Editorial
Mental Health Services in Schools: Issues for Implementation
Mental health services are often not provided to children who need them despite the national concern about early identification of mental illness. Reasons include failure to recognize problems, fear of stigma, and lack of resources. Most children who do receive mental health services receive them at school (Kataoka, et al., 2003), yet there is concern that evidencebased programs are not implemented or when they are fidelity may not be assured. Ten years ago, the New Freedom Commission Report recommended preventive services and an expansion of school-based mental health services that would assure screening, assessment, and treatment of mental health problems (New Freedom Commission Report on Mental Health Health, 2003). Researchers have identified the issues that influence the implementation of mental health services as the complexity of services required, the skill of the practitioners, the receptiveness of the child and family, and the school organizational factors as well as school climate (Shoenwald & Hoagwood, 2001; Langley, Nadeem, Kataoka, & Stein, 2010). School climate refers to the organizational perception of the relevance of a mental health programs. Without the perceived value, mental health programs will not succeed. The complexity of services is dependent on the actual child mental health problems or the goal of the services. Children may suffer from diagnosed psychiatric problems or may exhibit symptoms that are related to problems in the home. Services may be focused on prevention. Treatment services require skilled management by the psychiatric–psychological specialties, while support and preventive services require expertise and collaboration of the entire school health team. Thus, addressing the skill of practitioners requires a clear focus on the goal of the mental health program. Parental recognition of their child’s mental health problems and willingness to take steps to address problems is complicated by many factors including their own mental health, experience with the mental health system, and personal resources (Shoenwald & Hoagwood, 2001). Although all of these factors are important, school organizational factors undergird the success of health services programming including mental health programming. School nursing can play a major role in addressing organization factors such as working with administrators to formulate policies that are current and supportive of mental health services. Research has shown that barriers to implementation of mental health programs are related to competing responsibilites of the service team, lack of parent engagement, logistic barriers, and lack of support from school administrators and teachers (Langley, Nadeem, Kataoka, & Stein, 2010).
The Journal of School Nursing 29(6) 406 ª National Association of School Nurses 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1059840513509582 jsn.sagepub.com
Certainly, the competing responsibilities of the health services team are recognized, but redistributions of responsibilities should be identified that do not compromise necessary services. Parental engagement has been a continuing barrier and recognized for many years (Weist, Evans, & Lever, 2003). Strategies are emerging, however, which show professional engagement with parents increases willingness to provide consent for their children’s participation and retention in mental health promotion programs (Cowell, McNaughton, Ailey, Fogg, & Gross, 2009). Logistic barriers in schools include competition for space as well as scheduling. With a vision for a healthier school community, logistic barriers can usually be overcome. Finally, commitment and support for mental health programs from administrators and teachers typlically reduce all of the other barriers. School nurses are in an excellent position to garner that support by providing evidence that shows the need. Continuing mass violence by individuals with a long history of mental illness should embolden the school health team to close the gap in school-based mental health services. Julia Muennich Cowell, PhD, RN, APHN-BC, FAAN Executive Editor References Cowell, J., McNaughton, D., Ailey, S., Fogg, L., & Gross, D. (2009). Clinical trial outcomes of the meican american problem solving program (MAPS). Hispanic Health Care International, 7, 178–189. New Freedom Commission (2003). The President’s New Freedom Commission on Mental Health. Retrieved from Final Report. DHHS Pub. No. SMA-033832: http://www.cartercenter.org/ documents/1701.pdf Kataoka, S., Jaycox, L., Wong, M., Tu, W., P, E, Zaragoza, C., & Fink, A. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the american academy of child and adolescent psychiatry, 42, 311–318. Langley, A., Nadeem, E., Kataoka, S., & Stein, B. J. (2010). Evidence-Based Mental Health Programs in Schools: Barriers and Facilitators of Successful Implementation. School Mental Health, 2, 105–113. Shoenwald, S., & Hoagwood, K. (2001). Effectiveness, transportablility, and dissemination of interventions: What matters when? Psychiatric Services, 52, 1190–1197. Weist, M., Evans, S., & Lever, N. (2003). Handbook of school mental health: Advancing Practice and Research. Issues in clinical child psychology. New York: Kluwer Adademic/Plenum.
