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The target coverage rates used in the model are taken from the goals for 2030 agreed at the 74th World Health Assembly (WHA) in April 2021, namely “a 40 percentage point increase in effective coverage of refractive error by 2030” (WHO, 2021c).
For the ROI estimates in this report, the time period for the scale-up of interventions is 2021 to 2030 and the coverage rates are the same for males and females aged 10–14 and 15–19 years. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The modelling reported here differs from that in Sweeny, Muirhead and Hennessy (2023), which covered all age groups.
Using data on the prevalence of myopia and these coverage rates, the model estimates the numbers of adolescents treated by age, sex and severity of condition.
Using disability weights from the GBD database, it also calculates the number of life years saved, using DALYS and years of sight saved (YSS). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Under the assumptions outlined, reaching the WHA goal for refractive error in the 19 countries and territories would result in treating 2 261 802 female and 2 036 030 male adolescents, as shown in Table A2.21 in Annex 2.
These estimates were used to calculate the economic benefits associated with this improvement in eye health. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These benefits arise from improved labour force participation and productivity among working-age patients and improved educational participation and learning by school-age patients.
It is important to note that the additional benefits derived from savings to the health system, along with other intrinsic benefits such as increased social participation, were beyond the scope of this model. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
As such, the benefit estimates provided in this report should be considered a conservative estimate of the total economic benefits of improving eye health.
These calculations use demographic projections from the UN (2019), labour force participation rates from the ILO (2021), and GDP and similar economic data from the World Bank (2023b).
26 Adolescents in a changing world. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
26 Adolescents in a changing world.
The case for urgent investment The costs of interventions to achieve the target eye health outcomes were calculated by taking the unit cost of treatment and multiplying this by the number of persons treated, including a factor for an eye-health screening programme.
The unit costs were country-specific estimates provided by the FHF. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
As stated earlier, it is common with estimates of cost and benefits in the future that they are both discounted at the standard rate of 3% as recommended by the World Bank.
The discount rate applied represents the economic notion that a dollar in the future is worth less than a dollar today, and is standard in this type of modelling.
Discounting in this way means that benefits and costs are expressed in NPV terms. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The usual way of comparing benefits to costs is the BCR in which discounted benefits are divided by discounted costs.
The estimated benefits, costs and BCRs from a myopia treatment programme for adolescents in the 19 countries and territories are given in Table 2.5 (and Table A2.22 in Annex 2). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
In NPV terms, an expenditure of US$ 9092 million for treating myopia in adolescents would generate an economic benefit of US$ 191 429 million, resulting in an unweighted and weighted BCR of 13.0 and 21.1, respectively.
This BCR is similar to those in other studies using the same methodology across a range of health conditions other than eye health.
In our study, the BCRs for the 19 countries and territories range from 3.6 to 38.6 (as shown in Table A2.22 in Annex 2). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The modelling approach used here is described in more detail in the report to the FHF (Sweeny, Muirhead and Hennesy, 2023).
Table 2.5 Myopia in adolescents, summary of benefits and costs ($ million), and BCRs, 3% discount rate Status Economic benefit Cost BCR unweighted average BCR weighted average Upper middle-income countries 153 763 5 759 22.1 26.7 Lower middle-income countries 35 315 2 893 14.9 12.2 Low-income countries 2 351 441 4.8 5.3 Total 191 429 9 092 13.0 21.1 Source: Estimates from modeling. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
27 3.
Building connectedness, agency and resilience 3.
Building connectedness, agency and resilience Connectedness, resilience and agency are critical to good mental health.
Their absence can lead to anxiety and depression.
However, making the case for increased investment in building connectedness or improving agency and resilience can be challenging. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This chapter addresses this challenge by exploring the existing literature and offering a case study to demonstrate that significant economic benefits can be estimated from the impact of targeted interventions.
The links between connectedness, socioemotional capabilities, mental health and academic attainment provide a possible quantifiable pathway. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Taking this pathway can lead to a realization of the high economic returns to be achieved by investing in intervention programmes to reduce mental disorders and improve academic performance.
Connectedness is a term used to describe the important qualitative components of adolescent well-being, such as the sense of belonging at home, school and in the community.
Agency provides adolescents with a sense of empowerment to get on and do things in life. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Resilience is the capacity to overcome challenges and survive setbacks.
