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School Based Mental Health

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Kirsten True

on 6 March 2014

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Transcript of School Based Mental Health

Empirical Study
The Intensive Mental Health Program

-Meet the needs of children with emotional disturbances at school

-Help students with an emotional disorder attend school on a regular basis

-Operate from a public school base for students with early onset serious emotional disturbances

-Joint program between public university and public school district to provide services for emotionally disturbed children

Who is Involved?
-Students who are unable to function adequately in school


-Special education teachers

-School social workers

-School Psychologists


-Masters level clinicians

-Doctoral level clinical psychologists
The Program Continued...
-Enhances communication and consistency across all the child's settings

-Contains two important elements:
1. Point system
2."Gotcha Bucks"
Why is this important?
“Research shows that early identification and intervention can minimize the long-term disability of mental disorders” (NAMI)
The Program

-Service Delivery Model (Table 2)
School Based Mental Health
Kirsten True, Jenni Gunn, Morgan Stampley, and Andrea Strong
Public School System and University of Kansas
hr day Behavior Management Program

-Does not cost parents any money

-Creates strong working relationship and bond between school and family

-Structure for integrated services that address mental health, education, and other needs

-Both children and college students benefit from the program

-Notable improvement was shown in 75% of students in this program
-Difficult to have effective collaboration with different personality types and having public school personnel work with college students

-Everyone varied in the degree of understanding implementation of the program due to change in staff over the years

-25% of students did not show improvement

-A much needed mental health program for students with emotional disturbances

-Both children and college students benefit

-75% of students in program showed improvement

-Some may feel bringing in students training to be professionals is not reliable

-25% of student in program show no improvement

-Difficult for school personnel and college students to work together efficiently

-Parents may be concerned about program
Literature Review

The Relationship Between Academic Achievement and School-Based Mental Health Services for Middle School Students
-The study was conducted in a large, suburban school district in the southeastern region of the United States

-184 Middle School students (grades 6th, 7th, and 8th grade) receiving mental health services between 2008-2011

-Purpose: Examine the relationship between school-based mental health services and academic achievement in the areas of math and reading by race and gender.
-The effects of mental health difficulties are problematic for students in that they negatively impact academic performance, behavior, attendance, and school violence

-Racial and ethnic minority groups are less likely to use mental health services due to lack of access, and they also receive poorer quality care

-Individuals who live in poverty and those with the lowest levels of income and education are more likely to have a mental disorder
Who Did the Study?
-Lisa Williams

-Student studying for PhD in Philosophy

-University of Southern Mississippi
-Improvements in Reading, not Math

-Math achievement decreased

-Males (6.5%) reported as having serious difficulties higher than females (3.4%)

-Students referred were made up of 125 males and 59 females

-Positive relationship student participation in one or more of the identified school-based mental health services and student achievement in the area of reading for all students,
regardless of race or gender

-interventions to promote social and emotional health among students increases likelihood of improved academic performance

Contributing Factors
-Difference in curriculum demands

-Math curriculum changed during the school year and assignments became more demanding

-Study was limited to a single school district in southeastern United States

-Limited sample of students (only 184 students)
References available on the web:

- Organizations Focused on Special Education and School-Based Mental Health
- Background information and a diverse collection of papers and fact sheets that address children’s mental health issues and children’s access to care.


- Caring Across Communities, an initiative of the Robert Wood Johnson Foundation, was designed to help meet the mental health needs of immigrant children and youth by building on strong community-school partnerships.


- Links to two multi-site grant programs that are developing new service models for school-connected mental health services.


- Children and teen websites

Can you find books, materials, etc?
YouTube Videos
Pinterests Posts (my favorite)


- Center for Health and Health Care in Schools (CHHS) www.healthinschools.org
(George Washington Univ., School of Public health & Health Services, Wash., D.C.)
- A nonpartisan policy and program resource center that seeks to strengthen the well being of children through effective health programs and health care services in schools. The Center for Health and Health Care in Schools is committed to supporting the good health of children and adolescents by working with parents, teachers, health professionals and school administrators to strengthen successful school-based health programs in all communities in the U.S. Its website contains fact sheets on a variety of topics, a parent's resource area, and other information.
- Organizational and financing challenges
- Journal archives on key issues
o immigrant and refugee children
o school drug testing
o children’s health insurance
o school lunches
o HPV vaccinations
o eating disorders
- Educators and families
- Mental health education resources specific to administrators and teachers, parents, children, and teens
- Background info on school-based mental health
Ideas for Implementation
- Implement in general education or special education classrooms.
- Causative Theory: Describes the “how and why” of the program: how the program is expected to achieve particular outcomes, the relationship between the intervention and the outcomes, and the mediators or moderators of the intervention effect.
- Prescriptive Theory: Describes how the program should be implemented or the manner in
which daily activities of the program should proceed. This component includes the goals of the
program, the guidelines for the type of intervention to be provided, and the context that is
necessary for the successful implementation of the intervention.
- Plan a range of interventions or activities across different levels of the school environment. (School-wide interventions, specialized support interventions, classroom instructional supports, and family/community supports)

