Mental health interventions in schools in high-income countries

In the late 1980s, J. W. Fantuzzo and colleagues conducted a review of the selfmanagement literature in order to better define the characteristics of this class of interventions. Results indicated that many interventions were minimally studentdirected despite the title “self-managed” and that student-managed interventions demonstrated incremental effects above teacher-managed interventions. In the current study, updated information was compiled with regard to how self-management interventions have been described, including the degree to which self-management interventions continue to rely on external (i.e., teacher) contingencies. Review of the literature identified 16 different characterizations of self-management interventions, each of which varied widely in terms of the number of intervention components included as well as the degree to which students were involved in implementation. Although self-observation and recording of a predefined behavior appear to be the cornerstones of self-management interventions, meaningful differences were noted, including whether reinforcement was involved and whether changes in performance were tracked over time. Furthermore, although self-management interventions appear to have undergone a small shift toward increased reliance on internal (i.e., studentmanaged) contingencies, adults continue to play a large role in the implementation.

Review and Analysis of Literature on Self-Management Interventions to Promote Appropriate Classroom Behaviors (1988-2008).

Background— Computed tomography coronary angiography (CTA) has been shown to be accurate in detecting anatomic coronary arterial obstruction, but is limited for the detection of myocardial ischemia. The primary aim of this study was to assess the accuracy of 320-row computed tomography perfusion imaging (CTP) to detect atherosclerosis causing myocardial ischemia.

Methods and Results— Fifty symptomatic patients with recent single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) underwent a comprehensive cardiac computed tomography (CT) protocol that included 320-CTA, followed by adenosine stress CTP. CTP images were analyzed quantitatively for the presence of subendocardial perfusion deficits. All analyses were blinded to imaging and clinical results. CTA alone was a limited predictor of myocardial ischemia compared with SPECT, with a sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of 56%, 75%, 56%, and 75%, and the area under the receiver operator characteristic curve (AUC) was 0.65 (95% CI, 0.51–0.78, P =0.07). CTP was a better predictor of myocardial ischemia, with a sensitivity, specificity, PPV, and NPV of 72%, 91%, 81%, and 85%, with an AUC of 0.81 (95% CI, 0.68–0.91, P <0.001), and was an excellent predictor of myocardial ischemia on SPECT-MPI in the presence of stenosis (≥50% on CTA), with a sensitivity, specificity, PPV, and NPV of 100%, 81%, 50%, and 100%, with an AUC of 0.92 (95% CI, 0.80–0.97, P <0.001). The radiation dose for the comprehensive cardiac CT protocol and SPECT were 13.8±2.9 and 13.1±1.7; respectively ( P =0.15).

Conclusions— Computed tomography perfusion imaging with rest and adenosine stress 320-row CT is accurate in detecting obstructive atherosclerosis causing myocardial ischemia.

Computed tomography myocardial perfusion imaging with 320-row detector computed tomography accurately detects myocardial ischemia in patients with obstructive coronary artery disease

Research has shown that peer-mediated interventions produce positive academic outcomes for a wide range of students. The authors of this review examined the effectiveness of peer-mediated interventions on the academic functioning of students with emotional and behavior disorders (EBD). Fourteen studies using cross-age, same-age, classwide peer tutoring, or cooperative learning met the criteria set forth for this review. Findings from these studies indicate peer-mediated interventions were successful across academic subject areas and grade levels. However, the participants and settings used within these studies did not accurately reflect the current EBD population's ethnic or gender composition or actual classroom placement. Finally, despite the recent growth in the number of students identified with EBD, the number of research studies investigating academic interventions has declined.

Peer-Mediated Intervention Studies on Academic Achievement for Students with EBD A Review

Recent developments in policy and practice have emphasized the importance of promoting self-determination and supporting access to the general curriculum for youth with disabilities. To understand how these trends align, we examined the efforts of 340 general and special educators to promote student self-determination in high school classrooms. Educators attached considerable importance to providing instruction in skills related to self-determination and reported addressing these skills with moderate to high frequency in their classrooms. Although opportunities for students with disabilities to learn skills that promote self-determination were reported to be available across the curriculum, there were some differences across teachers and curricular area. We discuss avenues for promoting student self-determination within the general curriculum, as well as offer recommendations for future research.

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Promoting Self-Determination for Transition-Age Youth: Views of High School General and Special Educators

The purpose of this review was to report on the effectiveness and focus of academic self-management interventions for children and adolescents with emotional and behavioral disorders. Twenty-two studies published in 20 articles and involving 78 participants met inclusionary criteria. The overall mean effect size (ES) across those studies was 1.80 (range –0.46 to 3.00), indicating effects were generally large in magnitude and educationally meaningful. Self-monitoring interventions were the predominant type of self-management technique used by researchers. The mean ES for intervention types were self-evaluation (1.13), self-monitoring (1.90), strategy instruction techniques (1.75), self-instruction techniques (2.71), and multiple-component interventions (2.11). Interventions targeted improvement in math calculation skills more than any other area. The mean ES by academic area were math interventions (1.97), writing (1.13), reading (2.28), and social studies (2.66). There was evidence to support a claim of the generalization and maintenance of findings. Implications, limitations, and areas for future research are discussed.

Michael H. Epstein

Papers

A Review of Self-Management Interventions Targeting Academic Outcomes for Students with Emotional and Behavioral Disorders.