While different in nature, they are just as fundamental to adolescent well-being as more quantifiable attributes of well-being, such as skills, education and access to health services.
They are also the central concepts for Domains 2 (connectedness, positive values and contribution to society) and 5 (agency and resilience) in the UN H6+ conceptual framework for adolescent well-being (Ross et al., 2020). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Section 3.3 presents a case study based in part on the results of SEHER, a multi-component whole-school health promotion intervention in Bihar, India (Shinde et al., 2018).
The case study estimates a BCR of 25.6.
It reflects the combined effects of the intrinsic value of improved mental health and, even more importantly, from an economic perspective, the improved school performance that can result in better employment outcomes. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
To our knowledge, it is the first such study to estimate a BCR linking school connectedness to social and economic outcomes through mental health and education.
Before presenting the results of the case study, sections 3.1 and 3.2 discuss some of the interventions developed to improve connectedness, agency and resilience and the attempts to evaluate the cost- effectiveness of such interventions. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The discussion is based on scoping reviews conducted for this report on the effectiveness and cost-effectiveness of programmes to promote adolescents’ connectedness to family, school, peers and community (section 3.1), and programmes to promote adolescents’ agency and resilience (section 3.2).
With the exception of socioemotional learning and some specific intervention programmes to address deviant and criminal behaviour, there are very few investment evaluation studies employing cost-benefit analysis. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The Belfield et al.
(2015) study of components of socioemotional learning provides estimates of cost and benefits, which permits BCRs in the range of 3.5 to 13.9 to be derived.
3.1 Connectedness Connectedness means a sense of being cared for and supported as well as the feeling of belonging and closeness with others that comes from protective and sustained relationships within four main areas: family, school, peers and community (Blum et al., 2022). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Of these four, family connectedness and school connectedness have been shown to be the most powerful predictors of various indicators of adolescent maladjustment, such as emotional distress, suicidal ideation, violence and substance use (Resnick et al., 1997).
3.1.1 Family connectedness Blum et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
3.1.1 Family connectedness Blum et al.
(2022) indicated that, compared with less connected peers, adolescents who are connected to at least one parent experience fewer emotional problems (Ungar, 2004), fewer suicide attempts (Kuramoto-Crawford, 2017), fewer conduct disorders, better school performance (Gonzalez-DeHass, 2005), higher self-esteem, less involvement in violence (Farrell et al., 2010) and reduced substance use (Wills et al., 2003).
28 Adolescents in a changing world. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
28 Adolescents in a changing world.
The case for urgent investment Intervention programmes to support connectedness include parenting programmes and family therapy programmes.
Parenting programmes, such as the Triple P (Positive Parenting Program) in the United States of America and other countries, seek to provide greater support to parents and include parent training in discipline styles to deal with parent-teenager conflict and parental depression (Mihalopoulos et al., 2007; Sampaio et al., 2018). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Triple P was found to have positive impacts for both parents and adolescents.
Multi-systemic therapy (MST) programmes and functional family therapy (FFT) programmes have been used to reduce adolescent criminal behaviour and recidivism of those paroled or in rehabilitation.
MST is a multifaceted short-term home and community-based intervention, which has been used widely in HICs to address a range of adolescent problem behaviours.
However, a systematic review of MST by Littell et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
(2021) found that the benefits of MST are not well established nor consistent.
They concluded that its benefits may have been overstated.
Furthermore, to date, the trials of MST have only been conducted in Western, Educated, Industrial, Rich and Democratic countries (WEIRD), and the interventions may have different effectiveness in non-WEIRD countries.
FFT programmes have been estimated to provide a net economic benefit (Taxy et al., 2012). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
However, a systematic review of FFT for families (Littell et al., 2023) found no evidence of the effects of FFT compared with other active treatments.
Proponents have suggested substantial cost savings, but the Littell et al.
(2023) review indicates that the analysis was based on a narrow range of outcomes that may produce inflated estimates of treatment effects. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
3.1.2 School connectedness School connectedness indicates that students are confident that peers and adults in their school support, value and care about their individual well-being as well as their academic progress (CDC, 2022).
