This chapter covers the case study of This is me (#tosemjaz), a prevention programme aimed at developing social and emotional skills and self-image in adolescents in Slovenia. The case study includes an assessment of This is me 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: This is me is a prevention programme aimed at strengthening social and emotional skills and building a positive self-image as key protective factors of adolescent mental health. The programme consists of two universal prevention interventions. Intervention 1 (#tosemjaz) offers anonymous, simple, rapid, and free access to online expert advice answering youth’s questions, either asynchronously or synchronous via chat conversations. Intervention 2 consists of a comprehensive model of 10 preventive workshops that systematically address the development of social and emotional competencies and realistic self-evaluation. Intervention 2 targets school classes in primary/lower secondary education and is implemented mostly by teachers or school counsellors trained for that purpose.
Best practice assessment:
|
Criteria |
Assessment |
|---|---|
|
Effectiveness |
Evidence to evaluate the effectiveness of #tosemjaz online counselling (intervention 1) is not available. While most results from the study assessing the 10 preventive school workshops (intervention 2) are statistically non-significant, they suggest potential effects on student outcomes (interpersonal difficulties, coping and self-concept) that should be further evaluated. Classroom climate, as rated by the teachers, significantly improved by the end of the programme, compared with baseline (p=0.03). |
|
Efficiency |
This is me cost-effectiveness has not been evaluated. Cost-wise, both interventions require low investment in human resources. #tosemjaz online counselling mostly relies on the voluntary work of individuals that are trained to respond to queries by maximising advice and information developed over time. Volunteers are supported by a full-time (paid) editorial office. The 10‑workshop programme is implemented by teachers or school counsellors, mostly during class time. |
|
Equity |
Both This is me interventions are universal preventive strategies freely made available to youth (intervention 1) and to students (intervention 2) in Slovenia. These interventions have the potential to reach out to most vulnerable groups: the online advice can be used at any point in time, in an anonymous way and from anywhere with internet connection. The school workshops are deployed at the classroom level and mostly during class, potentially reaching groups at higher risk that would otherwise not seek for help. |
|
Evidence‑base |
Despite being implemented for long time, there is only one study evaluating This is me, namely the 10 school workshops programme. The study includes a control arm but ranks poorly on confounding and blinding. |
|
Extent of coverage |
#tosemjaz online counselling has answered more than 57 000 questions over a period of 23 years, mostly from girls. The severity of the problems driving the questions seems to have increased in recent years. In 2023, This is me school workshops have been deployed in 15% of Slovenian schools. |
Enhancement options: To enhance the effectiveness of the school-based programme intervention 2, it is essential to ensure that the complete set of 10 workshops is delivered as per the programme objective, to identify and maximise programme features that promote connectedness between students, and to select workshop providers that already have a positive relationship with students. To enhance equity, it is recommended to increase the uptake of #tosemjaz, particularly the synchronous chat sessions, by the population groups at higher risk of poor mental health, including those identified during the school workshops, bridging interventions 1 and 2. To enhance the evidence base, it is essential to conduct an outcome evaluation of the online services and improve the study design and outcome measures of the evaluation of the school-based programme. To enhance the extend of coverage, greater availability and dissemination of synchronous chat sessions would be beneficial, as well as boosting the number of schools receiving the programme.
Transferability: 22 out of 43 OECD and EU countries have the population, political and economic contexts that would facilitate the transfer of This is me, while another six countries require further political support. For the remaining 15 countries, the potential for transfer of This is me is more limited.
Conclusion: This is me promotes universal prevention efforts for youth mental health in Slovenia through a comprehensive approach that includes two separate interventions. Enhancements in terms of effectiveness, coverage and the evidence base could excel the value delivered by the programme.
This is me (“To sem jaz” in Slovenian) is a youth mental health prevention programme with the objective of supporting young people in coping with the everyday challenges of growing up. It focusses on developing social and emotional skills and self-image, in youth from 13 years old onwards.
The programme includes two complementary universal prevention interventions. Intervention 1 consists of online information and counselling services available via a dedicated website (www.tosemjaz.net), providing anonymous, publicly available and free access to expert advice on a voluntary basis. Intervention 2 consists of a comprehensive model of 10 preventive workshops implemented in schools. It follows an evidence‑based model for preventive work to develop social and emotional skills in the classroom.
This is me was founded in April 2001 in Celje, Slovenia. The online advice service was first implemented and has been ongoing for 23 years. Its creation was informed by a study on the needs of the target group (adolescents aged 14‑18), which highlighted the challenges of adolescence, especially about low self-image, unpleasant feelings and ways of coping with the everyday challenges of growing up. The two interventions are described below in more detail based mostly on information provided by the Celje Regional Unit of the National Institute of Public Health from Slovenia.
Intervention 1
The online service for young people, branded as #tosemjaz, provides a space for support, advice and counselling. #tosemjaz gives young people facing the challenges of growing up, access to verified, evidence‑based information and guidance from experts.
