Conceptualization and Treatment of Social Withdrawal in the Schools

Social withdrawal represents a class of behavior problems that are not as frequently referred by teachers in school settings as are disruptive, acting-out behaviors. Approximately 15% of all children referred to school psychologists and other mental health professionals in the schools are socially withdrawn. This paper provides several definitions of social withdrawal from a social skills perspective and presents a four-fold classification system of children's social skills deficits. Assessment procedures for identifying socially withdrawn children are briefly reviewed. Four social skills training strategies (i.e., modeling, coaching, peer-mediated interventions, and group contingencies) are reviewd and the relative efficacy of each are evaluated. Several commercially-available social skills training curricula designed for school settings are described at the conclusion of this paper.     

Enhancing the Behavioral and Mental Health Services Within School-Based Contexts

ABSTRACT

Recent health care reform provides many new opportunities to expand mental health and behavioral support to students in schools and school–community partnerships. Through newly available funding sources, as well as expanded legislative initiatives, school psychologists can advocate for and become leaders in delivering universal programming, tiered mental health supports, and formalized collaborative efforts with community agencies. The authors highlight the application of tiered levels of services, with current practice samples, designed to address students' mental and behavioral health. Implications for practice are discussed.     

The Role of Schools in Outcomes for Youth: Implications for Children's Mental Health Services Research

We explore the role of schools in children's mental health services research. Recent literature has suggested that schools play an important role in delivering services to children and adolescents with emotional and behavioral problems. Research in services research, though, has taken a fairly narrow view of which dimensions of school environments are relevant for inclusion in studies. We suggest that a broader view of school environments is appropriate and potentially beneficial to the field. Using Bronfenbrenner's ecological model as a guide, we conceptualize schools as microsystems. Such an approach suggests that all aspects of school environments (treatment as well as non-treatment) are likely to influence many of the outcomes that children's mental health services research frequently targets (e.g., behavioral problems, problematic peer relationships, academic achievement, school attendance). We review literature from a variety of disciplines to suggest relevant features of schools, with particular attention to the role of peer dynamics within schools. We conclude with implications of this expanded conceptualization of schools for children's mental health services research.     

Eating Disorders in an Israeli Women’s Prison: Correlates of the Risk

Extensive rates of child abuse and neglect (CAN), substance abuse disorders (SUDs), and mental health problems have been reported among incarcerated women. The link between CAN, SUDs, and eating disorders is well-documented, but little is known about the eating-disorder behaviors of incarcerated women. The purpose of this study was (a) to explore eating-disorder behaviors among incarcerated women in Israel; (b) to examine whether certain types of CAN are associated with eating disorders; and (c) to study the link between CAN, SUDs, mental health problems, and eating disorders. This cross-sectional study investigated eating-disorder behaviors in a sample of 62 incarcerated women in Israel. The findings indicated a high prevalence of eating disorders among incarcerated women; almost 70% exhibited the drive for thinness, which is considered a central feature of eating disorders. In addition, the findings revealed a high prevalence of CAN (84.2%), especially emotional abuse (57.9%) and emotional neglect (73.7%). I also found a high rate of co-occurrence of CAN, SUDs, mental health problems, and eating disorders. Bulimia nervosa, ineffectiveness, and low impulse regulation were found to be associated with SUDs and mental health problems (p?=?0.006, p?=?0.032, and p?<?0.001, respectively). The findings highlight the intersection of trauma with self-destructive behaviors, including co-occurrences of SUDs, eating disorders, and severe mental health problems as a result of negative childhood experiences, suggesting a need for simultaneous treatment interventions.     

Teachers’ Knowledge of Evidence-Based Interventions and Available School Resources for Children with Emotional and Behavioral Problems

School professionals need to be prepared to support children with emotional and behavioral problems. Teachers in particular should be aware of the resources provided by their school as well as the evidence-based practices available to support children with behavioral problems. This study explored general education teachers’ knowledge of 10 evidence-based interventions as well as resources and data collected at their schools to support children with mental health problems. Participants included 239 general educators from 5 school districts. Overall, most teachers had not heard of 9 out of 10 of the evidence-based programs presented. Teachers were also not sure whether their schools provided specific assessments and interventions to support children. One particularly noteworthy finding was that 57% of teachers were not sure whether their schools provided functional behavioral assessment and intervention planning. Findings illuminate a need for continued work in this area.     

