Group Discussion Post:

What are your first thoughts about screening all kids in a school for mental health problems? Can you think of any drawbacks? Do you think OT has a role in screening kids for mental health problems? After you complete the module, come back and comment on yours and/or others.

My first reaction when I hear that students should be screened for mental health is that I think it is a great idea! I think screenings are a very preventative measure to make sure the issues the children are going through are being addressed. I personally think schools should mandate therapy to all students regardless of their mental status. I think schools are stressful places where students are placed into peer pressure situations and are trying so hard to fit in that they suppress their feelings and try their best to not show emotions or seem “uncool.” I think if all students are required to attend therapy, they will feel less embarrassed and possibly share more than if they are screened and singled-out. I also think students fear the stigmatization that goes with the word therapy. The only drawback I can think of is how our society has shunned the word therapy as being a bad thing or something that “crazy people” participate in (as shown on T.V., movies, and throughout the media). The negative connotation that goes along with therapy is a sure-fire way to create a hostile environment within the school and can potentially promote bullying for the students who are singled-out due to a screening process. If all students are required to attend therapy at least once a quarter or every other week for 15 minutes to talk to a psychologist, I think students would be more willing to open up and talk about their problem, stressors, and home-life. I think OT’s do not necessarily play a role in the screening process, but I do think that OT’s have a responsibility to be constantly screening students for mental instabilities and they have the responsibility to report any questionable behaviors students participate in. OT’s are not as involved in the everyday life of the students in the schools, so they should be able to report, respond, and help with the screening process, but I do not think that they are the primary administers of the screening process.

Screening Tools:

Effective screening tools must be valid and reliable. Taking common errors into consideration, Jenkins (2003) suggested that practitioners examine the following aspects:

• Sensitivity—does the tool likely and reliably identify the at-risk students who are truly at risk for future academic problems? If it seems like the tool might over-identify too many students, then its usefulness is limited.

• Specificity—does the tool likely discriminate between and correctly identify those students who may present with concerns but are not at risk for future academic difficulties? A screening tool with good specificity, per Jenkins (2003), will truly reduce the number of false positives and be helpful in making decisions about how to disperse scare resources.

• Practicality—is it brief and simple? Is it efficient to use? Is it simple enough to be used on a wide scale? Can it be performed in the classroom or other key areas of the school? Can the results be determined rather quickly?

• Consequential Validity—Per Jenkins (2003), effective screening tools should be consequentially valid in that they do no harm to the student, avoid situations of inequitable treatment, and can be linked to effective/examined interventions and practices.

After reviewing the above list, take a moment to look up a few of the screening tools listed below. Examine the items in the tool. Do they seem to address strengths? Align with the dual-continua model of mental health? Dowdy (2014) notes that school-based screenings are mostly incomplete in that typically they only address a few mental health items or if they do address mental health it isn’t COMPLETE mental health, as most focus only on risk factors of distress and ignore the positive social-emotional supports.

• Eyberg Child Behavior Inventory: 2-16 years–15mins

• Child Symptom Inventory : 3–18 years-15mins

• Massachusetts Youth Screening Instrument : 12-17 years-10mins

• Pediatric Symptom Checklist : 4-16 years–10mins

• Problem-Oriented Screening Instrument for Teenagers: 12-19yrs–25mins

• Strengths and Difficulties Questionnaire : 3–16 years-10mins

• MSLSS--you already know that one!!

• Positive and Negative Affect Schedule for Children (10-item) : PANAS-C

• Social Emotional Health Survey-Secondary: SEHS-S

Retrieved from: TOT 1: Mental Health Screening (2019)

Strong federal support for school mental health programs and services is contained in the goals and recommendations within the President’s New Freedom Commission on Mental Health in 2003. Goal 4, specifically unites screening and schools.

