Integrating expanded school mental health programs and school‐based health centers

This article provides background on national movements toward expanded school mental health (ESMH) programs and school‐based health centers (SBHCs), and presents advantages and challenges of joining these two systems of child and adolescent health care. Delivering ESMH through SBHCs promotes an interdisciplinary approach, health–mental health care integration, and benefits including enhancing referral bases, improving screening of problems, and enhanced confidentiality and privacy. But this integrated approach also presents challenges including managing referrals and significant needs, handling crises, building a focus on prevention and mental health promotion, handling administrative demands, and coping with limited resources. These challenges, ideas for overcoming them, and future directions for this promising service delivery approach are discussed. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 297–308, 2003.     

Personal and systems‐level factors that limit and facilitate school psychologists' involvement in school‐based mental health services

The common path through which youth with mental health problems actually receive treatment is the education system. The current study used qualitative methodology to explore why school psychologists are not providing the level of mental health services that children need, leaders in the field call for, and practitioners desire. Thirty‐nine school psychologists participated in 11 focus groups; they responded to structured questions regarding the range of mental health services they currently provide, as well as the personal and systemic factors that facilitate and limit their provision of these mental health services. Analysis of themes that emerged across focus groups indicated that school psychologists provide a broad variety of mental health services with an emphasis on group and individual counseling as well as crisis intervention. The factors most often mentioned as prohibiting the delivery of such services included problems inherent to using schools as the site for service delivery, insufficient training, and a lack of support from department/district administration and school personnel. The enabling conditions that emerged most involved perceptions of ample support from administration and school personnel, sufficient integration into the school site, and particular personal characteristics, such as the desire to provide counseling and the ability to maintain personal boundaries. Implications for practitioners, administrators, and trainers are discussed. © 2010 Wiley Periodicals, Inc.     

Coordinated Strategies to Help the Whole Child: Examining the Contributions of Full-Service Community Schools

Full-service community schools are designed to increase students, and families' access to comprehensive and coordinated supports, services, and programs such as medical care, food aid, and enrichment activities. Despite widespread support, the research base documenting the efficacy of community schools is still emerging. Analyzing longitudinal data from 6 low-income, predominantly Latino community schools, this case study investigated whether students' participation in community-school programming influenced their attendance and achievement. Multilevel models indicated that youth who participated in extended learning programs or whose families were involved in family engagement opportunities exhibited greater attendance rates and achievement in math and English language arts, when compared to their nonparticipating peers. Findings provide promising evidence on the value of a comprehensive and integrated system of school supports that address the myriad needs of vulnerable student populations.     

The role of mental health professionals contributes to mental health promotion and prevention: innovative programmes in Serbia

It has been estimated that 9 to 13% of children and adolescents have a mental disorder that causes significant functioning impairment and that only one fifth of those who need mental health services actually receive them. The majority of children and adolescents are enrolled in schools, where they spend a considerable amount of time, and this is followed by the increasing efforts to establish collaboration between mental health professionals and school personnel. The role of mental health professionals is crucial in improving children’s mental health, as well as for providing better response to parents, educational staff and other agencies. There are several ways for a child psychiatrist to reach children and adolescents in a school setting: through individual student consultations (case consultations), through consultations to schools on general mental issues (systems consultations) and through promotion of mental health by creating and demonstrating evidence-based programmes for children, parents, school staff and others who are involved in child’s care. In order to achieve these goals, we need to establish partnerships and to define roles among organisations and individuals in the wider school environment, such as schools and school management, municipal authorities and administration, media, police, social welfare centres, health centres, parents and youth associations.     

