A Residents' Program for Educating Adolescents About Mental Health Issues lohn H. Coverdale, M.B., Ch.B. lohn Battaglia, M.D. Craig P. Bushong, M.D.
This paper describes a school-based program in which psychiatry residents educate adolescents about a variety ofmental health topics. Adolescents responded positively to theprogram andwere principally concerned about drugs, depression, suicide, andfamily problems. Residents also liked presenting in theschools. Participation in this program allowed residents to learn about agency consultation andsecondary prevention. Possibilities for program expansion are discussed.
O
ver the past several decades, access to adult activities (for example, drinking alcohol) by youths in the United States has increased without a comparable increase in preparation for these experiences. Psychiatrie and behavioral problems have replaced infectious disease as the major cause in this country of adolescent morbidity and mortality . Increasingly, adolescent lifestyle and risk-taking behaviors have contributed to the so-calIed "new morbidities" of youth, such as depression, substance abuse, physical and sexual abuse, and teenage pregnancy (1). In response to these urgent mental From the Department of Psychiatry and Behavioral Seiences. Baylor College of Medicine, Houston, Texas. Dr. Coverdale is an adjunct assistant professor and Dr, Bushong is a clinical assistant professor at Baylor . Dr . Battaglia is now an assistant professor of psychiatry at the University of Texas Southwestern Medical Center at Dallas. Address reprint requests to Dr . Battaglia, Department of Psychiatry, University of Texas, Southwestern Medical Center, 5161 Harry Hines Blvd ., Dallas, Texas 75235. Copyright © 1991 Academic Psychiatry.
I,,,
health problems, psychiatry residents from the Baylor College of Medicine and University of Texas, Houston, developed an educative intervention program for adolescents within public middle and high schools (1986). The program was intended primarily to benefit students by educating them on pertinent mental health issues and facilitating their ability to obtain treatment (secondary prevention). Goals for the psychiatry residents included learning about secondary prevention and working in the school system as consultants. In this paper we will describe how this program met these goals. The program was initiated by one of the authors (J.B.) and was developed and implemented entirely by psychiatry residents in the PGY-1 through PGY-4 levels of training, including child psychiatry fellows. This involved networking within and between several agencies.The residents first obtained authorization from training directors and department chiefs to participate in the program. Each resident also obtained permission from clinical site supervisors \ , 'I
~
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(attendings) to spend approximately onehalf of a regular workday at the schools. Faculty from the Department of Psychiatry served solely in an advisory capacity for this program. Authorization to work in the schools was obtained from the Houston Independent School Distriet Volunteers In Public Schools (VIPS)program. The residents' program was registered in the American Psychiatrie Association's Mentallllness Awareness Week (MIAW) activities schedule and was integrated into the speakers' bureau of the local psychiatrie society. One resident was subsequently invited to become a member of the public affairs committee of the local psychiatrie society.These communications were particularly important because they facilitated a good working relationship between the public schools and the psychiatrie community. The offices of public affairs at the Baylor College of Medicine and the University ofTexas, Houston, helped promote and follow the event through interviews with residents, news releases, and live coverage at the schools during the program's implementation. Once this network was established, initiation and training for the program began. Middle and high school teachers received flyers announcing that psychiatrie physicians were available during Mental Illness Awareness Week to speak with students about topics such as psychiatry, drugs, alcohol, suicide, and depression. The teachers requested presentations through VIPS, and the VIPS representatives scheduled these with the psychiatry residents. In preparation for the program, the psychiatry residents developed three training sessions. The first reviewed the procedure of contacting schools, teachers, and school counselors. It also addressed legal and public affairs issues, such as how to handle the student who reports suicidal feelings during the presentation. In the seeond session, several residents presented information about teenage suicide, depression, aIcohol, and drug \l .\I)I \ ll( 1'-.,H IlI\ ll\'r
