1
Chapter 1
INTRODUCTION
Introduction
This chapter will discuss the history and policy surrounding school based mental
health interventions, how they have affected teachers and school staff, and how the
various types of school based mental health interventions have caused potential for
problematic interactions between teachers, school support staff, and school based mental
health professionals in public schools throughout America. This chapter also discusses
the relevance, significance, and problems associated with mental health issues occurring
in youth attending public schools, the theoretical framework behind the study, and define
key terms. Finally, this chapter will briefly discuss assumptions, limitations, data
collection, and data analysis associated with the study.
Background
The merger of public education and school based mental health interventions has
a long and tenuous history involving the United States Federal Government, legislation,
and public school districts. Legislative actions in recent history have attempted to draw
attention to the need for mental health services in our public schools, and school districts
across the country have rolled out various programs aimed at providing mental health
services to students in an attempt to support the needs of students with mental health
issues. The results have produced a vast array of evidence-based, school-based mental
health services, various combinations of public school staff and professional mental
2
health service provider working conditions, and research and data surrounding the
effectiveness of school based mental health interventions. However, there is very little
research about the possible existence of a correlation between school staff and mental
health professional collaboration on school-based mental health interventions and school
staff perceptions about the mental health interventions being provided at their schools.
Integrating mental health interventions into the public school system dates back to
1975 when the Individuals with Disabilities Education Act (IDEA) first passed into
federal law mandating that students with mental and physical handicaps have equal rights
to public education (M. Atkins, K. Hoagwood, K. Kutash, E. Seidman, 2011 Cappella
and Larner 1999; Dryfoos, 1994). The first programs to address the mental and
psychological needs of students were implemented in the mid nineteen-eighties in a few
schools but later grew to placement in thousands of public schools across the nation
(Foster el al. 2005). This created the first shift from a solely academic driven school
environment, to an environment that now considered the needs of physical and mental
health for students which in turn created the first interactions between public school staff
and school based mental health professionals.
After a decade of developing programs that allowed children with mental and
physical disabilities to gain access to public education, the 1997 reauthorization of the
Individuals with Disabilities Education Improvement Act was passed by the United States
Congress. The reauthorization of IDEA drastically changed how schools were to educate
children who displayed challenging behaviors. The use of positive behavior supports
(PBS) were implemented at this time. PBS's attempted to move away from the punitive
3
nature of addressing negative behaviors in the school setting and examined the systems in
the child's life that negatively impacted the child resulting in negative behaviors exhibited
by the child (Wager, 1999). During this time functional behavioral assessments (FBA)
were recommended by IDEA for use by teachers in the classroom. The use of FBA's
were instituted as a means to address behaviors that impeded on the ability of students,
both with and without disabilities, to learn (Friend, 2006; Quinn, Gable, Rutherford,
Nelson, & Howell, 1998). The implementation of PBS and FBA placed further demands
on all teachers who came in contact with students with disabilities, and created the need
for new interactions, collaboration levels, and working relationships between school staff
and mental health professionals.
The 2004 reauthorization of IDEA is the most current federal policy regarding the
educational rights of mentally and physically handicapped students. The most recent
changes to IDEA provided local school districts with the ability to vary the way they
screen for disabilities and how they determine whether students qualify with a learning
disability.
The history of the merger between mental health services for children and public
education for students is fairly recent. The reform of public policy has been ongoing, and
has given public school districts the ability to work with some freedom to choose what
mental health services they want to offer to their students. These new developments in
public education mental health policy have made it necessary to conduct research specific
to individual school districts. Also, given that IDEA is less than fifty years old and has
undergone three reauthorizations, the need to examine school staff perceptions of these
4
programs is important.
Prevalence
Public schools are most children's first exposure to mental health services
(Franklin, C. S., Kim, J. S., Ryan, T. N., Kelly, M. S., & Montgomery, K. L. (2012),
Foster, S., Rollefson, M., Doksum, T., Noonan, D., Robinson, G., Teich, J., & ... Abt
Associates, I. D. (2005). In 2003, Foster et al collected survey data about school based
mental health services. The survey included all public school districts in the US. The
data concluded that one fifth of students on average received some type of schoolsupported mental health services in the school year prior to the study, and virtually all
schools reported having at least one staff member whose responsibilities included
providing mental health services to students. Foster's data also revealed that more than
80 percent of schools provided assessments for mental health problems, behavior
management consultation, and crisis intervention, as well as referrals to specialized
programs. A majority also provided individual and group counseling and case
management. Foster's data also shows that nearly half of all school districts (49 percent)
used contracts or other formal agreements with community-based individuals and/or
organizations to provide mental health services to students. The most frequently reported
community-based provider type was county mental health agencies. This massive study
is the most current source of data that examines the extent to which the educational and
mental health worlds are interacting. While Foster's data is rich with information about
the rates at which mental health services occur in the public school setting, there were no
data that examined the perceptions that school staff have about the mental health services
5
being implemented on their campuses (Foster et al., 2005).
Problem
The recent popularity of school based mental health interventions in the public
school setting has created new implementation practices which need to be examined to
further improve school based mental health best practices. There is a lack of research
pertaining to collaboration between teachers and school based mental health
professionals surrounding the implementation of school based mental health
interventions. Additionally, there is a lack of research exists that measures school staff
perceptions of school based mental health interventions being implemented at their
schools. Therefore examining the possible link between collaborative levels and staff
perceptions needs to be conducted to further understand the dynamics of school based
mental health interventions.
There is little data that measures collaboration between mental health
professionals and school staff such as teachers and support staff (Reinke, W. M.,
Stormont, M., Herman, K. C., Puri, R., & Goel, N., 2011), despite the fact that school
staff are often responsible for the initial student contact with school based mental health
interventions and mental health professionals. Therefore, school staff collaboration with
mental health professionals on school based mental health interventions can be important
to the ongoing assessment of the interventions' effectiveness and appropriateness for a
given student.
There is also little data which measures how school staff perceive the success a
given mental health intervention being conducted/implemented at their school is having
6
with the students engaged in that intervention. The amount of time that teachers and
school support staff spends with students who are recipients of these schools based
mental health interventions is significant, and therefore these staff members' perceptions
of how these interventions are working is important in evaluating outcomes for the
various interventions taking place on these campuses.
Lastly, there is also little data which measures correlations between those mental
health professional and school staff collaborative levels and how school staff perceive the
success a given mental health intervention being conducted/implemented at their school
is having with the students engaged in that intervention.
Significance
The American public school system is often the first time children with mental
health needs encounter mental health services (Franklin et al, 2012, Foster, 2005). 1317% of public school aged children are suffering from some form of mental health
disorder each year (Perou R, Bitsko RH, Blumberg SJ, Pastor P, Ghandour RM, Gfroerer
JC, Hedden SL, Crosby AE, Visser SN, Schieve LA, Parks SE, Hall JE, Brody D, Simile
CM, Thompson WW, Baio J, Avenevoli S, Kogan MD, Huang LN, & Division of Human
Development and Disability, National Center on Birth Defects and Developmental
Disabilities, CDC, Atlanta, Georgia, 2013). Therefore, the need to examine how teachers
and staff engage with school based mental health professionals is important. The need for
effective assessment of these correlations is critical for ongoing critique of school based
mental health interventions because they are now fully integrated into the public school
system, and odds are they are going to become more predominant in the future.
7
Theoretical Framework
The theoretical framework most applicable to this topic is the ecological model
which holds that in order to fully understand interactions within a setting it is important
to consider the multitude of settings within which interventions are taking place (
Bronfenbrenner, 1979; Trickett, 2009). Application of the ecological model is
appropriate for understanding the importance of measuring school staff perceptions of
school based mental health intervention effectiveness, and levels of interactions between
school staff and mental health professionals in the public school setting. Based on
ecological theory, considerations for multiple and interactive settings would consist of the
multiple settings which comprise the public school environment. Settings such as the
classroom, outside of the classroom, interactions between teachers, students, staff
members, and mental health professionals can all be considered when applying the
ecological model to intervention assessment and implementation. The ecological model's
ability to promote sound collaborative practices has lead to positive outcomes for school
based mental health interventions. As noted in Williams and Lawson (2013), the
application of the ecological model in their research assessing teacher confidence in
intervention implementation showed that school based mental health interventions which
relied on school staff and their interactions with others in the school environment and the
greater community had successful intervention outcomes.
8
Variables/Key Terms
School Based Mental Health Interventions- describe many interventions and services
aimed at supporting learning for those students with social and emotional difficulties that
impede their ability to function in the classroom. School based mental health
interventions are not based on specific mental health diagnosis, are defined as being
school-related, and are aimed at improving social and emotional functioning that supports
learning.
School Based Mental Health Professional- is a school based professional who delivers
mental health promotion and prevention programs that are designed to lessen
psychological issues, and promotes early intervention strategies that are rooted in
evidence based program design. The mental health professional also builds and promotes
school staff knowledge about mental health and implementation of mental health
interventions.
