It is estimated that 12 to 22 percent of America's youth under age 18 are in need of mental health services. In addition to the personal suffering experienced by children with emotional or behavioral problems and their families, it is estimated that the yearly cost of mental illness in the United States exceeds $80 billion.
Despite what the general public may believe and headlines may imply, a recent report co-authored by researchers in Penn State's Prevention Research Center for the Promotion of Human Development shows that important and meaningful progress has been made in preventive intervention with school-age children during the last decade.
Researchers led by Dr. Mark T. Greenberg, director of the center, conducted a review for the U.S. Department of Health and Human Services' Center for Mental Health Services on the effectiveness of prevention programs for reducing mental health problems in school-age children. Greenberg co-authored the review, "Preventing Mental Disorders in School-Age Children," with Dr. Celene Domitrovich, research associate, and Brian Bumbarger, research assistant. The review, which was presented to the CMHS in August, notes that advances in theory, program development, and scientific evaluation have led to important new findings showing the promise of preventive approaches.
"We identified thirty-four different programs found to significantly reduce aggression, depression and anxiety and improve behavior and problem-solving skills. This good news shows the potential promise of widespread prevention programs to reduce mental disorders and behavior problems in childhood in a manner similar to what our nation has done to reduce heart disease and cancer," says Greenberg, who holds the Edna Peterson Bennett Endowed Chair in Prevention Research in Penn State's College of Health and Human Development.
Public health models have long based their interventions on identifying and reducing risk factors for disease or disorders as well as promoting processes that protect against risk, says Greenberg.
The research on positive child development has focused the field of preventive mental health on understanding how risk and protective factors operate, and can be modified to alter the prevalence of mental disorders and problem behaviors in childhood. Risk factors, he adds, include biological, social, and contextual factors in the child, the family, the school or the community. Development is complex, and it is unlikely that there is a single cause of, or risk factor for, any disorder.
Thus, it is doubtful that most childhood behavioral disorders can be eliminated by treating causes that are purported to reside in the child alone, says Greenberg.
"It is also apparent that many identified risk factors are not linked to a specific disorder, but may associated instead with a variety of poor outcomes such as delinquency, violence, substance abuse, psychopathology, or school failure," says Greenberg. "A focus on increasing protective factors therefore may lead not only to a lower incidence of mental disorder, but also to improving the overall behavioral, social, and emotional competence of children."
The researchers also identified several characteristics that effective programs shared. Effective universal prevention programs (programs that were addressed to broad populations of children, families, and schools) focused on teaching emotional self-regulation as well as thinking and decision-making skills that improve social and emotional competence. Effective programs also created changes in the school and family ecology that supported the use and reinforcement of these new skills. Finally, they lasted one or more school years and were used regularly.
The review also found ten programs that have successfully reduced the risk for conduct problems. Disorders of conduct are one of the most prevalent and stable child psychiatric disorders.
"Many of our most costly and damaging societal problems, such as delinquency, substance use, and adult mental disorder, have their origins in early conduct problems, says Greenberg. Of the programs aimed at reducing the risk for conduct problems, Greenberg notes, a new generation of multi-component models that target the child, school, family, neighborhood, parents, teachers and peers seem to provide the promise of greater impact than programs that focus only on the child or family.
In addition, the review found several programs that have successfully reduced depressive symptoms, including programs that have reduced symptoms of anxiety and risk for suicide. These effective programs focus on teaching children and youth how to alter and utilize more effective thinking and behavioral coping strategies. The programs also showed children and adolescents how to more effectively use the support of others in times of stress. In addition, other programs were identified that successfully impact children experiencing the stress-related effects of divorce or childhood bereavement that often manifest themselves in mental or behavioral problems.
"The fact that we were able to identify more than thirty well-evaluated programs to reduce mental health problems in school-age children shows the potential promise of prevention. It also validates the progress made in prevention research over the past decade and reinforces the need for implementing research-based programs and holding them accountable for results," says Greenberg.
Among the review's findings:
* Short-term preventive interventions produce time-limited benefits, at best, with at-risk groups whereas multi-year programs are more likely to foster enduring benefits.
* Although preventive interventions may effectively operate throughout childhood (when developmentally-appropriate risk and protective factors are targeted) given the resistance to treatment of serious conduct problems, ongoing intervention starting in the preschool and early elementary years may be necessary to reduce morbidity.
* Preventive interventions are best directed at risk and protective factors rather than at categorical problem behaviors. With this perspective, it is both feasible and cost-effective to target multiple negative outcomes in the context of a coordinated set of programs.
* Interventions should be aimed at multiple domains, changing institutions and environments as well as individuals.
* Prevention programs that focus independently on the child are not as effective as those that simultaneously "educate" the child and instill positive changes across both the school and home environments. The success of such programs is enhanced by focusing not only on the child's behavior, but also the teacher's and family's behavior, the relationship between the home and school, and the needs of schools and neighborhoods to support healthy norms and competent behavior.
* There is no single program component that can prevent multiple high-risk behaviors. A package of coordinated, collaborative strategies and programs is required in each community. For school-age children, the school ecology should be a central focus of intervention.
The Prevention Research Center for the Promotion of Human Development aims to promote the well-being of children and youth and to reduce the prevalence of high-risk behaviors and poor outcomes in children, families and communities.
A copy of the report, "Preventing Mental Disorders in School-Age Children," is available under the publications' link on the Center's website at www.psu.edu/dept/prevention.
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Editors: Dr. Greenberg is at (814) 863-0112 or [email protected] Contact Steve Infanti at [email protected] or (814) 863-4325 if you need assistance.
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