abuse. Articles on these topics and pamphlets, such as "Facts for Families about Teenage Suicide" and "Glossary of Mental Illness Affecting Teenagers" (American Academy of Child Psychiatry), were distributed and made available for distribution in the classrooms. The third session covered information on how to give a talk in the schools and addressed practical issues, such as working in noisy classrooms and dealing with disruptive students. Residents received an outline of suggested topics for each presentation. They were instructed to inform students that school counselors were available for help if needed. Resource manuals from the local mental health association were given for distribution to the school counselors. Students were assembled for the 45minute presentations in single classrooms, combined classrooms, or large assembly halls. By the residents' estimates, more than half the classes comprised 40 students or less. Over 1,000 students, grades 6 through 12, heard the presentations. The presentation styles of the residents varied, as did the levels of interaction between the residents and students, although the majority of presentations were in the form of a lecture/ discussion. PROGRAMEVALUATION The results of our evaluation of this program have been previously published (2) and show that the students liked the presentations, found them helpful, and desired to hear more about mental health issues. Also, the group of students who heard the presentations showed more favorable attitudes toward seeking help and toward psychiatrists than a comparison group of students who did not hear the talks. Thus, the program seems to serve a secondary prevention function by fostering more favorable attitudes toward seeking help. In this study, 19 of the 20 participating residents completed evaluation forms at the II '!
end of each of the 53 presentations during the program's first year. Residents were polled on how they felt when giving individual presentations and responded on a fivepoint Likert scale (1 = liked very much, 5 = disliked very much). They also rated both the interest of the students and of the teachers on a five-point Likert scale (1 = very positive, 5 = very negative) and specified whether or not the presentation was helpful to students. Residents were also asked to list the principal concems of the dass and any other comments about the presentation. The residents indicated that they liked giving nearly all (93%) of the presentations. They also perceived that 89% of the presentations were helpful to the students and that, during 45% of the presentations, student participation was active. Student responses were rated as being somewhat or very positive in 83% of the presentations, neutral in 15%, and negative in 2% (one presentation). Similarly, teacher responses were rated as being positive in 90% of the presentations and none were rated negatively. The residents' responses indicated that students were concemed about a wide variety of topics (see Table 1). Drugs were the most frequently cited concem, followed by depression and psychiatry. The residents al-
so stated that the presence of the teacher was inhibiting in 9% of presentations, that the use of clinical cases as examples facilitated discussion in 7%, and that it was difficult to engage students in 6% of the presentations. In a telephone follow-up to this study, 15 of the participating residents were contacted and asked whether or not the experience had helped them to leam about working in schools as a consultant and whether it had helped with their training. Eleven thought that they had leamed about working in schools as a consultant, and all but one thought the experience had helped with their training. The most frequent response (given by four residents) was that the experience helped with training by providing contact with normal children when exposure had been minimal previously. Other responses inc1uded that it "expanded our confidence in being community educators," that "it was really gratifying getting involved and being a role model," and that "1 learned about the huge psychiatrie need of people in the mainstream community. It gives you a sense of social duty." The one resident who said the experience did not help her with her training indicated that it was not new since she had done something similar before, although "otherwise it might have helped."
TABLE1. Residents' perception of students' prindpal concerns during each presentation
Concern Drugs Depression Suidde Family problems Psychiatry How to get help Stress Medical information Teenage pregnancy Sexuality
No.of
Presentations
Percent
32 9
60.3 17.0 15.1 13.2 13.2 11.3
8
7 7 6 4
7.5
4 3 3
7.5 5.7 5.7
Note: Total number of presentations=53. Residents could !ist more than one principal concern.
'r
COMMENTARY AND PROCRAM GROWTH
Residents said that they liked the experience of presenting and perceived that students were helped. They also rated students as being interested and noted that they were concemed about a wide range of topics. The finding that drugs were perceived to be the principal concem of students might not be surprising given the pervasiveness of drug abuse problems among this age group (1). Residents were specifically encouraged to talk about this topic, as well as about depression, suicide, psychiatry, and how to get help for problems. They were not specifically en, \ I,
', ' 1
.
