School-based Mental Health Services

For over a decade, investigators from the Research and Training Center for Children's Mental Health have been studying the role of school-based mental health services in systems of care for children with emotional/behavioral disorders and their families.

We believe that effective and integrated school-based mental health services will be a key ingredient in the current transformation of children's mental health services in America, and schools will be central to providing support for the nation’s youth in an increasingly complex societal context. Resources provided here describe what we've learned about school-based mental health services today, how we reached this point, and how good planning decisions might be made in the future.

Recent federal initiatives and acts promote the schools’ role as an effective vehicle to meet the social and emotional needs of all children while achieving the highest academic standards. The 1999 Report of the Surgeon General on the Mental Health of the Nation, the 2001 No Child Left Behind Act, and the 2003 report from the New Freedom Commission on Mental Health have all focused attention on the potential of increasing the effectiveness and capacity of school-based mental health services to improve the emotional well being of all children as well as their academic achievement.

While these federal initiatives have had an important role in increasing advocacy and interest in school-based mental health services, their recommendations lack the specificity needed for implementation at a scale necessary for significant improvement in outcomes for children. For example, they have triggered an explosion of interest and activity in school-based mental health programming, yet outcomes for children who have emotional disturbances continue to be the poorest of all disability groups (Wager et al., in press). The field can be characterized as being fragmented and underdeveloped, and confused by conflicting terminology and professional perspectives.

The School-based Mental Health Services Study

Study 4: The School-based Mental Health Services Study examined one of the components in the Center’s model of factors contributing to implementation of an effective system of care; namely, the promotion of collaboration between key agencies. It is essential that effective collaboration between the school and mental health systems exist in order to better serve individual children and families, and to facilitate significant improvement in the mental health service delivery system.

The study investigated school-mental health collaboration in the context of the overall mental health system, and will specifically investigate two other factors in the Center’s model: financing methods that are consistent with implementing an effective system of care, and mechanisms that ensure strong family voice at all levels of the system.

School-wide Reform and Mental Health Policies in Urban Schools

Conducted from 1999 - 2004, Study 3 described models of school reform operating in urban areas that served diverse populations, and examined the relationship between reform activities and measures of student functioning. The Urban School and Community Study (USACS) was designed to investigate the relationship between reforms in regular education, special education and mental health and outcomes for students who have emotional and behavioral disabilities. The domains of outcomes at the student level included academic, emotional, behavioral, and community functions. This study sought to explicate the reform and restructuring activities of several different school-based models associated with positive outcomes as they occurred in state and local contexts.

There were four key findings from this study:

(1) Urban schools engaged in more reform activities yield higher levels of academic achievement for students who have emotional disturbances. The amount of reform and improvement operating in a school and levels of math achievement for students who have emotional disturbances was examined. The amount of engagement in improvement and reform activities was found to be correlated .36 with math achievement of students with emotional disturbances. The size of this correlation is classified as “medium” by Cohen (1988). Additionally, greater levels of reform were also associated with higher levels of exposure to the general education curriculum for students with emotional disturbances. These findings are important as they link policy changes with improved outcomes for students with emotional disturbances served in special education.

(2) Multiple models of delivering mental health services are operating in urban schools. Schools that are actively engaging in reform and improvement have been creative and, in some cases, have leveraged community relations to increase services for these children. We have found several approaches to delivering these services that include the following: (a) all services provided by school personnel during school hours; (b) a combination of services from school personnel and staff from community agencies who provide service in the school; and (c) services provided by a community agency that acts as a lead agency in implementing a large scale community-based service program that includes the school system as a collaborator with the other child serving agencies. Interestingly, these various models have produced a higher level of service utilization for the students in this study as compared to estimates from national studies.

(3) Students from ethnically diverse backgrounds, served in special education due to emotional disturbances, display very high levels of psychopathology and impaired functioning across multiple domains and this condition has persisted since early childhood. Through interviews with parents, standardized measures of psychopathology (the Child Behavior Checklist (CBCL), and functional impairment (the Columbia Impairment Scale (CIS)), were administered along with questions that ascertained the history of services used by the student. CBCL scores for the first 158 students (average age of 11.8 years) revealed that 73% were classified as either in the clinical or borderline range, indicating significant emotional disturbance. Additionally, the majority of the students (58%) were also classified in the clinical range of the CIS indicating substantial impairment due to the emotional disturbances. According to reports from parents, their child’s emotional problems were first noticed at an average age of 5.4 years. The first service for these problems was received at average age of 6.9 years. On average the youth were first placed in special education classrooms at eight year of age or about third grade. Therefore, when the amount of time these students spent in a special education program is compared to their time in a general education classroom, this indicates these students have spent 67% of their school careers enrolled in a special education program (Kutash & Duchnowski, 2004).

