The program that eventually became “Advocates 4 ALL Youth (ALLY)” originated in 2019 as a pilot project focused on suicide prevention for children and adolescents. School-based programs were identified as the most effective setting for such initiatives, offering broad access to all students, including those who may not yet show clear signs of mental health issues but are still at risk. At the time, most school-based mental health programs focused on students who were already identified as having high levels of symptoms of depression or anxiety. However, many schools struggled to implement these programs due to the high costs of screening all students, placing an additional financial strain on already underfunded institutions. Additionally, schools found that targeting students based on symptom screenings often led to stigma, and the programs were difficult to sustain due to limited mental health staff and resources. Finally, these programs often worsened mental health disparities, especially for racially and ethnically minoritized communities, which faced significant barriers to accessing funding and support for such initiatives.

For a quick snapshot of the program – download the InfoSheet.

Our proof-of-concept program, Building Resilience for Healthy Kids, launched in January 2020, concluded just as COVID-19 school closures began. The pilot was deemed successful, with notable improvements in students’ resilience after completing six sessions of the program. Students who initially reported elevated symptoms of both depression and anxiety showed significant reductions in anxiety, and their self-efficacy (belief in their own abilities) was notably enhanced. We also discovered that students who reported insufficient sleep did not experience the same benefits as those who got adequate rest. Lastly, the program demonstrated equitable outcomes across all student groups, including those from racial and ethnic minority backgrounds.

As schools prepared to reopen for the 2020-2021 academic year, we were ready to test our program using a more rigorous approach—a randomized controlled trial. We partnered with a new school to see if we could replicate the positive outcomes from our proof-of-concept. Between April and June 2021, 160 sixth-grade students (average age 11.6 years) were randomly selected to participate in the program. Compared to their peers, students who participated showed improvements in emotional regulation, with the greatest benefits observed in those who initially reported elevated symptoms of both depression and anxiety.

As the world witnessed the decline in youth mental health and well-being during and after the COVID-19 pandemic, the well-documented disparities in access to and treatment for mental health care became even more concerning. In response, Dr. Kaar decided to test the program in a new environment, partnering with colleagues at Auburn University in Auburn, AL. As students returned for the 2021-2022 academic year, Dr. Kaar and her team adapted the original program to meet the needs of a Title 1 elementary school in a rural Alabama community. Previously, Healthy Kids had been piloted in an urban middle school in Colorado, where 16% of students were eligible for free or reduced lunch, and 25% were documented as minority students. In the Alabama school, 5th and 6th graders were combined in an elementary setting, with 88% of students eligible for free or reduced lunch and 88% identified as minority students. The need to adapt the program for this new cultural context was clear. Using a health equity implementation framework, Dr. Kaar led the team in modifying the program to ensure it was culturally relevant, appropriate for the students’ literacy levels, and designed for sustainable delivery within the constraints of the school community. This newly adapted program, Advocates 4 ALL Youth (ALLY), aimed to incorporate local cultural styles and meet the specific needs of the students. The findings of this work have been published in a paper documenting the feasibility of delivering ALLY in a racially minoritized, low-income community. The paper also discusses the modifications made during implementation and presents the overall study outcomes.

Diversity,  Equity, and Inclusion (DEI) Statement. Diversity, equity, and inclusion are core values of Advocates 4 ALL Youth (ALLY), INC. We honor and celebrate the diverse identities of our volunteers, supporters, and the youth we serve. We recognize disparities in mental health care, particularly among racially and ethnically minoritized and low-income youth, who face challenges like educational inequalities and limited access to services. ALLY was created with and for these communities to reduce stigma, improve access to care, and promote mental health equity through increased mental health literacy. Our goal is to eliminate inequities in mental health care and ultimately prevent suicide.