This chapter covers the case study of Icehearts, a prevention programme that uses team sports to provide long-term mentoring support to socially vulnerable children and adolescents in Finland. The case study includes an assessment of Icehearts against the five best practice criteria, policy options to enhance performance and an assessment of its transferability to other OECD and EU27 countries.
Mental Health Promotion and Prevention
Best Practices in Public Health
Abstract
Description: Icehearts is a Finnish prevention programme that uses team sports to provide long-term mentoring support to socially vulnerable children and adolescents. Each Icehearts team consists of about 10‑25 children and is led by a mentor who supports the children at home, at school, after school and through team sports. The programme aims to prevent social exclusion, to promote social-emotional skills and to improve mental well-being. The Icehearts mentors are full-time, paid professionals with a 12‑year commitment to the child.
Best practice assessment:
|
Criteria |
Assessment |
|---|---|
|
Effectiveness |
At the group level, improved prosocial behaviour was found among programme participants at the 4‑year follow-up but no changes in emotional problems, conduct problems, hyperactivity or peer problems were observed. |
|
Efficiency |
Icehearts is estimated to save approximatively EUR 857 000 in social and healthcare costs over a 12‑year period while also reducing by half the number of people who are not in employment, education, or training (NEET). The decrease in NEET rates would correspond to an estimated EUR 1.9 million gain for the government through increased income tax revenues and lower unemployment benefits. Economic benefits are estimated to be more than four times higher than the investment in each Icehearts team. |
|
Equity |
The target group for Icehearts consists of socially vulnerable children and adolescents, often affected by factors such as single‑parent family, problem behaviour, or changes in family structure. |
|
Evidence‑base |
Icehearts was evaluated using data collection methods that are valid and reliable with low dropout rates, however, limitations of the study included the lack of a control group and a small sample size. |
|
Extent of coverage |
In Finland, there are currently 70 Icehearts team including over 1 000 children and adolescents. |
Enhancement options: To enhance efficiency, further cost-benefit analysis is needed to underline the economic viability of the programme. To enhance equity, Icehearts could consider expanding its options for sports-based activities to offer a wider range of opportunities. Currently, the programme is predominantly made up of boys, but actively facilitating the participation of girls could improve the equity of the programme. To enhance the evidence‑base, there is a need to secure long-term and sustainable research funding to enable comprehensive tracking of Icehearts teams throughout the duration of the programme. To enhance the extent of coverage, there is a need for increased administrative capacity to expand the programme further, either through increased funding or through partnerships with other organisations.
Transferability: The Icehearts Europe Project aims to upscale the Finnish Icehearts model across Europe and will pilot the model in Denmark, Estonia, Slovenia, Spain and Italy. The outcomes from the implementation will inform the refinements of the model, preparing for a wider adoption by stakeholders and organisations interested in the model.
Conclusion: Icehearts has demonstrated to some extent its potential in promoting social-emotional skills and mental well-being among socially vulnerable children in Finland, showing promising results in improving participants physical activity, social skills, and self-esteem.
Icehearts is a positive youth development programme that targets socially vulnerable children and adolescents by providing long-term support by a mentor through team sports (Appelqvist-Schmidlechner, Haavanlammi and Kekkonen, 2021[1]). Icehearts was established in 1996 as a non-governmental organisation in the city of Vantaa, Finland. The Icehearts programme aims to prevent social exclusion, to promote social-emotional skills and to improve mental well-being among children and youth. This is done through consistent long-term professional support in a trustworthy relationship between an Icehearts mentor and the children (Appelqvist-Schmidlechner, Haavanlammi and Kekkonen, 2021[1]).
Icehearts targets socially vulnerable children and adolescents, usually identified at the age of six, who are at risk of social marginalisation. The initiative, funded by the municipalities, aims to select children as a collaborative effort involving the municipality’s social services, preschool and first grade teachers, and Icehearts mentors. The selection process starts in preschool years where mentors attend preschool activities before starting the Icehearts team. Once the first grade has started, teachers and headmasters may also recommend children for the programme. The child’s carer ultimately decides whether the child will participate in the programme and the team activities.
