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The New Freedom Commission has called for a transformation in the delivery of mental health services in this country. The commission's report and recommendations have highlighted the role of school mental health services in transforming mental health care for children and adolescents. This article examines the intersection of school mental health programs and the commission's recommendations in order to highlight the role of school mental health in the transformation of the child and adolescent mental health system. Schools are uniquely positioned to play a central role in improving access to child mental health services and in supporting mental health and wellness as well as academic functioning of youths. The New Freedom Commission report articulated several goals related to school mental health: reducing stigma, preventing suicide, improving screening and treating co-occurring disorders, and expanding school mental health programs. The authors suggest strategies for change, including demonstrating relevance to schools, developing consensus among stakeholders, enhancing community mental health-school connections, building quality assessment and improvement, and considering the organizational context of schools.
PSYCHIATRIC SERVICES October 2007 Vol. 58 No. 10
The failure of the nation’s child
mental health system to fully
address the mental health
needs of children and adolescents has
been well documented and points to
the need to reconsider current policy
and practice (1–4). The lack of clear
direction or a unified vision to guide
efforts within the system arguably
contributes to the inadequacy of care
received by our nation’s youths.
In 2002, President George W. Bush
established the President’s New
Freedom Commission on Mental
Health to analyze the state of the
country’s mental health system. After
a year of study and input from more
than 2,000 stakeholders, the commis-
sion concluded that “the mental
health delivery system is fragmented
and in disarray . . . leading to unnec-
essary and costly disability, homeless-
ness, school failure and incarceration”
(5). The final report of the commis-
sion, Achieving the Promise: Trans-
forming Mental Health Care in Amer-
ica (5), highlighted unmet needs and
barriers to care, including fragmenta-
tion and gaps in care for children and
lack of a national priority for mental
health care. The report articulates six
goals and 19 recommendations that
target dramatic transformation and
improvement of child, adolescent,
and adult mental health systems (see
box on page 1332).
The commission unequivocally rec-
ognized that mental health services in
schools are a critical component in re-
building our mental health system for
children. Given that the recommen-
dations of the New Freedom Com-
mission report are consistent with the
goals of most school mental health
programs, efforts have been made to
identify the implications of the New
Freedom Commission report for ad-
vancing a school mental health policy
agenda (6,7). The New Freedom
Commission report includes very spe-
cific and direct linkage to school men-
tal health services and programs as
described in goal 4, “Early mental
health screening, assessment, and re-
ferral to services are common prac-
tice.” To reach this goal, the commis-
sion recommended that we “improve
and expand school mental health pro-
grams” (recommendation 4.2).
This article examines the intersec-
tion of school mental health and the
New Freedom Commission recom-
mendations in order to highlight the
role of school mental health in the
transformation of the child and ado-
lescent mental health system. We
conclude with specific recommenda-
tions for utilizing the New Freedom
Commission report as a meaningful
and useful framework for system
Transformation of Children’s Mental Health
Services: The Role of School Mental Health
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Dr. Stephan and Dr. Weist are affiliated with the Department of Psychiatry, University
of Maryland School of Medicine, 737 W. Lombard St., Rm. 426, Baltimore, MD 21201 (e-
mail: Dr. Kataoka is with the Department of Psychia-
try, University of California, Los Angeles. Dr. Adelsheim is with the Department of Psy-
chiatry, University of New Mexico, Albuquerque. Ms. Mills is with the Department of
Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Pub-
lic Health, Baltimore.
The New Freedom Commission has called for a transformation in the de-
livery of mental health services in this country. The commission’s report
and recommendations have highlighted the role of school mental health
services in transforming mental health care for children and adolescents.
This article examines the intersection of school mental health programs
and the commission’s recommendations in order to highlight the role of
school mental health in the transformation of the child and adolescent
mental health system. Schools are uniquely positioned to play a central
role in improving access to child mental health services and in supporting
mental health and wellness as well as academic functioning of youths. The
New Freedom Commission report articulated several goals related to
school mental health: reducing stigma, preventing suicide, improving
screening and treating co-occurring disorders, and expanding school
mental health programs. The authors suggest strategies for change, in-
cluding demonstrating relevance to schools, developing consensus among
stakeholders, enhancing community mental health–school connections,
building quality assessment and improvement, and considering the orga-
nizational context of schools. (Psychiatric Services 58:1330–1338, 2007)
steph.qxd 9/19/2007 9:08 AM Page 1330
School mental health
Throughout the United States
schools offer youths unparalleled ac-
cess to resources to address interre-
lated academic, emotional, behav-
ioral, and developmental needs. With
more than 52 million youths attend-
ing over 110,000 schools and more
than six million adults working in
schools, one-fifth of the U.S. popula-
tion can be reached in schools (5). In
fact, reports have documented that
of the small percentage of children
and adolescents who receive needed
mental health services, schools are
the most common setting in which
children access this care (1,8,9). Fur-
ther, data indicate that these services
are indeed reaching youths, includ-
ing youths from ethnic minority
groups and students with less obvious
problems, such as depression and
anxiety, who are unlikely to access
services in specialty mental health
settings (10–13).
School mental health programs of-
fer increased accessibility to students
by reducing many of the barriers to
seeking care in traditional settings,
such as transportation, child care, and
stigma, and by reducing the ineffi-
ciency of “no shows”; that is, when a
student does not keep an appoint-
ment, a school-based provider has the
ability to serve other students in the
time slot (14). Further, evidence sug-
gests that school mental health pro-
grams reduce stigma associated with
seeking mental health support (15),
increase opportunities to promote
generalization and maintenance of
treatment gains (16), and enhance ca-
pacity for mental health promotion
activities as well as universal and tar-
geted prevention effort (17,18). Com-
pared with traditional outpatient
mental health services, school mental
health services can offer more ecolog-
ically grounded roles for mental
health clinicians (that is, roles based
in the natural environment of the stu-
dent) (19). School mental health serv-
ices have been shown to enhance
clinical productivity, because students
are more accessible to mental health
staff (20).
In addition to these inherent ad-
vantages of school mental health serv-
ices, there is growing evidence that
school mental health programs can
have a positive impact on a number of
student, family, and school outcomes.
These services have resulted in re-
duced emotional and behavioral
problems, decreased disciplinary re-
ferrals, increased prosocial behavior,
increased family engagement, and
improvement in school outcomes,
such as fewer disciplinary referrals,
improved school climate, and fewer
special education referrals (21–28).
Further, there is growing recogni-
tion by policy makers and consumers
of the value of school mental health
programs and services. A recent poli-
cy statement on school mental health
released by the American Academy of
Pediatrics (29) underscores many of
these advantages, including improved
access to a range of services and en-
hanced opportunities for service co-
ordination. The policy statement ad-
vocates for effective collaboration be-
tween educators, primary health care
providers, and mental health profes-
sionals in implementing high-quality
school-based mental health services.
