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Cite as: Humphrey, N. & Wigelsworth, M. (2016). Making the case for universal school-based mental health screening. Emotional and Behavioural Difficulties [invited article], 21, 22-42.Making the case for universal school-based mental health screeningNeil Humphrey and Michael WigelsworthManchester Institute of EducationSchool of Environment, Education and DevelopmentEllen Wilkinson BuildingOxford RoadUniversity of ManchesterM13 9PLneil.humphrey@manchester.ac.uk0161 275 3404AbstractMental health difficulties affect 1 in 10 children and adolescents,?and?up to half of adult cases begin during the school years. ?The individual and societal impacts of such difficulties are huge, and include?poorer quality of life, lost economic productivity,?destabilisation of?communities, and high rates of health, education and social care service utilisation.? Using early intervention and prevention in schools as a central component of a co-ordinated response to this emergent?public?health crisis makes good sense.?Schools play a central role in the lives of children and their families, and their reach is unparalleled. ?It has been argued that truly comprehensive and effective mental health promotion in schools requires a universal screening component, but?this is a controversial proposition. ?In this article we explore some of the?opportunities and challenges posed by such a system. ?In doing so we critically assess international literature on social?validity (e.g. acceptability, feasibility and utility), definition and conceptualisation (e.g. what?do we mean by ‘mental health’ and related terms?), design and implementation (e.g. planning, tool?selection, linking to referral and intervention systems), psychometric considerations (e.g. are available instruments reliable and valid?), diversity (e.g. taking into account cultural variation) and costs and benefits (e.g. are the human, financial and material costs of universal screening justified by the improvements in provision and outcomes they bring?). ?We conclude by presenting a vision for a school-based system that takes into account these important factors.Keywords: mental health, universal, screening, assessment, schoolsMaking the case for universal school-based mental health screeningIntroductionMental health difficulties (MHDs) are changes in thinking, mood and/or behaviour that impair functioning ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Murphey", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barry", "given" : "Megan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vaughn", "given" : "Brigitte", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Child Trends", "id" : "ITEM-1", "issue" : "January", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "1-10", "title" : "Mental health disorders", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Murphey, Barry, & Vaughn, 2013)", "plainTextFormattedCitation" : "(Murphey, Barry, & Vaughn, 2013)", "previouslyFormattedCitation" : "(Murphey, Barry, & Vaughn, 2013)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Murphey, Barry, & Vaughn, 2013). In the two major classification systems used in the field (International Classification of Diseases and the Diagnostic and Statistical Manual) a distinction is drawn between internalising (e.g. anxiety and mood disorders) and externalising (e.g. conduct and hyperkinetic disorders) problems ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1192/apt.bp.113.011296", "ISSN" : "1355-5146", "abstract" : "Most disorders in medicine are classified using the ICD (initiated in Paris in 1900). Mental and behavioural disorders are classified using the DSM (DSM-I was published in the USA in 1952), but it was not until DSM-III in 1980 that it became a major player. Its success was largely influenced by Robert Spitzer, who welded its disparate elements, and Melvyn Shabsin, who facilitated its acceptance. Spitzer pointed out that most diagnostic conditions in psychiatry were poorly defined, showed poor reliability in test-retest situations, and were temporally unstable. The consequence was that the beliefs of the psychiatrist seemed to matter much more than the characteristics of the patient when it came to classification. Since DSM-III there has been a split between those who adhere to DSM because it is a better research classification and those who adhere to ICD because it allows more clinical discretion in making diagnoses. This article discusses the pros and cons of both systems, and the major criticisms that have been levelled against them.", "author" : [ { "dropping-particle" : "", "family" : "Tyrer", "given" : "P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Advances in Psychiatric Treatment", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2014", "7", "1" ] ] }, "page" : "280-285", "title" : "A comparison of DSM and ICD classifications of mental disorder", "type" : "article-journal", "volume" : "20" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Tyrer, 2014)", "plainTextFormattedCitation" : "(Tyrer, 2014)", "previouslyFormattedCitation" : "(Tyrer, 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Tyrer, 2014). 1 in 10 children and young people experience clinically significant MHDs ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Green", "given" : "Hazel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McGinnity", "given" : "Aine", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meltzer", "given" : "Howard", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ford", "given" : "Tamsin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodman", "given" : "Robert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Area", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2005" ] ] }, "title" : "Mental Health of Children and Young People in Great Britain", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Green, McGinnity, Meltzer, Ford, & Goodman, 2005)", "plainTextFormattedCitation" : "(Green, McGinnity, Meltzer, Ford, & Goodman, 2005)", "previouslyFormattedCitation" : "(Green, McGinnity, Meltzer, Ford, & Goodman, 2005)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Green, McGinnity, Meltzer, Ford, & Goodman, 2005), and 50% of adult cases originate in childhood or adolescence ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1469-7610.2007.01855.x", "abstract" : "Describe objectively the global gaps in policy, data gathering capacity, and resources to develop and implement services to support child mental health.", "author" : [ { "dropping-particle" : "", "family" : "Belfer", "given" : "Myron L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of child psychology and psychiatry, and allied disciplines", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2008", "3" ] ] }, "page" : "226-36", "title" : "Child and adolescent mental disorders: the magnitude of the problem across the globe.", "type" : "article-journal", "volume" : "49" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Belfer, 2008)", "plainTextFormattedCitation" : "(Belfer, 2008)", "previouslyFormattedCitation" : "(Belfer, 2008)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Belfer, 2008). Children who experience such difficulties are less likely to attend and achieve their potential in school ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bmj.a2981", "ISSN" : "0959-8138", "author" : [ { "dropping-particle" : "", "family" : "Colman", "given" : "I.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murray", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Abbott", "given" : "R. a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Maughan", "given" : "B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kuh", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Croudace", "given" : "T. 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B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British Medical Journal", "id" : "ITEM-1", "issue" : "jan08 2", "issued" : { "date-parts" : [ [ "2009", "1" ] ] }, "page" : "a2981-a2981", "title" : "Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort", "type" : "article-journal", "volume" : "338" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Colman et al., 2009)", "plainTextFormattedCitation" : "(Colman et al., 2009)", "previouslyFormattedCitation" : "(Colman et al., 2009)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Colman et al., 2009) and more likely to be unemployed as adults ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/0003684042000174001", "ISSN" : "0003-6846", "author" : [ { "dropping-particle" : "", "family" : "Farrington", "given" : "David P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Healey", "given" : "Andrew", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Knapp", "given" : "Martin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Applied Economics", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2004", "2", "1" ] ] }, "page" : "93-105", "title" : "Adult labour market implications of antisocial behaviour in childhood and adolescence: findings from a UK longitudinal study", "type" : "article-journal", "volume" : "36" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Farrington, Healey, & Knapp, 2004)", "plainTextFormattedCitation" : "(Farrington, Healey, & Knapp, 2004)", "previouslyFormattedCitation" : "(Farrington, Healey, & Knapp, 2004)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Farrington, Healey, & Knapp, 2004). Over the life course, the individual and societal impacts of MHDs are huge, and can include reduced quality of life, lost economic productivity, destabilization of communities, and high rates of health, education and social care utilization ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1469-7610.2007.01855.x", "abstract" : "Describe objectively the global gaps in policy, data gathering capacity, and resources to develop and implement services to support child mental health.", "author" : [ { "dropping-particle" : "", "family" : "Belfer", "given" : "Myron L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of child psychology and psychiatry, and allied disciplines", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2008", "3" ] ] }, "page" : "226-36", "title" : "Child and adolescent mental disorders: the magnitude of the problem across the globe.", "type" : "article-journal", "volume" : "49" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Belfer, 2008)", "plainTextFormattedCitation" : "(Belfer, 2008)", "previouslyFormattedCitation" : "(Belfer, 2008)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Belfer, 2008). In financial terms, the annual cost is around ?105 billion annually in England ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Centre for Mental Health", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "publisher-place" : "London", "title" : "The economic and social costs of mental health problems in 2009/10", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Centre for Mental Health, 2010)", "plainTextFormattedCitation" : "(Centre for Mental Health, 2010)", "previouslyFormattedCitation" : "(Centre for Mental Health, 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Centre for Mental Health, 2010), of which more than ?20 billion is spent on health and social care (more than double the annual cost of cancer diagnosis and treatment - Williams, 2013). By 2030, depression alone will yield the highest disease burden in high-income countries, accounting for nearly 10% of disability-adjusted-life-years ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1371/journal.pmed.0030442", "ISSN" : "1549-1676", "PMID" : "17132052", "abstract" : "BACKGROUND: Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results.\n\nMETHODS AND FINDINGS: Relatively simple models were used to project future health trends under three scenarios-baseline, optimistic, and pessimistic-based largely on projections of economic and social development, and using the historically observed relationships of these with cause-specific mortality rates. Data inputs have been updated to take account of the greater availability of death registration data and the latest available projections for HIV/AIDS, income, human capital, tobacco smoking, body mass index, and other inputs. In all three scenarios there is a dramatic shift in the distribution of deaths from younger to older ages and from communicable, maternal, perinatal, and nutritional causes to noncommunicable disease causes. The risk of death for children younger than 5 y is projected to fall by nearly 50% in the baseline scenario between 2002 and 2030. The proportion of deaths due to noncommunicable disease is projected to rise from 59% in 2002 to 69% in 2030. Global HIV/AIDS deaths are projected to rise from 2.8 million in 2002 to 6.5 million in 2030 under the baseline scenario, which assumes coverage with antiretroviral drugs reaches 80% by 2012. Under the optimistic scenario, which also assumes increased prevention activity, HIV/AIDS deaths are projected to drop to 3.7 million in 2030. Total tobacco-attributable deaths are projected to rise from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in 2030 under our baseline scenario. Tobacco is projected to kill 50% more people in 2015 than HIV/AIDS, and to be responsible for 10% of all deaths globally. The three leading causes of burden of disease in 2030 are projected to include H\u2026", "author" : [ { "dropping-particle" : "", "family" : "Mathers", "given" : "Colin D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Loncar", "given" : "Dejan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "PLoS medicine", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2006", "11" ] ] }, "page" : "e442", "title" : "Projections of global mortality and burden of disease from 2002 to 2030.", "type" : "article-journal", "volume" : "3" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Mathers & Loncar, 2006)", "plainTextFormattedCitation" : "(Mathers & Loncar, 2006)", "previouslyFormattedCitation" : "(Mathers & Loncar, 2006)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Mathers & Loncar, 2006). It is our contention that this is an emerging public health crisis. Although the prevalence of MHDs in childhood and adolescence stabilised in the early years of the new millennium following a sharp rise in previous decades ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00127-008-0310-8", "ISSN" : "0933-7954", "PMID" : "18250944", "abstract" : "BACKGROUND: Past studies have documented rising levels of conduct problems among UK adolescents in the last quarter of the twentieth century, and increased rates of emotional difficulties between the 1980s and 1990s.\n\nMETHOD: We used parent, teacher and youth ratings from two large scale, nationally representative studies of 5-15 year-old carried out in 1999 and 2004 to assess whether these increases continued into the early years of the new millennium.\n\nRESULTS: Ratings on most \"problem\" sub-scales remained stable or showed small declines over this period, and parent and teacher reports suggested small increases in levels of prosocial behaviours.\n\nCONCLUSIONS: The upward trends in rates of UK child adjustment problems noted since the 1970s and 1980s may have plateaued, and possibly begun to be reversed.", "author" : [ { "dropping-particle" : "", "family" : "Maughan", "given" : "Barbara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Collishaw", "given" : "Stephan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Meltzer", "given" : "Howard", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodman", "given" : "Robert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Social psychiatry and psychiatric epidemiology", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2008", "4" ] ] }, "page" : "305-10", "title" : "Recent trends in UK child and adolescent mental health.", "type" : "article-journal", "volume" : "43" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Maughan, Collishaw, Meltzer, & Goodman, 2008)", "plainTextFormattedCitation" : "(Maughan, Collishaw, Meltzer, & Goodman, 2008)", "previouslyFormattedCitation" : "(Maughan, Collishaw, Meltzer, & Goodman, 2008)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Maughan, Collishaw, Meltzer, & Goodman, 2008), spending reductions child and adolescent mental health services (CAMHS) in the last five years ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2015", "8", "6" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Buchanan", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BBC News Health", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "title" : "Children's mental health services 'cut by \u00a350m'", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Buchanan, 2015)", "plainTextFormattedCitation" : "(Buchanan, 2015)", "previouslyFormattedCitation" : "(Buchanan, 2015)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Buchanan, 2015) mean that the high proportion of unmet need discussed later in this article will continue to rise as eligibility/referral thresholds for service access inevitably increase. School is an ideal setting in which to identify those at risk of developing MHD and intervene early to address problems before they become deeply entrenched. The nature of schooling provides a critical opportunity to effect positive change – it is universal, begins early in life and entails periods of prolonged engagement with children and young people (totaling around 15,000 hours - ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Rutter", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Maughan", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mortimore", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ouston", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "1979" ] ] }, "publisher" : "Harvard University Press", "publisher-place" : "Cambridge, MA", "title" : "Fifteen thousand hours: secondary schools and their effects on children", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Rutter, Maughan, Mortimore, Ouston, & Smith, 1979)", "manualFormatting" : "Rutter, Maughan, Mortimore, Ouston, & Smith, 1979)", "plainTextFormattedCitation" : "(Rutter, Maughan, Mortimore, Ouston, & Smith, 1979)", "previouslyFormattedCitation" : "(Rutter, Maughan, Mortimore, Ouston, & Smith, 1979)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Rutter, Maughan, Mortimore, Ouston, & Smith, 1979) during which effective intervention strategies can be implemented. In most education systems, a tiered approach to intervention is evident ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/heapro/dar075", "abstract" : "The European Union Dataprev project reviewed work on mental health in four areas, parenting, schools, the workplace and older people. The schools workpackage carried out a systematic review of reviews of work on mental health in schools from which it identified evidence-based interventions and programmes and extracted the general principles from evidence-based work. A systematic search of the literature uncovered 52 systematic reviews and meta-analyses of mental health in schools. The interventions identified by the reviews had a wide range of beneficial effects on children, families and communities and on a range of mental health, social, emotional and educational outcomes. The effect sizes associated with most interventions were generally small to moderate in statistical terms, but large in terms of real-world impacts. The effects associated with interventions were variable and their effectiveness could not always be relied on. The characteristics of more effective interventions included: teaching skills, focusing on positive mental health; balancing universal and targeted approaches; starting early with the youngest children and continuing with older ones; operating for a lengthy period of time and embedding work within a multi-modal/whole-school approach which included such features as changes to the curriculum including teaching skills and linking with academic learning, improving school ethos, teacher education, liaison with parents, parenting education, community involvement and coordinated work with outside agencies. Interventions were only effective if they were completely and accurately implemented: this applied particularly to whole-school interventions which could be ineffective if not implemented with clarity, intensity and fidelity. The implications for policy and practice around mental health in schools are discussed, including the suggestion of some rebalancing of priorities and emphases.", "author" : [ { "dropping-particle" : "", "family" : "Weare", "given" : "Katherine", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nind", "given" : "Melanie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Health promotion international", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2011", "12" ] ] }, "page" : "i29-69", "title" : "Mental health promotion and problem prevention in schools: what does the evidence say?", "type" : "article-journal", "volume" : "26 Suppl 1" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Weare & Nind, 2011)", "plainTextFormattedCitation" : "(Weare & Nind, 2011)", "previouslyFormattedCitation" : "(Weare & Nind, 2011)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Weare & Nind, 2011). Universal mental health provision is designed to reach all children and prevent problems before they occur by equipping children with the intra- (e.g. self-regulation) and inter-personal (e.g. empathy) skills that can help them to be more resilient to the onset of MHD during difficult periods in their lives. An example of this kind of provision is the Second Step social and emotional learning curriculum ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Committee for Children", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2011" ] ] }, "publisher-place" : "Seattle, WA", "title" : "Review of research: Second Step Program (Kindergarten-Grade 5)", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Committee for Children, 2011)", "plainTextFormattedCitation" : "(Committee for Children, 2011)", "previouslyFormattedCitation" : "(Committee for Children, 2011)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Committee for Children, 2011). For children with nascent MHD, additional support may be required through selective/targeted interventions that seek to prevent the progression of symptoms. At this level of provision, interventions start to become differentiated according to the nature of the difficulties experienced by children. The small group work component of the social and emotional aspects of learning (SEAL) programme ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Department for Education and Skills", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2006" ] ] }, "publisher" : "DfES Publications", "publisher-place" : "Nottingham", "title" : "Excellence and enjoyment: social and emotional aspects of learning (Key Stage 2 small group activities)", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Department for Education and Skills, 2006)", "plainTextFormattedCitation" : "(Department for Education and Skills, 2006)", "previouslyFormattedCitation" : "(Department for Education and Skills, 2006)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Department for Education and Skills, 2006) provides a useful illustration. Finally, indicated interventions are designed for children identified as having prodromal or established MHD. At this level of provision, interventions are typically more intensive, lengthy, and often involve health, social or specialist community services ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Shucksmith", "given" : "Janet", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "English", "id" : "ITEM-1", "issue" : "July", "issued" : { "date-parts" : [ [ "2007" ] ] }, "title" : "Mental wellbeing of children in primary education ( targeted / indicated activities )", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Shucksmith, 2007)", "plainTextFormattedCitation" : "(Shucksmith, 2007)", "previouslyFormattedCitation" : "(Shucksmith, 2007)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Shucksmith, 2007). A school-based example can be seen in ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Bloomquist", "given" : "Michael L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "August", "given" : "Gerald J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ostrander", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of abnormal child psychology", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "1991" ] ] }, "page" : "591-605", "title" : "Effects of a school-based cognitive-behavioural intervention for ADHD children", "type" : "article-journal", "volume" : "19" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Bloomquist, August, & Ostrander, 1991)", "manualFormatting" : "Bloomquist, August, and Ostrander's (1991)", "plainTextFormattedCitation" : "(Bloomquist, August, & Ostrander, 1991)", "previouslyFormattedCitation" : "(Bloomquist, August, & Ostrander, 1991)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Bloomquist, August, and Ostrander's (1991) cognitive-behavioural intervention for children with ADHD. Numerous systematic reviews and meta-analyses attest to the fact that high quality, well implemented school-based mental health interventions can effect meaningful change for children and young people ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/heapro/dar075", "abstract" : "The European Union Dataprev project reviewed work on mental health in four areas, parenting, schools, the workplace and older people. The schools workpackage carried out a systematic review of reviews of work on mental health in schools from which it identified evidence-based interventions and programmes and extracted the general principles from evidence-based work. A systematic search of the literature uncovered 52 systematic reviews and meta-analyses of mental health in schools. The interventions identified by the reviews had a wide range of beneficial effects on children, families and communities and on a range of mental health, social, emotional and educational outcomes. The effect sizes associated with most interventions were generally small to moderate in statistical terms, but large in terms of real-world impacts. The effects associated with interventions were variable and their effectiveness could not always be relied on. The characteristics of more effective interventions included: teaching skills, focusing on positive mental health; balancing universal and targeted approaches; starting early with the youngest children and continuing with older ones; operating for a lengthy period of time and embedding work within a multi-modal/whole-school approach which included such features as changes to the curriculum including teaching skills and linking with academic learning, improving school ethos, teacher education, liaison with parents, parenting education, community involvement and coordinated work with outside agencies. Interventions were only effective if they were completely and accurately implemented: this applied particularly to whole-school interventions which could be ineffective if not implemented with clarity, intensity and fidelity. The implications for policy and practice around mental health in schools are discussed, including the suggestion of some rebalancing of priorities and emphases.", "author" : [ { "dropping-particle" : "", "family" : "Weare", "given" : "Katherine", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nind", "given" : "Melanie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Health promotion international", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2011", "12" ] ] }, "page" : "i29-69", "title" : "Mental health promotion and problem prevention in schools: what does the evidence say?", "type" : "article-journal", "volume" : "26 Suppl 1" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1111/j.1467-8624.2010.01564.x", "ISSN" : "1467-8624", "PMID" : "21291449", "abstract" : "This article presents findings from a meta-analysis of 213 school-based, universal social and emotional learning (SEL) programs involving 270,034 kindergarten