School-Based Mental Health Services: A Research Review

This paper provides a synthetic review of research on school-based mental health services. Schools play an increasingly important role in providing mental health services to children, yet most school-based programs being provided have no evidence to support their impact. A computerized search of references published between 1985 and 1999 was used to identify studies of school-based mental health services for children. Study inclusion was determined by (i) use of randomized, quasi-experimental, or multiple baseline research design; (ii) inclusion of a control group; (iii) use of standardized outcome measures; and (iv) baseline and postintervention outcome assessment. The application of these criteria yielded a final sample of 47 studies on which this review is based. Results suggest that there are a strong group of school-based mental health programs that have evidence of impact across a range of emotional and behavioral problems. However, there were no programs that specifically targeted particular clinical syndromes. Important features of the implementation process that increase the probability of service sustainability and maintenance were identified. These include (i) consistent program implementation; (ii) inclusion of parents, teachers, or peers; (iii) use of multiple modalities; (iv) integration of program content into general classroom curriculum; and (v) developmentally appropriate program components. Implications of these findings and directions for future research are discussed.     

Taking Cognitive-Behavior Therapy to School: A School-Based Mental Health Approach

This paper offers an overview using cognitive-behavior therapy (CBT) within a school system. In addition to providing services to individual students, this article provides an overview of implementing CBT into a system of school-wide mental health services. Interventions are discussed at three levels—universal school-wide interventions, target interventions with at-risk students, and intensive interventions with students in need. Examples of specific programs or intervention are given for each level.     

Mental Health Collaboration: A Survey of Practicing School Psychologists

Schools have become the primary setting for mental health service among youth. However, school-based providers are sometimes limited by lack of time, training, and other resources. Furthermore, problem-solving models emphasize the importance of developing partnerships with other professionals and agencies. Thus, it is critical to engage in collaborative practice with non–school-based, community mental health providers (CMHPs). The purpose of this study was to survey practicing school psychologists about their experiences in communicating and collaborating with CMHPs. Participants (n = 194) indicated their frequency of communication and collaboration with CMHPs; although communication (i.e., release and receipt of information) was typical, fewer school psychologists reported engaging in ongoing collaboration. Benefits and barriers to collaboration were identified, and implications for practice are discussed.     

Adolescent Satisfaction with School-Based Mental Health Services

Examining adolescents' satisfaction with mental health services is an important program evaluation activity. Their perceptions of whether services were beneficial and resulted in improved functioning are indices of treatment quality. Assessment of adolescent satisfaction with school-based mental health programs has been limited. In our study, adolescents receiving services from a School Mental Health Program (SMHP) completed satisfaction surveys. Participants were predominantly minority youth residing in an urban area. Results indicated that students were highly satisfied with their mental health services. Students valued the therapeutic relationship, catharsis associated with therapy, and skills they learned during therapy. Several factors influenced satisfaction ratings including clinician training and availability.     

A Call for Interdisciplinary Collaboration to Promote Musculoskeletal Health: The Creation of the International Musculoskeletal Mental and Social Health Consortium (I-MESH)

Despite increasing recognition of psychosocial factors in musculoskeletal conditions, its impact on reducing the global toll of musculoskeletal symptoms has been only incremental. It is time to bring together clinicians and researchers with heterogeneous backgrounds, unified by a commitment to reduce the global impact of musculoskeletal illness by addressing mental and social health factors. In 2020, we initiated the International Musculoskeletal Mental and Social Health Consortium. Our current key priority areas are: (1) Develop best practices for uniform terminology, (2) Understand barriers to mental and social health care for musculoskeletal conditions, (3) Develop clinical and research resources. The purpose of this paper is to render a call to interdisciplinary collaboration on the psychological aspects of musculoskeletal health. We believe this international interdisciplinary collaboration is pivotal to the advancement of the biopsychosocial model of musculoskeletal care and has the potential to improve the health of individuals with musculoskeletal conditions globally.

