By Dana Asby, CEI Director of Innovation & Research Support This is the second part of the special series School Mental Health Screening.
Is the 17% rise in anxiety disorder diagnoses among American youth (Child Mind Institute, 2018) due to an increase in teens’ rate of anxiety or because more schools, physicians, and other community institutions have increasingly begun to screen for mental illnesses?
It’s difficult to discern whether people are feeling more clinically anxious or we’re just better at noticing and diagnosing it. Regardless, schools are taking notice of the numbers and how mental health diagnoses impact their students, in positive and negative ways. Understanding the mental health of their students helps school leaders know which students need individual attention and which issues are pervasive enough to require a universal healing practice.
Considerations for Choosing the Right Instruments
As we mentioned in part one of this series, there is a plethora of validated and reliable mental health assessments for youth. Most mental health screeners are administered by school psychologists who have been trained to measure internalizing (anxiety or depression) and externalizing (hyperactive, aggressive, or disruptive) behaviors, individually or as a collection of behavior traits. Psychologists have access to an array of options, allowing them to determine the best measure(s) for specific circumstances.
If you are choosing a mental health screener(s) to use with the entire school population, think about the difficulties that seem to be most common among your students. No matter how you are using mental health assessments, trauma’s impact on mental health must be taken into consideration.
When a student has one or more adverse childhood experiences (ACEs), they may not be experiencing chronic clinical depression, but rather an inability to process their trauma in a healthy way. Because of this, adding a trauma screener to any mental health assessment can enhance school mental health support.
Psychologists, counselors, and social workers will be able to intervene in currently occurring ACEs and help victims understand past ACEs before focusing on addressing the symptoms of depression, anxiety, or PTSD.
Choosing which Tool Is Right for Your School
A number of evidence-based psychometric assessments indicate that someone might be at-risk for a mental illness. However, a mental illness diagnosis cannot be given after a single screener. Rather, students must be given an individual comprehensive assessment by a licensed psychologist or psychiatrist. Yet, mental health screeners can help inform how your mental health support team offers assistance—such as special accommodations or peer support—and interventions for individual students or entire school populations.
Here is a list of some of the most widely used tools that school leaders have found useful (NCTSN, n.d.):
Universal screener that identifies students at-risk for social, emotional, or behavioral developmental delays
Normed for ages 5-18
5-10 minutes
Measures physical concerns and strengths as well as internalizing and externalizing behaviors
Versions available for youth aged 1.5-5 and 6-18
15 minutes
It should be noted that the TRF is a part of the Achenbach System of Empirically Based Assessments that includes the TRF, Child Behavior Checklist (CBC), and the Youth Self Report (YSR) and is sometimes colloquially referred to as the CBC.
Measures adaptive and problem behaviors as well as thoughts and emotions
Normed for ages 2-21
10-50 minutes depending on which scales are included
Five separate inventories can be used together or separately to measure depression, anxiety, anger, classroom disruption, and self-concept
Normed for ages 7-18
20 minutes per inventory
Measures exposure to traumatic events and symptoms of PTSD
Normed for ages 6-18, with a version for children younger than 6 available
20 minutes
While these are some of the most utilized screeners that illuminate important mental health issues, this list is by no means complete. To explore more specific measures, visit The National Child Traumatic Stress Network’s catalog of measure reviews.
Tips for Universal Implementation
If your mental health support team makes the decision that universal screening is best for your school, one consideration is choosing which assessment(s) to use. To help inform that choice, we recommend doing a needs assessment. Ask teachers about concerns that they have or consult the data and see if any trends emerge.
You may find that one BYI inventory, the UCLA PTSD Reaction Index, and one BASC-3 scale make the most sense for your school community. With the use of electronic surveys that automatically compile student data in spreadsheets, you can complete an analysis and create individual student reports, as well as understand general trends in the student body, with relative ease. Many assessments, like the BASC-3 can be quite expensive, so explore your options to determine if there is a screener in the public domain that might be appropriate for your school.
No matter which screening method (universal or targeted) and assessment you choose, think intentionally about what to do with the data you collect. Remember that the reason for embarking on this journey is to support students’ mental health. If your school does not have a mental health support team, convening one might be a good first step to begin the conversation around school mental health screening. Stay tuned for our November e-Newsletter where we will explore SAMHSA’s efforts to support schools in creating comprehensive school mental health systems with their SHAPE system.
References
Child Mind Institute. (2018). Understanding anxiety in children and teens. 2018 Children’s Mental Health Report.
National Child Traumatic Stress Network (NCTSN). (n.d.). Measure reviews. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.