Mental health screening in schools

BACKGROUND: This article discusses the importance of screening students in schools for emotional/behavioral problems. METHODS: Elements relevant to planning and implementing effective mental health screening in schools are considered. Screening in schools is linked to a broader national agenda to improve the mental health of children and adolescents. Strategies for systematic planning for mental health screening in schools are presented. RESULTS: Mental health screening in schools is a very important, yet sensitive, agenda that is in its very early stages. Careful planning and implementation of mental health screening in schools offers a number of benefits including enhancing outreach and help to youth in need, and mobilizing school and community efforts to promote student mental health while reducing barriers to their learning. CONCLUSIONS: When implemented with appropriate family, school, and community involvement, mental health screening in schools has the potential to be a cornerstone of a transformed mental health system. Screening, as part of a coordinated and comprehensive school mental health program, complements the mission of schools, identifies youth in need, links them to effective services, and contributes to positive educational outcomes valued by families, schools, and communities.     

Comprehensive Health Screening in Elementary Schools: An Outcome Evaluation

A health screening program, piloted in 14 school districts in Texas from 1977 to 1979, was evaluated to determine the outcome of the screenings. Outcome measures used were the number of completed referrals, the number of conditions judged by health care providers not to exist and the number of problems of potential educational significance identified. While several problems were detected, the high rate of false positives and low referral completion reported from community health care providers leads to questions concerning the effectiveness of comprehensive health screening in the schools. However, the emphasis placed on identification during the screening of children with educationally significant problems may enable the schools to better serve these children. Referral follow-up in the community and schools to address identified problems would assure that the expenditure of funds for screening would not be futile.     

Evaluation of public health preschool child developmental screening: the process and outcomes of a community program.

We conducted a randomized controlled trial of a public health and education screening program aimed at all 4,797 four to five year old children registering for kindergarten in three school districts of southern Ontario, Canada. Children received either the Denver Developmental Screening Test (DDST) with a community health intervention program for positive screeness; the DDST with no intervention for positive screenees; or no screening test. The intervention program consisted of referral to the child's physician for assessment; a review conference between the child's teacher and the school health nurse; parent counseling; and monitoring of the child in school by the school health nurse. At the end of the third school year, no differences were found between positive screenees in the community health intervention group and the "no intervention" groups using individual academic achievement, cognitive, and developmental tests. Parents' reports revealed no differences between groups in children's mental, social, and behavioral well-being. However, parents of intervention program children had more worry about their child's school progress suggesting a potentially harmful labeling effect. In comparison to a random sample of children with normal DDST results, or a random sample of children who had randomly not been screened, the children with positive preschool DDSTs had substantially more school problems three years after screening.     

上海市闵行区华漕社区农民工学校学生沙眼患病情况调查

目的调查了解上海市闵行区华漕社区农民工学校学生沙眼的患病情况,并分析其影响因素。方法随机抽取华漕社区1所农民工学校和1所本地学校进行沙眼普查及沙眼问卷调查,比较2校的沙眼患病率并分析其影响因素。所有被调查对象均进行临床检查。结果调查农民工学校1 529名学生中,临床诊断194名学生患有沙眼,沙眼患病率为12.69%;本地学校975名学生当中,临床诊断52名学生患有沙眼,沙眼患病率为5.33%。农民工学校学生沙眼患病率明显高于本地学校(P<0.05);危险因素分析表明沙眼与是否共用毛巾、饭前便后洗手、用脏手揉眼睛、游泳、居住环境等因素密切相关。结论该社区农民工学校沙眼患病率仍较高,社区医院需每年对农民工学校学生进行沙眼普查,加大对农民工学生及家长的个人卫生习惯行为干预,增加学生对沙眼的认识。     

A tuberculosis screening and chemoprophylaxis project in children from a high risk population in Edmonton, Alberta.