through high school students. Compared to controls, SEL participants demonstrated significantly improved social and emotional skills, attitudes, behavior, and academic performance that reflected an 11-percentile-point gain in achievement. School teaching staff successfully conducted SEL programs. The use of 4 recommended practices for developing skills and the presence of implementation problems moderated program outcomes. The findings add to the growing empirical evidence regarding the positive impact of SEL programs. Policy makers, educators, and the public can contribute to healthy development of children by supporting the incorporation of evidence-based SEL programming into standard educational practice.", "author" : [ { "dropping-particle" : "", "family" : "Durlak", "given" : "Joseph a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Weissberg", "given" : "Roger P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dymnicki", "given" : "Allison B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Taylor", "given" : "Rebecca D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schellinger", "given" : "Kriston B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Child development", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "2011", "1" ] ] }, "page" : "405-32", "title" : "The impact of enhancing students' social and emotional learning: a meta-analysis of school-based universal interventions.", "type" : "article-journal", "volume" : "82" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1002/pits", "author" : [ { "dropping-particle" : "", "family" : "Sklad", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Diekstra", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ritter", "given" : "M", "non-dropping-particle" : "De", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ben", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gravesteijn", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Psychology in the \u2026", "id" : "ITEM-3", "issue" : "9", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "892-909", "title" : "Effectiveness of school-based universal social, emotional, and behavioral programs: do they enhance students' development in the area of skills, behavior and adjustment?", "type" : "article-journal", "volume" : "49" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Shucksmith", "given" : "Janet", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "English", "id" : "ITEM-4", "issue" : "July", "issued" : { "date-parts" : [ [ "2007" ] ] }, "title" : "Mental wellbeing of children in primary education ( targeted / indicated activities )", "type" : "article-journal" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "ISBN" : "07493797 (ISSN)", "abstract" : "Background: Research about the effectiveness of school-based psychosocial prevention programs for reducing aggressive and disruptive behavior was synthesized using meta-analysis. This work updated previous work by the authors and further investigated which program and student characteristics were associated with the most positive outcomes. Methods: Two hundred forty-nine experimental and quasi-experimental studies of school-based programs with outcomes representing aggressive and/or disruptive behavior were obtained. Effect sizes and study characteristics were coded from these studies and analyzed. Results: Positive overall intervention effects were found on aggressive and disruptive behavior and other relevant outcomes. The most common and most effective approaches were universal programs and targeted programs for selected/indicated children. The mean effect sizes for these types of programs represent a decrease in aggressive/disruptive behavior that is likely to be of practical significance to schools. Multicomponent comprehensive programs did not show significant effects and those for special schools or classrooms were marginal. Different treatment modalities (e.g., behavioral, cognitive, social skills) produced largely similar effects. Effects were larger for better-implemented programs and those involving students at higher risk for aggressive behavior. Conclusions: Schools seeking prevention programs may choose from a range of effective programs with some confidence that whatever they pick will be effective. Without the researcher involvement that characterizes the great majority of programs in this meta-analysis, schools might be well-advised to give priority to those that will be easiest to implement well in their settings. \u00a9 2007 American Journal of Preventive Medicine.", "author" : [ { "dropping-particle" : "", "family" : "Wilson", "given" : "S J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lipsey", "given" : "M W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American journal of preventative medicine", "id" : "ITEM-5", "issue" : "2", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "S130-S143", "title" : "School-Based Interventions for Aggressive and Disruptive Behavior. Update of a Meta-Analysis", "type" : "article-journal", "volume" : "33" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011; Shucksmith, 2007; Sklad, Diekstra, De Ritter, Ben, & Gravesteijn, 2012; Weare & Nind, 2011; Wilson & Lipsey, 2007)", "manualFormatting" : "(e.g. Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011; Shucksmith, 2007; Sklad, Diekstra, De Ritter, Ben, & Gravesteijn, 2012; Weare & Nind, 2011; Wilson & Lipsey, 2007)", "plainTextFormattedCitation" : "(Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011; Shucksmith, 2007; Sklad, Diekstra, De Ritter, Ben, & Gravesteijn, 2012; Weare & Nind, 2011; Wilson & Lipsey, 2007)", "previouslyFormattedCitation" : "(Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011; Shucksmith, 2007; Sklad, Diekstra, De Ritter, Ben, & Gravesteijn, 2012; Weare & Nind, 2011; Wilson & Lipsey, 2007)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(e.g. Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011; Shucksmith, 2007; Sklad, Diekstra, De Ritter, Ben, & Gravesteijn, 2012; Weare & Nind, 2011; Wilson & Lipsey, 2007). There is also broad agreement that an integrated approach to provision that offers a synthesis of universal, targeted and indicated interventions is likely to be the most effective model for schools, offering as it does increased intervention exposure for those who need it most, the possibility of additive or multiplicative effects brought about through the interaction of different interventions, improved sustainability, and increased implementation quality ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "00333085", "author" : [ { "dropping-particle" : "", "family" : "Domitrovich", "given" : "Celene E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bradshaw", "given" : "Catherine P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greenberg", "given" : "Mark T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Embry", "given" : "Dennis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Poduska", "given" : "Jeanne M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ialongo", "given" : "Nicholas S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Psychology in the Schools", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "71-88", "title" : "Integrated models of school-based prevention: Logic and theory", "type" : "article-journal", "volume" : "47" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Domitrovich et al., 2010)", "plainTextFormattedCitation" : "(Domitrovich et al., 2010)", "previouslyFormattedCitation" : "(Domitrovich et al., 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Domitrovich et al., 2010).The case for universal mental health screening in schoolsIn spite of the substantial and growing evidence base for mental health provision in schools, there is still significant room for improvement in the system. For example, the majority of schools in England report using approaches to intervention that have no evidential base ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Vostanis", "given" : "Panos", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Humphrey", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fitzgerald", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wolpert", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Deighton", "given" : "Jessica", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Child and Adolescent Mental Health", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2012" ] ] }, "title" : "How do schools promote emotional wellbeing among their pupils? 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Additionally, despite the rhetoric of the importance attributed to mental health, education policy has increasingly encouraged schools to maximise students’ academic attainment at the expense of their broader wellbeing and health ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bmj.g3078", "ISSN" : "1756-1833", "PMID" : "25134103", "author" : [ { "dropping-particle" : "", "family" : "Bonell", "given" : "Chris", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Humphrey", "given" : "Neil", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fletcher", "given" : "Adam", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moore", "given" : "Laurence", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Anderson", "given" : "Rob", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Campbell", "given" : "Rona", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMJ (Clinical research ed.)", "id" : "ITEM-1", "issue" : "may13_2", "issued" : { "date-parts" : [ [ "2014", "1", "13" ] ] }, "page" : "g3078", "title" : "Why schools should promote students' health and wellbeing.", "type" : "article-journal", "volume" : "348" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Bonell et al., 2014)", "manualFormatting" : "(Bonell et al., 2014)", "plainTextFormattedCitation" : "(Bonell et al., 2014)", "previouslyFormattedCitation" : "(Bonell et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Bonell et al., 2014), an issue to which we return later in this article. However, unmet need is perhaps the most significant of the problems to be addressed. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "author" : [ { "dropping-particle" : "", "family" : "Kelvin", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BBC News Health", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "", "title" : "Mental health help 'needed in schools'", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Kelvin, 2014)", "manualFormatting" : "Kelvin (2014)", "plainTextFormattedCitation" : "(Kelvin, 2014)", "previouslyFormattedCitation" : "(Kelvin, 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Kelvin (2014) reports that up to 75% of children in the UK who experience significant MHD do not access the support that they need, whether in the context of education, health or social care services. A similar proportion of unmet need is evident in other countries such as the USA ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "9781461476245", "author" : [ { "dropping-particle" : "", "family" : "Dvorsky", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Girio-Herrera", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Julie Sarno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Hadnbook of school mental health", "editor" : [ { "dropping-particle" : "", "family" : "Weist", "given" : "Mark D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "297-310", "publisher" : "Springer", "publisher-place" : "New York, NY", "title" : "School-based screening for mental health in early childhood", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Dvorsky, Girio-Herrera, & Owens, 2014)", "plainTextFormattedCitation" : "(Dvorsky, Girio-Herrera, & Owens, 2014)", "previouslyFormattedCitation" : "(Dvorsky, Girio-Herrera, & Owens, 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dvorsky, Girio-Herrera, & Owens, 2014). While this cannot solely be attributed to lack of effective early identification (for example, referral thresholds to CAMHS are increasingly stringent, and there are inequalities in service access among certain marginalized groups, such as those in black and minority ethnic communities), it is undoubtedly a major contributory factor, and on this basis we argue that a critical step-change in methods and practices is required. Indeed, this is one of the key tenets of the Department of Health’s recently published Future in Mind strategy document ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Department of Health", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "publisher-place" : "London", "title" : "Future in mind: promoting, protecting and improving our children and young people's mental health and wellbeing", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Department of Health, 2015)", "plainTextFormattedCitation" : "(Department of Health, 2015)", "previouslyFormattedCitation" : "(Department of Health, 2015)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Department of Health, 2015), which argues for improvements in, “early identification of need, so that children and young people are supported as soon as problems arise to prevent more serious problems developing” (p.33). Despite some recent advances (for example, the 2014 launch of Mind Ed, a Department of Health web portal designed to help adults working with children and young people spot the early signs of MHD), we still arguably operate according to two inefficient and ineffective models of service delivery. The first, ‘refer-test-place’ ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s12310-010-9036-3", "ISBN" : "1866-2633\\n1866-2625", "ISSN" : "18662625", "PMID" : "21088687", "abstract" : "School-based mental health professionals often conduct assessments and provide interventions on an individual basis to students with significant needs. However, due to increasingly limited resources and continuing high levels of need, a shift in service delivery is warranted. Efforts to move school psychological services from reactive and individual, to preventive and universal are ongoing. To further service delivery change, school-based mental health professionals can engage in systematic periodic mental health screening of all children. This article will (a) discuss screening for risk of emotional and behavior problems from a population-based approach, (b) describe how screening data can identify and monitor the needs of students, schools, and communities, and (c) provide future directions for screening practices. As continued changes to service delivery are imminent, information on how to utilize school-based screening data will be particularly valuable to mental health professionals working with or within schools.", "author" : [ { "dropping-particle" : "", "family" : "Dowdy", "given" : "Erin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ritchey", "given" : "Kristin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kamphaus", "given" : "R. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "School Mental Health", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "1-11", "title" : "School-Based Screening: A Population-Based Approach to Inform and Monitor Children's Mental Health Needs", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Erin Dowdy, Ritchey, & Kamphaus, 2010)", "manualFormatting" : "(Dowdy, Ritchey, & Kamphaus, 2010)", "plainTextFormattedCitation" : "(Erin Dowdy, Ritchey, & Kamphaus, 2010)", "previouslyFormattedCitation" : "(Erin Dowdy, Ritchey, & Kamphaus, 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dowdy, Ritchey, & Kamphaus, 2010), involves children with MHD being referred to a given professional (for example, an educational psychologist or mental health worker), who assesses their needs and provides advice regarding appropriate targeted/indicated provision. The second, what ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jsp.2006.05.005", "ISBN" : "0022-4405", "ISSN" : "00224405", "abstract" : "Universal screening is a critical prerequisite to providing early school-based prevention and intervention services for students at risk for or with academic, behavioral, or emotional difficulties. Although use of academic and behavioral screening has become more prevalent, criteria for making informed decisions about appropriate screening tools are not readily available to those who work in educational settings. The purpose of this article is to (a) highlight several considerations about the appropriateness, technical adequacy, and usability of academic or behavioral screeners and (b) provide a general assessment of the current state of science pertaining to universal screening. The article concludes with considerations for policy and practice. The framework presented may be useful in guiding those interested in evaluating, selecting, and researching school-based universal screening assessments. \u00a9 2006 Society for the Study of School Psychology.", "author" : [ { "dropping-particle" : "", "family" : "Glover", "given" : "Todd a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albers", "given" : "Craig a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of School Psychology", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "117-135", "title" : "Considerations for evaluating universal screening assessments", "type" : "article-journal", "volume" : "45" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Glover & Albers, 2007)", "manualFormatting" : "Glover and Albers (2007)", "plainTextFormattedCitation" : "(Glover & Albers, 2007)", "previouslyFormattedCitation" : "(Glover & Albers, 2007)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Glover and Albers (2007) call the ‘wait to fail’ model, involves children and young people’s MHD coming to the attention of education, care and/or health service professionals as the result of events that reflect deeply entrenched problems (for example, being permanently excluded from school or coming into contact with the criminal justice system). Both models are fundamentally flawed because they are highly variable and result in under-referral (thus undoubtedly contributing to the unmet need statistics noted above) and late-referral (meaning that critical opportunities for early intervention have been missed) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "9781461476245", "author" : [ { "dropping-particle" : "", "family" : "Dvorsky", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Girio-Herrera", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Julie Sarno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Hadnbook of school mental health", "editor" : [ { "dropping-particle" : "", "family" : "Weist", "given" : "Mark D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "297-310", "publisher" : "Springer", "publisher-place" : "New York, NY", "title" : "School-based screening for mental health in early childhood", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Dvorsky et al., 2014)", "plainTextFormattedCitation" : "(Dvorsky et al., 2014)", "previouslyFormattedCitation" : "(Dvorsky et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dvorsky et al., 2014). Furthermore, they operate against a backdrop of major cuts to child mental health services in two-thirds of Local Authorities since 2010 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Young Minds", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "publisher-place" : "London", "title" : "Local authorities and CAMHS budgets 2012/2013", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Young Minds, 2013)", "plainTextFormattedCitation" : "(Young Minds, 2013)", "previouslyFormattedCitation" : "(Young Minds, 2013)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Young Minds, 2013), which have had the effect of increasing pressure on schools to ‘pick up the pieces’ ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "O'Hara", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Guardian", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014", "4", "25" ] ] }, "title" : "Teachers left to pick up pieces from cuts to youth mental health services", "type" : "article-newspaper" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(O\u2019Hara, 2014)", "plainTextFormattedCitation" : "(O\u2019Hara, 2014)", "previouslyFormattedCitation" : "(O\u2019Hara, 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(O’Hara, 2014). At a broader level, the current state of affairs in children’s mental health can be seen as a reflective of the problems associated with societal inequality. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Wilkinson", "given" : "Richard", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pickett", "given" : "Kate", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "publisher" : "Penguin", "publisher-place" : "London", "title" : "The spirit level: why equality is better", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Wilkinson & Pickett, 2010)", "manualFormatting" : "Wilkinson and Pickett (2010)", "plainTextFormattedCitation" : "(Wilkinson & Pickett, 2010)", "previouslyFormattedCitation" : "(Wilkinson & Pickett, 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Wilkinson and Pickett (2010) highlight international evidence of the inverse relationship between child wellbeing and income inequality. The UK provides a useful case in point – extremely high levels of income inequality, juxtaposed against child wellbeing levels that were the lowest recorded among 21 developed counties in 2007 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "UNICEF", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Dimension Contemporary German Arts And Letters", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2007" ] ] }, "publisher-place" : "Florence, Italy", "title" : "An overview of child well-being in rich countries", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(UNICEF, 2007)", "plainTextFormattedCitation" : "(UNICEF, 2007)", "previouslyFormattedCitation" : "(UNICEF, 2007)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(UNICEF, 2007). So, what is to be done? It has been argued that a critical prerequisite to providing effective school-based prevention and intervention services is the adoption of a population-based approach embodied by a universal screening model. In such a system, all members of the student population in a school undergo brief assessments (which may be informed by teachers, parents and/or students themselves) designed to identify those at risk of developing MHD ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jsp.2006.05.005", "ISBN" : "0022-4405", "ISSN" : "00224405", "abstract" : "Universal screening is a critical prerequisite to providing early school-based prevention and intervention services for students at risk for or with academic, behavioral, or emotional difficulties. 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However, due to increasingly limited resources and continuing high levels of need, a shift in service delivery is warranted. Efforts to move school psychological services from reactive and individual, to preventive and universal are ongoing. To further service delivery change, school-based mental health professionals can engage in systematic periodic mental health screening of all children. This article will (a) discuss screening for risk of emotional and behavior problems from a population-based approach, (b) describe how screening data can identify and monitor the needs of students, schools, and communities, and (c) provide future directions for screening practices. 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The logic is simple: “before intervention can occur mental health problems must be identified” ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bmj.f5478", "ISSN" : "1756-1833", "PMID" : "24065552", "abstract" : "A recent BMJ study suggested that school based cognitive behavioural therapy programmes may not be effective in reducing depressive symptoms.1 I agree with the authors that further research and evaluation of such programmes are necessary. However, although school might not be the most appropriate setting for the treatment of childhood and adolescent mental health problems, it is the most appropriate setting for the identification of mental health problems in this population.", "author" : [ { "dropping-particle" : "", "family" : "Williams", "given" : "Simon", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British Medical Journal", "id" : "ITEM-1", "issue" : "September", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "24-26", "title" : "Bring in universal mental health checks in schools", "type" : "article-journal", "volume" : "5478" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Williams, 2013)", "manualFormatting" : "(Williams, 2013, p.5478)", "plainTextFormattedCitation" : "(Williams, 2013)", "previouslyFormattedCitation" : "(Williams, 2013)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Williams, 2013, p.5478), and periodic universal screening beginning as early as possible means that MHD can be identified before they reach clinically significant levels. Dvorsky et al (2014) propose three key benefits of such a system. First, by definition, universal screening means that all children and young people are assessed. Theoretically, this should have the effect of reducing the number of those at-risk being overlooked compared to the existing methods noted above. Second, universal screening provides a baseline for future monitoring and assessment. This means that a more data-driven approach to mental health provision in schools can be adopted. Third, universal screening can offer significant cost-savings over time. The basic logic here is that universal screening should lead to earlier intervention for emergent MHD, which is less intensive and expensive than indicated interventions for more severe or entrenched problems. However, despite these apparent benefits, universal mental health screening is extremely rare. For example, only 2% of schools in the USA use this approach as part of their routine practice ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Romer", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McIntosh", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Treating and preventing adolescent mental health disorders", "editor" : [ { "dropping-particle" : "", "family" : "Evans", "given" : "D.L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Foa", "given" : "E.B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gur", "given" : "R. 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This contrasts sharply with screening for physical health indicators (e.g. vision, hearing), which have been universally assessed for decades ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bmj.f5478", "ISSN" : "1756-1833", "PMID" : "24065552", "abstract" : "A recent BMJ study suggested that school based cognitive behavioural therapy programmes may not be effective in reducing depressive symptoms.1 I agree with the authors that further research and evaluation of such programmes are necessary. 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However, due to increasingly limited resources and continuing high levels of need, a shift in service delivery is warranted. Efforts to move school psychological services from reactive and individual, to preventive and universal are ongoing. To further service delivery change, school-based mental health professionals can engage in systematic periodic mental health screening of all children. This article will (a) discuss screening for risk of emotional and behavior problems from a population-based approach, (b) describe how screening data can identify and monitor the needs of students, schools, and communities, and (c) provide future directions for screening practices. As continued changes to service delivery are imminent, information on how to utilize school-based screening data will be particularly valuable to mental health professionals working with or within schools.", "author" : [ { "dropping-particle" : "", "family" : "Dowdy", "given" : "Erin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ritchey", "given" : "Kristin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kamphaus", "given" : "R. 