Controversy around intervention?
- Over the past decade, school-based health centers have struggled with budget cuts, staffing shortages and cramped office space in their mission to keep students healthy, but the Affordable Care Act is reshaping the landscape with $200 million in funding that will expand or create new health centers in public schools nationwide.

- Screening mental health problems in schools: Long-standing policy controversies have heated up as a result of increasing proposals for using schools to screen for mental health problems (e.g., depression screening).

- Despite the incredible benefits and relative minimal costs of a school-based model, some funding mechanism is essential. Whether through Medicaid or private or foundation funding, it is unlikely that a comprehensive school-based mental health program can sustain itself without outside support.

- It’s never easy being the “outsider.” For community mental health professionals being contracted with a school district, it is prudent to expect initial resistance. Territoriality may emerge. There may be the perception that you are there to make big changes. Some educators may not have been exposed to mental health programs, nor have they had training in the field. For this reason, mental health professionals must make themselves visible and be consistent and proactive in initiating meetings with key school staff, students, and parents when necessary.

- Another important factor is providing psych education to staff to help them understand mental health’s central role in adolescent life, relationships, and academic performance. The mental health professionals must take the time to educate the school about other services available through the agency. Inform school staff that functions such as psychiatric evaluation, medication management, group therapy, family therapy, case management, psychological evaluation, and crisis services can reduce their burden. It may take time, but a proactive, vigilant, and opportunistic approach to educating staff will pay off.

Did your search align with your research?
Yes! Why?
- There are advantages of teaming with a comprehensive community mental health organization. Services are available to youths year-round, beyond the academic school year and during breaks when support for children and youths can be limited. Community mental health clinicians, unlike their school counterparts, can see students even if they are suspended, not attending school, in detention, or in the hospital. They can support adolescents after hours through crisis and psychiatric services.
- Community mental health clinicians apply the latest evidence-based practices, including dialectical behavioral therapy, trauma-focused cognitive behavioral therapy, and functional family therapy. They also are effective practitioners of assertive community outreach; wraparound services that include family, community, and peer support; substance abuse treatment; crisis intervention; and additional services that school district mental health professionals may not have the capacity or experience to utilize. For many students, a key benefit is awareness. The presence of these services at school provides a level of access not typically available through the standard approach.
- School-based mental health programs, to be most effective, must be correctly constructed. While they may vary from school to school, there are some key characteristics consistent across all of them. School-based programs will not be effective unless there is collaboration and relationship building among parents, teachers, administrators, community mental health professionals, and students. An infrastructure, process, and clearly defined roles must be painstakingly developed to address the varying needs of the student body. And the program must have the right team members, who bring unique skill sets and experiences to the endeavor.
Example of School Mental Health Program
Final Thoughts
Literature review

Service Coordination and Children’s Functioning in a School-Based Intensive Mental Health Program
Who conducted the study
Richard W. Puddy, Michael C. Robert, Eric M. Vernberg, Erin P. Hambrick
The participants of this study
51 elementary school children with emotional disturbances
43 male and 8 females
School staffing- Special Education teachers and Paras
This study was done in Kansas in 2012
First stage self-reports screening questionnaire. In the current study, a screening instrument alone identified close to one in three students as positive screens. The clinical interview further reduced the proportion of youth identified as being at risk to one in five students.
The second stage process allows a 30% reduction in the number of students who otherwise would have been referred for additional services
The goal of this study was not to over-identify the students

