A systematic review of effectiveness and cost-effectiveness of school-based identification of children and young people at risk of, or currently experiencing mental health difficulties

Anderson, Janice R.; Ford, Tamsin; Soneson, Emma; Coon, Jo Thompson; Humphrey, Ayla; Rogers, Morwenna; Moore, Darren; Jones, Peter; Clarke, Emmet; Howarth, Emma

doi:10.1017/s0033291718002490

Cited by 77 publications

(96 citation statements)

References 54 publications

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“…However, there are no studies that we are aware of that have explicitly investigated the effectiveness of attendance data to identify emotional disorders in school settings. Given that universal screening approaches produce a high number of false positives [13], this is an important topic for future research.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, those that did have policies in place used disruptive behaviour as their main way of identifying students with mental health needs [12], which is most likely to miss those with internalising problems such as depression or anxiety. Furthermore, universal screening approaches for the identification of emotional disorder in schools produce a high number of false positives and may lack efficiency [13]. Therefore, new ways are needed to identify children and adolescents with emotional ill health.…”

Section: Introductionmentioning

confidence: 99%

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Emotional disorder and absence from school: findings from the 2004 British Child and Adolescent Mental Health Survey

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Ford

Moore

et al. 2019

Eur Child Adolesc Psychiatry

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Emotional disorder may be associated with absence from school, but the existing evidence is methodologically weak. We studied the relationships between anxiety, depression and emotional difficulties, and school absence (total, authorised and unauthorised) using data from the 2004 British Child and Adolescent Mental Health Survey (BCAMHS). The BCAMHS was a cross-sectional, community survey of 7977 5-to 16-year-olds. Emotional disorder was assessed using the Development and Wellbeing Assessment (DAWBA), and emotional difficulties using the Strengths and Difficulties Questionnaire (SDQ) completed by teachers and parents. Teachers reported days absent in the previous school term. Multivariable negative binomial regression was used to examine the impact of emotional disorder and difficulties on absence. Age, gender and general health were explored as moderators. Anxiety, depression and emotional difficulties were associated with higher rates of all types of absence [rate ratios for total absence: anxiety 1.69 (1.39-2.06) p < 0.001; depression 3.40 (2.46-4.69) p < 0.001; parent-reported emotional difficulties 1.07 (1.05-1.10) p < 0.001; teacher-reported emotional difficulties 1.10 (1.08-1.13) p < 0.001]. The strongest association was observed for depression and unauthorised absence. Relationships were stronger for secondary compared to primary school children. Health and educational professionals should be aware that children with poor attendance may be experiencing emotional ill health, regardless of absence type. The absence may provide a useful tool to identify those who require additional mental health support. Findings highlight the widespread burden of emotional disorder and the need to support those with emotional ill health in continuing to access education.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emotional disorder and absence from school: findings from the 2004 British Child and Adolescent Mental Health Survey

Finning

Ford

Moore

et al. 2019

Eur Child Adolesc Psychiatry

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“…a statement about the implications of these elements on a programme's implementation or sustainability). We excluded studies that focused on cost-effectiveness, as this outcome is included in our linked review (Anderson et al 2018). We had no restriction regarding informants about feasibility.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…School-based programmes have the potential to improve rates of MHD identification in CYP (Anderson et al 2018). In the design and implementation of such programmes, it is important to consider not only effectiveness, but also social validity (Craig et al 2008;Humphrey and Wigelsworth 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Despite the clear importance of, and recent policy focus on, early identification of MHD, there is a paucity of evidence for the effectiveness, feasibility, and acceptability of school-based identification models, especially within the UK (Fazel et al 2014;Humphrey and Wigelsworth 2016). A recent systematic review (Anderson et al 2018) examined the effectiveness of school-based models of identification. The present linked review sought to determine the feasibility of various models of school-based MHD identification.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of School-Based Identification of Children and Adolescents Experiencing, or At-risk of Developing, Mental Health Difficulties: a Systematic Review

et al. 2020

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Under-identification of mental health difficulties (MHD) in children and young people contributes to the significant unmet need for mental health care. School-based programmes have the potential to improve identification rates. This systematic review aimed to determine the feasibility of various models of school-based identification of MHD. We conducted systematic searches in Medline, Embase, PsycINFO, ERIC, British Education Index, and ASSIA using terms for mental health combined with terms for school-based identification. We included studies that assessed feasibility of school-based identification of students in formal education aged 3-18 with MHD, symptomatology of MHD, or exposed to risks for MHD. Feasibility was defined in terms of (1) intervention fit, (2) cost and resource implications, (3) intervention complexity, flexibility, manualisation, and time concerns, and (4) adverse events. Thirty-three studies met inclusion criteria. The majority focused on behavioural and socioemotional problems or suicide risk, examined universal screening models, and used cross-sectional designs. In general, school-based programmes for identifying MHD aligned with schools' priorities, but their appropriateness for students varied by condition. Time, resource, and cost concerns were the most common barriers to feasibility across models and conditions. The evidence base regarding feasibility is limited, and study heterogeneity prohibits definitive conclusions about the feasibility of different identification models. Education, health, and government agencies must determine how to allocate available resources to make the widespread adoption of school-based identification programmes more feasible. Furthermore, the definition and measurement of feasibility must be standardised to promote any future comparison between models and conditions.

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The Brief Evaluation of Adolescents and Children Online (BEACON): Psychometric development of a mental health screening measure for school students

Rapee,

Kuhnert,

Spence

et al. 2024

J Clin Psychol

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This paper describes the development and psychometric evaluation of a brief self‐report measure (BEACON) to inform universal mental health screening in schools. Items assess symptoms and impairment associated with anxiety and attention/hyperactivity problems (grades 4–11) as well as depression and eating difficulties (grades 6–11), with optional items for suicidality and self‐harm (grades 7–11). Initial item examination based on Item Response Theory (IRT) and classical test theory involved 3844 students in grades 4 through 11 (Study 1) and identified 18 items for grades 4–5 and 31 items for grades 6–11 that fulfilled pre‐set criteria. Study 2 extended testing with 10,479 students in grades 4–11 and added an additional four items assessing impairment associated with eating difficulties for older students (grades 6–11) creating a total of 35 items for grades 6–11. All items, for both grade‐level versions, met the pre‐set criteria for IRT and classical test theory analysis supporting their strength in the measurement of the dimensions of concern. The measure showed good reliability (subscale alphas .87 to .95). Validity was also demonstrated against standard symptom measures, school grades, school absenteeism, and help‐seeking. The BEACON appears to be a psychometrically sound measure to use in the first stage of school‐based screening for mental health problems.

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A systematic review of effectiveness and cost-effectiveness of school-based identification of children and young people at risk of, or currently experiencing mental health difficulties

Abstract: Well-designed pragmatic trials that include the evaluation of cost-effectiveness and detailed process evaluations are necessary to establish the accuracy of different identification models, as well as their effectiveness in connecting students to appropriate support in real-world settings.

Cited by 77 publications

References 54 publications

Emotional disorder and absence from school: findings from the 2004 British Child and Adolescent Mental Health Survey

Emotional disorder and absence from school: findings from the 2004 British Child and Adolescent Mental Health Survey

Feasibility of School-Based Identification of Children and Adolescents Experiencing, or At-risk of Developing, Mental Health Difficulties: a Systematic Review

The Brief Evaluation of Adolescents and Children Online (BEACON): Psychometric development of a mental health screening measure for school students

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