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It may reflect the fact that mental health has traditionally not been given equal weight to physical health in public policy ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "H. M. Government", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "publisher-place" : "London", "title" : "Healthy lives, healthy people: our strategy for public health in England", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(H. M. Government, 2010)", "plainTextFormattedCitation" : "(H. M. Government, 2010)", "previouslyFormattedCitation" : "(H. M. Government, 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(H. M. Government, 2010). The stigma associated with mental health is also a likely contributory factor ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.eurpsy.2014.02.007", "ISSN" : "17783585", "PMID" : "24726533", "abstract" : "Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe-primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship. \u00a9 2014 Elsevier Masson SAS.", "author" : [ { "dropping-particle" : "", "family" : "Evans-Lacko", "given" : "S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Courtin", "given" : "E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiorillo", "given" : "a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Knapp", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Luciano", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Park", "given" : "a. 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However, due to increasingly limited resources and continuing high levels of need, a shift in service delivery is warranted. Efforts to move school psychological services from reactive and individual, to preventive and universal are ongoing. To further service delivery change, school-based mental health professionals can engage in systematic periodic mental health screening of all children. This article will (a) discuss screening for risk of emotional and behavior problems from a population-based approach, (b) describe how screening data can identify and monitor the needs of students, schools, and communities, and (c) provide future directions for screening practices. As continued changes to service delivery are imminent, information on how to utilize school-based screening data will be particularly valuable to mental health professionals working with or within schools.", "author" : [ { "dropping-particle" : "", "family" : "Dowdy", "given" : "Erin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ritchey", "given" : "Kristin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kamphaus", "given" : "R. 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In truth, there are multiple challenges that mean universal school-based screening for MHD is ‘easier said than done’, and through the course of this article we discuss these in addition to the opportunities it can provide.Social validitySocial validity refers to the value and social importance attributed to a given innovation by those who are direct or indirect consumers of it ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/0271121412440186", "ISSN" : "0271-1214", "abstract" : "Social competence intervention studies published from 1970 to 2008 for preschoolers were reviewed for reports of social validity assessment. Analysis of 90 studies indicated that nearly 27% (n = 24) of studies reported at least one measure of social validity assessment for the goals (n = 7), procedures (n = 8), or effects (n = 19). The methods used for these assessments were described, including information about the participants, time of assessment, and results. Trends in the rate of social validity assessment, methodological concerns, and recommendations for further social validity assessments are discussed.", "author" : [ { "dropping-particle" : "", "family" : "Hurley", "given" : "J. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Topics in Early Childhood Special Education", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "164-174", "title" : "Social Validity Assessment in Social Competence Interventions for Preschool Children: A Review", "type" : "article-journal", "volume" : "32" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Luiselli", "given" : "J. K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reed", "given" : "D. D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Encylopedia of Child Behavior and Development", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "1406", "publisher" : "Springer", "title" : "Social valdity", "type" : "entry-encyclopedia" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Hurley, 2012; Luiselli & Reed, 2011)", "plainTextFormattedCitation" : "(Hurley, 2012; Luiselli & Reed, 2011)", "previouslyFormattedCitation" : "(Hurley, 2012; Luiselli & Reed, 2011)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Hurley, 2012; Luiselli & Reed, 2011). In this case, they are teachers and other school staff, parents, pupils and external education, health and social care professionals. Social validity is a critical but often overlooked consideration when new initiatives are launched in education. Adapting ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Wolf", "given" : "M. 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We begin our discussion of universal school-based screening for MHD on this issue because it is so fundamental. Without demonstrable social validity, innovations in education or elsewhere are unlikely to be widely adopted. Currently, “there is a dearth of information regarding the acceptability of screeners and screening process, along with the social importance of the effects of screening” ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "9781461476245", "author" : [ { "dropping-particle" : "", "family" : "Dvorsky", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Girio-Herrera", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Julie Sarno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Hadnbook of school mental health", "editor" : [ { "dropping-particle" : "", "family" : "Weist", "given" : "Mark D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "297-310", "publisher" : "Springer", "publisher-place" : "New York, NY", "title" : "School-based screening for mental health in early childhood", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Dvorsky et al., 2014)", "manualFormatting" : "(Dvorsky et al., 2014, p.307)", "plainTextFormattedCitation" : "(Dvorsky et al., 2014)", "previouslyFormattedCitation" : "(Dvorsky et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dvorsky et al., 2014, p.307). However, that which is available provides extremely useful insights.In terms of acceptability, there is little doubt that the goal of preventing MHD and promoting wellbeing among children and young people is considered to be socially important among the various stakeholders noted above. However, there are some concerns about the concept of universal screening as a means through which to achieve this. Among these, the idea that it will be a stigmatising process is common ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bmj.f5478", "ISSN" : "1756-1833", "PMID" : "24065552", "abstract" : "A recent BMJ study suggested that school based cognitive behavioural therapy programmes may not be effective in reducing depressive symptoms.1 I agree with the authors that further research and evaluation of such programmes are necessary. However, although school might not be the most appropriate setting for the treatment of childhood and adolescent mental health problems, it is the most appropriate setting for the identification of mental health problems in this population.", "author" : [ { "dropping-particle" : "", "family" : "Williams", "given" : "Simon", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "British Medical Journal", "id" : "ITEM-1", "issue" : "September", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "24-26", "title" : "Bring in universal mental health checks in schools", "type" : "article-journal", "volume" : "5478" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Williams, 2013)", "plainTextFormattedCitation" : "(Williams, 2013)", "previouslyFormattedCitation" : "(Williams, 2013)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Williams, 2013). At first, this may seem like an oxymoron – surely a universal approach would be destigmatising as no single person or group are singled out? However, concerns remain about the problem-focused nature of assessments (see later section on conceptualisation of mental health) and the possible later consequences in terms of ‘typing’ (e.g. the screening results trigger the application of a prototype for MHD that then acts as a filter through which the child’s future behaviour is observed). This is a particular issue in ‘false positive’ cases, where a screening instrument categorises a child incorrectly as at-risk. Sensitive handling of screening, identification, referral and intervention processes is therefore fundamental, alongside explicit efforts to reduce stigma that may include provision of mental health literacy initiatives for staff (e.g. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "10.1080/1754730X.2013.784615", "abstract" : "Mental disorders make up close to one-third of the global burden of disease experienced during adolescence. Schools can play an important role in the promotion of positive mental health as well as an integral role in the pathways into mental health care for adolescents. In order for schools to effectively address the mental health problems of their students, educators must improve their mental health literacy. The current study examines the impact of an educator training programme designed to support educators in the delivery of a high school mental health curriculum within their classrooms, such as health class. Specifically, a paired-samples t test was used to examine the change in educators' knowledge and attitudes regarding mental health following their participation in this educator training. Eighty-three educators participated in the training, and survey data from 79 were included in the final analysis. Structured feedback on the training was obtained. Significant increases in both knowledge and att...", "author" : [ { "dropping-particle" : "", "family" : "Kutcher", "given" : "S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wei", "given" : "Y.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McLuckie", "given" : "A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bullock", "given" : "L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Advances in School Mental Health Promotion", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013", "5", "13" ] ] }, "language" : "en", "publisher" : "TF", "title" : "Educator mental health literacy: a programme evaluation of the teacher training education on the mental health & high school curriculum guide", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Kutcher, Wei, McLuckie, & Bullock, 2013)", "manualFormatting" : "Kutcher, Wei, McLuckie, & Bullock, 2013)", "plainTextFormattedCitation" : "(Kutcher, Wei, McLuckie, & Bullock, 2013)", "previouslyFormattedCitation" : "(Kutcher, Wei, McLuckie, & Bullock, 2013)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Kutcher, Wei, McLuckie, & Bullock, 2013) and students (e.g. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/eip.12010", "ISSN" : "1751-7893", "PMID" : "23343220", "abstract" : "AIM: Conduct a systematic review for the effectiveness of school mental health literacy programs to enhance knowledge, reduce stigmatizing attitudes and improve help-seeking behaviours among youth (12-25 years of age).\n\nMETHODS: Reviewers independently searched PubMed, PsycINFO, Cochrane Library, CINAHL, ERIC, grey literature and reference lists of included studies. They reached a consensus on the included studies, and rated the risk of bias of each study. Studies that reported three outcomes: knowledge acquisition, stigmatizing attitudes and help-seeking behaviours; and were randomized controlled trials (RCTs), cluster RCTs, quasi-experimental studies, and controlled-before-and-after studies, were eligible.\n\nRESULTS: This review resulted in 27 articles including 5 RCTs, 13 quasi-experimental studies, and 9 controlled-before-and-after studies. Whereas most included studies claimed school-based mental health literacy programs improve knowledge, attitudes and help-seeking behaviour, 17 studies met criteria for high risk of bias, 10 studies for moderate risk of bias, and no studies for low risk of bias. Common limitations included the lack of randomization, control for confounding factors, validated measures and report on attrition in most studies. The overall quality of the evidence for knowledge and help-seeking behaviour outcomes was very low, and low for the attitude outcome.\n\nCONCLUSIONS: Research into school-based mental health literacy is still in its infancy and there is insufficient evidence to claim for positive impact of school mental health literacy programs on knowledge improvement, attitudinal change or help-seeking behaviour. Future research should focus on methods to appropriately determine the evidence of effectiveness on school-based mental health literacy programs, considering the values of both RCTs and other research designs in this approach. Educators should consider the strengths and weaknesses of current mental health literacy programs to inform decisions regarding possible implementation.", "author" : [ { "dropping-particle" : "", "family" : "Wei", "given" : "Yifeng", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hayden", "given" : "Jill A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kutcher", "given" : "Stan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zygmunt", "given" : "Austin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McGrath", "given" : "Patrick", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Early intervention in psychiatry", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2013", "5" ] ] }, "page" : "109-21", "title" : "The effectiveness of school mental health literacy programs to address knowledge, attitudes and help seeking among youth.", "type" : "article-journal", "volume" : "7" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Wei, Hayden, Kutcher, Zygmunt, & McGrath, 2013)", "manualFormatting" : "Wei, Hayden, Kutcher, Zygmunt, & McGrath, 2013)", "plainTextFormattedCitation" : "(Wei, Hayden, Kutcher, Zygmunt, & McGrath, 2013)", "previouslyFormattedCitation" : "(Wei, Hayden, Kutcher, Zygmunt, & McGrath, 2013)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Wei, Hayden, Kutcher, Zygmunt, & McGrath, 2013).There are also criticisms (albeit primarily among academic activists rather than the stakeholders noted above) of the notion that children’s wellbeing could/should become the focus of checklists (e.g. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Watson", "given" : "Debbie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Emery", "given" : "Carl", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bayliss", "given" : "Phil", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2012" ] ] }, "publisher" : "Policy Press", "publisher-place" : "Bristol", "title" : "Children's social and emotional wellbeing in schools: a critical perspective", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Watson, Emery, & Bayliss, 2012)", "manualFormatting" : "Watson, Emery, & Bayliss, 2012)", "plainTextFormattedCitation" : "(Watson, Emery, & Bayliss, 2012)", "previouslyFormattedCitation" : "(Watson, Emery, & Bayliss, 2012)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Watson, Emery, & Bayliss, 2012) in an education system already driven by ‘testocracy’. Finally, there are ethical questions, ranging from basic notions of informed consent (e.g. consent may be the most difficult to obtain from parents/carers of children most at risk for developing MHD - ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jsp.2006.11.005", "ISSN" : "00224405", "abstract" : "When embedded within a continuum of mental health services including both prevention and treatment, school-based mental health identification programs can promote improved academic and mental health functioning among students. This article describes the scientific status of assessment instrumentation that may be used for early mental health identification in schools. Currently available instruments are described in terms of their ability to accurately detect youth with mental health problems. Implications for selecting mental health screening and assessment instruments and integrating them into schools are discussed. 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A variety of forums related to public health, education, and research ethics were used in selection and illustration of the dilemmas, which include (a) community acceptance, (b) family rights, (c) identification, and (d) service delivery provision. Reference to regulations that may guide ethical decision making around the parameters of school-based behavioral assessment are provided along with specific implications for both research and practice.", "author" : [ { "dropping-particle" : "", "family" : "Chafouleas", "given" : "S. M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kilgus", "given" : "S. 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In relation to feasibility, ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.cbpra.2014.03.008", "ISSN" : "10777229", "abstract" : "Although best practice for children's mental health services emphasizes ongoing assessment and monitoring of clinical progress, community based clinicians inconsistently implement assessment as part of clinical care due to a variety of practical barriers. The current study explores which factors may be related to the use and function of evidence-based assessment (EBA) in real-world, clinical settings, particularly school mental health (SMH). Mixed methodologies surveying a national sample of SMH clinicians and interviewing clinicians and program managers were used to explore current assessment practices, including use of specific tools and barriers, facilitators and attitudes toward EBA. Results indicate that clinician level of experience is negatively related to overall attitudes toward EBA, particularly openness. The most commonly-reported barriers to using assessments were difficulty reaching parents, respondents not understanding items, and clinicians not having access to measures they like or need. Also, supervision, when received, does not often include EBA. Academic indicators were more regularly collected than any of the 18 clinical assessment tools queried. Qualitative themes including barriers and facilitators to conducting EBA, specific measures' weaknesses and strengths, strategies to increase response rates and regular administration, and program management considerations regarding EBA implementation provide supporting details to these results. Implications for ongoing quality improvement efforts by program managers and clinicians related to the feasible implementation of EBA in school mental health settings are discussed. \u00a9 2014.", "author" : [ { "dropping-particle" : "", "family" : "Connors", "given" : "Elizabeth H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arora", "given" : "Prerna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Curtis", "given" : "Latisha", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stephan", "given" : "Sharon H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cognitive and Behavioral Practice", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "60-73", "publisher" : "Elsevier B.V.", "title" : "Evidence-Based Assessment in School Mental Health", "type" : "article-journal", "volume" : "22" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Connors, Arora, Curtis, & Stephan, 2014)", "manualFormatting" : "Connors, Arora, Curtis, and Stephan's (2014)", "plainTextFormattedCitation" : "(Connors, Arora, Curtis, & Stephan, 2014)", "previouslyFormattedCitation" : "(Connors, Arora, Curtis, & Stephan, 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Connors, Arora, Curtis, and Stephan's (2014) survey of evidence-based assessment among school mental health clinicians in the USA reported that most common and widely used mental health measures (for example, the Strengths and Difficulties Questionnaire ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1469-7610.1997.tb01545.x", "ISSN" : "0021-9630", "author" : [ { "dropping-particle" : "", "family" : "Goodman", "given" : "Robert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Child Psychology and Psychiatry", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "1997", "7" ] ] }, "page" : "581-586", "title" : "The Strengths and Difficulties Questionnaire: A Research Note", "type" : "article-journal", "volume" : "38" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(R. Goodman, 1997)", "manualFormatting" : "- Goodman, 1997)", "plainTextFormattedCitation" : "(R. Goodman, 1997)", "previouslyFormattedCitation" : "(R. Goodman, 1997)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }- Goodman, 1997) were perceived as being easy to administer. However, respondents in the same study also raised concerns about difficulties reaching parents and children or parents not understanding assessment questions. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "9781461476245", "author" : [ { "dropping-particle" : "", "family" : "Dvorsky", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Girio-Herrera", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Julie Sarno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Hadnbook of school mental health", "editor" : [ { "dropping-particle" : "", "family" : "Weist", "given" : "Mark D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "297-310", "publisher" : "Springer", "publisher-place" : "New York, NY", "title" : "School-based screening for mental health in early childhood", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Dvorsky et al., 2014)", "manualFormatting" : "Dvorsky et al., (2014)", "plainTextFormattedCitation" : "(Dvorsky et al., 2014)", "previouslyFormattedCitation" : "(Dvorsky et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Dvorsky et al., (2014) note further pragmatic considerations such as brevity, cost and simplicity. Gresham and Elliot’s (2008) ‘Performance Screening Guide’ (PSG) aspect of the Social Skills Improvement System provides a useful example. Teacher feedback on the piloting of this instrument noted clear instructions and definitions/descriptors of domains of interest as being vital to instrument’s feasibility as a screener. Lengthy, expensive measures that have complicated scoring protocols are unlikely to be widely adopted by schools. There is evidence, however, that these requirements need not outweigh other considerations, such as psychometric characteristics. For example, Connors et al (2004) and ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1542/peds.2005-2965", "ISBN" : "0031-4005", "ISSN" : "1098-4275", "PMID" : "17200276", "abstract" : "OBJECTIVE: Despite available depression treatments, only one fourth to one third of depressed adolescents are receiving care. The problem of underdiagnosis and underreferral might be redressed if assessment of suicidality and depression became a more formal part of routine pediatric care. Our purpose for this study was to explore the feasibility and acceptability of implementing adolescent depression screening into clinical practice. METHODS: In this study we implemented a 2-stage adolescent identification protocol, a first-stage pen-and-paper screen and a second-stage computerized assessment, into a busy primary care pediatric practice. Providers tracked the number of eligible patients screened at both health maintenance and urgent care visits and provided survey responses regarding the burden that screening placed on the practice and the effect on patient/parent-provider relationships. RESULTS: Seventy-nine percent of adolescent patients presenting for health maintenance visits were screened, as were the majority of patients presenting for any type of visit. The average completion time for the paper screen was 4.6 minutes. Providers perceived parents and patients as expressing more satisfaction than dissatisfaction with the screening procedures and that the increased time burden could be handled. All providers wished to continue using the paper screen at the conclusion of the protocol. CONCLUSIONS: Instituting universal systematic depression screening in a practice with a standardized screening instrument met with little resistance by patients and parents and was well perceived and accepted by providers.", "author" : [ { "dropping-particle" : "", "family" : "Zuckerbrot", "given" : "Rachel a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Maxon", "given" : "Laura", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pagar", "given" : "Dana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davies", "given" : "Mark", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fisher", "given" : "Prudence W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shaffer", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Pediatrics", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "101-108", "title" : "Adolescent depression screening in primary care: feasibility and acceptability.", "type" : "article-journal", "volume" : "119" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Zuckerbrot et al., 2007)", "manualFormatting" : "Zuckerbrot et al. (2007)", "plainTextFormattedCitation" : "(Zuckerbrot et al., 2007)", "previouslyFormattedCitation" : "(Zuckerbrot et al., 2007)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Zuckerbrot et al. (2007) both highlight a range of robust measures that can be completed in 5 minutes or less. Finally, with regard to utility, the aforementioned study by Connors et al (2014) found a generally high level of perceived clinical value for common mental health measures. Similarly, a survey of over 300 head teachers by ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Taggart", "given" : "H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lee", "given" : "S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McDonald", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "publisher-place" : "London", "title" : "Perceptions of wellbeing and mental health in English secondary schools: a cross-sectional study", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Taggart, Lee, & McDonald, 2014)", "manualFormatting" : "Taggart et al. (2014)", "plainTextFormattedCitation" : "(Taggart, Lee, & McDonald, 2014)", "previouslyFormattedCitation" : "(Taggart, Lee, & McDonald, 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Taggart et al. (2014) found that among those whose secondary schools routinely used some kind of screening measure, 85% reported that they were effective (although it should be noted that the exact nature of ‘screening’ and what ‘effective’ means was not reported and is therefore open to interpretation). ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Gresham", "given" : "F. M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Elliot", "given" : "S. N.