ABSTRACT
Expanded school mental health (ESMH) programs involve the provision of comprehensive mental health services for youth in schools, including assessment, intervention, prevention, and consultation. Related to increased awareness of the benefits of these programs, and growing disenchantment with traditional forms of mental health service delivery for children, ESMH programs are growing rapidly in the United States. Coinciding with the growth of these programs is a developing interface between and among education and mental health professionals in schools. In this interface, there is an increasing need for real collaboration; however, associated with differences in professional training, language, and expectations, and related to "turf," such collaboration is often an elusive prospect. In this article, we review historical trends that provide background to the growing education-mental health interface in schools. We discuss tensions that arise between staff of various disciplines when ESMH programs are developed, and provide recommendations on strategies to develop truly collaborative approaches to the provision of comprehensive mental health services in schools.
Subject(s)
Cooperative Behavior , Mental Health Services/supply & distribution , School Health Services/supply & distribution , Adolescent , Child , Health Personnel , Humans , Teaching , United StatesABSTRACT
Six hundred fourth-graders rated how much they liked to play with each of their classmates and then nominated their three best friends; 296 of the 600 children were assigned sociometric classifications of popular, neglected, average, controversial, or rejected status (the remaining 304 children failed to meet inclusion criteria). Five years later, 267 of the 296 classified children (90.2%) were evaluated on measures of academic performance, social behavior, and psychological adjustment. The number and type of contacts with the juvenile justice system were also determined. In general, children classified as rejected or controversial tended to fare more poorly on indices of long-term adjustment than did children classified as popular, neglected, or average. Results are discussed in terms of the predictive validity of sociometric rating and nomination procedures and their utility in identifying children at risk for later maladjustment.
Subject(s)
Achievement , Adaptation, Psychological , Child Behavior Disorders/psychology , Interpersonal Relations , Peer Group , Sociometric Techniques , Adolescent , Child , Child Behavior Disorders/diagnosis , Female , Follow-Up Studies , Humans , Longitudinal Studies , Male , Personality Development , PsychometricsABSTRACT
Primary care visits provide opportunities for behavioral assessment of children and adolescents. Screening checklists, interviewing, behavioral observations, and parent and child monitoring of behavior are feasible assessment techniques for ongoing assessment of the child's behavioral and developmental status. The incorporation of behavioral assessment in primary care will result in better identification of children's behavioral and developmental problems and an improved health care system that is responsive to all aspects of children's health.
Subject(s)
Developmental Disabilities/diagnosis , Mass Screening/methods , Pediatrics/methods , Adolescent , Child , Clinical Protocols/standards , Developmental Disabilities/epidemiology , Developmental Disabilities/prevention & control , Humans , Interpersonal Relations , Mass Screening/organization & administration , Mass Screening/standards , Organizational Objectives , Parents/psychology , Pediatrics/organization & administration , Pediatrics/standards , Sick RoleABSTRACT
The authors discuss the growing movement in the United States to develop expanded school mental health programs. These programs represent partnerships between schools and community mental health agencies to expand the range of mental health services provided by schools. Such programs emphasize effective prevention, assessment, and intervention. The authors describe efforts that have been undertaken to improve the fragmented and incomplete nature of children's services and to proactively identify and address children's emotional and behavioral problems. They also discuss a strategy to improve youth mental health programs, which includes needs assessments and an analysis of existing programs in a community. They describe the augmenting roles played by the mental health and public health systems in expanding and improving school-based mental health services. The authors outline steps to minimize or avoid the turfism and negative attitudes that may arise among professionals from different disciplines when they collaborate to expand and improve school-based programs.
Subject(s)
Affective Symptoms/prevention & control , Child Behavior Disorders/prevention & control , Health Education , Mental Health Services , Patient Care Team , Public Health , School Health Services , Adolescent , Affective Symptoms/diagnosis , Affective Symptoms/psychology , Child , Child Behavior Disorders/diagnosis , Child Behavior Disorders/psychology , Health Plan Implementation , Health Services Needs and Demand , Humans , United StatesABSTRACT
Among 233 youths treated at a community mental health center, 51 were living with their grandparents. Youths who lived with grandparents were more likely to be male, African American, and younger. Frequent psychiatric diagnoses included oppositional defiant disorder, depressive disorders, and anxiety disorders. Common reasons for youths' placement with grandparents included parents' absence, substance abuse, or incarceration; abuse by parents; and death of parents. Caregivers were most often maternal grandmothers, and more than one-third of the grandmothers were age 62 or older. The findings highlight the need to develop treatment interventions for youths who are living with their grandparents and to create public policies to support grandparent caregivers.
