The horror of the mass killings of six faculty and twenty Sandy Hook Elementary School children is still painfully fresh, but it isn’t too soon to begin thinking about what needs to change to try and prevent this from happening again somewhere else. Much of the discussion following this tragedy will rightly focus on adopting some sensible gun regulations. But there are other areas that we need to focus on as well because our propensity for social violence is a broad and multifaceted problem. Our mental health system is another important area to address. Particularly with respect to children, our ability to identify and treat behavioral problems and mental illness needs to be strengthened. One aspect of this involves early mental health screenings. What follows here is a brief and partial list of articles, studies and references on the topic. It’s not too soon to start educating ourselves.
American academy of pediatrics
MENTAL HEALTH PROBLEMS: CAPACITY TO IDENTIFY, REFER, MANAGE
Summary: The purpose of Health, Mental Health and Safety Guidelines for Schools is to help those who influence the health and safety of students and school staff while they are in school, on school grounds, on their way to or from school, and involved in school-sponsored activities. The guidelines recognize that the primary mission of schools is to educate students. Schools also have a responsibility for students’ health and safety while they are at school. By addressing health, mental health, and safety issues (including transportation and motor vehicle safety), schools can improve students’ academic performance today and contribute to their increased longevity and productivity long after they leave school.
Excerpt: Early identification of students with, or at risk for, transient or on-going mental disorders, followed by early intervention can mitigate the severity and duration of these problems and reduce personal, social, educational, and financial costs to the student and family and the educational and health systems. Up to three-quarters of U.S. children receiving professional care for a mental health problem obtained services through a school-based program.
Citations: Suggested citation, prior to written publication:
Taras H, Duncan P, Luckenbill D, Robinson J, Wheeler L, Wooley S: Health, Mental Health and Safety Guidelines for Schools. (2004); Available at http://www.schoolhealth.org
Mental Health Screening in Schools
Summary: This article discusses the importance of screening students in
schools for emotional/behavioral problems. Elements relevant to planning and implementing effective mental health screening in schools are considered. Screening in schools is linked to a broader national agenda to improve the mental health of children and adolescents. Strategies for systematic planning for mental health screening in schools are presented. Careful planning and implementation of mental
health screening in schools offers a number of beneﬁts including enhancing outreach
and help to youth in need, and mobilizing school and community efforts to promote
student mental health while reducing barriers to their learning. When implemented with appropriate family, school, and community involvement, mental health screening in schools has the potential to be a cornerstone of a transformed mental health system.
Excerpt: “Youth with internalizing disorders such as depression, anxiety, or suicide ideation are not as easily identiﬁed as those with acting-out or externalizing disorders. Individuals with internalizing conditions comprise a signiﬁcant population; the 2003 Youth Risk Behavior Survey, a nationally representative sample of more than 15,000 high school students throughout the United States, found that in the 12-month period preceding the survey, 16.9% had seriously considered attempting suicide, 16.5% had
made a plan for attempting suicide, 8.5% had attempted suicide 1 or more times, and 2.9% had made an attempt requiring medical attention.
Citation: Weist MD, Rubin M, Moore E, Adelsheim S, Wrobel G. Mental health
screening in schools. J Sch Health. 2007; 77: 53-58.
Screening Mental Health Problems in Schools
Summary: This brief highlights the following issues:
• How appropriate is large-scale screening for mental health problems?
• Will the costs of large-scale mental health screening programs
outweigh the benefits?
• Are schools an appropriate venue for large-scale screening of mental
• Advocates for large-scale MH screening in schools see major benefits to individuals and
society of finding many more students with problems in order to treat them before the
problems become severe. In citing benefits for screening children and adolescents, the
assumption is that those identified will receive effective treatments. Based on this
assumption, key benefits claimed are preventing problems from becoming worse and
enhancing student success at school, which generates other benefits for students, their
families, and their teachers and for the society in terms of future productivity and which
reduces costs because there is less need for intensive treatments and special education.
