No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Student Outcomes From Participation in the Mental Health Action Plan Pilot Program: A Case Study
Psychology in the Schools
Abstract
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.
ResearchGate has not been able to resolve any citations for this publication.
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.
Background
The COVID-19 pandemic has caused significant stress and disruption for young people, likely leading to alterations in their mental health and neurodevelopment. In this context, it is not clear whether youth who lived through the pandemic and its shutdowns are comparable psychobiologically to their age- and sex-matched peers assessed before the pandemic. This question is particularly important for researchers who are analyzing longitudinal data that span the pandemic.
Methods
In this study we compared carefully matched youth assessed before the pandemic (n=81) and after the pandemic-related shutdowns ended (n=82).
Results
We found that youth assessed after the pandemic shutdowns had more severe internalizing mental health problems, reduced cortical thickness, larger hippocampal and amygdala volume, and more advanced brain age.
Conclusions
Thus, not only does the COVID-19 pandemic appear to have led to poorer mental health and accelerated brain aging in adolescents, but it also poses significant challenges to researchers analyzing data from longitudinal studies of normative development that were interrupted by the pandemic.
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.
In this article, we follow up on recommendations from the Division for Emotional and Behavioral Health (DEBH) for providing
school mental health (SMH) services by offering additional implementation suggestions for teachers and school staff. We
highlight the need for and urgency of SMH services, particularly during and after the pandemic, and also consider broad issues
that interfere with the success of SMH. We then provide a number of specific recommendations for integrating the delivery of
SMH services within a tiered system of supports that are intended to empower school staff to move toward implementation.
Last, we address how effective implementation can be facilitated by strong administrative support along with capacity building.
This study examines differential effects of the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program on behavioral and academic outcomes of middle school students. Researchers administered screenings to grade 6 students to assess traumatic stress and then randomized those with elevated levels to the CBITS treatment (n = 150; 47% female) or comparison group (n = 143; 53% female). Analyses examined the overall impact of CBITS and differential effects among subpopulations of students who reported clinically significant externalizing (n = 75; 67% female) or internalizing behavior (n = 185; 53% female) at baseline. Overall, students who received CBITS reported significantly reduced post-traumatic stress symptoms and marginally significant improvements in internalizing symptoms. Relative to counterparts in the comparison group, students exhibiting externalizing behaviors in the CBITS group reported significantly reduced post-traumatic stress, dissociation, anger, internalizing and total behavior problems, and also significantly improved scores on a standardized literacy assessment at posttest and follow-up. Students with internalizing behavior problems showed differential academic effects at 1-year follow-up; those in CBITS did significantly better on standardized math tests.
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.
Navigating academic demands in middle and high school may be particularly challenging for youth experiencing emotional and behavioral difficulties, and screening practices are a necessary first step in identifying youth in need of services. The goal of this study was to inform efficient universal screening practices in secondary schools by comparing 3 common methods of screening, including self- and teacher report on the Strengths and Difficulties Questionnaire, and grade point average (GPA) to indicate moderate and high levels of risk. Participants were 2,350 secondary students (47% female; 94% non-Hispanic White) and their teachers in 1 socioeconomically diverse school district. Using the moderate-risk criteria, there was low agreement among methods, and almost half the sample (46%) was identified as at risk by at least 1 of the 3 methods, indicating that responding to the needs of students who cross this liberal cutoff may not be feasible given school resources. Using the high-risk criteria reduced the agreement among screening measures. Self-report identified the most students as high risk and was more sensitive to teacher-rated concerns than the converse. If students were uniquely identified by teacher report, teachers rated them at high levels of risk, and predominant concerns were related to conduct problems. GPA captured few students with self- or teacher-rated internalizing or externalizing difficulties. Implications for universal screening within secondary schools are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Identifying youth with mental health concerns and connecting them to effective intervention is important because poor mental health is related to lower educational achievements, substance abuse, violence, compromised health, and reduced life satisfaction. This study examined the ability of teachers (n = 153) to accurately identify mental health concerns among elementary children using vignettes scenarios depicting children with severe and moderate externalizing or internalizing behavior problems. Teachers were asked to rate the seriousness of the problem, their concern for the child’s well-being, and whether they felt the student needed school-based or community mental health services. Findings indicated that teachers can accurately identify students with severe externalizing and internalizing problems. However, they were less accurate and less likely to think students with moderate or subclinical symptoms needed services. Additionally, teachers perceived externalizing problems to be more serious and more concerning, than internalizing problems. In most cases, teachers’ concern for the child’s well-being, but not their perceived seriousness of the problem, predicted endorsement of referral to school and/or community-based mental health professionals, even when controlling for the child’s gender. Implications for practice and future research areas are discussed.
