School-based Mental Health Research Articles

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.

Matters of Fidelity: School Provider Adherence and Competence in a Clustered Study of Adaptive Implementation Strategies

ABSTRACT Schools are a promising access point for youth with mental health concerns, but school-based mental health professionals (SPs) often need ongoing support to provide high-fidelity cognitive behavioral therapy (CBT). Adherence and competence, two critical elements of fidelity, were examined in a cluster-randomized implementation trial. We evaluated CBT adherence and then triangulated CBT adherence with end-of-study competence. We then evaluated the effects of two implementation supports, Coaching and (for slower-responding schools) Facilitation, on adherence and competence. By the end of the 43-week study period, 27.8% of SPs met adherence criteria. Adherent SPs scored higher on the competence measure, the CBT Competence Scale (t(116.2) = 3.71, p < .001). No significant difference in adherence was found among SPs at schools assigned to Coaching vs. not (Δ = 6.0%, p = .385), however SPs at schools randomized to Coaching scored significantly higher on two of the four competence subscales (Non-Behavioral and Behavioral skills). Among slower-responder schools, SPs at schools assigned to Facilitation were more likely to demonstrate adherence (Δ = 16.3%, p = .022), but there was no effect of Facilitation on competence. Approximately one quarter of SPs met adherence criteria in the trial; adequate delivery of exposure was a primary obstacle to reaching adherence. Facilitation may be especially suited to help SPs overcome barriers to delivery, whereas Coaching may be especially suited to help SPs improve CBT competence. Both are likely needed to build a mental health work force with the competence and ability to deliver EBPs in schools.

Collaborating with Families for Innovative School Mental Health

In this study, a comprehensive narrative literature review is presented, examining the cross-section between family engagement and student mental health. Guided by two research questions and grounded in resiliency theory, the overlapping spheres of influence framework, and the literature on protective factors and positive childhood experiences, this study unveiled five primary themes: emphasizing the importance of educators promoting supportive relationships at home, engaging families in building teacher–student connections, collaborating to establish routines and rituals, nurturing a sense of belonging at home and at school, and fostering collaborative problem solving and self-regulation. These themes are illuminated through practical vignettes. This study guides school-based mental health practitioners and educators and provides a roadmap for future research in family–school partnership for enhancing student well-being.

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.

Mental Well-Being Among Adversity-Exposed Adolescents During the COVID-19 Pandemic

Further research is needed to understand factors associated with well-being during the COVID-19 pandemic among adolescents who have experienced adverse childhood experiences (ACEs). To explore factors associated with improved mental health during the COVID-19 pandemic among adolescents who have experienced ACEs. This cross-sectional study used data from the baseline (2016-2018) and sixth (March 2021) COVID Rapid Response Research (RRR) surveys of the Adolescent Brain Cognitive Development study, which includes 21 sites across the US. Adolescents aged 11 to 15 years who completed the COVID RRR mental health measures were included. Data analyses were conducted from June to August 2023. School-based factors (eg, in-person school) and 8 coping behaviors (eg, exercise). The primary outcomes were adolescent-reported positive affect (PA) and perceived stress (PS). Adolescents were stratified by no ACEs, low-to-intermediate ACEs (1-3), and high ACEs (≥4). Linear regressions estimated associations between factors and mental health, adjusting for potential confounders. Unstandardized beta coefficients (B) were compared with equality of coefficients tests. The 4515 adolescents in this study (mean [SD] age, 13.3 [0.88] years; 51% [95% CI, 50% to 53%] female) were racially and ethnically diverse (American Indian/Alaska Native, 2% [95% CI, 2% to 3%]; Asian, 8% [95% CI, 7% to 9%]; Black, 11% [95% CI, 10% to 12%]; Latino or Hispanic, 17% [95% CI, 15% to 18%]; White, 61% [95% CI, 60% to 63%]; other, 1% [95% CI, 0% to 2%]). For youths with high ACEs, caring for one's body (PA B = 4.02 [95% CI, 1.39 to 6.66]; PS B = -0.92 [95% CI, -1.84 to 0.00]), exercising (PA B = 3.19 [95% CI, 0.46 to 5.92]; PS B = -1.41 [95% CI, -2.40 to -0.43]), and engaging in healthy behaviors (PA B = 4.07 [95% CI, 1.28 to 6.84]; PS B = -1.01 [95% CI, -1.98 to -0.05]) were associated with higher PA and lower PS scores. In-person schooling had a greater impact on PA scores for youths with high ACEs (B = 5.55 [95% CI, 2.08 to 9.01]) than youths with low-to-intermediate ACEs (B = 1.27 [95% CI, 0.27 to 2.27]). These findings suggest that in-person schooling and several coping behaviors (caring for one's body, exercising, and engaging in healthy behaviors) were associated with significantly higher PA and lower PS during the COVID-19 pandemic among adolescents with high ACEs. Adolescents with high ACEs demonstrated especially greater mental health scores when they reported in-person schooling. Future studies should build on these findings to identify clinical and school-based mental health protective factors for adolescents with high ACE risk.

