Expanded School Mental Health Research Articles

Stakeholder perspectives on the advantages and challenges of expanded school mental health services for publically-insured youth.

Although partnerships between community-based mental health (MH) organizations and school systems to deliver MH services on school grounds (i.e., expanded school mental health, ESMH services) are growing, qualitative research is needed about stakeholders' perspectives on ESMH services. This study collected qualitative data from caregivers, MH providers, and MH administrators recruited from three MH organizations to understand their perspectives regarding potential advantages and challenges associated with ESMH services. The three MH organizations were located in three regions of Georgia and the majority of youth served by the organizations were enrolled in Medicaid. We conducted four focus groups with 33 caregivers and 13 semistructured interviews with MH administrators and providers, and we implemented a thematic content analysis. Caregivers, providers, and MH administrators described how ESMH services could improve MH services by (a) facilitating appointment attendance through the reduction of logistical barriers to care (including geographic barriers, missed class time, and missed work time) and (b) enhancing communication between providers and teachers. However, some participants also described logistical issues with ESMH services including school space constraints and challenges scheduling appointments. In addition, some caregivers expressed concerns about peer stigma if MH services are delivered at school (vs. the clinic). Providers and MH administrators discussed problems with low caregiver engagement and challenges collaborating with school personnel that stem from lack of understanding of MH problems and treatment. Although ESMH services can improve MH treatment among low-income youth, MH providers and MH administrators may consider collaborating with school personnel to proactively develop strategies to address challenges to its success. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Improving Multitiered Systems of Support for Students With “Internalizing” Emotional/Behavioral Problems

A recently defined interconnected systems framework (ISF) provides explicit guidance on steps to align positive behavioral interventions and supports (PBIS) and expanded school mental health (SMH) within the multitiered system of support (MTSS). As PBIS and SMH strategies align, there are opportunities to expand and improve effective programs and services for students at all tiers of the MTSS. A prominent need is to improve programs and services for students presenting “internalizing” disorders such as those related to trauma, depression, and anxiety. In this article, we discuss relevant issues involved in improving multitiered systems/interventions for students presenting internalizing problems and provide guidance for this work in dimensions of cross-system collaboration (with major emphasis on effective teams), implementing evidence-based practices, and data-based decision making/quality improvement. The article concludes with recommendations for practice, research, and policy to improve MTSS for students presenting internalizing problems.

Teachers’ experiences collaborating in expanded school mental health: implications for practice, policy and research

AbstractTeachers are critical partners in expanded school mental health (ESMH) collaborations that aim to bring educators, community mental health professionals and families together to leverage expertise and resources for addressing non-academic barriers to learning. Although teachers are in a unique position to observe the day-to-day mental health needs of students, their roles in ESMH collaborations have been largely ignored leaving little research-based guidance for maximizing this practice strategy. To address this gap, this study explored 384 teachers’ experiences with ESMH collaboration including the types of collaborations they are engaged in, what influences those relationships and what they perceive to be the benefits of this practice strategy. The findings support previous conceptual and research contributions focused on collaboration, as well as suggest some specific influences on collaborative relationships between teachers and community mental health professionals. Implications for practice,...

The Expanded School Mental Health Collaboration Instrument [Community Version]: Development and Initial Psychometrics

The Expanded School Mental Health Collaboration Instrument [Community Version]: Development and Initial Psychometrics

Understanding Teachers' Perceptions of Student Support Systems in Relation to Teachers' Stress

Expanded school mental health (ESMH) programs are critical for addressing children's social and emotional development in schools. As broad, multisystem approaches, ESMH programs rely on teachers for effective and sustainable primary, secondary, and tertiary school mental health service delivery. In light of the increasing mental health needs among children, an improved understanding of specific ways in which teachers are affected by school mental health approaches can lead to improved implementation of such services. This is especially important considering existing evidence that teachers' ability to implement student support strategies is influenced by several other factors, including teacher stress. In light of this, this study investigated teachers' perceptions of student mental health needs, student support systems, and teacher stress. Results revealed that different aspects of student mental health needs and perceptions of student support systems predicted teachers' perceptions of stress. The article concludes with a discussion of the findings' implications for the development, dissemination, and implementation of strategies designed to address student mental health needs.

Three-year longitudinal study of school behavior and academic outcomes: results from a comprehensive expanded school mental health program

While there has been encouraging growth in the number of expanded school mental health programs (ESMH) across the country, few programs rigorously evaluate long-term academic outcomes associated with receipt of these services. This study examined the effects of services from an ESMH program on school behavior (number of out-of-school suspensions and attendance rates), and academic outcomes (standardized test scores in reading and math). Participants were 89 students from Kindergarten to 8th grade who received ESMH services and 89 students from a matched comparison group. Results revealed that ESMH services (i.e., treatment) did not have a statistically significant association with any of the school behavior or academic outcome variables. Findings are discussed in the context of theoretical and methodological challenges associated with program evaluations of ESMH. Implications for practitioners and researchers regarding program evaluation and response to stakeholders are addressed.

