School Personnel Can Help Prevent Mental Health Issues in Children

A new study, published in the Journal of the American Academy of Child & Adolescent Psychiatry, investigates the effect of elementary school-based mental health services as delivered by in school personnel, as opposed to highly trained researchers. The results of the random effects meta-analysis demonstrate strong outcomes when interventions incorporate contingency management, are implemented multiple times per week, target externalizing behaviors, and are incorporated into regular academic instructions.

“Against a concerning backdrop of serious problems in the accessibility of evidence-based treatments for youth, the present meta-analysis provides evidence of the important role that school-based personnel who are naturally in children’s lives can play in implementing mental health services,” the researchers, led by Amanda L. Sanchez of the Center for Children and Families at Florida International University, write.

Statistics on youth mental health suggest 1 in 5 youth between 13 and 18 years of age meet criteria for a mental health condition and 50% of lifelong mental health issues begin by the age of 14. Improving the quality of mental health resources in elementary schools is instrumental to the large-scale effort to promote mental well-being in schools nationwide.

School-based mental health services are more accessible to youth than community-based programs, which often require transportation and increase health care costs. The authors note that youth engaged in school-based mental health programs are more likely to participate in 3 sessions than community-based settings.

A large body of literature exists supporting mental health programs in elementary settings, however, less is known regarding the specifics of effective delivery, which is essential to inform policy change and large-scale implementation of effective preventative approaches. As the researchers note, highly trained research staff implement most of the programs implemented during research. This makes it difficult to translate results from the study when it comes to the realities of school-based interventions.

“A limited understanding of the effectiveness of school-based mental health services, when implemented by school professionals, could contribute to the limited application of evidence-based mental health practices in schools,” the researchers explain.

The current meta-analysis is the first to analyze studies utilizing school-based personnel for implementation as opposed to highly trained research staff. Forty-three studies, including data on close to 50,000 children, were examined. All studies were randomized trials conducted by school personnel with almost all interventions occurring within the classroom (95%). Results of the school-based mental health interventions demonstrated the most significant effect on externalizing behaviors, with a medium impact on internalizing behaviors, and a smaller effect on attention problems.

Moderating effects on mental health showed, “particularly large effects associated with targeted interventions and selective prevention, services that included contingency management, services that were integrated into academic instruction, services that were implemented multiple times per week or daily, and services that targeted externalizing problems.”

The researchers’ findings suggest relatively brief school-based interventions show comparable effects to more long-term interventions. However, the frequency was key to interventions showing stronger results than those delivered the same number of times but less frequently.

Not surprisingly, they found persistent disparities in access to mental health care among economically disadvantaged, ethnic, and racial minority populations when compared to their upper-to-middle class nonminority peers. Sanchez and her team highlight the importance of the current research in addressing this disparity, “Current support for the effectiveness of elementary school-based mental health services is particularly encouraging because the school-based delivery of care can overcome many of the key barriers faced by low-income and ethnic and racial minority children and families.”

This study provides an important contribution to school-based mental health literature, demonstrating the effectiveness of interventions delivered by current school staff and integrated into the existing academic curriculum. These results show the sizable potential that schools have to serve large numbers of students for effective and accessible preventive mental health services.

The researchers conclude:

“Recognizing the effective role school personnel can play in children’s mental health care and the serious problems in the accessibility and acceptability of office-based care, child psychiatrists are encouraged to increase referrals to school mental health programs for elementary school-age children. In addition, the findings provide important implications for principals and policymakers to consider how to strategically allocate funds for services that are most appropriate for delivery by school-based personnel.”

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Sanchez, A. L., Cornacchio, D., Poznanski, B., Golik, A. M., Chou, T., & Comer, J. S. (2018). The effectiveness of school-based mental health services for elementary-aged children: A meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 57(3), 153-165. (Link)