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UCLA School Mental Health Project
Center for Mental Health in Schools
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Continuing Education: Unit I

Addressing Barriers to Learning
New Directions for Mental Health in Schools

Section A: Introductory Overview

Section A Contents

Once upon a time, the animals decided that their lives and their society would be improved by establishing a school. The basics identified as necessary for survival in the animal world were swimming, running, climbing, jumping, and flying. Instructors were hired to teach these activities, and it was agreed that all the animals would take all the courses. this worked out well for the administrators, but it caused some problems for the students.
The squirrel, for example, was an "A" student in running, jumping, and climbing but had trouble in the flying class -- not because of an inability to fly, for she could sail from the top of one tree to another with ease, but because the flying curriculum called for taking off from the ground. The squirrel was drilled in ground-to-air take-offs until she was exhausted and developed charley horses from overexertion. This caused her to perform poorly in her other classes, and her grades dropped to "D"s.

"The duck was outstanding in swimming classes -- even better than the teacher. But she did so poorly in running that she was transferred to a remedial class. There she practiced running until her webbed feet were so badly damaged that she was only an average swimmer. But since average was acceptable, nobody saw this as a problem, except the duck.

In contrast, the rabbit was excellent in running but, being terrified of water, he was an extremely poor swimmer. Despite a lot of makeup work in swimming class, he never could stay afloat. He soon became frustrated and uncooperative and was eventually expelled because of behavior problems.

The eagle naturally enough was a brilliant student in flying class and even did well in running and jumping. he had to be severely disciplined in climbing class, however, because he insisted that his way of getting to the top of the tree was faster and easier.

It should be noted that the parents of the groundhog pulled him out of school because the administration would not add classes in digging and burrowing. The groundhogs, along with the gophers and badgers, got a prairie dog to start a private school. They all have become strong opponents of school taxes and proponents of voucher systems.

By graduation time, the student with the best grades in the animal school was a compulsive ostrich who could run superbly and also could swim, fly, and climb a little. She, of course, was made class valedictorian and received scholarship offers from all the best universities.

(George H. Reeves is credited with bringing this parable to America.)

Objectives for Section A

After completing this section of the unit, your should be able to:

identify a wide range of interveners who could play a role in counseling, psychological, and social service activity at a school

enumerate, with respect to the activities carried out by such interveners, two specific functions related to (a) providing direct services and instruction, (b)coordinating, developing, and providing leadership for programs, services, and systems, (c) enhancing connections with community resources

identify at least 2 major emerging trends related to health and psychosocial programs in schools

explain why schools should play a role in addressing mental health and psychosocial concerns and specify three related examples of possible new roles

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Contents of Section A

A Few Focusing Questions

Who at a school might help students with psychosocial concerns?
What factors put students "at risk?"
How might a school play a greater role in shaping a school's overall efforts to address barriers to learning and enhance healthy development?

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Contents of Section A

It is widely recognized that social, emotional, and physical health deficits and other persistent barriers to learning must be addressed if students are to benefit appropriately from their schooling.

Types of interveners who might play primary or secondary roles in counseling, psychological, and social service activity:

Instructional professionals
(e.g., regular classroom teachers, special education staff, health educators, classroom resource staff and consultants)

Health office professionals
(e.g., nurses, physicians, health educators, consultants)

Counseling, psychological, and social work professionals
(e.g., counselors, health educators, psychologists, psychiatrists, psychiatric nurses, social workers, consultants)

Itinerant therapists
(e.g., art, dance, music, occupational, physical, speech-language-hearing, and physical therapists, psychodramatists)

Personnel-in-training for the above roles


  • Aides
  • Classified staff (e.g., clerical and cafeteria staff, custodians, bus drivers)
  • Paraprofesionals
  • Peers (e.g., peer/cross-age counselors and tutors, mutual support and self help groups)
  • Recreation personnel
  • Volunteers (professional/ paraprofessional/ nonprofessional)

This box outlines an array of interveners involved in schools
who are concerned with mental health and psychosocial matters.

Many professionals struggle to

While all students can benefit from interventions to enhance social and emotional development, such activity is essential for those manifesting severe and pervasive problems.