Goal 4: Early mental health screening, assessment, and referral to services are common practice

• Recommendation 4.1: Improve the mental health of young children

• Recommendation 4.2: Improve and expand school mental health programs

• Recommendation 4.3: Screen for co-occurring mental and substance use disorders and link with integrated treatment strategies

• Recommendation 4.4.: screen for mental disorder across the lifespan

Retrieved from: TOT 1: Mental Health Screening (2019)

How Mental Health was Previously Viewed and How it is Improving:

Conceptualizations of school mental health were rooted in the medical model paradigm which focused on remediation or treatment of individual problems rather than population-based and preventative services (Dowdy, 2014). School-based mental health screens have mostly focused exclusively on risk factors or symptoms of mental illness (i.e. disorder-based screening measures). Guhn (2012) found that disorder-based screening measures and those focused on mental illness are limited to 15-20% of students. Moreover, problem-focused screens do not address positive contributions to mental health (Moore, 2015).

Moore and Colleagues (2015) provided a step-by-step framework for implementing Universal Complete Mental Health School Screenings, which included:

1. Identify the key participants and plan. It should be a multidisciplinary effort involving numerous stakeholders from teachers to administrators.

2. Select the Screening Tool. Make sure to consider the compatibility of the tool with the purposes of UNIVERSAL COMPLETE MENTAL HEALTH!

3. Obtain consent and assent.

4. Administer the Screen. Earmark substantial time for processing or tabulating the data/responses. If the school doesn't have the infrastructure for online assessment, consider the value of paper and pencil.

5. Analyze the Data

6. Follow-up

Complete mental health screening that includes strength-based information in the assessments expands the appeal of universal screening because all students, regardless of their level of impairment or risk, have significant strengths that can be utilized and built upon to achieve more optimal developmental pathways (Dowdy, 2014). Screening information that also looks at strengths is relevant for all students. As Moore (2015) reported, a strengths-based approach to school-based universal mental health screening serves to broaden educators’ understanding of mental health and can be used to inform proactive interventions that enhance strengths.

Complete mental health screening approaches are consistent with the dual-factor model of mental health, which was introduced in module 1. As a reminder, the dual-factor model of mental health conceptualizes complete mental health along 2 separate (but complementary and related) continua rather than opposite ends of the same continuum—a mental illness continuum and a mental wellness continuum. Complete mental health screening efforts should be more than just a search for illness or disorder. Effective complete mental health screenings should examine how to enhance and further foster psychological well-being and social-emotional strengths.

Retrieved from: TOT 1: Mental Health Screening (2019)

The Short Child Occupational Profile Evaluation (SCOPE)

SCOPE Review Submission

For this assignment, I am simply going to go through the questions you were asked to comment on and put in my answers. I used the SCOPE in my setting at the therapeutic day program and actually collected data for one of the validity studies. I also used the MOHOST extensively. MOHOST is the adult version of the SCOPE. I found the MOHOST was one of the most powerful tools I had in the box when it came to helping other providers in my setting understand the role and expertise of occupational therapy. I also found it really helpful to discuss my ratings with the people I was rating. Our discussion often led to a collaborative approach to therapy.

Consider the potential use of the SCOPE in practice: describe the characteristic of the child or a context for which you envision the SCOPE being a helpful screening tool. Provide support from the manual related to its reliability, validity, relevance, and currency particularly within the school setting. Describe what kinds of school activities you would likely observe to get the most useful information about the child's occupational performance. What other resources would you use in addition to the SCOPE. How would you use your findings?

My Responses:

Consider the potential use of the SCOPE in practice: Describe the characteristics of the child or a context for which you envision the SCOPE being a helpful screening tool.

