Understanding caregivers' help-seeking for Latino children's mental health care use

BACKGROUND: Latino children have persistent low rates of mental health service use. Understanding the factors that influence caregivers' decisions about whether to use mental health care for their children can help explain why. OBJECTIVE: The objective of this study was to investigate the factors reported by the primary caregiver that could help classify Puerto Rican children into users versus nonusers of mental health services and mental health versus school sector care, among users. SUBJECTS: Data were collected from a random Puerto Rican community sample of caregiver-child dyads. MEASURES: Version-IV of the Computerized Diagnostic Interview for Children (DISC) was used to assess psychiatric disorders in children. The Service Assessment for Children and Adolescents (SACA) was used to examine the types of services used for mental health problems. STATISTICAL METHODS: The Classification and Regression Tree (CART) approach was used to develop a simple model simulating caregivers' decision-making around taking children for mental health care and the setting for care. RESULTS: The classification model of use versus no use of mental health service suggested 3 significant predictors: child's level of impairment, parental concern, and child's difficulty in performing schoolwork. The classification model of sector of care, mental health versus school setting, identified 1 significant predictor, any disruptive disorder diagnosis. CONCLUSION:: Assisting caregivers in linking a child's impairment with need for mental health care might be a mechanism to reduce children's unmet need. Approaches such as CART, used to identify factors predicting consumer choices in marketing, might be useful to select strategies for social campaigns targeted toward decreasing unmet need.     

Mental Health Needs of Children in School Role of the Child Psychiatric Mental Health Nurse

This article addresses the mental health needs of children in the school system. Children are often exposed to situations in their lives that affect their ability to master developmental and academic tasks resulting in school difficulties. The school system has the opportunity to provide primary prevention and early intervention that will promote the mental health of children. The role of the child psychiatric mental health nurse in the school is described as one model for promoting the mental health of children.     

Bridging Cultures for Latino Children: School Nurse and Advanced Practice Nurse Partnerships

TOPIC:  Barriers to use of mental health services by Latino families include stigma, service costs, and disparity of services with cultural values and traditions. School nurses are in key positions to recognize mental health needs of Latino children and form relationships that facilitate family connections with mental health services. Advanced practice psychiatric nurses may be contracted by school districts to provide consultation to school nurses or may be available to school nurses through connections with school-based health centers. Case examples are provided to illustrate the value of school nurse consultation with an advanced practice psychiatric nurse in promoting awareness of cultural influences on children's symptoms and behaviors and developing culturally sensitive approaches to engage Latino children and families in school and health services.
PURPOSE:  This paper aims to review literature on Latino mental health and present rationale for school nurse and advanced practice nurse partnerships to promote culturally sensitive approaches that facilitate Latino family access and utilization of health services.
SOURCES:  Published literature and case scenarios.
CONCLUSIONS:  With advanced practice nurse consultation, school nurses identify mental health needs of Latino children and develop culturally sensitive approaches that bridge Latino families' access to and utilization of health services.     

A program to educate school nurses about mental health interventions.

Concerned with the increasing incidence of mental health problems in children and adolescents and the impact of these problems on students' school success and predisposition to self- and other-directed violence, the Multnomah Education Service District Department of School Health Services determined to become proactive by providing preventive interventions for students experiencing actual or potential mental health problems. An educational program was designed to assist school nurses in the identification of potential mental health problems. In addition, information about appropriate interventions for students at risk for aggression, violence, and other mental health pathology was presented. The program involved education on mental health assessment and intervention, as well as expert psychiatric clinical support for the development of student support groups. School nurses were then challenged to develop practice improvement projects incorporating this knowledge for a group of students in their work setting. This introductory article describes the project's general rationale and implementation process. The four articles following in this issue of The Journal of School Nursing describe the goals, implementation, and outcomes of the practice improvement projects developed for early intervention with students exhibiting attention disorders, school absenteeism, social withdrawal, and depression.     

Transitioning Children from Psychiatric Hospitals to Schools: The Role of the Special Educator

Over a quarter of a million U.S. students each year reside for a period of time in a psychiatric inpatient hospital setting to receive mental health treatment. Following inpatient treatment, most children are transitioned from the hospital into a regular school setting. Little is known about how these transitions are managed by hospital or school personnel. The current study examined the role of the special education teacher in this transition process. A national sample of special education teachers was surveyed about their involvement in the transition process. The majority of special education teachers reported active involvement in the transition process through contact with parents and hospital personnel. In addition, special education teachers reported behavior problems present in children upon their return to school and the skills, knowledge, or resources that would assist them in facilitating children's transitions. Implications for research, training, and practice are provided.     

Promoting emotional wellness: undergraduate clinical experiences in elementary schools

Historically psychiatric mental health community-based clinical experiences for nursing students were primarily with client populations in traditional settings. Experiences in mental health promotion, while incorporated into most mental health nursing courses, have been limited. The authors describe undergraduate clinical experiences in mental health promotion and prevention of psychiatric problems with elementary school children. The programmatic framework, project overview for clinical experiences, specific examples of projects, outcomes, and evaluation are presented.     