The purpose of this study was to support the identification of Social, Academic, and Emotional Behavior Risk Screener (SAEBRS) cut scores that could be used to detect high-risk students. Teachers rated students across two time points (Time 1 n = 1,242 students; Time 2 n = 704) using the SAEBRS and the Behavioral and Emotional Screening System (BESS), the latter of which served as the criterion measure. Exploratory receiver operating characteristic (ROC) curve analyses of Time 1 data detected cut scores evidencing optimal levels of specificity and borderline-to-optimal levels of sensitivity. Cross-validation analyses of Time 2 data confirmed the performance of these cut scores, with all but one scale evidencing similar performance. Findings are considered particularly promising for the SAEBRS Total Behavior scale in detecting high-risk students.
Collaborative, person-centered approaches to care planning are increasingly recognized as instrumental in supporting attainment of personal recovery outcomes. Yet, though much is known about factors that support person-centered planning, successful implementation often remains an elusive goal. This article reviews international efforts to promote person-centered care planning (PCCP) in the context of a randomized clinical trial in the United States and in the Meaningful and Measurable initiative, a collaborative action research project involving diverse provider organizations in Scotland. The authors review the history of international efforts to implement PCCP and offer preliminary evidence regarding its positive impact on both process outcomes (e.g., the nature of the primary therapeutic relationship and the service-user’s experience) and personal recovery outcomes (e.g., quality of life, community belonging, and valued roles). PCCP will be defined through descriptions of key principles and practices as they relate to both relational aspects (e.g., shifts in stakeholder roles and conversations) and documentation/recording aspects (e.g., how person-centered relationships are captured in written or electronic records). Similarities and differences between the United States and Scottish experiences of PCCP are highlighted and a series of recommendations offered to further implementation of this essential recovery-oriented practice.
The majority of studies on parent-child discrepancies in the assessment of adolescent emotional and behavioral problems have been conducted in Western countries. It is believed that parent-adolescent agreement would be higher in societies with a strong culture of familism. We examined whether parent-adolescent discrepancies in the rating of adolescent emotional and behavioral problems are related to parental and family factors in Taiwan. Participants included 1,421 child-parent pairs of 7th-grade students from 12 middle schools in Northern Taiwan and their parents. We calculated Pearson’s correlation coefficients to assess the relationship between parental (Child Behavior Checklist, CBCL) and adolescent (Youth Self Report, YSR) report of emotional/behavioral problem syndromes. Regression models were used to assess parent-adolescent differences in relation to parental psychopathology and family factors. We found that parent-adolescent agreement was moderate (r = 0.37). Adolescents reported higher symptom scores than their parents (Mean Total Problem Score: CBCL: 20.79, YSR: 33.14). Parental psychopathology was related to higher parental ratings and better informant agreement. Parents with higher socioeconomic status (SES) tended to report lower scores for adolescent problem syndromes, resulting in higher levels of disagreement. Greater maternal care was related to higher parent-adolescent agreement. Based on our study findings, we conclude that familism values do not seem to improve parent-child agreement in the assessment of adolescent problem syndromes. The finding that higher SES was related to increased discrepancies speaks to the need to explore the culture-specific mechanisms giving rise to informant discrepancies.
Restorative approaches to school discipline are increasingly being implemented throughout the United States in an attempt to reduce reliance on suspension and eradicate the racial discipline gap. Yet, little is known about the experience of students in classrooms utilizing restorative practices (RP). This study draws on student surveys (N = 412) in 29 high school classrooms. Hierarchical linear modeling and regression analyses show that high RP-implementing teachers had more positive relationships with their diverse students. Students perceived them as more respectful and they issued fewer exclusionary discipline referrals compared with low RP implementers. In addition, the findings demonstrate some initial promise of well-implemented RP for narrowing the racial discipline gap. The study found that higher RP implementers issued fewer discipline referrals to Latino and African American students compared with lower RP implementers. The study findings have implications for equity-focused consultation in schools that honor student experience of new programming.
