School-based Mental Health Programs Research Articles

Scope, Scale, and Dose of the World's Largest School-Based Mental Health Programs.

Untreated mental health problems are among the most disabling, persistent, and costly health conditions. Because they often begin in childhood and continue into adulthood, there has been growing interest in preventive mental health programs for children. In recent years, several such programs have been implemented at regional, state, or national scale, and although many experimental studies have documented positive outcomes of individual programs, this article represents the first attempt to systematically compare the largest programs in terms of scope, scale, and dose. The school-based mental health programs discussed in this review appear to have reached more than 27 million children over the last decade, and many of these programs have collected systematic outcomes data. The role that such programs can play in low- and middle-income countries (LMICs) is a secondary focus of this article. Until recently, wide-scaled, preventive, mental health interventions for children have been studied almost exclusively in high-income countries even though around 80% of the global population of children reside in LMICs. Since a number of programs are now operating on a large scale in LMICs, it has become possible to consider child mental health programs from a more global perspective. With both the increasing diversity of countries represented and the growing scale of programs, data sets of increasing quality and size are opening up new opportunities to assess the degree to which preventive interventions for child mental health, delivered at scale, can play a role in improving health and other life outcomes.

Collateral benefits: Unintended consequences of the Roots of Empathy program

ABSTRACT
 ObjectivesRoots of Empathy is a school-based mental health program with demonstrated effectiveness in reducing bullying and aggression, and raising children’s social/emotional competence and empathy. This study examines the program’s impact on several longer-term health and social outcomes that are related to the program’s goals, but not specifically targeted by the program’s design or objectives.
 ApproachThis study used linked, de-identified administrative records of health, education, social service use and justice system involvement for children and youth in Manitoba who participated in the ROE program, along with a carefully matched comparison group. Propensity scores were used along with hard matching on key variables to ensure comparability of groups. Outcome measures encompass a broad array of health, educational, and social indicators including hospitalization for injury, teen pregnancy, high school graduation, involvement with the criminal justice system, and suicide attempts. Analyses were performed at the Manitoba Centre for Health Policy (MCHP), using SAS 9.4.
 ResultsFindings from analyses of data from the pilot study (N=688) reveal several ‘collateral benefits’ that may be related to the program, though most differences did not reach statistical significance in this initial sample. (Results from the full sample will be available May 2016; N ~ 8000.) Compared to matched counterparts who did not receive the program, ROE participants had lower rates of teen pregnancy (6.6% vs 9.6%; p=0.19), and school grade repetition (2.4% vs 3.8%, p=0.09), and higher rates of high school graduation (77.7% vs 73.5%, p=.36). However, they also had higher rates of injury-related hospitalization (6.4% vs 5.0%, p=0.14). Even in this small pilot, sub-group analyses for some outcomes showed significant differences for some strata but not others. Analyses of the full study group (underway) will provide more robust results.
 ConclusionThese findings provide intriguing evidence suggesting beneficial impacts in several longer-term health and social outcomes that could feasibly be related to participation in the Roots of Empathy program. The multi-variable propensity scores and hard-matching algorithms used on this large group provide considerable confidence in attributing group differences to program participation. Results from the full sample will provide more conclusive results, and allow sub-group analyses. The linkage of databases from health, education, social service and justice systems provides a unique opportunity to examine the truly multi-dimensional long-term impacts of a program already proven to provide dramatic improvements in short and medium-term outcomes.