Young people can access the website and consult with experts in two different ways. Asynchronous online advice has been the model followed since the #tosemjaz implementation. Adolescents choose a nickname, describe their problem, and submit their question. An editorial team reviews each question, publishes it and assigns it to a member of the team, who will then publish the answer publicly. Synchronous online guidance and counselling has become available since March 2022. Through this format, young people have the option to anonymously chat with an expert who is online at the same time. The synchronous online sessions are regularly advertised on #tosemjaz website. For instance, in 2023, synchronous online sessions occurred three times a month with a psychologist and once a month with a gynaecologist. Although user registration asks young people to submit personal information, registration is not a mandatory condition for adolescents to receive an expert advice through the online service. Registered and unregistered users are equally likely to have access to expert advice.
#tosemjaz relies on a unique multidisciplinary network of volunteer professionals working online. In 2023, this network consisted of 61 psychologists, 17 medical doctors from various specialties (such as genecologist) and 22 counsellors from other fields such as social work, social pedagogy and sport, for a total of 100 volunteers contributing without financial remuneration. A secondary objective of This is me is to ensure the growth and diversity of this volunteer network and ensure the development of online counselling as a discipline, for example through the development of guidelines and standards to support further advice provided online.
The key requirement to become a counsellor is to have a bachelor’s or a master’s degree from an accredited higher education institution. Since 2019, all new counsellors are supervised by experts working in the editorial office. The possibility of consulting a supervisor remains available throughout their activity in case of doubts when preparing an answer. An editorial office plays a central role in the online advice service, by daily managing the communication between adolescents and experts and ensuring safe and respectful communication. The editorial office classifies and codes the online questions based on their content category, topic and subtopic, and if available, gender and age of the users. The periodic analysis of this information helps monitoring user needs and planning further preventive work. An e‑platform for content analysis known as #TSJDashboard is used by the editorial office to prepare regular monthly and annual reports on the activity provided.
The provision of online information and advice by experts is based on literature developed within the This is me programme, namely a monograph that contains almost 6 000 online questions answered till 2014 (also available for consultation by the general public and used as guidelines for the induction of new counsellors since 2023).
Online crisis interventions and editorial protocols are set up to manage cases of extreme distress and crisis situations. In these situations, online counsellors provide emotional relief to adolescents and relevant information and guidance to obtain face‑to-face professional help (per editorial protocol). In cases of extreme distress, the editorial staff might consult external experts from social services, police and justice.
Besides expert advice, #tosemjaz website is also a repository of professionally verified sources of information, including about 300 articles supported by pictures, graphics and infographics that cover a range of different topics (from the body to sexuality, love, relationships with family and friends, among others). Numerous articles and columns are supported by audio and video material and worksheets, particularly those dealing with mental health. Since 2022, this content is also proactively sent to subscribers in a e‑magazine called #tosemjaz. A friend when growing up.
Intervention 2
The second intervention that is part of This is me is a universal prevention programme in the school environment. It consists of 10 preventive workshops that help adolescents to build social and emotional skills and a better self-image.
This intervention has its origins in an information content produced for the #tosemjaz in 2007: “10 steps for a better self-image”. It was then further developed in a handbook for preventive work in schools, available from 2011 onwards. The current 10‑workshop programme is implemented based on the supplemented handbook Maturing through the This is Me programme: Development of social and emotional skills and self-image, available since 2019 and informed by an evaluation study conducted in 2017/18.
Each workshop is evidence‑based and addresses one or more of the fundamental areas of adolescent experience and behaviour, developing particular social and emotional competencies (Table 11.1). The activities of the workshop aim at strengthening skills that enable adolescents to cope more effectively with the challenges of growing up and help them building better quality relationships and greater mental resilience. This process can be put in the context of social and emotional learning, through which children and adolescents acquire fundamental social and emotional competencies in five interconnected fields: self-awareness, self-management, social awareness, relationship skills and responsible decision making (CASEL, 2012[1]). Social and emotional competencies are aimed at reducing risk factors and strengthening protective factors for successful psychosocial adaptation. The workshops aim at encouraging adolescents to have an active attitude towards setting goals, taking responsibility, solving problems, co‑operating with others, developing self-respect, coping with stress and improving other life skills.
Source: Information provided by the Celje Regional Unit of the National Institute of Public Health from Slovenia.
Workshops providers are both class and subject teachers and school counsellors. The workshops are typically scheduled during class time or tutor group periods. They are adapted to the adolescent phase of development (age 13 to 17), coinciding with the final years of primary and lower secondary education and the first year of upper secondary education. Primary and secondary schools are invited to plan and implement This is me, with the assistance of training on the programme’s concept and the provision of programme literature. The training of the implementation of the programme is provided to all the education professionals in the school, including teachers, school counsellors and principals. In addition, health and social care professionals, youth and NGOs workers who are part of the school environment may also receive the training. The model has been tested in practice and has obtained the expert recommendation of Slovenia’s National Education Institute for implementation in Slovenia’s schools.
The programme includes literature and materials made publicly available such as the handbook “Maturing through the This is Me programme: Development of social and emotional skills and self-image”, which consists of practical guidelines and instructions for workshop implementation, including worksheets for each workshop. The self-help manual What can I do to make it easier? has been published in 2022, aiming at adolescents aged 15 and over. It is based on the behavioural cognitive paradigm, helping young readers to understand the circular connection of thoughts, emotions and behaviour, providing guided self-help exercises, and making the link with the #tosemjaz website. Promotional materials and e‑work packs providing information about #tosemjaz online service are made available to schools as supplementary materials.
