A Randomized Trial of Specialty Mental Health Probation: Measuring Implementation and Effectiveness Outcomes

Although the research on specialty mental health probation (SMHP) is promising, there have been no randomized controlled trials (RCT) of the prototypical model advanced in the research literature and little focus on SMHP implementation. This study assesses the adoption of SMHP in two counties and examines its impact on mental health and criminal justice outcomes. Researchers conducted a RCT within a hybrid implementation-effectiveness study to examine intervention adoption as well as mental health treatment engagement and criminal justice outcomes for 100 individuals with serious mental illnesses on probation in one rural and one urban county in a southeastern state. Randomization produced equivalent treatment (n?=?47) and control (n?=?53) groups with no statistically significant differences between groups on demographic or background characteristics. Compared to standard probation officers, SMHP officers addressed the mental health needs of individuals with serious mental illness (i.e., adoption) at higher rates (p?<?0.001). Compared to individuals on standard caseloads, individuals on SMHP had a higher rate of mental health engagement (e.g., mental health assessment, attending treatment appointment; p?<?0.050); however, more individuals on SMHP caseloads had a new crime violation during follow-up compared with individuals on standard caseloads (p?<?0.01). In conclusions, results suggest successful adoption of the intervention and increased mental health engagement among those on SMHP caseloads. Results are consistent with the mixed findings on the impact of SMHP on improving criminal justice outcomes.

     

Transformation of children's mental health services: the role of school mental health

The New Freedom Commission has called for a transformation in the delivery of mental health services in this country. The commission's report and recommendations have highlighted the role of school mental health services in transforming mental health care for children and adolescents. This article examines the intersection of school mental health programs and the commission's recommendations in order to highlight the role of school mental health in the transformation of the child and adolescent mental health system. Schools are uniquely positioned to play a central role in improving access to child mental health services and in supporting mental health and wellness as well as academic functioning of youths. The New Freedom Commission report articulated several goals related to school mental health: reducing stigma, preventing suicide, improving screening and treating co-occurring disorders, and expanding school mental health programs. The authors suggest strategies for change, including demonstrating relevance to schools, developing consensus among stakeholders, enhancing community mental health-school connections, building quality assessment and improvement, and considering the organizational context of schools.     

Teacher ratings of mental health among school children in Kinshasa, Democratic Republic of Congo

AbstractAim In Africa, little is known about child mental health. This study piloted the Strengths and Difficulties Questionnaire (SDQ) in Kinshasa, investigated mental health problems and the association between these problems and school performance, demographic factors, illness and nutrition.Methods An epidemiological survey was conducted with 1,187 children, 7–9 years old, recruited from randomly selected schools. Mental health problems were assessed with the SDQ (a behavioural screening tool) administered to teachers. Stability of the factor structure was examined using principal component factor analysis of the SDQ items. The reliability was evaluated using measures of internal consistency of the SDQ scales.Results Factor analysis yielded five factors, similar to the published SDQ scales. The internal consistency was satisfactory on all of the SDQ scales. Using the 90^th percentile, the cut-off scores were somewhat higher than the published cut-off scores in this younger sample. Poor nutrition, low socioeconomic status and illness were found to increase the risk for mental health problems and low school performance.Conclusion SDQ may be considered useful to describe mental health problems among urban African children in Kinshasa. An association between mental health, school performance, demographic factors, illness and nutrition was found.     

Teachers’ Recognition of Children’s Mental Health Problems

Background: Teachers have a significant role to play in identifying children with mental health problems. However, teachers’ perceptions of children’s mental health problems are relatively unexplored. Method: Primary school teachers (N = 113) completed a questionnaire, composed of vignettes describing children with symptoms of a common emotional disorder and a common behavioural disorder, following which they were asked a number of questions regarding problem recognition and help‐seeking. Results: Teachers were able to recognise the existence of a problem and rate its severity. They were significantly more concerned about a vignette of a child with symptoms of a behavioural disorder than an emotional disorder. The gender of the child was found to independently predict teachers’ accurately recognising when a child had a problem. Conclusion: Teachers are good at recognising whether a child presents with a problem. However, their problem recognition is affected by both the gender of the child and the type of symptomatology being displayed (emotional versus behavioural).     