     

Effectiveness of School-Based Mental Health Services for Children: A 10-Year Research Review

A review of the literature from 1985 to 1995 on school-based mental health services for children was conducted using a computerized data-base search. Of the 5,046 references initially identified, 228 were program evaluations. Three inclusion criteria were applied to those studies: use of random assignment to the intervention; inclusion of a control group; and use of standardized outcome measures. Only 16 studies met these criteria. Three types of interventions were found to have empirical support for their effectiveness, although some of the evidence was mixed: cognitive-behavioral therapy, social skills training, and teacher consultation. The studies are discussed with reference to the sample, targeted problem, implementation, and types of outcomes assessed, using a comprehensive model of outcome domains, called the SFCES model. Future studies of school-based mental health services should (a) investigate the effectiveness of these interventions with a wider range of children's psychiatric disorders; (b) broaden the range of outcomes to include variables related to service placements and family perspectives; (c) examine the combined effectiveness of these empirically-validated interventions; and (d) evaluate the impact of these services when linked to home-based interventions.     

School-Based Mental Health Services: Definitions and Models of Effective Practice

ABSTRACT

School-based mental health services are those delivered by school-employed and community-employed providers in school buildings. With the implementation of provisions of the Patient Protection and Affordable Care Act (2010) that funds school-based health centers, school-based mental health services could become more broadly available in communities throughout the United States. Playing a pivotal role in promoting models for school-based services that maximize benefits to children and adolescents while making efficient use of communities' mental health resources are school psychologists. School psychologists, who recognize and respect the separated development of school and community mental health professions, can foster school–agency partnerships to coordinate children's mental health services that are comprehensive, child centered, family focused, and culturally competent. In this article, we provide three case examples using the Participatory Culture-Specific Intervention Model (B. K. Nastasi, R. B. Moore, & K. M. Varjas, 2004 Nastasi, B. K., Moore, R. B., & Varjas, K. M. (2004). School-based mental health services: Creating comprehensive and culturally specific programs. Washington, DC: American Psychological Association. [Google Scholar]) as exemplars for the implementation of community partnerships providing comprehensive culturally and contextually relevant school-based mental health services.     

Developing Black Mental Health Provision: Challenging Inequalities in Partnership

This article describes and comments upon the process of developing the Sanctuary project in London, a project that will provide two community-based crisis support services for African and African-Caribbean women and men in mental crisis and distress. This initiative is informed by the extensive research documenting the ways in which mainstream, mental health services fail Black people, and by evidence suggesting that innovations in service provision for Black people are often vulnerable and limited in their impact. In an effort to avoid replicating these problems, considerable emphasis has been given to developing the project in partnership with the main stakeholders—in this instance statutory and Black voluntary sector agencies as well as Black users, carers and community members. Within this context, issues relating to inequalities can be proactively addressed, thereby reducing the risk that they undermine the effectiveness of service provision at a later stage. However, working in partnership can also hinder or delay service developments if discussions between stakeholders become protracted or conflicts unresolved. The author draws on experience gained from this project to identify the potential as well as the difficulties of using a partnership approach to developing effective Black mental health provision. The author's role in the development of these projects has been as representative of one of the partners, the King's Fund Centre for Development.     

Effectiveness Research in the Context of School-Based Mental Health

There are many challenges to transporting evidence-based treatments from laboratories into real-world settings. However, if we hope to make our evidence-based treatments accessible and available to children and usable by community professionals, effectiveness research is imperative. We argue that schools represent an ideal real world setting in which to conduct such research. The goals of this paper are to present the advantages of conducting effectiveness research in the school setting and to encourage clinical researchers to engage in effectiveness research in this location, as there are benefits to children, pre-service professionals, communities, and researchers. We attempt to further advance the literature by discussing the challenges associated with this work and by providing a case example (The Youth Experiencing Success in School [Y.E.S.S.] Program) that demonstrates real world application of our recommendations.     

