title: Help seeking in school by Israeli Arab minority adolescents with emotional and behavioral problems: results from the Galilee Study.
abstract: Many distressed minority adolescents with little access to professional mental health services use teachers and school counselors as their main consultation sources. This paper presents data from the Galilee study on factors that may increase the probability of adolescents' help-seeking in school and discusses the needed linkage between the school mental health services and those provided by other agencies, in the framework of the Mental Health Reform in Israel.
  
  
  
  This cross-sectional survey included 1639, 9th grade students living in 5 Arab localities in the Galilee in northern Israel, representative of the Muslim and Druze populations. The study was carried out in two stages: in the screening stage, the Strengths and Difficulties Questionnaire (SDQ) was completed in the classroom. During the follow-up stage 704 students were selected and interviewed at home regarding service use in school and wellbeing at home. Their mothers were interviewed as well providing information on sociodemographic traits of the family. Total response rate was 69.3 % during the screening stage and 84.4 % during the follow-up. Students were categorized according to their SDQ scores and all students in the higher 25th percentile (high risk) and a simple systematic sample without replacement of those in the lower 75 % (low risk) were included in the follow-up study.
  
  
  
  Significantly more high risk than low risk students reported having felt the need to seek professional help (14.0 and 6.5 % respectively) and more high risk than low risk consulted a school source (27.1 and 15.2 %, respectively). Bivariate analyses show that among Muslim adolescents more high risk than low risk consulted a school source (30 vs. 16.2 % respectively) and among high risk students more Muslim than Druze sought help from a school source (30 vs. 18 %). Higher consultation rates were found among adolescents who felt uncomfortable at home, than among those who felt very comfortable. Binary logistic regression showed that for high risk adolescents, only religion remained significantly associated with help-seeking in school: Muslim students were 2 times more likely to seek help than Druze students. In the low-risk group, students who do not feel comfortable at home were 3.3 times more likely to seek help than those who feel comfortable at home. The main sources of consultation for both risk groups were the school counselor and the grade teacher.
  
  
  
  A constellation of factors may be associated with help-seeking in school by minority Israeli Arab adolescents: they are students at higher risk for an emotional or behavioral disorder, they have more socio-economic hardship, they feel less comfortable at home and they are more likely to live in the larger Muslim cities. Adolescents with less family support and particularly those not classified as being at high risk, are more likely to seek help from school counselors and teachers. The school staff may need additional training to care for the mental health needs of students. There is a need to integrate the school mental health services with the other government agencies that provide services to children and adolescents.
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; Child and Adolescent Mental Health Department, Ziv Medical Center, Zefat, 13100 Israel.
authors.forename: Raida
authors.initials: R
authors.lastname: Daeem
authors.affiliation: The Feinberg Child Study Center, Schneider Medical Center for Children in Israel, Petach Tikvah, 49202 Israel.
authors.forename: Ivonne
authors.initials: I
authors.lastname: Mansbach-Kleinfeld
authors.affiliation: Child and Adolescent Mental Health Department, Ziv Medical Center, Zefat, 13100 Israel ; The Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.
authors.forename: Ilana
authors.initials: I
authors.lastname: Farbstein
authors.affiliation: Department of Geography and Environmental Studies, University of Haifa, Haifa, 31905 Israel.
authors.forename: Raseem
authors.initials: R
authors.lastname: Khamaisi
authors.affiliation: Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.
authors.forename: Anneke
authors.initials: A
authors.lastname: Ifrah
authors.affiliation: The Galilee Society, The Arab National Society for Health Research and Services, PO Box 330, Shefa Amr, Israel 20200.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Sheikh Muhammad
authors.affiliation: Department of Child and Adolescent Psychiatry, The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, 49202 Israel.
authors.forename: Sylvana
authors.initials: S
authors.lastname: Fennig
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; Department of Child and Adolescent Psychiatry, The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, 49202 Israel.
authors.forename: Alan
authors.initials: A
authors.lastname: Apter
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D018912:Arabs / Q000523:psychology; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D000066505:Help-Seeking Behavior; D006801:Humans; D007514:Islam / Q000523:psychology; D007557:Israel; D016015:Logistic Models; D008297:Male; D008913:Minority Groups / Q000193:education / Q000523:psychology / Q000706:statistics & numerical data; D000066553:Problem Behavior / Q000523:psychology; D012574:Schools / Q000639:trends*; D012959:Socioeconomic Factors; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: Adolescents; Druze; Israeli Arab minority; Mental Health Reform Israel; Mental health; Muslim; SDQ; School help-seeking