Bringing Evidence-Based Child Mental Health Services to the Schools: General Issues and Specific Populations
Masia-Warner, Carrie, Nangle, Douglas W., Hansen, David J., Education & Treatment of Children
Epidemiological research indicates a high prevalence of psychiatric disorders among children and adolescents. Approximately 21% of children and adolescents, ages 9 to 17, have a diagnosable psychiatric disorder (Costello et al., 1996; Shaffer et al., 1996; U.S. Public Health Service, 2000), and additional youngsters experience social and emotional difficulties that do not meet symptom criteria for a disorder but cause considerable distress and impairment in functioning. Unfortunately, there is a significant gap between the many youth who are in need of treatment and those who actually receive mental health care (Burns et al., 1995; Leaf et al., 1996). According to the Surgeon General's 1999 report on mental health, 6 to 9 million youngsters with emotional problems are not receiving the help they require (U. S. Department of Health and Human Services, 1999). The failure to provide treatment to youth represents a major public health concern (U.S. Public Health Service, 2000).
Schools present a crucial avenue for ameliorating this problem, and have been designated as a key setting by the Surgeon General for identifying and addressing mental health needs in youth (U.S. Department of Health and Human Services, 1999). This proposed solution for increasing health care access is based on several observations. First, in a large study of children's mental health service use, of the only 16% of youth receiving mental health services, 75% received them at school (Burns et al., 1995). Second, schools provide unparalleled contact with youth (Adelman & Taylor, 1999; Weist, 1997), and therefore, represent a single location through which the majority can be reached (Anglin, 2003). Such ease of accessibility creates the optimal environment to launch prevention, early identification, and intervention efforts that may prevent the development of serious secondary dysfunction such as suicidal behavior or substance abuse (Weist, 1999).
In addition, children and families may avoid seeking help partly due to the stigma associated with traditional mental health treatment. Offering services in a familiar setting like schools may make treatment more acceptable (Catron & Weiss, 1994; Weist, 1999) since many children already receive school-based services for non-mental health concerns. On a related note, school programs reduce barriers common to treatment in community mental health services such as cost, transportation, and family and demographic factors (Catron, Harris, & Weiss, 1998; Wu et al., 1999), and thus, may offer opportunities that would otherwise be unavailable.
Moreover, psychiatric issues in children and adolescents are often not recognized, and adults frequently minimize problems experienced by youth (Clauss-Ehlers & Weist, 2002). Partnering with schools creates opportunities to educate and support school personnel and parents in identifying mental health issues and making appropriate referrals for treatment.
Finally, treatment implemented within schools provides opportunities to practice skills in realistic contexts and with diverse individuals, thereby increasing the likelihood of generalization to the natural environment (Evans, 1999; Evans, Langberg, & Williams, 2003). Treatment progress can be further encouraged and reinforced by peers and teachers. Such a real-world approach reduces the division between the treatment setting and natural environment, and may enhance the effectiveness of school interventions compared to clinic-based treatments (Evans et al., 2003).
Based on the many potential advantages, there has been a proliferation of school-based programs (Adelman & Taylor, 1998). Although some positive effects have been found for programs addressing anxiety disorders, depression, substance use, and conduct and emotional problems (Dadds et al., 1997, Dadds et al., 1999, Masia-Warner et al., 2005; Rones & Hoagwood, 2000), the effectiveness of the majority of school initiatives is largely unknown (Adelman & Taylor, 1998; Hoagwood & Erwin, 1997; Leff, Power, Manz, Costigan, & Nabors, 2001; Power, Manz, & Leff, 2003; Rones & Hoagwood, 2000). …