Advertisement

School Mental Health in Systems of Care

  • Philip J. Leaf
  • David Schultz
  • Laurel J. Riser
  • David B. Pruitt
Part of the Issues in Clinical Child Psychology book series (ICCP)

The Center for Mental Health Services (1997) estimates that from 9 to 13% of all children aged 9–17 have a serious emotional disturbance that either impairs or substantially interferes with their ability to function effectively at home, school, or within the community. More than 20 years ago, Knitzer (1982) found that two-thirds of children in need did not receive mental health services. Since the publication of that landmark report, concerns about the small number of youth with mental disorders who receive mental health services have not lessened (Leaf, Bogrov, & Webb, 1997; U.S. DePartment of Health and Human Services, 1999). Although recent research suggests that a greater proportion of children in need of mental services now receive them (Costello et aL, 1993; Leaf et al., 1996), few communities can claim that all or even most youth identified as having mental or emotional problems receive effective services

In most communities, mental health services have been provided primarily in outpatient clinics and inpatient units (Kiser, King, & Lefkovitz, 1999). Concern over the poor outcomes experienced by many youth with mental disorders, however, has led to a call for (1) the increased use of research-based treatments (Hoagwood et al., 2001; Kazdin & Weisz, 1998; Kutash & Rivera, 1996) and (2) a more effective “system of care” (Kiser, Lefkovitz, & Kennedy, 2001). The promise and controversy surrounding expanded use of research-based treatments has been widely discussed (Hoagwood et al., 2001; Kazdin & Kendall, 1998; Persons, 1995). Considerable evidence exists that, when implemented well, evidence-based services can result in significant improvements in children's outcomes. As discussed in other chapters in this volume, however, we are still learning how to implement and sustain these preventive and treatment interventions in school settings

A system of care is “a comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of severely emotionally disturbed children and adolescents” (Stroul & Friedman, 1996, p. 3). In response to the numerous reports describing deficiencies in the mental health services available to our nation's youth, the federal government, family advocacy groups, and academic training centers have devoted considerable time and effort to disseminating the concepts and philosophy of the Child and Adolescent Service System Program (cassp). This program develops infrastructures necessary for publicly funded community-based services for children and adolescents with serious emotional disturbances (Davis et al., 1995; Stroul & Friedman, 1986, 1996)

Communities will probably require both more effective systems of care and greater utilization of evidence-based practices to produce the outcomes they desire for emotionally disturbed children. To date, improvements in a community's system of care have been shown to improve access to and coordination between services for children but not, by themselves, to improve children's behaviors or school functioning significantly (Bickman, Noser, & Summerfelt, 1999). A community's system of care may coordinate services well between providers and between agencies such that more children with needs are identified and come into contact with service providers. The ultimate effectiveness of the system, however, remains dependent upon the individual, direct services provided to children and their families. If those delivering services to children continue to use practices not proven to affect children significantly, greater access to and coordination between services will not impact youth greatly

Most discussions concerning systems of care have focused on individual service needs of the youth and their families or home-based services (e.g., Multisys-temic Therapy; Schoenwald, Borduin, & Henggeler, 1998). Increasingly, however, mental health professionals and policymakers have focused on schools as a critical component of the system of care approach (Elias et al., 1997; Gottfredson, 2001; Leaf et al., 1997), Clinicians working in schools can access youth more easily than can those working in more traditional clinical settings (e.g., outpatient or inpatient clinics). In addition, these clinicians have a greater opportunity to establish procedures that will help preventmental disorders, substance abuse, and violence; that will facilitate the early detection and referral of youth with behavioral or emotional problems; that can provide an array of services delivered to children directly in the schools; and that can reintegrate youth with serious emotional or behavioral problems back into schools

This chapter suggests ways to think about school-based services from a system of care perspective. We first present six principles associated with the system of care approach and suggest ways in which mental health professionals working with and in schools might apply these principles to their work. We then provide an overview of the different types of services mental health clinicians might help provide within the school setting. As an example of a system of care approach, we then present a description of the school-based services provided within the Safe Schools, Healthy Students (ss-hs) project in Baltimore City. We conclude this chapter by suggesting ways in which to fund the system of care approach