Research recommendations for assessing potential harm from universal school-based mental health interventions

Research recommendations for assessing potential harm from universal school-based mental health interventions

Evaluating the effectiveness of a school-based mental health literacy intervention from a comprehensive demographic and social-cognitive perspective

Childhood and adolescence are a critical period for the onset of mental and neurodevelopmental disorders and a time when many can be first identified. Research demonstrates that mental health literacy applied in school settings may be an effective approach to address these challenges. In contrast to many existing studies conducted in multicultural and multilingual settings that treated subjects’ language as a demographic feature, the present study recognizes English proficiency as a social-cognitive factor and views the school-based mental health literacy (MHL) intervention as a learning process. The present study aimed to assess the effectiveness of school-based mental health literacy intervention and explore how ethnicity and English proficiency as a social-cognitive factor, as a modified, rather than a fixed variable, impacted the intervention outcomes. Grade 9 students (n = 240) from schools in West Canada with diverse social/cultural background received the intervention in the classroom delivered by trained teachers and completed the pre-test and post-test over a 6-month period. The intervention was effective in improving knowledge and help-seeking attitudes among all students. Non-Chinese and native English-speaking students performed the best on all outcomes. Gender demonstrated an association with changes in stigma, stress and wellbeing. English proficiency was linked to knowledge acquisition, while ethnicity was connected to changes of attitude-related outcomes. These findings deepened our understanding of how demographic and social-cognitive factors underlie changes in mental health literacy outcomes, which will facilitate the development of mental health literacy interventions for diverse student populations.

Validation and evaluation of school-based mental health literacy training program "The Guide Cymru" in Iranian adolescent students aged 13–15: study protocol

BackgroundSchools are an ideal setting for enhancing mental health literacy, a crucial strategy for improving adolescents’ mental health knowledge and attitudes and promoting help-seeking. "The Guide Cymru" program is an adaptation of the mental health literacy program" The Guide" that was developed in Canada. The program will be culturally adapted for 13- to 15-year-old Iranian adolescent students in the first secondary schools.MethodsIn this randomized controlled trial, using the stratified random sampling procedure, the whole eighth and ninth grade student body (aged 13 to 15) from Sirjan City's first secondary schools will be included in the study. Twenty first secondary schools will be randomly assigned to one of two groups: control or intervention. Finally, 562 students and 40 teachers will participate in the research. The tools of mental health literacy scale (MHLs), mental health general knowledge and attitudes related to mental disorders/illnesses are employed in this study.DiscussionThis trial aims to be to explore whether "The Guide Cymru", a mental health literacy program offered to students as part of the school curriculum, can decrease the stigma associated with mental health and promote help-seeking behaviors among students.

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).

