Welcoming 2024: supporting students’ well-being

Approximately 20% of children and adolescents (and adults) meet criteria for a psychiatric diagnosis (Agency for Healthcare Research and Quality US, 2022). Yet, most of these individuals do not receive mental health services (Substance Abuse and Mental Health Services Administration [SAMHSA], 2020) and when they do, services often deviate from best practice. While screening efforts have improved and stigma reduced over time, only a small percentage of affected youth are identified as having mental health problems. Frontline gate-keepers such as teachers or other school personnel may be perfectly positioned to identify and refer students (Levitt et al., 2007). Unfortunately, un- or under-treated mental illness tends to run a chronic course with escalating impairment and worsening symptomology over time. Numerous biopsychosocial factors may contribute to risk for developing psychological distress, including adverse life events and trauma, genetic predisposition, peer problems, family discord, neurobiological determinants, etc.; indeed, the list of contributing factors and associated buffers is long. One potential group of individuals at risk for psychological distress that has recently received attention includes students attending “high achieving schools.” To this end, I am very pleased to coauthor this introduction to 2024 with Rick Yang, an emerging scholar and advocate who shares the goal of raising awareness about this issue.

Recently, the National Academies of Sciences, Engineering, and Medicine added youth in “high achieving schools” to their list of “at-risk” groups, along with a number of other groups (e.g., youth living in poverty, recent immigrants/refugees, those with incarcerated parents, to name several; Wallace, 2019). Students in high-achieving schools have shown elevated rates of anxiety and depression (Luthar et al., 2020), which may be related in part to academic pressures for high performance and acceptance into elite universities, competition, family dynamics, and school climate. For many, even once-stress-relieving pastimes, like playing a musical instrument or participating in sports, no longer serve in a buffering role, and have evolved into a means to an end: admission into a competitive institution, followed by career success. The experience of stress is nearly ubiquitous among high school students. Three in four high school students and half of middle school students who participated in a national survey of 43,000 students from high-performing schools said they “often or always feel stressed” by their schoolwork. Getting into the college of their choosing was a concern for more than two-thirds of high school students (Wallace, 2019).

Overall, due to internal and external pressures, high-achieving youth – similar to many other groups across the world but perhaps for different reasons – are at risk for mental health concerns. To address concerns about student mental health within schools, a Multi-Tiered System of Supports (MTSS) has been employed to support the needs of all students (Ziomek-Daigle et al., 2016). MTSS is divided into three categories: universal mental health and wellness programming for all students (tier 1 supports), selective mental health supports for targeted groups of students with identified needs (tier 2), and targeted clinical services for individual students with more intensive needs (tier 3) (New York City Department of Education, 2023).

During his freshman year of high school, the second author founded SchoolSight: A Comprehensive Mental Health Vision. SchoolSight is a research-based advocacy project that developed various research reports on the state of mental health in high achieving schools and presented these data at various public forums to spread awareness about student mental health prevalence, screening and intervention. Through over a dozen interviews with district psychologists, social workers, and education administrators, a main takeaway was the dominant focus on tier 2 and 3 services. While providing individualized mental health services in school settings is important, preventative measures are likewise necessary and may bolster resiliency and coping skills in students (S. Swanko, personal communication, September 2, 2022) and prevent escalation of problems. Indeed, school-based preventative services have demonstrated modest effectiveness in reducing or preventing behavioral health problems in a cost-effective manner (Feiss et al., 2019). While there remains room for improvement in terms of maximizing program effects, these findings suggest the utility of intervening early across all students.

Children’s Health Care has been a leading forum for the dissemination of information about childhood health, including behavioral health both inside and outside of school settings. It has also been an academic home for many emerging scholars, such as Mr. Yang, as well as many more senior academic leaders, such as incoming associate editor Christopher Flessner. Dr. Flessner is a professor in the Department of Psychological Sciences at Kent State University where he focuses on three primary areas: pediatric food allergies; risk factors linked to the development and maintenance of anxiety and obsessive-compulsive symptoms in youth; and behavioral interventions for these problems. We are thrilled to have him join our team of Associate Editors (Amy Sato, Ph.D. and Carolyn Ievers-Landis, Ph.D.) and our world-class editorial board. Within Children’s Health Care, we highlight the role of multiple determinants of health, both positive and otherwise, that may be relevant to promote positive child outcomes. We welcome scholarly studies addressing child mental health, including those focused on physical health conditions and associated psychological factors. We hope that this editorial brings continued attention to the challenges that affect children, including those from high achieving schools, as innovative efforts will be necessary to address the complexity of this problem in order to facilitate adaptive health outcomes.

Acknowledgments

Mr. Yang would like to acknowledge Dr. Peter Faustino, Mr. Michael Orth, and Ms. Taneisha Carter for their invaluable guidance and support in his efforts to advance school mental health at the district, county, and national levels.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Research reported in this publication was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number P50HD103555 for use of the Clinical and Translational Core facilities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.