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.     

School consultation: The training needs of teachers and school psychologists

This paper describes the roles of teachers and school psychologists and presents an overview of current and prospective methods of providing services to special needs children. On the basis of the literature and professional experience, it is suggested that changes are needed in the provision of special education services. The consultative relationship between teachers and school psychologists is viewed as the key to successful classroom intervention for special needs children. Although each profession brings expertise into the consultative relationship, better training is needed for teachers and school psychologists to ensure that effective intervention strategies are developed.     

Early intervention for handicapped children: Efficacy issues and data for school psychologists

Providing early intervention services for handicapped children is a relatively new endeavor for school psychologists. Because of the recency of this activity, most school psychologists have not received formal training—yet are providing evaluation and intervention services to preschool children. It is necessary that school psychologists fully understand the efficacy issues and data pertinent to this service to benefit preschoolers and provide accountability data for this service. This article presents the major efficacy issues and the subsequent research data on early intervention for young handicapped children.     

The impact of PL 94-142 on the practice of school psychology: A national survey

This paper presents the results of a national survey of school psychologists to determine the impact of PL 94-142 on the role of the school psychologist. Data were based on responses to 856 surveys by practicing school psychologists who were selected randomly from the NASP membership list during 1979-80. The results suggested that this legislation has had remarkably little impact on the evaluation procedures used or on the school psychologist's role. The two clear changes that have occurred may have negative implications for psychological services (e.g., an increased focus on handicapped children and increased paperwork). It was found that many school psychologists are involved in evaluation, but do not have time to be involved in the IEP process, or to provide follow-up consultation, or direct intervention for prevention and/or therapeutic purposes. This problem was exacerbated in districts that had ratios of greater than 1,000 to 1. Despite these problems, many respondents view the legislation in positive terms, and feel it has helped to enlarge the scope of practice.     

An Evaluation of the Effectiveness and Acceptability of Teleconsultation

School-based psychological services are typically provided through a triadic model of consultation in which a school psychologist works directly with a teacher or school staff member to address the academic, behavioral, or mental health concerns of a student. With advances in current technology, school psychologists have the capacity to use videoconferencing to engage in their consultative responsibilities. Teleconsultation has the potential to improve the provision of consultative services by increasing school psychologists’ efficiency and providing individuals, especially those in rural areas, access to greater service. The current study evaluated the effectiveness and acceptability of teleconsultation as a means to deliver behavioral consultation services to three teachers and their students. A nonconcurrent multiple baseline across subjects was used. Results showed that consultants could develop a behavioral intervention with a teacher and effectively implement the intervention to improve student outcomes. Teachers also rated teleconsultation as an acceptable means for service delivery.     

Comprehensive school-linked services: Implications for school psychologists

This article reviews the primary concepts underlying the current movement toward the provision of comprehensive school-linked services for children and families in low-income communities and the implications of this movement for school psychologists. The development of collaborative partnerships involving schools, public, and community-based agencies is an attempt to increase the availability and accessibility of needed services to children and families. The adoption of collaborative governance and a case management system is intended to offer an alternative to the proliferation of separate categorical programs and the associated lack of coordination among programs. The hope is to emphasize prevention and efficient early intervention. Collaborative efforts can provide an opportunity for role expansion among school psychologists. This possibility is discussed within a consultation model of service delivery that is consistent with the collaborative nature of school-linked services and with the preventive stance that orginated them. School psychologists are in a position to contribute to team consultation, case management, and needs assessment. Implications for training are drawn.     

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.     

School psychology and college learning disabled students: Traning and service possibilities

In recent years, increased attention has been devoted to the applicability of school psychological services to the adult population. Despite such attention, few school psychologists currently are being prepared to service adults. This paper argues that, with increasing numbers of learning disabled students entering postsecondary institutions, there exists an opportunity for school psychology training programs to aid in the servicing of these legally handicapped adults, while, at the same time, providing valuable experience to school psychology students in servicing the adult population. Specifically, this paper provides the reader with an overview of services provided to college learning disabled students, discusses the relationship between such services and school psychological services, and identifies numerous and service possibilities that exist for the profession of school psychology.     

Role expansion in school psychology: The need for primary and secondary prevention services

A sample of 80 special education directors completed a survey regarding the functions of school psychologists, the degree of effectiveness of psychologists in delivering certain services, and activities in which they should become more (or less) involved. The results reveal that there is no single activity that accounts for the majority of the school psychologist's time. School psychologists were rated as more effective in assessment, consulting, and crisis intervention. Activities rated as needing more involvement were counseling and consultation. Although these results are supportive of role expansion and consistent with the literature, of particular concern was the failure to identify involvement with at-risk and regular education students as a major need. These concerns suggest that there is a need for increases in primary and secondary prevention services.     

Examining the role of school psychologists as providers of mental and behavioral health services

The school setting represents the most common setting by which youth receive mental and behavioral health (MBH) services (Farmer et al., 2003, Psychiatr Serv, 54, 60–66). Nevertheless, many school psychologists are not providing MBH services despite the high prevalence of need. Additional research is needed to understand factors leading to these deficits, as well as potential solutions to ameliorate these concerns. The current study surveyed 341 school psychologists across seven states and found current ratios are one school psychologist for every 1,500–2,000 students. Study results suggest school psychologists are providing a half to full day of universal, prevention-oriented MBH services each week whereas more targeted, direct services (e.g., individual or small group counseling) are offered 1–4 hr each week. The school psychologist-to-student ratios also demonstrated a statistically significant and inverse association with the provision of targeted MBH services, with higher ratios resulting in fewer MBH services. Respondents provided potential solutions for how to expand the delivery of MBH services within schools, including increased awareness and support among school and district administrators, as well as access to training and professional development related to MBH services.     