School mental health and
the commission report
The University of Maryland Center
for School Mental Health has con-
vened meetings and conducted policy
analyses to identify the most impor-
tant connections between the New
Freedom Commission report and the
Achieving the Promise Initiative and
school mental health. Four specific
recommendations of the New Free-
dom Commission report were deter-
mined to have the most proximal con-
nections to school mental health: re-
duce stigma, prevent suicide, screen
and treat comorbid mental and sub-
stance use disorders, and the obvious,
improve and expand school mental
health programs. Ideas explored by
the Center for School Mental Health
in relation to each of these themes are
discussed below, with an emphasis on
the role of school mental health in
creating system transformation.
Reduce stigma
Recommendation 1.1 of the New
Freedom Commission report advo-
cates for the implementation of a na-
tional campaign to reduce the stigma
of seeking mental health care and a
national strategy for suicide preven-
tion. Less than 30% of individuals
with psychiatric disorders seek treat-
ment (30,31), and stigma is a signifi-
cant barrier to help seeking and ac-
cessing services (32). Schools are a
key venue for supporting a campaign
to reduce stigma, and school mental
health services naturally reduce ob-
stacles to care related to stigma (32).
Focusing on mental health in
schools provides both natural and for-
mal opportunities for promoting anti-
stigma messages related to mental
health. With appropriate training and
community support, school staff can
normalize mental illness, convey pos-
itive messages about mental health,
and encourage students to engage in
activities that promote mental well-
ness. Formal avenues for reducing
mental health stigma in schools in-
clude integration of mental health
awareness into special and regular ed-
ucation curricula, including universal
PSYCHIATRIC SERVICES October 2007 Vol. 58 No. 10 11333311
Editor’s Note: This article is the
eighth in a series of articles ad-
dressing the goals that were es-
tablished by the President’s New
Freedom Commission on Men-
tal Health. The commission
called for the transformation of
the mental health system so that
all Americans have access to
high-quality services that pro-
mote recovery and opportunities
to pursue a meaningful life in
the community. The series is
supported by a contract with the
Substance Abuse and Mental
Health Services Administration
(SAMHSA). Jeffrey A. Buck,
Ph.D., and Anita Everett, M.D.,
developed the project, and Dr.
Buck and Kenneth S. Thomp-
son, M.D., are overseeing it for
SAMHSA. The series will fea-
ture 15 articles on topics such as
employment, housing, and lead-
ership, which will be solicited by
the journal’s editor and peer re-
viewed. Also planned are case
studies from each of the states
that received a SAMHSA-fund-
ed State Incentive Mental
Health Transformation Grant.
steph.qxd 9/19/2007 9:08 AM Page 1331
programs on social and emotional
learning, prevention programs, and
specialized interventions for prob-
lems. Simple messages, such as “men-
tal health refers to thoughts, feelings
and actions that contribute to success
in life,” can help to generalize the
concept of mental health as applica-
ble to everyone and to dispel negative
connotations that mental health
refers only to those with chronic men-
tal illness.
Schools also reduce stigma by of-
fering a naturalistic environment for
youths and families to seek assistance
for mental health needs. In contrast
to traditional community mental
health settings, which may be seen as
disconnected from a family’s daily en-
vironment, schools offer an ecologi-
cally sound alternative, providing
services directly in the living and
learning environment of children.
The availability and accessibility of
school mental health providers, ac-
cess to key informants such as teach-
ers, and the typical proximity of
schools to children’s neighborhoods
all further increase the likelihood of
care seeking. Because of their historic
ties to children, families, and commu-
nities, schools can also serve as a nat-
ural place for families to be exposed
to information about mental health
and available services.
Prevent suicide
Schools are also a critical venue for
developing and executing the second
proposal of recommendation 1.1—to
implement a national strategy to pre-
vent suicide. As noted, schools offer a
desirable site for both suicide preven-
tion campaigns and programs for
youths because of schools’ ability to
reach most youths, their inherent ties
to families and communities, and the
multiple opportunities for both for-
mal and informal education about
and prevention of mental health
problems and psychosocial problems,
including suicide.
Data from the 2003 Youth Risk Be-
havior Survey of a nationally repre-
sentative sample of more than 15,000
high school students throughout the
United States indicate that in the 12-
month period preceding the survey
16.9% had seriously considered at-
tempting suicide, 16.5% had made a
plan for attempting suicide, 8.5% had
attempted suicide one or more times,
and 2.9% had made an attempt re-
quiring medical attention (33). More
than 60% of adolescents who commit
suicide have mental health problems,
which often have existed for a year or
more before the suicide (34). There
is increasing national focus on pre-
venting teen suicide, as reflected in
the Call to Action to Prevent Suicide
by the U.S. Surgeon General (35)
and the more recent strategy docu-
ment (36) developed by the U.S. De-
partment of Health and Human Ser-
vices, the National Strategy for Sui-
cide Prevention, (www.mentalhealth. The
latter effort represents the first na-
tional blueprint to address suicide
and calls on schools to play a signifi-
cant role in efforts to prevent suicide
nationwide. Specifically, schools are
encouraged to collaborate with other
agencies, increase the implementa-
tion of research-supported preven-
tion programs, train key school per-
sonnel to identify youths at risk of sui-
cide, and develop effective suicide
screening programs that are directly
linked to needed services. It is also
noteworthy that the Substance Abuse
and Mental Health Services Adminis-
tration (SAMHSA) is providing key
federal leadership in suicide preven-
tion, including a grant program that
specifically emphasizes school-based
School-based efforts to address
suicide have been evaluated with
mixed results (37). One suicide pre-
vention strategy that is being imple-
mented in a number of districts
across the country is the school gate-
keeper training model, which has
several key components: training
school personnel (gatekeepers) to
improve their knowledge, attitudes,
and skills to appropriately intervene
with students at risk of suicide; pro-
PSYCHIATRIC SERVICES October 2007 Vol. 58 No. 10
PPrreessiiddeennttss NNeeww FFrreeeeddoomm CCoommmmiissssiioonn
GGooaallss aanndd RReeccoommmmeennddaattiioonnss
1.1. Advance and implement a national campaign to reduce the stigma of
seeking care and a national strategy for suicide prevention
1.2. Address mental health with the same urgency as physical health
2.1. Develop an individualized plan of care for every child with a serious
emotional disturbance
2.2. Involve consumers and families fully in orienting the mental health system
toward recovery
2.3. Align relevant federal programs to improve access and accountability for
mental health services
2.4. Create a comprehensive state mental health plan
2.5. Protect and enhance the rights of people with mental illness
3.1. Improve access to high-quality care that is culturally competent
3.2. Improve access to high-quality care in rural and geographically remote areas
4.1. Promote the mental health of young children
4.2. Improve and expand school mental health programs
4.3. Screen for co-occurring mental and substance use disorders and link with
integrated treatment strategies
4.4. Screen for mental disorders in primary health care across the life span and
connect individuals to treatment and supports
5.1. Accelerate research to promote recovery and resilience and ultimately to
cure and prevent mental illnesses
5.2. Advance evidence-based practices by using dissemination and demonstra-
tion projects and create a public-private partnership to guide their imple-
5.3. Improve and expand the workforce providing evidence-based mental health
services and supports
5.4. Develop the knowledge base in four understudied areas: mental health dis-
parities, long-term effects of medication, trauma, and acute care
6.1. Use health technology and telehealth to improve access and coordination of
mental health care, especially for Americans in remote areas or in under-
served populations
6.2. Develop and implement integrated electronic health record and personal
health information systems
steph.qxd 9/19/2007 9:08 AM Page 1332
viding crisis intervention to engage
suicidal students’ support networks;
and facilitating suicidal students’ re-
ferrals for treatment and counseling
(38). A recent study found that
among students who had been previ-
ously identified as at risk of suicide,
use of this gatekeeper model can in-
crease the proportion of students
who access specialty mental health
services in the community (39).
