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.     

Expanded School Mental Health Services: Assessing Needs Related to School Level and Geography

We surveyed 62 school administrators from three midatlantic (MD, VA, WV) and one northeastern (CT) state on factors relevant to developing school-based mental health programs. Administrators were from schools that varied on education level (elementary, middle, and high) and geographic location (urban, suburban, and rural), with equivalent numbers in each subgroup. Administrators provided ratings to questions grouped in five categories: (a) Stressful Conditions, (b) Internalizing Behavioral Problems, (c) Externalizing Behavioral Problems, (d) Substance Abuse, and (e) Barriers to Mental Health Care, and provided open-ended comments on needs of youth and mental health programs for them. They rated behavioral and substance abuse problems as progressively more serious as students advanced in school level. Urban youth were reported to encounter higher stress and present more severe internalizing problems than suburban or rural youth. Suburban and rural schools provided more health and mental health services than urban schools. Across geographic locales, physical health services far outnumbered mental health services. Findings related to barriers to mental health care, and the viability of schools as delivery sites for comprehensive mental health services, are discussed.     

The Expanded School Mental Health Collaboration Instrument [School Version]: Development and Initial Psychometrics

This article presents the psychometric properties of the Expanded School Mental Health Collaboration Instrument [School Version] (ESMHCI [SV]), a new measure for assessing ESMH collaboration from the perspective of school-employed professionals. A three-scale instrument (types of collaboration, influences on collaboration, and perceived benefits of collaboration) was initially developed based on theory, findings from focus group interviews, and a review of the literature. Exploratory factor analyses defined a set of factors for each of the three scales. Initial psychometric examination indicates preliminary evidence for validity and internal reliability. Implications for school professionals, policymakers, and researchers are offered.     

Effects of School-Based Mental Health Programs on Mental Health Service Use by Adolescents at School and in the Community

Many schools provide counseling to adolescents with behavioral and emotional problems on-site, but little is known about the use of school-based counseling services in the United States, and it is unclear whether these services complement or substitute for counseling services available outside of school. In this study data on mental health services offered in schools are used to estimate the probability of receiving emotional counseling at school and elsewhere. Where mental health services were available on-site, students were substantially more likely to see a counselor in the previous year, controlling for mental health status, health insurance coverage, and other factors. The effects of availability were greater for students enrolled in special education programs than for other students. However, these data also suggest that, relative to other schools, schools offering on-site mental health counseling do not increase or reduce use of counseling services outside of school on average.     

Readiness and School Improvement: Strategies for Enhancing Dissemination and Implementation of Expanded School Mental Health Practices

The primary purpose of this paper is to describe efforts to promote effective dissemination and adoption of an evidence-based school improvement model that incorporates expanded school mental health practices. A systematic readiness and capacity assessment process was used to identify and select pilot schools and school districts for participation in the Ohio Community Collaboration Model for School Improvement (OCCMSI: Anderson-Butcher et al, 2004, in press). In this paper we describe efforts used to incorporate assessment of readiness into selection, training, and implementation of OCCMSI, an evidence-based school improvement initiative. Assessments were used to ensure that pilot sites were ‘ready’ for adoption of the initiative and to promote attention to readiness and capacity as an integral part of the aims of the intervention. Assessments were based on the A-VICTORY model (Davis & Salasin, 1975; Robbins et al, 2003). Results from each readiness assessment were used to inform delivery of training and technical assistance in support of the implementation of the school improvement model. Our experience suggests that ongoing collection of information related to organizational readiness assists in adoption and implementation of effective practices and initiatives.     

Promoting the Growth,Improvement and Sustainability of School Mental Health Programs Worldwide

This introductory article reviews the development, vision, principles and aims of the International Alliance for Child and Adolescent Mental Health and Schools (Intercamhs), a network of more than 250 people from 26 countries involved in whole-school mental health promotion. Global issues related to child and adolescent mental health promotion and schools are discussed, including those related to language, collaborative practice and partnerships, involvement of young people and families, and research. An overview of the inaugural meeting of Intercamhs held in Portland, Oregon in October, 2003 is presented, along with reviews of seven additional papers and commentary included in this special issue.     

A Cross-Walk of Professional Competencies Involved in Expanded School Mental Health: An Exploratory Study

Expanded school mental health (ESMH) programs often involve individuals from a variety of professions working together to address student needs evident across school, family, and community systems. Profession-driven differences in philosophies, expectations regarding confidentiality, and graduate training that reinforces isolated rather than interprofessional approaches to working with students, however, represent real challenges to maximizing the potential of ESMH. To address these issues, this exploratory study identified a common set of competencies to support interprofessional practice in ESMH. A total of 51 competencies were identified across seven theme areas, including: (1) Key Policies and Laws; (2) Interprofessional Collaboration; (3) Cross-Systems Collaboration; (4) Provision of Academic, Social-Emotional, and Behavioral Learning Supports; (5) Data-Driven Decision-Making; (6) Personal and Professional Growth and Well-Being; and, (7) Cultural Competence. Mapping of the competencies to existing accreditation and practice standards for selected professions revealed shared and unique competencies. Implications for workforce development and future research are offered.     