Icehearts has broad selection criteria, allowing for the inclusion of children with a variety of social problems, regardless of whether or not they have a formal diagnosis. The programme is adaptable and suitable for children with behavioural, economic, developmental and mental health challenges. Common causes of social vulnerability among the children in Icehearts include difficulties in interacting with others, problem behaviour, changes in family structure or having a single‑parent family background (Appelqvist-Schmidlechner et al., 2017[2]). Children with symptoms that are so severe that prevent them from participating in a group setting may not benefit from the programme.
Each Icehearts team is led by a mentor who is a paid, full-time professional with a 12‑year commitment to the child. The Icehearts mentor works closely with schools and other support networks. The work of Icehearts mentors is roughly divided into four areas:
1. Team sports: The mentor organises and leads team sports activities. During the afternoon, the children of the team spend time together, play and participate in excursions with their mentor. Different sports are tested based on local opportunities.
2. After school activities: The mentor provides structured after-school programmes, including help with homework and organised afternoon activities.
3. Support with schoolwork: The mentor acts as an extra adult resource in the classroom, assisting children with their studies and contributing to a stable and supportive school environment.
4. Providing individual support to the child: When needed, the mentor works one‑to‑one with a child, providing a safe space for conversation and emotional support when problems arise in everyday life.
After primary school, from 7th grade until the age of 18, the emphasis is placed not only on the participation of organised sport but also on providing customised psychosocial support (Appelqvist-Schmidlechner, Haavanlammi and Kekkonen, 2021[1]).
Icehearts uses team sports as a tool to ensure the inclusion of marginalised children. Team sports provide an environment where children can experience a sense of belonging, learn social skills and make friends, while being physically active (Appelqvist-Schmidlechner, Haavanlammi and Kekkonen, 2021[1]). The Finnish Icehearts programme involves more than 1 000 children and adolescents participating in both girls’ and boys’ teams, with the majority of the participants being boys. Each team is led by a mentor of the corresponding gender, with girls’ teams being led by a female mentor and boys’ teams being led by a male mentor. Each mentor will have approximately 10‑25 children in their team. A team consists of a core group of around eight to ten children with more severe emotional and behavioural problems. An additional 10‑15 children with less severe challenges are also invited to join the team, these may include challenges such as coming from a single parent family, an immigrant background, or a low-income family (Appelqvist-Schmidlechner et al., 2024[3]).
This section analyses Icehearts against the five criteria within OECD’s Best Practice Identification Framework – Effectiveness, Efficiency, Equity, Evidence‑base and Extent of coverage (see Box 12.1 for a high-level assessment). Further details on the OECD Framework can be found in Annex A.
Effectiveness
At 4‑year follow-up, 49% of the Icehearts participants showed improved prosocial behaviour, whereas 34% showed a worsening situation, according to parent’s evaluations as measured by the Strengths and Difficulties Questionnaire (SDQ).
After one year, nearly four out of ten Icehearts children had improved social-emotional well-being, whereas nearly half showed a worsening, indicating mixed impacts.
According to mentors, over three‑quarters of children showed improvements in the areas of physical activity, social skills, friendships, self-esteem and mood.
Efficiency
Icehearts is estimated to save approximatively EUR 857 000 in social and healthcare costs over a 12‑year period while also reducing by half the number of young people who are not in employment, education, or training (NEET). This decrease in NEET rates would correspond to an estimated EUR 1.9 million gain for the government through increased income tax revenues and lower unemployment benefits.
Equity
Icehearts focusses on socially vulnerable children and adolescents, offering inclusion regardless of socio-economic status, gender, ethnicity or diagnosis.
Icehearts effectively reaches its target group, with participants being more likely to come from a single parent family or experiencing changes in family structures compared to the control group.
