Mental health and academic achievement: role of school nurses

Roles and Functions of School Mental Health Professionals Within Comprehensive School Mental Health Systems

Mental health concerns are on the rise among youth, contributing to a growing need for school-based mental health services. However, challenges to service provision arise due, in part, to workforce shortages, service fragmentation, and inefficient allocation of staff time. The current study describes the professional competencies and time allocation of four school-based mental health professions (i.e., school counselors, school psychologists, school social workers, and school nurses) in order to demonstrate how schools can leverage the skills of their existing staff to coordinate a comprehensive approach to support student mental health. First, we identified the core clinical competencies needed to implement the key features of comprehensive school mental health systems. Then, we crosswalked these clinical competencies with the training standards of the four professions. Finally, we conducted a systematic review of the literature to understand how these professionals' time is allocated, as well as their responsibilities related to the provision of mental health services. Results demonstrated that, although all four professions receive training in most of the core competencies needed to implement comprehensive school mental health services, their skillsets are often underutilized in day-to-day practice. Thus, we concluded that there are at least two untapped opportunities for school leaders to support student mental health-first, maximize the use of school mental health professionals through task-shifting (i.e., reassigning tasks less central to mental health service delivery to other staff), and second, implement an integrated model of school mental health services to efficiently leverage the mental health training of professionals.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12310-022-09535-0.

Campus Green Spaces, Academic Achievement and Mental Health of College Students

Mental health concerns have become a common problem among college students. Studies have shown that college students have a higher depression rate than the general population. The effect of campus green spaces on college students’ mental health has been widely studied. However, the internal mechanism of campus green spaces affecting college students’ mental health is not fully discussed. The data came from a cross-sectional survey of 45 Chinese universities. This paper discussed the relationship between campus green spaces, academic achievement, and college students’ mental health. Depending on gender, college students displayed different levels of mental health. The prevalence of depression among female students was higher than among male students. The effect of campus green spaces on mental health was higher in males than females, while the effect of campus green spaces on academic achievement had little gender difference. We call for the construction, improvement, and renewal of campus green spaces in the future not only to meet the needs of different gender groups, but also to pay more attention to the needs of female college students and improve the differences in mental health, so as to improve the mental health of the whole college student population.

Inverted U-Shaped Relationship between Physical Activity and Academic Achievement among Chinese Adolescents: On the Mediating Role of Physical and Mental Health

We aimed to clarify the relationship between Chinese adolescents' physical activity and academic achievement, the mediating role of physical and mental health, and provide a scientific reference for the integration of sports and education. Based on baseline data from the China Education Panel Survey, we conducted a nationwide study of 12,960 adolescents. We used nonlinear models, mediation effect analysis, and other measurement methods. Three significant findings emerged: (1) adolescent physical activity duration and academic achievement showed an inverted U-shaped relationship. Moderate physical activity improves academic achievement. The inverted U-shaped inflection point is about 3.549 h/week; (2) physical activity among the male group has a stronger effect on promoting academic achievement, while the positive effect of physical activity among females is not significant. The difference in effectiveness between urban and rural youth groups is relatively small, but the inflection point of rural youth groups is higher, and (3) the level of physical and mental health effectively mediates the inverted U-shaped influence of youth physical activity on academic achievement. We recommend that governments and schools should implement physical activity appropriately and suggest the feasibility of using physical activity to narrow the growth gap between urban and rural youth.

Screen Media Overuse and Associated Physical, Cognitive, and Emotional/Behavioral Outcomes in Children and Adolescents: An Integrative Review

INTRODUCTION

Screen media overuse is seen as a public health concern because of its negative effects on child and adolescent health. This integrative literature review examines recent empirical evidence on the relationship between screen media overuse and physical, cognitive, and emotional/behavioral outcomes in children and adolescents.

METHODS

Empirical research of experimental design, observational studies, and systematic reviews from several data sources was reviewed and synthesized to form the basis of this integrative review.

RESULTS

Screen media overuse is associated with poor sleep quality, shorter sleep duration, greater likelihood for overweight/obesity, lower executive functioning, poorer academic performance, and increased internalizing and externalizing problems. Bidirectional associations may exist.

DISCUSSION

Findings support the importance of understanding the impact of screen media use on health and wellbeing. Generating screen time guidelines and developing effective prevention/intervention strategies are critical to mitigating screen media overuse and its adverse outcomes in children and families.

Effectiveness of resilience training on social self-efficacy of the elementary school girls during COVID-19 outbreak

Children, especially girls, are more vulnerable during crises, who need to acquire skills such as social self-efficacy to meet the challenges of the environment. Given that, much progress has been made in e-learning; its capabilities can be used to promote children's health. This study aimed to determine the effect of virtual resilience training on the social self-efficacy of elementary school girls. This experimental study was performed on primary school girls aged 9-10 years in southeastern Iran. Students were selected by convenience sampling and divided into intervention (n = 40) and control (n = 37) groups by using randomized allocation. The Children's Social Self-Efficacy in Peer Interaction Scale was used for data collection before, immediately, and one month after the intervention. No significant difference was found between the two groups of intervention and control in the score of social self-efficacy before the intervention. However, the score of students in the intervention group improved immediately and one month after the intervention, and a significant difference was observed between the two groups (p = .0001). Virtual resilience training has improved the social self-efficacy of elementary school girls and facing challenges is inevitable in today's world, so resilience training seems necessary to prevent social and psychological harm in such children.