Some screening and prevention
efforts, including Columbia Univer-
sity’s TeenScreen Program (www. and the SOS Suicide
Prevention Program (40), have
demonstrated positive findings with
respect to identifying at-risk youths,
increasing knowledge about suicide
and depression, and reducing sui-
cide attempts. However, their suc-
cess has also been paired with con-
troversy related to concerns about
the large number of false-positive
screens and the limited capacity of
schools to respond to serious mental
health issues that may be unveiled
when screening programs are imple-
mented (41). Some of the concerns
regarding school-based universal sui-
cide screening are likely rooted in the
stigma associated with mental health
problems compared with other med-
ical issues, such as vision and hearing,
for which there is already schoolwide
Federal support for universal men-
tal health screening, as evidenced in
the New Freedom Commission rec-
ommendations, reflects the recogni-
tion that for most individuals with
mental illness symptoms begin in
childhood, which suggests that early
screening can play a critical role in
providing prevention and early inter-
vention to delay or eliminate the on-
set of symptoms (30). Weist and col-
leagues (42) have outlined a process
for addressing concerns about
school-based mental health screen-
ing that includes intensive planning,
collaboration, training, supervision,
and support to ensure the selection
of age-appropriate screening meth-
ods; parental consent and student as-
sent; trained and available staff and
mental health providers to conduct
screenings and follow-up treatment;
and resolution of logistical and liabil-
ity issues.
Screen and treat
co-occurring disorders
The New Freedom Commission ar-
gues for the screening and integrat-
ed treatment of comorbid mental
and substance use disorders in rec-
ommendation 4.3. The reality is that
co-occurring disorders are more
common than not among people
with mental illness or substance use
disorders (43). Even though the rate
of youth substance use has been de-
clining overall in the past decade,
half of adolescents have tried an illic-
it drug by the time they graduate
from high school (44). Of youths
identified as having substance use
disorders, it is estimated that up to
75% may have a co-occurring mental
health disorder (45).
Despite this reality most communi-
ties do not have the capacity to re-
spond to any level of substance abuse
concerns among youths because of
stigma, resource limitations, limited
evidence-based approaches, and the
failure of child-serving systems to
take responsibility for the problem
(46). Lack of ownership by a single
community system is also reflected in
schools, where substance abuse serv-
ices are often not well integrated into
the full continuum of mental health
service delivery for youths (47). Al-
though school-based mental health
providers are often the “default”
providers of substance abuse services,
limitations in preservice training and
lack of supervision and support in ev-
idence-based substance abuse treat-
ment for mental health providers
leave many providers unprepared to
address co-occurring mental health
and substance use problems (48).
Despite the existing challenges to
providing high-quality services to
youths with comorbid mental and
substance use problems, schools offer
inherent advantages in this arena.
Specifically, the federal focus on
funding prevention programs, such as
Safe and Drug Free Schools and ini-
tiatives of the Center for Substance
Abuse Prevention, have advanced the
integration of substance abuse pro-
gramming into schools across all
grade levels. Further, when evidence-
based substance abuse prevention ac-
tivities are implemented appropriate-
ly in schools, outcomes are positive
and strong, including delayed initia-
tion of use, decreased frequency of
use, and slowed or arrested progres-
sion to the use of more hazardous
substances (49). As discussed above,
schools are also uniquely staged to of-
fer screening of co-occurring mental
health and substance use problems,
given their ability to reach many stu-
dents, the growing infrastructure to
implement screening, and the evolu-
tion of guidelines to promote respon-
sible, effective screening protocols
(42). In addition, a number of pre-
vention and intervention programs
have been successfully implemented
in school settings.
Improve and expand school
mental health programs
Recommendation 4.2 of the New
Freedom Commission report is to
“improve and expand school mental
health programs.” When detection,
prevention, and early intervention
services for youths are provided in the
context of schools, negative conse-
quences such as school failure and co-
morbid substance abuse can be pre-
vented. Coordinated school service
approaches have been described that
integrate assessments with on-cam-
pus prevention services, early inter-
vention programs, and more intensive
systems-of-care services for the few
students who require multimodal
treatments across child-serving agen-
cies. However, as the Blueprint for
Change: Research on Child and Ado-
lescent Mental Health from the Na-
tional Institute of Mental Health has
noted, research advances in the de-
velopment of efficacious mental
health treatments for children and
adolescents have had minimal trans-
lation into community practice set-
tings such as schools (50).
Contributing to the slow progress
of bringing improved services into
schools is the reality that schools are
underresourced to address nonacade-
mic barriers to learning. Most dis-
tricts offer mental health supports to
only a small percentage of students,
often those in or being referred to
special education. Further, the quali-
ty of services for emotional or behav-
ioral disabilities that are provided to
youths in special education is ques-
tionable (51), with many youths re-
PSYCHIATRIC SERVICES October 2007 Vol. 58 No. 10 11333333
steph.qxd 9/19/2007 9:08 AM Page 1333
ceiving “no or poor” services to ad-
dress their individual needs (52).