Literature Review
How long has this intervention been around
Since the 90's
How many studies have been done
there has been a lot of studies done on School Based Mental Health. For our literature review we look at 4 main studies done with in the past 10 years.
All of the studies that we look at for this literature review look at different elements of School Base Mental Health practices
Why this study was done
This study is looking at screening methods for adolescents and parental awareness.
Studies examing parental awareness of their children’s self-injurious behavior indicate that fewer than 25% of parents.
Research on mental health and suicide risk screening demonstrates that approximately 1/3 of the students with serious mental health problems are identified through screening and not by school personnel suggesting that screening improves upon routine in-school mechanisms in identifying high risk students

What was done
This study measures include- depression, anxiety, irritability, social withdrawal and substance abuse
following criteria for this study: 1) presence of suicidal ideation in the last three months, 2) any history of a suicide attempt, 3) three or more of the five emotional problem questions reported as representing a “bad” or “very bad problem,” 4) Indication of being “more upset” after completing the CHS, 5) refusal to answer question(s), or 6) reporting needing help with an emotional problem.
The study compares a mental health screening program on identifying students that are at risk and refer them successfully to appropriate services
84% saw improvement in their behavior
The intervention reduced disruptive and self-injures behaviors
The point sheet help the student with their progress.

Controlled and Screening
Controlled goup- this group had exsiting routines of in-shcool identification and referral mechanisms. Each student had a team. Typically, teams include the school principal, a mental health professional, guidance counselor, teacher, school nurse, and school-based probation officer. The team meets weekly to review each referral and works with parents to develop individualized intervention plans
Screening group – the student in the screening group was asking to complete the Columbia health screening questionnaire. This questionnaire was used to identify student at risk for mental health problems. All of the student that score negative on the questionnaire, participated in an individual debriefing with a counselor. Students who scored positive were administered a second-stage clinical interview using the Post-Screening Structured Interview (PSSI). If a child was determined to be in need of mental health referral after the clinical interview, a referral was provided
What was done
The study was conducted on student with serious emoinal disturbances because these student did not alway recieve the appropriate servivces in either in their school or commmunity.
only 6 of the studnet were in theraputic classrooms. : daily attendance in the IMHP classroom, Group Check-In (59/week), individual therapy week for 30 min),group therapy 40 min), behavior monitoring chart called the Daily Point Sheet
This intervention provided the students with a half day at treatment center and the other part of their day was spent at school.
The student were given a point sheet for all of the enviorment that they had to face on a regular bases (schcol, home, the treatment center and the community ). This point sheet was to earn prizes at the treatment center for a reward for good behavior.
Identifying adolescents at risk through voluntary school-based mental health screening
This study was done in urban Pennsylvaina.
It took place the second semester
who conducted the study: Mathilde M. Husky, Adam Kaplan c, Leslie McGuire Laurie Flynn Christine Chrostowski, Mark Olfson
The participant of the study were 366 that were assigned to the screening group and 291 to the controlled group.
Planning, linking and monitoring
Planning- this meant creating an individualized plan for the student
Linking- ensuring that the individualized service plan is executed as intended in a timely, appropriate manner.
Monitoring - tracking the progress that the student is involed and making appropriate changes if needed.
The two aims to this study
• The first aim was to determine if service coordination and children functioning change over the treatment
• Second aim was to examine whether service coordination activities (planning linking and monitoring) were related to indicators of children adaptive functioning

What is this study looking at
This study is mainly looking at what sites were used at the schools
Counselors represented the most frequently mentioned onsite mental health providers during the 2001-02 school year. LSWs and/or licensed counselors were reported available on-site by 36 centers (60%), and alcohol/substance abuse counselors by 18 centers (30%). Only four centers (6.7%) reportedly had an unlicensed counselor on-site
Of the 1,385 public elementary and secondary schools in Maryland during the 2001-02 academic year ,60 (4.3%) had a school-based health center. Among schools with SBHC, 27 (45%) were located in elementary schools, and 33 (55%) were located in middle and/or high schools
This study was done by an annual survey
1) to enable the State to monitor operations, registration and utilization, staffing patterns, and services provided by each health center;
2) to provide the State with data that would allow for comparisons within and across jurisdictions in which SBHCs were located.
The survey asks about the on-site availability of 6 mental health care providers: psychiatrists, psychologists, licensed social workers/counselors, psychiatric nurse practitioners, alcohol/substance abuse counselors, and unlicensed counselors. The survey also asks if the center can be described the program if includes a mental health care component that provides diagnosis and treatment.

