Expanded school mental health programs: advancing reform and closing the gap between research and practice

A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe

Most mental disorders appear by age 14, but in most cases, they remain undiagnosed and untreated well into adulthood. A scoping review showed an absence of systematic reviews that address prevalence rates of mental disorders among children and adolescents in Europe that are based on community studies conducted between 2015 and 2020. To estimate the updated pooled prevalence of Anxiety Disorder, Depressive Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), Autism Spectrum Disorder, Eating Disorders, Substance Use Disorders (SUD), among children and adolescents living in Europe, a search strategy was conducted using MEDLINE, Embase and Psych Info and studies were also identified from reference lists and gray literature. Eligible studies were evaluated for reliability, validity, and bias. Trends of prevalence rates for each mental disorder were calculated. Almost one in five young people in Europe were found to suffer from a mental disorder, with a pooled prevalence rate of 15.5%. Anxiety disorders had the highest pooled prevalence rate (7.9% (95% CI 5.1-11.8%, I2: 98.0%)), followed by ADHD (2.9% (95% CI 1.2-6.9%, I2 = 94.3%)), ODD (1.9% (95% CI 1.0-3.7%, I2 = 98.4%)), depressive disorder (1.7% (95% CI 1.0-2.9%, I2 = 97.7%)), CD (1.5% (95% CI 0.6-3.8%, I2 = 98.8%)) and ASD (1.4% (95% CI 0.4-5.4%, I2 = 99.7%). No studies on SUD were identified. The mental health of children and adolescents may be improved by introducing routine screening, refining diagnostic sensitivity, raising awareness of mental disorders, minimizing stigma and socioeconomic inequality, as well as developing early intervention services. These facilitators of good mental health need to be prioritized, especially at a time of unprecedented risk factors for poor mental health.

Three-Year Outcomes of a School-Hospital Partnership Providing Multitiered Mental Health Services in Urban Schools

BACKGROUND

From the perspective of schools, children's mental health is essential to academic success. Multitiered systems of support (MTSS) that provide prevention/promotion, early identification/intervention, and clinical treatment services have been embraced as a promising means to deliver mental health services in the school setting.

METHODS

A school-hospital partnership tested the implementation over 3 consecutive academic years of an MTSS model for elementary through high-school students enrolled in 6 urban public schools. The model was designed to embed whole-school and classroom-level prevention/promotion programs alongside small group and individual services for selected youth. Utilization, satisfaction, and student- and school-level outcomes were assessed.

RESULTS

Students participating in early intervention had significantly improved social-emotional competencies and coping skills (particularly those students at highest risk), and students with mental health disorders who participated in clinical treatment had significantly improved symptoms and functioning. Schools significantly enhanced their capacity to provide mental health services across prevention/promotion, early identification/intervention, and crisis management domains. These findings were replicated across 3 consecutive years of program implementation.

CONCLUSIONS

A school-hospital partnership using an MTSS model was found to be feasible, valued, and effective in improving students' mental health status and schools' capacities to provide mental health services.

Challenges and ideas from a research program on high-quality, evidence-based practice in school mental health

This article reviews the progression of a research program designed to develop, implement, and study the implementation of "achievable" evidence-based practices (EBPs) in schools. We review challenges encountered and ideas to overcome them to enhance this avenue of research. The article presents two federally funded randomized controlled trials involving comparison of a four-component targeted intervention (Quality Assessment and Improvement, Family Engagement and Empowerment, Modular Evidence-Based Practice, Implementation Support) versus a comparison intervention focused on personal wellness. In both studies, primary aims focused on changes in clinician attitudes and behavior, including the delivery of high-quality EBPs and secondary aims focused on student-level impacts. A number of challenges, many not reported in the literature, are reviewed, and ideas for overcoming them are presented. Given the reality that the majority of youth mental health services are delivered in schools and the potential of school mental health services to provide a continuum of mental health care from promotion to intervention, it is critical that the field consider and address the logistical and methodological challenges associated with implementing and studying EBP implementation by clinicians.

Challenges to collaboration in school mental health and strategies for overcoming them

BACKGROUND

This article reviews challenges to collaboration in school mental health (SMH) and presents practical strategies for overcoming them.

