Prevention Science in
Children’s School
Mental Health
Beth Doll
University of Nebraska Lincoln
What are preventive school
mental health services?
Services that have been carefully
designed to meet the mental health
needs of ALL students enrolled in a
school
(Doll and Cummings, 2008; Chapter 1)
Referral vs. preventive
Referral
Assessment
Assessment
Planning + Services
Planning + Services
Prevalence of mental disorders
in the United States
Disorder
Children
Adolescents
All Mental Disorders
200
200
Anxiety Disorders
150
150
ADHD
74
54
Conduct Disorders
40
140
Depression
15
70
OCD
2-4
4
Autism, schizophrenia
3-4
3-4
National Comorbidity Survey
Replication (Adults)
Any disorder
Anxiety Disorders
Mood Disorders
Impulse Control Disorders
Substance Use Disorders
12-month
Lifetime
26.2%
46.4%
18.1%
28.8%
9.5%
20.8%
8.9%
24.8%
3.8%
14.6%
What we have learned from
prevalence…
 Age-of-onset for most mental disorders are concentrated





during the first two decades of life
20% of students in the typical school classroom meet the
criteria for one or more mental disorder
5% of students are typically receiving mental health services
through community or private mental health centers
1% of hundred students are identified with emotional or
behavioral disabilities
The US must direct a greater part of our thinking about public
mental health interventions to the child and adolescent years
Schools are the primary providers of mental health services to
children and adolescents
Risk = Students are more likely to be
unsuccessful adults
Risk
 Poverty

 Low parent education

 Marital/family dysfunction

 Poor parenting

 student maltreatment

 Poor health

 Parental illness

 Large family

Adult outcomes
Mental illness
Physical illness
Educational disability
Delinquency
Teen parenthood
Financial dependence
Unemployment
Low social competence
Doll & Lyon, 1998
Resilience = Vulnerable students who become
successful adults






Individual
Positive social orientation
Friendships
Internal locus of control
Positive self-concept
Achievement orientation
Community engagement






Family & community
Close bond with one caretaker
Effective parenting
Nurturing by other adults
Positive adult models
Connections with pro-social
organizations
Effective schools
Broad principles
 One in five school-age students in the USA has a





diagnosable mental disorder
Only ¼ of these students receive community mental health
services
The strongest predictors of students' mental health are
characteristics of communities and families
Schools are an important protective factor for many students
And they are the primary provider of mental health services
for many students
Students' school success is directly related to their
psychological wellness and mental disorders
And a roadmap to preventive
school mental health
 Promote students’ friendships
 Foster their self-determination and internal locus of control
 Strengthen their personal efficacy
 Build students self-discipline
 Provide frequent and authentic opportunities for adult nurturing
 Engage students with prosocial organizations in the community
 Provide students with opportunities to pass it forward
Goals of preventive school
mental health services
1.
Promote the psychological well-being of all students so that they
can achieve developmental competence
2.
Promote caretaking environments that nurture students and allow
them to overcome minor risks and challenges
3.
Provide protective support to vulnerable students; and
4.
Remediate social, emotional or behavioral disturbances so that
students can develop competence.
Intentional cycle of planning
 Carefully collect information about the mental health status of




students
Construct a plan describing the mental health services that are
needed, who provides them, and who receives them
 Competing needs are reconciled based on the urgency of
needs and the anticipated outcomes of services
 Incorporate school-wide, class-wide, small group, and
individual services
 Incorporate prevention, early intervention, and remedial
services
Implement the plan
Monitor the impact of services and the changing face of the
schools’ mental health needs
Refine the plan as needed
Making Classrooms Mentally Healthy
Evaluate &
Refine
Assess
Class
Needs
Plan &
Implement
Class
Changes
Make
Sense of
the Data
STEP ONE
Use the ClassMaps
Survey as a practical
and reliable measure of
the complex classroom
environment
Temporary playground - pre
Making Classrooms Mentally Healthy
STEP TWO
Information from the
CMS is then used in a
problem-solving
process that identifies
classroom strengths
and weaknesses
Evaluate &
Refine
Assess
Class
Needs
Plan &
Implement
Class
Changes
Make
Sense of
the Data
Making Classrooms Mentally Healthy
Evaluate &
Refine
Assess
Class
Needs
Plan &
Implement
Class
Changes
Make
Sense of
the Data
STEP THREE
The data-based
problem solving
process identifies
intervention strategies
to reinstate essential
contextual supports in
classrooms
Making Classrooms Mentally Healthy
STEP FOUR
Verify the effectiveness
of those supports once
they are implemented
Evaluate
& Refine
Assess
Class
Needs
Plan &
Implement
Class
Changes
Make
Sense of
the Data
Temporary playground - post
Continuum of school mental health
interventions
Remedial
Services
Selected mental
health services
Universal mental health services
Infrastructure building activities to anchor
preventive services in the community
Adapted from Doll & Cummings, 2008; Chapter 1; and from Doll (In press)
chapter in the Encyclopedia of Public Health, London: Elsevier
Assessing the collective
mental health of students
 Systematic analysis of existing school records
attendance or discipline records
 Epidemiological procedures including multi-tier assessment
models in which broad screening is followed by comprehensive
mental health assessments (Short & Strein, 2008; Chapter 2)
 Sampling
 Technically sound measures
 Traditional mental health assessments administered and
aggregated across the school’s enrollment (Baker, 2008;
Chapter 3)
 Assessment of demographic and functional risk and protective
factors