Relationship between Parental Involvement and Mathematics Achievement of Chinese Early Adolescents: Multiple Mediating Roles of Mental Health and Mathematics Self-Efficacy

This study conceptualized the multidimensional construct of parental involvement, including cognitive involvement, behavioral involvement, and personal involvement, and examined the mediating effects of student's mental health and mathematics self-efficacy. Questionnaires were administered to 2866 early adolescents and their parents in China; structural equation modeling and bias-corrected bootstrap methods were used. The results show that different dimensions of parental involvement had different effects on mathematics achievement. Additionally, results indicate that the influences of the multidimensional construct of parental involvement on mathematics achievement were either partially or completely mediated by student's mental health and mathematics self-efficacy. The findings also offer insight into possible interventions designed to explore how parental involvement promotes students' mathematics achievement through their children's mental health and mathematics self-efficacy.

Public health nurses in Canadian schools: An opportunity to build capacity and nursing scholarship

Public health nurses (PHNs) in Canada have the potential to significantly benefit the health and academic outcomes of school age children with its impact lasting into adulthood. Unfortunately, cuts in government funding over the years have diminished the presence of PHNs in schools and their ability to practice to their full scope. In the midst of a pandemic, having a strong nursing presence in schools may facilitate public health efforts and reduce the burden on teachers and administration. This discussion paper will explore the current role of nurses in Canadian schools in relation to school nurses in other parts of the world. An overview of the literature looking at the impact of the school nurse on school health (i.e., student health and academic outcomes) will be presented to provide evidence in support of rebuilding nursing capacity in Canadian schools. Finally, the Framework for 21st Century School Nursing Practice will be introduced as a viable nursing theory to facilitate rebuilding PHN capacity in schools.

Police and mental health in elementary and secondary schools: A systematic review of the literature and implications for nursing

WHAT IS KNOWN ON THIS SUBJECT?: Police are often called on to respond to student mental health needs in schools. School nurses, who are part of interdisciplinary mental health teams, may collaborate with responding police officers. Currently, there are no reviews of the literature describing the use of police to respond to mental health crises in schools. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This systematic review found six articles addressing police response to student mental health needs in elementary and secondary schools. Articles primarily focused on the School Resource Officer programme; however, there was a lack of research on the effectiveness of this and other programmes in addressing the mental health needs of students. This paper highlights a significant gap in knowledge about how police are involved in responding to student mental health crises within schools. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Understanding how police respond to mental health crises on school campuses will help nurses serve in collaborative roles with responding officers. This study highlights gaps in research that need to be addressed for researchers and policymakers to best support students in crisis.

ABSTRACT

INTRODUCTION: Response to student mental health crises involves interdisciplinary school-community teams, which can include police officers. This paper presents the first systematic review of literature on how police address mental health in school settings. Results have implications for school nurses interacting with responding police.

QUESTION/AIM

How are police involved in responding to student mental health needs in elementary and secondary schools?

METHOD

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, six articles met criteria for inclusion in this review.

RESULTS

Two themes were identified: (1) descriptions of roles of police in schools and (2) studies presenting programmes or models of police engagement. The most common use of police in schools is through the School Resource Officer model.

DISCUSSION

There are very few studies examining police involvement in mental health response in schools and little data available on whether prevailing models are effective. We are therefore unable to ascertain what impact school police have in responding to mental health crises or the extent to which they interact with school nurses.

IMPLICATIONS FOR PRACTICE

Understanding mental health crisis responses in schools can inform policy, practice, research and education for police and school providers, including nurses.

Factors Influencing Suicidal Ideation Among Adolescents: The Serial Mediating Effect of Depression and Sleep Quality on Attitude Toward Mental Health Services

The purpose of the current study was to examine the serial mediating effect of sleep quality and depression on the relationship between attitude toward mental health services and suicidal ideation among adolescents attending middle and high school in Daejeon City, South Korea. A total of 151 of 200 surveys were used for serial multiple mediation analysis. Suicidal ideation was positively associated with depression (r = 0.706, p < 0.001) and sleep quality (r = 0.173, p = 0.034), and negatively associated with age (r = -0.19, p = 0.02). Suicidal ideation was positively influenced by attitude toward mental health services (β = 0.261, p = 0.039), which was also influenced by depression (β = 2.805, p < 0.001). Depression was shown to have a significant mediating effect on the relationship of attitude toward mental health services for suicidal ideation (indirect effect = -0.828); however, sleep quality did not have an effect. Regular assessment of and interventions for depression are a priority for overall prevention of adolescent suicide. [Journal of Psychosocial Nursing and Mental Health Services, 58(11), 29-36.].

The modules of mental health programs implemented in schools in low- and middle-income countries: findings from a systematic literature review

BACKGROUND

Secondary schools in low- and middle-income countries (LMICs) provide health promotion, preventive, and early intervention services. Nevertheless, literature indicates that the modules of these services are either adapted or modified from existing mental health programs in developed countries. The literature also highlights the provision of non-comprehensive services (mental health promotion, prevention, and early intervention), in LMICs. These findings inform the need for undertaking this systematic literature review. The aim of this review was thus to identify the modules of school-based mental health programs (SBMHP) that have been implemented in LMICs to guide the development of a culturally sensitive comprehensive mental health program for adolescents in a LMIC country.

METHODS

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was used to guide this review. The following databases were searched in September 2018, to identify the relevant literature: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and ERIC. The search was conducted by the first author and reviewed by the authors.

RESULTS

Following the screening process, a total of 11 papers were identified and reviewed for quality. The systematic review highlighted that the mental health programs provided in schools included: an introduction module, a communication and relationship module, a psychoeducation module, a cognitive skills module, a behavioral skills module, establishing social networks for recovery and help seeking behavioral activities and a summary/conclusion module.