Subject(s)
Affective Symptoms/diagnosis , Caregivers , Child Rearing , Family , Adolescent , Affective Symptoms/epidemiology , Affective Symptoms/psychology , Black or African American/psychology , Black or African American/statistics & numerical data , Caregivers/psychology , Child , Child, Preschool , Community Mental Health Centers , Family/psychology , Female , Humans , Intergenerational Relations , Male , Maryland , Risk Factors , Social Support , White People/psychology , White People/statistics & numerical dataABSTRACT
This study reports the development of the My Life Questionnaire (MLQ), a self-report measure of factors that protect inner-city youth against stressors such as poverty, crime, and violence. An initial pool of 23 items reflecting important protective factors was developed through focus groups with inner-city youth and clinicians working with them in a school-based mental health program. Item-total correlations and factor analysis resulted in a 12-item measure containing three factors: avoiding negative peer influences, focusing on the future, and religious involvement. Scores on the MLQ were negatively correlated with behavioral problems, supporting its validity. The measure holds promise for use in clinical and research efforts with disadvantaged urban youth.
Subject(s)
Stress, Psychological/diagnosis , Stress, Psychological/prevention & control , Surveys and Questionnaires , Urban Population , Adolescent , Adult , Female , Humans , Male , Psychometrics/statistics & numerical dataABSTRACT
Because of concerns about increasing anxiety in a population that is at relatively low risk for developing cancer, some investigators have recommended that training in testicular self-examination (TSE) not be provided to adolescent males. However, empirical findings documenting a link between training in cancer detection and increased anxiety in adolescent males are lacking. In this preliminary study, we assessed whether training in TSE was actually associated with elevated state anxiety in two samples of adolescent males (29 ninth graders and 30 college underclassmen). For both groups, anxiety scores were well within normal limits at postassessment, indicating that a purported cost of the procedure may in fact not exist.
Subject(s)
Anxiety/psychology , Health Knowledge, Attitudes, Practice , Self-Examination/psychology , Testicular Neoplasms/prevention & control , Testis , Adolescent , Adult , Health Education , Humans , Male , Testicular Neoplasms/psychologyABSTRACT
The purpose of this study was to examine the predictive validity of a teacher nomination procedure for identifying at-risk children. Two hundred and twenty-five children were nominated by their teachers as well-adjusted (n = 75), socially withdrawn (n = 76), or socially aggressive (n = 74) during the fourth grade. Five years later, 198 of these children (88%) were located and their adjustment evaluated. Significant differences among the nominated children were found on a variety of measures, including academic grades, sociometric status, and social behavior. In addition, differences in school dropout and delinquent offenses were noted. Results are discussed in terms of the validity of teacher nomination procedures and their utility in identifying at-risk youth.
Subject(s)
Child Behavior Disorders/diagnosis , Personality Assessment , Social Adjustment , Social Behavior , Social Environment , Adolescent , Child , Child Behavior Disorders/psychology , Female , Follow-Up Studies , Humans , Male , Peer Group , Shyness , Social Desirability , Social IsolationABSTRACT
The movement to develop expanded school mental health programs is still in its early stages. For child and adolescent psychiatrists to become involved and effective means negotiating a culture that is novel for many schools and forming and maintaining relationships with diverse staff in mental health, health, and education.
Subject(s)
Community Psychiatry/methods , Consultants , Faculty , Interprofessional Relations , School Health Services/organization & administration , Adolescent , Child , Community Psychiatry/organization & administration , Cooperative Behavior , Humans , United StatesABSTRACT
OBJECTIVE: To investigate whether there are measurable gender differences in self-esteem and depression in elementary school-age children who have witnessed domestic violence. METHOD: Forty-five elementary school-age children who were identified as having witnessed domestic violence, and their teachers were surveyed for self-esteem, depression, and classroom behaviors. The results were compared between males and females using linear regression modeling. RESULTS: No significant gender differences were found for self-esteem and depression. An interaction between gender and post-traumatic stress was found to play a significant role in the interpretation of the results. CONCLUSIONS: Results indicated that higher levels of symptoms indicative of post-traumatic stress were associated with greater numbers of depressive symptoms and lower self-esteem for boys who had witnessed domestic violence. The results appeared similar to previous work with children and their emotional reactions to divorce.
Subject(s)
Depressive Disorder/epidemiology , Domestic Violence/psychology , Self Concept , Adaptation, Psychological , Child , Child Behavior Disorders/epidemiology , Child Behavior Disorders/etiology , Depressive Disorder/etiology , Female , Humans , Linear Models , Male , Sex Factors , Stress Disorders, Post-Traumatic/complications , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Surveys and Questionnaires , United StatesABSTRACT
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.