The family-focused mental health practice questionnaire

It is estimated that 1 in 5 children have a parent with a mental illness, and studies have shown that such children are more likely to develop mental health problems when compared with their peers. Research has demonstrated the benefits of mental health clinician family-sensitive practice to both parents and their children; however, a measure of clinician practice is not available. The psychometric properties of a questionnaire measuring family-focused practice in the psychiatric setting are reported here. There were 307 public adult mental health worker participants, predominantly from the nursing profession and working full time. Principal component analysis highlighted 14 subscales that summarize 49 items reflecting organizational and worker factors, such as skill/knowledge about the impact of parental mental illness on children and worker confidence. Subscales are discussed in relation to the literature and psychiatric policy. The measure appears a useful tool for evaluation, benchmarking for training and organizational improvement, and ultimately, for increasing quality services to parents, families, and particularly children associated with psychiatric services.     

School-based Adolescent Mental Health Project Survey of Depression, Suicidal Ideation, and Anger

This study on adolescent mental health was conducted in a school setting. Sixty-nine subjects, aged 16-18 years, were surveyed to provide data on anger, depression, and suicide ideation. Suicide ideation was present in 15.9% of subjects and depression in 14.1%. Subjects with suicidal ideation demonstrated greater levels of anger and poorer anger control. Recommendations are made for psychiatric nurses to collaborate with school administrators to develop programs with specific evaluation criteria to promote adolescent mental health in the schools.     

Identifying the mental health needs of preschool children.

The city of Chicago offers publicly funded preschool education to 20,000 3- and 4-year-olds through its State Pre-Kindergarten program. The students attend some 300 schools, and their health needs are monitored by 11 nurses and 8 aides. In the last several years, the nursing coordinator recognized the need to improve the mental health assessment skills of the school nurses. To that end, a relationship was developed with a child psychiatric nurse who had expertise in assessing young children's behaviors, particularly in the context of the classroom milieu. The collaboration of the school nurse and mental health nurse-consultant was structured as one-on-one sessions, each focusing on a particular child. A case is presented to illustrate the assessment method and accompanying suggestions for early intervention strategies. The case also points out how school nurses can structure assessments of at-risk children that lead to classroom-based interventions.     

不同文化层次精神科护士心理健康状况的调查

目的 了解不同文化层次精神科护士的心理健康状况，研究文化水平对精神科护士的心理健康影响。方法采用精神症状自评量表(SCL-90)对云南省十二个地州十三家医院从事精神科护理的人员进行测评，并将结果加以对照分析。结果不同文化层次精神科护士各因子分及总分由低到高依次为：大专、中专、高中、初中。大专护士除躯体化因子分外的其他各项因子分均低于国内常模。初中护士除人际关系因子分外的其他各项因子分均高于国内常模。大专护士与初中护士文化层次相差较大，各因子分之间的差距也较大，除敌对、偏执因子分外的其他因子分都存在显著性差异。结论文化层次相对高的护理人员心理健康状况也相对较好，心理健康状况由相对较好到差依次为：大专、中专、高中、初中。     

Tough Transitions: Mental Health Care Professionals' Perception of the Psychiatric Hospital to School Transition

Psychiatric reasons are among the most common causes of hospitalization for adolescents. A Consensual Qualitative Research approach was used to explore mental health professionals' perceptions of the needs of adolescents as they transition from psychiatric hospital to school. Academic, social, and emotional domains emerged as important areas of attention prior to and during the psychiatric hospital to school transition. Implications from interviews with 14 mental health professionals working in inpatient, outpatient, and school settings are reported.     

Listen to them draw: screening children in primary care through the use of human figure drawings

This literature review focuses on the Human Figure Drawing (HFD) methods put forth by Elizabeth Koppitz as a screening instrument. Children's drawings have potential as a mental health screening aide for health care practitioners in the primary care setting. This paper focuses on self-portrait drawings as a screening technique for emotional well-being, anxiety, and depression in school-aged children (6-12 years old). Using Koppitz's emotional indicators checklist for mental health, practitioners can use the child's HFD as a quick screening tool. Although the HFD is not diagnostic and can not be used as the sole indicator for anxiety or depression, two or more emotional indicators may signal to the clinician that further psychiatric assessment and referral is needed.     

Nursing Students’ Attitudes about Psychiatric Mental Health Nursing

The purpose of this study was to describe Masters entry nursing students’ attitudes about psychiatric mental health clinical experiences; preparedness to care for persons with mental illness; students’ perceived stigmas and stereotypes; and plans to choose mental health nursing as a career. A 31-item survey was administered to pre-licensure graduate nursing students who were recruited from a Masters entry nursing program from a university in a large city in the Midwestern US. Results indicated that clinical experiences provide valuable experiences for nursing practice, however, fewer students think that these experiences prepare them to work as a psychiatric mental health nurse and none plan to pursue careers as psychiatric mental health nurses. The findings support conclusions from other studies that increasing the amount of time in the clinical setting and adding specific content to the curriculum, particularly content related to the importance of psychiatric mental health nursing and the effects of stigma, may assist the profession's efforts to recruit and retain psychiatric mental health nurses. Further research is needed to determine the effectiveness of these strategies and to identify the best ways to implement them.     

