Improving child mental health and learning outcomes and reducing stigma and discrimination in conflict setting: findings from a cluster randomized controlled trial of a classroom-based psychosocial intervention in rural primary schools in Afghanistan

ERCT Criteria Breakdown

• Level 1 Criteria

  • C

    Class-level RCT

    • The study randomizes at the school level, which is stronger than class-level randomization and satisfies criterion C.
    • "A two-arm cluster-randomized controlled trial was conducted in 83 rural primary schools within three provinces of Afghanistan."
    • Relevant Quotes: 1) "A two-arm cluster-randomized controlled trial was conducted in 83 rural primary schools within three provinces of Afghanistan." 2) "Schools were randomly assigned (1:1) to one of two groups..." 3) "...students nested within schools – the unit of randomization for the intervention..." Detailed Analysis: Criterion C requires that the RCT randomizes at the class level (or a stronger unit) to reduce within-class contamination. The paper repeatedly describes a cluster trial where the randomized unit is the school. School-level randomization is stronger than class-level randomization because it reduces spillovers within a school and better isolates treatment exposure. Final Summary: Criterion C is met because the unit of randomization is the school (a stronger unit than class).
  • E

    Exam-based Assessment

    • Academic outcomes were measured using standardized instruments from a national framework developed with ACER and the Afghanistan Ministry of Education.
    • "Proficiency in reading and mathematics was measured with instruments from the Monitoring Trends in Educational Growth (MTEG) program, developed by the Australian Council for Educational Research (ACER) with the Afghanistan Ministry of Education..."
    • Relevant Quotes: 1) "Proficiency in reading and mathematics was measured with instruments from the Monitoring Trends in Educational Growth (MTEG) program, developed by the Australian Council for Educational Research (ACER) with the Afghanistan Ministry of Education (Australian Council for Educational Research, 2013)." 2) "MTEG is a national item response theory-based framework that tracks grade-level achievement and longitudinal growth from Grades 3 to 9..." Detailed Analysis: Criterion E requires exam-based assessments that are standardized and not custom-built to favor the intervention. The paper specifies that reading and mathematics were measured using MTEG instruments co-developed with ACER and the Afghanistan Ministry of Education, and describes MTEG as a national framework for tracking achievement and growth across grades. While these are not described as high-stakes examinations, the key ERCT requirement is standardization and independence from the study team’s intervention design; the paper’s description supports that. Final Summary: Criterion E is met because academic outcomes use standardized instruments from a national assessment framework (MTEG).
  • T

    Term Duration

    • The paper states that post-intervention measurement occurred after a minimum four-month intervention period, meeting term-duration follow-up.
    • "After a minimum of 4-month intervention, a postintervention survey took place."
    • Relevant Quotes: 1) "After a minimum of 4-month intervention, a postintervention survey took place." 2) "After at least 3 months of intervention implementation... post- intervention data were collected in all schools." Detailed Analysis: Criterion T requires that outcomes are measured at least one academic term after the intervention begins (typically about 3–4 months). The paper’s abstract explicitly states a "minimum of 4-month intervention" before the post-intervention survey, which meets the term-length threshold. A separate methods statement notes "at least 3 months" before post- intervention data collection; taken together, the paper documents a months-long follow-up window consistent with term-duration tracking. Final Summary: Criterion T is met because the paper reports at least a four-month period from intervention start to post-intervention measurement.
  • D

    Documented Control Group

    • The paper clearly defines the control condition as usual teaching with no intervention and presents baseline characteristics for both groups.
    • "The intervention group received the culturally adapted participatory psychosocial intervention (described below), while the control group received no intervention and continued with the usual teaching and learning processes."
    • Relevant Quotes: 1) "The intervention group received the culturally adapted participatory psychosocial intervention (described below), while the control group received no intervention and continued with the usual teaching and learning processes." 2) "Intervention and control groups were balanced on participant characteristics and children’s pre-intervention outcomes (Table 1)." 3) "Table 1 Baseline characteristics of child participants in the intervention and control groups" Detailed Analysis: Criterion D requires that the control group is well documented, including what it receives and baseline information enabling valid comparison. The paper explicitly states the control group received "no intervention" and continued usual teaching and learning. The paper also reports balance at baseline and provides a baseline table for both arms, which supports transparent comparison and documents the control group characteristics. Final Summary: Criterion D is met because the control condition and baseline characteristics for both groups are clearly documented.