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adelman, H. S., & Taylor, L. (2000). Looking at school health and school reform policy through the lens of addressing barriers to learning. Children's Services: Social Policy, Research, and Practice, 3,117–132.Google Scholar
  2. Banish, H. H., Saunders, M, & Wolf, M. M. (1969). Good behavior game: Effects of individual contingencies for group consequences on disruptive behavior in a classroom. Journal of Applied Behavior Analysis, 2,119–124.CrossRefGoogle Scholar
  3. Bickman, L., Noser, K., & Summerfelt, W. T. (1999). Long-term effects of a system of care on children and adolescents. Journal of Behavioral Health Services, 26,185–202.CrossRefGoogle Scholar
  4. Booney, V. H., & Pumariega, A. (Eds.). (2001). Clinical assessment of child and adolescent behavior, New York: Wiley.Google Scholar
  5. Center for Mental Health Services (1997). Comprehensive community mental health services for children program. Substance Abuse and Mental Health Services Administration: Technical Report.Google Scholar
  6. Costello, J. E., Burns, B. J., Angold, A., & Leaf, P. J. (1993). How can epidemiology improve mental health services for children and adolescents? Journal of the American Academy of Child and Adolescent Psychiatry, 32,1106–1114.PubMedCrossRefGoogle Scholar
  7. Davis, M., Yelton, S., & Katz-Leavy, J. (1995). “Unclaimed Children” revisited: The status of state mental health services. Journal of Mental Health Administration, 22, 147–176.PubMedCrossRefGoogle Scholar
  8. Dishion, T. J., & Andrews, D. W. (1995). Preventing escalation in problem behaviors with high-risk young adolescents: Immediate and 1-year outcomes. Journal of Consulting and Clinical Psychology, 63, 538–548.PubMedCrossRefGoogle Scholar
  9. Dishion, T. J., McCord, J., & Poulin, F. (1999). When interventions harm: Peer groups and problem behavior. American Psychologist, 54, 755–764.PubMedCrossRefGoogle Scholar
  10. Durlak, J. A., & Wells, E. (1997). Primary prevention mental health programs for children and adolescents: A meta-analytic review. American Journal of Psychology, 24, 115–152.Google Scholar
  11. Elias, M. J., Zins, J. E., Weissberg, R. P., Frey, K. S., Greenberg, M. T.t Haynes, N. M., Kessler, R., Schwab-Stone, M. E., & Shriver, T. P. (1997). Promoting social and emotional learning. Alexandria, VA: Association for Supervision and Curriculum Development.Google Scholar
  12. Gottfredson, D. C. (2001). Schools and delinquency. New York: Cambridge University Press.Google Scholar
  13. Greenberg, M. T., & Kusche, C. (1998). Promoting Alternative Thinking Strategies (PATHS). Boulder, CO: Center for the Study and Prevention of Violence.Google Scholar
  14. Hoagwood, K., Burns, B. J., Kiser, L., Ringeisen, H., & Schoenwald, S. K. (2001). Evidence-based practice in child and adolescent mental health services. Psychiatric Services, 52,1179–1189.PubMedCrossRefGoogle Scholar
  15. Ialongo, N. S., Werthamer, L., Kellam, S. G., Brown, C. H., Wang, S., & Lin, Y. (1999). Proximal impact of two first-grade preventive interventions on the early risk behaviors for later substance abuse, depression, and antisocial behavior. American Journal of Community Psychology, 27, 599–641.PubMedCrossRefGoogle Scholar
  16. Institute of Medicine (1993). Access to health care in America. Washington, DC: National Academy Press.Google Scholar
  17. Kazdin, A. (2000). Psychotherapy for children and adolescents: Directions for research and practice. New York: Oxford University Press.Google Scholar
  18. Kazdin, A. E., & Kendall, P. J. (1998). Current progress and future plans for developing effective treatments: Comments and perspectives. Journal of Clinical Child Psychology, 27, 217–226.PubMedCrossRefGoogle Scholar
  19. Kazdin, A. E., & Weisz, J. R. (1997). Identifying and developing empirically supported child and adolescent treatments. Journal of Abnormal Child Psychology, 5, 367–387.Google Scholar
  20. Kellam, S. G., Mayer, L. S., Rebok, G. W., & Hawkins, W. E. (1998). Effects of improving achievement on aggressive behavior and of improving aggressive behavior on achievement through two preventive interventions: An investigation of causal paths. In B. P. Dohrenwend (Ed.), Adversity, stress, and psychopathology(pp. 486–505). New York: Oxford University Press.Google Scholar
  21. Kiser, L. J., King, R.» & Lefkovitz, P. M. (1999). A comparison of practice patterns and a model continuum of ambulatory behavioral health services. Psychiatric Services, 50, 605–606, 618.PubMedGoogle Scholar
  22. Knitzer, J. (1982). Mental health services to children and adolescents: A national view of public policies. American Psychologist, 39, 905–911.CrossRefGoogle Scholar
  23. Kutash, K., & Rivera, V. R. (1996). What works in children's mental health services? Uncovering answers to critical questions. Baltimore: Paul H. Brookes.Google Scholar
  24. Leaf, P. J., Alegria, M., Cohen, P., Goodman, S. H., Horwitz, Hoven, Narrow, Vaden-Keirnan, & Regier (1996). Mental health service use in the community and schools: Results from the four-community MEGA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 889–897.PubMedCrossRefGoogle Scholar
