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Abstract
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Before
This randomized controlled trial evaluates a school-based mental health and psychosocial support (MHPSS) program for adolescents in conflict-affected regions of Armenia. The intervention combines nine months of teacher mentoring, access to a tech-supported platform for tailored recommendations, and a referral system for specialized psychological services. Three arms are compared: (1) mentoring plus tech support and referrals; (2) mentoring and referrals only; and (3) control. The study includes 450 schools and over 22,000 students and assesses impacts on students’ mental health, emotional well-being, social-emotional skills, and academic outcomes. The evaluation informs policy decisions on the scalability and cost-effectiveness of tech-enabled MHPSS in fragile contexts.
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In conflict-affected settings, schools become the primary institution responsible for supporting children's psychosocial recovery, effectively expanding the education production function beyond academic learning to include mental health and social-emotional development. Yet teachers in these contexts are typically trained only to deliver academic content and lack the skills to identify or address the psychological needs of trauma-exposed students. This mismatch between what schools are expected to produce and what teachers are equipped to deliver represents a critical deficit in the human capital of the teaching workforce—one with potentially compounding consequences, as untreated mental health conditions impair concentration, attendance, peer relationships, and learning. Understanding whether investments in teachers' psychosocial capacity can improve student outcomes, and what complementary inputs are needed, is a first-order question for education policy in the growing number of countries affected by conflict and crisis.
This paper investigates these questions through a randomized controlled trial across 450 schools and over 30,000 students and more than 3,800 in conflict-affected regions of Armenia. The core intervention provides nine months of specialized mentoring designed to equip teachers with the skills to integrate mental health and psychosocial support (MHPSS) into classroom practice. Trained mentors work directly with teachers over three phases of decreasing intensity, building capacity to recognize signs of distress, implement supportive classroom activities, and refer students with greater needs to specialized psychological services. This component directly targets the teacher skill constraint.
To test whether the returns to these skill investments depend on the information environment in which teachers operate, we cross-randomize access to a technology platform within the treatment group. The platform collects structured data from mentor observations and generates tailored, data-driven activity recommendations for individual teachers. By reducing the cost of acquiring and processing student-level information, the platform may allow teachers to allocate their newly acquired psychosocial skills more efficiently, matching support to the students and situations that need it most. The cross-randomization design allows us to distinguish between two hypotheses: that the binding constraint on effective psychosocial support in schools is teacher skill alone, or that even skilled teachers face information frictions that limit the productivity of their efforts.
Our primary outcomes are students' mental health and academic performance. We trace mechanisms through social-emotional skills, teacher support, peer environment, and educational aspirations. We also examine teacher-level outcomes to understand whether the intervention transforms how teachers engage with their expanded role. The findings contribute to the literature on teacher effectiveness and the production of non-cognitive skills, the economics of mental health in developing countries, and the broader question of when technology complements—rather than substitutes for—human expertise in education.
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JEL Code(s)
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I12, I15, I25, J15, O15
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Last Published
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August 04, 2025 06:24 AM
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April 09, 2026 09:28 PM
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Intervention (Public)
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Before
The MHPSS program is a scalable, needs-based initiative targeting teachers and students in grades 5 through 7. It includes three key components:
(1) 9 months of specialized training and mentorship to support teachers in integrating MHPSS tools into classroom activities. Mentors provide 20 hours of support per week in the first 3 months (phase 1), 5 hours of support per week in the second 3 months (phase 2), and mostly remote support in the last 3 months (phase 3).
(2) Access to an online platform with tailored, data-driven recommendations for teachers, starting in phase 2.
(3) Referral system for specialized support from school psychologists for children with greater needs.
The second component involves an a tech-supported mentor feedback loop for teachers, which is a web-based intervention that uses KoboToolbox for structured data collection from mentors and a Shiny dashboard for visualizing insights and generating activity recommendations for teachers.
This component ensures sustained support and complements lighter mentorship in later phases, promoting ongoing teacher development and the intervention’s long-term effectiveness. This platform is being developed and will be beta-tested during the first wave with a subgroup of teachers. Moreover, we will use the data from the first wave and second wave to train the algorithm of the platform.
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After
The intervention is a school-based mental health and psychosocial support (MHPSS) program designed to integrate psychosocial tools into classroom instruction for students in grades 5 through 7. Developed in partnership with the Armenian Ministry of Education, Science, Culture and Sports (MoESCS) and the Teach for Armenia Foundation, the program targets both displaced children from Nagorno-Karabakh and host students in Armenian public schools. The program deliberately avoids explicit "mental health" framing in school communications, a design choice made in consultation with the Ministry to navigate stigma and facilitate parental acceptance.
