Supporting children's mental health in schools: Teacher perceptions of needs, roles, and barriers.

There is a significant research to practice gap in the area of mental health practices and interventions in schools. Understanding the teacher perspective can provide important information about contextual influences that can be used to bridge the research to practice gap in school-based mental health practices. The purpose of this study was to examine teachers' perceptions of current mental health needs in their schools; their knowledge, skills, training experiences and training needs; their roles for supporting children's mental health; and barriers to supporting mental health needs in their school settings. Participants included 292 teachers from 5 school districts. Teachers reported viewing school psychologists as having a primary role in most aspects of mental health service delivery in the school including conducting screening and behavioral assessments, monitoring student progress, and referring children to school-based or community services. Teachers perceived themselves as having primary responsibility for implementing classroom-based behavioral interventions but believed school psychologists had a greater role in teaching social emotional lessons. Teachers also reported a global lack of experience and training for supporting children's mental health needs. Implications of the findings are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Transforming Mental Health Care for Children and Their Families.

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders. Training, research, practice, and policy implications for psychologists are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Where angels fear to tread: Issues in sampling, design, and implementation of school-based mental health services research.

Research on school-based mental health systems is an important but hazardous enterprise. Current trends suggest that child mental health professionals will increasingly focus on community service systems that are family-based and school-centered. Challenges to conducting research on effectiveness of such services include underidentification of children with emotional or behavioral disorders, lack of concordance between diagnostic criteria used in school vs mental health systems, problems of comorbidity, analysis of data from multiple informants, lack of interdisciplinary or interagency collaboration, community involvement, and a variety of other factors. These issues and suggestions for addressing them are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving Mental Health Service Utilization for Children and Adolescents.

Approximately 10% of children and adolescents have mental health problems necessitating intervention, but well below 50% of these children receive needed services, and far fewer receive the quality of care required to effectively reduce their impairments. Although system reform is needed to improve service utilization and quality of care for all children, preschoolers, girls, individuals of minority status, and the uninsured are most at risk for being underserved. Factors contributing to poor service utilization can be classified into two broad sets: sociopolitical factors referring to issues related to funding and access, and cultural/familial factors including beliefs about mental health services, providers, and treatments. This article describes the help-seeking process and focuses on cultural and familial factors that contribute to movement through these stages, with a particular focus on variables that are amenable to change by practitioners in the school and community, including school psychologists. Guidelines for understanding and changing the help-seeking behavior of families, including suggestions for creating service options, providing family education, and offering individualized family services, are described. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of The mental health of Asian Americans.

Reviews the book, The mental health of Asian Americans by Stanley Sue and James K. Morishima (1982). In The Mental Health of Asian Americans, Sue and Morishima assess the current status of theory and research strategies in this field and initiate dialogue regarding future directions for our investigative energies and service delivery efforts. They are largely successful at this ambitious mission. Their work represents one of the best and most comprehensive texts on the special issues related to Asian-American mental health. Although this book was published in 1982, the theories presented and issues discussed remain extremely pertinent to the problems encountered today in providing services to this population. The authors' major intent is not to demonstrate how to deal with cross-cultural issues in treating Asian-American clients, although therapeutic techniques with a particular client may be extrapolated from their discussion and numerous case examples. Instead, the authors focus on strategies for improving research and delivery of mental health services, and attaining a theoretical understanding of treatment issues within the cultural context. The content is aimed at those who are in training or currently participating in mental health research and service delivery to persons of Asian descent. Yet, this book is of interest to all professionals who are seeking a well-researched text which is grounded in theory and describes the importance of cultural factors in developing mental health services to an ethnic minority population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

State health care reforms: how they affect children and adolescents with emotional disorders and their families

This article reports on the Health Care Reform Tracking Project, a national study designed to describe and analyze state health care reforms and their impact on children and adolescents with emotional disorders and their families. It summarizes the results of the baseline survey of states conducted in 1995, exploring the nature and extent of the reforms in which states are engaged, most of which involve applying managed care technologies to their Medicaid programs. Trends across states are identified with respect to mental health service delivery, particularly with respect to children and adolescents. The article concludes with a discussion of issues and concerns related not only to mental health service delivery for children and adolescents with emotional disorders and their families but also to the systems of care that have been developing over the past decade to serve them. Some of these concerns include the lack of pilots or demonstrations, limited mental health coverage in some reforms, the lack of integration between mental health and substance abuse systems, the lack of special provisions for children, the need for more reliable bases for deriving capitation rates, the limited incorporation of systems of care, the need to incorporate interagency treatment planning and service delivery approaches, the lack of outcome measures specific to and appropriate for children, and the need for greater family involvement in the planning and implementation of these reforms.     

Prevention and remediation through group interventions.

