Schools and Identification of Mental Health Needs

The following article has been republished from the "Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda" completed in 2000. 

By:  Steve Forness, Ed.D.,
University of California, Los Angeles

Dr. Forness pointed out issues specific to mental health needs within the school system. Children with mental health needs are usually identified by the schools only after their emotional or behavioral problems cannot be managed by their regular classroom teacher. A series of parent conferences, discipline referrals, or trial interventions in the regular classroom may precede formal referral to special education. Under the Federal Individuals with Disabilities Education Act (IDEA), such children should be formally evaluated and, if found eligible, either placed in a special classroom or provided special assistance in their regular classrooms. The five largest categories of special education include: learning disabilities (LD), speech and language handicaps (SL), mental retardation (MR), and other health impaired (OHI) and emotional disturbances (ED). Learning disabilities and speech and language handicaps account for the majority of the 11% of school age children in special education. Fewer than 1% of children are found eligible in the school category of emotional disturbance. Compared to children in the two largest categories of special education (LD and SL) who are mostly mainstreamed (over 80%), fewer than half the children under the ED category are mainstreamed.

A study done by Dr. Forness and a colleague in California showed that the schools are doing a very poor job of identifying children, or at identifying them soon enough. Among thirteen-year-old children from 12 special classrooms for children with emotional disturbance, diagnoses such as depression (approximately one third), attention deficit hyperactivity disorder (approximately one fourth), and post-traumatic stress disorder secondary to abuse were made. Before these children got into special education, parents reported recognizing a problem at a mean age of 3.5. Outside agency records (e.g., discipline referral, prescription medication) indicated problems at a mean age of 5 (i.e., kindergarten), and the first documented intervention involving some sort of pre-intervention was at age 6.5. The first eligibility for special education was at about 7.8 years (i.e., toward the end of second grade), and in more than 50% of the cases, these children were placed in the category of LD, not in the category of ED. These children finally got the right services at age 10.

In another long-term study of about 3,700 children done with his colleagues at the University of Alabama in Birmingham, assessments were conducted and mental health needs were identified using two diagnostic analogs of risk for emotional or behavioral disorders. Here again, the vast majority of these identified children did not receive special education services. Among those who did, a small minority were identified in the category of ED. Most were primarily categorized under the LD with a few in the SL category, even when controlling for those kids with comorbid diagnoses of learning, speech or language problems.

Dr. Forness pointed out that one of the major barriers to identification lies in the seriously flawed definition of ED. As a consequence, many children in need are deemed ineligible because of technicalities in the school definition of ED, and a significant number appear to be misidentified in other categories of special education reserved for children with primary learning or language disorders. This may be due to school professionals' or parents' attempts to avoid the stigma of mental health disorders or problems in appropriate detection or recognition of such disorders. In either case, under-identification or misidentification may also make it less likely that such children will be referred to other agencies for needed mental health services. Cost-efficient systems for school mental health screening and methods for training regular and special education teachers in early detection of mental health disorders are available, but seldom used effectively, if at all, in actual school practice.

Suggestions from Dr. Forness include: (1) Train school professionals, especially classroom teachers, to recognize early symptoms of emotional and behavioral disorders; (2) Modify the school definition of mental health disorders, which is more restrictive than definitions for other school categories; and (3) Develop a more proactive identification process for mental health disorders in school, in which children are screened for emotional or behavioral disorders early in the school years, just as they are screened for visual acuity or other health problems.

Source

U.S. Public Health Service, Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda. Washington, DC: Department of Health and Human Services, 2000.

Corrected: December 12, 2008