School Mental Health and Foster Care: A Logical Partnership

School mental health is increasingly recognized as an effective framework of care for enhancing access to high quality mental health services for school age youth. This article discusses the potential role that school mental health can play in helping to address the mental health needs of children and adolescents in foster care, a group with elevated risk for mental health and educational problems when compared to other children and adolescents living in high risk environments. A full continuum of school mental health services, from prevention to intervention, offers opportunities to reach these youth before academic and emotional-behavioral problems escalate. Benefits and challenges to providing services to youth in foster care through school mental health are discussed and next steps toward developing a training curriculum that addresses core competencies needed for effective school-mental health-foster care integration are addressed.     

What works where? A systematic review of child and adolescent mental health interventions for low and middle income countries

Purpose

Child and adolescent mental health (CAMH) problems are common and serious all over the world and are linked to pre-mature deaths and serious dysfunction in adult life. Effective interventions have been developed in high income countries (HIC), but evidence from low income settings is scarce and scattered. The aim of this paper is to identify the most promising interventions in the area of global CAMH.

Method

A systematic review of all randomised controlled trials in CAMH in low and middle income countries (LAMIC) was carried out and supplemented by 1a level evidence from HIC as well as suitable information from child programme evaluations and adult studies in LAMIC.

Results

In behavioural disorders parent training is a highly promising intervention, which can successfully improve children’s compliance and bring down rates of conduct problems significantly. In young children cognitive, emotional and behavioural development can be enhanced through nutritional supplements and by stimulation through play, praise and reading. Trauma treatments can bring positive results even in severely traumatised children, who remain in unstable living conditions. In developmental disorders, there are successful prevention strategies as well as programmes that bring children out of isolation and improve their independence. Some classroom-based interventions for adolescents have reduced symptoms of common mental disorders as well as risk taking behaviours.

Conclusions

While many results are still tentative the evidence suggests that it is possible to develop affordable and feasible interventions that significantly improve the lives of affected children, their families and their communities around the world.     

How to improve the mental health care of children and adolescents in Brazil: Actions needed in the public sector

Introduction:Child/adolescent mental health (CAMH) problems are associated with high burden and high costs across the patient's lifetime. Addressing mental health needs early on can be cost effective and improve the future quality of life.Objective/Methods:Analyzing most relevant papers databases and policies, this paper discusses how to best address current gaps in CAMH services and presents strategies for improving access to quality care using existing resources.Results:The data suggest a notable scarcity of health services and providers to treat CAMH problems. Specialized services such as CAPSi (from Portuguese: Psychosocial Community Care Center for Children and Adolescents) are designed to assist severe cases; however, such services are insufficient in number and are unequally distributed. The majority of the population already has good access to primary care and further planning would allow them to become better equipped to address CAMH problems. Psychiatrists are scarce in the public health system, while psychologists and pediatricians are more available; but, additional specialized training in CAMH is recommended to optimize capabilities. Financial and career development incentives could be important drivers to motivate employment-seeking in the public health system.Conclusions:Although a long-term, comprehensive strategy addressing barriers to quality CAMH care is still necessary, implementation of these strategies could make.     

School nurses' perceived prevalence and competence to address student mental health problems

Due to under-identification of student mental health problems and limited specialty mental health providers in schools, school nurses are often faced with identifying and addressing student mental health needs. This exploratory study assessed prevalence and types of student mental health problems encountered by school nurses, as well as their prior training, perceived competence and levels of comfort addressing such problems. Data collected at a 2010 National Association of School Nurses conference from 78 school nurses suggest that in their view, 31% of students present with mental health concerns as their ‘primary’ presenting issue. School nurses reported moderate levels of comfort identifying specific problem areas, but limited comfort in mental health intervention and pre-service training to identify, assess, make referrals and/or intervene. Perceived competence identifying mental health concerns overall was predictive of perceived competence to make referrals. Implications and recommendations for professional development are presented.     

Establishing and Maintaining Important Relationships in School Mental Health Research

For this article, we investigated a complicated (and hypothesized, little-studied) area in school mental health research: namely how researchers establish and maintain successful relationships with key stakeholders in school settings. We identified key stakeholders that school mental health researchers have to consider when engaging in school-based research. Parents, youth, teachers, school leadership, school mental health professionals, district-level leaders, and community mental health partners are each specific stakeholders who may have differing (or even competing) agendas than that of the research team. In addition, professionals within these groups may have concerns or even suspicions about the researchers’ involvement in their school. To better understand these complex relational issues, we conducted a survey of leading school mental health researchers based on a convenience sample of researchers who attended a national school mental health research summit in October 2012. The survey data revealed that successful school mental health researchers have to continually work at creating and maintaining good relationships with school stakeholders, and consider these relationships crucial to conducting this research. In this article, we will describe barriers to recruitment and implementation and methods of overcoming the challenges identified in several case studies of school-based research in published articles and from our survey data. We present this information and propose a preliminary best practice model to developing and maintaining relationships with school professionals in SMH research.     

