School-based Health Research Articles

The Mokihana Program: The effectiveness of an integrated department of education and department of health school-based behavioral health approach.

As a result of difficulties with access to care and resulting low levels of service utilization, the mental health problems of children often go undiagnosed and untreated. One of the most promising approaches to increasing access to care is the delivery of mental health services in school settings, where almost all of the children in a community can be accessed. However, as a result of competing needs, cultures, and objectives, integrating mental health services into schools can be challenging. In the wake of a devastating hurricane in 1992 and efforts to identify and treat children with posttraumatic stress, many of these barriers were overcome on the island of Kauai, Hawaii and led to the development of the Mokihana Program, an integrated Department of Education and Hawaii Department of Health initiative for providing school-based behavioral health services. This study examined the effectiveness of the Mokihana Program in the treatment of 123 elementary age children and 56 adolescents by comparing teacher ratings of behavior problems and adaptive skills at intake and at 1-year follow-up. It was hypothesized that symptom severity would decrease from pretreatment to follow-up. Findings showed statistically significant improvements across a wide spectrum of behavioral problems and adaptive functioning. The authors explore the challenges and opportunities in sustaining and replicating this type of departmental integration in the service of children and youth.

Sex Education and Support of LGB Families: a Family Impact Analysis of the Personal Responsibility Education Program

The authorization of the Personal Responsibility Education Program (PREP) represents a significant legislative shift in how social policy in the United States implements school-based sexual health education to address concerns for youth health. In contrast to its abstinence-based predecessors, this federally funded program provides a more comprehensive approach to sex education that includes content on contraception, is evidence-based, and emphasizes diversity and service to vulnerable populations. Yet, despite these improvements to how sex education policy facilitates the healthy development of youth, the design and implementation of PREP do not provide substantial support of lesbian, bisexual, and gay (LGB) populations. This paper applies a family impact analysis framework to further explore this policy limitation and demonstrates how PREP perpetuates the heteronormative legacy of sex education in a way that continues to marginalize and harm LGB families.

Headteachers' prior beliefs on child health and their engagement in school based health interventions: a qualitative study.

BackgroundSchools play an important role in promoting the health of children. However, little consideration is often given to the influence that headteachers’ and school staff’s prior beliefs have on the implementation of public health interventions. This study examined primary school headteachers’ and school health co-ordinators’ views regarding child health in order to provide greater insights on the school’s perspective for those designing future school-based health interventions.MethodsA qualitative study was conducted using 19 semi-structured interviews with headteachers, deputy headteachers and school health co-ordinators in the primary school setting. All transcripts were analysed using thematic analysis.ResultsWhilst many participants in this study believed good health was vital for learning, wide variance was evident regarding the perceived health of school pupils and the magnitude of responsibility schools should take in addressing child health behaviours. Although staff in this study acknowledged the importance of their role, many believed the responsibility placed upon schools for health promotion was becoming too much; suggesting health interventions need to better integrate school, parental and societal components. With mental health highlighted as an increasing priority in many schools, incorporating wellbeing outcomes into future school based health interventions is advocated to ensure a more holistic understanding of child health is gained.ConclusionUnderstanding the health beliefs of school staff when designing interventions is crucial as there appears to be a greater likelihood of interventions being successfully adopted if staff perceive a health issue as important among their pupils. An increased dependability on schools for addressing health was expressed by headteachers in this study, highlighting a need for better understanding of parental, child and key stakeholder perspectives on responsibility for child health. Without this understanding, there is potential for certain child health issues to be ignored.

