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School Mental Health Care Coordination Practices: A Mixed Methods Study
... Within MTSS, Tier 1 (universal) support is provided to all students, Tier 2 (targeted) support is delivered for groups of students at risk for developing problems in the future, and Tier 3 (intensive) support is provided to individual students (Kern et al. 2022). However, a series of survey and interview studies conducted to assess school mental health providers' current practices and desires for systematizing and coordinating intensive, Tier 3 school mental health services (Nygaard et al. 2023;2024a;2024b) indicated "patchwork" coordination (Nygaard et al. 2024b, p. 1). School providers requested a proactive plan of care that included "specific intervention details, student goals, a team of supportive people with documentation of responsibilities, and a plan for progress monitoring and data collection, among other elements" (Nygaard and Ormiston 2025a, p. 1). ...
Since schools are an ideal setting for students to receive mental health services, Mental Health Action Plans (MHAPs) were developed to define and detail the ways in which student mental health needs can be addressed at school. Similar to Individualized Education Plans and 504 plans, MHAPs are individualized plans, grounded in person‐centered care planning. The goal of this case study was to identify how implementing a MHAP at the middle school level affected student mental health and academic performance. Three students (ages 11–13), caregivers, and teachers were included in the study. Two school counselors facilitated three MHAP Meetings per student throughout the 2022–2023 school year. Participant characteristics, MHAP Document details, and selected evidence‐based interventions are described. A one‐group pretest‐posttest design was employed by administering rating scales before and after the MHAP Program implementation. Descriptive statistics were used to examine the overall change in the pre‐post measure data and paired samples t ‐tests were used to compare mean ratings. Results suggest mixed, although promising, academic, social, emotional, and behavioral outcomes, in part due to informant discrepancies and limitations of the study design employed. The MHAP Program also highlighted student academic difficulties that required additional intervention. Study results indicated MHAPs could be a trauma‐informed mechanism to meet student mental health needs in school and connect students to additional academic support, as needed. Limitations and future directions are discussed.
Research supports the use of multi‐tiered systems of support (MTSS) for meeting student academic, behavioral, and socioemotional needs. MTSS is viewed as an ideal model to deliver school‐based mental health (SBMH) services to students. However, limited research has examined what this framework for service delivery looks like in practice. Utilizing a national participant sample and a mixed‐methods convergent (quan + QUAL) design, the purpose of this study is to examine participant use of MTSS for SBMH and to examine practitioners' perspectives on the implementation of Tier 2 and 3 services. Respondents in our current sample indicated a level of uncertainty regarding the identification of students for SBMH services and the delivery of Tier 2 and Tier 3 services, particularly as this relates to special education. Additionally, respondents indicated “insufficient” supports for the provision of Tier 3 services. Limitations, implications for practice, and future directions are discussed.
As students present to school with mental health needs, the role of schools has evolved to include the provision of school-based mental health services delivered across a continuum or multitiered system of supports. Within this framework of services, students can receive intensive mental health services at the Tier 3 level. School-based mental health systems must consider best practices in related fields to ensure schools are well equipped to handle intensive student mental health needs. This exploratory study used a national sample and employed a convergent QUAN+ qual design to explore professional perceptions that were associated with school mental health providers’ likelihood of having a proactive plan of care for students in need of mental health supports who are transitioning schools. Quantitative results suggested having sufficient Tier 3 services and sufficient resources (e.g., personnel and time) were associated with school mental health providers using a proactive plan of care. Qualitative results supported this finding and further highlighted potential barriers to school mental health providers’ buy in. Additional considerations for facilitating the use of a proactive plan of care in schools and implications for practice are provided. Limitations and future directions are discussed.
Although care coordination (CC; i.e., the organization of care activities between professionals to facilitate appropriate service delivery; McDonald et al., 2007) has yet to be studied extensively within schools, preliminary research suggests coordinating school mental health supports can be beneficial (Francis et al., 2021) and that interprofessional and interagency collaboration is warranted to meet student needs (McClain et al., 2022). We examined the perceptions of school mental health providers (SMHPs) regarding importance, quality, and engagement with within-district transition CC practices within a multitiered system of support framework. Participants were 163 SMHPs who endorsed being involved in designing, providing, or implementing mental health services in a U.S. school district. The three scales used to measure engagement with CC practices were based on the Care Coordination Measures Atlas (McDonald et al., 2014) and were found to have promising preliminary psychometrics. Descriptive statistics indicated SMHPs endorsed CC as very important but perceived school and district personnel to view it as less important, reported their own quality of CC was slightly above that of their school and district, and regularly engaged in broad CC practices. Moreover, bivariate correlations indicated SMHP’s personal views of CC importance were not associated with the quality of school and district CC, yet engagement in broad CC activities was associated with transition facilitation practices, and attitudes about CC were associated with engagement in broad CC activities. Implications of findings are discussed.
Normative transitions between educational settings can be important life events for young people, having the potential to influence mental health trajectories across the life course. Interventions to target transitions have been used to support children and young people as they transition between school settings, but there is limited synthesis of their effects. Seven databases were searched to identify studies of universal interventions focused on supporting mental health and wellbeing across three main types of educational transition: preschool to elementary school; school to school (including elementary to middle; middle to high and other combinations depending on country); and high school to post-compulsory education. Effect directions for behavioural, psychological/emotional and social measures of mental health were extracted for each study and synthesized using effect direction plot methodology. Searches identified 6494 records for screening. This resulted in 34 papers being included in the review, consisting of 24 different interventions. Social outcomes appeared more amenable to intervention than behavioural outcomes, with mixed findings for psychological measures of mental health. Intervention characteristics shifted based on the age of young person involved in the transition, with greater focus on parenting and school environment during the early transitions, and more focus on social support for the transition to post-compulsory education. A broad range of interventions were identified for supporting mental health and wellbeing across the three types of educational transition with mixed impact and diverse methodologies. More research is needed to identify transferable intervention mechanisms that may hold across different contexts and settings. PROSPERO registration number: CRD42020176336.
