title: Evaluating the effectiveness of a training program that builds teachers' capability to identify and appropriately refer middle and high school students with mental health problems in Brazil: an exploratory study.
abstract: BACKGROUND
  In Brazil, like many countries, there has been a failure to identify mental health problems (MHP) in young people and refer them to appropriate care and support. The school environment provides an ideal setting to do this. Therefore, effective programs need to be developed to train teachers to identify and appropriately refer children with possible MHP. We aimed to evaluate teachers' ability to identify and appropriately refer students with possible MHP, and the effectiveness of a psychoeducational strategy to build teachers' capability in this area.
  
  
  METHODS
  To meet the first objective, we conducted a case-control study using a student sample. To meet the second, we employed longitudinal design with repeated measures before and after introducing the psychoeducational strategy using a teacher sample. In the case control study, the Youth Self-Report was used to investigate internalizing and externalizing problems. Before training, teachers selected 26 students who they thought were likely to have MHP. Twenty-six non-selected students acted as controls and were matched by gender, age and grade. The underlying principle was that if teachers could identify abnormal behaviors among their actual students, those with some MHP would likely be among the case group and those without among the control group. In the longitudinal study, 32 teachers were asked to evaluate six vignettes that highlighted behaviors indicating a high risk for psychosis, depression, conduct disorder, hyperactivity, mania, and normal adolescent behavior. We calculated the rates of correct answers for identifying the existence of some MHP and the need for referral before and after training; teachers were not asked to identify the individual conditions.
  
  
  RESULTS
  Teachers were already able to identify the most symptomatic students, who had both internalizing and externalizing problems, as possibly having MHP, but teachers had difficulty in identifying students with internalizing problems alone. At least 50.0% of teachers learned to identify hypothetical cases as problematic and to make the appropriate referral, and 60.0% of teachers who before training could not identify normal adolescence learned to do so.
  
  
  CONCLUSIONS
  The strategy was partially effective but could be improved mainly by extending its duration, and including discussion of actual cases.
authors.affiliation: Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Borges Lagoa 570, 1° andar, São Paulo, SP CEP: 04038-030, Brazil. marleneapo@yahoo.com.br.
authors.forename: Marlene A
authors.initials: MA
authors.lastname: Vieira
authors.forename: Ary A
authors.initials: AA
authors.lastname: Gadelha
authors.forename: Taís S
authors.initials: TS
authors.lastname: Moriyama
authors.forename: Rodrigo A
authors.initials: RA
authors.lastname: Bressan
authors.forename: Isabel A
authors.initials: IA
authors.lastname: Bordin
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D000328:Adult; D001938:Brazil; D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000517:prevention & control*; D008605:Mental Health Services; D008875:Middle Aged; D015397:Program Evaluation; D012017:Referral and Consultation; D012572:School Health Services; D012574:Schools; D013334:Students; D013663:Teaching / Q000379:methods*