Stakeholder perspectives on factors influencing the successful implementation of whole-school approaches to mental health

Teachers and other school staff are increasingly relied on to address student mental health in secondary schools in Ireland. As part of the Wellbeing Policy Statement and Framework for Practice (2019), the Department of Education set out the ambition to place the promotion of wellbeing at the core and ethos of all schools in Ireland by 2023. This study investigates secondary school staff’s experiences of addressing mental health in schools through qualitative analysis of open question data provided by n = 359 school staff. Reflexive thematic analysis was used to analyse the data, resulting in three themes. The themes highlighted the salience of mental health in schools, the wide variety of ways mental health is integrated in Irish secondary schools, and how mental health in schools can be a source of pressure for staff. The findings of this study suggest that staff, while generally positive towards mental health engagement in schools, do not feel adequately prepared to deliver this content to the extent expected of them. Findings are discussed in relation to the Wellbeing Framework as well as the existing international literature on school based mental health content, and implications for policy and practice are proposed.

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

Counseling self-efficacy (CSE), defined as one's beliefs about his or her ability to effectively counsel a client, is an important precursor of effective clinical practice. While research has explored the association of CSE with variables such as counselor training, aptitude and level of experience, little attention has been paid to CSE among school mental health (SMH) practitioners. This study examined the influence of quality training (involving quality assessment and improvement, modular evidence-based practices, and family engagement/empowerment) versus peer support and supervision on CSE in SMH practitioners, and the relationship between CSE and practice-related variables. ANCOVA indicated similar mean CSE changes for counselors receiving the quality training versus peer support. Regression analyses indicated that regardless of condition, postintervention CSE scores significantly predicted quality of practice, knowledge of evidence-based practices (EBP) and use of EBP specific to treating depression. Results emphasize the importance of CSE in effective practice and the need to consider mechanisms to enhance CSE among SMH clinicians.Keywords: self-efficacy, school mental health, evidence-based practices, counselor training, depressionThere are major gaps between the mental health needs of children and adolescents and the availability of effective services to meet such needs (Bums et al., 1995; Kataoka, Zhang, & Wells, 2002). This recognition is fueling efforts to improve mental health services for youth in schools (Mellin, 2009; Stephan, Weist, Kataoka, Adelsheim, & Mills, 2007). At least 20% of all youth have significant mental health needs, with roughly 5% experiencing substantial functional impairment (Leaf, Schultz, Kiser, & Pruitt, 2003). Further, less than one third of children with such mental health needs receive any services at all.The President's New Freedom Commission on Mental Health (2003) documented the position of schools as a point of contact and universal natural setting for youth and families, recognizing schools as a key factor in the transformation of child and adolescent mental health services (Stephan et al, 2007). In the past 2 decades, there has been a significant push for full-service schools that expand beyond a sole focus on education, and employ community mental health practitioners to respond to the emotional and behavioral needs of students (Conwill, 2003; Dryfoos, 1993; Kronick, 2000). The education sector is the most common provider of mental health services for children and adolescents (Farmer, Bums, Phillips, Angold, & Costello, 2003), with 70%-80% of youth who receive any mental health services obtaining them at school (Bums et ah, 1995; Rones & Hoagwood, 2000). Therefore, attention must be paid to the quantity, quality and effectiveness of school mental health (SMH) services.School Mental HealthIn recent years, SMH programs, supported by both school staff (e.g., school psychologists, social workers, counselors) and school-based community mental health clinicians, have emerged as a promising approach to the provision of mental health services for students and families (Weist, Evans, & Lever, 2003). The growth of these programs has facilitated investigation of what constitutes high-quality SMH service provision (Nabors, Reynolds, & Weist, 2000; Weist et al., 2005). This work has been supported and furthered by the Center for School Mental Health, a federally funded technical assistance and training program to advance SMH programs within the United States. In collaboration with other SMH centers (e.g., UCLA Center for Mental Health in Schools) and interdisciplinary networks focused on school health, consensus was reached to develop a guiding framework defining best practices in SMH (Weist et al, 2005). These principles call for appropriate service provision for children and families, implementation of interventions to meet school and student needs, and coordination of mental health programs in the school with related community resources, among other things. …

