2016 Children’s Mental Health Report

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Targeted Interventions

Interventions that address specific concerns in specific populations of children are vital to mental health efforts in schools. Community partnerships have proven invaluable to many programs.

Aside from one-on-one mental health care from an office-based professional, clinicians have begun to develop school-based mental health interventions that leverage the environment to deliver care.

Below are two examples, one focused on aggression and the other on traumatic stress.

Second Step is an evidence-based prevention program for 4- to 14-year-olds that addresses impulsive and aggressive behavior, promotes anger management, and teaches problem-solving skills.

A study of 790 students showed that teacher and parent reports were not affected by the intervention—a common problem in school-based trials of behavioral approaches. But behavior observations by professional observers indicated significant decreases in physical aggression and increases in prosocial behavior.⁴⁶

Analysis of the program in 3,616 middle school students showed a 42% decrease in physical aggression⁴⁷ and a 20% decrease of bullying in special education environments.⁴⁸

Cognitive Behavioral Intervention for Trauma in Schools (CBITS) is an evidence-based intervention for children with symptoms of post-traumatic stress disorder (PTSD). Children are identified by experienced school personnel and treated by a trained professional working with the school.

PTSD is a significant problem in young people, particularly in the poor urban environments CBITS was developed to serve.

  • Lifetime PTSD in children 14-18: 5%⁴⁹

CBITS is a novel group intervention that lasts for 12 sessions (10 group and 2 individual) and can be delivered by school-based mental health personnel. A study of 126 students with PTSD and depression symptoms showed that, compared to no intervention, 86% reported less-severe PTSD symptoms and 67% reported less-severe depression symptoms.⁵⁰

⁴⁶ Grossman, D.C., Neckerman, H.J., Koepsell, T.D., Liu, P.Y., Asher, K.N., Beland, K., Frey, K., & Rivara, F.P. (1997). Effectiveness of a violence prevention curriculum among children in elementary school. A randomized controlled trial. JAMA. 277(20): 1605-11. doi:10.1001/jama.1997.03540440039030

⁴⁷ Espelage, D.L., Low, S., Polanin, J.R., Brown, E.C. (2013). Impact of a middle school program to reduce aggression, victimization, and sexual violence. Journal of Adolescent Health. 53(2): 180-186. doi: 10.1016/j.jadohealth.2013.02.021

⁴⁸ Espelage, D.L., Polanin, J.R., & Rose, C.A. (2015). Social-emotional learning program to reduce bullying, fighting, and victimization among middle school students with disabilities. Remedial and Special Education, doi: 10.1177/0741932514564564

⁴⁹ Merikangas, K., Hep, J., Burstein, M., Swanson, S., Avenevoli, S., Cui, L., Benejet, C…Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of American Academy of Child and Adolescent Psychiatry. 49(10): 980-989. doi: 10.1016/j.jaac.2010.05.017

⁵⁰ Stein, B.D., Jaycox, L.H., Kataoka, S.H., Wong, M., Tu, W., Elliott, M.N., & Fink, A. (2003). A mental health intervention for schoolchildren exposed to violence: a randomized controlled trial. JAMA, 290(5): 603-611. doi:10.1001/jama.290.5.603.