It has a positive association with school attendance, retention and academic performance (McNeely et al., 2003; Klem and Connell, 2004; Rosenfeld et al., 1998; Battin-Pearson et al., 2000; Barber et al., 1997). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
It was also found to be the strongest protective factor for both boys and girls to decrease substance use, school absenteeism, early sexual initiation, violence and risk of unintentional injury (for example, drinking and driving and not wearing seat belts) (Resnick et al., 1997). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
School connectedness during adolescence may also have long-lasting protective effects across a range of adult health outcomes including emotional distress, suicidal ideation, physical violence victimization and perpetration, multiple sex partners, STI diagnoses, prescription drug misuse and other illicit drug use (Steiner et al., 2019).
SEL encompasses broad-based programmes with multiple objectives that include connectedness, agency and resilience. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
They are generally embedded into a school curriculum and aim to help reduce risky behaviours such as violence and drug abuse (Durlak 2011; CASEL 2003).
They also form part of programmes designed to enhance non-cognitive skills and improve, among other things, academic performance (Gutman and Schoon, 2013a).
Taylor et al.
(2017) conducted a systematic review and meta-analysis of 82 school-based, universal SEL interventions, largely in the United States of America. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
This involved 97 406 kindergarten to high school students.
The study assessed outcomes at six months to 18 years post-interventions and found that there were significant positive effects with intervention participants having stronger SEL skills than those in the control group.
Other studies reported by Durlak et al.
(2011) and Zins, Weissberg et al.
(2004) demonstrate that SEL programmes can enhance academic achievement and attainment through improved school attendance, engagement, and motivation. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Belfield et al.
(2015) presented the costs and benefits of some specific SEL programmes based on the results of various studies conducted in Sweden and the United States of America. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
An outline of these is presented as follows: The 4Rs (Reading, Writing, Respect, and Resolution) programme focuses on SEL and literacy development from kindergarten to year five of primary school to ameliorate aggression and violence; The Positive Action programme, which is based on the theory that positive action makes us feel good and so becomes self-reinforcing, is a school-based curriculum and supplemental set of school cultural and family activities designed to promote students’ positive thinking, actions, and self-concept; 29 3. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Building connectedness, agency and resilience LST is a school-based classroom intervention to reduce harmful substance use and violence, generally delivered to at-risk students in middle and/or high school (age range of approximately 11–18 years); Second Step is a classroom-based social skills curriculum for preschool through to junior year of high school (year 12 of schooling, age 16–17 years), with a distinct curriculum for each grade; and Responsive Classroom is a pedagogical approach focusing on how teachers both teach and interact with elementary school students (age range of approximately 6–11 years). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
It is designed to provide teachers with strategies, structures, practices and techniques to improve their self-efficacy, to impact student social and emotional, academic and non-academic outcomes and to build a strong school community.
The estimates of BCRs across the interventions ranged from 3.5 to 13.9, with a median of about ten and an average NPV per 100 participants of US$ 618 380 (Belfield et al., 2015, p46). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The results are based on the development of SEL skills and how these skills influence future earnings.
Belfield et al.
(2015) proposed that these outcomes are mediated through changes in educational achievement and they established a framework for estimating the value of SEL skills in developed countries.
Major SEL intervention programmes have sought to address school connectedness by improving the school climate and providing comprehensive health promotion. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These have included the Australian Gatehouse Project and the Indian SEHER programme covering 75 schools in Bihar, India.
The Gatehouse Project was developed to address some of the limitations in earlier school health promotion work, building on whole-school change programmes.
The major aims were to increase levels of emotional well-being and reduce rates of substance use, known to be related to emotional well-being (Patton et al., 1998; Resnick et al., 1997). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The SEHER programme, when delivered by lay counsellors rather than teachers, “showed large effects on improving school climate and a range of health-related outcomes including depressive symptoms, bullying, violence, attitude towards gender equity and knowledge of reproductive and sexual health, compared with both the standard life skills intervention and the teacher-delivered intervention” (Shinde et al., 2018, p2466). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
3.1.3 Peer connectedness Peer connectedness is defined as perceptions of support, genuine caring and trust in one’s peer group (Bernat and Resnick, 2009).
Although they can sometimes be sources of pressure for antisocial behaviour, peers are often major influencers for pro-social behaviours (Resnick et al., 1997; Oldfield et al., 2016).
Young people who have strong peer relationships have better social and emotional functioning than their more isolated age-mates (Oldfield et al., 2016). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Sports-based development programmes are assumed to promote socioemotional skills, improve psychological well-being and foster traits that boost labour force productivity.
Beaman et al.
(2021) partnered with an international non-governmental organization to randomly assign 1200 young adults in Liberia to a sports and life skills development programme.
