Collaborations and Communication: A School-Based Depression Prevention & Intervention Program
Depression is a common problem among adolescents. The average age for a first onset of depression is 15, and about 20 percent of teens will have experienced significant depressive symptoms by the time they are 18. Suicide is the second leading cause of death among adolescents in the U.S. Research indicates that 16 percent of U.S. adolescents report seriously considering suicide in a one-year period, and eight percent of U.S. adolescents report making a suicide attempt. Studies have found that more than 50 percent of adolescents who committed suicide had a mood disorder at the time. Building on her ongoing depression prevention and intervention work with adolescents, Gladstone and her clinical research team are working with two Greater Boston towns to pilot in-school screenings.
Three years ago, you started working with the Natick Public Schools to pilot a depression screening and prevention program. How did that partnership begin?
The MetroWest Health Foundation approached me after they heard about a talk I had given at the Harvard School of Public Health about my depression prevention work. They were particularly interested in adolescent mental health because they knew from their own community surveys that this was a concern in the region, as it is throughout the U.S. The challenges youth face when they experience depression include difficult relationships with their families and peers, impaired school and work performance, increased risk for substance abuse, and increased suicidal behavior. The effects can persist across their lifetimes.
Marty Cohen, the president of the MetroWest Community Healthcare Foundation, was particularly interested in CATCH-IT, the internet-based depression prevention program I’ve been working on with colleagues from the University of Illinois at Chicago. But, CATCH-IT was designed for collaboration with primary care providers and wasn’t set up for schools. So I proposed another idea that built off some of our initial findings from our work on the CATCH-IT study. We had been surprised to find so many youth interested in our CATCH-IT intervention; when talking to us during phone screenings*, they were very forthcoming about their moods and mental health. We had identified several teens who not only showed signs of past depressive symptoms, but were actively depressed and even having suicidal thoughts. The phone screenings were critical to catching students who had NOT spoken to their parents or doctors about this, and we were able to get them referrals to services quickly. I remember thinking, “We should be talking to teens routinely.”
Marty Cohen liked the idea of trying similar screenings in a local high school and connected me with Dr. Peter Sanchioni, superintendent of Natick Public Schools. We had several great meetings with key partners in the school and community to plan the pilot, and with funding from the Foundation, we did so in 2015.
What did the program look like—how did you implement it?
When we started with Natick High, we wanted to increase mental health literacy in the school community—the students, teachers, school staff, and parents. We also wanted to prepare the community for a broad-based screening and intervention approach to both youth depression and suicidal behavior. With parental permission, we aimed to provide phone screening for all teens in the school community. And we were set up to conduct periodic follow-up assessments for all referred teens.
Before we even began the screening, though, we did a lot of educating. We held meetings with parents, school personnel, and students where we presented educational material on depression and how to recognize signs of suicide risk. We hung posters around the school to try to address the stigma of depression and to let the teens know how they could find us. And we connected with INTERFACE, a referral service at William James College, to make sure that there was a network of qualified practitioners for any teen in need.
What were the key findings that first year?
We learned a lot. Most important, there were several teens we identified as at risk, and we were able to get them connected to services confidentially. I think this was also important because the students hadn’t told even those teachers, guidance counselors, and other school staff with whom they had good relationships about their depressive symptoms or suicidal thoughts. This was the same result we had found when conducting phone screenings prior to enrolling teens in our CATCH-IT study. Adolescents were surprisingly open to talking with a caring professional they didn’t know, but who took the time to ask very specific screening questions. Over time, even previously skeptical community members became more receptive to the screenings. We had a lot of grateful parents, grateful teachers, and a lot of buy-in from the school.
While we intended to phone screen all the kids in the school, we quickly learned that phones were not the way to go. We were trying a kind of “cold call” effort with lots of teens and parents, and we were having a hard time reaching enough of them. We spent a lot of time chasing down parents to get consent, and we also learned that teens just don’t talk on the phone anymore; they text. Not everyone had home phones either. Parents were saying “You should just talk to them in school, they’ll talk to you in school, but you’re not going to get them on the phone.” We thus got IRB** approval to do just that. During the second half of the year we connected with many more students at school.
Tracy R. G. Gladstone, Ph.D., is an associate director and senior research scientist at the Wellesley Centers for Women as well as the inaugural director of the Robert S. and Grace W. Stone Primary Prevention Initiatives, which aims to research, develop, and evaluate programs to prevent the onset of depression and other mental health concerns in children and adolescents. Gladstone is also an assistant in psychology at Boston Children’s Hospital, an instructor at Harvard Medical School, and a research scientist at Judge Baker Children’s Center.