Factors affecting outcome in a school mental health service

The teacher-rated outcome on 70 consecutive school mental health referrals treated with brief psychiatric therapy was obtained. The major clinical and outcome findings were (1) 40% of the children showed a hyperactive-learning impaired pattern: (2) the use of stimulant medication for the majority of this group resulted in dramatic classroom improvement; (3) time-limited therapy for academically retarded, chronically misbehaving children produced limited classroom benefits; (4) parental antagonism toward school authorities was frequently related to student suspensions; (5) the child's IQ was a significantly (positive) outcome factor; (6) persistence in treatment was significantly greater when medication was prescribed.     

Towards School Mental Health in Nigeria: Baseline Knowledge and Attitudes of Elementary School Teachers

There is a shortage of child and adolescent mental health (CAMH) professionals all over the world, and this shortage is especially critical in most parts of the developing world. Schools have been identified as ideal settings to reach needy children in the community, and training teachers in CAMH issues can help improve early identification and appropriate referrals of children with mental health problems. As part of a needs assessment for developing a training programme, selected Nigerian elementary school teachers were asked to complete confidential questionnaires to determine their perceptions of mental health problems in school children. Teachers indicated that they had no previous CAMH training. Baseline assessments revealed that teachers' knowledge of CAMH was deficient, and attitudes to children with mental health problems revealed intolerance. Incorporation of CAMH care into teacher education curricula is a critical next step towards integrating school teachers as mental health collaborators in school mental health programmes in Nigeria.     

Development and implementation of a peer-based mental health support programme for adolescents orphaned by HIV/AIDS in South Africa

Aim: The article describes a framework and the process for the development of the peer-based mental health support programme and its implementation. The development of a peer-based mental health support programme is based on Erikson's theory on the adolescent phase of development, the psycho-educational processes; the peer approach and the orphaned adolescents lived experiences as conceptual framework.

Methods: A triangulation of five qualitative methods of photography, reflective diaries, focus groups, event history calendar and field notes were used to capture the lived experiences of adolescents orphaned to HIV and AIDS. Analysis of data followed Colaizzi's method of data analysis.

Results: The combination of psycho-education, Erikson's stages of development and peer support assisted the participants to gain knowledge and skills to overcome adversity and to assist them to become to more resilient.

Conclusion: The peer based mental health support programme if used would enhance the mental health of adolescent orphans.     

‘It just doesn’t feel right’: a mixed methods study of help-seeking in Irish schools

Schools are a key setting for mental health promotion and the provision of emotional support to students. As teachers and school counsellors are adults with whom adolescents have regular contact, it is likely they would be used as a help source by distressed students however there are few studies on this from an Irish context. A mixed methods design was used to identify the extent of adolescent help-seeking in addition to exploring what influences a young person’s decision to seek help in school. Findings generated through surveys (N = 856) and four focus group interviews (N = 35) with adolescents indicate that young people do not regard teachers and school counsellors as a potential help source. Barriers to seeking help include dislike of the dual role of counsellor/teacher and concerns about confidentiality. The provision of independent school counselling and increased mental health education were identified as factors that might increase help-seeking in school.     

Mental-health disparities between heterosexual and sexual-minority adolescents: Examining the role of informant discrepancies

IntroductionAn emerging literature documents substantial mental-health disparities by sexual orientation amongst adolescents, with sexual-minority youth exhibiting poorer mental health than heterosexual youth. This brief report provides the first empirical account of how the association between sexual-minority status and adolescent mental health differs depending on who assesses adolescents' mental health (child/mother/father/teacher), and how informant discrepancies in assessments of adolescent mental health differ by adolescents’ sexual orientation.MethodsData come from an Australian national sample of 14-/15-year-old adolescents (Longitudinal Study of Australian Children; n~3,000). Adolescent mental health is measured using multiple measures from the Strengths and Difficulties Questionnaire, and modelled using multivariable linear regression models.ResultsMental-health disparities between sexual-minority and heterosexual adolescents emerged irrespective of who assessed the child's mental health. However, their magnitude varied substantially by informant, being largest when mental-health was reported by adolescents (~0.7 standard deviations) and smallest when reported by teachers (~0.2 standard deviations). Discrepancies between mental-health scores collected from the child and other informants were largest for internalising than externalising behaviours, and in child-father than child-mother comparisons.ConclusionsUnderstanding informant discrepancies and their meaning is pivotal to designing surveys that generate robust insights into the health of sexual-minority adolescents, as well as appropriate policy interventions.     