• Level 2 Criteria

  • S

    School-level RCT

    • Schools were randomized to intervention and control conditions, meeting the school-level RCT requirement.
    • "The sample was stratified by province, and schools within each province were randomly assigned in a 1:1 ratio to one of two groups (40 to the intervention group and the remaining to the control group)."
    • Relevant Quotes: 1) "The sample was stratified by province, and schools within each province were randomly assigned in a 1:1 ratio to one of two groups (40 to the intervention group and the remaining to the control group)." 2) "...students nested within schools – the unit of randomization for the intervention..." Detailed Analysis: Criterion S requires randomization at the school (site/institution) level. The paper directly states that schools were assigned 1:1 to conditions, and it reiterates that schools were the unit of randomization in the analysis framework. Final Summary: Criterion S is met because randomization occurred among schools.
  • I

    Independent Conduct

    • The authors trained and supervised intervention delivery, and the paper does not document an external independent evaluator leading the study.
    • "The intervention was delivered by Afghan field-based educational staff, who were recruited from among the local community and trained on the intervention delivery during a 12-day-long training by the authors."
    • Relevant Quotes: 1) "The intervention was delivered by Afghan field-based educational staff, who were recruited from among the local community and trained on the intervention delivery during a 12-day-long training by the authors." 2) "After the training, field-based educational staff delivered several days of mock intervention... under the supervision of two of the authors." 3) "Data collection teams worked independently... from the field-based educational staff..." 4) "Data analysis was blinded." Detailed Analysis: Criterion I requires that the evaluation be conducted independently from the intervention designers to reduce bias risks in implementation, measurement, and analysis. The paper shows positive safeguards: separate data collection teams, masking efforts, and blinded analysis. However, the paper also shows the authors were directly involved in training and supervising intervention delivery. It does not clearly document that an external third-party evaluator (institutionally independent from the authors and intervention implementation chain) led data collection and analysis. Final Summary: Criterion I is not met because independent conduct is not clearly documented even though masking and blinding procedures are described.
  • Y

    Year Duration

    • Post-intervention measurement is described as occurring after about 3–4 months, which is below the ERCT requirement of at least 75% of an academic year.
    • "Children, teachers and parents were surveyed at baseline and four months postintervention."
    • Relevant Quotes: 1) "After a minimum of 4-month intervention, a postintervention survey took place." 2) "After at least 3 months of intervention implementation... post- intervention data were collected in all schools." Detailed Analysis: Criterion Y requires that outcomes be measured at least 75% of an academic year after the intervention begins. The paper describes post-intervention measurement occurring after approximately 3–4 months. While some baseline-to-endline calendar windows span longer periods in specific provinces, the paper’s stated design for post-intervention measurement is anchored to a months-long follow-up (around four months), which is clearly below the ERCT year-duration threshold. Final Summary: Criterion Y is not met because the study’s post-intervention follow-up is described as about four months rather than most of an academic year.
  • B

    Balanced Control Group

    • The intervention adds substantial time/training/support relative to the control, but these inputs are integral to the intervention package being tested against business-as-usual schooling.
    • "Schools were randomly assigned (1:1) to one of two groups: a treatment group composed of entire classes receiving a week-long classroom-based teacher-and-child psychosocial training, a one-day family engagement component, and a community-based system dynamics workshop; and a control group."
    • Relevant Quotes: 1) "Schools were randomly assigned (1:1) to one of two groups: a treatment group composed of entire classes receiving a week-long classroom-based teacher-and-child psychosocial training, a one-day family engagement component, and a community-based system dynamics workshop; and a control group." 2) "The intervention group received the culturally adapted participatory psychosocial intervention... while the control group received no intervention and continued with the usual teaching and learning processes." 3) "The intervention was delivered by Afghan field-based educational staff... trained on the intervention delivery during a 12-day-long training by the authors." 4) "Both teachers and parents were expected to continue carrying out all activities daily in class and at home." Detailed Analysis: Criterion B compares time and resource inputs across arms and asks whether any additional inputs are balanced, unless the additional inputs are integral to what is being tested. The intervention clearly includes substantial added resources relative to the control condition, including multiple trainings and ongoing daily activities. The control group is described as receiving no intervention and continuing usual teaching and learning. This is not "balanced" in a strict time/budget sense. However, the additional inputs appear to be core components of the treatment package (a structured psychosocial/SEL program delivered via training and ongoing activities). In that framing, the added inputs are not accidental confounds but the intervention being evaluated against business-as-usual. Final Summary: Criterion B is met because the additional time/training/support are integral to the intervention package being tested versus usual practice.