Teachers- To teach elementary school in California, one must have the Multiple Subject
Teaching Credential which authorizes teaching in preschool, kindergarten, grades 1-12,
and classes for adults.
All teachers employed by California public schools have obtained a Bachelor's Degree or
higher from a regionally accredited university, have completed an accredited teacher
preparation program including student teaching in addition to the Bachelor's degree, have
passed the California Subject Examination for Teachers (CSET), and have obtained a
Clear Credential.
Classified Employee- A classified employee is an employee of a school district who is in
9
a position not requiring certification, this "paraprofessional" subgroup consists of
teaching assistants, teacher's aides, pupil services aides, and library aides.
Office And Clerical Staff- Office and clerical staff are those school employees who
perform clerical or administrative support duties, such as a school secretary.
Other Staff- The "other" subgroup consists of the remaining non certified staff, such as
custodians, bus drivers, and cafeteria workers. The numbers of classified staff members
do not include preschool, adult education, or regional occupational center or program
classified employees.
California Public School- The term "school" is used to refer to all educational
institutions having the following characteristics: One or more teachers to give instruction,
an assigned administrator, based in one or more buildings, and has enrolled or
prospectively enrolled students.
Assumptions
It is assumed for this study in particular, that the school staff that were
administered the survey worked at a school that had at least one half time mental health
professional employed at the school. It is also assumed that these schools had multiple
school-based mental health interventions being implemented by mental health
professionals which addressed the identified mental health needs of students enrolled at
those schools.
Limitations
In order for the researcher to gain access to school staff perceptions about
interventions and collaborative levels a non- random convenience sample was used. Data
10
collected from this study revealed mental health professional/school staff collaborative
levels, and school staff perceptions of school based mental health interventions.
However, only sampling one public school district cannot provide cross population
generalization to any other school districts and holds little external validity because of the
non-random sampling. The researcher chose to survey participants he knew had a great
likelihood of providing responses; therefore creating limited external validity. If the
researcher had chosen to survey participants from different school districts there would
be more validity to the data collected and a better chance of getting varied responses
about collaboration and perception.
Data Collection
Over the course of January and February of 2014, convenience and purposive
sampling methods were used to collect data for this study. The elementary and middle
schools that were part of the study are not representative of all elementary and middle
schools in the state of California, but were accessible to the researcher and relevant to the
study. Data was collected by the researcher using a structured online survey. All data
that has been obtained was stored on a secure website with password protection that only
the researcher has access to. All physical data that was compiled was stored in a locked
filing cabinet. All data will be destroyed once the study is over in May 2014. Only the
researcher will have access to data obtained in this study
Data Analyzation
The researcher analyzed the data through the use of SPSS, statistical data analysis.
Statistical means tests and correlational tests were conducted between variables and
11
differences in means between groups were used to determine the results of the study. The
use of statistical data analysis allowed the researcher to quantify descriptive data, and
correlational data, as well as qualitatively analyze summary data gathered from the
survey.
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Chapter 2
LITERATURE REVIEW
Introduction
This chapter presents the themes that emerged through a review of the literature
about school-based mental health interventions. The literature reviewed in this chapter
was accessed using the data base and article searching site Academic Search Premier
(EBSCO) from the California State University of Sacramento online database. The
following themes emerged from the literature: (a) the historical context for the merger
between US public schools and Mental Health Services; (b) providers of mental health
intervention services in school; (c) components of school based mental health
interventions; (d) difficulties teachers, administrators, and schools face when
implementing school based mental health interventions, and (e) teacher perceptions about
school based mental health interventions.
History Of The Merger Between Public Schools And Mental Health Services
The merger of public education and school based mental health interventions has
a long and tenuous history involving the United States Federal Government, legislation,
and public school districts. Legislative actions in recent history have attempted to draw
attention to the need for mental health services in our public schools, and school districts
across the country have rolled out various programs aimed at providing mental health
services to students in an attempt to support the needs of students with mental health
issues. The results have produced a vast array of evidence-based, school-based mental
health services, various combinations of public school staff and professional mental
13
health service provider working conditions, and research and data surrounding the
effectiveness of school based mental health interventions. However, there is very little
research about the possible existence of a correlation between school staff and mental
health professional collaboration on school-based mental health interventions and school
staff perceptions about the mental health interventions being provided at their schools.
Integrating mental health interventions into the public school system dates back to
1975 when the Individuals with Disabilities Education Act (IDEA) first passed into
federal law mandating that students with mental and physical handicaps have equal rights
to public education (M. Atkins, K. Hoagwood, K. Kutash, E. Seidman, 2011; Cappella
and Larner, 1999; Dryfoos, 1994). The first programs to address the mental and
psychological needs of students were implemented in the mid nineteen-eighties in a few
schools but later grew to placement in thousands of public schools across the nation
(Foster el al., 2005). This created the first shift from a solely academic driven school
environment to an environment that now considered the needs of physical and mental
health for students, which in turn created the first interactions between public school staff
and school based mental health professionals.
After a decade of developing programs that allowed children with mental and
physical disabilities to gain access to public education, the 1997 reauthorization of the
Individuals with Disabilities Education Improvement Act was passed by the United States
Congress. The reauthorization of IDEA drastically changed how schools were to educate
children who displayed challenging behaviors. The use of positive behavior supports
(PBS) were implemented at this time. PBS's attempted to move away from the punitive
14
nature of addressing negative behaviors in the school setting and examined the systems in
the child's life that negatively impacted the child resulting in negative behaviors exhibited
by the child (Wagner, R.K., & Garon, T. (1999). During this time functional behavioral
assessments (FBA) were recommended by IDEA for use by teachers in the classroom.
The use of FBA's were instituted as a means to address behaviors that impeded on the
ability of students, both with and without disabilities, to learn (Jackson 2011; Quinn,
Gable, Rutherford, Nelson, & Howell, 1998). The implementation of PBS and FBA
placed further demands on all teachers who came in contact with students with
disabilities, and created the need for new interactions, collaboration levels, and working
relationships between school staff and mental health professionals.
The 2004 reauthorization of IDEA is the most current federal policy regarding the
educational rights of mentally and physically handicapped students. The most recent
changes to IDEA provided local school districts with the ability to vary the way they
screen for disabilities and how they determine whether students qualify with a learning
disability.
The merger between mental health services for children and public education for
students is fairly recent. The reform of public policy has been ongoing, and has given
public school districts the ability to work with some freedom to choose what mental
health services they want to offer to their students. These new developments in public
education mental health policy have made it necessary to conduct research specific to
individual school districts. Also, given that IDEA is less than fifty years old and has
undergone three reauthorizations, the need to examine school staff perceptions of these
15
programs is important.
School Based Psychological Counseling
Individual and group psychological school counseling has been a widely used
form of mental health intervention in the school setting (Franklin et al. 2012). Henning,
J. E., Stone, J. M., & Kelly, J. L. (2009) conducted a study that aimed to identify the most
commonly used form of mental health intervention in Illinois school districts and found
that individual psychological counseling was the most common form of mental health
intervention being implemented in schools. School counselors are specially trained
mental health professionals that identify student problems and help with resolving those
problems using well established counseling techniques. The counselor has the ability to
assess the student's problem and decide on other services and referrals that the student
may need that are beyond the scope of the school counselor, or that may be better
supported by teachers and support staff on or off the school campus. School counselors
operate within the policies of the given school, and are obligated to operate within state
and federal law in regards to best practices and mandated reporting. Individual schoolbased counseling deals with common issues surrounding stress, depression, self esteem
issues, body image, abuse, anxiety, cultural issues, suicidal thoughts, identity issues, and
drug abuse.
Individual and group psychological school counselors assist students in
discovering their strengths to better aid the student in being successful personally and
academically. Counselors employ many techniques to engage students such as guided
interviews, narrative therapy sessions, and aptitude and personality tests. Individual
16
psychological school counselors also observe children in the classroom to gain insight
about how students are engaged in activities in a social setting. Counselors are involved
with teachers and parents to evaluate the needs of students. Counselors are also in
contact with other school based mental health providers as well as school administrators
to provide successful outcomes for students.
Crisis Interventions
Crisis intervention training is one form of mental health intervention that public
schools across the nation use to defuse explosive behaviors that occur in the school
setting. Major media publicity has been shedding light on incidents where school staff
who have not been trained in crisis intervention have tried to implement various restraints
on students and the results have been that the staff has either inflicted harm on the student
or even death (Covillon, 2009). This has resulted in federally mandated policies for safe
and effective crisis intervention trainings for school staff that work with students.
Trainings differ to some degree but they all work to train the staff in prevention and deescalation, meaning that staff learn to determine when it is appropriate and safe to
restrain a student who presents a harm to himself or others, and how to safely restrain a
student within the parameters of the law. Crisis intervention training, on average,
involves 12 -16 hours of training, and is often offered by outside agencies (Covillon,
2009). The cost of training school staff can be high, but the number of students in the
public school system who present with serious emotional and behavioral problems that
can pose threats to themselves and other students is also high. This creates the need for
funding crisis intervention training, especially in the world of injuries (sometimes fatal)
17
and lawsuits that threaten the wellbeing of all members of the school community.
