A School-Based Intervention to Reduce Stigma & Promote Mental-Health Service Use

Purpose.

Research has documented that stigma and discrimination are painfully present in the lives of people with mental illnesses and their families, blocking opportunities, compromising self-esteem and keeping people from accessing helpful treatments The proposed project seeks a rigorous test, with long term follow-up, of an intervention in sixth grade classrooms that is designed to 1) improve knowledge, attitudes and beliefs about mental illnesses, 2) change behaviors toward people with mental illnesses and 3) facilitate appropriate help seeking for mental health problems. This study evaluates the short- and long- term effectiveness, both individually and in combinations, of 1) the Eliminating the Stigma of Differences curriculum, 2) contact with a young adult with a mental illness, and 3) the use of supplemental materials, including posters and other media that reinforce an anti-stigma message.

Design

The study involves two phases. Phase I is a pre-post design to assess changes in knowledge, attitudes, and behaviors in sixth-grade students from before the intervention to 3 weeks after its conclusion. Phase II is a longitudinal assessment of Phase I participants who were willing to participate in home-visit assessments at 6, 12, 18 and 24 months post intervention.

The study was designed as a fully crossed two by two by two factorial cluster randomized behavioral field experiment. Sixteen schools with separate zip codes from an urban school district in Texas were ranked according to performance on the statewide standardized assessment of math, English, and science. We randomly assigned the top eight schools to one of eight cells; the bottom-ranked eight schools were then assigned to a cell in the reverse order so that, for example, the top- and bottom- ranked schools were paired. Each cell (two schools in each) was randomly assigned to a study condition. Before the study began, two schools dropped out for non-study-related reasons. For this reason the study was repeated during a second academic year with a new set of sixth-grade students in five of the original schools chosen because they had demographic characteristics similar to the lost schools. Thus a total of 19 sixth-grade classes from 14 schools were included in the study.