The relationship between gender, depression, and self-esteem in children who have witnessed domestic violence.

OBJECTIVE: To investigate whether there are measurable gender differences in self-esteem and depression in elementary school-age children who have witnessed domestic violence. METHOD: Forty-five elementary school-age children who were identified as having witnessed domestic violence, and their teachers were surveyed for self-esteem, depression, and classroom behaviors. The results were compared between males and females using linear regression modeling. RESULTS: No significant gender differences were found for self-esteem and depression. An interaction between gender and post-traumatic stress was found to play a significant role in the interpretation of the results. CONCLUSIONS: Results indicated that higher levels of symptoms indicative of post-traumatic stress were associated with greater numbers of depressive symptoms and lower self-esteem for boys who had witnessed domestic violence. The results appeared similar to previous work with children and their emotional reactions to divorce.

Exposure to violence and neighborhood affiliation among inner-city youth.

Examined the prediction of exposure to violence by neighborhood affiliation in a sample of 167 inner-city adolescents (107 girls, 60 boys) age 14 to 19 years. Measures of exposure to violence, emotional and behavioral problems, and demographic information as well as a new neighborhood affiliation measure developed specifically for adolescents were administered. Adolescents reported fairly high rates of exposure to violence, supporting other recent research. Boys reported experiencing and witnessing significantly more violence than girls. In multiple regression analyses, higher neighborhood affiliation predicted greater exposure to violence at a trend level (p = .06), even when age, sex, length of residence in one's neighborhood, and concurrent emotional and behavioral problems were controlled. These findings suggest that greater affiliation or attachment to one's neighborhood may be an important risk factor for inner-city youth that should be investigated in larger samples.

Collaboration among the education, mental health, and public health systems to promote youth mental health.

The authors discuss the growing movement in the United States to develop expanded school mental health programs. These programs represent partnerships between schools and community mental health agencies to expand the range of mental health services provided by schools. Such programs emphasize effective prevention, assessment, and intervention. The authors describe efforts that have been undertaken to improve the fragmented and incomplete nature of children's services and to proactively identify and address children's emotional and behavioral problems. They also discuss a strategy to improve youth mental health programs, which includes needs assessments and an analysis of existing programs in a community. They describe the augmenting roles played by the mental health and public health systems in expanding and improving school-based mental health services. The authors outline steps to minimize or avoid the turfism and negative attitudes that may arise among professionals from different disciplines when they collaborate to expand and improve school-based programs.

Advancing efforts to address youth violence involvement.

Discusses the increased public attention on violence-related problems among youth and the concomitant increased diversity in research. Youth violence involvement is a complex construct that includes violence experienced in multiple settings (home, school, neighborhood) and in multiple forms (as victims, witnesses, perpetrators, and through family members, friends, and the media). Potential impacts of such violence involvement are considerable, including increased internalizing and externalizing behaviors among youth and future problems in school adjustment and life-course development. This introductory article reviews key dimensions of youth-related violence, describes an American Psychological Association Task Force (Division 12) developed to advance relevant research, and presents examples of national resources and efforts that attempt to address this critical public health issue.

Assessing the status of research on violence-related problems among youth.

Presents results of a systematic review of abstracts on studies related to violence and youth in an effort to identify areas that have received little attention in the psychological literature and to present recommendations for future research. A total of 1,168 empirical articles on violence-related problems in youth were identified by a PsycINFO (American Psychological Association, 1980-1999) search. These articles were then classified in a multidimensional grid, allowing for comparisons among different types of articles. A review of abstracts from these articles indicated that most of the research activity has been descriptive (e.g., reviewing correlates or predictors of violence involvement) or assessment related (e.g., evaluating specific measures). Fewer articles examined the treatment or prevention of violence-related problems among youth. Further, the majority of studies pertained to direct exposure to violence (as a victim or perpetrator), with very few studies looking at the effects of witnessing violence, knowing individuals exposed to violence, or being exposed to violence through the media. Comparing treatment and prevention articles, we found that the least empirical attention was paid to the prevention of violence-related problems in youth, and not a single study was identified through this search that sought to examine the prevention of youth witnessing violence. Implications for future research agendas are discussed.

