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.     

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.     

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.     

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.     

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.     

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.     

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.     

Elementary school teachers’ preferences for school‐based interventions for students with emotional and behavioral problems

Teachers’ adoption and implementation of evidence‐based programs is often limited. Program characteristics may be important facilitators or barriers of use, yet little is known about which attributes influence teacher decisions. Using a discrete choice experiment with a sample of general education elementary teachers (N = 230), we examined (a) preference for attributes of school‐based interventions, (b) relative preference for three intervention packages with experimentally manipulated characteristics, and (c) teacher characteristics related to the above preference profiles. Intervention outcomes were the most important characteristics in teachers’ intervention decisions. Most teachers’ responses suggested preference for a social and emotional learning program (57.9%) or school‐based consultation for behavioral interventions (35.8%); a small group of teachers preferred a general support intervention (5.8%). Teachers preferring the general support intervention reported greater mental health symptoms, lower mental health literacy and lower confidence in program effectiveness than peers preferring other interventions. Implications for intervention development and future directions are discussed.     

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.     

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.     

Discourse comprehension intervention for high‐functioning students with autism spectrum disorders: preliminary findings from a school‐based study

Many students with autism spectrum disorders (ASD) demonstrate comprehension difficulties. In the present study, 12 high‐functioning Swedish students with ASD (aged 10–15 years) took part in a naturalistic classroom‐based intervention to support comprehension of connected narrative discourse. An effective approach for supporting discourse comprehension in children with ASD was assumed to include: (i) providing teachers and students with a shared and explicit set of concepts for talking and thinking about the activity of comprehension, that (ii) can structure the child's discourse comprehension under scaffolding and modelling from the teacher. In the pre‐testing session, the students with ASD presented with poor discourse comprehension but receptive vocabulary and reading decoding skills close to normative performance. Post‐intervention test results, following 4 weeks of training, indicated specific and significant improvements in discourse comprehension. Support for the potential of this type of teaching was also obtained from teachers and students. The teachers reported that they would continue to use the same or similar comprehension instruction for 11 out of 12 students, and for multiple reasons, and students were also mostly positive to the training. Implications for practice and further research are discussed, as are limitations of the study.     

The wraparound process for youth with severe emotional behavioural disorders

The number of youth with serious emotional disorders has increased tremendously; unfortunately, meeting the needs of such children has been a challenge. In an effort to deal with the challenging behaviour exhibited by children and youths, expensive out‐of‐home placements such as juvenile justice centres and clinical and psychiatric hospitalisation, have been used. Unfortunately, these approaches have not been effective in reducing the rate of challenging and violent behaviours. Therefore, researchers continue seeking evidence‐based and cost‐effective strategies to use when dealing with children and youths with severe emotional disorders. One of the approaches that have emerged out of this search is the systems of care model, which places emphasis on shifting placement of individuals with severe emotional disturbance from restrictive institutional settings to less restrictive settings. Central to the systems of care model is the wraparound process. The approach involves providing a set of coordinated individualised services and natural supports to the child and family in their natural environment. The purpose of this paper is to provide a literature synthesis on the wraparound process.     

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.     

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.     

Self‐regulation empowerment program: A school‐based program to enhance self‐regulated and self‐motivated cycles of student learning

This article describes a training program, Self‐Regulation Empowerment Program (SREP), that school professionals can use to empower adolescent students to engage in more positive, self‐motivating cycles of learning. It is a two‐part approach whereby self‐regulated learning coaches (SRC) (a) use microanalytic assessment procedures to assess students' self‐regulation beliefs and study strategies and (b) train students to use these strategies in a cyclical, self‐regulation feedback loop. Ultimately, students learn how to set goals, select and monitor strategy effectiveness, make strategic attributions, and adjust their goals and strategies. The program was developed from social‐cognitive theory and research and integrates many of the essential features of the problem‐solving model. Interventions used in the SREP include graphing, cognitive modeling, cognitive coaching, and structured practice sessions. A case study is presented to illustrate procedures for implementing the program. Implications for school psychologists and teachers also are presented and discussed. © 2004 Wiley Periodicals, Inc. Psychol Schs 41: 537–550, 2004.     

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.     

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.