Downloaded from jsn.sagepub.com at UNIV CALIFORNIA SAN DIEGO on April 13, 2015
Mental Health Services in Schools: Issues for Implementation
Mental health services are often not provided to children who need them despite the national concern about early identification of mental illness. Reasons include failure to recognize problems, fear of stigma, and lack of resources. Most children who do receive mental health services receive them at school (Kataoka, et al., 2003), yet there is concern that evidencebased programs are not implemented or when they are fidelity may not be assured. Ten years ago, the New Freedom Commission Report recommended preventive services and an expansion of school-based mental health services that would assure screening, assessment, and treatment of mental health problems (New Freedom Commission Report on Mental Health Health, 2003). Researchers have identified the issues that influence the implementation of mental health services as the complexity of services required, the skill of the practitioners, the receptiveness of the child and family, and the school organizational factors as well as school climate (Shoenwald & Hoagwood, 2001; Langley, Nadeem, Kataoka, & Stein, 2010). School climate refers to the organizational perception of the relevance of a mental health programs. Without the perceived value, mental health programs will not succeed. The complexity of services is dependent on the actual child mental health problems or the goal of the services. Children may suffer from diagnosed psychiatric problems or may exhibit symptoms that are related to problems in the home. Services may be focused on prevention. Treatment services require skilled management by the psychiatric–psychological specialties, while support and preventive services require expertise and collaboration of the entire school health team. Thus, addressing the skill of practitioners requires a clear focus on the goal of the mental health program. Parental recognition of their child’s mental health problems and willingness to take steps to address problems is complicated by many factors including their own mental health, experience with the mental health system, and personal resources (Shoenwald & Hoagwood, 2001). Although all of these factors are important, school organizational factors undergird the success of health services programming including mental health programming. School nursing can play a major role in addressing organization factors such as working with administrators to formulate policies that are current and supportive of mental health services. Research has shown that barriers to implementation of mental health programs are related to competing responsibilites of the service team, lack of parent engagement, logistic barriers, and lack of support from school administrators and teachers (Langley, Nadeem, Kataoka, & Stein, 2010).
The Journal of School Nursing 29(6) 406 ª National Association of School Nurses 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1059840513509582 jsn.sagepub.com
Certainly, the competing responsibilities of the health services team are recognized, but redistributions of responsibilities should be identified that do not compromise necessary services. Parental engagement has been a continuing barrier and recognized for many years (Weist, Evans, & Lever, 2003). Strategies are emerging, however, which show professional engagement with parents increases willingness to provide consent for their children’s participation and retention in mental health promotion programs (Cowell, McNaughton, Ailey, Fogg, & Gross, 2009). Logistic barriers in schools include competition for space as well as scheduling. With a vision for a healthier school community, logistic barriers can usually be overcome. Finally, commitment and support for mental health programs from administrators and teachers typlically reduce all of the other barriers. School nurses are in an excellent position to garner that support by providing evidence that shows the need. Continuing mass violence by individuals with a long history of mental illness should embolden the school health team to close the gap in school-based mental health services. Julia Muennich Cowell, PhD, RN, APHN-BC, FAAN Executive Editor References Cowell, J., McNaughton, D., Ailey, S., Fogg, L., & Gross, D. (2009). Clinical trial outcomes of the meican american problem solving program (MAPS). Hispanic Health Care International, 7, 178–189. New Freedom Commission (2003). The President’s New Freedom Commission on Mental Health. Retrieved from Final Report. DHHS Pub. No. SMA-033832: http://www.cartercenter.org/ documents/1701.pdf Kataoka, S., Jaycox, L., Wong, M., Tu, W., P, E, Zaragoza, C., & Fink, A. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the american academy of child and adolescent psychiatry, 42, 311–318. Langley, A., Nadeem, E., Kataoka, S., & Stein, B. J. (2010). Evidence-Based Mental Health Programs in Schools: Barriers and Facilitators of Successful Implementation. School Mental Health, 2, 105–113. Shoenwald, S., & Hoagwood, K. (2001). Effectiveness, transportablility, and dissemination of interventions: What matters when? Psychiatric Services, 52, 1190–1197. Weist, M., Evans, S., & Lever, N. (2003). Handbook of school mental health: Advancing Practice and Research. Issues in clinical child psychology. New York: Kluwer Adademic/Plenum.
Downloaded from jsn.sagepub.com at UNIV CALIFORNIA SAN DIEGO on April 13, 2015
