Children and adolescents who are depressed: an ecological approach.

The purpose of this article is to provide school counselors with a framework for working with students who experience or display depressed feelings or behavior. Following an overview of depression, a framework based on the ecological model (Bronfenbrenner, 1979; Bronfenbrenner & Morris, 1998) is described. The framework offers school counselors a conceptual model to understand the diverse factors that can impact a student's life. The authors present composite case studies to illustrate ways that school counselors can utilize this framework to identify sources of depression as well as areas for intervention.

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Schools today are called upon to educate an increasing number of students with social and emotional needs that interfere with their academic success (Lockhart & Keys, 1998). As stress and emotional distress increase among children and adolescents, affordable mental health services are declining (Wylie, 1992). The rising number of students and families in need of mental health services, coupled with the decline in mental health programs (Wylie), places school counselors in the difficult position of sometimes being the only accessible mental health service provider for many students and families, particularly if they live in rural areas (Kennedy, 2004). School counselors may at times find themselves in the position of being the professional whom students and their families turn to first in moments of crisis and despair.

According to Israelashvili (1998), school counselors must be able to find the resources necessary to provide interventions that will help students cope with school despite their life challenges. School counselors are required to balance multiple needs as they attempt to fulfill many functions (Davis & Garrett, 1998) and, according to Kennedy (2004), are "asked to take on a wide variety of issues, from eating disorders and unemployment to depression and abuse and everything else in between" (p. 1). One of the challenges laced by school counselors is how to work with students who are experiencing one or more behavioral or emotional indicators of depression. Because most students spend a majority of their day in school, it is not unreasonable to assume that school counselors need to play a role in helping such students (Evans, Van Velsor, & Schumacher, 2002).

In our experience as professionals in the field of school counseling, we have found it helpful to think of the behavioral/emotional indexes of depression along a continuum (see Figure 1). At the far end of the continuum are those students who have been diagnosed with major depressive disorder. The National Institute of Mental Health (1999) has reported that as many as 3% of all children and 8% of all adolescents in the United States are classified as clinically depressed. Other data indicate that "over one in four youngsters will experience a serious episode of depression by the time they reach their eighteenth birthday" (Fassler & Dumas, 1997, p. 2). These students, represented at the upper end of the continuum, are experiencing clinical forms of depression that are of such severity that they are beyond the province of school counselors and are better served by specialized professionals such as psychiatrists, psychologists, and clinical social workers.

The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [APA], 2000) categorizes depression as a mood disorder and includes specific descriptors of the various types of depressive disorders. Typical behavioral/emotional indexes of depressive disorders displayed by children and adolescents include a decreased ability. to experience pleasure; irritability and anger; sadness; changes in appetite and weight; somatic complaints such as headaches and stomachaches; a sense of worthlessness, excessive guilt, and hopelessness; psychomotor extremes of either lethargy, or agitation; exhaustion and lack of energy; trouble concentrating, thinking clearly, or making decisions; insomnia or, less often, hypersomnia; suicidal ideation, threats, or behavior; and preoccupation with recurrent thoughts of death (APA; Kauffman, 1997; Vernon, 1999).

Viewing depression along the continuum in Figure 1 brings to light large numbers of students who may not have a diagnosis of dysthymic or major depressive disorder but who may be experiencing one or more of the behavioral/emotional indices of depressive disorders listed above. These children and adolescents, represented by the left-hand side of the continuum in Figure 1, display one or more indicators of depression that, although not sufficient for a clinical diagnosis, are still serious enough to prevent them from functioning at their optimal level academically and socially. Other students may be suffering from a depressive episode after experiencing a significant loss or change. School counselors, as the first line of mental health resource personnel in our public schools, can and should play a very active role in assisting these students (Evans et al., 2002).

Figure 1. Continuum of depression.

Not diagnosable *   Dysthymic       Major depressive disorder

* Displays some characteristics such as depressed mood most of the day,
loss of interest in pleasure, and so forth, but does not display other
or sufficient DSM-IV diagnostic criteria such as appetite change,
fatigue, or insomia for actual diagnosis. Therefore, student is
somewhat sad or displays low affect and/or energy and could still
benefit from intervention.