Current recommendations for tuberculosis control are to screen high risk populations and provide chemoprophylaxis for those infected. In Edmonton, Alberta, one strategy has been to identify and provide TB skin tests to newly arrived immigrant school age children from TB endemic areas. The difficulty has been in identifying these children in the school population. This article describes a process tried in 1993-94 to find a better approach and to determine the outcome of a concentrated effort at screening and follow-up of this population. Using this method, 1,146 students were TB skin tested using 5tu PPD: 15% showed significant reactions (10 mm), 89% were offered chemoprophylaxis, and 68% of those offered (84% of those accepting) completed 9 months of chemoprophylaxis. The success of this process was dependent on the dedicated follow-up provided by the specialty public health clinic devoted to the prevention and treatment of tuberculosis.     

Hearing and vision screening program for school-aged children

BACKGROUND: Hearing and vision screening programs for school-aged children are common, yet little is known about their impact. OBJECTIVE: To evaluate Michigan's screening program, in which local health department (LHD) staff screen school-aged children using standardized protocols. METHODS: This project was completed in three phases: interviews with officials and screening technicians from ten LHDs, audit of LHD records regarding outcomes of screening during the 2000-2001 school year, and telephone interviews with randomly selected parents of children with an abnormal screen. RESULTS: Variations in LHD program implementation pertained to methods for tracking outcomes, screening of older children, parental notification of screening results, and availability of follow-up hearing clinics. According to LHD records, documentation of follow-up examination after an abnormal screen was low (hearing 27%, vision 25%). In contrast, most parents reported follow-up (74% hearing, 76% vision), and many reported that this resulted in treatment (50% hearing, 74% vision). In logistic regression modeling, the odds of follow-up after hearing or vision screening according to parents was not associated with income, health insurance status, or race/ethnicity. For hearing screening, the odds of follow-up decreased with school grade (p <0.001); however, the proportion who received treatment did not vary by grade. For vision screening, follow-up did not vary by grade, but the proportion who received treatment increased with grade (p =0.05). CONCLUSIONS: According to parent reports, most children had follow-up after an abnormal screen, and the majority of these children received treatment. Screening school-aged children for sensory impairment appears to be an important public health function.     

Cost Documentation of School Nursing Follow-up Services

The cost of nursing services was documented as part of a grant to study the effect of school nursing follow-up on the outcome of dental screening. Eleven nurses participated in the study with experimental (n = 287) groups of fifth and sixth grade students from a large West Coast school district who were screened for caries. Stratifiers for the randomized group assignment were school, cavity severity, gender, ethnicity, and insurance coverage. A positive difference occurred for the 11 nurses (p = 0.0046). The cost of telephone follow-up averaged $8.92 for 26.69 minutes and compared favorably with a California state allowance of $11 for a half-hour of similar service. The study offers a beginning analytical formulation for examining field services in school and community health nursing using a naturalistic experimental design.     

Developing school-based BMI screening and parent notification programs: findings from focus groups with parents of elementary school students.

School-based body mass index (BMI) screening and parent notification programs have been advanced as an obesity prevention strategy. However, little is known about how to develop and implement programs. This qualitative study explored the opinions and beliefs of parents of elementary school students concerning school-based BMI screening programs, notification methods, message content, and health information needs related to promoting healthy weight for school-aged children. Ten focus groups were conducted with 71 participants. Parents were generally supportive of school-based BMI screening. However, they wanted assurance that student privacy and respect would be maintained during measurement and that BMI results would be provided to parents in a neutral manner that avoided weight labeling. They also believed that aggregate results should be disseminated to the larger school community to support healthy change in the nutrition and physical activity environments of schools. Implications for practitioners and researchers are discussed.     