This section analyses This is me against the five criteria within OECD’s Best Practice Identification Framework – Effectiveness, Efficiency, Equity, Evidence‑base and Extent of coverage (see Box 11.1 for a high-level assessment). Further details on the OECD Framework can be found in Annex A.
Evidence available to evaluate the performance of This is me differs by intervention. Information about the online advice service (intervention 1) mostly consists of process and user experience indicators with no formal evaluation of outcomes. The 10‑workshop programme (intervention 2) was initially evaluated in 2007 and underwent a more comprehensive evaluation in 2017/18. The objective was to provide schools with a verified model for conducting preventive work in the classroom (Sedlar et al., 2019[2]).
Effectiveness
Evidence to evaluate the effectiveness of #tosemjaz online counselling (intervention 1) is not available.
While most results from the study assessing the 10 preventive school workshops (intervention 2) are statistically non-significant, they suggest potential effects on student outcomes (interpersonal difficulties, coping and self-concept) that should be further evaluated.
Classroom climate, as rated by the teachers, significantly improved by the end of the programme, compared with baseline (p=0.03). Similar improvement is not identified in the classroom climate as rated by the students.
Efficiency
Cost-effectiveness of both interventions has not been evaluated. Both interventions require low investment in human resources. #tosemjaz online counselling mostly relies on the voluntary work of individuals that are trained to respond to queries by maximising advice and information developed over time. Volunteers are supported by a full-time (paid) editorial office. The 10‑workshop programme is implemented by teachers or school counsellors, mostly during class time.
Equity
Both interventions are universal preventive strategies freely made available to youth (intervention 1) and to students (intervention 2) in Slovenia. Both interventions have the potential to reach out to most vulnerable groups: #tosemjaz online counselling can be used at any point in time, in an anonymous way and from anywhere with internet connection. The school workshops are deployed at the classroom level and mostly during class, potentially reaching groups at higher risk that would otherwise not seek for help.
Evidence‑base
Most of the existing evidence on This is me effectiveness comes from one study that evaluated the 10 school workshops programme in 2017/18. The study includes a control arm but ranks poorly on confounding and blinding.
Extent of coverage
#tosemjaz online counselling has answered more than 57 000 questions over a period of 23 years, mostly from girls. The severity of the problems driving the questions seems to have increased in recent years. In 2023, This is me school workshops have been deployed in 15% of Slovenian schools.
Effectiveness
Intervention 1
Despite the extensive information produced about the #tosemjaz online counselling, there is no evaluation of the effectiveness of #tosemjaz on young people. Existing evidence describes the type of questions and responses posted on the #tosemjaz website, as well as some characteristics of online service users (see section Extent of coverage for more details). Additionally, a user survey and user interviews were conducted in 2013 but these focussed mostly on user experience and expectations. Results suggest that most users of the online counselling found the answers useful and helpful, and valued the possibility of writing about their problems anonymously and receiving verified expert advice. Similarly, the literature provides limited evidence on the effectiveness of online counselling. A meta‑analysis showed that online universal and selective (focussing on groups at risk) prevention interventions effectively reduce depressive symptoms, but have limited effects on anxiety and stress scores. But, these findings are based on interventions that include more intense and continued support than that is typically provided within #tosemjaz (e.g. some degree of cognitive or bias modification training) (Noh and Kim, 2023[3]). It is worth noting that while most literature on technology-delivered prevention for youth mental health is positive about the effectiveness of this mode of delivery, the studied interventions usually provide some degree of psychotherapy to groups at risk or with symptoms (selective or indicated prevention, respectively). As a result, it is not possible to extrapolate the results to #tosemjaz (Noh and Kim, 2023[3]; van Doorn et al., 2021[4]). The literature on help-seeking for mental health difficulties indicates that several attributes common to #tosemjaz are beneficial to the users. These include anonymity and privacy, ease of access and immediacy and the ability to connect with others and share experiences. Despite the lack of preference for formal mental health or government websites, young people value services with human contact and run by (mental health) professionals, online communities and discussion forums (Pretorius, Chambers and Coyle, 2019[5]).
Intervention 2
An evaluation study conducted in 2017/18 is the basis of This is me effectiveness assessment. It included 10 primary schools in which 224 students (mean age at baseline 12.9 years, corresponding to grade 8) participated in the workshop programme, provided by 13 education professionals at the class level. The study also collected data from 201 students from control classes (not subjected to the workshops) and from 64 teachers teaching the classes receiving workshops, but that were not involved in their implementation. Evaluations were conducted after five workshops (intermediate) and 10 workshops (final). Results from the final evaluation, described below, are obtained from 170 to 185 students per group, depending on the outcome (Sedlar et al., 2019[2]).