Partnering with school providers to codesign mental health interventions: An open trial of Act & Adapt in urban public middle schools

Schools are well positioned to provide access to youth mental health services, but implementing effective programs that promote emotional and behavioral functioning in school settings is complicated by the poor fit of interventions developed in research settings to complex school contexts. The current study formed a research–practice partnership with two urban public schools and mental health providers employed by those schools (N = 6, 100% female, 50% Black/African American, 50% White/Caucasian) in the adaptation of a depression prevention intervention, Act & Adapt. The intervention was modified by decreasing meeting time and streamlining session content, increasing flexibility, making intervention materials more similar to academic curriculum, and increasing the focus on managing disruptive behavior within group sessions. In an open trial, sixth-grade students (N = 22; 59% boys, 31% Hispanic, 22% Black/African American, 4% Asian, 30% White/Caucasian) at both schools who were identified as clinically “at risk” reported improvements from baseline to postintervention and at 1-year follow-up on measures of emotional and behavioral difficulties and coping strategies, with parallel results by caregiver report. The providers reported satisfaction with the intervention, and qualitative analyses of provider focus groups suggested both barriers and facilitators to research-practice collaborations to implement mental health interventions in schools.     

学校心理健康教育探究

学校心理健康教育对于学校心理学科建设极为重要。在学校中,人们将注意力集中于消除儿童和青少年学习障碍、提高发展其身心健康等规划方面。本文恰如其分地指出学校心理学在这场改革和变化中所发挥的重要作用,强调了学校心理健康教育的两个相关主题——实证应用和面向预防的总体调节,最后对两大相关主题展开详细讨论,研究其取得进步的事实,并评价其在学校心理学教育中的暗示作用．     

Creating synergy through collaboration: Safe schools/ healthy students in salinas,california

In Salinas, a city of 150,000 on the Central Coast of California, an $8 million federal grant program is helping children and their families grapple with issues pertaining to violence, substance abuse, mental health, and academic success. In just two years, the program has helped educators and service providers deter school crime, provide on‐campus therapy to troubled youth, increase participation in parenting programs, and decrease truancy at several schools. Most importantly, the Salinas initiative has helped providers coordinate services to children and families who need them most. Project directors say that approach will be crucial as they search for new ways to sustain Safe Schools/Healthy Students (SS/HS)‐funded programs. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 503–513, 2003.     

Mental health services in schools: A qualitative analysis of challenges to implementation,operation, and sustainability

Schools are increasingly recognized as a critical venue for the provision of comprehensive behavioral and mental health services for students. Unfortunately, difficulties associated with operating programs in schools often prevent evidence‐based practices from being implemented and sustained as intended. In this study, the experiences of school and community providers who were funded through the Safe Schools/Healthy Students Initiative to implement mental health services in a large, urban school district were investigated using a qualitative focus group methodology. Providers identified the major challenges they encountered with implementing, operating, and sustaining their programs as well as the strategies that they used to overcome those challenges. Strategies to enhance support of school‐based mental health programs are discussed. © 2005 Wiley Periodicals, Inc. Psychol Schs 42: 361–372, 2005.     

Evaluation in school‐based health centers

School‐Based Health Centers (SBHCs) are ideal primary care settings for improving children's access to and utilization of health care services. In this era of shrinking funding for social service programs, SBHCs may provide services to youth from low‐income families, who otherwise might lack access to health care services. However, the growth of SBHCs has outpaced evaluation efforts. More information is needed about what services are being provided, and for whom services are effective. This article reviews information that will assist in the development of evaluation efforts for SBHCs. A review of evaluation theory, ideas for evaluation in SBHCs, challenges to implementing research in schools, and future directions for evaluation efforts are presented. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 309–320, 2003.     

Type 1 diabetes mellitus case decisions: Health‐related service considerations for school psychologists

Type 1 diabetes mellitus (T1DM) is a chronic illness that can impact learning and often requires medical management in the school setting. School psychologists must therefore be knowledgeable of special service eligibility criteria associated with T1DM, the health‐related services often required of such students, and what health‐related services schools are obliged to provide. Although federal regulations speak to special service eligibility criteria to consider for children with T1DM, such codes do not outline what health services schools are expected to provide. One way to glean this information is by examining published case decisions involving diabetes health‐related services in the schools. Themes and examples in five decision categories provide vital information for school psychologists regarding school service planning for T1DM. © 2010 Wiley Periodicals, Inc.     