Students with chronic illnesses: guidance for families,schools, and students

ABSTRACT: Developed by a work group representing several nonprofit and federal health and education organizations, Students with Chronic Illnesses: Guidance for Families, Schools, and Students provides cross-cutting action steps to facilitate full participation in learning and other school activities by students with chronic diseases. Between 10% and 15% of children in the United States are affected by at least one chronic disease. This guide offers practical tips to help ensure that schools are responsive to the health needs of children with chronic illnesses.
Children with chronic health conditions are more likely to miss days from school, need specialized health care, and require special education services or homebound teaching. School health advocates agree that meeting the needs of these children requires collaboration among the students, their families, school personnel, and community health care providers. Such efforts can help students establish better attendance, improve their alertness and physical stamina, and face fewer restrictions on physical activity at school and fewer medical emergencies.
The guide addresses issues such as routine and urgent care needs of students, medication access and administration, and school personnel training to ensure compliance with applicable local, state, and federal regulations. While emphasizing the value of adopting general policies for supporting students with chronic conditions, the guide also encourages schools to develop and implement condition-specific and individualized protocols. The responsibilities of family members, school district officials, teachers and school administrators, and students are outlined to help each constituent fulfill these objectives.
The guide is available online at http: www.nhlbi.nih.gov health public lung asthma guidfam.htm .     

Barriers to Seeking Care Following School Vision Screening in Rochester, Minnesota

ABSTRACT: School vision screening provides an effective way to identify children who require vision therapy, usually glasses. To benefit from screening, children with abnormal screening test results must receive follow-up eye care, but care may be delayed for months or years. This project used community focus groups in Rochester, Minn., to identify barriers that may delay seeking professional care following school vision screening. Major barriers identified included lack of community awareness about the frequency and potential effect of refractive errors in children, a parental perception of inadequate communication between schools and the parents and community, high cost of corrective lenses, limited availability of convenient eye care appointments, and adolescents reluctance to wear glasses. Program planners developed a community action plan to address the perceived barriers.     

Kids Into Health Careers: A Rural Initiative

Purpose: To describe a project that introduces middle school and high school students living in Pennsylvania's rural geographic regions to nursing careers through outreach extended to students regardless of gender, ethnicity, or socioeconomic status. Method: The authors employed many strategies to inform students about careers in nursing. The methods included: working with guidance counselors, participating in community health fairs, taking part in school health career fairs, collaborating with Area Health Education Centers, serving on volunteer local education advisory boards, developing a health careers resource guide, and establishing a rural health advisory board. Findings: Developing developmentally appropriate programs may have the potential to pique interest in nursing careers in children of all ages, preschool through high school. Publicity is needed to alert the community of kids into health care career programs. Timing is essential when planning visits to discuss health care professions opportunities with middle and high school students. It is important to increase the number of high school student contacts during the fall months. Targeting high school seniors is particularly important as they begin the college applications process and determine which school will best meet their educational goals. Conclusions: Outcome measures to determine the success of health career programs for students in preschool through high school are needed. Evaluation methods will be continued over the coming years to assess effectiveness.     

The Brooklyn Center, Minnesota, Student Health Fair: An Impetus for Learning

Earle Brown School, Brooklyn Center, Minnesota, was the site of a health fair. Students, teachers, parents, agencies, and health professionals worked cooperatively to provide health information activities and screening opportunities for fair participants. Brooklyn Center's Health Fair created an awareness of health promotion for the entire community. The purpose was to present the district's newly revised school health education curriculum to stimulate positive community focus on health. Student involvement was integral in every facet of the fair from planning events to presenting health information. A sense of pride and ownership developed as students assumed responsibility for carrying out activities. Enthusiasm for participation was evident as 50% of the 1,300 students within the district were active in the fair. An enhanced self-concept on the part of the students was facilitated through active participation, and increased awareness of positive health behaviors and healthy lifestyles resulted. A spirit of cooperation between school, community, and agencies was strengthened leading to continued support for the goals of the new school health curriculum.     

Project Child Find: an intervention program that works

Project Child Find, a program designed to identify learning disabilities in preschool children, was begun in Broward County, Florida in 1975. The program consists of multi-disciplinary screenings for children aged two through five. An eight-step screening procedure is initiated on Saturdays approximately seven through ten times per year. Between 100 and 200 children are serviced during each screening; a total of about 1,200 children are seen during an entire calendar year. All children identified as possibly having conditions bearing upon their learning abilities are given complete physical and psychological evaluations. Those found to require intervention are either referred to appropriate community organizations for health or social services, or referred to a public school classroom for remedial services. Careful gathering of statistics and information during the screening and evaluation sessions helps school personnel develop and implement appropriate programs to meet the needs of all children.     