Predictors of violence exposure among inner-city youth.

Examined the ability of demographic variables and risk factors (parental substance use, number of people in the home, out-of-home placements, grades repeated, arrest history, and total life stress) to predict exposure to community violence among 342 high school students from inner-city Baltimore referred for mental health care in community centers or in the schools. Over 90% of the sample knew at least 1 victim of a violent act, 77% reported witnessing a violent act, and 47% reported past victimization by violence. Risk variables were more powerful regression predictors of violence exposure than demographic characteristics such as race, sex, or clinical setting. Even after controlling for demographic differences in violence exposure, risk factors as a group accounted for another 10% to 15% of variance. Life stress was the most consistent predictor of violence exposure for this sample, and life stress was the only variable to make a significant unique contribution to the prediction of all 4 violence criteria.

Toward a public mental health promotion and intervention system for youth.

Substantial limitations exist at all levels of mental health care for youth in most communities in the United States. Particular gaps exist in the areas of prevention, mental health promotion, and early intervention programs. The national movement toward enhancing mental health programs for youth in schools offers an important opportunity to fill gaps in the prevention-services continuum toward the development of a Public Mental Health Promotion and Intervention System for Youth. A strategy--the Child and Adolescent Program Planning Schema (CAPPS)--is presented to analyze gaps in a community's system of mental health programs for youth, and to facilitate planning toward development of a full continuum of programs from broad, population-based prevention, and mental health promotion strategies to treatment of youth with more established problems.

Mental health, health, and education staff working together in schools.

The movement to develop expanded school mental health programs is still in its early stages. For child and adolescent psychiatrists to become involved and effective means negotiating a culture that is novel for many schools and forming and maintaining relationships with diverse staff in mental health, health, and education.

Expanded school mental health services: assessing needs related to school level and geography.

We surveyed 62 school administrators from three midatlantic (MD, VA, WV) and one northeastern (CT) state on factors relevant to developing school-based mental health programs. Administrators were from schools that varied on education level (elementary, middle, and high) and geographic location (urban, suburban, and rural), with equivalent numbers in each subgroup. Administrators provided ratings to questions grouped in five categories: (a) Stressful Conditions, (b) Internalizing Behavioral Problems, (c) Externalizing Behavioral Problems, (d) Substance Abuse, and (e) Barriers to Mental Health Care, and provided open-ended comments on needs of youth and mental health programs for them. They rated behavioral and substance abuse problems as progressively more serious as students advanced in school level. Urban youth were reported to encounter higher stress and present more severe internalizing problems than suburban or rural youth. Suburban and rural schools provided more health and mental health services than urban schools. Across geographic locales, physical health services far outnumbered mental health services. Findings related to barriers to mental health care, and the viability of schools as delivery sites for comprehensive mental health services, are discussed.

Evaluation of expanded school mental health programs.

Expanded school mental health programs provide a full range of mental health services (assessment, treatment, case management, prevention) to youth in regular and special education, and typically involve close collaboration between schools and community agencies. A major challenge for these programs is documenting that provided services are of high quality and leading to enhanced outcomes for the youth and schools served by them. Dimensions of school mental health evaluations and a step-by-step process for conducting them are presented, using the example of a well established program in Baltimore. Challenges to such evaluation and strategies for overcoming challenges are also presented.

A questionnaire to measure factors that protect youth against stressors of inner-city life.

This study reports the development of the My Life Questionnaire (MLQ), a self-report measure of factors that protect inner-city youth against stressors such as poverty, crime, and violence. An initial pool of 23 items reflecting important protective factors was developed through focus groups with inner-city youth and clinicians working with them in a school-based mental health program. Item-total correlations and factor analysis resulted in a 12-item measure containing three factors: avoiding negative peer influences, focusing on the future, and religious involvement. Scores on the MLQ were negatively correlated with behavioral problems, supporting its validity. The measure holds promise for use in clinical and research efforts with disadvantaged urban youth.

