School-based Mental Health Services Research Articles

Assessing the Evidence Base for School-Based Promotion and Prevention Interventions: Introduction to the Series.

Schools are an important component in the mental health system of care for youths. Teachers and other school staff have unique opportunities to promote emotional wellness and prevent mental health conditions. Although numerous programs are available, identifying evidence-based and effective options is a significant challenge. This introduction lays out the rationale and methodology of the Assessing the Evidence Base (AEB) Series, a collection of systematic reviews of school-based mental health promotion and prevention approaches recommended by the National Academies of Sciences, Engineering, and Medicine for students in kindergarten through grade 12. Authors of the current AEB Series used the rating criteria derived from the 2014 AEB Series, which provided systematic reviews of a wide spectrum of interventions for mental and substance use disorders. Like its predecessor, the current series upholds a high standard of scientific rigor while ensuring that the information is easily accessible to various stakeholders in education, behavioral health, and communities. It describes the universal features included in each systematic review, such as a rating of the level of evidence for interventions, intervention program components, identification of interventions that have yielded positive outcomes for students from underserved populations, and a review of cost data. The AEB systematic reviews will serve as an important tool for decision makers involved in managing limited resources for various programs in school-based mental health services by synthesizing large bodies of research for use by leaders in education and behavioral health.

Characterizing Provider Readiness for Meeting Engagement Challenges in Youth Psychotherapy

ABSTRACT Despite significant efforts to increase the delivery of evidence-based practice (EBP), little is known about provider readiness to address challenges with treatment engagement, and it is unclear whether provider characteristics, such as EBP training history and attitudes toward EBP, relate to such readiness. This study aimed to characterize provider knowledge of engagement strategies – one aspect of readiness – and to estimate the association between that knowledge and other provider characteristics. Data came from a multisite, cluster-randomized trial examining a coordinated system for integrating evidence-based engagement strategies into school-based mental health services. Providers (N = 93) received one of two levels of training in engagement strategies and completed pre- and post-training engagement knowledge tests. Pre-training knowledge was not significantly correlated with EBP training history (r = .11, p = .29) or attitudes toward EBP (r = .20, p = .06). Linear mixed model analysis revealed a significant interaction of training and time when accounting for provider site (B = 2.21, SE=.74, t(1,89) = 2.98, p < .005), such that at post-training, providers trained in a coordinated system for applying engagement strategies showed significantly increased knowledge compared with those who received training on a list of the same engagement strategies and their definitions (F(1,285.3) = 71, p < .001). Findings suggest that providers’ readiness to act on the evidence base may be focally limited to their specific training experiences. Additionally, training providers in a coordinated system for using engagement strategies may be a promising approach to enhancing provider knowledge and delivery of engagement strategies, thus promoting the public health impact of EBP for youth mental health.

Health Conditions, Education Services, and Transition Planning for Adolescents With Autism.

Our objectives with this study were to describe the frequency of selected cooccurring health conditions and individualized education program (IEP) services and post-high school transition planning for adolescents with autism spectrum disorder and identify disparities by sex, intellectual ability, race or ethnicity, and geographic area. The study sample included 1787 adolescents born in 2004 who were identified as having autism through a health and education record review through age 16 years in 2020. These adolescents were part of a longitudinal population-based surveillance birth cohort from the Autism and Developmental Disabilities Monitoring Network from 2004 to 2020 in 5 US catchment areas. Attention deficit hyperactivity disorder (47%) and anxiety (39%) were the most common cooccurring health conditions. Anxiety was less commonly identified for those with intellectual disability than those without. It was also less commonly identified among Black adolescents compared with White or Hispanic adolescents. There was wide variation across Autism and Developmental Disabilities Monitoring Network sites in the provision of school-based IEP services. Students with intellectual disability were less likely to receive school-based mental health services and more likely to have a goal for postsecondary independent living skills compared with those without intellectual disability. A total of 37% of students did not participate in standardized testing. We identified disparities in the identification of cooccurring conditions and school-based IEP services, practices, and transition planning. Working with pediatric health and education providers, families, and adolescents with autism will be important to identify contributing factors and to focus efforts to reduce disparities in the supports and services adolescents with autism have access to and receive.

Mixed-methods needs assessment for development of school-based mental health implementation science capacity in low- and middle-income countries: Vietnam as a case example.