METHODS

The importance of collaboration to the success of SMH programs is reviewed, with a particular focus on collaboration between school- and community-employed professionals. Challenges to effective collaboration between school- and community-employed professionals in SMH are considered. Strategies for overcoming challenges to effective collaboration are presented.

RESULTS

Marginalization of the SMH agenda, limited interdisciplinary teamwork, restricted coordination mechanisms, confidentiality concerns, and resource and funding issues are key challenges to collaboration. Strategies targeted toward each of these challenges may help improve the effectiveness of SMH programs and ultimately student outcomes.

CONCLUSIONS

Collaboration between school- and community-employed professionals is critical to the success of SMH programs. Despite its promise, the success of SMH programs can be jeopardized by ineffective collaboration between school- and community-employed professionals. Strategies to overcome marginalization, promote authentic interdisciplinary teamwork, build effective coordination mechanisms, protect student and family confidentiality, and promote policy change and resource enhancements should be addressed in SMH improvement planning.

Mobile healthcare services in school-based health center

OBJECTIVES

In Taiwan, campus health problems are placing more and more pressure on school-based health centers (SBHCs). Moreover, SBHCs have insufficient resources to actively provide follow-up healthcare for students and faculty found to be overweight, chronically ill, or at high risk. In order to improve the quality of SBHC healthcare, a project was begun to enhance the efficiency of campus healthcare services by employing web-based and cell phone-based services. This project employed the Mobile Automated Medical Alert (MAMA) system, which was designed especially for campus health center use. Before implementing the MAMA system, a focus group of healthcare related staff identified areas in which SBHC healthcare services might be improved by the system and created a questionnaire to measure student and faculty response to the proposed services. Modifications to the MAMA design and service offerings were made based upon these questionnaire results.

METHOD

After the initial brainstorming session, the MAMA team created a survey instrument that was administered to students and faculty in order to understand their attitudes toward the proposed mobile healthcare services. Two hundred questionnaires were distributed to students and faculty at a private technical college in central Taiwan.

RESULTS

Among the respondents, 100% had cellular phones and used short-text messages. Ninety-five percent of the student respondents and 85% of the faculty respondents agreed that mobile healthcare system would improve the quality of the health care their SBHC was currently providing. Based on these positive survey responses, the MAMA system was implemented.

DISCUSSION/CONCLUSION

The current paper describes the process by which the MAMA team brainstormed proposed services and administered their survey. Survey results and the consequent changes to the MAMA system are discussed. Finally, recommendations are made for MAMA system use and a description is offered of the impact such systems might have on the future of college campus healthcare services.

Examining school health center utilization as a function of mood disturbance and mental health difficulties

PURPOSE

We examined the presence and severity of mood disturbance and mental health difficulties as predictors of students' utilization of school health centers.

METHODS

Mood disturbance and mental health difficulties were assessed through surveys completed at year end. Visits to school health centers were tracked prospectively over the year.

RESULTS

Twenty-three percent of students with mental health difficulties visited the school health centers. Students reporting mood disturbance and difficulties were more likely to use school health centers and to use them more frequently than were students without such difficulties. More than half of all visitors were judged by health clinic staff to be experiencing impairment in functioning and reported difficulties, which typically lasted more than 6 months duration.

CONCLUSIONS

Although the presence of mental health difficulties increases the probability of students' visiting school health centers, the majority of students with such difficulties do not avail themselves of this resource. Optimizing the effectiveness of school-based health services depends on understanding the interplay between availability and utilization of school-based services for students with mental health difficulties.

A survey of adolescents' knowledge about depression

Adolescent depression and suicide are major public health concerns. Best practices for suicide prevention and education in high schools are not well understood. The Adolescent Depression Awareness Program (ADAP) was developed to address depression education as an effective means towards decreasing the morbidity and mortality associated with adolescent depression. Adolescents' baseline knowledge about depression was assessed to enhance curriculum development. The survey was administered to 5,645 high school students between 1999 and 2003. Results indicated that students had a cursory knowledge of depression facts but had gaps in knowledge about treatment and symptom identification.