CONCLUSION

This review sheds light on the characteristics of the programs in LMICs. Two programs were found to be universal in nature. Five programs were directed at key risk factors or at-risk groups, and four were early intervention programs. The review also revealed that only one program out of the 11 programs included modules for parents. The synthesis indicated that all the identified programs were adapted or modified from existing programs. The dearth of comprehensive programs in LMICs was also revealed. Lastly, the review revealed seven modules that can be useful for developing a SBMHP.

Bullying Victimization Type and Feeling Unsafe in Middle School

Given their significance to school violence, this study quantifies the association between bullying victimization and perceptions of safety separately for victimization where the type is not specified versus victimization that is physical in nature. Generalized liner mixed modeling was employed with 5,138 sixth- to eighth-grade students in 24 schools who self-reported on their bullying victimization and perceptions of school safety on an anonymous survey in fall 2015. Results indicate a multiplicative interaction exists with regard to the odds of feeling unsafe at school among those who were bullied at all (odds ratio [ OR] = 3.1) compared to those who were bullied physically ( OR = 9.12). For school nurses who work with students with a variety of concerns and health issues, this research indicates that the use of bullying victimization as an outcome, proxy and/or predictor, requires inquiry into the type of bullying experienced to aid in the care and support received.

Cyberbullying and Social Media: Information and Interventions for School Nurses Working With Victims, Students, and Families

Social media has become an increasingly prevalent fixture in youths' lives, with over 90% of teenagers reporting daily usage. These online sites and applications have provided many positive opportunities for youths to connect and share ideas with others; however, social media has also become a major platform for cyberbullying. Victims often experience negative health outcomes directly related to cyberbullying. For this reason, it is critical that third parties, such as school nurses, are well versed in social media and the warning signs of those being victimized by cyberbullying. Therefore, this integrative review examines school nurses' knowledge of cyberbullying and social media and identifies the implications for school nursing practice regarding prevention and intervention processes.

Psychosocial Correlates of Jordanian Adolescents' Help-Seeking Intentions for Depression: Findings From a Nationally Representative School Survey

Little is known about help-seeking for depression among Jordanian adolescents who are a vulnerable population with high rates of depressive symptoms and few mental health services. The purpose of this study was to (1) explore Jordanian adolescents' helpseeking intentions for depression and (2) examine whether depression stigma, depression severity, or their interaction are associated with Jordanian adolescents' willingness to seek help for depression and the type of treatment they would seek. In collaboration with the Jordanian Ministry of Education, we conducted a nationally representative, school-based survey of adolescents aged 12-17 years ( N = 2,349). One fourth of the adolescents reported they would not seek professional help for depression, and those respondents had higher average depression scores. Among those adolescents willing to seek help, the most likely sources included family member (57%), school counselor (46%), psychiatrist (43%), religious leader (39%), and general health practitioner (28%). Lower stigma scores were associated with greater likelihood to seek psychotherapy or visit a psychiatrist, while higher stigma scores were associated with increased likelihood to seek help from a school counselor or a family member. Jordanian adolescents experience significant barriers to seeking professional help for depression. However, even among adolescents with greater depression severity and depression stigma, school counselors were identified as a key resource for help. These findings suggest that school-based interventions may fill a critical service need for adolescents with depression and other mental health problems. School nurses should be leveraged along with counselors to address mental health issues in this vulnerable population.

Positive psychotherapy for depression and self-efficacy in undergraduate nursing students: A randomized, controlled trial

Nursing students across the globe experience depressive symptoms, and many interventions have been used to alleviate their depression. However, few interventions focus on students' personal strengths and advantages. The aim of the present study was to explore the effects of an 8-week group positive psychotherapy (PPT) programme on depression and self-efficacy in full-time undergraduate nursing students. A randomized, controlled trial was conducted for 76 nursing students (34 in the experimental group, 42 in the control group). The Beck Depression Inventory-II and the General Self-Efficacy Scale were used to collect data prior to, immediately after PPT, 3 months', and 6 months' post-PPT. Repeated-measures analysis of variance indicated that the intervention significantly alleviated depression and improved self-efficacy (each P < 0.05); the effect of time and time-group interaction was also significant (each P < 0.05). The findings suggest that PPT could significantly relieve depressive symptoms and improve self-efficacy. We recommend that PPT is effective in alleviating depression and improving self-efficacy in undergraduate nursing students. Academic mental health nurses should appreciate the value of PPT and consider incorporating it in psychological support methods in order to facilitate nursing students' mental health.

Public health nurses’ experience, involvement and attitude concerning mental health issues in a school setting

The aim of the study was to describe and explore public health nurses’ perceptions of involvement and their attitudes concerning the mental health aspects of their work in schools. Furthermore, we wished to explore their need for useful approaches and training topics. The teenage years in particular are associated with an incidence of mental health problems such as depression. Public health nurses in schools have an extensive role in relation to health promotion and the prevention of both physical and mental health. A cross-sectional study with 284 public health nurses from 163 municipalities in Norway was carried out, using the Depression Attitude Questionnaire. The public health nurses reported various degrees of confidence and time spent working with mental health issues. Confidence was found to be related to further education and courses.