...,
\
'
' I
I
.
"
.
"
,
couraged to talk about family problems, although this was a category that was highly ranked as a specific concern of students, indieating that this might be an area that warrants more attention. Working in the schools provides a unique training experience for the psychiatry resident. Public schools are microcosms of a larger community, complete with welldefined social systems and subcultures. The opportunity to learn about different social systems has been cited as an advantage to programs where residents act as consultants to individuals within schools (3,4). In the Houston program, residents have an opportunity for exposure to "alternative" schools with special populations, such as students with either academic or behavioral problems. Many of the schools also serve children from families of low socioeconomic status and minority populations. Working within these systems helps residents appreciate the powerful role of context and culture in a biopsychosocial model. Moreover, by donating time to work in the schools, the residents may enhance a fresh image of the psychiatrist as a caring professional willing to volunteer time to the community. This idea is supported by the finding that the students who heard the presentations had more positive attitudes toward psychiatrists than those who did not. Also, because residents encourage adolescents to recognize the signs and symptoms of psychiatrie disorders and infonn them of treatment options, it is hoped that the students would then obtain help more quiekly and easily should they need it. This goal of secondary prevention was supported by the evaluation data, which showed that student attitudes toward receiving help and seeing a psychiatrist were enhanced. Thus, residents may study the different models of preventive interventions in the schools and learn about their comparative effectiveness (5). This provides academic exposure to an area that has a large and sophisticated literature. Since 1986, the program has grown an\( \ 1)1 \ 1I( I''''') ( 111 \
II~ ')
nually so that by MIAW 1990,the number of students, schools, and residents participating had more than doubled. Now a resident is appointed each year at the Baylor College of Medicine Psychiatry Residency to the p0sition of "Psychiatrie Representative to the Public Sector" (PRPS).This position was created to manage the increasing demands of coordinating various agencies in this public sector work. The PRPS works with VIPSrepresentatives, psychiatry residency programs, psychiatrie societies, and public affairs offices to conduct the program annually. In addition to this scheduled event, the PRPS works with teachers, administrators, VIPS representatives, and counselors throughout the year on additional presentations, referral information, and consultation on special problems. (Other psychiatrie residents have also participated throughout the year in similar ways.) This work has included requests for involvement with the educational staff and community (for example, giving talks on "stress" to teacher groups and the PTA). In this way the psychiatry resident learns to be a consultant by helping with both case consultation and systems consultation (6). In fact, "agency consultation" is a requirement of the revised essentials for residency training, a requirement that has become increasingly difficult to accomplish with diminished support for residency education from community health centers. This experience may provide an opportunity for development of agency consultation while not requiring expenditure of departmental funds. At this time, residents obtain supervision for their experience from faculty advisers on an as needed basis. If the program grows to include greater consultation demands from the residents, a full-time faculty advisor would be needed to supervise the residents and guide them through the inevitable difficulties of agency consultation work. These difficulties would include triangulation between the school administration and teachers and handling demands for direct service (7). :. \
Several possible avenues exist for program expansion as agency consultation. Residents could be assigned to either one school or one grade in a school throughout the year. There is evidence that intervention programs are more likely to be effective if they involve more than a "one-shot" presentation and involve the wider community (8). Thus, it would be advisable to incorporate resident interventions with family members and community organizations such as police and church groups. Any such expansion is critically dependent on the continued good working relationship between an of these agencies and would require active support by the consultant. The residency training program would need to expand in a correlative manner to include didactics and seminars on agency consultation to human services organizations as wen as educational interventions with adolescents. These courses could be taught from the perspective of several disciplines, including social work, psychology, epidemiology, and public health. Although these avenues may allow for program growth, including an increased faculty involvement and structured training requirements, educational program administrators must evaluate these changes carefully for their impact on the program. Faculty involvement may, for example, detract from the experience, as the enthusiasm
and success of the program may rely heavily on its total implementation by the psychiatry residents. On the other hand, without formal departmental support, the program is vulnerable to the vicissitudes of residents' interests . This paper, in describing a resident-initiated and -operated educational program in public schools, has suggested ways in which both adolescent students and psychiatry residents may benefit. As described, the time commitment for the residents involved is minimal, and the financial restraints are negligible. If programs such as this were expanded, consideration must be given to the additional benefits that might accrue for residents (as wen as for the adolescent target group in the wider community) compared with the potential training burden that would result. In the meantime, the Houston program has demonstrated success and has met some educational needs of the psychiatry residents. Finally, any new program development should be guided by evaluative research. Our hope is that this paper will stimulate other psychiatry training programs to further develop school-based educational programs.