Diminished Adolescent Social Well-Being During the COVID-19 Pandemic

Managing the COVID-19 pandemic involved implementing public health policies that disrupted students’ lives, creating conditions that substantially influenced their mental health and well-being. Subsequently, research focused on the mental health sequelae of increased depression and anxiety, but the possible impacts on adolescents’ social well-being have been largely unexamined. Social well-being is essential to youth’s overall mental health and can be diminished even without symptoms of depression and anxiety. This report explored heterogeneities in changes in adolescents’ social well-being from pre-COVID-19 to post-restrictions using longitudinal data from adolescents attending middle and high schools in California (N = 1,299; 49.9% female). Data collection involved four observations. Participants completed a school-based mental health wellness survey annually from 2019 to 2022. A latent profile analysis identified five profiles demonstrating distinctive social well-being trajectories. Two ordered profiles included Stable-High (28%) and Stable-Low (26%) patterns. Three groups represented nonordered profiles labeled as Succumbing (20%), Languishing (14%), and Recovering (12%). Pervasive decreases in social well-being were observed, and a significant portion of the adolescents did not recover to their pre-COVID-19 level by 2022. Adolescents in the Stable-High and Recovering profiles showed better psychological well-being, optimism, and school connectedness and less distress than their counterparts in the other three profiles. Mental health professionals should be aware of the pandemic’s effects on adolescents’ social well-being. Lower levels of social well-being may be a risk factor for adolescents developing generally jaded attitudes about their social networks and diminishing their potential engagement with sources of social support.

The Side Effects of Universal School-Based Mental Health Supports: An Integrative Review

A challenge with universal school-based mental health supports is the limited understanding of potential unintended or unanticipated outcomes. In this review, we examined 47 academic and gray literature sources to address the question, “What are the side effects of universal school-based mental health supports?” We discuss how universal supports can positively impact student mental health, enhance school staff’s knowledge and attitudes in addressing mental health topics, and contribute to an improved school climate. However, universal supports can also lead to school staff feeling the strain of resource and time pressures from integrating mental health programming into demanding schedules, voicing frustrations about or exhibiting resistance to mental health supports, and encountering varied, unpredictable outcomes for different student populations across system contexts.

Mapping education leadership of mental health promotion in one school district in British Columbia: A strength-based case study

Mental illness is a public health emergency threatening youth's social, physical, and economic vitality (Fahey & Koster, 2019). School-based mental health initiatives have been identified as a sustainable approach to this issue (World Health Organization, 2019). This study employed a qualitative case-based methodology to understand how educational leaders effectively implement mental health policies and programming. Three significant findings were identified: 1) the leadership of mental health initiatives formed a closely interconnected network of relationships with distributed responsibility across clearly identified roles and responsibilities within the school system and externally with the province and community-based supports; 2) Making network attributes and patterns of communication visible provided district and school-based leaders with discernable areas for intervention and growth serving as an impetus for system improvement; 3). Systems that effectively implement mental health policies and programming intentionally utilize multi-level, multi-institutional, and multi-disciplinary implementation teams by co-developing innovative ways to remove barriers to service.

Profiles of Mental Health Problems Among Adolescents

Adolescence is one of the developmental stages marked by the emergence of psychological turmoil, so it is not easy for some individuals to live through it. This study aimed to determine the general profile of typical mental health problems experienced by adolescents in East Java. This study used a descriptive survey conducted on adolescents aged 15–18 years in East Java. The sampling technique used is simple random sampling. Data were obtained using sociodemographic data and the Strengths and Difficulties Questionnaire (SDQ). The results show that emotional problems emerged as the most prevalent concern among older students, whereas younger students faced the highest prevalence of peer-related problems. Regarding gender, emotional problems and peer problems were the predominant contributors to the highest rates among female students, while conduct problems exhibited the highest rates among male students. The implications of the study point to the importance of addressing gender-based emotional and behavioral problems in adolescents within school settings. This emphasis is key to cultivating a state of mental health and well-being.&#x0D; Keywords: emotional problems, behavioral problems, gender, school-based mental health

Help, Teach, Counsel: How Terminology Changes in the ProQOL-5 Impact Score Reliability

Objective: This study evaluated score reliability of the Professional Quality of Life Scale (ProQoL) when contextualizing help to a relevant derivative. Method: The researchers evaluated score reliability across three datasets among school-based professionals (n = 122), teachers (n = 216), and mental health professionals (n = 543) using Cronbach’s alpha, McDonald’s omega, inter-item correlations and visual analysis. Results: Score reliability was acceptable across samples. However, item analysis indicated variability in responses indicating participants’ extracting different meaning or relevance to the items. Terminology changes may extract different meaning based on profession resulting in measurement error. Conclusions: Findings highlight use of one-word derivative changes to items may impact score reliability based on the professional activities represented. Researchers should adjust item terminology for clarity and relevance to all the professions represented in the sample. Evidence of the nature of professional activities with client or student trauma to secondary traumatic stress is presented.