Les enfants ayant un trouble du déficit de l’attention avec hyperactivité (TDAH) doivent relever diverses difficultés sur le plan comportemental, social et scolaire. Toutefois, il ne faut pas négliger l’importance de mettre en valeur les forces et les capacités de ces enfants, en particulier dans le contexte scolaire. Ce bref rapport porte sur l’application de la psychologie positive dans une population le plus souvent vue sous un jour négatif, les enfants présentant un TDAH. En particulier, cet article fournit un argument en faveur d’une meilleure compréhension de cette population et illustre la nécessité d’adopter une approche axée sur les forces de ces enfants, lorsqu’on travaille avec ces derniers ou qu’on les soutient. Sont discutées des façons possibles d’en arriver à une telle approche, à la fois en recherche et dans la pratique, appuyées par des concepts empruntés à des domaines de la psychologie positive, les perspectives relatives aux forces et la résilience. Les avantages d’une intégration de cadres tirés de la psychologie positive et les orientations éventuelles de cette démarche en matière de recherches sur le TDAH sont présentés, en insistant sur l’importance de relier les résultats à la pratique factuelle. Sont aussi examinées les répercussions pour la pratique en milieu scolaire; est alors soulignée l’importance de l’évaluation et des interventions basées sur les forces afin d’offrir aux enfants ayant un TDAH un soutien positif et équilibré. Il est conclu que la psychologie positive constitue une démarche équilibrée, harmonieuse et prometteuse pour une population le plus souvent perçue de façon négative. Une telle démarche a le potentiel de susciter les efforts visant à renforcer les capacités, tant chez les enfants qu’au sein de leur famille et de leur milieu scolaire.
Service disengagement is a pervasive challenge the mental health care system faces. Mental health services are of little value should persons with mental illnesses continue to opt out of receiving them. Consumers attribute disengagement from care to an absence of choice in their treatment. In response, the mental health system is adopting a person-centered model, based upon recovery principles, to engage consumers more actively in their care. Person-centered care planning is a promising practice involving collaboration to develop and implement an actionable plan to assist the person in achieving personal recovery goals.
This study design combines a parallel-group randomized controlled trial of community mental health organizations with qualitative methods to assess the effectiveness of person-centered care planning. Participants at 14 sites in Delaware and Connecticut will be randomized to treatment as usual or the person-centered care planning intervention. Participants will be in leadership (n = 70) or supervisory or direct care (n = 210) roles. The person-centered care planning intervention involves intensive staff training and 12 months of ongoing technical assistance. Quantitative survey data will be collected at baseline, 6 months and 12 months measuringperson-centered care planning competency and organizational factors. Consumer outcomes (engagement, medication adherence, functioning and consumer satisfaction) will be assessed by Medicaid and state-level data. Qualitative data focused on process factors will include staff and consumer interviews and focus groups. In this intent-to-treat analysis, we will use mixed-effects multivariate regression models to evaluate the differential impact of the person-centered care planning intervention on each consumer and implementation outcome as well as the extent to which clinician assessments of organizational factors are associated with the implementation outcome. Mixed methods will triangulate and strengthen the interpretation of outcomes.
The aim of this study is to generate valuable guidance for state systems engaged in scale-up and transformation efforts. Targeted staff selection for training to support sustainability will serve to provide further insight into important intervention implementation strategies. Person-centered care planning has the potential to enhance the impact of all evidence-based and recovery-oriented practices and bring practice into line with the emerging national guidelines in health care reform.
This trial was registered with ClinicalTrials.gov (Identifier: NCT02299492 ) on 21 November 2014 as New York University Protocol Record PCCP-13-9762, Person-Centered Care Planning and Service Engagement.
