Program Evaluation: We are focusing on the State Virginia Describe the measures, indicators, or survey tools you will use to evaluate your program, addressing reli

Improving Access to Mental Health Services for Adolescents in Virginia, USA

Stanley Belgarde, Kyrah Coone, Krisan Fragata, Colleen Illsley, Mary Munitz

Virginia Commonwealth University

NURS 607: Epidemiology and Population Health

Dr. Jane Chung and Dr. Leigh Ann Breckenridge

April 3, 2023

Improving Access to Mental Health Services for Adolescents in the Virginia, USA

With the many daily societal and behavioral pressures and challenges adolescents face, exacerbated by the COVID-19 pandemic, emotional and behavioral disorders are the most prevalent and costly chronic illnesses for the youth. Billions of dollars each year are spent on treating mental disorders in adolescents, representing one of the highest healthcare expenditures. According to the Centers for Disease Control and Prevention (2023), about 1 in 5 youth experience having a mental, emotional, or behavioral disorder such as anxiety, depression, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), or a disruptive behavior disorder. These mental health problems contribute to suicide, the second leading cause of death among adolescents in the United States (Twenge, 2020). A study revealed that 75–80 % of youth needing mental health services do not receive services (Miller et al., 2012).

Access to mental health is critical as mental health problems in the youth negatively impact their social functioning, educational, occupational, and overall quality of life. Mental health disorder experiences and thoughts of suicide in childhood and adolescence are related to a wide range of detrimental health outcomes in adulthood (Brådvik, 2018). Effective treatments for these mental health problems are available; however, gaps and disparities continue to exist between the prevalence and treatment rates among youth with access to mental health care caused by social determinants of health such as poverty, geographic location, and poverty (O’Brien et al., 2016). Therefore, it is vital to develop efficient and effective strategies to improve access to mental health services for the youth in Virginia, United States, given the estimated pervasiveness of emotional and behavioral disorders, the limited access to appropriate services, and the costs associated with these conditions.

Definition of Problem

Adolescents experience mental health concerns such as depression and anxiety. Suicide rates vary by age, race, ethnicity, and demographics (Twenge, 2020). Suicide causes severe physical, emotional, and economic impacts. People who have survived suicide attempts may experience serious injuries resulting in long-term physical and mental health effects. Suicide affects the health and well-being of families, friends, and the community. When people die by suicide, their surviving families and friends may experience guilt, anger, shock, and symptoms of anxiety or depression (Curtin, 2020). Despite the far-reaching effects of suicide and suicidal attempts, mental health-seeking behavior among adolescents remains low due to various factors, with a lack of resources leading.

Notably, two-thirds percent of the people dying from suicide have not received the help of mental health professionals. Poor access to mental health services has become a severe obstacle to preventing suicide among adolescents. Also, some of the reasons why most adolescents do not receive the help of mental health professionals are a lack of resources. Reinert et al. (2022) state that access to suicide prevention programs and mental health services has successfully lowered suicide rates. However, these resources are not readily available for most adolescents due to the shortage of critical mental health professionals, the lack of mental health specialists in their area, and the lack of support in addressing suicide crisis-intervention issues. In addition, the high costs of mental health services and lack of insurance coverage may make it challenging for adolescents to access them. As a result, most adolescents who do not rely primarily on the healthcare delivery systems to address their mental health needs do not have easy access to critical crisis intervention services.

Characteristics of the Target Population

Theoretically, this program aims to give adolescents more accessible, more reliable access to mental health resources at an affordable cost. In order to provide this support to our adolescent population, the program will be implemented directly in middle and high schools in Virginia; therefore, students have access to specific resources without having to worry about transportation, distance to mental health offices, or lack of time and money to obtain mental health treatment. According to the National Association of Secondary School Principals (NASSP), in the 2014–15 school year, there was one school counselor for every 482 students. However, the recommended ratio by the American School Counseling Association is one school counselor for every 250 students. Therefore, implementing this program in middle and high schools will also help take much of the burden off school staff members and allow the adolescents to be seen and treated in a timely manner. Ultimately, the goal is to have one “team” for each school district in Virginia, including a psychiatrist, psychologist, mental health counselor, guidance counselor, and social worker. This team would travel to different schools within their district each day and provide support to those who would like assistance addressing their mental health concerns. For example, there would be a team for Richmond City Public Schools, one for Portsmouth City Public Schools, Suffolk County Public Schools, and so forth.