Cumulative risk over the early life course and its relation to academic achievement in childhood and early adolescence

Early-life risk factors, such as family disruption, maltreatment, and poverty, can negatively impact children's scholastic abilities; however, most previous studies have relied on cross-sectional designs and retrospective measurement. This study investigated the relation between cumulative risk factors during the early life course and subsequent academic achievement in a cohort of children and adolescents. Data for this study were based on registry-data material from the LIFECOURSE study of 1151 children from the 2000 birth cohort in Reykjavik, Iceland, assembled in 2014-2016. Multiple lifetime risk factors, including maternal smoking during pregnancy, parent's disability status, being born to a young mother, number of children in the household, family income, number of visits to school nurses, and reports of maltreatment, were assessed. Latent class analysis and Analysis of Covariance (ANCOVA) were used to predict academic achievement in the 4th and 7th grades. Individuals with no risk factors reported the highest average academic achievement in the 4th (M=66 points, SD=17) and 7th grades (M=67 points, SD=15). There was a significant main effect for 4th-grade risk factors and academic achievement (F [7, 1146]=12.06, p<0.001) and a similar relationship between the risk factor profile and achievement scores in 7th grade (F [7, 1146]=15.08, p<0.001). Each additional risk factor was associated with a drop in academic achievement at both grade levels. We conclude that academic achievement declines in proportion to the number of risk factors in early life.

The Impact of Comprehensive School Nursing Services on Students' Academic Performance

Introduction: School nursing services should be evaluated through health and academic outcomes of students; however, it is observed that the number of studies in this field is limited. The aim of this study is to evaluate the impact of comprehensive school nursing services provided to 4th grade primary school students on academic performance of students.

Methods: The quasi-experimental study was conducted with 31 students attending a randomly selected school in economic disadvantaged area in Turky. Correlation analysis, repeated measures analyses of variance, multiple regression analysis were used to analyze the data with SPSS software.

Results: At the end of school nursing practices, an increase was occurred in students’ academic achievement grades whereas a decrease was occurred in absenteeism and academic procrastination behaviors. Whilst it was determined that nursing interventions including treatment/ procedure and surveillance was associated to the decrease of absenteeism, it also was discovered that the change in the health status of the student after nursing interventions was related to the increase of the academic achievement grade and the decrease of the academic procrastination behavior score.

Conclusion: In this study, the conclusion that comprehensive school nursing services contributed positively to the academic performance of students has been reached. In addition, it can be suggested that effective school nursing services should include services such as acute-chronic disease treatment, first aid, health screening, health improvement-protection, health education, guidance and counseling and case management.

Parent Coping With Adolescent Trichotillomania

Adolescents who struggle with trichotillomania (TTM; hairpulling disorder) are not alone, their parents also struggle. The focus of this qualitative study was to identify what parents (N = 30) perceive as stressful about parenting an adolescent with TTM and how they cope with these stressors. Parents described uncertainty about the course of the disorder and powerlessness in the ability to protect their adolescent from the reactions of others or assist them in curtailing the hairpulling as very distressing. Data analysis revealed eight coping strategies used to manage these stressors and the accompanying grief: (a) information gathering, (b) anticipatory guidance, (c) crying, (d) hypervigilance, (e) gaining emotional support from others, (f) acceptance, (g) goal revision, and (h) guiding rather than protecting their adolescent. The study findings can be used by school nurses to gain a deeper understanding of this disorder and to provide family-centered care in the school setting.

Needs, expectations and consequences for children growing up in a family where the parent has a mental illness

The lack of pan-European guidelines for empowering children of parents with mental illness led to the EU project CAMILLE - Empowerment of Children and Adolescents of Mentally Ill Parents through Training of Professionals working with children and adolescents. The aim of this initial task in the project was to analyse needs, expectations and consequences for children with respect to living with a parent with mental illness from the perspective of professionals and family members. This qualitative research was conducted in England, Finland, Germany, Italy, Norway, Poland and Scotland with 96 professionals, parents with mental illness, adult children and partners of parents with mental illness. A framework analysis method was used. Results of the study highlighted that the main consequences described for children of parental mental illness were role reversal; emotional and behavioural problems; lack of parent's attention and stigma. The main needs of these children were described as emotional support, security and multidisciplinary help. Implications for practice are that professionals working with parents with mental illness should be aware of the specific consequences for the children and encourage parents in their parental role; multi-agency collaboration is necessary; schools should provide counselling and prevent stigma.

Adolescent Depression in the Arab Region: A Systematic Literature Review

Adolescent depression is a primary cause of global disability and burden with considerable variability across countries in its prevalence, diagnosis, management, and prognosis. No systematic reviews have been published on adolescent depression in Arab countries despite the unique sociocultural background that can play a major role in shaping Arab depressed adolescents' prognosis and response to treatment. The purpose of this study was to provide such a review with the goal of identifying the necessary foundations for culturally competent mental health care practices to address the unique needs of Arab adolescents and their families. We systematically reviewed PubMed, CINAHL, PsycINFO, and available Arabic databases. We adhered to the PRISMA statement to guide the process of identification, selection, and appraisal of the reviewed articles. No restrictions were applied on publication date. The search was completed in December 2015. A total of 199 unique articles met criteria for screening at the abstract level; 47 articles were selected for review in full text; and 27 articles were included in the final analysis. Four emerging themes were identified: (1) few robust prevalence estimates of adolescent depression are available in Arab countries; (2) depression varies based on the individual characteristics of Arab adolescents; (3) context influences Arab adolescents' risk of experiencing depression; and (4) the stigma of depression negatively impacts help-seeking process among Arab adolescents. This review highlights the need for more community-based detection efforts that employ developmentally and culturally appropriate measurement instruments for adolescent depression. Furthermore, findings suggest the need for culturally competent care that integrates indigenous health practices into modern mental health systems. Nurses, who form the greatest proportion of health personnel in all Arab countries, are uniquely situated to help Arab adolescents experiencing depression restore, maintain, and/or promote their mental health and wellbeing.

