An Exploration of Rural School Mental Health Professionals’ Workforce Needs Post-COVID-19

Many youth entering the education system lack the social and behavioral skills necessary for academic achievement. This is an alarming trend considering that youth spend a substantial amount of their time in school and that social and emotional growth is closely linked with academic success. With 21% of children in the United States living in rural areas it is important to have mental health services available in rural schools. The quality and value of school mental health (SMH) approaches depend on service delivery by well-trained and prepared SMH professionals working within the system. This chapter details the general and specific competencies needed for rural SMH professionals. Additionally, findings from a large rural SMH needs assessment are provided for specific examples of areas of need in rural schools. The chapter concludes with suggestions for supporting SMH in rural schools.

Shortages of school counselors and other school mental health providers have presented ongoing concerns about meeting the mental health needs of students before, during, and following the COVID-19 global pandemic. During school closure due to COVID-19, school mental health professionals faced a variety of new challenges and stressors, presenting additional concerns that may be important to address for their recruitment and retention. To provide insight into the ways school principals can best support school-based mental health supports and services, this study aimed to understand the perspectives of school mental health professionals regarding principals’ leadership and support of positive workplace conditions during remote school operations due to COVID-19. Following a sequential mixed-methods design, this study included both quantitative and qualitative analyses, drawing on surveys completed by 74 school mental health professionals in a southeastern US state and in-depth interviews completed with a subsample of these professionals ( n = 14). Results of regression analyses suggested that positive perceptions of leadership and working conditions prior to school closures (measured retrospectively) were significantly associated with positive perceptions of leadership and conditions during remote/hybrid schooling. Results also suggested that principal support during remote/hybrid operations was positively associated with positive perceptions of working conditions. Findings from qualitative analyses indicated that many participants experienced supportive leadership practices from principals and cooperative team efforts among leaders and staff. Many participants also described challenges related to resources and service delivery. By positively cultivating and maintaining leadership and working conditions during school closures and other periods of stress and uncertainty, school leaders can help support the school professionals providing supports and services to some of our most vulnerable youth.

.The purpose of the study was to evaluate the Homework, Organization, and Planning Skills (HOPS) intervention for middle school students with attention deficit hyperactivity disorder (ADHD) as implemented by school mental health (SMH) providers using a randomized trial design. Seventeen SMH providers from five school districts implemented the HOPS intervention. Forty-seven middle school students with ADHD (Grades 6–8) were randomly assigned to receive the HOPS intervention or to a waitlist comparison group. Parent and teacher ratings of organizational skills and homework problems were collected pre- and postintervention and at a 3-month follow-up; school grades were also collected. Intervention participants demonstrated significant improvements relative to the waitlist comparison across parent-rated organized action (d = 0.88), planning (d = 1.05), and homework completion behaviors (d = 0.85). Intervention participants did not make significant improvements relative to the comparison group according to teacher ratings. SMH providers were able to implement the HOPS intervention with fidelity despite the fact that no formal ongoing consultation was provided.

The purpose of the study was to modify, test, and refine the Homework, Organization, and Planning Skills (HOPS) intervention for adolescents with ADHD for use by school mental health (SMH) providers. Ten SMH providers from three school districts implemented the HOPS intervention with 11 middle school students with ADHD. Parent and teacher ratings of materials organization and homework management were collected pre- and post-intervention and treatment fidelity was assessed. SMH providers and teachers participated in focus groups and provided feedback on ways to improve the feasibility and usability of the HOPS intervention. Students made large improvements in organization skills (d = 1.8) and homework problems (d = 1.6) according to parent ratings however, no improvements were observed on teacher ratings. Qualitative data generated from coding the focus groups and audio-recorded HOPS sessions were combined with the quantitative results to systematically refine the HOPS intervention for further evaluation of intervention effectiveness and disseminability.

