Developing Principles for Best Practice in Expanded School Mental Health

On the basis of activities of a federally funded national center for school mental health, review of literature on principles for best practice in child and adolescent mental health and school health, and consultation with national experts and family members, a set of 10 principles for best practice in school mental health was developed. A survey was developed enabling 1–6 point Likert ratings (clearly unimportant to clearly important) for each of the 10 principles. With an original sample of 426 people involved in education, school health or mental health, all 10 principles were strongly endorsed, receiving mean ratings ranging between 5.10 and 5.75. On the basis of qualitative feedback from this survey and interactive forums, language for 9 of the 10 principles was revised and a survey reflecting these changes was developed and administered to a validation sample of 86 respondents. As with the original sample, endorsements of the principles were strong, with mean ratings ranging between 5.45 and 5.79. Findings are discussed in relation to advancing interconnected agendas related to quality assessment and improvement and empirically supported practice in school mental health.     

Expanded School Mental Health: Challenges and Opportunities in an Emerging Field

Reviews the need for and development of expanded school mental health (ESMH) programs, which provide a continuum of mental health promotion and intervention through school–community partnerships. Since ESMH is a relatively new, but increasingly prominent field, countless issues are being addressed in practice and research and in efforts to bridge practice and research. We review particular content and context dimensions of ESMH in need of development including quality assessment and improvement, empirically supported practice, improving assessment and outcome evaluation, involving educators in the work, understanding school environments, and tailoring programs through qualitative research. Summaries of articles that amplify these themes are provided.     

When There Is No Blueprint: The Provision of Mental Health Services in Alternative School Programs for Suspended and Expelled Youth

A variety of alternative programs are being implemented in Canada and the United States for students who have exhibited conduct problems and who are suspended or expelled from their schools. Given the complexity of issues that these students frequently face, treatment must be multifaceted, wrap-around, delivered by trained professionals and be targeted to these students' unique biopsychosocial needs. This article reviews the literature on delivery of mental health services within the broader school-based context. Specific mental health issues endemic in the high-risk adolescent demographic are highlighted, and implications for mental health professionals, particularly psychologists, working with such individuals are discussed. Suggestions are made with respect to screening and assessment instruments and treatment.     

Parental Cultural Affiliation and Youth Mental Health Service Use

Studies indicate that African American, Asian/Pacific Islander, and Latino youth have higher rates of unmet mental health needs and lower rates of mental health service utilization compared to non-Hispanic White youth, suggesting that obstacles may exist in the help-seeking and service utilization pathway for minority youth. Parental cultural factors may significantly impact youth service use, and acculturation is one way to measure adherence to culture specific values, beliefs, attitudes, and behaviors. In this study, parental acculturation level, conceptualized as cultural affinity to 1) mainstream American culture and 2) an alternative culture, were examined as potential mediators of the relationship between race/ethnicity and youth service use. The current subsample (n=1364) was drawn from the Patterns of Care study, a larger study of at-risk youth who were active to at least one of five public sectors of care. Our subsample included all youth aged 6–17 who were African American, Asian/Pacific Islander, Latino, or Non-Hispanic Whites (66.6% male). The results indicate that parental acculturation level as measured by affinity to an Alternative Culture was a partial mediator in the relationship between race/ethnicity and mental health service use for Asian/Pacific Islander and Latino youth. Doctoral student in the SDSU/UCSD Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 100, San Diego CA, graduate research assistant, Child and Adolescent Services Research Center, Children’s Hospital, San Diego, 3020 Children’s Way (MC 5033), San Diego, CA 92123 Assistant Professor of Psychology, San Diego State University; Assistant Adjunct Professor of Psychiatry, University of California, San Diego, Research Scientist, Child and Adolescent Services Research Center, San Diego, 3020 Children’s Way (MC 5033), San Diego, CA 92123 Research Scientist, Child and Adolescent Services Research Center, Children’s Hospital, San Diego, Assistant Professor of Psychology, University of San Diego; Adjunct Assistant Professor of Psychiatry, University of California, San Diego, 3020 Children’s Way (MC 5033), San Diego, CA 92123 Research Professor of Psychiatry and Family and Community Medicine at the University of New Mexico, Adjunct Professor of Psychiatry at the University of California, San Diego; Emeritus Professor of Sociology at San Diego State University; Senior Research Scientist at the Child and Adolescent Services Research Center, Children’s Hospital, San Diego, 3020 Children’s Way (MC 5033), San Diego, CA 92123     