RTI; An Example Of School Based Mental Health Intervention
Response To Intervention (RTI) is a good example of teacher involvement in
school-based mental health intervention. RTI is considered the first widely used school
based mental health intervention that recruited the assistance of teachers as service
providers for mental health services for students. RTI is based on a three tier system for
intervention that emphasizes universal support, group support, and individual support.
RTI relies heavily on teacher participation, collaboration, ongoing data collection and
intervention implementation to be successful at addressing student mental health and
academic needs. Williams and Lawson (2011) stated that teachers involved in RTI were
at the forefront in generating referrals for students who they believed to be struggling
socially and emotionally. RTI is a good example of how teachers are the driving force
behind potential improvement in areas of academics and mental health on all three tiers
of the intervention.
Tier one of the RTI mode focuses on universal support which is almost
exclusively delivered by teachers. Implementation of the intervention at this level
focuses on behavioral modification techniques rooted in evidence based practice and is
implemented in the classroom. This stage also requires screening to identify at-risk
students (Bradley, Danielson, & Doolittle, 2007).
Tier two of RTI intervention involves identification of students who are
presenting social, behavioral, and academic problems that are not being remediated by
tier one of the RTI model. Tier two of RTI relies heavily on teacher collaboration with
18
mental health professionals and special education professionals. While general education
teachers may not be well trained in data collection and interpretation methods, special
education teachers are likely to train for, and garner experience in, the data collection
aspect of intervention implementation. Thus, the literature has noted that collaboration
between special education teachers and general education teachers is crucial in their
ability to guide intervention development and track intervention effectiveness (Richards,
S. Pavri, F. Golez, R. Canges, J. Murphy (2007).
Tier three of the RTI model consists of individual support. This tier of the
intervention focuses on prior data collection and interpretation that indicates deficits that
often require specialized one on one intervention. This aspect of the intervention also
demands rigorous data collection and ongoing analysis and collaboration with other staff
to guide the direction of the intervention and reassessment of intervention services.
While the RTI program is only one example of school based mental health interventions,
it highlights the importance of the role teachers play in the successful implementation of
the intervention. Richards et al., (2007) defined successful implementation of the
program as a cycle of data informed instruction guidance which requires proper staff
training and professional development in the avenues of progress monitoring, using data
to make instructional decisions, and implementing evidence-based interventions. The
underlying theme present in this critique of the RTI program is that teacher involvement
is at the cornerstone of the programs' success or failure; therefore, it is critical to
understand how teachers feel about being players in the area of school-based mental
health intervention.
19
School Based Mental Health Interventions Used By The Placerville Union School
District
Placerville Union School District (PUSD) is comprised of three schools;
Louisiana Schnell Elementary School, Sierra Elementary School, and Markham Middle
School. PUSD employees a variety of school based metal health interventions to address
the social emotional and behavioral needs of its students at the three school sites within
the district. Included in those are special education programs, a school social worker, a
speech therapist, a school physiologist, and on site individual and group counseling
services provided by New Morning Youth and Family Services.
New Morning Youth and Family Services is a family systems based counseling
agency that provides multiple school based mental health interventions to students and
parents all three schools in the school district. Services that provided by the agency
include individual and group counseling that focuses on research based counseling foci
such as aggression replacement training, behavior intervention, moral reasoning, and
social skills. Additionally, New Morning Youth and Family Services provides shelter
services for youth that students are encouraged to use if need be. New Morning Youth
and Family Services also offers parenting classes to parents of students in the district as
well.
Placerville Union School District employee’s one full time Speech Therapist to
conduct individual speech therapy for students who are cognitively and developmentally
delayed in their speech. In addition, PUSD also employee’s one full time School
Psychologist to conduct psychological testing and evaluations of students to determine
20
what types of mental health services and or special educational accommodations the
student may need. Furthermore, PUSD employees one School Social Worker who
oversees the homeless and transient student population of the district. The school social
worker works with students and their families to ensure that both the student as well as
their family are being connected with services that provide resources such as food,
clothing, shelter, and medical care. The school social worker tries to promote
consistency in the retention of educational instruction, as well as promote family
cohesiveness. Additionally, the school social worker also works hand in hand with
counselors, school physiologists, nurses, clerical staff, teachers, district administrators,
and other service providers to make sure this pocket of the student populations’ needs are
being met. PUSD’s School Physiologist and Speech Therapist, and School Social Worker
serve all three schools within the district.
Within PUSD, Markham Middle School houses a school based mental health
program entitled Safe School Ambassadors (SSA). SSA aims to empower students to
become the change agents for issues occurring on their campuses such as bullying, and
violence. SSA employed and inside out approach to change the social climate of the
school which is conducive to tolerance, inclusive, and non-violence. Students selected to
participate in SSA are identified by school staff members as leaders of the various groups
on campus. The rationale behind selecting these individuals is the influence that these
individuals can furnish within their respected groups on campus. Students receive two
days of off campus training, and ongoing trainings about topics such as conflict
resolution, communication skill development, and being a good listener etc. SSA
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members hold bi-monthly meetings to discuss on campus issues and propose solutions to
those problems. SSA also holds yearly events to raise awareness about issues deemed
relevant to the SSA members.
Who Is Providing Mental Health Intervention Services In Public Schools?
Public school districts in the United States are the primary service delivery points
for mental health services to children (Franklin et al., 2012; Foster, 2005). Therefore, to
appropriately deliver these services to students, it is crucial to understand who is involved
in the current patchwork of service providers in place. Franklin et al. (2012) compiled a
meta-analysis examining the extent of teacher involvement in school based mental health
interventions involving psychological and behavioral treatments in the public school
setting. They compiled data from 49 studies measuring the effect that the given
intervention had on students. The review of relevant data found that teachers actively
participated in 40.8% of the interventions. The study also revealed that teachers were the
primary deliverers of the interventions in 18.4% percent of cases. The study indicated
that there was more collaborative teacher participation in school based interventions with
mental health professionals than independent delivery of the intervention. Additionally,
the majority of the mental health interventions included in the study were interventions
which took place in the classroom and were more preventative in nature. It is worth
noting, however, that the teachers who delivered interventions achieved a medium effect,
which is the same as the overall study results (Franklin et al. 2012).
In the 2003 US Survey Report, Foster et al. (2005) indicated that almost all public
schools have a staff member whose duties include delivery of mental health services.
22
The 2003 US Survey Report also reported that one third of US school districts have a
staff member exclusively dedicated to delivering services, about a quarter of US school
districts have contracts with outside service providers who deliver mental health services,
roughly another third of US school districts have some combination of on-site school
staff, district administrative staff, and community providers delivering mental health
services, and about half of all US school districts reported that they have contracts and
formal agreements with individuals and community organizations to deliver mental
health services.
Foster et al. (2005) indicated that there is some form of mental health service
being delivered within all US public school districts included in the survey. The data
indicated that mental health services are being provided in some capacity throughout the
US public school system; however, the resources needed to continue with these services
are not growing at the same pace as the need for mental health services in the US public
school system. Unfortunately, the study indicated that while the need for mental health
services has been steadily increasing, funding and resources allocated for these services
has not kept pace with that increased need (Foster et al., 2005).
The 2003 US Survey Report went on to identify the most common Providers of
mental health services delivered to children in public schools. Foster et al. (2005)
indicated that school counselors were the most prevalent service providers, followed by
school nurses, school psychologists, and school social workers. While the study
indicated that mental health services are being provided to students in the US public
school systems, it also showed that counselors and school nurses are the predominant site
23
staff in place to provide mental health services.
While counselors and nurses are trained to be mental health service providers, the
survey found that educational and administrative factors impede actual service delivery
to children. These findings imply that counselors and nurses are the trained mental health
service providers responsible for the majority of mental health services offered to
students. However, these service providers often fall short in individual service delivery
due to increased participation in leadership roles within the school districts. Therefore, as
a result, the reliance on teachers to become the proxy mental health service providers has
increased.
Difficulties Teachers, Administrators, And Schools Face When Implementing School
Based Mental Health Interventions
The literature is in agreement that contextual elements of the school environment
need to be considered when implementing successful interventions (Chitiyo, 2009;
Richards et al., 2007; Cappella et al., 2011; Williams & Lawson, 2013). These
components are: (a) how schools use current staff to implement interventions, (b) how a
given intervention is integrated into the specific school environment, (c) proper
interpretation of intervention data, and (d) provision of teacher support from mental
health providers and administration. Positive intervention outcomes have all been
examined by researchers studying mental health interventions. While school-based
mental health interventions vary based on the desired outcome and the specific issues
being addressed within the school setting, the general components listed above are
typically involved in the success or failure of school-based mental health interventions.
