**4. Conclusion**

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

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 promising public health strategy and a way forward.
