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Addressing Adolescent Depression in Schools: Evaluation of
an In­service Training for School Staff in the United States
Carmen R. Valdez1 & Stephanie L. Budge2

1) University of Wisconsin­Madison, United States of America
2) University of Louisville, United States of America

Date of publication: October 24th, 2012

To cite this article: Valdez, C., & Budge, S. (2012). Addressing
Adolescent Depression in Schools: Evaluation of an In­service Training
for School Staff in the United States. International Journal of
Educational Psychology,1(3), 228­256.
doi: 10.4471/ijep.2012.13
To link this article: http://dx.doi.org/10.4471/ijep.2012.13

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IJEP – International Journal ofEducational Psychology Vol. 1 No. 3

October 2012 pp. 228-256

Addressing Adolescent
Depression in Schools:
Evaluation ofan In-service
Training for School Staffin the
United States

Carmen R. Valdez Stephanie L. Budge

University ofWisconsin-Madison University ofLouisville

Abstract

This study evaluated an adolescent depression in-service training for school

staff in the United States. A total of 252 school staff (e.g., teachers, principals,

counselors) completed assessments prior to and following the in-service and a

subsample of these staff participated in focus groups following the in-service

and three months later. Questionnaire and focus group data suggested that the

in-service increased school staff’s perceived awareness and knowledge of

adolescent depression and knowledge of how to connect with depressed

students, guide their learning process, and connect with students’ parents.

School staff viewed the in-service as a valuable tool for their school and

provided suggestions for the refinement of the in-service. Finally, perceived

changes in teacher behavior were reported three months later. Implications and

future directions were presented.

Keywords: adolescent depression, teachers, school-based program,
depression awareness, training.

2012 Hipatia Press

ISSN 2014-3591

DOI: 10.4471/ijep.2012.13



IJEP – International Journal ofEducational Psychology Vol. 1 No. 3

October 2012 pp.228-256

Tratando la Depresión de
Adolescentes en las Escuelas:
Evaluación de un Programa de
Formación Continuada de
Personal Escolar en Estados
Unidos

Carmen R. Valdez Stephanie L. Budge

University ofWisconsin-Madison University ofLouisville

Resumen

Este estudio evaluó un programa de formación continuada del personal escolar

en Estados Unidos sobre la depresión de adolescentes. Un total de 252

representantes del personal escolar (profesorado, directivos, asesores) completó

las evaluaciones antes y después de la formación y una submuestra de este

personal participó en grupos de discusión después de la formación y al cabo de

tres meses. Los datos de los cuestionarios y los grupos de discusión sugirieron

que la formación continuada incrementó la conciencia y el conocimiento de la

depresión adolescente y el conocimiento sobre como conectar con estudiantes

deprimidos, guiarles en su proceso de aprendizaje y conectar con sus padres. El

personal escolar vio la formación como una válida herramienta para su escuela

y presentaron sugerencias para su mejora. Finalmente, tres meses más tarde se

percibieron cambios en el comportamiento del profesorado. Se presentan las

implicaciones y las futuras líneas de trabajo.

Palabras clave: depresión en adolescentes, profesorado, programa basado en
la escuela, concienciación sobre la depresión, formación.

2012 Hipatia Press

ISSN 2014-3591

DOI: 10.4471/ijep.2012.13



230 Valdez & Budge - Addressing Adolescent Depression in Schools

Woodward, 2002). Adolescent depression is frequently accompanied by

decreased academic achievement, self-esteem, and competence, and

increased interpersonal difficulties (Calear & Christensen, 2010;

Fergusson & Woodward, 2002). Early detection and intervention are

critical to abate adolescent depression and associated risks (Moor et al.,

2007).

  Schools are an ideal setting for preventing depression because they

can reach a large proportion of adolescents whose depression might not

be identified (Chamberlin, 2009). In addition, school-based services for

depression may be more acceptable to adolescents than traditional

mental health services, given the convenience of these services and the

reduced stigma and cost of services in school settings (Calear &

Christensen, 2010; Chamberlin, 2009). Despite the promising role of

schools in addressing adolescent depression, rates of adolescent

depression continue to be unabated (Herman, et al, 2004).

  Schools in the United States are increasingly looking toward

evidence-based interventions to address adolescent depression. While

interventions have been developed for adolescents and evaluated in

randomized trials (see Calear & Christensen, 2010), adopting these

interventions in schools outside of the research context has proven

challenging (Olin, Saka, Crowe, & Hoagwood, 2009). Evidence-based

interventions may require significant operational funds and training, and

availability of space and staff time, all of which may not be available in

schools (Olin et al., 2009). To overcome these obstacles, recent studies

have increasingly incorporated school staff as program leaders in

school-based interventions. However, an Schools in the United States

are increasingly looking toward evidence-based interventions to address

adolescent depression. While interventions have been developed for

adolescents and evaluated in randomized trials (see Calear &

Christensen, 2010), adopting these interventions in schools outside of

the research context has proven challenging (Olin, Saka, Crowe, &

Hoagwood, 2009). Evidence-based interventions may require significant

operational funds and training, and availability of space and staff time,

epression is common in adolescence and is linked to future

depressive episodes, anxiety, early alcohol and substance

initiation, and suicide attempts and completion (Fergusson &D



231IJEP – International Journal ofEducational Psychology, 1(3)

all of which may not be available in schools (Olin et al., 2009). To

overcome these obstacles, recent studies have increasingly incorporated

school staff as program leaders in school-based interventions. However,

an examination of these interventions reveals that teachers are less

effective at implementing them than specialized school mental health

professionals or researchers (Calear & Christensen, 2010).