The impact of This is me workshops on students was measured in three domains:
interpersonal difficulties, measured with the Questionnaire on Interpersonal Difficulties in Adolescence in six domains: family relationships, friendships, relationships with the opposite sex, assertiveness, and public speaking (Inglés et al., 2008[6]);
coping, measured with the Adolescent Coping Questionnaire (Frydenberg et al., 2001[7]) and distinguishing between effective coping style (e.g. a focus on solving problems, maintaining friendships, focus on work, seeking professional help, accepting the support of others, seeking relaxing diversions, physical exercise) and ineffective coping style (e.g. ignoring problems, worrying, not overcoming, self-blame, keeping to yourself, wishful thinking);
self-concept, which captures the image that one has about herself, is measured with the Self-Concept Questionnaire (Musitu et al., 2016[8]), portraying characteristics, views and beliefs that individuals usually attribute to themselves overall and in specific dimensions (family/domestic environment, academic performance, social relationships, physical appearance, and emotional states).
Students attending the This is me workshops showed no change in their outcomes over time (from the baseline to intermediate and final measurements) in the three domains above, compared to the control group who experienced deterioration in these three areas. While interpersonal difficulties increased in the control group, mostly in the domains of friendships, opposite sex and assertiveness, students participating in This is me workshops had a (statistically non-significant) reduction in these problems by the end of the 10 workshops, both overall (mean ± standard deviation: 44.58 ±25.73 to 43.15 ±25.94, p=0.39) and in each of the six domains (Sedlar et al., 2019[2]; Boben, 2018[9]). Coping strategies did not change significantly in the intervention group, while both effective and ineffective strategies tend to decrease in the control group (Sedlar et al., 2019[2]; Boben, 2018[9]). Last, the self-concept of students in the control group decreases over time, mostly within the family environment, while for those participating in the 10‑workshop it remains mostly similar to baseline, displaying small positive increases in some specific dimensions.
Changes over time and between the intervention and control groups reported above are mostly small in magnitude and statistically non-significant. The non-significance of results might be associated with the small number of students participating in the study, and the heterogeneous composition of the students (e.g. the geographical location of the schools or the size and performance of the classes). While some schools selected more problematic classes to participate, other schools took the opposite approach.
In addition to student outcomes, the Classroom Environment Questionnaire (Zabukovec, 1998[10]) was used to measure the current and desired classroom climates as perceived by students and teachers. The control group reported some deterioration in the classroom environment, while the intervention group showed no change over time (Sedlar et al., 2019[2]; Boben, 2018[9]). Interestingly, classroom climate scores given by students were lower than the average scores given by their teachers (47.54±6.50 vs. 52.46±5.00, respectively) and students did also report a larger gap between existing and desired classroom climate than teachers (6.36±7.43 vs. 3.31±5.48, respectively). Teachers considered that the classroom climate had improved by the end of the programme, with improvement in the perception of the existing classroom climate (p=0.03) and existing interpersonal relationships (p=0.07). Last, measurement of satisfaction shows that students rated the workshops as satisfactory overall. They particularly appreciated the collaborative and supportive atmosphere in the classroom and the opportunity to express and exchange opinions with their classmates and the teacher (Sedlar et al., 2019[2]; Boben, 2018[9]).
Efficiency
Intervention 1
This is me online advice mostly relies on the voluntary work of individuals that are trained to respond to queries by maximising advice and information developed over time and are supported by a full-time (paid) editorial office. The voluntary contribution reduced the costs of the intervention, while the possibility to be based anywhere and participating remotely increases the pool of potential voluntaries. The efficiency of the intervention is enhanced by using past interactions to develop material which supports the experts, such as a bank of answers. Using past advice as a basis for future responses, help maximise the time dedicated to each request.
Intervention 2
Workshop providers are key actors for the deployment of the 10‑workshop programme to students. Between 2011/12 and 2022/23, the number of workshops held, and the number of providers included have varied upwards and downwards, without a clear trend. The average number of workshops per provider per year has also varied over time, from a minimum of 4.4 workshops per provider in 2012/13 to a maximum of 8.9 in 2022/23. Average numbers below 10 might be explained by two reasons, either most providers miss one or two workshops to complete the programme, or a small number of providers only deliver one of the 10 workshops.
Equity
Both interventions constituting This is me are universal preventive strategies freely made available to young people (intervention 1) and students (intervention 2) in Slovenia.
Intervention 1
#tosemjaz can be used at any point in time (asynchronous intervention) and from anywhere with internet connection, making it widely available by people at risk of mental ill-health. On the other hand, because it is digital, #tosemjaz might not be accessible to those without the technological resources and literacy needed, potentially being the most vulnerable and hard-to-reach population groups.
From about 5 400 online questions coded during 2020, 2021 and 2022, 81% were submitted by girls, and 19% by boys. A much larger proportion of girls using the service reveals gender difference in needs and expectations. It is likely that girls are either more aware of, or attribute more value to, the support provided by #tosemjaz.
Intervention 2
Because it is deployed at the classroom level, without requiring any proactive decision by students, the workshop programme might also potentially reach out to groups at risk that would otherwise not seek help. Additionally, the (multimedia) handbook What can I do to make it easier includes guided self-help exercises in the form of sound recordings, accessible to everyone, everywhere and at any time.