Although no single theory or approach can be expected to be effective in responding to the range of indexes of depressive disorders, one that holds much promise for school counselors is the ecological model, developed by Urie Bronfenbrenner in 1979 and described in Bronfenbrenner and Morris (1998). The ecological model provides a systematic and comprehensive approach to understanding the "bigger picture," namely identifying those personal/environmental factors contributing to a student's depression. Once armed with this "bigger picture," the counselor is in a position both to better understand the source or sources of the student's pain and to identify a range of possible responses and interventions.

ECOLOGICAL MODEL

Because the ecological model considers and incorporates factors inherent both within a student as well as within the student's school, family, and community, it provides a contextual map to help in understanding the many different factors contributing to the student's depressed behaviors, including broader social, cultural, and historical forces. As such, the model offers school counselors a useful framework for identifying appropriate interventions in their work with students whose behaviors fit along the depression continuum.

According to this model, children live in an interactive flow with their microsystem, which includes family, school, peers, and neighborhood. Interchanges between the child and his or her microsystem are affected by the interrelationships among, for example, home and school or the child's relationship with friends in the neighborhood and adults in the community (i.e., the mesosystem). The type and quality as well as the presence or absence of such relationships will obviously have impacts that can either mitigate or stimulate behavioral/emotional indexes of depression.

The model then broadens to focus on how the individual child and his or her microsystem are affected by those "settings" that, although perhaps not directly involving the child, have an impact on his or her life (i.e., the exosystem). Examples of the exosystem's impact include government cutbacks in health services needed by the child or a decision to add additional counseling services in a school. The model then moves to a perspective that encompasses culture, society, and global events, such as war; increases in rates of divorce; and poverty, racism, and environmental issues (i.e., the macrosystem). The macrosystem level may have subtle or dramatic influences on individual lives. The time in history that each individual lives out his or her lifetime (i.e., the chronosystem) frames the entire model. Considering depressive disorders from the chronosystem level is noteworthy in that it wasn't until the 1970s that it became widely accepted that children experience depression (Miller, 1998).

School counselors have direct access to individual students as well as various aspects of their microsystems--that is, the interactions involved with their school, family, neighborhood, and community. Recognizing that each individual's life is profoundly affected by the attitudes and ideologies of his or her school, family, and community culture, we consider interventions that address some of the pressures and stressors on students' lives stemming from these influences. The interventions selected then may focus not only on addressing the student's attitudes, belief, and behaviors, but also the attitudes, beliefs, and behaviors of the student's family, teachers, peers, and/or others having either direct or indirect influence on that student.

In addition, counselors using the ecological model would not only be trying to identify such contributing factors but would simultaneously be looking for possible sources of strength and healing within a child's or adolescent's world. These sources of healing may be thought of as protective or resiliency factors. Research on resilience indicates that one person who cares about and supports another can make a significant difference in that person's life (Guetzloe, 1994; Howard & Dryden, 1999; Seita, 1994). A sense of purpose and the opportunity to make meaningful contributions, whether in school, at home, or in the community, is another factor supporting resilience. The ecological model allows us to look within systems of the student's life for those people or situations that can foster healing and resilience.

Ultimately, the ecological model helps in answering the "who," "what," "when," "where," and "why" questions that guide interventions. From the outset, when applying the ecological model, school counselors must determine "who" is the focus of possible interventions. Is it the student or significant others who need to alter their attitudes, expectations, and/or behaviors? The answer to this question will determine whether the counselor directly addresses the student's depression by counseling with that student or whether the counselor indirectly addresses the student's depression by consulting with those of influence in the student's life (e.g., teachers, family, peers).

In so doing, the counselor then must consider "what" needs to change. Is it the student's behavior? Should the focus be on the attitudes and beliefs of the student? Is it the setting(s) in which the student experiences his or her depressive feelings and behaviors? Should the focus be on the behaviors, attitudes, and/or beliefs that individuals of significance have toward the student? All are potential factors for which interventions might be considered depending on their hypothesized influences on the student.