Finding effective preventive
assessment measures
 Center for Academic, Social, and Emotional Learning
(http://www.casel.org/assessment/tools.php): an annotated
bibliography of measures to monitor children’s social and emotional
well-being; CASEL-developed tools
 The Annenberg Institute for School Reform
(http://www.annenberginstitute.org/tools/index.php): a bibliography
describing measures of children’s developmental health that can be
used school-wide or district-wide
 The World Health Organization
(http://www.who.int/school_youth_health/assessment) describes the
Global school-based student health survey that measures behavioral
risk factors of adolescents.
Adapted from Cummings & Doll, Chapter 12; and Doll (In press) chapter in
the Encyclopedia of Public Health, London: Elsevier
Creating a preventive plan for
school mental health services
To match the mental health needs against services provided in the
school and community – Resource mapping (Adelman & Taylor,
Chapter 11)
 UCLA Center for Mental Health in the Schools
(Http://smhp.psych.ucla.edu): A packet including instructions
and tools for mapping community resources onto school
mental health needs
 Collaborative for Academic, Social and Emotional Learning
(www.casel.org): a practice rubric for implementing and
sustaining social emotional learning interventions in schools.
 The World Health Organization
( http://www.who.int/school_youth_health/assessment):
Rapid Assessment and Response Guide for strategies to
improve health-promotion in schools.
Options for interventions
 Partnering with families to enhance students’ mental health (Christenson,
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Whitehouse, & VanGetson, 2008; Chapter 4)
School-wide approaches to behavior problems (Bear, 2008; Chapter 5)
Response to intervention: A school-wide approach for promoting academic
wellness for all students (Martinez & Nellis, 2008; Chapter 6)
Social and emotional learning: A school-wide approach to intervention for
socialization, friendship problems, and more (Merrell, Gueldner, & Tran,
2008; Chapter 7)
School-wide approaches to intervention for school aggression and bullying
(Swearer, Espelage, Love, & Kingsbury, 2008; Chapter 8)
School-wide approaches to prevention of and intervention for depression
and suicidal behaviors (Mazza & Reynolds, 2008; Chapter 9)
Evaluation of prevention
services
1.
2.
3.
4.
5.
6.
7.
Were the services effective in reducing the frequency or
severity of children’s psychiatric disorders?
Were the services effective in increasing children’s
psychological wellness and developmental competence?
What were the unintended positive or negative consequences
of the services?
What factors increased or decreased the services
effectiveness?
Were the preventive mental health services implemented with
fidelity?
Were the preventive mental health services acceptable to
children? To families? To mental health service providers?
How can the evaluation data be used for refining and
enhancing the community’s mental health services for
children?
Evaluation resources
 Center for Academic, Social, and Emotional Learning
provides an Implementation Toolkit (available at no cost
from www.casel.org) that includes publicly available
measures and suggestions for evaluation practices
 the Evaluation Center at Western Michigan University
(http://www.wmich.edu/evalctr/checklists/index.html)
includes annotated bibliographies describing major
evaluation models, measures, and tools for self-checking
an evaluation plan.
 UCLA Center for Mental Health in the Schools
(http://smhp.psych.ucla.edu) provides a technical aid
packet on evaluation and accountability
Adapted from Cummings & Doll, 2008; Chapter 12 and from Doll (In press)
chapter in the Encyclopedia of Public Health, London: Elsevier
Ten essential preventive
mental health services
1.
2.
Monitor students’ mental health status including their
academic, social-emotional and relational competence
Diagnose and investigate psychological disturbance in
students
3.
Inform, educate and empower students and their families
about mental health issues
4.
Mobilize school-family-community partnerships to identify and
solve psychological disturbances
5.
Develop policies and plans that support student, family,
school and community mental health efforts
Ten essential preventive
mental health services
6.
7.
8.
9.
10.
Implement policies and practices that protect students mental
health and ensure developmental competence
Link students and their families to universal, selected and
intensive interventions as needed
Provide appropriate staff training and monitor throughout
intervention
Evaluate effectiveness, accessibility, and quality of school
mental health services
Research new insights and innovative approaches to
promoting mental health
Cummings & Doll, 2008; Chapter 12
Mental health is essential
to schooling
School mental health’s goal of promoting
psychological wellness is not ancillary
to students’ academic success, but is
integral to it
Possibilities of preventive
services
 Reconcile school mental health services with students’ mental




health needs
Strengthen the planfulness of mental health services
Leverage existing resources so that more students receive
mental health services earlier and with more impact
Integrate and coordinate school and community mental health
services around common goals
Highly compatible with the mission of public schools


To provide students with the knowledge and skills necessary for
productive and successful lives
A mission that is shared with other important societal entities
such as families, churches, the legal system, and social
services
Limitations of preventive services
 Principally implemented in a small scale in practice
 Only possible within institutions that are already population-
focused (e.g., schools, military bases, public health services)
 Demand for services is much greater than anticipated
 Payoff of preventive services may be several budget-cycles
removed from their initial implementation
 Incompatible with many funding mechanisms
Doll, B., & Cummings, J. (2008).
Transforming School Mental
Health Services: preventive
approaches to promoting the
competency and wellness of
children. Thousand Oaks, CA:
Corwin Press / NASP.
CONTACT INFORMATION
Beth Doll, PhD.
University of Nebraska Lincoln
Bdoll2@unl.edu