A Comparative Study on School-based Mental Health Program in Korea and Australia

본 연구는 휴먼서비스통합의 관점에서 아동·청소년 정신건강서비스 통합 전략과 주요속성을 중심으로 한국과 호주의 학교기반 정신건강서비스 모형을 비교분석하였다. 주요 분석결과는 다음과 같다. 첫째, 학교연계 전략을 추구하는 한국의 Wee프로그램은 좁은 소유권과 과제 포트폴리오, 단순한 참여자 구조, 낮은 자율성, 낮은 수준의 응집성으로 나타났다. 둘째, 학교중심 전략으로 대표되는 호주의 MindMatters프로그램은 넓은 소유권과 좁은 과제 포트폴리오, 복잡한 참여자 구조, 높은 자율성, 그리고 중간 수준의 응집성을 가진다. 두 국가의 이러한 차이는 해당 국가가 추구하는 아동·청소년 정신건강정책의 방향성과 우선순위를 보여준다. 이러한 사례 비교분석 결과는 우리나라의 아동·청소년 정신건강서비스 전달체계 개선에 있어 다음과 같은 측면에서 시사점을 제공한다. 첫째, 호주의 정신건강서비스개혁은 지역사회중심의 정신건강서비스체계 구축과 생애주기에 따른 예방적 개입을 위한 포괄적 지원이라는 측면에서 긍정적으로 평가 될 수 있다. 특히, 지역사회중심의 정신건강서비스 체계 구축을 강조하고 있는 한국의 현 시점에서 호주의 정신건강정책과 서비스전달체계는 적절한 정책정보를 제공해줄 수 있다. 둘째, 프로그램의 측면에서, 호주의 MindMatters프로그램은 실제로 호주 청소년자살율과 자살생각 감소에 긍정적인 기여를 하고 있는 것으로 평가되고 있다. 한국 역시 Wee센터를 중심으로 아동청소년 정신건강에 대한 예방적 접근이 시도되고 있어 현재 `위기 아동 상담`에 집중된 센터의 기능 확장과 나아가 휴먼서비스의 관점으로의 변화, 나아가 지역사회중심정신건강 통합서비스로의 변화 가능성을 시사한다. 이러한 과정에서 MindMatters의 교육적접근은 유용한 준거자료로 활용 될 수 있다.

Attitude towards School, Conflict, Violence and Mental Health Status among School Going Adolescents: A Gender Comparison

In Manipur violence is very common in different forms. Its impact is significant. During the time of conflict and violence, Adolescents are restless and actively involved in such psycho-social conflict, which leads to disruptive in mental health and education. The aim of the study was to assess the gender difference in attitude towards school, conflict, violent and mental health status among the school going adolescents. The present study was a survey on school going adolescents aged 13-17 years, from class VIII to XII in Imphal, Manipur, India. For the study two private schools and two hundred students, both boys & girls were selected using simple random sampling technique. Semi Structured Socio demographic data sheet, Attitude towards School scale, Attitude towards Conflict scale, Attitude towards Violence scale and Strength and Difficulties Questionnaire were administered to the students. The result shows that there was no gender difference on attitude towards school and conflict. On attitude towards violence significant difference was found between boys and girls (t=2.84,p≤0.05). In mental health status, 9% of boys and 11% girls were having emotional symptoms; 33% of boys and 28% girls were having Conduct Problem, 16% of boys and 5 % of girl students were having hyperactivity. Further, attitude towards schools was positively correlated with emotional (r=.096) and it has negative correlation with conduct problem (r=-.52) and hyperactivity (r=-.128). Attitude towards conflict has positive correlation with emotional symptoms (r=.164), conduct problem (r=.008), hyperactivity (r=.107) and Attitude towards violence has positive correlation with emotional symptoms (r=.014), conduct problem (r=.046), hyperactive (r=.133).. School-based mental health program are needed for adolescents who are at high risk for exposure to community violence is required.

Perception of primary school teachers to school children's mental health problems in Southwest Ethiopia.

Teachers perception of child mental health problems and their attitude to school-based mental health services helps in designing early intervention strategies aimed at promoting the service. However, little is known in this regard among primary school teachers in Ethiopia. Therefore, this study assessed perceptions and attitude of primary school teachers to child mental health problem and school-based mental health programs in Jimma town, southwest Ethiopia in 2013. A cross-sectional study design was implemented among 568 primary school teachers in Jimma town, from 1 to 30 October 2013. Perceptions and attitude of teachers to children with mental health problems and school mental health related information were assessed using a structured self- administered questionnaire. About 40% of teachers recognized the list of psychopathology items presented to them as child mental health problems while 54.4% of them rated child mental health problem as severe. Externalizing behaviors were perceived as the most severe problems. Teaching experience and teaching in public schools were significantly associated with the perception of severe type of child mental health problems. About 95% of teachers acknowledged that school-based mental health programs are important but limited availability was reported. Despite the high problem severity ratings, teachers' perception of the psychopathology as a mental health problem in children was low. There was also a favorable attitude on the importance and the need of school-based child mental health programs. Thus, creating mental health awareness for teachers and establishing school mental health services to intervene in child mental health problem is crucial.