School Psychology: Training Individuals for One of the Best Kept Secrets in Professional Psychology

Abstract

School psychology training at the doctoral level is discussed. Given the increasing diversity in the schools as well as the varied education and mental health needs of the population, school psychology training is necessarily broad, involving traditional skills such as assessment, intervention, consultation, and counseling, all of which are taught within a context of a changing school population with changing needs. Because there is compulsory education, school psychologists’ interface with a broad cross-section of individual children, their parents, and their teachers. Moreover, school psychological practice is not limited to schools, as doctoral school psychologists are health service providers; many of these individuals work in other settings for which they are trained to provide services. The complexities and challenges of training school psychologists within this broad agenda effectively across domains are discussed.     

三维干预促进小学生心理健康的研究

为了探索有效的小学生心理健康教育模式,以昆明市两所普通小学分别作为实验组和对照组进行了为期两年的实验研究,对影响小学生心理健康的主要因素:教师、家长和学生自身三个子系统进行了多侧面的三维干预。结果表明:(1)实验组学生比对照组学生的总体一般焦虑水平下降;(2)学习适应性提高;(3)问题行为症候群的学生人数和问题行为比干预前明显减少。验证了教师、家长、学生三维干预结合模式对促进小学生心理健康的有效性。     

Protecting older adults in the Israeli health system: Cross-cultural interactions involved in legal and social elder abuse interventions

ABSTRACT

In 2002 the World Health Organization published a categorical definition of “Elder Abuse,” but the relevant social and legal interventions differ markedly even among Western-oriented countries. This article compares and contrasts approaches to this widespread and very serious problem in the New York City and the Israeli health-care systems. In today’s world, the members of a family do not all necessarily live on the same continent, so professionals must be aware of the way things are done in countries other than their own. The differences in the interventions employed, or not employed, in these two specific systems highlight the need to understand not only how elder abuse is dealt with in each place, but the conceptual framework that governs it. The present article can serve as a guide for American professionals and others concerned with the problems of elder abuse who function within the Israeli health care system.     

Teacher Job Stress and Satisfaction in Urban Schools: Disentangling Individual-, Classroom-, and Organizational-Level Influences

Schools remain among the most frequent providers of children’s mental health services, particularly in low-income urban settings. Several decades of research have focused on training teachers to implement evidence-based interventions for minimizing disruptive behavior. Studies consistently demonstrate robust improvements in student behavior and learning; however, the impact on teachers’ work-related stress or satisfaction is not well understood. Six urban, high-poverty elementary schools were randomly assigned to a school mental health services model (Links to Learning; L2L) for referred, disruptive students or to services and professional development as usual (SAU). Teachers (n = 71, K-4 general education teachers) in L2L schools participated in professional development and consultation in two universal and two targeted interventions to reduce disruptive behaviors and promote learning. Teachers (n = 65) in SAU schools participated in professional development as usual. Multiple regression models examined teacher reports of individual-level self-efficacy, classroom-level student functioning, and school-level organizational health as predictors of stress and satisfaction. Findings revealed no significant difference between conditions on teacher work-related stress or satisfaction. Organizational health was the strongest predictor of stress and satisfaction. Training on and implementation of evidence-based classroom interventions did not appear to significantly impact teachers’ work-related stress or satisfaction. Instead, findings point to organizational climate and teacher connectedness as potential levers for change, supporting prior work on teacher stress and satisfaction in schools. The significance of targeting organizational factors may be particularly significant in urban school districts.     

Seeking help when transgender: Exploring the difference in mental and physical health seeking behaviors between transgender and cisgender individuals in Ireland

Abstract

Background: While there is growing awareness of the need to support the physical and mental wellbeing of transgender people, some may be reluctant to seek help from healthcare professionals. Little is understood about the mechanisms that influence help-seeking behavior in this group.

Aims: This study aimed to compare transgender and cisgender participants in their likelihood to seek help for both physical and mental health conditions, and to explore whether this help-seeking behavior is predicted by a range of sociodemographic and psychological variables.

Methods: 123 participants living in Ireland (cisgender= 67; transgender= 56) completed a questionnaire which included demographic questions, as well as measures of optimism (LOT-R), self-esteem (RSES), psychological distress (GHQ-12), attitudes towards seeking psychological help (ATSPPH-SF), and attitudes towards seeking help for a physical health problem (Attitudes Towards Seeking Medical Help Scale- Action/Intervention subscale). Associations between predictor variables and mental and physical health seeking were explored using correlation analysis and stepwise regressions.

Results: Transgender participants were less likely to seek help for a physical health issue than cisgender participants, but did not differ in mental health help-seeking behaviors. Results suggest that this may be due to differences in optimism, self-esteem and psychological distress. Transgender participants had significantly lower optimism and self-esteem, which were two factors linked to poorer physical health seeking behaviors. Optimism also emerged as a significant predictor in mental health seeking behaviors.