Mental health concerns are on the rise among youth, contributing to a growing need for school-based mental health services. However, challenges to service provision arise due, in part, to workforce shortages, service fragmentation, and inefficient allocation of staff time. The current study describes the professional competencies and time allocation of four school-based mental health professions (i.e., school counselors, school psychologists, school social workers, and school nurses) in order to demonstrate how schools can leverage the skills of their existing staff to coordinate a comprehensive approach to support student mental health. First, we identified the core clinical competencies needed to implement the key features of comprehensive school mental health systems. Then, we crosswalked these clinical competencies with the training standards of the four professions. Finally, we conducted a systematic review of the literature to understand how these professionals’ time is allocated, as well as their responsibilities related to the provision of mental health services. Results demonstrated that, although all four professions receive training in most of the core competencies needed to implement comprehensive school mental health services, their skillsets are often underutilized in day-to-day practice. Thus, we concluded that there are at least two untapped opportunities for school leaders to support student mental health—first, maximize the use of school mental health professionals through task-shifting (i.e., reassigning tasks less central to mental health service delivery to other staff), and second, implement an integrated model of school mental health services to efficiently leverage the mental health training of professionals.
Schools are the most common venue in which children and youth receive mental health services. To organize delivery of mental health care to such a large number of children, use of school teams is often recommended. Yet, there is limited empirical literature about the composition of school mental health teams or teams’ relations to service provision. This study investigated team composition, including team multidisciplinarity (number of different types of professionals) and the presence of a community provider, and the relations of these two variables to service provision at Tier 1 (mental health promotion), Tier 2 (early intervention) and Tier 3 (intensive treatment) for 386 schools representing different school sizes, locations, and urbanicity. Results suggested team multidisciplinarity and the presence of a community provider were related to more frequent endorsement of service provision at schools. Practice and research implications are discussed including possible application to hiring decisions and further research with longitudinal data and information on service quality.
During the immediate period following psychiatric hospitalization, adolescents are at increased risk for suicide attempts and rehospitalization. Because most adolescents return to school during this time, school-related experiences are important considerations during the transition from inpatient hospitalization. This study sought to understand how adolescent perceptions of school may change following hospitalization, and how these changes may predict recovery from a suicide-related crisis. Participants included 155 adolescents (Mage = 15.2 years; 68.6% female, 65.4% White; 14.7% Hispanic/Latinx; grades 7–12) hospitalized for a suicide-related crisis assessed 3 weeks and 6 months following discharge. Results from Latent Change Score models indicated a worsening of perceptions of teacher relationships (mean change (Δ) = 1.52), connectedness to learning (Δ = 1.55), parent involvement (Δ = 1.82), and academic satisfaction (Δ = 1.34), as well as higher frequency of perceived bullying victimization (Δ = 0.71) following hospitalization. Poorer perceptions of teacher relationships and higher frequency of perceived bullying victimization during hospitalization (β = 0.31 and 0.34), as well as worsening changes of teacher relationships and increased frequency of perceived bullying victimization following hospitalization (β = 0.48 and 0.41) were associated with higher levels of suicidal ideation severity 3 weeks following discharge. Poorer and worsening perceptions of teacher relationships were associated with higher levels of suicidal ideation intensity at 3 weeks (β = 0.37 and 0.54). Poorer perceptions of connectedness to learning during hospitalization emerged as a significant predictor of higher levels of suicidal ideation intensity 6 months following hospitalization (β = 0.20). Results reinforce the importance of fostering positive adult relationships and preventing bullying both prior to and immediately following psychiatric hospitalization.
Care coordination is both a well-known concept discussed in a wide range of multidisciplinary health care literature and a familiar nursing role in clinical practice; however, the definition of care coordination lacks role clarity across disciplines and within the nursing profession. Despite variations, defining factors of care coordination practice exist; however, role ambiguity limits the effective implementation of evidence-based care coordination in practice and policy. Following Walker and Avant's eight-step concept analysis method, we aim to further clarify care coordination as a concept and practice role and examine the value that nursing brings to its implementation.
Enhanced care coordination is essential to improving access to and navigation between youth mental health services. By facilitating better communication and coordination within and between youth mental health services, the goal is to guide young people quickly to the level of care they need and reduce instances of those receiving inappropriate care (too much or too little), or no care at all. Yet, it is often unclear how this goal can be achieved in a scalable way in local regions. We recommend using technology-enabled care coordination to facilitate streamlined transitions for young people across primary, secondary, more specialised or hospital-based care. First, we describe how technology-enabled care coordination could be achieved through two fundamental shifts in current service provisions; a model of care which puts the person at the centre of their care; and a technology infrastructure that facilitates this model. Second, we detail how dynamic simulation modelling can be used to rapidly test the operational features of implementation and the likely impacts of technology-enabled care coordination in a local service environment. Combined with traditional implementation research, dynamic simulation modelling can facilitate the transformation of real-world services. This work demonstrates the benefits of creating a smart health service infrastructure with embedded dynamic simulation modelling to improve operational efficiency and clinical outcomes through participatory and data driven health service planning.