24
Survey data shows that public schools are responding to the need for mental
health services on their campuses; however, they are also showing an increasing need for
services to address issues that are arising as a result of trying to address mental health
issues (Foster el al., 2005). Foster et al. (2005) noted that there are many factors public
schools face when reaching for positive mental health intervention outcomes. While the
school setting is continually becoming more open to integrating mental health
interventions, and community partners are able to offer mental health services applicable
to the school setting, teachers are continually facing challenges as they adapt to the
merging of education and mental health services (Mitchem, K., Richards, A., & Wells, D.
2001).
Of those challenges, the most notable are staff collaboration, time allocated to
intervention implementation, proper interpretation of the data produced by the
intervention being implemented, communication with school administrators, and lack of
necessary training (Chitiyo, 2009; Richards et al., 2007; Cappella et al., 2011; Williams
& Lawson, 2013). Morgan Chitiyo (2009) examined barriers schools faced in the
implementation of school based mental health interventions. He used an ecological
framework to examine what systems within the school environment were affecting the
behavior of those students who were receiving intervention. The study employed
convenience sampling and surveyed 21 teachers in an Illinois school district. The survey
used quantitative data analysis, which revealed that if teachers were to participate in
another mental health intervention involving students in the classroom, they would want
more collaboration from administration, cultivate more staff buy-in before
25
implementation, specifically tailor the interventions to the selected population receiving
intervention, provide more staff training, and use more data collection and behavior
management tools during the intervention (Chitiyo, 2008). The study revealed the
problems/ obstacles that teachers faced during and after participating in implementation
of mental health interventions. The study's findings suggest that more collaboration with
administration, staff buy-in, one-on-one time with students, and more training on how to
better implement interventions is needed to have positive outcomes for students
participating in the given intervention. The study had multiple limitations. first, it was
only conducted within one school district and its findings lack generalizability to other
settings and populations, and secondly, it was a pilot study, and, therefore, had not
established any true reliability and validity measures. The study also highlighted that the
factors teachers reported from the survey should be considered the foundation to the
fundamental success of school based mental health programs, and to ignore or fail to
address these factors could lead to a compromise in the quality of services delivered to
students (Chitiyo, 2008). These challenges are very general and are comprised of many
aspects that will be extrapolated on in this section.
S.C. Berzin, Khm O'brien, A. Frey, Ms Kelly, M.E. Alvarez, & G.L. Shaffer
(2011) aimed at trying to further understand the collaborative process that exists between
professional school-based mental health providers and educators. The article made note
of the limited data regarding the collaboration between teachers and mental health
providers in the public school setting. The study used secondary data analysis acquired
from the 2008 National School Social Work Survey to identify subsets of social workers
26
who were providing various collaborative support services to teachers who were
considered to be the primary mental health service providers for their students. Results
from the study indicated varying degrees to which school social workers collaborated
with teachers. The study also reported that social worker’s felt they had roles in
educating, and supporting teachers as they adapt to the role of being considered a primary
mental health service provider. While the study provided insight into the various levels
of collaboration that occur between social workers and teachers, the study does not take
into consideration the teachers' perspective concerning the collaborative exchange.
Finally, Berzin et al., (2011), examined the role of social workers in school-based mental
health services, and concluded that while teachers and staff differed in collaborative
practices, yet opportunities existed to enrich collaboration with teachers as they serve as
primary mental health providers to students with social, emotional, and behavioral needs
.
Lack of teacher and staff collaboration has been cited by several studies as a
barrier to successful implementation of mental health interventions in schools (Foster et
al., 2005; Chitiyo et al., 2008; Richards et al., 2007; Cappella et al., 2011; Williams &
Lawson, 2013). Cappella et al. (2011) conducted a summary review which article
examined multiple models that guide the way in which research should be conducted
about how school-based mental health interventions are being delivered to students. The
article examined these approaches through the scope of community psychology, and
socio-ecological theory and methodology approaches. They argued that in the context of
school based mental health intervention implementation, socio-ecological theory
27
considers how systems within the school setting are interacting with each other. The
study also employed community psychology theory, which asserts that collaboration with
stakeholders in the school community and proper program and process valuation theories
need to be used to guide intervention. The study concluded that the best way to
implement, assess and execute successful school-based mental health interventions is to
create a collaborative working environment within the school environment that promotes
the use of an ongoing informed feedback loop between stakeholders, such as teachers,
mental health professionals and school administration (Cappella et al., 2011).
While Cappella et al. (2011) did not contribute original data to the relevant
literature, the application of relevant theories to the topic of school-based mental health
intervention research contributes to the growing body of literature pertinent to the
subject, and, therefore, should be considered by the researcher of the current study.
Cappella et al. (2011) noted that teachers may not have access to information about
mental health interventions which might instruct them regarding effective
implementation of those interventions. This finding indicated that while teachers try to
implement mental health interventions in their classrooms, they lack collaboration with
colleagues and other mental health professionals to move the interventions into a
positive, meaningful, and effective direction that considers emotional, behavioral, and
educational goals. Chitiyo (2009) also stated that lack of teacher-staff collaboration
could lead to intervention success in some settings and losses in others, which can lead to
lack of ability to generalize success across contexts.
Outcomes resulting from inconsistencies in service delivery can result in failure to
28
positively affect the entire population of students receiving intervention services.
Chitiyo et al. (2009) identified the difficulty of forming proper instructional methodology
of alternative or replacement behaviors and lack of collaboration as the primary
difficulties associated with the implementation of mental health interventions. This
finding suggested that successful teacher-staff collaboration is geared toward integrating
mental health interventions, lack of collaboration with other teachers and mental health
professionals hinders the potential for the success of intervention. Therefore, research
has concluded that successful mental health interventions in schools requires supporting
professional development and promoting collaboration and communication (Haager &
Mahdavi, 2007).
Teachers have traditionally been faced with a multitude of tasks aimed at
promoting academic and social development for their students, which can prove to be
challenging for many teachers. Richards et al. (2007) conducted a summary review
examining the roles of general and special education teachers who were participating in
the school-based mental health intervention called Response to Intervention otherwise
known as RTI. They examined the needs of these educators, such as education
concerning the implementation of the intervention itself and the need for professional
development regarding the theoretical and practical application of the intervention. The
study concluded that while teachers may feel competent in their ability to successfully
deliver academic material, they do not feel the same way about delivering mental health
interventions (Richards et al., 2007).
Richards et al. (2007) identified the obstacle of time as a key factor in the success
29
or failure of interventions. The study found that integration of mental health services into
the school setting created even more demand for teachers to allocate their time to proper
implementation of mental health interventions. Their study, which concerned
strengthening schools to better serve students involved in the response to intervention
model of school-based mental health services, stated that while many school districts
want to implement mental health interventions on their school campuses, they lack the
time required to provide adequate professional training to properly support students with
mental health issues.
As teachers integrate mental health interventions into their interactions with their
students, data collection has also been reallocated to the teacher. Multiple factors
contributing to successful mental health intervention rely on how well teachers adapt to
being competent in this new skill set. Richards et al. (2007) suggested that teachers need
to help with technical tasks such as data recording in order to validate interventions in
their schools. Without proper technical assistance from staff for intervention assessment,
any strides in the positive movement of identifiable barriers and gains that present
themselves during implementation can be hindered. Lack of proper data interpretation
skills may result in a loss of data due to improper data collection. Furthermore, among
the findings of Richards et al. (2007) was the finding that teachers needed technical
assistance in the data collection process. Particularly illustrative of the difficulty in data
collection for teachers was the article's comparison of the inability of teachers to conduct
proper data collection techniques to teachers who are asked to teach curriculum in which
they have no expertise.
30
Understanding Teacher Perceptions Of School Based Mental Health Interventions
Reinke et al. (2011) attempted to systematically identify teachers’ perceptions of
mental health needs in their schools surrounding their own knowledge, skills, training
experiences, training needs, their roles for supporting children’s mental health, and
barriers they were encountering that hindered the support for mental health needs in their
school settings. Through an ecological theory framework, the authors examined reasons
why best practices, which were implemented in research trials for evidence-based mental
health interventions, were not being implemented once they were introduced by
educators and mental health professionals in the public school setting. The study
employed the use of a Mental Health Needs and Practice questionnaire to survey 292
teachers from early childhood development programs and elementary schools from five
different school districts set in urban, suburban, and rural settings in Missouri (Reinke et
al., 2011).
Reinke et al. (2011) investigated participants' demographic information relating to
the participant-educators and their schools, as well as their insights regarding the role
schools play in delivering mental health services to their students, and their knowledge
and overall attitudes about school-based mental health interventions. The methodology
and sampling techniques used to obtain data from school districts that differ in terms of
demographic characteristics increased the generalizability of the study to the greater
population. One limitation to the study, however, was that the sample population was
limited to one state in the US.
As Reinke et al. (2011) noted, few studies have been conducted that assessed
31
teachers’ perceptions of mental health needs in schools or their preparedness for
supporting children with mental health needs. Numerous studies have been conducted
that examined the effects of mental health interventions on the students involved in the
interventions and the outcomes associated with effects to the overall school “climate.”
