National Trends in Implementing Wraparound: Results from the State Wraparound Survey

The wraparound process has been promoted in the children’s services field as a mechanism to achieve collaborative service planning and delivery for families of young people with complex emotional and behavioral needs that span multiple agencies. We compared results of two surveys of state children’s mental health directors, completed in 1998 and 2008, to derive estimates of the extent of wraparound implementation in the United States and to better understand trends in how wraparound has been implemented and supported over time. Results from 2008 found that 88% of states reported having some type of wraparound program that conformed to the definition and provided an estimate of 100,000 children and families served via wraparound in that year. Between 1998 and 2008, states reported increased application of wraparound standards, a greater number of agencies involved in wraparound initiatives, and more formal evaluations of wraparound initiatives. Results provide substantiation of the widespread implementation of wraparound implementation in the United States, and evidence that the model is becoming more consistently supported by formal implementation structures over time.     

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.     

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.     

Caregiver Factors Predicting Service Utilization Among Youth Participating in a School-based Mental Health Intervention

Large numbers of children and adolescents experience diagnosable psychiatric disturbances; however, the majority of those with need do not utilize mental health services. Characteristics of caregivers are important predictors of which youth will access and continue to use services over time. In recent years school-based mental health intervention programs have played a key role in identifying youth with mental health needs and linking them to treatment. In this study we sought to identify the caregiver demographic and contextual factors that predict days of service use among youth participating in a school-based mental health intervention program. Our sample included 85 youth ages 5–18 and their caregivers. We analyzed the data using bivariate and multivariate Poisson regressions with caregiver factors as the independent variables and days of service as the dependant variable. We found significant bivariate and multivariate associations for every caregiver demographic (sex, age, race) and contextual (education, employment, income, insurance, health, strain, and was it the caregivers idea to seek treatment) factor that was examined. In this study we identified the caregiver factors that are likely important in predicting youth service utilization even when steps have been taken to improve identification and access.     

Developing community alternatives to group home placement for SED special education students in the Ventura County System of Care

Interagency planning and resource development were used to improve available services for severely emotionally disturbed special education students who were in or at-risk of being placed in residential care. Augmented local school-based and regional day treatment services were financed by a Ventura County Social Services Agency trust fund and delivered cooperatively by the County Mental Health Agency and local education agencies. Revenues generated by the new service positions were planned to restore the trust fund. Outcomes following service implementation included: (a) an average reduction of 3.5 youths in the expected number of youths in group home placement per month; (b) a total reduction of $290,011 in the expected annual cost of placement; and (c) generation of $281,238 in Medi-Cal revenue by the school-based and day treatment components of the system of care. The implications of these outcomes are discussed in terms of existing trends in numbers of identified seriously emotionally disturbed students and their service needs and the processes that were involved in planning and implementing the service augmentation.     

Mental Health and Incarcerated Youth. II: Service Utilization

The incarceration of mentally ill youth is a serious problem not receiving the same attention as in adults. In this study, we examine the level of prior service utilization in incarcerated youth versus youth receiving community mental health services. We randomly recruited youth from middle South Carolina served by a local community mental health center (CMHC; n = 60), hospitalized in the state adolescent inpatient program (n = 50), and incarcerated in the S.C. Dept. of Juvenile Justice facilities (n = 75). We used a Services History to evaluate episodes of prior utilization of mental health, social service, educational, residential, and volunteer services, as well as the DISC-PC 2.3 to evaluate DSM-III-R diagnoses and symptoms and the CBCL and YSR to evaluate behavioral symptomatology. Incarcerated, hospitalized, and CMHC youth utilized similar levels of educational services and social services. Incarcerated youth had a significantly lower lifetime utilization of outpatient and acute mental health services and significantly higher utilization of out-of-home residential services than the other groups. These services utilization variables, along with gender and age, significantly distinguish incarcerated youth from the clinical groups, with clinical variables not serving to significantly distinguish them. Our results indicate the need to develop programs to prevent the entry of mentally ill/emotionally disturbed youth into the juvenile justice system. Youth who are at risk for incarcenation may benefit from intensive mental health services to prevent out-of-home placement and later incarceration.     