Results of the 2017/18 evaluation study show significant differences in the impact of the school workshops on boys and girls. Boys displayed better results than girls in terms of interpersonal difficulties, particularly those linked to public speaking. The workshops had the greatest impact on the girls in terms of their ability to employ effective coping strategies (Sedlar et al., 2019[2]; Boben, 2018[9]).
Evidence‑based
The evidence on This is Me is mainly collected from a study conducted in 2017/18 to evaluate intervention 2 (workshop programme conducted in schools) (Sedlar et al., 2019[2]). Other evidence on This is me consists of process indicators showing the volume and extent of the support provided.
The Quality Assessment Tool for Quantitative Studies assesses the quality of evidence as strong in the domains of “Data collection methods” and moderate in “Selection Bias”, “Study Design” and “Withdrawals and dropouts” (Table 11.2) (Effective Public Health Pratice Project, 1998[11]).
Source: Effective Public Health Practice Project (1998[11]), “Quality assessment tool for quantitative studies”, https://www.nccmt.ca/knowledge-repositories/search/14; Sedlar et al. (2019[2]), “Evalvacija šolskega preventivnega programa To sem jaz”.
Extent of coverage
Intervention 1
During the 23 years that #tosemjaz online counselling has been in available (2001 to 2023), experts have answered more than 57 000 questions, corresponding to an annual average of 2 500 questions. On an annual basis, the website receives about 180 000 unique visitors, more than 260 000 visits and 1 000 000 page views. About 75% of the questions are answered in less than three days. Age and gender distribution of questions has remained mostly stable over time. From the 5 429 questions coded by the editorial staff from 2020 to 2022, 81% were from girls and 19% from boys; 46% were submitted by young people aged 14‑17, 32% by 18‑21 and 19% by 10‑13. About half of questions were classified either as “Mental health” (20%), “Physical health” (17%) and “Relationships” (16%) categories. Two main changes have been noted in the inflow of questions for the past years. First, a growth in overall number of questions received after March 2022, when the website went through a redesign. Second, an increase in the proportion of questions classified as “most severe” from 15% to 20% from 2021 to 2022 (questions that relate to the topics of suicide, anxiety, depression, eating disorders, self-harm, family and peer violence, and sexual abuse). Since 2017, and with the exception of 2023, there has been an increase in the number of questions related to suicide (from 52 to 100 questions between 2017 and 2022).
Intervention 2
In the school year 2022/23, around 15% of schools in Slovenia were included in the 10‑workshop programme, for a total of 132 primary and secondary schools in which 209 workshop providers ran 1 855 workshops involving more than 19 000 adolescents. This has been the highest number of providers, schools and workshops achieved in the last 12 years of the programme although the volume has been varying over the years rather than following a stable increasing trend.
Interventions 1 and 2
More recently, the scope and coverage of This is me is partially extended beyond the boundaries of both interventions through the materials and information being disseminated. Copies of the handbook What can I do to make it easier? were made available to 637 primary and secondary schools, reaching all school counselling services in Slovenia, and to 706 services in the fields of healthcare and social care that work with young people. In total, 52 000 copies of the handbook were printed over the period 2022-2024, In 2023, in the context of the Slovenian Year of Mental Health national campaign, every student in Slovenia making the transition from primary or lower secondary school to upper secondary school (grade 9) had received a printed copy of the handbook, which in turn refers to the content of #tosemjaz website.
Another dimension of This is me coverage refers to the training of educators and other professionals dealing with youth. In 2019, copies of the newly developed version of the handbook providing workshop implementation guidance (Maturing through the This is Me programme) were offered to all libraries, primary and secondary schools in Slovenia (100% coverage). Information about the programme reached more than 6 000 professionals from the fields of education, healthcare and social care through events held in 2020 and 2022; and 433 school counsellors received the training in 2022. Dissemination materials promoting intervention 1 have also been widely distributed in schools (e.g. traditional and PDF posters, animated online content for school websites and digital displays).
Enhancing effectiveness
Intervention 1
Increasing the number of synchronous guidance and counselling sessions and their dissemination offers opportunities to improve the continuity of support provided to young people that need more than a one‑off interaction through the asynchronous format. During the online chat sessions, young people can follow-up on the advice received immediately, ask follow-up questions, and provide additional details on their situation that allows counsellors to target their support. Existing evidence on online universal prevention interventions should be considered in ensuring a common and evidence‑grounded approach to this web-based chat support, within the context of #tosemjaz. Evidence suggests that most online help-seeking happens after 11 pm and that online services available 24 hours a day are valued (Pretorius, Chambers and Coyle, 2019[5]). Expanding sessions to these terms might require remuneration of experts providing the sessions and might also represent a shift from universal to selective prevention.
With regards to the asynchronous #tosemjaz services, the lack of effectiveness evaluations prevents detailed recommendations about enhancing this domain of the intervention.
Intervention 2
Ensuring that the full set of the 10 school workshops is completed. Results of both quantitative and qualitative analyses indicate that the effectiveness of the programme increases with the number of workshops provided. This may be due to the opportunity for students to consolidate new ways of thinking and behaving. Putting more emphasis in completing the 10 workshops is particularly relevant given the (reported) challenges to find the time within the classic curricula to implement the full programme. In addition, it would be relevant to assess the impact of longer periods of implementation, in line with the recommendation based on the 2017/18 study, to space the 10‑workshops over the course of two school years. Having an audit and fidelity-of-implementation model to assess the content of the workshops provided would be an important step towards ensuring the programme consistently delivers its maximum value across the different schools.