The authors thank 0,. James Lomax, who contributed to thisarticle.
References
1. Blurn R: Contemporary threats to adolescent health in the United States. JAMA 1987; 257:3390-3395 2. Battaglia J, Coverdale J, Bushong C: Evaluation of a mental illness awareness week program in publie schools. Am J Psychiatry 1990; 147:324-329 3. Powell G, Mesmer R:School consultation experience in a residency program. Hosp Community Psyehiatry 1973; 24:170-171 4. Berkovitz IH, Sinclair E:Teaehing ehild psychiatrists about intervention in school systems.Journal of Psychiatrie Education 1984; 8:240-245 5. Botvin GJ: Substance abuse prevention research:
I' ;
recent developments and future directions, J Sch Health 1986; 56:36~374 6. Nagler 5, Cook P: Same ideological eonsiderations underlying amental health consultation program to the publie schools. Community Ment Hea1th J 1973; 9:244-252 7. Jellinek MS: School eonsultation: evolving issues. J Am Acad Child Adolesc Psychiatry 1990; 29:311-314 8. Pentz MA, Dwyer]H, Mackinnon DP, et al: A multicommunity tria1 for primary prevention of adolescent drug abuse. JAMA 1989; 261 :3~3266
\ \ )i ~
\ I ! :, . \. i \ J I ~ I
I, ' •
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This paper describes a school-based program in which psychiatry residents educate adolescents about a variety ofmental health topics. Adolescents responded positively to theprogram andwere principally concerned about drugs, depression, suicide, andfamily problems. Residents also liked presenting in theschools. Participation in this program allowed residents to learn about agency consultation andsecondary prevention. Possibilities for program expansion are discussed.
O
ver the past several decades, access to adult activities (for example, drinking alcohol) by youths in the United States has increased without a comparable increase in preparation for these experiences. Psychiatrie and behavioral problems have replaced infectious disease as the major cause in this country of adolescent morbidity and mortality . Increasingly, adolescent lifestyle and risk-taking behaviors have contributed to the so-calIed "new morbidities" of youth, such as depression, substance abuse, physical and sexual abuse, and teenage pregnancy (1). In response to these urgent mental From the Department of Psychiatry and Behavioral Seiences. Baylor College of Medicine, Houston, Texas. Dr. Coverdale is an adjunct assistant professor and Dr, Bushong is a clinical assistant professor at Baylor . Dr . Battaglia is now an assistant professor of psychiatry at the University of Texas Southwestern Medical Center at Dallas. Address reprint requests to Dr . Battaglia, Department of Psychiatry, University of Texas, Southwestern Medical Center, 5161 Harry Hines Blvd ., Dallas, Texas 75235. Copyright © 1991 Academic Psychiatry.