Streaking and self-care planning: the influence of integrating a well-being initiative in one teacher education program

ABSTRACT Concerns about teacher burnout, compassion fatigue, and retaining early career professionals have prompted teacher education programs to seek out ways to promote mental and emotional health during pre-service teacher training. This two-year, educational design study explored pre-service teachers’ experiences with the implementation of two school-based mental health interventions: the intentional introduction of self-care planning during field experience practicums, and the promotion of ‘streaking’, a health promotion event, to encourage pre-service teachers to implement a daily individual mental health intervention. Data were collected at several different points over a two-year period through surveys and individual interviews. The data analysis indicated that this two-tiered approach holds promise as a health promotion activity, however other intentional and educational actions were needed to ensure that pre-service teachers had the resources and tools required to support their mental and emotional health during their practicum courses. A further finding suggested that the term ‘self-care’ was widely misunderstood by study participants and work is needed to help pre-service teachers understand the importance of self-care during their practicum as a prevention strategy for well-being once they begin their teaching career.

Childhood trauma and major depression in Chinese college students: mediating role of Internet addiction and victimization of domestic violence

Aim: Major depression disorder in adolescents has received much attention around the world. While the factors correlated with major depression in adolescents have been extensively described, the mechanisms underlying the complexity of the relationship between childhood traumatic experiences and major depression have been less studied. This study investigated both the direct influence of childhood trauma on major depression and whether the mediation of domestic violence victimization and Internet addiction played a role in connecting childhood trauma to major depression. Method: The school-based mental health survey was conducted in April 2023 in northeast Chinas Heilongjiang Province. We collected sociodemographic information and targeted mental health outcomes with standardized questionnaires. Hierarchical multiple logistic regression and structural equation modeling were used to analyze the data. Results: The study included 596 college students. The prevalence of major depression and Internet addiction was 31.2% and 21.6%, respectively. 16.4% of participants reported experiences of childhood trauma and 12.8% reported being victims of domestic violence. Childhood trauma, domestic violence victimization and Internet addiction have direct effects on major depression. The total effect of childhood trauma on suicidal ideation was 0.201 (p &amp;lt; 0.001). Domestic violence victimization and Internet addiction play mediating roles between childhood trauma and depression. Internet addiction plays a mediating role between domestic violence and major depression. Childhood trauma has direct and indirect effects on major depression of college students. Domestic violence victimization and Internet addiction play mediating roles in major depression of college students. Understanding these relationships will help develop and implement more targeted interventions and strategies to improve the mental health of Chinese college students.

Reasons for non-participation of children and adolescents in a large-scale school-based mental health project.

Non-participation in mental health studies is an under-explored but very important topic. Investigating reasons for non-participation holds promise for the planning of future study designs and recruitment strategies. This study aimed at investigating reasons for children and adolescents (C&A) not participating in a school-based mental health research project. Data collection took place within the school-based recruitment of a large-scale multi-site project ("ProHEAD-Promoting Help-seeking using E-technology for Adolescents") in Germany. Participants were N = 534 C&A aged ≥ 12 years attending secondary schools. The present cross-sectional study analyzed anonymous survey data of C&A who themselves or whose parents, respectively, did not provide written consent to participate in the mental health research project. The questionnaire consisted of 14 items covering potential reasons for non-participation, and four free text fields. Besides descriptive statistics, free text field answers were analyzed using qualitative content analysis. Students indicated an average of M = 2.94 (SD = 1.75) reasons for their non-participation in the project. In the descriptive analysis of indicated items, the three most frequently reported reasons for non-participation included students reporting to not be concerned by the topic "mental health" (n = 290, 54.3%), not having returned the consent form to the teacher (n = 175, 32.8%), and not having time for participation (n = 149, 27.9%). In the qualitative content analysis, the most frequently assigned categories were organizational reasons (n = 216, 57.1%), general disinterest in study participation (n = 139, 36.8%), and personal attitudes toward the topic "mental health" (n = 84, 22.2%), such as not being concerned with the topic "mental health" (n = 23, 6.1%) or being too concerned with the topic "mental health" (n = 16, 4.2%). The study provides unique insights into reasons for C&A and their caregivers not participating in a large federally funded mental health research project. The results suggest that in order to increase participation rates, stigma should be reduced, parents as well as teachers should be involved where possible, and the use of incentives might be helpful. The study highlights the importance of assessing reasons for non-participation, especially in online intervention studies on mental health.

