School Mental Health Providers Research Articles

United States Schools and the Opioid Crisis: Charting New Directions

ABSTRACT Background The opioid epidemic has created unprecedented challenges in the United States (US), including hundreds of thousands of lives lost to overdose in the past five years. Expansion of prevention and treatment for opioid use disorder (OUD) is urgently needed, as evidence-based strategies exist but many remain unable to access life-saving services. Purpose To inform school health and mental health providers, educators and school administrators about the causes and consequences of the US opioid epidemic and to provide practical solutions for engineering multi-tiered systems of support for children and families affected by the epidemic, including through opioid misuse, OUD, and opioid overdose. Methods We review the literature on the history of and current challenges associated with the opioid epidemic in the US. Results The collateral damage of OUD is pervasive, impacting children and families across the US. We found no health education programs focusing on this topic in US schools, underscoring a critical need and cogent practice/policy avenue. Discussion Schools are uniquely positioned to respond to the opioid epidemic, but school health and mental health providers, educators, and other professionals who work in schools must have accurate knowledge of the opioid epidemic, understand the challenges it is causing for children and families, and be familiar with best practices in prevention and treatment. Translation to Health Education Practice This review provides a succinct overview of the history of the opioid epidemic, examines its impacts on children and families, and provides a call to action for schools to partner in our national response.

School mental health care coordination practices: A mixed methods study

Mental health services are increasingly being delivered within schools via a multi-tiered system of supports. Although care coordination, or the deliberate organization of activities and personnel required to facilitate care, is viewed as an imperative for meeting student needs in school, there is a paucity of research on practices for coordinating mental health care for students receiving intensive, Tier 3 services. With a national participant sample from the United States and a convergent mixed methods design, the purpose of the present study was to explore the nature of care coordination practices implemented by school mental health providers for students with intensive mental health needs. Through both survey (N = 163) and interview (N = 13) responses, school mental health providers indicated mental health care coordination practices are not systematized and follow informal, provider-initiated procedures. However, providers endorsed engaging in more than one type of care coordination practice at a time and highlighted the importance of communication practices for coordinating mental health care. We detail the prevalence and associations among reported engagement with (a) broad care coordination, (b) communication, (c) transition facilitation, and (d) information sharing practices, and describe subthemes for the qualitative theme: School transition planning for students with mental health needs is currently patchwork and requires effective collaboration. We discuss limitations, implications for practice, and future directions.

Importance, quality, and engagement: School mental health providers' perceptions regarding within-district transition care coordination practices.

Although care coordination (CC; i.e., the organization of care activities between professionals to facilitate appropriate service delivery; McDonald et al., 2007) has yet to be studied extensively within schools, preliminary research suggests coordinating school mental health supports can be beneficial (Francis et al., 2021) and that interprofessional and interagency collaboration is warranted to meet student needs (McClain et al., 2022). We examined the perceptions of school mental health providers (SMHPs) regarding importance, quality, and engagement with within-district transition CC practices within a multitiered system of support framework. Participants were 163 SMHPs who endorsed being involved in designing, providing, or implementing mental health services in a U.S. school district. The three scales used to measure engagement with CC practices were based on the Care Coordination Measures Atlas (McDonald et al., 2014) and were found to have promising preliminary psychometrics. Descriptive statistics indicated SMHPs endorsed CC as very important but perceived school and district personnel to view it as less important, reported their own quality of CC was slightly above that of their school and district, and regularly engaged in broad CC practices. Moreover, bivariate correlations indicated SMHP's personal views of CC importance were not associated with the quality of school and district CC, yet engagement in broad CC activities was associated with transition facilitation practices, and attitudes about CC were associated with engagement in broad CC activities. Implications of findings are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supplemental Material for Importance, Quality, and Engagement: School Mental Health Providers’ Perceptions Regarding Within-District Transition Care Coordination Practices

Supplemental Material for Importance, Quality, and Engagement: School Mental Health Providers’ Perceptions Regarding Within-District Transition Care Coordination Practices

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 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.

