Mental Health in Schools

Engaging Learners, Preventing Problems, and Improving Schools

Howard S. Adelman, Linda Taylor

• Publisher: Skyhorse
• Year: 2015
• ISBN:
  9781510701021
• Topic: Bildung
• Subtopic: Bildungsberatung

For many children, schools are the main or only providers of mental health services. In this visionary and comprehensive book, two nationally known experts describe a new approach to school-based mental health—one that better serves students, maximizes resources, and promotes academic performance.
The authors describe how educators can effectively coordinate internal and external resources to support a healthy school environment and help at-risk students overcome barriers to learning. School leaders, psychologists, counselors, and policy makers will find essential guidance, including:
• An overview of the history and current state of school mental health programs, discussing major issues confronting the field
• Strategies for effective school-based initiatives, including addressing behavior issues, introducing classroom-based activities, and coordinating with community resources
• A call to action for higher-quality mental health programming across public schools—including how collaboration, research, and advocacy can make a difference
Gain the knowledge you need to develop or improve your school's mental health program to better serve both the academic and mental health needs of your students!

PART I

The Field of Mental Health in Schools

To paraphrase Goethe: Not moving forward is a step backward.

In many schools, the need for enhancing mental health is a common topic. And as recognized by the final report of the President’s New Freedom Commission on Mental Health (2003) and The 2007 Progress Report on the President’s New Freedom Initiative, efforts to enhance interventions for children’s mental health must involve schools. Thus, many of those interested in improving education and those concerned about transforming the mental health system in the United States of America and elsewhere are taking a new look at schools (Adelman & Taylor, 2008, 2009; Center for Mental Health in Schools, 2004c; Kutash, Duchnowski, & Lynn, 2006; O’Connell, Boat, & Warner, 2009).

However, while mental health in schools is widely discussed, what’s being talked about often differs in fundamental ways. Various agenda are pursued. Divergent policy, practice, research, and training agenda emerge. The result is confusion and conflict. This all adds to the continuing marginalization of efforts to advance mental health in schools (Taylor & Adelman, 2002).

In spite of or perhaps because of the multiple agenda, mental health in schools is an emerging new field. This reality is reflected in federally funded national centers focused on policy and program analyses; published books, reports, and scholarly journals; and university research and training programs. In addition, organizations and centers that have relevance for a school’s focus on mental health and psychosocial concerns continue to burgeon. These include a variety of technical assistance, training, and resource centers (see Gateway to a World of Resources for Enhancing MH in Schools—available at http://smhp.psych.ucla.edu/gateway/gateway_sites.htm).

As we explore ways to advance the field, a brief overview of its past and present will provide a logical jumping off place and a good foundation for moving forward.

1

Mental Health in Schools

Past and Present

A variety of psychosocial and health problems have long been acknowledged as affecting learning and performance in profound ways. Moreover, behavior, learning, and emotional problems are exacerbated as youngsters internalize the debilitating effects of performing poorly at school and are punished for the misbehavior that is a common correlate of school failure.

Efforts to address mental health concerns in schools are not new. What’s new is the emergence of the field of mental health in schools. We begin by highlighting some of what has transpired over the last 60 years.

PAST AS PROLOGUE

Because of the obvious need, school policy makers have a lengthy, if somewhat reluctant, history of trying to assist teachers in dealing with problems that interfere with schooling. Prominent examples are seen in the range of health, social service, counseling, and psychological programs schools have provided from the end of the 19th century through today (Baumgartner, 1946; Christner & Mennuti, 2009; Dryfoos, 1994; Flaherty, Weist, & Warner, 1996; Tyack, 1992).

One interesting policy benchmark appeared in the middle of the 20th century when the National Institute of Mental Health (NIMH) increased the focus on mental health in schools by publishing a monograph on the topic (Lambert, Bower, & Caplan, 1964). Since then, many initiatives and a variety of agenda have emerged. Included are efforts to expand clinical services in schools, develop new programs for at risk groups, and incorporate programs for the prevention of problems and the promotion of social-emotional development (Adelman & Taylor, 1994; Califano, 1977; Collaboration for Academic, Social, and Emotional Learning, 2003; Dryfoos, 1994; Knitzer, Steinberg, & Fleisch, 1990; Millstein, 1988; Steiner, 1976; Stroul & Friedman, 1986; Weist & Murray, 2007).

Bringing Health and Social Services to Schools

Over the past 20 years, a renewed emphasis in the health and social services sectors on enhancing access to clients led to increased linkages between schools and community service agencies, including colocation of services on school sites (Center for the Future of Children, 1992; Warren, 2005). This school-linked services movement added impetus to advocacy for mental health in schools. It promoted school-based health centers, school-based family resource centers, wellness centers, afterschool programs, and other efforts to connect community resources to the schools.

Many advocates for school-linked services coalesced their efforts with those working to enhance initiatives for youth development, community schools, and the preparation of healthy and productive citizens and workers (Blank, Berg, & Melaville, 2006). These coalitions expanded interest in social-emotional learning and protective factors as ways to increase students’ assets and resiliency and reduce risk factors (Greenberg et al., 2003; Hawkins, Kosterman, Catalano, Hill, & Abbott, 2008). However, the amount of actual mental health activity in schools generated by these efforts remains relatively circumscribed (Foster et al., 2005; Teich, Robinson, & Weist, 2007).

Federal Support for the Field of Mental Health in Schools

In 1995, a direct effort to advance mental health in schools was initiated by the U.S. Department of Health and Human Services through its Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau, Office of Adolescent Health (Anglin, 2003). The purpose of the initiative is to enhance the role schools play in mental health for children and adolescents. Specifically, the emphasis is on increasing the capacity of policy makers, administrators, school personnel, primary care health providers, mental health specialists, agency staff, consumers, and other stakeholders so that they can enhance how schools and their communities address psychosocial and mental health concerns. Particular attention is given to mental health promotion, prevention, and responding early after the onset of problems as critical facets of reducing the prevalence of problems and enhancing well-being.