Beginning Steps in School Mental Health in India: A Teacher Workshop

As emphasised by this journal, school mental health (SMH) programmes and services, when done well, lead to valued outcomes for students and systems focused on children and adolescents. However, SMH is nearly non-existent in India. Acute scarcity of trained manpower is the main stumbling block. It is therefore imperative to facilitate the process of SMH with some alternative measures, and one way is to enable the primary stakeholders. Towards this end, at the Central Institute of Psychiatry, Ranchi, India a workshop for teachers was conducted which focused on various aspects of SMH. The effectiveness of the workshop was assessed with the help of pre-post and five-month follow-up assessments which showed increased understanding by teachers of psychological problems in children from participation in the workshop. Admittedly, this is a very early step, but we hope that our experiences will be helpful in moving SMH forward in developing nations.     

Patterns of Child and Adolescent Mental Health Care in Greece

During the last 20 years the mental health care system in Greece underwent a dramatic change; the implementation of the EEC Reg. 815/84 programme contributed to a significant shift towards the extramural care and rehabilitation of patients with long-term mental health problems. The child and adolescent mental health (CAMH) care system was transformed by this change to a lesser degree. Despite bureaucratic obstacles and other difficulties, a substantial number of CAMH outpatient services have been developed in Greece. They are concentrated mainly in the larger cities and they focus on providing assessment and to some extent therapy and counselling; prevention and promotion of CAMH are not yet perceived as priority areas. In addition, there is a lack of specialised day care services for specific populations such as young people with disorders of the autistic spectrum and intellectual disabilities. There have been some recent improvements in education and research in the field of CAMH but these sectors are in need of further investment and development. Unfortunately, the current economic crisis has affected both the development of new services and the optimal functioning of those already in operation. Nevertheless, Greece must invest in CAMH and the rights of the children and young people should be protected.     

Training Health Professionals for Child and Adolescent Mental Health Care in Nigeria: A Qualitative Analysis

There is no organised training and service for CAMH in Nigeria. A 3-day course in child mental health aimed at multidisciplinary health professionals was developed and evaluated to inform future training. Developing the course involved multi-professional consultation. Course evaluation involved the completion of questionnaires by delegates (present from 5 of the 6 geopolitical zones of Nigeria) before and after the training. Training needs expressed include skills to manage CAMH problems in their own context, greater understanding of normal child development and strategies to train others. Most participants reported that their expectations were met and would affect their practice especially with regard to collaboration.     

Sensitizing the teachers towards school mental health issues: an Indian experience

The School Mental Health (SMH) services play critical roles fostering positive mental health and helping children with psychological problems. Despite its proven value, SMH services remain less developed in India. In this context, sensitizing teachers about child mental health issues could be considered as an important step in SMH promotion. Towards this goal, a large scale sensitization program for school teachers on SMH issues was carried out in an Indian city. This paper reports the process and the outcome of this sensitization program.     

Editorial: CAMH – meeting the changing mental health needs of children in the 21st century

This is a challenging time for all journals but particularly for those such as CAMH, which must achieve a balance between informing, influencing and transforming the quality and effectiveness of the mental healthcare available to children, young people, their parents and families, while endeavouring to publish high‐quality scientific papers in terms of indicators such as the impact factor (IF). It is also a challenging time more widely in terms of the changing mental health needs of children, and the ability of CAMH services to meet them. This editorial discusses a number of changes that will be made the CAMH journal in 2017 to address these issues.     

The Role of Teachers in School-Based Suicide Prevention: A Qualitative Study of School Staff Perspectives

In response to concerns over youth suicide, there has been an increase in school-based suicide prevention programs. However, we know little about teacher perspectives on school-based suicide prevention and mental health programs. This study examined teacher roles in the implementation of a district-wide suicide prevention program through focus groups and interviews with middle school teachers, administrators, and other school personnel. Study results highlighted teachers’ critical role in detecting students at risk for suicide. Factors that appeared to facilitate teacher participation in the suicide prevention program included well-defined crisis policies and procedures, communication of these procedures, collaboration across staff, and the presence of on-campus mental health resources. Participants identified a need for direct teacher training on risk factors for suicide, crisis response, and classroom management. Other strategies for improving suicide prevention efforts included in-school trainings on mental health resources and procedures, regular updates to these trainings, and greater visibility of mental health staff.     