The study did not find any evidence of improved psychosocial outcomes or resilience. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
It did, however, find evidence that the programme caused a 0.12 standard deviation increase in labour force participation.
Secondary analysis suggests that the effects are strongest among those likely to be most disadvantaged in the labour market.
One intervention programme, the Teen Connection Project, was created for high school students in the United States of America to help improve the quality of their peer relationships (Humphrey, 2022). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
For the intervention, students would meet in small groups for discussions guided by a trained facilitator.
Over time, the initiative aimed to demonstrate to students that their peers could be healthy sources of support.
Four months after the group sessions concluded, the students who received the intervention displayed lower levels of depressive symptoms and higher levels of academic engagement than control group members (Allen et al., 2021). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
3.1.4 Community connectedness Community connectedness reflects social cohesion.
Adolescent perceptions of connectedness are measured by: neighbourhood safety; adult willingness to act if they see vandalism or criminal activity in the neighbourhood; the extent to which people in the neighbourhood look out for each other; a personal sense of belonging in the community; and having a voice in the community (Blum et al., 2022).
30 Adolescents in a changing world. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
30 Adolescents in a changing world.
The case for urgent investment One successful programme is CTC, a multi-country programme originating in Washington state, United States of America.
It has a five-step programme: get started get organized, develop a community profile, create a community action plan and implement and evaluate.
Communities implementing CTC first complete five phases of training and an installation process over 12 to 18 months. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The interventions are not pre-specified but left up to the communities to choose ones of particular local relevance.
Kuklinski et al.
(2021) estimated the sustained impacts and long-term benefits and costs of the CTC prevention system.
This was evaluated in a longitudinal cluster-randomized trial involving 24 communities in seven states within the United States of America. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The study found that CTC had a statistically significant global effect on primary outcomes, and also on combined primary and secondary outcomes.
A cost-benefit analysis provided estimates of net benefit per participant of US$ 7152, increasing to US$ 17 919 when secondary impacts (e.g., earnings) were included.
While CTC has been evaluated as cost-effective, this was not an evaluation of any specific intervention since the selection of intervention(s) depended on local community choice. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
However, other studies have shown that community-driven development (White et al., 2018) had no impact on social cohesion or governance.
3.1.5 Review of the economic evaluation literature The primary aim of the scoping reviews discussed in this chapter was to identify studies that reported full economic analyses such as benefit-cost, cost-effectiveness or other cost analyses relating to connectedness including social capital and social relations for adolescents. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
A search to identify peer-reviewed literature in any language was conducted in six databases (Medline, PubMed, CINAHL, PsychInfo, Cochrane Library, Web of Science) in accordance with the PRISMA guidelines, as well as a search of the TUFTS registry of cost-effective analysis studies.
Fifteen articles were identified: seven from the selected databases, two from the TUFTS registry and six from other sources (Open Grey Database, GoogleScholar.com and Google.com using keywords).
Most were from HICs. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Most were from HICs.
Only two were from LMICs and LICs.
Almost all the studies focussed their outcomes on deviant behaviour, such as harmful substance use and alcohol use, and five had a crime focus (four about recidivism).
One study (Moodie et al., 2009) included consideration of school dropout and adult offending.
A Ugandan study by Tozan et al.
(2022) examined disruptive behaviour disorders and had a focus on interventions with family groups. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Thirteen studies (nine were based on RCTs) included an economic evaluation and the two other studies only reported economic costs.
Dopp et al.
(2014), for instance, undertook a benefit-cost study of multisystemic therapy for serious juvenile offenders, obtaining a BCR of 5.04 in savings to taxpayers and crime victims over 25 years. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
In summary, the outcomes of the scoping review were that: studies with well-developed economic evaluations tended to be for narrow outcomes, such as harmful substance use, disruptive behaviours and criminal activity (four intervention programmes with cost-benefit analysis were focussed on recidivism); studies concentrated on adolescent problems rather than an assessment of preventive or promotive programmes; none examined how increased connectedness impacted employment; and studies tended to focus on males rather than females. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
3.2 Agency and resilience Agency has been described as multidimensional (Vijayaraghavan et al., 2022) and its interpretations can vary across contexts.
Kabeer (1999) defined agency as “the capacity to make choices and the power to act on those choices, especially to claim and voice rights” (p439).