Mental Health
"A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” (World Health Organization).
Mental Illnesses
Disturbs a person’s thinking, mood, ability to relate to others, and their daily lifestyles
Anxiety disorders
Autism Spectrum Disorders
Personality Disorders
Posttraumatic Stress Disorder
Tourette's Syndrome
Mental Illnesses
in Children

* Majority of the disorders begin before the age of 14
* Can manifest as early as preschool
* Only 20 percent are identified and receive services
Husky, Mathilde, Adam Kaplan, Leslie McGuire, Laurie Flynn, Christine Chrostowski, and Mark Olfson. "Identifying adolescents at risk through voluntary school-based mental health screening."
Journal of Adolescence
. (2011): 505-511. Print.

Innocent, Marjorie. DETERMINANTS OF MENTAL HEALTH SERVICES IN MARYLAND SCHOOL-BASED HEALTH CENTERS. Baltimore, Maryland: Johns Hopkins University in conformity, 2005. 29-92. Print.

Puddy, Richard, Michael Roberts, Eric Vernberg , and Erin Hambrick. "Service Coordination and Children’s Functioning in a School-Based Intensive Mental Health Program." (2001): 948-962. Print.

* Genetics, brain chemistry, environmental factors, including stress, all play a role in a child’s behavior and mood
* Approximately 50% of students age 14 and older with mental illnesses drop out of school. Highest dropout rate of any disability group.
* If left unidentified and untreated, individuals usually end up in jail and prison
* National Institute of Mental Health—an alarming 65 percent of boys and 75 percent of girls in juvenile detention have at least one mental illness
Increased Risk of Suicide
Over 90 percent of children and adolescents who commit suicide have a mental disorder
School has been proven to be the best environment to receive needed services
School Based Mental Health (SBMH) Interventions
Services provided by a school to help foster mental health in students with mental illnesses
"Services can range from prevention and skills development to intervention and evaluation, referral and collaboration, and consultation and counseling" (NASP)
Usually consists of 3 tiers
Tier One
Preventive mental health programs and services
* Activities target children in all school settings
"Preventive programs focus on decreasing risk factors and building resilience, including providing a positive, friendly, and open social environment at school."
Tier 2
“Consists of targeted mental health services that are designed to assist students who have 1 or more identified mental health needs but who function well enough to engage successfully in many social, academic, and other daily activities”
* Provides group and individual therapy to students
Tier 3
“Targets the smallest population of students and addresses needs of children with severe mental health diagnoses and symptoms”
* Provides students with a variety of curricular and extracurricular activities. These options increases the likelihood of success amongst students. It is important that students experience some form of success during their school life.
* Provides access to community and family supports associated with healthy emotional development
This study was done from 2001-2002 in Maryland
The study was given by Marjorie Alice Innocent
There we 60 schools Maryland that participated in this study.
45% were elementary schools, 22% were middle schools, 30% were high school. Four of the schools were both high school and middle school

May consist of behavioral issues addressed in an IEP
* Includes multidisciplinary team
* Special Education Services
*Individual & Family therapy
* pharmacotherapy
*School & Social agencies
SBMH Determination
results indicate that mental health diagnosis was 1.5 times more likely to be available on-site in centers where students could not access mental health care without parental permission; yet access to mental health care without parental permission was 16 times more likely to be available in centers offering mental health diagnosis on-site
Middle and high schools were 4.6 times more likely to have medication management and administration available on-site, and four times more likely to have access to psychotropic medication follow-up on-site
Based on analysis results, these counselors were 17 times more likely to be available on-site in middle or high schools than in elementary schools students access to mental health services without parental permission were over seven times more likely to provide the service.
These results indicated that middle and high school age students have more access to these service

* School psychologists, other staff members, and parents come together to create a variety of services geared towards meeting the needs of the students
* Similar to the process for special education services, students need to be screened, evaluated, identified, and referred for services
*Student should exhibit signs of emotional disturbance.
SBMH Services
* Based on the needs of the individual, social skills instruction may be provided
* Interventions are implemented for students with chronic behavior and emotional needs
* Small group and/or individual counseling is provided
* Children and their families may be referred to community service agencies related to mental health needs
Most SBMH interventions involve behavioral or cognitive-behavioral interventions
Insight-oriented talk therapy
Supportive counseling
Treatment vary depending on mental illness
Example: Anxiety and Depression (considered internalizing disorders)
a. Uses cognitive-behavioral therapy
b. Self-monitoring of mood and physiological symptoms
c. Engaging in activities they enjoy
d. Use of self-rewards
e. Relaxation and imagery
f. Assertiveness and social skills training
g. Cognitive restructuring
Treatment for Anxiety
“Coping Cat”
18-session group cognitive-behavioral treatment for anxiety
Suitable for children ages 9-13
Same-sex groups of 3-5 youth (recommended to promote discussion of anxiety symptoms and group cohesion)
Uses the acronym FEAR (Feeling Frightened, Expecting bad things to happen, Attitudes and Actions that help, Results and Rewards) to help youth remember the cognitive-behavioral steps involved in coping” (CSMH-University of Maryland)