Examining the Classroom Impact of the Bounce Back Trauma Intervention: Implications for Selecting Progress Monitoring Tools

Limited research has examined the impact of Bounce Back (BB), a trauma-focused intervention for elementary-age students, on student academic engagement and daily classroom behavior. This study utilized both ongoing direct and indirect measures of student functioning to evaluate student progress and inform the implementation of BB. Participants were six U.S. students (four male and two female). We employed an AB single-subject design across cases with follow-up, and we collected data via the Direct Behavior Rating–Single Item Scale (DBR-SIS). We also employed a quasi-experimental pretest–posttest design using the Strengths and Difficulties Questionnaire (SDQ), Social, Academic, and Emotional Behavior Risk Screener (SAEBRS), and mySAEBRS across raters before/after intervention implementation. We found either direct or indirect assessment could be used to monitor intervention effectiveness for youth who presented with some internalizing and externalizing problems, whereas indirect measures (i.e., rating scales) showed the primary effect for youth with solely internalizing problems, and direct assessment (i.e., DBR-SIS) showed the primary effect for youth with predominantly externalizing behaviors. Selecting progress-monitoring tools based on presenting concerns is important to adequately monitor the effectiveness of school-based mental health interventions. Implications for practice are discussed.

Perceived Emotional Self-Efficacy and Life Satisfaction of Elementary School Children on the US-Mexico Border.

Objectives. It has been established that an adult's perceived ability to effectively address negative emotions predicts their life satisfaction. To increase the understanding of ethnic minority children's mental health and quality of life, this study examined the relationship between perceived emotional self-efficacy and life satisfaction of Hispanic children. Methods. Using the nonexperimental-correlational research design and the convenience sampling method, a total of 176 fourth-, fifth-, and sixth-grade students (73 boys, 103 girls; 88% Hispanic) in one public elementary school on the US-Mexico border were recruited to participate in this study. Emotional self-efficacy was measured using the emotional subscale of the Self-Efficacy Questionnaire for Children and subjective well-being was measured using the Student Life Satisfaction Scale. Spearman correlation and ordinal regression analyses were used to test the study hypotheses. Results. Consistent with findings from the current literature, emotional self-efficacy was positively associated with subjective well-being. Children in lower elementary grades were more likely to report higher emotional self-efficacy than those in higher elementary grades. Boys were more likely to report higher life satisfaction than girls. Conclusions and Relevance. Using a sample of elementary school children with Hispanic backgrounds on the US-Mexico border, this study attested to the empirical link between emotional self-efficacy and life satisfaction. Our study findings stress the importance of early identification of students with low emotional self-efficacious beliefs and the early introduction of social-emotional learning programs in elementary schools to enhance students' emotional self-efficacy. This study contributes to positive psychology literature and provides insights for future school-based mental health practice and research.

Benefits and barriers: Improving boys’ mental health education in high schools

Adolescents are facing an unprecedented mental health crisis worldwide. Yet, mental health literacy and experiences of mental illness vary significantly with gender. For example, male deaths by suicide are twice as high as females on average globally, with the trend of gender disparity in mental illness emerging in high school and continuing into adulthood. With the majority of mental illnesses also emerging in adolescence, high schools are uniquely positioned to provide timely preventative mental health education for boys. To date, however, school-based mental health education programs are predominantly gender-neutral. We conducted a narrative review of the literature in mental health education programs for high school aged boys aged 12–18 years within schools and the wider community. To address the question How can high schools provide better mental health education for their male students? searches were undertaken in four databases, ProQuest (including ERIC), Informit (including A+ Education), PsychINFO and Google Scholar, between January 2021 and November 2023. There were no restrictions on publication date. Our findings suggested that to improve mental health knowledge and attitudes towards mental health and help seeking, school-based programs should be gender transformative, draw on best practice and theory in sociology, psychology, and boys’ pedagogy, utilise co-design so that student voice can be prioritised, and be tailored to the school's sociocultural context. Recommendations for schools are discussed.