More children are being screened for mental health issues. But then what?

Child mental health screenings are expanding across the country. But as more children are identified as needing help, families can have a tough time getting help from already stretched resources.

a mental health crisis Among children and teens who have been fermenting for years that have worsened as routines have been disrupted in the pandemic and Many children have faced isolation and loss. Schools have added or expanded screenings for mental health or emotional well-being, and earlier this month, a panel of medical experts Children and adolescents between the ages of 8 and 18 are recommended to be screened for anxiety disorders. It follows a recommendation from the American Academy of Pediatrics in March that pediatricians screen teens 12 and older for suicide risks.

Families are now struggling to understand the new wave of assessments and what to do if a problem arises. Child psychologists and psychiatrists often have long waiting lists, and Many service providers do not take insuranceleaving families in a bind for fees. And schools have limited resources to deal with mental health issues. On average, there is one psychologist in school for every 1,200 students from kindergarten through 12th grade, according to the National Association of School Psychologists.

Schools and doctors are trying to address the gap. Some schools add therapy groups, teach children ways to manage difficult emotions or expand training for mental health staff. Pediatricians train families in habits that can improve mental health, such as Get enough sleepexercise and healthy foodsOr they teach patients emotional coping strategies.

The next challenge will be what to do when you identify a person in danger. That’s stricter, says pediatrician Katherine Williamson of the Orange County, California, Department of Children’s Health. “Mental health resources are incredibly limited.”

Some schools say they screen only a subset of students for mental health issues because they know they won’t be able to meet the increased demand that assessments will reveal.

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“If we screen 700 kids for anxiety, we know 35% to 40% are likely to come back positive, then what are you going to do with that? We can’t support that clinically,” says Ryan Sherman, director of wellness at Midway Public Schools in Massachusetts. Dr. Sherman notes that psychologists and psychiatrists in their area of ​​the state also have long waiting lists for appointments.

Last year, Medway decided to screen seventh and eighth graders who were chronically absent for anxiety disorders, because those are the years when anxiety rises among students, says Dr. Sherman. Students who were found to have moderate or severe anxiety were invited to join a weekly group discussing coping methods. The groups are expanding this year to focus on helping children practice techniques for managing disturbing thoughts and feelings.

Questions from doctors

As screenings gain traction, families may see a range of approaches to how they assess their children. Whether in doctors’ offices or schools, parents (or teachers) can complete questionnaires for younger children, while older children and teens may answer the questions themselves.

In doctors’ offices, questions about mood and behavior are often asked along with inquiries about school and friends. If the answers suggest a problem in a specific area, such as depression or anxiety, the doctor is likely to follow up with questions about those specific mental health conditions, says Rebecca Baum, MD, a developmental behavioral pediatrician and professor of pediatrics at Nordic University. Carolina School of Medicine.

In schools, some specific problems such as anxiety, Suicidal thoughts and behaviorsor symptoms of post-traumatic stress. Other schools use questionnaires that cover general social and emotional well-being: Children may be asked how attached they are to their school, how willing they are to keep trying when they encounter obstacles and how optimistic they are, says Erin Doody, a professor in the Counseling Program, Clinical and School Psychology at the University of California, Santa Barbara.

Dr. Williamson of Orange County is helping to lead the new effort for its medical system to screen all patients 12 years of age and older for depression each year. This includes questions about how often patients have been disturbed by “lack of interest or pleasure in doing things” or “difficulty falling or staying asleep, or sleeping for long periods” in the previous two weeks.

Her patients who need mental health treatment often have to wait several months to get an appointment with a child psychologist or psychiatrist. During the waiting period, Dr. Williamson says it helps families focus on making sure their children are getting enough sleep, exercise and nutrition, all of which can affect mental health. if There is a risk of suicideShe will advise parents to remove any firearms from the home and secure medication. Children who are suicidal, meaning they think of a method and make a plan, are sent to the emergency room.

Some pediatricians teach patients brief techniques from cognitive behavioral therapy, an effective treatment for anxiety and depression, such as relaxation exercises and methods for controlling negative thoughts that can fuel distress. Pediatricians also treat children and teens with antidepressant medications, such as Prozac and Lexapro.

New efforts in schools

Some schools use the examination to form class-level or school-wide lessons that teach skills such as decision-making and how to regulate emotions.

Sheila Desai, director of educational practice for the National Association of School Psychologists, says that parents are informed about assessments in schools, and can often review the questions asked and can also opt out.

Parent groups in some areas have backed away from mental health screening, expressing concerns about medical privacy and questioning the role of schools in students’ mental health.

Others welcome these measures. “I think it’s a good idea to find out if kids have an emotional turmoil or anxiety. Sometimes it doesn’t go out to the parent and sometimes it doesn’t go out to the parent nor the Daddy can see it.”

Fairfield Public Schools says its approach is not aimed at identifying mental health disorders but is aimed at measuring skills including “self-management” and “goal-directed behavior,” according to a statement from the district official.

Methuen Public Schools in Massachusetts began screening fifth through 12th graders for symptoms of PTSD in 2021, adding to existing assessments of anxiety and depression. John Crocker, the school’s director of mental health and behavioral services for the district, believes that screening — and subsequent interventions — may have prevented more serious mental health problems.

Mr. Crocker says about 38% of high school students have scores indicating moderate or severe symptoms of PTSD. These students were invited to participate in therapy groups at school or received individual therapy by psychologists, counselors, and social workers in their schools. The district provided mental health staff at the school with additional training on how to handle trauma.

Write to Andrea Petersen at

do you need help? The Suicide and Crisis Lifeline contact number is 988.

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