School-based Mental Health Services Research Articles

School Mental Health as a Public Health Strategy: Progress, Implementation, and Sustainability Considerations

Mental health is an immediate concern for public health and government officials due to the increase in mental ill health issues among young people and adults. School-based mental health services (SBMHSs) have grown rapidly in recent years, in response to this, as policy debates focus on the health and economic implications of mental for individuals and society. School-based mental health programs are focused on identifying, intervening, and providing mental health support to children and young people through the promotion of mental health and well-being within schools. With their increased presence and funding in both high- and low-income countries, concerns have been raised regarding their effectiveness, implementation, and sustainability as a means of early intervention and reducing adult mental health issues. While there are some promising results on the effectiveness of SBMHS, many barriers have been identified which hinder the implementation and sustainability of these services. Barriers include cultural and contextual factors for local adaptation; the specifics of intervention delivery; school capacity, leadership, and commitment; and system-level factors such as frameworks, policies, and government support. The research findings highlight that barriers and facilitators for the implementation and sustainability of school-based mental health interventions are not dissimilar to those observed in health, improvement, and educational interventions. As such, further research is needed to provide clarity on the principles needed to implement and sustain school-based mental services which effectively provide relevant and timely access to mental health support and services to children and young people.

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.

COVID-19 and the Impact on School-Based Mental Health Professionals

Abstract In March of 2020, many school systems transitioned to fully virtual platforms in an attempt to stop the spread of COVID-19. In the following months, schools remained online, transitioned to hybrid (partially online, partially in-person) models, or reopened completely. School-based mental health professionals (SBMHPs) remained responsible for meeting the mental health needs of students in the school system, regardless of the setting. This study sought to find out how COVID-19 and the subsequent changes in school setting have impacted SBMHPs. Through ethnographic observations of a nonprofit providing school-based mental health services as well as qualitative interviews with SBMHPs, this study uncovered a range of impacts. SBMHPs experienced an increase in demand for support with meeting basic needs and improving attendance and academics. Further, SBMHPs continued to provide counseling and crisis response services; however, these services had to be significantly adapted for each unique school setting (virtual, hybrid, and in-person). Despite these significant role changes, SBMHPs were adaptive and continued to meet the needs of students.

Culturally adapting youth mental health first aid training for Asian Americans.

Despite high rates of mental health challenges, Asian Americans are less likely to seek out and receive school-based mental health services (SBMHSs) than their non-Asian peers. The Youth Mental Health First Aid (YMHFA) training is an 8-hr manualized public education program designed to educate adults on recognizing common mental health challenges among adolescents and intervening. However, no published research has evaluated YMHFA among Asian Americans. We culturally adapted YMHFA for Asian Americans (Asian American parents and youth workers) and used a pretest/posttest design to evaluate its effectiveness. Specifically, we (a) added one 2-hr session before the YMHFA to augment engagement with the curriculum and (b) contextualized the YMHFA curriculum content to ensure cultural sensitivity for Asian American participants. Thirty-one Asian immigrant parents (Mage = 45.55, SD = 3.6) and 24 Asian American youth workers (Mage = 23.17, SD = 3.67) participated in YMHFA. Participants' mental health literacy (MHL) and their confidence in using MHFA skills significantly increased after the training. Participants also participated in four focus groups after the training to share their experiences. Participants stated that they benefited from this training and suggested additional cultural adaptations to make the program more appropriate for Asian Americans. Culturally adapted YMHFA may be an effective way to promote MHL and engage Asian Americans in mental health services. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Congress Passes First Significant Gun Safety Bill in Decades

Congress Passes First Significant Gun Safety Bill in Decades

APA Pleased Over Recent Legislative Wins but Must Keep Pushing

APA Pleased Over Recent Legislative Wins but Must Keep Pushing

Roles and Functions of School Mental Health Professionals Within Comprehensive School Mental Health Systems.