I,,,
health problems, psychiatry residents from the Baylor College of Medicine and University of Texas, Houston, developed an educative intervention program for adolescents within public middle and high schools (1986). The program was intended primarily to benefit students by educating them on pertinent mental health issues and facilitating their ability to obtain treatment (secondary prevention). Goals for the psychiatry residents included learning about secondary prevention and working in the school system as consultants. In this paper we will describe how this program met these goals. The program was initiated by one of the authors (J.B.) and was developed and implemented entirely by psychiatry residents in the PGY-1 through PGY-4 levels of training, including child psychiatry fellows. This involved networking within and between several agencies.The residents first obtained authorization from training directors and department chiefs to participate in the program. Each resident also obtained permission from clinical site supervisors \ , 'I
~
\1 : , - . \. l \II'.! I, ) . I \11
["li
( ( l\" ] 1\1)\11 I ; \/
(attendings) to spend approximately onehalf of a regular workday at the schools. Faculty from the Department of Psychiatry served solely in an advisory capacity for this program. Authorization to work in the schools was obtained from the Houston Independent School Distriet Volunteers In Public Schools (VIPS)program. The residents' program was registered in the American Psychiatrie Association's Mentallllness Awareness Week (MIAW) activities schedule and was integrated into the speakers' bureau of the local psychiatrie society. One resident was subsequently invited to become a member of the public affairs committee of the local psychiatrie society.These communications were particularly important because they facilitated a good working relationship between the public schools and the psychiatrie community. The offices of public affairs at the Baylor College of Medicine and the University ofTexas, Houston, helped promote and follow the event through interviews with residents, news releases, and live coverage at the schools during the program's implementation. Once this network was established, initiation and training for the program began. Middle and high school teachers received flyers announcing that psychiatrie physicians were available during Mental Illness Awareness Week to speak with students about topics such as psychiatry, drugs, alcohol, suicide, and depression. The teachers requested presentations through VIPS, and the VIPS representatives scheduled these with the psychiatry residents. In preparation for the program, the psychiatry residents developed three training sessions. The first reviewed the procedure of contacting schools, teachers, and school counselors. It also addressed legal and public affairs issues, such as how to handle the student who reports suicidal feelings during the presentation. In the seeond session, several residents presented information about teenage suicide, depression, aIcohol, and drug \l .\I)I \ ll( 1'-.,H IlI\ ll\'r
abuse. Articles on these topics and pamphlets, such as "Facts for Families about Teenage Suicide" and "Glossary of Mental Illness Affecting Teenagers" (American Academy of Child Psychiatry), were distributed and made available for distribution in the classrooms. The third session covered information on how to give a talk in the schools and addressed practical issues, such as working in noisy classrooms and dealing with disruptive students. Residents received an outline of suggested topics for each presentation. They were instructed to inform students that school counselors were available for help if needed. Resource manuals from the local mental health association were given for distribution to the school counselors. Students were assembled for the 45minute presentations in single classrooms, combined classrooms, or large assembly halls. By the residents' estimates, more than half the classes comprised 40 students or less. Over 1,000 students, grades 6 through 12, heard the presentations. The presentation styles of the residents varied, as did the levels of interaction between the residents and students, although the majority of presentations were in the form of a lecture/ discussion. PROGRAMEVALUATION The results of our evaluation of this program have been previously published (2) and show that the students liked the presentations, found them helpful, and desired to hear more about mental health issues. Also, the group of students who heard the presentations showed more favorable attitudes toward seeking help and toward psychiatrists than a comparison group of students who did not hear the talks. Thus, the program seems to serve a secondary prevention function by fostering more favorable attitudes toward seeking help. In this study, 19 of the 20 participating residents completed evaluation forms at the II '!