Risk Factors and Comorbidities for Occasional and Daily Smoking in European Adolescents: Results of the Seyle Project

Background Smoking among adolescents is still a major public health problem and a global concern. Early onset and long-term smoking are associated with physical and psychological health problems. Objective To identify risk factors and comorbidities for occasional and daily smoking among European adolescents. Methods In the context of the Europe-wide 'Saving and Empowering Young Lives in Europe” (SEYLE) study we surveyed 12,328 youths at the age of 13 to 17 from 11 countries. We applied questions from the Global School-Based Student Health Survey to determine nicotine consumption as well as other risk behaviors. Psychiatric symptoms were assessed by the Strengths and Difficulties Questionnaire, the Becks Depression Inventory-II, the Zung Self-Rating Anxiety Scale, the Deliberate Self-Harm Inventory and the Paykel Suicide Scale. Results On average 30.9% of adolescents reported daily smoking and the onset of smoking was reported by 35.3% between the age of 12 and 13 already. Multinomial logistic regression model showed significant correlations between adolescent smoking and migration background, living in single parent households, no physical activity, parental smoking and physical fights. Further it revealed significant associations of adolescent smoking with alcohol consumption, illegal drug use, anxiety, conduct problems, hyperactivity, suicidal ideation, self-injury and internet-dependence. Conclusion Our data show that adolescent smoking is associated with psychosocial factors, especially family setting and parental behaviors. Further, smoking and psychiatric problems are highly correlated. Therefore, early preventive measures are necessary and essential not only for adolescents but also for their parents.

Suicidal ideation among school-attending adolescents in Dar es Salaam, Tanzania

Background: Suicidal ideation is an understudied risk factor for suicidal intent. The present study investigates the patterns and risk factors for suicidal ideation among a sample of school-attending adolescents in Dar es Salaam, Tanzania. Methods: This study examined secondary data collected in 2006 through the Global School-Based Student Health Survey. The data were collected via two-stage cluster sampling representative of all secondary schools in Dar es Salaam. We compared adolescents who reported suicidal ideation (SI) and those who reported a plan to carry out a suicide attempt (SP), with those reporting neither ideation nor an attempt (controls) within the 12 months preceding the survey. Our analyses targeted demographic, behavioral, social, mental health and family factors. Results : A total of 2,176 students aged 11-16 years participated. Within the recall period, 7% (n=149) of participants had thought about suicide with 6.3% (n=136) having created a plan to carry out an attempt. Fifty percent of those reporting SP were female. We found that significant associations existed across all categories of psychological health, substance use and among those who reported being bullied. In the multivariate analysis adolescents reporting suicidal intent were more than twice as likely to report having been lonely (RRR=2.33; CI=1.36-4.01); more likely to suffer from depressive symptoms (RRR=2.26; CI=1.56-3.27) and have previously used an illicit substance (RRR=1.97; CI=1.12-3.48). We found an inverse association with age and suicidal planning (RRR=0.74; CI=0.62-0.90) as well as poverty and SP (RRR=0.53; CI=0.29-0.98) and an increased likelihood for adolescents reporting SP to be lonely (RRR=2.76; CI=1.55-4.90) and depressed (RRR=3.98; CI=2.71-5.86). Tobacco use (RRR=2.15; CI=1.22-3.78) and illicit substance use (RRR=1.99; CI=1.10-3.60) were associated with SP as was having parents who were knowledgeable of what adolescents did during their free time (RRR=2.15; CI=1.07-4.31). Respondents who reported having no friends were also more likely to report SP (RRR=3.68; CI=2.22-6.08). Conclusion: Our results suggest that, as in high-income settings, psychological factors, risky health behaviors such as substance use, and social and familial support impact suicidal ideation. This knowledge should be used to help inform further research as well as prevention and intervention strategies.

A School-Based Suicide Risk Assessment Protocol

Suicide remains the third leading cause of death among young people in the United States. Considering that youth who contemplate suicide generally exhibit warning signs before engaging in lethal self-harm, school-based mental health professionals can play a vital role in identifying students who are at risk for suicidal behavior. Nevertheless, the assessment of vulnerable children and adolescents is a challenging undertaking, with many variables considered relevant to the determination of a student's suicide risk level. This article introduces school-based mental health professionals to the Student Suicide Risk Assessment Protocol, an evaluation tool developed by the author to aid in the determination of student suicide potential, assist with the selection of appropriate interventions, and allow for documentation of school personnel's actions taken to mitigate a student's suicide risk.

