No Child Overlooked: Mental Health Triage in the Schools.

The acuity of mental health needs is increasing at an alarming rate. It has been reported that "one in five children or adolescents in the U.S. manifest a diagnosable mental health or addictive disorder" (Couse & Srebnik, 2003). Today's children face new forms of the traditional critical stressors: grinding poverty, environmental impoverishment, economic instability, family dysfunction, increased threat of violence, temptation, and predation. According to the National Institute of Mental Health (2003), about 21% of all children between the ages of 9 and 17 are affected by some form of mental health problem. The most prevalent mental health disorders suffered by these children are anxiety disorders (13.0%), disruptive behavior disorders (10.3%), mood disorders (6.2%), and substance use disorders (2.0%). But even among the general population of school age youth, the Clarke, Coombs, and Walton (2003) survey revealed that today's children are impacted by stressors which are often precursors to mental health concerns. These concerns, listed in descending order of importance, included family problems, school examinations, school work, personal appearance, peer and intimate relationships, and bullying. Schools serve not only as front line mental health support for children and adolescents; for many, school counselors may be the only mental health support available (Bailey, 2000; Baruch, 2001; Clarke et al., 2003; The Mental Health Foundation, 1999; Weist, Lowie, Flaherty, & Pruitt, 2001). Limited access to mental health care is especially acute for children of poverty (Lockhart & Keys, 1998; Morse, 2003). Responding to the emerging need for school mental health support, recent opinion advocates for organizing mental health care for young people as a school-based multidisciplinary partnership among mental health professionals (Bailey, 2000; Clarke et al., 2003; Tashman et al., 2000; The Mental Health Foundation, 1999; Weist et al., 2001). It is urged that this multidisciplinary team adopt a preventive focus (Weist, 2003), especially in school districts where resources are scarce and in which children are at greatest risk (Nabors & Prodente, 2002). While the ASCA National Model (American School Counselor Association, 2003) specifically argues against school counselors serving as mental health therapists in the schools, it solidifies the school counselor's role in assessment of personal/social problems and, in a global sense, providing for student's mental health needs. While mental health professionals, especially those in school settings, care for children and adolescents whose difficulties have triggered a referral for treatment, signs of the development of their disorder have usually been long evident (Forness, 2003). Even at a time where the field of mental health is embracing primary prevention, school mental health professionals remain tied to a tertiary care model, awaiting the eruption of disruptive symptomatology before remedial interventions are employed (Forness, 2003). To implement primary preventive measures or begin early stage remedial intervention, early identification of problems is paramount. Within-school population screening for mental health problems is a necessary precursor to the design and implementation of school-relevant, primary prevention strategies for those at risk for development of mental health concerns and can facilitate case identification for early stage mental health intervention with students who are already exhibiting the signs and symptoms of mental disorder. Consistent with the call for increased mental health support in schools, Keys, Bemak, and Lockhart (1998) proposed that school counselors should be trained and equipped to recognize students whose behavior problems are outside the range of normal development. In response to this challenge, we will describe the core notions of mental health screening, describe a brief screening tool which can support a school counselor's assessment efforts, and, describe how the screening tools can be used in a school setting. …