Reinke et al. (2011) suggested that, in order to develop effective school-based mental
health services, the marriage of mental health and education needs to be promoted and
reformed. The current model for school-based mental health interventions is one that
relies heavily on teachers. Teachers are often asked to implement interventions and refer
students for additional supports; therefore, it is important to understand how teachers
perceive themselves as stakeholders for school-based mental health interventions (Reinke
et al., 2011).
Mental health professionals, such as school psychologists and school counselors,
often operate on an individual basis while school-based mental health interventions
employ and incorporate school staff to deliver intervention services to students.
Therefore, the importance of knowing how both teachers and staff perceive school-based
mental health interventions is critical for the success of interventions on multiple levels.
Mental health professionals need to understand how the teachers and staff who
engage with the students involved in the interventions feel about how a given mental
health intervention is working within the school environment. Atkins et al. (2011)
conducted a summary review of recent policies which had been used in the public school
setting to integrate public education with mental health. The article examined the
intended and unintended results of programs which instituted the merger of education and
32
mental health, such as the Freedom Commission on Mental Health on the integration of
education and mental health. The study employed the ecological framework to critically
examine the lack of consensus surrounding implementation, lack of strong empirical data
of mental health programs, and the need for both strong consideration of methods of
introduction of the mental health programs into the school environment and assessment
of the adaptation of students and teachers to the interventions. The methodology
employed lent itself to limitations due to lack of data analysis. The article pointed
towards the need for more research development to measure how mental health programs
are working in the public education sphere in an effort to place priority on supporting,
growing and developing mental health services in public school systems (Atkins M,
Frazier S, Leathers S, Graczyk P, Talbott E, Adil J, 2011).
Atkins et al. (2011) highlighted the importance of teacher perceptions to bridge
the gap between research and practice to achieve praxis because teachers are the primary
change agents due to their ability to control the child's learning environment. While
mental health professionals are often managing school based mental health interventions,
teachers and support staff are most often the intervention service providers. Also, at the
most fundamental level, studies have noted the importance of determining if teachers
value the need for supporting children with mental health needs ( Ringeisen, H.,
Henderson, K., & Hoagwood, K. (2003); Schaughency & Ervin, 2006). If teachers do
not see a need for mental health services, it may become hard for teachers to invest the
time and effort needed to successfully implement interventions. Secondly, as Atkins et
al. (2008) evidenced, in order to truly base mental health interventions on the evidence
33
gathered from past data and interventions, it is crucial to go further than strictly
examining the pre-test post-test data collection produced from the various intervention
programs. It is crucial to engage teachers because they can be the most influential
change agents in the school settings due to their committed and established relationship
to the children's education.
Williams and Lawson (2013) conducted a study in Australia that surveyed 1397
teachers, and conducted interviews with 37 teachers regarding mental health services,
identification of students with mental health needs, and their ability to administer mental
health intervention in the school setting. Through the use of quantitative data analysis the
study indicated that about fifty to seventy-five percent of the teachers surveyed said they
felt knowledgeable about some aspects of mental health promotion and that they were
able to identify students with mental health needs about two thirds of the time. Their
study reported high generalizability due to its ease of replication through the application
of the same questionnaire. However, due to the geographically remote location being
considered, and the varying policy implementation that exists between American and
Australian public school based mental health services there is some lack of
generalizability. They concluded that teachers play a major role in promoting mental
health knowledge and self-awareness around topics, such as depression, anxiety, social
skills, emotional regulation, and identifying early signs of mental health issues (Williams
& Lawson, 2013). Therefore, as Reinke et al. (2011) noted, “insights into the attitudes
and perceptions of teachers can help school psychologists address important issues for
reform and capacity building” (Reinke et al., 2011, p. 2).
34
Finally, studies have noted a lack of research on teachers' perceptions concerning
the new roles they have adopted surrounding mental health needs in schools. With the
introduction of new curriculum, such as mental health promotion, teachers are being
asked to work in areas with which they may be unfamiliar (Williams & Lawson, 2013).
In order to qualitatively gage intervention effectiveness, “understanding school staff
perspectives about the context that mental health interventions are being implemented in
is necessary to bridge the research to practice gap in school-based mental health
practices” (Reinke et al., 2011, p. 11).
35
Chapter 3
METHODS
Introduction
In order to address perceptions school staff have regarding mental health
interventions being implemented at the school they work at, and collaborative levels
between those staff and school based mental health professionals this study explored
collaborative levels and school staff perceptions through the use of a survey. In addition
to further addressing the objective of the study, this chapter will identify: (A) study
design, (B) study sample, (C) data collection, (D) instruments used, (E) data analysis, (F)
and the protection of human subjects.
Study Objective
The objective of the study was to identify whether collaboration with
mental health professionals has an impact on teacher and staff perceptions about schoolbased mental health interventions taking place at their school of employment. The
primary research question of the study was: Does teacher/staff collaboration with mental
health professionals and administration impact teacher/staff perceptions of mental health
interventions taking place at their school of employment?
Study Design
The researcher used a descriptive study design. Using a descriptive research
design helped illuminate and identify collaboration between teachers and mental health
professionals, teachers' perceptions of interventions taking place at their schools, and
relationships between the two aspects of the study. Descriptive research had a goal of
36
collecting a mix of qualitative and quantitative data. The purpose of the design was to
gain an understanding of underlying reasons for the potential problem, and to provide
insight into the setting of the problem which can generate ideas for hypotheses for future
quantitative research.
Study Sample
Participants for the research study were full and part time staff members of
public elementary schools within the Placerville Union School District, located in
Placerville, California. All 45 participants were full time teachers, or non-teacher school
support staff members. Teachers refer to individuals who possess a teaching credential
and are employed by the school district to teach children attending the school being
surveyed, while non-teacher staff members refers to para educators, office aids, and other
support staff but does not include nurses, psychologists, counselors, and administration
such as principals and vice principals. Determination of staff member status (teacher or
non-teacher staff member) was based on self-reports by the participants.
Participants were recruited through the use of non-random convenience
sampling methods. The researcher started by emailing a summary of the survey to
administration at the various elementary and middle schools targeted for participation in
the study. To prevent an oversampling from one elementary school in the school district,
and to preserve the generalizability of the study, the researcher provided multiple
reminders to all school site contacts to ensure recruitment of participants from all schools
in the study. No inducements were offered.
The researcher chose to use non-random convenience sampling because in
37
order to gather data about school based mental health interventions in one specific school
district. The purpose of gathering data was not to identify how to correct school based
mental health intervention implementation, but to try to identify correlations that may be
present within different aspects of intervention implementation. The analyzed data that is
collected from participants may be used to inform school administration about trends in
intervention implementation as well as staff perceptions about interventions on their
campuses to better direct future policies and programs within their schools.
Data Collection
Over the course of January and February of 2014, convenience and purposive
sampling methods were used to collect data for this study. The elementary and middle
schools that were part of the study are not necessarily representative of all elementary
and middle schools in the state of California but were accessible to the researcher and
relevant to the study. Data was collected by the researcher using a structured online
survey. All data that has been obtained will be stored on a secure website with password
protection that only the researcher has access to. All data that is compiled will be stored
in a locked filing cabinet, this was destroyed in May 2014. Only the researcher will have
access to data obtained in this study
Instruments
Based on a review of the literature, a 21 question survey was developed for the
purpose of the study. The survey consisted of both closed-ended and open-ended
questions that ask participants' for their opinion of what they believe constitutes adequate
school based mental health services and their own perceptions about their school's mental
38
health service practices. Twelve of the questions were quantitative using a nominal level
of measurement such as employment classification, and the type of school they worked at
(elementary or middle school), collaborative levels, training, data collection, and time
allocation. Seven of the questions were asked using a likert scale. For the researchers
likert scale questions the participants were asks to rate their level of agreement with how
effective mental health interventions were at addressing issues occurring on campus.
Two of the questions were check box questions asking the participants to identify mental
health services occurring on their campus. One question was open ended and asked
participants to list any school based mental health interventions they thought were
effective at addressing mental health issues amongst students.
Data Analysis
The data was analyzed through the use of SPSS, statistical data analysis. The use
of statistical means tests provided the researcher with frequencies and disruptive statistics
which produced means, medians, modes, and percentages pertaining to the survey
questions asked of participants. Data was also used to determine strengths and
correlations between variables, and differences in means between groups.
Protection Of Human Subjects
On November 22nd, 2013, the researcher received confirmation that the
Division of Social Work Research Review Committee had approved the Human Subjects
Application, and had determined that the study was exempt and was assigned approval
number: 13-14-039. Within the appendix there will be a copy of the consent form, and
survey.
39
After the research was determined to pose no risk, the survey was administered to
the participants. No names were included in the questionnaire and the subject matter did
not cross any personal boundaries. The testing tool did not evoke any additional
discomfort more than what participants may be encountering in their daily lives. There
were no physical procedures in the research study other than asking participants to fill out
an online survey and acknowledging implied consent. The risk or discomfort involved
therefore did not exceed what is expected in their daily lives. There was no equipment or
instruments, besides the survey, used in this study. Therefore, there was no risk of
discomfort or harm. There were no drugs or pharmaceuticals used in this research.
