The Impact of School Mental Health Services on Out-of-School Suspension Rates

The current study investigated whether the presence of school-based mental health clinicians in an urban school district was associated with reduced out-of-school suspension rates. Forty one elementary schools with expanded school mental health (ESMH) programs were compared to 41 schools without ESMH programs. Correlational analyses revealed associations between suspension outcomes and several school-level demographic variables including school attendance rate, percent of students in poverty, and percent of nonwhite students in the school. After controlling for these variables, however, results of stepwise linear regressions demonstrated no significant differences between ESMH and non-ESMH schools on suspension outcomes. Results of the current study suggest that the presence of ESMH clinicians will not necessarily impact suspension rates in an elementary school. Targeted and well-implemented approaches to address behaviors that lead to suspension, or school- and system-level policies to provide alternatives to suspensions, will likely be a better route to achieving this outcome.     

Expanded School Mental Health: Challenges and Opportunities in an Emerging Field

Reviews the need for and development of expanded school mental health (ESMH) programs, which provide a continuum of mental health promotion and intervention through school–community partnerships. Since ESMH is a relatively new, but increasingly prominent field, countless issues are being addressed in practice and research and in efforts to bridge practice and research. We review particular content and context dimensions of ESMH in need of development including quality assessment and improvement, empirically supported practice, improving assessment and outcome evaluation, involving educators in the work, understanding school environments, and tailoring programs through qualitative research. Summaries of articles that amplify these themes are provided.     

Factors that Influence Mental Health Stigma Among 8th Grade Adolescents

Unmet mental health need is a significant problem for adolescents. Although stigma is identified as a major barrier to the use of mental health services among youth, there is limited research on this topic. In-depth interviews (n=57) among a sample of 8th grade students in a suburban, mid-Atlantic community portray adolescent mental health attitudes and how these views are shaped. Satisfactory personal experiences with mental health services as well as accurate mental health knowledge contribute to positive mental health attitudes among teens. The anticipation of negative responses towards mental health care-seeking from family members, peers, and school staff are key factors in teens’ comfort and willingness to address mental health concerns. The research provides critical information on the factors that contribute to the development of stigma and emphasizes the need to address stigma in youth mental health education, programs, and treatment plans. Authors are affiliated with the Johns Hopkins Bloomberg School of Public Health, Department of Population and Family Health Sciences. Dr. Chandra has a background in adolescent health, and is particularly interested in improving the accessibility and appropriateness of youth mental health services and involving young people in the translation of research into practice. Dr. Minkovitz is interested in improving preventive service delivery, enhancing quality of care, and understanding maternal factors that influence children’s receipt of health care     

Overcoming Challenges to Using Evidence-Based Interventions in Schools

The Center for School Mental Health Assistance at the University of Maryland recently completed a review of evidence-based prevention and treatment programs that can be used by school mental health clinicians. Based on the review, a school-based program operating in 22 Baltimore City schools has purchased and trained clinicians in a number of protocols for evidence-based interventions. We present findings from this review and make pragmatic recommendations for school mental health programs to overcome the challenges associated with the use of evidence-based interventions.She received her doctorate in childclinical psychology from the University of Missouri-Columbia. Her research interests are in the area of the development, prevention, and treatment of juvenile delinquency and youth externalizing disorders.who does research in the area of childrens mental health services and the implementation of wraparound services in real-world settings.University of Maryland School of Medicine. His research is in the area of testing the effectiveness of School Mental Health Programs and the effects of community violence on youth mental health.involved in research related to school mental health, school-based health centers, and prevention of risky behavior among adolescents.Postdoctoral fellow at the time of the study.Postdoctoral fellow at the time of the study.     

School-based health services for urban adolescents: Psychosocial characteristics of clinic users vs nonusers

Evaluated psychosocial differences between adolescent users and nonusers of an urban school-based health clinic, considering the influence of gender. As expected, a number of gender differences were found (e.g., girls reported more fear, were rated as more likeable by peers than boys). Examination of differences based purely on clinic use indicated that nonusers were rated as more socially withdrawn by their peers than clinic users; otherwise, these two groups did not differ on psychosocial measures. Gender by clinic-status interaction effects were found for academic measures (e.g., nonusing boys had more absences and lower grades than boys who used the clinic). A group of intensive clinic users (n=14) reported higher levels of emotional distress than other students, and surprisingly, most of these students were not receiving mental health services.Received Ph.D. from Virginia Polytechnic Institute and State University in 1991. Research interests include evaluation of school mental health services, empirical development of interventions for children, and the impact of violence on urban youth.Received B.A. from Loyola College. Interested in applied work with adolescents and adults.Received B.A. from Cornell University. Interests include stress and coping in children, identification of resilience factors, and evaluation of child mental health systems of care.Received Ph.D. from the University of Oklahoma in 1967. Research interests in psychophysiology, sleep disorders, and biofeedback and instrumentation.Received M.D. from Duke University in 1968. Research interests include training in child and adolescent psychiatry, adolescent psychopathology, and the development of school mental health programs.     

