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

Abstract

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.

Acceptability and Feasibility of Early Identification of Mental Health Difficulties in Primary Schools: A Qualitative Exploration of UK School Staff and Parents’ Perceptions

“…Although there have been calls for the introduction of school-based universal screening in the UK as a strategy for enhancing the prevention of mental health problems and narrowing the treatment gap (Humphrey & Wigelsworth, 2016;Williams, 2013a, Williams, 2013b, there is a lack of published research evaluating the effectiveness of this approach in a UK context (Anderson et al, 2018). Furthermore, there is a lack of evidence on the acceptability and feasibility of school-based identification methods (Soneson et al, 2020).…”

“…Despite the clear importance of, and recent policy focus on the early identification of MHDs, there is a paucity of evidence on the effectiveness, feasibility, and acceptability of school-based identification models, especially within the UK and in primary schools settings (Anderson et al, 2018;Fazel et al, 2014;Humphrey & Wigelsworth, 2016;Soneson et al, 2020). The current study aimed to explore the 'in principle' acceptability of four key methods of identification from key stakeholders in primary/elementary schools using qualitative methods.…”

Behavioural activation for overweight and obese adolescents with low mood delivered in a community setting: feasibility study

“…These findings were in line with evidence from a systematic review of the feasibility of school-based identification of young people experiencing or at-risk of developing mental health difficulties, which also found cost, time, resources and obtaining consent were common barriers. 26 It is important to note that in-person screening was more successful than postal screening; this may reflect the younger age of those contacted via postal screening, although the stark difference suggests this is not the case. Interestingly, our findings did support previous research 5 that suggested it was more common to have mood difficulties without weight problems than it was to have weight problems without low mood.…”

Advancing methodology for scoping reviews: recommendations arising from a scoping literature review (SLR) to inform transformation of children and adolescent mental health services.

“…We highlight additional steps we have taken and describe how our methodology deviated from the original Arksey's and O'Malley's framework (8) to aid the pragmatic purpose of our SLR. This paper focuses only on methodological aspects of the SLR; ndings from the review are published elsewhere (17)(18)(19).…”