It can assist an adolescent to conceptualize a goal and then work towards achieving it. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Resilience is defined as the capacity to adapt to change or disruptions (Vidyarthi et al., 2021) and is associated with the characteristic of hardiness.
Resilience does not so much imply an invulnerability to stress, but rather an ability to recover from negative events (Garmezy, 1991; Fonagy et al., 1994).
An adolescent’s resilience is determined by the extent of agency that they have.
31 3. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
31 3.
Building connectedness, agency and resilience Resilience can be anticipatory (the ability to prepare and avoid the impact of shocks), absorptive (the ability to absorb, cope with and buffer the impact of shocks), adaptive (the ability to adapt to future risks) and transformative (the ability to make changes that help reduce the underlying causes of risks) (Vidyarthi et al., 2021). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
As with connectedness (Domain 2 of the Adolescent Well-being Framework), there have been some valuable studies on the role of agency and resilience in adolescent well-being over the past two decades, including both empirical work and programme development and implementation.
Individual characteristics, as well as social and economic factors, affect a person’s agency and resilience. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Many programmes have been developed, and in some cases evaluated, to address these factors, as listed below: SEL programmes (discussed above under connectedness, but they have strong links to agency and resilience).
Programmes, often with a focus on gender relations, such as Champions for Change (Plan International, 2023) and the Access, Services and Knowledge (ASK) (CIN, 2016) and Program H (Doyle and Kato-Wallace, 2021).
These are discussed later in the chapter. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These are discussed later in the chapter.
For economic factors, UNICEF’s UPSHIFT programme (UNICEF, 2023b) has been implemented in many countries.
There are many multisectoral programmes, especially in Africa, such as the Adolescent Girls Initiative (Austrian et al., 2020), incorporating violence prevention, education, health and wealth creation.
This initiative has been the subject of a cost-effectiveness evaluation.
Singh et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Singh et al.
(2022) provide an evidence map of a range of interventions for women’s empowerment in LMICs.
These included economic interventions, capacity building interventions (such as LST, technical and vocational training, business training and information and communications technology [ICT] training).
Several of the interventions have been included in our study, however, some are related to older women, not adolescents, and were therefore excluded.
Maiorano et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Maiorano et al.
(2021) developed a method to measure empowerment, which includes a direct measurement of decision-making, defined as the ability to make choices; a measure of whether people have reasons to value those choices; and a measure of the role that prevailing social norms play in determining people’s ability to make strategic life choices.
3.2.1 Factors affecting agency and resilience A range of factors impact both agency and resilience. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
They can be affected by individual factors such as self-identity, which is determined by “their age, religion, ethnicity and sex, their sexual orientation, gender identity and expression (SOGIE), where they live and whether they are disabled” (Vidyarthi et al., 2021, p2); or by macro-level factors such as policies, laws, sociocultural norms and economic forces (Blum et al., 2014). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
To have agency, an adolescent needs to possess: self-efficacy (belief in their capacities and ability to succeed); self-esteem (their overall sense of self-worth); a sense of mattering (feeling of being important/significant); and the experience of bodily autonomy (right to governance over one’s body) in an environment free from all forms of gender-based violence (GBV) and discrimination.
They also need to feel connected at home, in schools, with peers, in communities and online. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The self-identity of adolescents can be determined by deep-rooted social and gender norms (Ricker and Ashmore, 2020).
Girls, in particular, have limited agency in contexts where females are not valued or social norms (such as child marriage) limit their potential to achieve agency.
Girls, particularly in poor regions, may have truncated educational opportunities (UNFPA, 2012) or be regarded as economic commodities to settle familial debts or disputes (Parsons et al., 2015). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Unequal power structures that limit an adolescent’s choice and opportunities, including aspects such as gender norms, sexuality, mobility, participation and decision-making and access to and control over resources, limit the sense of self-identity and agency.
A range of factors have been identified as supporting resilient outcomes for adolescents across different sociological domains (Gartland et al., 2019). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These include individual factors such as coping style, cognition, optimism and self-esteem (e.g., Ben-David and Jonson-Reid, 2017); positive family relationships and social connectedness within the family (Ben-David and Jonson-Reid, 2017; Marriott et al., 2014); and community factors, including social connectedness within the family (Fantuzzo et al., 2012).
32 Adolescents in a changing world.
The case for urgent investment Wilson et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The case for urgent investment Wilson et al.