Examining Multiracial Youth in Context: Ethnic Identity Development and Mental Health Outcomes

Although multiracial individuals are the fastest growing population in the United States, research on the identity development of multiracial adolescents remains scant. This study explores the relationship between ethnic identity, its components (affirmation, exploration), and mental health outcomes (anxiety, depressive symptoms) within the contexts of schools for multiracial adolescents. The participants were multiracial and monoracial minority and majority high school students (n = 4,766; 54.6 % female). Among the participants, 88.1 % were Caucasian, 7.4 % were African American, and 4.5 % were multiracial. The research questions examined the relationship between ethnic identity exploration and affirmation on mental health outcomes and explored the role school context plays in this relationship. The findings suggested that multiracial youth experience more exploration and less affirmation than African Americans, but more than Caucasians. In addition, multiracial youth were found to have higher levels of mental health issues than their monoracial minority and majority peers. Specifically, multiracial youth had higher levels of depressive symptoms than their African American and Caucasian counterparts. Multiracial and Caucasian youth had similar levels of anxiety but these levels were significantly higher than African Americans. School diversity did not influence mental health outcomes for multiracial youth. These findings provide insight into the experiences of multiracial youth and underscore the importance of further investigating factors that contribute to their mental health outcomes.     

Experiences of Racism,Racial/Ethnic Attitudes,Motivated Fairness and Mental Health Outcomes Among Primary and Secondary School Students

While studies investigating the health effects of racial discrimination for children and youth have examined a range of effect modifiers, to date, relationships between experiences of racial discrimination, student attitudes, and health outcomes remain unexplored. This study uniquely demonstrates the moderating effects of vicarious racism and motivated fairness on the association between direct experiences of racism and mental health outcomes, specifically depressive symptoms and loneliness, among primary and secondary school students. Across seven schools, 263 students (54.4 % female), ranging from 8 to 17 years old (M = 11.2, SD = 2.2) reported attitudes about other racial/ethnic groups and experiences of racism. Students from minority ethnic groups (determined by country of birth) reported higher levels of loneliness and more racist experiences relative to the majority group students. Students from the majority racial/ethnic group reported higher levels of loneliness and depressive symptoms if they had more friends from different racial/ethnic groups, whereas the number of friends from different groups had no effect on minority students’ loneliness or depressive symptoms. Direct experiences of racism were robustly related to higher loneliness and depressive symptoms in multivariate regression models. However, the association with depressive symptoms was reduced to marginal significance when students reported low motivated fairness. Elaborating on the negative health effects of racism in primary and secondary school students provides an impetus for future research and the development of appropriate interventions.     

School Climate & Sexual and Gender Minority Adolescent Mental Health

Sexual/gender minority (Sexual/gender minority people are also referred to as Lesbian, Gay, Bisexual, Transgender, Queer) youth are more likely than cisgender heterosexual youth to exhibit depressive symptoms and be victimized. School climate research indicates that the presence of a Gay–Straight Alliance (a Gay–Straight Alliance or Gender-Sexuality Alliance is also referred to as a GSA and is a youth group to support sexual/gender minority youth), a supportive school climate, and seeking help from teachers are associated with more positive mental health outcomes; however, they are not typically measured together. This study uses a survey that measures all four measures of school environment with a national sample of 240 sexual/gender minority high school students ages 14–18 (mean age 15.77) where 53% of participants had a Gay–Straight Alliance in their school. The sample is 53% cisgender, 100% sexual minority and 62% white. Adjusting for demographics and presence of a Gay–Straight Alliance, fewer depressive symptoms were associated with lower help-seeking intentions for suicidal thoughts. The presence of Gay–Straight Alliance was not statistically associated with past-month help-seeking intentions or behaviors. Additionally, a more supportive school climate was associated with lower anxiety and depressive symptoms. However, the presence of a Gay–Straight Alliance was not statistically associated with anxiety or depressive symptoms. These findings suggest that a supportive school climate and supportive school personnel may be important for supporting the mental health of sexual/gender minority students.

