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1 New Advances in Health Promotion and Early Detection of Illness D. A. Santor, Ph.D. Provincial Centre of Excellence for Child and Youth Mental Health.

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Presentation on theme: "1 New Advances in Health Promotion and Early Detection of Illness D. A. Santor, Ph.D. Provincial Centre of Excellence for Child and Youth Mental Health."— Presentation transcript:

1 1 New Advances in Health Promotion and Early Detection of Illness D. A. Santor, Ph.D. Provincial Centre of Excellence for Child and Youth Mental Health School of Psychology University of Ottawa

2 2 illness treatment Challenges treatment recovery

3 3 Current Strategies to address Mental Health Difficulties in schools  school based health centres  mass screening  universal mental health curriculum and interventions illness treatment

4 4 Current Strategies to maximize outcomes in Treatment  treat early and aggressively  combination therapies  develop new treatments  continuous monitoring of progress treatment recovery

5 5 Part 1: Early Monitoring of Progress in Treatment.

6 6 Santor & Segal (2001)

7 7 Lambert et al. 2005

8 8

9 9 On-line Implementation:

10 10 Part 2: Early Detection of Difficulties in Schools. Strategy 1: School based health centres.

11 11 What’s the chance of visiting the school health centre given that you have difficulty, or distress, or want help for a problem? Santor, LeBlanc, Poulin, Kusumukar (2005b)

12 12 What proportion of young people with difficulties actually use school based health centres? Santor, LeBlanc, Poulin, Kusumukar (2005b) Less than 1/5 of young people with distress or mental health problems causing impairment visit school health centres

13 13 How are SBHCs used by individuals with and without distress? Santor, LeBlanc, Poulin, Kusumukar (2005b)

14 14 Summary:  SBHC is a limited resource, which is disproportionately used.  Results illustrate the two competing goals: screening / triage versus service provision.  Still not being used by the majority of individuals with mental health problems.

15 15 Strategy 2. Mass Screening Part 2: Early Detection of Difficulties in Schools.

16 16 November 23, 2004 - - The act, signed into law on October 21, 2004, authorized $82 million over three years for the development of youth suicide prevention and intervention programs.

17 17 Columbia TeenScreen Program “The ultimate goal of the TeenScreen Program is to ensure that all youth are offered a mental health check-up before leaving high school. Our primary objective is to help communities establish permanent early identification programs through which youth are screened for mental disorders and suicide risk factors.”

18 18 Case Study: TeenScreen Program  Step 1. Information and Parental Consent

19 19 Step 1. Information and Parental Consent  Step 2. Participants Complete Screening Tool Case Study: TeenScreen Program

20 20 Step 1. Information and Parental Consent Step 2. Participants Complete Screening Tool  Step 3. Debriefing of Youth Case Study: TeenScreen Program

21 21 Step 1. Information and Parental Consent Step 2. Participants Complete Screening Tool Step 3. Debriefing of Youth  Step 4. Mental Health Assessment Case Study: TeenScreen Program

22 22 Results 9th-12th grade students attending seven New York high schools (N = 1,729). 28% (n = 489) of the students endorsed one of the items and therefore met criteria for being at risk of suicide. The most balanced algorithm had a sensitivity of 0.75, a specificity of 0.83, and a positive predictive value ranging from 16-33% (p. 75).

23 23 Do results support the viability of mass screening?

24 24 US Task Force on Prevention (2002). … reversed their 1996 recommendation recommending screening adults for depression in physician practices. …. but concluded that the evidence is insufficient to recommend for or against routine screening of children or adolescents. US Task Force on Prevention (1996). … insufficient evidence to support use of mass screening in either adults or children.

25 25 Importance of prevalence or base rates.

26 26 School factors affecting base rates  10% of student absent at any time,  10% drop out by year end.  Young people who are absent and drop out tend to be young people experiencing difficulties, the very group you wish to screen.

27 27 Recruitment factors affecting base rates.

28 28 Illness factors affecting base rates Onset Screening symptom course

29 29 Should we worry about the poor performance of screening programs, given that they do identify some individuals?  if the goal is just to identify some young people with difficulties, there are more effective ways of doing this.  currently the majority of young people with illness are being missed.  program costs for Teen Screen range from $2000 to $3000 per school / per year. The strongest predictor of help seeking was wanting help for a serious mental health problem

30 30 Can screening be improved?

31 31 Optimizing Cut Scores  The standard approach it to identify scores on measures with which individuals can be designated at “depressed” which minimize misclassifications. But …

32 32 SN = 0.70 SN = 0.65 SN = 0.85

33 33 What about improving the base rate?

34 34 What would a screening program look like which explicitly acknowledges the importance of increasing base rates?

35 35 all youth distressed need treatment typical screening grouptargeted screening group

36 36 Goal 1: Can we increase the base rates?

37 37 Cascade Model of Help Seeking: Do you want help? What help is available? Is it a problem? Difficulty or Illness Help or Treatment Santor, Kusumakar, LeBlanc & Poulin (2005a).

38 38 Help Seeking Intervention Mental Health Visits Emotional Support Santor, Kusumakar, LeBlanc & Poulin (2005a). 64% 32%

39 39 Mental Health Screening Program for Physicians: Improved Screening ?=+

40 40 Summary: Help seeking among distressed young people can be increased. But access to the resource is still limited.

41 41 Goal 2: Increase accessibility of the resource?

