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Concept: Fostering Mental, Emotional, and Behavioral Health Among Children in School Settings: Opportunities for Complementary and Integrative Health

Project Concept Review

Council Date: September 10, 2021

Program Director: Della White, Ph.D.


Mental, emotional, and behavioral (MEB) disorders (e.g., anxiety disorders, depression, substance use disorders, behavior disorders) often manifest during childhood or adolescence, with 75 percent developing by age 24. The 2019 National Academies of Sciences, Engineering, and Medicine report Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda, commissioned by the Centers for Disease Control and Prevention (CDC), National Center for Complementary and Integrative Health (NCCIH), National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH), and Substance Abuse and Mental Health Services Administration (SAMSHA), highlighted that 50 percent of adolescents in the United States have some mental health disorder, and 40 percent of children who meet the criteria for one MEB disorder also meet the criteria for at least one of the others. Further, suicide is the second most common cause of death among people aged 10–34 years, and the use of alcohol and other substances continues to pose significant public health risks to child health that can continue into adulthood. Indeed, MEB disorders contribute to high rates of disability, school dropout, cardiovascular and metabolic diseases, lost years of productivity, incarceration, and homelessness. Importantly, poor MEB health negatively impacts academic performance, and this carries over into postsecondary education. Preventive interventions that address an array of MEB health outcomes, including complementary and integrative health interventions, are important for promoting MEB health and preventing MEB disorders among children.

Children have limited access to MEB health services, and this is especially true for children living in low-resourced communities and racial/ethnic minority and underserved youth. Schools have increasingly become key access points of MEB health services for children and have the capacity to reach large populations of children at different developmental time periods. There is mounting evidence that it is feasible to conduct mindfulness-based interventions and yoga in school settings. Results from various studies have indicated mindfulness is effective in reducing anxiety, depression, and stress and in improving coping responses, emotion awareness and regulation, and positive feelings among adolescents. Mindfulness training has also been associated with prevention of substance use and alcohol use behavior. Similarly, preliminary evidence indicates that yoga may be effective in reducing stress, enhancing mood and well-being, and improving both physical and mental health among children. Key limitations of existing research include use of small sample sizes, lack of fidelity monitoring and longitudinal data, use of nonexperimental research designs, and lack of active control conditions. There is a need for rigorous research to build the evidence base for the effectiveness of complementary and integrative health approaches for promoting MEB health and preventing MEB disorders among children.

Purpose of Proposed Initiative

The purpose of the proposed initiative is limited to the support of multisite clinical trials to test the efficacy of complementary and integrative health approaches with physical and/or psychological therapeutic inputs (often called mind and body interventions) for MEB health in children and adolescents. Trials supported in this initiative must be conducted in school settings. The goal of this specific research initiative is to contribute to the evidence base on complementary and integrative health approaches for promoting MEB health and preventing MEB disorders. NCCIH will continue to work with other National Institutes of Health (NIH) Institutes, Centers, and Offices to identify ways to support research on implementation strategies to facilitate reach, adoption, adaptation, scale-up, and sustainability of evidence-based MEB health prevention interventions in school settings.


The objectives to be met by this concept include but are not limited to the following:

  • Studies that support rigorous testing of complementary and integrative health interventions to promote healthy MEB development and/or prevent MEB disorders in school settings.
  • Studies that examine MEB health as well as the impact on the whole child, including academic and physical health outcomes.
  • Studies that focus on reducing health disparities and advancing equity in MEB health among children in underserved and low-resource school settings.
  • Studies that assess multiple levels of influence on MEB health outcomes (e.g., individual, interpersonal, community, societal).