Identifying and maximising programme features that promote connectedness between students and with teachers. Qualitative insight from students, teachers and workshop providers collected during the 2017/18 evaluation suggests that changes in co‑operation, trust and openness in communication had occurred among students during the programme. Workshop providers reported increasing integration and co‑operation among students, as well as willingness to integrate classmates that had previously been excluded from the class dynamics. Student highlighted having mostly valued co‑operation, and expression and exchanging opinions (Sedlar et al., 2019[2]; Boben, 2018[9]). A higher level of school connectedness is associated with lower levels of depressive and anxiety symptoms (Raniti et al., 2022[12]). Understanding if there are specific workshops or mechanisms in the delivery that promote this aspect might present opportunities to increase the effectiveness of this prevention strategy.
Selecting workshop providers that already have a (positive) relationship with the students. Differences in results across schools seem to be linked to the relationship established between students and the workshop provider, with better results appearing when this relationship was already established before the programme. Although 70% of students had already received the workshop from one of their teachers (alone or in partnership with other counselling staff) (Sedlar et al., 2019[2]), this proportion could still be increased by making it a key recommendation that workshop providers have an existing relationship with the class.
Further recommendations on enhancing effectiveness require evidence on a different set of outcomes. Universal prevention in schools is established in the literature as effective on a large range of outcomes including emotional distress, behavioural problems and academic achievement (Harrison et al., 2022[13]; Nice, 2022[14]), which should be studied for This is me. Literature also suggests that multicomponent and multilevel interventions increase in effectiveness (Harrison et al., 2022[13]). In the context of This is me there are potential opportunities to maximise the links between the school-based intervention (intervention 2) and the online advice (intervention 1). #tosemjaz could be used beyond its universal approach to provide selective or indicated (for individuals identified through screening or with symptoms) prevention to students identified during the workshops. Students in critical periods of the life course (e.g. family break-ups, bereavement, developmental transitions during puberty, among others) and students identified as requiring extra support to develop their social and emotional skills could be referenced to synchronous support through the online chatting sessions. On the other direction, all the existing opportunities to disseminate #toemjaz support during the 10‑workshop programme should be maximised, given that several universal preventive online activities have schools as points of departure (Noh and Kim, 2023[3]).
Enhancing efficiency
Ensuring the completeness of the 10 workshops per class would improve efficiency. Efforts that boost effectiveness and coverage without significant increases in costs will have a positive impact on efficiency. Between 2012/13 and 2022/23, the average number of workshops per provider varied between 4.4 and 8.9, potentially suggesting that a considerable proportion of 10‑workshop programmes is not fully implemented. A low level of completeness not only threatens effectiveness of the intervention but also fails to maximise the training received and the experience acquired. Active efforts should be done to promote programme completion and the implementation of several workshop programmes/year by provider.
Enhancing equity
Intervention 1 and 2
Increasing the uptake of interventions 1 and 2 by groups at higher risk of poor mental health due to their socio-economic status, migration background, identifying as LGBTQI+, among others. Being designed as universal prevention This is me interventions do not focus on specific (groups of) young people. Given that youth in most vulnerable circumstances is usually harder to reach, measuring and strengthening their uptake could be made a priority.
Complementing This is me with new specific components aiming to address the needs of youth in most vulnerable circumstances. Existing evidence supports the effectiveness of multicomponent and/or multilevel preventive interventions (Harrison et al., 2022[13]). Determining the exact nature of these interventions/components requires additional data collection and evidence generation to shed the light on the distributional effects of This is me interventions, to identify what groups might benefit the least/have larger unmet need.
Intervention 1
Increasing the uptake of #tosemjaz online advice services in boys. The large proportion of #tosemjaz questions that is submitted by girls (81% between 2020 and 2022) hints a potential to increase on information about the online advice, or a result of known gender-patterns in help-seeking attitudes around this age. Part of this difference might also be a consequence of higher need from girls, and type of support each group prefers. While the former reason for the differences could be addressed by improvements in the dissemination content and channels aimed at boys, the later reasons are more challenging to address and might require designing intervention dedicated to boys.
Enhancing the evidence‑base
Intervention 1
Carrying out an evaluation of the #tosemjaz online counselling effectiveness. Future evaluations of #tosemjaz should go beyond process indicators and user experience and study the impact on outcomes. Despite the one‑off nature of #tosemjaz online advice, the evaluation of its effectiveness could be achieved through the implementation of pre‑post measurement tools or through a randomised evaluation (comparing the active provision of information through the expert answer with the access to an information portfolio without interaction, for example) (Shen et al., 2023[15]; Hoffberg, Stearns-Yoder and Brenner, 2020[16]). For better evidence on youth needs and on the coverage of the intervention more characteristics should (tentatively) be collected from users, while maintaining the option of full anonymity. A relevant variable to measure, at least for the synchronous component of #tosemjaz, would be the repeated use of the intervention, to identify the frequent users of the online chat (Efe et al., 2023[17]).