When considering demographics, there is a wide range of cultural and social factors that must be taken into consideration. Specific considerations include the language barrier in certain districts of Virginia. For example, the Modern Language Association (MLA) Language Map Data Center recorded in 2010 that, in Arlington County, only 70.97% of the population speaks English as their first language, whereas, in Richmond, 90.36% of people speak English as their first language. Therefore, an important consideration is whether or not we need to include a translator or a translation system in our program. Another consideration with specific populations is finances. While this program provides free mental health services, if deemed necessary that a student needs psychiatric medications or potential hospitalization, will they have the insurance or financial capability to afford them? Another consideration with this population is, because they are adolescents, is it necessary to contact parents regarding potential care a student might receive? Given the adolescent population, the concerns above regarding specific demographics will be taken into consideration when establishing this program.

Needs Assessment

Conducting a mental health needs assessment for adolescents should be done in a way that is easy for adolescents to participate in. The assessment should include a questionnaire that highlights critical psychological disorders that adolescents can be vulnerable to, such as anxiety, depression, and suicide, but also helps narrow in on adolescents in need in regards to sample size based on the number of submissions. It should also feature questions that assess suicide risk, which could aid in prioritizing adolescents with safety risks. The assessment should also highlight financial needs in the event that psychiatric resources are needed and financial barriers do not impede the adolescent. According to the National Academy for State Health Policy (2022), states have already taken action in passing policy that provides improved resources for assisting with mental health. Virginia is among those states to provide funding and initiate development on designing a mental health task force. However, there should be another assessment for school counselors to complete to help identify specific needs for the school they operate in. Lastly, the questionnaire should also be presented so adolescents can submit mental health information without fear of information disclosure.

In terms of a model in which the mental health needs assessment could be presented, a secured online survey would be the best method to appeal to adolescents. Even if an adolescent cannot access a smartphone or smart device to submit a mental health needs assessment, it could be done from the online resources available in school or a library. The survey would have key depression questions from the PHQ-9 questionnaire, the GAD-7 questionnaire for anxiety, and the Young Mania Rating Scale for bipolar disorder, for example. The survey could be submitted to a school counselor or a behavioral health team via secure messaging for prompt follow-up with the adolescent and family. The survey would not be a means for mental health diagnosis but a method for early intervention for mental health crises in the adolescent population.

Description of the Program

The program to be implemented will comprise a team of professionals, including a psychiatrist, psychologist, mental health counselor, guidance counselor, and social worker. This team will go into each middle and high school in a district quarterly to provide mental health education and support services, meet with staff guidance counselors, and provide insight into resources available to adolescents who struggle with mental health. The day will include time for different areas for each member to support students and staff in each school.

To start the day, the team will provide education sessions to each grade individually or as a general assembly. They will discuss mental health, who is at a higher risk for developing mental health illnesses, specific areas that adolescents may see these illnesses presenting (such as the inability to concentrate with ADHD), and generalized coping mechanisms that can be applied to various areas (National Institute of Mental Health, 2021). The students and staff will have an opportunity to ask questions and engage. Educational material will be given out, as well as QR codes for apps that are available for mental health support. Following this educational session, the team will have the opportunity to come to speak to classes and talk to students individually if the student requests. This information is documented and is passed along to guidance counselors who are staffed at the school so that they can follow up further with students who have been identified as ones who may be struggling with mental health or at high risk. During the education sessions, information will be shared with students to shed light on the available resources in times of crisis or attempted suicide.

One of the primary resources this team will share with students is the use of the 988 Suicide and Crisis Lifeline. When dialed, this number provides 24/7 free emotional and mental support to people in suicide or mental health crisis. The students can access this lifeline by call or text. According to the program’s website, this program has answered over 23 million calls since 2005 from people in a mental health crisis. The program can dispatch a mental health professional to the scene if needed (Substance Abuse and Mental Health Services Administration, 2023). The goal of promoting this resource to adolescents would be to assist them in mental health crises to prevent attempted suicide ultimately.

Following education and discussion with the students, the team would then meet with the school guidance counselors on staff to provide them with support, insight, and other available resources that they may need to be made aware of. The team will share at-risk students that have been identified so that the guidance counselors can follow up with these students and provide them with the support and resources they might need.

After the education and discussion sessions, the students will be sent optional online questionnaires to fill out privately if they want to learn about more resources available or feel they need additional mental health support.

Mission Statement

To be committed to enhancing mental health awareness, promoting wellness of the individual, family, and community, and increasing equitable access to treatment and services for the youth.

To assist adolescents experiencing mental health problems by serving mental health education and support through prevention, intervention, treatment, and education.

