Running Head: MENTAL HEALTH AND DISORDERS 1

Jennifer Rivas

HSC 435 Sec 02

Best Practice Research Paper

Mental Health and Disorders

WC: 2,259
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Being free of disease does not solely indicate health; one must also have the ability to

cope with the environment and be in control of ones emotions. Mental health is a key component

to have a healthy status, but it is not a widely discussed aspect. The U.S. Department of Health

and Human Services (HHS) describes mental health as, “ . . . our emotional, psychological, and

social well being. It affects how we think, feel, and act” (HHS, n,d.). According to Healthy

People 2020, “Mental disorders are one of the most common causes of disability. The resulting

disease burden of mental illness is among the highest of all diseases” (Healthy People 2020,

n.d.). With the scope of the problem put into perspective, around 43.6 million U.S adults who are

18 years and older suffer from a mental illness in a given year. (HP 2020, n.d.) Mental health

disorders and conditions don’t only affect adults. It has been reported that most mental illness

starts at a young age, and can develop to a serious debilitating mental disorder or illness. Data

from the National Health and Nutrition Examination Survey (NHANES) indicate that, “…13

percent of children ages 8-15 had a diagnosable mental disorder within the pervious year

(National Institute of Mental Health, n.d.). Mental health disorders and illness may lead to

substance abuse, suicide, as well major adverse social and economic outcomes. Although there is

numerous factors that contribute to mental health some factors include, trauma, stressful life

situations, medical conditions, self-esteem, and biological factors. Through various methods,

interventions have been implemented to prevent and reduce mental disorder. Children and

adolescents, disregarding race and ethnicity as well sexual orientation, are the target group that

will be further discussed in the interventions.

Literature Review

To maintain a healthy mental health state, several interventions that have been effectively

implemented highlight and indicate the use of several methods to have a successful outcome. In
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the journal, “Prevention of anxiety symptoms in primary school children: Preliminary results

from a universal school based trial,” a three intervention method implementation at a primary

school illustrates great preventative results for anxiety symptoms in children. The intervention

sample consisted of 489 school-aged children, from eight different primary schools, in which the

children ranged from 10 to 12 years of age. The primary schools were, “… randomly assigned to

one of the three intervention conditions: psychologist-led intervention (PI), teacher-led

intervention (TI), or a standard curriculum (usual care) with monitoring condition (SC)” (Barrett

& Turner, 2001). For the teacher-led and the psychologist-led intervention, the “Friends for

Children” intervention program was implemented which consisted of 10 weeks for 75 minute

session a week, meanwhile the students in the usual care with monitoring condition took part the

“standard classroom curriculum.” The “Friends for Children” program is a cognitive-behavior

intervention aims to “assists children in learning important skills and techniques that help them

cope with and manage anxiety… techniques include relaxation, cognitive restructuring, attention

training, parent-assisted exposure, and family and peer support” (Barrett & Turner, 2001).

Results from the study showed that there was a significant decrease in self reported anxiety from

the teacher- and psychologist led interventions, compared to the standard curriculum. Although

stronger statistical data supported the PI and TI conditions, all interventions reflected

improvement on the self report measures of anxiety. It is important to note that characteristics of

anxiety are a well-known risk factor for several depressive and anxiety disorders in adolescences.

These practices show effective ways mental health can be improved and encouraged at an early

age to prevent development and bring awareness.

In another cognitive behavioral intervention, “COPE (Creating Opportunities for Personal

Empowerment)” shows an effective method to implement in school settings. In the evidence-

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based practice, COPE is guided by the cognitive theory and cognitive behavioral therapy to

reduce anxiety and depression disorders and symptoms among adolescents. In the intervention, a

sample of 16 teenagers ranging from 10 to 17 years of age with history of mental health

problems, such as anxiety and depression from two high schools were gathered. The program

included seven cognitive behavioral skills building (CBSB) sessions in which COPE “ teaches

the adolescents that how they think directly impacts how they feel and how they behave”

(Melnyk, Kelly & Lusk, 2014). The sessions where incorporated in a group session, and were 50

minutes long held once a week. Finding from the intervention demonstrate that there was

significant decrease in depression score from the pre-COPE to the post-COPE measurements

evaluations, as well a decrease in anxiety scores. The positive outcomes with the students, who

identified with having negative mental health symptoms, indicated that the COPE program was

effective way to implement a prevention program in a school based setting with at-risk youth.

Since mental heath illnesses such as depression have a public health impact, this intervention

represented a great best practice approach to target adolescents for preventative practices.