Worldwide, the majority of youth reside in low- and middle-income countries (LMIC). School-based mental health (SBMH) services are particularly important in LMIC, in part because of LMIC's limited mental health infrastructure. Among the challenges to developing SBMH in LMIC are limited implementation science (IS) capacity, critical for identifying barriers to evidence-based intervention (EBI) use and dissemination, etc., specific to the local country context. A key step in IS capacity development is conducting a needs assessment, to identify barriers (and their solutions) to IS development itself within the local context. The present study conducted an IS needs assessment focused on SBMH in the Southeast Asian LMIC of Vietnam. Seventy-five Vietnamese mental health professionals in SBMH-related fields participated in a mixed-methods study. Vietnamese SBMH researchers and practitioners most likely to have experience and/or interest in IS were selected for study recruitment. Professionals' formal understanding of and experience with IS as a scientific field was highly limited. However, after reading a brief but detailed description of IS, participants' interest in IS training was high, and their mean rating of its potential utility for Vietnam to develop SBMH was 4.7 on a 1-5 scale. Participants also reported on barriers and potential solutions for EBI use in SBMH in Vietnam. Contrary to expectations, the most frequent and severe barriers were not financial but related to limited stakeholder engagement. Overall, these and other study results provide some suggestions how IS capacity to support SBMH may be most efficiently developed in settings such as Vietnam. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Building Resilience to Reduce Mental Health Illnesses: Guidelines for Government Actions

Childhood and adolescence are crucial stages for the development of mental well-being. Despite this significance, about 20% of U.S. children experience mental health disorders. The COVID-19 pandemic has further heightened this concern. This study investigates the intricate interplay of biological, psychological, and social mechanisms in shaping resilience towards mental health disorders. It also examines the implications of this analysis for future U.S. government actions in fostering resilience among children. After an in-depth analysis, biological, psychological, and social mechanisms are all proven to have profound impacts on the development of mental health resilience. But social mechanisms (e.g., parent-child bonds) emerge as the most influential ones, as they can determine the extent to which biological (e.g., oxytocin hormone) and psychological mechanisms (e.g., optimism) play in resilience development. This discovery highlights the importance of social dimensions in bolstering mental health resilience. As a result, effective government measures should prioritize these aspects to optimize the synergistic potential of the three mechanisms (biological, psychological, and social). Potential measures include enhancing school-based mental health services and improving living standards in low-income areas.

Effects of School-Based Mental Health Services on Youth Outcomes

Effects of School-Based Mental Health Services on Youth Outcomes

9.3 School-Based Mental Health Services: An Essential Tool in Closing the Disparities Treatment Gap for ADHD

9.3 School-Based Mental Health Services: An Essential Tool in Closing the Disparities Treatment Gap for ADHD

School-Based Mental Health Services Can Increase Access to Care and Decrease Suicide Attempts

School-Based Mental Health Services Can Increase Access to Care and Decrease Suicide Attempts

Remodeling Broken Systems: Addressing the National Emergency in Child and Adolescent Mental Health.

A national emergency in child and adolescent mental health was declared in the United States in 2021 in the wake of the COVID-19 pandemic. This Open Forum discusses potential solutions to better support child and adolescent mental health by improving or expanding school-based mental health services, child psychiatry access programs, virtual mental health services, and new models of care (e.g., integrated youth services hubs and crisis stabilization units). The success of such programs is dependent on stable funding, strong leadership and accountability, robust and well-trained workforces, systems integration, and attention to health equity.

Implementing depression care in under-resourced communities: a school-based family resilience skill-building pilot randomized controlled trial in the United States.

Youth in under-resourced communities are more likely to have greater social risk factors for mental health needs yet have less access to needed care. School-based mental health services are effective in treating common disorders such as adolescent depression; however, few have a family-centered approach, which may especially benefit specific populations. Utilizing a community-partnered approach, we adapted an established, trauma-informed, resilience skill-building family intervention for adolescents with depression. We conducted a small randomized controlled feasibility pilot of an adapted intervention in a large school district that serves predominately low-income, Latinx students in the Southwest United States between 2014-2017. Youth between the ages of 12-18 years old with a Patient Health Questionnaire (PHQ-8) score of 10 or higher, who spoke English or Spanish, were recruited from 12 school mental health clinics. Twenty-five eligible adolescents with depression and their participating caregivers were enrolled and randomly assigned to receive either the adapted intervention, Families OverComing Under Stress for Families with Adolescent Depression (FOCUS-AD), or usual care, Cognitive Behavioral Therapy (CBT) only. Most of the sample was Latinx and female. We evaluated feasibility, acceptability, and preliminary effectiveness. Among participants who completed standardized assessments administered at baseline and approximately five months post-randomization (n = 10 FOCUS-AD, n = 11 CBT only), effectiveness was explored by identifying significant changes over time in adolescent mental health within the FOCUS-AD and CBT only groups and comparing the magnitude of these changes between groups. Nonparametric statistical tests were used. We found the FOCUS-AD intervention to be feasible and acceptable; participant retention was high. Adolescent symptoms of depression (measured by the PHQ-8) improved significantly from baseline to follow-up for youth in both FOCUS-AD (median decrease [MD] = 10, p = 0.02) and control (MD = 6, p = 0.01) groups, with no significant difference across the two groups. Results were similar for symptoms of PTSD (measured by the Child PTSD Symptom Scale; FOCUS-AD MD = 12.5, p = 0.01; CBT only MD = 7, p = 0.04; no significant difference between groups). Family-centered approaches to depression treatment among adolescents living in under-resourced communities may lead to improved mental health, although further research is warranted.