Small activity groups in the school

The authors report on a long-term project in mental health in an urban school district utilizing a structured activity group program as a method of developing preventive mental health activities in the schools. Over a 12-year period, more than 350 children between the ages of 6 and 15 and 32 teacher-leaders participated in work with 64 groups. Evaluations show positive results in providing mental health services which bridge the gap between classroom and formal psychiatric assistance, inservice training of faculty in the diagnosis of emotionally based learning problems, and developing insights about schools as social institutions. The authors suggest that warnings sounded by earlier investigators about such programs need not discourage future development of this consultation modality.     

Impact of a modest delay in school start time in Hong Kong school adolescents

ObjectiveTo examine the effects of a modest delay (15 min) in school start time (SST) on adolescent sleep patterns, mood, and behaviors.MethodsTwo secondary schools in Hong Kong with a total of 1173 students (intervention: n = 617; comparison school n = 556) completed both baseline and follow-up questionnaires. School start time was delayed by 15 min, from 7:45 a.m. to 8:00 a.m., in the intervention school. The comparison school maintained their regular SST at 7:55 a.m. Students' sleep-wake patterns, daytime sleepiness, and mental and behavioral aspects were assessed by validated questionnaires before and after the intervention.ResultsStudents in the intervention school significantly delayed their weekday wake-up time (p < 0.001) and increased their total time in bed (p < 0.001) when compared to students in the comparison school. Both groups experienced a delay in their weekday bedtime. The students in the intervention school showed improved mental health [General Health Questionnaire (GHQ) score, p = 0.015], better prosocial behaviors (p = 0.009), better peer relationships (p < 0.001), greater attentiveness (p < 0.001), less emotional problems (p = 0.002), and less behavioral difficulties (p < 0.001) as measured by Strengths and Difficulties Questionnaire (SDQ).ConclusionsA modest delay (15 min) in school start time can increase adolescent sleep with corresponding improvement in mood and behaviors. Current findings have significant implications for education policy, suggesting that school administrators and policy makers should systematically consider delaying school start time to promote sleep and health among school-aged adolescents.Clinical trial registrationChiCTR-TRC-12002798. The trial protocol can be accessed at: http://www.chictr.org/en/proj/show.aspx?proj=3955.     

Short-term perspectives of parents and teachers on school reintegration of childhood brain tumour survivors

ABSTRACT

Objective: To discover short-term changes in perspectives of parents and teachers of childhood brain tumour survivors on school reintegration, in order to reveal similarities and differences between them over time. Methods: Semi-structured interviews were conducted with parents and teachers of five children at the start and the end of a 1-year period following the child’s school re-entry. Results: Thematic analysis of data resulted in three main themes: ‘the child’s performance and wellbeing’, ‘the school’s attitude and approach’ and ‘communication and working together’. Parental concerns about child-specific changes and the school’s approach to the child could either decrease or increase over time. Teachers remained focused on assessing their pupil’s learning potential and finding ways of appropriate support. Their different perspectives on communication and working together became more pronounced. Conclusions: This study emphasizes the importance of clear communication and collaboration, coordinated follow-up and availability of healthcare professionals during the child’s school reintegration.     

Certain reflections of a child psychiatrist on school failure

School failure is an important phenomenon about which not only the teachers are very much concerned, but also the sociologists and the political authorities. As it is the main reason why people consult them, child psychiatrists, psychologists and professionals in mental health are led to consider, beside the specific psychopathological factors, the socio-cultural and pedagogical aspects involved in different ways everytime a child meets difficulties at school. The programs of intervention resulting from this dynamic approach raise the question of the limits of the psychiatrists' competence and practice. The cooperation with the school in particular should take into account the risks arising from any confusion between therapeutic and pedagogic responsibilities. Finally, serious school failure leads us to question how special education works, when considering inadaptation only as a consequence of deficits. We should compare the advantages of such a system in connection with the possibilities-still to be imagined- of integration through the channel of ordinary school teaching.     

A package of interventions to reduce school dropout in public schools in a developing country

OBJECTIVE: School dropout rates are staggeringly high in developing countries, even for elementary school children. This study aims to assess the feasibility and initial efficacy of a package of interventions tailored to reduce school dropout in public schools in an urban city in Brazil. METHOD: Two public schools with similar high rates of dropout in elementary grades were selected. In one of them, a package of universal preventive interventions was implemented during a school year, including two workshops with teachers, five informative letters to parents, three meetings with parents at school, a telephone helpline at school, and a 1-day cognitive intervention. For children who stayed ten consecutive days out of school without reason, mental health assessment and referral to mental health services in the community were offered. In the second school, no intervention was implemented. RESULTS: After this 1-year intervention, there were significant differences between the two schools in rates of both dropout (P < 0.001) and absenteeism in the last trimester (P < 0.05; effect size = 0.64). In the intervention school, 18 (45%) youths returned to school after intervention among the 40 at-risk students. Moderate engagement of school staff was the main logistic problem. CONCLUSIONS: Our findings suggest that programs combining universal primary preventive strategies and interventions focused on at-risk students can be implemented and useful in developing countries to reduce school dropout.     