Examining facilitators and barriers to evidence‐based professional practice by mental health providers in schools

AbstractThis exploratory study surveyed school mental health providers across the United States to examine their perception of the facilitators and the barriers to evidence‐based professional practice (EBPP) when offering mental health services to students in schools and to identify any group differences of these perceptions. A national sample of school counselors, school psychologists, and social workers (N= 303, 86.5% female) was surveyed using an original questionnaire. Results of the study identified 12 perceived facilitators to EBPP: educational and professional standards, continuing education training, graduate school training, personal theoretical orientation, publications from professional organizations, individual student needs, peer support from coworkers, providing supervision to other professionals, access to research, access to resources to provide specific programs and interventions, student preferences, and use of treatment plans. No perceived barriers to EBPP were identified when looking at the whole sample. However, an examination of specific groups within the study revealed two barriers: use of treatment plans and providing supervision to other professionals. Findings provide an updated understanding of perceived facilitators and barriers to EBPP and set the stage for future interventions targeting these factors. Implications and future research directions are discussed.

Implementation strategies to promote measurement-based care in schools: evidence from mental health experts across the USA

BackgroundDespite an established taxonomy of implementation strategies, minimal guidance exists for how to select and tailor strategies to specific practices and contexts. We employed a replicable method to obtain stakeholder perceptions of the most feasible and important implementation strategies to increase mental health providers’ use of measurement-based care (MBC) in schools. MBC is the routine use of patient-reported progress measures throughout treatment to inform patient-centered, data-driven treatment adjustments.MethodsA national sample of 52 school mental health providers and researchers completed two rounds of modified Delphi surveys to rate the relevance, importance, and feasibility of 33 implementation strategies identified for school settings. Strategies were reduced and definitions refined using a multimethod approach. Final importance and feasibility ratings were plotted on “go-zone” graphs and compared across providers and researchers to identify top-rated strategies.ResultsThe initial 33 strategies were rated as “relevant” or “relevant with changes” to MBC in schools. Importance and feasibility ratings were high overall for both survey rounds; on a scale of 1 to 5, importance ratings (3.61–4.48) were higher than feasibility ratings (2.55–4.06) on average. Survey 1 responses resulted in a reduced, refined set of 21 strategies, and six were rated most important and feasible on Survey 2: (1) assess for readiness and identify barriers and facilitators; (2) identify and prepare champions; (3) develop a usable implementation plan; (4) offer a provider-informed menu of free, brief measures; (5) develop and provide access to training materials; and (6) make implementation easier by removing burdensome documentation tasks. Provider and researcher ratings were not significantly different, with a few exceptions: providers reported higher feasibility and importance of removing burdensome paperwork than researchers, providers reported higher feasibility of train-the trainer approaches than researchers, and researchers reported higher importance of monitoring fidelity than providers.ConclusionsThe education sector is the most common setting for child and adolescent mental health service delivery in the USA. Effective MBC implementation in schools has the potential to elevate the quality of care received by many children, adolescents, and their families. This empirically derived, targeted list of six implementation strategies offers potential efficiencies for future testing of MBC implementation in schools.

Developmental Considerations in a Problematic Ecology: Achieving Equity and Socially Just Learning Environments for African American Adolescents With Emotional and Behavioral Challenges

This article critically discusses the ecology of public schools in the United States: systemic barriers and associated biases that permeate these learning contexts and derail efforts to close opportunity gaps for African American adolescents with emotional and behavioral challenges. Using results from a mixed-methods study, we illustrate the ubiquity of an a-developmental perspective that guides perceptions of what is needed to keep these students in and successful at school. A close examination of school mental health providers’ perceptions of what is important and feasible in public school contexts shows recommended interventions to be necessary but not sufficient. We highlight important considerations in the reframing of schools as a dynamic developmental system and conclude with recommendations about how to harness adolescents’ strengths to generate strategies that move us toward more equitable and socially just schooling.