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2008" ] ] }, "publisher" : "Pearson", "publisher-place" : "Minneapolis, MN", "title" : "Social Skills Improvement System: Rating Scales Manual", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Gresham & Elliot, 2008)", "manualFormatting" : "Gresham & Elliot (2008)", "plainTextFormattedCitation" : "(Gresham & Elliot, 2008)", "previouslyFormattedCitation" : "(Gresham & Elliot, 2008)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Gresham & Elliot (2008) also report positive feedback from teachers regarding the PSG, most notably that the instrument (which covers academic and non-academic domains, e.g. pro-social behaviour) referred to useful behaviours and helped to provide a more comprehensive assessment of their students. Finally, the aforementioned study by Zuckerbrot et al (2007), which focused on the pilot of a screening tool for adolescent depression in primary care, reported that most providers in their sample felt that it had aided their identification of children in need of help, made them feel more comfortable in addressing depression, and that they would continue using the tool.Education policy and the ‘zero sum game’ approach to attainment and healthIrrespective of the evidence that universal screening (and, by extension, mental health promotion more generally) is considered to be a socially important innovation by key stakeholders such as teachers and school leaders, it is vital to also consider the policy directives and mandates under which they operate, since it is often these that dictate whether such innovations gain traction ‘at the chalkface’. In this sense, the current education policy landscape presents a major challenge. Since 2010, successive governments (first Coalition, subsequently Conservative) have actively dismantled key aspects of the education system that supported an emphasis on pupil health and wellbeing in schools. To whit, government endorsement of the social and emotional aspects of learning programme was withdrawn; participation in the National Healthy Schools programme is no longer funded; personal, social and health education remains non-statutory; the Ofsted inspection framework no longer focuses explicitly on personal development and wellbeing; and an initiative that effectively replaces the early years foundation stage profiling exercise with baseline academic testing on school entry is currently being trialled with a view to a national scale-up in 2016. These policy shifts are part of a highly rationalist/technicist model of education, and reflect what ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1136/bmj.g3078", "ISSN" : "1756-1833", "PMID" : "25134103", "author" : [ { "dropping-particle" : "", "family" : "Bonell", "given" : "Chris", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Humphrey", "given" : "Neil", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fletcher", "given" : "Adam", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moore", "given" : "Laurence", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Anderson", "given" : "Rob", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Campbell", "given" : "Rona", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMJ (Clinical research ed.)", "id" : "ITEM-1", "issue" : "may13_2", "issued" : { "date-parts" : [ [ "2014", "1", "13" ] ] }, "page" : "g3078", "title" : "Why schools should promote students' health and wellbeing.", "type" : "article-journal", "volume" : "348" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Bonell et al., 2014)", "manualFormatting" : "Bonell et al (2014)", "plainTextFormattedCitation" : "(Bonell et al., 2014)", "previouslyFormattedCitation" : "(Bonell et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Bonell et al (2014) have termed the ‘zero-sum game’ view of attainment and health (e.g. academic attainment is singularly important in promoting economic competetiveness; any time spent on improving health and wellbeing in schools means less time for traditional academic instruction and thus produces lower attainment).Schools are therefore likely to need a signficant ‘hook’ and it is here where the growing body of evidence on the relatonship between mental health and academic attainment comes to the fore. In particular, research on developmental cascades has shown how, for example, early mental health difficulties can erode later academic attainment ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1017/S0954579410000337", "ISBN" : "0954579410", "ISSN" : "1469-2198", "PMID" : "20576184", "abstract" : "The current study was initiated to increase understanding of developmental cascades in childhood in a sample of at-risk boys (N = 291; 52% White). Mothers, teachers, and boys reported on boys' externalizing problems, internalizing difficulties, and academic competence. Consistent with hypotheses regarding school-related transitions, high levels of externalizing problems were associated with both low levels of academic competence and high levels of internalizing problems during the early school-age period, and with elevations in internalizing problems during the transition to adolescence. Low levels of academic competence were associated with high levels of internalizing problems in middle childhood, and with high levels of externalizing problems during the transition from elementary school to middle school. Shared risk factors played a minimal role in these developmental cascades. Results suggest that there are cascading effects of externalizing problems and academic competence in childhood and early adolescence, and that some cascading effects are more likely to occur during periods of school-related transitions. 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Similarly, research is available that challenges the view of academic attainment as the sole driver of economic competitiveness (e.g. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Goodman", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Joshi", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nasim", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tyler", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "publisher-place" : "London", "title" : "Social and emotional skills in childhood and their long-term effects on adult life", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(A. Goodman, Joshi, Nasim, & Tyler, 2015)", "manualFormatting" : "Goodman, Joshi, Nasim, & Tyler, 2015)", "plainTextFormattedCitation" : "(A. Goodman, Joshi, Nasim, & Tyler, 2015)", "previouslyFormattedCitation" : "(A. Goodman, Joshi, Nasim, & Tyler, 2015)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Goodman, Joshi, Nasim, & Tyler, 2015). Active promotion and dissemination of such evidence is likely to be a necessary part of any campaign to introduce universal screening in schools given the current education policy landscape.Definition and conceptualisationWhat we mean and understand by ‘mental health’ and related terms (e.g. social and emotional wellbeing) is obviously a critical consideration for universal screening. The discourse of mental health is extremely controversial, and there is a long-standing objection to the ‘illness framework’ (e.g. disease and disorder) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Pilgrim", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "publisher" : "Sage Publications", "publisher-place" : "London", "title" : "Key concepts in mental health", "type" : "book" }, "uris" : [ "", "" ] }, { "id" : "ITEM-2", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Rogers", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pilgrim", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2014" ] ] }, "publisher" : "Open University Press", "publisher-place" : "Buckingham", "title" : "A sociology of mental health and illness", "type" : "book" }, "uris" : [ "", "" ] } ], "mendeley" : { "formattedCitation" : "(Pilgrim, 2014; Rogers & Pilgrim, 2014)", "plainTextFormattedCitation" : "(Pilgrim, 2014; Rogers & Pilgrim, 2014)", "previouslyFormattedCitation" : "(Pilgrim, 2014; Rogers & Pilgrim, 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Pilgrim, 2014; Rogers & Pilgrim, 2014) particularly as applied in the educational context ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/13540602.2011.580525", "ISBN" : "1354-0602", "ISSN" : "1354-0602", "abstract" : "Schools have increasingly been targeted as appropriate sites for mental health promotion and teachers are considered well placed to identify issues concerning students\u2019 social and emotional well-being. Whilst teachers are now expected to be responsive to a wide range of student needs and circumstances, they receive little in their pre-service and subsequent teacher education to adequately prepare them for such realities. This paper reports the findings of a study that investi-gated teacher perspectives on student mental health and mental health education, including their sense of self-efficacy in relation to promoting and supporting children\u2019s mental well-being in schools. These findings highlight a complex interplay between teachers\u2019 constructions of\u2018mental health\u2019, the importance they place on mental health promotion in schools, issues of teacher confidence, role identity conflict and school culture, as well as teachers\u2019 own sense of mental well-being. The discussion signals a need to pay close attention to the assump-tions, values, beliefs and attitudes of teachers in relation to children\u2019s mental health since these are integral to their confidence and skill in supporting chil-dren\u2019s social and emotional well-being.", "author" : [ { "dropping-particle" : "", "family" : "Graham", "given" : "Anne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Phelps", "given" : "Renata", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Maddison", "given" : "Carrie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fitzgerald", "given" : "Robyn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Teachers and Teaching: theory and practice", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "479-496", "title" : "Supporting children's mental health in schools: teacher views", "type" : "article-journal", "volume" : "17" }, "uris" : [ "", "" ] } ], "mendeley" : { "formattedCitation" : "(Graham, Phelps, Maddison, & Fitzgerald, 2011)", "plainTextFormattedCitation" : "(Graham, Phelps, Maddison, & Fitzgerald, 2011)", "previouslyFormattedCitation" : "(Graham, Phelps, Maddison, & Fitzgerald, 2011)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Graham, Phelps, Maddison, & Fitzgerald, 2011). This conceptualisation can be seen as negative, stigmatising, and problematizing those experiencing difficulties, while also serving to reinforce social exclusion of marginalised individuals and groups ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S0140-6736(06)68184-1", "ISSN" : "01406736", "PMID" : "16473129", "author" : [ { "dropping-particle" : "", "family" : "Link", "given" : "Bruce G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Phelan", "given" : "Jo C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Lancet", "id" : "ITEM-1", "issue" : "9509", "issued" : { "date-parts" : [ [ "2006", "2", "11" ] ] }, "page" : "528-529", "title" : "Stigma and its public health implications", "type" : "article-journal", "volume" : "367" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Link & Phelan, 2006)", "plainTextFormattedCitation" : "(Link & Phelan, 2006)", "previouslyFormattedCitation" : "(Link & Phelan, 2006)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Link & Phelan, 2006). As a result, ‘difficulties’ or ‘problems’ have begun to replace ‘disorders’ in the collective mental health lexicon as these terms are generally considered to be less value-laden ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Pilgrim", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "publisher" : "Sage Publications", "publisher-place" : "London", "title" : "Key concepts in mental health", "type" : "book" }, "uris" : [ "", "" ] } ], "mendeley" : { "formattedCitation" : "(Pilgrim, 2014)", "plainTextFormattedCitation" : "(Pilgrim, 2014)", "previouslyFormattedCitation" : "(Pilgrim, 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Pilgrim, 2014), but even this may be viewed as problematic. Consider this article. Thus far we have referred to mental health difficulties, and discussed the identification/classification of children and young people who may be at-risk of developing internalising and/or externalising difficulties, symptoms and/or problems. To some this kind of language will be considered retrograde.Partly in response to the issues noted above, recent years have seen the emergence of an ‘enhancement agenda’ embodied by a strengths-based discourse that emphasizes agency and resilience ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/13540602.2011.580525", "ISBN" : "1354-0602", "ISSN" : "1354-0602", "abstract" : "Schools have increasingly been targeted as appropriate sites for mental health promotion and teachers are considered well placed to identify issues concerning students\u2019 social and emotional well-being. 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Viewed through this lens, mental health is fundamentally about a state of wellbeing as opposed to illness, and shifts in thinking about the role of schools have accompanied this. Thus, we have seen a dramatic increase in the popularity of universal social and emotional learning programmes and other approaches that focus on the promotion of competencies rather than the remediation of problems ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Humphrey", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "publisher" : "Sage Publications", "publisher-place" : "London", "title" : "Social and emotional learning: a critical appraisal", "type" : "book" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Vostanis", "given" : "Panos", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Humphrey", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fitzgerald", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wolpert", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Deighton", "given" : "Jessica", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Child and Adolescent Mental Health", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2012" ] ] }, "title" : "How do schools promote emotional wellbeing among their pupils? 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More broadly, wellbeing and in particular ‘the pursuit of happiness’ ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Centre Forum Commission", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "publisher-place" : "London", "title" : "The pursuit of happiness: a new ambition for our mental health", "type" : "report" }, "uris" : [ "", "" ] } ], "mendeley" : { "formattedCitation" : "(Centre Forum Commission, 2014)", "plainTextFormattedCitation" : "(Centre Forum Commission, 2014)", "previouslyFormattedCitation" : "(Centre Forum Commission, 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Centre Forum Commission, 2014) have entered the mainstream discourse of mental health, and the positive psychology movement has gained a significant foothold in education ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Furlong", "given" : "M. 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For example, Ecclestone and Hayes ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "0415397014", "author" : [ { "dropping-particle" : "", "family" : "Ecclestone", "given" : "Kathryn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hayes", "given" : "Dennis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2008" ] ] }, "number-of-pages" : "200", "publisher" : "Routledge", "title" : "The Dangerous Rise of Therapeutic Education", "type" : "book" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1080/03054980902934662", "ISSN" : "0305-4985", "author" : [ { "dropping-particle" : "", "family" : "Ecclestone", "given" : "Kathryn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hayes", "given" : "Dennis", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Oxford Review of Education", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2009", "6" ] ] }, "page" : "371-389", "title" : "Changing the subject: the educational implications of developing emotional well\u2010being", "type" : "article-journal", "volume" : "35" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Ecclestone", "given" : "Kathryn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Education Policy", "id" : "ITEM-3", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "455-470", "title" : "Resisting images of the 'diminshed seld': the implications of emotional well-being and emotional engagement in education policy", "type" : "article-journal", "volume" : "22" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Ecclestone & Hayes, 2008, 2009; Ecclestone, 2007)", "manualFormatting" : "(2008, 2009)", "plainTextFormattedCitation" : "(Ecclestone & Hayes, 2008, 2009; Ecclestone, 2007)", "previouslyFormattedCitation" : "(Ecclestone & Hayes, 2008, 2009; Ecclestone, 2007)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(2008, 2009) and others (e.g. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Watson", "given" : "Debbie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Emery", "given" : "Carl", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bayliss", "given" : "Phil", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2012" ] ] }, "publisher" : "Policy Press", "publisher-place" : "Bristol", "title" : "Children's social and emotional wellbeing in schools: a critical perspective", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Watson et al., 2012)", "manualFormatting" : "Watson, Emery, and Bayliss, 2012)", "plainTextFormattedCitation" : "(Watson et al., 2012)", "previouslyFormattedCitation" : "(Watson et al., 2012)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Watson, Emery, and Bayliss, 2012) have critiqued the increased attention on the promotion of wellbeing in education, arguing that in spite of its apparently positive focus, this approach is still fundamentally about vulnerability and the diminishment of the human subject. One might also argue that an approach to understanding mental health that purposively ignores or underplays notions of distress risks drawing much-needed support away from those who need it most.Somewhere in between is the ‘dual factor’ approach, which conceptualises mental health as comprising two distinct dimensions, representing the experience of symptoms of psychological distress and adaptive functioning respectively ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "978-1-4614-7623-8", "author" : [ { "dropping-particle" : "", "family" : "Dowdy", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kamphaus", "given" : "R. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Twyford", "given" : "J. 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Importantly, this model posits mental illness and health not as forming a single continuum, but rather as complementary but discrete continua ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/10474412.2014.929951", "ISSN" : "1047-4412", "author" : [ { "dropping-particle" : "", "family" : "Dowdy", "given" : "Erin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Furlong", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Raines", "given" : "Tara C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bovery", "given" : "Bibliana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kauffman", "given" : "Beth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kamphaus", "given" : "Randy W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Dever", "given" : "Bridget", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Price", "given" : "Martin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murdock", "given" : "Jan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Educational and Psychological Consultation", "id" : "ITEM-1", "issue" : "March 2015", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "1-20", "title" : "Enhancing School-Based Mental Health Services With a Preventive and Promotive Approach to Universal Screening for Complete Mental Health", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Erin Dowdy et al., 2014)", "manualFormatting" : "(Dowdy et al., 2014)", "plainTextFormattedCitation" : "(Erin Dowdy et al., 2014)", "previouslyFormattedCitation" : "(Erin Dowdy et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dowdy et al., 2014). This model of mental health is illustrated in NICE’s current definition, which posits emotional, social and psychological wellbeing as each including these distinct dimensions (e.g. emotional wellbeing is viewed in terms of happiness and confidence and anxiety and depression) (ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "National Institute for Health and Care Excellence", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "publisher-place" : "London", "title" : "Social and emotional wellbeing for children and young people", "type" : "report" }, "uris" : [ "", "" ] } ], "mendeley" : { "formattedCitation" : "(National Institute for Health and Care Excellence, 2013)", "manualFormatting" : "National Institute for Health and Care Excellence, 2013)", "plainTextFormattedCitation" : "(National Institute for Health and Care Excellence, 2013)", "previouslyFormattedCitation" : "(National Institute for Health and Care Excellence, 2013)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }National Institute for Health and Care Excellence, 2013).Even with such a framework, it is important not to underestimate the influence of different professional lexicons and the barriers these may produce. Indeed, mental health can be seen as a microcosm of the wider challenges associated with multi-agency collaboration in children’s services more generally. The lack of a common language is a central component of this ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Richford", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "publisher" : "University of Manchester", "title" : "Health, education and social care professionals\u2019 perspectives on risk and resilience in vulnerable young people and an exploration of the usefulness of this approach in promoting effective multi agency work", "type" : "thesis" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Richford, 2013)", "plainTextFormattedCitation" : "(Richford, 2013)", "previouslyFormattedCitation" : "(Richford, 2013)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Richford, 2013), and there will likely be differential reactions to a screening instrument that purports to focus upon (for example) ‘mental health (difficulties)’, ‘social and emotional wellbeing’, or ‘emotional and behavioural difficulties’, among education, health and social care professionals. This is important because the terminology used about and within a screening system will influence its perceived acceptability among those who make use of it. For example, it may be that a focus on children’s ‘social and emotional wellbeing’ may be considered more palatable among teachers than one that is seen as foregrounding ‘mental health difficulties’. In terms of content, a screener that mirrors the dual factor model outlined above perhaps offers the most acceptable and comprehensive approach ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/10474412.2014.929951", "ISSN" : "1047-4412", "author" : [ { "dropping-particle" : "", "family" : "Dowdy", "given" : "Erin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Furlong", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Raines", "given" : "Tara C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bovery", "given" : "Bibliana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kauffman", "given" : "Beth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kamphaus", "given" : "Randy W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Dever", "given" : "Bridget", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Price", "given" : "Martin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murdock", "given" : "Jan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Educational and Psychological Consultation", "id" : "ITEM-1", "issue" : "March 2015", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "1-20", "title" : "Enhancing School-Based Mental Health Services With a Preventive and Promotive Approach to Universal Screening for Complete Mental Health", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Erin Dowdy et al., 2014)", "manualFormatting" : "(Dowdy et al., 2014)", "plainTextFormattedCitation" : "(Erin Dowdy et al., 2014)", "previouslyFormattedCitation" : "(Erin Dowdy et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dowdy et al., 2014). However, the inclusion of domains relating to children’s social-emotional competence, resilience and/or adaptive functioning more broadly can only be useful if the data produced is subsequently used to inform provision in a manner that is consistent with the underlying model. So for example, areas of strength could be highlighted in order to prompt discussion about how these may be capitalised upon in order to mitigate the impact of difficulties being experienced in other domains. Alternatively, dual factor data could be used as a means to identify students at the very highest levels of risk (e.g. high symptoms/distress, minimal competence/strengths) who may be require immediate and intensive intervention ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/10474412.2014.929951", "ISSN" : "1047-4412", "author" : [ { "dropping-particle" : "", "family" : "Dowdy", "given" : "Erin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Furlong", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Raines", "given" : "Tara C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bovery", "given" : "Bibliana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kauffman", "given" : "Beth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kamphaus", "given" : "Randy W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Dever", "given" : "Bridget", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Price", "given" : "Martin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Murdock", "given" : "Jan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Educational and Psychological Consultation", "id" : "ITEM-1", "issue" : "March 2015", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "1-20", "title" : "Enhancing School-Based Mental Health Services With a Preventive and Promotive Approach to Universal Screening for Complete Mental Health", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Erin Dowdy et al., 2014)", "manualFormatting" : "(Dowdy et al., 2014)", "plainTextFormattedCitation" : "(Erin Dowdy et al., 2014)", "previouslyFormattedCitation" : "(Erin Dowdy et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dowdy et al., 2014). Unfortunately, this does not seem to be a feature in current screening practices. Where screening instruments do include domains relating to areas of competence or strength (e.g. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s12310-014-9123-y", "ISSN" : "1866-2625", "author" : [ { "dropping-particle" : "", "family" : "Skaar", "given" : "Nicole R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Christ", "given" : "Theodore J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jacobucci", "given" : "Ross", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "School Mental Health", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "137-149", "title" : "Measuring Adolescent Prosocial and Health Risk Behavior in Schools: Initial Development of a Screening Measure", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Skaar, Christ, & Jacobucci, 2014)", "manualFormatting" : "Skaar, Christ, & Jacobucci's (2014)", "plainTextFormattedCitation" : "(Skaar, Christ, & Jacobucci, 2014)", "previouslyFormattedCitation" : "(Skaar, Christ, & Jacobucci, 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Skaar, Christ, & Jacobucci's (2014) Pro-social and Health Adolescent Risk Behaviour Scale (PHARBS) incorporates a pro-social behaviour domain), these are often simply reverse-engineered during scoring to fit a deficit model (and thus, the PHARBS pro-social subscale is used to identify pro-social risk).Design and implementationTraining and goal clarificationInitial training and goal clarification for school staff are critical for a number of reasons. From a technical standpoint, training can help to improve: (i) awareness of mental health and MHD; (ii) consistency of screening across informants; (iii) understanding of how to score and use the data generated through screening at different levels (e.g. individual, class, school); (iv) communication with parents; and (v) referral and intervention practices following screening ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "9781461476245", "author" : [ { "dropping-particle" : "", "family" : "Dvorsky", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Girio-Herrera", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Julie Sarno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Hadnbook of school mental health", "editor" : [ { "dropping-particle" : "", "family" : "Weist", "given" : "Mark D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "297-310", "publisher" : "Springer", "publisher-place" : "New York, NY", "title" : "School-based screening for mental health in early childhood", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Dvorsky et al., 2014)", "plainTextFormattedCitation" : "(Dvorsky et al., 2014)", "previouslyFormattedCitation" : "(Dvorsky et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dvorsky et al., 2014). From a conceptual standpoint, training may also be used as an opportunity to clarify the intended purpose of screening and the role it plays in the wider system of mental health provision in a given school. This, alongside alleviation of pragmatic concerns likely to be expressed by many teachers (e.g. the time taken to engage in the screening process, how the data will actually be used) will likely increase the perceived social validity of the system (and thus increase the likelihood that it will be adopted, implemented with consistency and sustained over time).Measure selection and approach to screeningAssessment of child and adolescent mental health is a burgeoning field, and there certainly is no shortage of available measures that could theoretically be used in a universal screening system. For example, a recent systematic review by ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/1753-2000-8-14", "ISSN" : "1753-2000", "PMID" : "24834111", "abstract" : "There is a growing appetite for mental health and wellbeing outcome measures that can inform clinical practice at individual and service levels, including use for local and national benchmarking. Despite a varied literature on child mental health and wellbeing outcome measures that focus on psychometric properties alone, no reviews exist that appraise the availability of psychometric evidence and suitability for use in routine practice in child and adolescent mental health services (CAMHS) including key implementation issues. This paper aimed to present the findings of the first review that evaluates existing broadband measures of mental health and wellbeing outcomes in terms of these criteria. The following steps were implemented in order to select measures suitable for use in routine practice: literature database searches, consultation with stakeholders, application of inclusion and exclusion criteria, secondary searches and filtering. Subsequently, detailed reviews of the retained measures' psychometric properties and implementation features were carried out. 11 measures were identified as having potential for use in routine practice and meeting most of the key criteria: 1) Achenbach System of Empirically Based Assessment, 2) Beck Youth Inventories, 3) Behavior Assessment System for Children, 4) Behavioral and Emotional Rating Scale, 5) Child Health Questionnaire, 6) Child Symptom Inventories, 7) Health of the National Outcome Scale for Children and Adolescents, 8) Kidscreen, 9) Pediatric Symptom Checklist, 10) Strengths and Difficulties Questionnaire, 11) Youth Outcome Questionnaire. However, all existing measures identified had limitations as well as strengths. Furthermore, none had sufficient psychometric evidence available to demonstrate that they could reliably measure both severity and change over time in key groups. The review suggests a way of rigorously evaluating the growing number of broadband self-report mental health outcome measures against standards of feasibility and psychometric credibility in relation to use for practice and policy.", "author" : [ { "dropping-particle" : "", "family" : "Deighton", "given" : "Jessica", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Croudace", "given" : "Tim", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fonagy", "given" : "Peter", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "Jeb", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Patalay", "given" : "Praveetha", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wolpert", "given" : "Miranda", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Child and adolescent psychiatry and mental health", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "14", "title" : "Measuring mental health and wellbeing outcomes for children and adolescents to inform practice and policy: a review of child self-report measures.", "type" : "article-journal", "volume" : "8" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Jessica Deighton et al., 2014)", "manualFormatting" : "Deighton et al., (2014)", "plainTextFormattedCitation" : "(Jessica Deighton et al., 2014)", "previouslyFormattedCitation" : "(Jessica Deighton et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Deighton et al., (2014) identified 117 measures, filtering down eventually to 11 ‘best of field’ tools (e.g. those with the strongest evidence base). Similarly, a systematic review of measures of children’s social-emotional competence by our research team identified 189 before subsequently filtering down to 12 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/02667361003768526", "ISSN" : "0266-7363", "author" : [ { "dropping-particle" : "", "family" : "Wigelsworth", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Humphrey", "given" : "Neil", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kalambouka", "given" : "Afroditi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lendrum", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Educational Psychology in Practice", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2010", "6" ] ] }, "page" : "173-186", "title" : "A review of key issues in the measurement of children\u2019s social and emotional skills", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1177/0013164410382896", "ISSN" : "0013-1644", "abstract" : "This study presents the findings of a systematic review of measures of social and emotional skills for children and young people. The growing attention to this area in recent years has resulted in the development of a large number of measures to aid in the assessment of children and young people. These measures vary on a number of variables relating to implementation characteristics and psychometric properties. The methodology of the review followed the general principles of systematic reviewing, such as systematic search of databases, the adoption of predetermined set of inclusion and exclusion criteria, and a multistage filtering process. The review process resulted in the retention of 12 measures, which are presented and discussed in relation to key issues in this area, including difficulties with the underlying theory and frameworks for social and emotional skills, inconsistent terminology, the scope and distinctiveness of available measures, and more practical issues such as the type of respondent, location, and purpose of measurement.", "author" : [ { "dropping-particle" : "", "family" : "Humphrey", "given" : "N.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kalambouka", "given" : "A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wigelsworth", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lendrum", "given" : "A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Deighton", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wolpert", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Educational and Psychological Measurement", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2011", "6", "29" ] ] }, "page" : "617-637", "title" : "Measures of Social and Emotional Skills for Children and Young People: A Systematic Review", "type" : "article-journal", "volume" : "71" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Humphrey et al., 2011; Wigelsworth, Humphrey, Kalambouka, & Lendrum, 2010)", "plainTextFormattedCitation" : "(Humphrey et al., 2011; Wigelsworth, Humphrey, Kalambouka, & Lendrum, 2010)", "previouslyFormattedCitation" : "(Humphrey et al., 2011; Wigelsworth, Humphrey, Kalambouka, & Lendrum, 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Humphrey et al., 2011; Wigelsworth, Humphrey, Kalambouka, & Lendrum, 2010). Available instruments vary greatly in what they purport to measure (e.g. mental health difficulties, social-emotional competence), their scope and specificity (e.g. some provide a broadband index of MHD, whereas others focus on a specific aspect, such as depression), implementation characteristics (e.g. age range, informant type, length and completion time) and psychometric properties (see section on this below). Some measures (e.g. the Beck Youth Inventory - ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Beck", "given" : "J.S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beck", "given" : "A. T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jolly", "given" : "J. B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2001" ] ] }, "publisher-place" : "San Antonio", "title" : "Beck Youth Inventories manual", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Beck, Beck, & Jolly, 2001)", "manualFormatting" : "Beck, Beck, & Jolly, 2001)", "plainTextFormattedCitation" : "(Beck, Beck, & Jolly, 2001)", "previouslyFormattedCitation" : "(Beck, Beck, & Jolly, 2001)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Beck, Beck, & Jolly, 2001) are proprietary and there are therefore financial costs associated with their use; others (e.g. the Strengths and Difficulties Questionnaire - ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1469-7610.1997.tb01545.x", "ISSN" : "0021-9630", "author" : [ { "dropping-particle" : "", "family" : "Goodman", "given" : "Robert", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Child Psychology and Psychiatry", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "1997", "7" ] ] }, "page" : "581-586", "title" : "The Strengths and Difficulties Questionnaire: A Research Note", "type" : "article-journal", "volume" : "38" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(R. Goodman, 1997)", "manualFormatting" : "Goodman, 1997)", "plainTextFormattedCitation" : "(R. Goodman, 1997)", "previouslyFormattedCitation" : "(R. Goodman, 1997)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Goodman, 1997) are freely available for widespread use. Instrument selection should take into account these factors, while also balancing the goodness of fit with local need (e.g. intended purpose, developmental appropriateness, required timing and frequency of assessment) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "9781461476245", "author" : [ { "dropping-particle" : "", "family" : "Dvorsky", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Girio-Herrera", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Julie Sarno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Hadnbook of school mental health", "editor" : [ { "dropping-particle" : "", "family" : "Weist", "given" : "Mark D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "297-310", "publisher" : "Springer", "publisher-place" : "New York, NY", "title" : "School-based screening for mental health in early childhood", "type" : "chapter" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.jsp.2006.05.005", "ISBN" : "0022-4405", "ISSN" : "00224405", "abstract" : "Universal screening is a critical prerequisite to providing early school-based prevention and intervention services for students at risk for or with academic, behavioral, or emotional difficulties. Although use of academic and behavioral screening has become more prevalent, criteria for making informed decisions about appropriate screening tools are not readily available to those who work in educational settings. The purpose of this article is to (a) highlight several considerations about the appropriateness, technical adequacy, and usability of academic or behavioral screeners and (b) provide a general assessment of the current state of science pertaining to universal screening. The article concludes with considerations for policy and practice. The framework presented may be useful in guiding those interested in evaluating, selecting, and researching school-based universal screening assessments. \u00a9 2006 Society for the Study of School Psychology.", "author" : [ { "dropping-particle" : "", "family" : "Glover", "given" : "Todd a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albers", "given" : "Craig a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of School Psychology", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "117-135", "title" : "Considerations for evaluating universal screening assessments", "type" : "article-journal", "volume" : "45" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Dvorsky et al., 2014; Glover & Albers, 2007)", "plainTextFormattedCitation" : "(Dvorsky et al., 2014; Glover & Albers, 2007)", "previouslyFormattedCitation" : "(Dvorsky et al., 2014; Glover & Albers, 2007)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dvorsky et al., 2014; Glover & Albers, 2007).However, it is also important to note that standardised measures of mental health are not the only means through which to operate a universal screening system. Other approaches include screening for exposure to risk factors associated with MHD (e.g. exposure to domestic violence), or using simple nomination methods (e.g. asking teachers to nominate children they consider to be at increased risk of developing MHD). ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s11121-006-0026-5", "ISSN" : "13894986", "PMID" : "16850278", "abstract" : "The accuracy of screening methods for predicting children's internalizing, externalizing, or total behavior problems by 1-year follow-up were compared. Parents and teachers completed two screening measures each: a measure of exposure to multiple family risk factors (the Family Risk Factor Checklist: FRFC) and a simple nomination question of child risk status, which involved informants answering one question concerning whether they believed a child was at higher risk than average of developing a mental health problem in the future. Both parents and teachers were more accurate at identifying children at risk of externalizing than internalizing disorders. For parents, the FRFC showed similar sensitivity to simple nomination as a screen for predicting later total behavior problems, lower sensitivity for internalizing problems, and there was a nonsignificant trend for the FRFC to have higher sensitivity for externalizing problems than simple nomination. The specificity of simple nomination was somewhat higher than that of the FRFC for all three mental health outcomes. For teachers, simple nomination showed higher sensitivity than the FRFC for predicting internalizing, externalizing, and total behavior problems, but the difference was nonsignificant for internalizing problems. The specificity for both teacher screens was similar across mental health outcomes. For a population base rate of externalizing problems of 13%, teacher nominations for children at risk of externalizing problems had a sensitivity of 69%, specificity of 78%, positive predictive value (PPV) of 32%, and negative predictive value (NPV) of 94%. Teacher nominations of at-risk children had greater predictive accuracy than parent nominations. The simple nomination method shows promise as a cost-efficient screen. When screening children who did not yet have behavioral symptoms, both parent and teacher measures resulted in substantial misclassification errors. However, the use of these screening measures at a population level could benefit large numbers of children who subsequently receive selective preventive interventions.", "author" : [ { "dropping-particle" : "", "family" : "Dwyer", "given" : "Sarah B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nicholson", "given" : "Jan M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Battistutta", "given" : "Diana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Prevention Science", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "343-357", "title" : "Parent and teacher identification of children at risk of developing internalizing or externalizing mental health problems: A comparison of screening methods", "type" : "article-journal", "volume" : "7" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Dwyer, Nicholson, & Battistutta, 2006)", "manualFormatting" : "Dwyer, Nicholson, and Battistutta (2006)", "plainTextFormattedCitation" : "(Dwyer, Nicholson, & Battistutta, 2006)", "previouslyFormattedCitation" : "(Dwyer, Nicholson, & Battistutta, 2006)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Dwyer, Nicholson, and Battistutta (2006) report on the utility of both methods, and we explore this study in the section on psychometric considerations. Of particular note at this juncture is their overall conclusion that, “Simple nomination deserves attention as a screening method… the results of the current study suggest that simple nomination may be used to identify children for selective interventions with reasonable confidence that its predictive validity is as good, if not better than, other currently available (longer) screening instruments” (p.352). Thus, nomination may offer an effective and expedient alternative to standardized measures. That said, we should also consider the findings of ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Miller", "given" : "Faith G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cohen", "given" : "Daniel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chafouleas", "given" : "Sandra M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Riley-tillman", "given" : "T Chris", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Welsh", "given" : "Megan E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fabiano", "given" : "Gregory A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Risk", "given" : "Behavioral", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Miller", "given" : "Faith G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cohen", "given" : "Daniel", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chafouleas", "given" : "Sandra M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Riley-tillman", "given" : "T Chris", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Welsh", "given" : "Megan E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fabiano", "given" : "Gregory A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "School Psychology Quarterly", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "title" : "A Comparison of Measures to Screen for Social , Emotional , and Behavioral Risk", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Miller et al., 2014)", "manualFormatting" : "Miller et al. (2014)", "plainTextFormattedCitation" : "(Miller et al., 2014)", "previouslyFormattedCitation" : "(Miller et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Miller et al. (2014), whose study found that standardised measures were more accurate and reliable than school nomination. However, it is important to note that the manner in which the latter study conceptualized ‘nomination’ was very different to the Dwyer study, being based upon evidence of referral and supplementary support for a student rather than a teacher’s perceptions of their likelihood of developing MHD.In some studies of universal screening, the above methods are combined in a multi-stage system. For example, in ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/0143034311403036", "ISBN" : "0143-0343\\r1461-7374", "ISSN" : "0143-0343", "author" : [ { "dropping-particle" : "", "family" : "Kettler", "given" : "R. 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The authors’ analyses indicated that, “these types of tools appear to work well in multiple settings for assigning students to relatively inexpensive non-restrictive interventions, or as first stages in multi-stage systems for screening” (Kettler et al, 2012, p.108). The initial nomination stage was highly sensitive, correctly identifying almost all students in need, but also misidentifying many who did not need help. While this misclassification is of concern given the possible consequences of ‘false positive’ identification noted earlier, it does suggest that nomination may be an effective (and extremely time efficient) first stage in a universal screening model. In such a model, one of the purposes of a more detailed assessment at the second stage could conceivably be to ‘separate the wheat from the chaff’ vis-à-vis true positives and false positives identified through nomination before referrals for intervention are made. Other models exist that entail additional layers of assessment prior to referral that may increase the accuracy of identification practices even further (see for example the Systematic Screening for Behavior Disorders approach outlined by ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jsp.2006.11.003", "ISBN" : "00224405", "ISSN" : "00224405", "PMID" : "20618906", "abstract" : "This article provides a review of current practices and tools used in the proactive screening of behaviorally at-risk students within the context of schooling. While there are many obstacles to the early detection of vulnerable students, some recent developments have helped make educators more receptive to early identification and prevention approaches. In addition to describing current best practices, this article reviews promising innovations in screening and early identification that the authors believe are worth considering and whose structural characteristics, required accommodations, and critical features may make them more acceptable to educational users. Implications for the training of school psychologists in the screening and early identification of high-risk students are reviewed and recommendations offered for future research. ?? 2006 Society for the Study of School Psychology.", "author" : [ { "dropping-particle" : "", "family" : "Severson", "given" : "Herbert H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Walker", "given" : "Hill M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hope-Doolittle", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kratochwill", "given" : "Thomas R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gresham", "given" : "Frank M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of School Psychology", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "193-223", "title" : "Proactive, early screening to detect behaviorally at-risk students: Issues, approaches, emerging innovations, and professional practices", "type" : "article-journal", "volume" : "45" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Severson, Walker, Hope-Doolittle, Kratochwill, & Gresham, 2007)", "manualFormatting" : "Severson, Walker, Hope-Doolittle, Kratochwill, and Gresham, 2007)", "plainTextFormattedCitation" : "(Severson, Walker, Hope-Doolittle, Kratochwill, & Gresham, 2007)", "previouslyFormattedCitation" : "(Severson, Walker, Hope-Doolittle, Kratochwill, & Gresham, 2007)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Severson, Walker, Hope-Doolittle, Kratochwill, and Gresham, 2007), but these may become impractical because of the additional data requirements with each successive rmantsA fundamental consideration in the design of universal screening is who actually provides information (e.g., teacher-, parent- and/or self-report) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "9781461476245", "author" : [ { "dropping-particle" : "", "family" : "Dvorsky", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Girio-Herrera", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Julie Sarno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Hadnbook of school mental health", "editor" : [ { "dropping-particle" : "", "family" : "Weist", "given" : "Mark D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "297-310", "publisher" : "Springer", "publisher-place" : "New York, NY", "title" : "School-based screening for mental health in early childhood", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Dvorsky et al., 2014)", "plainTextFormattedCitation" : "(Dvorsky et al., 2014)", "previouslyFormattedCitation" : "(Dvorsky et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dvorsky et al., 2014). Use of child self-report aligns with calls for an increased focus on the child’s perspective ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "H. M. Government", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2004" ] ] }, "publisher-place" : "England", "title" : "Children Act 2004", "type" : "legislation" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(H. M. Government, 2004)", "manualFormatting" : "(e.g. Children Act - H. M. Government, 2004)", "plainTextFormattedCitation" : "(H. M. Government, 2004)", "previouslyFormattedCitation" : "(H. M. Government, 2004)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(e.g. Children Act - H. M. Government, 2004) and also offers a feasible model for a population-based approach when compared to the possible data burden imposed by using teacher-report. There is evidence that children as young as 7-8 are able reporters of their mental health, particularly in relation to internalizing difficulties (e.g. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s10802-006-9027-x", "ISSN" : "0091-0627", "PMID" : "16649000", "abstract" : "Item response theory (IRT) and categorical data factor analysis (CDFA) are complementary methods for the analysis of the psychometric properties of psychiatric measures that purport to measure latent constructs. These methods have been applied to relatively few child and adolescent measures. We provide the first combined IRT and CDFA analysis of a clinical measure (the Short Mood and Feelings Questionnaire--SMFQ) in a community sample of 7-through 11-year-old children. Both latent variable models supported the internal construct validity of a single underlying continuum of severity of depressive symptoms. SMFQ items discriminated well at the more severe end of the depressive latent trait. Item performance was not affected by age, although age correlated significantly with latent SMFQ scores suggesting that symptom severity increased within the age period of 7-11. These results extend existing psychometric studies of the SMFQ and confirm its scaling properties as a potential dimensional measure of symptom severity of childhood depression in community samples.", "author" : [ { "dropping-particle" : "", "family" : "Sharp", "given" : "Carla", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goodyer", "given" : "Ian M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Croudace", "given" : "Tim J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of abnormal child psychology", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2006", "6" ] ] }, "page" : "379-91", "title" : "The Short Mood and Feelings Questionnaire (SMFQ): a unidimensional item response theory and categorical data factor analysis of self-report ratings from a community sample of 7-through 11-year-old children.", "type" : "article-journal", "volume" : "34" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Sharp, Goodyer, & Croudace, 2006)", "manualFormatting" : "Sharp, Goodyer, & Croudace, 2006)", "plainTextFormattedCitation" : "(Sharp, Goodyer, & Croudace, 2006)", "previouslyFormattedCitation" : "(Sharp, Goodyer, & Croudace, 2006)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Sharp, Goodyer, & Croudace, 2006). However, below this age the information provided may be questionable because of the literacy, self-awareness and competence in social understanding required to complete screening measures (that is, younger children may provide unreliable data because they cannot access the written text properly, do not yet have the level of self-insight required, and/or are not yet able to use social comparison as an appropriate frame of reference for understanding their thoughts, feelings and behaviour). Children generally report higher levels of difficulties than their parents, but report less impact of these perceived difficulties ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/1471-244X-10-56", "ISSN" : "1471-244X", "PMID" : "20637090", "abstract" : "BACKGROUND: Discrepancies between parents and children in their assessment of children's mental health affect the evaluation of need for services and must be taken seriously. This article presents the differences between parents' and children's reports of the children's symptoms and social impairment, based on the results of the Strengths and Difficulties Questionnaire (SDQ). The interrelationship between relational aspects and socio-demographic factors with patterns of disagreement are explored.