Mental health, health, and education staff working together in schools

The movement to develop expanded school mental health programs is still in its early stages. For child and adolescent psychiatrists to become involved and effective means negotiating a culture that is novel for many schools and forming and maintaining relationships with diverse staff in mental health, health, and education.     

International school mental health: global approaches, global challenges, and global opportunities

School mental health programs from developed countries demonstrate that both the practice and research are becoming more important to policy makers, educators, health providers, parents, and other stakeholders. Some United Nations agencies and other international organizations have begun work to advance school mental health internationally. School-based mental health programming needs to be considered as part of usual child and youth mental health policies and plans, whether those are national or other jurisdictional in nature. Currently, a paucity of evidence-based and cost effective child and youth global mental health policies/programs exist, limiting school-based mental health programs being developed, implemented, or sustained.     

Mental health consultation for school social workers: A conceptual model

There are some very seriously disturbed children, families, and teachers who require individual casework or other individual therapeutic help. However, in the face of the mental health job to be done in the schools, mental health consultation is one very important way of utilizing the scarce talents of social workers in a more effective way for more children. A conceptual model of mental health consultation is presented and a special adaptation to mental health consultation in the school setting is illustrated.He was for many years psychiatric consultant to the San Francisco Unified School District.     

Associations between Lifetime Spanking/Slapping and Adolescent Physical and Mental Health and Behavioral Outcomes

Background:Many parents use physical forms of punishment, including spanking to correct perceived misbehavior. While some authors suggest spanking/slapping is a distinct and “milder” form of physical punishment, parents’ use of spanking is consistently associated with poor outcomes for their children. However, less is known about the relationship between spanking/slapping and health and behavioral outcomes in adolescence independent of other childhood adversities.Objectives:The objectives of this study were to examine the associations between lifetime experiences of spanking on the bottom and/or slapping on the hand and 3 adolescent outcomes: (a) mental health disorders, (b) physical health conditions, and (c) defiant behaviors, after adjusting for other types of childhood adversities and child maltreatment.Methods:Cross-sectional data from the provincially representative 2014 Ontario Child Health Study (N = 6,537 dwellings, response rate = 50.8%) were used. The current study focused on one selected child aged 14 to 17 years within a household (n = 1,883) with data collected from the adolescent and the parent/caregiver. Logistic regression models were used to identify associations with lifetime experiences of spanking/slapping 3 or more times (vs. 0 to 2 times).Results:Lifetime spanking/slapping was independently associated with increased odds of mental health disorders, physical health conditions, and defiant behaviors in adolescence after adjusting for childhood adversities and child maltreatment (unadjusted and adjusted odds ratios ranging from 1.29 to 2.19).Conclusions:These findings suggest that lifetime spanking/slapping is uniquely associated with harmful mental, physical, and behavioral outcomes in adolescence, and efforts should focus on its prevention.     

Training in child and adolescent psychiatry for primary health care nurses in South Africa

Objective — To obtain feedback from primary care nurses who attended two study days in child and adolescent mental health. The study days aimed to equip nurses with basic assessment and intervention skills for the most common problems in child and adolescent psychiatric nursing.

Method — All 144 and 68 primary care nurses who attended Study Days 1 and 2 respectively completed confidential questionnaires after each day.

Key findings — Over 80% of the nurses practised in settings in which one would expect to encounter children or adolescents suffering from, or at risk for, mental health problems. Weekly contact with youngsters with mental health problems was reported by 61.1% of the nurses. The majority of nurses (77.8%) reported consulting with other professionals when managing these problems. Important barriers to child and adolescent mental health services provision at primary care level included busy clinics, training deficits and time management. Only 2.8% reported that lack of interest was a barrier. There was an overwhelmingly positive response to both study days. The nurses were able to apply what they had learned between the study days. Almost half usually spent at least 30 minutes on counselling when managing children or adolescents with mental health problems. Many unmet needs for further training, consultation and supervision were identified.

Conclusions — The next challenge is to investigate whether such study days result in more positive outcomes for children and adolescents with mental health problems and their families.