Early career Black women in school-based mental health fields: Understanding their experiences of workplace discrimination

This study aimed to understand school mental health providers' experiences with racism and other forms of discrimination (i.e., gendered-based discrimination) at work, with an exclusive focus on early career Black women. Participants included 10 Black women in school-based mental health fields, namely school psychology and school counseling. All participants completed one individual interview and data analysis was grounded in a transcendental phenomenological approach. Findings revealed three key themes: (1) Affinity and Action, (2) Individual Experience of Discrimination, and (3) Systemic Racism and Discrimination Impacting Students of Color. Participants were passionate about advocating for all students and liberating marginalized students from oppressive school structures. However, participants' own experiences with discrimination impacted their well-being and job satisfaction. The participating women utilized several strategies to cope and push for change (e.g., reporting to the human resource personnel). Yet, people in power precluded their efforts and the emotional toll led some participants to question whether they should transition to a new field of practice. Findings from this research support calls for increased attention to Black women in school mental health fields, because they are placed at risk of experiencing work discrimination due to their intersectional identities.

A storyboarding approach to train school mental health providers and paraprofessionals in the delivery of a strengths-based program for Latinx families affected by maternal depression.

Mental health professionals in schools and the community are often overburdened and underfunded in high-need areas, limiting their capacity to deliver needed family-based mental health interventions. To address this issue, paraprofessional school personnel (e.g., family engagement liaisons) can facilitate these family-based mental health interventions alongside licensed mental health professionals, thereby increasing access to mental health services for families with mental health needs. To train professional and paraprofessional school personnel in maternal depression and interventions, we used storyboarding, a narrative storytelling method traditionally used to create films. Latinx families who had previously participated in a family-focused program for maternal depression shared real life stories focused on themes of (a) maternal depression, (b) impact on children, (c) cultural views and role of immigration, (d) self-harm and suicide, and (e) what families need. In this conceptual paper, we describe our engagement of families in a multistep process of storyboarding that resulted in video modules of family stories for a training website and in-person workshop for school professionals and paraprofessionals. We conclude with how community-engaged tools such as storyboarding can be used to increase awareness and reduce stigma of maternal depression among staff training to deliver family-focused mental health programs in schools.

Supporting School Mental Health Providers: Evidence from a Short-Term Telementoring Model.

BackgroundTo support student mental health, school staff must have knowledge of evidence-based practices and the capacity to implement them. One approach used to address this challenge is a group-based telementoring model called Extension for Community Healthcare Outcomes (ECHO). In other applications (e.g., healthcare settings), ECHO has been shown to increase healthcare professionals’ self-efficacy and knowledge of evidence-based practices leading to improved patient outcomes.ObjectivesThis study examined the potential for ECHO to be used as a method for increasing school staff engagement and knowledge of evidence-based school mental health practices.MethodsUsing a quasi-experimental design, this study compared outcomes across two professional development experiences aimed at promoting school staff ability to provide evidence-based mental health services. School staff from four school districts participated in a school mental health training initiative. All participants (N = 57) had access to asynchronous, online mental health modules. A sub-sample (n = 33) was also offered monthly ECHO sessions.ResultsTests of group difference in outcomes revealed significant increases in engagement with online learning (d = 0.58) and satisfaction (d = 0.82) for those who participated in ECHO as compared to those who did not. Knowledge about evidence-based practices was not significantly different between groups.ConclusionsResults suggest that group-based telementoring may be a promising approach for improving engagement and satisfaction with training initiatives aimed at promoting evidence-based school mental health practices. However, further study of ProjectECHO using experimental designs is needed to make causal inferences about its effect on provider outcomes.

Amid state workforce issues, California Alliance tackles student MH needs

The nation continues to grapple with a growing youth mental health crisis, exacerbated by not just the pandemic, but also the resulting shortage of school mental health counselors and providers and other needed resources. Students are grappling with stress, anxiety, social distancing, remote learning and behavioral challenges with returns to in‐person learning.