(2021) identified risk factors as including poverty, violence and marginalization while youth education was identified as a protective factor.
Vidyarthi et al.
(2021) included lack of parental involvement, bullying, violence and low self-esteem/self-image as risk factors.
These can impact adolescents’ cognitive, social and emotional development and negatively affect learning, competence and educational achievement.
Vidyarthi et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Vidyarthi et al.
(2021) added that, as is the case with health and nutrition, there is a two-way link between education and agency and resilience.
Saleem and Mevawala (2019) and Frankenberg et al.
(2013) indicated that education is a protective factor that helps cultivate skills to enhance agency and resilience and plays a role in coping with disasters over the longer term. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
However, it is also acknowledged that education itself and education policies can lead to inequalities (UNICEF, 2016) and there is evidence that rising inequalities in education can increase the risk of conflict.
Bullying can impact children’s short- and long-term physical and emotional development, school performance and mental and physical health. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
3.2.2 Interventions to improve agency and resilience Individual factors Interventions for individual factors include the provision of information, access to services, access to resources and those that help build social and emotional or non-cognitive skills and enhance SEL.
The focus of SEL is on the process of acquiring the attitudes, competencies, knowledge and skills essential for learning, being effective and having a sense of well-being. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
We have already noted the importance of social and emotional skills for a child’s development, enabling them to respond appropriately to social interactions.
These are often regarded as soft skills and personality traits. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Heckman and colleagues have demonstrated the importance of cognitive and socioemotional factors, which they defined as traits such as conscientiousness, self-control and self-discipline (Heckman et al., 2014), in determining favourable educational and lifetime earnings outcomes (Heckman and Kautz, 2012).
The curriculum of Promoting Alternative Thinking Strategies (PATHS) aimed at elementary school children is an exemplar of school-based SEL programmes (Humphrey et al., 2018). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
PATHS teaches self-control, emotional awareness and social problem-solving skills.
A recent meta-analysis shows that the programme improved grades by 0.33 standard deviations and achievement test scores by 0.27 standard deviations (Durlak et al., 2011). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Interventions for social factors Some major interventions for addressing social factors include: Plan International’s Champions of Change for Gender Equality and Girls’ Rights programme, which is active in 41 countries, most of which are LICs and MICs, and aims to advance gender equality through youth engagement (Plan International, 2023); the Yes I Do programme of the Yes I Do Alliance, which aims to enable adolescent girls to decide if, when and with whom they marry and have children, and to protect them from FGM/cutting (Kakal et al., 2016; Yes I Do, 2018); and the ASK programme of the Youth Empowerment Alliance, which seeks to improve the SRH rights of young people (15–24 years) by increasing their uptake of SRH services in Kenya, Uganda, Ethiopia, Ghana, Senegal, Pakistan and Indonesia (CIN, 2016). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Other programmes include Program H (Doyle and Kato-Wallace, 2021), the Adolescent Girls’ Initiative (AGI) (Austrian, et al., 2020), BRAC’s Women’s Empowerment programme in Uganda (Bandiera et al., 2020), Positive Youth Development programmes (Roth and Brooks-Gunn, 2016) and a programme to assist victims of the Lord Resistance Army suffering from post-traumatic stress (van Reisen et al., 2018).
These are discussed briefly in turn. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
These are discussed briefly in turn.
Program H engages young men to help change gender norms related to masculinities that perpetuate gender inequality (Doyle and Kato-Wallace, 2021).
The programme seeks to promote SRH rights and to prevent violence against women and girls.
It is now used globally in around 36 countries and has been named best practice by the World Bank and WHO (Doyle and Kato-Wallace, 2021). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The Doyle and Kato-Wallace (2021) review of the evidence related to Program H included three RCTs, nine quasi-experimental designs and two pre-post evaluations (without a comparison group) with sample sizes ranging from 100 to more than 3000.
Overall, the review found that Program H had produced positive changes in young men’s gender attitudes in most, but not all settings.
More gender-equitable attitudes 33 3. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
More gender-equitable attitudes 33 3.
Building connectedness, agency and resilience among participating young men were found in nine of the 14 studies reviewed.
No costing or cost-benefit analysis was undertaken.
A study in Northern Uganda for victims of the Lord Resistance Army suffering from post-traumatic stress compared the effect on economic development of existing government-initiated social protection programmes (cash and in-kind) with a trauma counselling programme. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The study found that the effect of the trauma counselling programme on income and social economic resilience was higher than the effect of the social protection programmes.