Schools play a central role in promoting children’s and young people’s positive mental health and provide a key setting and learning environment for developing core competencies across the social, emotional and behavioural domains. In this chapter, we examine the rationale for promoting children’s and young people’s mental health and well-being in the school setting and the international evidence base on the implementation of school-based programmes is considered. In addition, one of the key approaches to promoting mental health in schools, the adoption of a whole-school approach, is presented. The key components of the whole-school approach are examined, providing examples of evidence-based, whole-school social and emotional learning and bullying prevention interventions. Case studies of whole-school interventions are presented, which illustrate the challenges of implementing and evaluating a whole-school approach, and key factors are identified that are crucial in supporting the adoption of a whole-school approach to mental health promotion.

Background: The mental health od school-age children is of growing concern in many countries. School professionals require the competences and methods to intervene effectively to promote mental health in schools. Objective: The objective of this study was to describe school professionals’ perceptions of the competences needed and effective methods to promote mental health in primary schools. Design and setting: Qualitative study conducted in five European countries. Method: Multidisciplinary focus group interviews were conducted with teachers, school nurses, psychologists and social workers in Greece ( n = 2), Lithuania ( n = 3), Slovenia ( n = 2), Bulgaria ( n = 2) and Finland ( n = 2). Data were analysed using qualitative content analysis. Results: Competences perceived as required for mental health promotion in primary schools were related to (1) knowledge of child development and mental health among primary school age children, (2) skills such as communication and empathy and (3) teachers’ self perception as health promoters. Insufficient attention is currently given to the development of these competences in basic teacher education and ongoing professional development. Providing a safe and inclusive school environment for children and families, early intervention and the use of structured models of support were viewed as effective approaches to use. Digital tools, online materials, and online support were seen as having a valuable role to play in children’s mental health promotion. Conclusion: School professionals require multiple competences to undertake mental health promotion in primary schools. The development of these competences is best supported by basic and ongoing education. Teachers, school nurses, psychologists and social workers see mixed methods as likely to be most effective in promoting mental health in primary schools.

Mental health interventions in schools

In this podcast, we talk to Lauren Cross about her research interests around mental health and wellbeing in schools and inequalities during childhood and adolescence, as well as her co-authored CAMH debate paper ‘Is There a True Global Children and Young People's Mental Health Crisis Fact or Fiction’.

INTRODUCTION: Response to student mental health crises involves interdisciplinary school-community teams, which can include police officers. This paper presents the first systematic review of literature on how police address mental health in school settings. Results have implications for school nurses interacting with responding police. How are police involved in responding to student mental health needs in elementary and secondary schools? Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, six articles met criteria for inclusion in this review. Two themes were identified: (1) descriptions of roles of police in schools and (2) studies presenting programmes or models of police engagement. The most common use of police in schools is through the School Resource Officer model. There are very few studies examining police involvement in mental health response in schools and little data available on whether prevailing models are effective. We are therefore unable to ascertain what impact school police have in responding to mental health crises or the extent to which they interact with school nurses. Understanding mental health crisis responses in schools can inform policy, practice, research and education for police and school providers, including nurses.

P-866 - The whole school approach for enhancing childern's mental health in Pakistani schools

