A roadmap to equitable school mental health screening.

Youth in the United States are experiencing mental health concerns at alarming rates. Considering the nation's legacy of racism and growing recognition of the impact of social determinants of health on educational and mental health inequities, it is imperative to re-envision how we approach mental health screening in schools to center equity. A focus on mental health screening for the sole purpose of identifying individual at-risk students ignores key contextual considerations, is ineffective in addressing health and educational inequities, and has the potential to perpetuate oppressive practices in schools. Equity-focused mental health screening requires a shift from individual- and deficit-focused approaches to systems- and holistic-focused approaches that (a) identify strengths and stressors among individuals, groups, and communities; (b) dismantle structural forms of oppression; and (c) promote positive mental health outcomes for minoritized youth. Integrating recommendations from the educational equity literature and critical school mental health frameworks, this paper identifies core considerations for equitable school mental health screening and provides guiding principles for each phase of the screening process, from screening readiness to execution to follow up. To implement these recommendations and transform school-based mental health care, schools should (a) incorporate multiple perspectives; (b) prioritize student, family, and community voices; and (c) build collaborative partnerships to co-construct a vision for equitable school mental health.

Associations Between School Mental Health Team Membership and Impact on Service Provision.

Schools are the most common venue in which children and youth receive mental health services. To organize delivery of mental health care to such a large number of children, use of school teams is often recommended. Yet, there is limited empirical literature about the composition of school mental health teams or teams' relations to service provision. This study investigated team composition, including team multidisciplinarity (number of different types of professionals) and the presence of a community provider, and the relations of these two variables to service provision at Tier 1 (mental health promotion), Tier 2 (early intervention) and Tier 3 (intensive treatment) for 386 schools representing different school sizes, locations, and urbanicity. Results suggested team multidisciplinarity and the presence of a community provider were related to more frequent endorsement of service provision at schools. Practice and research implications are discussed including possible application to hiring decisions and further research with longitudinal data and information on service quality. Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-021-09493-z.

Rates of Mental Health Service Utilization by Children and Adolescents in Schools and Other Common Service Settings: A Systematic Review and Meta-Analysis.

A meta-analysis was conducted to examine the relative rates of youth mental health service utilization across settings among the general population and among those with elevated mental health symptoms or clinical diagnoses. Rates of school-based mental health were compared to outpatient, primary care, child welfare, juvenile justice, and inpatient. Nine studies presented rates of mental health service use for general-population youth in the U.S., and 14 studies presented rates for youth with elevated symptoms or clinical diagnoses. Random effects meta-analysis was used to calculate mean proportions of youth receiving care in each sector. Of general population youth, 7.28% received school mental health services. Rates for other sectors are as follows: 7.26% in outpatient settings, 1.76% in primary care, 1.80% in inpatient, 1.35% in child welfare, and 0.90% juvenile justice. For youth with elevated mental health symptoms or diagnoses, 22.10% of youth were served by school-based mental health services, 20.56% outpatient settings, 9.93% primary care, 9.05% inpatient, 7.90% child welfare, and 4.50% juvenile justice. Schools and outpatient settings are the most common loci of mental health care for both the general population and samples of youth with elevated symptoms or clinical diagnoses, although substantial amounts of care are also provided in a range of other settings. Results hold potential for informing resource allocation, legislation and policy, intervention development, and research. Given that mental health services are delivered across many settings, findings also point to the need for interconnection across child-serving sectors, particularly schools and outpatient clinics.

Middle and High School Student Perspectives on Digitally-Delivered Mental Health Assessments and Measurement Feedback Systems.

Implementation of measurement-based care (MBC) by child-serving community mental health providers, particularly school-based providers, is low. To inform user-centered design of measurement feedback systems (MFSs) and MBC implementation more broadly, semi-structured interviews were conducted with 61 middle and high school students. Interviews explored student preferences for and perceived helpfulness of different assessment methods and use of MFS in counseling. Results indicate that student preference for digitally-administered assessment is equivocal, with preferences being influenced by student perceptions of the ease of use, impersonalization, and confidentiality. Students with exposure to the MFS found it helpful when used by their provider to share assessment feedback.

School-Based Telepsychiatry in an Urban Setting: Efficiency and Satisfaction with Care.

Background and Introduction: Given the shortage of child psychiatrists in most areas, telepsychiatry may increase accessibility of psychiatric care in schools, in part by improving psychiatrists' efficiency and reach. The current study assessed consumer and provider satisfaction with school-based telepsychiatry versus in-person sessions in 25 urban public schools and compared the efficiency of these service delivery models. Materials and Methods: In total, 714 satisfaction surveys were completed by parents, students, school clinicians, and child psychiatrists following initial (26.3%) and follow-up (67.2%) visits (6.4% did not indicate type of visit). Most of these surveyed visits were for medication management (69.9%) or initiation of medication (22%). Efficiency analyses compared time saved via telepsychiatry versus in-person care. Researchers also conducted focus groups with providers to clarify preferences and concerns about telepsychiatry versus in-person visits. Results : Consumers were highly satisfied with both in-person and telepsychiatry-provided school psychiatry services and showed no significant differences in preference. Providers reported both in-person and telepsychiatry were equally effective and showed a slight preference for in-person sessions, citing concerns about ease of video equipment use. Telepsychiatry services were more efficient than in-person services, as commute/setup occupied about 28 psychiatrist hours total per month. Discussion and Conclusions: Findings suggest that students, parents, and school clinicians perceive school-based telepsychiatry positively and equal to on-site care. Child psychiatrists have apprehension about using equipment, so equipment training/preparation and provision of technical support are needed. Implications of study findings for telepsychiatry training and implementation in schools are discussed.