SAMHSA recently released the re-
port of the first national survey of
school mental health in the United
States for the 2002–2003 school year
(53). According to the report, over
80% of U.S. schools provided assess-
ment for mental health issues, consul-
tation for behavioral problems, and
some level of crisis intervention serv-
ices. Children with more serious is-
sues are commonly referred to com-
munity agencies. Around two-thirds
of schools reported providing individ-
ual and group counseling and some
case management services. However,
because of the way the survey was
structured, respondents could indi-
cate that a service was provided even
it was for only one student or a few
students, which likely resulted in ex-
aggeration of services actually provid-
ed. Also notable was that education
leaders at local and state levels ex-
pressed the perception that mental
health needs of students were in-
creasing while funding was not ade-
quate to meet these needs and was
predicted to decrease, not increase.
These school leaders also expressed
concern about the many barriers to
successfully referring students for
services in other community agen-
cies. Thus these findings suggest that
the majority of schools offer some lev-
el of mental health services but that
these services are not sufficient to
meet youths’ needs and that connec-
tions with other community systems
remain a significant challenge.
It has been challenging to advocate
for school mental health services as a
transformative force in children’s
mental health when schools are in
essence undergoing their own trans-
formation related to the No Child
Left Behind Act. Despite evidence
linking empirically supported mental
health promotion to academic ach-
ievement and school success (28,
54–58), education system reform has
directed relatively little attention to
nonacademic barriers to learning. In-
stead, these educational reforms have
for the most part focused on grades
and test scores for reading and math
to the exclusion of other subjects,
with no attention to the mental health
and well-being of students. Further
research is needed to bridge this di-
vide between educational reform ef-
forts and the transformation of school
mental health and to encourage
greater collaboration between educa-
tors and school mental health pro-
viders in the development of pro-
grams that support academic success.
School mental health
and transformation
An analysis of school mental health
services and the New Freedom Com-
mission report reveals their mutual
goal of maximizing healthy develop-
ment and success for all children
through the provision of high-quality
mental health services in a public
health framework that ensures access
to all youths and families. Although
the New Freedom Commission re-
port reviews critical dimensions for
needed change, it does not detail how
such change will occur or be funded.
Systemic change is extremely chal-
lenging partly because of limited re-
sources and resistance to movement
away from the status quo. Without
purposeful action from a diversity of
stakeholders aimed at implementa-
tion of the New Freedom Commis-
sion recommendations, it is likely that
the document will remain relatively
unused. From a historical perspec-
tive, Friedman (59) noted, “the mere
articulation of policy through legisla-
tion or regulation is rarely adequate
to accomplish the goals of the policy.”
Below are suggestions for facilitating
transformation of child and adoles-
cent mental health services through
the school system.
Demonstrate relevance to schools
In an era of paramount attention to
the academic achievement of our
children, school mental health has
the advantage of articulating a pow-
erful message linking mental health
to school success. The argument for
integrated approaches to reduce
both academic and nonacademic bar-
riers to learning is supported by
mounting evidence demonstrating a
strong positive association between
psychological wellness and academic
success (28,54–58). Research sug-
gests that 46% of the failure to com-
plete secondary school is attributable
to psychiatric disorders (60). Thus it
is not difficult to conceive of advoca-
cy and public awareness efforts that
highlight the need for attention to
school mental health in overall men-
tal health system change. For the
transformation of children’s mental
health services to expand school
mental health, it is necessary to gen-
erate understanding and buy-in from
educators through the dissemination
of clear and strong messages about
the importance of mental health and
the negative impact of mental illness
on school success. To that end, the
school mental health field must
clearly define specific academic fac-
tors—for example, grades, discipline
referrals, promotion, dropout, and
school connectedness—that are in-
fluenced by mental health promotion
and intervention.
Develop consensus
among stakeholders
One way to develop messages about
school mental health and programs
that speak to the school community
more clearly is to develop consensus
across diverse school stakeholders in
a true participatory partnership.
From mental health antistigma cam-
paigns on campus to early mental
health intervention programs target-
ing at-risk students, all school mental
health activities would benefit from
being informed, created, implement-
ed, and disseminated through a part-
nership of school stakeholders, in-
cluding youths, families, educators,
administrators, providers, and com-
munity members and leaders. This
would help to ensure that the multi-
ple missions and goals of school and
community stakeholders are ad-
dressed and that school mental health
programs are both feasible and cul-
turally relevant and acceptable.
There is a significant need to pro-
mote true involvement of the public
in discussions about mental health
and transformation of the education
system and ideas to advance school
mental health. A number of strategies
could be used to promote such public
involvement. First, the New Free-
dom Commission report can be used
as a tool for discussions about school
mental health among diverse stake-
holder groups. This is currently being
done by the IDEA Partnership (www.
PSYCHIATRIC SERVICES October 2007 Vol. 58 No. 10
steph.qxd 9/19/2007 9:08 AM Page 1334 and www.shared Second, the interdiscipli-
nary nature of school mental health
(with families and youths included as
one of the disciplines) can be ac-
knowledged, and interdisciplinary
networking and training can be in-
creased, such as the networking and
training that occurs at the Center for
School Mental Health annual confer-
ence on advancing school mental
health ( Third,
social marketing efforts can be devel-
oped that speak to the promise and
challenges of school mental health in
plain language written for diverse
stakeholder audiences.
Enhance community mental
health–school connections
A major focus for the authors of this
article has been advancing a shared
family-school-community agenda, ev-
idenced by strong family and youth
leadership and strong collaboration
between the education system and
the child and adolescent mental
health system in building school men-
tal health. This has also been a major
theme in the expanded school mental
health framework and at the Univer-
sity of Maryland Center for School
Mental Health.
A number of strategies to strength-
en these partnerships are promising.
A first strategy is reaching out to and
encouraging leadership in relevant
professional organizations to support
this agenda. Such organizations in-
clude the National Association of
State Directors of Special Education,
the National Association of State
Mental Health Program Directors,
the Council of Chief State School Of-
ficers, the National Council of State
Legislatures, and the American Col-
lege of Mental Health Administra-
tors, which already espouse and
demonstrate support for such an inte-
grated agenda. A second strategy is
tracking strong examples of family-
school-community collaboration to
advance school mental health, which
is done at annual conferences and in
books (61,62), and moving toward In-
ternet-based evolving directories of
programs to promote networking and
collaboration across communities,
states, and organizations (www.shar A third strategy to
strengthen partnerships is to capitalize
on federal grant opportunities that pro-
mote such partnerships, such as Sys-
tem of Care (SAMHSA), Safe Schools/
Healthy Students (SAMHSA and De-
partment of Education), and Mental
Health Integration Into the Schools
(Department of Education).
