Modeling the Impact of School-Based Universal Depression Screening on Additional Service Capacity Needs: A System Dynamics Approach

Abstract

Although it is widely known that the occurrence of depression increases over the course of adolescence, symptoms of mood disorders frequently go undetected. While schools are viable settings for conducting universal screening to systematically identify students in need of services for common health conditions, particularly those that adversely affect school performance, few school districts routinely screen their students for depression. Among the most commonly referenced barriers are concerns that the number of students identified may exceed schools’ service delivery capacities, but few studies have evaluated this concern systematically. System dynamics (SD) modeling may prove a useful approach for answering questions of this sort. The goal of the current paper is therefore to demonstrate how SD modeling can be applied to inform implementation decisions in communities. In our demonstration, we used SD modeling to estimate the additional service demand generated by universal depression screening in a typical high school. We then simulated the effects of implementing “compensatory approaches” designed to address anticipated increases in service need through (1) the allocation of additional staff time and (2) improvements in the effectiveness of mental health interventions. Results support the ability of screening to facilitate more rapid entry into services and suggest that improving the effectiveness of mental health services for students with depression via the implementation of an evidence-based treatment protocol may have a limited impact on overall recovery rates and service availability. In our example, the SD approach proved useful in informing systems’ decision-making about the adoption of a new school mental health service.

Applying the Policy Ecology Framework to Philadelphia’s Behavioral Health Transformation Efforts

“…Formal modeling approaches, ranging from logic models (Goeschel, Weiss, & Pronovost, 2012; W. K. Kellogg Foundation, 2004) and causal modeling frameworks (Weiner, Lewis, Clauser, & Stitzenberg, 2012) to more complex approaches like system dynamics modeling (Hovmand, 2014; Lyon, Maras, Pate, Igusa, & Vander Stoep, 2015; Powell, Beidas, et al, 2015) could be used to combine implementation strategies at multiple levels and study their effects. Finally, taxonomies of implementation strategies (e.g., Michie et al, 2013; Powell, Waltz, et al, 2015) and formal reporting guidelines designed to inform the reporting of implementation strategies in the published literature (e.g., Albrecht, Archibald, Arseneau, & Scott, 2013; Proctor, Powell, & McMillen, 2013) could be used to carefully document system-level implementation strategies.…”

Advancing Implementation Research and Practice in Behavioral Health Systems

“…Finally, Zimmerman et al (this issue) show how participatory system dynamics can be useful in the preparation phase by simulating different implementation plans prior to actual implementation. Similar approaches could also be used to simulate the impact of other assessment or intervention approaches (e.g., Lyon, Maras, Pate, Igusa, & Vander Stoep, 2015). …”

Collaborative care in schools: enhancing integration and impact in youth mental health

“…Despite the established ability of SBMH to promote service accessibility (Kataoka, Stein, Nadeem, & Wong, 2007; Lyon, Ludwig, VanderStoep, Gudmundsen, & McCauley, 2012), a number of barriers inhibit the provision of optimally engaging and effective care. Barriers include continued stigma surrounding mental health treatment (Bowers, Manion, Papadopoulos, & Gauvreau, 2013), an insufficiently sized SBMH workforce to address the service needs of school populations (Lyon, Maras, Pate, Igusa, & VanderStoep, 2015), and low use of high-quality, evidence-based practices (EBP) among existing school practitioners (Owens et al, 2014). Greater use of integrated approaches for providing mental health care in schools could substantially improve mental, emotional, behavioral, and academic outcomes for youth by improving the effectiveness, efficiency, and contextual appropriateness of education sector services (Atkins, Hoagwood, Kutash, & Seidman, 2010; Bruns et al, 2016; Stephan, Mulloy, & Brey, 2011).…”

“…This work represents the first step in an iterative process designed to adapt the CC model for use in schools with the goals of improving (a) the capacity of schools to provide mental health services, (b) mental health service accessibility, and (c) the use of evidence-based practices. The project, titled Accessible, Collaborative Care for Effective School-based Services (ACCESS) , is intended to be responsive to barriers such as an insufficiently sized SBMH workforce to address the service needs of school populations (Lyon, Maras, et al, 2015) and low use of high-quality evidence-based practices among existing school practitioners (Evans & Weist, 2004; Owens et al, 2014). …”