Prevalence, attitude, and factors associated with risky health habits and behavior of secondary school students, Almajardah, Saudi Arabia

Background: Adolescents make up to 20% of the world’s population. However, they have traditionally been neglected as a distict target group and subsumed under the proportion of family, women, and child’s welfare and health. Objective: To study the prevalence of and attitude toward selected health-risk behaviors (smoking, alcoholism, substance abuse, and violence) and their possible associated risk factors among secondary school students, Almajardah, KSA. Materials and Methods: A cross-sectional study among male Saudi adolescents enrolled in secondary schools at Almajardah city during the scholastic years 1434–1435. Data were collected using an Arabic-validated self-administered questionnaire. The questionnaire was based on State and Local Youth Risk Behavior survey and Global School-based Student Health survey. Result: The study included 442 male secondary school students. Their age ranged between 16 and 22 years with a mean of 17.8 and standard deviation of 1.1 years. More than one-third of the studied students (36.9%) reported at least one history of quarrel (violence) during the last year, and 8.4% of them required medical and/or hospital care as a result of quarreling. Thirty-seven students (8.4%) carried an arm at school during the last month. Smoking was reported by 22.6% of the studied students. Almost one-sixth (16.5%) of the students used to drink alcohol, and 4.1% of them reported having done it all the days of the last month. About one-sixth (16.7%) of the students were taking addictive substances. The substances used were mostly hashish and sedatives (59.5% and 40.5%, respectively). Student’s academic achievement was negatively predicted by all of the studied risky practices. Students’ age and their paternal education and/or job were among the important predictors for practicing risky behaviors. Conclusion: Secondary school male students in Almajardah, KSA, have a number of risky behaviors. The most important one is violence. Although alcohol drinking, smoking, and use of addictive substances are less, they constitute a major concern. Almost 38% of the studied students did not practice any risky behavior. Safety practices are lacking, and the rates of exposure to accidents or injuries are high.

The Affordable Care Act and school-based mental health services

The Patient Protection and Affordable Care Act (ACA) offers a potentially significant effect on school-based mental and behavioral health services.

School-Based Mental Health Professionals’ Bullying Assessment Practices: A Call for Evidence-Based Bullying Assessment Guidelines

A sample of 483 school-based mental health professionals completed a survey about the training they have received related to conducting bullying assessments in schools, competence in conducting an assessment of bullying, and the bullying assessment methods they used. Results indicate that school counselors were usually informed about incidents of bullying more frequently than school psychologists. Whereas the majority of school-based mental health professionals surveyed reported some level of competence in using assessment tools for bullying, few reported using empirically based instruments to assess for bullying. This article discusses results and implications, namely, the need to identify clinically meaningful tools for the assessment of bullying and the need to adopt more formal and empirically based methods of assessment in schools.

Between education and psychology: school staff perspectives

When discussing contributions from psychology in/to educational practices like school-based mental health promotion, it is peculiar that psychologists (of an educational or clinical kind) or education-oriented sociologists, both not often based in schools or classrooms, dominate the topic. It has been acknowledged that school staff have been over looked and underutilised in contributing to the discussion, particularly as this pertains to sharing perspectives on how they experience their role in relationship to education policy and practice. The study presented here looked to address this situation by seeking the perspectives of school staff on a range of concerns situated at the nexus between education and psychology. Contrary to the type of displaced assessment intimated above, this group of school staff generally accepts they perform a crucial task in supporting students, their main concern being to incisively question how they might negotiate existing role-related pressures to better current school-based practice.

Prevalence, comorbidities, and cofactors associated with alcohol consumption among school-going adolescents in Malaysia.

