We live in a complicated world requiring complex skills. We must prepare our children to cope and to compete. They need reading, social studies, science and math more than ever, but they also need social skills, problem solving, superior reasoning and good mental health. There is a societal need to reduce the incidence of violence in our schools, as well.
When children and teens are focused on problems at home or within themselves, they often do not do well in school. School success and good mental health are intrinsically tied together. Additionally, school success and good mental health are linked to life success. Identifying those youth who are in need of help can reduce suffering and improve mental health, school success, and life success. Good mental health aids development, learning, interpersonal relationships, and the ability to cope with stress more effectively.
Approximately 1 in 5 children & adolescents (20%) experience the signs and symptoms of a mental health disorder during the course of a year. These children are estimated to have severe emotional or behavioral problems that significantly interfere with their daily functioning. Yet, less than one-third of the children under the age 18 with a serious disturbance receive any MH Services. Often the services they do receive are inadequate or inappropriate (Children’s Defense Fund). Ten percent of children in any given classroom (3/30) are ready to learn at the curriculum level (Dr. Adleman & Dr. Taylor UCLA School Mental Health Project).Only 16% of all children receive any mental health services. Follow through for children receiving mental health services in school is much greater than those referred to community services. Of the 16% that receive MH services, 70-80% receive that care in a school setting (healthinschools.org), yet less than 10% of all school districts in the United States currently have an established School Based Mental Health Program (Center for School Mental Health Assistance, Dr. Mark Weist 2001, University of Maryland).
To assess the effectiveness of school based mental health (SBMH) services in reducing emotional, school, home, and behavioral problems of youth, Robert Schmidt, MA and Kathryn Seifert, Ph.D. collaborated on the evaluation of outcomes for a SBMH program for a rural mid-Atlantic School district. Coordination of mental health services with educators, Department of Social Services, the Department of Juvenile Services, and the Development Disabilities program contributed to the program’s success.
The project began in 1999 with a Federal grant to the school district and the project is ongoing. Youth were referred to the project from teachers, guidance counselors, parents, student self-referrals and other agencies such as the Departments of Social Services and Juvenile Services and Law Enforcement. The student’s scores on the Devereaux, BASC, CARE and several school measures such as absenteeism, disciplinary referrals, violence related suspensions, and other suspensions were measured at the beginning of services and at the beginning and end of each school year.
From 1999 to 2004, 36% youth were referred because of symptoms of depression, 26% because of family problems, and 24% because of behavior problems. Examples of reasons for referral to the program included: crying in class, child can’t stay focused, student found out mom is terminally ill, youth’s parents going through divorce, and recent sexual abuse. There were 84 referrals to the program in 1999, compared to 437 students in 2002 and 239 students in 2003. Peak referral times were in October and February. Youth in the transition years of sixth and ninth grades were referred to the program most often. In 2000, 2,132 mental health sessions were provided, in contrast to an amazing 15,763 sessions in 2003.
A group of 632 students who participated in the program showed significantly improved attitudes toward teachers and school, mental health symptoms, and self-esteem during and after services. Students participating in SBMH in years one and two had significantly better school attendance (56 and 57% increase) when compared to non-participants (66 and 59% decrease). Additionally for the group of participants, absenteeism increased 44% before participation and decreased 53% during participation.
Students had a significant (40%) decrease in disciplinary referrals when compared to non-participants (20% decrease). Participants in years one and two had a significant decrease in suspensions (32% and 27%) from school when compared to non-participants (33 and 16% increases). Parents reported that their children were having significantly fewer problems after receiving services. Youth self-reported significantly improved commitment to school, interpersonal relationships and self-esteem, as well as fewer stress related problems. Students reported significantly reduced school maladjustment and clinical maladjustment and improved attitude toward parents and emotional well-being.
Evaluation of the success of the program revealed several key components. One important component was having a central school/mental health coordinator to be an organizer, ombudsman, problem solver, program evaluator, and coordinator of the two systems. Additionally, the mental health service must be an integral part of the school system, not just an adjunct or add-on. Mental health staff need to communicate and attend meetings with school personnel. Mental health professionals can provide workshops and consultation to teachers, guidance counselors, and administrative staff.
Funding for the project came from mental health third party billing and grant funding. Supplemental funds allowed mental health professionals to attend meetings, consult with school personnel, and provide services for children and youth who do not meet medical necessity criteria of their insurance companies. It is also important to include families as an essential part of the program.
In a time when all programs are struggling to cope with funding cuts, collaborative programs, such as this one can make services more efficient and cost effective. Many families of troubled youth are involved in more than one service, in addition to the school. Coordination of multiple services is beneficial to the families and helps improve outcomes for youth.
This project demonstrated that school based mental health services improved student well-being, behavior and school success, while showing a significant decrease in violence and other behavior problems at home and at school. The study is ongoing and a second site has been added.