Subject(s)
Health Promotion/organization & administration , Mental Health Services/organization & administration , Public Health Administration , School Health Services/organization & administration , Adolescent , Child , Humans , Planning Techniques , United StatesABSTRACT
Expanded school mental health (ESMH) programs provide a range of mental health services to youth in special and regular education including prevention, assessment, treatment, and case management. Despite the rapid growth of ESMH programs in the United States and elsewhere, many communities still do not have ESMH programs and those that do exist often fail to implement empirically validated intervention and treatment strategies. Systematic prevention efforts remain a lauded, yet illusive goal. For ESMH programs to fulfill their promise of improved access, increased productivity and improved behavioral outcomes, researchers, school-based mental health service providers, and educators must work together to move child mental health programs beyond limiting constructs and approaches. These issues are reviewed and an example of an "ideal" approach to implement best practices in schools and close the gap between research and practice is offered.
Subject(s)
Health Care Reform/organization & administration , Mental Health Services/organization & administration , School Health Services/organization & administration , Adolescent , Child , Female , Health Services Research/organization & administration , Humans , Male , Program Development , Program Evaluation , Sensitivity and Specificity , United StatesABSTRACT
Significant growth and improvement of school mental health programs has occurred in recent years. However, evaluation of outcomes for children receiving these services is needed to provide accountability data and ensure the sustainability of these programs. When designing studies, evaluators must overcome several challenges that may threaten the validity of their conclusions. In this paper, threats or challenges to the internal and external validity of results from evaluation studies are reviewed. Suggestions are provided for overcoming these challenges, in order to encourage future evaluation activities in this developing field and to document the impact of services for youth and their families.
Subject(s)
Mental Health Services/organization & administration , School Health Services/organization & administration , Adolescent , Child , Female , Humans , Male , Program Evaluation , Reproducibility of Results , Sensitivity and Specificity , United StatesABSTRACT
Expanded school mental health (ESMH) programs address the limitations of traditional mental health agencies in meeting the needs of youth by providing a full range of services in a familiar and nonstigmatizing setting. Because of the central role families play in the lives of children, their involvement in ESMH can enhance the effectiveness of treatments and ensure that services are responsive to the needs of the larger community. Increasing family involvement, however, is a complex and resource-intensive endeavor, and requires consideration of the goals of the ESMH program and potential obstacles to meeting those goals. The challenges of involving family members in ESMH, guidelines for determining the program's goals with respect to family involvement, and strategies for achieving these goals are described. Underlying the strategies is the need to be flexible, creative, and respectful of the beliefs and concerns of the families served by the ESMH program.
Subject(s)
Family/psychology , Mental Health Services/organization & administration , Patient Participation , School Health Services/organization & administration , Adolescent , Adult , Child , Guidelines as Topic , Health Knowledge, Attitudes, Practice , Health Services Needs and Demand , Humans , Organizational Objectives , Patient Selection , Quality Assurance, Health Care , United StatesABSTRACT
Each mental health discipline offers unique contributions to the development and operation of school-based mental health programs. The collaboration of professionals from different disciplines with each other, as well as with health and educational staff, is essential for service delivery in school settings. Conversely, interprofessional conflicts and turf issues can impede the development of effective school-based mental health programs. The authors, who represent counseling, nursing, psychiatry, psychology, and social work, discuss the roles and competencies of each profession in providing school-based mental health services. Training requirements within each discipline that relate to school mental health are described. Barriers to effective interdisciplinary collaboration, and methods of overcoming them, are delineated.
Subject(s)
Job Description , Mental Health Services/organization & administration , Patient Care Team/organization & administration , School Health Services/organization & administration , Adolescent , Child , Clinical Competence , Cooperative Behavior , Health Personnel/education , Health Personnel/psychology , Humans , Interprofessional Relations , United StatesABSTRACT
We evaluated the effects of two health education teaching methods, a pamphlet based on a task-analyzed checklist and two professionally developed films, on the completeness, accuracy, and maintenance of testicular self-examinations (TSE). Subjects (N = 48) were videotaped while performing a TSE after training and at a follow-up visit. Direct observation of the tapes showed that checklist-based training resulted in more complete and longer TSEs (p < .05). Social validation ratings, however, suggested that physicians were unable to discriminate reliably the performances of subjects taught using the two methods. Accuracy of detection of simulated lesions on plastic models was also similar for the two groups. Adherence to TSE recommendations was high during the study, but declined across the follow-up period. Further study is needed to promote adherence to TSE and to document the effects of early detection on morbidity and mortality of testicular cancer.