Build quality assessment
and improvement
An overarching construct in school
mental health is advancing quality as-
sessment and improvement, which
can be viewed as inclusive of all rele-
vant processes—needs assessment
and resource mapping; stakeholder
involvement; coordination of services
in schools; connecting school mental
health services in schools to related
community programs and efforts; se-
lecting, training, supporting, and
coaching staff; emphasizing high-
quality and evidence-based services;
evaluating services provided to indi-
vidual students and at the program
level; and connecting evaluation
findings to continuous quality im-
provement cycles and advocacy ef-
forts. There is a great need for ap-
proaches to measure and improve
the quality of school mental health
services, and some measures are now
available, including the School Men-
tal Health Quality Assessment Ques-
tionnaire (63) and the Mental Health
Planning and Evaluation Template
Central in the quality agenda, and
receiving increased attention, is the
goal of making evidence-based servic-
es feasible in schools (64,65). Several
successful models of development
and implementation of mental health
services in schools exist along the con-
tinuum of care and should be consid-
ered examples for future work in the
area. Two representative examples
are LifeSkills Training (www.lifeskill- and Cognitive Behav-
ioral Intervention for Trauma in
Schools (66), both of which were de-
veloped for implementation in
schools. These two programs have
demonstrated positive outcomes
among participants according to both
psychosocial and academic indicators
and have been endorsed by SAMHSA
as model programs.
It is important to note that promot-
ing quality assessment and improve-
ment in school mental health will
help to increase the likelihood of ef-
fective services that achieve out-
comes valued by families and
schools. This in turn will help to pro-
pel school mental health agendas in
communities and states, contributing
to real systems transformation as
called for by the Achieving the
Promise initiative.
Consider the organizational
context of schools
In addition to improving the quality
of school mental health at the
provider and program levels, trans-
formation of mental health services
for youths must also attend to the sys-
tem and organizational issues that are
relevant for schools. Leadership sup-
port within an organization has been
found to be an important factor in the
adoption of new programs, and com-
mitment from school administrators
has been shown to strongly influence
the implementation of prevention
programs (67,68). Successful adop-
tion of mental health programs has
also been shown to be related to the
climate and structure of the organiza-
tion (69,70) and may be related to the
readiness of a school to adopt a new
school mental health program. Simi-
larly, school mental health programs
may be more successfully implement-
ed if there is minimal burden on in-
structional staff in schools, especially
given heightened pressures to per-
form under No Child Left Behind.
As evidence-based mental health
programs are implemented in the
school system, factors such as federal
and state policies that influence the
financing of school mental health pro-
grams can also greatly influence dis-
semination of evidence-based pro-
grams in schools. For example,
SAMHSA’s National Child Traumatic
Stress Initiative has supported the
dissemination of trauma-informed
best practices in community settings
such as schools (,
which has resulted not only in im-
proved quality of services in schools
for traumatized youths but also in sus-
tained services through community-
school partnerships (25,71). Similarly
the Mental Health Services Act in
California provides for additional
PSYCHIATRIC SERVICES October 2007 Vol. 58 No. 10 11333355
steph.qxd 9/19/2007 9:08 AM Page 1335
funds through state taxes to support
the dissemination of mental health
care, including prevention and early
intervention services for children and
adolescents in school settings. By hav-
ing access to funding that does not
compete with education dollars,
schools may have more incentive to
support mental health services on
The President’s New Freedom Com-
mission report provides a launching
point from which school mental
health programs can expand the
scope and depth of child mental
health services. By delivering these
services in a naturalistic community
setting that minimizes some of the
barriers to accessing care for youths
and their families, school mental
health programs can play a critical
role in operationalizing the recom-
mendations of the New Freedom
Commission report, both in terms of
supporting the resiliency of youths
and providing effective services for
those who need mental health care.
The New Freedom Commission has
built upon previous federal initiatives,
such as the U.S. Surgeon General’s
reports on mental health (8,9) and the
Children’s Mental Health Confer-
ence (72), by emphasizing the need to
improve the dissemination of evi-
dence-based treatments in communi-
ty settings and increasing the aware-
ness of mental health issues across
child-serving agencies.
This article has outlined some of
the ways in which national school
mental health efforts are aligned with
the goals and recommendations of
the New Freedom Commission.
From this national agenda for trans-
forming mental health care in the
United States, several key strategies
have also been discussed in terms of
addressing these goals in schools, in-
cluding demonstrating relevance to
schools, developing consensus among
stakeholders, enhancing community
mental health–school connections,
building quality assessment and im-
provement, and transforming school
mental health services in the organi-
zational context of schools.
Implications for a research agenda
to support this transformation would
also involve greater collaboration
across academic disciplines and true
partnerships with community stake-
holders that inform the direction of
the research questions and the de-
sign, implementation, and dissemina-
tion of services in schools. If school
mental health programs are to im-
prove and expand effectively, joint ef-
forts by education and mental health
researchers toward the achievement
of both academic success and emo-
tional well-being for students are nec-
essary. Greater participatory research
with school-community partners can
enlighten the research agenda in such
a way that barriers to providing serv-
ices on campuses are reduced. Ap-
proaching mental health services in
schools through the lens of an educa-
tor, a student, or an administrator will
enhance the development of novel
approaches to address stigma, treat
co-occurring disorders, and prevent
suicide—all of which are relevant to
the school culture as well as cultural-
ly appropriate for the community be-
ing served.
Recent federal legislation to sup-
port mental health in schools reflects
progress in advancing the school
mental health agenda. Namely, the
Mental Health in Schools Act of
2007, introduced by Senators Dodd,
Domenici, and Kennedy, proposed
significant funding to local education
agencies to expand existing school
mental health efforts through com-
munity-family-school partnerships.
The bipartisan legislation emphasizes
a public health approach to mental
health that includes prevention and
promotion, positive behavioral sup-
ports, and targeted intervention and
stresses cultural and linguistic com-
petence. Further, the proposed legis-
lation underscores the importance of
program accountability by requiring
the use of evidence-based practices
and outcome measurement.
Two other recent Senate bills re-
flect critical federal support for
school-based services, including men-
tal health: Senate Bill 600, the
School-Based Health Clinic Estab-
lishment Act (introduced February
15, 2007) and Senate Bill 1669, the
Healthy Schools Act of 2007 (intro-
duced June 20, 2007). If passed, Sen-
ate Bill 600 would authorize the first-
ever federal program for school-
based health centers, the large major-
ity of which would include mental
health providers and all of which
would provide at least some level of
mental health care to students. The
Healthy Schools Act of 2007 similarly
supports the inclusion of mental
health services in school-based health
centers by ensuring procedures for
payment under Medicaid and the
State Children’s Health Insurance
Program to school centers certified
by the Department of Health and
Human Services. In addition, the leg-
islation recognizes that mental health
must be considered a part of compre-
hensive care by establishing a mini-
mum criterion for “primary health
services” as the core group of services
offered by school-based health cen-
ters, including comprehensive health
and mental health assessments, inter-
vention, and treatment. Together
with enhanced advocacy, effective
policy, and development of estab-
lished models of mental health care in
schools, federal legislation of this na-
ture is necessary to ensure that trans-
formation of the children’s mental
health system is inclusive of schools.