One Small Step at a Time: Implementing Continuous Quality Improvement in Child and Youth Mental Health Services

Continuous quality improvement (CQI) is increasingly being adopted by health care, including child and youth mental health services. As part of the commitment to ongoing quality improvement, child and youth mental health teams in the Fraser region in British Columbia undertook CQI projects over a one year period (2007–2008). The projects covered a range of domains and service features and staff gained experience in developing projects. Patience, management support and ongoing dialogue were key elements in the implementation of CQI. Three projects are highlighted to illustrate how teams developed their own unique projects and the outcomes.     

Rationale and Strategies for Central Involvement of Educators in Effective School-Based Mental Health Programs

Unfortunately, for many mental health professionals classroom teachers and other educators are, at best, viewed primarily or solely as useful sources of information about a child, and their broader, invaluable roles as members of the mental health team are diminished or dismissed. This article examines the conceptual rationale and empirical support for central involvement of educators (especially classroom teachers) in effective mental health services, and in effective expanded school-based mental health programs. The importance of partnerships with educators for school-wide mental health promotion efforts, as well as for the success of primary and secondary prevention initiatives, are highlighted. Effective strategies and recommendations for enhancement of educator-mental health professional collaboration are included.     

Factors Associated with Physician Discussion of Health Behaviors with Adolescents

Behaviors developed in adolescence influence health later in life. The purpose of this study was to investigate the frequency of health care provider's discussion of health behaviors with overweight and non-overweight adolescents and identify demographic and health behaviors related to exercise, hours of television viewing, and weight issues associated with these discussions. A Cross sectional survey of urban adolescents was conducted. Trained interviewers administered surveys over a three month period in 2001 at an urban academic pediatric and adolescent clinic. The 252 adolescents surveyed had a mean age of 15 with 49% categorized as being at risk for overweight/overweight and 51% as normal weight using the CDC percentiles for BMI. While 16% of the adolescents reported that their physician or nurse discussed the amount of television they watched, rates of discussion related to exercise (58%), and weight (54%) were much higher. In multivariate analyses, health care provider discussions with adolescents regarding exercise were more common for overweight (O.R.=2.42, 95% C.I. [1.28–4.57]) and at risk for overweight (O.R.=1.98, 95% C.I. [1.03–3.81]) adolescents, whereas physician discussion of television viewing was not associated with weight. Discussions of weight were more common for female (O.R.=2.18, 95% C.I. [1.21–3.95]), African-American (O.R.=2.53, 95% C.I. [1.40–4.57]), and overweight (O.R.=3.92, 95% C.I. [1.97–7.81]) adolescents. Even after adjusting for weight, race and gender strongly influenced the frequency of discussions about weight in physician offices. Although health care providers frequently address weight and exercise with adolescents, more discussions related to sedentary behaviors such as television viewing may be warranted to address adolescent obesity.Received PhD in Epidemiology from University of California, San Diego. Research interests include smoking prevention and cessation among adolescents and health promotion interventions.Received MD from University of Missouri-Kansas City and MPH from Johns Hopkins University. Research interests include health services research and research in support of measurable, systematic improvements in the quality of medical care.Received medical degree from Christian Medical College, Punjab, India and Master of Public Health from University of Kansas School of Medicine. Research interests include diet and physical activity behaviors, role of the environment in obesity and obesity prevention, especially among children and adolescents.Received MBBS from Allama Iqbal Medical College, Punjab University, Lahore, Pakistan and MPH from University of Kansas Medical Center. Research interests include smoking cessation, database design, implementation, data management and analysis, and use of information technology in health care settings.Director, Cancer Prevention, Control, and Population Sciences, Kansas Cancer Institute. Received MD/MPH from Tulane University and MS from Harvard School of Public Health. Research interests include disparities in healthcare; smoking cessation among underserved populations, specifically African Americans; diet, nutrition, obesity, and physical activity.     

