A Cross-Walk of Professional Competencies Involved in Expanded School Mental Health: An Exploratory Study

White privilege and teacher perceptions of teacher-child relationship quality

In this study, we investigated differences in teachers' perceptions of the teacher-child relationship from kindergarten through second grade as a function of child race and gender from the perspective of critical race theory and the cultural synchrony hypothesis. Given the extensive evidence of White privilege and anti-Black racism in the US education system, we expected that teachers, particularly White teachers, would perceive their relationships with White children more positively than with Black children. Controlling for family SES and child gender, results supported this hypothesis. Black boys had the highest risk of being perceived by teachers as having poor relationships with teachers in kindergarten (highest conflict and lowest closeness) and White girls had the lowest risk. In addition, teachers perceived relationships with Black boys as increasing in conflict across first and second grades at higher rates than with White and female children. These findings remained after examining teacher-child racial match as a moderator. Our results indicate that racism and sexism work together to explain the perceptions teachers have of children in the early elementary grades. Implications for training teachers and school psychologists on anti-racism and cultural competency are discussed.

Roles and Functions of School Mental Health Professionals Within Comprehensive School Mental Health Systems

Mental health concerns are on the rise among youth, contributing to a growing need for school-based mental health services. However, challenges to service provision arise due, in part, to workforce shortages, service fragmentation, and inefficient allocation of staff time. The current study describes the professional competencies and time allocation of four school-based mental health professions (i.e., school counselors, school psychologists, school social workers, and school nurses) in order to demonstrate how schools can leverage the skills of their existing staff to coordinate a comprehensive approach to support student mental health. First, we identified the core clinical competencies needed to implement the key features of comprehensive school mental health systems. Then, we crosswalked these clinical competencies with the training standards of the four professions. Finally, we conducted a systematic review of the literature to understand how these professionals' time is allocated, as well as their responsibilities related to the provision of mental health services. Results demonstrated that, although all four professions receive training in most of the core competencies needed to implement comprehensive school mental health services, their skillsets are often underutilized in day-to-day practice. Thus, we concluded that there are at least two untapped opportunities for school leaders to support student mental health-first, maximize the use of school mental health professionals through task-shifting (i.e., reassigning tasks less central to mental health service delivery to other staff), and second, implement an integrated model of school mental health services to efficiently leverage the mental health training of professionals.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12310-022-09535-0.

Supporting School Mental Health Providers: Evidence from a Short-Term Telementoring Model

Background

To support student mental health, school staff must have knowledge of evidence-based practices and the capacity to implement them. One approach used to address this challenge is a group-based telementoring model called Extension for Community Healthcare Outcomes (ECHO). In other applications (e.g., healthcare settings), ECHO has been shown to increase healthcare professionals' self-efficacy and knowledge of evidence-based practices leading to improved patient outcomes.

Objectives

This study examined the potential for ECHO to be used as a method for increasing school staff engagement and knowledge of evidence-based school mental health practices.

Methods

Using a quasi-experimental design, this study compared outcomes across two professional development experiences aimed at promoting school staff ability to provide evidence-based mental health services. School staff from four school districts participated in a school mental health training initiative. All participants (N = 57) had access to asynchronous, online mental health modules. A sub-sample (n = 33) was also offered monthly ECHO sessions.

Results

Tests of group difference in outcomes revealed significant increases in engagement with online learning (d = 0.58) and satisfaction (d = 0.82) for those who participated in ECHO as compared to those who did not. Knowledge about evidence-based practices was not significantly different between groups.

Conclusions

Results suggest that group-based telementoring may be a promising approach for improving engagement and satisfaction with training initiatives aimed at promoting evidence-based school mental health practices. However, further study of ProjectECHO using experimental designs is needed to make causal inferences about its effect on provider outcomes.

