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t’s parents, teachers or psychologists who are the first to spot warning signs in children’s mental health, right? Actually, that screening role is played most often by nurses, says Mary Muscari, associate professor at the Decker School of Nursing, who has worked for years on the front lines of pediatric mental health.

“Normally, kids don’t go to counselors,” Muscari explains. “By the time they get to therapists, something is really wrong.” It’s school nurses who often pick up on the early risk factors because they focus on prevention and physiological issues that can lead to behavior problems.

What nurses and other experts are finding is an increase in psychological problems among children and adolescents. Almost one in four has a mental-health problem, according to a 2006 report by the American Psychological Association, and suicide is the third-leading cause of death in those ages ı5–ı9, according to the American Association of Suicidology.

Muscari has made it her charge to write and speak about these issues for nurses, parents and teachers. Despite findings during the ı990s on the formative role of peers, she says, some parental basics are more important than ever: moms and dads who pay attention, family meals, and lots of communication between parents and kids.

When the National Association of Pediatric Nurse Practitioners (NAPNAP) decided to improve awareness of and address adolescent mental-health problems, Muscari was one of four committee members who made it happen and continues to propel efforts through KySS, Keep your children/yourself Safe and Secure, according to Dolores Jones, the association’s director.

Muscari’s stamp is evident, from KySS’s strategic plan to its national survey of families and health-care providers. She’s also deeply involved in its training programs and annual conference. Muscari’s books and articles have clarified KySS research for parents and teachers, as have her many public presentations. “She’s a dynamic speaker and really relates to the audience,” Jones says.

Her popular writing has been equally influential. Muscari started developing how-to books for parents after the Columbine school shootings in April ı999 in Denver. At the time, she was scheduled to lead a workshop on youth violence. When it attracted four times more people than expected, she immediately began planning a book to help parents recognize and reduce violence in children. Not My Kid: 21 Steps to Raising a Non-Violent Child appeared in 2002.

One relief for many parents is that youth violence isn’t spreading wildly. Statistically, youth violence peaked in ı993, Muscari says. The rise in psychological problems in children, however, can greatly complicate the already-difficult task of parenting.

“It’s harder to raise kids than it used to be,” Muscari says, in part because of outside influences, including technology. Every frightening event worldwide appears on television; fictional programming is equally violent. “Today’s kids see about 70,000 TV murders in their lifetime,” Muscari says. She gives frequent talks to help parents and nurses understand the effects of such exposure.

She also offers counsel on time spent with computers and video games. “Parents need to help kids balance between tech and touch,” says Muscari, who deals with such issues in Let Kids be Kids: Rescuing Childhood, published in 2006. “You need tech to survive, but you also need to know how to solve schoolyard problems face to face,” she says. Her commonsense approach has attracted attention. Muscari has been interviewed by and quoted in regional and national media, from the Washington Post to NPR to Parents magazine.

“It’s rare to find parents who do not want the best for their kids, even when they don’t know how,” Muscari says. “I compliment parents when I see their kids doing good stuff. Most do a good job, even during incredibly difficult circumstances.”