Academic journal article Journal of School Health

Utility of Psychosocial Screening at a School-Based Health Center

Academic journal article Journal of School Health

Utility of Psychosocial Screening at a School-Based Health Center

Article excerpt

Psychosocial dysfunction, recognized 20 years ago as the "new morbidity" in pediatric practice, now represents the leading cause of disability in childhood and adolescence.[1,2] Epidemiological research estimates that 14%-20% of American children have one or more psychiatric disorders in the moderate to severe range.[3,5] Poor and minority children face an even greater risk.[6-8] Numerous studies have shown that untreated mental health problems can develop into more severe psychosocial impairment as children move into adolescence, placing them at risk for school drop-out and increased use of health care services.[9-10] The federal government, the Bureau of Maternal and Child Health, the American Academy of Pediatrics, and the American Medical Association all set standards for early identification and treatment of childhood and adolescent mental disorders.[3]

Despite the high prevalence of emotional and behavioral problems, and mandates from heath care and the federal government, only one-sixth to one-half of children and adolescents with psychosocial dysfunction are identified. Of these, only one-fifth receive mental health services.[2] Given these discouraging figures, at least some progress has been made with the development of screening questionnaires to increase identification of psychosocial dysfunction in children. The Pediatric Symptom Checklist (PSC) is a 35-item questionnaire designed to detect psychosocial problems in school-aged children.[11,12] Studies using the PSC in a broad range of pediatric settings and populations have shown that use of a brief, parent-completed screening measure greatly improves physician recognition of children's psychosocial problems.[13-15]

Traditionally, pediatricians have served as the primary resource for recognition of psychosocial problems in children and adolescents. However, adolescents see office-based clinicians less than any other age group, and they are least likely to make or keep appointments. Transportation difficulties, inability to make or keep appointments during regularly scheduled hours, concerns about confidentiality, and fear of judgment or insensitivity about issues of sexuality, substance abuse, or emotional distress also keep adolescents from using health care services. In addition, comprehensive mental health services for children and adolescents tend to be discouraged under managed care.[16-18]

In recent years, schools have assumed a major role in managing children's psychosocial problems. One epidemiological study showed that as many as 70%-80% of children receiving mental health services did so only at school, making the education system "the de facto system of care for youth with mental health problems."[19] Schools can increase access to mental health services for children and adolescents by offering these services through school-based health centers (SBHCs). Care given in SBHCs addresses specific needs of adolescents and includes primary, acute, and preventive health care, routine screening, mental health, reproductive counseling, and anticipatory guidance. SBHCs also help overcome barriers that limit access to mental health services including lack of health insurance, transportation difficulties, and insufficient attention to the particular needs of adolescents.[20] In addition, adolescents value the convenience of health care from SBHCs by familiar staff whom they trust.[21]

Schools offer ideal settings for large-scale screening of children and adolescents. Schools set standards for age-appropriate expectations for children, and they provide a longitudinal view of children's functioning in a normative, controlled setting. For older children and adolescents who may be asserting independence from parents and home and focusing more on peers and school activities, school-based screening may be especially important to identify troubled youth needing mental health services before disciplinary measures are required.

Originally designed for pediatric primary care, the Youth Pediatric Symptom Checklist (PSC-Y) has been shown to correlate highly with teachers' and guidance counselors' ratings of students' needs for services, academic failure, and PSCs completed by adolescent students. …

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