School-Based Mental Health Practitioners: A Resource Guide for Educational Leaders

School-based mental health practitioners can offer enhanced support to schools and students; yet their training, roles, and expertise vary. The roles of these professionals are often conflated, misunderstood, or marginalized in their utility throughout the school system. The purpose of this manuscript is to enhance the capacity of educational leaders to make informed hiring, contracting, and role assignment decisions that best fit school and student needs regarding school mental health services. We clarify the landscape of two distinct groups of qualified school mental health professionals-those who are education certified and those who are independently licensed; each group represents professionals from multiple disciplines. We illuminate similarities and differences of these professionals and juxtapose the utility of traditional mental health versus school-based mental health. We then discuss the similarities and differences of qualified school mental health professionals described within the context of traditional and school-based mental health preparation and service delivery. We conclude by contributing three resources for educational leaders to support the process of engaging school-based mental health practitioners. First, we offer a planning guide to understand state variations in certification requirements across professionals. Second, we provide a hiring guide primer that summarizes education requirements and delineates role orientations for school mental health practitioners. Third, we provide an interview guide to help clarify a candidate’s experience and skills useful to contemporary school needs. We conclude by offering recommendations for educational leaders to become more effective consumers of school-based mental health services.

Associations Between School Mental Health Team Membership and Impact on Service Provision

Schools are the most common venue in which children and youth receive mental health services. To organize delivery of mental health care to such a large number of children, use of school teams is often recommended. Yet, there is limited empirical literature about the composition of school mental health teams or teams’ relations to service provision. This study investigated team composition, including team multidisciplinarity (number of different types of professionals) and the presence of a community provider, and the relations of these two variables to service provision at Tier 1 (mental health promotion), Tier 2 (early intervention) and Tier 3 (intensive treatment) for 386 schools representing different school sizes, locations, and urbanicity. Results suggested team multidisciplinarity and the presence of a community provider were related to more frequent endorsement of service provision at schools. Practice and research implications are discussed including possible application to hiring decisions and further research with longitudinal data and information on service quality.

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) to Improve Collaboration in School Mental Health: Protocol for a Mixed Methods Hybrid Effectiveness-Implementation Study

BACKGROUND

Public schools in the United States are the main providers of mental health services to children but are often ill equipped to provide quality mental health care, especially in low-income urban communities. Schools often rely on partnerships with community organizations to provide mental health services to students. However, collaboration and communication challenges often hinder implementation of evidence-based mental health strategies. Interventions informed by team science, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), have the potential to improve treatment implementation and collaboration within schools.

OBJECTIVE

The objective of this study is to improve communication and collaboration strategies among mental health and school staff by adapting an evidence-based team science intervention for school settings. We present a protocol for a hybrid effectiveness-implementation study to adapt TeamSTEPPS using stakeholder feedback, develop a tailored implementation plan, and pilot the adapted content in eight schools.

METHODS

Study participants will be recruited from public and charter schools and agencies overseeing school mental health services in the local metro area. We will characterize current services by conducting a needs assessment including stakeholder interviews, observations, and review of administrative data. Thereafter, we will establish an advisory board to understand challenges and develop possible solutions to guide additional TeamSTEPPS adaptations along with a complementary implementation plan. In aim 3, we will implement the adapted TeamSTEPPS plus tailored implementation strategies in eight schools using a pre-post design. The primary outcome measures include the feasibility and acceptability of the adapted TeamSTEPPS. In addition, self-report measures of interprofessional collaboration and teamwork will be collected from 80 participating mental health and school personnel. School observations will be conducted prior to and at three time points following the intervention along with stakeholder interviews. The analysis plan includes qualitative, quantitative, and mixed methods analysis of feasibility and acceptability, school observations, stakeholder interviews, and administrative data of behavioral health and school outcomes for students receiving mental health services.

RESULTS

Recruitment for the study has begun. Goals for aim 1 are expected to be completed in Spring 2021.

CONCLUSIONS

This study utilizes team science to improve interprofessional collaboration among school and mental health staff and contributes broadly to the team science literature by developing and specifying implementation strategies to promote sustainability. Results from this study will provide knowledge about whether interventions to improve school culture and climate can ready both mental health and school systems for implementation of evidence-based mental health practices.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04440228; https://clinicaltrials.gov/ct2/show/NCT04440228.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/26567.

Implementation of a national mental health intervention in educational communities: What do successful teams do differently?

