It’s Not Just the Squeaky Wheels That Need the Oil: Examining Teachers’ Views on the Disparity Between Referral Rates for Students with Internalizing Versus Externalizing Problems

Abstract

Due to an existing disparity between service need and service use of mental health services for adolescents experiencing internalizing problems, a simultaneous mixed-methods research design was employed to investigate how to reduce this discrepancy within an educational context. A total of 152 secondary teachers from seventeen South Australian schools completed an online questionnaire, and content analysis was used to explore the qualitative data. Results of the present study highlighted a further disparity: Teachers perceived they faced an expectation to identify the symptoms of internalizing problems in their students; yet did not feel sufficiently capable to put this expectation into practice. This is particularly problematic as teacher referral is the most common pathway to treatment. Recommendations to reduce this disparity are presented, and findings hold implications for pre-service teaching programs, policy, and current government funding initiatives.

Teachers’ Knowledge of Anxiety and Identification of Excessive Anxiety in Children

“…In addition, they also used several other indications to inform their judgments including observing a range of behaviours, the child's perceived emotional state, verbal information (including reports from the child or others and the child's approach to verbalizing), and by witnessing the consequences this has on the child's adjustment, academic outcomes, and social competence. These findings provide an insight into how teachers recognise excessive anxiety in children and indicate that, despite feeling ill prepared and under-confident to recognise and respond to mental health problems in children (Papandrea & Winefield, 2011;Rothi et al, 2008;Walter et al, 2006), teachers may have the knowledge of how to identify excessive anxiety in children. It is likely that further education and training may strengthen teachers' self-efficacy in the identification process and may assist with referrals.…”

“…A study investigating Australian pre-service teachers' knowledge of internalising disorders in primary school children found that incidental exposure (i.e., personal experiences of friends and family, community media and school-based practicum), is the main knowledge source on internalising problems for pre-service teachers and that this exposure contributed to their common-sense estimates of internalising problems in the classroom (Bryer & Signorini, 2011). Papandrea and Winefield (2011) found that Australian teachers recognise that there is an expectation for them to identify symptoms of anxiety in students, however, they do not feel sufficiently capable to put this expectation into practice due to their lack of training. Similar results have been reported in the United States of America (Walter, Gouze, & Lim, 2006) and the United Kingdom (Rothi et al, 2008).…”

“…Researchers have found that teachers frequently fail to notice children with internalising problems because these children are often well behaved (Molins & Clopton, 2002) or teachers assume that internalising problems will improve as the child matures (Green et al, 1996). Recent studies have found that although teachers are able to recognise the existence of psychological disorders, they are far more concerned about children with externalising disorders than internalising disorders (Loades & Mastroyannopoulou, 2010;Papandrea & Winefield, 2011;Walter et al, 2006). Given the high prevalence of internalising disorders, such as anxiety disorders, these findings may indicate that teachers have difficulty understanding what internalising disorders are, the consequences of these disorders, or how to identify symptoms that are indicative of an internalising disorder.…”

Mental health related contact with education professionals in the British Child and Adolescent Mental Health Survey 2004

“…This is likely to reflect multiple barriers to identifying and managing internalizing disorders. Young people themselves are often reluctant to initiate help-seeking from professionals for anxiety and depression (Gulliver et al, 2010), whilst teachers have cited obstacles including insufficient training, inadequacy of support, and the more pressing need to manage disruptive disorders in the classroom amongst others (Papandrea & Winefield, 2011). More recently the evaluation of the Targeting Mental Health in Schools (TaMHS) programme failed to find an impact on emotional problems, acknowledging that schools may be better at identifying and addressing externalizing disorders (Wolpert et al, 2013).…”

“…However, professionals in both education and health acknowledge limits to joint working -a significant minority of professionals in CAMHS express low confidence in their abilities to identify and offer advice about children's education needs related to their mental health problems -and the majority report having received no training in this area (Vostanis et al, 2011). Similarly, studies have reported teacher preference for exploring educational resources for help rather than refer to health, and uncertainty about what support from health might be required ( Andrews et al, 2010;Moor et al, 2007;Papandrea & Winefield, 2011). This is likely to be perpetuated by a perceived mismatch between the expectation that schools will address and refer these problems, and the availability of mental health consultation and services (Rothì et al, 2008).…”