The program operates through a mentor-centered delivery model and consists of three components:
Component 1: Mentor-led teacher training and in-classroom support. Trained mentors work alongside teachers to build their capacity to integrate MHPSS activities into daily instruction. The program draws on a database of over 62 psychosocial activities spanning different subjects, grade levels, durations, and activity types. These activities were designed with the support of international and local mental health experts and local curriculum specialists, taking the roll-out of the current national curriculum into consideration. The mentoring follows a phased structure over nine months with gradually decreasing intensity:
Phase 1 (Months 1-3): Full-time intense training. Mentors engage with teachers for 40 hours per week (5 hours per day, 4 days per week). The first month focuses on group training sessions after classes and in-classroom support, where mentors introduce MHPSS tools and observe their application. In the second month, out-of-classroom support shifts toward personalized one-on-one discussions with individual teachers requiring additional assistance. The third month consolidates learning, with increased in-classroom support and brief individual check-ins to ensure all teachers can integrate the tools into their teaching.
Phase 2 (Months 4-6): Part-time mentorship and monitoring. Mentor support reduces to 10 hours per week, focused primarily on in-classroom observation, feedback, and guidance. The mentor's role evolves toward ensuring adoption and fostering teacher autonomy in implementing the MHPSS tools.
Phase 3 (Months 7-9): Light support and follow-up. Mentors conduct monthly school visits and weekly phone-based check-ins. This phase is designed to reinforce practices, troubleshoot implementation challenges, and prepare school staff to continue MHPSS activities independently after the program ends.
Component 2: Referral system for specialized support. Children identified as requiring additional support are referred to school psychologists for specialized services according to their needs. The school psychologist provides continuity in referral services, while the principal ensures institutional support for MHPSS integration beyond the program period.
Component 3: Activities recommendation tool (cross-randomized within treatment). A key implementation challenge is activity selection: teachers must eventually choose independently from the database of 62+ psychosocial activities, a task that field observations suggest is difficult given the breadth of options and heterogeneity of classroom contexts. To test whether data-driven guidance can improve activity-context matching, access to a technology platform is cross-randomized within treated schools.
The tool is a web application in which teachers input five classroom parameters (number of students, subject area, grade level, duration, and preferred activity type) and receive a ranked list of recommended activities. Rankings are based on a composite score weighting activity effectiveness (based on mentor evaluations), fit with the teacher's classroom parameters, and teacher-reported preferences from prior usage. Activity data are collected by mentors through structured journals administered via KoboToolbox, processed via Google Sheets, and served to the web application. All tool usage (logins, activities viewed, activities saved, and activities implemented) is tracked by the team.
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Primary Outcomes (End Points)
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Student mental health (stress, anxiety, depression)
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Mental health (stress, anxiety, depression)
Academic performance (math and Armenian language)
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Primary Outcomes (Explanation)
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Mental health is measured using two complementary instruments. The first is the Depression, Anxiety, and Stress Scale for Youth (DASS-Y; Szabo and Lovibond, 2022), a 21-item scale adapted for the Armenian context and validated for children and adolescents aged 7–18. The instrument comprises three subscales of seven items each, measuring depression, anxiety, and stress separately. The second instrument is the Library of Universal Mental Health Instruments (LUMI), developed by the Child Mind Institute's Global Center for Child and Adolescent Mental Health. LUMI is a free, multilingual, and culturally sensitive assessment tool designed for individuals aged 3 to 24, offering reliable measurement across multiple mental health domains, adapted and validated for the Armenian context. We administer the anxiety, depression, and PTSD modules.
Academic performance is measured using grade-specific assessments in Armenian Language and Mathematics, developed specifically for this study by curriculum specialists in collaboration with the Ministry of Education.
We may additionally include clinical assessments as a third instrument, contingent on approval by the Ministry of Education. If approved, these assessments will be conducted by psychologists trained in the instrument by specialists from the Republican Pedagogical-Psychological Center (RPPC).
Academic performance is measured using grade-specific assessments in Armenian Language and Mathematics, developed specifically for this study by curriculum specialists in collaboration with the Ministry of Education.
DASS-Y and academic performance data will be collected at midline (after six months of the intervention) and endline (at the end of the nine months of the intervention). LUMI will be collected at endline only across the three waves. Clinical assessments, if approved, may be conducted at endline in waves 2 and 3.
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Experimental Design (Public)
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Before
The first experimental group (T1) will receive 9 months of intervention, which includes all activities from the three components described earlier. In addition to the teacher training and in-classroom support from mentors, as well as the referral system, teachers in schools assigned to this group will also receive tailored, data-driven recommendations from the tech-supported mentor feedback loop. We will pilot the platform during the first wave of the study and make any necessary adjustments based on the results. Therefore, this experimental group will participate in waves 2 and 3 only. The total number of schools assigned to this treatment group will be 75 (3,750 students and 825 teachers and school staff, approximately), with half in wave 2 and half in wave 3.
The second experimental group (T2) will receive 9 months of intervention, including activities from components 1 and 3 described earlier (training and in-classroom support from mentors, as well as the referral system). This group will be included across all three waves of the study. In total, we will have 150 schools (7,500 students and 1,650 teachers and school staff, approximately), with 75 in wave 1 and 75 in waves 2 and 3.