Unlike the school-based interventions previously mentioned, the intervention “Child

FIRST” (Child and Family Interagency, Resource, Support, and Training) is a home based,

psychotherapeutic intervention that aims to address multiple factors such as depression and

behavioral problems and trauma and exposure to violence. The method of the intervention

Included a randomized sample of 78 children in the Child First group and 79 in the usual care

group; the children were age 6-36 months. The group in the Child First program received

psychotherapeutic parent-child treatment and a comprehensive built system of care characterized

by the needs of the children and the parent. The usual care group had access to services from the

community providers. The families where assessed at 6 months as well as at the end of the 12
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month program, which included of weekly visits of the Child First ranging up to 50 minutes a

day. In children who were assigned to the Child First program, he outcomes of the intervention

resulted in improved language and externalizing symptoms compared to those who were in the

usual care (Lowell, Carter, Godoy, Paulicin, & Brigg-Gowan, 2011). There was also a

significance improvement on families to increase access to community-based services such as

mental health. The results conclude that Child First is a best practice in intervention and

prevention of mental health. To improve the receipt of services like mental health and decrease

behavioral and externalizing behaviors shows the effectiveness of personalized home based

programs for promoting positive involved lifestyle.

Similar to the Child Frist intervention, the intervention “Early Pathways,” is a mental

health, home-based program focused on young children. Early Pathways is designed with the

following four components:

. . . strengthening the parent-child relationship through child-led play, maintaining

developmentally appropriate expectations of children and cognitive methods for calmly

and thoughtfully responding to disruptive behaviors, using positive reinforcement to

strengthen prosocial behavior, and using time limited strategies for reducing disruptive

behaviors. (Harris, Fox, & Love, 2015)

The early pathway intervention was aimed a children, both toddles and preschoolers, living in

poverty through weekly treatment sessions ranging from one to two hour. The sample included

199 children ranging from the ages 1 to 5 and that would be consider to be in poverty, that was

sectioned off to a randomly assigned treatment group such as the “immediate treatment (IT) or

wait list control (WL) conditions. The therapy was terminated after the parent and clinician met

the treatment goals (Harris et al, 2015). From the outcomes, “results indicated that parents in the
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IT condition reported significant improvements in their child’s disruptive and prosocial

behaviors…)” (Harris et al, 2015). This outcome signifies the effectiveness of an home based

treatment that can target children who are at risk and susceptible to development of negative

behavioral and cognitive functioning and who may not have access to a service treatment, such

as in school settings.

Finally, the last interventions distinguishes the effectiveness a public health approach to

prevent morbidity from mental health. The journal, “Outcomes Evaluation of a Public Health

Approach to Suicide Prevention in an American Indian Tribal Nation,” a suicidal behavior

prevention programs was implemented as a public health approach targeting youth on American

Indian reservation. The program was involved in extensive out reach providing workshops and

session to the community in schools or public facilities. A lot of the sessions were aimed at

identifying individuals with risk as well as risk factors involved. The educational and awareness

program was implemented for the span of 15 years, which mainly targeted adolescents in the

ages ranging from 11 to 18 years old. Youth members of the community that had risk for suicide

where treated or refereed to services that would be able to complete diagnosis and develop a

treatment. The outcomes of the suicide prevention program illustrated and an “an annual mean

number of total self-destructive acts dripped from 36 to 14 between 1988 and 2002, an absolute

drop of 61.1%” (May, Serna, Hurt, & DeBruyn, 2005). This public health approach, indicated

that a consistent prevention program that includes mental health services is a best practice to

reduce the number of suicidal behavior and attempts, while addressing all risk factors not only

specific ones. With this prevention program, adolescent who come from historic trauma or

susceptive to psychological and social issues, can be targeted while having community support

and engagement.
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Intervention Proposal

After thorough research for the best evidence based practices, for my intervention I

would implement a cognitive behavior therapy (CPT) and pair it with mindfulness Based

cognitive therapy (MBST). The intervention would include a sample of roughly 150-250

students from minority background in a Hispanic based city or town. The target student age

group would be from 11 to 13 years of age, or middle school students. The reason for this

specific age group is to have them gain the necessary skills to cope with more stressful situation

and mange their emotions; as well improves mental health status and practices at a younger age.

The main goal for the intervention, like Healthy people 2020 Mental Health and Disorder Goals,

is to implement successful prevention programs and methods to improve mental health and

receive the necessary skill to access and seek appropriate mental health services. Since the

adolescent will be attending school, the best way to implement the program would be in the

different middle schools in that town as part of the school curriculum.

