School Mental Health

Asian American adolescents tend to underutilize mental health services at school and often do not receive the mental health services they need. Parents play an important role in youth mental health service utilization. However, few studies have examined Asian American parents’ knowledge and beliefs about the help-seeking process. The present qualitative study explores Asian American parents’ beliefs about helpful strategies for addressing youth mental illness (i.e., depression and eating disorders) with special attention to school-based strategies. Nineteen Asian American parents (M = 46.05 years, SD = 4.2) completed a semi-structured interview. The interviews were coded for themes to understand Asian American parents’ beliefs about helpful strategies for addressing youth mental illness. Four general themes relating to ways of addressing youth mental health concerns emerged: providing social support, teaching and educating about mental health, seeking professional help, and identifying the problem and finding the cause. The roles that the school and culture play in each of these strategies are discussed. Implications are given for school-based mental health providers based on the finding.

The optimal model of intervention for children with ADHD is typically a multimodal approach involving a partnership across the family, school, and primary care health systems. Unfortunately, even when multimodal interventions are available, mental health services generally are underutilized, particularly by children and families of racial and ethnic minority background who often reside in under-resourced, urban settings. Partnering to Achieve School Success (PASS) was developed as a service based in urban primary care settings to foster partnerships among the family, school, and primary care practice and promote engagement in intervention. This study was designed to examine the pre-treatment telephone history of contacts between clinicians and families to determine early indicators of engagement and potential strategies to improve treatment initiation. The data were derived from a retrospective analysis of 80 cases referred by primary care providers to PASS. Findings indicated that success rates of clinician-initiated contact and number of parent-initiated attempts were independent predictors of treatment initiation. Also number of minutes of actual phone contact predicted treatment initiation. Follow-up analyses suggested that amount of phone contact may serve as a mediator in the relationship between phone contact (clinician-initiated and parent-initiated) and treatment initiation. The predictive value of telephone contact was affirmed, and strategies for using phone contact to improve treatment initiation were discussed.

Intervention researchers have often failed to assess treatment integrity; when integrity is examined, the focus is typically on whether the steps of intervention have been applied and not on quality of implementation. In the few studies that have investigated intervention quality, the emphasis has been on how intervention is delivered and not how it is received or the degree of participant engagement. This study was designed to examine participant engagement, specifically teacher investment, in the context of family interventions for children with attention-deficit/hyperactivity disorder (ADHD) that were linked with the school. The interventions included Family–School Success (FSS), a program that engages families and schools in a problem solving partnership, and Coping with ADHD through Relationships and Education (CARE), a program designed to provide education and support to families. Participants included the families and teachers of children in grades 2 through 6; 45 sets of families and teachers participated in FSS and 48 were in CARE. The Teacher Investment Questionnaire (TIQ) was designed to assess teacher engagement in intervention. The TIQ is a rating scale for clinicians to be completed during and after treatment. The findings provided support for the reliability and validity of the TIQ. Level of teacher involvement was demonstrated to decline with advancing grade level for FSS, but not CARE. Parent ratings of the quality of the family–school relationship as well as the level of teacher support for homework, assessed at baseline, were shown to be significantly related to clinician ratings of teacher investment post-intervention. The findings highlight the importance of assessing participant engagement in intervention. Strategies to refine the assessment of teacher investment were discussed.

Homophobic name-calling and sexual violence are prevalent among US high school students and have been associated with a host of negative consequences including anxiety, depression, and substance use disorders, especially among sexual and gender minority youth. Although homophobic name-calling and sexual violence are linked to common risk and protective factors, most prior studies have failed to include gender and sexual minority groups. The present study used path analyses to explore the associations between eight protective factors and the outcomes of homophobic name-calling perpetration, homophobic name-calling victimization, sexual violence perpetration, and sexual violence victimization. The sample included LGB (n = 938), transgender (n = 140), and heterosexual (n = 3,744) high school students in Colorado, USA (N = 4,822). Protective factors included: (1) family support; (2) peer support; (3) friendships with trusted adults; (4) participating in healthy activities; (5) helping others; (6) spirituality; (7) access to counseling; and (8) access to medical services. For homophobic name-calling perpetration and victimization, significant negative associations emerged across different groups for the protective factors of family support, peer support, helping others, spirituality, counseling, and medical access. For sexual violence perpetration and victimization, significant negative associations emerged across different groups for the protective factors family support, peer support, and counseling access. Findings suggest that prevention and intervention efforts to address gender-based harassment should focus on building protective, supportive environments across the schools, families, and communities.

The negative consequences for victims and perpetrators of school violence are significant, multifaceted and, if left unchecked, can have personal costs that may last well into their adult lives. Universal violence preventive interventions may not be sufficiently effective in mitigating problems among middle school youth who exhibit risk of violent behavior. School-based mental health (SBMH) approaches show promise for reducing problems among the minority of youth responsible for violence perpetration, although the impact of teacher-delivered SBMH has been somewhat limited. The present study examines the impact of practitioner-delivered SBMH in middle school settings, with (a) a three-armed randomized controlled trial (RCT) comparing Expanded SBMH and Enhanced SBMH to Standard SBMH and (b) a separate quasi-experiment comparing the three SBMH arms in the RCT to a separate set of non-randomized, non-SBMH schools. SBMH schools who expanded their services saw decreases in aggressive behavior and victimization, across both study structures, that were either statistically significant, meaningful based on Cohen effect size conventions or both. These results suggest that the expansion of practitioner-delivered mental health services to youth who are at risk of violence perpetration, but would otherwise be ineligible for, or unable to afford, services achieves a significant impact on the larger school environment.

