CNCSP 102 Literature Review

Running head: SCHOOL-BASED MENTAL HEALTH 1

School-Based Mental Health

Erin Dowdy, Matthew Quirk, and Jenna Chin

University of California, Santa Barbara

[NOTE. No Abstract needed for this assignment]

SCHOOL-BASED MENTAL HEALTH 2      

School-Based Mental Health

School-based mental health generally refers to the delivery of any type of mental health

services within a school setting. However, the term is in need of a clearer conceptual framework

due to the variety of school settings in which it is applied including charter schools, public

schools, and school programs in hospitals or juvenile justice settings (Kutash, Duchnowski, &

Lynn, 2006). More fundamentally, the term mental health is plagued with ambiguity. Although

mental “health” is a positive concept, it is often used in reference to mental illness and

encompasses services provided to those with diagnosable mental disorders or other serious

psychopathology. Emerging research on “dual-factor” (Suldo & Shaffer, 2008) or “two-factor”

(Keyes, 2009) models of mental health suggest that mental illness and mental wellness are not on

a single continuum, but rather are separate, complementary constructs (Keyes, 2005). Thus, an

individual’s “mental health” may be best understood when both competencies as well as deficits

are considered (Furlong, Sharkey, Boman, & Caldwell, 2007) and school-based mental health

services should encompass both wellness-enhancing and symptom-reduction goals.

Despite the lack of definitional clarity, there is a clear need for the establishment of

school-based mental health services as schools often become the de-facto mental health care

system for many children and adolescents (Hoagwood & Johnson, 2003). This is, in part, due to

the fact that a substantial number of children do not receive primary health care services

elsewhere, particularly children from impoverished backgrounds who are at elevated risk for

poor behavioral outcomes (Kelleher, Moore, Childs, Angelilli, & Comer, 1999).

Research conducted over the past decade has provided evidence supporting the efficacy

of multiple school-based mental health service delivery frameworks, including population-based

models (Doll & Cummings, 2008), three-tiered models (Nastasi & Varjas, 2008), policy vision

SCHOOL-BASED MENTAL HEALTH 3       frameworks (Adelman & Taylor, 2003), and community schools (Blank, Quinn, & Kim, 2003).

This research, along with recent legislation and changes to educational policies (e.g., The

President’s New Freedom Commission on Mental Health, 2003; Individuals with Disabilities

Education Act, 2004), has resulted in an increased focus on addressing children’s mental health

needs in schools.

School-Based Mental Health and Academics

The increased attention on school-based mental health has also been driven, at least in

part, by research clearly showing relations between children’s social and emotional well-being

and academic achievement (Hinshaw, 1992; Jimerson, Egeland, & Teo, 1999). Students with

emotional and behavioral disorders experience low overall academic achievement, as measured

by achievement test scores (Bradley, Doolittle, & Bartolotta, 2008; Reid et al., 2004). The

academic differences between students functioning well (in terms of their behavioral and

emotional health) and those that are not functioning well are quite drastic. Specifically, estimates

suggest that 75% of students with significant emotional and behavioral problems in the U.S. are

achieving below expected grade levels in reading and 97% are below expected grade levels in

math (Bradley et al.).

While behavioral and emotional problems are significant barriers to academic

achievement, positive behavioral and emotional health is associated with academic success

(Atkins, Frazier, Adil, & Talbott, 2003; Catalano, Haggerty, Osterle, Fleming, & Hawkins,

2004). Yet these relations should not be interpreted in isolation. Meta-analyses show that

learning is influenced by a variety of both proximal (e.g., psychological, instructional, and home

environments) and distal (e.g. economic, organizational, and policy) factors (Wang, Haertel, &

Walberg, 1993) and that academic success can be attributed to the constellation and interplay of

SCHOOL-BASED MENTAL HEALTH 4       multiple variables. Studies have suggested some specific moderating variables that further

explain the relation between behavioral and emotional problems and academic achievement. For

example, students who have stronger relationships with their teachers (Hughes, Luo, Kwok &

Loyd, 2008) and/or have teachers who utilize strong classroom management and reinforcement

techniques (Sutherland, Lewis-Palmer, Stichter & Morgan, 2008) experience more favorable

academic outcomes. These variables, amongst others, should be considered in the

conceptualization of emotional and behavioral problems, as well as in the formulation of

interventions.