Treatment for Depression
“Stark School-Based Intervention for Depression”
26-session group cognitive-behavioral intervention
Tested and shown to be effective with 4th-7th graders with elevated levels of depression
Includes self-control techniques (e.g., self-monitoring, self-reinforcement), social skills training, assertiveness training, relaxation training, imagery, and cognitive restructuring

Family component
Focuses on increasing positive family activities
Trains parents to help children use their new skills (CSMH-University of Maryland)

Treatments for ADHD
i. Group-administered treatment
ii. Targets youth with impulse-control problems
iii. Teaches them to use a systematic problem-solving process to slow themselves down and brainstorm ways to respond to interpersonal and academic situations more successfully
Method is taught through
1. Modeling
2. Role-playing
3. Rewards for use of new skills
A minimum of 20, 50-minute sessions (more if participants need more practice in the skills)
Led by two therapists
Uses an extensive reward system (using “Stop-and-Think Dollars”) is employed to encourage pro-social behavior, and response costs are used for misbehavior
Designed for youth ages 9-13.
Treatment only addresses the impulsive component of ADHD, not noncompliance, disruptive behavior, or aggression that is often found in youth with ADHD
(CSMH-University of Maryland)
“Cognitive-behavioral therapy for impulsive children”
The Study
Roberts, Michael, et al. "Lessons Learned From The Intensive Mental Health Program: A School-Based, Community Oriented Program For Children With Serious Emotional Disturbances." Journal Of Child & Family Studies 17.2 (2008): 277-289. Academic Search Premier. Web. 5 Mar. 2014.

Typical or Troubled School Mental Health Education Program. Fulton County, 2013.

Vernberg, Eric, Michael Roberts, and Joseph Nyre. "The Intensive Mental Health Program: Development And Structure Of The Model Of Intervention For Children With Serious Emotional Disturbances." Journal Of Child & Family Studies 17.2 (2008): 169-177.Academic Search Premier. Web. 5 Mar. 2014.

Williams, Lisa O. "The Relationship Between Academic Achievement and School Based Mental Health Services for Middle School Students." Diss. University of Southern Mississippi, 2012. (2012). Print.
* Universal Prevention Programs are also utilized: Focuses on enhancing children’s ability to identify and manage their emotions and teaches them how to behave appropriately in interpersonal conflicts.
* Most SBMH interventions focus on the overall mental health of the student
a. There are numerous interventions that deal with behavioral issues
b. Some deal with preventative measures, even practicing safe sex
c. Teaching effective coping mechanisms
d. Increasing positive interactions with themselves, family members, and others
"Empirically-Supported Interventions in School Mental Health." University of Maryland. Center
for School Mental Health Assistance, n.d. Web. 28 Feb. 2014. <http://csmh.umaryland.edu/Resources/ResourcePackets/files/empiricallysupported.pdf>.

"Facts on Children's Mental Health in America." National Alliance on Mental Illness. N.p., n.d.
Web. 27 Feb. 2014. <http://www.nami.org/Template.cfm?Section=federal_and_state_policy_legislation&template=/ContentManagement/ContentDisplay.cfm&ContentID=43804>.

"School-Based Mental Health Services." Pediatrics: Official Journal of the American Academy
of Pediatrics. American Academy of Pediatrics, n.d. Web. 28 Feb. 2014. <http://pediatrics.aappublications.org/content/113/6/1839.full?sid=f049b524-f902-47e9-82d2-b16c3e36bec8>.

"School-Based Mental Health Services & School Psychologists." Social/Emotional
Development. National Association of School Psychologists, n.d. Web. 27 Feb. 2014. <http://www.nasponline.org/resources/handouts/sbmhservices.pdf>.

"School-based Mental Health Tool Kit 2008." The Center for Community Solutions, n.d. Web.
27 Feb. 2014. <http://www.units.muohio.edu/csbmhp/network/toolkit.pdf>.
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