Evidence‑base
Icehearts was evaluated based on the results from the Icehearts longitudinal study and had “good” data collection method with valid and reliable measures, and scored “good” in terms of withdrawals and dropouts with a high percentage of participants who completed the study (80%).
The limitations of the study included the lack of a control group and a small sample size.
Extent of coverage
There are currently 70 Icehearts teams across Finland with over 1000 children and adolescents included in the programme.
Effectiveness
Prosocial behaviour was improved in half of Icehearts children, but there was no decrease in behavioural difficulties at 4‑year follow-up
A longitudinal study by Appelqvist et al. (2024[3]) showed improvement in prosocial behaviour at the 4‑year follow-up. The study sample comprised 65 boys who participated in the Icehearts programme and a community reference sample (control group) of 75 boys recruited from the same school and another school in the same municipality. The Strengths and Difficulties Questionnaire (SDQ) was used to assess the children’s outcomes (Box 12.2). The study found that nearly half of the Icehearts participants (49%) showed an improvement in prosocial behaviour after four years, while approximately one‑third (34%) showed a deterioration in their situation, based on parents’ evaluation. The authors suggested that participation in team sports allows Icehearts children to interact with peers and improve their social skills in a positive environment, which may contribute to an improvement in prosocial behaviour. No statistically significant changes were found for the other SDQ subscales (e.g. peer problems, hyperactivity, conduct problems, etc.).
The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening questionnaire that is widely used to assess emotional and behavioural problems in children and adolescents aged 2‑17 years. It is available in several languages and in different versions, such as for parents, teachers or self-completion.
The SDQ consists of 25 items on a three‑point scale: not true, somewhat true, certainly true. The scoring procedure for the SDQ links each of the 25 items to one of the five distinct subscales:
1. Conduct problems
2. Emotional symptoms
3. Hyperactivity
4. Peer relationship problems
5. Prosocial behaviour
The sum score for each of these subscales ranges from zero to ten.
The first four subscales can be added together to give a total difficulties score, which score ranges from 0 to 40.
In addition, the SDQ can be used to assess three primary indicators often examined in studies:
Internalising problems: a combination of emotional symptoms and peer relationship problems;
Externalising problems: a combination of conduct problems and hyperactivity;
Prosocial behaviour: corresponding to the prosocial behaviour subscale.
Source: Goodman (1997[4]), “The strengths and difficulties questionnaire: A research note”, https://doi.org/10.1111/j.1469-7610.1997.tb01545.x; Goodman, Lamping and Ploubidis (2010[5]), “When to use broader internalising and externalising subscales instead of the hypothesised five subscales on the strengths and difficulties questionnaire (SDQ): Data from British parents, teachers and children”, https://doi.org/10.1007/s10802-010-9434-x.
While the study did not find a reduction in behavioural difficulties among the participants of the Icehearts programme, the absence of further deterioration after facing severe challenges and vulnerabilities can be considered a positive outcome in itself. The programme may have prevented further negative developments that could have occurred without it, through the provision of support and long-term mentorship (Appelqvist-Schmidlechner et al., 2024[3]).
Social-emotional well-being improved in nearly four out of ten Icehearts children at one year follow-up, although it worsened in nearly half of children
A study by Appelqvist & Kekkonen (2020[6]) looked at changes in the behaviour and emotional life of Icehearts children, as reported by parents. The study is part of the Icehearts longitudinal study, which runs from 2015 to 2028, and was conducted with children from five Icehearts teams. A total of 46 children participated in the study, all boys aged 6 to 8 years old and in their first year of primary school at the start of the study in 2015. The study found that after one year, 39% of the participating children had an improvement in their SDQ total difficulties score, 47% had a worsening, and the remaining 22% had an unchanged situation. In addition, positive changes were observed in children who had not yet developed serious behavioural and emotional problems, as well as in children who were using psychiatric services (Appelqvist-Schmidlechner and Kekkonen, 2020[6]).
