Review
The Effectiveness of School-Based Mental Health Services for Elementary-Aged Children: A Meta-Analysis

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Objective

Given problems and disparities in the use of community-based mental health services for youth, school personnel have assumed frontline mental health service roles. To date, most research on school-based services has evaluated analog educational contexts with services implemented by highly trained study staff, and little is known about the effectiveness of school-based mental health services when implemented by school professionals.

Method

Random-effects meta-analytic procedures were used to synthesize effects of school-based mental health services for elementary school-age children delivered by school personnel and potential moderators of treatment response. Forty-three controlled trials evaluating 49,941 elementary school-age children met the selection criteria (mean grade 2.86, 60.3% boys).

Results

Overall, school-based services demonstrated a small-to-medium effect (Hedges g = 0.39) in decreasing mental health problems, with the largest effects found for targeted intervention (Hedges g = 0.76), followed by selective prevention (Hedges g = 0.67), compared with universal prevention (Hedges g = 0.29). Mental health services integrated into students’ academic instruction (Hedges g = 0.59), those targeting externalizing problems (Hedges g = 0.50), those incorporating contingency management (Hedges g = 0.57), and those implemented multiple times per week (Hedges g = 0.50) showed particularly strong effects.

Conclusion

Considering serious barriers precluding youth from accessing necessary mental health care, the present meta-analysis suggests child psychiatrists and other mental health professionals are wise to recognize the important role that school personnel, who are naturally in children’s lives, can play in decreasing child mental health problems.

Section snippets

Study Selection Criteria

Studies that satisfied 6 criteria were included: the study assessed school-based services specifically targeting mental health problems; service was implemented by school-based personnel or personnel indigenous to the school environment (research staff could be involved but could not be the primary service implementer); the study entailed a randomized, between-subjects, controlled comparison or quasi-experimental design that used matched samples to minimize selection bias; the study assessed

Preliminary Findings

Forty-three studies evaluating 49,941 children met the inclusion criteria33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73 (see Table 1 and Supplement 1, available online, for characteristics and references of studies included in the meta-analysis). All studies involved classroom implementation except for 2 (5%). Interestingly, only a minority of studies (25.6%; k = 11) evaluated

Discussion

The present meta-analysis synthesized the empirical literature on controlled evaluations of elementary school-based mental health services delivered by school personnel, computing overall pooled effects across studies, and determining factors associated with variations in the effects. Services delivered by school-based personnel collectively demonstrated a small-to-medium effect on child mental health problems, with particularly large effects associated with targeted interventions and selective

References (84)

  • A.P. Daunic et al.

    Classroom-based cognitive-behavioral intervention to prevent aggression: efficacy and social validity

    J Sch Psychol

    (2006)
  • A.P. Daunic et al.

    Reducing developmental risk for emotional/behavioral problems: a randomized controlled trial examining the Tools for Getting Along curriculum

    J Sch Psychol

    (2012)
  • L.J. Dolan et al.

    The short-term impact of two classroom-based preventive interventions on aggressive and shy behaviors and poor achievement

    J Appl Dev Psychol

    (1993)
  • J. Hutchings et al.

    A randomized controlled trial of the impact of a teacher classroom management program on the classroom behavior of children with and without behavior problems

    J Sch Psychol

    (2013)
  • K.M. Lewis et al.

    Effects of positive action on the emotional health of urban youth: a cluster-randomized trial

    J Adolesc Health

    (2013)
  • L.D. Miller et al.

    Evaluation of a preventive intervention for child anxiety in two randomized attention-control school trials

    Behav Res Ther

    (2011)
  • R. Rooney et al.

    Reducing depression in 9-10 year old children in low SES schools: a longitudinal universal randomized controlled trial

    Behav Res Ther

    (2013)
  • S.J. Wilson et al.

    School-based interventions for aggressive and disruptive behavior: update of a meta-analysis

    Am J Prev Med

    (2007)
  • E.J. Costello et al.