Development of a Brief Group CBT Intervention to Reduce COVID-19 Related Distress Among School-Age Youth

School-aged youth have been significantly impacted by the COVID-19 pandemic. The effects of the pandemic will likely have long-standing effects on the well-being of youth, and access to mental health care is even more critical during this time. For the past 5 years, TRAILS (Transforming Research into Action to Improve the Lives of Students) has been working throughout the state to increase utilization of evidence-based mental health practices among K-12 school mental health professionals (SMHPs). By leveraging SMHPs who are widely accessible to students, TRAILS seeks to improve youth access to effective mental health care and reduce current mental health inequities. In March 2020, TRAILS responded to the COVID-19 pandemic by developing a group manual designed to be delivered virtually by SMHPs to help students develop effective coping skills to mitigate the impact of COVID-19. TRAILS focuses on promoting use of CBT and mindfulness, as these skills are ideally suited for school-based delivery, and thus the new manual, Coping with COVID-19 (CC-19), was grounded in these modalities. This article will describe the design, development, and deployment of the CC-19 program to address the mental health needs of students in the context of the pandemic. Early acceptability and penetration data will also be discussed.     

Returning special education students to regular classes

Students are often placed in school special education classes, but they are seldom returned to regular classes. This study of 30 students who were returned points out that by careful screening and orientation such students can be academically successful. The role of the counselor in dealing with special education students has been badly neglected in educational literature, yet he is in an excellent position to correct some of the abuses that exist in schools where the special education program is considered terminal.     

Comparative Effects and Social Validation of Support Strategies to Promote Mindfulness Practices Among High School Students

Abstract

We compared the effects of support strategies for promoting formal mindfulness practices of 9th grade high school students who participated in a 10-week school-based mindfulness education program. The students also completed social validity ratings of the support strategies they selected and the formal mindfulness practices they learned. All of the support strategies were associated with increased average minutes of formal mindfulness practices. Students who did not select an extra support strategy also had increased minutes of formal mindfulness practices but of less magnitude in contrast to the two most effective strategies. The social validity ratings of the support strategies ranged from equivocal to good approval, and the students gave positive ratings to the majority of formal mindfulness practices. We discuss the implications of these findings for designing mindfulness education programs, implementing practice-promoting support strategies, and conducting mindfulness research with school children and youth.     

School Interventions for Dishonest Behavior

Cheating, lying, and nonconfrontative stealing (i.e., theft which does not involve use of force with a victim) are dishonest behaviors that cause much concern and occur quite extensively in educational settings. These behaviors have long been acknowledged by mental health and special service practitioners to be predictive of later social and emotional maladjustment. Issues pertinent to effective diagnosis of dishonest behavior in school settings are initially discussed. Published behavioral intervention approaches are reviewed. Finally, school environment factors that contribute to dishonesty in children and suggestions for school-based prevention strategies are presented.     

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.     

中国大学生心理健康教育创新体系的构建

社会各界对于心理健康服务的需求为我国心理学带来新的发展机遇,心理学家有责任积极参与这项工作。文章介绍了为在中国构建大学生心理健康教育的创新体系所做的几项工作:(1)编写用于全国大学生心理健康教育骨干教师培训的规范教材;(2)对全国高校大学生心理健康工作骨干教师进行专业培训;(3)编写大学生心理健康教育学生读本;(4)研制中国大学生心理健康测评系统;(5)组建全国高等学校学生心理健康教育专家指导委员会。     

School-Based Services for Pregnant and Parenting Adolescents

The literature on adolescent pregnancy and parenthood is reviewed from the standpoint of services which can be provided within school settings, and in which special services personnel can play a central role. Five potential service areas are discussed: school-based student child care, contraception information and distribution, sexuality values clarification, improvement of parenting skills, and case management/counseling. Exemplary programs are identified and discussed within each of these five areas, and program elements and implementation issues are discussed.     

National Trends in Implementing Wraparound: Results of the State Wraparound Survey, 2013

The wraparound process aims to provide an effective practice-level approach to coordinating care for youths with complex behavioral health needs, and reformed system structures to support such integration of care. The current study provides an update to two prior surveys of state children’s mental health directors, completed in 1998 and 2007, on the extent of wraparound implementation in the United States and implementation supports that have been employed. Results from 2013 found that 100 % of states reported having some type of wraparound program that conformed to the definition and yielded an estimate of 75,000 children and families served via wraparound in that year. States reported a continued increase in use of wraparound standards; however, fewer states reported collection of fidelity data, and availability of internal resources for training and coaching. Over three-quarters of states reported availability of parent to parent peer support, and 46 % of states are supporting wraparound implementation by blending or braiding funding across child-serving systems. Results also revealed that 61 % of states had a centralized oversight entity for wraparound, an important finding given that such “statewideness” was also associated with more youth served, greater accountability, use of standards, and other implementation supports.     