The next crucial component in designing an intervention is the "when," the time frame when it is implemented and when improvement may be expected. The time period must be realistic and reasonable for the intended intervention. Often, a new approach may generate hope and optimism for a "quick fix" that quickly turns to disappointment if the outcome fails to live up to expectations. Or, if an intervention is to be implemented at times that disrupt typical individual, classroom, family, or community routines, it is unlikely that it will be sustained or even implemented as intended. As such, in designing interventions, creativity and flexibility are desirable qualities for those who use the ecological model.

"Where" the intervention occurs is also an important consideration. A close match between where the intervention occurs and the student's microsystem is necessary to better ensure lasting changes. Finally, the "why" and "how" also must be evaluated. Determining why an intervention is required and how it will best be implemented are philosophical, political, and logistical issues that must be considered.

Within the ecological model, interventions may be directed at an individual level, as in conventional counseling practices, and/or at broader systemic levels. At times, for example, a student's depression may actually be a symptom of some aspect of the student's world that has gone awry for that individual. If the intervention focuses primarily on the student without trying to make some improvements in broader environmental/systemic areas that are negatively affecting that student, improvement is unlikely.

Because interventions are guided by working hypotheses, that is, best guesses, conceptualizing depression mostly from an individual level without incorporating broader environmental/systemic factors that may be contributing to the individual's depressed behavior may lead to a limited range of hypotheses that in turn may generate ineffective interventions. The ecological model can be extremely useful in helping generate a wider range of viable hypotheses thereby contributing to potentially more effective interventions. The purpose of this article is to describe how the ecological model can be useful to school counselors as they design and implement effective interventions to address students with behavioral/emotional indexes of depression (Karan, 1988).

UTILIZING THE ECOLOGICAL MODEL

This section describes applications of the ecological model. It starts by describing the leadership role of the school counselor in convening teams representing those of significance to the student. Such teams assist in identifying student/environmental factors contributing to a student's depression and in selecting interventions at microsystem and macrosystem levels for addressing these factors. Hypothetical case study illustrations based on applications of the model at these different levels are included.

A school counselor can frame interventions utilizing the ecological model by gathering together people who are significant in the life of the student (drawn from the microsystem and exosystem) to work as a team. School counselors are in a unique position to take the leadership in bringing together this team and then facilitating the intervention process by using their knowledge of resources in the home, school, and community.

Drawing from the microsystem level, the team may include members of the family and colleagues from within the school system, such as the school psychologist, teachers, teaching assistants, special educators, coaches, and/or school nurses, as well as key members of the student's life outside of school. Community support people drawn from the macrosystem level (and invited with the consent of the student and family) might include therapists, medical professionals, social workers, or spiritual leaders. Mentors who are important to the student could be invited as well, such as a music or art teacher, a Big Brother or Big Sister from a companion program, and/or a Scout leader. The team, which also may include the student if appropriate, can identify a range of factors that may be contributing to the student's depression and generate a wide range of possible interventions that are tailored to the individual student and his or her life context.

The ecological model provides the team with a framework to identify factors in the student's ecosystem that may be a source of pain or discomfort as well as to identify positive or resiliency factors that can be built upon and strengthened. Teams can use this information to suggest, plan, and help to implement changes that can make a significant difference in the student's life. The following sections provide examples of some of the ways the ecological model can be applied in identifying both student and environmental factors contributing to a student's depression and in selecting interventions at microsystem and macrosystem levels for addressing these factors. The examples that follow are hypothetical, yet based on the types of situations that the authors have found present themselves to school counselors.

FOCUSING ON THE INDIVIDUAL

According to the ecological model, the individual child or adolescent is the focal point. At times both the catalyst for depression and the focus of interventions may be intrinsic to the student and involve issues within the student's physical, cognitive, and/or social-emotional domains. As one of its first tasks, the team should consider factors including physical health, activity level, nutrition, sleep patterns, stress, the possibility of a learning issue, and the need for a referral to a mental health specialist.

Prior to the team meeting, a complete medical examination should be given to rule out underlying conditions that can produce symptoms that may be mistaken for depression. For example, mononucleosis and other infectious diseases, allergies, and thyroid problems are among the more common conditions with symptoms similar to those of depression. Other, less common conditions include autoimmune disorders, inflammatory bowel disease, and sleep disorders including obstructive sleep apnea (personal communication, Betsy A. Brooks, M.D., August 22, 1999).