  Less favorable outcomes of teacher-led depression interventions may

be a function of limited training in depression intervention (Maag &

Swearer, 2005) and limited time available for implementation of

intensive interventions (Evers, Prochaska, Van Marter, Johnson, &

Prochaska, 2007). Thus, efforts should focus less on training teachers to

intervene clinically with their depressed students, and more on training

teachers to detect adolescent depression and offer supportive strategies

to students within the classroom setting (Maag & Swearer, 2005).

Teachers are well-positioned to detect depression because of their

regular student interactions (Puura et al., 1998), affording them the

opportunity to notice student changes in mood and behavior, peer

relationships, classroom participation, and school performance and

attendance (Auger, 2004; Maag & Swearer, 2005).

  Teachers often struggle to identify depression in students (Auger,

2004; Burns et al., 1995). In a study by Auger, there was only a .22

correlation between teacher-identified depressed adolescents and self-

identified depressed adolescents. Burns and colleagues found teachers

recognized signs of depression in only 0.6%-16% of depressed

adolescents. In a more recent study by Moor and colleagues (2007),

teachers were only able to identify as depressed half of their students

who had been clinically diagnosed with depression by a mental health

professional. For school counselors to receive timely referrals of

depressed adolescents, improving teachers’ recognition of adolescent

depression is paramount (Maag & Swearer, 2005).

  In addition to increased detection, teachers could learn classroom

strategies that are consistent with their teaching practices and that aim to

enhance their interactions with depressed students (Maag & Swearer,

2005). For example, teachers could be taught about the value of

establishing a personal connection with depressed adolescents (e.g.,

showing warmth, providing individualized attention), of enhancing



adolescents’ learning of classroom curriculum (e.g., pacing assign-

ments, using motivational techniques, praising for effort, making

instructional modifications), and of connecting these students to

supportive peers and other school professionals (Herman et al., 2004).

Teachers would also be well-positioned to initiate parent involvement

for students for whom they have concerns about depression (Auger,

2004). Training teachers to detect signs of adolescent depression and to

incorporate classroom-based support strategies is more likely to sustain

in schools than using specialized interventions.

  Low-cost, less intense depression awareness programs for teachers

need to be evaluated. School-based depression awareness programs

have been widely used in the United States, but many have limited

effectiveness data. Other programs, such as “Red Flags” in Ohio

(Newman, Smith, Newman, & Brown, 2007), are difficult to replicate

because they lack uniformity in implementation. Without uniformity,

schools may adopt partial elements of programs to save costs. However,

sub-optimal program levels may not address the needs of at-risk

adolescents.

  One promising program, “It’s Time! Adults Addressing Youth and

Teen Depression” (hereafter called “It’s Time!”), is a school-based in-

service for school staff. “It’s Time!” was developed at InHealth

Wisconsin, a non-profit outreach organization. Program developers

facilitate the program and train other facilitators via modeling and

observation, review of program content and manuals, discussion of

strategies, and ongoing face-to-face, phone, and email coaching and

support. “It’s Time!” is implemented uniformly across schools.

  Theoretically, “It’s Time!” is based on the Transtheoretical Model

(Prochaska, Johnson, & Lee, 2009) and Theory of Social Support

(House, 1981) to create change. The Transtheoretical Model posits that

change occurs when one recognizes a need for change, believes there is

realistic hope that one can make the change, and has a plausible plan for

change and the maintenance of it (Prochaska et al., 2009). “It’s Time!”

trains school staff to recognize that adolescent depression is an

important issue and that prevention is possible and can be accomplished

with the right tools and supports in place. In addition, “It’s Time!” is

based on Social Support Theory which contends that identification of

232 Valdez & Budge - Addressing Adolescent Depression in Schools



depression is more likely to occur within a supportive environment (i.e.,

schools) in which emotional, instrumental, and informational resources

for change can be provided (House, 1981). These resources include

establishing a personal connection with depressed adolescents,

supporting depressed adolescents academically, and collaborating with

parents and school professionals to coordinate care.

  “It’s Time!” aims to increase awareness, improve intervention and

support skills, and promote connections to resources in school settings

(see Table 1).

233IJEP – International Journal ofEducational Psychology, 1(3)

Table 1

Description of“It’s Time!” in-service

Topics/Activities Format
Time

(minutes)

Video/Slides Experiential

X 10

Educational Topics X 75

Brain chemistry ofdepression

Depression in the school setting

What helps teens who are depressed

Importance ofawareness and treatment

Importance ofpersonal connections

Things school staffcan do to help

Behavioral responses
and crisis management

Depression causes and signs



  The in-service is a low-intensity (2-hour) and low-cost program

($1000) that has been conducted in over 75 public and private schools in

Wisconsin, as well as Oregon, Vermont, North Carolina, Illinois,

Indiana, Minnesota, and Maine. An unpublished evaluation of the

program conducted in five schools shows that a percentage of in-service

school staff increased their (a) curiosity about students’ attitudes,

behaviors, and academic problems (82%), (b) strategies to create

positive connections with depressed students (82%), (c) conversations

with other school staff about how to better understand and connect with

these students (66%), and (d) contacts with parents about how to best

understand and connect with their child (44%) (InHealth Wisconsin,

2006).

