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Emotional/behavioral difficulties and mental health service contacts of students in special education for non-mental health problems.

Article Excerpt
Mental health (MH) disorders are now recognized as leading health concerns for youth in the United States. While studies of child psychiatric disorders in the United States have reported widely varying prevalence estimates, recent reviews of these research studies gauge the median prevalence of functionally impairing psychiatric disorders in youth to be about 12%. (1,2) Among youth with impairing MH problems, it is well documented that many do not receive MH services. (3,4) Those youth who do receive MH services obtain these services in a variety of settings including private health care offices, hospital outpatient clinics, community clinics, and schools. (5-8) Often, schools are the first setting in which MH problems are identified. (6) Schools are also the major providers of many basic MH treatment services including assessment of MH problems, behavior management consultation, crisis intervention, and referral to specialized programs such as family therapy. Services offered by schools include services provided by school staff and often services from community-based MH providers. (9)

Within schools, special education programs have emerged as important providers of services for youth with MH problems. From its inception, the Individuals with Disabilities Education Act (IDEA) has included "emotional disturbance" as 1 of the conditions entitling students to special education services. (10) In 1991, Attention Deficit Hyperactivity Disorder was recognized as a behavioral condition in the "Other Health Impairment" category that could qualify students for special education services, thus increasing the number of students entitled to special education services. (11) There has also been increasing recognition of the MH needs of students who receive special education services because of non-MH conditions. (12) Along with these changes in special education, there has been a growing awareness of the importance of MH services for all youth. As the recent report of the President's New Freedom Commission on Mental Health notes, there is a need to improve and expand school MH programs so that appropriate MH services are available to all school-age youth. (13)

The present study focuses on the lack of recent MH service contacts of students in special education for non-MH problems who have parent reports of impairing emotional/behavioral difficulties. The lack of recent MH service contacts of these students was compared with the experience of 2 other groups of youth with impairing emotional/behavioral difficulties: students in special education for MH problems and youth not in special education.

METHODS

Sample

The analysis was based on responses for children aged 6-17 years from the 2001, 2003, and 2004 National Health Interview Survey (NHIS). The NHIS is an ongoing survey, conducted by the National Center for Health Statistics, of a nationally representative sample of the US civilian noninstitutionalized population. Health and sociodemographic information are collected for all sample household members. Additional information is obtained for 1 randomly selected child in each family from an adult in the household who is knowledgeable about the child's health and use of health care services. Because over 90% of the respondents for sample children were parents, the respondent is referred to as a parent. Each year approximately 14,000 children are selected for the NHIS Sample Child Questionnaire. In 2001, 2003, and 2004, the final response rate for the Sample Child Questionnaire ranged from 79% to 81% (information about the NHIS is available at http://www.cdc.gov/nchs/nhis.htm). (14)

Supplements about special topics are periodically added to the NHIS. In 2001, 2003, and 2004, the NHIS included a set of detailed questions from the extended version of the Strengths and Difficulties Questionnaire (SDQ) to assess child MH. In 2002, these detailed questions about child MH were not included. To increase the reliability of estimates, data from 2001, 2003, and 2004 were combined. The analysis was based on information for 25,122 youth.

Measures

Special Education Groups. Parents were asked if a youth currently received special education services. If parents responded affirmatively, they were asked if the youth received these services for an emotional/ behavioral problem. Youth were classified into 3 groups based on the answers to the 2 questions about the use of special education services: (1) youth in special education for non-MH problems, (2) youth in special education for MH problems, and (3) youth not in special education.

Sociodemographic Variables. Parents provided information about the youth's age, sex, race/ethnicity, health insurance coverage, and family income. The following Hispanic origin and racial categories were used: Hispanic (any race or races), non-Hispanic black (single race), non-Hispanic white (single race), and other non-Hispanic racial groups. A hierarchy of 3 mutually exclusive categories was developed to describe health insurance coverage at the time of interview. The first category includes youth with private coverage (any comprehensive plan) and public insurance other than Medicaid or State Children's Health Insurance Program (SCHIP). Youth in this category may also have Medicaid or SCHIP coverage. The second category includes youth who only have coverage through Medicaid or other need-based state-sponsored health plans such as SCHIP. The third category includes uninsured youth who are not covered by any of the types of private or public health insurance included in the first and second categories....

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