School Psychology: Training Individuals for One of the Best Kept Secrets in Professional Psychology

Abstract

School psychology training at the doctoral level is discussed. Given the increasing diversity in the schools as well as the varied education and mental health needs of the population, school psychology training is necessarily broad, involving traditional skills such as assessment, intervention, consultation, and counseling, all of which are taught within a context of a changing school population with changing needs. Because there is compulsory education, school psychologists’ interface with a broad cross-section of individual children, their parents, and their teachers. Moreover, school psychological practice is not limited to schools, as doctoral school psychologists are health service providers; many of these individuals work in other settings for which they are trained to provide services. The complexities and challenges of training school psychologists within this broad agenda effectively across domains are discussed.     

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.     

Preparation of school psychologists for school-based consultation: A training activity and a service to community schools

Presents a set of training experiences to develop school-based consultation skills in preservice school psychologists and discusses problems in implementing this model of service. Based on their experience in training school psychologists at the University of California, Berkeley, the authors report on preparing students to deal with teacher and principal expectations. Also discussed are methods for mobilizing teachers to plan more precisely to meet the needs of individual pupils in the classroom. A distinction is made in the paper between school-based and community-based mental health consultation.     

Interagency Collaboration

Abstract

Child welfare, education, health, juvenile justice, and mental health systems have simultaneously initiated movements to reform services to troubled children during the past ten years. Recently, these agencies have shown increased interest in bringing their change efforts together for a more unified system of care. This paper describes essential components of systems of care and interagency collaboration. A case illustration describes a setting in which special service providers in schools, particularly special education administrators and school psychologists, played major roles in the conceptualization and implementation interagency collaboration for a system of care.     

Collaborative Communication Between Psychologists and Primary Care Providers

Psychologists frequently collaborate in the care of patients managed in primary care. Communication with a patient’s primary care team is important to ensure coordination and continuity of care. The communication is far from seamless. Although The Health Information Privacy and Portability Act (HIPPA) is designed to promote sharing of clinical information while protecting patient confidentiality, unique problems arise when mental health records are included. Mental health records are subject to different regulations to protect the patient’s confidentiality. Thus, what is communicated and how it will be accomplished are challenges. Further, psychologists and primary care providers often view documentation differently, resulting in different styles of documenting that may also impede coordinated care. Increasingly, health care systems are moving toward electronic medical records, creating greater opportunities for an integrated record. Improved communication through the record can keep other providers abreast of the mental health care being provided as well as suggestions they can use to reinforce the mental health care treatment plan.     

The Relationship of Parental Divorce to Health Status of Parents and Children

Based on data from the divorce adjustment project conducted by the National Association of School Psychologists and Kent State University, the study reported herein focused on physical and mental health status of children and parents. The nationwide sample included 341 children from divorced families and 358 from intact families randomly selected from first, third, and fifth grade classrooms by 144 school psychologists. Results from ANOVAs indicated that health ratings for divorced-family children as well as their parents and siblings were lower than ratings for their counterparts in intact families. Correlational and multiple regression results revealed a wide array of both concurrent and longitudinal relationships, illustrating interdependence among divorce, physical and mental health condition, stress indices, and academic and social competence criteria. Implications of the results for school-based special services providers are discussed.     

The Interface between Mental Health Providers, Families, and Schools: Parent and Child Attitudes about Information-Sharing

Youth with emotional and behavioral disorders (EBD) are at an increased risk for school problems and negative consequences into adulthood, increasing the need for collaboration between families, school personnel and mental health providers. Current treatment guidelines emphasize the importance of information-sharing between providers and schools, yet few studies have addressed parents’ or students’ attitudes and preferences about this process or about the disclosure of mental health-related information to school professionals. Using a sample of 73 pairs of parents and their adolescents seeking outpatient treatment, this study assessed parental and adolescent attitudes about disclosure of mental health treatment information to school personnel. The majority of parents reported that the school should be informed that their adolescent was receiving counseling or medication for EBD, and that they should be the primary informant, rather than providers. By comparison, adolescents preferred more discretion about their involvement in treatment. Taken together, the study results highlight a number of implications relevant to the therapeutic relation and the process of obtaining and sharing mental health-related treatment information with various school personnel. Future research directions regarding the consultative and collaborative process with school personnel are also discussed.     

