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.     

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.     

Quality assurance and school‐based mental health services

Clinicians affiliated with expanded school mental health (ESMH) programs provide a range of mental health services for youth in schools. ESMH services offer unique opportunities for collaboration between school psychologists and mental health clinicians from the community to increase the quality of care for youth receiving mental health services. The number of ESMH programs is increasing; therefore, developing quality assurance (QA) activities for these programs is important to document accountability and provide evidence for effectiveness. In this paper, suggestions for phases and objectives for QA programs in ESMH programs and examples of suggested activities are presented. Assessment of the program structure as well as treatment process and outcome are critical phases. Important QA activities include examining staff training activities, assessment of stakeholder perceptions of services, conducting satisfaction surveys, examining therapy process, and investigating treatment outcomes. Results of QA evaluations should inform policy.QA programs need to be developed and the impact of QA activities in enhancing the quality of care provided by clinicians in schools should be evaluated. © 1999 John Wiley & Sons, 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.     

Inter‐agency approaches to the development of a school‐based student health service

Young people living in rural areas lack opportunities for accessing health advice and care without reference to a parent, carer, or other adult. In this article Jane Harrison and Jane Bullock provide the rationale for the development in 1997 of Bodyzone, a school‐based health service to address this problem. Presented here as a case study, Bodyzone, twenty of which have been started in Oxfordshire, demonstrates the value of such a service to young people and teachers. The multi‐agency sessions are held once a week either on school premises or in youth or sports centres nearby. The service is accessed by self‐referral and the sessions are drop‐in. The provision of this service enables young people to begin to take responsibility for their health and to meet health professionals on their own territory, rather than that of the agency.     

Implementing a school‐based health center: The Winston‐Salem/Forsyth County experience

This article traces the inception and implementation of school‐based health centers in the Winston‐Salem/Forsyth County (NC) school system. The challenges that arose during implementation are discussed, along with the opportunities that SBHCs provide to enhance the provision of comprehensive services for children. The involvement of the several school psychologists in the initial planning, organization and implementation of these centers is delineated as an example for other school psychologists who are interested in working with school‐based health centers. School‐based health centers represent an opportunity for school psychologists to assume a leadership role in the delivery of enhanced health and mental health services for children and families. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 289–296, 2003.     

A review of psychotherapy outcome research: Considerations for school‐based mental health providers

Evaluating psychotherapeutic outcome is an important endeavor given psychology's focus on identifying effective treatments. There is ample evidence to suggest that psychotherapy interventions for children and adolescents are effective. Unfortunately, the child and adolescent psychotherapy outcome literature lags behind the adult‐focused outcome literature in some important areas, as children and adolescents are often viewed as extensions of adults. This review analyzes the pertinent youth meta‐analyses, examining treatment, client, and therapist variables relevant to positive outcomes. We also consider the impact of variables that have received more attention in the adult psychotherapy outcome literature (i.e., the therapeutic alliance, therapist effects, and allegiance effects) and their possible impact on child and adolescent outcomes. Our hope is that this discussion benefits school‐based mental health professionals when discerning what works best with the youth population. © 2010 Wiley Periodicals, Inc.     

Cultural‐competence considerations for contemporary school‐based threat assessment

Threat‐assessment procedures are advanced for their utility in reducing racial disparities in punitive and exclusionary school discipline outcomes. Generally unexamined, however, is bias in who gets referred for school‐based threat assessment and under what circumstances. Cultural‐competence considerations hold promise for addressing sources of bias in the evaluation of threats made in the school setting. Using a quantitative approach, this systematic literature review examines the degree to which contemporary cultural‐competence considerations are embedded in 24 school‐based threat‐assessment articles published between 2007 and 2017. Results indicate generally poor coverage of considerations for cultural competence both within and across threat‐assessment articles. An analysis of change in cultural‐competence considerations by year of publication suggests that more recently published threat‐assessment literature has generally not integrated concurrent advancements in concepts of cultural competence. Preliminary guidance for incorporating contemporary cultural‐competence considerations into school‐based threat‐assessment procedures are provided.     

