (CSQ) Scales In: LL Sederer and B Dickey, editors. Outcome assessment in clinical practice. Baltimore, MD: Williams & Wilkins (1996)

Google Scholar