Expanded school mental health programs: advancing reform and closing the gap between research and practice.

Expanded school mental health (ESMH) programs provide a range of mental health services to youth in special and regular education including prevention, assessment, treatment, and case management. Despite the rapid growth of ESMH programs in the United States and elsewhere, many communities still do not have ESMH programs and those that do exist often fail to implement empirically validated intervention and treatment strategies. Systematic prevention efforts remain a lauded, yet illusive goal. For ESMH programs to fulfill their promise of improved access, increased productivity and improved behavioral outcomes, researchers, school-based mental health service providers, and educators must work together to move child mental health programs beyond limiting constructs and approaches. These issues are reviewed and an example of an "ideal" approach to implement best practices in schools and close the gap between research and practice is offered.

Overcoming challenges in outcome evaluations of school mental health programs.

Significant growth and improvement of school mental health programs has occurred in recent years. However, evaluation of outcomes for children receiving these services is needed to provide accountability data and ensure the sustainability of these programs. When designing studies, evaluators must overcome several challenges that may threaten the validity of their conclusions. In this paper, threats or challenges to the internal and external validity of results from evaluation studies are reviewed. Suggestions are provided for overcoming these challenges, in order to encourage future evaluation activities in this developing field and to document the impact of services for youth and their families.

Demographic and clinical characteristics of emotionally disturbed children being raised by grandparents.

Among 233 youths treated at a community mental health center, 51 were living with their grandparents. Youths who lived with grandparents were more likely to be male, African American, and younger. Frequent psychiatric diagnoses included oppositional defiant disorder, depressive disorders, and anxiety disorders. Common reasons for youths' placement with grandparents included parents' absence, substance abuse, or incarceration; abuse by parents; and death of parents. Caregivers were most often maternal grandmothers, and more than one-third of the grandmothers were age 62 or older. The findings highlight the need to develop treatment interventions for youths who are living with their grandparents and to create public policies to support grandparent caregivers.

Psychosocial functioning of youth receiving mental health services in the schools versus community mental health centers.

Evaluated psychosocial differences between youth receiving mental health services in Community Mental Health Centers (CMHCs; n = 79) as compared to youth receiving services from a program operating in 10 Baltimore schools (n = 186). Racial and gender differences were shown, with more African American youth and females in the School than CMHC sample. Multivariate analyses that controlled for these racial and gender differences failed to reveal significant effects, indicating comparable functioning on measures of life stress, violence exposure, family support, self-concept, and emotional/behavioral problems for youth from the two samples. However, particularly for those with internalizing disturbances, youth in the School sample were less likely to have received prior mental health services than youth from the CMHCs. Findings support the conclusion that school-based mental health programs are reaching youth who need mental health services, who otherwise may not receive them.

Progress in adolescent mental health.

This chapter reviews the status of emotional and behavioral problems in adolescents and current issues in their assessment and treatment. The authors emphasize the need for the development of mental health programs for adolescents in natural settings such as schools, and present a conceptual framework for intervention based on provider knowledge of risk and protective factors.

Toward collaboration in the growing education-mental health interface.

Expanded school mental health (ESMH) programs involve the provision of comprehensive mental health services for youth in schools, including assessment, intervention, prevention, and consultation. Related to increased awareness of the benefits of these programs, and growing disenchantment with traditional forms of mental health service delivery for children, ESMH programs are growing rapidly in the United States. Coinciding with the growth of these programs is a developing interface between and among education and mental health professionals in schools. In this interface, there is an increasing need for real collaboration; however, associated with differences in professional training, language, and expectations, and related to "turf," such collaboration is often an elusive prospect. In this article, we review historical trends that provide background to the growing education-mental health interface in schools. We discuss tensions that arise between staff of various disciplines when ESMH programs are developed, and provide recommendations on strategies to develop truly collaborative approaches to the provision of comprehensive mental health services in schools.