The History and Future of School Mental Health

Beginning in the 1980s, mental health programs in schools began to expand beyond those delivered solely by schools and school employees. This was related to growing recognition of the limitations of separate community and school mental health efforts, and of the benefits of working together. These “expanded” school mental health (SMH) programs began to gain momentum in the 1990s and are now a major national force. This chapter reviews key milestones in the history of the field and the critical policy themes (e.g., federalism, school decision-making, healthcare reform, financing) that are being confronted. It concludes with a review of major opportunities for the further growth and development of the field, including embedding programs within multi-tiered systems of support, improving training and workforce development, improving interdisciplinary and cross-system collaboration, enhancing high-quality and evidence-based practice, and developing effective systems of implementation support. A brief review of international developments concludes the chapter.

Consultation and Collaboration to Increase Integrity in School Mental Health

The chapter “Consultation and Collaboration to Increase Integrity in School Mental Health,” in School Mental Health Services for Adolescents, describes the indirect service delivery model of school consultation, in which a consultant works with a consultee (e.g., teacher, school staff), who in turn provides direct service to a client. The importance of treatment integrity in the process is highlighted. Imperative to the process of school consultation is defining and measuring treatment integrity, or the degree with which a treatment is adhered to, the competence of the individual delivering the treatment as intended, and the extent to which the treatment can be differentiated from other existing treatments. Issues and challenges of measuring and increasing integrity are discussed.

Classroom-Based Services for Adolescents With Mental Health Needs

The chapter “Classroom-Based Services for Adolescents With Mental Health Needs,” in School Mental Health Services for Adolescents, describes a classroom-based three-tiered framework of prevention and intervention that is efficient and cost-effective. A rationale is provided for why the three-tiered framework, typically applied at the school-wide level, is also a good fit for individual classrooms. Following the rationale, the chapter provides details of specific interventions across the three tiers that have solid or emerging evidence for effectiveness in secondary settings. For each intervention, a rationale is provided, followed by specific procedures and strategies for implementation, as well as research to support the effectiveness of the intervention. The chapter ends by discussing broader implementation issues in the form of individual barriers teachers face and larger systemic barriers in secondary school settings.

Managing Chronic Health Concerns

The chapter “Managing Chronic Health Concerns,” in School Mental Health Services for Adolescents, reviews biopsychosocial influences on learning and behavior and presents service models targeted for youth with chronic medical conditions. Systemic issues (e.g., racial disparities, disjointed delivery of care, poor communication) are reviewed, with the conclusion that school-based services for chronically ill adolescents are essential to a high-quality continuum of care. This chapter provides strategies for identifying students and reviews common school-based support mechanisms for chronically ill youth. Three common health conditions—asthma, diabetes, and obesity—are highlighted. Finally, this chapter proposes a service delivery model that embraces a behavioral and developmental-ecological framework and focuses on school as a central context, with integration of services across home, school, and medical settings.

Enhancing Attention and Organization in Adolescents

The chapter “Enhancing Attention and Organization in Adolescents,” in School Mental Health for Adolescents, describes the constructs and importance of attention and organization in secondary schools and their relationship to attention-deficit/hyperactivity disorder. Difficulties attending in classroom settings can lead to serious academic impairment, which in turn can lead to a host of negative outcomes for adults. Attempts to alter the negative effects of inattention and disorganization have resulted in the development of interventions and services to address these issues. The authors begin by describing methods of identifying risk and the effects of developmental changes associated with assessment. Next, the authors describe school-based services, including services frequently provided in schools, and evidence-based services. Finally, the authors describe a service delivery model for implementing services in schools.

Mental Health Promotion With Aboriginal Youth

Aboriginal youth in Canada are at disproportionate risk for a range of mental health concerns compared to their non-Aboriginal counterparts. To address this disparity, communities, researchers and policymakers have called for culturally relevant prevention and intervention programming to mitigate risk and promote well-being. A number of promising initiatives have been developed that are grounded in culture. The goal of these programs is to maximize the protective influence of multiple facets of culture in youth’s lives, such as cultural identity, connectedness, and engagement in traditional practices. One such program is The Fourth R: Uniting Our Nations, a strengths-based, culturally relevant program delivered to Aboriginal youth in Canadian schools. This chapter outlines the rationale for promoting such programming with Aboriginal youth. We describe the development and evaluation of the Uniting Our Nations program. We also highlight the importance of authentic partnerships and committing to a time frame that is sufficient for this work.

Addressing Adolescent Drug Abuse

The chapter “Addressing Adolescent Drug Abuse,” in School Mental Health Services for Adolescents, examines several topics related to adolescent substance use: brain development and its implications for mental health services, evidence-based prevention and intervention programs, and the utility of clinical services adapted for school settings. Substance use by adolescents continues to be a public health concern. Not only does recent research show relatively high rates of use, but the onset of substance use during the teenage years has been linked to subsequent substance use disorders and is associated with a wide range of social, learning, and psychological consequences. The need is great for schools to address this public health issue by utilizing the growing number of existing evidence-based prevention and intervention programs.

Working with Adolescents with Autism Spectrum Disorder

The chapter “Working with Adolescents with Autism Spectrum Disorders,” in School Mental Health Services for Adolescents, provides information and guidance related to identification and referral, evidence-based practices, and service delivery issues and models for adolescents with autism spectrum disorder (ASD). The authors open the chapter with a brief history of autism, beginning with the category of Pervasive Developmental Disorder in the DSM-III in 1980, and culminating with the changes made in criteria for ASD in the DSM-5 in 2013. Next, the authors explore issues related to assessment, including diagnosis of ASD during adolescence and assessing challenges to be targeted in schools. They then describe evidence-based practices that can be implemented to train teachers and paraprofessionals, intervene with ASD, and avoid problems before they occur. Finally, the authors present service delivery issues and models when working with adolescents with ASD in secondary schools.

Regulating Emotions

The chapter “Regulating Emotions,” in School Mental Health Services for Adolescents, examines various aspects related to emotion regulation, including its identification, assessment, and intervention, according to evidence-based practice. Internalizing disorders represent an area of marked concern for youth, particularly during the developmental stage of adolescence. Particularly troublesome is empirical evidence that suggests an increasing prevalence rate of depression among youth. In the chapter, prevalence of disorders is examined, as well as different modalities by which psychopathology in the schools can be screened for and more formally evaluated. Various forms of cognitive-behavioral prevention and intervention are discussed and considered for appropriateness within a particular school context. Obstacles to implementation are considered and recommendations for a model of service delivery are offered.

Screening and Progress Monitoring in Secondary Schools

The chapter “Screening and Progress Monitoring in Secondary Schools,” in School Mental Health Services for Adolescents, examines social, emotional, and behavioral screening in secondary schools. Mental health disorders in adolescence are known to be associated with poor school and life outcomes, including academic underachievement, school dropout, drug use, and physical aggression. This chapter reviews universal screening at the secondary level, which provides evidence to help assess instruction in the school and identifies those students who may not be making expected progress. In addition, the authors describe barriers to screening. They present data on types of common problems, justification for engaging in screening, and methods for screening and progress monitoring, including guiding principles and time lines.