Physical activity, social skills, friendships, self-esteem and mood improved in more than three‑quarters of children
Another study by Appelqvist and Kekkonen (2020) looked at mentor’s evaluations of Icehearts children. Results showed that after four years, almost all children were still involved in team activities and two out of three children were still involved in after-school activities. In addition, mentors estimated that the Icehearts activity had at least somewhat improved the children’s physical activity, social skills, friendships, self-esteem and mood for the majority of children (76%‑84%). The long-term support and presence of the mentor in the child’s daily life was seen as an important factor in supporting the child (Appelqvist-Schmidlechner and Kekkonen, 2020[7]).
Efficiency
A cost-benefit analysis was conducted in 2017 based on the outcomes of one Icehearts team that participated in the programme for 12 years (Hilli, 2017[8]). Register data from the 1987 national cohort study was used as a comparison group. The analysis focussed on the use of social and health services and being not in employment, education, or training (NEET) as outcome variables.
The findings showed that participation in the programme reduced the need for heavy social and healthcare interventions, resulting in saving of approximately EUR 857 000 in social and healthcare costs over 12 years. In addition, the programme halved the number of NEET cases. Among 32 boys who participated in an Icehearts team at different times, the predicted number of NEETs was 10, but only 5 were observed, corresponding to a 50% reduction. The reduction in NEET rates is estimated to generate EUR 1.9 million in government revenues through increased tax revenues and lower unemployment benefits, due to higher education attainment (Hilli, 2017[8]).
When combined, the total estimated economic benefit of the programme amounts EUR 2.8 million per Icehearts team over 12 years. With an estimated annual budget per team of approximatively EUR 50 000, or EUR 600 000 for the 12‑year period, the benefits exceed the costs by more than four times. Programme costs are covered by the municipality in which the Icehearts team operates and include the costs associated with the mentor, such as salaries, insurance, travel costs, administration and occupational health services. Icehearts also receives donations covering expenses such as rental of sports facilities, camps, excursions and snacks, which brings the budget to around EUR 60 000‑65 000. Icehearts has a flexible cost structure, with mentors responsible for organising activities within the available budget. Some municipalities allow Icehearts to use sports facilities and classrooms free of charge.
Equity
Icehearts targets socially vulnerable children and adolescents who are at risk for social exclusion and marginalisation. The programme includes children regardless of their socio-economic background, gender, ethnicity or diagnosis. The selection criteria for Icehearts children are broad and flexible and are designed to accommodate children with or without a diagnosis. This includes children with behavioural problems, mental health problems, poor economic background and developmental disorders.
Icehearts has been successful in identifying, reaching and supporting children who need early intervention due to their family or adverse life situation. A study by Appelqvist and colleagues (2017[2]) investigated the psychosocial well-being of children aged 6‑to‑8‑year‑old participating in the initial phase of the Icehearts programme. The study included 46 children who participated in the Icehearts programme, compared with a control group of 180 children of the same age. Results showed that Icehearts successfully identifies and reaches the target groups. Icehearts participants were more likely to come from single‑parent families and to have experienced changes in their family structure, compared to the control group. For instance, 60% of the Icehearts children had experienced a parental separation, compared to 18% in the control group, and 40% had experienced a mother or father moving away or a new partner joining the family, compared to 13% in the control group. Participants and their families were more prone to face a number of challenges, including those related to health, mental health, and financial issues. Two-thirds of the Icehearts participants experienced social-emotional and behavioural problems, and around 40% experienced frequent conflicts with other children and often felt worried or cried (Appelqvist-Schmidlechner et al., 2017[2]).