Therefore, there is no risk of discomfort or harm as well.
Issues of privacy and safety were mentioned in the implied consent statement
presented to the subject prior to taking the survey. Privacy was ensured through
anonymity during the actual data collection period. Consent was implied once the , the
participant began to complete the online survey. No names were used on the survey and
the researcher was not present during the period in which participants were filling out the
survey. Participants were given the option to submit the survey electronically after
completion. At the completion of the data analysis, all surveys will be destroyed. It was
expected that the research study involved no risk when it came to issues of safety.
40
Chapter 4
ANALYSIS OF DATA
Introduction
This chapter presents the findings of the study that focus on staff perceptions of
the effectiveness of mental health interventions being complimented on their campuses,
and collaborative levels between teachers and various mental health services providers.
This chapter begins with demographic information regarding the study participants and
presents the the finding of the study as it relates to the literature review.
Findings from the survey are presented here in the same order as the questions
were posed to teachers. Readers who are interested in the precise phrasing of the
inquiries are invited to consult the copy of the survey instrument that can be found in
Appendix B. Correlations were tested for “collaboration” (Q4-Q8) and “helpfulness of
school based interventions” (Q11-Q17) questions. Where linear relationships between
two questions were identified, they were flagged for significance at the 0.01 level.
Statistically significant results, which are results that can generally be relied upon, are
indicated where applicable; results that are not statistically significant are also noted.
Demographics
Figure 1 depicts the three current employment classifications of responding
educational professionals. The largest group of respondents are California Accredited
Teachers (80 percent). The second largest group of respondents are School Support Staff
/Classified Employees (11 percent). The remainder are Para Educators – Classified
Employees.
41
CURRENT EMPLOYMENT CLASSIFICATION
California Accredited
80.0%
School Support Staff
11.1%
Para Educator
8.9%
Figure 11
Figure
42
As shown in figure 2, the largest group of responders work in elementary schools.
This is followed by middle schools. Elementary school represents 64 percent while
middle school represents 36 percent.
TYPE OF SCHOOL WORK IN
Elementary
64.4%
Middle School
35.6%
Figure 2
2
Figure
43
The Number Of Children School Staff Work With Who Are Receiving Some Type
Of School Based Mental Health Intervention
Table 1 displays the number range of children receiving mental health
intervention who work with educational professionals. The most common number range
of students is one to three children (36 percent). This is followed by four to seven
children (22 percent). These two combine total 58 percent.
Number Range of Children Receiving Mental Health Intervention
Table 1
None
One to Three Children
Four to Seven Children
Eight to Eleven Children
Twelve to Fourteen Children
Fourteen or More Children
FREQUEN
CY
1
16
10
3
2
13
PERCEN
T
2.2
35.6
22.2
6.7
4.4
28.9
44
Levels Of School Staff Collaboration With School Psychologists
The extent to which educational professionals collaborate with School
Psychologists on their campus are presented in figure 3. The ranges for this question are
daily to yearly. The largest group of educational professionals never collaborate with
School Psychologists. This is followed by collaboration on a monthly basis (27 percent).
Finally, the third largest group collaborates on a quarterly basis (20 percent).
EXTENT TO WHICH THERE IS
COLLABORATION WITH SCHOOL PSYCHOLOGISTS
Monthly
26.7%
Weekly
15.6%
Daily
2.2%
Quarterly
20.0%
Never
28.9%
Yearly
6.7%
Figure 3
Figure
3
45
Levels Of School Staff Collaboration With Individual And Group Psychological
Counselors
As shown in figure 4, more than half of the education professionals never
collaborate with individual and group psychological counselors on their campus. This is
followed by sixteen percent collaborating on a monthly basis. Monthly and weekly
collaboration total one-third (30 percent).
EXTENT TO WHICH THERE IS COLLABORATION WITH
INDIVIDUAL AND GROUP PSYCHOLOGICAL COUNSELORS
Monthly
15.6%
Weekly
13.3%
Quarterly
8.9%
Daily
2.2%
Yearly
8.9%
Never
51.1%
Figure
Figure 44
46
Levels Of School Staff Collaboration With Other Teachers And Support Staff About
The Mental Health Interventions Offered On Their Campuses
Figure 5 depicts the extent to which educational professionals collaborate with
other teachers and support staff on their campus. Majority of the collaboration occurs on
a weekly basis. This is followed by collaboration on a monthly basis (27 percent). These
total two-thirds (60 percent).
EXTENT TO WHICH THERE IS COLLABORATION WITH OTHER
TEACHERS AND SUPPORT STAFF
Daily
17.8%
Weekly
33.3%
Never
6.7%
Yearly
8.9%
Quarterly
6.7%
Monthly
26.7%
Figure 56
Figure
47
Levels Of School Staff Collaboration With School And District Administration
About The Mental Health Interventions
As shown in figure 6, two-fifths of the educational professionals collaborate with
school and district administration on a monthly basis (42 percent). In addition, a little
over one-fifth collaborate school and district administration on a weekly basis (22
percent). These two total more than two-thirds (64 percent).
EXTENT TO WHICH THERE IS COLLABORATION WITH SCHOOL
AND DISTRICT ADMINISTRATION
Weekly
22.0%
Daily
4.9%
Never
9.8%
Monthly
41.5%
Quarterly
7.3%
Figure 76
Yearly
14.6%
48
The Extent To Which School Staff Perceive School Based Mental Health
Interventions To Be Beneficial To Students
Means ratings of how school staff perceive mental health interventions as being
beneficial are presented in figure 7. These ratings are calculated on a scale from one to
five where one equals not at all beneficial and five equals completely beneficial. Here,
majority of the ratings are somewhat above the level of somewhat beneficial, with two
ratings right under somewhat beneficial.
Figure 7
49
School Staff s’ Knowledge Of Mental Health Interventions Taking Place On Their
Campuses
Table 2 depicts the mental health interventions educational professionals are
aware of on their campus. Educational professionals are most aware of individual
counseling, individual education plans, psychological testing/assessments, and referral
services to outside service providers.
School Staff Knowledge of Mental Health Interventions Taking Place On Their Campuses
Table 2
N=40
Individual Counseling
Group Counseling
Medication
Individual Education Plan
Family Intervention
Crisis Intervention
Psychological Testing/Assessment
Referral Services to Outside Service Providers
Entire Campus Preventative Mental Health
Interventions
Other
FREQUENC
Y
39
19
29
37
17
25
36
36
PERCEN
T
97.5
48.7
72.5
92.5
42.5
62.5
90.0
90.0
9
22.5
1
2.5
50
Levels Of School Staff Awareness Of School Based Mental Health Interventions
Students They Work With Are Engaged In
Table 3 depicts the school staff awareness of mental health interventions students
they work with are engaged in on their campus. Students are most engaged in individual
counseling, psychological testing/assessments, referral services to outside service
providers, and medication.
Levels of School Staff Awareness of School-Based Mental Health Interventions
Students Are Engaged In
Table 3
N=38
Individual Counseling
Group Counseling
Medication
Individual Education Plan
Family Intervention
Crisis Intervention
Psychological Testing/Assessment
Referral Services to Outside Service Providers
Entire Campus Preventative Mental Health Interventions
Other
FREQUEN
CY
36
13
25
33
11
12
29
28
3
1
PERCE
NT
94.7
34.2
62.5
86.8
28.9
31.5
76.3
73.6
7.8
2.6
51
Levels Of School Staff Training Received About School Based Mental Health
Interventions
As demonstrated in figure 8, more than half of the educational professionals
receive yearly mental health intervention training on their campus (54 percent). On the
other hand, a little over a third of educational professionals said they never receive
training on mental health intervention on their campus (34 percent).
EXTENT TO WHICH HOW OFTEN MENTAL HEALTH
INTERVENTION TRAINING IS GIVEN
Quarterly
9.8%
Yearly
53.7%
Monthly
2.4%
Never
34.1%
Figure 8
9
Figure
52
Levels Of School Staff Data Recording For Students Participating In School Based
Mental Health Interventions
Figure 9 represents how often mental health intervention data is recorded. Almost
two-fifths of the educational professionals said they never record mental health
intervention data (39 percent). This is followed by quarterly recorded data (27 percent).
EXTENT TO WHICH HOW OFTEN MENTAL HEALTH
INTERVENTION DATA IS RECORDED
Quarterly
9.8%
Yearly
53.7%
Monthly
2.4%
Never
34.1%
Figure
Figure 10
9
53
Levels Of School Staff Work Time Allocated To Working With Mental Health
Interventions
As shown in figure 10, hardly any time of day is allocated to working with mental
health interventions (61 percent). The other third of mental health professionals spend
some of their day working with mental health professionals (34 percent).