The Impact of Gender and Family Processes on Mental Health and Substance Use Issues in a Sample of Court-Involved Female and Male Adolescents

Greater empirical attention directed toward gender-sensitive assessment strategies that concentrate on family-specific factors is thought to be both timely and necessary, especially with regard to outcome variables associated with mental health and substance abuse in at-risk adolescent populations. A sample of 2,646 court-involved adolescents was used to test two competing models regarding relationships among disruptive family processes, mental health (as both internalizing and externalizing problems), and substance abuse issues according to gender. The results of multiple group structural equation modeling procedures indicated that disrupted family processes were significantly associated with higher levels of internalizing problems, externalizing problems, and substance abuse in both male and female youth. For females, however, disrupted family processes were more related to internalizing problems and substance abuse than externalizing problems. Further, the relationship between disrupted family processes and substance abuse was not mediated by mental health issues, indicating a lack of support for the alternative model tested in this study. Together, the findings underscore the primacy of the family’s impact on issues related to adolescent development and well-being in tandem with the need for a more gender sensitive approach to the needs of court-involved males and females.

Trajectories of Anxiety During Elementary-school Years and the Prediction of High School Noncompletion

Previous research has provided mixed results regarding the effect of anxiety on academic achievement. Building on this body of research, the present longitudinal study pursued two goals. The first goal was to describe trajectories of anxiety during elementary-school years. The second goal was to determine the predictive value of these trajectories on high school noncompletion after controlling for personal (i.e., gender, classroom behaviors, and academic achievement) and familial (i.e., sociofamilial adversity) characteristics. A community sample of 1,817 children (887 boys, 930 girls) participated in this study. Results showed that anxiety tended to fluctuate from kindergarten to Grade 6 for different groups of children. Furthermore, the result of a logistic regression analysis indicated that group membership for anxiety predicted high school noncompletion by age 20. As a whole, these findings suggest that considering heterogeneous developmental patterns of anxiety during elementary-school years appears quite useful for predicting an important outcome such as high school noncompletion.

Maternal Acceptance as a Moderator of the Relation Between Threat to Self Appraisals and Mental Health Problems in Adolescents from Divorced Families

Appraisals about the implications of stressful events that are evaluated as involving a threat to self (negative self-evaluation, negative evaluation from others, rejection by others) have been shown to place youth at risk for the development of mental health problems. This longitudinal study tested a protective-stabilizing interactive model, in which high maternal acceptance was predicted to mitigate the prospective relation between threat to self appraisals and change in adolescents’ mental health problems six months later. Participants were 89 adolescents from divorced families ages 10–12 and residential mothers. Adolescents reported on threat to self appraisals from the most stressful event experienced in the past month. Mothers and youth reported on maternal acceptance and mental health problems. Multiple regression analyses provided support for the protective effects of maternal acceptance on adolescents’ mental health problems. Intervention implications are discussed. Ana Brown is a pre-doctoral fellow in prevention research (NIMH 2 T32 MH18387–19) and doctoral student in the Department of Psychology at Arizona State University, Tempe, AZ. Research interests include the study of children’s appraisals and responses to stressful events in the prevention of mental health problems. Sharlene Wolchik is a clinical psychologist and professor in the Department of Psychology at Arizona State University, Tempe, AZ. Her research focuses on identifying risk and protective factors for children whose parents have divorced. She also has designed and evaluated the efficacy of preventive interventions for children from divorced families and children who have experienced parental bereavement. Jenn-Yun Tein is a research associate professor and Co-Director of the Research Methodology Core of the Prevention Research Center at Arizona State University, Tempe, AZ. Her research interests include analyses of mediation and moderation of preventive interventions as well as applications of methodology and statistics in prevention research. Irwin Sandler is a Regents’ Professor in the Department of Psychology and Director of the Prevention Research Center at Arizona State University, Tempe, AZ. His research interests focus on understanding resilience for children exposed to stress and on the development, evaluation and dissemination of programs to promote resilience and prevent mental health problems for children in stress.     