A clinician's effectiveness in treatment depends substantially on his or her attitude toward -- and understanding of -- the patient as a person endowed with self-awareness and the will to direct his or her own future. The assessment of personality in the therapeutic encounter is a crucial foundation for forming an effective working alliance with shared goals. Helping a person to reflect on their personality provides a mirror image of their strengths and weaknesses in adapting to life's many challenges. The Temperament and Character Inventory (TCI) provides an effective way to describe personality thoroughly and to predict both the positive and negative aspects of health. Strengths and weaknesses in TCI personality traits allow strong predictions of individual differences of all aspects of well-being. Diverse therapeutic techniques, such as diet, exercise, mood self-regulation, meditation, or acts of kindness, influence health and personality development in ways that are largely indistinguishable from one another or from effective allopathic treatments. Hence the development of well-being appears to be the result of activating a synergistic set of mechanisms of well-being, which are expressed as fuller functioning, plasticity, and virtue in adapting to life's challenges.
This document outlines the fundamentals of the Creating Cultures of Trauma-Informed Care approach to organizational change. Buyilidng on core vales of safety, trustworthiness, choice, collaboration, and empowerment, this framework includes equal attention to the experiences of those receiving and those providing services. Though built on a foundation of behavioral health (mental health and substance abuse) agencies, this approach has been adapted to schools, to general medical settings, and to a variety of correctional settings, including juvenile justice.
We examined the measurement of educational outcomes related to children's mental health treatments. A total of 85 papers describing 88 randomized controlled trials that included at least one educational outcome and one mental health outcome were included in these analyses. Forty-five different measures were identified as the primary educational outcome of interest in these studies. Educational measures reflected academic achievement (64.2%), academic and behavioural skills (20.1%), attendance (11.2%), quality of the learning environment (3.4%) and academic self-efficacy (1.1%). Positive educational outcomes were demonstrated by treatments delivered in school and non-school settings. There was a significant association between improvement on educational and mental health outcomes. Within the literature of children's mental health treatments, few studies (14.86%) measure educational outcomes. Of those that do, there is significant diversity in measurement methods. Nevertheless, these results offer promise that mental health treatments can succeed in improving both mental health symptoms and educational performance.
During the past decade there has been an increasing interest in positive psychology, which promotes a shift away from the traditional deficit-based model of mental health to a framework that emphasizes social-emotional strengths. The building of strengths and an emphasis on the prevention of problems are at the forefront of positive psychology and equally important in the field of school psychology. Based on a review of the extant literature, this article addresses four important questions: (a) What is strength-based assessment? (b) Why use strength-based assessment in school psychology? (c) What are examples of strength-based assessments? and (d) What are the limitations and needs for further research related to strength-based assessment? Implications for both research and practice are emphasized throughout.
Child and adolescent patients may display mental health concerns within some contexts and not others (e.g., home vs. school). Thus, understanding the specific contexts in which patients display concerns may assist mental health professionals in tailoring treatments to patients' needs. Consequently, clinical assessments often include reports from multiple informants who vary in the contexts in which they observe patients' behavior (e.g., patients, parents, teachers). Previous meta-analyses indicate that informants' reports correlate at low-to-moderate magnitudes. However, is it valid to interpret low correspondence among reports as indicating that patients display concerns in some contexts and not others? We meta-analyzed 341 studies published between 1989 and 2014 that reported cross-informant correspondence estimates, and observed low-to-moderate correspondence (mean internalizing: r = .25; mean externalizing: r = .30; mean overall: r = .28). Informant pair, mental health domain, and measurement method moderated magnitudes of correspondence. These robust findings have informed the development of concepts for interpreting multi-informant assessments, allowing researchers to draw specific predictions about the incremental and construct validity of these assessments. In turn, we critically evaluated research on the incremental and construct validity of the multi-informant approach to clinical child and adolescent assessment. In so doing, we identify crucial gaps in knowledge for future research, and provide recommendations for "best practices" in using and interpreting multi-informant assessments in clinical work and research. This article has important implications for developing personalized approaches to clinical assessment, with the goal of informing techniques for tailoring treatments to target the specific contexts where patients display concerns. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
This manuscript summarizes areas of school mental health (SMH) research relevant to the interplay between students’ academic and social–emotional outcomes. After advancing a multidimensional conceptualization of academic success at the levels of individual students and schools, we summarize observational and intervention studies that connect students’ mental health to their academic achievement, with acknowledgment of the bidirectional relationship. Then, current and future directions of SMH research are discussed, including (a) the impact of SMH health initiatives and services on schools’ achievement, (b) the need to address the mental health of historically neglected subgroups of students, and (c) interdisciplinary collaborations necessary to support enhanced outcomes. Based on the findings from these literature integrations, we conclude with recommendations and implications for research and practice.