International and Irish studies have indicated negative trends in the mental health and wellbeing of young people over recent years. Indeed, the most recent wave of the Health Behaviour of School-Aged Children study shows that Ireland ranked 24 out of 36 countries on overall adolescent mental health. This is in stark contrast to Ireland’s high rankings on adolescent academic and social skills (1st) and physical health (11th) within the study (Cosma et al., 2023). In the face of these worrying trends, in many countries, including Ireland, there is a growing awareness that wellbeing is both an outcome and an enabler of learning, such that academic goals can only be addressed within the context of positive wellbeing. The psychosocial environment in schools is critical for fostering students’ emotional and social wellbeing. Schools hold significant potential to promote wellbeing and mental health given their capacity to (a) reach diverse young people, (b) facilitate social connections and (c) host wide-ranging interventions. Indeed, children and adolescents themselves describe school as having a large impact on their wellbeing (ONS, 2020). Ireland has made significant strides in promoting student wellbeing and mental health in schools in recent years. The Department of Education and Youth’s approach to supporting both wellbeing and mental health in schools and educational contexts is set out in its Wellbeing Policy Statement and Framework for Practice (2018), and is evaluated at school level through the school self-evaluation process. However, despite these policy strides, significant concerns and disagreement remain regarding how best to promote and even monitor student wellbeing and mental health in school contexts. Addressing this issue, the current review adopts a narrative approach to exploring how wellbeing and mental health are promoted and monitored in school contexts in Ireland and internationally. A broad range of literature underpins the findings presented, including quantitative and qualitative empirical articles, policy reports, government agency documents and publications from international organisations (e.g., UNESCO, OECD). Together these sources ensure a wide range of insights from various disciplines. The findings from this evidence base provide the basis for recommendations on how the Irish Wellbeing Policy Statement and Framework for Practice could be further developed.

Recent government policies and initiatives such as ‘Extended Schools’, Social and Emotional Aspects of Learning (SEAL) and Every Child Matters (ECM) are a recognition that schools play a wider role beyond their traditional ones as citadels of learning. Within this new paradigm is an understanding that children and young people’s education may be adversely affected by their emotional well-being which in turn translates as mental ill health. The importance of children’s mental health in schools cannot be over-emphasised and this importance is evidenced by a government initiative - Targeted Mental Health in Schools (TaMHS) which enables children and young people to access mental health services in schools. This thesis explores and critiques the notion that mental health is a social construction and argues that the constructions that teachers and parents have of mental health goes a long way in determining which children are referred to and access TaMHS therapeutic interventions. This thesis adopts a qualitative approach and more specifically, the use of thematic analysis as a method of exploring mental health constructions held by relevant teaching staff, the parents of the children interviewed and the children themselves. The analysis also revealed that regardless of the TaMHS therapeutic intervention used, the therapies were viewed as having a positive effect on the children as a whole and there was a keen desire that the programme continues in light of the benefits garnered by the recipients of the therapies, that is, the children. The thesis highlights the importance of the voice of the child within educational and mental health paradigms by giving them the opportunity, through semi-structured interviews, to talk about their experiences of poor emotional well-being. The local authority where the TaMHS project was located had therapies that were delivered by qualified and trainee therapists specialising in art, play, drama therapies, counselling and reflexology; Educational Psychologists (EPs) were not involved in the delivery of therapies. This thesis argues that because EPs work extensively with children and young people in schools using a number of psychometric, evaluative and therapeutic interventions, they should therefore have a more prominent role in the delivery of therapies but for this to become a reality then the ways in which EPs are trained may have to be reviewed again. This thesis concludes by further examining the role of the EP within mental health structures and suggests ways in which the role of the EP can become more prominent within such structures.

Increasing rates of mental health difficulties for young people in the UK are often described, though seldom from young people’s perspective or viewpoint. The Schools NorthEast Healthy MindED Commission works towards supporting schools to understand and mitigate the factors affecting young people’s mental health, and through doing so enable better resilience. This research extends from the work of the commission. Utilising the World Health Organisation mental health definition, we supported schools to have conversations with young people about the factors that affect their mental health. Staff from regional schools were trained and supported to carry out focus group discussions and complete initial data analysis. Meta-analyses of findings were carried out to identify illuminative themes. Findings were fed back to establish face validity and so allow further action planning – not reported here. Themes are considered against established theory and the wider literature. In addition to illustrating the usefulness of listening to young people in order to understand mental health in school contexts, crosscutting themes of relationships, agency, and rest and recovery were concluded as key to enabling mental health within school contexts.