Acknowledgments and disclosures
This work was supported by cooperative agree-
ment U45-MC-00174-10-0 from the Office of
Adolescent Health, Maternal and Child Health
Bureau (Title V, Social Security Act), Health
Resources and Services Administration, with
cofunding from the Center for Mental Health
Services, Substance Abuse and Mental Health
Services Administration. It was also supported
by grant 1-R01-MH-71015-01-A1 from the
National Institute of Mental Health.
The authors report no competing interests.
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steph.qxd 9/19/2007 9:08 AM Page 1338
... This may be because schools have limited financial resources, and funding mental health services may further diminish the financial resources, which may further result in undermining the primary goal (education) of schools (Atkins et al., 2010). However, Stephan et al. (2007) have further argued that schools forget that depression could be a burden on the educational attainment of children, as depression may make learning difficult for children and teaching to be less effective for children with severe depressive disorder. ...
تعتبر أعراض الاكتئاب شائعة بين طلاب المرحلة الابتدائية. وفقًا لمنظمة الصحة العالمية، فإن الاكتئاب هو السبب الأول للإعاقة، ويعتبر ثاني أهم اضطراب في عام 2020. وقد أفاد نحو 8% و 20% من الطلاب بأنهم يعانون من أعراض الاكتئاب. كما أن الاكتئاب مرتبط بشكل كبير بعدم القدرة على التأقلم مع البيئة الدراسية خلال المرحلة الابتدائية. أهداف الدراسة: 1- تقييم مدى استعداد المعلمين وقدرتهم على التعرف على التلاميذ الذين يعانون من أعراض الاكتئاب والإبلاغ عنها. 2- البحث في تصورات معلمي المدارس الابتدائية السعوديين بشأن أسباب اكتئاب التلاميذ. عينة الدراسة: تكونت الدراسة من 15 معلماً. تم التواصل مع 23 مدرسة للوصول إلى العينة المستهدفة المكونة من 15 معلمًا. طرق الدراسة: تم جمع بيانات هذا البحث من معلمي المدارس الابتدائية والثانوية في المملكة العربية السعودية. تم جمع البيانات باستخدام المقابلات شبه المنظمة. تم تحليل البيانات موضوعيًا، في حين أن المقابلات كانت تحتوي على بعض الأسئلة المحددة مسبقًا. نتائج الدراسة: وجدت الدراسة أنه في حين أن تدريب المعلمين قد يحسن قدرتهم على اكتشاف أكثر المشكلات والأعراض المتعلقة بالاكتئاب، فإن عدم وجود آلية دعم مناسبة للمعلمين يؤثر على قدرتهم على التعامل مع الحالات التي يلاحظونها.
... This represents an evolution from a focus on bureaucratic processes and liability protection to an articulation of standards. The standards encompass the full continuum of processes, procedures, and practices required for high quality, comprehensive school mental health (Ambrose et al., 2002;Nabors et al., 2003;President's New Freedom Commission on Mental Health, 2003;Stephan et al., 2007;Stephan et al., 2015). ...
... This is important, as the majority of adolescents with mental health problems do not receive treatment (Merikangas et al., 2011). Given the few positive results for the performance anxiety program, and the fact that school mental health services are associated with lower stigma (Stephan et al., 2007), school-based performance anxiety programs have some potential to be beneficial for adolescents during the first years of secondary school. Nevertheless, follow-up research is needed to establish long-term effects, as well as the effective ingredients of such programs. ...
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Background Given that high levels of stress during adolescence are associated with negative consequences, it is important that adolescents with psychological needs are supported at an early stage, for instance with interventions at school. However, knowledge about the potential of school-based programs targeting adolescents with psychological needs, aimed at reducing school or social stress, is lacking. Objective The current study aimed to investigate the effectiveness of two targeted school-based skills-training programs, addressing either skills to deal with performance anxiety or social skills. Methods Two randomized controlled trials were performed with participants who self-selected to one of the programs. The sample comprised of N = 361 adolescents ( M age = 13.99 years, SD = 0.83) from various educational levels and ethnic identity backgrounds. The performance anxiety program included N = 196 participants ( N = 95 in the experimental group), while the social skills program included N = 165 participants ( N = 86 in the experimental group). MANCOVA’s were performed. Results The performance anxiety program had a small effect on reducing adolescents’ test anxiety. Furthermore, for adolescents who attended more than half of the sessions, the program had small effects on reducing test anxiety and fear of failure. The program did not improve adolescents’ coping skills or mental health. The social skills program was not effective in improving social skills, social anxiety, and mental health. Conclusions A relatively short, targeted program addressing skills to deal with performance anxiety can have the potential to reduce adolescents’ performance anxiety. Trial registration International Clinical Trials Registry Platform (Netherlands Trial Register, number NTR7680). Registered 12 December 2018. Study protocol van Loon et al., (2019).
... In Theory of Nodes, all the life events experienced before, especially the social relationships such as family, community, culture, and spirituality 27 , were engaged in the formation of an individual's lifeview via superposition mechanism (Figure 1). 1. Family environments in early life play a baseline role in the development of lifeview, and the mental status of parents significantly influences the mental health of the child 28,29 (Fig.1a). 2. The context of schools has deep effects on the mental health of children and youths 30 (Fig.1b). 3. Work circumstances, such as what the individual learns from colleagues, friends, and the working environment 31 , have a strong impact on her/his lifeview and directly influence the individual's quality of life (Fig.1c). ...
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The first detailed description of the morphology of gastric ulcer was reported ~230 years ago, but the mechanism has yet to be elucidated. Moreover, peptic ulcers, including duodenal and gastric ulcers, are currently considered an infectious disease caused by Helicobacter pylori, but how the infection leads to ulceration remains elusive. To address these challenges, a recently published Complex Causal Relationship was applied to analyze the existing data. Peptic ulcers were identified as a psychosomatic disease triggered by psychological stress, where Helicobacter pylori plays a secondary role in only the late phase of the disease. This etiology explained all the characteristics and observations/phenomena of peptic ulcers in a series of 6 articles. This second article focused on the pathogenesis of gastric ulcers. Based on hereditary predisposition, the accumulation of past life experiences incurs the formation of a negative lifeview. Consequently, the individual tends to negatively evaluate themselves or current life events, leading to acute psychological stress. The psychological stress triggers the release of aberrant neurotransmitters in the central nervous system, which in turn cause the transmission of pathogenic nerve impulses to the stomach, resulting in a ‘pre-ulcer lesion’ in the gastric wall and eventually, gastric ulcer. This psychopathological model elucidated 12 characteristics and 24 observations/phenomena of gastric ulcer, along with the roles of gastric acid, Helicobacter pylori, and NSAIDs. The effectiveness suggests that theoretical research and empirical study are equally important in medical explorations, and the guiding roles of philosophy are indispensable for the major progress of life science and medicine.