Facilitating Help Seeking Behavior and Referrals for Mental Health Difficulties in School Aged Boys and Girls: A School-Based Intervention

Although the need for early intervention for mental health difficulties is widely acknowledged, few studies have attempted to explicitly increase actual help seeking behavior for mental health difficulties. Students in intervention classrooms received two one-hour, in-class workshops on distress and help seeking and were compared to students in non-intervention classrooms in a 2-level hierarchical model. More frequent help seeking behavior and more mental health referrals were observed among students in the intervention group than among students in the comparison group. Effects were moderated by the level of distress experienced by students, but not by help seeking attitudes, and could not be accounted for by school staff referrals or website utilization. Results showed that help seeking behavior for mental health difficulties and mental health referrals can be increased with only a moderate investment in time, but that benefits of school-based intervention may be greatest among students with specific needs, such as high levels of distress.

Feasibility of the <Emphasis Type="Italic">MindMatters</Emphasis> School Mental Health Promotion Program in American Schools

Assessed the feasibility of the Australian MindMatters program, a whole school mental health promotion program for application in the United States (U.S.). Forty-two participants representing school and community stakeholder groups from four U.S. communities (urban, rural, suburban, small town) evaluated the program for application in their communities through a research process involving discussion and endorsement ratings of relevance and likely impact. The majority of participants (85%) indicated that the program would help students in their community schools feel safe and valued, and participants indicated strong endorsement for MindMatters curriculum units focusing on suicide prevention and addressing bullying and harassment. Participants rated their own stakeholder group (e.g., teacher, school administrator, and parent) as being most likely to support and implement the program, suggesting that providing qualitative feedback on a program may help to increase a sense of ownership over it. Ideas for tailoring programs developed in other settings for application in local communities are discussed.     

关于解决北京市劳动模范医疗问题的调查与思考

劳动模范为国家和社会做出了突出贡献,他们是国家的宝贵财富。党和政府历来都十分重视劳模工作。近年来,随着国家医疗制度的改革,劳模因医疗负担过重造成劳模生活困难。针对出现的新问题,开展调查研究,找出问题根源,制定措施,切实解决劳模困难。     

转型期员工心理健康服务研究：工会模式- 以辽宁省为例

转型期员工面临较大的压力,心理健康问题比较突出。工会在提供心理健康服务方面兼备效率和效果的双重优势,采用分段购买方式与专业机构建立"委托—代理—共建"关系,以"心理健康服务共享中心"(PHSSC)为核心,将会费作为服务经费的主要来源,由专业人员提供服务并收集相关数据进行分析和趋势预测,制定相应的管理与监督机制,通过专业服务保障并提升员工心理健康水平。     

Gender Differences in the Longitudinal Impact of Exposure to Violence on Mental Health in Urban Youth

There is evidence of gender differences in psychopathology during adolescence, but little research has investigated gender differences in trauma-related symptoms. Exposure to violence is a commonly experienced potentially traumatic event among urban adolescents, and the few studies examining gender differences in its mental health impact have produced inconsistent findings. The present study examines the moderating effects of gender on the longitudinal association between exposure to violence and a variety of mental health symptoms (externalizing, internalizing, PTSD, dissociation) in a racially diverse urban adolescent sample (N = 615; 50.6% female; Time 1 mean age = 14.15; Time 2 mean age = 16.70). For both genders, exposure to violence prospectively predicted increases in all types of symptoms. Although boys reported more exposure to violence on average, girls experiencing violence were more likely to experience dissociative (but not PTSD, internalizing, or externalizing) symptoms. The results suggest that adolescent girls exposed to potentially traumatic events may be especially vulnerable to experiencing certain trauma-related symptoms and imply gender-specific pathways to trauma-related psychopathology.     