Understanding ADHD in Black Adolescents in Urban Schools: A Qualitative Examination of Factors that Influence ADHD Presentation, Coping Strategies, and Access to Care

ABSTRACT The high school years are a challenging developmental period for adolescents with attention- deficit/hyperactivity disorder (ADHD), their families, and those who work with them in the school system. Moreover, racially minoritized families and schools in low-resource, urban settings often experience additional adverse experiences that can make access to evidence-based mental health care particularly difficult. This qualitative investigation into the experiences of Black high school students with ADHD, their caregivers, teachers, and school mental health providers (SMHPs) aimed to understand this community’s experiences with ADHD across development and to explore the barriers/facilitators to adequate services. Through focus group interviews with stakeholders (i.e., 6 adolescents with a diagnosis of ADHD, 5 caregivers of adolescents with ADHD, 6 teachers, 5 school mental health providers), themes emerged related to (1) developmental changes observed in ADHD presentation in high school students and (2) contextual factors (including barriers/facilitators to optimal school and home functioning). These themes led to the development of an ecological model that show various contextual factors influencing the experiences of Black adolescents with ADHD in under-resourced urban public high schools (e.g., adolescents’ coping strategies, caregiver involvement, teacher burden or lack of ADHD-knowledge, socio-economic status, access to care). This qualitative study represents the first step of a treatment development project assessing the implementation of a depression prevention intervention for Black adolescents with ADHD in urban public-school settings. Clinical implications (e.g., coordination of care between home and schools, increasing attention to social determinants of health, ensuring culturally competent discussion of ADHD and its treatment) are discussed.

School-Based Suicide Risk Assessment Using eHealth for Youth: Systematic Scoping Review.

BackgroundSuicide is a leading cause of death among youth and a prominent concern for school mental health providers. Indeed, schools play a key role in suicide prevention, including participating in risk assessments with students expressing suicidal ideation. In the context of the COVID-19 pandemic, many schools now need to offer mental health services, including suicide risk assessment, via eHealth platforms. Post pandemic, the use of eHealth risk assessments will support more accessible services for youth living in rural and remote areas. However, as the remote environment is a new context for many schools, guidance is needed on best practices for eHealth suicide risk assessment among youth.ObjectiveThis study aims to conduct a rapid, systematic scoping review to explore promising practices for conducting school-based suicide risk assessment among youth via eHealth (ie, information technologies that allow for remote communication).MethodsThis review included peer-reviewed articles and gray literature published in English between 2000 and 2020. Although we did not find studies that specifically explored promising practices for school-based suicide risk assessment among youth via eHealth platforms, we found 12 peer-reviewed articles and 23 gray literature documents that contained relevant information addressing our broader study purpose; thus, these 35 sources were included in this review.ResultsWe identified five key recommendation themes for school-based suicide risk assessment among youth via eHealth platforms in the 12 peer-reviewed studies. These included accessibility, consent procedures, session logistics, safety planning, and internet privacy. Specific recommendation themes from the 23 gray literature documents substantially overlapped with and enhanced three of the themes identified in the peer-reviewed literature—consent procedures, session logistics, and safety planning. In addition, based on findings from the gray literature, we expanded the accessibility theme to a broader theme termed youth engagement, which included information on accessibility and building rapport, establishing a therapeutic space, and helping youth prepare for remote sessions. Finally, a new theme was identified in the gray literature findings, specifically concerning school mental health professional boundaries. A second key difference between the gray and peer-reviewed literature was the former’s focus on issues of equity and access and how technology can reinforce existing inequalities.ConclusionsFor school mental health providers in need of guidance, we believe that these six recommendation themes (ie, youth engagement, school mental health professional boundaries, consent procedures, session logistics, safety planning, and internet privacy) represent the most promising directions for school-based suicide risk assessment among youth using eHealth tools. However, suicide risk assessment among youth via eHealth platforms in school settings represents a critical research gap. On the basis of the findings of this review, we provide specific recommendations for future research, including the need to focus on the needs of diverse youth.

School Mental Health Providers’ Perspectives on the Impact of COVID-19 on Racial Inequities and School Disengagement

School disengagement is a critical factor that will likely exacerbate long-standing racial inequities in educational outcomes during the aftermath of the coronavirus disease (COVID-19) pandemic. Due to their training and contact with at-risk students, school social workers and other school-based mental health professionals (SMHP) are in an ideal position to understand the impact of COVID-19 and virtual learning on K–12 students. To that end, this study reports on findings from a survey of SMHP about the differential impact that the COVID-19 outbreak is having on students and their families. The findings suggest that COVID-19 has had a tremendous impact on families overall, especially among populations who were experiencing hardships before the current outbreak. In addition, several barriers were noted for student learning, with many students—particularly students of color—completely disengaging from school during spring 2020. However, SMHP reported several important insights on how to support students and their families—some requiring immediate action on the part of school districts and others requiring greater community-level investment into the economic, social, emotional, and overall health of families. Findings are discussed in light of addressing disengagement and educational inequities for students of color.