  This study is the first external evaluation conducted of the “It’s

Time!” program. The evaluation was exploratory because program

developers were interested in expanding the scope of the intervention

based on consumer feedback. Thus, this study examined whether staff

participating in the “It’s Time!” in-service would (a) perceive increased

knowledge of depression from pre to post-test, (b) perceive increased

knowledge of strategies to use with their students, and (c) value the use

of the program in schools. Finally, staff perceptions of increased use of

supportive strategies with students with depression over a three-month

time period were explored. Possibilities for program expansion were

also explored during focus groups.

Completion of"What do you believe" exercise

Hope and lessons learned

Snowball activity

Reframing activity

X 10

X

X

15

20

234 Valdez & Budge - Addressing Adolescent Depression in Schools

Table 1 (continued)

Description of“It’s Time!” in-service

Topics/Activities Format
Time

(minutes)

Video/Slides Experiential



Method

Five high schools and one middle school in southeastern and south

central Wisconsin were recruited by the program developers to

participate in “It’s Time!”. Schools received the in-service free of cost

for agreeing to participate in the evaluation. The in-service was offered

at the beginning of the academic year as part of mandated professional

development training for school staff. Participation in the study was

voluntary and all procedures were conducted in accordance with the

institutional review board of the evaluators’ university. The in-service

and evaluation were conducted at each participating school.

  Four of the schools were located in the suburbs of two adjoining

cities and the remaining two were urban within one of the cities. Based

on school records, more than half of students in the urban schools in this

study were African American and more than half of students were

eligible for free or reduced lunch. Over three quarters of suburban

students were non-Hispanic White and no more than one-fifth of

students was eligible for free or reduced lunch. The suburban schools

were significantly larger and accounted for 94% of school staff. One of

the urban schools was a charter school for children who had a history of

being bullied.

  Of 252 school staff participating in this study, 85% were teachers, 5%

were school counselors, 3% were special education teachers, and the

remaining 6% were other personnel and administrators. More than half

(62%) of the school staff were female and 95% were non-Hispanic

White. All invited school staff participated in the in-service and

evaluation.

Participants

Design and Procedure

A multi-time point design was utilized to evaluate school staff’s

perceived knowledge of depression and use of supportive strategies with

their depressed students. Pre- and post-questionnaires were administered

and a first round of focus groups took place on the same

235IJEP – International Journal ofEducational Psychology, 1(3)



day ofthe in-service (post) and again three months later (follow-up).

  The evaluation team consisted of a faculty member and five graduate

students from a local university. Before the in-service began, the

evaluation team handed out packets with the instruments to the entire

school staff at the end of their mandated school orientation. After

reading a consent form and agreeing to participate in the evaluation,

further instructions for participation in the study were given. Individuals

who participated in the focus groups were nominated by the principal at

each participating school and had different levels of experience with a

student with depression.

236

In-service Description

The in-service was conducted by InHealth staff and consisted of a 75-

minute video presentation, supplemental materials, and two interactive

activities. These components were scripted in a manual and presented

sequentially over two hours.

  Video presentation. The video presentation consisted of 15 real

stories of local students, parents, and teachers/other adults and

informational slides. Student stories told of their experiences with

depression, typical and atypical symptoms, and ways that teachers

offered effective support. Parents discussed their experience of dealing

with their children’s depression and teachers provided examples of ways

in which they identified and supported their students with depression.

The informational slides were alternated with the video stories to

maintain participants’ interest and to reinforce the content ofthe stories.

  Supplemental materials. Immediately following the video

presentation, school staff were provided two handouts intended to

reinforce knowledge of depression and to increase staff’s sense of

competence in addressing adolescent depression. The “Reframing”

handout included examples of situations in which adults can effectively

interact with students by altering their perspectives and behaviors. The

“Talking with Parents” handout provided strategies to reach out to

parents ofstudents experiencing depression.

  Interactive activities. Next, groups of 10-20 persons each were

formed for two interactive activities which were designed to engage

Valdez & Budge - Addressing Adolescent Depression in Schools



actively school staff through experiential learning (Bonwell & Eison,

1991). At the beginning of the in-service, school staff engaged in the

Snowball activity by discussing myths, facts, and how their personal

beliefs about adolescent depression were formed from prior life

experiences. Staff wrote these beliefs anonymously on a piece of paper,

crumpled the paper into a ball, and tossed it into a box. At the end of the

in-service, facilitators created an imaginary physical space in the room

designated to represent different beliefs of adolescent depression.

School staff retrieved one of the ‘snowballs’ from the box and

physically moved to the sign (“strongly agree,” “agree,” “disagree,” and

“strongly disagree”) that was consistent with the beliefs on their

snowball. They then discussed why the person who completed that

snowball might have held that belief and how that person’s beliefs might

have changed after the in-service.

  In the Script Rewrite activity, a handout with five scripted scenarios

involving interactions with depressed adolescents was distributed to

school staff to help them develop a plausible plan for supporting

students. School staff role-played the scenarios for 30 minutes. Next,

they were asked to read the “Reframing” handout described above and

revise and role-play the new interactions.

Measures

All measures were developed by the authors with expert input and pilot

tested at a school similar to those in the study receiving the in-service

but not participating in this study.