BackgroundAssessment of mental health in schools has garnered increased interest in recent years. Children spend a large proportion of their waking hours in schools. Teachers can act as gatekeepers by playing a key role in identifying children with mental health difficulties in the classroom and making the necessary onward referrals to external services. The prevalence of mental health difficulties, their impact on schooling (and beyond) and the importance of early intervention means that it is incumbent on schools to identify and support potentially affected children.AimsPrevious reviews focused on mental health interventions in schools; however, this review focuses on the assessment of mental health in schools and on teachers' perceptions of this, as such a review is still lacking. Therefore, the study fills a gap in the existing literature while also providing new, highly relevant evidence that may inform policy making in this area.Composition of studies included in this reviewThis review included 19 studies. Five studied teachers exclusively at primary/elementary level, and seven focused on secondary level, while six included both primary and secondary teachers. Three studies employed mixed methods, ten were primarily qualitative studies, and five were primarily quantitative.MethodsBronfenbrenner's (The ecology of human development: Experiments by nature and design, Harvard University Press, 1979) framework, adapted by Harvest (How can EPs best support secondary school staff to work effectively with children and young people who experience social, emotional and mental health difficulties? 2018), which includes the mature version of the theory (Tudge et al., 2009, J. Fam. Theory Rev., 1, 198), was used to analyse the literature.ResultsResults found that lack of training in assessment of mental health and ‘role conflict’ were key barriers; some teachers attributed this to their lack of knowledge, skills and confidence in the area.ConclusionImplications for practice and research are discussed in relation to the importance of sustained training both pre‐service and in‐service.

1. Introduction: Advancing Mental Health Practice and Research in Schools M. Weist, S. Evans, N. Lever. Part I: Background, Policy, and Advocacy. 2. History of School-Based Mental Health Services in the United States L. Flaherty, D. Osher. 3. Toward a Comprehensive Policy Vision for Mental Health in Schools H. Adelman, L. Taylor. 4. Effective Advocacy for School-Based Mental Health Programs K. Hogan Bruen, C. Clauss-Ehlers, D. Nelson, M. Faenza. 5. Mobilizing Research To Inform a School Mental Health Initiative: Baltimore's School Mental Health Outcomes Group E. Bruns, C. Walrath, M. Glass-Siegel, M. Weist. 6. Overcoming the Challenges of Funding School Mental Health Programs S. Evans, M. Glass-Siegel, A. Frank, R. Van Treuren, N. Lever, M. Weist. Part II: Enhancing Collaborative Approaches. 7. Mental Health in Schools: Programs of the Federal Government T. Menden Anglin. 8. Enhancing Collaboration within and across Disciplines To Advance Mental Health Programs in Schools N. Rappaport, D. Osher, E.Greenberg Garrison, C. Anderson-Ketchmark, K. Dwyer. 9. The Community Schools Approach: Improving Student Learning, Strengthening Families and Communities M. Blank, J. Quinn, H. Kim. 10. Partnering with Families in Expanded School Mental Health Programs J. Axelrod Lowie, N. Lever, M. Grady Ambrose, S. Tager, S. Hill. 11. System, Agency, and Stakeholder Collaboration To Advance Mental Health Programs in Schools N. Lever, S. Adelsheim, C. Prodente, K. Christodulu, M. Ambrose, J. Schlitt, M. Weist. Part III: School Mental Health in Context. 12. School-Based Mental Health Services in Urban Communities M. Atkins, S. Frazier, J. Abdul Adil, E. Talbott. 13. The Mental Health for Immigrants Program: Program Design and Participatory Research in the Real World B. Stein, S. Katoaka, L. Jaycox, E. Steiger, M. Wong, A. Fink, P. Escudero, C. Zaragoza. 14. School-Based Mental Health on a United States Army Installation M. Faran, M. Weist, A. Saito, L. Yoshikami, J. Weiser, B. Kaer. 15. Serving the Most Severe of Serious Emotionally Disturbed Students in School Settings J. Nyre, E. Vernberg, M. Roberts. 16. Children with Special Health Care Needs in School: Responding to the Challenge through Comprehensive School-Based Health Care C.M. Schaeffer, M. Weist, J. McGrath. Part IV: Moving toward Best Practice. 17. School Mental Health in Systems of Care P. Leaf, D. Schultz, L. Kiser, D. Pruitt. 18. Training for Effective Practice in the Schools T. Power, P. Manz, S. Left. 19. Continuous Quality Improvement and Evaluation of Expanded School Mental Health Programs L. Nabors, H. Lehmkuhl, M. Weist. 20. Strength-Based Approaches to Assessment in Schools M. Epstein, M. Harniss, V. Robbins, L. Wheeler, S. Cyrulik, M. Kriz, J. Nelson. 21. Facilitating the Implementation of Evidence-Based Prevention and Mental Health Promotion Efforts in Schools P. Graczyk, C. Domitrovich, J. Zins. Part V: Cross-Cutting Issues. 22. Preventing and Addressing Crises and Violence-Related Problems in Schools M. Kerr. 23. Achieving Generalization in School-Based Mental Health S. Evans, J. Langberg, J. Williams. 24. Cultural Sensitivity, Relevance, and Competence in School Mental Health M. Mock. 25. Addressing Unique Ethical and Legal Challenges in Expanded School Mental Health C. Prodente, M. Sander, C. Grabill, M. Rubin, N. Schwab.