     

Examining Youth and Program Predictors of Engagement in Out-of-School Time Programs

Prior research suggests that youths’ engagement in out-of-school time programs may be a crucial factor linking program participation to positive outcomes during adolescence. Guided by the theoretical concept of flow and by stage-environment fit theory, the present study explored correlates of engagement in youth programs. Engagement was conceptualized as the extent to which youth found the program activities enjoyable, interesting, and challenging. The current study examined how program content, monetary incentives, and youth demographic characteristics were linked to youth engagement among a sample of primarily low-income middle and high school youth attending 30 out-of-school programs (n = 435, 51 % female). Results from multilevel models suggested that program content and staff quality were strongly associated with youth engagement. Youth who reported learning new skills, learning about college, and learning about jobs through activities in the program were more engaged, as were youth who found the staff caring and competent. Results demonstrated that the link between learning content for the future and engagement was stronger for older youth than younger youth. In addition, there was a trend suggesting that providing a monetary incentive was associated negatively with youth engagement. Taken as a whole, these findings have important implications for researchers, practitioners, and policymakers interested in understanding the characteristics of out-of-school time programs that engage older youth.     

Attitudes toward mental health services among homeless and matched housed youth

Homeless youth experience high rates of mental health problems yet they under-utilize mental health services. The present study surveyed 56 homeless youth and 97 matched at-risk housed youth on their attitudes toward mental health services, and investigated the link between social support and attitudes. Results showed groups shared similar neutral to positive attitudes. Higher levels of social support were associated with increased positive attitudes toward services. Further analyses found that lesbian/gay/bisexual/questioning youth held more positive attitudes compared to heterosexual youth. Implications of the current study can assist service providers with eliminating barriers and increasing mental health service use.     

Mental Health and Educational Experiences Among Black Youth: A Latent Class Analysis

Disproportionately lower educational achievement, coupled with higher grade retention, suspensions, expulsions, and lower school bonding make educational success among Black adolescents a major public health concern. Mental health is a key developmental factor related to educational outcomes among adolescents; however, traditional models of mental health focus on absence of dysfunction as a way to conceptualize mental health. The dual-factor model of mental health incorporates indicators of both subjective wellbeing and psychopathology, supporting more recent research that both are needed to comprehensively assess mental health. This study applied the dual-factor model to measure mental health using the National Survey of American Life—Adolescent Supplement (NSAL-A), a representative cross-sectional survey. The sample included 1170 Black adolescents (52% female; mean age 15). Latent class analysis was conducted with positive indicators of subjective wellbeing (emotional, psychological, and social) as well as measures of psychopathology. Four mental health groups were identified, based on having high or low subjective wellbeing and high or low psychopathology. Accordingly, associations between mental health groups and educational outcomes were investigated. Significant associations were observed in school bonding, suspensions, and grade retention, with the positive mental health group (high subjective wellbeing, low psychopathology) experiencing more beneficial outcomes. The results support a strong association between school bonding and better mental health and have implications for a more comprehensive view of mental health in interventions targeting improved educational experiences and mental health among Black adolescents.     

One Small Step at a Time: Implementing Continuous Quality Improvement in Child and Youth Mental Health Services

Continuous quality improvement (CQI) is increasingly being adopted by health care, including child and youth mental health services. As part of the commitment to ongoing quality improvement, child and youth mental health teams in the Fraser region in British Columbia undertook CQI projects over a one year period (2007–2008). The projects covered a range of domains and service features and staff gained experience in developing projects. Patience, management support and ongoing dialogue were key elements in the implementation of CQI. Three projects are highlighted to illustrate how teams developed their own unique projects and the outcomes.     

Feasibility of the <Emphasis Type="Italic">MindMatters</Emphasis> School Mental Health Promotion Program in American Schools

Assessed the feasibility of the Australian MindMatters program, a whole school mental health promotion program for application in the United States (U.S.). Forty-two participants representing school and community stakeholder groups from four U.S. communities (urban, rural, suburban, small town) evaluated the program for application in their communities through a research process involving discussion and endorsement ratings of relevance and likely impact. The majority of participants (85%) indicated that the program would help students in their community schools feel safe and valued, and participants indicated strong endorsement for MindMatters curriculum units focusing on suicide prevention and addressing bullying and harassment. Participants rated their own stakeholder group (e.g., teacher, school administrator, and parent) as being most likely to support and implement the program, suggesting that providing qualitative feedback on a program may help to increase a sense of ownership over it. Ideas for tailoring programs developed in other settings for application in local communities are discussed.     

Horsing around: Using equine facilitated learning to support the development of social-emotional competence of students at risk of school failure

The social-emotional issues some students experience can place them at risk of school failure. Traditional methods of support can be ineffective or not sustainable and new alternative approaches need to be attempted to support social-emotional competency, school engagement, and success for students at risk. This article discusses preliminary outcomes of an equine facilitated learning (EFL) program specifically designed to focus on using horses to improve the resilience and social-emotional competency in students perceived as “at risk” of school failure. This qualitative exploratory study used interviews and observations over a six month period to listen to the voices of the students themselves about their experiences of EFL. Initial findings from the pilot study suggest that EFL programs can be a novel and motivating way to promote resilience training and social-emotional development of students at risk of failure and, in turn, improve their level of engagement and connection with school environments.     