(4) The School Improvement Index (SII) is a valid and reliable measure of school reform including special education. This instrument warrants widespread dissemination. Two types of psychometric studies have been conducted on the SII. The validity of the SII was established through a study that revealed the SII could discriminate between schools nominated as actively engaged in reform and schools nominated as not actively engaged in reform activities. The reliability of the SII has also been supported with high interclass correlations (.85) between multiple raters independent of the study. The psychometric properties of the SII are discussed in the article by Duchnowski, Kutash, and Oliveira (2004).

More Publications on School-based Mental Health Services

Training Teachers to Conduct Trial-Based Functional Analyses

The purpose of this study was to determine whether teachers trained via an in-service training would be able to conduct trial-based functional assessments with high procedural integrity.

Youth Suicide Prevention School-based Guide: 2012 Edition

Designed to provide accurate, user-friendly information for school administrators, staff, and faculty, the Guide is now available online and printed copies can be purchased.

Supporting Parents Who Have Youth with Emotional Disturbances Through a Parent-to-Parent Support Program

Published in the Journal: Administration & Policy in Mental Health & Mental Health Services Research (Online First)

Prevent-Teach-Reinforce: The School-Based Model of Individualized Positive Behavior Support

With this book, education professionals will learn how to prevent behavior problems by adjusting the curriculum and environment; teach proactive communication skills; and reinforce prosocial behavior and academic achievement.

Phase I - III Reports: Developing Sustainable Infrastructure in Support of Quality Field-Based Practice

These documents report on Phases I, II and III of SIP and report how the Children's Board of Hillsborough County can maximize investment in locally developed programsm and promote, implement, and sustain best practice for positive child and family outcomes.

FASST Implementation Toolkit: Developing Sustainable Infrastructure in Support of Quality Field-Based Practice

This toolkit was produced as part of Developing Sustainable Infrastructure in Support of Quality Field-Based Practice (SIP) project, a collaborative effort of The Children’s Board of Hillsborough County Children’s Future Hillsborough, Family and School Support Teams (FASST), and the USF Department of Child and Family Studies. The toolkit has been designed to support implementation of the FASST
program as intended based on the current program theory.

A Process for Scaling Up SWPBS (School-Wide Positive Behavior Support) with Fidelity

This publication addresses how Florida may be able to scale-up and sustain over 3700 schools to implement Tier 1 PBS with fidelity. The process for scaling up implementation of School-Wide Positive Behavior Support with fidelity has been developed by the Office of Special Education Program’s Center on Positive Behavioral Interventions and Support and has been further examined by the State Implementation and Scaling up of Evidence-based Practices Center funded by OSEP.

22nd Annual Research Conference Proceedings

Features presentation summaries from symposia, paper presentations and poster presentations, organized around the central themes of the annual research conference.

Parent to Parent: A Synthesis of the Emerging Literature

This literature review attempts to provide a synthesis of the emerging literature pertaining to parent-to-parent support. The purpose of this review is twofold: (1) to uncover any evidence of the effectiveness of parent-to-parent support; and (2) to examine the concepts, constructs, and key elements of parent-to-parent that should be considered when designing a program (i.e., case management, training, and contact methods).

The Role of Mental Health Services in Promoting Safe and Secure Schools

This guidebook is part of a series developed by the Hamilton Fish Institute on School and Community Violence and the Northwest Regional Educational Laboratory (NWREL) to provide resources, tools, and guidance for creating safe school settings and involving the community in supporting students of all ages.

21st Annual Research Conference Proceedings

Features presentation summaries from symposia, paper presentations and poster presentations, organized around the central themes and full agenda of the annual research conference.

Response to Intervention and Positive Behavior Support: Brothers from Different Mothers or Sisters with Different Misters?

This article offers an overview of how a Response to Intervention approach to education is consistent with Positive Behavior Support principles and practices.

Family Driven Care: Are We There Yet?

This report acquaints readers with the concept of family-driven care for children who have emotional and behavioral disturbances. From this context, the authors provide information about evidence-based practices that are effective interventions to help the children and their families. This information will help families, educators, and mental health service providers plan effective interventions for the children in their care.

Linking Community Helpers and Services with Schools Serving Latino Families: An Orientation to the RAICES/Promotoras Model Training Curriculum

This guide introduces and describes a model and associated training curriculum designed to support communities in their efforts to strengthen partnerships that better link Latino children and families with school personnel and service providers.