Connectedness, belonging and feelings about school among healthy and chronically ill Icelandic schoolchildren

The purpose of this research was to evaluate the level of school connectedness and feelings about school among Icelandic preteenagers who were either with or without a chronic health condition. The study is cross-sectional with 480 children of 10–12 years old (209 boys and 271 girls) and 38 teachers participating from 12 randomly selected public elementary schools in Reykjavik, Iceland. Data were collected from March 2004 to early June 2004. Independent t -tests and multivariate regression analyses were used to test the hypotheses. Girls were found to report significantly higher connectedness to their school and significantly higher positive feelings about their school than the boys. Children with chronic illnesses were found to report significantly lower school connectedness and significantly lower positive feelings about their school than children without chronic illness(es). Further, Icelandic preteenagers with a mental illness or learning disabilities were found to report significantly lower school connectedness and significantly lower positive feelings about their school than their school mates who had physical chronic illness(es). The teachers' perception of children's social competence significantly predicted both the girls' and the boys' perception of their connectedness to school and feelings about school. Preventive actions need to be taken by school nurses and other school personnel to prevent disengagement in schools, especially for preteenage boys and for chronically ill children, specifically children dealing with mental illnesses or learning disabilities.     

Medical and psychiatric comorbidities in children and adolescents: a guide to issues and treatment approaches

Chronic medical illness among children and adolescents is a growing concern with implications for informal and formal caregivers. When coupled with a psychiatric comorbidity, implications grow exponentially. Nurses who care for child and adolescent populations play a crucial role in optimizing physical and mental health when they interface with patients and their caregivers. Evidence-based interventions can promote positive outcomes and enhance quality of life, whereas failure to use evidence-based approaches has serious consequences to the health of youth with medical and psychiatric comorbidities.     

Teaching children about mental health and illness: a school nurse health education program.

A mental health education program designed by school nurses for children ages 10- 12 was developed in 2000-2001 and expanded with broader distribution in 2004-2005. Six classroom sessions, each 45 minutes in length, provided information and activities to increase children's awareness of mental health and illness. Education program content included facts about the brain's connection to mental health, information about healthy ways to manage stress, resources and activities to promote mental health, common mental health problems experienced by children, and how to seek help for mental health problems. Classes included a combination of didactic presentation and open discussion, encouraging students to ask questions and allowing the school nurse to correct misinformation. Analysis of pre- and posttests from 370 elementary and middle school students revealed statistically significant improvements in their knowledge of mental health and mental illness.     

Predictors of psychiatric symptom scores in a sample of Turkish high school students

Most mental health problems start in adolescence and early adulthood. According to the literature, one out of five children and adolescents suffers at least one mental health problem. In this cross-sectional study, the distribution of psychiatric symptom scores among 728 Turkish high school students in grades 9, 10, and 11 was examined and associated with the students' gender, type of school, and grade level, as well as parental attitudes. The Brief Symptom Inventory and The Global Severity Index were used in this study. The latter is a global index of the former, and assesses indications of psychopathological disturbance. Girls score significantly higher than boys on all subscales of the Inventory, and specifically the Index. The highest Global Severity Index scores were obtained from the students who were attending vocational high schools, those who were in 11th grade, and those who indicated indifferent parental attitudes. This study revealed the need for a closer investigation of those students who are at severe risk of mental health problems.     

Juvenile Mental Health Courts for Adjudicated Youth: Role Implications for Child and Adolescent Psychiatric Mental Health Nurses

TOPIC: Juvenile mental health courts for adjudicated youth. PURPOSE: To describe the role of psychiatric nurses in reducing mental health disparities for adjudicated youth via juvenile mental health courts. SOURCES: ISI Web of Knowledge; Sage Journals Online; HighWire; PubMed; Google Scholar and Wiley Online Library and websites for psychiatric nursing organizations. Years included: 2000–2010. CONCLUSIONS: Juvenile mental health courts may provide a positive and effective alternative to incarceration for youth with mental health problems with psychiatric nurses playing a key role in program implementation.     

School refusal in children and adolescents

School refusal is a problem that is stressful for children, families, and school personnel. Failing to attend school has significant short- and long-term effects on children's social, emotional, and educational development. School refusal often is associated with comorbid psychiatric disorders such as anxiety and depression. It is important to identify problems early and provide appropriate interventions to prevent further difficulties. Assessment and management of school refusal require a collaborative approach that includes the family physician, school staff, parents, and a mental health professional. Because children often present with physical symptoms, evaluation by a physician is important to rule out any underlying medical problems. Treatments include educational-support therapy, cognitive behavior therapy, parent-teacher interventions, and pharmacotherapy. Family physicians may provide psychoeducational support for the child and parents, monitor medications, and help with referral to more intensive psychotherapy.