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Contents of Section A

Some of the many important functions such personnel can carry out are listed below:

Types of functions provided
Direct services and instruction
(based on prevailing standards of practice and informed by research)
Identifying and processing students in need of assistance (e.g., initial screening, gatekeeping and triage, client consultation, referral, initial monitoring of care)
Indepth assessment (individuals, groups, classroom, school, and home environments)
Crisis intervention and emergency assistance (e.g., psychological first-aid and follow-up; suicide prevention; emergency services, such as food, clothing, transportation)
Primary prevention through protection, mediation, promoting and fostering opportunities, positive development, and wellness (e.g., guidance counseling; contributing to development and implementation of health and violence reduction curricula; placement assistance; advocacy; liaison between school and home; gang, delinquency, and safe-school programs; conflict resolution)
Transition and follow-up (e.g., orientations, social support for newcomers, follow-thru)
Treatment/therapy/counseling, remediation, rehabilitation (incl. secondary prevention)
Increasing the amount of direct service impact through ongoing management of care multidisciplinary teamwork, consultation, training, and supervision

Coordination, development, and leadership for programs, services, resources, systems
Needs assessment
Coordinating activities (e.g., participating on resource coordinating teams to enhance coordination across disciplines and components; with regular, special, and compensatory education in and out of school)
Mapping and enhancing resources and systems
Developing new approaches (incl. facilitating systemic changes)
Monitoring and evaluating intervention for quality improvement, cost-benefit accountability, research
Advocacy for programs and services and for standards of care in the schools
Pursuing strategies for public relations and for enhancing financial resources

Enhancing connections with community resources
Strategies to increase responsiveness to referrals from the school
Strategies to create formal linkages among programs and services

Few schools, of course, can afford the entire array of personnel and activity outlined. And, because so many young people experience serious problems that interfere with learning and performing in school, most schools indicate that they need much more than they have.

The problem of at risk students has grown so great that educators find they must hold special national summits where the emphasis is not only on the academic plight of students, but also on how to make schools safe.

Keith Geiger, President of the National Education Association, reflecting on the association's 1995 "Safe Schools Summit," laments:

How does a history teacher explain the relevance of the Emancipation Proclamation to students who feel enslaved by fear? How does a guidance counselor persuade a boy to study hard and aim for college if that boy, in his gut, doesn't expect to live past his 20th birthday?

Am I exaggerating? David Satcher, director of the U.S. Centers for Disease Control and Prevention, told the summit about a major new CDC survey of 16,000 students, grades 9 through 12 in both public and private schools.

Nearly 22 percent of those surveyed said they had carried a weapon in the previous month. Nearly one quarter (24.1%) of students had seriously considered attempting suicide in the previous 12 months; 8.6 percent had actually attempted suicide in that period. This study follows an earlier CDC finding that violence among young people has reached "epidemic" proportions (p. 14).

  • There is growing consensus about the crisis nature of the situation. And it is widely recognized that failure to address the problems of children and schools can only exacerbate the health and economic consequences for society.
  • New directions call for functions that go beyond direct service and traditional consultation. All who work in the schools must be prepared not only to provide direct help but to act as advocates, catalysts, brokers, and facilitators of systemic reform. Particularly needed are efforts to improve intervention efficacy through integrating physical and mental health and social services.
  • Ultimately, the need is for systemic restructuring of all support programs and services into a comprehensive and cohesive set of programs.
  • Comprehensive approaches recognize the role school, home, and community life play in creating and correcting young people's problems. From such a perspective, schools must provide interventions that address individual problems and system changes. In this regard, there is renewed interest in the notion that school-based and linked services increase access to underserved and hard-to-reach populations.

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Contents of Section A

State of the Art

An extensive literature reports positive outcomes for psychosocial interventions available to schools.

Data on diagnosable mental disorders (based on community samples) suggest that from 12% to 22% of all children suffer from mental, emotional or behavioral disorders, and relatively few receive mental health services. The picture is even bleaker when expanded beyond the limited perspective of diagnosable mental disorders to include all young people experiencing psychosocial problems and who Joy Dryfoos defines as "at risk of not maturing into responsible adults." The number "at risk" in many schools serving low-income populations has climbed over the 50% mark. Harold Hodgkinson , director of the Center for Demographic Policy, estimates across the nation 40% of students are in "very bad educational shape" and "at risk of failing to fulfill their physical and mental promise." Because so many live in inner cities and impoverished rural areas and are recently arrived immigrants, he attributes their school problems mainly to conditions they bring with them when they enter kindergarten. These are conditions associated with poverty, difficult and extremely diverse family circumstance, lack of English language skills, violent neighborhoods, physical and emotional problems, and lack of health care. One impact is that at least 12% fail to complete high school, which leads to extensive consequences for them, their families, and society.

While many of the reports are from narrowly focused brief demonstrations, the research is promising. A significant number of appropriately developed and implemented programs demonstrate benefits for schools (e.g., better student functioning and attendance, less teacher frustration) and for society (e.g., reduced costs for welfare, unemployment, and use of emergency and adult services).