Suicidal Behaviors Among Adolescents - The Role of School and Home Environment.

This study aimed to determine the prevalence of suicidal behaviors (ideation, planning, and attempts) among adolescents aged 13-16, and to identify psychosocial correlates of suicidal behaviors. The 2010 Kuwait Global School-Based Student Health Survey (GSHS) cross-sectional study employed a two-stage cluster sample design targeting a representative sample of 2,672 students. A weighting factor was applied to make inferences to all students of the same age. Students' suicidal behaviors were the focus of this paper. The prevalence rates of suicide ideation, planning, and attempts were 20.0% (95% CI = 18.5-21.6%), 14.0% (95% CI = 12.7-15.4%), and 18.1% (95% CI = 16.6-19.5%), respectively. About 26% of adolescents reported at least one suicidal behavior, while 8.5% experienced all three suicidal behaviors. Multivariate analysis revealed that girls, smoking, physical violence, feeling lonely, exposure to bullying at school, and having nonempathetic parents were significant correlates of the experience of suicidal behaviors among adolescents. Moreover, suicidal ideation stood out as a predictor of attempting suicide more than suicidal planning in both the total population and separately by gender. The prevalence of suicidal behaviors was alarmingly high among Kuwaiti adolescents. Adverse school and home environments strongly contributed to such behaviors. School-based mental health programs are necessary to reduce these life-threatening behaviors in Kuwait.

An Occupational Therapist–Led Yoga Intervention for Anxious Youth: Outcomes and Implications for Research and Practice

Abstract Date Presented 4/8/2016 There is a need for effective, school-based mental health programs. Yoga is widely used and suited to address the needs of anxious children. Occupational therapists use yoga, are mental health experts, and are highly present in schools, making them essential to improving yoga research and school mental health services. Primary Author and Speaker: Lindy Weaver

A randomized controlled trial of strong minds: A school-based mental health program combining acceptance and commitment therapy and positive psychology

To date, most early intervention programs have been based on emotion regulation strategies that address dysfunctional cognitive appraisals, problem-solving skills, and rumination. Another emotion regulation strategy, ‘acceptance’ training, has largely been overlooked. To examine the efficacy of this strategy, a school-based mental health program combining positive psychology with acceptance and commitment therapy (Strong Minds) was evaluated in a randomized controlled trial with a sample of 267 Year 10 and 11 high-school students in Sydney, Australia. Mixed models for repeated measures examined whether the program led to reductions in symptoms amongst students who commenced the program with high depression, anxiety, and stress scores, and increased wellbeing scores amongst all students. Results demonstrated that compared to controls, participants in the Strong Minds condition with elevated symptom scores (n=63) reported significant reductions in depression (p=.047), stress (p=.01), and composite depression/anxiety symptoms (p=.02) with medium to strong effect sizes (Cohen's d=0.53, 0.74, and 0.57, respectively). Increased wellbeing (p=.03) in the total sample and decreased anxiety scores (p=.048) for students with elevated symptoms were significant for Year 10 students with medium effect sizes (Cohen's d=0.43 and 0.54, respectively). This study tentatively suggests that including the emotion regulation strategy of acceptance in early intervention programs may be effective in reducing symptoms and improving wellbeing in high school students. Further research to investigate the generalizability of these findings is warranted.

School-Based Psychiatric Mental Health Nurse Practitioners to Decrease Inappropriate Psychiatric Pediatric Emergency Rooms Presentations.

An alarming number of children are being referred to pediatric emergency rooms for disruptive behavior disorders (DBDs) such as attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorders. Although presenting symptoms of an exacerbation of disruptive behaviors may be urgent, often they do not require emergency care and could have been efficiently handled through outpatient care. Inappropriate emergency room (ER) referrals have been linked to inadequate school, family, or self-referrals. This article proposes using psychiatric mental health nurse practitioners, known in some states as advanced practice registered nurses, in school-based mental health programs as an intervention with the greatest potential to decrease disparities in access to child psychiatric health care and to offer the psychoeducation and support necessary to prevent inappropriate ER presentations for DBDs.

