By Dana Asby, CEI Director of Innovation & Research Support
This is the first part of the special series School Mental Health Screening.
Universal screening has improved the physical outcomes for millions of children who get routine dental and eye exams at their school buildings each year. Screening for mental health issues in schools has become a topic of discussion for many district leaders. Will the benefits of identifying students most at-risk of physical health problems translate when those difficulties are in the mental health realm? The answer is complicated.
What Are School Mental Health Screenings?
The Substance Abuse and Mental Health Services Administration’s (SAMHSA) National School Mental Health Curriculum (NSHC) highlights that while school mental health training is “often used to identify students at risk for a mental health or substance use concern,” it can also be used to identify student strengths and needs (MHTTC, 2019).
Typically, a school mental health screening is a brief survey administered by a teacher, counselor, school psychologist, or other staff member or completed by the student themselves. Screeners can assess a specific mental health concern such as anxiety, depression, and post-traumatic stress disorder. They can also be used to look at a variety of behaviors that may indicate risk for one or more potential diagnoses.
At the recent Institute on Psychiatric Sciences (IPS): Mental Health Services Conference, I asked several experts on mental health which tool they recommended for schools to get a snapshot of a student’s mental health. They responded that the Behavior Assessment System for Children, Third Edition (BASC-3) is a comprehensive and trusted screener, appropriate for Pre-K-12 students. This screener takes 10-50 minutes to complete depending on how much information you want to collect. Because it looks at behavior patterns, emotions, and feelings, it can alert educators to both internalizing and externalizing behaviors. To learn more about mental health screening options, read part two of this article series.
Why Screen Universally?
SAMHSA identified several benefits to screening universally at the school level (MHTTC, 2019):
Shift from being reactive to proactive
Systematic and strategic resource allocation
Opportunity for early intervention
Increased crisis prevention and school safety
Serious mental illness (SMI) can affect every aspect of a person’s life. People experiencing an SMI have poorer health, academic, social, and career outcomes than their typical peers. Living with an SMI can make everyday tasks unmanageable. However, when an SMI is detected early enough in a person’s life, interventions can completely change the trajectory of development.
When schools screen universally, they are ensuring that every student’s mental health is a high priority. If mental health screening begins in early elementary school, students who have a mental health issue will get the treatment they need as soon as possible. After a screening, if schools discover that many of their students are at-risk of developing the same or similar mental health issues, a universal intervention or targeted group interventions can be implemented to address that concern.
Considerations Before Implementing Universal Screening
While there are many benefits to screening all students for mental health concerns, there are also reasons why universal screening may not be right for your school population. Before beginning this process, ensure that you have a process in place for referral and services for students who are identified. Additionally, consider whether teachers are prepared to implement activities that may facilitate the wellbeing of students who are identified. It would be unconscionable to identify students and then not follow through with some supports.
Find out how invested other stakeholders such as parents, teachers, and the students themselves, are in mental wellbeing. It will be important to explain why you are spending class time on this activity. School counselors or social workers may be able to help with this process.
It can also be challenging to get parental consent due to the prevalent stigma around mental illness. Parents might worry that if their child is identified as potentially having a mental illness, that they may be isolated or bullied by peers. This worry may not be unfounded as mental health labels can follow a child throughout their school career. In addition to peer isolation, educators may consciously or unconsciously treat children who have been identified differently.
Does your school have the staff, time, and funding capacity to screen all students and analyze the data? Some schools have developed methods to make the screening and data analysis time-efficient for staff and students. For tips on effective use of mental health screeners, read part two of this series.
While the earliest psychological assessments were largely developed from studies done on White, middle class populations, more recent research has attempted to look at how different populations of children demonstrate traits. Educators who work with diverse populations may find that they are getting a lot of “false positives” or seeing students slip through the cracks without being identified because the language or concepts used in the screeners are not culturally appropriate for their population. Psychologists today are more aware of this issue and strive to study their instruments with populations that include youth with a variety of socio-economic, racial and ethnic, and cultural backgrounds.
Before a school makes the decision to administer surveys that give them an idea of which students are at-risk of or experiencing a mental health issue, they should ask themselves why they are screening. As neuropsychologist Larry Seidman told his mentees, “If you are going to measure something, be prepared to do something about it” (IPS Conference, 2019). Screening students for risk of mental illness is a pointless endeavor if you don’t do anything with the data you collect.
Institute on Psychiatric Sciences (IPS): Mental Health Services Conference. (2019). Personal interactions.
Mental Health Technology Transfer Center Network (MHTTC). (2019).Virtual learning session 4: Screening. Substance Abuse and Mental Health Services Administration and National Center for School Mental Health.