1. 2 Facilitating Mental Health Promotion and Early Detection of At Risk Youth D. A. Santor, Ph.D. Provincial Centre of Excellence for Child and Youth.

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Facilitating Mental Health Promotion and Early Detection of At Risk Youth

D. A. Santor, Ph.D.

Provincial Centre of Excellence for Child and Youth Mental Health School of PsychologyUniversity of OttawaOttawa, Canada

A. Bagnell, MD.

Maritime Psychiatry IWK Health Centre Dalhousie UniversityHalifax, Canada

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20%

60%

Intensive Treatment

Selected Intervention

Universal

Sev

erit

y +

Imp

airm

ent

+ R

eso

urc

es

At Risk

20%

Q: How do we allocate resources?

Indicated Intervention

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illness treatment

Two Challenges:

intervention

improvement

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Current Strategies to address Mental Health Difficulties in schools

school based health centres mass screening universal mental health interventions

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Strategy 1: School based health centres.

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What’s the chance of visiting the school health centre given that you have difficulty, or distress, or want help for a problem?

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

Serious MentalHealth Problem

ProblemCausing

Impairment

Wanting Help Distressed Social Problem EmotionalProblem

Visit | Problem

Visit | No Problem

Santor, LeBlanc , Poulin, Kusumukar (2005b)

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What proportion of young people with difficulties actually use school based health centres?

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0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Serious Problem ProblemCausing

Impairment

Wanting Help Distressed Social Problem EmotionalProblem

Santor, LeBlanc , Poulin, Kusumukar (2005b)

Less than 1/5 of young people with distress or mental health problems causing impairment visit school health centres

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Strategy 2. Mass Screening

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Columbia TeenScreen Program

“The ultimate goal of the TeenScreen Program is to ensure that all youth are offered a mental health check-up before leaving high school. Our primary objective is to help communities establish permanent early identification programs through which youth are screened for mental disorders and suicide risk factors.”

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Results

9th-12th grade students attending seven New York high schools (N = 1,729).

28% (n = 489) of the students endorsed one of the items and therefore met criteria for being at risk of suicide.

The most balanced algorithm had a sensitivity of 0.75, a specificity of 0.83, and a positive predictive value ranging from 16-33% (p. 75).

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US Task Force on Prevention (2002).

… reversed their 1996 recommendation recommending

screening adults for depression in physician practices.

…. but concluded that the evidence is insufficient to recommend for or against routine screening of children or adolescents.

US Task Force on Prevention (1996).

… insufficient evidence to support use of mass screening in either adults or children.

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School factors affecting base rates

10% of student absent at any time,

10% drop out by year end. Young people who are absent

and drop out tend to be young people experiencing difficulties, the very group you wish to screen.

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Onset Screening

symptom course

Factors Affect Screening (3): Symptom Course

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Strategy 3. School Based Programs

1. Universal – everybody participates

2. Selective – at risk

3. Indicated – early signs

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Universal Programs δ = 0.12

Selective Prevention δ = 0.30

Indicated Prevention δ = 0.23

Results:

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How do we improve the effectiveness of universal programs?

improve knowledge up take monitor implementation continuously extend learning beyond the classroom

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Maximizing the Impact, Uptake and Sustainability of School Based Health and Mental Health Initiatives with On-line resources

Santor and Bagnell (2008)

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Is the internet a viable delivery system

75 percent of adolescents have used the internet to locate health information online, slightly more than the numbers downloading music and playing games

more than half of all young people may prefer to obtain health information online as opposed to other media

99% of youth had access to the internet and that 79% of youth had internet access at home.

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Developing a Flexible internet-based delivery system

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ContentYooMagazine Our flagship magazine focuses on a range

of health, mental health and developmental topics, including nutrition and exercise, boys and girls health, injury prevention, bullying and relationships.

Q&A Each week, we answer new questions posted by youth.

Q&A Archive Browse or search our archive of over 2000 Q&As asked by students and answered by experts

Quizzes Test your knowledge about development, health and sexuality.

Questionnaires Take standardized, interactive questionnaires on a range of topics.

News Bulletins We post new fact sheets on emerging trends each month on a range of health, development and well-being topics.

Hot Topics We showcase materials on critical topics each month, including bullying, STIs, self harm.