Objective:
Tailoring service planning to clients' personal life goals, or person-centered planning, has emerged as a recovery-oriented practice. This study examined the impact of person-centered planning and collaborative documentation on service engagement and medication adherence within community mental health centers (CMHCs).
Methods:
Ten CMHCs were assigned randomly to receive training in person-centered planning and collaborative documentation or provide usual treatment. Medication adherence and service engagement were measured for 11 months (May 2009-March 2010) for 367 clients. Models compared changes in medication adherence and service engagement among clients of CMHCs in the control and experimental conditions.
Results:
Medication adherence increased significantly at CMHCs in the experimental condition (B=.022, p≤.01) but showed no significant change at CMHCs in the control condition (B=.004, p=.25). Appointment no-shows at CMHCs in the experimental condition were reduced (odds ratio=.74, p=.001).
Conclusions:
Person-centered planning and collaborative documentation were associated with greater engagement in services and higher rates of medication adherence.
A developmental cascade model linking competence and symptoms was tested in a study of a normative, urban school sample of 205 children (initially 8 to 12 years old). Internalizing and externalizing symptoms and academic competence were assessed by multiple methods at the study outset and after 7, 10, and 20 years. A series of nested cascade models was tested through structural equation modeling. The final model indicated 2 hypothesized cascade effects: Externalizing problems evident in childhood appeared to undermine academic competence by adolescence, which subsequently showed a negative effect on internalizing problems in young adulthood. A significant exploratory effect was consistent with internalizing symptoms containing or lowering the net risk for externalizing problems under some conditions. These 3 cascade effects did not differ by gender and were not attributable to effects of IQ, parenting quality, or socioeconomic differences. Implications are discussed for developmental models of cascades, progressions, and preventive interventions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discrepancies often arise among multiple informants' reports of child and adolescent psychopathology and related constructs (e.g., parenting, family relationship quality and functioning, parental monitoring). Recently, studies using various designs (laboratory, longitudinal, randomized controlled trial, meta-analysis) have revealed that discrepancies among informants' reports (a) yield important information regarding where children express behaviors (time course, features of the context[s] of behavioral expression) and about the informants who observe their expression, (b) demonstrate stability over time in both community and clinic settings, (c) predict poor child and adolescent outcomes in ways that the individual informants' reports do not, and (d) can be used to identify meaningful treatment outcomes patterns within randomized controlled trials. Using existing data sources, the articles in this special section expand upon this emerging body of research. In particular, the articles illustrate how clinical science and practice can use informant discrepancies to increase understanding of the causes and consequences of, as well as treatments for, child and adolescent psychopathology.
To promote improved student outcomes, school mental health providers (SMHPs) monitor implementation fidelity when implementing evidence‐based interventions. Current approaches for implementation fidelity monitoring (e.g., intervention checklists) do not account for other relevant implementation indicators best captured through qualitative data. Therefore, this study employed a multi‐faceted approach to monitoring implementation fidelity of the Mental Health Action Plan (MHAP) Program, a school‐based person‐centered care planning program developed to coordinate mental health care at school. The purpose of this mixed methods study was to explore the extent to which the MHAP Program was implemented as intended by describing determinants (i.e., barriers and facilitators) to adherent implementation. Three participant triads (student, caregiver, teacher) and three SMHPs were included in the study. Implementation fidelity checklists and field note data was collected and analyzed using reflexive thematic analysis and descriptive statistics. Qualitative results provided greater context for the quantitative results and elucidated potential adaptations to enhance youth‐intervention fit. Themes related to the caregiver‐child relationship, logistical barriers, student factors, SMHP competing responsibilities, and team dynamics impacted implementation fidelity. Implications for monitoring implementation fidelity of school mental health interventions via qualitative methods as well as study limitations are discussed.
Introduction
Many mental disorders begin in early childhood. Without timely treatment, mental disorders experienced by young children can impair their learning ability and relationships with others, causing lifelong complications. However, not all children with a mental disorder in early childhood receive treatment.
Methods
Using data collected from 46,424 children aged 2 to 8 years in the 2 most recent cycles of the National Survey of Children’s Health (2021 and 2022), we estimated the prevalence of having a mental disorder and investigated factors associated with young children not receiving mental health care when needed. All analyses were adjusted for survey weights to account for the complex sampling design and nonresponse biases in generating nationally representative estimates.