Outcomes of a school‐based mental health program for youth with serious emotional disorders

The present study describes a comprehensive, day treatment program conducted in public school classrooms for children with serious emotional disorders (SED) and presents data evaluating program efficacy. Behavioral outcomes are presented for 142 children, ages 5 to 18 years, over the course of an academic year. Treatment efficacy was assessed using a behavioral outcome measure, the Youth Outcome Questionnaire. At initial evaluation, all children were exhibiting emotional symptoms beyond the scope of outpatient services, with 97% being classified as having a Severe Emotional Disorder. At the 9‐month follow‐up, 50.7% of the sample showed overall symptom reduction, and 27.5% scored below clinical cutoff levels, indicating remission of symptoms to within normal limits. Treatment response was equally likely among boys and girls, and across diagnostic categories. Elementary school‐aged children and adolescents made equivalent gains in the program; however, mixed‐model, repeated‐measures ANOVA revealed a significant group × time interaction ( p < .05), indicating that these groups showed different patterns of improvement over time. © 2002 Wiley Periodicals, Inc. Psychol Schs 39: 661–675, 2002.     

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.     

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.     

School‐based health centers: Opportunities and challenges for school psychologists

School psychologists have the potential to contribute to the development and delivery of health and mental health services through school‐based health centers (SBHCs). Possible roles for school psychologists within SBHCs are described. Factors that influence school psychologists' efforts within SBHCs are discussed, including factors such as system reforms, school system governance, importance of SBHC to stakeholders, and availability of funding. Knowledge of collaborative problem solving, effective prevention and intervention strategies, and recognition of limitations of traditional mental health programs were also identified as facilitators of the school psychologist's role in a SBHC. Factors that may impede the development of SBHCs are reviewed. These factors include definitional confusion, deemphasis on prevention, community stigma, limited resources, lack of integration and coordination of services, and an emphasis on a narrow role of providing only medical services. Additional factors discussed include the narrow role of school psychologists, space limitations, the challenge of collaboration, role strain, and lack of research on interventions within a SBHC. Strategies for overcoming barriers are suggested. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 253–264, 2003.     

Parent and teacher satisfaction with school‐based psychological reports

School psychologists spend a great deal of time translating assessment results into a psychoeducational report. The importance of creating reports that are both useful and understandable to the readers of the report while also being efficient for the school psychologist cannot be overstated. This study examines parent and teacher perceptions regarding the quality, understandability, and usefulness of school‐based psychological reports. Results of the surveys indicate that both parents and teachers perceive psychological reports as focusing more on tests and test scores as opposed to information that helps to understand the child or assists with intervention development. Strategies for upgrading reports to better meet the needs of parent and teacher readers are discussed.     

Effectiveness of school‐based psychotherapy: A meta‐analysis of dissertation research

A meta‐analysis was conducted with 65 school‐based psychotherapy and counseling dissertations over the last 10 years (1998–2008) to assess if a file‐drawer problem (i.e., studies conducted but not published that, as a whole, have different results than studies in the same area published) exists in the school‐based outcome literature. An overall mean effect size of 0.44 was found for 73 treatment interventions. This effect size is comparable to Prout and DeMartino's 1986 meta‐analysis conducted with published school‐based studies and approximately half a standard deviation smaller than Prout and Prout's 1998 meta‐analysis of school‐based intervention studies. A bias does appear to exist but seems to be smaller than the bias found in the general child and adolescent psychotherapy outcome literature. Most of the dissertation studies evaluated group interventions and used a cognitive–behavioral or skills training intervention. Skills training and interventions with elementary‐school students yielded the largest effect sizes. Comparisons of the current study with previous school‐based intervention meta‐analyses are discussed as are suggestions for future research. © 2010 Wiley Periodicals, Inc.     

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.     

A school‐based violence prevention model for at‐risk eighth grade youth

This study examined the effectiveness of a school and community‐based violence prevention program for at‐risk eighth‐grade students in three public schools in Florida. School officials matched intervention students with community‐based mentors in an employment setting to allow targeted youth to explore careers and receive one‐on‐one intervention from an adult mentor. Intervention students were compared to a control group of students not receiving mentorship services. This study used MANOVA and t‐test analyses to examine six outcomes measured: (1) unexcused absences; (2) number of in‐school suspensions; (3) number of days of in‐school suspensions; (4) number of out‐of‐school suspensions; (5) number of days of out‐of‐school suspensions; and (6) total number of infractions committed on school property. The findings suggested that mentored students, as compared to control group students, had significant reductions in total number and days of suspensions, days of sanction, and infractions committed on school property. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 403–416, 2003.