Service User Perception of and Satisfaction with Programs Having Higher Education and Employment Goals for People Diagnosed with Mental Illness

This study examined quantitative and qualitative outcomes of service users’ perceptions of and satisfaction with a program having higher education and employment goals. In a one-group post-test design, 48 participants with various mental health diagnoses completed a quantitative questionnaire and 29 of those participated in qualitative focus groups. Participants identified positive and negative aspects of the program and provided recommendations for change. Results indicated that service users with higher education and employment goals benefit from a multi-faceted program that includes person-centered individualized care, concrete, goal-directed activities, practitioners who are compassionate and knowledgeable, and plans addressing setbacks and obstacles.     

Evaluation of a Congressionally Mandated Wraparound Demonstration

In order to determine whether expenditures for mental health could be reduced and quality improved, Congress mandated that the Department of Defense conduct a demonstration project utilizing a wraparound mental health service system for child and adolescent military dependents. A longitudinal quasiexperimental design was used to evaluate the cost-effectiveness of the demonstration. The results showed that children in the Wraparound Group received more wraparound services than those in the treatment as usual (TAU) Comparison Group. These services included case management, in-home treatment, and other nontraditional services. The Demonstration also provided better continuity of care. Multiple methods were used to investigate the impact of wraparound. Both groups showed some improvement on some measures but there were no differences between the groups in functioning, symptoms, life satisfaction, positive functioning, or sentinel events. Regardless of which statistical model was used to estimate costs, the Demonstration was also more expensive. The higher level of expenditures for the Wraparound group was a result of some expensive traditional care and the addition of nontraditional services. Several possible explanations of these results are provided.     

Integrating Narrative Family Therapy in an Outdoor Behavioral Healthcare Program: A Case Study

Adolescent mental health is a significant societal concern in the United States. Diagnosable mental health disorders have been reported at rates of 10–20 % among children and adolescents and this does not include adolescents experiencing personal and interpersonal distress not meeting diagnostic criteria. Adolescents who do not respond to traditional mental health services are often placed in residential treatment centers or other out-of-home treatment programs. Outdoor Behavioral Healthcare (OBH) is growing as a viable treatment option for adolescents who struggle with emotional, behavioral or substance related problems; however, questions have been raised about how to integrate the family into an OBH treatment setting. This article describes a case study illustrating how techniques from Narrative Family Therapy can be used to accomplish this integration, and offers a view of using Narrative Family Therapy to further involve families in the treatment and post-treatment process in an OBH program.     

Moving Forward with Systems of Care: Needs and New Directions

The articles in this Special Issue on system change within systems of care (SOCs) provide guidance regarding strategies for modifying SOCs to address the needs of different populations, and ways for changing systems to support more positive child and family outcomes. This paper frames central needs, unanswered questions, and issues that remain for those working to implement SOCs. Specific needs and new directions considered include: (1) rigorous implementation-focused research to identify the necessary and sufficient elements of SOCs and the primary practice approach currently used in SOCs, wraparound; (2) applied research to assess SOCs and document their effectiveness in non-standard or non-traditional settings (i.e., non-mental health settings, including child welfare, juvenile justice, local housing authorities); (3) controlled outcome studies for school-based wraparound initiatives; (4) research to document the effectiveness of the family support efforts that are part of most SOCs; and (5) attention to context, for families, service providers, and collaborative implementation efforts, by researchers and providers alike. Progress in these areas can inform well-targeted system change efforts in the context of SOCs, a critical need given changes in federal funding for these initiatives.     

Teacher efficacy: A model for teacher development and inclusion

Students with special needs must have the opportunity to learn in inclusive classrooms. However, this requires that classroom teachers believe that (a) students can learn in spite of any negative environmental influences in their lives, and (b) they personally have the ability to reach any student. Securing this teaching efficacy for teachers in inclusive classroom settings requires paradigm shifts in preservice and inservice teacher development programs with the precept that all students can learn and that we can assist them. The authors, one a regular and the other a special education teacher educator, collaborate to explore the issue of how best to provide and maintain a positive personal teaching efficacy among regular teacher education candidates who are faced with the challenges of having students with varying levels of ability and behavioral responses in their classrooms.     

General and Domain-Specific Self-Esteem Among Regular Education and Special Education Students

We examined the global and domain-specific self-esteem of students who are emotionally disturbed, students who are learning disabled, and students who are in regular education classrooms. Students who were emotionally disturbed or learning disabled had lower global self-esteem than did students in regular education classes. The specific domains in which students in special education felt that they were less competent than students in regular education included social skills, leadership skills, and academics. However, the 2 groups of students in special education did not differ from one another. No differences emerged between the groups on a measure of self-esteem that is less subject to social desirability concerns. Implications of this research for education are discussed.