Looked After Children in Residential Homes

Background: Looked after children in residential children's homes constitute a particularly vulnerable group who are known to have high rates of mental health problems and limited access to services.
Method: A survey was undertaken in Leeds to determine what proportion of these children are involved with mental health services, and to look at the different ways in which child and adolescent mental health services across the city are currently working with this group.
Results: Of the 177 children in residential children's homes in August 2000, 64% had had some contact with child mental health services in the previous 5 years and 27% were in current contact. Thirty-six percent had had no contact with services over the past five years.
Conclusions: It was anticipated from a review of the literature that a higher proportion of children would have been currently in contact with services. The findings suggest that the pattern of services offered to this group of children is changing, with an increase in consultation with, and training of, staff in residential children's homes. The paper ends with a discussion of whether or not this is a positive change and how CAMH resources might best be utilised in the future.     

Introduction: Looked‐after children

Looked‐after children (LAC) (also known as children in care) are among the most vulnerable group in our society. This is in terms of their risk of a range of poor outcomes including mental health, educational attainment and social wellbeing (Meltzer, Gatward, Corbin, Goodman, & Ford, 2003). Over the past decade, it has become increasingly clear that LAC have a higher prevalence of mental health problems than the general population, including children living with their families in ‘high‐risk’ populations. These children present with high rates of, not only emotional and behavioural problems, but also neurodevelopmental problems. The present Virtual Issue focusing on the mental health of this group of young people brings together research published in CAMH over the past 15 years.     

Child and Adolescent Mental Health Policies,Programmes and Infrastructures across Europe

To support development of effective policy and action for child and adolescent mental health (CAMH), key national and/or regional information on monitoring, evaluation, obstacles and opportunities in CAMH from 15 European countries was collected. National expert groups in each country were created to collect the data and complete a specially designed questionnaire. The data highlight that 1) the implementation and outcomes of CAMH policies and action plans are not assessed systematically in Europe, 2) prevalence data on positive mental health, mental disorders and risk, and vulnerable populations is heterogeneous and patchy across Europe, 3) children and adolescents are rarely involved in decision-making processes affecting CAMH practices, 4) CAMH issues are not included in all relevant higher education qualifications, 5) budgets dedicated to CAMH issues are not identifiable, specific or sufficient in the long term, and 6) stakeholders and the general public are not considered to be widely aware of the determinants of CAMH.     

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.     

Training School Mental Health Providers to Deliver Cognitive-Behavioral Therapy

Anxiety disorders are among the most prevalent mental health difficulties experienced by youth. A well-established literature has identified cognitive-behavior therapy (CBT) as the gold-standard psychosocial treatment for youth anxiety disorders. Access to CBT in community clinics is limited, but a potential venue for the provision of CBT for child anxiety disorders is the school setting. The present study examined a subset of data from a larger study in which therapists from a variety of settings, including schools, were trained in CBT for child anxiety (N?=?17). The study investigated the relationship between provider- and organizational-level variables associated with training and implementation among school mental health providers. The present findings indicate a positive relationship between provider attitudes and adherence to CBT. Self-reported barriers to implementation were also identified. Integrating CBT into school mental health providers?? repertoires through training and consultation is a critical step for dissemination and implementation of empirically supported psychosocial treatments.     

Mental Health Center and School District Partnership for Emotionally Disturbed Children

The award winning partnership between a school district and mental health facility to operate a special day program for severely emotionally disturbed children is described. The Northside Independent School District in San Antonio, Texas has contracted with the Southwest Mental Health Center for 15 years to provide clinical program management, counseling, and consultation plus the behavior management services by mental health workers. Over fifty elementary age children participate daily in the Northside Children's Center therapeutic program. The District assigns special education teachers and necessary support staff for this program plus the school facility. Parent satisfaction has been positive and school attendance is congruent with both District and State averages for regular students.     

Building Child and Adolescent Psychiatry Expertise in Ghana Through Training and Knowledge Dissemination: a Review of the Initial Collaboration Stages,Opportunities, and Challenges

Purpose of Review

Improving child and adolescent mental health (CAMH) is a priority worldwide. The majority of children with psychiatric conditions in low-middle-income countries (LMIC), like Ghana, receive no treatment due largely to limited resources and few CAMH training opportunities. The Komfo Anokye Teaching Hospital (KATH) and University of Michigan (UM) established a partnership to expand CAMH training for general psychiatrists in Ghana. Lessons learned from the early stages of the collaboration can serve as an adaptable roadmap for similar efforts to expand CAMH training in LMIC.

Recent Findings

Previous articles have discussed global academic partnership, training, and capacity building programs; however, early challenges, opportunities, and preparatory stages involved in creating a mutually beneficial collaboration aimed at improving child psychiatry expertise in a LMIC are under explored in the global mental health literature. This article seeks to fill that gap by using examples to highlight unique considerations for institutions in the initial stages of establishing their global partnership.

Summary

The early stages of a global partnership can impact the success of the collaboration. Collaborations should be bi-directional, sensitive to local culture, and flexible and establish achievable sustainable goals.