Alcohol is deleterious to physical and mental health as well as social well-being. This study aims to examine the prevalence of alcohol consumption and factors associated with its use among school-going Malaysian adolescents. The Global School-Based Student Health Survey (GSHS) 2012 employed 2-stage clustering design to Malaysian secondary school respondents aged 12 to 17 years. The prevalence of current alcohol usage was 8.9% (95% confidence interval [CI]: 7.8-10.07) overall, 11.2% (95% CI: 9.80-12.80) among males, and 23.4 (95% CI: 21.40-25.50) among Chinese students. Multivariate logistic regression showed that adolescents who had used alcohol were more likely to have used substance (adjusted odds ratio [aOR] = 3.39; 95% CI: 2.33-4.99), experienced injury (aOR = 1.53; 95% CI: 1.20-1.95), and engaged in sexual behaviors (aOR = 1.42, 95% CI: 1.12-1.79), and fights (aOR = 1.23; 95% CI: 1.08-1.41). The current national policies on alcohol should be strengthened to curb alcohol consumption among adolescents.

Cannabis Use and Its Social Correlates among In-School Adolescents in Algeria, Morocco, Palestine, Peru, and Tonga

The aim of this study was to assess the prevalence of cannabis use and associated factors among school-going adolescents in Algeria, Morocco, Peru, Palestine and Tonga. Using data from the Global School-Based Student Health Survey (GSHS), we assessed the prevalence of cannabis use and social correlates among adolescents (N=15226). The overall lifetime cannabis use was 3.2% and current cannabis use was 2.6%. Lifetime and current cannabis use was higher in Tonga (7.5% and 6.8%, respectively) than in any other of the five study countries. Variables positively associated with the outcome in multivariable analysis were male gender, poverty (went hungry), current smoking, having been in a physical fight, had an injury, and frequent consumption of fast food. Efforts to prevent and control cannabis use may need to address a cluster of risk behaviours, in particular cigarette smoking. DOI: 10.5901/mjss.2014.v5n9p558

School-based youth health nurses and adolescent decision-making concerning reproductive and sexual health advice: How can the law guide healthcare practitioners in this context?

School-Based Youth Health Nurses (SBYHNs) work in Queensland high schools, providing sexual and reproductive health care/advice (amongst other things) to adolescents. SBYHNs are often responsible for referring high school students to other health care practitioners or external health services/community agencies. One of the difficulties faced in this context is how to assess the issue of capacity in terms of the adolescent’s ability to provide consent to his or her own health care without parental involvement. This is important because it enables SBYHNs to maintain confidentiality with adolescents, which encourages adolescents to obtain sexual health advice. In this paper we outline the key legal principles relevant to nurses working in this field. We provide some practical examples of issues faced by SBYHNs and consider how the issue of Gillick competency is relevant to these examples. We demonstrate that the law seeks to prioritise the concept of confidentiality and aims to avoid exposing adolescents to harm that may result from unsafe sexual practices. Importantly, the issues discussed in this paper are relevant to nurses working within this field in all Australian jurisdictions.

Teachers as therapeutic agents: perceptions of a school-based mental health initiative

Teacher–child relationship building (TCRB) is a play-based professional development programme adapted from kinder training and filial therapy. Intended for early education teachers and students, TCRB is designed to strengthen the teacher–child relationship, improve student behaviour, enhance academic involvement and develop teachers' classroom management skills. In the current study, we utilised a phenomenological approach to examine teachers' perceptions of the initial implementation of TCRB through identifying individual and collective perspectives in the summation of themes. Findings indicated that the teachers perceived the TCRB model to be informative, well organised, appropriately structured and effective in enhancing teacher–child relationships, improving classroom management skills and reducing behavioural problems among child participants. Limitations of the study, implications and suggestions for future research are discussed.

School-based youth health nurses and adolescent decision-making concerning reproductive and sexual health advice: How can the law guide healthcare practitioners in this context?

Abstract School-Based Youth Health Nurses (SBYHNs) work in Queensland high schools, providing sexual and reproductive health care/advice (amongst other things) to adolescents. SBYHNs are often responsible for referring high school students to other health care practitioners or external health services/community agencies. One of the difficulties faced in this context is how to assess the issue of capacity in terms of the adolescent's ability to provide consent to his or her own health care without parental involvement. This is important because it enables SBYHNs to maintain confidentiality with adolescents, which encourages adolescents to obtain sexual health advice. In this paper we outline the key legal principles relevant to nurses working in this field. We provide some practical examples of issues faced by SBYHNs and consider how the issue of Gillick competency is relevant to these examples. We demonstrate that the law seeks to prioritise the concept of confidentiality and aims to avoid exposing adolescents to harm that may result from unsafe sexual practices. Importantly, the issues discussed in this paper are relevant to nurses working within this field in all Australian jurisdictions.

