Elizabeth H. Connors

Strategies for Integrating Mental Health into Schools via a Multitiered System of Support

To fully realize the potential of mental health supports in academic settings, it is essential to consider how to effectively integrate the mental health and education systems and their respective resources, staffing, and structures. Historically, school mental health services have not effectively spanned a full continuum of care from mental health promotion to treatment, and several implementation and service challenges have evolved. After an overview of these challenges, best practices and strategies for school and community partners are reviewed to systematically integrate mental health interventions within a schools multitiered system of student support.

School nurses' perceived prevalence and competence to address student mental health problems

Due to under-identification of student mental health problems and limited specialty mental health providers in schools, school nurses are often faced with identifying and addressing student mental health needs. This exploratory study assessed prevalence and types of student mental health problems encountered by school nurses, as well as their prior training, perceived competence and levels of comfort addressing such problems. Data collected at a 2010 National Association of School Nurses conference from 78 school nurses suggest that in their view, 31% of students present with mental health concerns as their ‘primary’ presenting issue. School nurses reported moderate levels of comfort identifying specific problem areas, but limited comfort in mental health intervention and pre-service training to identify, assess, make referrals and/or intervene. Perceived competence identifying mental health concerns overall was predictive of perceived competence to make referrals. Implications and recommendations for professional development are presented.

Key priorities, challenges and opportunities to advance an integrated mental health and education research agenda

A critical priority for the fields of education and mental health is to develop an integrated research agenda to advance empirical and practical progress towards the goal of reducing a significant research to practice gap. This study presents qualitative findings from an intensive dialogue meeting held with a multidisciplinary sample of 35 leaders in education, childrens mental health and related fields. Comprehensive data from the meeting by three independent notetakers were analysed and integrated to fully capture the discussion of research priorities for education and mental health. Synthesized content represented the three categories of key priorities, challenges and opportunities towards an integrated mental health and education research agenda. Themes identified by qualitative analysis of the notes, as well as suggestions, current progress and future directions for reducing the research-to-practice gap, are described.

A National Initiative to Advance School Mental Health Performance Measurement in the US.

Abstract Standardized health performance measurement has increasingly become an imperative for assuring quality standards in national health care systems. As compared to somatic health performance measures, behavioral health performance measures are less developed. There currently is no national standardized performance measurement system for monitoring comprehensive school mental health in the USA. Drawing upon related initiatives in the school mental health field and national performance standards for behavioral health care in non-school settings, the current study describes the identification, development, and refinement of quality and sustainability performance measures for comprehensive school mental health. A three-phase method involving literature review and expert consensus, nominal group decision-making, and a modified Delphi process resulted in the development of two performance assessments, which include 12 domains and 67 indicators. Future directions for national performance measurement among school mental health systems to drive improvement in quality and sustainability are considered.

Intentional research design in implementation science: implications for the use of nomothetic and idiographic assessment

The advancement of implementation science is dependent on identifying assessment strategies that can address implementation and clinical outcome variables in ways that are valid, relevant to stakeholders, and scalable. This paper presents a measurement agenda for implementation science that integrates the previously disparate assessment traditions of idiographic and nomothetic approaches. Although idiographic and nomothetic approaches are both used in implementation science, a review of the literature on this topic suggests that their selection can be indiscriminate, driven by convenience, and not explicitly tied to research study design. As a result, they are not typically combined deliberately or effectively. Thoughtful integration may simultaneously enhance both the rigor and relevance of assessments across multiple levels within health service systems. Background on nomothetic and idiographic assessment is provided as well as their potential to support research in implementation science. Drawing from an existing framework, seven structures (of various sequencing and weighting options) and five functions (Convergence, Complementarity, Expansion, Development, Sampling) for integrating conceptually distinct research methods are articulated as they apply to the deliberate, design-driven integration of nomothetic and idiographic assessment approaches. Specific examples and practical guidance are provided to inform research consistent with this framework. Selection and integration of idiographic and nomothetic assessments for implementation science research designs can be improved. The current paper argues for the deliberate application of a clear framework to improve the rigor and relevance of contemporary assessment strategies.