A qualitative study exploring adolescents' experiences with a school-based mental health program.

BackgroundSupporting positive mental health development in adolescents is a major public health concern worldwide. Although several school-based programs aimed at preventing depression have been launched, it is crucial to evaluate these programs and to obtain feedback from participating adolescents. This study aimed to explore adolescents’ experiences with a -based cognitive-behavioral depression prevention program.MethodsEighty-nine adolescents aged 13–15 years were divided into 12 focus groups. The focus group interviews were analyzed using qualitative content analysis.ResultsThree categories and eight subcategories were found to be related to the experience of the school-based program. The first category, intrapersonal strategies, consisted of the subcategories of directed thinking, improved self-confidence, stress management, and positive activities. The second category, interpersonal awareness, consisted of the subcategories of trusting the group and considering others. The third category, structural constraints, consisted of the subcategories of negative framing and emphasis on performance.ConclusionsThe school-based mental health program was perceived as beneficial and meaningful on both individual and group levels, but students expressed a desire for a more health-promoting approach.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2368-z) contains supplementary material, which is available to authorized users.

Use of task-shifting to scale-up child mental health services in low-resource Ugandan schools: role of contextual factors on program implementation

Objectives Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs, but this region has limited access to mental health services to address these needs. Despite the success of numerous interventions for promoting child mental health, most evidencebased programs (EBPs) are not available in SSA. This study utilizes a task-shifting strategy and trains teachers as community health workers (CHWs) to utilize EBP strategies and provide basic child mental health services in schools. This paper focuses on two implementation objectives: 1) investigating the transportability of an EBP (ParentCorps-a school-based mental health program) from a developed country to a SSA country-Uganda by evaluating quality of implementation; and 2) studying the influences of contextual factors (i.e., agency setting, individual characteristics) on implementation processes and outcomes (e.g., CHWs’ level of engagement and utilization of EBP strategies).

Evidence for the Effectiveness of a National School-Based Mental Health Program in Chile

Skills for Life (SFL) is the largest school-based mental health program in the world, screening and providing services to more than 1,000,000 students in Chile over the past decade. This is the first external evaluation of the program. Of the 8,372 primary schools in Chile in 2010 that received public funding, one-fifth (1,637) elected to participate in SFL. Each year, all first- and third-grade students in these schools are screened with validated teacher- and parent-completed measures of psychosocial functioning (the Teacher Observation of Classroom Adaptation-Re-Revised [TOCA-RR] and the Pediatric Symptom Checklist-Chile [PSC-CL]). Students identified as being at risk on the TOCA-RR in first grade are referred to a standardized 10-session preventive intervention in second grade. This article explores the relationships between workshop participation and changes in TOCA-RR and PSC-CL scores, attendance, and promotion from third to fourth grades. In all, 16.4% of students were identified as being at-risk on the TOCA-RR. Statistically significant relationships were found between the number of workshop sessions attended and improvements in behavioral and academic outcomes after controlling for nonrandom selection into exposure and loss to follow-up. Effect sizes for the difference between attending most (7-10) versus fewer (0-6) sessions ranged from 0.08 to 0.16 standard deviations. This study provides empirical evidence that a large-scale mental health intervention early in schooling is significantly associated with improved behavioral and academic outcomes. Future research is needed to implement more rigorous experimental evaluation of the program, to examine longer-term effects, and to investigate possible predictors of heterogeneity of treatment response.

A Universal Mental Health Promotion Programme for Young People in Italy.

