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Authors: Eike Siilbek (National Institute for Health Development), Andero Uusberg (University of Tartu), Karin Streimann (National Institute for Health Development)
Background: Effective school-based mental health problem prevention requires collaboration across multiple levels of the prevention system. However, different actors may have diverging perspectives on how this system functions. This study compares how school personnel and government stakeholders in Estonia understand the organisation of school-based prevention, with the aim of identifying common ground and mismatches that may impact prevention quality.
Methods: Five workshops were conducted with school personnel (39 participants), and three with officials from various levels of government, including municipal, county, and state representatives (17 participants). In each workshop, participants first identified actors in the prevention domain and placed them onto a map. They then drew arrows signifying links between the actors, including prevention delivery, funding, materials and training, and general cooperation. Individual workshop maps were merged into one map for the school groups and one for the government groups. These two maps were then compared.
Results: The school and government maps showed broad agreement on key prevention providers, such as schools, parents, healthcare, and providers of extracurricular activities. However, differences emerged in how each group perceived roles and responsibilities. For example, school groups emphasised their role in implementing prevention activities aimed at parents—a point largely absent in the government map.
Differences were also seen in perceptions of funding. Government participants saw training for prevention staff as mainly funded by state organisations, whereas school teams reported that schools often cover training costs themselves. As for cooperation, government participants emphasised county-level coordination, which schools rarely mentioned.
Discussion: By mapping different perspectives on the prevention system, we highlight important discrepancies between government perspectives and the schools’ lived experiences. These gaps may lead to misaligned expectations and unclear responsibilities. In the future, interventions could address these discrepancies and improve the effectiveness of school-based prevention efforts.
| Conflict of interest | None |
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