Mental health services in schools: utilization, effectiveness, and consent.

Western Psychiatric Institute and Clinic/University of Pittsburgh Medical Center, PA 15213, USA.
Clinical Psychology Review (Impact Factor: 7.18). 04/1999; 19(2):165-78.
Source: PubMed


The integration of education and behavioral health services in schools continues to evolve at a rapid pace. Proponents argue that school-based behavioral health programs have many benefits, including greater access to care and improved effectiveness as compared to clinic- or hospital-based services. While preliminary research is encouraging, in general the claims of school behavioral health are not supported by data. Some critics focus on negative aspects of school behavioral health. They claim that behavioral health is being forced upon students and can cite many examples of counseling and treatment administered to children without parental consent. Utilization, effectiveness, and consent are three topics that deserve a great deal of attention in this emerging field, and are the focus of this review.

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    • "Universal prevention interventions conducted in the school context have many advantages including reducing recruitment, screening, transportation and attrition difficulties, and reaching a broad range of children and adolescents with varying levels of psychopathology, ranging from those at risk, to those with sub-clinical or clinical symptoms. Furthermore, potential advantages involve reducing stigmatization, enhancing peer support and reducing psychosocial difficulties within the classroom, and thus promoting learning and healthy development in children and adolescents (Amburster, Andrews, Couenhoven, & Blau, 1999; Evans, 1999; Kubiszyn, 1999). "
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    • "The effectiveness of school-based mental health programs has been well-documented (Burns and Hoagwood 2004; Hoagwood and Burns 2005; Kazdin 2005; Stephan et al. 2007). School-based mental health services have been shown to enhance access to other services (Cappella et al. 2011; Weist et al. 1999), assist in reducing the stigma of seeking help from formal sources (Nabors and Reynolds 2000), promote generalization and maintenance of treatment gains (Evans 1999), improve school climate by increasing the perceptions of support available to students and teachers (Bruns et al. 2004; Walrath et al. 2004), and promote a natural, ecologically grounded approach to helping children and families (Atkins et al. 2003; Weist et al. 1999). However, despite the availability of mental health services in most schools, youth with mental health problems (especially ADHD, depression) still face difficulties in accessing them (Foster et al. 2005; Nabors and Reynolds 2000; USDHHS 2001). "
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    ABSTRACT: Black adolescents with mental health problems are less likely than non-Black adolescents with mental health problems to receive treatment, primarily for non-financial reasons including negative perceptions of services and providers, and self-stigma associated with experiencing mental health problems. To better understand these obstacles, 16 adolescents and 11 caregivers, recruited from two K-8th grade elementary-middle schools, participated in four focus groups guided by the unified theory of behavior to explore mental health help-seeking behaviors and perceptions of mental health services. In the focus groups, caregivers acknowledged more positive attitudes about seeking mental health services than adolescents, but both expected the experience of actually doing so to be negative. Adolescents and caregivers also acknowledged social norms that inhibit their mental health help-seeking. Therefore, we conclude that interventions targeting expectancies and social norms might increase the connection of urban, under-resourced Black adolescents and their families to mental health services, and be particularly important given the long-term consequences of untreated mental health problems for this group.
    Journal of Child and Family Studies 01/2013; 22(1):107-121. DOI:10.1007/s10826-012-9668-z · 1.42 Impact Factor
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    • "A final point of discussion surrounds the issue of consent and confidentiality. Evans (1999) raised consent as a key issue for school mental health programs, particularly the need for parental consent. While a broad discussion of consent and confidentially is beyond the scope of this paper, we briefly raise some aspects in the COPE process relevant to this issue. "
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    ABSTRACT: Expanding linkages between mental health services and schools is one strategy to improve early access to help children with emerging mental health problems. However, there are few descriptions of such outreach efforts in Canada. This report describes one model used in Alberta, Canada. Key aspects of the organization and operation of the Community Outreach in Pediatrics/Psychiatry and Education (COPE) program are described. The COPE program provides child psychiatric and paediatric consultations to families and schools throughout the elementary school systems in the Calgary and Rocky View School Districts in Alberta, Canada. Participating schools refer prioritized children with emotional, behavioural and/or developmental problems. After an inter-professional screening process, most children go on to a physician-based assessment within the school setting which involves the child, family and key school personnel. Following assessment, an action plan is developed and attempts are made to link children and families with needed services. The COPE program represents one approach to linking mental health services with students through schools. Further study is required to determine the range of such models used in Canada. In addition, evaluation of these and other models are sorely needed to better determine the cost-effectiveness of these approaches.
    Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent 09/2008; 17(3):122-30.
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