In Italy, the Mental Health Unit of the National Institute of Public Health has developed a school-based mental health programme based on a structured handbook. The aim of this programme is to promote self-efficacy, psychological well-being, and life satisfaction. In this study, we evaluated the effectiveness of this programme. We used data from 308 students who participated in a study in 9 Italian high schools during the 2011-2012 school year. In order to analyse the school intervention programme, we set up a pre-post test design study involving 18 classrooms (8 of which acting as a control). The schools were selected via a snowball technique, and then the classrooms that agreed to participate were randomly assigned to intervention and control groups. The programme was performed during regular school hours in one-hour a week sessions for a total of 20 hours of classroom time. Assessments before and 2 months after the programme were performed using Regulatory Emotional Self-Efficacy, Satisfaction With Life, and Ryff's Psychological Well-Being Scales. The results showed an improvement in self-efficacy in regulating negative affect, overall psychological well-being, and satisfaction with life. These results demonstrate that the programme produced significant positive effects on the mental health status of participating students.

Socioeconomic inequalities in mental well-being among Hungarian adolescents: a cross-sectional study.

IntroductionAccording to several empirical studies, mental well-being is significant in adolescence; adolescent’s social network is undergoing radical changes while at the same time depression is increasing. The primary goal of our study is to determine whether socioeconomic status (SES) is associated with mental health status of Hungarian adolescents and the strength and nature of this association.MethodsOur sample was comprised of three high schools of Debrecen (the second largest city of Hungary). Data were collected in January 2013. In all, 471 students filled out the questionnaire from 22 classes (14–18 years old). ‘Absolute’ (education and occupational status of the parents, assessed by the adolescent) and ‘subjective’ (self-assessment of family’s social class) SES measures and five mental health indicators (shyness, loneliness, need to belong, psychosomatic symptoms, self-esteem) were involved. Descriptive statistics and binary logistic regression analyses were used to examine the relationships between family SES and mental health indicators.ResultsOur results indicate that association between adolescents’ ‘subjective’ SES and mental well-being is not gradient-like. Manual employment and unemployment status of both parents also proved to be significant determinants of mental health status.ConclusionsAccording to our results, professionals of school-based mental health programs should consider students whose parents are unemployed or have manual occupational status as a high risk group in terms of mental well-being.

Children’s reactions to the 2010 Chilean earthquake: The role of trauma exposure, family context, and school-based mental health programming.

Theoretically derived factors (preexisting child characteristics, trauma exposure, caregiver–child relationship, and school-based mental health programming) were examined as potential correlates of distress in children residing in the region closest to the epicenter of the 2010 Chilean earthquake. One year before the earthquake, 2nd-grade students who attended 9 schools that provide government-run mental health intervention programs were assessed via parent and teacher reports for pre-intervention psychosocial difficulties. Between 3–6 months after the earthquake, a preexisting non-trauma focused, school-based intervention was delivered. Approximately 9 months post-earthquake, 117 of these children (randomly selected; mean age 7.59), were interviewed about their experiences during the earthquake and their subsequent psychological responses. Children were exposed to multiple disaster-related traumatic events (M 4.90; SD 1.78); most reported posttraumatic stress (PTS) symptoms and 25.6% met criteria for the Diagnostic and Statistical Manual of Mental Disorders-defined (DSM–IV-TR; APA, 2000) probable PTSD. Female gender and exposure to violent, injurious, or death-related postdisaster traumas were correlated with PTS symptoms. Children’s reports of characteristics of the home environment (conflict with their caregiver, caregiver unavailability to discuss the earthquake) were positively associated with PTS symptoms. Children’s perceptions of caregiver unavailability to discuss the earthquake were associated with higher ongoing earthquake-related worry. Participation in the mental health intervention was associated with significantly lower earthquake-related worry and appeared to protect at-risk youth from elevated PTS symptomatology. Results suggest that participation in school-based mental health programs may be protective for children postdisaster and a negative family environment may be associated with increased postdisaster distress. Implications and potential applications of findings are discussed.