Some common behavioral/emotional indexes of depression are decreased energy and activity level. This can create a vicious cycle in that this decreased energy means that people are less likely to get the exercise that produces endorphins, the body's natural antidepressant (Bloomfield & McWilliams, 1994). People who are depressed have been found to have low levels of endorphins, and increasing endorphins has a positive effect on depression (Dubuque, 1998). Increasing the student's opportunities to become active during the school day is a simple intervention that can be effective in combating depression. Involving the child in choosing the activity maximizes the chance that the student will participate more enthusiastically. In addition to vigorous exercise, such as running, dancing, and lifting weights, students can walk, practice yoga, stretch, garden, and get involved with active games in the gym or on the playground. These activities can be incorporated into both the student's school day and after-school activities.

Another individual level factor the team should consider is the student's nutritional intake, as nutrition is an important means of enhancing well-being (Bloomfield & McWilliams, 1994). The school nurse or a dietician may help in uncovering nutritional factors contributing to the student's depressed feelings or behaviors. An unbalanced or inadequate diet can lead to feelings of fatigue and lethargy. In one example, a school nurse suggested that Rachel, a 15-year-old who "lacked enthusiasm and always seemed to be tired," be tested for anemia. It was discovered that Rachel was indeed anemic and changes in diet along with iron supplements gave her the additional energy she needed to cope more effectively.

Soda, coffee, and other caffeine- and sugar-containing substances can affect moods and energy cycles. Although caffeine provides an initial boost, a drop in mood and energy may follow (Carter & Clayton, 1995). Ronnie, a high school junior complaining of both a lack of energy and headaches, discovered that his pattern of caffeine and sugar consumption was contributing to both problems.

A change in sleep patterns, either sleeping too much or too little, is a common sign of depression (APA, 1994). Insomnia, for example, is one behavior pattern that can be addressed by the team. The school nurse and other medical professionals can help with assessing and treating its physiological concomitants while the school counselor can brainstorm ways with family members to create an atmosphere in the home that is conducive to sleep. Changes at home might include eliminating noisy and overstimulating media; establishing a regular bedtime ritual; creating a relaxing and cozy environment with soft music and lighting; reading or telling bedtime stories; or relaxing in a bubble bath, followed by a cup of warm milk and honey or herbal tea.

Practicing meditation, yoga, and relaxation exercises may be useful methods for helping children and teens experiencing some of the typical behavioral/ emotional signs of depression (e.g., irritability and anger, trouble concentrating). Students can learn through these practices to calm down, center themselves, and focus. Robbie, a fourth grader with dyslexia and a diagnosis of depression, found brief sessions of group relaxation exercises led by his counselor to be very helpful. After these sessions, Robbie reported that he was able to go back to class feeling less angry and more relaxed. He reported that the rest of his school day went more smoothly after these sessions.

Adolescents who are depressed are more likely to experience increased difficulty in school (Evans et al., 2002). When teachers or parents imply that a student needs to be more motivated, or the student observes peers accomplishing their academic tasks without difficulty, or when school has been a source of repeated failure experiences, it is easy to understand how that student would begin to feel misunderstood, dejected, or incapable. This would be frustrating for any student but would be of particular concern for those with undiagnosed learning disabilities because depression is more likely in people with learning disabilities than in the general population (Rodis, Garrod, & Boscardin, 2001). Thus, addressing the student's depression without assessing for possible learning disabilities and/or arranging for various accommodations would still leave that student vulnerable while only superficially addressing the real problems.

For example, Nate, a bright (full-scale IQ of 125) and extremely verbal middle school student, was becoming increasingly irritable and withdrawn. His grades were dropping 'along with his school attendance. Instead of only addressing his feelings and behaviors within counseling sessions, the school counselor requested additional psychoeducational testing. After being tested, Nate was identified as a student with a learning disability, as manifested in his difficulties with organization and attention. Because he was such a bright student, he had been able to compensate for his disability quite adequately throughout elementary school and continued to do so until he entered middle school where more of the skills in which he was limited were required. Once Nate, the school, and his family understood the problem, they were able to support him in discovering strategies that helped him to bypass his difficulties and to encourage him in his areas of strength, which included theater and student government. This intervention may have started with Nate in the microsystem level but evolved to the mesosystem level--in this case, the family and school connection.