Discussion: The lack of a significant difference for mental health help-seeking between the transgender and cisgender participants is encouraging, as it suggests that there is less stigma surrounding mental illness than expected, however findings also contradict previous findings suggesting that physical health is less stigmatized. This could be due to stigma relating to gender-specific healthcare and suggests that healthcare professionals should acknowledge the specific healthcare needs and concerns among transgender individuals.     

Physical activity in employees with differing occupational stress and mental health profiles: A latent profile analysis

ObjectivesTo examine whether employees with differing occupational stress and mental health profiles differ in their self-reported levels of physical activity.DesignCross-sectional survey data.MethodThe sample consisted of 2660 Swedish health care workers and social insurance officers (85% women, M = 46.3 years). Latent profile analysis was performed to identify classes. Between-class-differences in physical activity were tested via χ²-tests and multinominal logistic regression analyses using sex, age, BMI, marital status, children at home, caregiving, and smoking as covariates.ResultsLatent profile analysis resulted in a six-profile solution. Two pairs of classes had equal stress levels, one pair with high stress, one pair with moderate stress. Within each pair, one group showed some resilience (i.e. only moderate mental health problems despite high stress or good mental health despite moderate stress), whereas the other did not. The other two classes were characterized by either low stress and good mental health or moderate-to-high stress and elevated mental health problems. Participants who were resilient to high or moderate stress were more active than participants of the corresponding non-resilient classes. Participants with low stress and good mental health reported the highest physical activity levels, participants with high stress and high mental health problems reported the lowest physical activity levels.ConclusionsThe findings suggest that physical activity is associated with resilience to occupational stress, and that beyond primary prevention efforts to make work less stressful regular physical activity should be a target variable for health professionals working in the occupational setting.     

Suicide and the Law

SUMMARY

The purpose of this chapter is to delineate how mental health professionals can prevent their clients from acting in a suicidal manner while protecting themselves against potential liability when a client attempts or completes suicide. In our increasingly litigious society mental health professionals can apply their understanding about the elements of legal liability in cases involving client suicidal behaviors to structure their services in a manner to meet their responsibility in treating potentially suicidal clients.     

Presidential Address: Team Science Across Disciplines: Advancing CBT Research and Practice on Hoarding

This presidential address focuses on the recent history of research and practice on hoarding disorder (HD) as a potential model for coordinating interdisciplinary teams of professionals within and outside mental health fields to advance scientific efforts to understand and resolve mental health problems. To identify, assess, and intervene with clients who have HD, psychologists, social workers, psychiatrists, and other service professionals are needed, including those in public health, housing, medicine, aging and protective services, fire, safety, and animal protection. Research findings and practice methods developed by many of my colleagues highlight the various skills of these diverse disciplines and fields. Of particular interest are multimethod assessments and CBT interventions that span individual, group, and family treatments, delivered in the office, at home and via the web by mental health and other professionals, as well as peers. Outcomes are positive, but there remains much work to do to improve understanding and intervention outcomes.     

Intertransference: Transference Relationships between Members of the Psychotherapy Team

Abstract

There has been limited published research on the effectiveness of manualized psychoeducational approaches for the mental health and behavioral problems of child sexual abuse (CSA) survivors. The present study aims to add to the evidence base for the effectiveness and acceptability of such interventions. A total of 37 enrolled into a brief psychoeducation program (i.e., 10 sessions) aiming to help stabilize mental health and behavioral outcomes (e.g., self-harm), while on the waiting list for mental health services. Participants completed a set of self-rated measures at baseline, pre-intervention, post-intervention and 3-month follow-up. Although there was no change over time with regard to general distress, traumatic symptomatology, depression, anxiety, self-esteem, and life satisfaction, completers were less likely to report self-harm and presented with decreased rates of smoking, alcohol and substance misuse, and involvement in illegal and antisocial behaviors at post-treatment and follow-up. Qualitative data also suggested that overall the program is well tolerated by participants, despite the high attrition rate (43%). Although further research is required to establish the efficacy of this intervention, preliminary results indicate that the new intervention may be useful for stabilizing behavioral problems at post-treatment and follow-up. Strategies to improve attrition rates in future research and clinical practice are discussed.     

