Trauma-Informed, School-Anchored Mental-Health Pathway After Disasters in the Philippines: A Mixed-Methods Quasi-Experimental Evaluation Linking Clinical Outcomes to Referral-Chain KPIs

Abstract

In a high-disaster-risk Philippine setting, we evaluated a school-anchored, trauma-informed mental-health pathway linked to community care using a convergent mixed-methods, matched-school design. The pathway (screening → brief skills groups → warm/hot referral → structured follow-up) was analyzed by intention-to-treat linear mixed models for PCL-5, PHQ-9, GAD-7 (primary) and WHO-5, WHODAS (secondary), with prespecified moderation/mediation by referral timeliness/closure and classroom fidelity. Reach was high and balanced (~92% vs 91%). At T1, symptoms declined modestly (PCL-5 Δ −3 to −5; g ≈ 0.30–0.35), with favorable T2 maintenance; WHO-5 rose and WHODAS showed small functional gains. MCID/responder rates favored intervention. Service performance improved (≤7-day closure +17 pp; any-time closure +13 pp; median wait −8 days). Delivery met targets (fidelity ≈1.7/2; IRR ≈0.75–0.80), and larger gains aligned with higher fidelity and shorter waits/closure. Conclusion: When fidelity ≥1.6/2, first contact ≤7 days, and follow-up ≳80%, the pathway is feasible and clinically meaningful. Ethics: parental consent, student assent, Data Privacy Act compliance; no external commercial funding.