There are increasing numbers of children and adolescents who are affected by chronic health or emotional problems. Many children and adolescents do not receive adequate services in the community, and, untreated, these problems often become a barrier for success in school (Adelman & Taylor, 1998). Meeting the physical and mental health needs of these children and their families presents a formidable professional challenge that requires the coordinated efforts of many disciplines, including health education, nursing, nutrition, school counseling, and school psychology (Zins & Wagner, 1997). School-based health centers (SBHCs) are one example of interdisciplinary efforts to provide comprehensive physical and mental health care for children and adolescents. Most SBHCs have adopted a primary care orientation and offer physicals, acute care treatment for illnesses and minor injuries, and often provide ongoing care for chronic illnesses. Some provide dental care, and many provide preventive and health promotion programs. Originally established in urban areas, they are quickly developing in rural and suburban areas as well because they provide enhanced access to a variety of services in one convenient location. There is a growing body of evidence that SBHCs have positive effects for students. Children using SBHCs have a net gain in their number of health care visits and are much more likely to access mental health services when an SBHC is available in their school. This is especially true for children who are typically underserved: children in rural areas, minority youth, and homeless children. SBHC services also have been shown to result in a decrease in emergency room visits and referrals for specialty treatment. Students receiving school-based mental health care have an increase in academic achievement, reduced disciplinary problems, and fewer absences from school. Consumer satisfaction studies have found that students are very satisfied with SBHC services, are comfortable being seen in a center, and find the range of services acceptable. SBHCs are being established at an increasing rate, and they are becoming a part of mainstream health care in the United States (Koppelman & Lear, 2000). Although in operation for 25 years, SBHCs have received little attention in the counseling literature. Many school practitioners are not familiar with these centers and issues related to providing full-service health care through the schools. This article reviews one of the few special journal issues on SBHCs that have focused on school mental health providers. * Article Reviews The May 2003 issue of Psychology in the Schools presented a series of articles on the issues involved in the implementation of SBHCs. Although many of the articles were written from the perspective of school psychologists, the information in the issue is applicable to other school and community mental health practitioners. Several articles from this issue are reviewed, followed by a discussion of the implications for counseling practice and counselor education. Development of SBHCs Meyers and Swerdlik (2003) described the barriers and opportunities affecting the development of SBHCs in their article School-Based Health Centers: Opportunities and Challenges for School Psychologists. They discussed the influence of various factors on the establishment of SBHCs, such as system reforms, school system governance, the importance of SBHC to stakeholders, and availability of funding. They reviewed some of the factors that may impede the development of SBHCs, including definitional confusion, community stigma, limited resources, lack of integration and coordination of services, and an emphasis on a narrow role of medical services. There are a number of strategies that were suggested by Meyers and Swerdlik (2003) to overcome the formidable challenges in the development of SBHCs. Many solutions can be implemented during program establishment by approaching development as system-level reform and by becoming a player at the table, educating stakeholders, and conducting effective needs assessments. …

The purpose of this cross-sectional study was to examine burnout profiles and organizational variables that impact burnout in school mental health providers, such as school counselors, school psychologists, social workers, and interventionists. We disseminated a survey to a large sample of school personnel across a Midwestern state. From the larger sample, we analyzed responses from school mental health providers (n = 120), as there are severe shortages of these professionals within the state and across the country. When shortages occur, caseloads are higher, thus increasing the work demands and the propensity for burnout. With burnout leading to attrition from the field, this creates a vicious cycle that could be prevented through the awareness and implementation of strategies to counteract the factors contributing to burnout. Results indicate school mental health providers (n = 120) in this state endure high levels of emotional exhaustion, while still maintaining a sense of personal accomplishment. Further, higher levels of perceived organizational support and job satisfaction appeared to lower burnout, whereas respondents who worked in schools implementing a multi-tiered system of support experienced higher burnout. Key findings, implications for practice, limitations, and future directions are discussed.

Background Despite the ubiquity of chart notes and their well-known impact on medical providers’ job stress and satisfaction, little is known about how mental health providers interact with and are impacted by documentation requirements, particularly in school environments. Objective This qualitative study sought to investigate school mental health providers’ perspectives on and experiences with documentation. Method Four focus groups with eight school mental health providers were conducted. Providers were asked about their current documentation practices and desired changes to their electronic health record system. Recordings of focus groups were transcribed and analyzed for themes using a rapid qualitative analytic approach. Results Key themes revolved around the purpose, features, time demands, training needs, and writing processes surrounding chart notes. Providers reported spending substantial time and energy on documentation and viewed chart notes primarily as a billing requirement, but also valued their utility for treatment planning, outcome monitoring, and clinical accountability. Providers expressed frustration with redundant data entry, lack of protected time for documentation, insufficient training for and communication around updates to documentation requirements, and strained interactions with supervisors during editing. Providers highlighted scheduling protected work time for documentation, enhancing documentation training with a focus on habit formation, standardizing supervisory expectations and providing documentation specific training for supervisors, and redesigning electronic health record interfaces with automation and checklists as strategies that could improve their experiences with chart notes. Conclusions Providers highlighted the ways current training and supervision practices, time constraints, and electronic health record functionality contribute to job stress and burnout while also noting the value of documentation for treatment planning and processing difficult emotions. Roadmaps outlining further research that is needed to understand these suggestions from providers in the larger context of clinical documentation, as well their potential benefits and tradeoffs for providers and other stakeholders, are discussed.

