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Teacher Recognition, Concern, and Referral of Children’s Internalizing and Externalizing Behavior Problems


Identifying youth with mental health concerns and connecting them to effective intervention is important because poor mental health is related to lower educational achievements, substance abuse, violence, compromised health, and reduced life satisfaction. This study examined the ability of teachers (n = 153) to accurately identify mental health concerns among elementary children using vignettes scenarios depicting children with severe and moderate externalizing or internalizing behavior problems. Teachers were asked to rate the seriousness of the problem, their concern for the child’s well-being, and whether they felt the student needed school-based or community mental health services. Findings indicated that teachers can accurately identify students with severe externalizing and internalizing problems. However, they were less accurate and less likely to think students with moderate or subclinical symptoms needed services. Additionally, teachers perceived externalizing problems to be more serious and more concerning, than internalizing problems. In most cases, teachers’ concern for the child’s well-being, but not their perceived seriousness of the problem, predicted endorsement of referral to school and/or community-based mental health professionals, even when controlling for the child’s gender. Implications for practice and future research areas are discussed.

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Funding for this study was provided by the first author’s institution. Participating schools were drawn from a project supported by Award No. 2015-CK-BX-0018, awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this publication/program/exhibition are those of the author(s) and do not necessarily reflect those of the Department of Justice.

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Correspondence to Joni W. Splett.

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All authors declare they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Waiver of written consent procedures was used in this study. Prior to administration of the survey, a graduate research assistant read informed consent materials aloud to all teachers attending a school faculty meeting and answered questions. Informed consent was implied by those teacher participants completing the survey.

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Splett, J.W., Garzona, M., Gibson, N. et al. Teacher Recognition, Concern, and Referral of Children’s Internalizing and Externalizing Behavior Problems. School Mental Health 11, 228–239 (2019).

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  • School mental health
  • Early identification
  • Internalizing behavior problems
  • Teacher professional development
  • Teacher mental health literacy