Expanded school mental health: exploring program details and developing the research base

Expanded school mental health (ESMH) programs, the focus of this special issue, provide comprehensive mental health care to youth in general and special education through partnerships between schools and community mental health agencies and programs. As these programs progressively develop in the United States, there is a critical need to build the research and evidence base for them. This article presents background to the national movement toward ESMH and provides an overview of articles contained in this special issue, which provide in-depth details and early research findings on diverse aspects of mental health programs in schools. Advantages of greater involvement of behavioral professionals in ESMH are discussed.

Funding a full continuum of mental health promotion and intervention programs in the schools

PURPOSE

To assess the availability of public and private financing sources to support comprehensive school mental health programs. The paper focuses on "expanded school mental health" (ESMH) programs, which provide a full array of mental health promotion and intervention services to youth in general and special education through school-community partnerships.

METHODS

A range of strategies to fund ESMH services are reviewed, including fee-for-service funding, as well as grants, contracts, and other mechanisms from federal, state, local, and private sources.

RESULTS

An objective national study of the characteristics and financing of ESMH programs has yet to be conducted. Existing evidence suggests that funding for these programs is patchy and tenuous. Many programs are being funded through fee-for-service programs, which generally only support the provision of more intensive services (e.g., assessment, therapy) and are associated with significant bureaucracy and other concerns (e.g., the need to diagnose students). As programs move to enhance funding for preventive and mental health-promoting activities and services, there is an increasing need for grants, contracts, and other sources of support.

CONCLUSION

Progress in the national movement toward ESMH will be promoted through an interconnected agenda of quality improvement, evaluation of program effectiveness, and the advancement of advocacy. These developments will facilitate policy improvements and increased funding for the full continuum of mental health promotion and intervention in the schools.

Residential adolescent substance abuse treatment: recommendations for collaboration between school health and substance abuse treatment personnel

Thousands of youth participate in residential substance abuse treatment each year. After completing treatment, many of these youth return to school. This study analyzed the process of substance abuse treatment at the Generations Youth Program, and identified opportunities for collaboration with school health personnel. A qualitative case study design was employed. Analysis of the treatment process revealed the primary goal of treatment was to assist youth in developing a belief in their ability to remain sober. This goal was achieved through a peer support network, development of self-control, and acquisition of treatment knowledge. Youth who develop these skills are successfully discharged from treatment and return to home and school. Opportunities exist for collaboration between school health and substance abuse treatment personnel to enable discharged youth to remain drug free.

Theoretical basis and program design of a school-based mental health intervention for traumatized immigrant children: a collaborative research partnership

This article describes a collaborative research model for school-based mental health services that targets children who are recent immigrants with violence-related mental health symptoms. The model describes a conceptual framework used in the establishment of an academic-community partnership during the development, evaluation, and implementation of the Mental Health for Immigrants Program (MHIP), a school-based mental health intervention. The article discusses the challenges that occurred and provides specific examples of how a participatory research partnership may work together through all program phases--design through implementation and program evaluation--to meet a specific community's needs and produce generalizable knowledge. The challenges and limitations of collaborative research approaches also are discussed, with particular emphasis on the role of participatory research in the development and evaluation of school-based mental health programs.

Advancing efforts to address youth violence involvement

Discusses the increased public attention on violence-related problems among youth and the concomitant increased diversity in research. Youth violence involvement is a complex construct that includes violence experienced in multiple settings (home, school, neighborhood) and in multiple forms (as victims, witnesses, perpetrators, and through family members, friends, and the media). Potential impacts of such violence involvement are considerable, including increased internalizing and externalizing behaviors among youth and future problems in school adjustment and life-course development. This introductory article reviews key dimensions of youth-related violence, describes an American Psychological Association Task Force (Division 12) developed to advance relevant research, and presents examples of national resources and efforts that attempt to address this critical public health issue.

Toward a public mental health promotion and intervention system for youth

Substantial limitations exist at all levels of mental health care for youth in most communities in the United States. Particular gaps exist in the areas of prevention, mental health promotion, and early intervention programs. The national movement toward enhancing mental health programs for youth in schools offers an important opportunity to fill gaps in the prevention-services continuum toward the development of a Public Mental Health Promotion and Intervention System for Youth. A strategy--the Child and Adolescent Program Planning Schema (CAPPS)--is presented to analyze gaps in a community's system of mental health programs for youth, and to facilitate planning toward development of a full continuum of programs from broad, population-based prevention, and mental health promotion strategies to treatment of youth with more established problems.