Interpersonal trust and disaffected high school youth

The study consisted of two parts. First, a new scale of interpersonal trust for adolescents was constructed using a representative sample of 70 students from a community high school. Second, the hypothesis was tested that disaffected youth compared to the more conventional would show less interpersonal trust. Two matched groups of 57 students each were employed for the second part of the study. Results indicate that the new scale is a reliable and valid measure. Correlates of the scale disclose that trust is associated with interpersonal distance, certain developmental factors, and the quality of parent-adolescent relations. Results from the second part of the study tend to confirm the hypothesis in that greater trust scores were found among students with more conventional beliefs.This study was partly supported by NIMH Grant No. MH9210, Ford Foundation Grant No. 69-0264B, and the Jessie and C. Clement Stone Foundation.Received his Ph.D. from the University of Kansas. Currently working on personality and clinical problems of adolescents and adults.Recieved his Ph.D. from the University of Michigan. Plans to continue his work of program development in the area of affect education in secondary schools.Received his Ph.D. from Harvard University. Current work is in the area of community mental health.     

School predictors of alcohol use in high school Hispanic and non-Hispanic youth

Many youth alcohol prevention programs are not culturally sensitive and have focused on avoidance tactics. Given the differences in alcohol use and the possibly differing intervention strategies for Hispanic and non-Hispanic youth, this study aims to analyze the contributing factors of alcohol use within these two groups. Two hundred and one high school students participated in a survey. Findings indicate that prevention programs should focus on situational opportunities to use alcohol for both Hispanic and non-Hispanic youth. For Hispanic students, school management skills did not relate to less alcohol use, as expected. There should be less emphasis on how risky drinking can be, and more emphasis on the moral implications or “wrongness” of drinking, particularly for non-Hispanics. The discussion includes some possible interpretations of the relationship between skill management skills and heightened alcohol use for Hispanic students.     

Does child care quality matter? A comparison of children's developmental outcomes across classrooms with different quality standards

It has long been an established view that children who attend high-quality early learning programs are more likely to be school ready. However, some studies have found that program quality is not as important to child outcomes as is participating in some form of early learning. This study aimed to compare 2 early learning classrooms in the same school with different quality standards to determine whether the differences in quality significantly affected children's developmental gains during the academic year. Results indicated no significant differences in the developmental outcomes of children on the basis of classroom type. One possible explanation for the lack of differences is that both classrooms were in the same school. Other studies have found that child care programs benefit from partnerships with programs that have higher quality standards. The findings demonstrate a need for further research about the benefits of child care program partnerships.     

Supporting children of parents with mental health problems through professionally assisted lay support – the “godparents” program

Children with parents with mental health problems have an increased risk of adverse developmental outcomes. Nonetheless, services for these children are still scarce in Switzerland. Therefore, an innovative program was developed, implemented, and evaluated in close practitioner-researcher cooperation. The program aims to support these children by providing lay supporters as so-called “godparents” to them. The program evaluation shows that the continuity of contacts between children and godparents builds the ground for a relationship that fosters the children’s development and relieves their parents. A carefully undertaken process of matching families with godparents appears to be crucial for a lasting godparenthood. However, a main challenge is the acquisition of godparents, who engage on a voluntary basis in the program.     

Understanding Students’ Transition to High School: Demographic Variation and the Role of Supportive Relationships

The transition to high school is disruptive for many adolescents, yet little is known about the supportive relational processes that might attenuate the challenges students face as they move from middle to high school, particularly for students from more diverse backgrounds. Identifying potential buffers that protect youth across this critical educational transition is important for informing more effective support services for youth. In this study, we investigated how personal characteristics (gender, nativity, parent education level) and changes in support from family, friends, and school influenced changes in socioemotional adjustment and academic outcomes across the transition from middle to high school. The data were drawn from 252 students (50% females, 85% Latina/o). The results revealed declines in students’ grades and increases in depressive symptoms and feelings of loneliness across the high school transition, with key variation by student nativity and gender. Additionally, stable/increasing friend support and school belonging were both linked to less socioemotional disruptions as students moved from middle to high school. Increasing/stable school belonging was also linked to increases in school engagement across the high school transition. These findings suggest that when high school transitions disrupt supportive relationships with important others in adolescents’ lives, adolescents’ socioemotional well-being and, to a lesser extent, their academic engagement are also compromised. Thus, in designing transition support activities, particularly for schools serving more low-income and race/ethnic minority youth, such efforts should strive to acclimate new high school students by providing inclusive, caring environments and positive connections with educators and peers.