EXTENT TO WHICH THE AMOUNT OF TIME IN THE DAY IS
ALLOCATED TOWARDS WORKING WITH
MENTAL HEALTH INTERVENTIONS
Hardly Any
61.0%
A Lot
4.9%
Some
34.1%
Figure
Figure 11
10
54
Levels Of School Staff Work Time Allocated To Correcting, Redirecting, r
Individually Working With Students Who Are Engaged In Some Form Of Mental
Health Intervention
Educational professionals’ responses when asked how much in their day is
allocated towards correcting, directing, or individually working with students who are
engaged in some form of mental health intervention is depicted in Figure 11. The
majority of educational professionals said they allocate some of their day towards this
(59 percent). This is followed by one-fifth saying they spend hardly any of their day
towards this (20 percent).
EXTENT TO WHICH THE AMOUNT OF TIME IN THE DAY IS
ALLOCATED TOWARDS WORKING WITH STUDENTS WHO ARE
ENGAGED IN MENTAL HEALTH INTERVENTIONS
Hardly Any
19.5%
Majority
7.3%
Some
58.6%
A Lot
14.6%
Figure
Figure 12
11
55
Correlations
Correlations were tested for “collaboration” (Q4-Q8) and “helpfulness of schoolbased interventions” (Q11-Q17) questions. Where linear relationships between two
questions were identified, they were flagged for significance at the 0.01 level.
Statistically significant results, which are results that can generally be relied upon, are
indicated where applicable; results that are not statistically significant are also noted.
Out of the seven question statements on “helpfulness of school-based interventions”
(Q11-Q17), five were proven to have statistical significance at the 0.01 level. For the
statement, “To what extent do you feel school based mental health interventions are
helping students’ academic performance in the classroom,” there was a negative
correlation. At -.379, as academic performance in the classroom increases, collaboration
with school and district administration about the mental health intervention offered
decreases.
With regards to the statement, “To what extent do you feel school based mental
health interventions are helping students’ behavior in the classroom,” there was a
negative correlation with collaboration with school and district administration. At -.383,
as students’ behavior in the classroom increases, collaboration with school and district
administration about the mental health intervention offered decreases.
For the statement, “To what extent do you feel school based mental health
interventions are helping to lower suspension and disciplinary referrals at your school,”
there was a negative correlation. At -.462, as interventions lower suspension and
disciplinary referral increases, collaboration with school and district administration about
56
the mental health intervention offered decreases.
For the statement, “To what extent do you feel school based mental health
interventions are helping to lower tardiness and absenteeism at you school,” there was a
negative correlation. At -.463, as interventions lower suspension and disciplinary referral
increases, collaboration with school and district administration about the mental health
intervention offered decreases.
When it comes to the statement, “Overall, how effective do you feel the schoolbased mental health interventions are at your school,” there was a negative correlation. At
-.455, as the overall effectiveness of school-based interventions increases, collaboration
with school and district administration about the mental health intervention offered
decreases.
57
Chapter 5
CONCLUSIONS, RECOMMENDATIONS, AND IMPLICATIONS
Introduction
This chapter summarizes the study’s conclusion. The literature yielded important
and relevant information regarding school based mental health interventions. The aim of
the study was to gather descriptive data about school staff engagement with school based
mental health interventions as well as to illuminate any relationships that existed between
how school based mental health interventions were being implemented at schools and
how school staff perceived their success correcting emotional and behavioral problems
exhibited by students. This chapter will include a discussion about the conclusions found
as a result of this study, recommendations for the study and implementation of school
based mental health interventions in the future, and this study's implications for social
work policy and practice.
Conclusions
The purpose of this study was to provide a source of information and data
regarding school staff perceptions regarding the implementation of school based mental
health interventions. Several questions helped guide the study: how often does school
staff collaborate with mental health service providers about school based mental health
interventions? What mental health interventions are school staff aware of on their
campuses? What do school staff think about the effectiveness of the school based mental
health interventions taking place on their campuses? Do school staff engage in trainings
and data collection for school based mental health interventions, and, if so, how much
58
time are they allocating to those tasks? Do relationships or patterns exist between any of
these factors listed above? These questions mentioned above drove the research and
design of the study.
The study included 39 school staff who were employees at Placerville Union
School district. Results from this study showed interesting data regarding school staff
and school based mental health interventions such as school staff time allotment for
interventions, levels of training for interventions, collaboration with mental health
professionals as well as each other, and correlations between school staff perceptions of
school based mental health interventions and collaborative levels with school
administration. The sample was small (39) and may not represent the entire population
of school staff within the Placerville Union School district. However for this sample of
participants, there is reason to believe that some school staff have positive feelings
towards school based mental health interventions when they feel they are being supported
by their administrators.
The literature showed the multitude of school based mental health interventions,
the tapestry of professionals in the school setting who implement those services, and
predictors of success and barriers in the implementation of school based mental health
interventions. The literature is in agreement that contextual elements of the school
environment need to be considered when implementing successful interventions (Chitiyo,
2009; Richards et al.,2007; Cappella et al., 2011; Williams & Lawson, 2013), and the
data produced from my study examined those contextual elements.
The demographics recorded from the data reflected demographical employment
59
norms amongst public schools. The largest group of respondents were California
Accredited Teachers (80 percent). The second largest groups of respondents were school
support staff /Classified Employees (11 percent). The remainders were Para
Educators/Classified Employees. Of those respondents, more than half of the educational
professionals receive some form of yearly mental health intervention training on their
campus (54 percent). On the other hand, a little over a third of educational professionals
said they never receive training on mental health intervention on their campus (34
percent). This data indicates limited school staff exposure to trainings and data
collections associated with school based mental health interventions. Almost two-fifths
of the educational professionals said they never record mental health intervention data
(39 percent). This is followed bythose who record data quarterly (27 percent).
In regards to time allotment for school based mental health interventions, this
study indicated that while the majority of respondents report they allocate hardly any
time of day to working on mental health interventions (61 percent), and the other third of
respondents spend some of their day working with mental health professionals (34
percent). The majority of educational professionals said they allocate some of their day
towards correcting, directing, or individually working with students who are engaged in
some form of mental health intervention working (59 percent). This is followed by onefifth of respondents reporting that they spend hardly any of their day on this (20 percent).
This indicates low levels of school staff time allocation towards working with school
based mental health interventions, yet high levels of time were consumed by correcting,
directing, or individually working with students who are engaged in some form of mental
60
health intervention. This data indicates that teachers play a role in school based mental
health intervention even when they have little contact with mental health professionals.
An important aspect of the study illuminated the lack of collaboration that exists
between school staff and psychological counselors. Fifty one percent of respondents of
report never collaborating with individual and group psychological counselors on their
campus, and this was followed by sixteen percent of school staff collaborating on a
monthly basis. Conversely, respondents were most aware of individual counseling,
followed by individual education plans, psychological testing/assessments, and referral
services to outside service providers. This data indicates that school staff reported low
levels of working collaboratively with mental health professionals, however they were
able to identify multiple school based mental health interventions taking place on their
campus. Additionally, the majority of school staff reported that they perceived the
school based mental health interventions being implemented on their campus to be
somewhat above the level of somewhat beneficial, with two ratings right under somewhat
beneficial.
As opposed to collaboration with mental health professionals, my study showed
that teachers and support staff have tendencies to collaborate with each other frequently
regarding school based mental health interventions. Thirty three percent of collaboration
occurs on a weekly basis. This is followed by collaboration on a monthly basis (27
percent), and daily (18 percent). This data indicates that school staff seek out each other
for consultation regarding school based mental health interventions. Additionally, 42
percent of the educational professionals collaborate with school and district
61
administration on a monthly basis, and 22 percent collaborate with school and district
administration on a weekly basis. These findings suggest that collaboration regarding
school based mental health interventions occurs frequently between school staff and
school administrators
Finally, the study indicated a negative correlation between collaboration among
school staff and district administration and how school staff perceived the effect that
school based mental health interventions had on student’s behavior in the classroom.
With a correlation of -.383, responders reported perceptions of diminished effectiveness
that school based mental health interventions had students’ behavior in the classroom,
and respondents also tended to report that collaboration between school staff and district
administration about the mental health intervention offered decreased.
Recommendations
This section of the chapter will discuss recommendations that came about due to
this study in regards to addressing school based mental health interventions in the future.
First, more research into school based mental health interventions in the public school
setting needs to be conducted. Correlation data from this study also points toward the
need for more research examining effective collaborative practices between school staff
and school administration. Finally, consideration for collaboration levels, school staff
perceptions, training, and time allotment for school based mental health interventions
need to be considered as a result of this study.
This study indicates the potential need for school staff to allocate more time to
working with school based mental health interventions because of the time consumed by
62
correcting, directing, or individually working with students who are engaged in some
form of mental health intervention. Based on the data from this study, collaborative work
between school staff and administration regarding correcting, directing, or individually
working with students who are engaged in some form of mental health intervention may
be the best plan for improving how school staff perceive school based mental health
interventions.
