Introduction
Over the past twenty years, mental health problems among children and adolescents have been increasing worldwide. Research showed that nearly half of all psychiatric disorders diagnosed in adulthood actually begin in childhood and adolescence. In recent years, the prevalence of mental illness in Iran has been on the rise. This indicates the need to pay attention to the effectiveness of existing interventions and adopt strategies to manage these conditions. Schools can help identify and address significant mental health problems in children and adolescents.
Therefore, due to the need to identify problems related to mental health among students and their proper management by offering specialized medical services to them, recently a relevant research project has been fully implemented in schools of all grades in Iran. The research project, entitled the School Mental Health (SMH) Program, is evidence-based and its protocol is published in the form of a handbook. The handbook is approved by all member states of the World Health Organization (WHO) in the Eastern Mediterranean Region. The present study aims to assess the efficacy of this program in Iranian schools, find its shortcomings, and provide recommendations to improve it. 

Methods
The present study was a qualitative study using conventional content analysis that used a semi-structured in-depth interview and FGD to obtain information from groups of stakeholders. Purposeful sampling was used in this study. In this study, a total of 5 focus groups were held. The interviews continued until the saturation was reached so that no new code was found. Accordingly, a pilot project, according to the above-mentioned published handbook, has been implemented in schools after translation and customization.

Results
The findings of the present study were presented in four themes: 1. Program strengths, 2. program weaknesses, 3. factors preventing the achievement of program objectives and 4. recommendations for program improvement. It is to be noted that 50 codes were extracted and 14 subcategories were obtained.
According to some participant 's opinion about strengths: "The course has made us a little more open, a little more focused on some kids" and "one of the strengths of empowerment was, raising the sense of responsibility in the selected instructors and their strong commitment, which was the basis for these interventions in schools ".
According to some participant 's opinion about Weaknesses: "I think the issue of families is a gap in this project", "we have to have feedback; we don't get specialized results" and "the selected trainers were people who had 1. Not enough time, 2. Lack of expertise and 3. That, like a social worker, did not have a wide field of work."
According to some participant 's opinion about factors preventing the achievement: "The problem in the treatment process is that the families don't cooperate, or if they do, it's not continuous, and also they don't go for treatment and there is a fear of stigmatization."

According to some participant 's opinion about program improvement
"Keep in mind that these teachings are very effective for children and teachers, as well as parents "and "we really need to have one person on the subject of psychology in every school" (Table 1). 



Conclusion 
The present study evaluated the School Mental Health Program, and since the research in this field is small and vague, we examined the mentioned topics using the stakeholders’ perspectives.
School-centered interventions mostly involved school members and context for primary interventions. The results of the study showed that the interventions led to the empowerment of teachers and educators in these schools for identifying students’ psychiatric disorders compared to pre-intervention status, reducing teachers’ burnout and improving classroom management, as well as changing their attitudes toward students' psychological problems. Studies have shown that trained teachers have a high potential to participate in the provision of mental health services and that educational interventions in the group of teachers who were not trained have been able to improve teachers' attitudes toward identifying and referring students. Thus, the teacher is at the forefront of mental health programs that are in direct contact with students. 
Factors that prevent the achievement of the project goals were: financial problems and lack of education of students and their families for seeking counseling, the quality of counseling services at the core of counseling (lack of expertise in various fields and lack of feedback to lower levels), the high workload of some teachers and time constraints of the selected trainers.
One of the limitations of this plan was the lack of attention to family education and their justification for participation and follow-up. Moreover, programs that focused on multiple target groups (such as individuals, families, and school staff) and combination programs that focused on behavioral changes of students, teachers, families, and relationships between school, family, and other social institutions were the most influential.
Modifications to some rules and regulations in education, feedback, and appropriate responses from specialized levels (counselling centers and community-based mental health centers) to lower levels. Improving enrollment and reporting, continuous and gradual retraining, lack of intensive training, coordination of all project members, including teachers, educators, counselling centers, considering incentives for the positive performance of teachers and educators are also recommended.
Among the recommendations made one is that the project results should continue and the participation of all stakeholders should be sought and supported for its sustainability
The overall results of the evaluation of the School Mental Health Program showed its effectiveness. The new and practical model of the School Mental Health Program has opened a new perspective on school-based interventions. Change in organizations is more complex and requires resources, facilities, expertise, and time. Therefore, by foreseeing and drawing a broad and appropriate outlook, while realistically recognizing the situation, proper steps should be planned and implemented to organize the establishment of mental health services in schools.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1398.865).

Funding
This study was funded by Iran University of Medical Sciences.

Authors contributions
The authors contributed equally to preparing this paper.

Conflicts of interest
The authors declare no conflict of interests.

Acknowledgements
The authors would like to thank the participants for their cooperation.

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