Shared responsibility: school nurses' experience of collaborating in school-based interprofessional teams

BACKGROUND

The Swedish Education Act (2011) mandated a new combination of services to boost students' physical health, their mental health and special education through interprofessional pupil health and well-being (PH) teams. For Swedish school nurses, providing these services presents new challenges.

AIM

To describe how Swedish school nurses experience their work and collaboration within the interprofessional PH teams.

METHODS

Twenty-five school nurses (SNs) were interviewed in five focus groups. Content analysis was used to examine the data and to explore SNs' workplace characteristics by using the components of the sense of coherence (SOC) framework.

RESULTS

SNs' experiences of work and collaboration within PH teams can be described using three domains: the expectations of others regarding SNs' roles, SNs' contributions to pupils' health and well-being, and collaboration among SNs within PH teams. The results indicate a discrepancy between SNs' own experiences of their contribution and their experiences of other professionals' expectations regarding those contributions. Some duties were perceived as expected, comprehensible, manageable and meaningful, while other duties - though expected - were perceived as less meaningful, taking time away from school-related matters. Other duties that were not explicitly expected - promoting general health and creating safety zones for pupils, teachers and parents, for example - were nonetheless perceived as meaningful. Collaboration within PH teams was considered meaningful, comprehensible and manageable only if the objectives of the team meetings were clear, if other professionals were available and if professional roles on the team were clearly communicated.

CONCLUSION

The SNs reported a lack of clarity regarding their role in PH and its implementation in schools, indicating that professionals in PH teams need to discuss collaboration so as to find their niche given the new conditions. SOC theory emerged as a useful framework for discussing concrete work-related factors in the school environment.

Collaboration Between PNPs and School Nurses: Meeting the Complex Medical and Academic Needs of the Child With ADHD

Pediatric nurse practitioners take a lead role in diagnosing and coordinating the care of children with attention deficit hyperactivity disorder (ADHD). School nurses offer rich insight into the child's health and social and academic functioning in the school setting. School nurses develop individualized health care plans, administer and monitor medications, provide valuable input on Individualized Education Plans and Section 504 Accommodation Plans, and serve as the point person in communicating with the medical provider. Pediatric nurse practitioners can enhance the collaboration with school nurses by establishing communication parameters, streamlining medication regimens, and facilitating development of educational curricula for school nurses regarding evidence-based ADHD management. Optimizing partnerships with school nurses will provide better surveillance of treatment efficacy and can facilitate improved health and academic and social outcomes for children with ADHD.

School Nurses’ Experiences of Managing Young People With Mental Health Problems

Prevalence of mental health disorder is increasing among young people. It is recognized that early intervention is essential in supporting young people, and care provided within schools to support emotional well-being is recommended as part of this process. A scoping review was undertaken examining school nurses’ experiences of supporting the mental health of schoolchildren. Findings suggest that school nurses have a central role in supporting young peoples’ mental health, although a number of barriers exist which impact on school nurses’ preparedness for this aspect of their role. While there are inconsistencies in the provision of mental health training available to support school nurses, when training is implemented it has positive outcomes for service provision and quality of care. A number of challenges for school nurses were also identified, and recommendations for practice are suggested in the article.

Psychopathology and Related Psychosocial Factors in Children with Office Discipline Referrals at School: Evidence from a Developing Country

Many childhood psychiatric disorders present their first symptoms as challenging behaviors at school. Evidence from cross-national studies enhance the understanding of the biological and cultural variables underlying these behaviours. In this study, we aim to identify the psychopathology among children with office disciplinary referrals and assess psychosocial risk factors related to this situation. Forty-seven students who had received an office discipline referral and eighty-three controls who had never been given an office disciplinary referral participated in this study. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children--Present and Lifetime, socio-demographic data form were administered to children to assess their respective psychopathologies and psychosocial risk factors. Attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, and obsessive compulsive disorder were significantly higher in children with Office discipline referrals. Psychiatric assessment should be one of the first steps in the evaluation processes of assessing challenging behaviors at school.

Connecting Students to Mental Health Care: Pilot Findings from an Engagement Program for School Nurses

Schools function as the major provider of mental health services (MHS) for youth, but can struggle with engaging them in services. School nurses are well-positioned to facilitate referrals for MHS. This pilot study examined the feasibility, acceptability, and preliminary efficacy of an engagement protocol (EP) designed to enhance school nurses' utilization of evidence-based engagement practices when referring youth to MHS. Participants were six school nurses and twenty-five adolescents in a large, urban school district. School nurses reported positive attitudes towards the EP, suggesting that they found it feasible and acceptable. Though there were small increases in school nurses' use of engagement practices and in adolescents' readiness for services following training, due to limited sample size, differences were not statistically significant. Still, pilot results suggest preliminary efficacy of training school nurses to strategically implement evidence-based engagement practices to increase adolescents' engagement in MHS.

Health promotion in schools: a multi-method evaluation of an Australian School Youth Health Nurse Program

Background

Health promotion provides a key opportunity to empower young people to make informed choices regarding key health-related behaviours such as tobacco and alcohol use, sexual practices, dietary choices and physical activity. This paper describes the evaluation of a pilot School Youth Health Nurse (SYHN) Program, which aims to integrate a Registered Nurse into school communities to deliver health promotion through group education and individual sessions.