\n\nMETHODS: Differences in the prevalence and means of SDQ symptom and impact scores were obtained from 8,154 primary school children, aged between 10 and 13 years, and their parents. Agreement between matched pairs was measured using Pearson's and Spearman's rho correlations. Socio-demographic variables, communication patterns and parental engagement were analysed as possible correlates of informant discrepancies using bivariate and multivariate logistic regression models.\n\nRESULTS: In general, although children reported more symptoms, they reported less impact of perceived difficulties than parents. The parents were more consistent in their evaluation of symptoms and impact than were the children. Exploration of highly discrepant subgroups showed that, when children reported the most symptoms and impact, qualitative aspects of the parent-child relationship and family structure seemed to be more powerful predictors of disagreement than were gender of the child and socio-demographic variables. When parents reported the most symptoms and impact, low parental educational level, low income and male gender of the child played an additional role.\n\nCONCLUSIONS: Our findings underline the importance of paying attention to child reports of emotional-behavioural difficulties, particularly when parents do not identify these problems. Considerations on what meaning parent-child discrepancy might have in the context of the parent-child relationship or the family's psychosocial status should be integrated in the overall understanding of the child's situation and subsequent recommendations.", "author" : [ { "dropping-particle" : "", "family" : "Roy", "given" : "Betty", "non-dropping-particle" : "Van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Groholt", "given" : "Berit", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Heyerdahl", "given" : "Sonja", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Clench-Aas", "given" : "Jocelyne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMC psychiatry", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2010", "1" ] ] }, "page" : "56", "title" : "Understanding discrepancies in parent-child reporting of emotional and behavioural problems: Effects of relational and socio-demographic factors.", "type" : "article-journal", "volume" : "10" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Van Roy, Groholt, Heyerdahl, & Clench-Aas, 2010)", "plainTextFormattedCitation" : "(Van Roy, Groholt, Heyerdahl, & Clench-Aas, 2010)", "previouslyFormattedCitation" : "(Van Roy, Groholt, Heyerdahl, & Clench-Aas, 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Van Roy, Groholt, Heyerdahl, & Clench-Aas, 2010).Teachers are a viable alternative and are often the primary informant in school-based mental health screening ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s12310-010-9036-3", "ISBN" : "1866-2633\\n1866-2625", "ISSN" : "18662625", "PMID" : "21088687", "abstract" : "School-based mental health professionals often conduct assessments and provide interventions on an individual basis to students with significant needs. However, due to increasingly limited resources and continuing high levels of need, a shift in service delivery is warranted. Efforts to move school psychological services from reactive and individual, to preventive and universal are ongoing. To further service delivery change, school-based mental health professionals can engage in systematic periodic mental health screening of all children. This article will (a) discuss screening for risk of emotional and behavior problems from a population-based approach, (b) describe how screening data can identify and monitor the needs of students, schools, and communities, and (c) provide future directions for screening practices. As continued changes to service delivery are imminent, information on how to utilize school-based screening data will be particularly valuable to mental health professionals working with or within schools.", "author" : [ { "dropping-particle" : "", "family" : "Dowdy", "given" : "Erin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ritchey", "given" : "Kristin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kamphaus", "given" : "R. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "School Mental Health", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "1-11", "title" : "School-Based Screening: A Population-Based Approach to Inform and Monitor Children's Mental Health Needs", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Erin Dowdy et al., 2010)", "manualFormatting" : "(Dowdy et al., 2010)", "plainTextFormattedCitation" : "(Erin Dowdy et al., 2010)", "previouslyFormattedCitation" : "(Erin Dowdy et al., 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dowdy et al., 2010). They benefit from seeing a child’s behaviour in school and can also use their collective experience with other children as a frame of reference in providing accurate ratings. However, the burden imposed and loss of sensitivity in the measure itself when a single teacher is required to complete it about every child in his/her class (as is common practice in universal screeners) represent substantive limitations of this approach. There are also concerns that teachers are less accurate in identifying internalizing difficulties than externalizing problems (the latter being more salient to classroom management) ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/01650250444000171", "ISSN" : "0165-0254", "abstract" : "The psychological adjustment of ethnic minority children has received little research attention, particularly in Britain. The present study set out to investigate the adjustment of Indian children living in Britain as well as the adjustment of their English peers. The sample consisted of 125 children (66 Indian and 59 English) between the ages of 7 and 9 years (M = 8.51, SD = 0.62) and their parents and teachers. Mothers, fathers, and teachers reported about the children's problem behaviour, and parents also reported on their acculturation strategy and use of their Indian language. Analyses revealed that overall Indian children seem to be well adjusted in Britain. Nevertheless, according to parental reports, they exhibited more internalising problems than did their English peers. No significant differences, however, were found for externalising or total problem behaviour. Furthermore, within the Indian group, it was found that children whose mothers and fathers were more traditional in their acculturation style displayed lower levels of externalising, internalising and total problem behaviour, according to their teachers. In addition, children whose mothers and fathers utilised their Indian language to a greater extent displayed lower levels of externalising and total problem behaviour (teachers' reports). These findings highlight the importance of examining the adjustment of ethnic minority children in multiple contexts.", "author" : [ { "dropping-particle" : "", "family" : "Atzaba-Poria", "given" : "Naama", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pike", "given" : "Alison", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Barrett", "given" : "Martyn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International Journal of Behavioral Development", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2004", "1", "1" ] ] }, "page" : "449-460", "title" : "Internalising and externalising problems in middle childhood: A study of Indian (ethnic minority) and English (ethnic majority) children living in Britain", "type" : "article-journal", "volume" : "28" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Atzaba-Poria, Pike, & Barrett, 2004)", "plainTextFormattedCitation" : "(Atzaba-Poria, Pike, & Barrett, 2004)", "previouslyFormattedCitation" : "(Atzaba-Poria, Pike, & Barrett, 2004)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Atzaba-Poria, Pike, & Barrett, 2004), and indeed they report feeling less equipped to understand the signs of emotional distress in children ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s12310-011-9063-8", "ISSN" : "18662625", "abstract" : "Due to an existing disparity between service need and service use of mental health services for adolescents experiencing internalizing problems, a simultaneous mixed-methods research design was employed to investigate how to reduce this discrepancy within an educational context. A total of 152 secondary teachers from seventeen South Australian schools completed an online questionnaire, and content analysis was used to explore the qualitative data. Results of the present study highlighted a further disparity: Teachers perceived they faced an expectation to identify the symptoms of internalizing problems in their students; yet did not feel sufficiently capable to put this expectation into practice. This is particularly problematic as teacher referral is the most common pathway to treatment. Recommendations to reduce this disparity are presented, and findings hold implications for pre-service teaching programs, policy, and current government funding initiatives. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)", "author" : [ { "dropping-particle" : "", "family" : "Papandrea", "given" : "Kate", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Winefield", "given" : "Helen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "School Mental Health", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "222-235", "title" : "It's Not Just the Squeaky Wheels That Need the Oil: Examining Teachers' Views on the Disparity Between Referral Rates for Students with Internalizing Versus Externalizing Problems", "type" : "article-journal", "volume" : "3" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Papandrea & Winefield, 2011)", "plainTextFormattedCitation" : "(Papandrea & Winefield, 2011)", "previouslyFormattedCitation" : "(Papandrea & Winefield, 2011)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Papandrea & Winefield, 2011). These issues notwithstanding, teacher ratings typically have greater predictive validity than other informants, although this may be at least in part attributable to shared rater variance (e.g. teachers have more influence on some of the outcomes being predicted - such as academic grades - than parents; ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s12310-010-9036-3", "ISBN" : "1866-2633\\n1866-2625", "ISSN" : "18662625", "PMID" : "21088687", "abstract" : "School-based mental health professionals often conduct assessments and provide interventions on an individual basis to students with significant needs. However, due to increasingly limited resources and continuing high levels of need, a shift in service delivery is warranted. Efforts to move school psychological services from reactive and individual, to preventive and universal are ongoing. To further service delivery change, school-based mental health professionals can engage in systematic periodic mental health screening of all children. This article will (a) discuss screening for risk of emotional and behavior problems from a population-based approach, (b) describe how screening data can identify and monitor the needs of students, schools, and communities, and (c) provide future directions for screening practices. As continued changes to service delivery are imminent, information on how to utilize school-based screening data will be particularly valuable to mental health professionals working with or within schools.", "author" : [ { "dropping-particle" : "", "family" : "Dowdy", "given" : "Erin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ritchey", "given" : "Kristin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kamphaus", "given" : "R. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "School Mental Health", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "1-11", "title" : "School-Based Screening: A Population-Based Approach to Inform and Monitor Children's Mental Health Needs", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Erin Dowdy et al., 2010)", "manualFormatting" : "Dowdy et al., 2010)", "plainTextFormattedCitation" : "(Erin Dowdy et al., 2010)", "previouslyFormattedCitation" : "(Erin Dowdy et al., 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Dowdy et al., 2010).Parents, by contrast, can provide detailed information about children’s behaviour in the home context, but typically have quite a restricted frame of reference when compared to teachers ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/02667361003768526", "ISSN" : "0266-7363", "author" : [ { "dropping-particle" : "", "family" : "Wigelsworth", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Humphrey", "given" : "Neil", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kalambouka", "given" : "Afroditi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lendrum", "given" : "Ann", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Educational Psychology in Practice", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2010", "6" ] ] }, "page" : "173-186", "title" : "A review of key issues in the measurement of children\u2019s social and emotional skills", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Wigelsworth et al., 2010)", "plainTextFormattedCitation" : "(Wigelsworth et al., 2010)", "previouslyFormattedCitation" : "(Wigelsworth et al., 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Wigelsworth et al., 2010). Like teachers, they are generally considered to be accurate raters of externalizing problems but may significantly under-estimate internalizing difficulties ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s11121-006-0026-5", "ISSN" : "13894986", "PMID" : "16850278", "abstract" : "The accuracy of screening methods for predicting children's internalizing, externalizing, or total behavior problems by 1-year follow-up were compared. Parents and teachers completed two screening measures each: a measure of exposure to multiple family risk factors (the Family Risk Factor Checklist: FRFC) and a simple nomination question of child risk status, which involved informants answering one question concerning whether they believed a child was at higher risk than average of developing a mental health problem in the future. Both parents and teachers were more accurate at identifying children at risk of externalizing than internalizing disorders. For parents, the FRFC showed similar sensitivity to simple nomination as a screen for predicting later total behavior problems, lower sensitivity for internalizing problems, and there was a nonsignificant trend for the FRFC to have higher sensitivity for externalizing problems than simple nomination. The specificity of simple nomination was somewhat higher than that of the FRFC for all three mental health outcomes. For teachers, simple nomination showed higher sensitivity than the FRFC for predicting internalizing, externalizing, and total behavior problems, but the difference was nonsignificant for internalizing problems. The specificity for both teacher screens was similar across mental health outcomes. For a population base rate of externalizing problems of 13%, teacher nominations for children at risk of externalizing problems had a sensitivity of 69%, specificity of 78%, positive predictive value (PPV) of 32%, and negative predictive value (NPV) of 94%. Teacher nominations of at-risk children had greater predictive accuracy than parent nominations. The simple nomination method shows promise as a cost-efficient screen. When screening children who did not yet have behavioral symptoms, both parent and teacher measures resulted in substantial misclassification errors. However, the use of these screening measures at a population level could benefit large numbers of children who subsequently receive selective preventive interventions.", "author" : [ { "dropping-particle" : "", "family" : "Dwyer", "given" : "Sarah B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nicholson", "given" : "Jan M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Battistutta", "given" : "Diana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Prevention Science", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "343-357", "title" : "Parent and teacher identification of children at risk of developing internalizing or externalizing mental health problems: A comparison of screening methods", "type" : "article-journal", "volume" : "7" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1186/1471-2431-14-2", "ISSN" : "1471-2431", "PMID" : "24397489", "abstract" : "BACKGROUND: Identify children at-risk of having mental health problems is of value to prevent injury. But the limited agreement between informants might jeopardize prevention initiatives. The aims of the present study were 1) to test the concordance between parents and children reports, and 2) to investigate their relationships with parental reports of children' unintentional injuries.\\n\\nMETHODS: In a population-based sample of 1258 children aged 6 to 11, the associations between child psychopathology (using the Dominic Interactive and the Strengths and Difficulties Questionnaire) and unintentional injuries in the past 12 months were examined in univariate and multivariate models.\\n\\nRESULTS: As compared to children, parents tended to overestimate behavior problems and hyperactivity/inattention, and underestimate emotional symptoms. Unintentional injury in the last 12-month period was reported in 184 out of 1258 children (14.6%) and multivariate analyses showed that the risk of injury was twice as high in children self-reporting hyperactivity/inattention as compared to others. However this association was not retrieved with the parent-reported instrument.\\n\\nCONCLUSION: Our findings support evidence that child-reported measures of psychopathology might provide relevant information for screening and injury prevention purposes, even at a young age. It could be used routinely in combination with others validated tools.", "author" : [ { "dropping-particle" : "", "family" : "Constant", "given" : "Aymery", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dulioust", "given" : "Judith", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wazana", "given" : "Ashley", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shojaei", "given" : "Taraneh", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pitrou", "given" : "Isabelle", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kovess-Masfety", "given" : "Viviane", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMC pediatrics", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "2", "title" : "Utility of self-reported mental health measures for preventing unintentional injury: results from a cross-sectional study among French schoolchildren.", "type" : "article-journal", "volume" : "14" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Constant et al., 2014; Dwyer et al., 2006)", "plainTextFormattedCitation" : "(Constant et al., 2014; Dwyer et al., 2006)", "previouslyFormattedCitation" : "(Constant et al., 2014; Dwyer et al., 2006)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Constant et al., 2014; Dwyer et al., 2006). As noted earlier, there are also legitimate concerns about reach and participation in relation to parents of at-risk children ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.cbpra.2014.03.008", "ISSN" : "10777229", "abstract" : "Although best practice for children's mental health services emphasizes ongoing assessment and monitoring of clinical progress, community based clinicians inconsistently implement assessment as part of clinical care due to a variety of practical barriers. The current study explores which factors may be related to the use and function of evidence-based assessment (EBA) in real-world, clinical settings, particularly school mental health (SMH). Mixed methodologies surveying a national sample of SMH clinicians and interviewing clinicians and program managers were used to explore current assessment practices, including use of specific tools and barriers, facilitators and attitudes toward EBA. Results indicate that clinician level of experience is negatively related to overall attitudes toward EBA, particularly openness. The most commonly-reported barriers to using assessments were difficulty reaching parents, respondents not understanding items, and clinicians not having access to measures they like or need. Also, supervision, when received, does not often include EBA. Academic indicators were more regularly collected than any of the 18 clinical assessment tools queried. Qualitative themes including barriers and facilitators to conducting EBA, specific measures' weaknesses and strengths, strategies to increase response rates and regular administration, and program management considerations regarding EBA implementation provide supporting details to these results. Implications for ongoing quality improvement efforts by program managers and clinicians related to the feasible implementation of EBA in school mental health settings are discussed. \u00a9 2014.", "author" : [ { "dropping-particle" : "", "family" : "Connors", "given" : "Elizabeth H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arora", "given" : "Prerna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Curtis", "given" : "Latisha", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stephan", "given" : "Sharon H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cognitive and Behavioral Practice", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "60-73", "publisher" : "Elsevier B.V.", "title" : "Evidence-Based Assessment in School Mental Health", "type" : "article-journal", "volume" : "22" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Connors et al., 2014)", "plainTextFormattedCitation" : "(Connors et al., 2014)", "previouslyFormattedCitation" : "(Connors et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Connors et al., 2014). Given this, it should come as no surprise that a comprehensive, multi-informant approach is recommended. Each informant provides unique information that is superior to that provided by the others alone. Furthermore, a multi-informant approach may yield concurrent advantages in terms of better data monitoring and increased communication between teachers and parents ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "9781461476245", "author" : [ { "dropping-particle" : "", "family" : "Dvorsky", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Girio-Herrera", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Julie Sarno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Hadnbook of school mental health", "editor" : [ { "dropping-particle" : "", "family" : "Weist", "given" : "Mark D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "297-310", "publisher" : "Springer", "publisher-place" : "New York, NY", "title" : "School-based screening for mental health in early childhood", "type" : "chapter" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1007/s12310-010-9036-3", "ISBN" : "1866-2633\\n1866-2625", "ISSN" : "18662625", "PMID" : "21088687", "abstract" : "School-based mental health professionals often conduct assessments and provide interventions on an individual basis to students with significant needs. However, due to increasingly limited resources and continuing high levels of need, a shift in service delivery is warranted. Efforts to move school psychological services from reactive and individual, to preventive and universal are ongoing. To further service delivery change, school-based mental health professionals can engage in systematic periodic mental health screening of all children. This article will (a) discuss screening for risk of emotional and behavior problems from a population-based approach, (b) describe how screening data can identify and monitor the needs of students, schools, and communities, and (c) provide future directions for screening practices. As continued changes to service delivery are imminent, information on how to utilize school-based screening data will be particularly valuable to mental health professionals working with or within schools.", "author" : [ { "dropping-particle" : "", "family" : "Dowdy", "given" : "Erin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ritchey", "given" : "Kristin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kamphaus", "given" : "R. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "School Mental Health", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2010" ] ] }, "page" : "1-11", "title" : "School-Based Screening: A Population-Based Approach to Inform and Monitor Children's Mental Health Needs", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Erin Dowdy et al., 2010; Dvorsky et al., 2014)", "manualFormatting" : "(Dowdy et al., 2010; Dvorsky et al., 2014)", "plainTextFormattedCitation" : "(Erin Dowdy et al., 2010; Dvorsky et al., 2014)", "previouslyFormattedCitation" : "(Erin Dowdy et al., 2010; Dvorsky et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dowdy et al., 2010; Dvorsky et al., 2014). As is seen below, this proposition is also supported by psychometric evidence. Nonetheless, concerns remain about the feasibility of such a system, which could easily become unwieldy and impractical.Use and sharing of data: the question of ‘what happens next’Irrespective of other considerations discussed in this paper, universal screening in schools can only meet its ultimate aim of improving mental health and wellbeing and reducing the distress experienced by children and young people if the data it produces is used effectively and efficiently. So, for example, it is vital that screening is properly connected to follow-up services (e.g. monitoring and/or further assessment, early intervention) both in and out of school - what ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "9781461476245", "author" : [ { "dropping-particle" : "", "family" : "Dvorsky", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Girio-Herrera", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Julie Sarno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Hadnbook of school mental health", "editor" : [ { "dropping-particle" : "", "family" : "Weist", "given" : "Mark D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "297-310", "publisher" : "Springer", "publisher-place" : "New York, NY", "title" : "School-based screening for mental health in early childhood", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Dvorsky et al., 2014)", "manualFormatting" : "Dvorsky et al. (2014)", "plainTextFormattedCitation" : "(Dvorsky et al., 2014)", "previouslyFormattedCitation" : "(Dvorsky et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Dvorsky et al. (2014) call the “coordination of care” (p.305). An important issue to be addressed here is the notion of ‘treatment validity’, e.g. the extent to which a given assessment procedure contributes to improved outcomes by clearly signposting areas of concern that can be explicitly linked to particular forms of recommended intervention ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/1534508410379842", "ISBN" : "1534508410379", "ISSN" : "1534-5084", "author" : [ { "dropping-particle" : "", "family" : "Cook", "given" : "C. R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Volpe", "given" : "R. 