Educators' perceptions of youth mental health: Implications for training and the promotion of mental health services in schools

ABSTRACTTo promote improved student outcomes, school mental health providers (SMHPs) monitor implementation fidelity when implementing evidence‐based interventions. Current approaches for implementation fidelity monitoring (e.g., intervention checklists) do not account for other relevant implementation indicators best captured through qualitative data. Therefore, this study employed a multi‐faceted approach to monitoring implementation fidelity of the Mental Health Action Plan (MHAP) Program, a school‐based person‐centered care planning program developed to coordinate mental health care at school. The purpose of this mixed methods study was to explore the extent to which the MHAP Program was implemented as intended by describing determinants (i.e., barriers and facilitators) to adherent implementation. Three participant triads (student, caregiver, teacher) and three SMHPs were included in the study. Implementation fidelity checklists and field note data was collected and analyzed using reflexive thematic analysis and descriptive statistics. Qualitative results provided greater context for the quantitative results and elucidated potential adaptations to enhance youth‐intervention fit. Themes related to the caregiver‐child relationship, logistical barriers, student factors, SMHP competing responsibilities, and team dynamics impacted implementation fidelity. Implications for monitoring implementation fidelity of school mental health interventions via qualitative methods as well as study limitations are discussed.

BackgroundSuicide is a leading cause of death among youth and a prominent concern for school mental health providers. Indeed, schools play a key role in suicide prevention, including participating in risk assessments with students expressing suicidal ideation. In the context of the COVID-19 pandemic, many schools now need to offer mental health services, including suicide risk assessment, via eHealth platforms. Post pandemic, the use of eHealth risk assessments will support more accessible services for youth living in rural and remote areas. However, as the remote environment is a new context for many schools, guidance is needed on best practices for eHealth suicide risk assessment among youth.ObjectiveThis study aims to conduct a rapid, systematic scoping review to explore promising practices for conducting school-based suicide risk assessment among youth via eHealth (ie, information technologies that allow for remote communication).MethodsThis review included peer-reviewed articles and gray literature published in English between 2000 and 2020. Although we did not find studies that specifically explored promising practices for school-based suicide risk assessment among youth via eHealth platforms, we found 12 peer-reviewed articles and 23 gray literature documents that contained relevant information addressing our broader study purpose; thus, these 35 sources were included in this review.ResultsWe identified five key recommendation themes for school-based suicide risk assessment among youth via eHealth platforms in the 12 peer-reviewed studies. These included accessibility, consent procedures, session logistics, safety planning, and internet privacy. Specific recommendation themes from the 23 gray literature documents substantially overlapped with and enhanced three of the themes identified in the peer-reviewed literature—consent procedures, session logistics, and safety planning. In addition, based on findings from the gray literature, we expanded the accessibility theme to a broader theme termed youth engagement, which included information on accessibility and building rapport, establishing a therapeutic space, and helping youth prepare for remote sessions. Finally, a new theme was identified in the gray literature findings, specifically concerning school mental health professional boundaries. A second key difference between the gray and peer-reviewed literature was the former’s focus on issues of equity and access and how technology can reinforce existing inequalities.ConclusionsFor school mental health providers in need of guidance, we believe that these six recommendation themes (ie, youth engagement, school mental health professional boundaries, consent procedures, session logistics, safety planning, and internet privacy) represent the most promising directions for school-based suicide risk assessment among youth using eHealth tools. However, suicide risk assessment among youth via eHealth platforms in school settings represents a critical research gap. On the basis of the findings of this review, we provide specific recommendations for future research, including the need to focus on the needs of diverse youth.

