**Acknowledgements**

relationships with others and self-esteem and self-control can diminish emotional symptoms, withdrawal, depressed symptoms, and worry, even for young children from 3 to 6. Also, data clearly shows that the decrease of risks for development of internalized problems is not uniform for all children: benefits vary depending upon sets of negative behaviors or

Analyses conducted for subgroups of children show that effectiveness depends upon child's capacity and needs. For children that are low risk but seem to have smaller issues in relating to others and lower social skills as well as lower learning behaviors, it is plausible to conclude that mental health promotion intervention like PATHS is very useful. For that group of children that need additional but not clinical support, improvement of classroom climate, boost of social competencies, and focus on feelings, such classroom intervention gives promising results. For that subgroup, improvement of emotion regulation and decline in withdrawal happened within a year of program implementation. Our results for high-risk children subsample show that they need additional care and support, probably more attention within indicated prevention approach or even clinical support. Nevertheless, within comprehensive policy addressing mental and emotional well-being of children, Croatian example shows that universal strategies are helpful and should be considered when planning prevention of internalized symptoms.

This chapter focused on internalized problem prevention in academic setting, since they are integral part of every classroom. Teachers and even parents do not recognize them in exact amount; children and youth tend to hide them and avoid reporting they need help. Findings from literature clearly accent that schools have an important role in reducing internalized problems, starting early on with emotional well-being promotion and responding to first symptoms. Comprehensive whole-school approach to mental health and internalized problems could serve as a climate change since research shows that besides supporting relationships, skill-building approach is most promising. Effects of school prevention programs are small to moderate, but thinking strategically, comprehensive planning of interventions on all

More research is needed to identify effectiveness of various types of programs, but it seems that universal school prevention programs have small to moderate effects and there is evidence that mindfulness programs also reduce internalizing symptoms. Conclusions for internalized problem selective and indicated prevention are still mixed, some studies showing effects in reducing depressive symptoms and enhancing emotional regulation and coping skills, but other studies show effect only for some measures. Making general conclusions is hard since studies are usually focused on specific internalized problem, depression being most often nowadays. Answer to a public health problem has to be comprehensive. Combination of investments from early years, coming from universal approach such as socio-emotional learning and mindfulness-based programs, and then being followed with selective programs for those in elevated risk and indicated interventions for those showing first symptoms, seems

levels could relieve the burden on health care and social services.

promising public health strategy and a way forward.

lack in social or learning skills.

134 Health and Academic Achievement

**4. Conclusion**

Studies mentioned in this chapter were financed by the Unity through Knowledge Fund, Republic of Croatia, and the local authorities of three Croatian regions. Josipa Basic, retired full professor of Faculty of Education and Rehabilitation Sciences, University of Zagreb, Croatia, was the project leader; Celene Domitrovich, now at Department of Psychiatry, Georgetown University, USA, was the coleader. Robert L. Nix, University of Wisconsin, Madison, USA, contributed to the chapter by conducting analyses.