Methods

The evaluation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. The objectives were to explore: 1) whether the Program was accessible to the high school students; 2) the impacts of the Program on key stakeholders; 3) which factors affected adoption of the Program; 4) whether implementation was consistent with the Program intent; and 5) the long-term sustainability of the Program. Research included retrospective analysis of Program records, administration of a survey of student experiences and interviews with 38 stakeholders.

Results

This evaluation provided evidence that the SYHN Program is reaching students in need, is effective, has been adopted successfully in schools, is being implemented as intended and could be maintained with sustained funding. The nurses deliver an accessible and acceptable primary health care service, focused on health promotion, prevention and early intervention. After some initial uncertainty about the scope and nature of the role, the nurses are a respected source of health information in the schools, consulted on curriculum development and contributing to whole-of-school health activities.

Conclusions

Findings demonstrate that the SYHN model is feasible and acceptable to the students and schools involved in the pilot. The Program provides health promotion and accessible primary health care in the school setting, consistent with the Health Promoting Schools framework.

Electronic supplementary material

The online version of this article (doi:10.1186/s12912-015-0071-0) contains supplementary material, which is available to authorized users.

Mental Health Promotion in School: Schoolchildren's and Families' Viewpoint

While developing mental health work in schools, it is very important to consider the viewpoint of pupils. Parents can also give remarkable information on their children's viewpoint. The purpose of this study was to produce a description of the concepts used by schoolchildren aged 12–16 years and their families associated with promoting mental health in schools. The research material comprised interviews with schoolchildren and mothers, and verbal answers from the school well-being profile survey (n = 426). The analysis was conducted by applying the grounded theory method as introduced by Strauss. The study was conducted in a Finnish comprehensive school.

Mental health promotion in comprehensive schools

The purpose of this paper is to describe a participatory action research process on the development of a professional practice model of mental health nurses in mental health promotion in a comprehensive school environment in the city of Oulu, Finland. The developed model is a new method of mental health promotion for mental health nurses working in comprehensive schools. The professional practice model has been developed in workshops together with school staff, interest groups, parents and students. Information gathered from the workshops was analysed using action research methods. Mental health promotion interventions are delivered at three levels: universal, which is an intervention that affects the whole school or community; selective, which is an intervention focusing on a certain group of students; and indicated, which is an individually focused intervention. All interventions are delivered within the school setting, which is a universal setting for all school-aged children. The interventions share the goal of promoting mental health. The purposes of the interventions are enhancing protective factors, reducing risk factors relating to mental health problems and early identification of mental health problems as well as rapid delivery of support or referral to specialized services. The common effect of the interventions on all levels is the increase in the experience of positive mental health.

Neurological and biological foundations of children's social and emotional development: an integrated literature review

This article provides an integrated review of the expert literature on developmental processes that combine social, biological, and neurological pathways, and the mechanisms through which these pathways may influence school success and health. It begins with a historical overview of the current understanding of how attachment relationships and social environments influence brain development and plasticity and are, therefore, central to the physical and mental health of individuals and populations. It then expands on the effect of plasticity in relation to behavior and learning at school. This article concludes with a discussion of the role the school nurse may play in supporting health and learning by recognizing signs of relational stress and by advocating for prevention strategies.

Identifying Symptoms of Depression and Anxiety in Students in the School Setting

Early detection of mental health problems in school-age children offers the opportunity for prompt referral to treatment which is critical to their success in school. School nurses are in a key position to screen for mental health issues in the school setting. This article discusses how school nurses began a new initiative to use two validated screening tools, the Patient Health Questionnaire–9 item for detecting depression and the 5-item Screen for Child Anxiety Related Emotional Disorders for detecting anxiety in middle school/high school-aged children in selected urban schools. Students having positive screens were referred to the multidisciplinary school-based Student Assistance Program team for further evaluation and referral. These screens improved the identification and referral for treatment of children suffering from anxiety and/or depression by expediting the connection to services.

Universal adolescent depression prevention programs: a review

Although the subject of adolescent depression has gained significant attention, little is being done in the way of primary prevention. The purpose of this article is to conduct a review of the literature through the lens of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. This review was conducted utilizing several online databases, as well as web and hand searches. Eleven studies were identified through a process of elimination and critically appraised by a two-tiered method. Results indicated cognitive-behavioral universal prevention interventions can be effective on decreasing depressive symptomalogy in adolescents. All reviewed studies were conducted in the school environment by professionals and/or school staff; however, only three of the programs implemented demonstrated adoption and sustainability. School nurses can be instrumental in bridging the gap between the planning and developing of prevention programs and translation into the real-world school environment.

Scientifically supported mental health intervention in schools: meeting accountability demands with an online resource

Legislation has been passed that holds schools increasingly accountable for the proficiency of all students, including those with mental health problems. A critical obstacle impeding the ability of schools to effectively support students is the lack of access to quick, pre-screened, and organized information about scientifically-supported interventions that effectively address youth mental health problems. A new mental health best practices database was developed and made available online that provides access to free and user-friendly information about evidence-based interventions for use in schools. School staff will be better able to meet accountability demands of legislation and to effectively respond to student mental health problems.