Thus, the literature is encouraging. It provides a menu of "best practices."

And the search for better practices remains a high priority and must be pursued with full consideration of the diverse demographics and conditions that exist in our changing society.

Schools are engaged in an increasingly wide array of activity, including promotion of social and emotional development, direct services, outreach to families, and various forms of support for teachers and other school personnel. There is enhanced emphasis on coordination and collaboration within a school and with community agencies to provide the "network of care" necessary to deal with complex problems over time. Thus, services in schools are expanding and changing rapidly. Schools' efforts to address health and psychosocial problems encompass
  • prevention and prereferral interventions for mild problems
  • high visibility programs for high-frequency problems
  • strategies to address severe and pervasive problems.

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Contents of Section A
Contents of All Three Units

Emerging Trends

Proliferation of health and psychosocial programs in schools tends to occur with little coordination of planning and implementation. As awareness of deficiencies has increased, major systemic changes have been proposed. Four emerging trends are

Each trend has implications for what goes on in schools.

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New Roles for Schools

Schools have always been called upon to deal with physical health, psychosocial, and mental health concerns. In recent years, these calls have increased.

Moreover, emerging trends require that all school staff continue to expand their roles in advocating and facilitating systemic reforms so that they can be more effective in addressing barriers to student learning and promoting healthy development.

Through an expanded set of roles and functions, such personnel can play a potent role in creating a comprehensive, integrated approach to meeting the needs of the young by helping to weave together what schools can do with what the community offers.

The relatively small number of pupil service personnel available to schools can provide only a limited amount of direct services. Such personnel can have an impact on greater numbers of students if their expertise is used to a greater degree at the level of program organization, development, and maintenance than currently is the case.

Good preservice, interprofessional, and continuing education ensure that a variety of school professionals have specialized understanding of cause (e.g., psychosocial factors and pathology) and intervention (e.g., approaching problem amelioration through attitude and motivation change and system strategies). This knowledge can have many benefits. For instance, mental health perspectives of "best fit" and "least intervention needed" strategies can contribute to reduced referrals and increased efficacy of mainstream and special education programs. With respect to pre and inservice staff development, such perspectives can expand educators' views of how to help students with everyday upsets as well as with crises and other serious problems -- in ways that contribute to positive growth. Specialized mental health understanding also can be translated into programs for targeted problems (e.g., depression, dropout prevention, drug abuse, gang activity, teen pregnancy).

Despite the range of knowledge and skills they bring to a setting, specialists usually are able to see only a small proportion of the many students, families, and school staff who could benefit from their efforts. This is not surprising given the relatively few of these personnel most school districts employ and the many roles they are called on to assume.

This lamentable state of affairs raises several points for discussion. One often discussed idea is that greater dividends (in terms of helping more people) might be forthcoming if such personnel devoted their talents more to prevention. At an even more fundamental level, it seems likely that larger numbers would benefit if they devoted a greater portion of their expertise to creating a comprehensive, integrated approach for addressing barriers to learning and enhancing healthy development. For this to happen, however, there must be a shift in priorities with respect to how they use their time.

Specifically, this involves redeploying time to focus more on functions related to

(a) coordination, development, and leadership (e.g., to evolve and maintain resource integration) and

(b) evolving long-lasting collaborations with community resources.

Given the opportunity, school staff can contribute greatly to creation of a comprehensive, integrated approach.

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Contents of Section A
Contents of All Three Units

Concluding Comments

Emerging trends are reshaping the work of specialists in schools. New directories call for going beyond direct service and beyond traditional consultation. All who work in schools must be prepared not only to provide direct help but to act as advocates, catalysts, brokers, and facilitators of systemic reform. particularly needed are efforts to improve intervention outcomes by integrating physical and mental health and social services. More comprehensively, the need is for systemic reform and restructuring of all education support programs and services to improve the state of the art and provide a safely net of care for generations to come.

This raises many questions. one you may want to think about and discuss at this point is: how well integrated at my school are the programs to address barriers to learning and enhance healthy development?

The surprised principal, waving the achievement test scores,
confronts Ms. Smith, the second grade teacher.

"How did you get these low IQ students to do so well?"
"Low IQ?" she repeats with equal surprise. "What do you mean, low IQ?"
"Well, didn't you see their IQ scores on the list I sent you last fall?"
"Oh no!" Ms. Smith exclaims, "I thought those were their locker numbers!"

Move on to:
Unit I Section A Continued

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Contents of Section A