Parenting contributors to early emerging problem behaviour in children of mothers in methadone maintenance treatment

This study explored whether variations in parenting provided by mothers with substance‐abuse disorders are related to behaviour problems in their young children and whether specific parenting practices are associated with specific types of behaviour problems. Mother‐reported and observational assessments were used to examine contributions of parenting behaviour and home environment to internalizing and externalizing behaviour problems in 150 preschool children of mothers receiving methadone‐maintenance treatment for heroin addiction. In multivariate analyses, mother‐reported child externalizing behaviour was related to greater maternal harshness and to mother history of illicit drug use during pregnancy but not other features of substance use and treatment history. Observer‐coded child internalizing behaviour was related to less maternal sensitivity and less provision of learning activities in the home. Additionally, mother report of her own psychopathology symptoms was related to mother‐reported, but not observer‐coded, child internalizing and externalizing problems. Findings suggest that women in substance abuse treatment should receive parenting interventions and that interventions should focus on increasing maternal sensitivity, reducing harshness, and providing children with cognitively stimulating environments. Findings also suggest that the need for attention to ongoing mental health problems of women in substance abuse treatment—both for their own well‐being and the well‐being of their children.

Highlights

• This study explored whether variations in parenting provided by mothers with substance‐abuse disorders are related to behavior problems in their young children.
• Maternal harshness was related to child externalizing behavior, low sensitivity, and low provision of learning opportunities to child internalizing problems.
• Findings suggest that women in substance abuse treatment should be provided access to parenting interventions.

     

A conceptual model for mental health and performance of North American athletes: A mixed methods study

ObjectiveThe demands of sport create psychological and physical challenges for athletes, making it essential to understand what factors contribute to mental health and performance optimization in sport. The purpose of this mixed-methods investigation was to develop a conceptual model for mental health and performance of North American athletes.MethodForty-three experienced athletes, coaches, and sport professionals identified, sorted, and rated 113 behaviors, thoughts, and feelings that contribute to optimal mental health and performance for athletes. Using Multidimensional Scaling, the research team created a two-dimensional point map of participant responses. Hierarchical Cluster Analysis was then used to reveal underlying clusters in the data.FindingsSeven clusters emerged from the data: Stress Management, Mental Skills, Self-Awareness, Managing Setbacks, Intentional Practice, Team Relationships, and Social Support. Though all clusters were rated as important to mental health and/or performance, the Managing Setbacks cluster displayed high importance ratings for both mental health and performance.ConclusionOur preliminary findings suggest a comprehensive approach to athlete thoughts, feelings, and behaviors contributes to optimal mental health and performance for North American athletes.     

The President’s New Freedom Commission: Capitalizing on Opportunities to Advance School-Based Mental Health Services

The report from President George W. Bush’s New Freedom Commission on Mental Health (NFC), Achieving the Promise: Transforming Mental Health Care in America(2003), proposes goals and recommendations for improving mental health services. This report has significant implications for the delivery of mental health services through the schools. A focused discussion of the potential opportunities and challenges of implementing NFC recommendations related to school-based mental health is presented. Strategies for addressing five key areas at the intersection of school mental health and the Commission’s recommendations include: stigma reduction, suicide prevention, expansion and improvement of school mental health, and screening and treatment of co-occurring mental health and substance abuse disorders.     

Mental Health, Social Environment and Sexual Risk Behaviors of Adolescent Service Users: A Gender Comparison

We examined individual mental health problems (depression, conduct disorder, and substance abuse) and social environment (family, peer, and neighborhood) factors associated with the sexual risk behaviors of male and female adolescents. Interviews with 778 adolescents, aged 14 to 18, showed that both mental health problems and social environment were related to adolescents' involvement in sexual risk behaviors. Conduct disorder symptoms, substance abuse or dependence symptoms, and the interaction between peer misbehavior and neighborhood problems were significantly associated with risky sexual behaviors. Peer misbehavior was a particularly strong factor related to sexual risk behaviors for youths who lived in neighborhoods with multiple problems. The only gender differences were found in age, with older males more likely to report engaging in high risk sexual behaviors. This study suggests the utility of multidimensional intervention strategies to deal with various adolescent problem behaviors, including risky sexual behaviors, within the context of their social environment.     

RECENT TRENDS IN RESPONSE TO CHILD VICTIMIZATION

Abstract

This chapter serves as an introduction to the many roles of health care professionalsin the assessment, care, and treatment of child victimization. It concentrates on those professionals caring for the physical health of victims of child abuse and neglect, although there are many similarities between child maltreatment and other family violence victims. In reviewing the health impact of maltreatment and the historical contributions of health care professionals, it discusses the roles that health care disciplines play in clinical care, training, research, and advocacy and their interaction with the community's child welfare, legal, and criminal justice systems.