A systematic review of effectiveness and cost-effectiveness of school-based identification of children and young people at risk of, or currently experiencing mental health difficulties

• Published in: Psychological medicine Vol. 49; no. 1; p. 9
• Main Authors: Anderson, Joanna K, Ford, Tamsin, Soneson, Emma, Coon, Jo Thompson, Humphrey, Ayla, Rogers, Morwenna, Moore, Darren, Jones, Peter B, Clarke, Emmet, Howarth, Emma
• Format: Journal Article
• Language: English
• Published: England 01-01-2019
• Subjects: Adolescent; Child; Child, Preschool; Cost-Benefit Analysis; Humans; Mental Disorders - diagnosis; Outcome and Process Assessment, Health Care; Schools; mental wellbeing; screening; education; identification; children; schools; mental health; students; young people
• ISSN: 1469-8978
• DOI: 10.1017/S0033291718002490

Although school-based programmes for the identification of children and young people (CYP) with mental health difficulties (MHD) have the potential to improve short- and long-term outcomes across a range of mental disorders, the evidence-base on the effectiveness of these programmes is underdeveloped. In this systematic review, we sought to identify and synthesise evidence on the effectiveness and cost-effectiveness of school-based methods to identify students experiencing MHD, as measured by accurate identification, referral rates, and service uptake.
Electronic bibliographic databases: MEDLINE, Embase, PsycINFO, ERIC, British Education Index and ASSIA were searched. Comparative studies were included if they assessed the effectiveness or cost-effectiveness of strategies to identify students in formal education aged 3-18 years with MHD, presenting symptoms of mental ill health, or exposed to psychosocial risks that increase the likelihood of developing a MHD.
We identified 27 studies describing 44 unique identification programmes. Only one study was a randomised controlled trial. Most studies evaluated the utility of universal screening programmes; where comparison of identification rates was made, the comparator test varied across studies. The heterogeneity of studies, the absence of randomised studies and poor outcome reporting make for a weak evidence-base that only generate tentative conclusions about the effectiveness of school-based identification programmes.
Well-designed pragmatic trials that include the evaluation of cost-effectiveness and detailed process evaluations are necessary to establish the accuracy of different identification models, as well as their effectiveness in connecting students to appropriate support in real-world settings.