This chapter explores how supporting graduate students and supervisors can reduce the burden on mental health professionals serving high-needs schools. When resources and staff are stretched thin, school mental health providers are forced to focus all their efforts into Tier 3 supports. With such high numbers of students assigned to so few professionals, burnout is high due to high need and low support. In already high need areas, this added tension directly impacts staff retention and student success. Staff shortage limits availability and ability for supervisors to properly fulfill their duties, leaving supervising incoming school mental health professionals out of the question. Project BEAMS (behavioral, emotional, and mental support for schools) uses federal grants to partner grade schools with universities in order to serve high-need communities. To do this, the program provides stipends to driven students and potential supervisors to increase school mental health staffing. In addition, it provides learning opportunities for them and other staff and integrates existing services to best serve students, emphasizing evidence-based and inclusive practices. Implementing a cares team, teachers, parents, staff, and the district consult and work together to best support students. Using a response to intervention framework, student support is modified according to outcomes. Supporting programs like this one via policy and funding allows for significant and lasting impact to students, trainees, schools, and the community as a whole, especially as it relates to inclusivity and creating safe environments. A case study is provided to outline the process and potential of these programs.

Children with ADHD comprise one of the most common groups requiring supports from school mental health providers, yet current school structures and special education policies are not optimally situated to support and adapt to the inconsistent behaviors that are the hallmark of children with ADHD. The present paper reviews and synthesizes contemporary evidence-based reviews for school mental health interventions for children with ADHD across the preschool, elementary, and middle/high school levels to provide an overview of recommendations for best practice for school mental health practitioners. The preponderance of evidence across meta-analyses, systematic reviews, and practice guidelines support classroom contingency management strategies, with emerging evidence supporting training in organizational skills and homework supports. Behavioral parent training is also a supported intervention, but relatively few attempts have been made to evaluate it when integrated into school environments. A comprehensive, integrated approach for treating ADHD in school settings across universal, targeted, and indicated tiers is presented, providing an initial outline of a framework for school mental health treatment that could be utilized by school mental health practitioners.

Nearly 14% of all youth display disordered eating patterns. Despite the prevalence of these disorders, there is limited literature on the integration of eating disorder support services in schools. Further, there is often limited eating disorder knowledge and training for school mental health (SMH) professionals. This paper describes a two-phase study involving qualitative and quantitative components examining the perspectives of adolescents in recovery from eating disorders, family members, and SMH professionals. Fourteen participants were recruited from an eating disorder treatment facility in the southeastern USA. Eight adolescent females who received treatment for disordered eating while in primary or secondary school and six of their mothers completed interviews. In addition, 720 SMH and allied professionals were surveyed on their knowledge and training in disordered eating identification and intervention and their perspectives on service provision, with 561 complete and usable surveys. Analyses of adolescent and family data revealed the following themes that hindered or helped recovery: Isolation, Perfectionism, Difficulties with Self-Acceptance and Comparison to Others, Uncertainty, Teacher Identification, Support in Recovery. Themes surrounding the benefits of including SMH services for this population included: Increased Awareness, Support in Recovery, Family Involvement, and Linking to Resources. Results revealed that the majority of SMH professionals did not receive training in the identification and/or intervention of disordered eating. Data suggested that lack of referrals and limited knowledge, skills, and time interfered with their ability to effectively identify and intervene. Findings provide a foundation for understanding the experiences of adolescents with disordered eating and the role of SMH programs in assisting them.

Stakeholders' Perspectives on the Recommendations of the President's New Freedom Commission on Mental Health

To evaluate the effectiveness of 2 brief school-based interventions targeting the homework problems of adolescents with attention-deficit/hyperactivity disorder (ADHD)-the Homework, Organization, and Planning Skills (HOPS) intervention and the Completing Homework by Improving Efficiency and Focus (CHIEF) intervention, as implemented by school mental health providers during the school day. A secondary goal was to use moderator analyses to identify student characteristics that may differentially predict intervention response. Two-hundred and eighty middle school students with ADHD were randomized to the HOPS or CHIEF interventions or to waitlist, and parent and teacher ratings were collected pre, post, and at a 6-month follow-up. Both interventions were implemented with fidelity by school mental health providers. Participants were pulled from elective periods and sessions averaged less than 20 min. Participants in HOPS and CHIEF demonstrated significantly greater improvements in comparison with waitlist on parent ratings of homework problems and organizational skills and effect sizes were large. HOPS participants also demonstrated moderate effect size improvements on materials management and organized action behaviors according to teachers. HOPS participants made significantly greater improvements in parent- and teacher-rated use of organized actions in comparison with CHIEF, but not on measures of homework problems. Moderation analyses revealed that participants with more severe psychopathology and behavioral dysregulation did significantly better with the HOPS intervention as compared to the CHIEF intervention. Brief school-based interventions implemented by school providers can be effective. This type of service delivery model may facilitate overcoming the oft cited research-to-practice gap. (PsycINFO Database Record