The control group (C) in each wave will not receive any activities or content related to the intervention. They will be invited to complete the surveys following the same protocols as the schools assigned to the treatment group in each wave. We will have a control group in each wave, consisting of 75 schools per wave, for a total of 225 control schools (11,250 students and 2,475 teachers and school staff, approximately).
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We implement a staggered cluster randomized controlled trial across 450 public schools in Armenia, carried out in three waves of 150 schools each. Schools were eligible if they (i) teach students in grades 5 through 7, (ii) have at least one displaced student, and (iii) are classified as basic (grades 1–9) or secondary (grades 1–12). From 468 eligible schools, we selected 450 by ranking schools within regions and school categories based on their share of displaced students.
Within each wave, schools are randomly assigned with equal probability to a treatment group (75 schools per wave, 225 total) or a control group (75 schools per wave, 225 total), stratified by municipality. Treatment schools receive the full nine-month MHPSS program, consisting of mentor-led teacher training and in-classroom support combined with a referral system for specialized psychological services. Control schools do not receive any program activities during the intervention period but complete the same survey instruments following identical protocols.
Within treatment schools, we implement a second randomization to evaluate the activities recommendation tool. In each wave, half of the treatment schools are randomly assigned to receive the tool and the other half continues with the standard program without the tool, stratified by region and rurality (urban vs. rural). This cross-randomization allows us to estimate the marginal effect of data-driven activity selection on student outcomes, holding constant the core mentoring and referral components.
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Randomization Method
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Randomization done in office by a code prepared by the researchers
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Randomization was conducted in office using code prepared by the researchers.
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Planned Number of Observations
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22,500 students, 4,950 teachers
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30,100 students, 3,833 teachers
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Sample size (or number of clusters) by treatment arms
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Students:3,750 in T1, 7,500 in T2, and 11,250 in C
Teachers and school staff: 825 in T1, 1,650 in T2, and 2,475 in C
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Main randomization: 225 schools assigned to treatment (75 per wave) and 225 schools assigned to control (75 per wave). Approximately 15,050 students and 1,917 teachers per arm.
Within-treatment cross-randomization: in each wave, approximately half of the 75 treatment schools are assigned to receive the activities recommendation tool and the other half continues with the standard program without the tool. That is, 7,525 treated students in schools that received the tool and the intervention and 7,525 treated students in schools that did not receive the tool, only the intervention.
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Power calculation: Minimum Detectable Effect Size for Main Outcomes
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See PAP
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Additional Keyword(s)
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Mental health, learning, psychosocial support, conflict, refugees, Armenia
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Keyword(s)
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Crime Violence And Conflict, Education, Health
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Crime Violence And Conflict, Education, Health, Post Conflict
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Secondary Outcomes (End Points)
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Academic performance — standardized math and language assessments
Emotional well-being
Emotional regulation
Social-emotional skills and school behavior
Teacher's mental health and wellbeing
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Students: Non-cognitive (socio-emotional) skills; teacher support; peer environment; educational aspirations.
Teachers: Mental health, non-cognitive (socio-emotional) skills, mental health literacy, peer environment
Implementation fidelity: characteristics of psychosocial activities implemented, time on task, classroom culture, and socioemotional skills.
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Secondary Outcomes (Explanation)
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Secondary outcomes reported by students are organized into four families:
- The first family captures non-cognitive (socio-emotional) skills through three measures: emotion regulation, self-efficacy, and grit.
- The second family captures teacher support as a dimension of school inputs, measured through the teacher support and innovation in practices and interactions with students.
- The third family captures the peer environment through four measures: peer interaction, social cohesion, peer integration; and loneliness (reverse-coded).
- The fourth family captures educational aspirations, measured through items on the highest level of education students expect to complete and their perceived importance of schooling for future opportunities.
All families of students' secondary outcomes will be collected at midline and endline. However, some of the measures in the families are going to be collected at midline only. All measures in the families will be collected at endline.
Secondary outcomes reported by teachers/educators are organized into five families:
- The first family captures mental health through four measures: stress, anxiety, depression, and burnout.
- The second family captures teacher mental health literacy through two measures: attitudes towards mental health, mental health awareness.
- The third family consists of teacher skills and behavior using three measures: self-efficacy, empathy, prosocial behavior)
- The fourth family captures teacher beliefs and mindsets through four measures: teacher bias, outcome accountability, fixed mindset, self-confidence
- And the fifth family captures peer environment through three measures: peer sensitivity, cultural pluralism, student-teacher interactions.
Implementation fidelity outcomes reported by mentors collected through classroom observation journals and are organized into the following families: characteristics of psychosocial activities implemented, time on task (time on learning), classroom culture (supportive learning environment, positive behavioral expectations), and socioemotional skills (autonomy, perseverance, social and collaborative skills).
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Pi as first author
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No
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Yes
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