Improving the impact of school-based mental health and other supportive programs on students' academic outcomes: how do we get there from here?

This is the second issue in a two-part special series on evaluating the educational and academic impact of school-based programs that provide non-academic types of support, including mental health, mentoring, and family support. The papers in this series detail challenges and provide insights and practical applications based on theory and empirical research to make strong contributions toward developing, evaluating, and improving academic outcomes. Papers include a comprehensive literature review of randomized controlled studies of mental health treatments that included academic outcomes; a matched comparison group evaluation of an expanded school mental health program; a description of a qualitative process of developing a brief, modularized school-based mental health intervention partially designed to focus on academic outcomes; and a randomized study comparing academic outcomes between students who received one session of motivational interviewing to students who received two sessions paired with weekl...

School-Related and Social–Emotional Outcomes of Providing Mental Health Services in Schools

This study evaluated student outcomes of an expanded school mental health (ESMH) model that placed community mental health clinicians on-site in schools to identify and treat children with mental health needs. The first aim of this study was to consider school-related outcomes (suspension rates and attendance rates) for those students who received ESMH treatment (n = 159) were compared to a matched high-risk sample that did not receive such services (n = 148). Results demonstrated differences between groups over time on measures of suspensions and attendance but not academic achievement. The second aim of this study was to evaluate change in social-emotional functioning (Strengths and Difficulties Questionnaire Scores) over time for the treatment group. Results indicated significant improvements on several parent and teacher ratings. Despite limitations of the ESMH framework examined in this study, the overall results suggest some promising advantages for students who received ESMH services.

The Expanded School Mental Health Collaboration Instrument [School Version]: Development and Initial Psychometrics

This article presents the psychometric properties of the Expanded School Mental Health Collaboration Instrument [Community Version], a measure for assessing collaboration from the perspective of community-based mental health professionals working in schools. A three-scale instrument (Types of Collaboration, Influences on Collaboration, and Perceived Benefits of Collaboration) was developed based on findings from focus group interviews and a review of the literature. This instrument complements an existing measure of collaboration that considers the perspectives of school professionals involved in expanded school mental health (ESMH). Exploratory factor analyses were used to define a set of factors for each of the three scales. Preliminary psychometric examination suggests this is a promising instrument that should be studied further. Implications for ESMH practitioners and researchers are proposed.

Exploring Stakeholder Perceptions of Facilitators and Barriers to Implementation of an Expanded School Improvement Model

The study reported in this article explored stakeholders' perceptions of “barriers and facilitators” related to the successful adoption and implementation of a comprehensive school improvement model that emphasizes expanded school mental health. In particular, this study explored perceived barriers and facilitators related to these efforts and whether there were any preliminary differences in perceptions based on stakeholder role. Forty stakeholders involved in the pilot program of the Ohio Community Collaboration Model for School Improvement were interviewed. Lack of buy-in and understanding of the improvement efforts, student home life, and limited time were identified as the top barriers to school improvement efforts. Professional development, leadership, and on-site consultation were identified as important facilitators for success. Variance in the reported barriers and facilitators by stakeholder role suggest a need for targeted professional development and consultation opportunities to address the unique needs of various stakeholder groups. School social workers, who are educated around systems change, collaboration, and resource acquisition, may play an important role in supporting and leading these types of efforts.

Examining interdisciplinary collaboration within an expanded school mental health framework: a community–university initiative

This article describes a pilot study on interdisciplinary collaboration within an expanded school mental health (ESMH) framework using a community–university model in three elementary schools in a high-needs small urban district in the northeastern USA. This 2-year qualitative study explores the experiences of the interdisciplinary team directly involved in implementing this project. The goal of this research was to deepen the current knowledge base about the benefits and challenges of this innovative model by learning from practicing implementers' perspectives. Findings are discussed in terms of literatures relevant to advancing children's educational progress, physical and mental health with an emphasis on the collaborative process. This article also identifies next steps useful to professionals and scholars interested in initiating or studying interdisciplinary collaboration within an ESMH framework using a community–university model.

Mapping changing territories: Developing an expanded school mental health network in a post-earthquake Chinese context

Mapping changing territories: Developing an expanded school mental health network in a post-earthquake Chinese context

Educator Readiness to Adopt Expanded School Mental Health: Findings and Implications for Cross-Systems Approaches

Expanded school mental health (ESMH) professionals routinely partner with schools to provide ESMH services. An improved understanding of educators' perspectives in these partnerships is essential. In fact, these approaches often rely on educators as critical change agents. However, educators have traditionally received little training or preparation in children's mental health (Koller & Bertel, 2006). Existing research identifies the importance of readiness as a key construct for individuals' willingness to adopt innovations. Educators in Missouri (N = 89), Ohio (N = 32), and Kansas (N = 1) completed a 66-item online survey assessing readiness to adopt ESMH approaches, perceptions of stress, teaching self-efficacy, professional support, and students' mental health needs. Hierarchical regression analysis revealed that educator stress, perceptions of students' mental health needs, and teaching self-efficacy were all predictors of educators' readiness to adopt ESMH approaches. These findings could prove rele...

