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Prevention Is a System, But Do We Know How It Works?

„I am struggling,“ says Emma*, a 9th grade teacher at an Estonian secondary school, „The mental health of young people is one of these topics I want to work on, but I’m struggling. I would actually really like to have a school-wide mental health curriculum. I mean, mental health topics are included in the curriculum, but I would just like to map out exactly where these places are and how much attention is paid to them, how systematically it is done.”

“Well, it’s not done systematically, that’s the problem,” answers Laura, a high school teacher at a different school, “We will do something, we will get to check something off again. But we don’t do it systematically, we don’t discuss with others what they are doing, right?”

Emma and Laura’s conversation is just one example of the struggles school staff face in trying to prevent students’ mental health problems. Many schools have realised that preventing problems is a better approach than dealing with consequences later, and that schools have an important role to play here. Indeed, many schools are engaged in prevention, whether that’s through official prevention programmes or other activities, such as shaping the school environment, developing children’s social and emotional skills or offering opportunities for meaningful participation.

And yet, staff like Emma and Laura struggle. That is because prevention is not something one enthusiastic teacher can do alone. Even if the whole school is on board, effective prevention isn’t just dependent on the schools themselves, but also on the many other partners or organisations surrounding the school: from parents and communities to developers of prevention programmes and different levels of government that fund and oversee this work.

Prevention is a system. But it turns out we don’t actually know much about this system. In Estonia, we don’t have a clear overview of who is involved in school-based prevention, what exactly they do, and how they interact. This is why, as part of my PhD project, we decided to map the current school-based prevention system in Estonia. We began by meeting with school staff all over Estonia, as well as representatives from local governments and state-level organisations. In collaborative mapping workshops, participants could list the actors that they thought were important for school-based prevention, place them on a map relative to the school, and draw out different links between the partners, such as which actors implement prevention activities, which ones provide materials and training for implementers, which actors exchange information or plan activities together, and where money for prevention comes from and where it goes. Later, we sent out a survey to all Estonian schools, with the aims of validating the map developed from the workshop data and collecting more information on the quality of different relationships and problems in the current system. Putting the workshop and survey data together, we were able to map the partners involved in prevention, their relationships with schools, and potential areas of improvement.

One thing we found was that the quality of relationships generally matters more than quantity. Schools that fare better in prevention have largely the same partners as those who struggle. The difference lies in relationship quality. Schools that are more satisfied with their partners also report more effective prevention work.

One key relationship is that between the schools and parents. This is also where schools most often experience difficulties. As one support specialist explained:

We have quite a lot of different programmes for children. But we noticed that parent training and support is something every school has tried to – or struggled to – do on their own. They do online trainings and then only three parents come.”

Not only is it difficult to engage parents, but schools also lack the materials and support for working with them. When we spoke about this with local and state-level organisations, they did not see providing prevention activities to parents as the school’s responsibility. This role was given to other partners like child protective services or local municipalities. This raises the question of what role schools should have in parent-focused prevention. While it may be correct that schools needn’t be responsible for everything, it is clear that the schools themselves sense a need to engage with parents and must feel supported in this.

The confusion around different partners’ roles in prevention did not just concern the school. The county was seen as an important partner in school-based prevention by local and national governments. However, most schools did not mention the county as really being involved in their prevention work. This might be because the county level doesn’t have a very clearly defined role in school-based prevention, so the schools may not always perceive them as an important actor.

While some partnerships may be missing, others are perhaps too numerous. For example, schools mentioned how materials and trainings are being offered by so many partners – from universities to ministries and private companies – that it all becomes difficult to navigate.

So where do we go from here? Many of the problems we found seem to boil down to something more universal. “It’s not done systematically, that’s the problem”. Schools see the greatest need for improvement in organisational aspects of prevention, such as prevention planning and internal coordination, cooperation with external partners, staff support, and availability of trained personnel.

To better understand this phenomenon, we can turn to the Interactive Systems Framework for Dissemination and Implementation, which distinguishes between two types of prevention support: innovation-specific and general capacity-building (Wandersman et al., 2008). Innovation-specific support refers to training and assistance related to a particular intervention—something many Estonian schools already access through external programmes and trainings. General capacity-building, on the other hand, focuses on strengthening an organisation’s overall infrastructure, skills, and motivation. Our findings suggest that while innovation-specific support is somewhat available, general capacity-building may be lacking. Schools operate with considerable autonomy, which can offer flexibility, but can also leave them without necessary guidance and support for planning, implementing and evaluating prevention. In short, schools have had to navigate the prevention system without a map to follow.

By mapping the current system and finding specific areas to improve, we have begun to better understand the path forward. These findings can help designing support systems that are both evidence-based and grounded in the real-world experiences of schools. The next step is to turn this understanding into action by strengthening coordination across levels, clarifying partner roles, and ensuring schools have not only programmes to deliver, but also the support and strong relationships to help them thrive in the complex system of prevention.

 

* All quotes are genuine excerpts from workshops with school staff. Participants’ names have been changed for confidentiality.

About the Author

 

Eike Siilbek is a junior researcher at the Estonian National Institute for Health Development (NIHD) and a PhD student in the Institute of Psychology at the University of Tartu. Her research interests include mental health problem prevention, systems science, and behavioural science. Eike’s PhD project focuses on mapping the mental health problem prevention system in Estonia and identifying potential interventions to enhance the effectiveness of the system.

Boris Chapoton
Boris Chapoton

OpenEdition suggests that you cite this post as follows:
EUSPR Early Careers Forum (May 5, 2026). Prevention Is a System, But Do We Know How It Works? Preventing disease and ill health. Retrieved June 8, 2026 from https://doi.org/10.58079/166j8


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