School-based Mental Health Service Research Articles

Multilevel Factors of School-Based Mental Health Service Utilization Among Middle and High School Students

Multilevel Factors of School-Based Mental Health Service Utilization Among Middle and High School Students

School-Based Mental Health Service Utilization Through the COVID-19 Pandemic and Beyond.

We examined trends in mental health service utilization before, during, and in the immediate return to in-person learning throughout the COVID-19 pandemic. Retrospective chart review was assessed for changes in odds of any visit being a mental health encounter from five school-based health centers from the 2018-2019 to the 2021-2022 school years. Data are limited to the in-person school year from mid-August to early June. Data were assessed from 1239 students seen through 2256 visits over the 4 school years (Mage = 12.93). The odds of any visit being related to a mental health encounter increased each school year, with the 2020 to 2021 and 2021 to 2022 school years having significant increases in odds (both compared to the first and to the antecedent school year). In addition, during the 2019 to 2020 and 2020 to 2021 school years, the odds of a repeated mental health encounter significantly increased from year to year. Findings indicate a steadily increasing number of mental health service utilization needs among adolescent students that was significantly exponentiated throughout the COVID-19 pandemic.

Generating Actionable Evidence for School-Based Mental Health Service Delivery: Public-Academic Partnership Based Evaluations.

Public-academic partnership-based program evaluations can generate actionable evidence for policymaking, program design and implementation in improving school-based mental health service delivery. The University of Pennsylvania Center for Mental Health and public behavioral health care agencies in Philadelphia in the United States have evaluated Philadelphia's school mental health programs reimbursable through Medicaid billing since 2008. The variety of evaluations include (1) examining acute mental health service use of children receiving school-based mental health care and Medicaid expenditure, (2) examining children's externalizing and internalizing behaviors to measure school mental health providers' performance, and (3) examining effects of different types of school mental health programs on children's behavioral health functioning, school outcomes, and other out-of-school service use. This paper reports key findings of these evaluations, discusses how programs have been refined based on evaluation results, and shares lessons learned for successful public-academic partnership-based evaluations to promote use of actionable evidence.

School-Based Mental Health Practitioners: A Resource Guide for Educational Leaders.

School-based mental health practitioners can offer enhanced support to schools and students; yet their training, roles, and expertise vary. The roles of these professionals are often conflated, misunderstood, or marginalized in their utility throughout the school system. The purpose of this manuscript is to enhance the capacity of educational leaders to make informed hiring, contracting, and role assignment decisions that best fit school and student needs regarding school mental health services. We clarify the landscape of two distinct groups of qualified school mental health professionals-those who are education certified and those who are independently licensed; each group represents professionals from multiple disciplines. We illuminate similarities and differences of these professionals and juxtapose the utility of traditional mental health versus school-based mental health. We then discuss the similarities and differences of qualified school mental health professionals described within the context of traditional and school-based mental health preparation and service delivery. We conclude by contributing three resources for educational leaders to support the process of engaging school-based mental health practitioners. First, we offer a planning guide to understand state variations in certification requirements across professionals. Second, we provide a hiring guide primer that summarizes education requirements and delineates role orientations for school mental health practitioners. Third, we provide an interview guide to help clarify a candidate’s experience and skills useful to contemporary school needs. We conclude by offering recommendations for educational leaders to become more effective consumers of school-based mental health services.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12310-022-09530-5.

Recent Trends in School-Based Mental Health Services Among Low-Income and Racial and Ethnic Minority Adolescents

This survey study uses publicly available data from the National Survey on Drug Use and Health to evaluate school-based mental health (MH) service use among low-income and racial and ethnic minority adolescents.

Engaging Parents in Mental Health Services: A Qualitative Study of Community Health Workers' Strategies in High Poverty Urban Communities.

Empirical engagement-promoting strategies in child and family mental health services have been identified largely within the context of clinic-based services delivered by mental health professionals. However, the magnitude of unmet youth mental health need necessitates expanding the scope of mental health services, and the associated engagement strategies, beyond traditional models and service providers. The present study aimed to extend our understanding of engagement strategies to a school-based mental health service model, using a community health worker (CHW) workforce implementing an early intervention program with parents and school-aged children (K-4) in high poverty urban communities. Qualitative semi-structured individual interviews were conducted with 16 CHWs to capture their descriptions of the engagement strategies they utilized with parents throughout program implementation. Transcripts were coded and themes were identified following procedures for thematic analysis. Thematic analyses revealed ten themes describing a range of engagement strategies falling into two overarching categories: (1) rapport building, and (2) responsive delivery. Themes within the rapport building category included non-judgmental supportive listening, increasing social proximity, praise, privacy and confidentiality, and leveraging relationships. Themes within the responsive delivery category included flexibility, consistency, advocacy, incentives, and meeting needs. Findings provide preliminary evidence regarding the ability of CHWs to identify and implement a range of engagement strategies with parents and families that parallel empirically-based engagement strategies in traditional services. These findings speak to the potential of this workforce to engage underserved families in mental health services, underscoring the important role for CHWs in reducing mental health disparities.