Poverty and Serious Mental Illness: Toward Action on a Seemingly Intractable Problem

This paper examines the issue of poverty among people with serious mental illness (SMI), positioning it as a key issue to be confronted by community mental health systems and practitioners. The paper reviews three perspectives on poverty, considering how each sheds light on poverty among people with SMI, and their implications for action: (a) monetary resources, (b) basic needs, and (c) capabilities. The paper argues that community mental health programs and systems are currently unable to address poverty as they are overly focused on individual‐level interventions that, on their own, cannot raise people out of poverty. The paper calls for a social justice value, informed by the concept of citizenship, as a necessary complement to the recovery concept that has informed community mental health practice for almost 25 years. Finally, the paper argues that community psychologists, with their concepts, methods, and values, are well positioned to contribute to this important issue. However, it also contends that addressing poverty requires collaboration from community psychologists with researchers and practitioners from other fields and domains of expertise to begin to make progress.     

Mental health consultation to law enforcement: Secret Service development of a Mental Health Liaison Program

The Mental Health Liaison Program developed and used by the Secret Service is presented as a model for comprehensive, multidimensional interactions between law enforcement and mental health systems, with particular focus on assessing and preventing violent behavior. The structure of the program pairs consultants—psychologists and psychiatrists—with Secret Service field offices to provide (a) consultation regarding risk assessment and case management of individuals who threaten or display inappropriate interest in the President or other protectees; (b) training for agents on risk assessment, mental illness, and mental health care issues; and (c) liaison activities between the Secret Service and the mental health community. Practical benefits to the Secret Service are discussed to encourage more systematic use of broad based psychological and psychiatric consultation to law enforcement, with a goal of enhanced intersystem communication and collaboration. The need for program evaluation and outcome research is discussed in the context of applying the model to improve other mental health and law enforcement systems interactions. © 1998 John Wiley & Sons, Ltd.     

Pediatric topics in the school psychology literature: publications since 1981

Pediatric topics have potential importance to school psychology given the field's new, broadly conceived definition, reconceptualization of schools as health delivery sites, burgeoning pediatric knowledge with educational implications, and expansion of pediatricians' roles into behavioral realms. This article addresses the rate at which pediatric-related articles were published among school psychology journals (Journal of School Psychology, Psychology in the Schools, School Psychology International, School Psychology Review, and School Psychology Quarterly) from 1981 to 2001. The overall number of such articles increased from 11 during the 1981-1983 interval to more than twice as many during every subsequent 3-year interval. Articles, some reporting empirical findings and others offering reviews or practice suggestions, concerning traditional health conditions and attention deficit hyperactivity disorder (ADHD) appeared to be ample. Fewer articles concerned with school psychologists as health care providers and school psychologist-pediatrician collaboration were found. The available literature seems to support school psychologists' widening role definition.     

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.     

The School-Based Mental Health Collaboration (SBMHC): A Multi-Level University-School Partnership

This article describes The School-Based Mental Health Collaboration (SBMHC), a novel school-based mental health partnership between Teachers College, Columbia University, and several high-poverty public grade schools in New York City. SBMHC is grounded in attachment and mentalization theory and practice. It applies nested mentalization to multilevel work with all school stakeholders, encouraging school leaders, faculty, staff, and parents to use mentalization with children, many of whom have experienced trauma. Graduate students serve as classroom consultants (CC), spending a half day per week in the classroom observing, doing push-in interventions, co-teaching a social-emotional learning curriculum, coaching the teacher, and making referrals for children. CCs follow up on referrals and coordinate among parents, teachers, and off-site providers. The CCs in turn receive weekly didactics and reflective clinical supervision. SBMHC works with school leaders to assess the school’s social-emotional climate, identify unmet need for mental health services, and locate low-cost providers in the community. SBMHC is a promising model that aims to enhance social-emotional learning for all students while also identifying and referring symptomatic students. It thus combines universal and targeted approaches to serving high-risk students at low-resourced schools.     

Families in Crisis

Abstract

Families are in crisis. With an increasing array of problems affecting children in the home, from child abuse to familial alcoholism, schools are facing a vast array of behavioral and emotional concerns affecting childhood behavior. Unfortunately, many negative behaviors are learned at home. Violent and aggressive behaviors, for example, as well as drug and alcohol abuse, are often demonstrated by parents. From a community perspective, schools are in a pivotal position from which to intervene. Yet, many school-based mental health professionals, including school psychologists, school counselors, and school social workers, lack the knowledge to provide direct interventions. This article examines contemporary problems facing families, considers the home-school linkage, and explores interventions for schools and school-based mental health professionals.     

