How would mental health screening in schools benefit children? When students experience mental health problems, they are less likely to thrive in school and more likely to be disruptive in class and engage in unhealthy or disruptive activities. This has an adverse impact on their educational success as well as the success their classmates achieve.

Experts in the field report that 20% of children and youth need mental health services but only 1/3 of those who need it receive any help. Of those who do receive help, the overwhelming majority (70%) receive services at school. A 2012 study that followed a national sample for a year reported a rate of 40.3% teens between 13 and 18-years old had experienced at least one disorder.

When children act out, teachers and parents can identify them as potentially needing mental health services, but a large percentage of children internalize their problems which leads to depression, anxiety, self-harm, and suicide. These children are far more difficult to identify and may appear to be well adjusted students.

In 2007, Dr. Kessler of the Department of Health Care Policy at Harvard Medical school reported “First onset of mental disorders usually occurs in childhood or adolescence, although treatment typically does not occur until a number of years later.” Kessler also mentioned that “Later onsets are mostly secondary conditions. Severe disorders are typically preceded by less severe disorders that seldom are brought to clinical attention.”

 

Challenges

Implementing a broad-based screening program presents many challenges and involves stakeholders with varied skill sets.

Challenges associated with implementing mental health screenings in schools:

  1. Availability of Funding for screenings and addressing problems identified by the screenings
  2. Ensuring the tools are developmentally and culturally appropriate
  3. Stigma about Mental Health
  4. Psychometrically sound testing that is validated, affordable, and reliable (empirically evaluated)
  5. Personnel skilled to administer the tests
  6. Resources to address identified issues (evidence-based solutions)
  7. What to screen for (risk factors or diagnostic criteria or both)
  8. Complexity of navigating myriad funding sources
  9. Communication between key players
  10. Parental buy-in and determination of whether consent is required
  11. Compliance with HIPAA and FERPA
  12. Agreement on goals associated with testing programs
  13. Policies and procedures relating to how the data will be used and who has access
  14. What to do if there are insufficient resources available to meet urgent needs identified via screening
  15. Communication and sharing of aggregated data

In 2016, a Swedish study found it only took 1.5 years to achieve a positive return on their investment (ROI) for the cost of prevention. The return was achieved as the result of a reduction in the number of students needing more intense and costly support.

Learn how the eINSIGHT platform for school-based mental health needs assessment can help your school improve student mental health and success.

Pros & Cons of Different Approaches

The first step is determining the desired outcomes to provide a basis to compare the approaches. Prevention reduces expenditures,  unnecessary suffering, and is the least expensive approach.

Public Health Model

A public health model focuses on health promotion and early detection and provides methods to provide appropriate care to those who experience. A multiple gating approach where all students are screened during the first level of testing and facilitates further testing for individuals when testing indicates they are at risk or in need of help.

In 2014, a mere 15% of schools used a public health approach to screening for mental illnesses.

Across the long-term, the public health model will achieve superior results and allow each school district to track their progress and make meaningful comparisons between themselves and other districts. The downside is that there are many unknowns to be worked out by interdisciplinary teams which will take time and money.

Crisis Management

The current system is largely reactive, responding to problems after they occur. Essentially, a student must fail in some way before they are afforded assistance under the current system. While some health promotion efforts are made, they’re not universally available.

Even children who are mandated to receive help under Medi-Cal regulations often do not receive assistance with their mental health.

The upside of this system is that it is in place and familiar. No work is required to implement it. The downside is the increasing prevalence of troubled youth who self-harm, suffer from depression, anxiety, and suicide ideation, and who commit violent acts.

Health Promotion (Prevention Without Screening)

There is a robust body of evidence that supports providing children with increased social and emotional skills and helping them develop resilience lessens the likelihood of them developing mental illnesses, addictions, or dropping out of school.

There are numerous evidence-based health promotion programs that achieve excellent results such as Triple P and the MindUp program sponsored by the Goldie Hawn Foundation.

The positive side of this approach is that it helps a significant number of children, including at risk children. The downside is the inability to identify those who need additional assistance.

Anonymous Screening

Anonymous screening is already done via The Youth Risk Behavior Surveillance System (YRBSS) and, in California, the California Healthy Kids Survey (CHKS).

The upside of anonymous screening is that it avoids the stigma associated with mental health and has been shown to elicit more truthful answers because of the sense of safety anonymity provides. The downside is that it prevents identification that facilitate the providing of needed resources to children who are at risk.

 

California Leading the Way with Programs and Special Initiatives

The Mental Health Services Act of 2004 provides funding to California counties to provide mental health services. The California Mental Health Services Authority (CalMHSA) is charged with prevention and early intervention (PEI) in California’s K-12 public schools. State legislature recently launched a $50 million program for schools to fill big gaps in mental healthcare for children and teens.

California provides funding for mental health from a variety of sources that can make it difficult and time consuming to identify available resources. Funding sources available across the state include Medi-Cal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), Community services and Support (CSS), AB 602: Special Education Local Planning Area Allocation (SELPA), AB 114: Educationally-Related Mental Health Services (ERMHS), Local Control Funding Formula (LCFF), and the PEI mentioned earlier.

This alphabet soup of mental health initiatives can make it appear to the public as if the resources are more than adequate because they won’t understand the nuances and limitations of the various sources.

Learn how the eINSIGHT platform for school-based mental health needs assessment can help your school improve student mental health and success.