Mental Health in Schools: Engaging Learners, Preventing Problems, and Improving Schools By Howard Adelman PhD, & Linda Taylor PhD 22010, Corwin, USA, 310 pp. $41.95, ISBN: 9781412975384 Reviewed by Courtney Matz, M.A. Growing numbers of children are suffering needlessly because their emotional, behavioral, and developmental needs are not being met by the very institutions and systems that were created to take care of them. -U.S. Department of Health and Human Services (2001) found in Adelman and Taylor (2010) In public schools across the United States school administrators, teachers, psychologists, counselors and other support staff face the challenge of ensuring their students receive needed mental health services despite budget cuts and other significant logistical constraints . For example, with the elimination of AB 3632 funding in 2010, Local Educational Agencies across California are feeling immense pressure to deliver mental health services to students who previously received assistance from the Department of Mental Health. A timely addition to the educational literature, authors Adelman and Taylor comprehensively address this juxtaposition of need and constraint in their most recent book, Mental Health in Schools: Engaging Learners, Preventing Problems, and Improving Schools. Within the text, readers are provided with valuable information regarding the restructure, development, and enhancement of school-based mental health programs. The authors open with a review of the history and current state of mental health in schools and move toward making suggestions for how to better address the mental health needs of students. They advocate persuasively for effective collaboration among stakeholders when providing mental health services in the public school systems. School psychologists, in particular, may find the guidelines provided by the authors useful in paving the way for school-based mental health service delivery models because they will undoubtedly be responsible for creating comprehensive programs to address student needs. PAST School based mental health service providers have historically been tasked with large number of referrals for the provision of mental health services and it is estimated that the ratio of school psychologists to students will continue to rise from 1 to 2,500 to even larger numbers (Ringeisen, Henderson, & Hoagwood, 2003). Adelman and Taylor begin their analysis of mental health services with an historical review. The authors evaluate the proliferation of legislation and public policy, which has sparked various movements in the delivery of school-based mental health services. They argue that these undertakings, including the President's New Freedom Commission on Mental Health (2003) and the 2007 Progress Report on the President's New Freedom Initiative, have created conflicting agendas. These initiatives call for schools to be involved in the provision of mental health services while at the same time demanding that they maximize their focus on instruction in the school setting. As a result, practitioners are often perplexed about how to balance these demands and implement these services in the schools and their surrounding communities. School systems have traditionally operated under a deficit model of mental health service delivery, which consists of the marginalization and compartmentalization of services seen as auxiliary or unnecessary for the betterment of the whole. For example, student support programs and services are often added to the educational curriculum on an ad hoc basis, via student support personnel who are rarely part of the school's overarching organizational structure. Adelman and Taylor assert that this compartmentalization of service, does not effectively address the challenges our students have encountered and will continue to face. Thus, the only way to meet the needs of the students is to develop a comprehensive approach of service delivery. …