Ample evidence suggests that PK‐12 students experience racism and other forms of discrimination in school and that these experiences have a deleterious impact on their mental health. Several studies have shown a consistent and strong relationship between racism and negative mental health outcomes including increased depression and anxiety, decreased self‐worth and self‐esteem, as well as psychological maladjustment. School‐based mental health services can ensure that racial and ethnic minoritized (REM) students gain access to mental health services. Because schools are one place where REM students experience structural and individual discrimination, it is critical that school‐based mental health providers utilize strategies to promote school climates that are safe and affirming for these students. Using a multitiered system of support framework, we describe the tier 1 interventions to promote positive school racial climate and the elements of culturally responsive practices to be integrated into tier 2 and tier 3 interventions to improve mental health outcomes for REM youth.
To date, minimal research has explored the perceptions of secondary school staff regarding their realized and potential contributions to the redress of mental health stigma and support of students with mental health concerns within school environments. The aim of this study was to identify and describe the practicable roles school staff perceive of themselves to hold with respect to promoting mental health, challenging stigma, and responding to student mental health problems. Using an interpretive qualitative approach, semi-structured interviews were conducted following purposive and convenience sampling of school staff (n = 48) including classroom teachers, school counsellors, psychologists, administrators, and various support staff members employed with two secondary schools in southern Alberta, Canada. A structured interview guide was utilized to assess the roles, tasks, and processes school staff undertake to assist students with their mental health concerns. Four main themes inductively emerged from the data: (1) Relationships matter: Establishing and maintaining strong relationships with students, their caregivers, and other staff members are critical to addressing student mental health issues; (2) Empathetic and receptive communication is an antidote to stigma: Various communication processes contribute to disclosures of mental health concerns and challenges; (3) Connecting and facilitating timely access to the right person is key for students experiencing emotional crises; and (4) Facilitators and barriers to addressing student mental health concerns. Clinical implications and policy recommendations are provided to inform directions for administrators, educators, and caregivers regarding student mental health supports.
Levels of Evidence: Qualitative study.
The need for mental health services in schools is increasing. Teachers are expected to meet student's academic needs but may find their role impacted by the need for mental health support among students (Bruhn et al., 2014; Kaffenberger & O'Rouke‐Trigiani, 2013). The purpose of this study is to elicit teacher perspectives on addressing the mental health needs of students in school. Staff members from one school in a Midwestern state were interviewed to examine their perspectives related to student mental health. Thirteen classroom teachers (n = 13), four related arts teachers (n = 4), seven special education staff members (n = 7), three building support personnel (n = 3), two office staff (n = 2), and four support staff members (n = 4) were interviewed, for a total of 33 participants (n = 33). Participant experience ranged from 2 to 37 years in education. Utilizing an inductive thematic analysis approach (Braun & Clarke, 2006), information regarding teachers' current knowledge of, roles, and approaches to support students with mental health needs in schools is presented across four main themes. Directions for future research, training, and practice are described.
A meta-analysis was conducted to examine the relative rates of youth mental health service utilization across settings among the general population and among those with elevated mental health symptoms or clinical diagnoses. Rates of school-based mental health were compared to outpatient, primary care, child welfare, juvenile justice, and inpatient. Nine studies presented rates of mental health service use for general-population youth in the U.S., and 14 studies presented rates for youth with elevated symptoms or clinical diagnoses. Random effects meta-analysis was used to calculate mean proportions of youth receiving care in each sector. Of general population youth, 7.28% received school mental health services. Rates for other sectors are as follows: 7.26% in outpatient settings, 1.76% in primary care, 1.80% in inpatient, 1.35% in child welfare, and 0.90% juvenile justice. For youth with elevated mental health symptoms or diagnoses, 22.10% of youth were served by school-based mental health services, 20.56% outpatient settings, 9.93% primary care, 9.05% inpatient, 7.90% child welfare, and 4.50% juvenile justice. Schools and outpatient settings are the most common loci of mental health care for both the general population and samples of youth with elevated symptoms or clinical diagnoses, although substantial amounts of care are also provided in a range of other settings. Results hold potential for informing resource allocation, legislation and policy, intervention development, and research. Given that mental health services are delivered across many settings, findings also point to the need for interconnection across child-serving sectors, particularly schools and outpatient clinics.
Effective collaboration is associated with positive outcomes for students and is a key component of equitable educational opportunities. There are challenges to effective collaboration, however, as our understanding of it differs based on the various definitions in the literature. The purpose of this systematic review is to identify the common constructs across definitions of collaboration as a means to develop a universal model that can be used in the schools. Through the development of a “building blocks” framework, we provide a common definition and identify the steps that must be taken before true collaboration can occur. This model highlights the iterative nature of the collaborative process and the importance of revisiting the foundational aspects of collaborative development. The systematic review focuses on using a common definition for research and the practice of collaboration.
Background
The relevance of context in implementation science is reflected in the numerous theories, frameworks, models and taxonomies that have been proposed to analyse determinants of implementation (in this paper referred to as determinant frameworks). This scoping review aimed to investigate and map how determinant frameworks used in implementation science were developed, what terms are used for contextual determinants for implementation, how the context is conceptualized, and which context dimensions that can be discerned.
Methods
A scoping review was conducted. MEDLINE and EMBASE were searched from inception to October 2017, and supplemented with implementation science text books and known published overviews. Publications in English that described a determinant framework (theory, model, taxonomy or checklist), of which context was one determinant, were eligible. Screening and inclusion were done in duplicate. Extracted data were analysed to address the study aims. A qualitative content analysis with an inductive approach was carried out concerning the development and core context dimensions of the frameworks. The review is reported according to the PRISMA guidelines.
Results
The database searches yielded a total of 1113 publications, of which 67 were considered potentially relevant based on the predetermined eligibility criteria, and retrieved in full text. Seventeen unique determinant frameworks were identified and included. Most were developed based on the literature and/or the developers’ implementation experiences. Six of the frameworks explicitly referred to “context”, but only four frameworks provided a specific definition of the concept. Instead, context was defined indirectly by description of various categories and sub-categories that together made up the context. Twelve context dimensions were identified, pertaining to different aggregation levels. The most widely addressed context dimensions were organizational support, financial resources, social relations and support, and leadership.