Evidence‑base
The results on the effectiveness of Icehearts are based on the longitudinal study by Appelqvist-Schmidlechner & Kekkonnen (2020[6]), which is part of the Icehearts longitudinal study from 2015 to 2028. The Icehearts longitudinal study and other on-going and future studies of Icehearts are presented in Box 12.3. The Quality Assessment Tool for Quantitative Studies assesses the quality of evidence as strong in the domains of “Data collection methods” and “Withdrawals and Dropouts”, moderate in “Study Design”, and weak in “Selection Bias”, “Confounders” and “Blinding” (Table 12.1).
Source: Effective Public Health Practice Project (1998[9]) “Quality assessment tool for quantitative studies”, https://www.nccmt.ca/knowledge-repositories/search/14; Appelqvist-Schmidlechner & Kekkonnen (2020[6]), “Muutokset Icehearts-lasten käyttäytymisessä ja tunneelämässä. Tuloksia Icehearts-pitkittäistutkimuksesta”.
The Finnish Institute for Health and Welfare is currently conducting two longitudinal studies involving the Icehearts programme: the Icehearts longitudinal study and the Children and Youth Social Impact Bond (SIB) Study. The Icehearts longitudinal study runs from 2015 to 2028 and aims to investigate the psychosocial well-being of children participating in the Icehearts programme and the perceived benefits and effects of the programme. The study follows five Icehearts teams (n=65) for 13 years, until the participating children reach the age of 20. A mixed methods approach will be used, combining quantitative (questionnaires and register data) and qualitative (interviews and observations) research methods.
The Children and Youth SIB Study aims to assess the cost-effectiveness of various preventive initiatives targeting disadvantaged children and adolescents, including Icehearts. The study runs from 2019 to 2031 and uses the SIB (Social Impact Bond), which is a form of impact investing model that is particularly suited to the financing and effective implementation of promotional and preventive activities. Specifically, SIB have been used to finance the implementation of the Icehearts programme in cities, such as Hämeenlinna, with private investment funds financing the programme for six children for 12 years. The programme is expected to generate cost savings for local authorities and governments, for instance related to the use of social and health services. Part of these savings will be used to pay in return the investment funds. The re‑payments depend on pre‑defined outcomes (e.g. whether the service users are in education or employment, having avoided “afterwards services” and exclusion from normal life). The Children and Youth SIB Study aims to provide information on the cost-effectiveness of the approaches financed by the Children SIB, to study the impact of the activities on the psychosocial well-being of children and young people, and to examine the feasibility of using the Children SIB to fund preventive work in municipalities and regions.
Icehearts Finland also has its own follow-up tool that systematically collects data. This data includes mentors’ assessment of each child’s progress twice a year, parents’ assessment of their child’s progress once a year, and children’s assessment of their own progress once a year.
Source: Terveyden ja hyvinvoinnin laitos (n.d.[10]), “ Pitkittäistutkimus ehkäisevän toiminnan kustannus-vaikuttavuudesta (Lapset SIB)”, https://thl.fi/tutkimus-ja-kehittaminen/tutkimukset-ja-hankkeet/pitkittaistutkimus-ehkaisevan-toiminnan-kustannus-vaikuttavuudesta-lapset-sib-; Finnish Institute for Health and Welfare (THL) (n.d.[11]), “Icehearts longitudinal study”, https://thl.fi/en/research-and-development/research-and-projects/icehearts-longitudinal-study; Government Outcomes LAB, 2021”Children’s Welfare Social Impact Bond, Finland”, https://golab.bsg.ox.ac.uk/knowledge-bank/case-studies/childrens-welfare-social-impact-bond-finland/.
Extent of coverage
Icehearts currently has 70 teams in operation and over 1000 children are involved in the programme across Finland. Each team consists of a permanent mentor and sometimes additional support staff. In total, there are approximately 95 people working with Icehearts children. Each Icehearts team consists of 10‑25 children aged 6‑18. The programme operates in 14 municipalities across Finland, including Helsinki, Vantaa, Espoo, Tampere, Turku, Pori, Seinäjoki, Riihimäki, Hämeenlinna, Lahti, Lappeenranta, Joensuu, Kerava and Ulvila. Despite the high demand for the model, Icehearts has a small central team, consisting of four people in the administration and four people in the support department, which limits the ability to expand the model.