Dissemination and implementation science in program evaluation: A telemental health clinical consultation case example

Increased attention has been placed on evaluating the extent to which clinical programs that support the behavioral health needs of youth have effective processes and result in improved patient outcomes. Several theoretical frameworks from dissemination and implementation (D&I) science have been put forth to guide the evaluation of behavioral health program implemented in the context of real-world settings. Although a strong rationale for the integration of D&I science in program evaluation exists, few examples exist available to guide the evaluator in integrating D&I science in the planning and execution of evaluation activities. This paper seeks to inform program evaluation efforts by outlining two D&I frameworks and describing their integration in program evaluation design. Specifically, this paper seeks to support evaluation efforts by illustrating the use of these frameworks via a case example of a telemental health consultation program in pediatric primary care designed to improve access to behavioral health care for children and adolescents in rural settings. Lessons learned from this effort, as well as recommendations regarding the future evaluation of programs using D&I science to support behavioral health care in community-based settings are discussed.

School mental health professionals’ training, comfort, and attitudes toward interprofessional collaboration with pediatric primary care providers

Abstract Despite the well-documented need for interprofessional collaboration (IPC) between school mental health (SMH) professionals and pediatric primary care providers (PCPs), research on current collaborative practices of these professionals is limited. Accordingly, using survey methodology, this study investigated SMH professionals’ previous training and training interests, degree of comfort with, attitudes toward, and current practices in IPC with pediatric PCPs. The majority of SMH professionals reported having received some training in IPC and endorsed high levels of interest in additional training. Further, comfort in IPC skills varied considerably based on the skill queried. While SMH professionals indicated IPC was of high importance, results revealed the relative infrequency of IPC with pediatric PCPs. Finally, increased frequency of IPC with pediatric PCPs was associated with positive attitudes toward IPC. Study results underscore the importance of addressing attitudes toward IPC and have implications for advancing research and training in SMH professionals IPC with pediatric PCPs.

Student-focused supports to promote mental health and well-being

A unique benefit of mental health service provision in schools is the opportunity to address mental health promotion, prevention and early intervention to improve students’ psychosocial and academic outcomes (Durlak & Wells, 1997; Greenberg et al., 2003; O’Connell, Boat, & Warner, 2009). This shift toward early intervention helps ensure that those students with or at risk for mental health problems will receive earlier treatment, a practice that will guide them toward a trajectory that avoids the development or exacerbation of symptoms. Moreover, the specific focus on universal mental health promotion complements the early intervention model by leveraging important natural supports such as teachers and administrators to support the mental health and wellness of all students (Atkins, Hoagwood, Kutash, & Seidman, 2010). The articles in the current issue highlight the importance of school-based mental health promotion programs that are well-suited for the school context due to being student-guided (e.g. mindfulness approaches, peer education, youth mentoring), brief in duration, and leveraging the natural environment (e.g. classroom-based intervention, multiple school record and teacher observation data sources, classmates as peer educators). Moreover, although the motivational interviewing review conducted by Snape and Adkinson included some studies focusing on students already experiencing mental health concerns, most of the work represented in the current issue focuses on school-based services and supports that are appropriate to promote all students’ well-being and success. Articles in this issue represent school mental health research conducted in Ireland (O’Reilly and colleagues), New Zealand (Bernay and colleagues), the United Kingdom (Snape and Atkinson), Romania (Snape and Atkinson), and the United States (Snape and Atkinson; McQuillin and colleagues). The first article in this issue by O’Reilly and colleagues illustrates evaluation outcomes of a school-based peer mental health education training program in post-primary schools in Ireland. Findings from self-report surveys indicated that participants (N = 30 students training to become peer educators) showed significant changes in presentation skills, mental health knowledge, and beliefs about help-seeking. There were also non-statistically significant improvements in participants’ self-esteem, decision-making, and problem-solving skills, perhaps due to ceiling effects given participants’ baseline strengths in these areas. This is a promising example of the positive impact that becoming a peer educator can have on the wellness of students who volunteer. Next, in a randomized, controlled study of 72 middle-school students, McQuillin and colleagues evaluated the efficacy of a brief school-based mentoring program in the United States. Existing literature focuses on youth mentoring relationships which typically do not last longer than a few months. Short-term mentorship programs have been found to be associated with greater risk of harm to clients when the termination of the mentor–mentee relationship is not anticipated. Therefore, McQuillin and colleagues tested the effectiveness of an intentionally brief, goal-focused mentorship program. When compared to the no-treatment group, students who participated in the mentoring curriculum showed statistically significantly higher math and English grades, life satisfaction, and fewer school absences. This study also provides a comprehensive review of the theoretical bases and application of mentoring curricula.