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At this point, it is worth returning to the research cited earlier that shows that the majority of schools in England report engaging in interventions that have no evidential base, being mainly locally developed and untested (Vostanis et al, 2013). The same study reported that almost all schools rely on their staff to lead interventions, but that few consider staff training, consultation, and/or supervision as a key part of their overall approach to supporting children’s mental health. This is a salient reminder that universal screening has to be seen in the wider context of the need for reform in other aspects of school mental health provision. As noted in the introduction to this article, there is no shortage of evidence that high quality, well implemented school-based mental health interventions can effect meaningful change for children and young people, so perhaps what we need know more about is how to by improve the ‘science to service’ link and thus increase the scale-up and sustainability of those which are more likely to produce better outcomes ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.appsy.2008.11.001", "ISSN" : "09621849", "abstract" : "The article addresses the adaptation of evidence-based prevention and positive youth development programs for community use. Two complementary approaches for adapting programs are described. In the \u201cadapted\u201d approach, programs are modified to accommodate the culture, climate, and operations of the organization delivering the program. In the \u201cadaptive\u201d approach, programs are modified to accommodate the characteristics, needs and preferences of the individual or family receiving the program. Two examples are provided that illustrate how both adapted and adaptive intervention strategies have been incorporated by community practitioners into the implementation of the Early Risers conduct problems prevention program.", "author" : [ { "dropping-particle" : "", "family" : "August", "given" : "Gerald J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gewirtz", "given" : "Abigail", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Realmuto", "given" : "George M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Applied and Preventive Psychology", "id" : "ITEM-1", "issue" : "1-4", "issued" : { "date-parts" : [ [ "2010", "6" ] ] }, "page" : "72-85", "title" : "Moving the field of prevention from science to service: Integrating evidence-based preventive interventions into community practice through adapted and adaptive models", "type" : "article-journal", "volume" : "14" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(August, Gewirtz, & Realmuto, 2010)", "plainTextFormattedCitation" : "(August, Gewirtz, & Realmuto, 2010)", "previouslyFormattedCitation" : "(August, Gewirtz, & Realmuto, 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(August, Gewirtz, & Realmuto, 2010). Alongside this, questions are raised regarding training, expertise and capacity in schools, and of course funding, to which we return in the section on costs and benefits. Sharing of data with parents and other stakeholders is a key component of the linkage process, particularly when the involvement of agencies external to the school (e.g. educational psychology and/or child and adolescent mental health services) is likely to be necessary, as in cases where an indicated intervention appears to be warranted. What data is shared with parents and how it is presented appears to be absolutely vital, as this may influence not just awareness but help seeking (e.g. service utilisation) and other changes in behaviour ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "9781461476245", "author" : [ { "dropping-particle" : "", "family" : "Dvorsky", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Girio-Herrera", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Julie Sarno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Hadnbook of school mental health", "editor" : [ { "dropping-particle" : "", "family" : "Weist", "given" : "Mark D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "297-310", "publisher" : "Springer", "publisher-place" : "New York, NY", "title" : "School-based screening for mental health in early childhood", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Dvorsky et al., 2014)", "plainTextFormattedCitation" : "(Dvorsky et al., 2014)", "previouslyFormattedCitation" : "(Dvorsky et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dvorsky et al., 2014). There is also considerable potential for other uses of the data generated through universal mental health screening in schools. Aggregation of data to class, year and/or school levels can provide important indicators of the wellbeing of the school population and subgroups within it (e.g. those with special educational needs, those eligible for free school meals). If the frequency and timing of administration permits, this data may also be used to monitor and evaluate universal provision in the school or be used in school improvement planning more generally. These uses may be particularly salient given the increasing requirements for schools to provide ‘hard’ (e.g. quantifiable) evidence of pupil outcomes in areas of functioning where routinely collected data (e.g. attendance, attainment, exclusions) may not be appropriate or sufficient. So, for example, data collected though universal screening could feasibly be used to provide evidence for the schools inspectorate, Ofsted. An obvious candidate for data linkage from universal screening is the Behaviour and Safety strand of the inspection framework. Inspectors are also required to consider the spiritual, moral, social and cultural development of pupils, while also considering the extent to which the needs of a range of pupils (including those with special educational needs) are met ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Office for Standards in Education", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2012" ] ] }, "publisher-place" : "Manchester", "title" : "The framework for school inspection", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Office for Standards in Education, 2012)", "plainTextFormattedCitation" : "(Office for Standards in Education, 2012)", "previouslyFormattedCitation" : "(Office for Standards in Education, 2012)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Office for Standards in Education, 2012). Of note is the requirement that, “judgements must not be made solely on the basis of what is seen during an inspection. Inspectors must take into account a range of evidence… over an extended period… [including] the results of any surveys carried out or commissioned by the school” (ibid, p.18-21). Hence, universal screening may yield particularly strong ‘added value’ above and beyond early identification of MHD.Psychometric considerationsThe technical adequacy of a given screening instrument is of course vital if it is to serve its intended purpose. Drawing upon ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jclinepi.2006.03.012", "ISSN" : "0895-4356", "PMID" : "17161752", "abstract" : "OBJECTIVES: Recently, an increasing number of systematic reviews have been published in which the measurement properties of health status questionnaires are compared. For a meaningful comparison, quality criteria for measurement properties are needed. Our aim was to develop quality criteria for design, methods, and outcomes of studies on the development and evaluation of health status questionnaires. STUDY DESIGN AND SETTING: Quality criteria for content validity, internal consistency, criterion validity, construct validity, reproducibility, longitudinal validity, responsiveness, floor and ceiling effects, and interpretability were derived from existing guidelines and consensus within our research group. RESULTS: For each measurement property a criterion was defined for a positive, negative, or indeterminate rating, depending on the design, methods, and outcomes of the validation study. CONCLUSION: Our criteria make a substantial contribution toward defining explicit quality criteria for measurement properties of health status questionnaires. Our criteria can be used in systematic reviews of health status questionnaires, to detect shortcomings and gaps in knowledge of measurement properties, and to design validation studies. The future challenge will be to refine and complete the criteria and to reach broad consensus, especially on quality criteria for good measurement properties.", "author" : [ { "dropping-particle" : "", "family" : "Terwee", "given" : "Caroline B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bot", "given" : "Sandra D M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Boer", "given" : "Michael R", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Windt", "given" : "Dani\u00eblle A W M", "non-dropping-particle" : "van der", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Knol", "given" : "Dirk L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dekker", "given" : "Joost", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bouter", "given" : "Lex M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vet", "given" : "Henrica C W", "non-dropping-particle" : "de", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of clinical epidemiology", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2007", "1" ] ] }, "page" : "34-42", "title" : "Quality criteria were proposed for measurement properties of health status questionnaires.", "type" : "article-journal", "volume" : "60" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Terwee et al., 2007)", "manualFormatting" : "Terwee et al's (2007)", "plainTextFormattedCitation" : "(Terwee et al., 2007)", "previouslyFormattedCitation" : "(Terwee et al., 2007)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Terwee et al's (2007) proposed quality criteria for health status questionnaires, systematic reviews of measures in child mental health and related fields (e.g. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/1753-2000-8-14", "ISSN" : "1753-2000", "PMID" : "24834111", "abstract" : "There is a growing appetite for mental health and wellbeing outcome measures that can inform clinical practice at individual and service levels, including use for local and national benchmarking. Despite a varied literature on child mental health and wellbeing outcome measures that focus on psychometric properties alone, no reviews exist that appraise the availability of psychometric evidence and suitability for use in routine practice in child and adolescent mental health services (CAMHS) including key implementation issues. This paper aimed to present the findings of the first review that evaluates existing broadband measures of mental health and wellbeing outcomes in terms of these criteria. The following steps were implemented in order to select measures suitable for use in routine practice: literature database searches, consultation with stakeholders, application of inclusion and exclusion criteria, secondary searches and filtering. Subsequently, detailed reviews of the retained measures' psychometric properties and implementation features were carried out. 11 measures were identified as having potential for use in routine practice and meeting most of the key criteria: 1) Achenbach System of Empirically Based Assessment, 2) Beck Youth Inventories, 3) Behavior Assessment System for Children, 4) Behavioral and Emotional Rating Scale, 5) Child Health Questionnaire, 6) Child Symptom Inventories, 7) Health of the National Outcome Scale for Children and Adolescents, 8) Kidscreen, 9) Pediatric Symptom Checklist, 10) Strengths and Difficulties Questionnaire, 11) Youth Outcome Questionnaire. However, all existing measures identified had limitations as well as strengths. Furthermore, none had sufficient psychometric evidence available to demonstrate that they could reliably measure both severity and change over time in key groups. The review suggests a way of rigorously evaluating the growing number of broadband self-report mental health outcome measures against standards of feasibility and psychometric credibility in relation to use for practice and policy.", "author" : [ { "dropping-particle" : "", "family" : "Deighton", "given" : "Jessica", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Croudace", "given" : "Tim", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fonagy", "given" : "Peter", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "Jeb", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Patalay", "given" : "Praveetha", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wolpert", "given" : "Miranda", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Child and adolescent psychiatry and mental health", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "14", "title" : "Measuring mental health and wellbeing outcomes for children and adolescents to inform practice and policy: a review of child self-report measures.", "type" : "article-journal", "volume" : "8" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1177/0013164410382896", "ISSN" : "0013-1644", "abstract" : "This study presents the findings of a systematic review of measures of social and emotional skills for children and young people. The growing attention to this area in recent years has resulted in the development of a large number of measures to aid in the assessment of children and young people. These measures vary on a number of variables relating to implementation characteristics and psychometric properties. The methodology of the review followed the general principles of systematic reviewing, such as systematic search of databases, the adoption of predetermined set of inclusion and exclusion criteria, and a multistage filtering process. The review process resulted in the retention of 12 measures, which are presented and discussed in relation to key issues in this area, including difficulties with the underlying theory and frameworks for social and emotional skills, inconsistent terminology, the scope and distinctiveness of available measures, and more practical issues such as the type of respondent, location, and purpose of measurement.", "author" : [ { "dropping-particle" : "", "family" : "Humphrey", "given" : "N.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kalambouka", "given" : "A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wigelsworth", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lendrum", "given" : "A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Deighton", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wolpert", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Educational and Psychological Measurement", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2011", "6", "29" ] ] }, "page" : "617-637", "title" : "Measures of Social and Emotional Skills for Children and Young People: A Systematic Review", "type" : "article-journal", "volume" : "71" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Jessica Deighton et al., 2014; Humphrey et al., 2011)", "manualFormatting" : "Deighton et al., 2014; Humphrey et al., 2011)", "plainTextFormattedCitation" : "(Jessica Deighton et al., 2014; Humphrey et al., 2011)", "previouslyFormattedCitation" : "(Jessica Deighton et al., 2014; Humphrey et al., 2011)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Deighton et al., 2014; Humphrey et al., 2011) and ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jsp.2006.05.005", "ISBN" : "0022-4405", "ISSN" : "00224405", "abstract" : "Universal screening is a critical prerequisite to providing early school-based prevention and intervention services for students at risk for or with academic, behavioral, or emotional difficulties. Although use of academic and behavioral screening has become more prevalent, criteria for making informed decisions about appropriate screening tools are not readily available to those who work in educational settings. The purpose of this article is to (a) highlight several considerations about the appropriateness, technical adequacy, and usability of academic or behavioral screeners and (b) provide a general assessment of the current state of science pertaining to universal screening. The article concludes with considerations for policy and practice. The framework presented may be useful in guiding those interested in evaluating, selecting, and researching school-based universal screening assessments. \u00a9 2006 Society for the Study of School Psychology.", "author" : [ { "dropping-particle" : "", "family" : "Glover", "given" : "Todd a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Albers", "given" : "Craig a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of School Psychology", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "117-135", "title" : "Considerations for evaluating universal screening assessments", "type" : "article-journal", "volume" : "45" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Glover & Albers, 2007)", "manualFormatting" : "Glover and Albers' (2007)", "plainTextFormattedCitation" : "(Glover & Albers, 2007)", "previouslyFormattedCitation" : "(Glover & Albers, 2007)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Glover and Albers' (2007) suggested considerations for universal screening assessments, we propose the following validation criteria: (i) content validity (are the constructs of interest comprehensively represented by the items in the measure?) is evident where the instrument has a clear measurement aim, target population, description of measurement domains, has been through a rigorous item selection and reduction process, and contains items with a high degree of interpretability (e.g. low reading level, short, simple items); (ii) internal consistency (are items in a (sub) scale homogenous and thus measuring the same construct?) can be demonstrated through exploratory and/or confirmatory factor analysis that establish the presence of a single or multiple domains, followed by Cronbach’s Alpha co-efficients for each (sub)scale in the 0.70-0.9 range; (iii) criterion validity (do scores on a given instrument relate to a gold standard measure?) is considered strong with a correlation of 0.70 or greater with an existing, well-validated measure; (iv) construct validity (do scores on a given measure relate to other outcomes in a way that is theoretically consistent with the constructs being assessed?) can include, for example, the ability of the screener to distinguish between ‘known’ groups (e.g. with and without referrals to child and adolescent mental health services); (v) reproducibility (do repeated assessments in stable individuals produce similar results?) can be assessed by examining levels of agreement or reliability, such as a Kappa co-efficient of at least 0.70; (vi) responsiveness (can the measure detect clinically important change over time?) can be shown through, for example, the ability of the measure to distinguish between individuals who have and have not changed (as classified by an external criterion) with a receiver operating characteristics area under the curve of at least 0.70; and (vii) interpretability (are scores meaningful in a qualitative sense?) can be aided by the availability of descriptive statistics (e.g. means and standard deviations) for a representative reference population and any relevant subgroups.In addition to the above, we propose that viable measures must have demonstrable predictive validity (do scores accurately predict a future state that is theoretically consistent with what is being measured?). Although technically a subset of construct validity (see above), predictive validity is so central to the concept of universal mental health screening that it warrants special consideration. Glover and Albers (2007, p.120) suggest that it can be thought of in terms of sensitivity (e.g. of those later found to be at-risk, what proportion is correctly identified?), specificity (e.g. of those not later found to be at-risk, what proportion is correctly identified?), positive predictive value (PPV) (e.g. what proportion of all those identified as at-risk were ‘valid positives’?) and negative predictive value (NPV) (e.g. what proportion of all identified as not being at-risk were ‘valid negatives’?). These indices arguably represent the most important benchmark for the utility of universal screening measures. However, both the NPV and PPV vary as a function of the base rates of the construct being assessed (e.g. as the prevalence of MHD in a given population increases, the PPV increases and the NPV decreases) (Dwyer, Nicholson & Battistuta, 2006), and as such the predictive validity of a given instrument will likely fluctuate depending upon the level of need at a local level. Also, the veracity of predictive validity rests upon the assumption of a robust external criterion for the determination of the future state that is assessed (e.g. that ‘measure X’, used as the indicator of the future state, is not subject to error and can be considered an accurate index of a child’s mental health).In a useful illustration of the complexities of deterring the predictive validity of universal mental health screening, ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s11121-006-0026-5", "ISSN" : "13894986", "PMID" : "16850278", "abstract" : "The accuracy of screening methods for predicting children's internalizing, externalizing, or total behavior problems by 1-year follow-up were compared. Parents and teachers completed two screening measures each: a measure of exposure to multiple family risk factors (the Family Risk Factor Checklist: FRFC) and a simple nomination question of child risk status, which involved informants answering one question concerning whether they believed a child was at higher risk than average of developing a mental health problem in the future. Both parents and teachers were more accurate at identifying children at risk of externalizing than internalizing disorders. For parents, the FRFC showed similar sensitivity to simple nomination as a screen for predicting later total behavior problems, lower sensitivity for internalizing problems, and there was a nonsignificant trend for the FRFC to have higher sensitivity for externalizing problems than simple nomination. The specificity of simple nomination was somewhat higher than that of the FRFC for all three mental health outcomes. For teachers, simple nomination showed higher sensitivity than the FRFC for predicting internalizing, externalizing, and total behavior problems, but the difference was nonsignificant for internalizing problems. The specificity for both teacher screens was similar across mental health outcomes. For a population base rate of externalizing problems of 13%, teacher nominations for children at risk of externalizing problems had a sensitivity of 69%, specificity of 78%, positive predictive value (PPV) of 32%, and negative predictive value (NPV) of 94%. Teacher nominations of at-risk children had greater predictive accuracy than parent nominations. The simple nomination method shows promise as a cost-efficient screen. When screening children who did not yet have behavioral symptoms, both parent and teacher measures resulted in substantial misclassification errors. However, the use of these screening measures at a population level could benefit large numbers of children who subsequently receive selective preventive interventions.", "author" : [ { "dropping-particle" : "", "family" : "Dwyer", "given" : "Sarah B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nicholson", "given" : "Jan M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Battistutta", "given" : "Diana", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Prevention Science", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "343-357", "title" : "Parent and teacher identification of children at risk of developing internalizing or externalizing mental health problems: A comparison of screening methods", "type" : "article-journal", "volume" : "7" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Dwyer et al., 2006)", "manualFormatting" : "Dwyer, Nicholson, and Battistutta's (2006)", "plainTextFormattedCitation" : "(Dwyer et al., 2006)", "previouslyFormattedCitation" : "(Dwyer et al., 2006)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Dwyer, Nicholson, and Battistutta's (2006) aforementioned study assessed the accuracy of a simple nomination method (e.g. informants are asked whether a given child has, in their opinion, a higher than average chance of developing MHD) and a family risk-factor checklist (e.g. exposure to adverse life events, poor parenting practices) as predictors of the presence of MHD one year later (as determined by scores on the Child Behaviour Checklist ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Achenbach", "given" : "T. M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "1991" ] ] }, "publisher-place" : "Burlington, VT", "title" : "Manual for the Child Behavior Checklist/4-18 and 1991 profile", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Achenbach, 1991)", "manualFormatting" : "- Achenbach, 1991)", "plainTextFormattedCitation" : "(Achenbach, 1991)", "previouslyFormattedCitation" : "(Achenbach, 1991)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }- Achenbach, 1991). For all three measures, data was collected from both teachers and parents. The authors’ analyses suggested that the accuracy of both screening models varied as a function of informant (parent, teacher), domain of MHD (internalizing, externalizing) and presence of symptoms at baseline (present, absent), from which we can infer that a comprehensive, multi-informant approach is therefore likely to provide optimal sensitivity and specificity. Accommodation of diversityAny universal education initiative rightly needs to be “culturally competent” ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "978-1-4614-7623-8", "author" : [ { "dropping-particle" : "", "family" : "Dowdy", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kamphaus", "given" : "R. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Twyford", "given" : "J. M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Dever", "given" : "B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Handbook of school mental health", "editor" : [ { "dropping-particle" : "", "family" : "Weist", "given" : "Mark D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "311-321", "publisher" : "Springer", "publisher-place" : "New York, NY", "title" : "Culturally competent behavioral and emotional screening", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(E Dowdy et al., 2014)", "manualFormatting" : "(Dowdy, Kamphaus, Twyford, & Dever, 2014, p.311)", "plainTextFormattedCitation" : "(E Dowdy et al., 2014)", "previouslyFormattedCitation" : "(E Dowdy et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dowdy, Kamphaus, Twyford, & Dever, 2014, p.311) before it can be considered fit for purpose. By this we mean it reflects and is respectful of the various forms of diversity (e.g. gender, cultural, socio-economic, ethnic, linguistic) inherent in the school population. At a practical level, this means that universal mental health screening instruments need to be as accessible as possible (e.g. making translated versions available for parents and/or children whose first language is not English, or ensuring that the reading age of instructions and items is as low as possible to improve accessibility for those with literacy difficulties). However, there are also concurrent psychometric and technical considerations. Translated versions need to demonstrate measurement equivalence in order to be valid. Use of differential item functioning analyses during the validation of a given instrument is recommended here as it is able to inform the selection of items that behave equivalently across a range of various subgroups of the school population ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/0734282912465570", "ISSN" : "0734-2829", "author" : [ { "dropping-particle" : "", "family" : "Deighton", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tymms", "given" : "P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vostanis", "given" : "P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Belsky", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fonagy", "given" : "P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Martin", "given" : "a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Patalay", "given" : "P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wolpert", "given" : "M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Psychoeducational Assessment", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2012", "11", "20" ] ] }, "title" : "The Development of a School-Based Measure of Child Mental Health", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(J. Deighton et al., 2012)", "manualFormatting" : "(see for example Deighton et al's (2013)", "plainTextFormattedCitation" : "(J. Deighton et al., 2012)", "previouslyFormattedCitation" : "(J. Deighton et al., 2012)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(see for example Deighton et al's (2012) validation of the Me and My School measure of MHD). An alternative approach is offered by ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/1534508410379842", "ISBN" : "1534508410379", "ISSN" : "1534-5084", "author" : [ { "dropping-particle" : "", "family" : "Cook", "given" : "C. R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Volpe", "given" : "R. 