The use of the Nabarro Thinness Chart in identifying children for nutrition supplementation in Sri Lanka

This study compares the use of the Nabarro Thinness Chart with other nutritional screening tools among school children in Sri Lanka. It concludes that this method is a simpler, more precise approach to assess students requiring food supplementation in community programmes than others which are commonly utilized.     

Is School Vision Screening Effective?

ABSTRACT: A population-based cohort of all children entering kindergarten in a three-year period (N = 2,938) was followed retrospectively from kindergarten through 12th grade to estimate incidence of abnormal school vision screening tests and rates of follow-up by community ophthalmologists or optometrists. Overall 28% of children had at least one abnormal school vision screening test. Abnormal screening with referral increased from 1.2% of five-year-olds to 9.1% of 13-year-olds. Overall, 91% of children referred had further evaluation by eye care professionals. However, visits to an eye care professional often were delayed; median time was 0.8 years for children seeing an ophthalmologist and 1.8 years for children seeing an optometrist. Results support the continued use of simple visual acuity screening in schools. Consideration should be given to screening children beyond age 12 and developing methods to increase the rapidity of parental response to referral recommendations.     

School screening in remote Aboriginal communities — results of an evaluation

As part of ongoing quality assurance, the effectiveness of the school screening program in meeting the health needs of Aboriginal children in a rural district in the Northern Territory Top End was evaluated. The major health problems of Aboriginal children were analysed for their suitability for screening programs. A prospective cross-sectional study used routinely collected field data from the school screening program in 1993. To ascertain follow-up, children who had failed screening tests had their clinic notes reviewed. A total of 774 children from 11 remote communities were screened.
The results confirmed high level of disease, with rates for anaemia, malnutrition and trachoma reaching 39%, 22% and 26% respectively. Nearly one-third failed the hearing screening, urinalysis was abnormal in 19%, 3% failed visual acuity and 6% were considered to have abnormal heart auscultation.
Many of the major health problems did not meet the recommended criteria for screening programs and others would be better dealt with by ongoing surveillance rather than a single screening. Some abnormalities found on screening were inadequately investigated and/or treated. This evaluation has demonstrated a limited role for school screening in identifying and meeting the health needs of Aboriginal children living in remote areas. In collaboration with the NT Department of Education, a school-age child health policy, including a new school-age child health surveillance program, is being developed. This promotes greater participation by communities, families and schools with the aim of improving the health and learning outcomes for all school-age children in the NT.     

A school-based program to increase seatbelt use

To improve rates of seatbelt use in young school children and their parents, a curricular intervention was evaluated in a before-after trial over a 15-week period. A public school for pre-kindergarten through second grade (ages 4 to 8 years) in Yonkers, New York, was studied; all of 422 students were included and finished the study. A sequential group of parent drivers were also evaluated, although they were not subject to active intervention. All students were involved in a month-long curricular intervention to raise their awareness of seatbelt use and car safety ("May is Buckle-up Month"). Independent professional observers measured seatbelt use in a nonblinded manner before the intervention, after the intervention, and 1 month after the intervention. Belt use among students increased from 46% to 66% (P less than .01), and stayed at 63% at follow-up, although boys showed an insignificant change. Parent use improved from 47% to 61% (P less than .01), and remained at 62% at follow-up. Intensive curricular exposure to the use of seatbelts can measurably improve the use of belts by young school children. Parental behavior also shows a marked improvement. Such interventions can be organized by community health practitioners, including those in full-time practice, with minimal funding.     