Conclusions
The findings suggest variation with regard to how the frameworks were developed and considerable inconsistency in terms used for contextual determinants, how context is conceptualized, and which contextual determinants are accounted for in frameworks used in implementation science. Common context dimensions were identified, which can facilitate research that incorporates a theory of context, i.e. assumptions about how different dimensions may influence each other and affect implementation outcomes. A thoughtful application of the concept and a more consistent terminology would enhance transparency, simplify communication among researchers, and facilitate comparison across studies.
Electronic supplementary material
The online version of this article (10.1186/s12913-019-4015-3) contains supplementary material, which is available to authorized users.
Many youth with autism spectrum disorder (ASD) may benefit from interdisciplinary care coordination. Communication and collaboration between the school and clinic settings is particularly important when youth with ASD are receiving both special education and clinic-based services. The responsibility of initiating coordinated care has historically been with the medical home (e.g., primary care clinicians), however, educational professionals (e.g., school psychologists) are also well positioned to assume a leadership role in care coordination. Little is known about the current state, feasibility, or effectiveness of school psychologists leading care coordination efforts. The current study utilizes a mixed-method approach to understand school psychologists’ engagement in interdisciplinary collaboration across settings, a central tenet to coordinated care, in providing services to youth with ASD.
Despite the prevalence and negative consequences of depressive disorders among youth, as well as the need for schools to adopt and implement a continuum of mental health services to address depressive disorders, school mental health providers receive very limited guidance in the selection and application of appropriate evidence-based depression prevention and intervention programs for use within a school-based multi-tiered system of support (MTSS). With the goal of supporting school-based mental health providers in the delivery of evidence-based practices targeting depressive symptoms among youth within a MTSS framework, the following study sought to conduct a critical review of the existing school-based prevention and intervention programming for depressive disorders for youth. A systematic, four-stage review was performed from which 119 studies examining 57 unique programs were identified. A review of the studies, including presentation of various participant (e.g., age, grade, ethnicity), study (e.g., control group, randomization), and program (e.g., primary focus, findings, MTSS tier) characteristics, is included. Implementation considerations review and future directions for research are discussed.
Objective/Design
Well documented asthma disparities in Chicago pose a continual challenge for the Chicago Public Schools (CPS). Coordinated Healthcare for Complex Kids (CHECK) is a health care demonstration project funded by a Centers for Medicare and Medicaid Services Health Care Innovation Award. A collaborative partnership was formed between CHECK and CPS. With CHECK support, CPS administered a survey to 160 nurses to understand the asthma problems nurses perceived and interest in intervention.
Results
Seventy‐five per cent (n = 120) completed the survey. While asthma was the top diagnosis managed by 95%, 72% reported gaps in asthma understanding. Appropriate communication between school nurses and providers occurred 33% of the time; 18% believed they received sufficient support to follow‐up on deficient paperwork. The barriers mentioned were lack of medications (73%), time (67%), and communication with providers (61%). When asked their opinions on potential interventions, 78% of nurses supported web‐based applications, 66% community health workers (CHW), and 66% stock albuterol in schools.
Conclusions
The greatest barriers for CPS nurses with asthma management are time and communication. Potential interventions such as web‐based communication applications and CHW in schools were well received.
This manuscript describes an implementation of a new model for integrated school mental health services. By incorporating trauma-informed practices with universal screening and teacher coaching, this study examined the processes and procedures necessary to deliver school-based mental health services across Tier I and Tier II within a Multi-Tiered Systems of Support. Developed through an iterative process, this decision-making framework was designed based on feedback from school-based partners, periodic and planned review of program effectiveness, and collecting of data to inform key decisional cut points. A middle school within a large, urban school district was selected as the demonstration site. Teachers received in-service training on both universal mental health screening and effective classroom management practices. Teachers screened students in the fall, winter and spring to assess class and school-wide risk levels. A group of coaches then conducted weekly observations of teachers and provided visual and written performance feedback facilitate development of teachers’ classroom management skills. Preliminary data suggests a significant reduction in suspensions and disciplinary infractions. Implications for school psychological services will be provided, as well as future implementation plans including data to inform Tier II intervention selection.
The transition to high school is disruptive for many adolescents, yet little is known about the supportive relational processes that might attenuate the challenges students face as they move from middle to high school, particularly for students from more diverse backgrounds. Identifying potential buffers that protect youth across this critical educational transition is important for informing more effective support services for youth. In this study, we investigated how personal characteristics (gender, nativity, parent education level) and changes in support from family, friends, and school influenced changes in socioemotional adjustment and academic outcomes across the transition from middle to high school. The data were drawn from 252 students (50% females, 85% Latina/o). The results revealed declines in students’ grades and increases in depressive symptoms and feelings of loneliness across the high school transition, with key variation by student nativity and gender. Additionally, stable/increasing friend support and school belonging were both linked to less socioemotional disruptions as students moved from middle to high school. Increasing/stable school belonging was also linked to increases in school engagement across the high school transition. These findings suggest that when high school transitions disrupt supportive relationships with important others in adolescents’ lives, adolescents’ socioemotional well-being and, to a lesser extent, their academic engagement are also compromised. Thus, in designing transition support activities, particularly for schools serving more low-income and race/ethnic minority youth, such efforts should strive to acclimate new high school students by providing inclusive, caring environments and positive connections with educators and peers.
