Our Science

Shamiri means "thrive." We are building a future where young people, everywhere, can thrive.

The youth mental health crisis demands innovative solutions backed by rigorous evidence. We test everything: clinical outcomes, scalability across contexts, implementation by partners, and cost-effectiveness that enables scale

Building a learning organization

A commitment to science and learning

The youth mental health crisis demands innovative solutions backed by rigorous evidence. We test everything: clinical outcomes, scalability across contexts, implementation by partners, and cost-effectiveness that enables scale

Therapeutic innovation

Our mission is to deploy evidence-based interventions at-scale. Therapeutic innovation allows us to actively test and expand our toolkit of interventions for youth mental health and wellbeing. We do this to ensure that these interventions effectively improve mental health outcomes and quality of life for young people.

Process innovation

Process innovation allows us to create systems that function with less effort, fewer resources, and minimal fidelity loss. Through process innovation, we optimize how we work to eliminate administrative burden, enhance training and supervision, and ensure that our infrastructure for delivering interventions is sustainable as we scale.

Behavior change innovation

Behavior change innovation allows us to understand the root causes of the problems that we address and understand what keeps young people from seeking help. We design interventions that reduce stigma and build demand for mental health support—tackling both supply and demand sides of the care equation.

Shamiri means "thrive". We are building a future where young people can thrive.

Testing our model's efficacy

Does our model work?

Does our model create consequential impact in young people's lives? To answer this, we've conducted randomized controlled trials to examine effect sizes and durability of change.

Testing our model's efficacy

Pilot RCT testing Shamiri vs. active control

Our first study was a pilot randomized controlled trial with 51 youths experiencing clinically-elevated depression and/or anxiety.This was an individual-level trial where youth were randomized to receive either the Shamiri intervention or an active "study-skills" control group of equal dosage and duration.Results showed significant reductions in depression (d = .32, p = .03) and anxiety (d = .56, p=.004) as well as improvements in academic performance and perceived social support.Importantly, these effects were comparable to those from traditional youth psychotherapy trials and were published in Behavior Therapy.

Shamiri Pilot Study Results

Depression

PHQ-8 Score

Shamiri

Control

Anxiety

GAD-7 Score

Shamiri

Control

Shamiri 2.0

Well-power RCT testing Shamiri vs. active control

Our second study was a large, substantially-powered, pre-registered replication: Shamiri 2.0, with 413 high-symptom youths across diverse school settings in Kenya.

This study met rigorous WHO and International Committee of Medical Journal Editors (ICMJE) standards for clinical trials.

We found larger reductions in depression (d = .35, p = .01) and anxiety (d = .37, p = .04) in the Shamiri groups than in the study-skills control, sustained at two-week follow-up and extended to seven-month follow-up. These findings were published in JAMA Psychiatry, a top-ranked psychiatric journal.

Shamiri JAMA Study Results

Depression

PHQ-8 Score

Shamiri

Control

Anxiety

GAD-7 Score

Shamiri

Control

Consequential impact

How do these effects translate into real lives?

Meaningful and consequential improvements

80% of youth with clinically-elevated depression don't meet criteria for depression after 4 weeks

82% of youth with clinically-elevated anxiety don't meet criteria for anxiety after 4 weeks

Beyond mental health

Youth experience between half-to-full letter grade improvement in academic performance

Youth report strengthened social relationships with peers, teachers and loved ones

Follow-up: Ongoing long-term studies show maintained mental health improvements and emerging evidence of positive effects on educational attainment and livelihood outcomes

Costs and cost-effectiveness

Is our model cheap enough?

Without affordable economics, impact doesn't scale. Thus we need to demonstrate both clinical effectiveness and a cost structure governments and communities (our ultimate Payer-at-Scale) can sustain.

Cost-per-client

Making our model cheap enough for our Payer-at-Scale

To reach government-scale adoption, we're targeting $3 per youth—a price point that fits within education budget lines.

In 2021, our cost was $22.17 per youth. Through systematic optimization and scale, we've driven that to $7.86 (2024). By 2027: $5 per youth. By 2030: $3 per youth—a 86% reduction from launch.