The study had aimed to include a cost-benefit analysis but was unable to complete it (van Reisen et al., 2018).
The AGI–Kenya (AGI-K) programme comprised interventions that were delivered to over 6000 girls aged 11–15 years in two marginalized areas of Kenya (Kibera [urban] and Wajir [rural]). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The interventions aimed to build social, education, health and economic assets for girls as well as improve household economic assets in the medium-term.
This would lead to delayed childbearing in the longer term.
Austrian et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Austrian et al.
(2020) described the four interventions of the AGI-K as follows: The Violence Prevention (V) intervention included community dialogues and action plans with a key group of adult stakeholders in each community meeting regularly to discuss the challenges facing girls in their area then developing and implementing a plan to address at least one of those challenges. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The Education (E) intervention was a conditional cash transfer (CCT) that included a bimonthly payment to the household, direct payment of a portion of school fees and a schooling kit for the girls.
All incentives were conditional on the girl’s enrolment and regular attendance at school.
The Health (H) intervention included weekly girls’ group meetings or safe spaces facilitated by a young woman from the community, which covered a range of health and life-skills topics. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The Wealth Creation (W) intervention included financial education (FE) within the group meetings as well as savings accounts in the urban site and home banks in the rural site.
In evaluating the effectiveness of the interventions, Austrian et al.
(2020) found that in Kibera, at the end of the two-year intervention, girls in the three packages with CCT had improved rates of primary school completion and transition to secondary school. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
They had also improved outcomes in a range of SRH knowledge measures, although it did not affect the acceptability of intimate partner violence.
In Wajir, the education results were similar but there was no significant impact on SRH knowledge.
A cost-effectiveness and benefits valuation study in Kibera indicated a monetary benefit of US$ 55 per girl and US$ 94 per out-of-school girl in Wajir.
Kangwana et al.
(2022) also studied the AGI–K intervention, quantifying favourable results for the programme. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
BRAC’s women’s empowerment programme developed in Uganda included the provision of: hard vocational skills to enable adolescent girls to start small-scale income-generating activities and what are referred to as soft life skills to build knowledge, enabling girls to make informed choices about sex, reproduction and marriage.
Bandiera et al. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Bandiera et al.
(2015) evaluated the programme and found that four years post-intervention, adolescent girls in treated communities that had received the programme were more likely to engage in income-generating activities and that teen pregnancy had fallen by a third.
The study also provided the costs and benefits of the programme.
Catalano et al.
(2018) systematically reviewed Positive Youth Development programmes in LMICs. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Their study found that 60% of the 35 programmes with rigorous evaluation demonstrated at least one positive effect on behaviours, including harmful substance use and risky sexual activity and/or more distal developmental outcomes such as employment and health indicators. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
3.3 Case study – connectedness, in search of economic evaluations of its impact 3.3.1 Introduction to case study The Lancet Commission on Adolescent Health and Wellbeing recommended schools as a setting for promoting adolescent health and well-being (Patton et al., 2016).
Broad-based programmes addressing connectedness have generally been school-based.
These are variants of socioemotional learning 34 Adolescents in a changing world. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The case for urgent investment programmes that have included positive action, life skills and initiatives directed at changing the school climate to achieve a greater sense of belonging (Patton et al., 2000).
Given the difficulty of directly measuring the relationship between connectedness and economic outcomes, there are few evaluations of programmes addressing the economic implications of connectedness and certainly none for LICs or LMICs of which we are aware. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
One way of measuring this relationship is to use indirect methods, such as the potential links between connectedness and school climate, school climate and mental health measures and mental health and academic outcomes as a way of establishing measurable relationships between connectedness and other variables that can be evaluated from an economic perspective.
In developing this case study, we had two objectives. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
One was to identify the evidence for the impact of intervention programmes, such as socioemotional learning, on connectedness and school climate so as to improve mental health and education outcomes.
The second was to use the results obtained by the SEHER study to estimate the costs and benefits of extending the SEHER study to the state of Bihar. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The SEHER study reported a substantial reduction in depression rates with an effect size of -1.19 arising from the intervention, but it did not attempt to estimate its economic implications through education outcomes or the monetized value of its health effects.