Collaborative care (CC) is an innovative approach to integrated mental health service delivery that focuses on reducing access barriers, improving service quality and lowering health care expenditures. A large body of evidence supports the effectiveness of CC models with adults and, increasingly, for youth. Although existing studies examining these models for youth have focused exclusively on primary care, the education sector is also an appropriate analogue for the accessibility that primary care offers to adults. CC aligns closely with the practical realities of the education sector and may represent a strategy to achieve some of the objectives of increasingly popular multi-tiered systems of supports frameworks. Unfortunately, no resources exist to guide the application of CC models in schools. Based on the existing evidence for CC models, the current paper (1) provides a rationale for the adaptation of CC models to improve mental health service accessibility and effectiveness in the education sector; (2) presents a preliminary CC model for use in schools; and (3) describes avenues for research surrounding school-based CC, including the currently funded Accessible, Collaborative Care for Effective School-based Services project.
The education sector offers compelling opportunities to address the shortcomings of traditional mental health delivery systems and to prevent and treat youth mental, emotional, and behavioral (MEB) problems. Recognizing that social and emotional wellness is intrinsically related to academic success, schools are moving to adopt multi-tier frameworks based on the public health model that provide a continuum of services to all children, including services to address both academic and MEB problems. In this article, we review the potential value of multi-tier frameworks in facilitating access to, and increasing the effectiveness of, mental health services in schools, and review the empirical support for school-based mental health interventions by tier. We go on to describe a community–academic partnership between the Seattle Public Schools and the University of Washington School Mental Health Assessment, Research, and Training (SMART) Center that exemplifies how multi-tier educational frameworks, research and evidence, and purposeful collaboration can combine to improve development and implementation of a range of school-based strategies focused on MEB needs of students. Finally, we present a set of 10 recommendations that may help guide other research and practice improvement efforts to address MEB problems in youth through effective school mental health programming.
This Policy Statement was reaffirmed April 2023
Understanding a care coordination framework, its functions, and its effects on children and families is critical for patients and families themselves, as well as for pediatricians, pediatric medical subspecialists/surgical specialists, and anyone providing services to children and families. Care coordination is an essential element of a transformed American health care delivery system that emphasizes optimal quality and cost outcomes, addresses family-centered care, and calls for partnership across various settings and communities. High-quality, cost-effective health care requires that the delivery system include elements for the provision of services supporting the coordination of care across settings and professionals. This requirement of supporting coordination of care is generally true for health systems providing care for all children and youth but especially for those with special health care needs. At the foundation of an efficient and effective system of care delivery is the patient-/family-centered medical home. From its inception, the medical home has had care coordination as a core element. In general, optimal outcomes for children and youth, especially those with special health care needs, require interfacing among multiple care systems and individuals, including the following: medical, social, and behavioral professionals; the educational system; payers; medical equipment providers; home care agencies; advocacy groups; needed supportive therapies/services; and families. Coordination of care across settings permits an integration of services that is centered on the comprehensive needs of the patient and family, leading to decreased health care costs, reduction in fragmented care, and improvement in the patient/family experience of care.
Background
The literature on the prevalence of mental disorders affecting children and adolescents has expanded significantly over the last three decades around the world. Despite the field having matured significantly, there has been no meta-analysis to calculate a worldwide-pooled prevalence and to empirically assess the sources of heterogeneity of estimates.Methods
We conducted a systematic review of the literature searching in PubMed, PsycINFO, and EMBASE for prevalence studies of mental disorders investigating probabilistic community samples of children and adolescents with standardized assessments methods that derive diagnoses according to the DSM or ICD. Meta-analytical techniques were used to estimate the prevalence rates of any mental disorder and individual diagnostic groups. A meta-regression analysis was performed to estimate the effect of population and sample characteristics, study methods, assessment procedures, and case definition in determining the heterogeneity of estimates.ResultsWe included 41 studies conducted in 27 countries from every world region. The worldwide-pooled prevalence of mental disorders was 13.4% (CI 95% 11.3–15.9). The worldwide prevalence of any anxiety disorder was 6.5% (CI 95% 4.7–9.1), any depressive disorder was 2.6% (CI 95% 1.7–3.9), attention-deficit hyperactivity disorder was 3.4% (CI 95% 2.6–4.5), and any disruptive disorder was 5.7% (CI 95% 4.0–8.1). Significant heterogeneity was detected for all pooled estimates. The multivariate metaregression analyses indicated that sample representativeness, sample frame, and diagnostic interview were significant moderators of prevalence estimates. Estimates did not vary as a function of geographic location of studies and year of data collection. The multivariate model explained 88.89% of prevalence heterogeneity, but residual heterogeneity was still significant. Additional meta-analysis detected significant pooled difference in prevalence rates according to requirement of funcional impairment for the diagnosis of mental disorders.Conclusions
Our findings suggest that mental disorders affect a significant number of children and adolescents worldwide. The pooled prevalence estimates and the identification of sources of heterogeneity have important implications to service, training, and research planning around the world.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology. Qualitative Research in
This track combined exposure to the software technologies and packages relevant for LHC experiments and the engineering aspects of software development. The lectures provided an overview of LHC++/Anaphe and ROOT and covered those aspects of software engineering most relevant for HEP software development. It showed, in a practical sense, how software engineering can help in the development of HEP applications based on the LHC++/Anaphe and ROOT software suites and also gave a taste of working on large software projects that are typical of LHC experiments. A series of hands-on tutorials performed by the students were based exercises to solve given problems. The tutorials followed the natural progression of physics analysis exploring the major packages of LHC++/Anaphe and ROOT on the way. This paper presents an overview of the software engineering lectures by R.Jones, the tutorials and feedback session. Details of the lectures on LHC++/Anaphe and ROOT are reported in separate papers of these proceedings.