Delivering A Digital Mental Health Service in Australian Secondary Schools: Understanding School Counsellors' and Parents' Experiences.

This study examined school counsellors’ and parents’ experiences of a school-based digital mental health service (Smooth Sailing) that screened students’ mental health and provided automated psychological care. The Smooth Sailing service was offered to 4 secondary schools in New South Wales, Australia, for a 6-week trial period with 59 students taking part. The participating school counsellors (n = 4) completed a semi-structured interview to explore their experiences. Parents of students who had consented to being contacted (n = 37/59) were invited to complete an anonymous online survey about their child’s participation. Six parents completed the survey. The school counsellors expressed overall support for the service and cited the ease of service use, its ability to identify students at-risk, and the provision of psychoeducation to students as clear benefits. They identified some barriers to the service, such as parental consent and suggested strategies to improve uptake and engagement, such as incentives, more frequent screening and use with older students. Parents also reported positive experiences with the service, expressing appreciation for mental health screening in schools and a new system to connect them and their child to school counselling services. Taken together, these findings provide initial support for delivering the Smooth Sailing service in secondary schools.Trial registration:This trial was registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12617000977370).

Associations of Sociodemographic Factors and Psychiatric Disorders With Type of School-Based Mental Health Services Received by Youth

PurposeSchools provide access to mental health services for traditionally underserved youth. However, there is variability in the types of school-based services students receive (e.g., school counseling, services in separate classrooms, or schools serving students with psychiatric disorders). Prior research has typically not distinguished among these different types of school-based services. The present study examines sociodemographic characteristics and disorders associated with the types of services received in schools. MethodsData were analyzed from a sample of adolescent–parent pairs in the U.S. National Comorbidity Survey Adolescent Supplement who received school mental health services (N = 1,204). DSM-IV diagnoses were based on the Composite International Diagnostic Interview administered to adolescents and questionnaires self-administered to parents. Adolescents (aged 13–18 years) and parents also responded to questions about lifetime school-based mental health service receipt. ResultsAmong those receiving school-based mental health services, almost one-third (29.7%) received services in a separate classroom and almost one-fourth (22.3%) in a separate school. Increased likelihood of lifetime placement in a separate classroom or school was detected among older youth, males, blacks, Latinos, youth with learning disabilities, those whose parents had fewer years of education, and those who received community-based mental health services. Oppositional defiant disorder was associated with increased lifetime placement in a separate school. ConclusionsThe results advance the evidence base by indicating that racial/ethnic minority youth and those whose parents have fewer years of education were more likely to receive school-based mental health services in separate settings. These results provide more context to studies of school-based mental health service receipt.

Emotional and Behavioral Problems among Adolescents in Pokhara City in Nepal

Adolescents are highly vulnerable to psychiatric disorders, which often have serious negative consequences for their academic achievement and potential social life. The aim of the study is to estimate the prevalence of emotional and behavioral problems among adolescents. A descriptive cross-sectional study design was adopted to identify the emotional and behavioral problems among adolescents using cluster sampling technique. Assessment was done on students of grade 7-11 from two schools in city in Nepal using self-administered questionnaire, Youth Self-Report (YSR-11/18) 2001, developed by Achenbach System of Empirical Based Assessment and self developed socio-demographic questionnaires. Data was coded and analyzed using SPSS (20). Descriptive statistic and inferential statistic (Chi square, Fisher Exact and Odds ratio-OR) were used to analyze data. Altogether 330 adolescents were enrolled in study with mean age 14.3 yrs (range 11-18, male-152, female-178). Prevalence of EBPs was 30.0% (Male-38.8% female-22.5%). Internalizing problems (35.8%) were more common than externalizing (18.5%). Occurrence of EBPs was significantly associated with Sex (OR= 2.2 p=0.001), type of family (OR=1.8 p=0.035) and types of school (private: public OR=2.1 p=0.004). Among narrow band scales most common problems were social (17.6%), thought (15.5%), somatic (13%), anxious depression (12.1%) and aggression(10.3%). There was significant association between sex with EBPs on narrow band scales, male adolescents were more likely to have thought-problem (OR=3.7 p=<0.001, rule-breaking problem (OR=8.5, p=0.02), aggressive behavior (OR=3.7 p=0.001) while female were more likely to have social problems (OR=2.6 p=0.002). Emotional and behavioural are a serious mental health concern among adolescents. An intervention strategy (School-based mental health service) maybe required to understand their problems and provide appropriate counseling.