Intervention 2
Enhancing the study design and outcome measures of the evaluation of the school-based programme. Given the limitations of the 2017/18 evaluation and the modifications to the intervention since then an additional study would represent important improvement to the current evidence base. The study should include sample size calculations to avoid the potential problem of small numbers, a more extended follow-up assessment beyond the end of the 10 workshop programme, the randomisation of classes allocated to the intervention and the control group, and a larger range of outcomes, informed by the existing evaluations of other universal school-based preventive programmes: emotional distress (e.g. anxiety, depressive and stressful symptoms), behavioural problems (e.g. positive social behaviour and conduct problems) and academic achievement (Nice, 2022[14]). Robust evidence about the benefits of universal interventions is particularly relevant in the context of potential for iatrogenic harm, as well as the crowded school curriculums and resulting opportunity costs (Nice, 2022[14]).
Intervention 1 and 2
Evidence of cost-effectiveness is needed for both interventions, aiming at establishing the potential value‑for-money these might return given the low investment in workforce needed.
Enhancing extent of coverage
Intervention 1
Increasing synchronous chat sessions availability and dissemination. These sessions could be reframed as selective and/or indicative prevention activity to be targeted at students identified during the school workshops as being at higher risk distress or in need of improving their social and emotional skills. In addition to providing general information about the chat sessions for all those attending the workshops, targeted recommendations could be made for those in greater needs. Importantly, increasing demand for the online chat format of advice might require reinforcements in the recruitment and training of volunteer experts, as well as some adaptation of this training to the synchronous format of communication. Experience with and literature on traditional helplines may provide useful insight to inform these modifications.
Intervention 2
Boosting the number of schools receiving the programme. While materials and training about This is me have been made available country-wide, the proportion of Slovenian schools currently implementing the 10‑workshop programme (15%) should be increased to bring the programme to a larger number of students. Evidence about the implementation of universal mental health prevention programmes in schools suggests that some strategies are more effective in improving adoption: informing and engaging principals as local opinion leaders, improving teachers’ buy-in and organising regular school personnel implementation meetings. Training does also seem to be positively associated with adoption, mostly when used in combination with other strategies. These different options together with insight from school auscultation should be considered when scaling up This is me in the Slovenian context (Baffsky et al., 2023[18]).
This section explores the transferability of This is me 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 This is me.
Previous transfers
This is Me has not been transferred to other OECD countries, although several countries have analogous programmes of workshops/sessions strengthening students social and emotional learning.
Transferability assessment
This section outlines the methodological framework to assess transferability followed by analysis results.
Methodological framework
A few indicators to assess the transferability of This is me were identified (Table 11.3). 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 Slovenia, 48% of individuals have used the internet for seeking health information in the last three months, slightly below the median of OECD and EU countries of (53%). Therefore, the majority of countries have favourable conditions for the transfer of This is me (intervention 1).
b) In terms of the share of individuals volunteering time to an organisation in the past month (27%), Slovenia is positioned on the highest quartile of the distribution for OECD and EU countries, suggesting that Slovenian population is more used to engage in volunteering than most countries being considered for This is me (intervention 1) transferability.
c) The number of psychologists per 1 000 population in Slovenia (0.09) is lower than for most of OECD and EU countries with available data (median 0.43), suggesting that the availability of psychologists in most countries may facilitate the implementation of This is me (intervention 1).
d) In Slovenia, teacher’s motivation is in the lowest quartile of the OECD and EU countries (0.89). high teacher’s motivation is likely to facilitate the transfer of This is me (intervention 2) in countries.
e) Slovenia’s ratio of students to teaching staff is 19.05, which is among the highest of OECD and EU countries. As most countries have a lower ratio of students to teaching staff, they should have favourable conditions for the transfer of This is me (intervention 2).
f) As in Slovenia, the vast majority of countries (90%) have a strategy or action plan to guide the implementation of mental health policy. This suggests that This is me is likely to benefit from existing infrastructure and experience to be implemented.
g) Most countries (90%) do also have policies and programmes to support and promote the mental health of children and adolescents, including Slovenia. Implementing This is me can benefit from the prioritisation of this policy domain in most countries.
h) Similarly, 90% of the countries have policies and programmes in place to support mental health in educational settings, suggesting an appropriate policy landscape across the health and education domains to implement This is me (intervention 2).
i) Policies and programmes for integrating digital technologies and tools into mental health service delivery are slightly less common, only in place in 74% of the countries, including Slovenia.
j) Slovenia allocates 0.5% of its GDP to prevention, which is above the OECD and EU median of 0.45%. Countries with a higher spending on prevention are more likely to have economic support for the transfer of This is me.
k) Data on spending on early childhood education and primary and secondary schools as a percentage of GDP is missing for Slovenia. However, a higher share of spending should be favourable to the transfer of This is me (intervention 2) as a school prevention activity. OECD and EU countries median is 3.77%.
A darker shade indicates This is me 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 11.3.