The school psychologist's role as an assessment consultant

Consumers of school psychological services are interested in receiving a broader range of services from school psychologists than the traditional diagnostic one. One strategy that school psychologists might employ, in order to free up more time for providing alternative services, is to minimize their diagnostic function on the Child Study Team and become assessment consultants. This article discusses the types of services that an assessment consultant could provide to a Child Study Team.     

The 2002 Conference on the Future of School Psychology: Implications for Consultation,Intervention, and Prevention Services

In November 2002, the multisite Conference on the Future of School Psychology was sponsored by major professional associations of school psychologists. Conference goals included achieving consensus on current and future demands for school, conceptualizing the practice of school psychology in the face of diminishing numbers and increasing demand for services, and developing an agenda to use school psychology resources to maximize the benefits to the children and schools. Consultation, intervention, and prevention were major themes in all conference activities. The present article provides an overview of the conference and a summary of issues and outcomes from the conference that relate to educational and psychological consultation services.     

Philosophical differences between early childhood education and special education: Issues for school psychologists

Increasingly, professional psychologists are extending their services from school-age children to young handicapped children. Psychological intervention and education issues regarding this group of children are complicated by the fact that the field of early childhood special education itself is in its infancy. This article presents the emerging field of early childhood special education, clarifies some major concerns in educating young handicapped children, and raises issues for school psychologists working in this area.     

Group counseling in the schools: Legal,ethical, and treatment issues in school practice

School psychologists are interested in providing effective and efficient direct services to children. With a wide spectrum of psychological problems impacting children, group counseling represents one viable and valuable intervention. Given the complexity of group counseling, many schools and school psychologists are interested in legal and ethical issues impacting group interventions. From the attainment of appropriate consents for counseling to ethical dilemmas, the challenges involved in direct services are large. This article reviews mental health issues transforming children's mental health, considers differing group counseling models and stages of group development, and examines contemporary legal and ethical dilemmas inherent in school practice. Uniquely, a question‐and‐answer format is used to highlight legal issues for practice. © 2008 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.     

THE PROVISION OF COUNSELING SERVICES AMONG SCHOOL PSYCHOLOGISTS: AN EXPLORATION OF TRAINING,CURRENT PRACTICES,AND PERCEPTIONS

Although school psychologists have been called on in recent literature to assume a leadership role in a collective and comprehensive effort to address students’ mental health needs, many practitioners find that their professional roles continue to be narrowly focused on special education‐related activities, such as individualized assessment and eligibility determination. Meanwhile, students’ mental health needs have never been greater. The current study focused specifically on school psychologists’ provision of school‐based counseling, an activity that has been shown to be effective in addressing students’ mental health needs, as well as a professional role that many practitioners have expressed a desire to expand. A national sample of school psychologists responded to an Internet survey related to various aspects of counseling service delivery, including their training to provide services, current practices, and perceptions of the importance for school psychologists to assume the responsibility of providing school‐based counseling services.     

Reasons and rationales for neuropsychological tests in a multitier system of school services

Many contemporary learning disabilities (LD) experts advocate a multitiered service delivery system. Included in this formulation is the obligation to deliver for each struggling student increasingly sophisticated and intensive services before special education is considered. For students who evidence failed response to intervention, an evaluation, suggested by some to comprise minimal cognitive and extensive achievement testing, typically ensues and helps to determine special education eligibility. We argue that neuropsychological tools are essential at this point in the process. In contrast to minimal standardized testing, use of these tools permits school psychologists to perform their most important mission – to understand, predict, and control (improve) student behavior and development by identifying learning syndromes, rather than discrete academic deficits. This article argues for neuropsychological tests as a way for school psychologists to recognize patterns of learning problems reported in the peer‐reviewed literature, which in turn promotes effective planning and intervention. © 2008 Wiley Periodicals, Inc.     

Consistency of administrators' and psychologists' actual and ideal perceptions of school psychologists' activities

Questionnaires asking for actual and ideal perceptions of the role of the school psychologist were completed by 80 school psychologists, 37 directors of pupil personnel services, and 29 superintendents in Virginia public schools. Administrators and school psychologists are in substantial agreement regarding the amount of time the psychologist actually devotes to different job activities. Approximately 75% of the psychologist's time is spent in Meyers' Level I activities (Meyers, 1973). All groups desire a reduction in the time spent in assessment, but they differ as to what intervention levels should be increased. Psychologists see the saved time most appropriately spent in interventions at the system level. Discrepancy between actual and desired roles is discussed in terms of the impact of P.L. 94–142. The consistency of psychologists' actual and ideal perceptions correlated significantly and negatively with their job satisfaction. This relationship is discussed in terms of role conflict, and a comparison is made of actual roles with the emphasis in two professional journals.     

Transition services for students with intellectual disabilities: School psychologists’ perceptions

For individuals with intellectual disabilities (ID), transition services increase access to postschool opportunities. School psychologists should contribute to transition services but have reportedly limited involvement in this area. This study distributed a national survey (N = 176) assessing school psychologists’ current knowledge, attitudes, and behaviors regarding transition services for students with ID. Results indicated that attitudes toward and knowledge of the ID population were significant predictors of transition task performance, and knowledge was a significant predictor of transition‐related attitudes and behaviors. The results provided preliminary evidence that increasing school psychologists’ specific knowledge of transition services and encouraging positive attitudes toward the transition needs of students with ID may increase school psychologists’ performance in transition practice. Specific recommendations are provided.