Faculty Bibliography

Replies to comments by H. S. Adelman and L. Taylor; S. R. Forness; R. M. Friedman; and M. D. Weist (see record 2003-04925-009, 2003-04925-010, 2003-04925-011, and 2003-04925-012, respectively) on the papers by K. Hoagwood and J. Johnson; W. Strein et al; and L. Hunter (see record 2003-04925-006, 2003-04925-007, and 2003-04925-008, respectively) regarding a public health perspective on or framework for school psychology and behavior problems. The author suggests that the 4 commentaries offer very thoughtful and nuanced perspectives on how to extend the revisionist approach to school psychology suggested in the special issue of the journal. Each commentary identifies important permutations to the public health framework described, and they articulate additional themes, roles, or perspectives that can be usefully added to it. The author addresses each commentary individually in her response.

Suggests that concerns regarding American schools and mental health services for children abound, including inadequate educational achievement, school violence, over-referral to special education and disproportionate placement of minorities into special education, under-utilization of mental health services for children, and a poorly coordinated system of child mental health services. All of the above concerns share 2 common attributes: (1) they are statements regarding populations, rather than specific individuals; and (2) they are best addressed by changing system-wide elements of psychological service delivery. The authors argue that, although conceptualizing school psychology as primarily an indirect service specialty has advanced the thinking about effective service delivery, conceptualizing school psychological services from a public health perspective will provide an even broader framework that can increase both the efficacy and efficiency of school psychologists' work.

Reviews have identified mental health interventions that are relevant to schools; unfortunately, this research pays insufficient attention to the school context. Several aspects of school context likely influence the ability of schools to change current practices or adopt new ones. Relying on an organizational framework, a three-level model of school context particularly relevant to the delivery mental health interventions: (a) individual, (b) organizational, and (c) state or national-level factors are described. This article argues that effective school-based mental health care will result from the marriage of system reform efforts, capacity building, and the delivery of empirically driven intervention strategies.

In response to U.S. Public Health Service projects promoting attention to disparities in the outcomes of mental health treatments, in July 2001, the American Psychological Association, the National Institute of Mental Health, and the Fordham University Center for Ethics Education convened a group of national leaders in bioethics, multicultural research, and ethnic minority mental health to produce a living document to guide ethical decision making for mental health research involving ethnic minority children and youths. This report summarizes the key recommendations distilled from these discussions.

Until the 2001 Surgeon General's report there had been no acknowledgment of the need for a national plan for research priorities to improve services and reduce illness burden for children and adolescents with severe mental disorders. Barriers to services among those in need include individual and family factors, and clinician and service system factors. Additionally, little reserch is available on the impact of major policy reforms on children's ability to obtain efficacious care. Critical research gaps exist in a number of areas with the prevention and early intervention area representing a particularly important missed opportunity.

This paper explores the potential of community-based, public health-oriented interventions as a tool for reducing the burden of affective disorders on individuals, their families, and communities. The paper reviews the use of community-based interventions with other health-related problems and describes potential applicability for affective disorders such as changing public attitudes, reducing social stigma, facilitating access, or supporting treatment adherence for populations in their community settings. An agenda for developing this field of intervention research is proposed.

To expand and accelerate research on mood disorders, the National Institute of Mental Health (NIMH) developed a project to formulate a strategic research plan for mood disorder research. One of the areas selected for review concerns the development and natural history of these disorders. The NIMH convened a multidisciplinary Workgroup of scientists to review the field and the NIMH portfolio and to generate specific recommendations. To encourage a balanced and creative set of proposals, experts were included within and outside this area of research, as well as public stakeholders. The Workgroup identified the need for expanded knowledge of mood disorders in children and adolescents, noting important gaps in understanding the onset, course, and recurrence of early-onset unipolar and bipolar disorder. Recommendations included the need for a multidisciplinary research initiative on the pathogenesis of unipolar depression encompassing genetic and environmental risk and protective factors. Specifically, we encourage the NIMH to convene a panel of experts and advocates to review the findings concerning children at high risk for unipolar depression. Joint analyses of existing data sets should examine specific risk factors to refine models of pathogenesis in preparation for the next era of multidisciplinary research. Other priority areas include the need to assess the long-term impact of successful treatment of juvenile depression and known precursors of depression, in particular, childhood anxiety disorders. Expanded knowledge of pediatric-onset bipolar disorder was identified as a particularly pressing issue because of the severity of the disorder, the controversies surrounding its diagnosis and treatment, and the possibility that widespread use of psychotropic medications in vulnerable children may precipitate the condition. The Workgroup recommends that the NIMH establish a collaborative multisite multidisciplinary Network of Research Programs on Pediatric-Onset Bipolar Disorder to achieve a better understanding of its causes, course, treatment, and prevention. The NIMH should develop a capacity-building plan to ensure the availability of trained investigators in the child and adolescent field. Mood disorders are among the most prevalent, recurrent, and disabling of all illnesses. They are often disorders of early onset. Although the NIMH has made important strides in mood disorders research, more data, beginning with at-risk infants, children, and adolescents, are needed concerning the etiology and developmental course of these disorders. A diverse program of multidisciplinary research is recommended to reduce the burden on children and families affected with these conditions

Affective disorders impose a substantial individual and societal burden. Despite availability of efficacious treatments and practice guidelines, unmet need remains high. To reduce unmet need and the burden of affective disorders, information is needed on the distribution of burden across stakeholders, on barriers to reducing burden, and on interventions that effectively reduce burden at the levels of practice, community, and policy. This article provides the report of the Working Group on Overcoming Barriers to Reducing the Burden of Affective Disorders, for the National Institute of Mental Health Strategic Plan on Mood Disorders. We review the literature, identify key gaps, and recommend new research to guide national efforts to reduce the burden of affective disorders.