Sharon H. Stephan

Transformation of Children's Mental Health Services: The Role of School Mental Health

The New Freedom Commission has called for a transformation in the delivery of mental health services in this country. The commissions 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 commissions 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.

Mental health interventions in schools in high-income countries

Mental health services embedded within school systems can create a continuum of integrative care that improves both mental health and educational attainment for children. To strengthen this continuum, and for optimum child development, a reconfiguration of education and mental health systems to aid implementation of evidence-based practice might be needed. Integrative strategies that combine classroom-level and student-level interventions have much potential. A robust research agenda is needed that focuses on system-level implementation and maintenance of interventions over time. Both ethical and scientific justifications exist for integration of mental health and education: integration democratises access to services and, if coupled with use of evidence-based practices, can promote the healthy development of children.

Challenges and Ideas from a Research Program on High-Quality, Evidence-Based Practice in School Mental Health

This article reviews the progression of a research program designed to develop, implement, and study the implementation of “achievable” evidence-based practices (EBPs) in schools. We review challenges encountered and ideas to overcome them to enhance this avenue of research. The article presents two federally funded randomized controlled trials involving comparison of a four-component targeted intervention (Quality Assessment and Improvement, Family Engagement and Empowerment, Modular Evidence-Based Practice, Implementation Support) versus a comparison intervention focused on personal wellness. In both studies, primary aims focused on changes in clinician attitudes and behavior, including the delivery of high-quality EBPs and secondary aims focused on student-level impacts. A number of challenges, many not reported in the literature, are reviewed, and ideas for overcoming them are presented. Given the reality that the majority of youth mental health services are delivered in schools and the potential of school mental health services to provide a continuum of mental health care from promotion to intervention, it is critical that the field consider and address the logistical and methodological challenges associated with implementing and studying EBP implementation by clinicians.

A review of educational outcomes in the children's mental health treatment literature

We examined the measurement of educational outcomes related to childrens 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 childrens 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.

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.

Telepsychiatry and School Mental Health

The provision of mental health services in schools has been one effective strategy for reaching out to a greater number of youth to identify and provide treatment for mental health issues. With the increasing challenges related to shortages in child and adolescent psychiatrists, it is critical to develop models of care that can maximize a full range of mental health services for all children and adolescents who need them. Telehealth offers an innovative distance technology strategy to effectively and efficiently provide access to psychiatric services in schools. Telepsychiatry has the potential to better link and enhance the provision of health services, and can be particularly beneficial in addressing geographic distance and/or capacity issues. This article describes the clinical, educational, and administrative uses of telemental health in the school environment with mental health professionals and staff.

The Effect of Waiting Time on Youth Engagement to Evidence Based Treatments

Prolonged waiting times to receive mental health services are common and may have negative consequences. This study examines the relationship between waiting time and treatment engagement among 2,054 youth referred to an evidence based treatment (EBT). Findings indicate that families are more likely to refuse services if they face longer waiting times. Families exposed to a prolonged waiting time were also more likely to drop out prematurely from Functional Family Therapy, but this relationship was not significant among youth receiving Multisystemic Therapy. Implications for EBT implementation and strategies for engaging families are discussed.

Integrating the Family Check-Up and the parent Coping Power program

Engaging families in school-based preventive interventions for aggressive youth can be especially challenging. The current article describes an integration of a parent engagement model, called the Family Check-Up, with an evidence-based intervention for youth with aggressive behaviours called Coping Power. The overall goal of the integration was to increase parental involvement and exposure to the core elements of the Coping Power programme to optimize impact on families and their children. We describe both models, summarize evidence of their efficacy when implemented alone, and provide a rationale for their integration. We also provide case examples to illustrate the implementation of the integrated programme in schools as well as feasibility data to support its continued study and implementation.

National Survey on Expanded School Mental Health Services

In the 20072008 academic year, the Center for School Mental Health broadly disseminated an electronic survey to Expanded School Mental Health (ESMH) stakeholders in order to better understand ESMH programs in the United States. The survey asked respondents to share data about their ESMH programs across several domains including staffing, funding, service modalities, evidence-based practises and programs, and partnerships. Respondents reported on 156 ESMH programs. This paper highlights the results of the ESMH survey. Findings from the ESMH survey add to the limited literature on what may be typical and not typical in ESMH services and programming in the United States. Implications related to research, practise and workforce development are discussed.

Contextual Features of Public Schools in the United States as Settings for Mental Health Promotion

Scanning the current policy and practice landscape of mental health promotion in the United States reveals indicators of significant progress in establishment of comprehensive school-based programs and services. At the same time, however, there remain significant challenges to advancing the SMH agenda. Using a conceptual lens, the authors elucidate fundamental political and practical dimensions of public education that must be addressed, including collaboration with stakeholders opposed to school mental health and partnering with teachers in mental health promotion. Concept mapping is introduced as a strategy to increase understanding about the role of school mental health in public education.