Counseling is one of the most important tools in the treatment of depression. While fully respecting the biological, systemic impact of depression on the young person and those close to the individual, the ultimate goal of any intervention is to promote and maintain healthy life skills. These include self-awareness and an appreciation for one's positive assets (Ivey & Ivey, 1999), a developmentally appropriate understanding of the conditions giving rise to the emotional distress, and effective strategies for handling life's challenges. Counseling may be provided in school or outside of school and either individually, with the family, or in a group. Counseling may be particularly important for someone who broods about difficulties (Bloomfield & McWiliams, 1994).

Janet, a high school senior, was devastated after the breakup of a relationship. A counselor used cognitive/behavioral therapy to help her to reexamine her thoughts and then move forward. In addition to counseling and encouraged by both her mother and her school counselor, Janet began volunteering at a local child-care center through the school's service learning program. Working with young children helped her to refocus her energy and gave her renewed confidence in herself.

FOCUSING ON THE MICROSYSTEM: FAMILY, PEERS, SCHOOL, AND COMMUNITY

When we view the student from an ecological perspective, a wide range of possible interventions emerges. In this section, interventions that can be considered as originating in the microsystem-including family, peers, school, and community resources--are addressed. The reader must keep in mind the interactive nature of the complex microsystems operating in each individual's life (i.e., mesosystem).

Family

Difficulties that begin in the home often manifest themselves within the school setting (thus illustrating the mesosystem). Lucy, a third grader, appeared sad and irritable and was having trouble concentrating in school. Her recently divorced parents were putting her in the middle of their conflicts. Lucy was particularly upset because her mother quizzed her about her father's new partner. In this situation, the counselor worked with Lucy's parents to change their behavior. This included a referral for family counseling and to a group for newly divorced parents. Helping Lucy discover strategies that worked for her (e.g., phoning a friend or reading a book rather than witnessing her parents fighting) was both solution-focused and self-empowering.

Peers

Direct instruction in social skills can be a powerful intervention, especially when loneliness and feelings of rejection are contributing to the student's feelings of depression. Protocols for how to act in social situations and direct instruction and practice with feedback in the skills necessary for making and keeping friends are concrete ways to support children and adolescents whose lack of social skills intensify their isolation (Dwyer, 1998).

Nine-year-old Joanna's awkwardness in joining groups and her habit of interrupting others in mid-sentence were factors contributing to her lack of friends and thus her depression. After 12 weeks in a "Friendship Group" led by her school counselor, Joanna learned more effective ways to approach a group of children with whom she wanted to play. Her peers in the Friendship Group agreed to give Joanna a signal when she interrupted someone. This support assisted her in overcoming this habit. The experience of being in a counselor-led group not only taught Joanna more effective social skills but also provided her with a group of friends in her class. This connection with peers was significant in reducing her isolation and her feelings of depression.

A six-session unit the school counselor created for Joanna's class on identifying, naming, and expressing feelings further strengthened the group intervention. Developing a "feeling" vocabulary can be very helpful for students as part of the process of learning to name emotions for themselves and to express emotions appropriately to others (Dubuque, 1998).

School

Further analysis of the microsystem might reveal that for a child or adolescent who is depressed, sitting in class all day could be tedious and tiring. Exhaustion and difficulty concentrating can heighten this negative experience. Time to be active, creative, and playful is important for everyone but can be a lifesaver for those who are depressed. Play and the arts can be windows into the inner emotional landscape, enhancing self-knowledge, self-expression, and communication.

Play is the natural medium for young children. Both play and the arts provide pathways for self-expression and confidence building that can be easily incorporated into the school day. As Howard Gardner (1983) pointed out, one person may shine in mathematics while another excels in the visual arts or interpersonal skills. It is crucial to find areas of competence for young people, but especially urgent for those who are depressed.

For example, physical education classes are natural places for group building if noncompetitive games are encouraged (Burak-Maholik, 1993). If a student likes to draw, paint, throw pots, or dance, then opportunities can be built into the school day for these creative and potentially healing activities. The positive feelings that result from such activities may spill over into other aspects of the student's life, creating opportunities for joy, laughter, connection, and positive feedback.