Wellness promotion in the schools: Enhancing students' mental and physical health

Wellness promotion addresses both the reduction of disorder and disease and the enhancement of mental and physical health. There is increasing evidence of a strong and reciprocal relationship between mental and physical health, and linking these two areas may be particularly useful for promoting positive youth development in school contexts. This article discusses the relationship between mental and physical health in children and adolescents, and how to promote both within schools. Topics discussed include the benefits of (a) hope and optimism, (b) structured extracurricular activities, and (c) sport and exercise psychology for school‐based health and wellness promotion. These topics are linked in that each has the potential to positively affect both mental and physical health in children and adolescents in schools. © 2007 Wiley Periodicals, Inc.     

Evaluation of a school‐based transition program designed to facilitate school reentry following a mental health crisis or psychiatric hospitalization

In recent decades, increasing attention has been paid to the number of adolescents experiencing extended absences from school due to mental health crises. Upon returning to school, these students often face difficulties in functioning, risk of relapse, and vulnerability to academic failure and social isolation. This paper presents results of a study examining a school‐based support program model designed to provide short‐term academic, social, and emotional support to help students successfully reacclimatize to school after an extended absence. The paper describes demographic, academic, and clinical characteristics of 189 program participants across eight high schools. Improvements were observed in participants’ day‐to‐day functioning based on the results of pre/postassessments completed by program clinicians. Preliminary data showed positive trends in participants’ school attendance and high school graduation rates. Finally, the paper considers implications for school‐based mental health practice and next steps in related research.     

The impact of changing neighborhoods,switching schools,and experiencing relationship disruption on children’s adjustment to a new placement in foster care

When children enter a new foster care placement they may experience several different transitions. Not only will a child move in with a new family, he or she may move to a different neighborhood, change schools, lose contact with old friends, be placed apart from one or more siblings, and have limited contact with his or her biological parents. The current study examined the impact of these transitions on foster children’s adjustment to a new placement in out-of-home care. The sample consisted of 152 youth ages 6–17.5 who participated in the second National Survey of Child and Adolescent Well-Being (NSCAW II) study and who were residing with relative or non-relative foster families at the time of the Wave I interview. During the Wave I interview, youth were asked to report on the types of transitions they experienced when they moved into their current placement. Linear and Poisson regressions were used to estimate the effect of the transitions on youths’ relationships with their new families, mental health, relationships with peers at school, and school engagement. The results showed that youth whose biological mothers contacted them more than once a month had more symptoms of mental health problems than youth who had less contact with their biological mothers. In contrast, changing schools had a positive impact on youths’ mental health, and youth who were separated from siblings were more likely to get along well with their school peers. Implications for improving youth’s adjustment to new foster care placements are discussed.     

Delivering school‐based mental health services by school psychologists: Education,training, and ethical issues

Consistent with the priority goals of the 2002 Future of School Psychology Conference, the National Association of School Psychologists' Blueprint for Training and Practice III advocates for school psychologists becoming “leading mental health experts in schools.” In this regard, the present article reviews the prevalence and incidence of children's mental health problems in the schools, followed by a historical overview of the nature of school‐based mental health services. We discuss education and training issues and related ethical and professional practice issues that focus on the ethics codes of the National Association of School Psychologists and the American Psychological Association that are associated with the delivery of mental health services by school psychologists. Recommendations are offered for graduate‐level coursework and field experiences in the delivery of school‐based mental health services, as well as future directions for research in this area. © 2011 Wiley Periodicals, Inc.     

The school‐based health center as a resource for prevention and health promotion

The importance of school‐based health centers (SBHCs) in overall prevention and health promotion programming is growing as they become increasingly common in schools. SBHCs can improve access to comprehensive physical and mental health services for children and families, and make a significant contribution to universal prevention efforts in schools. Partnering with school‐based health centers in the overall prevention and health promotion programming provides an opportunity for school psychologists to broaden their impact on the entire school population. This article describes the role and primary functions of SBHCs and how these centers can provide important prevention and health promotion services for children and adolescents. Research regarding SBHCs' primary prevention outcomes is also reviewed with the goal of providing school psychologists the necessary background to work collaboratively with SBHCs. © 2007 Wiley Periodicals, Inc.     

