Perceived emotional distress and behavioral problems are quite prevalent among high school students, the reasons for which were discussed in Part I of this series. The difficulties encountered in assessing the efficacy of several programs that were proposed to remedy the situation were discussed in Part II. Briefly, several of those programs that focused on specific behaviors (e.g., substance abuse), required highly trained personnel or daily sessions. These programs often used inclusion criteria which did not allow for the results to be generalized to the students in the average high school who suffer from emotional distress or milder behavioral problems. Subjective emotional distress was not used as an inclusion criterion, and there was no attempt to assess the impact of proactive intervention prior to the appearance of serious behavioral problems. Little attention was paid to measuring the psychological impact of such groups or the students' perception of improvement, two crucial factors which ultimately determine the utilization rate of the programs and their influence on the students' attitude toward school, peers, and family. In-school volunteer-facilitated peer support groups have not been adequately studied as an early intervention and management program despite some hints in the literature of probable efficacy and economic feasibility.
This article reports the authors' experience with a volunteer-facilitated, in-school student-assistance program based on voluntary participation of students in peer support groups. The focus was on the students' assessment of their improvement, and the program's acceptability at the end of the third year of implementation.
In the academic year 1990-1991 a proactive student-assistance program based on volunteer-facilitated peer-support groups was implemented in a Southwestern high school. Students aged 14-19, who experienced emotional distress or behavioral problems were recruited by providing information about group availability to all students at the beginning of the year. Because of the anonymity of the responses, the characteristics of the respondents could not be identified. Table 1 shows the demographic characteristics of the catchment area and the students in this school.
Students who perceived that they had emotional distress or behavioral problems and wanted help referred themselves to be evaluated by the school counselor to decide whether help was needed. In addition, any concerned person (peer, teacher, parent) or an external agency could, anonymously submit the name of a student for evaluation. The self-referred students and those referred by others were then invited for an interview to determine the type and degree of help each of them needed. Students who were in immediate danger to self or others and those whose problems were severe enough to require hospitalization or out-of-school help were referred to the appropriate health authority (approximately 10% were so referred). Those whose emotional distress or behavioral problems were significant enough to warrant intervention were invited to participate in weekly small peer groups (8-12 students). The choice of group was based on the reason given for referral. The different groups available are summarized in Table 2. It was noted that once the reasons for referral and the available groups were discussed, there was very little disagreement between the students and counselor about the most appropriate group, but the final decision was to be made by the counselor.
Participation in the groups was strictly voluntary regardless of the type of referral or the reason for it. Students did not receive academic credit for participation, and those who withdrew from the groups were not penalized. Participants were expected to complete, on their own, any class work missed. Approximately 5% of those who joined the groups declined to continue participation; 60% of the withdrawals occurred in the first three weeks and 40% at a later point. …