http://www.mentalhealthcommission.gov/reports/FinalReport/FullReport-05.htmGrowing evidence shows that school mental health programs improve educational outcomes by decreasing absences, decreasing discipline referrals, and improving test scores.114 The key to improving academic achievement is to identify mental health problems early and, when needed, provide appropriate services or links to services. The extent, severity, and far-reaching consequences make it imperative that our Nation adopt a comprehensive, systematic approach to improving the mental health status of children.
Clearly, school mental health programs must provide any screening or treatment services with full attention to the confidentiality and privacy of children and families. The Columbia University TeenScreen® program provides a model for early intervention. (See Figure 4.2.)The Commission recommends that Federal, State, and local child-serving agencies fully recognize and address the mental health needs of youth in the education system. They can work collaboratively with families to develop, evaluate, and disseminate effective approaches for providing mental health services and supports to youth in schools along a critical continuum of care. This continuum includes education and training, prevention, early identification, early intervention, and treatment.
Figure 4.2. Model Program: Screening Program for Youth
Program
Columbia University TeenScreen® Program Goal
To ensure that all youth are offered a mental health check-up before graduating from high school. TeenScreen® identifies and refers for treatment those who are at risk for suicide or suffer from an untreated mental illness. Features
All youngsters in a school are given a computer-based questionnaire that screens them for mental illnesses and suicide risk. At no charge, the Columbia University TeenScreen® Program provides consultation, screening materials, software, training, and technical assistance to qualifying schools and communities.
In return, TeenScreen® partners are expected to screen at least 200 youth per year and ensure that a licensed mental health professional is on-site to give immediate counseling and referral services for youth at greatest risk. The Columbia TeenScreen® Program is a not-for-profit organization funded solely by foundations. When the program identifies youth needing treatment, their care is paid for depending on the family's health coverage.
Outcomes
The computer-based questionnaire used by TeenScreen® is a valid and reliable screening instrument.151 The vast majority of youth identified through the program as having already made a suicide attempt, or at risk for depression or suicidal thinking, are not in treatment.152 A follow-up study found that screening in high school identified more than 60% of students who, four to six years later, continued to have long-term, recurrent problems with depression and suicidal attempts.153
Biggest challenge
To bridge the gap between schools and local providers of mental health services. Another challenge is to ensure, in times of fiscal austerity, that schools devote a health professional to screening and referral.
How other organizations can adopt
The Columbia University TeenScreen® Program is pilot-testing a shorter questionnaire, which will be less costly and time-consuming for the school to administer. It is also trying to adapt the program to primary care settings.
Website
www.teenscreen.org
Sites where implemented
69 sites (mostly middle schools and high schools) in 27 StatesThe No Child Left Behind Act of 2001154 is designed to help all children, including those with serious emotional disturbances reach their optimal potential and achievement.
To fulfill the promise of this Act, schools must work to remove the emotional, behavioral, and academic barriers that interfere with student success in school. Consequently, it is critical to strengthen mental health programs in schools. This effort may involve: Working with parents, local providers, and local agencies to support screening, assessment, and early intervention;
Ensuring that mental health services are part of school health centers;Ensuring that these services are Federally funded as health, mental health, and education programs;Building on a recommendation from the President's Commission on Excellence in Special Education155 to implement empirically supported prevention and early intervention approaches at the school district, local school, classroom, and individual student levels; and
Creating a State-level structure for school-based mental health services to provide consistent State-level leadership and collaboration between education, general health, and mental health systems.
Since the IDEA requires that a variety of professionals collaborate in the school and in the community, the Commission urges that coordinating services be regarded as a "related service" in the child's Individual Education Plan (IEP). In developing the IEP, there should be a stronger family focus and youth involvement and support. The training and research funds designated in this Act should be considered for use to train teachers, related services professionals, and parents to recognize signs of emotional and behavioral problems in children, make appropriate referrals for assessment and services and classroom accommodations,
and implement and evaluate evidence-based school mental health interventions.On a related topic, the Commission recognizes the particular challenges for youth in transition from adolescence to adulthood. IDEA has transition requirements beginning at age 14, but to date, these requirements have not resulted in acceptable post-school outcomes.
Studies show that approximately 42% of students with serious emotional disturbances graduate from high school as opposed to 57% of students with other disabilities.81 Schools and local mental health agencies could improve their collaboration and use of evidence-based practices to develop transition-to-work services so that children with serious emotional disorders can move successfully from school to employment or to post-secondary education.