Flooding Schools: School Mental Health Providers and the Climate Crisis

Flooding Schools: School Mental Health Providers and the Climate Crisis

Can School Mental Health Providers Deliver Psychosocial Treatment Improving Youth Attention and Behavior in Mexico? A Pilot Randomized Controlled Trial of CLS-FUERTE

Background: Despite well-established Evidence-Based Treatments (EBTs) for Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), many low-resource settings lack EBT access. Methods: We conducted a school-clustered randomized controlled pilot of CLS-FUERTE (a multicomponent behavioral EBT adapted for children in Mexico) with 58 students. We randomly assigned four schools to receive CLS-FUERTE and four to receive school services as usual. We compared groups post-treatment on parent- and teacher-rated ADHD/ODD symptoms and impairment. Results: CLS-FUERTE fidelity, attendance, engagement, and acceptability was high and students receiving CLS-FUERTE showed greater improvement in teacher-rated ADHD, ODD, and impairment, as well as parent-rated ADHD and impairment, compared to students receiving usual services. Conclusions: Pilot results suggest that psychosocial EBTs can be successfully implemented by School Mental Health Providers in Mexico.

Barriers to Mental Health Help Seeking at School for Asian– and Latinx–American Adolescents

Adolescents are most likely to receive mental health services in schools compared to other settings; however, few studies have examined barriers to mental health help seeking at school for ethnic minority adolescents. The current mixed-methods study utilized surveys and semi-structured interviews to explore the mental health literacy (MHL), stigma toward mental illness, and perceived barriers toward help seeking at middle or high schools among 55 adolescents (81.8% female; 50.0% Asian–American, 44.6% Latinx–American, 5.4% Asian/Latinx bi-racial; M age = 17.13 years, SD = 2.33). Participants’ MHL was assessed using case vignettes that depicted adolescents with symptoms of depression or bulimia. Overall, 83.9% of participants correctly recognized depression and 57.1% correctly recognized bulimia from the vignettes. Stigma correlated with perceived helpfulness of the formal service providers (r = − .37, p < .01). Qualitative analysis of participant interviews revealed important knowledge, attitudinal, and practical barriers that inhibit Asian– and Latinx–American adolescents from seeking help for mental health problems at school. The current work has implications to assist school personnel and mental health providers in understanding and reducing barriers to help seeking for Asian– and Latinx–American adolescents.

Emotional and behavioral problems among sexual minority youth in Thailand.

Sexual minority youth (SMY) had more risk behaviors and mental health problems than heterosexual youth. Relatively little research has differentiated among lesbian/gay, bisexual, and questioning (LGBQ) youth. To examine the differences in emotional and behavioral problems between LGBQ youth in the city of Northern Thailand. Data were from a school-based, cross-sectional study of grade 7-12 students in secondary and vocational schools. Five hundred and forty-three students who identified themselves as LGBQ and 3829 heterosexual peers completed the Youth Self-Report (YSR). Of 12.4% of LGBQ participants, 4.1% identified themselves as lesbian/gay, 4.8% as bisexual, and 3.5% were unsure. SMY had significantly higher scores in internalizing problems (16.84 VS 13.99, 95% confidence interval [CI] 1.94-3.77, P < 0.001), externalizing problems (15.23 VS 13.51, 95% CI 0.97-2.45, P < 0.001), and total behavioral scores (55.26 VS 47.16, 95% CI 5.55-10.63, P < 0.001) than their heterosexual peers. In sexual minority subgroup analyses, all syndrome subscales were highest in the bisexual group followed by the lesbian/gay group, and the questioning group, respectively. LGBQ high school students had greater psychosocial problems than their heterosexual counterparts. Bisexual students were at the greatest risks of emotional and behavioral problems. Pediatricians and school mental health providers should be aware of emotional and behavioral problems among LGBQ students.