The findings associated with this study recommend that collaboration between
school staff and school administrators regarding school based mental health interventions
should occur more frequently, and be supported further. This data also indicates that
school staff seeks out each other for consultation regarding school based mental health
interventions. The correlation indicated that as perceptions diminished in regard to the
effectiveness that interventions had on students’ behavior in the classroom, so did
collaboration between school staff and school and district administration about the mental
health interventions offered. Therefore fostering further collaboration on school based
mental health programs could improve the perceptions that school staff have about them.
School staff reported low levels of working collaboratively with mental health
professionals, however they were able to identify multiple school based mental health
interventions taking place on their campuses. This data indicates that school staff is
aware of mental health services offered. The data could not identify correlations that
existed between these factors, and therefore additional time spent working with mental
health professionals may not necessarily improve the perceptions that school staff have
about the services they offer to their students. Further research is also recommended to
63
examine relationships between working collaboratively with mental health professionals
and perceptions school staff have regarding school based mental health interventions.
Additionally, the majority of school staff reported that they perceived the school
based mental health interventions being implemented on their campus to be somewhat
above the level of somewhat beneficial, with two ratings right under somewhat
beneficial. This data indicates limited school staff exposure to trainings and data
collections associated with school based mental health interventions. Based on this data,
trainings conducted and supported by school and district administration may have a
positive effect on school staff perceptions of intervention. Further research is also
recommended to examine relationships between school staff training in mental health
interventions and school staff perceptions school staff have regarding school based
mental health interventions.
Implications For Social Workers
School based mental health interventions are becoming increasingly more present
in the public school setting. Foster et al. (2005) indicated that there is some form of
mental health service being delivered within all US public school districts, and that while
the need for mental health services has been steadily increasing, funding and resources
allocated for these services has not kept pace with that increased need. Therefore,
implications for social work include additional research, awareness, education and
consolidations for effective social work practice within the scope of mental health
intervention service delivery in the public school setting.
Further research into school based mental health interventions in the public school
64
setting needs to be conducted to bridge the research to practice gap that exists. Data
collected from this study also coincides with the literature which calls for more research
examining effective school staff and school administration collaboration techniques and
practices (Chitiyo, 2009). Based on the data brought forth in this study, social workers
should try to find a way to tap into the collaboration that already exists among school
staff.
Social workers should consider working closely with administration to achieve
successful outcomes when working with school based mental health interventions.
Direct practice with school staff can be effective and helpful in building relationships and
creating buy in for a given intervention, but may not necessarily be needed for successful
intervention implementation. The reality is that teachers are extremely busy. Teachers
are continually facing challenges as they adapt to the merging of education and mental
health services (Mitchem, Richards, & Wells, 2001). If effective execution of and buy in
for school based mental health interventions, could happen with limited and carefully
chosen tasks proven to be effective that would be the most desirable outcome for
intervention execution. Therefore research needs to be done to examine what aspects of
school staff participation with intervention is effective at producing a positive effect.
Finally, social workers should consider the context of school based mental health
intervention implementation. Social work practice in the public school setting should
examine how systems such as school staff, administration, mental health professionals,
support staff, para-educators, nurses, school physiologists, school social workers,
counselors, student’s parents within the school setting are interacting with each other.
65
Lastly, social workers need to consideration the spirit times before working the public
school sector. In an era when our culture is shifting from an industrial manufacturing
economy to a service based economy, the pressure to sell schools on trainings aimed to
address school based mental health often only overwhelm school staff. The lack of
resources to hire additional school staff, and the phasing out of supportive administrative
staff, such as vice principals, and guidance counselors have left many public schools with
less employees, yet more complexities with the students they serve. In theory it is easy to
train school staff to be better employees, but at what point are we asking the impossible
from this staff members who already feel overwhelmed? Therefore, social workers need
to be mindful of the already overloaded plate of school staff, and consider alternate
narratives as to how we are going to make sure that we effectively, responsibly, and
thoughtfully implement and execute school based mental health interventions in the
future.
66
APPENDICES
67
APPENDIX A
Consent To Participate As A Research Subject
Consent To Participate As A Research Subject
Hello All,
My name is Kyle Miller. I am a second year Master’s in Social Work student at
Sacramento State University, and former employee of Placerville Union School District. I
am soliciting your participation in a survey that will provide the data for my thesis
project. I would greatly appreciate your participation, and thank you in advance for
taking a few minutes out of your busy days to take the survey. Below is a link to the
online survey. Click on it,and it should take to the survey itself. If you have any
questions or concerns regarding the survey please feel free to contact me via the email
provided below. Also, below is information regarding informed consent, please read it
over before you take the survey.
LINK TO SURVEY:
https://www.surveymonkey.com/s/L2VHNQX
Purpose of the Study:
This study will examine school-based mental health intervention correlates within the
public school setting.
Procedures to be followed:
You will participate in an online survey, where you will be asked to answer questions in
regard to your experience as a staff member with school based mental health
interventions at the school you are
Duration/Time:
68
This survey should take between 5 -10 minutes in all.
Statement of Confidentiality:
Your participation in this research is confidential. The survey does not ask for any
information that would identify who the responses belong to. In the event of any
publication or presentation resulting from the research, no personally identifiable
information will be shared because your name is in no way linked to your responses.
Voluntary Participation:
Your decision to participate in this research is voluntary. You can stop at any time. You do
not have to answer any questions you do not want to answer.
Implied Consent:
Your submission of the completed online survey implies your understanding of this study
and consent to participate. Thank you for your participation.
69
APPENDIX B
School Staff Perception Questionnaire
Survey Questions
1. What is your employment classification:
teacher
para educator
school support staff
2. What is the type of school you work in?
Elementary
middle school
3. How many children do you work with directly that receiving some type of school
based mental health intervention that you are aware of?
None 1-3 children
4-7 children
8-11 children 12-14 children 14 or more children
4. To what extent do you collaborate with School Psychologists on your campus.
daily weekly
monthly
quarterly
yearly
never
5. To what extent do you collaborate with individual and group psychological counselors
on your campus
daily weekly
monthly
quarterly
yearly
never
6. To what extent do you collaborate with individual and group therapists on your
campus?
daily weekly
monthly
quarterly
yearly
never
70
7. To what extent do you collaborate with other teachers and support staff about the
mental health interventions offered on your campus?
daily weekly
monthly
quarterly
yearly
never
8. To what extent do you collaborate with school and district administration about the
mental health interventions offered on your campus?
daily weekly
monthly
quarterly
yearly
never
9. Please identify any mental health interventions taking place on your campus that you
are aware of?
Referral Entire
services
Individu
Individual Group
al
Family
Crisis
campus
Psychologica to
preventativ
l testing/
outside
e mental
health
counselin counselin medicatio educatio interventi
interventi assessment
service
g
on
provider interventio
g
n
n plan
on
s
ns
10. What school-based mental health interventions are the students you work with
engaged in that you are aware of?
Referral Entire
other
71
services
Individu
Individual Group
al
Family
Crisis
campus
Psychologica to
preventativ
l testing/
outside
e mental
health
counselin counselin medicatio educatio interventi
interventi assessment
service
g
on
provider interventio
g
n
n plan
on
s
other
ns
11. To what extent to do feel school based mental health interventions are helping
students' academic performance in the classroom?
1
2
3
4
5
6
Not at all
7
Completely
beneficial
12. To what extent to do feel school based mental health interventions are helping
students behavior in the classroom?
1
Not at all
2
3
4
5
6
7
Completely
72
beneficial
13. To what extent do feel school based mental health interventions are effective at
addressing bullying?
1
2
3
4
5
6
Not at all
7
Completely
beneficial
14. To what extent do feel school based mental health interventions are effective at
addressing fighting?
1
2
3
4
Not at all
5
6
7
Completely
beneficial
15. To what extent do feel school based mental health interventions are helping to lower
suspension and disciplinary referrals at your school?
73
1
2
3
4
5
6
Not at all
7
Completely
beneficial
16. To what extent do feel school based mental health interventions are helping to lower
tardies and absenteeism at your school?
1
2
3
4
5
6
Not at all
7
Completely
beneficial
17. How effective do you feel the school-based mental health interventions are at your
school?
1
2
3
4
5
6
Not at all
7
Completely
beneficial
18. On average, how much training do you receive in a year about the various schoolbased mental health interventions that are taking place on your campus?
74
monthly
quarterly
yearly
never
19. How much data recording such as documentation, creating reports, and recording
observations for students participating in school based mental health interventions do you
participate in during an average year
monthly
quarterly
yearly
never
20. On average, how much time of your day is solely allocated to working with mental
health interventions? (This can be anything from discussing mental health services
for students with service providers and administration, referring students/families
to mental health services, to actually delivering mental health services to students
inside and outside of the classroom).
hardly any (0-15minutes) some (15-45 minutes) a lot (45 minutes – 2 hours)
majority (2hours +)
21. On average, how much time of your day is allocated to correcting, redirecting, or
individually working with students who are engaged in some form of mental health
75
intervention?
hardly any (0-15minutes) some (15-45 minutes) a lot (45 minutes – 2 hours)
majority (2hours +)
76
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