To determine prevalence and correlates of need and unmet need for care coordination in a national sample of children with mental health conditions.
Using data from the 2007 National Survey of Children's Health, we identified children aged 2 to 17 years with ≥1 mental health condition (attention-deficit/hyperactivity disorder, anxiety disorder, conduct disorder, or depression) who had received ≥2 types of preventive or subspecialty health services in the past year. We defined 2 outcome measures of interest: (1) prevalence of need for care coordination; and (2) prevalence of unmet need for care coordination in those with a need. Logistic regression models were used to estimate associations of clinical, sociodemographic, parent psychosocial, and health care characteristics with the outcome measures.
In our sample (N = 7501, representing an estimated 5 750 000 children), the prevalence of having any need for care coordination was 43.2%. Among parents reporting a need for care coordination, the prevalence of unmet need was 41.2%. Higher risk of unmet need for care coordination was associated with child anxiety disorder, parenting stress, lower income, and public or no insurance. Parents reporting social support and receipt of family-centered care had a lower risk of unmet need for care coordination.
Approximately 40% of parents of children with mental health conditions who reported a need for care coordination also reported that their need was unmet. Delivery of family-centered care and enhancing family supports may help to reduce unmet need for care coordination in this vulnerable population.
During the transition from primary to secondary school, students typically experience a new social environment, moving from primary school with small intact classes throughout the day with one main teacher, to a larger secondary school with teachers, classrooms and often classmates changing throughout the day. During this time, students report a reduced sense of connectedness, which has been associated with symptoms of depression and anxiety. This study investigated the temporal association between feeling connected to school and mental health prior to and over the transition period. Data were obtained from 3,459 students in a longitudinal study of adolescents’ knowledge, attitudes and experiences of bullying victimisation and perpetration during the transition from primary school to secondary school. Students completed a questionnaire at four time points from Grade 7 to the end of Grade 9. Path analysis was used to model relationships between school connectedness, depression and anxiety. The findings suggest reciprocal relationships between connectedness and mental health where increased connectedness to school is associated with decreased depression and anxiety; conversely, increased depression and anxiety is associated with decreased connectedness to school. The significant reciprocal associations found in the cross-lag models in the first two years of secondary school indicate the need to intervene during the transition period to improve students’ social and mental health outcomes.
Objective: This study examines the quality of evaluation studies using qualitative research methods in the social work literature in terms of a number of criteria commonly adopted in the field of qualitative research. Method: Using qualitative and evaluation as search terms, relevant qualitative evaluation studies from 1990 to 2003 indexed by Social Work Abstracts were examined, and their quality was evaluated. Results: The review shows that the quality of published evaluation studies using qualitative research methods in the social work field is not high and that many of the reviewed studies are not sensitive to the following issues: philosophical base of the study, auditability, bias, truth value, consistency, and critical interpretations of the data. Conclusions: Social workers using findings arising from published evaluation studies using qualitative research methods in social work should be cautious and social workers conducting qualitative evaluation studies should be sensitive to the issue of quality. Adequate training for social workers on qualitative evaluation should also be carried out.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Mental health policy for youth has been constrained by a paucity of nationally representative data concerning patterns and correlates of mental health service utilization in this segment of the population. The objectives of this investigation were to examine the rates and sociodemographic correlates of lifetime mental health service use by severity, type, and number of DSM-IV disorders in the National Comorbidity Survey-Adolescent Supplement.
Face-to-face survey of mental disorders from 2002 to 2004 using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview in a nationally representative sample of 6,483 adolescents 13 to 18 years old for whom information on service use was available from an adolescent and a parent report. Total and sector-specific mental health service use was also assessed.
Approximately one third of adolescents with mental disorders received services for their illness (36.2%). Although disorder severity was significantly associated with an increased likelihood of receiving treatment, half of adolescents with severely impairing mental disorders had never received mental health treatment for their symptoms. Service rates were highest in those with attention-deficit/hyperactivity disorder (59.8%) and behavior disorders (45.4%), but fewer than one in five affected adolescents received services for anxiety, eating, or substance use disorders. Comorbidity and severe impairment were strongly associated with service utilization, particularly in youth with behavior disorders. Hispanic and non-Hispanic Black adolescents were less likely than their White counterparts to receive services for mood and anxiety disorders, even when such disorders were associated with severe impairment.
Despite advances in public awareness of mental disorders in youth, a substantial proportion of young people with severe mental disorders have never received specialty mental health care. Marked racial disparities in lifetime rates of mental health treatment highlight the urgent need to identify and combat barriers to the recognition and treatment of these conditions.
This paper describes the application of mixed method designs in implementation research in 22 mental health services research studies published in peer-reviewed journals over the last 5 years. Our analyses revealed 7 different structural arrangements of qualitative and quantitative methods, 5 different functions of mixed methods, and 3 different ways of linking quantitative and qualitative data together. Complexity of design was associated with number of aims or objectives, study context, and phase of implementation examined. The findings provide suggestions for the use of mixed method designs in implementation research.
New Orleans school children participated in an assessment and field trial of two interventions 15 months after Hurricane Katrina. Children (N = 195) reported on hurricane exposure, lifetime trauma exposure, peer and parent support, posttraumatic stress disorder (PTSD), and depressive symptoms. Teachers reported on behavior. At baseline, 60.5% screened positive for PTSD symptoms and were offered a group intervention at school or individual treatment at a mental health clinic. Uptake of the mental health care was uneven across intervention groups, with 98% beginning the school intervention, compared to 37% beginning at the clinic. Both treatments led to significant symptom reduction of PTSD symptoms, but many still had elevated PTSD symptoms at posttreatment. Implications for future postdisaster mental health work are discussed.