Navigators and Negotiators: An Ecologically Informed Qualitative Study of Providers’ Perspectives on Their Roles in School-Based Mental Health Services

School-based mental health services (SMHS) offer a unique opportunity to embed support within a key developmental context, yet little research has examined SMHS providers’ fit within schools’ complex ecologies. Using a social-ecological framework, this qualitative study draws on focus groups with 67 SMHS providers from two large mental health systems to examine how school setting characteristics and interactions with school actors influenced their experiences providing SMHS. Thematic analysis revealed the importance of feeling valued by and connected to school staff, which facilitated strong ongoing communication and more effective collaboration. Providers described a flexible approach to communication and collaboration, including leveraging opportunities for informal conversation (e.g., in hallways or classrooms) to overcome barriers and boost their perceived value and connectedness. Opportunities for communication and connectedness were enhanced when providers worked in fewer schools, held roles on interdisciplinary teams, spent time in common spaces, when school staff shared providers’ understanding of mental health and SMHS, and when school policies and structural features facilitated their inclusion. Providers also discussed the variety of factors, including their place in the school ecology, that informed student wellbeing (e.g., disciplinary versus supportive responses to challenging student behaviors). This study suggests potential mechanisms on individual, school, and district levels to strengthen SMHS providers’ value and connectedness within the school ecology, and the importance of these factors to maintain strong communication and collaboration and effectively support youth and families.

School Principals’ Perceived Barriers and Facilitators to the Normalization of School-Based Mental Health Services: A Multimethod Investigation

School Principals’ Perceived Barriers and Facilitators to the Normalization of School-Based Mental Health Services: A Multimethod Investigation

Individualized Education Programs and Transition Planning for Adolescents With Autism.

The study objectives were to examine the contents of individualized education programs (IEPs) of adolescents with autism spectrum disorder (ASD), including postsecondary transition goals, services, and changes in special education classification over time. This study involved a longitudinal population-based surveillance cohort from the Autism Developmental Disabilities Monitoring Network from 2002 to 2018 in 3 catchment areas in the United States. The sample included 322 adolescents who were born in 2002, identified with ASD, and had an IEP available for review at ages 15-16 years. We found that 297 (92%) adolescents with ASD had an IEP including a transition plan. Those without intellectual disability (ID) were more likely to have postsecondary education and employment goals and have those goals be to pursue higher education or competitive employment compared with those with ID. Forty-one percent of adolescents with ASD had a postsecondary living arrangement goal. Although 28% of adolescents with ASD received school-based mental health services, none of these adolescents were Black; additionally, 15% of those with ID received mental health services compared with 34% without ID. The percentage of adolescents with ASD served under an autism classification increased from 44% at age 8 years to 62% by age 16. We identified gaps and disparities in school-based postsecondary transition planning. Working with education partners, families, and adolescents will be important to identify what challenges contribute to these findings and what supports are needed to improve the equity and quality of the transition planning process for adolescents with ASD so they are prepared for adulthood.

Welcome to our world: Lessons that the mental health community can learn from sex education advocates.

School-based instruction and services can effectively support both reproductive and mental health for youth, complementing family and community efforts. Though favored by a large majority of families, school-based sex education can engender controversy, and recently, mental health advocates have begun to face similar challenges around topics such as social-emotional learning and school-based counseling services. This article provides an overview of the emerging trend of opposition to school-based mental health instruction and services, which shares many similarities with opposition to sexual health instruction. In light of these trends, cross-sectoral partnerships in support of health education become all the more crucial. Additionally, the mental health community can benefit from lessons learned by sex education advocates.

School-based Mental Health Supports During COVID-19: School Professional Perspectives.

The present study explored the ways school professionals adapted school-based mental health supports and services for remote delivery during the COVID-19 pandemic. We surveyed 81 school professionals (e.g., counselors, psychologists, social workers) and conducted in-depth interviews with a subsample of professionals (n=14) to explore their perceptions and experiences of supporting youth with mental health concerns and suicide-related risk during the fall and winter of the 2020-2021 school year. Commonly endorsed school-based mental health interventions (e.g., counseling services, checking in), ways of communicating (phone, email), and individuals delivering supports and services to students with suicide-related risk (e.g., counselors, teachers) were identified based on school professional survey responses. Qualitative findings point to facilitators (e.g., specific platforms for connecting with students and families) and barriers (e.g., limited communication) to successful service delivery during COVID-19. Findings highlight the creative ways school support professionals adapted to provide school-based mental health supports. Implications for remote school-based mental health services during and following the pandemic are discussed.