Mental health promotion: guidance and strategies

Public mental health incorporates a number of strategies from mental well-being promotion to primary prevention and other forms of prevention. There is considerable evidence in the literature to suggest that early interventions and public education can work well for reducing psychiatric morbidity and resulting burden of disease. Educational strategies need to focus on individual, societal and environmental aspects. Targeted interventions at individuals will also need to focus on the whole population. A nested approach with the individual at the heart of it surrounded by family surrounded by society at large is the most suitable way to approach this. This Guidance should be read along with the European Psychiatric Association (EPA) Guidance on Prevention. Those at risk of developing psychiatric disorders also require adequate interventions as well as those who may have already developed illness. However, on the model of triage, mental health and well-being promotion need to be prioritized to ensure that, with the limited resources available, these activities do not get forgotten. One possibility is to have separate programmes for addressing concerns of a particular population group, another that is relevant for the broader general population. Mental health promotion as a concept is important and this will allow prevention of some psychiatric disorders and, by improving coping strategies, is likely to reduce the burden and stress induced by mental illness.

The school nursing profession in relation to Bourdieu's concepts of capital, habitus and field

AIM

The aim was to define the work and professional role of school nurses, in terms of Bourdieu's key concepts of capital and habitus.

METHOD

A qualitative study with a deductive approach, based on data from six focus-group interviews with 24 school nurses and 15 individual interviews with school nurses. Thus, a total of 39 school nurses participated in the study. The data were analysed using content analysis.

RESULTS

The results explain, in terms of Bourdieu's key concepts of capital and habitus, how school nurses experience their work in the educational setting. A model including different aspects of school nurses' work is shown.

CONCLUSION

The new Swedish Education Act focuses on promoting students' general health, so that they are able to reach their academic potential. In this task, the school nurse is to be one of a group of several professionals working together. The present study shows how school nurses experience their professional role and their work in relation to Bourdieu's concepts of capital, habitus and field. To strengthen the school nursing profession, school nurses need to show their competence in promoting students' health.

School nurses' perspectives on managing mental health problems in children and young people

AIMS AND OBJECTIVES

To explore the views of school nurses regarding mental health problems in young people and their potential for engaging in mental health work with this client group.

BACKGROUND

Mental health problems in children and young people are an important public health issue. Universal children's services play a key role in identifying and managing these problems and, while school nurses have an important function in this work, little is known about their views on this aspect of their role.

DESIGN

A qualitative research design employing focus group methodology.

METHOD

School nurses (n = 33) were purposively sampled from four school nursing teams in two English cities for a series of focus groups. The focus group data were audio-recorded, transcribed and subsequently analysed using 'framework'.

RESULTS

Four principal themes emerged from the data. In these themes, school nurses were found to value their involvement with the mental health of young people, recognising this as an important area of practice. Several obstacles to their work in this area were identified: heavy workloads, professional rivalries, a lack of confidence and limited education and training opportunities. The importance of support from local specialist mental health teams was emphasised.

CONCLUSIONS

School nurses can be engaged in mental health work though, as public health specialists, their role should focus on health promotion, assessment, signposting and early intervention activities. To facilitate mental health work, school nurses are able to draw on established interpersonal skills and supportive networks; however, workload and a lack of confidence need to be managed and it is important that they are supported by constructive relationships with local specialist mental health teams.

RELEVANCE TO CLINICAL PRACTICE

This study has implications for nurses and healthcare practitioners interested in enhancing the mental health of children and young people in school settings.

The Integration of Counseling and Nursing Services into Schools

The purpose of this comparative review was to examine the legislative evolution of school guidance and school nursing over the past century, in hopes of identifying reasons why guidance counselors have been more successful in compliance to recommended ratios than school nurses. A literature review was conducted including CINAHL, MEDLINE, ERIC and other EBSCO databases. The results from this review indicate school guidance programs have been included in more federal legislation, mandating funding, education and certification requirements, which gives counselors a uniformly recognizable credential understood by educators. An extensive effort to develop a national model of school guidance has assisted counselors to uniformly show how they impact student academic success. School nurses can learn how to further integrate the school nursing role into education from the example of guidance counselors.

Connecting with frequent adolescent visitors to the school nurse through the use of intentional interviewing

Nurses as accessible, helping adults within schools have daily opportunities to reach adolescents with unmet mental health needs. Understanding the relationship between frequent clinic visits or somatic complaints as a sign of underlying problems, which may be organic or psychoemotional in origin, requires the unique skill set of the school nurse. The welcoming school nurse, who cares for students with acceptance and emotional availability, nurtures the development of trust and meaningful personal connection. It is through this relationship that effective care and case finding occurs. Attachment to the school nurse as a responsive adult fosters a sense of school connectedness, which is associated with academic success. Intentional Interviewing is a person-centered, evidence-based approach that can be used by school nurses in this important work.

Psychometric evaluation of the Turkish version of the Pediatric Symptom Checklist-17 for detecting psychosocial problems in low-income children

AIMS

To evaluate the usefulness of Pediatric Symptom Checklist-17 in identifying psychosocial problems in low-income, Turkish children.

BACKGROUND

Epidemiological data indicate that 10-20% of children in primary care settings exhibit significant psychosocial problems. Early detection and treatment of these problems may lead to considerable health benefits. However, the brief and valid screening tool for children with psychosocial problems is not available in Turkey.

DESIGN

Survey.

METHODS

A sample of 306 parents with children between 6-16 years of age who were attending primary schools in Istanbul was included. The psychometric properties of the scale were established by examining the content, convergent, discriminant, construct validity and internal consistency and stability. Receiver operating characteristic analysis was conducted to estimate the optimal cut-off score of scale using the Child Behaviour Checklist as the criterion standard.

