Schools need accurate and efficient ways to identify youth with mental health problems, in part to provide services to such students whose mental health concerns pose barriers to learning. The present study involved an investigation of the accuracy of one method--relying on educators (teachers, a team of school-based mental health professionals, and a school nurse) to identify early adolescents who self-report elevated levels of anxiety or depression. With respect to teachers as screening agents, the possible variability in rates of accurate identification as a function of number of teachers involved in the process (i.e., pooling nominations from multiple subject area teachers for a single student rather than from a single subject area teacher) was examined. The present study also included an examination of the demographic and psychological features of students who are more likely to be missed (i.e., self-report elevated symptoms but are not detected) or misidentified (i.e., self-reported symptoms in the typical range but were incorrectly identified as symptomatic) by educators. Participants included 233 middle school students in grades 7 to 8, 19 teachers, and 6 school-based mental health professionals. Approximately 15.5% and 12% of student participants twice-reported at-risk levels of anxiety and depression, respectively. At-risk was defined as T-scores more than one standard deviation from the norm group mean on psychometrically sound narrowband measures of anxiety and depression. Teachers correctly identified 58.33% of these anxious students and 32.14% of the students with elevated depression, but misidentified 34.52% of non-symptomatic students for anxiety and 23.41% for depression. The school-based mental health staff was largely less accurate than the teachers. The team of school-based mental health professionals accurately identified 12.50% of students for anxiety and 26.32% for depression, and falsely identified 10.31% for anxiety and 25.49% for depression. The school nurse correctly identified 14.81% of students for anxiety and 14.29% for depression, and misidentified 16.26% for anxiety and 17.83% for depression. Taken together, the use of educator nominations in identification of internalizing middle school students appears most defensible when relying on teacher judgments to identify youth with elevated anxiety. The combined group of core subject area teachers (language arts, math, and social studies) was more accurate than teachers from a single subject area, suggesting that teacher nominations should be elicited from multiple groups of core subject area teachers, particularly math and language arts. Rather than nominating students themselves, school-based mental health professionals may be better situated to deliver professional development to teachers regarding the identification of anxiety and depression. Additionally, although several demographic (i.e., gender, race/ethnicity, socioeconomic status) and psychological features (i.e., symptom severity, symptom type; also socially desirable responding and life satisfaction) were examined for students who were missed and misidentified, few differences emerged between the pairs of groups with similar self-reported levels of symptoms. Exceptions included that students who were misidentified reported higher levels of depressive symptoms (albeit still in the typical range) and less satisfaction with their lives than students who were not nominated by teachers. Thus, teachers may detect some mild mood or quality of life differences among students that do not align with students' self-report of symptoms. The practical implications of all study findings, as well as directions for future research, are discussed

This study examined the utility of a brief, strength-based approach to mental health screening. A strength-based based approach to mental health screening focuses on the social and emotional competencies taught and supported by the school context. As such, a strength-based approach to mental health screening is aligned with a three-tiered response to intervention model aimed at maximizing the effectiveness of universal supports and early detection of students who may benefit from additional intervention.

As a universal screening method, teacher nominations have been found to both miss and misidentify a substantial proportion of students with internalizing disorders such as anxiety and depression (Cunningham & Suldo, 2014; Gelley, 2014; Moor et al., 2007). Although some research has explored the accuracy of teacher nominations when used to identify students with anxiety and depression, no research examined the teacher characteristics that are potentially related to accuracy. The current study conducted a secondary analysis of an archival dataset (Gelley, 2014) to determine which characteristics of teachers (N= 19) are more closely related to accuracy in identifying middle school students (N = 233) with elevated levels of anxiety or depression. Teacher characteristics examined include: teacher self-efficacy beliefs in identifying students with anxiety and depression, teacher acceptance of the general method of asking teachers as a whole to identify students with anxiety and depression, teacher gender, years teaching, and subject taught. Multiple regression analyses were used to examine the relationships between the aforementioned teacher characteristics and teacher accuracy, defined by the conditional probability indices sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The combined predictors explained 38 to 69% of the variance in those indicators of accuracy. Results indicated that in predicting sensitivity, being a language arts or math teacher (as compared to being a social studies teacher), having fewer years of professional experience, and reporting greater acceptance of method may predict higher sensitivity rates. In regards to specificity, higher teacher self-efficacy, being a social studies teacher, being male, and having fewer years of professional experience predicted higher specificity rates. In terms of PPV, having higher acceptance of method and more self-efficacy may explain higher PPV rates. Finally, in terms of NPV, having fewer years of professional experience may explain higher NPV rates. Results from this study may be used to guide collaboration and consultation with teachers in universal screenings, and may inform teacher training programs aimed to increase teacher knowledge and confidence identifying students experiencing emotional distress at school.

Problem: A major gap in adolescent mental health services exists in the United States. Nearly 80% of children and adolescents who are defined as needing mental health services are not receiving mental health care. School-based services have demonstrated promise as a strategy to address this gap. The purpose of this dissertation is to determine how a large urban school system implemented and sustained an innovative service of care model in response to financial, human resource, and community constraints and opportunities. Methods: A case study of the San Diego Unified School District’s (SDUSD) Mental Health Resource Center (MHRC) was completed using Pettigrew and Whipp's Content, Context, and Process Model of Strategic Change (PWM) as the theoretical framework that guided the research. Three primary sources of evidence were collected covering a fifteen-year period of implementation (1999–2014): 1) documents; 2) archival records; and, 3) interviews. The interviews were conducted with local and state stakeholders (n=20) and with students who received MHRC services and their parents (n= 15). A chronological reconstruction was completed and all data underwent a content analysis to organize and identify emergent themes based on the PWM framework. Results: Eight factors were identified as critical to the implementation and sustainability of the MHRC: establishing the legitimacy of school as environment for the delivery of mental health services; aligning education and mental health policies; implementing cross systems collaboration; utilizing data to improve performance and prioritize services; strengthening parent and student involvement; commitment to lead; institutionalization of mental health training; and, investment in staff. Further analysis assessed potential system improvements and opportunities for new collaborations and produced sustainability recommendations for SDUSD and MHRC administration, staff, and stakeholders. Conclusion: The MHRC provides a unique systems model that can inform best practices and policy decisions regarding the implementation and sustainability of school-based mental health services. Lessons learned from the sustainability of the MHRC support schools as a legitimate environment for the delivery of mental health services and the integration of mental health services in schools as a feasible strategy to improve student academic and mental health outcomes.

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