4 - (SYM 36) Scaling Cognitive-behavioural-based Intervention (Super Skills for Life) in Schools

Background: Anxiety and depression among adolescents are rising rapidly in low- and middle-income countries (LMICs), yet access to evidence-based cognitive–behavioural interventions remain limited due to workforce shortages and stigma. School-based CBT-based intervention programmes offer scalable solutions, but rigorous trials with long-term follow-up and implementation evaluation remain scarce in LMICs.

Aims: The MyHeRo study aims to (1) evaluate the effectiveness and cost-effectiveness of a school-based CBT-based psychosocial intervention (Super Skills for Life; SSL) delivered by trained school staff in preventing anxiety and depression and improving wellbeing at 12-month follow-up; and (2) examine contextual factors influencing implementation outcomes, including uptake, acceptability, and feasibility.

This presentation reports preliminary implementation findings.

Methods: We are conducting a two-arm cluster randomised controlled trial in 20 secondary schools in poor regions in Malaysia. A total of 428 adolescents (ages 12–14) with moderate to severe anxiety and/or depression will be recruited and classroom-randomised to SSL or a Study-Skills control. SSL is an eight-session, manualised, group-based CBT intervention. Implementation is evaluated using the Consolidated Framework for Implementation Research (CFIR) and RE-AIM framework for complex interventions.

Results: CFIR-based findings indicate high acceptability and appropriateness of SSL, driven by its structured CBT content, cultural relevance, and alignment with national school mental health initiatives. Feasibility was influenced by school-level constraints such as scheduling, attendance, and resources; however, strong leadership engagement, facilitator self-efficacy, and flexible delivery strategies supported implementation.

Conclusions: This study provides one of the first large-scale evaluations of a CBT-based, school-based preventive intervention in an LMIC integrating effectiveness and implementation science. Findings highlight the potential of task-shifting CBT delivery to school staff to promote adolescent mental health and support sustainable scale-up in resource-limited settings.