| Eligibility criteria |
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More narrowly defined age and clinical criteria, assessed by brief standardised tools: (i) enrolled in grades 9–12; (ii) proficient in written/spoken Hindi; (iii) referral was not primarily for a learning difficulty; and (iv) clinically elevated presentation indicated by YTP item score ≥6 or SDQ Impact score ≥2.
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Handouts (see below) distributed to students falling below these thresholds.
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Criteria (i) to (iii) were retained.
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Criterion (iv) modified as follows: clinically elevated presentation indicated by SDQ Total Difficulties score in Borderline/Abnormal range (≥19 boys, ≥20 girls); SDQ Impact score ≥2; SDQ chronicity item >1 month.
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| Theoretical components |
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| Content/delivery |
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Problem solving was the main practice element, delivered through guided self-help.
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Printed self-help materials substantially re-designed, with more attractive, colourful illustrations and professional design; shorter and simpler text.
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Problem-solving steps presented using the acronym ‘SONGS’: identify a problem situation (S); identify options (O) to solve the problem; narrow down the options by considering pros and cons (N); go for it by trying out the best option (G); sit back and evaluate the outcome (S).
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Workbook: new structure (‘learn it, practice it, do it’) applied across each step of problem solving to encourage learning and generalisation from workbook exercises; more varied, realistic vignettes.
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Handouts: updated set of 13 handouts structured around SONGS to facilitate integration with workbook; topics included study skills, relaxation, effective communication, stress management, anger management, bullying, understanding love, sexuality, domestic violence, eating healthy, sleep hygiene, making a career choice and managing grief.
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Problem solving retained as main practice element, but delivered through active, counsellor-led face-to-face intervention.
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Problem-solving steps presented using the acronym ‘POD’: identify and prioritise distressing/impairing problems (‘Problem identification’); generate and select coping options to modify the identified problem directly (problem-focused strategies), and/or to modify the associated stress response (emotion-focused strategies) (‘Option generation’); implement and evaluate the outcome of this strategy (‘Do it’).
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Three psychoeducational ‘POD booklets’ explained problem solving through illustrated stories in comic book format.
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Each booklet described a different problem-solving step and suggested corresponding practice exercise; these were distributed sequentially to reinforce learning from sessions and encourage skills practice.
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Emotion-focused coping strategies presented as potential options in ‘quick tips’ section of booklets; tips were selected from the most commonly used handouts in Pilot 1 and were no longer matched to presentations.
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At the final session, participants received a full-colour POD poster that summarised the three steps of problem solving.
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| Providers |
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Therapists: three (one per school) female psychologists with postgraduate degrees; deployed with the intention that non-specialists would take over at a later stage of piloting.
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Three counselling assistants recruited to help with sensitisation, processing of referrals and issuing session reminders.
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Supervision structure initially expert-led, with peer group supervision taking up increasing share of the weekly 3-hour allocation.
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Therapists: newly recruited counsellors, including nine college graduates (both males and females) aged above 18 years with no prior training in psychotherapy.
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Attended weekly 2-hour peer group supervision meetings, in which they discussed one or two audio-recorded sessions and rated session quality using a structured scale.
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Weekly telephone calls (up to 30 minutes) with supervisors (psychologists from Pilot 1) to monitor caseload and manage risk; option for ad hoc calls as needed.
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Counsellors were also responsible for co-facilitating classroom sensitisation activities with a researcher.
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Counsellors received separate manuals for delivering the problem-solving intervention and sensitisation session.
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| Dosing |
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Standard duration of Step 1 extended to 6 weeks, with proactive efforts to schedule face-to-face guidance sessions at weeks 1, 2, 4 and 6.
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Flexibility around 2 additional meetings (up to a maximum of 6), according to student need and preference.
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Rapid delivery schedule with 4–5 sessions (20-30-minute duration) delivered over 3–4 weeks.
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Flexibility around exact number and spacing of sessions, but emphasis placed on ‘front-loading’ contacts in order to build therapeutic momentum.
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| Methods for tailoring |
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Idiographic problem measure (YTP) used as a method for selecting relevant handouts at intake (also part of eligibility screening).
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Session-by-session YTP ratings shared in graphical format and used as basis for collaborative discussions about need for additional guidance sessions.
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Progress assessed using simplified mood and problem measures, incorporating ‘emojis’ on a 5-point Likert scale.
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As before, ratings were tracked and reviewed at each session in a graphical format and informed intervention schedule and supervisory discussions.
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| Sensitisation plan |
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Classroom sessions offered a ‘taster’ of problem solving (focused on academic stress) in order to: (i) satisfy demand among students with more transient problems; (ii) socialise students to problem solving; and (iii) provide clear information to students about methods and intended outcomes of school counselling.
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Interested students approached the psychologist directly to initiate a referral.
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Whole-school sensitisation activities included briefings with school principals and teachers in order to: (i) focus referrals on clinically elevated presentations; and (ii) encourage teachers to discuss referrals with students before passing on details.
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Re-designed classroom sessions emphasised self-identification and normalisation of mental health problems.
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Structured around animated video which provided age-appropriate information about types, causes, impacts and ways of coping with common mental health problems, followed by guided group discussion.
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Students received a self-referral form with normalising information and question-based prompts to assist with self-identification of mental health problems.
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Self-referral could be initiated in person, via the self-referral form, or by depositing a slip with the student's name into a drop-box.
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Whole-school sensitisation involved more structured/scripted briefings for school staff.
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