  Effectiveness pre- and post-in-service questionnaires. School staff

completed a 10-minute questionnaire prior to the video presentation,

which consisted of six open-ended items that assessed need for the in-

service and baseline knowledge of depression and strategies with

depressed adolescents. An open-ended questionnaire was developed to

assess participants’ own pre-existing (pre) and acquired (post)

knowledge of depression and strategies. This format contrasts with a

forced-choice or Likert questionnaire that might alert participants to

desired responses (Maag et al., 1988). The questionnaire was rooted in

DSM-IV-TR depression symptomology (American Psychiatric

Association, 2000) and in program evaluation literature (Owen &

237IJEP – International Journal ofEducational Psychology, 1(3)



Rogers, 1999). The questionnaire included an open-ended item

measuring staff’s baseline awareness and knowledge of adolescent

depression (i.e., “What indicators get you to suspect that a student might

be depressed?”). Three additional items evaluated existing use of

strategies with depressed students: “What specific strategies have

worked for you to (a) connect with adolescents who might be depressed,

(b) guide the learning process of adolescents who might be depressed?,

and (c) talk to parents ofadolescents who might be depressed?”

  Assessing perceived changes in knowledge about depression at the

end of the in-service, four items paralleling the baseline knowledge and

the existing use of strategies from the pre-in-service questionnaire items

were administered: “Now that you have seen the program, what

indicators of depression were new or clarified for you that you will look

for in adolescents who might be depressed?,” “What new strategies will

you plan to use to (a) connect with adolescents who might be

depressed?, (b) guide learning in the classroom for adolescents who

might be depressed?, and (c) talk to parents ofadolescents who might be

depressed?”

  Focus groups. Each of the six schools agreed to participate in focus

groups following the completion ofthe in-service and post-questionnaires.

Facilitated by members of the evaluation team, the focus groups were

semi-structured (see Table 2) and consisted of 4 to 7 individuals each (41

total), with a range of sex, age, and teaching/work experience.

  Focus group questions were designed to evaluate school staff’s

acceptability of the in-service, particularly the in-service’s strengths and

limitations, and recommendations for improvement and further

development. The focus groups were audio-recorded and lasted 60 to 90

minutes. Three months after the initial focus groups, two schools

participated in follow-up focus groups. These focus groups consisted of

both school staff who had and had not participated in the initial focus

groups to obtain a range of responses. The follow-up focus groups

consisted of six questions designed to assess staff-reported perceived

changes over time in their recognition of depression and strategies with

depressed adolescents.

238 Valdez & Budge - Addressing Adolescent Depression in Schools



Table 2

Focus Group Questions at Post- In-service and Three-Month Follow-Up

POST-IN-SERVICE QUESTIONS

  1. What did you think about the in-service overall?

  2. What did you think about the content ofthe video?

  3. What did you think about the interactive activities?

  4. What, ifanything, did you learn from the in-service?

  5. How do you think this invice could be used in your school?

  6. Were there any specific experiences that you would have liked to

  see discussed in the in-service?

THREE-MONTH FOLLOW-UP QUESTIONS

  1. Since the last focus group, what are you doing differently with

  students who might be depressed?

  5. What would you think ofa web-based training program for

  teachers and other school staffabout youth depression?

  2. What kind ofstrategies would you like to learn about regarding

  your students with depression?

  3. What cultural aspects, ifany, would you like to see added to the

  in-service?

  4. What kinds offollow-up in-service programs do you need?

239IJEP – International Journal ofEducational Psychology, 1(3)



Pre-in-service and post-in-service questionnaires. Open-ended

responses from the questionnaires were entered into tables and coded in

teams of 2-3 trained members from the evaluation team. To establish

reliability, data were also coded individually by the two authors of this

study. Based on content analysis methodology outlined by Krippendorff

(2004), the open-ended responses were broken down into

recording/coding units by making categorical distinctions, which are

codes that are distinguished to be separate based on specific description.

Thus, the coders analyzed the content specifically for each question,

identifying when a new coding unit arose and tallying the number of

participants who mentioned the same coding units. The two coders

reached consensus ifthe coding units were coded in separate ways.

  Focus groups. After the data had been transcribed, the focus groups

were coded in three separate phases based on focus group methodology

outlined by Krueger and Casey (2000) and Morgan (1997). In the first

phase, data were coded in order to reflect the main ideas of each

paragraph. After the main ideas had been coded, these were placed into

larger categories that captured emerging themes. Lastly, these categories

were placed into three larger categories: Strengths of the In-service,

Areas for Improvement and Suggestions for the In-service.

  To ensure rigor, credibility checks were utilized. First, triangulation

consisted of comparing the focus group data with the other measures

from this study, as well as other outside reports of school staff’s

experiences with depression. This was achieved by extracting the main

themes from the content codes and the focus groups to determine if

there were aspects that were convergent or divergent. Second, coded

information was reviewed by an auditor who was not involved in the

data collection or analysis to determine applicability ofcodes.

240 Valdez & Budge - Addressing Adolescent Depression in Schools

Integrity of Methods

Results

Questionnaires

Awareness and perceived knowledge of adolescent depression. Prior

to the in-service, school staff identified common indicators of



depression among adolescents. These indicators and the percentages

ofstaff endorsing these indicators include: withdrawal from others and

activities (22%), change in behavior (17%), drop in grades (16%),

change in mood and affect (13%), and change in eating and sleeping

habits (9%), among others. A few of these indicators were new for a

number of school staff after the in-service, particularly withdrawal

(17%), behavior changes (14%), and changes in eating and sleeping

habits (6%). Atypical signs of depression emerged for a percentage of

school staff (25%) that were not reported prior to the in-service. These

signs include sensitivity to noise, physical pain, masking (expressions of

happiness), and anxiety.