Goals/Objectives

This program's ultimate overarching goal is to improve access to mental health services for adolescents and reduce the number of adolescents suffering from mental illnesses. In order to achieve this goal, our team created the program above, which describes the smaller steps we can take to get there. When creating the goals and objectives, the priority was considering the target population and how they could be reached most effectively. One goal for the program is to eventually integrate a mental health support "team" into every school district, allowing students convenient access to mental health treatment. Furthermore, with the implementation and integration of this program into middle and high schools, another goal is to raise awareness and reduce the stigma surrounding mental illness by using this program to educate and familiarize students with the signs and symptoms of mental illnesses and when to seek treatment. This can be achieved by engaging students in educational learning and encouraging them to ask questions about mental illness. Providing adolescents with the support and resources they need to combat the mental illness they may be dealing with is also one of the goals. These resources include possible referrals to a specific therapy, potential medical prescription, or education one of the team members provided on coping with specific mental struggles. Taking these program goals into account, a reduction in the number of adolescents with mental health illnesses and an improvement in the overall health status of adolescents is expected to be seen in the future.

References

Brådvik, L. (2018). Suicide risk and mental disorders. International Journal of Environmental Research and Public Health, 15(9), 2028. https://doi.org/10.3390/ijerph15092028

Curtin. (2020). State suicide rates among adolescents and young adults aged 10-24: United States, 2000-2018. National Vital Statistics Reports, 69(11), 1–10.

Centers for Disease Control and Prevention. (2023, March 8). Improving access to children’s mental health care. https://www.cdc.gov/childrensmentalhealth/access.html#improving-strategies

Generalized anxiety disorder 7-item (GAD-7) (no date) National HIV Curriculum. Available at:

https://www.hiv.uw.edu/page/mental-health-screening/gad-7 (Accessed: March 30, 2023).

Miller, B. D., Blau, G., Christopher, O. T., & Jordan, P. (2012). Sustaining and expanding systems of care to provide mental health services for children, youth and families across America. American Journal of Community Psychology, 49(3–4), 566–579. https://doi.org/10.1007/s10464-012-9517-7

Miller, C. J., Johnson, S. L., & Eisner, L. (2009). Assessment Tools for Adult Bipolar Disorder. Clinical psychology : a publication of the Division of Clinical Psychology of the American Psychological Association, 16(2), 188–201. https://doi.org/10.1111/j.1468-2850.2009.01158.x

Needs assessment (no date) SAMHSA. Available at:

https://www.samhsa.gov/dtac/disaster-response-template-toolkit/needs-assessment (Accessed: March 30, 2023).

O'Brien, D., Harvey, K., Howse, J., Reardon, T., & Creswell, C. (2016). Barriers to managing child and adolescent mental health problems: a systematic review of primary care practitioners' perceptions. The British journal of general practice: the journal of the Royal College of General Practitioners, 66(651), e693–e707. https://doi.org/10.3399/bjgp16X687061

Olivia Randi, Z.G. (2023) States take action to address children's mental health in Schools,

NASHP. National Academy for State Health Policy. Available at: https://nashp.org/states-take-action-to-address-childrens-mental-health-in-schools/ (Accessed: April 1, 2023).

PHQ-9 Depression Test Questionnaire (no date) Patient.info. Available at:

https://patient.info/doctor/patient-health-questionnaire-phq-9 (Accessed: March 30, 2023).

Reinert, M., Frize, D., & Nguyen, T. (2021, October 1). The state of mental health in america 2022. http://hdl.handle.net/10713/17070

Twenge, J. M. (2020). Increases in depression, self‐harm, and suicide among US adolescents after 2012 and links to technology use: possible mechanisms. Psychiatric Research and Clinical Practice, 2(1), 19-25. https://doi.org/10.1176/appi.prcp.20190015

National Institute of Mental Health. (2021). Attention-deficit/hyperactivity disorder in children and teens: What you need to know. U.S. Department of Health and Human Services. Retrieved April 1, 2023, from https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-in-children-and-teens-what-you-need-to-know

Substance Abuse and Mental Health Services Administration. (2023). 988Lifeline. 988 Lifeline. Retrieved April 1, 2023, from https://988lifeline.org/about/

Marys cites

https://www.nassp.org/mental-health-in-middle-level-and-high-schools/#:~:text=Data%20from%20the%20U.S.%20Department%20of%20Education%20Office,have%20regular%20access%20to%20school-based%20mental%20health%20professionals .

https://apps.mla.org/map_data

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