School Psychology in Rural Contexts: Ethical, Professional, and Legal Issues

Geographic Disparities in the Availability of Mental Health Services in U.S. Public Schools

INTRODUCTION

The purpose of this study was to examine geographic variation in the availability of and barriers to school-based mental health services.

METHODS

A weighted, nationally representative sample of U.S. public schools from the 2017-2018 School Survey on Crime and Safety was used. Schools reported the provision of diagnostic mental health assessments and/or treatment as well as factors that limited the provision of mental health services. Availability of mental health services and factors limiting service provision were examined across rurality, adjusting for school enrollment and grade level. The analysis was conducted in December 2021.

RESULTS

Half (51.2%) of schools reported providing mental health assessments, and 38.3% reported providing treatment. After adjusting for enrollment and grade level, rural schools were 19% less likely, town schools were 21% less likely, and suburban schools were 11% less likely to report providing mental health assessments than city schools. Only suburban schools were less likely than city schools to provide mental health treatment (incidence rate ratio=0.85; 95% CI=0.72, 1.00). Factors limiting the provision of services included inadequate access to professionals (70.9%) and inadequate funding (77.0%), which were most common among rural schools.

CONCLUSIONS

Significant inequities in school-based mental health services exist outside of urban areas.

Small Towns Talk: Clinical Competency Described Among Rural School Psychologists in Saskatchewan

School psychologists serve the learning needs of students through assessment, intervention, and consultation. The school psychologist can often be the only mental health professional who travels into rural communities. In an effort to adapt to this context of clinical isolation, rural school psychologists develop specialty competencies to serve their clients. This study explores the competencies required among school psychologists practicing in rural regions of Saskatchewan. Eight rural school psychologists participated in a thematic Delphi process to describe the competencies needed in rural school psychology. The participants engaged in three rounds of data collection and collective data analysis and arrived at a strong level of agreement on the final outcomes. The findings describe rural school psychology knowledge (i.e., community knowledge, generalist knowledge, and system knowledge), skills (i.e., relationship skills, core psychologist skills, efficiency skills, and communication skills), attitudes (i.e., flexibility, openness, and compassion), and behaviors (i.e., being responsive, being empowering, being available, and being procedural). The present study results contribute to better defining and understanding the multiple roles and practices of rural school psychologists. Recommendations of the study invite psychologists, clinical supervisors, and psychology training programs to incorporate an emphasis on interpersonal relationships, a generalist approach to psychological services, and consider creative practices of rural practitioners to the initial training and ongoing professional development of school psychologists.