  Strategies to connect with depressed adolescents. Over half of

school staff (51%) reported that establishing a positive teacher-student

relationship was an important tool to connect with adolescents on the

pre-in-service questionnaire. The relationship would be formed by

spending more individualized time with students, regularly monitoring

students’ feelings and school activities, and offering encouragement,

trust, consistency, respect, and active listening. School staff also

reported connecting with adolescents by seeking involvement from

others, with 18% of school staff involving other school staff and other

students, and 8% contacting parents. On the post- in-service

questionnaire, 55% of school staff endorsed the importance of the

teacher-student relationship. As part of this relationship, school staff

indicated that genuine interest and the use of soft questions (e.g., “How

are you doing today?”) were important strategies. Soft questions were

contrasted with questions that convey critical comments (e.g., “Why are

you always late to class?”). Twenty-four percent of school staff also

endorsed educating students about depression via self-disclosure and

examples. For some, writing a note to a student as an invitation to talk

would prove helpful; for others, it would be handing out an index card

for students to write the name of a school staff member in whom they

can confide. In addition, a few school staff (11%) indicated that they

would allow accommodations for students.

  Strategies to guide the learning process of depressed students.

Prior to and following the in-service, 26% of school staff and 40% of

school staff, respectively, reported that curriculum accommodations

241IJEP – International Journal ofEducational Psychology, 1(3)



were important in guiding the learning process of students experiencing

depression. The primary accommodations reported were providing

additional assistance on assignments, breaking down assignments into

smaller steps, offering alternate assignments, and extending deadlines.

Other accommodations included forming small groups, allowing short

breaks, and creating structured activities. Prior to the in-service, 36% of

school staff endorsed forming a one-to-one relationship with the student

to guide their learning process. This relationship was characterized by

using self-disclosure, dedicating individual time to student, and

motivating students through their interactions. After the in-service, 14%

of school staff endorsed the use of this strategy. A number of school

staff reported strategies not mentioned prior to the in-service. Promoting

a quieter environment in the classroom (12%), using supportive and soft

questions (17%) and using an index card to connect adolescents to

supportive adults (8%), as described above were also important.

  Strategies to talk to parents of depressed students. On the pre- in-

service questionnaire, 58% of school staff reported that they

communicate with parents about their concerns when they suspect a

student is depressed. At the end of the in-service, 67% of school staff

reported that they would talk with the parents of depressed students’

about their concerns. At both time points, school staff reported that

contact with parents needs to focus on asking about and describing

specific behaviors and signs of depression, discussing emotional and

academic changes in the student, and creating an open dialogue in

which parents feel comfortable asking questions. Teachers would

approach parents about these topics with calm, honesty, active listening,

and empathy. After the in-service, school staff who endorsed talking to

parents added that they would ask parents more questions about their

children’s functioning and avoid placing blame on the family. Existing

strategies were also reinforced by the in-service. These include holding

parent-teacher conferences (18% pre-, 6% post-), providing parents with

resources to help adolescents (7% pre-, 8% post-), maintain regular

contact (6% pre-, 4% post-), and involve other school professionals (2%

pre-, 4% post-).

242 Valdez & Budge - Addressing Adolescent Depression in Schools



243IJEP – International Journal ofEducational Psychology, 1(3)

Focus Group Themes

Areas of strength of in-service. A first area of strength identified by

school staff was the format ofthe in-service. School staff indicated that

the student stories were real, genuine, and heartfelt, instilled hope, and

the most helpful aspect of the presentation. One focus group participant

indicated, “I thought it was really good, coming from their hearts. I was

really impressed, it was better than the [other programs] we have.” Staff

reported that it was also helpful that the stories were local. Staff noted

that the parent stories provided powerful and refreshing perspectives

about students’ depression. Staff stated that the video was applicable to

a wide audience of parents, students, and teachers. The video was

described as “up-to-date,” “well-edited,” and appropriate in length.

  A second area of strength identified by school staff was the

presentation of the in-service. Many school staff reported that the

presentation was “informative,” and “effective at raising awareness

about depression and increasing compassion towards students.” School

staff expressed that the in-service facilitators were excellent, dynamic,

and interesting. Importantly, school staff commented on the importance

of the training at the beginning of the school year “because it raised

awareness into the upcoming year.”

  The content ofthe in-service was a third strength identified by school

staff. Many of the school staff mentioned that the statistics about

depression and recovery were powerful:

When [the facilitator] presented the statistics that, yes, people can

get help and you can make a difference, it’s like, okay, maybe I can

do something in my little way in the classroom just to help that

person and to have them connect with me. So I felt it empowered

me that, yes I can make a difference.

  Similarly, school staff indicated that the video challenged their

stereotypes of depressed students and emphasized that depression can

affect any individual. A number of school staff also mentioned that the

physiological aspects of the presentation were informative and that the

diagrams were helpful in explaining how depression manifests in the

brain. One focus group member commented that the presentation about



the brain helped her to understand how powerful these physiological

influences are and how early they can predispose adolescents for

depression.