People who are depressed tend to have less confidence and less energy to invest in whatever they do; therefore, they tend to accomplish less, while simultaneously viewing circumstances in their most negative light. This fuels a cycle of increasingly negative feedback from the environment and may further the momentum toward depression. Perfectionism and harsh self-judgment can contribute to a deepening of the cycle of depression (Cleve, 1996). To interrupt this negative cycle, the student needs to experience success. Success breeds success and sometimes comes one small step at a time. Based on Fassler and Dumas' (1997) premise that setting realistic goals is helpful when working with students who are depressed, the team can work together to literally build success into the student's day by ensuring that academic goals are achievable by this student at this time and by involving the student in the discussion of goal setting. In addition, temporary accommodations for academic requirements can be considered, as the pace of the child's progress may be slowed down (Fassler & Dumas).

Feelings of success are based on accomplishment and meaningful feedback from the environment. As practitioners we have found it helpful to make efforts to have the school day begin and end with a positive experience and to try to build on student strengths both inside and outside of school. Examples of areas to consider include sports, computers, the arts, community service, helping others in the school or the community, hobbies, pets, nature and outdoor activities, and woodworking--the possibilities are endless.

Community Resources

An ecological perspective includes linking students with community-based support services when appropriate and fostering resiliency through connections with caring adults. School counselors cannot and should not try to become the "be all and end all." Most communities offer a wide range of resources including outside therapists, family counseling, support groups, parent groups, Big Brother/ Big Sister programs, mentoring, bereavement counselors, and al-Anon and drug/alcohol centers.

The school counselor is in a unique position to know the needs of both the student and the family as well as the availability of resources in the community. The counselor can play a key role in linking people with services and, in cooperation with other school and public/private agency professionals--for example, school psychologist, school social worker, vocational rehabilitation counselor, or agency caseworker--may uncover sources of funding for these services when necessary.

INTERVENTIONS THAT FOCUS ON THE MACROSYSTEM

Cultural Values

Given that the attitudes and ideologies of the family, school, and community are significant parts of the child's social context, an ecological approach to interventions for children and youth who are depressed must consider whether any or all of these cultural contexts may be contributing to the child's depression. For example, American culture emphasizes material consumption and competition. Our technological society bombards us with information. A frenetic pace of life leads to disconnection from nature. The hurried pace and chaotic rhythm of life increase stress levels not only for adults but also for children and adolescents.

According to Bronfenbrenner and Morris (1998), such aspects of our cultural environment can interfere with the development of children and adolescents. "Instability and chaos in the principal settings in which human competence and character are shaped--in the family, child-care arrangements, schools, peer groups, and neighborhoods"--are risk factors impeding the healthy development of young people today (p. 995). Time pressure, stress, and the sense that life is out of control can lead to or exacerbate the experience of depression. Teams can explore whether the speed and hurried pace of students' lives, the chaos that results from multiple activities, complex child-care arrangements, and/or multiple demands on the lives of parents and/or caretakers are contributing factors to the depression. If so, interventions can focus on making changes within these social contexts.

Having the time to listen to our children is an intervention that requires neither money nor medication. In our hurried society, people are rarely listened to in the course of their day. Students who arc depressed may find it especially difficult to communicate the need to be heard, even though their need to be heard is particularly urgent. Fassler and Dumas (1997) suggested that listening may be the most helpful way that parents can support their child. As noted previously in this article, some students may need to be taught a feeling vocabulary in order to express themselves verbally. Others may benefit from having the arts incorporated into their academic and home lives to provide for new forms of self-expression. Some may feel more at ease communicating through journal writing (Burak-Maholik, 1993). School counselors are in a strong position to work with students, teachers, and family members to facilitate opportunities for students to be listened to and for them to express their feelings and thoughts in the course of their day.

Social Conditions

The emerging field of eco-psychology (Firman & Klugman, 1999; Roszak, Gomes, & Kanner, 1995) has insights regarding stresses within the social system that may help us to understand why so many young people's development in our high-pressure society is marred by depression. According to eco-psychologist Carla Brennan (personal communication, September 3, 1999), disconnection from nature and the speeded-up tempo of modern life contribute to stress, anxiety, and depression, and young people are particularly vulnerable to these stresses.