Sustainability of Teacher Implementation of School-Based Mental Health Programs

Evidence-based prevention and intervention programs are increasingly being implemented in schools and it therefore is becoming increasingly important to understand the complexities of program implementation under real-world conditions. Much research has focused on the contextual factors that influence program implementation but less work has attempted to provide an integrated understanding of mechanisms (e.g., teacher-training processes) that affect teachers' program implementation. In this paper, we review literature on factors related to teachers' implementation of school-based prevention and intervention programs, then from this review abstract what we believe are four basic ingredients that characterize potentially sustainable teacher-implemented classroom programs. Finally, we present a sequential model, based on these ingredients, of the naturalistic processes underlying sustainability of teachers' program implementation and describe how this sustainability can be enhanced through provision of teacher training and performance feedback from a classroom consultant.     

Confidentiality and Mental Health/Chaplaincy Collaboration

Confidentiality can both facilitate and inhibit working relationships of chaplains and mental health professionals addressing the needs of service members and veterans in the United States. Researchers conducted this study to examine opportunities for improving integration of care within the Department of Defense (DoD) and Department of Veterans Affairs (VA). Interviews were conducted with 198 chaplains and 201 mental health professionals in 33 DoD and VA facilities. Using a blended qualitative research approach, researchers identified several themes from the interviews, including recognition that integration can improve services; chaplaincy confidentiality can facilitate help seeking behavior; and mental health and chaplain confidentiality can inhibit information sharing and active participation on interdisciplinary teams. Cross-disciplinary training on confidentiality requirements and developing policies for sharing information across disciplines is recommended to address barriers to integrated service delivery.     

Enhancing the Behavioral and Mental Health Services Within School-Based Contexts

ABSTRACT

Recent health care reform provides many new opportunities to expand mental health and behavioral support to students in schools and school–community partnerships. Through newly available funding sources, as well as expanded legislative initiatives, school psychologists can advocate for and become leaders in delivering universal programming, tiered mental health supports, and formalized collaborative efforts with community agencies. The authors highlight the application of tiered levels of services, with current practice samples, designed to address students' mental and behavioral health. Implications for practice are discussed.     

Hmong Mental Health Needs Assessment: A Community-Based Partnership in a Small Mid-Western Community

The overall goal of this assessment was to verify the mental health needs of Hmong living in a mid-west community in order clarify the format, content, and feasibility of providing mental health services for Hmong in the future. Using a Community-Based Participatory Research (CBPR) model, we held four focus groups with 36 men, women, adolescents and professionals, all of Hmong descent, as well as interviewed 28 individual medical, mental health, education, and social service providers in the Eau Claire community. Our Hmong sample was frequently unclear about what “mental” health meant, indicating a low level of mental health literacy. Results confirmed that there are significant mental health needs in this refugee and immigrant population. Participants described problems consistent with depression, post-traumatic stress disorder (PTSD), anxiety disorders, somatoform disorders, and severe social stress and acculturation difficulties in every generation. Elder people and male adolescents were described as the most disaffected and in need of immediate services. It will be critical to address mental health literacy before designing future interventions. Treatment suggestions were provided with the intention of removing barriers and incorporating culturally sensitive methodologies, while continuing to work closely with our local mental health providers and Hmong leadership.     

School-Based Mental Health Programs and Services: Overview and Introduction to the Special Issue

School-based mental health (SBMH) programs and services have grown progressively in the United States in the past two decades, related in part to increased recognition of their advantages and heightened federal support. However, SBMH is an emerging field, with many issues needing attention. This introductory article provides a context for the special issue by highlighting the importance of increased conceptual clarity about SBMH, enhanced mental health—education systems integration, and advancement of the SBMH research base. Key elements for success of SBMH programs and services are discussed, as underscored recently by the report of the New Freedom Commission on Mental Health (2003) and other important initiatives. These elements include (a) school–family–community agency partnerships, (b) commitment to a full continuum of mental health education, mental health promotion, assessment, problem prevention, early intervention, and treatment, and (c) services for all youth, including those in general and special education. A synopsis of the articles in the special issue is provided, emphasizing their conceptual and empirical contributions to delivery and sustainability of effective mental health practices in schools.     