  25. Leaf, P. J., Bogrov, M., & Webb, M. B. (1997). The East Baltimore Mental Health Partnership. In S. W. Henggeler & A. B. Santos (Eds.), Innovative approaches for difpcult-to-treat populations. Washington, DC: American Psychiatric Press.Google Scholar
  26. Lochman, J. E., & Lenhart, L. A. (1993). Anger coping intervention for aggressive children: Conceptual models and outcome effects. Clinical Psychology Review, 13, 785–805.CrossRefGoogle Scholar
  27. Lochman, J. E., & Wells, K. C. (1996). A social-cognitive intervention with aggressive children: Prevention effects and contextual implementation issues. In R. D. Peters & R. S. McMahon (Eds.), Preventing childhood disorders, substance abuse, and delinquency. Thousand Oaks, CA: Sage.Google Scholar
  28. Lochman, J. E., Wells, K. C, Lenhart, L., & Colder, C. (1996, May). Cognitive-behavioral and behavioral parent training preventive intervention for boys at risk for substance use: Initial analyses of the Coping Power Program. Poster presented at the National Prevention Research Conference, Washington, DC.Google Scholar
  29. Lourie, I. S., Stroul, B. A., & Friedman, R. M. (1998). Community-based systems of care: From advocacy to outcomes. In M. H. Epstein & K. Kutash (Eds.), Outcomes for children and youth with emotional and behavioral disorders and their families: Programs and evaluation best practices(pp. 3–19). Austin, TX: PRO-ED, Inc.Google Scholar
  30. McGinnis, E., & Goldstein, A. P. (1997). Skillstreaming the elementary school child. Champaign, IL: Research PressGoogle Scholar
  31. Pedro-Carroll, J. L., & Alpert-Gillis, L. J. (1997). Preventive interventions for children of divorce: A developmental model for 5 and 6 year old children. Journal of Primary Prevention, 18, 5–23.CrossRefGoogle Scholar
  32. Pedro-Carroll, J. L., Alpert-Gillis, L. J., & Cowen, E. L. (1992). An evaluation of the efficacy of a preventive intervention for 4th–6th grade urban children of divorce. Journal of Primary Prevention, 13, 115–130.CrossRefGoogle Scholar
  33. Pedro-Carroll, J. L., & Cowen, E. L. (1985). The Children of Divorce Intervention Program: An investigation of the efficacy of a school-based prevention program. Journal of Consulting and Clinical Psychology, 53, 603–611.PubMedCrossRefGoogle Scholar
  34. Persons, J. B. (1995). Why practicing psychologists are slow to adopt empirically-validated treatments. In S. C. Hayes, V. M. Follette, R. M. Dawes, & K. E. Grady (Eds.), Scientific standards of psychological practice: Issues and recommendations. Reno, NV: Context Press.Google Scholar
  35. Reynolds, A. ]., & Temple, J. A. (1998). Extended early childhood intervention and school achievement: Age thirteen findings from the Chicago Longitudinal Study. Child Development, 69, 231–246.PubMedGoogle Scholar
  36. Schoenwald, S. K., Borduin, C. M., & Henggeler, S. W. (1998). Multisystemic therapy: Changing the natural and service ecologies of adolescents and families. In M. H. Epstein & K. Kutash (Eds.), Outcomes for children and youth with emotional and behavioral disorders and their families: Programs and evaluation best practices(pp. 485–511). Austin, TX: PRO-ED, Inc.Google Scholar
  37. Seitz, V., Rosenbaum, L. K., & Apfel, N. H. (1985). Effects of family support intervention: A ten-year follow-up. Child Development, 56, 376–391.PubMedCrossRefGoogle Scholar
  38. Stark, K. D., Reynolds, W. M., & Kaslow, N. J. (1987). A comparison of the relative efficacy of self-control therapy and a behavioral problem-solving therapy for depression in children. Journal of Abnormal Child Psychology, 15, 91–113.PubMedCrossRefGoogle Scholar
  39. Stark, K. D., Rouse, L., & Livingston, R. (1991). Treatment of depression during childhood and adolescence: Cognitive-behavioral procedures for the individual and family. In P. Kendall (Ed.), Child and adolescent therapy(pp. 165–206). New York: Guilford.Google Scholar
  40. Stroul, B. A. (1993). Systems of care for children and adolescents with severe emotional disturbances: What are the results?Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center.Google Scholar
  41. Stroul, B. A., & Friedman, R. M. (1986). A system of care for seriously emotionally disturbed children and youth. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center.Google Scholar
  42. Stroul, B. A., & Friedman, R. M. (1996). The system of care philosophy. In B. A. Stroul (Ed.), Children's mental health: Creating systems of care in a changing society(pp. 3–22). Baltimore, MD: Brookes.Google Scholar
  43. Tolan, P. H., & Guerra, N. G. (1994). Prevention of delinquency: Current status and issues. Applied and Preventive Psychology, 3, 251–273.CrossRefGoogle Scholar
  44. U. S. Department of Health and Human Services (1999). Mental health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.Google Scholar
  45. Zigler, E., & Styfco, S. J. (1994). Head Start: Criticisms in a constructive context. American Psychologist, 49,127–132.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2003

Authors and Affiliations

  • Philip J. Leaf
    • 1
  • David Schultz
    • 1
  • Laurel J. Riser
    • 2
  • David B. Pruitt
    • 2
  1. 1.Johns Hopkins University Bloomberg School of Public HealthBaltimoreMaryland
  2. 2.University of Maryland School of MedicineBaltimoreMaryland

Personalised recommendations