Parent Involvement with African American Families in Expanded School Mental Health Practice

The positive impact of parental involvement on academic success has been well documented, but less is known about parental involvement with African American families. The studies that do exist often label African American families as uninvolved in their children's education. They often overlook the different aspects of participation that are critical to understanding the involvement of African American families. This article discusses the literature on African American parental involvement. Based on the Multicultural Counseling Competencies framework, an approach for working with African American families is described. Specific implications for practitioners working in expanded school mental health are provided.

Using Data to Inform Program Design and Implementation and Make the Case for School Mental Health

This article describes an evaluation and research system developed over many years by the Minneapolis Public Schools Expanded School Mental Health Program. The authors describe the rationale underlying the systems development, the challenges encountered and solutions developed throughout building the system, and the future directions for research and evaluation. Use of data to continuously inform program design and implementation will be discussed. Examples of preliminary program evaluation outcomes and results from two quasi-experimental studies will be presented. Recommendations for future research are discussed, and the need for more longitudinal studies investigating the impact of expanded school health on educational behaviors and academic achievement is emphasized.

Measuring interprofessional team collaboration in expanded school mental health: Model refinement and scale development

Expanded school mental health (ESMH) utilizes interprofessional collaboration to implement learning support and mental health promotion strategies in schools. This study reports on the early development and initial psychometric examination of a new scale, the Index of Interprofessional Team Collaboration for Expanded School Mental Health (IITC-ESMH), for measuring the functioning of interprofessional teams. Exploratory factor analysis results, using data collected from 436 members of interprofessional teams in schools, yielded a 26-item scale with a four-factor model (a) Reflection on Process, (b) Professional Flexibility, (c) Newly Created Professional Activities, and (d) Role Interdependence. Cronbach's alphas for the four factors were .91, .91, .84, and .80 respectively. The findings from this study provide evidence to support the IITC-ESMH as a reliable instrument for measuring interprofessional collaboration.

A Cross-Walk of Professional Competencies Involved in Expanded School Mental Health: An Exploratory Study

Expanded school mental health (ESMH) programs often involve individuals from a variety of professions working together to address student needs evident across school, family, and community systems. Profession-driven differences in philosophies, expectations regarding confidentiality, and graduate training that reinforces isolated rather than interprofessional approaches to working with students, however, represent real challenges to maximizing the potential of ESMH. To address these issues, this exploratory study identified a common set of competencies to support interprofessional practice in ESMH. A total of 51 competencies were identified across seven theme areas, including: (1) Key Policies and Laws; (2) Interprofessional Collaboration; (3) Cross-Systems Collaboration; (4) Provision of Academic, Social-Emotional, and Behavioral Learning Supports; (5) Data-Driven Decision-Making; (6) Personal and Professional Growth and Well-Being; and, (7) Cultural Competence. Mapping of the competencies to existing accreditation and practice standards for selected professions revealed shared and unique competencies. Implications for workforce development and future research are offered.

National Survey on Expanded School Mental Health Services

In the 20072008 academic year, the Center for School Mental Health broadly disseminated an electronic survey to Expanded School Mental Health (ESMH) stakeholders in order to better understand ESMH programs in the United States. The survey asked respondents to share data about their ESMH programs across several domains including staffing, funding, service modalities, evidence-based practises and programs, and partnerships. Respondents reported on 156 ESMH programs. This paper highlights the results of the ESMH survey. Findings from the ESMH survey add to the limited literature on what may be typical and not typical in ESMH services and programming in the United States. Implications related to research, practise and workforce development are discussed.

Crossing the river stone by stone: developing an expanded school mental health network in post-quake Sichuan

This paper chronicles and consolidates my personal experience and professional journey in China in the past one year after the 512 Sichuan earthquake erupted on 12 May 2008.Several summer children projects I helped to organize had evolved into an expanded school mental health network. As I critically reflect on the pertinent issues in developing professional school social work practice in Sichuan, I shall also outline the challenges and opportunities of relief work in China's context, drawing from the systems perspective. Maximizing available local resources and facilitating the natural development of support network seems to be a useful approach in disaster recovery work. Furthermore, the need for professionals, especially outsiders, to be respectful and be culturally sensitive is valuable.

From Thought to Action in School Mental Health Promotion

In the global mental health movement, school mental health (SMH) promotion is an increasingly prominent approach and emerging field. Here, we chronicle the development of three innovations in SMH in the United States, from the early idea stage through development, current status and future directions. The innovations are The Ohio Mental Health Network for School Success, a prominent state initiative that is attempting to build a cogent shared schoolfamily-community system agenda for SMH in one state, Expanded School Mental Health in Baltimore City, a prominent local initiative that has grown from involvement in four to 105 schools in 20 years, and the Mental Health Planning and Evaluation Template, an internet-based and user-friendly approach for quality assessment and improvement of mental health promotion in schools. Each example includes challenges and opportunities, and collectively they represent powerful ideas for moving school mental health promotion from thought to action.