The Expanded School Mental Health Collaboration Instrument [Community Version]: Development and Initial Psychometrics

This article presents the psychometric properties of the Expanded School Mental Health Collaboration Instrument [Community Version], a measure for assessing collaboration from the perspective of community-based mental health professionals working in schools. A three-scale instrument (Types of Collaboration, Influences on Collaboration, and Perceived Benefits of Collaboration) was developed based on findings from focus group interviews and a review of the literature. This instrument complements an existing measure of collaboration that considers the perspectives of school professionals involved in expanded school mental health (ESMH). Exploratory factor analyses were used to define a set of factors for each of the three scales. Preliminary psychometric examination suggests this is a promising instrument that should be studied further. Implications for ESMH practitioners and researchers are proposed.     

Unpacking Interdisciplinary Collaboration in Expanded School Mental Health: A Conceptual Model for Developing the Evidence Base

Despite its appeal and promise for addressing the multi-layered needs of young people, there is a lack of research documenting the extent to which interdisciplinary collaboration affects outcomes valued by schools, families, and communities. To address this gap in understanding, this review synthesizes the literature to consider the meaning, goals, processes, contextual influences, and anticipated outcomes of interdisciplinary collaboration in expanded school mental health. Based on this review, a conceptual model to help support the efforts of researchers, policy makers, and practitioners who are interested in understanding the relationship between interdisciplinary collaboration and outcomes is offered. Recommendations for developing the evidence base are also suggested.     

Psychometric Properties of an Assessment for Mental Health Recovery Programs

The concept of recovery can be operationalized from either the point of view of the consumer, or from the perspective of the agency providing services. The Milestones of Recovery Scale (MORS) was created to capture aspects of recovery from the agency perspective. Evidence establishing the psychometric properties of the MORS was obtained in three efforts: Inter-rater reliability using staff at The Village, a multi-service organization serving the homeless mentally ill in Long Beach, California; inter-rater reliability was also obtained from Vinfen Corporation, a large provider of housing services to mentally ill persons in Boston, Massachusetts. A test–retest reliability study was conducted using staff rating of clients at The Village, and evidence for validity was obtained using the Level of Care Utilization System (LOCUS) as a validity measure. The intra-class correlation coefficient for the inter-rater reliability study was r = .85 (CI .81, .89) for The Village and r = .86 (CI .80, .90) for Vinfen Corporation; test–retest reliability was r = .85 (CI .81, .87); and validity coefficients for the LOCUS were at or above r = .49 for all subscales except one. There is sufficient evidence for the reliability and validity of the MORS.     

Methodology Considerations in School Mental Health Research

Research in the area of school mental health (SMH) has undergone rapid evolution and expansion, and as such, studies require the use of diverse and emerging methodologies. In parallel with the increase in SMH research studies has been greater realization of the complex research methods needed for the optimal measurement, design, implementation, analysis, and presentation of results. This paper reviews key steps needed to effectively study SMH research questions. Considerations around research designs, methods for describing effects and outcomes, issues in measurement of process and outcomes, and the foundational role of school and community research partnerships are discussed within the context of SMH research studies. Ongoing developments within SMH research methods are presented as illustrative examples.     

Medico-Legal Risk Associated with Pediatric Mental Health Telephone Consultation Programs

Clinicians providing consultation through mental health telephone consultation programs express concern about the potential legal risk of the practice. In this survey of six state mental health telephone consultation program directors, we report the annual number of children referred for consultation and the number of lawsuits against consultant clinicians. Between 2004 and 2010, 3,652 children per year were referred nationally, and there were no medical malpractice lawsuits against clinicians related to telephone consultation program activity. Although medico-legal risk is always present, the findings of this national study suggest the risk for clinicians providing mental health telephone consultation may be lower than perceived.     

Formative Evaluation of a Framework for High Quality, Evidence-Based Services in School Mental Health

The purpose of this study was to test a three component framework for enhancing quality in school mental health (SMH), focusing on quality assessment and improvement (QAI), family engagement/empowerment, and modular evidence-based practice (EBP) implementation in three established SMH programs. The study involved a 2-year, multisite (Delaware, Maryland, Texas) formative evaluation with clinicians randomly assigned to participate in either the QAI (target) intervention or a Wellness Plus Information (WPI, comparison) intervention. As hypothesized, clinicians who participated in the QAI condition demonstrated significantly greater implementation of quality indicators and greater implementation of EBP as compared to clinicians in the WPI condition. However, contrary to original hypotheses, findings did not reveal differences between the conditions in knowledge or attitudes toward EBP, clinician self-efficacy, or student psychosocial outcomes. Implications for future research on quality improvement in SMH are discussed, with an emphasis on the need to examine the impact of increased implementation and resource support to SMH clinicians.