For our study, first, we derived an estimate of the intrinsic value of the health effects through the reduction in disease burden as measured by DALYs. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Second, we used the results of the meta-analyses of the outcome of SEL programmes (Durlak et al., 2011; Taylor et al., 2017; Corcoran et al., 2018) to estimate the likely impact on academic performance.
Third, we modelled these effects to estimate the BCR for the SEHER intervention for Bihar, India.
3.3.2 School climate and connectedness The SEHER study owes part of its design to the pioneering school-based Gatehouse Project aimed at improving school climate. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The Gatehouse Project provided each school with an assessment of its school climate based on three targeted areas of social interaction: security, social connectedness and gaining positive regard through valued participation (Patton et al., 2000).
There are few studies of similar broad-based intervention programmes in LICs or LMICs linking connectedness to mental health and education outcomes. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The SEHER programme is one of the few large-scale programmes examining the impact of an intervention to improve school climate on mental health outcomes.
SEHER programme SEHER involved a three-arm RCT designed to assess the effectiveness of a multi-component whole-of-school intervention programme for grade nine students in government-run secondary schools in Bihar, India. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The intervention programme was compared with the standard government-run, classroom-based life skills Adolescence Education Programme (AEP).
In one intervention arm, the SEHER programme was conducted by classroom teachers while the other was run by lay counsellors.
The programme run by lay counsellors was more effective.
The teacher-run programme provided little improvement over the AEP (Shinde et al., 2018).
The programme ran for two years and was evaluated after eight and again at 17 months. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The measured effects of the interventions after 17 months were significantly higher than after eight months.4 Only the effects after 17 months are shown in Table 3.1. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The lay counsellor programme had a marked effect on the school climate (measured by the Beyond Blue School Climate Questionnaire), radically altering the relationships between students, teachers and the administration through a programme of meetings, workshops, speak-out boxes and a wall magazine as well as general assemblies conducted by the principal. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The lay counsellor programme had a marked positive effect on school climate and depressive symptoms, attitude towards gender equity, knowledge of SRH and frequency of bullying as shown in Table 3.1.
4.
Except for knowledge of SRH which was marginally lower.
35 3.
Building connectedness, agency and resilience Table 3.1 Results from SEHER lay counsellor intervention after 17 months Outcomes Adj.
mean difference Adj. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
mean difference Adj.
mean difference 95% CI Effect size SMD Effect size 95% CI School climate 7.33 6.60 to 8.06 p<0.001 2.33 1.97 to 2.50 p<0.001 Depressive symptoms -4.64 -5.83 to -3.45 p<0.001 -1.19 -1.56 to -0.82 p<0.001 Attitude towards gender equity 1.02 0.65 to-1.40 p<0.001 0.53 0.27 to 0.79 p<0.001 Knowledge of SRH 0.28 0.09 to 0.48 p=0.004 0.15 0.03 to 0.26 p=0.016 Frequency of bullying -2.77 -3.40 to -2.14 p<0.001 -2.22 -2.84 to -1.60 p<0.001 Notes: SMD is standard mean difference. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
CI is confidence interval.
Source: Shinde et al.
(2020).
The impact of the lay counsellor interventions on school climate was especially large (effect size = 2.33), indicative of the degree of change in the school’s overall operations towards a more participatory environment.
The effects on bullying (effect size = -2.22) and depressive symptoms (effect size = -1.19) were also significantly large. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
A further study of the programme results sought to distinguish the mediating role of school climate on depressive symptoms, experience of bullying and perpetration of violence through three of its subcomponents (relationships at school, sense of belonging, commitment to academic achievement and participation in school events) in three separate models (Singla et al., 2021). | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
The study used path models and mediation software to estimate the impact of school climate on the three outcomes: depressive symptoms, experience of bullying and perpetration of violence.
Each was found to have a good fit. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |
Each was found to have a good fit.
Overall, the results showed that: A positive school climate, characterized by supportive and engaged relationships with teachers and peers and a sense of belonging and active participation, would lead to lower rates of depressive symptoms, experiences of bullying, and perpetration of violence.
(Singla et al., 2021, p97) While the impact on school climate and its impact on mental health was large and significant, the study did not extend to education outcomes. | https://transfered-docs-lawep.s3.amazonaws.com/thematic1e/rr/1726050126293.pdf | https://www.unfpa.org/sites/default/files/pub-pdf/adolescents-in-a-changing-world---the-case-for-urgent-invesment.pdf |