Parental attitudes towards an online, school-based, mental health service: implications for service design and delivery

ABSTRACTObjective: Parents are important facilitators of mental healthcare for their adolescent children. An online, school-based, mental health service may assist parents in gaining access to care. This study explored parental attitudes towards this new type of service provision.Method: The study was undertaken in July and August 2016. Semi-structured interviews were used to understand parents’ attitudes towards a proposed online, school-based service called Smooth Sailing. Themes were identified through thematic analysis. Fourteen parents were interviewed.Results: Seven key themes emerged. Parents’ own experiences seeking help and awareness of mental health services, their perceived prevalence of mental health issues in youth and the appropriateness of online and school-delivered care, the desire to be involved in their child’s care, alongside concerns about stigma, service trust and credibility, and the availability of face-to-face support, were all found to influence parents’ attitudes to the proposed service.Discussion: This study confirmed that parents have both positive and negative attitudes towards online, school-based mental health service provision. By understanding these attitudes, service providers are better equipped to develop strategies to mitigate concerns and promote engagement. In doing so, parents are likely to be more supportive of their child seeking help for mental health in the school setting.

How Do School Mental Health Services Vary Across Contexts? Lessons Learned from Two Efforts to Implement a Research-Based Strategy

Although the education sector has been referred to as the “de facto” mental health system for children and adolescents, such statements obscure the tremendous heterogeneity of school-based mental health (SMH) initiatives. This study asked how different school contexts and SMH provider types may influence different aspects of SMH service delivery. Data are derived from results of evaluations of implementation and outcomes of a research-based practice model (the Brief Intervention for School Clinicians [BRISC]) tested in two common but quite different SMH contexts. In one context, BRISC was implemented in a large urban school district by externally employed practitioners working in schools (n = 5); in the second context, BRISC was implemented across a large Canadian province by school-employed mental health practitioners (n = 24). Results suggest that certain variables showed small differences across contexts, including intervention adherence, and perceived relevance, acceptability, and feasibility of BRISC. Other variables varied much more substantively, such as baseline seriousness of mental health needs, rate of out referral of students to alternative community-based services, and student mental health outcomes. Although exploratory, the current study focuses a useful lens on practice patterns across SMH contexts in secondary schools and underscores the importance of considering contextual factors early in an implementation process.

Longitudinal Determinants of School-Based Mental Health Service Use for Girls and Boys with Externalizing Behavior Problems

Studies suggest that girls with externalizing problems (ExtP) who receive school-based mental health services may have more severe impairments than boys. In addition, girls with ExtP who receive mental health treatments have been found do so for shorter durations, but this remains to be confirmed among children receiving school-based mental health services. This study sought to (1) examine gender differences in students’ characteristics and problem severity at study inception and in mental health service use at school at 12-, 24- and 36-month follow-up and (2) investigate longitudinal child, family and school determinants of service use among girls and boys. Participants were 370 elementary school students (149 girls) receiving school-based mental health services for ExtP. Child, family and school determinants of mental health services at school were examined ecologically from parent and teacher reports at study inception and follow-up points. Proportionally more girls than boys presented clinical ExtP and fewer retained services at each follow-up point. Multilevel generalized estimating equations models indicated that, among girls, conflict with teacher, affiliation with deviant peers and poor academic functioning significantly increased the likelihood of mental health service use over time but that ExtP severity was the most robust independent predictor. A broader set of determinants emerged for boys, including ExtP severity, internalizing problems and affiliation with deviant peers. These results suggest that adults may be more sensitive to boys’ difficulties than to girls’ and that girls who receive school mental health services typically present more severe impairments.

Child Community Mental Health Services in Asia Pacific and Singapore's REACH Model.

In recent decades, there have been concerted efforts to improve mental health services for youths alongside the challenges of rising healthcare costs and increasing demand for mental health needs. One important phenomenon is the shift from traditional clinic-based care to community-based mental health services to improve accessibility to services and provide patient-centred care. In this article, we discuss the child and adolescent community mental health efforts within the Asia-Pacific region. We also discuss Singapore’s community and school-based mental health service, known as the Response, Early Intervention and Assessment in Community Mental Health (REACH). This article discusses how REACH has evolved over the years in response to the changing needs of youths in Singapore. Finally, we discuss the current challenges and future directions for youth mental health care.

Students with Dual Diagnosis: Can School-Based Mental Health Services Play a Role?

ABSTRACTThis article describes and investigates initial findings from the Esperanza Mental Health Services (EMHS) Program, which is an intensive outpatient program that provides individual and group mental health services for students with “dual diagnosis” or developmental disabilities and co-occurring mental health problems. Previous research substantiates that the mental health needs of this population are significant, yet often go unaddressed in school settings. Preliminary outcomes for a sample of 61 children ages 4–22 suggest improvements in important school indicators, such as suspensions and absences during the year of program implementation, as well as positive changes in parent-reported mental health functioning. Lastly, parent satisfaction regarding these services and supports was high. The implications of these results for a proposed school-based mental health service delivery model within a multi-tiered system of prevention and intervention are discussed.