United we stand, divided we fall: the education and training needs of clinical child psychologists

Reviews efforts to delineate training needs for psychologists who are providing clinical services to children, adolescents, and families. In particular, this article (a) describes efforts of clinical child and other psychologists who work with children, adolescents, and families to develop education and training guidelines; (b) discusses the overlap among various child and adolescent providers within psychology; and (c) highlights several key competencies that have been identified as important for all psychologists in practice roles with children and adolescents. In particular, we emphasize the need for greater collaboration and integration among various psychological specialties that focus on children, adolescents, and families and for greater system-wide discussion of training needs and priorities.     

Succeeding in Rural Mental Health Practice: Being Sensitive to Culture by Fitting in and Collaborating

Sustainable solutions to the access to mental health care problems are complex and must address both the availability of mental health care resources and the acceptability of those resources to consumers. The purpose of this study was to determine how to address the acceptability problem by learning from medical and mental health care providers what mental health therapists need to know to be successful in providing care in rural communities. Using a qualitative design, focus groups were conducted in three rural communities (<2,500) with medical and mental health care providers practicing in these communities. Data were analyzed using inductive qualitative methods. Results indicate that in addition to sound clinical skill, mental health therapists should (A) be sensitive to the culture of the rural community in which they are working and (B) practice in a way that accommodates to the care culture of the community. The latter includes spending time with patients commensurate with what is expected by other providers, engaging in generalist practice, and collaborating with local providers in patient care. An important implication of these results is that mental health care must be acceptable to both the residents of the community and the gatekeepers to health care.     

The President’s New Freedom Commission: Capitalizing on Opportunities to Advance School-Based Mental Health Services

The report from President George W. Bush’s New Freedom Commission on Mental Health (NFC), Achieving the Promise: Transforming Mental Health Care in America(2003), proposes goals and recommendations for improving mental health services. This report has significant implications for the delivery of mental health services through the schools. A focused discussion of the potential opportunities and challenges of implementing NFC recommendations related to school-based mental health is presented. Strategies for addressing five key areas at the intersection of school mental health and the Commission’s recommendations include: stigma reduction, suicide prevention, expansion and improvement of school mental health, and screening and treatment of co-occurring mental health and substance abuse disorders.     

Outpatient benefits for mental health services in Medicare. Alignment with the private sector?

Revision of Medicare's benefit for outpatient mental health care is long overdue. The Omnibus Reconciliation Act of 1987 expands the covered limit to $2,200 (from the $500 set in 1966) but retains the 50% coinsurance requirement for beneficiaries. There are several strong arguments supporting further changes in the benefit to reduce the coinsurance and include psychologists as covered providers. These are need among the elderly, changes in Medicare's inpatient reimbursement system, and innovations in treatment. Outpatient mental health care is a very small portion of Medicare expenditures, amounting to less than .1% of total costs. Using data from the Bureau of Data Management and Strategy at the Health Care Financing Administration (HCFA), it was estimated that $41.8 million was paid by HCFA for outpatient mental health care in fiscal year 1984. This article estimates the costs to Medicare and beneficiaries of reducing the coinsurance to 20% and including psychologists as eligible providers.     

Psychologists'' and teachers'' reactions to mental health and behavioral school consultation

School psychologists and elementary school teachers were shown videotapes of a psychologist consulting with a teacher, with the psychologist using either behavioral or mental health consultation techniques. Problem situations and teacher-consultee verbalizations did not differ across the two sets of videotapes. Afterwards, subjects judged the effectiveness of of the consultation and the personal attributes of the consulting parties. In general, teachers preferred behavioral consultation, while psychologists rated the mental health consultation as more effective. Implications of these findings for consultation reaearch and practice are discussed.     

School-based applications of the wraparound process: Early results on service provision and student outcomes

The application of a school-based wraparound approach presents different challenges, perspectives, and knowledge from those seen in mental health or child welfare settings. For the past three years, the La Grange Area Department of Special Education's Wraparound Project has been implementing a school-based individualized service network that is now being integrated into the larger local and state special education, mental health, and social service systems. We present school-based applications of wraparound for students with emotional and behavioral disabilities, including the community and system context, program application, evaluation process and preliminary results. Students who were identified through self-contained special education classrooms were compared to students who were identified from various other school and mental health settings. Students from the school-based program were less clinically involved than students identified from other settings. Service provision differed between program groups and by out-of-home experiences. Finally, the use of wraparound approaches across a variety of educational settings to prevent out-of-school and out-of-home care are discussed.