One of the first things to consider when looking at this assessment (and MOHOST) is that these are NOT assessments specific to any condition, nor does it assess deficit. These assessments start with the idea that all people participate in occupation and the items on the assessments are some characteristics of participation. Rather than focusing on the person’s “problems” or abnormalities, it helps focus the process on the barriers to participation. This is one of the most powerful things about MOHO as a theoretical framework. This is why the approach is not based on a norm referenced approach but rather a set of ratings that help to address the participation barriers. Because of this basic approach the SCOPE can be used for any child, in any situation between birth and 21 – regardless of whether a child has a diagnosis or identifiable disorder. I used it as a screening tool to recognize the areas of occupation with the most barriers (volition, habituation, etc.) I then collaborated with the child (and/or the parent) to reason through the next step of intervention – be that solving the problem or doing further assessment in order to identify what is getting in the way of participation. I found kids who bought into additional assessment were much more willing to complete it well. Parent’s also found it to be more appealing than some of the options.

I used SCOPE in a therapeutic day program (much smaller population of kids by the way). I found it was really useful to address population wide issues. What were the constructs of occupation that large numbers of kids struggling with? We could then look at school wide interventions to address participation. There is a wealth of research in the recovery literature to link participation in occupation as a means to recovery. The SCOPE is a nice tool for identifying ways the school can support participation – beyond academics. For example I was involved in helping develop a music program, recess activities, volunteer programs and clubs – we developed a science club, boys and girls clubs. I would have done these things anyway but the assessment gives data and schools love data. Since it can be used as an outcomes tool you could also re-screen to see if there is a change both on the individual and school level. I think the rating would require non-OT’s to be trained and there is some time involved in doing the ratings so that needs to be considered. It is possible to have faculty trained to rate kids in different setting, OT would do the interpretation.

Provide support from the manual related to its reliability, validity, relevance, and currency particularly within the school setting.

Most everyone did a nice job here. I will not reiterate other than to say the value of reading this information before you implement an assessment in a setting is that you can develop a solid rationale for your choice in using it. Do make sure you understand the difference between validity and reliability. I was always prepared to discuss this when implementing assessments or even interventions. I can’t say I remembered the “numbers.” It was more about knowing what I would say if someone asked me why I was doing what I was doing. Also knowing why I chose to do one over another. This goes a long way to legitimize OT and bring attention to the value we add to a team.

Describe the kinds or school activities you would likely observe to get the most useful information about the child’s occupational performance.

Again many of you said the same thing. If you are doing the screening you are going to watch a young child in a variety of settings – lunch, recess, music or PE class, the classroom of course. I might attend a Girl or Boy Scout meeting if they have one on sight. When kids come in each morning, or when they prep to leave school in the afternoon is particularly telling. I want settings in which they indicate volition, routines and skills. I also want to understand the different environments they participate in and how those environment serve to support or get in the way of participation for a child. Remember that you can really gather the info to make the ratings any way you want. I might use a good interview with the parent of a child or with kids who can respond to an interview. And of course you do a lot of observing in therapy sessions and even during an evaluative session.

What other resources would you use in addition to the SCOPE?

No matter where I worked in the past, I always had a set of evaluations that I could draw from. I had evaluations that addressed all areas of the MOHO constructs from volition (interests, efficacy, control, etc.) to assessments that allowed me to learn about roles and routines (several interviews, the role checklist) and a variety of assessment around skills and performance (The AMPS, the ACIS, sensory assessments, perceptual motor stuff, some motor assessments (though I didn’t use these much). Once I completed the screening tool I could draw from the evaluation pool (if need be), to determine the reason for the barriers. The decision to draw a particular evaluation form from my pool was driven by the screening tool and collaboration with the child or family. The SCOPE provided me the rationale for my choices.

How would you use your findings?

I think I addressed this earlier. As a screening tool it would help map out the remaining assessment process to focus on areas of need. As a school wide screening it could be used to identify kids who are struggling with participation for whatever reason and then open the opportunity to complete further assessment. It could also be used to address school wide interventions and outcomes, driving implementation of programs to address common participation barriers. The SCOPE does include that focus on environment (not the kid’s interaction with environment but the environmental influence on participation). This is a really important aspect of MOHO assessments you don’t see in others. I would tap into that part of the assessment for a school wide screening of how the environment supports participation in a wide variety of activities.