end of each of the 53 presentations during the program's first year. Residents were polled on how they felt when giving individual presentations and responded on a fivepoint Likert scale (1 = liked very much, 5 = disliked very much). They also rated both the interest of the students and of the teachers on a five-point Likert scale (1 = very positive, 5 = very negative) and specified whether or not the presentation was helpful to students. Residents were also asked to list the principal concems of the dass and any other comments about the presentation. The residents indicated that they liked giving nearly all (93%) of the presentations. They also perceived that 89% of the presentations were helpful to the students and that, during 45% of the presentations, student participation was active. Student responses were rated as being somewhat or very positive in 83% of the presentations, neutral in 15%, and negative in 2% (one presentation). Similarly, teacher responses were rated as being positive in 90% of the presentations and none were rated negatively. The residents' responses indicated that students were concemed about a wide variety of topics (see Table 1). Drugs were the most frequently cited concem, followed by depression and psychiatry. The residents al-
so stated that the presence of the teacher was inhibiting in 9% of presentations, that the use of clinical cases as examples facilitated discussion in 7%, and that it was difficult to engage students in 6% of the presentations. In a telephone follow-up to this study, 15 of the participating residents were contacted and asked whether or not the experience had helped them to leam about working in schools as a consultant and whether it had helped with their training. Eleven thought that they had leamed about working in schools as a consultant, and all but one thought the experience had helped with their training. The most frequent response (given by four residents) was that the experience helped with training by providing contact with normal children when exposure had been minimal previously. Other responses inc1uded that it "expanded our confidence in being community educators," that "it was really gratifying getting involved and being a role model," and that "1 learned about the huge psychiatrie need of people in the mainstream community. It gives you a sense of social duty." The one resident who said the experience did not help her with her training indicated that it was not new since she had done something similar before, although "otherwise it might have helped."
TABLE1. Residents' perception of students' prindpal concerns during each presentation
Concern Drugs Depression Suidde Family problems Psychiatry How to get help Stress Medical information Teenage pregnancy Sexuality
No.of
Presentations
Percent
32 9
60.3 17.0 15.1 13.2 13.2 11.3
8
7 7 6 4
7.5
4 3 3
7.5 5.7 5.7
Note: Total number of presentations=53. Residents could !ist more than one principal concern.
'r
COMMENTARY AND PROCRAM GROWTH
Residents said that they liked the experience of presenting and perceived that students were helped. They also rated students as being interested and noted that they were concemed about a wide range of topics. The finding that drugs were perceived to be the principal concem of students might not be surprising given the pervasiveness of drug abuse problems among this age group (1). Residents were specifically encouraged to talk about this topic, as well as about depression, suicide, psychiatry, and how to get help for problems. They were not specifically en, \ I,
', ' 1
.
...,
\
'
' I
I
.
"
.
"
,
couraged to talk about family problems, although this was a category that was highly ranked as a specific concern of students, indieating that this might be an area that warrants more attention. Working in the schools provides a unique training experience for the psychiatry resident. Public schools are microcosms of a larger community, complete with welldefined social systems and subcultures. The opportunity to learn about different social systems has been cited as an advantage to programs where residents act as consultants to individuals within schools (3,4). In the Houston program, residents have an opportunity for exposure to "alternative" schools with special populations, such as students with either academic or behavioral problems. Many of the schools also serve children from families of low socioeconomic status and minority populations. Working within these systems helps residents appreciate the powerful role of context and culture in a biopsychosocial model. Moreover, by donating time to work in the schools, the residents may enhance a fresh image of the psychiatrist as a caring professional willing to volunteer time to the community. This idea is supported by the finding that the students who heard the presentations had more positive attitudes toward psychiatrists than those who did not. Also, because residents encourage adolescents to recognize the signs and symptoms of psychiatrie disorders and infonn them of treatment options, it is hoped that the students would then obtain help more quiekly and easily should they need it. This goal of secondary prevention was supported by the evaluation data, which showed that student attitudes toward receiving help and seeing a psychiatrist were enhanced. Thus, residents may study the different models of preventive interventions in the schools and learn about their comparative effectiveness (5). This provides academic exposure to an area that has a large and sophisticated literature. Since 1986, the program has grown an\( \ 1)1 \ 1I( I''''') ( 111 \
II~ ')