Source: Eurostat (2023[19]), Individuals using the internet for seeking health-related information, https://ec.europa.eu/eurostat/databrowser/view/tin00101/default/table?lang=en (accessed on 24 February 2025); Gallup (2023[20]), Share of individuals volunteering time to an organization in the past month (%), OECD (2021[21]), A New Benchmark for Mental Health Systems: Tackling the Social and Economic Costs of Mental Ill-Health, Paris, https://doi.org/10.1787/4ed890f6-en; OECD (2021[22]), OECD Data Explorer - Teacher motivation, https://doi.org/10.1787/health-data-en (accessed on 16 April 2024); OECD (2021[23]), 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[24]), 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[25]), 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[26]), Mental Health Systems Capacity Questionnaire 2023 - Policies and programmes to support mental health in educational settings; OECD/WHO Regional Office for Europe (2023[27]), Mental Health Systems Capacity Questionnaire 2023 - Policies and programmes for integrating digital technologies and tools into mental health service delivery; OECD (2024[28]), OECD Data Explorer - Prevention spending as a percentage of GDP, http://data-explorer.oecd.org/s/1nl (accessed on 7 April 2024); OECD (2024[29]), OECD Data Explorer - Spending on early childhood education and primary and secondary schools as a percentage of GDP, http://data-explorer.oecd.org/s/1nl (accessed on 5 September 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 11.3. 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 11.1 and Table 11.5:
Based on high-level indicators, countries in cluster one have population, political, and economic conditions in place to support the introduction of This is me. This cluster comprises 22 countries, including Slovenia.
Countries in cluster two have population, sector-specific and economic arrangements to support the implementation of This is me. However, these countries may wish to consider ensuring that the implementation aligns with political priorities. This cluster consists of six countries.
Countries in cluster three have sector-specific conditions to support the transferability of This is me, although they may wish to undertake further analysis to ensure that the programme is affordable, aligns with political priorities, and has population arrangements in place to facilitate the transfer. This cluster consists of 15 countries.
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 11.2 outlines several new indicators policymakers could consider before transferring This is me.
In addition to the indicators within the transferability assessment, policymakers are encouraged to collect information for the following indicators:
Population context
What is the level of interest among young people in seeking information online? And is this interest equally distributed across different sociodemographic groups? (intervention 1)
What is the proportion of young people without access to internet (in own devices)? (intervention 1)
What is the level the mental health literacy and knowledge of social and emotional competences in children and parents? (intervention 2)
Sector specific context
What is the level of digital literacy among psychologists and other mental health practitioners? What are their beliefs about provision of digital mental health support? (intervention 1)
What is the proportion of schools with universal prevention activities implemented in the domains of mental health? (intervention 1)
What is the level of mental health literacy among teachers and school staff? (intervention 2)
What is the time available within class timetable to implement new activities? (intervention 2)
Political context
What is the level of cross-sectoral co‑operation between policymakers and institutions working in the domains of education and health?
Economic context
Are there dedicated funds to implement promotion of good mental and prevention of mental ill-health objectives?
This is me consists of two different interventions aimed at protecting adolescent mental health: online expert counselling answering youth’s questions either asynchronously or synchronous via chat conversations (intervention 1) and a school-based programme of 10 preventive school workshops in primary and lower secondary education (intervention 2).
Better evidence is needed to adequately judge the effectiveness of This is me interventions. Existing results from an evaluation of the 10‑workshop programme show that the workshops have improve classroom climate. They also suggest potential effects on student outcomes (interpersonal difficulties, coping and self-concept) (non-significant) that should be further evaluated. While cost-effectiveness has not been evaluated, This is me interventions mostly rely on volunteering or within-class teacher work, without requiring large workforce investments. Evidence about cost-effectiveness is also needed to corroborate value returned by the potential low-cost of the interventions.
As a universal prevention strategy, This is me has the potential to easily reach all young people, including those in most vulnerable circumstances. Still, dedicated efforts could be done to ensure that harder to reach people are aware of #tosemjaz and benefiting from the school workshops, including through better bridging interventions 1 and 2.
An expansion of This is me can be achieved through an increase of the availability and dissemination of online chat sessions and the extension of the coverage of the 10‑workshop programme to more Slovenian schools (currently only 15%).
Based on high-level indicators, This is Me interventions are highly transferable in 22 out of 43 OECD and EU countries, and intermediately transferable to six countries. All countries have the opportunity to tailor mental health prevention strategies according to their specific needs, resources and contexts. This also applies to certain countries that may encounter challenges related to population arrangements, political priorities and the affordability of implementing the programme.
Box 11.3 outlines next steps for policymakers and funding agencies.
Next steps for policymakers and funding agencies to enhance This is me are listed below:
Design and implement evaluations of This is me interventions 1 and 2, including its cost-effectiveness.
Implement an auditing and monitoring and fidelity-of-implementation model to assess the content of the workshops when scaling up the school-based programme in all Slovenian schools (intervention 2).
Expand the availability and dissemination of synchronous support provided in #tosemjaz through only chat sessions (intervention 1). If needed, consider the remuneration of experts providing these sessions.
Build additional links between interventions 1 and 2 of This is me, namely by providing students identified to be in need during the class workshops with support from the #tosemjaz online chat sessions.
Examine the barriers facing by schools to implement This is me intervention 2, to increase the share of schools receiving the programme.
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