Advocacy in Action
Expanding the Role of the School Psychologist in the Delivery of School-Based Mental Health Services
By Katie Eklund, Kelly Vaillancourt, & Trisha Pedley
Approximately 20% of children in the United States experience significant mental, emotional, or behavioral symptoms that would qualify them for a psychiatric diagnosis (Burns et al., 1995; Costello et al., 2003). Unfortunately, only 15%–30% of these children receive any type of help or support (Ringel & Sturm, 2001; United States Public Health Service, 2000). Furthermore, as many as 1 in 7 adolescents have no health insurance and therefore are unable to receive third-party reimbursable mental health services in the private sector (Crespi & Howe, 2002). This indicates that sole reliance on referrals to providers outside the school environment may not be a realistic way for all children and families to access mental health services.
School-based mental health services are suggested as one strategy in beginning to address many of the unmet mental health needs of children and youth. An estimated 70%–80% of all mental health care for children and adolescents is delivered in school settings and students are more likely to seek help when needed if school-based mental health services are provided (Burns et al., 1995; Slade, 2002), making schools the ideal environment for the assessment and provision of mental health services (Farmer, Burns, Phillips, Angold, & Costello, 2003). As children have been found to receive more services through schools than through any other system (Hoagwood & Erwin, 1997), school psychologists are well positioned to serve as providers. School Psychology: A Blueprint for Training and Practice III indicates, “School psychologists should be the leading mental health experts in schools who are knowledgeable about development in social, affective, and adaptive domains” (Ysseldyke et al., 2006, p. 20). School psychologists have the knowledge, training, and skills to effectively deliver evidence-based counseling and mental health services in the context of the school setting and to coordinate collaboration with community providers.
There is compelling evidence to suggest that school-based counseling and psychotherapy is effective for children and adolescents as it is among the most innovative approaches to reaching at-risk or hard to reach youth (Sklarew, Twemlow, & Wilkinson, 2004; Zirkelback & Reese, 2010). Moreover, adapting effective clinical practices to fit the school context may help begin to address health disparities. School psychologists, who are trained to provide counseling services to children within the context of education, should be integrally involved in this type of service delivery. The need for school-based mental health services is detailed in special education regulations and national reports indicating that schools should provide services that target the mental health needs of youth (U.S. Department of Education, 2006; New Freedom Commission on Mental Health, 2003; United States Public Health Service, 2000). Such school-based programs have been found to not only advance the mental wellness of children and youth, but to also improve academic achievement and behavioral functioning, indicating that schools can be a vital resource for psychological services (Crespi & Rigazio-DeGilio, 1996; Owens & Murphy, 2005).
Transforming School Mental Health Services
School psychologists are called upon to help transform children's mental health by becoming well versed in the delivery of school-based mental health services. The following suggestions are proposed to help move school psychology students, practitioners, supervisors, and training programs in this direction.
Provide professional development opportunities for practicing school psychologists to increase their knowledge and expertise in the provision of evidence-based counseling interventions. The benefits of school-based mental health are best supported when there is a theoretical understanding of the cause of the presenting problems that can then be matched with appropriate evidence-based interventions (Hughes & Theodore, 2009; Merrell & Buchanan, 2006). Professional development opportunities could encompass a review of evidence-based interventions, instruction on how to monitor student progress and treatment fidelity, and designing supervision for ethical issues that will arise in the provision of mental health services.
School psychologists are well positioned to provide mental health services within schools, concurrently assessing the interpersonal functioning of students and the environmental context of schools. School psychologists recommend counseling or psychotherapy as an intervention when the relationship between typical development and the difficulty the child is experiencing is accounted for by interpersonal functioning and not the environmental factors in the school (Hughes & Theodore, 2009; Miller, Tansy, & Hughes, 1998). Research has demonstrated that when a child's individual needs can be appropriately addressed, the student's overall emotional, social, and cognitive development is supported so that he or she can be engaged in learning (Brazelton & Greenspan, 2000). Concurrently assessing individual and contextual factors can provide a comprehensive approach to ensuring student success.
Collaborate with teachers and school staff in the provision of school mental health services. Teachers should be seen as a valuable resource because they are often in the best position to observe behavioral patterns and provide insight as to why a student might be struggling. Many teachers and school personnel also soften toward addressing difficult students upon realizing the reasons why the students struggle. The reciprocal exchange of information between teacher and school psychologist can help direct both interventions within a counseling session as well as outline needed modifications within the classroom.
Work with school and district administration to help promote school psychologists as appropriate providers of school mental health services and to emphasize the link between mental wellness and improved student outcomes. Research has indicated that school leaders often place a low priority on addressing the mental health needs of students, which can impact how services are prioritized in a school setting (Adelman & Taylor, 2002). Research consistently demonstrates that improvements in the behavioral, social, and emotional well-being of a child are significantly related to improved academic achievement and standardized test scores, as well as lower rates of mental illness, school drop out, and juvenile delinquency (Nelson et al., 2004; Owens & Murphy, 2005). School administrators may benefit from increased awareness of the wide array of services school psychologists can provide and how these services are linked to improved student outcomes.
Training programs should create or enhance current courses to provide comprehensive training in the areas of counseling and psychotherapy. Previous research has indicated that this is a practice need. Among current practitioners, (a) 90% report using psychotherapy in the school setting while only 50% received formal coursework; and (b) fewer than 50% received training in providing evidence-based clinical interventions within a school context (Levenson & Evans, 2000; Loe, Jones, Crank, & Krach, 2009; Tharinger, Pryzwansky, & Miller, 2008). A practical challenge confronting the training of graduate students in counseling techniques is the gap between current graduate curricula and the skills needed in the field (Fuhriman & Burlingame, 2001). Students are soon-to-be practitioners that need to become acquainted with a current research base that informs a variety of effective psychological practices (Hunsley, 2007). Helping students better understand how to integrate theory and research into best practice should remain central to graduate curricula and training programs.
Increase internship opportunities for school sites providing mental health services to students and families. Training programs can provide practicum or internship experiences with school psychologists who are competent in providing therapeutic interventions (Perfect & Morris, 2010). These training opportunities could include joint supervision by university faculty and school-based practitioners to ensure students receive necessary didactic training.
Collaboration with other service providers. School psychologists often provide services alongside other school mental health providers (such as school social workers and school counselors) as well as outside community providers, requiring effective communication both within and outside the school setting. Such collaboration is required so that services are not duplicated and students receive appropriate information about the variety of services offered by each provider (Perfect & Morris, 2010; Porter, Epp, & Bryant, 2000). School-based and community practitioners are encouraged to develop ongoing partnerships around effective services delivery to student's, families, and school staff.
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Katie Eklund, PhD, is an assistant professor in the school psychology program at the University of Arizona in Tucson. Kelly Vaillancourt, PhD, NCSP, is NASP Director of Government Relations. Trisha Pedley is a graduate student in the school psychology program at Loyola Marymount University in Los Angeles, CA.