Enhancing effectiveness
Reducing the workload of mentors could help mitigate the risk of overload. Icehearts owners reported that Icehearts mentors are managing a substantial workload, being responsible for large teams of 10‑25 children with a 12‑year commitment. The Icehearts team is often made up of children with severe needs and these situations demand a considerable amount of time, energy and commitment from the mentors. Mentors are involved in many areas, including team sports, schoolwork, family support and individual support, and this requires a high level of commitment. Based on the information collected from interviews, the workload of mentors may pose a potential risk of burnout, stress, and/or exhaustion among the mentors, and may impact on their ability to provide effective and empathetic support. However, despite these challenges, turnover among Icehearts mentors is reportedly very low.
Enhancing efficiency
Enhancing the efficiency of the Icehearts programme is important to optimise the allocation of resources and maximise the positive outcomes for the participants. Further information on the cost-effectiveness of the Icehearts programme will be available in the following years through the Children and Youth SIB study, where Icehearts is one of the studied interventions. The cost-effectiveness will be analysed based on service use of the programme participants.
Enhancing equity
The equity and inclusivity of the Icehearts programme can be improved by making it more accessible to participants, by making a greater effort to find ways for every child to be physically active. After a few years in the programme, the team has to choose a sport (ice hockey, football, floorball, etc.). However, children’s motivation can vary depending on the sport that is chosen for the team. To address this, Icehearts could consider offering a wider range of sport-based activities to ensure that all participants are enthusiastic about the programme. By expanding the range of sports-based activities and opportunities for physical activity, participants can explore and engage in areas that match their interests.
Expanding the Icehearts programme to include more girls could enhance the equity of the programme. Currently, Icehearts is predominantly made up of boys and boys’ teams and, there are opportunities to create a more balanced and diverse participant base. By actively facilitating the participation of girls and creating more girls’ teams, Icehearts can ensure a more balanced access to the benefits of the programme for all genders. Many girls face unique challenges during childhood and adolescence and the presence of a trusted mentor could benefit their personal growth and well-being.
Icehearts has the potential to be adapted to better serve minority communities in Finland, ensuring that the programme is inclusive for children from diverse backgrounds. In 2014, the initiative broadened its scope by launching a Swedish-speaking organisation – the Active Explorers Club – in Espoo, Finland. Today, five Swedish-speaking Icehearts teams operate in the Helsinki and Espoo areas, providing support and intervention services to at-risk children and adolescents in both Finnish- and Swedish-speaking communities (Icehearts, n.d.[12]). To enhance inclusivity, the programme could continue to expand its multilingual offerings and incorporate culturally relevant activities tailored to the needs of various minority groups.
Enhancing the evidence‑base
The Icehearts programme has accumulated a substantial body of evidence through a variety of studies and ongoing longitudinal research. However, given the long duration of the programme, it is costly to conduct comprehensive long-term studies. The specific selection process for Icehearts participants makes it difficult to establish appropriate control groups and to randomise research. The scarcity of ongoing funding and research resources represents a significant challenge to improving the evidence base for Icehearts.
To strengthen the evidence base, it is essential to secure long-term and sustainable research funding to conduct comprehensive longitudinal research following Icehearts teams over the duration of the programme. In addition, increasing the number of participants in both the control group and the intervention group would contribute to a more robust research base.
Enhancing extent of coverage
Expanding the extent of coverage for Icehearts is an important consideration in reaching a larger number of participants in need of support. However, due to limited administrative capacity of the programme, this presents a significant challenge. To overcome this, it is essential to explore ways to increase the funding of the programme and to build close partnerships and collaborations with schools, communities, municipalities, other organisations or support services to gain further support and mutualise resources. These strategies would assist in broadening the programme’s reach and extending its support to a larger audience.
