Youth mental health screening in schools and pathways to care for at-risk students

Schools (n=100) from a broad range of social, regional and economic areas will be invited to participate in the project. Once schools have volunteered to participate, the schools will be randomly assigned to either receive immediate screening (experimental group; n=50) or delayed screening (control group; delayed by 9 months; n=50). Students in Years 4-11 in the immediate screening group will complete a mental health screening tool, consisting of a series of questions relating to their mental health. The screening tool will be delivered through an online survey system (REDCap) during PDHPE/health class at school (overseen by a health/welfare teacher, with the school psychologist available for additional support at the time of screening, should students need it). This initial screening tool will consist of a large pool of items, taken from a range of standard emotional health questionnaires - Spence Children’s Anxiety Scale (SCAS; Spence, 1998), Child Anxiety Life Interference Scale (CALIS; Lyneham et al., 2013), Personal Experiences Checklist – Short Form (PECK-SF; Prinz, Costa, Chervonsky, & Hunt, 2019), RADAR (Child and Youth versions; Burns & Rapee, 2016, 2019), Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997), Epworth Sleepiness Scale (ESS; Johns, 1991), Adolescent Sleep Hygiene Scale (ASHS; LeBourgeois et al., 2005), Child Health Utility instrument (CHU-9D; Stevens, 2008), and the Eating Disorder Examination Questionnaire (EDE-Q; Fairburn & Beglin, 2008). This screening tool will take approximately 30 minutes for students to complete. Adherence will be monitored by utilising REDCap website analytics that measure survey commencement and completion (partial or total). Ultimately, this large set of items will be reduced to a small set of the best possible items and will form the final brief screener. We envisage that the final brief screener will take no more than 10 minutes for students to complete. To validate our screening tool, students and parents will be invited to be interviewed by a clinical psychologist using structured diagnostic interviews (the current gold standard for diagnosis of mental health disorders) – we will use the Anxiety Disorders Interview Schedule, Child and Parent version to diagnose anxiety and mood disorders, which will be augmented with the eating disorders section from the KSADS and self-harm items from the Deliberate Self-Harm Inventory. Additionally, parents will be asked to complete an online survey with measures of prior help-seeking, quality of life and attitudes towards acceptability of school screening. We will also ask to access school data on student school attendance and academic performance, as these are known correlates with mental health issues. These will serve as validators to the screening tool so we can assess how accurately our screener identifies at-risk youth. The final brief screener will be developed based on these validators and Item Response Theory analysis. We will identify those students who score in the “at-risk” range on any measure of emotional health problems as soon as possible after screening and communicate this to schools (for students identified as at-risk of suicide or self-harm, identification and communication to schools will be immediate - within 24 hours). School psychologists and welfare teachers will work with identified students and their families to offer pathways to relevant support services, according to the most accepted and approved processes identified by key stakeholders (students, parents, school staff, mental health clinicians, and policy makers). Approximately 9 months later, students in the immediate screening group will complete the final brief screener. At this same time, students allocated to the delayed screening group will complete the final brief screener for the first time. This will allow a direct comparison of the emotional health and professional help-seeking between students whose schools had engaged in the screening and pathways to care process (experimental group) and those whose schools had not engaged in the process (control group). Students in the delayed screening group will complete the screener for a second time approximately 6 months later.