Learning to Share

Learning to Share

Book Review: School-based mental health: A framework for intervention by D. S. Lean and V. A Colucci

Book Review: <i>School-based mental health: A framework for intervention</i> by D. S. Lean and V. A Colucci

School-based Health and Supportive Services for Pregnant and Parenting Teens: Associations with Birth Outcomes of Infants Born to Adolescent Mothers

to-severe depressive symptoms. Multivariate analyses revealed that participants who reported depressive symptoms were more likely than those who did not to be African American (versus Hispanic: adjusted odds ratio [AOR] 1⁄4 2.17; 95% Confidence Interval [CI] 1⁄4 1.14-4.16; p 1⁄4 .019), and to report limited contact with the father of the baby (AOR 1⁄4 2.18; 95% CI 1⁄4 1.16-4.13; p 1⁄4 .016), prior verbal abuse (AOR 1⁄4 2.23; 95% CI 1⁄4 1.11-4.47; p 1⁄4 .023), and physical or sexual abuse (AOR 1⁄4 1.84; 95% CI 1⁄4 1.04-3.28; p 1⁄4 .038). Depressed adolescents also experienced higher levels of family criticism (AOR 1⁄4 1.67; 95% CI 1⁄4 1.07-2.60; p 1⁄4 .025) and lower levels of general support (AOR 1⁄4 1.81; 95% CI 1⁄4 1.24-2.64; p 1⁄4 .002). The Hosmer and Lemenshow Goodness of Fit Test 1⁄4 8.370(8), p 1⁄4 .398, indicating an acceptable fit to the data. Conclusions: The results of the study indicated that pregnant adolescents are confronted with many environmental challenges that affect their mental health and well-being. Interventions that incorporate partners and families to address the multiple needs of this priority population are sorely needed. Sources of Support: This project was funded by the Department of Health and Human Services, Office of Adolescent Pregnancy Programs (OAPP).

Schools, Sex Education, and Support for Sexual Minorities: Exploring Historic Marginalization and Future Potential

School-based adolescent sexual health education in the United States has long served as a means of combating emotional and physical threats to the well-being of youth. However, this sex education has since its inception marginalized the experiences and health concerns of lesbian, gay, and bisexual (LGB) students and contributed to school environments frequently hostile toward sexual minority groups. Growing concern for the welfare and educational experiences of sexual minorities suggests the need to improve school-based support for LGB students. This article explores this challenge by examining the relationship between sex education and sexual minorities. Through a review of the history of adolescent sexuality and sex education, and continuing barriers to support for LGB students, this article reveals how marginalization of LGB groups has manifested within schools and argues improving education with regards to LGB groups is necessary to develop equitable and safe educational environments. Suggestions for improving support of sexual minorities in schools and sex education are discussed.

Alcohol and other psychoactive substances in Africa and the Americas: results from the WHO Global School-based Student Health Survey

Objective: The objective of this study was to estimate the prevalence of current alcohol use and its association with cigarette and drug use among 13–15-year-olds in Africa and the Americas.Method: Cross-sectional data of the WHO Global School-based Student Health Survey from nine countries in the WHO African Region and seven countries/territories in the WHO Region of the Americas were analysed. Single and joint prevalence rates, and prevalence odds ratios were computed.Results: In the majority of countries, alcohol was the most often consumed psychoactive substance, with the prevalence of current alcohol use outweighing the prevalence of current cigarette and lifetime drug use. Gender differences for alcohol were not marked. The use of alcohol was strongly associated with cigarette or drug use, indicating clustering.Conclusions: For the bulk of countries in the Americas and for single countries in Africa, current alcohol use is as high as prevalence rates occurring in other parts of the world. It is imperative to monitor psychoactive substance use among adolescents in these countries to be able to prevent future health and social harm with the information gained.