‘Typical or Troubled’: Early Intervention Program With Proven Effectiveness

Many of our members may not appreciate the role of the APA Foundation. It is APA’s fundraising arm that is responsible for developing programs to promote mental health and provide public education.

I must admit that until I sat on the Foundation Board last year as president-elect, I never understood all of the fantastic programs that are accomplished through the APA Foundation. For example, there are programs related to workplace mental health, partnerships with the judicial system, and partnerships with faith-based organizations. In this column, I am highlighting just one of the programs, the “Typical or Troubled?” early intervention program. The importance of this program was illustrated to me during a recent session with one of my patients.

My patient was very upset about the suicide of a neighbor’s 16-year-old son. She told me that she had recently been to the neighbor’s house and noticed that the son was watching video games all the time. The neighbor told her that the son was starting to worry about getting into a good college and also had recently stopped being friends with some “popular kids” who the son said were starting to use drugs and alcohol. The neighbor also described her son’s behavior as “typical” of adolescent struggles, and my patient and the neighbor jokingly reminisced about their own struggles when they were adolescents.

During her psychotherapy session, my patient agonized about how she and her neighbor may have missed obvious signs of the boy’s distress. Her reaction was similar to how many people react whenever adolescents unexpectedly die as a result of suicide. We wonder whether the suicide could have been prevented. Were there signs of depression, substance abuse, or psychosis that were missed? Would early intervention have prevented the progression of more severe problems?

To prevent the type of tragedy that occurred with my patient’s neighbor, the APA Foundation has developed the “Typical or Troubled?” program that helps train teachers, other school personnel, and parents to recognize the early signs of mental illness in middle-school and high-school students, while simultaneously breaking down stigma through the promotion of awareness, outreach, and education. In addition to identifying the warning signs of mental illness, “Typical or Troubled?” trains participants on how to have that crucial initial conversation about referring a patient to care. The program focuses on teachers, other school personnel, and parents because they are often the first individuals to notice problems.

Training people to recognize the signs and behaviors of possible mental illness is important because it will lead to referrals for treatment. The U.S. Department of Health and Human Services reports that approximately 20 percent of youth aged 9 to 17 have a diagnosable mental disorder. The most common disorders are anxiety, depression, posttraumatic stress disorder, substance abuse, and attention/conduct disorder. In addition, psychotic illness and bipolar disorder often begin to manifest in adolescence or earlier. According to a report by the American Academy of Child and Adolescent Psychiatry, symptoms of 50 percent of all diagnosable mental illnesses manifest by age 14, and 75 percent by age 24. In the juvenile justice system, 70.4 percent of youth have been diagnosed with at least one mental disorder.

There is good scientific evidence that if psychiatric disorders are identified early and treated, long-term problems and disability can be prevented or at least mitigated. As we know, there are excellent treatments for adolescents who have psychiatric symptoms. Even adolescents who have symptoms consistent with the prodrome of psychosis can be treated using medication, psychosocial therapies, and supportive services. Early intervention in adolescents who are at high risk for developing schizophrenia may improve short-term clinical outcomes.

Since 2005, “Typical or Troubled?” has been implemented in over 1,500 schools in 38 states and territories and has resulted in the training of over 80,000 people in the early detection and identification of mental illnesses. The cost of “Typical or Troubled?” is covered by a grant to schools that apply for the program; they are then provided with a full set of an evidence-based, medically accurate education curriculum on mental illness and early identification. An emphasis on helping traditionally underserved communities means that the program has been developed in a number of different languages, such as Spanish and Creole. The Creole program, which was piloted in a large Haitian community in Miami-Dade, was met with great enthusiasm and participation. ■

More information on “Typical or Troubled?” can be accessed here.