The method of the intervention will include the framework for cognitive behavior therapy

and mindfulness therapy. With parental and school consent, student will take part in the weekly

program that will take place once a week for 45 minutes. Before the program therapy begins,

students will take a pre-survey and mental health test to identify risk and symptoms regarding

mental health illnesses or disorders such as stress, depression, and anxiety. During the six-month

program implementation, using CBT, students will engage in ways to identify thoughts and

emotions and how to deal with them appropriately. With this group therapy, negative emotions,

thoughts, and behavior identification and construct management planning, can be addressed and

reach a wider amount of individuals, instead of one to one. The MBST will aim to help

individuals cope with a menthe health problem such as depressions that already exist and help
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reduce symptoms. Techniques like relaxation practices, and management skills will help students

be more cognitive aware and decipher their emotions. At the end of the 6-month intervention,

students will be asked to take a post survey and test to compare results with students that only

engaged in the normal health instructional curriculum.

Due to the target adolescent population at a minority town, there might be several

limitations and barriers that can interfere with the intervention. Since the intervention is focused

on only Hispanic students in a small town, there might be cultural aspects like belief or lack of

trust, that parents may not want their child to engage in such program. There might also be

questions of generalizability due to the fact that the study is focused on one ethnicity and a

specific age group. School conferences and meeting as well as activities, may interfere with the

sessions that would be conducted during that time span. Since the pre and post surveys and test

are self-reported, the data may not be accurate as students may fell uncomfortable sharing their

actual symptoms or disorders. With these limitations and barriers, more intricate intervention

may be implements to assess the students at a more thorough level.

Conclusion

Mental disorders are not uncommon among children and adolescents and if not treated,

symptoms may develop as one ages which can be fatal. It general, it is important to address

mental health but targeting young age groups have shown to reduce the symptoms of progressing

mental illnesses or disorders and promote healthy lifestyles. With suicide being on the top charts

for leading cause of death among adolescents, mental health is an aspect of health that needs to

be further implements and advocated to decrease the overall progressive burden of disease. The

use of evidence based practices such as cognitive behavior therapy, multidimensional

intervention applications, mindfulness therapies and the public health approach, have shown to
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be effective best practices to promote a positive mental heath status as well reduce and manage

the negative mental health aspects. With an intervention that focuses on both cognitive behavior

therapy and a construct mindfulness practice, adolescents will have the skills to cope and manage

their emotions and thoughts and start practicing healthy behaviors that will be beneficial to

improve their mental health and practice strategies that can prevent mental disorders.
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References

Barrett, P., & Turner, C. (2001). Prevention of anxiety symptoms in primary school children:

Preliminary results from a universal school-based trial. British Journal Of Clinical

Psychology, 40(4), 399.

Harris, S. E., Fox, R. A., & Love, J. R. (2015). Early Pathways Therapy for Young Children in

Poverty. Counseling Outcome Research and Evaluation, 6(1), 3-17.

doi:10.1177/2150137815573628

Healthy People 2020. (n.d.). Mental Health and Mental Disorders. Retrieved April 9, 2017, from

https://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental-

disorders

Lowell, D.I., Carter, A. S., Godoy, L., Paulicin, B., & Brigg-Gowan, M. J. (2011). A randomized

controlled trial of child FIRST: A comprehensive home-based intervention translating

research into early childhood practice. Child Development, 82(1), 193-208.

doi:10.1111/j.1467-8624.2010.01550.x

MacKenzie, M. B., & Kocovski, N. L. (2016). Mindfulness-based cognitive therapy for

depression: trends and developments. Psychology Research and Behavior Management,

9, 125–132. http://doi.org/10.2147/PRBM.S63949

May, P. A., Serna, P., Hurt, L., & DeBruyn, L. M. (2005). Outcome Evaluation of a Public

Health Approach to Suicide Prevention in an American Indian Tribal Nation. American

Journal of Public Health, 95(7), 1238–1244. http://doi.org/10.2105/AJPH.2004.040410

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Melnyk, B. M., Kelly, S., & Lusk, P. (2014) Outcomes and feasibility of a manualized cognitive-

behavioral skills building intervention: Group COPE for depressed and anxious

adolescents in school settings. Journal Of Child And Adolescents Psychiatric Nursing.

27(1), 3-13. doi:10.1111/jcap.12058

National Institute of Mental Health (NIMH). (n.d.). Any Disorder Among Children. Retrieved

April 9, 2017, from https://www.nimh.nih.gov/health/statistics/prevalence/any-disorder-

among-children.shtml

U.S. Department of Health and Human Services (HHS). (n.d) What Is Mental Health? Retrieved

April 9, 2017, from https://www.mentalhealth.gov/basics/what-is-mental-

health/index.html