Brennan (personal communication, September 3, 1999) suggested designing interventions that encourage students to spend time exploring nature in a relatively unstructured, adventuresome way. This can be done alone, if appropriate, with peers, or with adult mentors. The interventions can be as simple as experiencing fresh air, flowers, sunshine, snow, rain, animals, and pond life. Students or entire classes can plant vegetables, work in a community garden, visit a greenhouse, maintain a woodland trail, or paint or photograph nature. Summers and vacations can be spent participating in Outward Bound, Scouts, canoe trips, or nature camps. These are only a few of the possible paths for healing through a deepening connection with nature.

Education

School counselors can initiate school-based education programs involving primary, secondary, and tertiary prevention efforts (Evans et al., 2002). At the primary prevention level, education about depression can have a positive impact on our culture. Teachers, staff, parents, and students can be taught the signs of depression through training sessions tailored to the particular audience and presented by the school counselor, school psychologist, school social worker, or a professional in the community with this particular area of expertise. Early identification of depression is more likely when people arc more knowledgeable about early signs; early recognition is more likely to lead to more effective treatment (Miller, 1998).

In addition to teaching others to recognize the signs of depression, the school counselor can initiate school-based prevention programs at the secondary level of prevention in which the focus is on students with current difficulties and risk factors that make them susceptible to depression. Prevention efforts at the tertiary level, in which the focus is on supporting students who have already developed depression, are intended to enhance their functioning. Knowing that one is not alone, that we all experience degrees of discouragement and sadness, may help reduce feelings of isolation and shame. Information about the actual incidence of depression may help people to realize how common and widespread depression is in our society. The use of education to reduce the stigma of depression is in itself an intervention, as students may be less likely to engage in self-blame, adding guilt and shame for being depressed to their already heavy burdens. "Depression is no one's fault" (Carlson, 1998, p. 1).

A WORD OF CAUTION

The ideas in this article are not intended in any way to usurp referrals to community mental health professionals (Evans et al., 2002) or to replace emergency interventions such as calling in a crisis or suicide assessment team, psychiatric evaluation, and/or immediate hospitalization. Immediate action must be taken if a student appears to be unable to function--for example, is not able to attend classes, is not eating or sleeping, is constantly in tears or incoherent, and/or there is suicidal ideation. No student in such a high-risk condition should ever be left alone.

All schools need a crisis intervention plan that details the process for handling such emergencies. It is assumed that many seriously depressed students will be on medication and will continue to be monitored regularly by their physician. For some students, medication alone may help alleviate their symptoms and enable them to function quite well. Yet, for others, medication may only address part of the problem. For these students, the school-based team, in collaboration with the student's prescribing physician, may find that some of the ecologically based interventions suggested in this article would prove to be useful adjuncts to their medication.

CONCLUDING THOUGHTS

The purpose of this article was to describe how the ecological model can improve school counselors' chances of designing and implementing effective interventions to address depression. An ecological approach emphasizes collaboration with a team that, at various times, would include other professionals from both within and outside the school and other significant people in the student's life. Instead of focusing interventions primarily on the student, school counselors using an ecological approach would be simultaneously recognizing and, at times, carefully modifying the delicate balance between the person and the systems of people, places, and things that interact both directly and indirectly with that person. With the leadership of the school counselor, the team can identify sources of the student's depression, resiliency factors within the student's broader ecological systems, and areas for intervention. School counselors are encouraged to consider an ecological framework when dealing with students who fall along the depression continuum.

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Karen Abrams, Ph.D., is a guidance counselor at Pembroke Hill and Village Schools in Pembroke, NH.

Susan K. Theberge, Ed.D., is an associate professor of Education/Special Education/Early Childhood at Keene State College in Keene, NH, coordinator of the School Counseling Program, and faculty co-chair of the Keene State College Diversity Commission. E-mail: [e-mail]

Orv C. Karan, Ph.D., is a professor of Education and the coordinator of the Counseling Psychology Program at the University of Connecticut at Storrs.