  The final strength identified by school staff was the in-service’s

applicability to teachers. Participants expressed learning (a) the value of

establishing a personal connection with students, (b) the importance of

supporting the student rather than understanding the causes of

depression, and (c) the use of simple communication strategies. School

staff commented on the utility of using a 3X5 index card for students to

identify an adult in school with whom they would feel comfortable

talking about their depression. One member described what was helpful

for her:

It made me think about the times when I’ve tried to be firm and

what a tremendous impact of what we say has on these kids for a

long time and so it made me think really carefully about using

gentle words.

  Areas for improvement of the in-service. A first area of improvement

identified by school staff participating in the focus group referred to

tools for addressing students’ depression. Although an overwhelming

majority of staff reported increased awareness of depression among

their students, many indicated not having enough knowledge of how to

proceed in supporting their students. Some participants stated that they

would have liked more practical information about how to (a) carry out

curriculum modifications, (b) engage in communication with students

and parents about depression, and (c) provide resources and improve

access to community services for their students.

  A second area for improvement identified by school staff pertained to

issues ofdiversity. Some focus group participants reported that the video

was not sufficiently representative of racial minority students orstudents

of different sexual orientations, academic abilities, and lifestyles (e.g.

gothic). A teacher from an urban school noted:

…I liked that [the video] was local. I noticed however, that for

some people it may seem really racially or ethnically diverse; for

us it was not diverse at all. And that’s Wisconsin and that’s [our

244 Valdez & Budge - Addressing Adolescent Depression in Schools



town] in particular, so segregated here. You might want to have

different videos for different audiences that have more people who

look like them. And as was discussed there are a lot of cultural

issues that come up [with] depression, and we need to make sure

that those cultural issues are addressed differently for different

audiences.

  A third area for improvement was the role of the teacher in

addressing students’ depression. Several teachers struggled with

integrating their role as a teacher with that of counseling. One member

mentioned that teachers should work within a larger team of

professionals, and not be expected to provide counseling. Teachers at

one school expressed concern about mandatory reporting if they asked

students too many questions about their lives. The length of the in-

service was identified by school staff as a fourth area for improvement.

In particular, some staff indicated that the informational slides of the

video portion were too long and wished more time had been allocated to

the interactive activities.

  Finally, school staff indicated that the interactive activities could be

improved. School staff indicated that the skit rewrite activity was more

helpful than the snowball activity because it provided a positive and

alternative way of thinking and interacting with adolescents. They

wished there was more time for this activity and that the groups were

broken down even further to allow for more discussion. Many liked the

snowball activity because they liked learning about other people’s

perspectives; however, some found the activity difficult to understand.

  Recommendations for the in-service. A first recommendation made

by school staffwas that the in-service be adapted to students. Focus group

participants stated that the video-stories could effectively be shown to

students with some modifications. Suggested modifications included (a)

simplified and shorter presentation of statistics; (b) reduced information

about biology; (c) decreased focus on parents; (d) increased focus on peer

support; (e) increased explanation of treatment; (f) decreased number of

interactive activities; and (g) addition of a facilitator training program

for teachers, peers, and counselors. They also stated that the in-service

presentation be conducted in smaller groups to allow for more

245IJEP – International Journal ofEducational Psychology, 1(3)



meaningful discussion. The following comment was indicative of

adaptations for adolescents suggested by participants:

I think I would have [peers], maybe not a parent because they

really can’t empathize with a parent… They could talk about how

it impacted their family but they’d have to hear it from a person of

their age group.

  A second recommendation for improving the in-service is that it be

adapted for parents. Participants indicated that parents with children of

all ages might benefit from watching the video if it was shown during

PTA meetings or made available to parents online. Staff thought that the

video for parents could be accompanied by a list of resources to get their

children in services. Finally, it was suggested that a separate video be

made for teachers on how to approach and collaborate with parents

about their children. A focus group member discussed showing the

video to parents:

Our video policy is that when we have certain things that are

questionable, that we offer a previewing. I wonder whether you

said this is something we’d like to show students and those parents

who are most concerned might [come].

  Incorporating diversity into the in-service was a third

recommendation made by school staff. A common suggestion from

school staff participating in the focus group was to increase

representation of different minorities in the in-service. A few from the

urban schools mentioned that an in-service specific to urban African

American adolescents could include the following: (a) how to talk to

young African American males about depression, (b) using a community

effort to address this population, and (c) workshops led by an African

American speaker from the community to talk about his or her own

depression. They suggested that this approach could be adapted to other

groups ofadolescents, such as sexual minorities.

  Fourth, school staff recommended additional training opportunities.

School staff overwhelmingly requested a follow-up in-service consisting

of practical and experiential activities. This training could be achieved

246 Valdez & Budge - Addressing Adolescent Depression in Schools



by including (a) role-plays of teachers responding to students, (b)

reenactments of effective classroom strategies, (c) teacher-created

vignettes about students with depression for group discussion, and (d)

legal guidelines for student disclosure and mandatory reporting.

  A fifth recommendation made by school staff pertained to suggested

content areas. One participant suggested that it would be helpful to talk

about the different types of therapy that are available for depression.

School staff from one particular school mentioned that it would be

helpful to have a segment on post-partum depression, since they had

many pregnant students. They also shared that it would be important to

include more information about physical pain and somatic symptoms

that often accompany depression and how those may affect students.

The last suggestion made was to provide more information about how

students feel about taking medications in school. The following is a

specific suggestion made by a focus group member:

We now have a sense of diagnosing the problem; now [we’re]

searching for the “What next? How do you seek this help?”

Especially with people with limited income and limited education,

how do you seek help, what is a reasonable thing.

