Children's Hospital Neighborhood Partnerships

The Initiative:

• teaches children and teens how to identify depression and promote overall mental health
• trains educators and parents how to recognize the signs of depression and other mental health problems
• creates innovative tools for the prevention of mental illness
• is led by a specially trained preventionist who trains two Swensrud Fellows per year

We understand that some factors associated with the development of depression are beyond the scope of what schools are able to target. However, there are many skills that adolescents can use to help bolster their emotional well-being, and these can be incorporated into every school day. It is our hope that we can prevent emotional disturbances from becoming more serious crises by teaching students to actively employ recognition and coping skills.

This curriculum is comprehensive in its approach -- it includes information about preparing a school system for initiating a depression prevention program, provides staff development exercises, student and classroom activities, and resources to assist staff in working with students who need more individualized mental health services.

Our goal is to provide a tool that describes how to create a program from onset to finish and includes information relevant to a wide spectrum of students ranging from those whose needs are only for prevention, to those who confront daily struggles to succeed in school while battling a mental illness.

Preparation
The preparation section introduces the philosophy and purpose of the activities, and discusses how a school system prepares to implement a prevention program with its students. A "top-down" approach is recommended, where administrators and school leaders are equally as invested in the prevention of depression as the staff conducting the interventions. While we recognize that not all staff will be directly involved in implementation, the entire school system should feel comfortable with this information so everyone is prepared for the response from students and parents.

A range of resources are also offered, including surveys for needs assessments, sample organizing guides and exercises for guiding staff development workshops. Finally, suggestions for best practices are offered. These suggestions are based on the feedback provided by many students, teachers, and parents.

Curriculum
The second section, curriculum, focuses on the implementation of the activities. Clear, step-by-step instructions are provided for presenters, and interspersed throughout the activities are sample questions and responses that students have given while participating in the activities.

Sample adaptations to meet the needs of specific classes/circumstances, as well as handouts to be used for individual use with students are offered. Also in this section, readers will find information regarding the correlation between aspects of the activities and Massachusetts Department of Education English Language Arts and Comprehensive Health Curriculum Frameworks.

We understand that initiating conversations about depression will likely generate some questions from students and might lead some to seek additional assistance. It is indeed our hope this will be the case, and that students will seek help early rather than wait until a crisis arises.

To help students with these questions or self-referrals, we have created a "toolkit" for staff which includes sample interview questions, contracts for safety, case management sample forms, tips on how to work with students already diagnosed with depression and post-hospitalization re-entry plans.

Evaluation
Finally, the third section, evaluation, discusses how to approach outcomes. It is critical to evaluate the effectiveness of any tool designed for prevention. Educators are encouraged to determine the initial one or two outcome measures most appropriate to their school systems for measuring the impact of interventions. Sample student, teacher and parent evaluations for use after activities are also included in the manual.

Unfortunately, depression and other mental health issues are affecting school-aged children at staggering rates.

• The Surgeon General's Report on Mental Health stated that the majority of children and adolescents do not receive the mental health services they need.
• More than 800,000 American teenagers suffer from depression each year, and more than 500,000 make a suicide attempt that requires medical attention.
  (Columbia University 2003)
• Sixty to 80 percent of adolescents with depression go undiagnosed or untreated - and untreated depression can lead to deteriorating schoolwork, high absenteeism, dropping out, strained peer and adult relationships and potential suicide.
• Depression directly or indirectly results in 1700 teen suicides per year; in a Youth Risk Behavior Survey administered annually in Boston, 20 percent of high school students reported considering suicide.
• Suicide is the second leading cause of death for Massachusetts young people, ages 15-24, and suicide rates nationwide have tripled since 1950.
• In Boston, two in five high school seniors report recent (within the last 30 days) alcohol use, and one in five reported binge drinking. Marijuana use is also prominent among Boston high school students, with over 20 percent reporting current use.
  (Boston Public Health Commission 2003)
• Of youngsters who reported making a suicide attempt in the past year, over one-third used illegal drugs in the past month, and more than a quarter reported binge drinking.
  (Boston Public Health Commission 2003)
• According to a statewide survey, high school students in Massachusetts who reported alcohol use were twice as likely to have attempted suicide in the past 12 months as their non-drinking peers.
  (Boston Public Health Commission 2003)

Swensrud Depression Prevention Initiative
CHNP/Beardslee
1 Autumn Street, #715
Boston, MA 02215-5366
Phone: 617-355-6730
Fax: 617-730-0271
Director:
Email Nadja Reilly, PhD