Classroom Activities

Lesson plans and teaching modules on a range of health and mental health topics will be posted each month.

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Food is Fuel! Learn about nutrition. Test your food knowledge.

StressExplained.What is it? Do you have it? What to do about it.

De-STRESSLearn the ABCs of Stress and Stress Relief.

SelfHarm&HelpSeeking?Five things you need to know. How to get help.   

GoFitness!Get active. Walk to Moscow. 

What's in the mix?Drugs, alcohol and substances. How they affect you.

Mental Health.Mental Health and Mental Illness. What’s the difference?

BoysHealth.Owner's manual and body book.

RelationshipsFinding romance. Making Friends.

SexualDecisionMaking.Ready to do it. Doing it. Done it.

SummerTime..Beach Knowledge and JobSafety. 

GirlsHealth.Owner's manual and body book.

FittingIn | MeetYourBullyFitting-in. Bullying. Victimization

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How is it used by students?

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im a 16 year old girl, for the past three months i've been feeling alot different then i used to, i find i have trouble sleeping at night and trouble staying asleep. my body and head constantly hurt though my doctor says i have no medical problems i've been eating alot less and my mood swings are out of control. during the past three weeks things have only gotten worst i've become extreamly sensitive crying about everything and yesterday i cut my arms up with some keys. i can't control my sadness and i was hoping it would pass. my parents say its a phase that everyone goes through but i think i need some help. is this a phase? or do i need to see a doctor??

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okay this might sound stupid but i have learned about sex -- i know what goes on and everything, i am very well educated on the subject, but i sorta wonder in between all this orgasm stuff-- like i know what they are and how they happen and that it vary's from guys to girl-- but is like sex like one orgasm then its over ?like how can this go on for along time? is sex really short ...cant it be long? like after the orgasm thing what happens? like i ask do you go again or...what? i hope you get what i am asking thanks!

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Infrastructure & …

Customize

Each school can decide which components and resources they wish to keep or elect to hide.

Email Updates

Get email updates each month about what is new for you.

Addresses / Links

Online listings of local support groups, and agencies as well as other quality websites.

School Hotlines

Provide students in your school direct access to school guidance and health professionals on key issues, such as bullying or drug use..

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... EvaluationScreening

ToolsAccess and complete empirically validated screening tools for teachers on a range of topics including ADHD.

Stress Quiz

Our monthly stress quiz prompts students to complete a stress checklist monthly, allowing students to track changes in stress levels from month to month.

Health Survey

Conduct an annual on-line health survey of students in your school, and view results of the survey on-line

Monthly Statistics

Local and regional staff can download usage statistics directly from our administrative website – allowing schools to track usage and evaluate trends.

Annual Health and Motivation for

Learning Survey

School Climate Measure

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406 400

1266

947

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200

400

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Total Q&A Asked Total Stress Quiz

Year 1

Year 2

2174

6542

11037

31526

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10000

15000

20000

25000

30000

35000

Total Logons Total Q&A View ed

Year 1

Year 2

Utilization Data (N = 500 – or one typical school)

Santor, LeBlanc , Poulin, Kusumukar (2005c)

How is the Resource Used by Young People?

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1000

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Hour of Day

Num

ber

of

Logons

30 Logons

Santor, LeBlanc , Poulin, Kusumukar (2005c)

This group of young people scored higher on measures of depression and difficulties

How is the Resource Used Throughout the Day?

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Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug0

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Santor, LeBlanc , Poulin, Kusumukar (2005c)

Number of visitorsNumber of visits

Mean number of visits

How is the Resource Used Throughout the Year?

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Can Mass Screening be improved with on-line resources?

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Results: Screening On-Demand

The positive predictive value for the Symptom Checklist – for predicting sustained mood problems (assessed at year end) – was 0.45 in the subgroup of website visitors who completed the Symptom Checklist once.

The positive predictive value increases to 0.73 in the subgroup of individuals who completed the Symptom Checklist more than twice.

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Can we enhance school based interventions with on-line resources?

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YooMagazine

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yoomagazine.net

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Schools currently implementing YooMagazine Health and Mental Health Literacy Program Total Number of Schools: 100 Total Number of Students with access: 25,000 + Total Number of Teachers: 1000 +

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