School Mental Health Professionals’ Perceptions of Principal Leadership and Working Conditions During Remote and Hybrid School Operations During the COVID-19 Pandemic

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.

Guidelines for implementing and adapting evidence-based interventions with marginalized youth in schools.

With growing diversity within the U.S. population and notable barriers to accessing behavioral health care, marginalized youth are placed at risk for developing psychosocial and mental health problems. Promoting evidence-based interventions (EBIs) through school-based mental health services may improve accessibility and quality of care for marginalized youth facing mental health disparities. Culturally sensitive interventions (CSIs) may further improve engagement with and effectiveness of EBIs with marginalized youth. In this article, we provide guidelines for advancing CSIs when implementing and adapting EBIs with marginalized youth in schools. First, we emphasize inclusive strategies for advancing CSIs with marginalized youth in schools, focusing on antiracist adaptations to interventions and using a community-based participatory research approach when implementing EBIs. Following, we discuss techniques for tailoring CSIs to more effectively support marginalized youth and their families with school-based prevention and treatment. Specifically, we recommend using the Adapting Strategies for Promoting Implementation Reach and Equity framework as a guide to promote equitable implementation as well as key strategies for engaging marginalized youth and their families with school-based EBIs. Ultimately, we offer these guidelines to address disparities and inform more equitable practice in youth mental health care-and to motivate future studies advancing culturally responsive services with marginalized youth in schools. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Securing School-Based Mental Health Services for Students With Disabilities: An Illustration of the Six-Component Approach

The IDEA requires schools to evaluate and provide services to students who have a mental health issue that is deemed an educational disability or a mental health issue that is comorbid with an educational disability. Etscheidt and colleagues (this issue) propose a six component approach to securing school-based mental health services for students with disabilities. This article illustrates the six component approach using two vignettes. The first vignette involves a preschool student referred due to aggression who has not been previously identified as eligible for special education. The second vignette involves a 5th grade student who was receiving special education services under the category of SLD who’s academic progress had plateaued.

Geographic Disparities in the Availability of Mental Health Services in U.S. Public Schools

The purpose of this study was to examine geographic variation in the availability of and barriers to school-based mental health services. A weighted, nationally representative sample of U.S. public schools from the 2017-2018 School Survey on Crime and Safety was used. Schools reported the provision of diagnostic mental health assessments and/or treatment as well as factors that limited the provision of mental health services. Availability of mental health services and factors limiting service provision were examined across rurality, adjusting for school enrollment and grade level. The analysis was conducted in December 2021. Half (51.2%) of schools reported providing mental health assessments, and 38.3% reported providing treatment. After adjusting for enrollment and grade level, rural schools were 19% less likely, town schools were 21% less likely, and suburban schools were 11% less likely to report providing mental health assessments than city schools. Only suburban schools were less likely than city schools to provide mental health treatment (incidence rate ratio=0.85; 95% CI=0.72, 1.00). Factors limiting the provision of services included inadequate access to professionals (70.9%) and inadequate funding (77.0%), which were most common among rural schools. Significant inequities in school-based mental health services exist outside of urban areas.

Mental Health Clinic Administrators' Perspectives on the Impact of Clinic-School Partnerships on Youth Mental Health Services Continuity and Quality.

Partnerships between mental health (MH) clinics and school systems in which providers deliver MH services on school grounds are growing. To date, however, there is little research examining MH clinic administrator perspectives on how this service delivery model affects continuity and quality of MH services among low-income youth. We conducted a state-wide (online and mail) survey of administrators at MH clinics (n = 60) to assess their perspectives on the advantages and challenges of school MH services for Medicaid-enrolled youth. Among survey respondents (n = 44), 86% reported that their clinic had at least one school partnership. With respect to advantages, more than four-fifths reported that school-based MH services (compared to clinic-based services) were very helpful or extremely helpful (versus not helpful at all, a little helpful, or somewhat helpful) for: (1) reducing gaps in MH treatment (86.8%); (2) improving communication between MH providers and teachers (86.9%), and (3) improving the overall quality of MH care (89.5%). In addition, the estimated no-show rate for appointments in school settings (7.2%) was lower than the estimated no show-rate for clinic appointments (23.9%; p < 0.01). Several challenges were also reported; more than two-thirds of respondents reported difficulties when delivering school-based services related to parent engagement (i.e., appointment attendance [89.5%], communication [81.6%], timely consent [68.4%]) that occurred sometimes, often, or always (versus rarely or never). As MH clinics continue to enter into and expand partnerships with schools, stakeholders should implement family-centered strategies to enhance engagement. Nevertheless, MH clinic administrators highlight potential benefits of school MH services (compared to clinic-based services) with respect to continuity and quality of MH care.