    Prevalence and development of psychiatric disorders in childhood and adolescence

    Arch Gen Psychiatry

    (2003)
  • R.C. Kessler et al.

    Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the national comorbidity survey replication adolescent supplement

    Arch Gen Psychiatry

    (2012)
  • J.S. Comer et al.

    Health-related quality of life across the anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

    J Clin Psychiatry

    (2011)
  • R.C. Kessler et al.

    Lifetime prevalence and age-of-onset distributions of mental disorders in the world health organization’s world mental health survey initiative

    World Psychiatry

    (2007)
  • J. Owens

    Early childhood behavior problems and the gender gap in educational attainment in the United States

    Sociol Educ

    (2016)
  • S.M. Eyberg et al.

    Evidence-based psychosocial treatments for children and adolescents with disruptive behavior

    J Clin Child Adolesc Psychol

    (2008)
  • C.K. Higa-McMillan et al.

    Evidence base update: 50 years of research on treatment for child and adolescent anxiety

    J Clin Child Adolesc Psychol

    (2016)
  • M. Olfson et al.

    Trends in mental health care among children and adolescents

    N Engl J Med

    (2015)
  • M. Alegría et al.

    Disparities in Child and Adolescent Mental Health and Mental Health Services in the US

    (2015)
  • A.F. Garland et al.

    Racial and ethnic differences in utilization of mental health services among high-risk youths

    Am J Psychiatry

    (2005)
  • S.H. Kataoka et al.

    Unmet need for mental health care among US children: variation by ethnicity and insurance status

    Am J Psychiatry

    (2002)
  • B.J. Burns et al.

    Children’s mental health service use across service sectors

    Health Aff

    (1995)
  • E.M. Farmer et al.

    Pathways into and through mental health services for children and adolescents

    Psychiatr Serv

    (2003)
  • M.S. Atkins et al.

    Schooling and children’s mental health: realigning resources to reduce disparities and advance public health

    Annu Rev Clin Psychol

    (2017)
  • E. Saeki et al.

    Response to intervention (RtI) in the social, emotional, and behavioral domains: current challenges and emerging possibilities

    Contemp Sch Psychol

    (2011)
  • A.K. Langley et al.

    Bounce back: effectiveness of an elementary school-based intervention for multicultural children exposed to traumatic events

    J Consult Clin Psychol

    (2015)
  • J.S. Owens et al.

    Implementation science in school mental health: key constructs in a developing research agenda

    School Ment Health

    (2014)
  • M. Rones et al.

    School-based mental health services: a research review

    Clin Child Fam Psychol Rev

    (2000)
  • A.R. Lyon et al.

    Easier said than done: Intervention sustainability in an urban after-school program

    Adm Policy Ment Health

    (2011)
  • A.P. Field

    Meta-analysis of correlation coefficients: a Monte Carlo comparison of fixed-and random-effects methods

    Psychol Methods

    (2001)
  • L.V. Hedges et al.

    Statistical Methods for Meta-Analysis

    (1985)
  • J.L. Vevea et al.

    Publication bias in research synthesis: sensitivity analysis using a priori weight functions

    Psychol Methods

    (2005)
  • P.M. Barrett et al.

    Prevention of anxiety symptoms in primary school children: preliminary results from a universal trial

    Br J Clin Psychol

    (2001)
  • N.L. Baum et al.

    Training teachers to build resilience in children in the aftermath of war: a cluster randomized trial

    Child Youth Care Forum

    (2013)
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    This work was supported in part by the National Institutes of Health (K23 MH090247; principal investigator, Dr. Comer).

    Disclosure: Dr. Comer has received royalties from Worth/Macmillan Publishers and has received grant support from the Andrew Kukes Foundation for Social Anxiety. Ms. Cornacchio has received funding support from the National Institutes of Health. Mss. Sanchez, Poznanski, Golik, and Mr. Chou report no biomedical financial interests or potential conflicts of interest.

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