Transporting CBT for Childhood Anxiety Disorders into Inner-City School-Based Mental Health Clinics

The systematic expansion of evidence-based cognitive behavioral (CBT) protocols into the schools provides an opportunity for training front-line service providers in the early identification of anxious children and in the delivery of evidence-based treatments to children who might otherwise go without such treatment [Weist, M. D., & Evans, S. W. (2005). Expanded school mental health: Challenges and opportunities in an emerging field. Journal of Youth and Adolescence, 3, 3­6]. In this article, we discuss the progress of our ongoing study aimed at transporting manualized CBT for anxious youth into inner-city school-based clinics. In this context, we outline the rationale for the study and specific adaptations and obstacles encountered to date.     

Collaboration Between Clergy and Mental Health Professionals: A Review of Professional Health Care Journals From 1980 Through 1999

Given the frontline role of community clergy in mental health care, this study examined how collaboration with clergy was viewed by mental health and other health professionals outside of the religious community. Searches of health care journals on Medline and PsycINFO yielded 44 articles from non‐religious journals from 1980 through 1999 that specifically addressed collaboration between clergy and mental health professionals. Seven themes were identified through content analysis, including the benefits of collaboration to each profession, the need to increase the clergy's knowledge about mental heath, and the importance of referrals. Discussion about interdisciplinary referrals significantly increased over time, r_ø (1, N = 44) = .31, p < .05).     

The North American Career Development Partnership: Experiment in International Collaboration

This article describes how career development programs became the focus of an international partnership between the United States and Canada. Beginning in 1976 in the United States, the National Occupational Information Coordinating Committee (NOICC) and its State Occupational Information Coordinating Committees (SOICCs) developed training and materials that promote the use of occupational and labor market information. Similarly, in the early 1970s, Canada began to explore the feasibility of creating a computer‐based career information delivery system. What follows is the story of an unusual and significant international collaboration. It concludes with identification of lessons learned.     

The Effectiveness of Cultural Adjustment and Trauma Services (CATS): Generating Practice-Based Evidence on a Comprehensive, School-Based Mental Health Intervention for Immigrant Youth

A collaborative study of Cultural Adjustment and Trauma Services (CATS), a comprehensive, school-based mental health program for traumatized immigrant children and adolescents, was conducted to generate practice-based evidence on the service delivery model across two school districts. Program effectiveness was assessed by testing whether client functioning and PTSD symptoms improved as a result of 7 separate service elements. An array of clinical services including CBT, supportive therapy, and coordinating services were provided to all students, and an evidence-based intervention for trauma, TF-CBT, was implemented with a subset of students. Greater quantities of CBT and supportive therapy increased functioning, while greater quantities of coordinating services decreased symptoms of PTSD. TF-CBT services were associated with both improved functioning and PTSD symptoms, although TF-CBT was implemented with fidelity to the overall comprehensive service model rather than the structured intervention model. Results suggest the comprehensive school-based model was effective, though different service components affected different student outcomes. Implications of these findings for immigrant mental health interventions and implementing structured evidence-based practices into community mental health programs are discussed. Suggestions are made for future research on existing mental health practices with immigrants.     

Interdisciplinary Knowledge Translation: Lessons Learned from a Mental Health: Fire Service Collaboration

Collaborative approaches are being increasingly advocated for addressing a variety of health, mental health and social needs for children, youth and families. Factors important for effective knowledge translation of collaborative approaches of service delivery across disciplines, however, have not been rigorously examined. TAPP-C: The Arson Prevention Program for Children is an intervention program for child and adolescent firesetters provided collaboratively by fire service and mental health professionals. The present study examined the adopter, innovation, and dissemination characteristics associated with TAPP-C implementation, protocol adherence and extent of collaboration by 241 community-based fire service professionals from communities across Ontario. Results revealed that dissemination factors are particularly important for understanding program implementation, adherence and cross-discipline collaboration. Moreover, the findings of this study show significant benefits to both within discipline (intra-disciplinary) and across discipline (interdisciplinary) knowledge translation strategies.