Increasing global knowledge exchange in school mental health

Since its inception, Advances in School Mental Health Promotion (ASMHP) has emphasized its international focus, both in terms of manuscript solicitation and readership. This focus reflects two overarching principles: (1) innovation and progress in school mental health is occurring across the globe, with unique pockets of excellence in specific topics occurring in individual communities, countries, and continents, and (2) as a field, we will increase our efficiency and promote more meaningful, impactful, and sustainable growth if we work collectively as an international force. Since our first issue was published in January of 2008, we have continued to receive and publish manuscripts from a diverse, international cadre of leading school mental health researchers and practitioners. Before introducing the multinational collection of papers for this special issue, I will review our history of international submissions and publications, as well as highlight some promising current international endeavors in the field of school mental health. To date, our submissions reflect 21 countries. Likewise, our published papers reflect an international authorship, with 16 countries represented. Notably, the majority of submission and publications are from authors in the USA, Canada, Australia, and the UK, respectively. This may reflect relative advancement of school mental health in these fields, but also likely reflects less systematic outreach by ASMHP to other countries. Thus, a goal in our strategic plan is to increase outreach to both authors and readers from a more diverse international audience, with support of our editorial board and publisher. We have been privileged to witness and participate in recent advancements in the area of global school mental health. First, our Annual Conference on Advancing School Mental Health, co-sponsored by our national Center for School Mental Health (CSMH, http:// csmh.umaryland.edu) at the University of Maryland (funded by the United States Department of Health and Human Services, Health Resources and Services Administration) and the IDEA Partnership (funded by the Office of Special Education Programs), has seen a sharp increase in international attendance in recent years. Our recent conferences have included participants from several countries, including Australia, Canada, China, Denmark, England, Germany, Hong Kong, Ireland, Japan, New Zealand, South Korea, and the USA. This, in part, reflects the work initiated by the International Alliance for Child and Adolescent Mental Health in Schools (INTERCAMHS), founded at the conference in 2003, and also just the growth in attention globally to the importance of mental health in schools. A second notable development occurred at the 2014 World Congress on Mental Health Promotion, during which the first meeting of the School

The Mental Health Training Intervention for School Nurses and Other Health Providers in Schools

School nurses encounter many students presenting with mental health needs. However, school nurses report that they need additional training and resources to be able to support student mental health. This study involved a multilevel, stakeholder-driven process to refine the Mental Health Training Intervention for Health Providers in Schools (MH-TIPS), an in-service training and implementation support system for school health providers, including school nurses, to increase their competence in addressing student mental health concerns. Findings highlighted the importance of mental health content including assessment, common factors of positive therapeutic mental health interactions, common elements of evidence-based mental health practice, and resource and referral mapping. Additionally, multifaceted ongoing professional development processes were indicated. Study findings indicate that, with recommended modifications, the MH-TIPS holds promise as a feasible, useful intervention to support school nurse practice and ultimately impact student mental health and educational outcomes.