... Our review demonstrates the importance of and critical need for greater investigation of individual-level factors related to stakeholders engaging with PSSP interventions. Understanding stakeholders' perspectives is key to the success of school-based mental health interventions (Movsisyan et al., 2021;Stephan et al., 2007). More research focusing on understanding of stakeholder's perspectives will contribute to ensuring that PSSP interventions are suitable, acceptable and compatible with school and community contexts, which will enhance the translation of PSSP research findings to practice. ...
Suicide is the fourth leading cause of death among adolescents, globally. Though post-primary, school-based suicide prevention (PSSP) has the potential to be a key strategy for preventing adolescent suicidal thoughts and behaviours (STBs), there are persisting challenges to translating PSSP research to practice. Intervention and contextual factors relevant to PSSP are likely key to both PSSP effectiveness and implementation. As such, this systematic review aimed to summarise the effectiveness of PSSP for adolescent STBs and highlight important intervention and contextual factors with respect to PSSP. PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials were searched to identify randomised and non-randomised studies evaluating the effectiveness of interventions located in post-primary, school-based settings targeting adolescent STBs. PSSP effectiveness and intervention and contextual factors were synthesised narratively. Twenty-eight studies were retained, containing nearly 47,000 participants. Twelve out of twenty-nine trials comparing intervention and independent control comparators reported statistically significant reductions in STBs postintervention, and 5/7 trials comparing preintervention and postintervention scores demonstrated significant reductions in STBs over time. Reporting and analysis of intervention and contextual factors were lacking across studies, but PSSP effectiveness and intervention acceptability varied across type of school. Although school personnel commonly delivered PSSP interventions, their input and perspectives on PSSP interventions were lacking. Notably, adolescents had little involvement in designing, inputting on, delivering and sharing their perspectives on PSSP interventions. Twenty out of twenty-eight studies were rated as moderate/high risk of bias, with non-randomised trials demonstrating greater risks of bias and trial effectiveness, in comparison to cluster randomised trials. Future research should prioritise complete reporting and analysis of intervention and contextual factors with respect to PSSP, involving key stakeholders (including adolescents and school personnel) in PSSP, and investigating key stakeholders’ perspectives on PSSP. Given the inverse associations between both study quality and study design with PSSP effectiveness, particular consideration to study quality and design in PSSP research is needed. Future practice should consider PSSP interventions with universal components and PSSP which supports and involves key stakeholders in engaging with PSSP.
... 4 School-nurses are at the forefront in the school-setting as health experts caring for children, identifying students struggling with psychosocial, mental, emotional, or physical issues. 13 School-nurses spend an estimated 33% of their time addressing student MH-issues, 5,14 and in one study, over 40% of school-nurses working with adolescents reported they provided emergency management for a suicidal student in the prior school year. 15 Making appropriate referrals to MH professionals in the school and community is a common school-nurse intervention for a student with MH-concerns. ...
Objectives No studies have examined school-nurse visits related to mental health (MH) during the COVID-19 pandemic. We examined changes in the rate of MH-related school-nurse visits before and during the COVID-19 pandemic. Methods We analyzed school-nurse visit data (n=3,445,240) for subjects Grade K-12 in U.S. public schools using electronic health record software (SchoolCare, Ramsey, NJ). Data between January 1-December 31 in 2019 (pre-COVID-19 pandemic) vs. January 1-December 31 in 2020 (during COVID-19 pandemic) were compared. For each year, total visits to a school-nurse were calculated for general MH, anxiety, and self-harm. The exposure was number of school-nurse visits in each time period (2019 vs. 2020). The main outcome was change in the rate of general MH, anxiety, and self-harm visits in 2019 vs. 2020. Results There were 2,302,239 total school-nurse visits in 2019 vs. 1,143,001 in 2020. During the COVID-19 pandemic, the rate of visits for general MH increased by 30% (4.7 to 6.1 per 10,000 visits, 95%CI [18%,43%]; p<0.001), and visits for anxiety increased by 25% (24.8 to 31 per 10,000 visits, 95%CI [20%,30%]; p<0.001). There was no significant difference in self-harm visits across all ages during the COVID-19 pandemic. Conclusions Our study found a significant increase in the rate of school-nurse visits for MH and anxiety during the COVID-19 pandemic, suggesting the pediatric population is at-risk for increased negative MH-effects associated with the pandemic and highlights a critical role of school-nurses in identifying youth with potential MH-needs.
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Background Public health interventions that target children's physical, mental, and emotional health will enhance their ability to learn and grow. Although more complex, school initiatives that address multiple ecological levels and take a holistic view may be more effective and likely to lead to lasting change. Aims This article presents the framework of Commit to Be Fit (C2BF) as an example of how schools can integrate multi-level and holistic approaches for health. This innovative school-based intervention includes activities addressing individual, home, school, and community to create a culture of wellness. We describe the implementation of C2BF and its basis in ecological models and give examples of activities across three components: cafeteria, classroom, and community. We discuss challenges and note that leadership engagement and alignment were critical elements for C2BF's success thus far. Discussion C2BF uses a school-based multi-level approach to creating a culture of wellness and holistic health for students, teachers, and community members. C2BF is unique compared to other school-based programming and includes activities that address all eight domains posited for program sustainability within public health. Built to be flexible and adaptive, C2BF was able to successfully pivot during the COVID pandemic and also follow new science. Conclusion C2BF and other multi-level holistic approaches are more likely to achieve long-term change by utilizing strategies across the multiple levels of the ecological model to improve health and wellbeing.