This study aimed to identify the elements that characterize local teams which implement a nationwide preventive mental health intervention in schools and achieve better results. A mixed-methods sequential explanatory design was conducted in two phases: (a) teams were characterized according to their level of achievement in the preventive intervention through latent class analysis; and (b) case studies of three teams with different implementation results were conducted by performing content analysis on interviews, observations, and documents. It was established that the more effective teams have better planning, the more they are familiar with the intervention, and more aware of their strengths and weaknesses. This team also implement culturally pertinent actions aimed at increasing knowledge about the intervention, which causes schools to experience it as part of their community, since they include the intervention in their regular dynamics. Lastly, the importance and relevance of these elements when working in educational communities is discussed.

Conceptualizations of professional competencies in school health promotion

Purpose

– The purpose of the paper is to contribute to the conceptualization and discussion of professional competencies needed for supporting the development of the whole-school approach in school health promotion (SHP).

Design/methodology/approach

– The paper is based on a conceptual synthesis of literature, guided by a theoretical perspective on health promotion agency and professional competencies to identify core competency domains and elements. This is followed by a discussion of focus, gaps and links in conceptualizations of competency domains and elements.

Findings

– The synthesis identifies five core competency domains: policy-development; organizational development; professional development; development of students’ learning; and development of health promotion activities. Three critical gaps in the conceptualizations of competency domains and elements are identified and discussed: the downplay of the development of learning domain and the narrow focus on cognitive elements within it; the narrow focus on cognitive elements and technical-organizational elements in the development of HP activities domain; and the downplay of affective competency elements across domains.

Practical implications

– The five competency domains may provide an overall guiding tool for professionals tasked with practice and competency development in SHP, and a point of departure for the development of conceptualizations of professional competencies in concrete practice contexts.

Originality/value

– The paper delineates an overall professional competency model for SHP, discusses the specific demands on professional competencies within this field in relation to this model, and addresses three critical gaps in the conceptualizations of competency.

Strategies for integrating mental health into schools via a multitiered system of support

To fully realize the potential of mental health supports in academic settings, it is essential to consider how to effectively integrate the mental health and education systems and their respective resources, staffing, and structures. Historically, school mental health services have not effectively spanned a full continuum of care from mental health promotion to treatment, and several implementation and service challenges have evolved. After an overview of these challenges, best practices and strategies for school and community partners are reviewed to systematically integrate mental health interventions within a school's multitiered system of student support.

Exploring the impact of a pre-service interprofessional educational intervention for school mental health trainees

With collaborative interprofessional teams integral to school mental health (SMH) service delivery, pre-service educational strategies are needed to promote interprofessional collaboration among SMH trainees. The current study evaluated the effectiveness, feasibility, and acceptability of a pre-service, interprofessional SMH educational intervention focused on promoting the cross-disciplinary competencies essential for SMH practice. Eight SMH trainees participated in the study. Using a mixed-method design, quantitative pre/post competency data were collected via trainee self-report. Qualitative data were collected through a focus group and reflection journals. Results indicate that the intervention promoted competency in all areas, with significant growth in the provision of learning supports to youth. Key factors influencing intervention feasibility included time/scheduling, changing school team composition, and project coordination. Trainees' perceptions of the educational intervention were related to buy-in, clinical experience, and role flexibility. Implications for the design of pre-service interprofessional SMH education strategies are discussed.

THE CRITICAL ROLE OF SCHOOL PSYCHOLOGY IN THE SCHOOL MENTAL HEALTH MOVEMENT

School mental health (SMH) programs are gaining momentum and, when done well, are associated with improved academic and social-emotional outcomes. Professionals from several education and mental health disciplines have sound training and experiences needed to play a critical role in delivering quality SMH services. School psychologists, specifically, are in a key position to advance SMH programs and services. Studies have documented that school psychologists desire more prominent roles in the growth and improvement of SMH, and current practice models from national organizations encourage such enhanced involvement. This article identifies the roles of school psychologists across a three-tiered continuum of SMH practice and offers an analysis of current training and professional development opportunities aimed at such role enhancement. We provide a justification for the role of school psychologists in SMH, describe a framework for school psychologists in the SMH delivery system, discuss barriers to and enablers of this role for school psychologists, and conclude with recommendations for training and policy.