Although interprofessional collaboration is emphasized as important in schools, little is known about how it should be organized. We analyzed the effects of an organizational model of interprofessional collaboration, the LOG model. The model aims to improve interprofessional collaboration by identifying and improving various meeting places for collaboration, involving municipal school leaders, principals, staff, and interprofessional collaborators, and by increasing feedback from meeting places in and around schools. In a cluster-randomized design including 35 Norwegian primary schools, 19 schools were randomized to the experimental group and implemented the LOG model, and 16 were randomized to a control group. A total of 142 interprofessional collaborators (e.g., school nurses, social workers, and principals) received a questionnaire prior to randomization, with one- and two-year follow-up. Using a validated scale to measure interprofessional team collaboration, we evaluated the effects of the model on collaborators’ perceptions in four dimensions: (a) Reflection on process, (b) Professional flexibility, (c) Newly created professional activities, and (d) Role interdependence. During the first, but not the second year of follow-up, the results demonstrated positive and statistically significant effects of the LOG model on the dimensions Reflection on process (p< .001) and Newly created professional activities (p= .016). Our findings demonstrate the potential of interventions addressing interprofessional collaboration at the organizational level.
While there is evidence suggesting school-based transitions impact student mental health and academics (Lester et al., 2013 Lester, L., Waters, S., & Cross, D. (2013). The relationship between school connectedness and mental health during the transition to secondary school: A path analysis. Australian Journal of Guidance and Counselling, 23(2), 157–171. https://doi.org/10.1017/jgc.2013.20[Crossref] , [Google Scholar]), it is unknown how these transitions specifically impact the domains of social, academic, and emotional behavior, as measured via the Social, Academic, and Emotional Behavior Risk Screener (SAEBRS). The purpose of this study was to explore the relationship between school-based transitions and teacher ratings of student SAEBRS scores in a midsize, suburban school district. Using paired t-tests and McNemar’s test we examined changes in SAEBRS scores and benchmark risk levels across grade level changes and school-based transitions. SAEBRS scores decreased significantly from 8th to 9th grade (school-based transition) in the total, academic, and emotional subscales, although risk level did not increase significantly during this transition. In contrast, SAEBRS scores increased significantly in each subscale as students transitioned from 7th to 8th grade (no school-based transition). Implications for research and school psychology are discussed.
Impact Statement
Findings from this study confirm students transitioning to high school experience academic and emotional behavior risk, as observed by teachers. In contrast, students transitioning from the middle grade in their school to the top grade (e.g., 7th to 8th grade) experienced improvement in social, academic, and emotional behavior. Therefore, school psychologists can focus school-based mental health efforts on equipping students with the socioemotional skills and academic enablers to cope prior to the transition to high school.
Children learn best when they are healthy. Therefore, access to school-based health and providing family support for social needs play an essential role in shaping a child's ability to succeed academically. The purpose of this mixed-methods review, which considers studies with all methods, is to describe and examine the effect of US school-based care coordination programs on all the outcomes reported. Care coordination is an organized approach to connect families to resources in the community to address social needs. The literature search identified 260 papers published since 2012 through CINAHL, ERIC, EMBASE, MEDLINE, Social Sciences Full Text, and Web of Science, from which 11 were included that described a US school-based care coordination program. An a priori organizing framework: Program Development, Implementation, and Evaluation were used to organize the findings. Whether quantitative or qualitative, all evaluation results were transformed into qualitative texts, then converted into codes then themes. Various health and learning issues such as asthma and vision screening were addressed. More than half of the care coordination programs were nurse-led. Parents and students characterized care coordination activities as convenient, trusting, and perceived to improve parent-teacher engagement. They also enhanced asthma knowledge and management, immunization adherence, follow-up care for vision and hearing, mental health, and school attendance. Nevertheless, challenges included staff shortages, unmet family needs, privacy laws regarding student data, and lack of resources (i.e., medications). This review highlights the need to expand school-based care coordination programs in the US and conduct robust program evaluations to assess their effectiveness.
This review examines the history and contemporary landscape of school mental health, describing evidence that schools are an essential component of the system of child and adolescent care and providing recommendations to advance this vital care delivery system. This literature review of scientific data and shifts to policy and practice in school mental health documents the evolution of collaboration between the education and mental health systems to support student mental health. This review describes best practices and provides examples for achieving the standards of the comprehensive school mental health systems model in states and local communities. Data demonstrate that multitiered systems of mental health support and services in schools, including mental health promotion, prevention, early intervention, and treatment, improve academic and psychosocial functioning and reduce risk of poor outcomes, including mental illness and school failure. Policy and practice shifts in the field reflect a movement toward integrating mental health systems into the education sector, including preparing the education workforce to promote mental health and to support early identification of and intervention to address mental illness. To create a full continuum of mental health supports for students, states and districts can draw on national best practices and state exemplars as they install multitiered systems of mental health supports in all schools, conduct universal student mental health monitoring, and coordinate school and community mental health systems.
The aim of this article is to develop and assess a model for care coordination (CC). A novel hybrid approach of Decision-Making Trial and Evaluation Laboratory (DEMATEL) and partial least square structural equation modelling (PLS-SEM) has been used to assess the CC model. The study has been conducted in four phases: (a) literature review, (b) Delphi session, (c) development of CC model through DEMATEL and (d) validation of the model through PLS-SEM. The study involves perspectives of service providers as well as service receivers, for which data were collected from hospitals across India. The literature review and Delphi session helped in finalising the seven measures of CC. Identified measures of CC are: IT-enabled coordination, inter-professional teamwork and consistency, patient centredness, communication and information transfer, physical infrastructural facilities and requirements, delivery of quality care, and facilitating transitions and accountability. Patient-centredness was found to be the most important construct of CC. Delivery of quality care is the most influenced construct and is affected by all the other constructs. Based on the results, practitioners may develop an overarching strategy to deliver seamless care and better health outcomes. This understanding may help in designing processes which in turn would deliver health as a social good.