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Abstract The COVID-19 pandemic negatively impacted the mental health of children, youth, and their families which must be addressed and prevented in future public health crises. Our objective was to measure how self-reported mental health symptoms of children/youth and their parents evolved during COVID-19 and to identify associated factors for children/youth and their parents including sources accessed for information on mental health. We conducted a nationally representative, multi-informant cross-sectional survey administered online to collect data from April to May 2022 across 10 Canadian provinces among dyads of children (11–14 years) or youth (15–18 years) and a parent (> 18 years). Self-report questions on mental health were based on The Partnership for Maternal, Newborn & Child Health and the World Health Organization of the United Nations H6+ Technical Working Group on Adolescent Health and Well-Being consensus framework and the Coronavirus Health and Impact Survey. McNemar’s test and the test of homogeneity of stratum effects were used to assess differences between children-parent and youth-parent dyads, and interaction by stratification factors, respectively. Among 933 dyads (N = 1866), 349 (37.4%) parents were aged 35–44 years and 485 (52.0%) parents were women; 227 (47.0%) children and 204 (45.3%) youth were girls; 174 (18.6%) dyads had resided in Canada
This chapter addresses the complexity of preparing school mental health practitioners to practice in educational settings. We identify the multiple disciplines that are recognized by federal legislation as qualified school mental health practitioners and describe the school-specific certification regulations, standards, and practice models across several professional groups. We detail workforce development and practitioner barriers to service provision in schools. Next, we offer several best practice recommendations for workforce development. We push forward the call for a unified, interdisciplinary model in school mental health, to cohesively align practitioners toward enhanced collaboration across disciplines with a revitalized focus rooted in pursuits of social justice. In conclusion, we provide a case study exemplar of an interdisciplinary post-masters certification program.
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Background Schools have been increasingly employing dance movement psychotherapists to support children cope with daily worries and stress, express and understand their emotions, develop self-awareness and self-esteem. However, evidence on the impact of dance movement psychotherapy as a tool for prevention of mental health difficulties in childhood remains limited. Methods Sixteen children (aged 7–9) with mild emotional and behavioral difficulties from two primary schools were randomly assigned to a Dance Movement Psychotherapy (DMP) intervention or to a waiting list, within a larger pilot cross-over randomized controlled study which aimed to (a) test whether all elements of study design can work together and run smoothly in a full-scale RCT; and (b) investigate the effectiveness of arts therapies in improving children’s health related quality of life (HRQOL; EQ-5D-Y), wellbeing and life functioning (Child Outcome Rating Scale; CORS), emotional and behavioral difficulties (Strengths and Difficulties Questionnaire; SDQ), and duration of sleep (Fitbits). The therapeutic process was also evaluated through interviews with children, participant observations, the Children’s Session Rating Scale (CSRS), and ratings of adherence to the therapeutic protocol. Results The findings indicated that DMP led to improvements in children’s life functioning, wellbeing, duration of sleep, emotional and behavioral difficulties, but not in quality of life. The improvements were maintained at the follow-up stages, up to 6 months post-intervention. Interviews with children also suggested positive outcomes, such as self-expression; emotional regulation; mastery and acceptance of emotions; improved self-confidence and self-esteem; reduced stress; and development of positive relationships. However, children would have preferred smaller groups and longer sessions. Conclusion This study indicated that all outcome measures would be suitable for inclusion in a larger randomized controlled trial, though the EQ-5D-Y is not recommended as a stand-alone measure due to its lack of sensitivity and specificity for young participants. The adherence to the therapeutic protocol ratings differed between children and adults, highlighting the need to include children’s voice in future research. Strategies are also proposed of how to conduct randomization of participants in ways that do not hinder the therapeutic process.
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Confronted by increasing incidents of violent behavior in schools, educators are being asked to make schools safer. Schools, however, receive little guidance or assistance in their attempts to establish and sustain proactive discipline systems. One area of need lies in directions for use of existing discipline information to improve school-wide behavior support. In this article, we describe how office discipline referrals might be used as an information source to provide an indicator of the status of school-wide discipline and to improve the precision with which schools manage, monitor, and modify their universal interventions for all students and their targeted interventions for students who exhibit the most severe problem behaviors.
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Without prevention strategies, schools can expect to observe behavioral difficulties in more than 20% of the school population. Using schoolwide systems of positive behavioral support, schools can decrease the number of problem behaviors by students, providing a clearer focus for intervention on the students with the greatest support needs. This article presents a case example of schoolwide positive behavioral support, including its planning, implementation, and outcomes. The entire process of creating schoolwide teams, determining actions, and developing consensus is described in detail with specific examples. Outcomes of school-selected dependent variables indicate large decreases in the number of students excluded from the classroom learning environment for problem behaviors. Details of specific problems and issues are discussed with examples.
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Objective To describe the use of mental health and substance abuse services by children and adolescents as reported from the four community sites included in the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study.
With the growing challenges that children confront daily, schools must be prepared at any given moment to intervene on their behalf. And school professionals must be well trained to attend not only to the most routine mental health needs of its students but also to respond quickly and effectively to significant traumatic events. All this in addition to addressing demands to narrow the achievement gap, increase the rate of school success, and lower the dropout rate. Along with an introductory chapter that focuses on advancing school-based mental health practice and research, the Handbook of School Mental Health addresses a broad range of issues, including how to: • Build and enhance collaborative approaches among the various individual, group, system, and agency stakeholders. • Ensure best practices are used in all systems of care; provide effective training for all professionals; introduce strength-based approaches to assessment in schools; and facilitate the implementation of evidence-based practices. • Prevent and effectively manage crises and violence in schools while addressing the unique ethical, cultural, and legal challenges of school mental health. This volume is an essential resource for the diverse coalition of school mental health staff and advocates including educators, social workers, school psychologists, school counselors and other professionals who work with and are concerned with the well-being of children.
Theory and research regarding the diffusion of innovations and technology transfer have advanced our understanding of how new ideas and technologies are developed, disseminated, adopted, and implemented by individuals and organizations. Although diffusion has been studied in other fields, it is not often applied to mental health and substance abuse treatment. However, findings from diffusion-of-innovations research can assist in bridging research-practice gaps that lead to clients receiving treatments whose effectiveness has not been assessed or to clients not receiving the most effective treatments. This article reviews theory and research regarding the diffusion of innovations and highlights areas for application to mental health treatment, including the transportability of treatments into real-world settings, strategies to disseminate treatments, attributes of treatments that affect their adoption, and organizational change factors that affect implementation.
Reviews have identified mental health interventions that are relevant to schools; unfortunately, this research pays insufficient attention to the school con- text. Several aspects of school context likely influence the ability of schools to change current practices or adopt new ones. Relying on an organizational frame- work, a three-level model of school context particularly relevant to the delivery of mental health interventions: (a) individual, (b) organizational, and (c) state or na- tional-level factors are described. This article argues that effective school-based mental health care will result from the marriage of system reform efforts, capacity building, and the delivery of empirically driven intervention strategies.
The integration of education and behavioral health services in schools continues to evolve at a rapid pace. Proponents argue that school-based behavioral health programs have many benefits, including greater access to care and improved effectiveness as compared to clinic- or hospital-based services. While preliminary research is encouraging, in general the claims of school behavioral health are not supported by data. Some critics focus on negative aspects of school behavioral health. They claim that behavioral health is being forced upon students and can cite many examples of counseling and treatment administered to children without parental consent. Utilization, effectiveness, and consent are three topics that deserve a great deal of attention in this emerging field, and are the focus of this review.