This section explores the transferability of Icehearts and is broken into three components: 1) an examination of previous transfers; 2) a transferability assessment using publicly available data; and 3) additional considerations for policymakers interested in transferring Icehearts.
Previous transfers
The Icehearts Europe project is currently being implemented to scale up the Finnish Icehearts model to a European level. The International Sport and Culture Association (ISCA) and Icehearts Finland are working together to launch a Europe‑wide expansion of the programme, collaborating with 10 partners across Europe. The aim of the project is to promote the well-being and mental health of disadvantage and at-risk children and adolescents in Europe, based on the Finnish Icehearts model. The project runs for three years (2023-2025), and the model is piloted in five countries: Denmark, Estonia, Slovenia, Spain and Italy. The selected programme implementers are considered as first adopters and will test the Icehearts Europe model during the project. The results of these pilots will be used to refine the model and train facilitators so that second adopters (e.g. stakeholders and organisations interested in the Icehearts model) can potentially implement the programme in the future. The project is funded by a EUR 4 million EU4Health Action Grant (ISCA, 2023[13]; Icehearts, n.d.[14]). The feasibility of transferring Icehearts to other EU countries is further reinforced by the existence of a Swedish-speaking version of the model.
Transferability assessment
This section outlines the methodological framework to assess transferability followed by analysis results.
Methodological framework
Several indicators to assess the transferability of Icehearts were identified (see Table 12.2). Indicators were drawn from international databases and surveys to maximise coverage across OECD and non-OECD European countries. Please note, the assessment is intentionally high level given the availability of public data covering OECD and non-OECD European countries.
Results
The main findings of the transferability assessment are summarised below:
a) In Finland, the ratio of students to teaching staff is 8.42, which is below the median of 12.7 in OECD and EU countries. Countries with a lower ratio of students to teaching staff have better conditions for the transfer of Icehearts.
b) As in Finland, the vast majority of countries (90%) have a strategy or action plan to guide the implementation of mental health policy. This suggests that Icehearts is likely to receive political support in most potential transfer countries.
c) The vast majority of countries (90%) have policies and programmes to support and promote the mental health of children and adolescents, including Finland. Countries with policies that support this have better potential for transferability.
d) As in Finland, a large proportion (90%) of countries have policies and programmes in place to support mental health in educational settings. As many of the Icehearts activities take place in schools, this finding suggests that Icehearts would be likely to receive political support in most potential transfer countries.
e) Finland does not have policies and programmes in place to address stigma and discrimination, while 93% of countries do have this in place. Countries with policies that support this have a greater potential for the transfer of Icehearts.
f) Finland allocates 4.70% of its current health expenditure to preventive care, which is above the OECD and EU median of 4.42%. Countries with a higher spending on prevention are more likely to have economic context for the transfer of Icehearts.
A darker shade indicates Icehearts is more suitable for transferral in that particular country
Note: n/a = no available data. The shades of blue represent the distance each country is from the country in which the intervention currently operates, with a darker shade indicating greater transfer potential based on that particular indicator (see Annex A for further methodological details). The full names and details of the indicators can be found in Table 12.2.
Source: OECD (2021[15]), OECD Data Explorer - Ratio of students to teaching staff, http://data-explorer.oecd.org/s/1nm (accessed on 16 April 2024); OECD/WHO Regional Office for Europe (2023[16]), Mental Health Systems Capacity Questionnaire 2023 - Strategy or action plan that guide implementation of the mental health policy; OECD/WHO Regional Office for Europe (2023[17]), Mental Health Systems Capacity Questionnaire 2023 - Policies and programmes to support and promote mental health of children and adolescents; OECD/WHO Regional Office for Europe (2023[18]), Mental Health Systems Capacity Questionnaire 2023 - Policies and programmes to support mental health in educational settings; OECD/WHO Regional Office for Europe (2023[19]), Mental Health Systems Capacity Questionnaire 2023 - Policies and programmes to address stigma and discrimination; OECD (2022[20]), OECD Data Explorer - Prevention spending as a percentage of current health expenditure, http://data-explorer.oecd.org/s/1nl (accessed on 11 April 2025).