RESULTS

Convergent validity was supported, and discriminant validity suggested that the scale successfully discriminated among the normal, borderline and clinical range groups. Although, exploratory factor analysis extracted three factors, confirmatory factor analysis did not meet the criteria for good model fit. Internal consistency was found to be 0·81; test-retest reliability was found to be 0·72. The area under curve was found to be 0·91 and optimal cut-off score was found to be 12 (sensitivity: 0·81; specificity: 0·86) for clinical range psychopathology.

CONCLUSION

The results provided an empirical support for extending the use of the Pediatric Symptom Checklist-17 in the primary care settings. The Turkish version of the Pediatric Symptom Checklist-17 showed an adequate reliability and validity for its use in low-income, Turkish children.

RELEVANCE TO CLINICAL PRACTICE

Primary care providers can use the Pediatric Symptom Checklist-17 for early identification of childhood psychosocial problems in primary care settings. This easy-to-use tool can provide guidance to care providers for further assessment of children.

Teaching kids to cope with anger: peer education

Anger could be an early warning signal of violent behavior. Early peer education health promotion in relation to anger management could help children before uncontrolled anger becomes a problem in adolescence and adulthood. Peer education has been identified as a viable intervention strategy worldwide with various prevention programs for youth. The purpose of this article is to describe an anger management program (Teaching Kids to Cope with Anger, TKC-A 4th-8th graders) co-led by high school peer educators in an urban school district's summer school enhancement program. A program of five modules will be described. This paper discusses the peer educator implementation and recommendations for future implementation.

Evidence-based programs in school settings: barriers and recent advances

In spite of multi-disciplinary calls for the use of evidence-based practice in schools, empirically supported interventions are not being implemented in most schools. To increase the use of evidence-based programs in schools, it may be necessary first to identify characteristics of those programs and other factors that represent barriers to their use. This study examined implementation requirements and the availability of program information of 51 school-based intervention programs. Analyses revealed implementation obstacles such as high start-up costs, challenging training and staffing requirements, and a lack of easily accessible information about programs. Research and practice implications of these findings are presented.

Associations between psychosomatic symptoms in adolescence and mental health symptoms in early adulthood

This longitudinal study explored associations between psychosomatic symptoms in adolescence and mental health symptoms in early adulthood. The baseline data were collected in 1996 from 14-year-old pupils (n = 235; 116 girls, 119 boys) at schools using a structured questionnaire that included a 14-item scale of psychosomatic symptoms. The follow-up data were collected in 2006 from the same persons at the age of 24 using the Symptom Checklist-90. Follow-up questionnaires were returned by 149 (63.4%) young adults (88 women and 61 men). Young adults who had many psychosomatic symptoms in adolescence suffered more often than the others from somatization and anxiety symptoms in early adulthood. In addition, women had more symptoms of depression and paranoid ideation, and men had more interpersonal sensitivity and psychotic symptoms. Psychosomatic symptoms in adolescence might be important signals of mental health and this should be taken seriously in school health and in general primary care.

Sex differences in self-reported anxiety in rural adolescents

An anxiety disorder affects 13 out of every 100 children. The purpose of this paper is to determine if there are differences in self-reported anxiety between male and female rural adolescents. In total, 193 students aged 14-17 years in three western Pennsylvania rural high schools, USA, were surveyed. The majority of participants were Caucasian (86.5%, n = 167), female (53.4%, n = 103), and aged 15.57 years (SD = 0.93). The females' mean self-reported anxiety score was higher than the males' score (P < 0.0001). The females' mean score was 25.09 (SD = 13.83; a score > or =25 may indicate the need for further evaluation for the presence of a potential anxiety disorder), while the males' mean score was 16.88 (SD = 10.81). Of interest, all the five factor (specific types of anxiety) scores were significantly different between males and females at P < 0.05. Evidence-based implications for the mental health nurse's practice will be discussed. Anxiety screening is promoted to identify adolescents who may need mental health treatment and referrals, especially rural female adolescents.

A Correlational Study of the Relationship Between a Coordinated School Health Program and School Achievement: A Case for School Health

The study was conducted to determine whether there is a relationship between the Coordinated School Health Program (CSHP) and student academic performance. Data were collected from schools and the community for three reports for 50 states and the District of Columbia (DC). The School Health Policies and Programs Survey (SHPPS), the National Assessment of Educational Progress (NAEP), and the U.S. Census 2000 Profile were used to study the relationships among three parameters: (a) The intervention called a CSHP: (b) Student achievement; and (c) Rate of poverty in each state. A stepwise regression analysis was conducted, controlling for poverty using state-level data. Components of a CSHP had statistically significant relationships with academic achievement. Students in states with policies promoting students' health demonstrated higher academic scores and higher rates of high school completion.

Anger correlated with psychosocial variables in rural youth

Uncontrolled anger is a contributing force in the three leading causes of adolescent death: homicide, suicide, and injuries. Anger may be one of the early warning signs which could lead to violent behavior. The purpose of this study was to examine the relationship between anger experience and expression with the potential correlates of life events, perceived social support, self-esteem, optimism, drug use, anxiety, and depressive symptoms in rural adolescents. The participants (n = 193) were aged 14 to 17 years old in ninth through eleventh grades enrolled at three rural Western Pennsylvania public high schools. Participants completed nine questionnaires. Negative life events, anxiety, drug use, and depressive symptoms had significant positive correlations with anger. In addition, anger was found to have significant negative correlations with the adolescents' perceived family support, self-esteem, and optimism. With this knowledge, health promotion programs conducted by pediatric nurses can target anxiety, drug use, and depressive symptoms while bolstering family support, self-esteem, and optimism to promote anger management in adolescent health care.