Results
In 2021 and 2022, 19.0% of US children aged 2 to 8 years had 1 or more mental disorders. Of these children, 9.1% reported not receiving any needed health care in the previous 12 months, and of these, 45.8% reported not receiving mental health services when needed. The primary reasons for not receiving needed health care were problems getting an appointment (72.1%), issues related to cost (39.3%), and services needed not being available in the area (38.5%). Poor experiences with health care providers were consistently associated with not receiving needed mental health services among children with mental disorders.
Conclusion
Our findings suggest a strong link between health care factors and not receiving needed mental health services among US children with a mental disorder in early childhood. In addition to increasing the availability of mental health services and expanding health insurance coverage, future public health efforts should prioritize enhancing patients’ experiences with health care providers.
Research has demonstrated school-based problem-solving teams (SB PSTs) can effectively improve student functioning while reducing special education referrals and disproportionality. Despite wide-spread use, research has yet to explore how research and best-practice guidance has translated to applied SB PST implementation. Survey responses from 3,233 educators begins this exploration. Study results provide insight into SB PST prevalence, processes, procedures, composition, and targeted outcomes as well as educator perceptions of team efficiency and effectiveness. Study findings supported the hypotheses that applied SB PST implementation varies widely across team name, activities, membership, and perceived efficiency and effectiveness and are likely not as effective as research suggests. These findings may be related to the infrequent alignment of reported practices with evidence-based guidance.
The purpose of this study was to evaluate the structural validity, internal consistency, and measurement invariance of scores from the Social, Academic, and Emotional Behavior Risk Screener–Student Rating Scale (mySAEBRS), a student self-report universal screening tool. Participants included 24,094 K–12 students who completed the mySAEBRS. Confirmatory factor analyses (CFAs) supported the fit of a bifactor model, wherein each item corresponding to both a general factor (i.e., Total Behavior) and one of three narrow factors (i.e., Social Behavior, Academic Behavior, and Emotional Behavior). Such model fit was superior to that of alternative factor structures (i.e., unidimensional, correlated-factor, and higher order). A review of pattern coefficients suggested items were relatively split, with some items loading higher on the general factor and others loading higher on their narrow factor. A series of multigroup CFAs supported the configural and metric invariance of the bifactor model, while yielding less consistent support for scalar/threshold invariance. Omega reliability coefficients indicated each mySAEBRS scale was associated with acceptable internal consistency (>.70). However, when accounting for other factors, only the Total Behavior, Social Behavior, and Emotional Behavior scales demonstrated acceptable internal consistency (i.e., >.50). Implications for practice and directions for future research are discussed.
Background
School-based interventions (SBIs) are well-established and effective treatments for improving child mental health. Specific school-based topics include prevention (Tier I-III) and interventions (e.g. cognitive-behavioural programmes and daily report cards). Methods
We performed a systematic literature search in five commonly used online databases (ERIC, MEDLINE, PsycARTICLES, PsycINFO and PSYNDEX) for English-language articles published between 1993 and 2015. Additional sources included reference lists of relevant articles and book chapters. ResultsWe identified a number of successful behavioural or cognitive-behavioural programmes yielding moderate to strong effects for a range of emotional and behavioural problems. The implementation of these programmes and the collaboration of the involved settings (school and home) and persons are important factors for their effectiveness under real-life conditions. Conclusions
Effective SBIs are valuable tools for students with mental health problems if evidence-based cognitive-behavioural interventions are applied and rules of translational algorithms and implementation science are respected.
The primary purposes of this investigation were to (a) continue a line of research examining the psychometric defensibility of the Social, Academic, and Emotional Behavior Risk Screener — Teacher Rating Scale (SAEBRS-TRS), and (b) develop and preliminarily evaluate the diagnostic accuracy of a novel multiple gating procedure based on teacher nomination and the SAEBRS-TRS. Two studies were conducted with elementary and middle school student samples across two separate geographic locations. Study 1 (n = 864 students) results supported SAEBRS-TRS defensibil-ity, revealing acceptable to optimal levels of internal consistency reliability, concurrent validity, and diagnostic accuracy. Findings were promising for a combined multiple gating procedure, which demonstrated acceptable levels of sensitivity and specificity. Study 2 (n = 1534 students), which replicated Study 1 procedures, further supported the SAEBRS-TRS' psychometric defensi-bility in terms of reliability, validity, and diagnostic accuracy. Despite the incorporation of revisions intended to promote sensitivity levels, the combined multiple gating procedure's diagnostic accuracy was similar to that found in Study 1. Taken together, results build upon prior research in support of the applied use of the SAEBRS-TRS, as well as justify future research regarding a SAEBRS-based multiple gating procedure. Implications for practice and study limitations are discussed.