• Level 3 Criteria

  • R

    Reproduced

    • No independent peer-reviewed replication by a different research team was identified, and the paper itself only discusses replication as a future possibility.
    • "These results enhance the possibility of successful implementation (replication and scaling up) in other regions within Afghanistan or other conflict-affected contexts."
    • Relevant Quotes: 1) "These results enhance the possibility of successful implementation (replication and scaling up) in other regions within Afghanistan or other conflict-affected contexts." Detailed Analysis: Criterion R requires evidence that the study has been independently reproduced by another research team in another context, published in a peer-reviewed outlet. The quoted statement is aspirational (it describes the possibility of replication and scaling), not evidence that such a replication has occurred. After checking publicly available sources tied to this trial (including its registry record and related project pages) and searching for later peer-reviewed replications by other author teams, no independent replication of this specific trial was found at the time of this ERCT check. Final Summary: Criterion R is not met because independent replication evidence was not found.
  • A

    All-subject Exams

    • The study reports standardized academic outcomes for reading/general knowledge and mathematics, but it does not assess all core subjects.
    • "Proficiency in reading and mathematics was measured with instruments from the Monitoring Trends in Educational Growth (MTEG) program..."
    • Relevant Quotes: 1) "Proficiency in reading and mathematics was measured with instruments from the Monitoring Trends in Educational Growth (MTEG) program..." 2) "Secondary outcomes included reading and mathematical literacy, mathematical problem-solving..." Detailed Analysis: Criterion A requires standardized exam-based outcome measurement across all main subjects taught at the relevant level, to detect cross-subject tradeoffs. The paper’s academic outcomes are confined to reading/general knowledge and mathematics (numeracy and arithmetic problem-solving). The paper does not describe standardized assessments in additional core subjects (for example, science or social studies) for Grades 3–6. Final Summary: Criterion A is not met because outcomes are not measured across all core subjects using standardized exams.
  • G

    Graduation Tracking

    • The study does not track participants until graduation, and ERCT rules require Y to be met for G to be met.
    • Relevant Quotes: 1) "After a minimum of 4-month intervention, a postintervention survey took place." Detailed Analysis: Criterion G requires follow-up tracking through graduation (for the relevant schooling stage). The paper describes a baseline and a post-intervention assessment after a months-long interval and does not report graduation outcomes or tracking through graduation. Additionally, ERCT dependency rules specify that if Criterion Y (Year Duration) is not met, then Criterion G (Graduation Tracking) is not met. Since Y is not met here, G cannot be met. Final Summary: Criterion G is not met because graduation tracking is not reported and the year-duration prerequisite (Y) is not satisfied.
  • P

    Pre-Registered

    • The trial was registered in ISRCTN in late 2024, after enrolment and the study period described in the paper, so it is not pre-registered.
    • "This trial has been registered on November 27, 2024 with the International Standard Randomized Controlled Trials Number registry (ISRCTN83632872; https:// www.isrctn.com/trialist)."
    • Relevant Quotes: 1) "This trial has been registered on November 27, 2024 with the International Standard Randomized Controlled Trials Number registry (ISRCTN83632872; https:// www.isrctn.com/trialist)." 2) "We conducted a two-stage cluster-randomized controlled trial in rural primary schools... between May 1, 2021, and December 31, 2023..." 3) "Pre-intervention data were collected... between October 2, 2021 and December 30, 2021..." Additional Quotes (Registry Check): 4) "Registration date 27/11/2024" 5) "Date of first enrolment 01/05/2022" 6) "Completion date 30/12/2023" Detailed Analysis: Criterion P requires that the study protocol is pre-registered before the study begins (i.e., before recruitment/enrolment and certainly before baseline data collection). The paper itself reports a registration date of November 27, 2024, while also describing trial activity and data collection occurring during 2021–2023. The ISRCTN record likewise lists a "Registration date 27/11/2024" and a "Date of first enrolment 01/05/2022", which indicates the registration occurred after enrolment started (retrospective registration). The record also lists completion in 2023, further reinforcing that the 2024 registration cannot function as a pre-registration for this completed trial. Final Summary: Criterion P is not met because registration occurred after enrolment and data collection had already begun.