고등학교 학생들의 정서행동특성에 영향을 미치는 요인

Purpose: The purpose of this study was to identify the factors influencing emotional and behavioral characteristics of high school students. Methods: This was a descriptive survey using a convenience sample of 672. <TEX>$1^{st}$</TEX>, <TEX>$2^{nd}$</TEX> and <TEX>$3^{rd}$</TEX> grade high school students in Inchoen city. Emotional and behavioral characteristics were measured by AMPQ-II scale consisting of 38 items and depression was measured by BDI consisting of 21 items. The subjects were given a self-reporting questionnaire. Collected data were analyzed by frequency, mean, t-test, ANOVA, Scheff<TEX>$\acute{e}$</TEX>-test, <TEX>${\chi}^2$</TEX>-test and multiple regression using the SPSS/WIN 20.0 program. Results: General high school students and vocational high school students were more likely to have emotional or behavior troubles, experience depression, and plan suicide than special-purpose high school students. Significant predictors influencing emotional and behavior characteristics were the 'type of high school' and 'depression'. Conclusion: There is a need to develop school-based mental health programs, especially targeting female students, general high school students and vocational high school students.

AMA to Work With APA, Other Groups on Integrated Care

AMA to Work With APA, Other Groups on Integrated Care

Investigating mental fitness and school connectedness in Prince Edward Island and New Brunswick, Canada.

As youth struggle with anxiety and depression, promoting positive mental fitness is a primary concern. Canadian school-based mental health programs that focus on positive psychology and positive mental health initiatives emphasize safe and supportive environments, student engagement, resilience, and self-determination. This study examined predictors of mental fitness and its 3 components (autonomy, competence, and relatedness). School Health Action Planning and Evaluation System-Prince Edward Island (SHAPES-PEI) and the New Brunswick Student Wellness Survey (NB SWS) are data collection and feedback systems that survey youth about 4 health behaviors. Grade 7-12 students in Prince Edward Island (N = 3318) and New Brunswick (N = 7314) completed a mental fitness questionnaire in 2008-2009 (PEI) and 2006-2007 (NB). Four linear regression models were conducted to examine student characteristics associated with mental fitness, autonomy, competence, and relatedness. Positive associations were found between school connectedness (p < .0001) and mental fitness, as well as autonomy, competence, and relatedness. There were also significant relationships between affect, pro-social and antisocial behaviors, tried smoking, and mental fitness. A better understanding of adolescent health and its predictors is needed. By identifying core parameters for mental fitness, we can inform how to address students' needs through appropriate programs and policies supporting healthy school environments.

School-based mental health prevention for Asian American adolescents: Risk behaviors, protective factors, and service use.

This study drew on epidemiological data from a large urban school district to evaluate the implementation of a school-based mental health (SBMH) prevention initiative at 15 high schools. The purpose of this research was to measure the prevalence of student risk factors and protective factors by race and ethnicity and assess the engagement of Asian youth in prevention services. Results indicated statistically significant racial and ethnic group differences in the prevalence of risk factors (self-reported depressive symptoms, substance use, externalizing behavior at school, failing grades, truancy, and discrimination by school adults and peers), and protective factors (school, home, and peer assets). Controlling for gender, family structure, risk behaviors, protective factors, and school composition, Black (OR 2.31, p .001), Latino (OR 1.36, p .05), and multiracial (OR 1.42, p .01) students had significantly higher odds of using their SBMH program than Asian students. Among Asian ethnic subgroups, Cambodian youth (OR .62, p .01), were the only group that had lower odds of accessing school-based services than their Chinese peers. Findings suggest that, to reach underserved Asian American adolescents, prevention programs must address cultural and contextual influences on adolescent help seeking when program outreach and enrollment strategies are being developed. Additional research in the field of prevention science is needed to understand the mechanisms driving patterns of prevention service use by race and ethnicity.

Mental health predicts better academic outcomes: a longitudinal study of elementary school students in Chile.

The world's largest school-based mental health program, Habilidades para la Vida [Skills for Life (SFL)], has been operating on a national scale in Chile for 15years. SFL's activities include using standardized measures to screen elementary school students and providing preventive workshops to students at risk for mental health problems. This paper used SFL's data on 37,397 students who were in first grade in 2009 and third grade in 2011 to ascertain whether first grade mental health predicted subsequent academic achievement and whether remission of mental health problems predicted improved academic outcomes. Results showed that mental health was a significant predictor of future academic performance and that, overall, students whose mental health improved between first and third grade made better academic progress than students whose mental health did not improve or worsened. Our findings suggest that school-based mental health programs like SFL may help improve students' academic outcomes.