Currently, psychiatric and behavioral problems are the number one health problem among young people ages 10-18 (Blum, 1987; Bushong, Coverdale, & Battaglia, 1992). Psychiatric and behavioral disorders, including depression, can have devastating effects at this age and often lead to school failure, violence and suicide (Birmaher & Brent, 1998; Lewinsohn, Rohde, Klein, & Seeley, 1999). Moreover, research indicates that depressed youths are being seriously under-diagnosed and under-treated, causing a great burden to both individuals and society (Blum, Beuhring, Wunderlich, & Resnick, 1996; Hirschfeld, et al., 1997; Horwath, Johnson, Klerman, & Weissman, 1994).
Depression that originates in adolescence will often persist into adulthood if not adequately treated (Lewinsohn, Rohde, Klein, & Seeley, 1999; Weissman, et al., 1999). Further, mental health services are often unavailable (Katon, et al., 1996) and even when they are available, real or perceived barriers limit utilization for our youth (Angold, et al., 1998; Blum, 1991; Lamarine, 1995). For example, a large statewide study of student access to health services in Oregon found that many adolescents felt they needed, but did not receive, medical care for personal or emotional problems (Zimmer-Gembeck, Alexander, & Nystrom, 1997).
In 1990, the American Academy of Pediatrics strongly recommended that education about depression and suicide prevention be integrated into the educational system (Committee on School Health, 1990). More recently, the Surgeon General's "Call to Action to Prevent Suicide, 1999" advocated 15 recommendations centered on three principals- Awareness, Intervention and Methodology (AIM). These recommendations strongly urge that training about suicide risk assessment and treatment be instituted for all human service professionals including clergy, teachers, correctional workers and social workers. While a number of programs have been designed to disseminate knowledge and to provide interventions for depression and suicide (Shaffer & Craft, 1999), almost no literature to date has been published about programs designed to train teachers and school personnel.
Teachers and/or parents are the primary sources to observe and gather information concerning the behavioral problems of children and adolescents (Gresham, 1984; Verhulst, Koot, & Van Der Ende, 1994). However, they commonly feel either poorly equipped or reluctant to consider that a child's academic or social difficulties may be related to poor emotional health (Lamarine, 1995). Nevertheless, educators have considerable experience observing a range of normal child and adolescent behavior (Verhulst, Koot, & Van Der Ende, 1994), and are in a favorable position to identify significant developmental and behavioral problems (Kazdin, 1990; Resnick, et al. 1997). Indeed, research has shown it frequently falls to the schools and the teaching profession to provide the initial link to treatment (Adelman & Taylor, 1999; Klein, McNuity, & Flatau, 1998). In an effort to more effectively handle the emotional, social and psychological problems of our youth, many schools are now attempting to provide some version of onsite mental health services (Adelman & Taylor, 1999; Flaherty, Weist, & Warner, 1996; Jepson, Juszczak, & Fisher, 1998; King, 1996; Waxman, Weist, & Benson, 1999). In addition, when surveyed, many youth identify school personnel as important resources for health and counseling needs (Fotheringham & Sawyer, 1995; Klein, McNulty, & Flatau, 1998; Shaffer, Garland, Vieland, Underwood, & Busner, 1991).
Because childhood and adolescent depression is treatable and early identification and treatment have shown to be effective (Hirschfeld, et al., 1997; Weissman, et al., 1999), public health approaches are needed to enhance early recognition and interventions for young people who suffer from depression. …