The Impact of Pubertal Timing and Parental Control on Adolescent Problem Behaviors

This study examined the relationship among pubertal timing, parental control, and problem behaviors. There were 267 participants, whose ages ranged from 9 to 16 years. Both maternal and paternal psychological control predicted problem behaviors over and above the effects of behavioral control. For boys, early maturation and high levels of paternal psychological control, whereas for girls, on-time maturation and low levels of paternal psychological control were associated with low levels of internalizing problem behaviors. Early maturation and high levels of maternal psychological control predicted high levels of externalizing problem behaviors. The implications of these findings were discussed in terms of the detrimental effects of psychological control on adolescent wellbeing, the role that pubertal timing may or may not play during this period, and finally the need to separately examine fathers’ parenting and mothers’ parenting while investigating the impact of parental control on adolescent problem behaviors. Rübab G. Arım is a Doctoral Student at the University of British Columbia. She received her M.A. degree in Human Learning, Development, and Instruction from the University of British Columbia. Her major research interests include evaluating the long-term impact of biological and contextual factors on adolescent problem behaviors. Jennifer D. Shapka is an Assistant Professor at the University of British Columbia. She received her Ph.D. in Human Development and Applied Psychology from the University of Toronto. Her major research interests include identifying patterns of risk and protective factors impacting adolescent well-being over time.     

Mental Health Literacy and Eating-Disordered Behavior: Beliefs of Adolescent Girls Concerning the Treatment of and Treatment-Seeking for Bulimia Nervosa

This research examined the “mental health literacy” of adolescents concerning eating-disordered behavior. A vignette describing a fictional 16-year old female meeting diagnostic criteria for bulimia nervosa was presented to 522 female high school students, followed by a series of questions concerning treatment of and treatment-seeking for the problem described. Results indicated that primary care practitioners, mothers and close female friends were most highly regarded as potential sources of help. Self-help interventions, including the use of vitamins and minerals, were also highly regarded, whereas participants were less positive about the benefits of mental health specialists and ambivalent about the use of anti-depressant medication. Most participants believed that the problem described would be difficult to treat, and that relapse was likely even given appropriate treatment. An additional finding of note was that among participants with a high level of eating disorder symptoms (n=36, 6.9%), recognition of an eating problem was poor. We conclude that beliefs likely to be conducive to low and/or inappropriate treatment-seeking for eating problems may be common among adolescent girls. In addition, the findings suggest that prevention programs for the eating disorders need to target not only at-risk individuals, but also individuals in their immediate social environment.     

高等教育学习者的学校归属感培养与图书馆资源利用

学校归属感缺失的学生学业半途而废的可能性增大,负面效果会加重.基于图书馆资源所拥有的特质,可以利用图书馆电子资源作为媒介,整合图书馆与继续教育学院人力资源,利用图书馆平台传播校园文化,形成现实班集体与虚拟社区有效结合,同时图书馆开设综合信息检索课程,利用图书馆平台实施远程课程教学等,以培养学生学校归属感.     

The Effect of Negative Emotion on Licit and Illicit Drug Use Among High School Dropouts: An Empirical Test of General Strain Theory

General Strain Theory (GST) argues that drug use is one way adolescents mitigate negative emotions brought on by aversive environmental stimuli. To date, many of the empirical tests of the strain-drug use relationship have neglected to include measures of negative emotion, despite its prominence in GST's etiology of deviant behavior. The following study tests the mediating effects of despair on the strain-drug use relationship, evaluating the effects of parental reactions to leaving school on post-dropout drug use. The moderating effects of recency of dropout and gender of respondent are also considered. Results show that negative parental reactions to dropout affect drug use for females only, and that despair does not mediate this relationship. This type of negative affect has direct effects on drug use for both genders, rather than the indirect effects predicted by GST. These findings affirm prior research linking depressive negative affective states to drug use, but suggests that the relationship between strain and such emotional states is more complex than the theory suggests, particularly when the moderating effects of gender are considered.