Recent data have emerged suggesting the benefits of a modular rather than manualized approach to treating anxiety disorders, particularly in school settings. However, little is known about the use of specific modules or their relation to treatment process or response. Using data from a modular cognitive behavioral treatment for anxiety disorders delivered by school clinicians, this study examined (a) the frequency of module use (e.g., exposure, cognitive restructuring), (b) whether therapy session process variables (e.g., therapeutic relationship) varied by module, and (c) the relation between specific module use and treatment response. Data from 124 therapy sessions were used to address these questions. Therapy sessions were delivered by 11 school-based clinicians to a sample of 16 volunteer youth (mean age 11.1 years; 68.8 % female, 87.5 % African-American) as part of a randomized controlled trial (Ginsburg et al. in Child Youth Care Forum 41:1–19, 2011). After each therapy session, clinicians identified the module used and rated various process variables. Treatment response was assessed by blind evaluators who conducted diagnostic interviews with children and parents post-intervention and at a 1-month follow-up. The most frequently used modules were exposure (47 % of sessions), psychoeducation (20 % of sessions), and cognitive restructuring (18 % of sessions). Session process variables (e.g., child involvement, therapeutic relationship) varied by module. No individual module predicted treatment response. Findings suggest that newly trained clinicians do not use CBT modules with equal frequency and type of module does not appear to affect key treatment variables. Future studies are needed to explore the reasons clinicians select specific modules as well as the quality of implementation.

Teacher consultation is commonly used to ensure that classroom-based interventions are implemented with fidelity to achieve targeted outcomes, yet the consultation process is not well understood. Consultant-teacher relationship quality is one feature of consultation that may promote intervention outcomes—both directly and indirectly via teachers’ implementation. The current study used mediation models to examine the direct links between consultant-teacher relationship quality, assessed from the perspective of the consultant and teacher, and observed dyadic teacher–child interactions, as well as the indirect effect through teachers’ implementation fidelity and dosage. Implementation data come from the Banking Time intervention (N = 168 children, 57 teachers), a dyadic teacher–child intervention that targets the quality of interactions between teachers and preschoolers perceived to display disruptive behavior. Consultants (N = 4) worked with teachers to support their implementation of specific Banking Time practices. Findings supported a direct link between consultant-reported relationship quality and teachers’ observed interactions with children; however, no evidence for an indirect effect was found. Consultant-reported relationship quality predicted implementation dosage but not fidelity. Across findings, consultant-reported relationship quality emerged as a stronger predictor of outcomes than teacher-reported relationship quality. Results have implications for school-based interventions that employ teacher consultation to support teachers.

Suicidal thoughts and behaviors are highly prevalent among adolescents, and peers are often the first, and sometimes only, people to know about youth suicidality. Since many adolescents do not directly disclose suicidal thoughts, school-based suicide prevention programs aim to train youth to recognize warning signs of suicide in their peers that serve as “cues” to refer at-risk peers to an appropriate adult. However, peer-presented cues vary widely in presentation, and adolescents are more likely to recognize overt (i.e., obvious or explicit) as opposed to covert (i.e., hidden or implied) cues. The type of cue exhibited may, in turn, affect whether adolescents make a referral to an adult. The current study examined whether training suicide prevention influences referral intentions for overt and covert suicide cues. Participants included 244 high school students (54% female; Mage = 16.21) in the Southeastern United States who received suicide prevention training (SOS; signs of suicide) as part of their health curriculum. Prior to training, students endorsed higher referral intentions for peers exhibiting overt compared to covert cues. Training was associated with increased intentions to refer peers across cue type, but referral intentions for covert cues improved significantly from pre to post-training while those for overt cues remained high and stable. Findings suggest that suicide prevention training might differentially improve students’ ability to detect and respond appropriately to less obvious indicators of suicide risk. These findings may inform the adaptation and development of future, more nuanced school-based suicide prevention programming.

Internalizing and externalizing problems commonly co-occur with adolescent post-traumatic stress and grief reactions. However, little is known about whether these co-occurring symptoms moderate adolescents’ response to sequenced components of trauma- and grief-focused interventions. Forty-four middle school students (aged 12–14) rated their self-identified Top Problem during a 17-week flexibly tailored course of Trauma and Grief Component Therapy for Adolescents (TGCTA), a group-based treatment for traumatized and bereaved youth. Baseline internalizing and externalizing symptoms were examined as potential moderators of adolescents’ response to skills-building (Module I), narrative-sharing (Modules II and III), and developmental progression (Module IV) phases of intervention. Piecewise analyses of change during the three treatment phases indicated that adolescents with more internalizing symptoms showed significantly less improvement during the skills-building phase and significantly more improvement during the narrative construction phase. Findings provide preliminary evidence that: (a) traumatized and bereaved adolescents show different trajectories of response to different TGCTA components as a function of internalizing versus externalizing baseline symptoms and (b) assessing self-nominated problems and broad-spectrum internalizing and externalizing symptoms can guide trauma- and bereavement-informed treatment planning and monitoring.