42 42 Interactive Health Magazine for Youth Located at Directed by Santor and Bagnell

43 43 Food is Fuel! Learn about nutrition. Test your food knowledge. Stress Explained. What is it? Do you have it? What to do about it. De-STRESS Learn the ABCs of Stress and Stress Relief. SelfHarm&HelpSeeking? Five things you need to know. How to get help. GoFitness! Get active. Walk to Moscow. What's in the mix? Drugs, alcohol and substances. How they affect you. Mental Health. Mental Health and Mental Illness. What’s the difference? BoysHealth. Owner's manual and body book. Relationships Finding romance. Making Friends. SexualDecisionMaking. Ready to do it. Doing it. Done it. GirlsHealth. Owner's manual and body book. FittingIn | MeetYourBully Fitting-in. Bullying. Victimization Featured Topics …

44 44 Content YooMagazineOur flagship magazine focuses on a range of health, mental health and developmental topics, including nutrition and exercise, boys and girls health, injury prevention, bullying and relationships. Q&AEach week, we answer new questions posted by youth. Q&A ArchiveBrowse or search our archive of over 2000 Q&As asked by students and answered by experts QuizzesTest your knowledge about development, health and sexuality. QuestionnairesTake standardized, interactive questionnaires on a range of topics. News BulletinsWe post new fact sheets on emerging trends each month on a range of health, development and well- being topics. Hot TopicsWe showcase materials on critical topics each month, including bullying, STIs, self harm. Classroom ActivitiesLesson plans and teaching modules on a range of health and mental health topics will be posted each month. Regular Topics …

45 45 Evaluation Screening Tools Access and complete empirically validated screening tools for teachers on a range of topics including ADHD. Stress QuizOur monthly stress quiz prompts students to complete a stress checklist monthly, allowing students to track changes in stress levels from month to month. Health Survey Conduct an annual on-line health survey of students in your school, and view results of the survey on- line Monthly Statistics Local and regional staff can download usage statistics directly from our administrative website – allowing schools to track usage and evaluate trends. Track Usage and Health Needs …

46 46 How is it used by students?

47 47 im a 16 year old girl, for the past three months i've been feeling alot different then i used to, i find i have trouble sleeping at night and trouble staying asleep. my body and head constantly hurt though my doctor says i have no medical problems i've been eating alot less and my mood swings are out of control. during the past three weeks things have only gotten worst i've become extreamly sensitive crying about everything and yesterday i cut my arms up with some keys. i can't control my sadness and i was hoping it would pass. my parents say its a phase that everyone goes through but i think i need some help. is this a phase? or do i need to see a doctor??

48 48 I had sex for the 3rd time about five days ago. During this I started to bleed, so we stopped. For a few days after it was just little spot amounts. It's been five days and now I'm bleeding so much i have to wear a tampon. It's straight blood. I was wondering what's wrong and if I need so see some one or if it will just go aways on it's own?

49 49 My mom was watching TV and I tried to ask her a question and she interupted and yelled SHUT UP. Then I took a deep breath and she thretened me with a kinfe. and thats not the only time she threatened to hurt me. she gets angary at me all the time. i never did anything. she once hit me with a hot cookie sheet. I end up running and screaming for her sometimes. I can't stand another minute living with her. She never belives anything I say, She always tries to hurt me. Above is just a few examples of her ingorance. What can I do?

50 50 okay this might sound stupid but i have learned about sex -- i know what goes on and everything, i am very well educated on the subject, but i sorta wonder in between all this orgasm stuff-- like i know what they are and how they happen and that it vary's from guys to girl-- but is like sex like one orgasm then its over ?like how can this go on for along time? is sex really short...cant it be long? like after the orgasm thing what happens? like i ask do you go again or...what? i hope you get what i am asking thanks!

51 51 Utilization Data (N = 500 – or one typical school) Santor, LeBlanc, Poulin, Kusumukar (2005c) How is the Resource Used by Young People?

52 52 30 Logons Santor, LeBlanc, Poulin, Kusumukar (2005c) This group of young people scored higher on measures of depression and difficulties How is the Resource Used Throughout the Day?

53 53 Santor, LeBlanc, Poulin, Kusumukar (2005c) Number of visitors Number of visits Mean number of visits How is the Resource Used Throughout the Year?

54 54 Part 2: Early Detection (and Treatment) of Difficulties in Schools. Strategy 3: Universal Programs and Curriculum.

55 55 Universal Programs δ = 0.12 Selective Prevention δ = 0.30 Indicated Prevention δ = 0.23

56 56 illness treatment What’s the Goal treatment recovery

57 57 Cascade Model of Help Seeking: Do you want help? What help is available? Is it a problem? Difficulty or Illness Help or Treatment Santor, Kusumakar, LeBlanc & Poulin (2005a).

58 58 Q1: Is this a viable screening tool? Santor, LeBlanc, Poulin, Kusumukar (2005c)

59 59 30 Logons New Indicators of Distress and Dysfunction Santor, LeBlanc, Poulin, Kusumukar (2005c)

60 60 Time 1Time 2 score New Screening Algorithms

61 61 Can the Website Increase Detection? The positive predictive value for the Symptom Checklist – for predicting sustained mood problems (assessed at year end) – was 0.45 in the subgroup of website visitors who completed the Symptom Checklist once. The positive predictive value increases to 0.73 in the subgroup of individuals who completed the Symptom Checklist more than twice.

62 62 Does Using the Website Help? Visits to the website were positively associated with visits to school health centers, guidance counselors and referrals to a health professional. Santor et al. (in press). Online Health Promotion, Early Identification of Difficulties and Help Seeking in Young People. JAACAP.

63 63 Thank you demo / mydemo

64 64

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