To help consolidate findings from the transferability assessment above, countries have been clustered into one of three groups, based on indicators reported in Table 12.2. Countries in clusters with more positive values have the greatest transfer potential. While this analysis provides a high-level overview assuming some simplifications, it is important to note that countries in lower-scoring clusters may also have the capacity to adopt the intervention successfully. For further details on the methodological approach used, please refer to Annex A.
Key findings from each of the clusters are below with further details in Figure 12.1 and Table 12.4:
Countries in cluster one has sector-specific, political and economic arrangements in place to readily transfer Icehearts to their local context. This cluster includes 25 countries.
Countries in cluster two have the political support to implement Icehearts, but they may wish to consider that the programme is affordable and can be implemented within the municipality’s environment. This cluster includes 13 countries.
Countries in cluster three have sector-specific arrangements in place to transfer Icehearts, but they may wish to consider ensuring that the programme is affordable and that it aligns with political priorities. This cluster includes a small number of countries (five).
Note: Bar charts show percentage difference between cluster mean and dataset mean, for each indicator.
Source: OECD analysis.
Source: OECD analysis.
New indicators to assess transferability
Data from publicly available datasets alone is not ideal to assess the transferability of public health interventions. Box 12.4 outlines several new indicators policymakers could consider before transferring Icehearts.
In addition to the indicators within the transferability assessment, policymakers are encouraged to collect information for the following indicators:
Population context
What is the ethnicity and cultural diversity of the target population?
What is the level of knowledge about social and emotional skills in children/parents?
What is the level of health literacy in the population?
Sector specific context
What is the level of acceptability of the Icehearts approach in the school (teachers, pupil’s parents)?
What infrastructure is available in the community to encourage team sport and activities?
Political context
Has the intervention received political support from key decision makers?
Has the intervention received commitment from key decision makers?
Economic context
What is the cost of the intervention (e.g. annual salary of an Icehearts mentor)?
Icehearts is a Finnish prevention programme for socially vulnerable children and adolescents. Through long-term professional support from an Icehearts mentor, the programme aims to prevent social exclusion, to promote social-emotional skills and to improve mental well-being. Each Icehearts team is led by a mentor and consists of 10‑25 children, with a sports team formed to ensure the inclusion of marginalised children.
Icehearts has been effective in reaching its target groups and the majority of Icehearts children have shown improvements in physical activity, social skills, friendship, self-esteem and mood, according to Icehearts mentors. The effectiveness of Icehearts is mixed, with some children showing improvements in social-emotional well-being and prosocial behaviour, and others worsening in these areas.
Icehearts is highly transferable to 25 OECD and EU countries and intermediately transferable to other 13 countries. The transferability analysis using clustering suggests that Icehearts can be readily transferred to 58% of countries, which were included in the cluster of highest transferability. Besides, 30% of countries were included in the cluster of intermediate transferability.
The transfer of the Finnish Icehearts model to other European countries is currently underway through the Icehearts Europe project, funded by the European Union. The pilot implementation countries are Denmark, Estonia, Spain, Slovenia and Italy. This project will help to gather information on the contextual differences between the implementation sites and the next step will focus on adapting and refining the model based on diverse contexts to ensure broader, successful implementation.
Box 12.5 outlines next steps for policymakers and funding agencies.
Next steps for policymakers and funding agencies to enhance Icehearts are listed below:
Ensure funding to continue the implementation of the programme as well as for future scale‑up and transfer efforts.
To facilitate the implementation of the Icehearts model in new countries, ensuring strategic support from key stakeholders (e.g. schools, communities, municipalities) for successful adaptation and integration of the programme.
References
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