Reviews the book, The handbook of group intervention for children and families edited by Karen C. Stroiber and Thomas R. Kratochwill (see record 1998-07256-000). This book addresses current needs of psychologists and other mental health practitioners who are working across ecologies to address problems of children and youth. As such, this text is an excellent resource for school psychologists, school counselors, and others who are attempting to broaden service delivery systems and procedures. Although this handbook is appropriate for practitioners across a variety of mental health disciplines, it also meets the current needs of school psychologists by addressing gaps often found in school psychology service delivery and training models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice.

Children and adolescents who are exposed to traumatic events are helped by numerous child-serving agencies, including health, mental health, education, child welfare, first responder, and criminal justice systems to assist them in their recovery. Service providers need to incorporate a trauma-informed perspective in their practices to enhance the quality of care for these children. This includes making sure that children and adolescents are screened for trauma exposure; that service providers use evidence-informed practices; that resources on trauma are available to providers, survivors, and their families; and that there is a continuity of care across service systems. This article reviews how traumatic stress impacts children and adolescents' daily functioning and how various service systems approach trauma services differently. It also provides recommendations for how to make each of these service systems more trauma informed and an appendix detailing resources in the National Child Traumatic Stress Network that have been produced to meet this objective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-systems approach to evidence-based practice for children and adolescents.

Improving outcomes for children and adolescents with mental health needs demands a broad meta-systemic orientation to overcome persistent problems in current service systems. Improving outcomes necessitates inclusion of current and emerging evidence about effective practices for the diverse population of youth and their families. Key components of the meta-system for children with emotional or behavioral needs include families, cultural norms and values, and service sectors such as schools, pediatric health centers, specialty mental health systems, juvenile justice systems, child protection services, and substance use treatment systems. We describe each component of the meta-system, noting challenges to the provision of evidence-based practice (EBP) and highlighting ways to optimize outcomes. Our focus is on the inclusion of evidence-based assessment and interventions, including prevention, within a developmentally driven and culturally responsive contextual model. Recommendations for addressing disparities in research funding and essential steps to foster communication and coordination of EBP across settings are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Citizens shaping policy: The Canadian Mental Health Association's framework for support project.

Fifteen plus years of work in mental health policy development from a community development perspective under the aegis of the Canadian Mental Health Association are described. The evolution of a model de-emphasizing formal mental health services and emphasizing partnerships between consumers, family members, the community at large, and mental health service providers is presented. Particular attention is paid to the value of re-investing in natural support systems both through the diversion of funds to such groups and the recognition of such systems as integral components of the cultural response to serious mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A step in the right direction: A resource for collaboration on health-related issues.

Reviews the book, Health-related disorders in children and adolescents edited by L. Phelps (see record 1998-07780-000). This edited text provides an overview of 96 medical conditions that place children at risk of developing psychological or educational problems. The central feature of this book is that it is intended as a reference tool for professionals who collaborate with medical professionals. Increasingly, there have been many vehicles for school psychologists to collaborate with medical professionals, including comprehensive school health care programs and school-based health clinics, and community-based coordinated services that provide children and youth comprehensive care. In this regard, school psychologists are likely to encounter increasing numbers of children who experience health disorders, along with more traditional areas of practice including mental health and educational issues. Although not a purely medically oriented text, Phelps has taken a perspective that school psychologists work within the context of a multidisciplinary team of professionals who are likely to provide services for these children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adaptation of medical care to the changing disease spectrum of adolescents

The spectrum of diseases affecting today's children and adolescents has changed. Today's urgent health problems are no longer acute and infectious disorders but much rather psychosomatic and chronic disorders. However, the present health delivery system has not adapted its structure to this changed spectrum of disease. This paper reports on a study carried out by the project "Health Risks and Structures of Medical and Mental Health Care." The project belongs to the North Rhine-Westphalian Consortium for Public Health, and the study was carried out in cooperation with the Special Research Unit 227: "Prevention and Intervention in Childhood and Adolescence." Results show that a small proportion of adolescents actually consult general practitioners. Inadequate cooperation between medical and mental health care services as well as insufficient links between these services and the life world of adolescents have led to a situation in which the use of professional assistance meets with barriers. As a result, adolescents continue to avoid visiting a physician even when they have already become ill. For this reason, there is an increasingly strong need to consider how to change the structures of medical and mental health care. Proposals are developed that meet the needs of adolescents and are oriented toward the requirements arising from the changing spectrum of disease.     

Research strategies toward a conception of positive mental health.

Problem areas in the field of science for a concept of mental health and the question of how research may be brought to advance our understanding of optimal human functioning are considered. Major sections are: Some Conceptual Difficulties with "Mental Health," The Frontal Assault, The Multiple Criterion Approach, Fundamental Research in Personality, and Systems Theory as a Frame of Reference. "The systems framework as a way of thinking ties mental health to our most general conceptions of personality in a schema that permits or, better, requires elaboration by research… . Mental health… is complex and not easily schematized." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ecological constraints on mental health services.