The core of the work has been embedded in two national centers. The two, which were initially funded in 1995 with a primary emphasis on technical assistance and training, successfully reapplied during the 2000 open competition. A third open competition for a five-year funding cycle was offered in 2005 with an increasing emphasis on policy and program analyses to inform policy, practice, research, and training. Again, the initially funded centers applied and were successful in the process. The two centers are the Center for Mental Health in Schools at UCLA and the Center for School Mental Health at the University of Maryland, Baltimore. (It should be noted from 2000 through 2006, HRSA and the Substance Abuse and Mental Health Services Administration [SAMHSA] braided resources to jointly support the initiative.)

Other federal initiatives promote mental health in schools through a smattering of projects and initiatives. These include (1) programs supported by the U.S. Department of Education’s Office of Safe and Drug-Free Schools (including a grants program for the Integration of Schools and Mental Health Systems), its Office of Special Education and Rehabilitative Services, and some of the school improvement initiatives under the No Child Left Behind Act; (2) the Safe Schools/Healthy Students initiative, which is jointly sponsored by SAMHSA and the U.S. Departments of Education and Justice; (3) components of the Centers for Disease Control and Prevention’s Coordinated School Health Program; and (4) various projects funded through SAMHSA’s Elimination of Barriers Initiative and Mental Health Transformation State Incentive Grant Program. Several other federal agencies support a few projects that fit agenda for mental health in schools. All of the above have helped the field emerge; none of the federal programs are intended to underwrite the field. Government-funded projects are time limited and affected by economic downturns.

In recent years, a growing number of states have funded projects and initiatives, and a few have passed legislation with varying agenda related to mental health in schools. A variety of public and private entities also support projects that contribute to the emerging field.

Other countries are moving forward as well. The growing interest around the world is reflected in the establishment in the early 2000s of the International Alliance for Child and Adolescent Mental Health and Schools, which has members in 30 countries (Weist & Murray, 2007).

Call for Collaboration

Few doubt the need for collaboration. Over the years, those with a stake in mental health in schools frequently have called for joining forces (Center for Mental Health in Schools, 2002; Rappaport, Osher, Garrison, Anderson-Ketchmark, & Dwyer, 2003; Taylor & Adelman, 1996). Building bridges across groups, however, is complex and requires a long-term commitment. We discuss this matter in detail in Chapter 13.

One contemporary effort began in 2000 when the National Association of State Mental Health Program Directors and the Policymaker Partnership at the National Association of State Directors of Special Education (2002) met to explore how the two entities could collaborate to promote closer working relations between state mental health and education agencies, schools and family organizations. A concept paper entitled “Mental Health, Schools and Families Working Together for All Children and Youth: Toward a Shared Agenda” was produced with funds from the Office of Special Education Programs. The paper was designed to encourage state and local family and youth organizations, mental health agencies, education entities, and schools across the nation to enter new relationships to achieve positive social, emotional, and educational outcomes for every child. The vision presented is for schools, families, child-serving agencies, and the broader community to work collaboratively to promote opportunities for and to address barriers to healthy social and emotional development and learning. The aim is to align systems and ensure the promise of a comprehensive, highly effective system for children and youth and their families. In stating the need for agencies and schools to work together, the report stresses the following:

While sharing many values and overarching goals, each agency has developed its own organizational culture, which includes a way of looking at the world; a complex set of laws, regulations and policies; exclusive jargon; and a confusing list of alphabet-soup acronyms. Funding sources at the federal, state, and local levels have traditionally reinforced this separation into silos. The result is that agencies are almost totally isolated entities—each with its own research and technical assistance components and its own service delivery system, even though they are serving many of the same children. The isolation of each agency, combined with its bureaucratic complexity, requires a long-term commitment of all partners to bridge the gaps between them. Collaborative structures must be based on a shared vision and a set of agreed upon functions designed to enable a shared agenda. Legislative, regulatory or policy mandates may help bring agency representatives to the table, but development of true partnerships and the successful accomplishment of goals depends on participants gaining trust in one another as they pursue a shared agenda. (pp. 16–17)

The Policymaker Partnership provided some funds for six states to form state-based Communities of Practice for Education, Mental Health, and Family Organizations. When the funding for the Policymaker Partnership ended, the Individuals with Disabilities Education Act (IDEA) Partnership (funded by the U.S. Department of Education’s Office of Special Education Programs) has continued to facilitate the Communities of Practice initiative (IDEA Partnership, 2005).

School Professionals Have Led the Way

Historical accounts stress that schools have used their resources to hire a substantial body of student support professionals—variously called support staff, pupil personnel professionals, and specialists. Current status data are available from the School Health Policies and Program Study (Brener, Weist, Adelman, Taylor, & Vernon-Smiley, 2007; Centers for Disease Control and Prevention, 2007). This study, conducted by a unit of the Centers for Disease Control and Prevention (CDC), collected data from 51 state departments of education, 538 school districts, and 1,103 schools. Findings indicate that 56% of states and 73% of districts had a policy stating that student assistance programs would be offered to all students, but only 57% of schools offered such programs. Findings for specialist support staff indicate that 78% of schools had a part- or full-time counselor, 61% had a part- or full-time school psychologist, 42% had a part- or full-time social worker, 36% had a full-time school nurse, and an additional 51% had a part-time nurse. Considerable variation, of course, exists state by state.

While the numbers fluctuate, professionals employed by school districts continue to carry out most of the activity relate...