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They suggest that instead, we may conceptualise the various factors noted above as moderators of screening outcomes that need to be factored into analysis and scoring alongside pertinent school level contextual variables (e.g. urbanicity, climate), ultimately producing more dynamic classifications. Although this would require a very large and diverse normative sample and would be technically complex to operationalize, it raises the possibility of a screening system that is sensitive to both individual difference and context.At a broader level, screening models must be respectful of different cultural norms and practices, particularly where these apply directly to mental health. For example, there is considerable cultural variation in understandings of the dual concepts of mental health and illness and the extent to which they are (or should be) discussed openly ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Fernando", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "edition" : "3rd Editio", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "publisher" : "Palgrave Macmillan", "publisher-place" : "London", "title" : "Mental health, race and culture", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Fernando, 2010)", "plainTextFormattedCitation" : "(Fernando, 2010)", "previouslyFormattedCitation" : "(Fernando, 2010)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Fernando, 2010). Alongside this, issues of acculturation, discrimination (whether perceived or real) and openness to services are of paramount importance ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "978-1-4614-7623-8", "author" : [ { "dropping-particle" : "", "family" : "Dowdy", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kamphaus", "given" : "R. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Twyford", "given" : "J. M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "V.", "family" : "Dever", "given" : "B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Handbook of school mental health", "editor" : [ { "dropping-particle" : "", "family" : "Weist", "given" : "Mark D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "311-321", "publisher" : "Springer", "publisher-place" : "New York, NY", "title" : "Culturally competent behavioral and emotional screening", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(E Dowdy et al., 2014)", "manualFormatting" : "(Dowdy et al., 2014)", "plainTextFormattedCitation" : "(E Dowdy et al., 2014)", "previouslyFormattedCitation" : "(E Dowdy et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Dowdy et al., 2014).Costs and benefits For universal school-based screening to have any hope of improving early identification methods and practices in child and adolescent mental health, the evidence needs to demonstrate that this model is demonstrably superior to existing provision in a variety of ways. Given that the research in this area is in its relative infancy, there are currently many more questions than answers. We still know relatively little about the costs (human, financial, material, other) associated with different screening models (e.g. single vs. multi-stage, nomination vs. standardized measure). Williams (2013) provides a basic estimate of ?27 per child using the child self-report Beck Youth Inventory as an exemplar screening tool, extrapolating that all 7 year-olds in the UK could be screened for less than ?18.5 million. This is weighed against the savings that could be made through earlier intervention (for example, ?115,000-150,000 per case for conduct disorder; Williams, ibid) as a result of screening. However, this estimate is somewhat rudimentary and makes a number of assumptions that would influence cost and acceptability (for example, use of a proprietary measure as opposed to one that is publically available at minimal or no cost - ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.cbpra.2014.03.008", "ISSN" : "10777229", "abstract" : "Although best practice for children's mental health services emphasizes ongoing assessment and monitoring of clinical progress, community based clinicians inconsistently implement assessment as part of clinical care due to a variety of practical barriers. The current study explores which factors may be related to the use and function of evidence-based assessment (EBA) in real-world, clinical settings, particularly school mental health (SMH). Mixed methodologies surveying a national sample of SMH clinicians and interviewing clinicians and program managers were used to explore current assessment practices, including use of specific tools and barriers, facilitators and attitudes toward EBA. Results indicate that clinician level of experience is negatively related to overall attitudes toward EBA, particularly openness. The most commonly-reported barriers to using assessments were difficulty reaching parents, respondents not understanding items, and clinicians not having access to measures they like or need. Also, supervision, when received, does not often include EBA. Academic indicators were more regularly collected than any of the 18 clinical assessment tools queried. Qualitative themes including barriers and facilitators to conducting EBA, specific measures' weaknesses and strengths, strategies to increase response rates and regular administration, and program management considerations regarding EBA implementation provide supporting details to these results. Implications for ongoing quality improvement efforts by program managers and clinicians related to the feasible implementation of EBA in school mental health settings are discussed. \u00a9 2014.", "author" : [ { "dropping-particle" : "", "family" : "Connors", "given" : "Elizabeth H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arora", "given" : "Prerna", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Curtis", "given" : "Latisha", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stephan", "given" : "Sharon H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cognitive and Behavioral Practice", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "60-73", "publisher" : "Elsevier B.V.", "title" : "Evidence-Based Assessment in School Mental Health", "type" : "article-journal", "volume" : "22" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Connors et al., 2014)", "manualFormatting" : "Connors et al., 2014)", "plainTextFormattedCitation" : "(Connors et al., 2014)", "previouslyFormattedCitation" : "(Connors et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Connors et al., 2014), while also presuming that screening would result in appropriate referral for early intervention (as yet unproven – although see below). In a more rigorous analysis, ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1746-1561.2009.00410.x.Cost-Effectiveness", "author" : [ { "dropping-particle" : "", "family" : "Kuo", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stoep", "given" : "Av", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "\u2026 of School Health", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "277-285", "title" : "Cost\u2010Effectiveness of a School\u2010Based Emotional Health Screening Program", "type" : "article-journal", "volume" : "79" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Kuo & Stoep, 2009)", "manualFormatting" : "Kuo and Stoep (2009)", "plainTextFormattedCitation" : "(Kuo & Stoep, 2009)", "previouslyFormattedCitation" : "(Kuo & Stoep, 2009)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Kuo and Stoep (2009) provided detailed cost estimates of a universal, multi-stage screening system for 11-12 year-olds (the ‘Developmental Pathways Screening Program’ – DPSP). Per student costs were determined to range from ?4.53 (first-stage, universal screening) to ?24.99 (second-stage, clinical evaluation for those students who screened positive in the first stage), averaging out at between ?5.78 to ?8.88 per student within a given school depending upon the proportion who screen positive at the first stage. These estimates are promising as they suggest that a robust screening system need not be prohibitively expensive. Indeed, there are means through which the cost could be reduced even further. For example, the first stage of the DPSP involves completion of written questionnaires, with associated material (c. 14p per student) and scoring (c.?1 per student) costs ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1746-1561.2009.00410.x.Cost-Effectiveness", "author" : [ { "dropping-particle" : "", "family" : "Kuo", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stoep", "given" : "Av", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "\u2026 of School Health", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "277-285", "title" : "Cost\u2010Effectiveness of a School\u2010Based Emotional Health Screening Program", "type" : "article-journal", "volume" : "79" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Kuo & Stoep, 2009)", "plainTextFormattedCitation" : "(Kuo & Stoep, 2009)", "previouslyFormattedCitation" : "(Kuo & Stoep, 2009)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Kuo & Stoep, 2009). We would argue that the use of a secure online portal would likely be more cost-efficient, even after factoring in the costs of its development and maintenance.Alongside estimates of the financial costs associated with the introduction of universal screening, consideration also needs to be given of how such a system would be funded. If we take Williams’ (2013) proposal as a very high-end estimate (see discussion of this above), the c.?18.5m required to establish school-based universal screening nationally would represent around 0.09% of the aforementioned ?20 billion annual expenditure on health and social care services associated with MHD (Centre for Mental Health, 2010), or approximately 0.03% of the ?54 billion annual budget of the Education Funding Agency, who support state-supported education for children and young people up to the age of 19 (see .uk/government/organisations/education-funding-agency). Given the government’s recent commitment to improving early identification of need in relation to MHD (Department of Health, 2015), it is not infeasible to suggest that one or both of these budgets could and should be used to fund universal screening.Taking an alternative, more ‘localized’ (as opposed to centralized) estimation, the cost of implementing universal screening in a single form entry primary school with an average class size of 27 ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Department for Education", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2011" ] ] }, "publisher-place" : "London", "title" : "Class size and education in England: evidence report", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Department for Education, 2011)", "plainTextFormattedCitation" : "(Department for Education, 2011)", "previouslyFormattedCitation" : "(Department for Education, 2011)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Department for Education, 2011) at the beginning of Key Stage 1 and Key Stage 2 would be ?1458, marginally more than the current ?1320 annual pupil premium funding allocated for a single child registered as eligible for free school meals in primary education (.uk/pupil-premium-information-for-schools-and-alternative-provision-settings). Of course, there are other costs associated with the downstream reforms to school-based mental health provision (e.g. training of staff, provision of effective interventions) needed in order for the potential benefits of universal screening to be realized, but our interest here is in the discrete costs of the system itself. What about the short and long-term benefits of universal screening? In relation to the latter, many questions remain. Does universal screening reduce or prevent the incidence and/or severity of MHD over time? Does it reduce the proportion of unmet need? Does it reduce the time taken for children and young people to receive the services they need? The simple answer is that we do not yet know for sure; these are all critical questions that future research needs to address (ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-1-4614-7624-5", "ISBN" : "9781461476245", "author" : [ { "dropping-particle" : "", "family" : "Dvorsky", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Girio-Herrera", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owens", "given" : "Julie Sarno", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Hadnbook of school mental health", "editor" : [ { "dropping-particle" : "", "family" : "Weist", "given" : "Mark D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "297-310", "publisher" : "Springer", "publisher-place" : "New York, NY", "title" : "School-based screening for mental health in early childhood", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Dvorsky et al., 2014)", "manualFormatting" : "Dvorsky et al., 2014)", "plainTextFormattedCitation" : "(Dvorsky et al., 2014)", "previouslyFormattedCitation" : "(Dvorsky et al., 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Dvorsky et al., 2014). With regard to the former, however, there is emerging evidence of the superiority of screening when compared to traditional methods. For example, ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s12310-013-9109-1", "ISBN" : "1866-2625\\n1866-2633", "ISSN" : "1866-2625", "abstract" : "Systematic screening is one strategy to enhance the early identification of behavioral and emotional problems among youth. Although conceptually sound, it is unclear if screening is more or less effective than current school identification practices in identifying youth with behavioral and emotional concerns. This study compares screening for behavioral and emotional risk with current identification practices in schools to determine differences among referral methods, across a sample of elementary aged students (N = 867). Results indicated that of the 160 students identified as at-risk by the screening measure, only 61 were previously identified through current school identification methods, highlighting the potential benefit of screening to enhance early identification. Results demonstrated internalizing and externalizing behaviors were significantly correlated with at-risk status by identification method. Furthermore, students identified as demonstrating behavioral and emotional concerns by both the screener and receiving school-based services had significantly lower academic achievement. Implications and future research needs are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)", "author" : [ { "dropping-particle" : "", "family" : "Eklund", "given" : "Katie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dowdy", "given" : "Erin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "School Mental Health", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "40-49", "title" : "Screening for behavioral and emotional risk versus traditional school identification methods", "type" : "article-journal", "volume" : "6" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Eklund & Dowdy, 2014)", "manualFormatting" : "Eklund and Dowdy's recent study (2014)", "plainTextFormattedCitation" : "(Eklund & Dowdy, 2014)", "previouslyFormattedCitation" : "(Eklund & Dowdy, 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Eklund and Dowdy's recent study (2014) demonstrated that universal screening identified a greater proportion of at-risk students than standard teacher referral practices (akin to the refer-test-place model noted above) across a sample of nearly 900 primary-aged children. The profile of externalizing difficulties among these previously ‘unidentified’ children was suggestive of significant unmet need, being two standard deviations higher than those identified through traditional methods. However, the authors also found a subgroup of students identified through standard school methods that were not picked up by the screener. Assuming the low likelihood of ‘false positives’ in the refer-test-place model, this rather telling finding indicates that the sensitivity of universal screening tools likely requires further optimization, and/or that it should be used in conjunction with existing methods rather than as a replacement for them. Finally, there is tentative evidence that universal screening may lead to improved service access, at least in the short term. The study by Kuo and Stoep (2009) noted earlier reported that at 6-week follow-up, 72% of referrals (e.g. to a school counselor or outside mental health agency) produced through the DPSP screener had resulted a successful linkage to a given service/intervention (e.g. school counsellor). This data needs to be interpreted with caution as we do not know how the proportion of successful linkages within the time-frame compared to usual practice in the participating schools – although given the figures noted earlier with regard to unmet need, we can perhaps assume that this represents a considerable improvement.Conclusion – a vision for universal school-based mental health screeningWe began this article by arguing that there is an emerging public health crisis in relation to MHD among children and young people. Both the evidence base and basic common sense dictate that the school system is a crucial component of an effective response to this crisis. The notion of early intervention and prevention is not novel in this context, but has arguably been granted a new ‘lease of life’ in the last five years and this is clearly reflected in the current and recent policy discourse (e.g. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Department of Health", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "publisher-place" : "London", "title" : "Future in mind: promoting, protecting and improving our children and young people's mental health and wellbeing", "type" : "report" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Allen", "given" : "G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Review Literature And Arts Of The Americas", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2011" ] ] }, "publisher-place" : "London", "title" : "Early intervention: the next steps", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Allen, 2011; Department of Health, 2015)", "manualFormatting" : "Allen, 2011; Department of Health, 2015)", "plainTextFormattedCitation" : "(Allen, 2011; Department of Health, 2015)", "previouslyFormattedCitation" : "(Allen, 2011; Department of Health, 2015)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }Allen, 2011; Department of Health, 2015). Despite this, there has been remarkably little movement or innovation with regard to the fundamental question of how early identification – which of course is a necessary prerequisite of early intervention – can be improved. In this paper we have presented the case for universal, school-based mental health screening as a central component of service reform in this area. From the preceding discussion of theory and research on screening it should be clear that we do not view this as some kind of magic bullet. Indeed, there are still many critical questions that remain to be answered. However, the evidence of potential is very strong, and we therefore propose that universal screening deserves serious consideration as the central mechanism through which we may make the necessary improvements to early identification methods and practices in this field. The current context is ripe. Now more than ever mental health is at the forefront of public policy, and in spite of the aforementioned issues in relation to education policy post-2010, there have been signs that mandate of responsibility for pupil mental health and wellbeing in schools ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jsp.2006.11.003", "ISBN" : "00224405", "ISSN" : "00224405", "PMID" : "20618906", "abstract" : "This article provides a review of current practices and tools used in the proactive screening of behaviorally at-risk students within the context of schooling. While there are many obstacles to the early detection of vulnerable students, some recent developments have helped make educators more receptive to early identification and prevention approaches. In addition to describing current best practices, this article reviews promising innovations in screening and early identification that the authors believe are worth considering and whose structural characteristics, required accommodations, and critical features may make them more acceptable to educational users. Implications for the training of school psychologists in the screening and early identification of high-risk students are reviewed and recommendations offered for future research. ?? 2006 Society for the Study of School Psychology.", "author" : [ { "dropping-particle" : "", "family" : "Severson", "given" : "Herbert H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Walker", "given" : "Hill M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hope-Doolittle", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kratochwill", "given" : "Thomas R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gresham", "given" : "Frank M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of School Psychology", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "193-223", "title" : "Proactive, early screening to detect behaviorally at-risk students: Issues, approaches, emerging innovations, and professional practices", "type" : "article-journal", "volume" : "45" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Severson et al., 2007)", "plainTextFormattedCitation" : "(Severson et al., 2007)", "previouslyFormattedCitation" : "(Severson et al., 2007)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(Severson et al., 2007) is beginning to gain renewed vigour ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Department for Education", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "publisher-place" : "London", "title" : "Mental health and behaviour in schools", "type" : "report" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "(Department for Education, 2014)", "manualFormatting" : "(e.g. Department for Education, 2014)", "plainTextFormattedCitation" : "(Department for Education, 2014)", "previouslyFormattedCitation" : "(Department for Education, 2014)" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }(e.g. Department for Education, 2014).On the balance of the evidence discussed, what might this look like on the ground? We envisage a secure online screening system underpinned by high quality training for teachers (and other stakeholders) that provides a solid baseline of mental health literacy, the technical process of screening and clarification of its purpose, goals and role within the broader system. The screening process is undertaken on at least an annual basis in order to provide adequate data for regular identification of new cases and monitoring of the progress of those who have previously been identified (thereby allowing for an adaptive system of intervention). In the early phase of primary education, teachers and parents are the principal informants given the developmental considerations relating to child self-report. However, from the age of around 7 (e.g. the beginning of Key Stage 2 in England) child self-report is fully integrated and given equivalent weighting to teacher and parent views. Challenges of reach, accessibility and diversity are not ignored, but instead embraced from the outset. The screener is available in multiple languages, has a low reading age, and is available offline in hard copy for those without internet access. Among so-called ‘hard to reach’ groups, local support, incentives and advocates are used to promote truly universal access and engagement. Clear information about the purpose and goals of screening is communicated in a sensitive, culturally competent manner. Of particular note is the foregrounding of information regarding use and sharing of data to ensure informed consent.The screening tool itself is a bespoke, publically available measure that operates with a two-stage system that begins with simple nomination and is followed up with a robust standardised measure. This means that teachers can complete the initial stage in a very short period of time. The second stage is applied to those children flagged through the initial nomination. The standardised measure used at this point balances psychometric robustness with practical considerations, and is used to produce a more detailed mental health profile that can be used to inform referral for intervention, while also filtering out any false positive cases identified through nomination. The measure reflects a dual factor model of mental health. Teacher data is triangulated with that provided by parents and children to optimise the sensitivity and specificity of the tool. Weighting of perspectives is dynamic and reflects the evidence base regarding different informants (e.g. under- or over-reporting of a given informant for a specific domain of functioning when the child is at a particular developmental phase). The tool is underpinned by a very large, representative normative sample. The process takes into account individual and contextual differences in producing classifications. Resultant information on MHD risk status in addition to areas of adaptive functioning is provided to relevant stakeholders (including external agencies and services as appropriate) to enable a swift, shared decision-making process regarding referral for intervention that takes into account areas of strength and resilience that may be capitalised upon. Referrals are made as early as possible following screening and are supported by a reformed system of school mental health provision in which practice is evidence-informed and a central hub for external services that can provide additional support and/or more intensive, indicated intervention as required (e.g. child and adolescent mental health teams). Data produced through the screening process is also used in aggregated forms at class and school levels to monitor and evaluate provision, inform school improvement planning and provide evidence in support of school inspections. Downstream monitoring of effects in terms of reductions in the incidence and/or severity of MHD over time, changes in proportion of unmet need and time taken for children and young people to receive appropriate services are used as robust markers to determine the utility of universal screening as a means through which to improve the mental health of children and youth.ReferencesADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4-18 and 1991 profile. Burlington, VT: University of Vermont.Allen, G. (2011). Early intervention: the next steps.. London: H.M. Government.Atzaba-Poria, N., Pike, A., & Barrett, M. (2004). Internalising and externalising problems in middle childhood: A study of Indian (ethnic minority) and English (ethnic majority) children living in Britain. International Journal of Behavioral Development, 28, 449–460. doi:10.1080/01650250444000171August, G. J., Gewirtz, A., & Realmuto, G. M. (2010). 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