This transforms our unit economics: Peer counseling ($25), community group therapy ($45), lay-delivered CBT in LMICs ($175), private therapy in Kenya ($400/session), US/UK school programs ($700/student). Shamiri delivers clinical-grade outcomes at 1-5% of these costs

Shamiri Cost Comparison

Cost per youth served

$700

$600

$500

$400

$300

$200

$100

$0

$7

Shamiri

$25

Peer
Counseling

$45

Group
Therapy

$175

Lay CBT in
LMICs

$400

Private
Therapy

$700

School-Based
Programs

Cost-Effectiveness

Cost-effectiveness

Cost per clinically meaningful improvement

Depression

2022

$113.56

↓

2023

$23.94

79% reduction

Anxiety

2022

$61.88

↓

2023

$21.18

66% reduction

Cost Effectiveness: Health economics approach

Cost-effectiveness per clinically meaningful improvement

Cost per youth served only matters if the intervention works. Using CHEERS guidelines (gold standard for health economic analysis), we measured cost per clinically-meaningful improvement—the actual price to move someone from clinical depression or anxiety to recovery

In 2022, we achieved clinically-meaningful depression improvement for $113.56 and anxiety improvement for $61.88. By 2023, those numbers dropped to $23.94 for depression and $21.18 for anxiety. These reductions came from systematic optimization and scale, not from compromising clinical quality. We're proving the equation works: high-fidelity delivery combined with community-based scale equals both clinical effectiveness and radical affordability.

Costs and cost-effectiveness

Comparison through Quality-Adjusted Life Years

To compare Shamiri against other health interventions globally, we translate mental health impact into Quality-Adjusted Life Years (QALYs)—the same metric used to evaluate treatments for physical health conditions.

A QALY combines how much someone's health improves with how long that improvement lasts. One QALY represents one year in perfect health. This metric allows economists to compare very different health programs on a common scale of health gained per dollar spent.

We measure depression outcomes using the Patient Health Questionnaire (PHQ-8), a validated clinical tool. To translate these symptom changes into health-related quality of life gains, we use existing research that statistically links changes in PHQ scores to changes in the EQ-5D—a standard global measure of health utility used in cost-effectiveness research.

Using data from our published randomized trial, we translated average reductions in depression scores at 7-month follow-up. Using research that shows that each each 5-point improvement in PHQ corresponds to roughly a 0.03-point increase in EQ-5D utility, or about 0.006 per PHQ point, we calculated a utility gain from our depression reduction scores.
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This translation allows us to calculate cost per QALY gained and compare our intervention directly to other health programs worldwide—demonstrating that mental health treatment delivers measurable economic value on the same scale used to evaluate treatments for physical health conditions.

Cost per QALY Comparison

Cost per QALY: Shamiri vs Other mental health interventions

*Sources: Osborn et al., JAMA Psychiatry (2021); Furukawa et al. (2021); Wright et al. (2016); Wolf et al. (2022); Clarke et al. (2022); Domino et al. (2008); Ali et al. (2024).

Shamiri means "thrive". We are building a future where young people can thrive.

Shamiri 2.0

Can others implement our model?

Clinical trials prove efficacy under controlled conditions. Real-world effectiveness is messier. Could other organizations deliver Shamiri without us?

We conducted implementation research across 3,983 youth in diverse Kenyan schools. Some received Shamiri through our direct implementation (Shamiri Hubs). Others received it through community-based organizations using a 'train the trainers' approach (Shamiri Partners).

Results: No significant differences in depression or anxiety outcomes between Shamiri-led and partner-led delivery. This provided evidence that our model is 'simple enough'—others achieve the same results independently.

Shamiri Dissemination Trial Results

Depression

PHQ-8 Score

Shamiri Hubs

Partner Organizations

Anxiety

GAD-7 Score

Shamiri Hubs

Partner Organizations

Our Science Board

Our science board brings together leading researchers in clinical psychology, implementation science, economics, and global mental health—providing rigorous oversight and methodological guidance