  A sixth recommendation pertained to the timing ofthe in-service. In

order to enhance learning, many school staff suggested dividing the in-

service into sections over a few days or follow-up sessions, rather than

one day. Many also thought it would be helpful to conduct the program

shortly after school has started so they can use the information with

specific students in mind. Additionally, they stated that it would be

helpful to show the video to teachers and students but within a close

timeframe so the teachers could provide a context and support to

students. The timing of the in-service is crucial as noted by a focus

group member:

I would want to [get a follow-up training], not right away, like

maybe a month, six weeks, give you time to observe the kids out

there and get frustrated enough that you want to know where to go

and then answer questions for you.

IJEP – International Journal ofEducational Psychology, 1(3) 247



  A final recommendation referred to supporting materials. School staff

indicated that it would be helpful to have a handout of the presentation

at the beginning of the in-service so they could follow the presentation

and keep for future reference. They also shared that it would be helpful

to have a handout of mental health resources, particularly for uninsured

students.

Follow-up Focus Groups

  Addressing what has changed for the schools and for them personally

since the initial focus groups three months prior, school staff from two

of the high schools (one urban, one suburban) reported changes in their

interactions with students. One teacher mentioned that she is “not more

lenient, but gives depressed students different assignments.” Another

teacher mentioned that she shares her own experience of depression

when she is talking with her students. As one teacher reported:

One of the things the video did was… made me rethink my way,

because I tend to be really strict about accepting late work and so

really recognizing what the students are going through and

thinking about depression and the impact on grades and how to

handle that in the classroom, it kind of turned me around a little bit

and I was thinking okay this is something that I need to be a little

bit more conscious of, and not just being hard line about it.

  One school has since implemented check-ins about their students with

depression with the other teachers at staff meetings allowing for better

coordination of student services. Another school has since invited

speakers to talk about depression to school staff. School staff from both

schools said that these conversations were rare prior to the in-service

and that the in-service brought it to the forefront for all school staff.

School staff reported additional areas in which they desired increased

knowledge and skills. Regarding resources and strategies, staff from one

school indicated that they wanted to learn more about empathy to help

them interact with students. They also expressed a desire to learn more

about substance abuse and self-injurious behaviors in their students

since these are increasingly common among their students.

248 Valdez & Budge - Addressing Adolescent Depression in Schools



Finally, staff wanted to learn more about outside resources. Others

expressed interest in learning about student pressures and stress-

reduction techniques school staff can use with their students who are

beginning to show signs of depression. Other staff stated interest in

strategies to engage parents in regular conversations about the emotional

health of their children. A focus group member mentioned:

One of the things that I thought was still lacking was a very direct

process of what to do with a student who is making comments

about being suicidal. There is somebody who's coming to train us

on that because it was something that I still felt like I didn't

absolutely know what to do.

IJEP – International Journal ofEducational Psychology, 1(3) 249

Discussion

The current study was an exploratory evaluation of the “It’s Time!

Adults Addressing Youth and Teen Depression” in-service for school

staff in a middle school and high schools in two Midwestern U.S. cities.

Benefits of the in-service is that (a) it targets school staff as natural

change agents in the students’ natural environment, (b) the information

is disseminated to staff via varied instructional methods to enhance

learning of knowledge and skills, (c) the content of the in-service is

manualized to ensure integrity of implementation by facilitators, (c) the

in-service can be implemented in a brief period of time and at a

relatively low cost, and (d) the materials were developed locally, thereby

increasing acceptability among school staff.

  Our first area of examination was whether school staff who

participated in the in-service would report increased perceived

knowledge of adolescent depression after the in-service. Findings

suggest the in-service increased staff’s reported knowledge of common

signs of depression, and introduced new signs of depression that were

not mentioned by staff prior to the in-service, including student masking

(i.e., expressions of happiness), sensitivity to noise in the classroom,

physical pain, and anxiety. Whether perceived knowledge translates into

actual use of strategies with students with depression should be the next

step in the in-service’s evaluation.



  With respect to our second area of examination that school staff

would perceive learning new strategies in dealing with adolescent

depression, a comparison of the pre- and the post-questionnaires showed

that the staff reported learning new strategies to connect with depressed

adolescents and guide their learning process. It appears that for some

staff, the strategies were not new but were reinforced by the in-service.

In addition, strategies reported on the post-questionnaire that had not

been previously mentioned by staff on the pre-questionnaire included

using supportive, empathic questions to connect with students,

providing a quieter classroom environment, and providing an index card

to students to identify a teacher or school staff they trusted and could

turn to about their depression. Finally, strategies to connect with parents

of depressed adolescents were new for some school staff but no

strategies were reported that had not been previously mentioned by

other school staff.

  The third area of examination was whether school staff who

participated in the in-service would perceive the in-service as an

acceptable and feasible tool to dealing with depression. Qualitative data

from focus groups immediately following the in-service and three

months later suggested that the in-service was valued by school staff

because it used real, local stories of students and teachers to educate

staff about adolescent depression. Many school staff considered the in-

service to be the best training they had received on adolescent

depression. Others suggested that the in-service could be made available

to adolescents and their parents. Staff from the urban schools expressed

a need for more cultural diversity in the stories and more inclusion of

contextual factors affecting many urban adolescents. School staff would

have liked follow-up sessions to reinforce their new strategies with

adolescents and parents.

  Three months later, focus group participants provided preliminary

evidence of sustained perceived knowledge and the emergence of

behavior change during the three-month period following the in-service.