Proposes 4 principles for community mental health programing that are consistent with an ecological thesis: (1) Assessment methods are focused on the total population rather than on those persons who presently receive a mental health service. (2) Mental health services are designed to reduce a high risk for community service. (3) Professional and research services are created as local community resources. "By initiating the informal coordination of current services, the community mental health program helps to create specific new community services as needed." (4) The program plans for change; this involves mobilizing anticipatory problem-solving resources not only for clients but for professionals as well. A "conception of community mental health work based upon the ecological thesis that adaptive programs change" is presented. (39 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health services in Louisiana school-based health centers post-Hurricanes Katrina and Rita.

Following Hurricanes Katrina and Rita, Louisiana school-based health centers (SBHCs) were called on to respond to a sharp increase in mental health needs, especially for displaced students coping with grief, loss, trauma, and uncertainty. To assess the impact of the hurricanes on the students and the needs of SBHC mental health providers (MHPs), we surveyed MHPs in each of the SBHCs under the auspices of the Louisiana Department of Health and Hospitals, Office of Public Health. SBHC practitioners from around the state reported that mental health service utilization rose during the 2005-2006 school year, but utilization of services increased most significantly in schools receiving the majority of displaced students. Anxiety and adjustment problems were noted as increasing the most following the hurricanes. A multitude of other conditions was also reported. By the time of this survey in April 2006, the reported prevalence of most symptoms had declined, but all remained above their pre-hurricane levels. Self-reported needs of SBHC MHPs are also discussed in light of the major natural disasters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of outpatient mental health service use by American youth.

Among American children and adolescents aged 1 to 17 years, the 12- to 17-year-olds represent the largest users of outpatient mental health services. This study utilizes a nationally representative sample of this age group from the 2005 National Survey on Drug Use and Health to illuminate predictors of services use from three treatment settings: day treatment programs, mental health clinics/centers, and private/in-home settings. Univariate analyses were used to calculate the percentages of the study sample that used mental health services in these settings. In bivariate analyses, the authors estimated the strength of the associations between available predisposing, need, and enabling factors and the outcomes. Multiple logistic regressions estimated the independent effects of each covariate on the outcomes. Lifetime depression, lifetime general anxiety, delinquent behaviors, drug dependence, and Medicaid were consistent predictors of services use in the three treatment settings. Several other factors were associated with services use in bivariate analyses but lost most of their statistical significance when the authors adjusted for other confounders. Interpreted in light of its potential limitations, this study has important research and policy significance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meeting mental health needs following a natural disaster: Lessons from Hurricane Katrina.

Hurricane Katrina had a devastating impact on hundreds of thousands of Louisiana and Mississippi families. Housing was destroyed, jobs were lost, and family members were separated, sometimes in different states and without communication. Postdisaster stress reactions were common, with vulnerable individuals most affected. Mental health services were not adequate to meet immediate needs, and postdisaster mental health issues often emerge over time. This article describes the mental health needs of dislocated and evacuee children and families and the steps that were taken to develop mental health programs that would be sustainable over time to meet this new level of need. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emerging issues in research on lesbians' and gay men's mental health: Does sexual orientation really matter?

Theoretical writings and research suggest that the onset, course, treatment, and prevention of mental disorders among lesbians and gay men differ in important ways from those of other individuals. Recent improvements in studies of sexual orientation and mental health morbidity have enabled researchers to find some elevated risk for stress-sensitive disorders that is generally attributed to the harmful effects of antihomosexual bias. Lesbians and gay men who seek mental health services must find culturally competent care within systems that may not fully address their concerns. The affirmative therapies offer a model for intervention, but their efficacy and effectiveness need to be empirically documented. Although methodological obstacles are substantial, failure to consider research questions in this domain overlooks the welfare of individuals who may represent a sizable minority of those accessing mental health services annually. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mental health service utilization among African American and Caucasian mothers and fathers.

Mental health services have been routinely underutilized. This study investigated the influence of parents' gender, race, and psychopathology on perceived barriers and attitudes toward mental health utilization for themselves and for their children. A unique contribution of this study is the examination of father, mother, and child factors influencing service utilization from the parents' perspective. A total of 194 African American and Caucasian parents were recruited from the community to participate. Parents completed measures on barriers and attitudes toward treatment for themselves and for their children, history of mental health service utilization for themselves and for their children, and their own current psychological symptoms. Results indicated that 36.3% and 19.4% of parents and children, respectively, had used mental health services during their lifetime. Parents perceived fewer barriers and had more positive attitudes toward seeking services for their children than for themselves. Race and gender differences were found in parents' perceptions of barriers and attitudes toward treatment. Furthermore, barriers, attitudes, and psychopathology predicted parents' plans for future utilization of mental health services. The clinical implications of this study and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community-based systems of care for children's mental health services

Community-based mental health systems of care for children, adolescents, and their families involve innovative approaches to improve access, utilization, financing, clinical efficacy, and cost-effectiveness of mental health services provided to children and adolescents within the context of their home communities. This model offers numerous advantages as rising needs for mental health services in an increasingly diverse population of children and families are recognized, while public and private resources are increasingly stressed. This report reviews the history of the development of this model, its basic principles, its emerging research literature, and its application within a managed care context.