A moment of change: Facilitating refugee children's mental health in UK schools

This paper describes the role of schools in supporting the overall development of refugee children and the importance of peer interactions. It argues that the UK school into which a refugee child arrives can be considered an extreme setting. Refugee and asylum-seeking adolescents were interviewed following their contact with a school-based mental health service. The social recognition granted to them by peers in ‘moments of change’ gave them the motivation to change, the confidence to seek psychological help, to study harder and make more friends. It concludes that schools in extreme settings are often the best placed institution to address the psychosocial needs of children and should therefore adopt this enhanced role.

Introduction to the Special Issue - Renewing a Vision

This special issue of the Canadian Journal of School Psychology examines the vision and the capacity of schools to be strategically positioned as a hub for service delivery in meeting the mental health needs of Canada’s children and youth. Canada’s leading researchers and practitioners are represented in this contribution that addresses issues ranging from the extent of the need and the stigma of mental health challenges to the critical role of teachers in program and service implementation. It concludes with contributions of the current status of Canadian school-based mental health services along with a commentary on a vision for a holistic service delivery model for children and youth at risk. As the guest editors, we trust that this compilation will serve as a signpost for the future of school-based mental health service advocacy and development.

Mental Health in Schools: Engaging Learners, Preventing Problems, and Improving Schools

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. …

School-Based Mental Health Programs for Students Who Have Emotional Disturbances: Academic and Social-Emotional Outcomes

Most schools offer some type of school-based mental health service to students, and there is a growing body of empirically rigorous studies examining the effects on academic and mental health outcomes for students. However, students classified as having emotional disturbances are under-represented in these studies. Using a convenience sample of four different types of school-based mental health programs, changes in achievement levels and social and emotional functioning in youth with emotional disturbances served in special education (n = 148) were examined. Longitudinal results reveal there was improvement in either the emotional or social functioning of these youth in all four programs, while results for improvement in achievement levels were less consistent. Results reveal that in the targeted sample of programs with intensive or multifaceted services, there was improvement in academic as well as social and emotional functioning in these youth. Implications for school-based mental health services are discussed.

Step-Up: Promoting Youth Mental Health and Development in Inner-City High Schools

African American and Latino youth who reside in inner-city communities are at heightened risk for compromised mental health, as their neighborhoods are too often associated with serious stressors, including elevated rates of poverty, substance abuse, community violence, as well as scarce youth-supportive resources, and mental health care options. Many aspects of disadvantaged urban contexts have the potential to thwart successful youth development. Adolescents with elevated mental health needs may experience impaired judgment, poor problem-solving skills, and conflictual interpersonal relationships, resulting in unsafe sexual behavior and drug use. However, mental health services are frequently avoided by urban adolescents who could gain substantial benefit from care. Thus, the development of culturally sensitive, contextually relevant and effective services for urban, low-income African American and Latino adolescents is critical. Given the complexity of the mental health and social needs of urban youth, novel approaches to service delivery may need to consider individual (i.e., motivation to succeed in the future), family (i.e., adult support within and outside of the family), and community-level (i.e., work and school opportunities) clinical components. Step-Up, a high school-based mental health service delivery model has been developed to bolster key family, youth and school processes related to youth mental health and positive youth development. Step-Up (1) intervenes with urban minority adolescents across inner-city ecological domains; (2) addresses multiple levels (school, family and community) in order to target youth mental health difficulties; and (3) provides opportunities for increasing youth social problem-solving and life skills. Further, Step-Up integrates existing theory-driven, evidence-based interventions. This article describes Step-Up clinical goals, theoretical influences, as well as components and key features, and presents preliminary data on youth engagement for two cohorts of students.

The Influence of Group Training in the Incredible Years Teacher Classroom Management Program on Preschool Teachers’ Classroom Management Strategies

This study examined changes in preschool teachers’ perceptions of classroom management strategies following group training in the recently revised Incredible Years Teacher Classroom Management Program (C. Webster-Stratton, 2006). The authors used a pre/post follow-up design across 2 groups that each met for 8 sessions over an 8–10-week period for a total of 32 hr of training. Twenty-four preschool teachers from one of the lowest income and highest unemployment counties in the state of Michigan participated in the program. To examine short-term maintenance effects, the authors collected follow-up data 16 weeks after all teachers completed the training. The authors found improvements in teachers’ perceptions of positive classroom management strategies and their use. Transporting this evidence-based teacher training program to school-based mental health service delivery settings warrants additio- nal study.