prevention, with criteria for certification specified, no comparable position exists in the mental health area.

Education Providers

Neither the core curriculum for a bachelor’s degree nor the process for obtaining a teaching certificate anticipate that teachers will be prepared to recognize risk factors or detect early evidence of MEB disorders in their pupils. Coursework for education degree students includes descriptions of mental disorders (along with physical disorders and retardation), but it does not systematically include how to identify, intervene, or refer children at risk for MEB disorders. Special education trains teachers to recognize and work with children who have special needs that schools, by law, must address. Children with externalizing disorders (conduct, hyperactivity) are identified and directed to remedial programs when they are disruptive. Children with internalizing disorders (e.g., withdrawal, anxiety, depression) are often not identified for attention because they do not impose an added burden on the teacher or classroom. As federal mandates for testing and academic achievement have been strengthened, MEB issues have been relegated to lower priority status for teachers. Training in evidence-based behavior management techniques for teachers is essential for helping them to address the behavior problems that can develop into MEB disorders (Epstein, Atkins, et al., 2008).

The National Association of School Psychologists has 25,000 members and strongly encourages mental health promotion and prevention of disorders through a variety of programs. For example, Prevention, Crisis Intervention and Mental Health is 1 of 11 domains of the organization’s continuing professional development program (NASP Professional Development; see, accessed September 29, 2008). However, the contribution of school psychologists has limitations as a result of school budget contractions. Except for a few schools that have adopted specific experimental or innovative universal or selective interventions, most schools do not prepare their staff to screen for risk factors, nor do they adopt universal measures to decrease risk or enhance protective factors (personal communication, Mary Boat, College of Education, University of Cincinnati). In many ways, this is an opportunity lost, but transformational changes will be needed in school systems to respond to this opportunity. Nevertheless, the school setting represents one of the best opportunities for prevention interventions, whether universal, selective, or indicated.

Preschools and day care centers (for children from birth to age 5) may be in the most advantageous position to observe young children and identify risks or early symptoms. However, preschool teachers often have less training than school teachers and are frequently unprepared to engage

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