Mental health concerns are on the rise among youth, contributing to a growing need for school-based mental health services. However, challenges to service provision arise due, in part, to workforce shortages, service fragmentation, and inefficient allocation of staff time. The current study describes the professional competencies and time allocation of four school-based mental health professions (i.e., school counselors, school psychologists, school social workers, and school nurses) in order to demonstrate how schools can leverage the skills of their existing staff to coordinate a comprehensive approach to support student mental health. First, we identified the core clinical competencies needed to implement the key features of comprehensive school mental health systems. Then, we crosswalked these clinical competencies with the training standards of the four professions. Finally, we conducted a systematic review of the literature to understand how these professionals’ time is allocated, as well as their responsibilities related to the provision of mental health services. Results demonstrated that, although all four professions receive training in most of the core competencies needed to implement comprehensive school mental health services, their skillsets are often underutilized in day-to-day practice. Thus, we concluded that there are at least two untapped opportunities for school leaders to support student mental health—first, maximize the use of school mental health professionals through task-shifting (i.e., reassigning tasks less central to mental health service delivery to other staff), and second, implement an integrated model of school mental health services to efficiently leverage the mental health training of professionals.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12310-022-09535-0.

The use of mental health services among children in kinship care: an application of Andersen’s Behavioral Model for Health Services Use

ABSTRACT This study examined predisposing, enabling, and need factors associated with mental health (MH) services, the use of school-based, medical-based, and specialty MH services, and the use of ≥2 MH services among children in kinship care. We analyzed a sample of children in kinship care (N = 718) selected from wave II of the National Survey on Child and Adolescent Well-Being II. Results indicated that child’s age, gender, ethnicity (being Hispanic) and clinically significant internalizing and externalizing problems were associated with their use of MH services. Furthermore, results indicated being Hispanic, older children, living in poverty primarily with male caregivers, and having clinically significant externalizing problems were associated with higher odds of receiving school-based MH services, while being a girl and living with caregivers with better physical health were associated with lower odds of receiving medical-based MH services. Experiencing household challenges and living with caregivers with better MH were associated with the odds of receiving specialty MH services. Experiencing household challenges, being Hispanic and older children, and living in formal kinship care were associated with higher odds of receiving ≥2 MH services. These findings suggest the importance of providing accessible and diverse MH services to children in kinship care.

State Policies that Impact the Design of Children's Mental Health Services: A Modified Delphi Study.

To identify the state-level policies and policy domains that state policymakers and advocates perceive as most important for positively impacting the use of children’s mental health services (CMHS). We used a modified Delphi technique (i.e., two rounds of questionnaires and an interview) during Spring 2021 to elicit perceptions among state mental health agency officials and advocates (n = 28) from twelve states on state policies that impact the use of CMHS. Participants rated a list of pre-specified policies on a 7-point Likert scale (1 = not important, 7 = extremely important) in the following policy domains: insurance coverage and limits, mental health services, school and social. Participants added nine policies to the initial list of 24 policies. The “school” policy domain was perceived as the most important, while the “social” policy domain was perceived as the least important after the first questionnaire and the second most important policy domain after the second questionnaire. The individual policies perceived as most important were school-based mental health services, state mental health parity, and Medicaid reimbursement rates. Key stakeholders in CMHS should leverage this group of policies to understand the current policy landscape in their state and to identify gaps in policy domains and potential policy opportunities to create a more comprehensive system to address children’s mental health from a holistic, evidence-based policymaking perspective.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10488-022-01201-6.

School-Based Mental Health Initiative: Potentials and Challenges for Child and Adolescent Mental Health.