Specifically, many teachers noted positive changes in their behavior

with students to connect on a personal level and to facilitate their

learning process. Individual staff also reported feeling more empathy

and caring for their students, which positively influenced how they

250 Valdez & Budge - Addressing Adolescent Depression in Schools



IJEP – International Journal ofEducational Psychology, 1(3) 251

supported their students’ learning in the classroom. One school had also

changed their procedures for addressing adolescent depression. As a

result of the in-service, this school initiated regular staff meetings to

coordinate services for students with depression.

  The findings of this preliminary evaluation are consistent with other

depression awareness programs, such as the Adolescent Depression

Awareness Program (ADAP) (Swartz et al., 2010) and the “Red Flags”

Program (Newman et al., 2007), which have been widely used in

Maryland and Ohio, respectively. In all of these programs (including

“It’s Time!”), a school-based curriculum using multiple teaching

modalities (e.g., videos, interactive activities, discussion) was used to

raise awareness of adolescent depression. Like “It’s Time!,” these

programs show promise in increasing awareness of adolescent

depression and of mobilizing supportive strategies when a student is

depressed. Although ADAP is designed for students, teachers, and

parents, published evaluation data appears to be available for the student

curriculum only, thus limiting the generalizations that can be made to

the teacher program. Furthermore, “Red Flags” does not have uniform

implementation of instructional materials, making it difficult to replicate

in other studies.

Limitations

This study was limited to measuring perceived awareness and

knowledge and the findings cannot confirm that these perceptions or

self-reports translate into actual changes in these domains or that they

lead to improved services for adolescents (Moor et al., 2007). While

initial evidence from the follow-up focus groups points to the in-

service’s potential for increasing coordination among staff regarding

students with depression and enhancing staff interactions with these

students, a systematic evaluation of school staff behavior (e.g., student-

reported staff interactions with students, referral rates, school-wide

initiatives) and adolescent outcomes (e.g., reduction in school absences,

enhanced academic skills and performance, reported somatic

complaints) is warranted.

  Second, the use of questionnaires and focus groups allowed for an



Schools can play a critical role in the identification of students with

depression and in the prevention of risk and promotion of student well-

being (Calear & Christensen, 2010). “It’s Time!” holds promise of

improving recognition of depression by targeting school staff who

already have regular contact with depressed students. The in-service

targets strategies that are accessible to and readily implemented by

school staff, including connecting with students on a personal level,

providing classroom accommodations, and reaching out to other

professional staff to support students (Maag & Swearer, 2005).

Promoting these types of skills increases the acceptability and

sustainability of these types of programs in schools (Herman et al.,

2004).

  This study points to the importance of collaboration between

educational psychologists and educators in detecting student depression.

Because educational psychologists rely on teacher referrals of students

with depression, working closely with teachers is instrumental (Maag et

al., 1988). Educational psychologists could do this by (a) training school

staff in the recognition of depression, (b) laying out clear guidelines for

referrals, (c) visiting classrooms to assist in the identification and

exploration of potential program impact and acceptability, and the

multi-time design allowed for an exploration of perceived knowledge

and change over time. However, the exploratory nature of this

evaluation and the non-experimental design (e.g., lack of comparison

group) precluded complex comparisons and statistical quantification of

the in-service’s effectiveness. A longitudinal, experimental design with

more time points and randomization of schools to comparison and

intervention conditions is needed to test the efficacy ofthe in-service.

  A third limitation of this study is the generalizability of findings to

other school settings. Since data collection took place in public schools,

it may be difficult to generalize the findings to private schools.

However, a major strength of our sampling is the inclusion of both

urban and suburban schools from small and large metropolitan cities in

the Midwest.

Implications and Recommendations

252 Valdez & Budge - Addressing Adolescent Depression in Schools



IJEP – International Journal ofEducational Psychology, 1(3) 253

monitoring of adolescents, and (d) serving as liaison between teachers

and parents and between school, family, and community resources

(Maag et al., 1988; Maag & Swearer, 2005). Additionally, psychologists

can be actively involved in the implementation, evaluation and

sustainability of programs (Pfeiffer & Reddy, 1998), such as “It’s

Time!”

  Proponents of school-based mental health services have a unique

opportunity to shape public policy (Herman et al., 2004). Drawing

attention to the role of schools in preventing depression and other risks

for adolescents (e.g., pregnancy) in a manner that is cost-effective and

sustainable can lead to increased funding of school training programs

and nation-wide wrap-around services in schools, such as school health

centers (Chamberlin, 2009).

  The debilitating nature of depression in adolescents calls for specific,

cost-effective programs to be implemented within the schools. By

training school staff to become familiar with adolescent depression,

schools have the potential to promote students’ mental health and their

associated educational outcomes (Herman et al., 2004).

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Carmen R. Valdez is Assistant Professor in the Department of

Counseling Psychology at the University ofWisconsin-Madison

School ofEducation, United States ofAmerica.

Stephanie L. Budge is Assistant Professor in the Department of

Educational and Counseling Psychology at the University of

Louisville College ofEducation and Human Development, United

States ofAmerica.

Contact address: Direct correspondence to Carmen R. Valdez at

Department ofCounseling Psychology, University ofWisconsin-

Madison, 301 Education Building, 1000 Bascom Mall, Madison, WI

53706. Phone: 608-263-4493. Email: cvaldez@wisc.edu.

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