Improving educational outcomes for at‐risk students

Drawing on data from a longitudinal study of at‐risk youth (n = 593), this article reports on the analysis of factors that enabled these youth to succeed at school. It considers the impact of three baseline factors (age, gender, ethnicity) and a number of time‐dynamic factors [positive school environment, additional educational support, positive peer and parent relationships, exclusion/expulsion from school, depression and externalising individual risk, as well as the involvement of a range of services (mental health, justice, welfare)] upon educational progress. Over time, the educational status of this group of youth deteriorated. Differences were observed for indigenous, older and male youth who had poorer outcomes on average. Positive peer groups and a positive school environment predicted better outcomes, while the use of harsh disciplinary practices such as expulsion was the strongest predictor of poorer educational outcomes and had a pervasive negative impact on all three educational progress measures. Formal services did not make an appreciable difference to educational outcomes, while the provision of additional educational support only contributed to keeping youth enrolled in educational programmes but did not appreciably improve their educational outcomes. Improving educational outcomes for at‐risk youth requires a pan‐system response, whereby schools reduce the use of expulsion and create a positive school climate, other professionals support schools to retain challenging students at school and the positive resources generated by pro‐social peer groups are harnessed.     

Implementation of school‐based wellness centers

This article describes the planning, implementation, and evaluation of school‐based Wellness Centers operated by the Riverside Unified School District in Riverside, CA, as part of the Safe Schools/Healthy Students Initiative funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). We describe the program as planned in terms of the theoretical model for the intervention and the evaluation design, and discuss the actual implementation including accomplishments and challenges. The program was designed to promote positive development and wellness for individual students via self‐ and teacher‐referrals for personal and mental health problems handled through a case management and referral process, support groups, and other activities such as after‐school programs, mentoring, tutoring, and parent training. An effort was also made to promote wellness at the school level by providing wellness campaigns, information, and compatible policies and procedures designed to enhance healthy development. Our observations are based on a qualitative assessment that was a component of the evaluation. A more detailed evaluation examining the impact of school‐wide and student‐focused activities on academic and behavioral outcomes is currently underway. However, we do include comments from students suggesting that the Wellness Center concept holds much promise for school‐based mental health and violence prevention services. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 473–487, 2003.     

特殊困境未成年人家庭教育的地方立法保障

家庭教育影响孩子一生,家长应该肩负起加强孩子思想道德、人身安全、心理健康、行为习惯等教育任务的主体责任。可是,对于一些留守、流动、孤残等特殊困境儿童,家庭教育的实施还存在很大困难。为了保障特殊困境家庭的未成年人健康成长,重庆等一些地方通过地方立法,界定了政府、学校和社会为特殊困境未成年人提供家庭教育指导服务的法律责任,产生了良好的社会效果,但也存在一些保障范围不足的问题。为此,地方立法应该建立一种家庭尽责、政府推进、学校指导和社会参与的家庭教育关爱机制,让更多的特殊困境未成年人能够享有科学优质的家庭教育指导服务。     

SCHOOL PSYCHOLOGISTS AS MENTAL HEALTH PROVIDERS: THE IMPACT OF STAFFING RATIOS AND MEDICAID ON SERVICE PROVISIONS

As one out of five children in the United States demonstrate some type of mental or behavioral health concern warranting additional intervention, federal policies have emphasized the need for school‐based mental health (SBMH) services and an expansion of Medicaid reimbursement for eligible children and families. Most youth access mental health services at school; therefore, it is important to evaluate how staffing ratios, credentialing, and state Medicaid policies may influence school psychologists’ involvement in the delivery of SBMH services. A survey of 192 school psychologists found that as practitioner to student ratios increased, the availability and provision of SBMH services decreased. As state Medicaid policies have been found to influence the provision of mental health services at school, current study results demonstrate an association between state level Medicaid policies and the number of school psychologists qualified to bill for Medicaid‐reimbursable services. Implications for service delivery and policy development are discussed.