Although it is difficult to determine if behavioral problems lead to underachievement or

vice versa (Bradley et al., 2008), the relation can be explained, in part, by examining the reduced

exposure to instruction that often co-occurs with emotional and behavioral difficulties. Students

with emotional and behavioral problems exhibit behaviors which often lead to less instructional

exposure. For example, students with emotional and behavioral problems experience higher

rates of suspensions, expulsions (Wagner et al., 2005), and absenteeism (Lane, Carter, Pierson, &

Glaeser, 2006). Additionally, students with emotional and behavioral problems drop out of

school at alarmingly higher rates than the general population. For example, U. S. national

longitudinal studies show that more than half of students identified as having significant

emotional or behavioral problems leave the educational system by dropping out (United States

Public Health Service, 2000) and of those that do remain in school, only 42% graduate with a

diploma (Bradley, Doolittle, & Bartolotta, 2008).

Although there is growing support for the provision of school-based mental health

services, there remain some criticisms. Critics often express concerns that schools are not the

appropriate place for mental health services, claiming that they fall outside of the scope of the

SCHOOL-BASED MENTAL HEALTH 5       educational system (Adelman & Taylor, 2003). These concerns stem from fears that academic

instructional time may be compromised by time spent dealing with mental health issues and that

the mental health of students should not be a primary concern of educators. However, if services

are not provided within the schools many students will not receive mental health treatment,

leading to significant emotional and financial costs for children, families, schools, and society

(Insel, 2008; Dickstein, 2009).

Summary and Remaining Questions

Schools, teachers, parents, and researchers acknowledging the importance of mental

health services are advised to: provide a comprehensive array of services (i.e. not only services

for mental illness), provide individualized services to reduce the child’s barriers to learning,

promote early identification and early intervention services, provide services within the least

restrictive environment, involve families in the planning and delivery of services, and integrate

all services provided through various agencies both within the school and community (Leaf et

al., 2003). In summary, a variety of research supports that school-based mental health services

positively affect academic outcomes (e.g., Zins, Weissberg, Wang, & Walberg, 2004); however,

additional research is still needed to better understand the dynamics of the relations between

services, student mental health, and academic success.

1. What types of mental health services are associated with improved student mental

health?

2. What is the directionality of the relation between mental health and academic

outcomes?

SCHOOL-BASED MENTAL HEALTH 6      

References

Adelman, H.S. & Taylor, L. (2003). Toward a comprehensive policy vision for mental health in

schools. In M. D. Weist, S. W. Evans & N. A. Lever (Eds.), Handbook of school mental

health: Advancing practice and research. New York, NY: Kluwer Academic/Plenum

Publishers (pp. 23-43).

Benjet, C., Borges, G., Medina-Mora, M. E., Zambrano, J., & Aguilar-Gaxiola, S. (2009). Youth

mental health in a populous city of the developing world: results from the Mexican

Adolescent Mental Health Survey. Journal of Child Psychology and Psychiatry, 50(4),

386-395. doi: 10.1111/j.1469-7610.2008.01962

Blank, M. J., Quinn, J. & Kim, H. (2003). The community schools approach: improving student

learning, strengthening families and communities. In M. D. Weist, S. W. Evans & N. A.

Lever (Eds.), Handbook of school mental health: Advancing practice and research. New

York, NY: Kluwer Academic/Plenum Publishers (pp. 119-133).

Doll, B. & Cummings, J. A. (2008). Best practices in population-based school mental health

services. In A. Thomas & J. Grimes (Eds.), Best Practices in School Psychology V (pp.

1333-1347). Bethesda, MD: National Association of School Psychologists.

Hughes, J. N., Luo, W., Kwok, O. & Loyd, L. K. (2008). Teacher-student support, effortful

engagement, and achievement: a 3-year longitudinal study. Journal of Educational

Psychology, 100(1), 1-14. doi: 10.1037/0022-0663.100.1.1

Jimerson, S., Egeland, B., & Teo, A. (1999). A longitudinal study of achievement trajectories:

Factors associated with change. Journal of Educational Psychology, 91(1), 116-126.

doi:10.1037/0022-0663.91.1.116

[NOTE. Just a subset of example references; papers should list all works reviewed]