Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Modeling the Impact of School-Based Universal Depression Screening on Additional Service Capacity Needs: A System Dynamics Approach

TitleModeling the Impact of School-Based Universal Depression Screening on Additional Service Capacity Needs: A System Dynamics Approach
Publication TypeJournal Article
Year of Publication2016
AuthorsLyon, AR, Maras, MA, Pate, CM, Igusa, T, Vander Stoep, A
JournalAdm Policy Ment Health
Date PublishedMar
ISBN Number0894-587x
Accession Number25601192
Keywords*Health Services Needs and Demand, Adolescent, depression, Depression/diagnosis/*epidemiology, Depressive Disorder/diagnosis/*epidemiology, Humans, implementation, Mass Screening, Mental Health Services/*manpower/supply & distribution, Models, Theoretical, Needs Assessment, School Health Services/*manpower/supply & distribution, School mental health, screening, Students, system dynamics modeling, Systems Analysis

Although it is widely known that the occurrence of depression increases over the course of adolescence, symptoms of mood disorders frequently go undetected. While schools are viable settings for conducting universal screening to systematically identify students in need of services for common health conditions, particularly those that adversely affect school performance, few school districts routinely screen their students for depression. Among the most commonly referenced barriers are concerns that the number of students identified may exceed schools' service delivery capacities, but few studies have evaluated this concern systematically. System dynamics (SD) modeling may prove a useful approach for answering questions of this sort. The goal of the current paper is therefore to demonstrate how SD modeling can be applied to inform implementation decisions in communities. In our demonstration, we used SD modeling to estimate the additional service demand generated by universal depression screening in a typical high school. We then simulated the effects of implementing "compensatory approaches" designed to address anticipated increases in service need through (1) the allocation of additional staff time and (2) improvements in the effectiveness of mental health interventions. Results support the ability of screening to facilitate more rapid entry into services and suggest that improving the effectiveness of mental health services for students with depression via the implementation of an evidence-based treatment protocol may have a limited impact on overall recovery rates and service availability. In our example, the SD approach proved useful in informing systems' decision-making about the adoption of a new school mental health service.