"Treatment Planning for Person-Centered Care puts the entire concept of individualized service planning into understandable language for all readers. The authors have captured the essence of active involvement of the persons served in the identification of needs (as well as strengths) and the development of a plan that will address those needs. This book is definitely in concert with and supports the CARF Behavioral Health standards, and would be an excellent resource to better understand how to move towards a person-centered assessment and planning process." -Nikki Migas, M.P.A., Managing Director, Behavioral Health Customer Service Unit, CARF the Rehabilitation Accreditation Commission "This book encourages the field to turn a very important corner. It clarifies the goals and the processes that Mental Health and Alcohol/Drug systems presently need to focus on: joining with clients to help them enter/re-enter their communities and successfully exit the treatment systems. This book will help practitioners develop the necessary conceptual overview as well as individual components of service plans that will significantly enhance our clients chances for real world success." -Ed Diksa, California Institute for Mental Health "The authors take what for many clinicians is irritating paperwork requirement, treatment planning, that is a diversion from their "real" work of therapy and turn it into a valuable tool. By placing the person, the client at the center of planning, Adams and Grieder take the reader step by step through a transforming process. They lead us to re-think whose goals we are trying to achieve in treatment. This book could precipitate many fruitful seminar discussions during clinical training." -Eric Goplerud, Ph.D., George Washington University Medical Center Treatment Planning for Person-Centered Care is a process-oriented book, guiding therapists in how to engage clients in building collaborative treatment plans that result in better outcomes. Suitable as both a reference tool and as a text for pre-degree training programs, the book addresses the entire process of treatment, from assessment through outcome evaluation. The book is relevant to providers in all settings, with a practical approach and case examples throughout. About the authors: Neal Adams, MD, PhD is past president of the American College of Mental Health Administration and board certified in general psychiatry. Diane Grieder, M.Ed, has over 20 years experience consulting on improved mental health delivery systems. A prologue and epilogue are included by Dr. Wilma Townsend, a leading consumer advocate, consultant, and trainer in the field. * Enhance the reader's understanding of the value and role of treatment planning in responding to the needs of adults, children and families with mental health and substance abuse treatment needs * Build the skills necessary to provide quality, person-centered, culturally competent and recovery / resiliency-orientated care in a changing service delivery system * Provide readers with sample documents, examples of how to write a plan, etc. * Provide a text and educational tool for course work and training as well as a reference for established practioners * Assist mental health and addictive disorders providers / programs in meeting external requirements, improve the quality of services and outcomes, and maintain optimum reimbursement.
Developed out a community participatory research partnership with schools, the Cognitive-Behavioral Intervention for Trauma in Schools Program is a targeted intervention for school children who have experienced a traumatic or violent event and have symptoms of posttraumatic stress disorder. This article describes the original development of the program, with its emphasis on student diversity and school culture. The authors describe the program and its elements, as well as developments over the past decade of work that include modifications for special populations, implementation and dissemination activities, and research on these efforts.
Previous research has provided mixed results regarding the effect of anxiety on academic achievement. Building on this body
of research, the present longitudinal study pursued two goals. The first goal was to describe trajectories of anxiety during
elementary-school years. The second goal was to determine the predictive value of these trajectories on high school noncompletion
after controlling for personal (i.e., gender, classroom behaviors, and academic achievement) and familial (i.e., sociofamilial
adversity) characteristics. A community sample of 1,817 children (887 boys, 930 girls) participated in this study. Results
showed that anxiety tended to fluctuate from kindergarten to Grade 6 for different groups of children. Furthermore, the result
of a logistic regression analysis indicated that group membership for anxiety predicted high school noncompletion by age 20.