Active parental consent for a school-based community violence screening: comparing distribution methods

BACKGROUND: Students are unable to benefit from many school programs designed to address their mental health needs if their parents do not consent to their participation. As part of an ongoing effort in a large urban school district to meet the mental health needs of students traumatized by violence exposure, this paper examines the impact of alternative approaches on parental response and consent rates for an initial screening to participate in a school mental health program. METHODS: Two alternative approaches were used to obtain consent for students to participate in a school-based intervention for students exposed to violence. For one cohort, consent forms were distributed along with school information and other school forms during a parent orientation meeting. In the other cohort, school mental health clinicians visited student homerooms to distribute consent forms and explain the program and evaluation to students. RESULTS: There were significantly higher rates of return of consent forms (89.8% vs 53.2%) and parents consenting to participate (69.6% vs 27.9%) among parents receiving consent forms at a school meeting than among parents whose forms were distributed to children in a classroom, with comparable rates of active refusals to participate (20.1% vs 25.3%). CONCLUSIONS: Overall return rates and rates of consent for screening participation were substantially higher when the consent form and accompanying materials were provided directly to parents rather than distributed in the classroom and sent home with students. These findings have implications for efforts to obtain active consent from parents for students to participate in school mental health programs.     

上海市某社区初级中学生心理健康状况调查分析

目的调查社区初级中学生心理健康状况,分析不同性别、年级群体心理健康水平,为开展初中学生心理干预提供理论依据。方法抽取某社区3所初级中学所有学生,以调查问卷形式完成SCL-90（90项症状清单）量表。结果初中学生除了在人际关系因子中与普通人群无明显差异外,其余总分、总均分、躯体化、强迫、抑郁、焦虑、敌对、恐怖、偏执和精神病性等因子均与一般人群不同（P均〈0.01）,且初中学生心理健康状况不如一般人群;初中女生在抑郁、焦虑和恐怖因子中与男生存在显著差异（P〈0.05）,且不如男生健康;初中各年级学生在多项因子的心理健康水平均存在差异（P总均分、躯体化、强迫、抑郁、偏执、精神病性P〈0.01、焦虑和敌对P〈0.05）,且各因子状况随年级增加有不同程度恶化,尤其是毕业年级在所有因子中均有明显恶化现象（P均〈0.01）。外来务工子女与城镇子女心理健康水平无明显差异。结论初级中学生心理健康水平低于一般人群,是心理健康干预的重点人群。初中女生、毕业年级和初二年级是初中学生心理弱势群体,需根据其不同心理困扰特点,采取早期综合性干预措施。相对外来务工子女而言城镇学生的心理适应优势并不明显,同时城镇子女可能存在生活与心理独立方面弱势。     

Frequent fliers, school phobias, and the sick student: school health personnel's perceptions of students who refuse school

BACKGROUND: This study explored school personnel's perceptions of school refusal, as it has been described as a “common educational and public health problem” that is less tolerated due to increasing awareness of the potential socioeconomic consequences of this phenomenon. METHODS: In‐depth interviews were conducted with school personnel at the middle school (N = 42), high school (N = 40), and district levels (N = 10). The findings focus on emergent themes from interviews with school health personnel (N = 12), particularly those themes related to their perceptions of and role in working with school‐refusing students. RESULTS: Personnel, especially school health services staff, constructed a typification of the school‐refusing student as “the sick student,” which conceptualized student refusal due to reasons related to illness. Personnel further delineated sick students by whether they considered the illness legitimate. School health personnel referenced the infamous “frequent fliers” and “school phobics” within this categorization of students. Overarching dynamics of this typification included parental control, parental awareness, student locus of control, blame, and victim status. These typifications influenced how personnel reacted to students they encountered, particularly in deciding which students need “help” versus “discipline,” thus presenting implications for students and screening of students. CONCLUSIONS: Overall, findings suggest school health personnel play a pivotal role in screening students who are refusing school as well as keeping students in school, underscoring policy that supports an increased presence of school health personnel. Recommendations for school health, prevention, and early intervention include the development of screening protocols and staff training.