With the growing adoption and implementation of multi-tiered systems of support (MTSS) in school settings, there is increasing need for rigorous evaluations of adaptive-sequential interventions. That is, MTSS specify universal, selected, and indicated interventions to be delivered at each tier of support, yet few investigations have empirically examined the continuum of supports that are provided to students both within and across tiers. This need is compounded by a variety of prevention approaches that have been developed with distinct theoretical foundations (e.g., Positive Behavioral Interventions and Supports, Social-Emotional Learning) that are available within and across tiers. As evidence-based interventions continue to flourish, school-based practitioners greatly need evaluations regarding optimal treatment sequencing. To this end, we describe adaptive treatment strategies as a natural fit within the MTSS framework. Specifically, sequential multiple assignment randomized trials (SMART) offer a promising empirical approach to rigorously develop and compare adaptive treatment regimens within this framework.
School-based mental health services are those delivered by school-employed and community-employed providers in school buildings. With the implementation of provisions of the Patient Protection and Affordable Care Act (2010) that funds school-based health centers, school-based mental health services could become more broadly available in communities throughout the United States. Playing a pivotal role in promoting models for school-based services that maximize benefits to children and adolescents while making efficient use of communities' mental health resources are school psychologists. School psychologists, who recognize and respect the separated development of school and community mental health professions, can foster school–agency partnerships to coordinate children's mental health services that are comprehensive, child centered, family focused, and culturally competent. In this article, we provide three case examples using the Participatory Culture-Specific Intervention Model (B. K. Nastasi, R. B. Moore, & K. M. Varjas, 2004 Nastasi, B. K., Moore, R. B., & Varjas, K. M. (2004). School-based mental health services: Creating comprehensive and culturally specific programs. Washington, DC: American Psychological Association. ) as exemplars for the implementation of community partnerships providing comprehensive culturally and contextually relevant school-based mental health services.
Schools have played an increasingly central role in providing mental health services to youth, but there are limitations to the services that are available through school-based mental health professionals. Thus, collaboration with non-school-based community mental health providers is oftentimes necessary. As collaboration can address limitations of school-based services and enhance and complement school-based services, it has been identified as best practice in comprehensive mental health service delivery. This collaboration column provides a brief review that highlights the critical opportunities for collaboration between school- and non-school-based professionals. Potential barriers to effective collaboration are also discussed, and strategies are introduced to overcome these barriers in order to provide effective and complementary mental health services to students in need.
The realisation that most mental disorders have their onset before the age of twenty-five has focused psychiatric research towards adolescent mental health. This book provides vivid examples of school mental health innovations from eighteen countries, addressing mental health promotion and interventions. These initiatives and innovations enable readers from different regions and disciplines to apply strategies to help students achieve and maintain mental health, enhance their learning outcomes and access services, worldwide. Through case studies of existing programs, such as the integrated system of care approach in the USA, the school-based pathway to care framework in Canada, the therapeutic school consultation approach in Turkey and the REACH model in Singapore, it highlights challenges and solutions to building initiatives, even when resources are scarce. This will be essential reading for educators, health providers, policy makers, researchers and other stakeholders engaged in helping students achieve mental health and enhance their learning outcomes.
The alarming number of youth with unmet mental health needs in the US is a significant social problem. The pilot school-based mental health project described here established an innovative multi-system partnership between an urban school district, a public mental health agency, and a local university to better meet the mental health needs of youth in one community. This qualitative study employed in depth interviews with six key administrators who were instrumental in developing and executing the project to explore the most important factors that promoted the successful collaboration. Results of the interviews identified five major themes: (a) perceptions of the project, (b) barriers to collaboration, (c) motivating factors, (d) sustainability, and (e) lessons learned. Findings may be especially helpful to other communities interested in establishing a multi-system intervention to support at risk youth. Implications for practice and research are discussed.
Psychiatric hospitalization is an intensive intervention designed to stabilize adolescents who are experiencing an acute mental health crisis. Reintegrating to school after discharge from psychiatric hospitalization can be overwhelming for many adolescents (E. V. Clemens, L. E. Welfare, & A. M. Williams, 2010). The authors used a consensual qualitative research approach (C. E. Hill et al., 2005; C. E. Hill, B. J. Thompson, & E. N. Williams, 1997) to explore 14 mental health professionals’ perceptions regarding assets and barriers to adolescents’ successful school reintegration after psychiatric hospitalization. The authors describe the implications for educators and parents derived from participant interviews.
School mental health programs from developed countries demonstrate that both the practice and research are becoming more important to policy makers, educators, health providers, parents, and other stakeholders. Some United Nations agencies and other international organizations have begun work to advance school mental health internationally. School-based mental health programming needs to be considered as part of usual child and youth mental health policies and plans, whether those are national or other jurisdictional in nature. Currently, a paucity of evidence-based and cost effective child and youth global mental health policies/programs exist, limiting school-based mental health programs being developed, implemented, or sustained.
Advancing comprehensive school mental health: Guidance from the field
- S Hoover
- N Lever
- N Sachdev
- N Bravo
- J Schlitt
- O Acosta Price
- L Sheriff
- J Cashman
Hoover, S., Lever, N., Sachdev, N., Bravo, N., Schlitt, J., Acosta Price, O., Sheriff, L. &
Cashman, J. (2019). Advancing comprehensive school mental health: Guidance from the
field. Baltimore, MD: National Center for School Mental Health. University of Maryland
School of Medicine.