We are the Association for Child and Adolescent Mental Health or ACAMH for short. And this is ACAMH Learn. [MUSIC PLAYING] Hello. I am Jean-Francois Trani, a Professor at the School of Public Health at Washington University in St. Louis, United States. I will introduce today our Child Resilience in Afghanistan study or CRAS aimed at improving child mental health and learning outcomes and reducing stigma and discrimination in a conflict setting, namely Afghanistan. So let me first start talking about the crisis and the gap in mental health in conflict settings. Existing research, primarily from high income countries has shown that social and emotional learning interventions can significantly improve academic achievement and psychosocial well-being. Yet evidence remains scarce and lacks a rigorous scientific basis for children living in low income countries, and particularly in conflict and crisis contexts. Actually for over four decades, children in Afghanistan have grown up amidst harm, violence, and pervasive poverty. These chronic stressors are powerful social determinants of poor mental health, including high rates of anxiety, depression, and trauma. Despite this acute need of children, Afghanistan faces a massive shortage of specialised mental health services, with only an estimated 100 psychiatrists serving the entire nation in 2019, and probably less now that many fled the country after the Taliban took over the government. Furthermore, mental illness remains highly stigmatised, often leaving children to suffer in silence to avoid shame. So what is the study design and what is our task shifting approach? To address this gap, our team of researchers conducted a clustered, randomised-controlled trial across 83 rural primary schools in the province of Badakhshan, Ghazni, and Thakkar of Afghanistan. The trial involved over 3,800 children in grades 3 through 6, along with their teachers and their parents. A defining feature of this study was its task-shifting approach. Rather than relying on rare specialists, the intervention was delivered by locally recruited field staff who were trained by the authors for 12 days, myself, spending a lot of time in Afghanistan across the years. The strategy aimed to create a viable, scalable model for closing the mental health treatment gap in resource poor conflict zones. So what is the intervention? It's a multisystem strategy. The intervention used a ecological approach, recognising that a child well-being is tied to their home, to their school, and their community. The programme consisted of three main components. First, a week long classroom training for teachers and children together focusing on social and emotional learning, mindfulness, and stress management. Second, a one day family engagement component to equip parents with tools for positive, non-punitive discipline and emotional support. Third, community-based system dynamics workshops where school stakeholders, students, teachers, and parents in separate workshops co-constructed a shared mental model of childhood well-being and provided feedback about the intervention and how it may improve child mental well-being. All materials were culturally adapted, replacing abstract concepts with local analogies, such as for instance, replacing an exercise about decision-making, looking at what tool the child take with him and his team if they were to explore a desert island after a ship wreckage. We don't have sea in Afghanistan. Therefore, we shifted the example towards a scenario where a child is in a car breaking down, either in a desert like Ghazni province or in Afghan mountains context, like Badakhshan. And we ask the same questions, what will you take with you? You're allowed one item per person. Do you decide to wait for help? Or do you decide to go to request support? And the child has to show leadership, critical thinking, and decision-making. So this was one of 42 activities. Key findings and the impact of dosage. The results revealed that while there were no overall treatment effects on mental health for the full sample, significant gains were achieved in academic outcomes. Children in the intervention group showed marked improvements in reading literacy, mathematical literacy, and mathematical problem-solving. Additionally, the programme significantly reduced school-based discrimination. One of the most critical findings related to intervention dosage. In schools that completed the programme within 90 days, about three months, children showed significant reductions in depression and anxiety, as well as improved life skills and learning outcomes. However, in schools where the intervention lasted longer than 90 days, these benefits often plateaued or even reversed as the external political environment grew more restrictive. So we also studied gender differences, political context, and the unique contribution of a study. The study highlights the profound impact of the Taliban takeover in 2021. While boys saw significant decline in depression and anxiety, girls exhibited less mental health improvement compared to the control group. We attribute this gender disparity to the increasingly restrictive social environment and the banning of girls' education, which likely negated the intervention's psychosocial benefits for female students. Despite these external shocks, girls still showed significant academic gains in reading and mathematics, proving that supportive classroom environments remain vital even in times of political upheaval. To conclude, what is the roadmap for the future? The unique contribution of this study lies in its scale being the largest trial of its kind in a conflict setting, and its proof that non-specialised local community members can successfully deliver effective mental health support even during a period of total national regime change. It demonstrates that community-led, school-based interventions are feasible and effective way to protect the development of children in crisis. By investing in these local, scalable strategies, we can ensure that even children living in the most difficult circumstances have a chance to learn, to heal, and hope for a better future. Thank you for your attention. [MUSIC PLAYING]