As a whole, these findings suggest that considering heterogeneous developmental patterns of anxiety during elementary-school
years appears quite useful for predicting an important outcome such as high school noncompletion.
Providing culturally competent and person-centered care is at the forefront of changing practices in behavioral health. Significant health disparities remain between people of color and whites in terms of care received in the mental health system. Peer services, or support provided by others who have experience in the behavioral health system, is a promising new avenue for helping those with behavioral health concerns move forward in their lives.
We describe a model of peer-based culturally competent person-centered care and treatment planning, informed by longstanding research on recovery from serious mental illness used in a randomized clinical trial conducted at two community mental health centers.
Participants all were Latino or African American with a current or past diagnosis within the psychotic disorders spectrum as this population is often underserved with limited access to culturally responsive, person-centered services. Study interventions were carried out in both an English-speaking and a Spanish-speaking outpatient program at each study center. Interventions included connecting individuals to their communities of choice and providing assistance in preparing for treatment planning meetings, all delivered by peer-service providers. Three points of evaluation, at baseline, 6 and 18 months, explored the impact of the interventions on areas such as community engagement, satisfaction with treatment, symptom distress, ethnic identity, personal empowerment, and quality of life.
Lessons learned from implementation include making cultural modifications, the need for a longer engagement period with participants, and the tension between maintaining strict interventions while addressing the individual needs of participants in line with person-centered principles. The study is one of the first to rigorously test peer-supported interventions in implementing person-centered care within the context of public mental health systems.
Perspectives on the Mental Health Action Plan (MHAP) Pilot Program
- M A Nygaard
- . E Ormiston
Nygaard, M. A., and H. E. Ormiston. 2025c. Perspectives on the Mental
Health Action Plan (MHAP) Pilot Program [Manuscript Submitted for
Publication].
Trauma Symptom Checklist for Children
- Par
What Is a Behavior Intervention Plan?Child mind institute
- G Miller
Miller, G. 2022, May 5. What Is a Behavior Intervention Plan? Child
mind institute. https://childmind.org/article/what-is-a-behaviorintervention-plan/.
A Preliminary Exploration of Key Elements in Proactive Plans of Care for School Mental Health Service Coordination
- M A Nygaard
- . E Ormiston
Nygaard, M. A., and H. E. Ormiston. 2025a. A Preliminary Exploration
of Key Elements in Proactive Plans of Care for School Mental Health
Service Coordination [Manuscript Submitted for Publication]. Indiana
University, Bloomington.
What Is Children's Mental Health?
Centers for Disease Control and Prevention. 2022c. What Is Children's
Mental Health? https://www.cdc.gov/childrensmentalhealth/basics.html.
Using i-Ready as a Student Growth Measure. i-Ready
- Curriculum Associates
Curriculum Associates, LLC. 2022. Using i-Ready as a Student Growth
Measure. i-Ready. https://core-docs.s3.us-east-1.amazonaws.com/
documents/asset/uploaded_file/4752/CDAPS/4171799/iready-deepdive-using-i-ready-as-a-student-growth-measure-2022.pdf.
Social, Academic, and Emotional Behavior Risk Screener (SAEBRS)
- S P Kilgus
- S M Chafouleas
- T C Riley-Tillman
- N P Von Der Embse
Kilgus, S. P., S. M. Chafouleas, T. C. Riley-Tillman, and
N. P. von der Embse. 2014. Social, Academic, and Emotional Behavior
Risk Screener (SAEBRS). Theodore J. Christ & Colleagues.
Homework, Organization, and Time-Management Skills (HOPS) Intervention: A Treatment Manual
- J Langberg
Langberg, J. 2022. Homework, Organization, and Time-Management
Skills (HOPS) Intervention: A Treatment Manual (2nd ed.). National
Association of School Psychologists.
Helping Measure Person-Centred Care: A Review of Evidence About Commonly Used Approaches and Tools Used to Help Measure Person-centred Care. The Health Foundation: Inspiring Improvement
- D De Silva
de Silva, D. 2014. Helping Measure Person-Centred Care: A Review of
Evidence About Commonly Used Approaches and Tools Used to Help
Measure Person-centred Care. The Health Foundation: Inspiring
Improvement. Retrieved from https://www.health.org.uk/sites/default/
files/HelpingMeasurePersonCentredCare.pdf.