Teachers and main contacts in residential youth care institutions' report of mental health problems among adolescents

Objectives: Adolescents living in Residential Youth Care (RYC) institutions are generally less successful later in life than other children across a wide range of areas, including poor education. It is important to identify... [ view full abstract ]

Objectives: Adolescents living in Residential Youth Care (RYC) institutions are generally less successful later in life than other children across a wide range of areas, including poor education. It is important to identify factors that increase healthy school adaption in order for these adolescents to accomplish school in a proper way since education is important for a successful adult life. They do not have parental educational support, and it is up to the institutional staff and teachers to fill this gap. Mental health problems are a serious hindrance for learning. How good are the main contact at the institutions and teachers at school at identifying the adolescents’ mental health problems? The aim of the present study was therefor to explore whether mental health problems, as assessed by a child and adolescent psychiatric diagnostic interview, among adolescents living in RYC institutions were detected by primary contacts at the institutions and teachers at school. The research question was whether the adolescents’ internalizing (affective and anxiety) disorders, externalizing (Conduct Disorder (CD)) and ADHD problems as reported by teachers and primary contacts were consistent with the diagnostic categories identified in the psychiatric diagnostic interview. As symptoms of externalizing (CD) problems and ADHD are more easily identified as disruptive, we hypothesized that teachers and primary contacts more easily detected these two categories than internalizing problems.
Method: All residents between the ages of 12-23 years living in RYC in Norway were invited to participate in the study. Of 601 available children, 201 refused participation, thus 400 children participated in the study, 230 girls, mean age=16.9, SD=1.2 and 170 boys, mean age=16.5, SD=1.5. The Child Behaviour Checklist (CBCL), Teacher’s Report Form (TRF) of the ASEBA and The Child and Adolescent Psychiatric Assessment (CAPA) were used. Sensitivity and specificity between these instruments are calculated. A ROC curve (receiver operating diagnostic curve) was constructed by connecting corresponding values of sensitivity and specificity for CBCL and TRF with the CAPA diagnostic standard.
Results: We observed that there is a significant gap between mental health problems diagnosed by the CAPA interviews and the problems reported by the main contact on CBCL and teachers on TRF. Main contacts showed higher sensitivity than teachers, while teachers showed higher specificity than main contacts. Both main contacts and teachers classify externalizing problems like ADHD fairly well in both genders, and also CD in girls. Both teachers and main contacts, however, have more problems detecting internalizing problems.
Teachers have a tendency to see most students as healthy and might underestimate the severity of their problems, while main contacts might overestimate the number of problems and see people as more sick than they really are, giving the adolescents less responsibility and fewer demands instead of encouraging them to do their best.
Conclusion: There is a problematic miss-match between real mental health problems (CAPA) and problems as reported by main contact and teachers. Especially is this the case for internalizing problems. Many problems seem to be unrecognized by significant others in these adolescents’ life. CWS should revise their intake procedures so possible problems are detected early and necessary treatment introduced. It is important to identify factors that increase healthy school adaption among these adolescents.