In citing benefits for using schools as a venue for public health programs, as compared to
other community venues, matters of ready access and reduced costs are stressed, as well
as the benefits to schools of having students with problems treated.
• Those who oppose large-scale screening raise a host of concerns (i.e., potential costs). For some, there is a fundamental fear that society will mandate such screening and thereby interfere with what should remain a personal family matter and will violate rights to privacy, consent, and parental control. Others are concerned that screening will increase referrals for nonexistent treatment resources and that the dollars budgeted for screening will reduce the dollars allocated for treatment. Still others point to the evidence that available screening methods used in schools produce too many errors (e.g., false positive identifications, inappropriate over-identification of subgroups such as some ethnic groups and boys with externalizing problems and girls with internalizing problems). Relatedly, they argue there will be insufficient follow-up assessment resources to correct for false positive identifications. And, some argue there are significant costs resulting from selffulfilling prophecies and stigmatization.
In arguing against using schools, there is the social philosophical argument that mental
health is one of those matters that should remain a domain for family, not school,
intervention. More pragmatically, it is argued that scarce school time and resources should not be used for matters not directly related to teaching. Others point to the lack of enough competent school personnel to plan, implement, and evaluate large-scale screening.
Examples of documents covering the issues:
Screening Aimed at Preventing Youth Suicide (2005)
by Ellie Ashford for the National School Board Association’s School Board News
http://www.nsba.org/site/print.asp?TRACKID=&VID=55&ACTION=PRINT&CID=682&DID=36189 Provides a quick overview for school boards of some of the controversies and places them in the context of current events.
Screening for Depression: Recommendations and Rationale (2002)
by U.S. Preventive Services Task Force for Agency for Healthcare Research and Quality
Screening for Suicide Risk: Recommendation and Rationale (2004)
by U.S. Preventive Services Task Force for Agency for Healthcare Research and Quality
Citation: The Center is co-directed by Howard Adelman and Linda Taylor and operates
under the auspices of the School Mental Health Project, Dept. of Psychology, UCLA,
Write: Center for Mental Health in Schools, Box 951563, Los Angeles, CA90095-1563
Phone: (310) 825-3634 Fax: (310) 206-5895 Toll Free: (866) 846-4843
email: email@example.com website: http://smhp.psych.ucla.edu
Mental health screening in schools
Summary: This article discusses the importance of screening students in schools for emotional/behavioral problems. Elements relevant to planning and implementing effective mental health screening in schools are considered. Screening in schools is linked to a broader national agenda to improve the mental health of children and adolescents. Strategies for systematic planning for mental health screening in schools are presented.
Excerpt: When implemented with appropriate family, school, and community involvement, mental health screening in schools has the potential to be a cornerstone of a transformed mental health system. Screening, as part of a coordinated and comprehensive school mental health program, complements the mission of schools, identifies youth in need, links them to effective services, and contributes to positive educational outcomes valued by families, schools, and communities.
Division of Child and Adolescent Psychiatry, Center for School Mental Health Analysis and Action, University of Maryland School of Medicine, Baltimore, MD 21201, USA. firstname.lastname@example.org
Study pushes early identification of kids’ mental health problems
Lisa Chedekel, Conn. Health I-Team Writer
Published 09/14/2012 12:00 AM
Updated 09/15/2012 12:13 AM
Josue, 15, was born to a 12‐year‐old mother. Exposed to domestic violence and abuse, he struggled in school early on and received a special education evaluation in Grade 4 that found weaknesses in reading, math and writing.
By 13, he had been diagnosed with symptoms of bipolar disorder, depression, learning disabilities and attention deficit disorder. Yet, he started high school with limited support services and ended up suspended from school and referred to the juvenile justice system.
“Red flags for mental and behavioral health problems are often clear before the end of second grade,” said Andrea Spencer, educational consultant to the Center and dean of the School of Education at PaceUniversity, whose work was funded with a grant from the Connecticut Health Foundation. “It is imperative that we improve screening and identification, so support for these children can be provided before their academic careers are at risk.”
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