nually so that by MIAW 1990,the number of students, schools, and residents participating had more than doubled. Now a resident is appointed each year at the Baylor College of Medicine Psychiatry Residency to the p0sition of "Psychiatrie Representative to the Public Sector" (PRPS).This position was created to manage the increasing demands of coordinating various agencies in this public sector work. The PRPS works with VIPSrepresentatives, psychiatry residency programs, psychiatrie societies, and public affairs offices to conduct the program annually. In addition to this scheduled event, the PRPS works with teachers, administrators, VIPS representatives, and counselors throughout the year on additional presentations, referral information, and consultation on special problems. (Other psychiatrie residents have also participated throughout the year in similar ways.) This work has included requests for involvement with the educational staff and community (for example, giving talks on "stress" to teacher groups and the PTA). In this way the psychiatry resident learns to be a consultant by helping with both case consultation and systems consultation (6). In fact, "agency consultation" is a requirement of the revised essentials for residency training, a requirement that has become increasingly difficult to accomplish with diminished support for residency education from community health centers. This experience may provide an opportunity for development of agency consultation while not requiring expenditure of departmental funds. At this time, residents obtain supervision for their experience from faculty advisers on an as needed basis. If the program grows to include greater consultation demands from the residents, a full-time faculty advisor would be needed to supervise the residents and guide them through the inevitable difficulties of agency consultation work. These difficulties would include triangulation between the school administration and teachers and handling demands for direct service (7). :. \
Several possible avenues exist for program expansion as agency consultation. Residents could be assigned to either one school or one grade in a school throughout the year. There is evidence that intervention programs are more likely to be effective if they involve more than a "one-shot" presentation and involve the wider community (8). Thus, it would be advisable to incorporate resident interventions with family members and community organizations such as police and church groups. Any such expansion is critically dependent on the continued good working relationship between an of these agencies and would require active support by the consultant. The residency training program would need to expand in a correlative manner to include didactics and seminars on agency consultation to human services organizations as wen as educational interventions with adolescents. These courses could be taught from the perspective of several disciplines, including social work, psychology, epidemiology, and public health. Although these avenues may allow for program growth, including an increased faculty involvement and structured training requirements, educational program administrators must evaluate these changes carefully for their impact on the program. Faculty involvement may, for example, detract from the experience, as the enthusiasm
and success of the program may rely heavily on its total implementation by the psychiatry residents. On the other hand, without formal departmental support, the program is vulnerable to the vicissitudes of residents' interests . This paper, in describing a resident-initiated and -operated educational program in public schools, has suggested ways in which both adolescent students and psychiatry residents may benefit. As described, the time commitment for the residents involved is minimal, and the financial restraints are negligible. If programs such as this were expanded, consideration must be given to the additional benefits that might accrue for residents (as wen as for the adolescent target group in the wider community) compared with the potential training burden that would result. In the meantime, the Houston program has demonstrated success and has met some educational needs of the psychiatry residents. Finally, any new program development should be guided by evaluative research. Our hope is that this paper will stimulate other psychiatry training programs to further develop school-based educational programs.
The authors thank 0,. James Lomax, who contributed to thisarticle.
References
1. Blurn R: Contemporary threats to adolescent health in the United States. JAMA 1987; 257:3390-3395 2. Battaglia J, Coverdale J, Bushong C: Evaluation of a mental illness awareness week program in publie schools. Am J Psychiatry 1990; 147:324-329 3. Powell G, Mesmer R:School consultation experience in a residency program. Hosp Community Psyehiatry 1973; 24:170-171 4. Berkovitz IH, Sinclair E:Teaehing ehild psychiatrists about intervention in school systems.Journal of Psychiatrie Education 1984; 8:240-245 5. Botvin GJ: Substance abuse prevention research:
I' ;
recent developments and future directions, J Sch Health 1986; 56:36~374 6. Nagler 5, Cook P: Same ideological eonsiderations underlying amental health consultation program to the publie schools. Community Ment Hea1th J 1973; 9:244-252 7. Jellinek MS: School eonsultation: evolving issues. J Am Acad Child Adolesc Psychiatry 1990; 29:311-314 8. Pentz MA, Dwyer]H, Mackinnon DP, et al: A multicommunity tria1 for primary prevention of adolescent drug abuse. JAMA 1989; 261 :3~3266
\ \ )i ~
\ I ! :, . \. i \ J I ~ I
I, ' •
I \ i I i " '!I
