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Facilitating Mental Health Promotion and Early Detection of At Risk Youth. D. A. Santor, Ph.D. Provincial Centre of Excellence for Child and Youth Mental Health School of Psychology University of Ottawa Ottawa, Canada.

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facilitating mental health promotion and early detection of at risk youth

Facilitating Mental Health Promotion and Early Detection of At Risk Youth

D. A. Santor, Ph.D.Provincial Centre of Excellence for Child and Youth Mental Health School of PsychologyUniversity of OttawaOttawa, Canada

A. Bagnell, MD. Maritime Psychiatry IWK Health Centre Dalhousie UniversityHalifax, Canada


Intensive Treatment


Selected Intervention

Indicated Intervention

Severity + Impairment + Resources



At Risk

Q: How do we allocate resources?







Two Challenges:


Current Strategies to address Mental Health Difficulties in schools

school based health centres

mass screening

universal mental health interventions


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)


Less than 1/5 of young people with distress or mental health problems causing impairment visit school health centres

What proportion of young people with difficulties actually use school based health centres?

Santor, LeBlanc , Poulin, Kusumukar (2005b)


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.”



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).


US Task Force on Prevention (1996).

… insufficient evidence to support use of mass screening in either adults or children.

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.

school factors affecting base rates
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.


symptom course



Factors Affect Screening (3): Symptom Course


Strategy 3. School Based Programs

1. Universal – everybody participates

2. Selective – at risk

3. Indicated – early signs



Universal Programs δ= 0.12

Selective Prevention δ = 0.30

Indicated Prevention δ = 0.23


How do we improve the effectiveness of universal programs?

 improve knowledge up take

 monitor implementation continuously

 extend learning beyond the classroom


Maximizing the Impact, Uptake and Sustainability of School Based Health and Mental Health Initiatives with On-line resources

Santor and Bagnell (2008)

is the internet a viable delivery system

Is the internet a viable delivery system

75 percent of adolescents have used the internet to locate health information online, slightly more than the numbers downloading music and playing games

more than half of all young people may prefer to obtain health information online as opposed to other media

 99% of youth had access to the internet and that 79% of youth had internet access at home.


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??


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!


Annual Health and Motivation for Learning Survey

School Climate Measure

... Evaluation


How is the Resource Used by Young People?

Utilization Data (N = 500 – or one typical school)

Santor, LeBlanc , Poulin, Kusumukar (2005c)


30 Logons

This group of young people scored higher on measures of depression and difficulties

How is the Resource Used Throughout the Day?

Santor, LeBlanc , Poulin, Kusumukar (2005c)


Mean number of visits

Number of visitors

Number of visits

How is the Resource Used Throughout the Year?

Santor, LeBlanc , Poulin, Kusumukar (2005c)


Results: Screening On-Demand

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.


Monthly Evaluation


WorkShop 1

WorkShop 2

+ eLearning

WorkShop 3

+ No eLearning


Schools currently implementing YooMagazine Health and Mental Health Literacy Program Total Number of Schools: 100

Total Number of Students with access: 25,000 +

Total Number of Teachers: 1000 +


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