Languishing Students: Linking Complete Mental Health Screening in Schools to Tier II Intervention.

Despite innovations in the screening and early identification of students who may benefit from school mental health services, many schools struggle to link screening to intervention decisions, particularly at the Tier II level. Universal complete mental health screening, which measures strengths along with risk factors, is a strength-based approach that enables identification of students who do not report active mental health risk yet have limited psychosocial strengths. These languishing students are ideal candidates for Tier II interventions. Using a case study to link screening to intervention, this paper describes a contemporary approach to complete mental health screening, identify candidates for Tier II intervention, select appropriate interventions, and monitor student outcomes. Implications and challenges for school psychologists are discussed.

School Sense of Community, Teacher Support, and Students' School Safety Perceptions.

This study examined the association between two characteristics of school climate (sense of community and teacher support, measured both at the individual and at the school level) and students' feelings of being unsafe at school. The study involved a sample of 49,638 students aged 10-18 years who participated in the 2010-2012 California Healthy Kids Survey. Using hierarchical linear modeling (HLM), our findings revealed that, at the individual level, students perceiving higher levels of sense of community and teacher support at school were less likely to feel unsafe within the school environment. At the school level, sense of community was negatively associated with unsafe feelings, whereas there was no association between school-level teacher support and feelings of being unsafe at school.

Adolescent gang involvement: The role of individual, family, peer, and school factors in a multilevel perspective.

Youth gang involvement is a serious public health challenge as adolescents involved in gangs are more likely than others to engage in violence and aggression. To better understand gang involvement, we examined the role of protective (empathy and parental support) and risk (peer deviance and lack of safety at school) factors, as well as their interactions, in predicting adolescent gang affiliation. The study involved a sample of 26,232 students (53.4% females; mean age = 14.62, SD = 1.69) participating in the California Healthy Kids Survey (CHKS), a survey investigating a wide range of youth health and risk behaviors administered in all California schools every 2 years. Using hierarchical linear modeling (HLM), findings indicated that high levels of empathy and parental support were associated with a lower likelihood of affiliating with a gang. Associating with deviant peers and perceiving the school as unsafe were positively correlated with gang membership. At the school level, lack of safety and type of school (special education, vocational, or alternative school vs. comprehensive schools) were associated with greater probability of gang membership. Empathy mitigated the association between deviant peers and gang membership.

Psychosocial functioning of bullied youth who adopt versus deny the bully-victim label.

This study addressed a need for research on the association between adopting or denying the label of bully victim and students' psychosocial functioning. Participants were 1,063 students in Grades 5, 7, and 9 in a school district in the northeastern United States. Students were grouped based on their pattern of responses to (a) the California Bully Victimization Scale (Felix et al., 2011), which does not use the term "bully," but includes behavioral items assessing frequency of peer victimization and whether or not that victimization involved any perceived power disadvantage, and (b) the Olweus Bully/Victim Questionnaire (Solberg & Olweus, 2003; Solberg, Olweus, & Endresen, 2007), which queries self-identification as a bully victim. We compared groups using a series of planned comparisons with ANOVA on self-reported emotional distress and withdrawal, behavioral reactivity and conduct problems, and prosocial behavior and peer competence, as measured by the Strengths and Difficulties Questionnaire (Goodman, 1997). Results revealed complexities regarding the experience of bullying. The perception of a power difference and having been bullied both related to psychosocial functioning in an interactive way, suggesting that both are important to query. Moreover, students who labeled themselves as victims of bullying reported poorer psychosocial functioning than those who had the experience of being bullied but did not adopt that label.

How school can teach civic engagement besides civic education: The role of democratic school climate.

Civic engagement, defined as involvement in community life, is influenced by reciprocal relationships between individuals and contexts and is a key factor that contributes to positive youth development. The present study evaluates a theoretical model linking perceived democratic school climate with adolescent civic engagement (operationalized as civic responsibility and intentions for future participation), taking into account the mediating role of civic discussions and perceived fairness at school. Participants were 403 adolescents (47.9 % male) ranging in age from 11 to 15 years old (mean age = 13.6). Path analysis results partially validated the proposed theoretical model. Higher levels of democratic school climate were associated with higher levels of adolescent civic responsibility; the association was fully mediated by civic discussions and perceived fairness at school. Adolescents' civic responsibility, then, was positively associated with a stronger intention to participate in the civic domain in the future.