School-based mental health support services allow children and adolescents easy access to services without requirement of traveling to clinics and hospitals. We describe a School Mental Health Support Scheme (SMHSS) piloted in Hong Kong and discuss the challenges and learnings from the experience. This conceptual paper argues that accessibility is not the only advantage of such services. Teachers are significant others in child development, alongside with families. They play a central role in impacting the children's/adolescents' needs for competence and adult attachment, while schools provide an expanded social network of peers for one's social relationship. The fulfillment of these needs has powerful implications in the mental health of the children/adolescents. Teachers can help students to develop a sense of competence with self-worth and self-identity via providing guidance and feedback, whether they be on one's strengths or weaknesses, with acceptance, tolerance and unconditional positive regard. Particularly, the latter define a form of teacher-student relationship or adult attachment that offers the children/adolescents emotional security and nourishment, protecting them from failings and adversities. Teachers can also supervise and guide their students' social development with peers at schools. A recent meta-analysis has found preliminary evidence that those school-based mental health services integrated into the teachers' routine teaching activities are more effective. Teachers, who are overworked and stressed by the schools' overemphasis on academics and grades, have yet to fully grasp their unique roles in supporting students with mental health needs. This paper ends by advocating a paradigm shift in which both the healthcare professionals and educators should forge a mutually beneficial collaboration in jointly enhancing the mental health of children/adolescents at schools.

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.

Referral Patterns for Emergency Psychiatric Evaluations and Effect of School Mental Health Services in New York City, 2018.

Pediatric mental health issues are increasing while access to care is decreasing. This is reflected in a growing number of patients seeking emergency psychiatric evaluations (EPEs) in the emergency department (ED). This was a retrospective review of patients seeking EPE in the ED of a children's hospital between September and December 2018, which compares patients referred from the community versus those from schools as well as patients from schools with and without school-based mental health services (SMH). A total of 546 EPEs were analyzed, with 187 (34%) referred from schools. School referrals were younger, had a shorter length of stay and lower admission rates. When comparing those from schools with SMH, those referred from schools without SMH were younger and less acutely ill. Higher acuity children from schools with SMH suggest that SMH staff managed less severe situations on site. The role of SMH as a triaging tool and provider of mental health services should be studied as they may reduce the burden on EDs for EPEs.

School-Based Mental Health Services for Racial Minority Children in the United States

Racial minority children have been an underserved population and are particularly vulnerable due to limited access to community resources, especially mental health services. Schools have been noted as appropriate that environment to deliver services for underserved children (Blewett, Casey, & Call, 2004). However, little is known about the effectiveness of exiting school-based services targeting minority students. Therefore, this study reviewed past research regarding the effects of school-based mental health services (SBMHS) for racial minority children and analyzed the methodological and cultural features. By applying the Levels of Evidence-Based Intervention Effectiveness (LEBIE) scale and the cultural sensitivity criteria, the researchers examined whether existing SBMS were designed with rigor and cultural sensitivity. Our study analyzed the effects of SBMS with child-centered play therapy or resilience-building programs on mental illness of racial minority groups of children, such as increasing social connectedness and decreasing depressive symptoms. Our study findings implied that SBMS should be provided for students of color who have limited access to resources and health care services in their communities. School professionals also need to reach out in multiple contexts to students of color by understanding structural racism and oppression.

Misleading News Coverage of Research Findings Poses a Risk to Youth Mental Health and Safety

Misleading News Coverage of Research Findings Poses a Risk to Youth Mental Health and Safety

Implementing School-Based Mental Health Services: A Scoping Review of the Literature Summarizing the Factors That Affect Implementation.

Background: Mental illness in children and youths has become an increasing problem. School-based mental health services (SBMHS) are an attempt to increase accessibility to mental health services. The effects of these services seem positive, with some mixed results. To date, little is known about the implementation process of SBMHS. Therefore, this scoping review synthesizes the literature on factors that affect the implementation of SBMHS. Methods: A scoping review based on four stages: (a) identifying relevant studies; (b) study selection; (c) charting the data; and (d) collating, summarizing, and reporting the results was performed. From the searches (4414 citations), 360 were include in the full-text screen and 38 in the review. Results: Implementation-related factors were found in all five domains of the Consolidated Framework for Implementation Research. However, certain subfactors were mentioned more often (e.g., the adaptability of the programs, communication, or engagement of key stakeholders). Conclusions: Even though SBMHS differed in their goals and way they were conducted, certain common implementation factors were highlighted more frequently. To minimize the challenges associated with these types of interventions, learning about the implementation of SBMHS and using this knowledge in practice when introducing SBMHS is essential to achieving the best possible effects with SMBHSs.