Voices from the Field: A Blueprint for Schools to Increase the Involvement of Families Who Have Children with Emotional Disturbances

This document describes how the school and mental health systems can increase the involvement of parents in developing and assisting with services for their children with serious emotional disturbances.

Educating Students with Emotional Disturbances: A National Perspective on Programs and Services

This article presents results of a study of students with emotional disturbances (ED) and their experiences at the elementary, middle, and high school grade levels.

School-Based Mental Health: An Empirical Guide for Decision-Makers

The "Yellow Book" provides a discussion of barriers to school-based services with the intention of improving service effectiveness and capacity.

The Special Education Elementary Longitudinal Study (SEELS) and the National Longitudinal Transition Study (NLTS2): Study Designs and Implications for Youth With Emotional Disturbance

This article describes design features of two longitudinal studies, the Special Education Elementary Longitudinal Study (SEELS) and the National Longitudinal Transition Study (NLTS2), and to outline their potential implications for policy, practice, research, advocacy, and system development for children and youth with emotional disturbances (ED).

Real Manuals for Real Teachers

The four teacher-friendly manuals serve as guides to the implementation of evidence-based practices by special education teachers.

The Children and Youth We Serve: A National Picture of the Characteristics of Students with Emotional Disturbances Receiving Special Education

This article provides a national perspective of children and youth with emotional disturbances (ED) served in special education using data from the Special Education Elementary Longitudinal Study (SEELS) and the National Longitudinal Transition Study-2 (NLTS2).

Program-Wide Positive Behavior Support:Supporting Young Children’s Social-Emotional Development and Addressing Challenging Behavior

Provides a report on the program-wide implementation of the "Teaching Pyramid", a model of program-wide Positive Behavior Support for early childhood applications, within a Head Start Program.

Systematically Examining School Improvement Activities Including Special Education

This report provides sytematic information about school reform and improvement and its relationship to special education.

The Mental Health Needs of Youth with Emotional and Behavioral Disabilities Placed in Special Education Programs In Urban Schools

This paper describes the psychosocial characteristics of youth served in special education due to emotional disturbances in urban communities (N = 158).

Family Involvement in Functional Assessment: A Guide for School Professionals

This free, downloadable manual provides teachers with guidance on how to involve families in the functional assessment and behavior support plan development process. A step-by-step process is described and helpful forms are provided.

The Youth Suicide Prevention School-Based Guide

The Guide is a tool that provides a framework for schools to assess their existing or proposed suicide prevention efforts (through a series of checklists) and provides resources and information that school administrators can use to enhance or add to their existing program. First, checklists can be completed to help evaluate the adequacy of the schools' suicide prevention programs. Second, information is offered in a series of issue briefs corresponding to a specific checklist.

Positive Educational Planning: A Guide to Thoughtful Preparation for the Educational Planning Process

This free, downloadable booklet provides a portfolio families can use to gather and share priorities and insights about their child in preparation for educational or service planning activities. Included within the form are sections that guide families to describe their child, share perspectives on their child's learning characteristics and identify desired outcomes.

Improving Outcomes for Students Through the Application of a Public Health Model to School Psychology: A Commentary

This overview contains a summary of the application of public health principles and concepts, which have the potential to improve outcomes for children served in our schools.

Safe Schools/Healthy Students initiative: Pinellas County, Florida

The Safe Schools/Healthy Students (SS/HS) Initiative in Pinellas County, FL, emerged as a part of a broader local effort to implement creative educational and mental health programs to support children and families. This initiative focused on capacity building, prevention, and intervention efforts and comprehensive evaluation to address the barriers to learning and enhance healthy development.

A School, Family, and Community Collaborative Program for Children who have Emotional Disturbances

This article provides the rationale, development, implementation and evaluation of a school-based program for students with emotional disturbances and who are served in a special education setting.

A Comparison of the Academic Progress of Students with Emotional and Behavioral Disabilities and Students with Learning Disabilities.

This article presents findings from a study comparing academic progress over five years for students with emotional and behavioral disorders and students with learning disabilities. Factors related to academic achievement (attendance, behavior offenses, type of special education setting, school mobility and early retention) were examined as to their contribution to achievement over time for these two groups.

The School and Community Study: Characteristics of Students who have Emotional and Behavioral Disabilities Served in Restructuring Public Schools

This article presents preliminary results from an ongoing study of the effects of school reform and restructuring on students with serious emotional and behavioral disabilities (SED).

For more information:

Krista Kutash, Ph.D.
Al Duchnowski, Ph.D.
Louis de la Parte Florida Mental Health Institute - MHC 2333
13301 Bruce B. Downs Blvd.
Tampa, FL 33612
813-974-4661

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