Teacher and School Characteristics Associated with the Identification and Referral of Adolescent Depression and Oppositional Defiant Disorders by U.S. Teachers

Abstract

Teachers contribute to the process of identifying and referring students for mental health services, however, relatively little is known about how they make those decisions and how decision-making differs across school contexts. This study used a vignette-based method to investigate individual and school contextual factors associated with the likelihood that teachers identify and refer students for mental health services. Teachers were recruited from public middle and high schools across the U.S. using a stratified random sampling strategy. Teachers (N = 462) responded to vignettes by indicating their concern for students, as well as their likelihood of providing mental health referrals. Vignettes varied by problem type (depression, oppositional defiant disorder), problem severity (moderate, severe), and student gender (male, female). Data on school characteristics were extracted from the U.S. Department of Education database. Regression models indicated several significant associations of teacher demographic characteristics and school characteristics with vignette ratings. For example, female teachers were more likely than males to rate vignettes as concerning, and middle school teachers were more likely than high school teachers to indicate they would refer students for mental health services. Teachers in schools with a higher proportion of Black students rated depression vignettes as less serious and indicated they were less likely to refer students for mental health services than teachers in majority white schools. Results suggest school characteristics may contribute to established disparities in mental health service access. Findings have implications for targeting mental health supports in schools.

Preschool teachers’ knowledge, beliefs, and self-efficacy concerning autism: A parallel mixed-methods study of an intervention to improve autism identification

“…Obeid et al (2015) and van‘t Hof et al (2020) confirmed the absence of a relationship between stigma and knowledge, suggesting that stigma and beliefs must be tackled directly, rather than being addressed by increasing knowledge. However, Green et al (2022) highlighted that a single training approach might not be equally practical for different school and cultural contexts. For instance, in the United States, knowledge of autism is higher and stigma towards autism is lower than in Lebanon (Obeid et al, 2015).…”

U.S. Middle and High School Teacher Attributions of Externalizing Student Behavior

“…Participants were middle and high school teachers recruited from a sample of schools across the United States (Green et al, 2022). To identify teachers, we downloaded a list of all U.S. public middle and high schools from the Department of Education website and stratified by region of the country and urbanicity.…”

“…These final vignettes were 100-130 words with symptom descriptions based on ODD criteria from the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5; American Psychiatric Association [APA], 2013). Subsequently, we validated the vignettes using data from 14 clinical and research experts in child and adolescent mental health and data from 100 school psychologists recruited from the National Association of School Psychologists mailing list (Green et al, 2022). This validation process was used to confirm that the "severe" vignettes reflected greater impairment than the "moderate" vignettes and that the vignettes were considered realistic.…”

“…According to the Gateway Provider Model (Stiffman et al, 2004), teacher decision-making is influenced by factors including (a) students’ need for services, (b) student predisposing characteristics (e.g., gender, race/ethnicity, risk factors), (c) enabling factors (e.g., service availability and acceptability), and (d) structural characteristics (e.g., characteristics of the organization). Prior studies have focused on students’ need for services and student predisposing characteristics, finding that both have important associations with whether teachers provide mental health referrals (Green et al, 2018; Headley & Campbell, 2011; Loades & Mastroyannopoulou, 2010; Splett et al, 2019). Less well known is how organizational structures of schools may be associated with whether teachers decide to respond supportively or punitively.…”