2 - (SYM 36) Toward the Next Generation of Universal Prevention in School: Rethinking Cbt-based School Programs for Children's Mental Health

Mental health problems among children and adolescents have been increasing worldwide, underscoring the urgent need for early intervention and prevention strategies. Among preventive approaches, universal school-based programs are a particularly promising avenue considering their scalability and accessibility. Thus, our research team developed the Universal Unified Prevention Program for Diverse Disorders (Up2-D2; Ishikawa et al., 2019), a 12-session intervention grounded in cognitive behavioral and positive psychological principles.

Findings from several open trials indicate promising outcomes of the Up2-D2 program, including enhancement of self-efficacy, reductions in general difficulties, and alleviation of anxiety and depressive symptoms (Kishida et al., 2022, 2023; Oka et al., 2021). More recently, the program has been implemented at a whole-city level in several municipalities and has been adapted and transported to Finnish schools to examine its cross-cultural effectiveness (Mori et al.., 2025).

At the same time, limitations of universal school-based prevention have been increasingly debated (Andrews & Foulkes, 2025). For example, comparatively smaller effects relative to targeted interventions, difficulties in sustaining long-term benefits, and the potential for unintended negative effects. Against this background, this presentation explores the current progress and ongoing challenges of universal prevention for child and adolescent mental health in school contexts.

First, we discuss methodological challenges related to outcome measurement in universal prevention, particularly how to define, detect, and meaningfully interpret effects when effect sizes for mental health outcomes are modest. Second, the challenge of balancing quality control and scalability in real-world implementation is discussed, given the stratified nature of school-based data and the need for pragmatic hybrid trial designs. Third, teachers’ experiences including professional fulfillment and mental health literacy are highlighted as a potentially indispensable yet often-overlooked mechanism for achieving broader and more sustainable effects of universal interventions.

Overall, this presentation seeks to promote international dialogue on the advancement of theory, methodology, and implementation in school-based universal prevention for youth mental health.