Volume 12, Number 4
Fall, 2007

Mental Health in Schools:
Much More than Services for a Few

It's wonderful to be able to provide individual and small group counseling/therapy for those children and adolescents who need it. It's tragic that not enough of these clinical services are equitably available. It's fortunate that schools have been able to provide such services at least for a few students via school personnel and/or co-located and linked community service providers.

It is clear, however, that the number of students experiencing behavior, learning, and emotional problems far outstrips the possibility of providing more than a small percentage with clinical services – even if this were the best way to address the wide range of concerns.

Given all this, leaders concerned with advancing mental health in school need to focus on much more than just increasing clinical services. That, of course, has long been the message conveyed by advocates for prevention programs. It is also the message conveyed by those who stress that concerns about mental health involve much more than the focus on mental illness. This latter view includes an emphasis on promoting youth development, wellness, social and emotional learning, and fostering the emergence of a caring, supportive, and nurturing climate throughout a school.

In the abstract, most stakeholders support all efforts to advance the mental health field. When it comes to policy, however, competition arises related to priorities. Advocates for those with serious and chronic personal problems know there are not enough available and accessible services, especially for low income families. So, they mainly support expansion of specialized clinical services and tend to view other mental health agenda items (e.g., prevention) as competition for sparse resources.

One poignant irony in all this is that advocacy for specialized clinical services has contributed not only to identifying more students who have diagnosable problems, but also to formally assigning diagnostic labels to many commonplace behavior, learning, and emotional problems. In the last decade the number of youngsters diagnosed as ADHD, LD, and clinically depressed has escalated exponentially. As a result, students whose problems can and should be addressed through other means are consuming resources needed for those with severe and chronic problems. And, the demand for clinical services continues to outstrip supply in alarming ways.

Continuing along this path is untenable.

Needed: Widespread Acknowledgment of the Zero Sum Game

A zero sum game is a situation or interaction in which one participant's gains result only from another's equivalent losses. In trying to make the world a better place for children and adolescents, many advocates feel they must focus strategically and laser-like on one concern because resources are sparse and distributed politically. Thus, they enter into a zero sum game.

The continuing tendency of many advocates for mental health in schools is to compete in this way even though it pits the needs and interests of some youngsters against the needs and interests of others. And, too often, it generates counterproductive relationships among school staff and between school and community professionals, with the situation sometimes exacerbated by narrow pursuit of specific professional guild interests.

It is inevitable that some advocates will fight for specific groups of children and adolescents. Given current policy inequities, however, they can hope only for small zero sum successes. With respect to mental health in schools, usually this means immediate clinical help for a few more students, but at a cost for others that seldom is articulated.

The mission of schools calls for ensuring that all students have an equal opportunity to succeed at school and beyond. Therefore, advocacy for mental health in schools must address the needs and interests of all students. And, given that these needs and interests depend largely on the way school staff function, advocacy for mental health in schools must encompass a focus on staff as well as students.

Needed: A New Advocacy Coalition for the Few AND the Many

Anyone who has done a substantive analysis of what schools do to address psychosocial and mental health concerns can articulate a host of deficiencies. Adequate data are available to make the case that something needs to be done to improve matters. In an age of data driven decision making, one would hope that school improvement planning would significantly redress the deficiencies. However, as Goodwin and Dean (2007) have sagely noted with respect to data driven decision making: "data are no more instructive than tea leaves. Schools must dig below the surface to get at the real issues and address them head on rather than serving up a ‘cocktail' of symptom treating medications." Data are one thing; interpretation of data is quite another.

Those who view mental health in schools through the lens of providing as many specialized clinical services as possible point to the number who are not served and then advocate for more services. A different agenda surfaces when the situation is viewed by those concerned mainly with classroom management and school discipline interventions. And, still other agenda arise when the concern is about promoting youth development, wellness, social and emotional learning, and fostering the emergence of a caring, supportive, and nurturing climate throughout a school.

The different perspectives have led to advocacy for a variety of initiatives, such as Positive Behavior Support, Coordinated School Health, Safe Schools/Healthy Students, Response to Intervention, Early Intervening, social and emotional learning, character education, projects to ameliorate bullying, violence, substance abuse, pregnancy, dropouts, efforts to enhance school connectedness and student re-engagement, and many more. Each initiative focuses on a major concern; each has a political constituency and a silo of economic support; each has established a niche. And, each has contributed to the piecemeal, ad hoc, and often simplistic approaches that characterize efforts to address problems.

Putting it Together to Transform Student and Learning Supports

Given that many problems experienced by students arise from the same underlying causes, it makes sense not to consider each separately. Indeed, various policy and practice analyses indicate that it is unwise to do so. The complexity of factors interfering with learning and teaching underscore the need to coalesce efforts to address the variety of factors that interfere with a school accomplishing its mission. And, the coalesced efforts must be embedded into the larger agenda for school improvement.

To these ends, we have suggested that four fundamental concerns must be brought to school improvement planning tables. These concerns stress the need to:

  1. Expand policy – broadening policy for school improvement to fully integrate, as primary and essential, a comprehensive, multifaceted, and cohesive system for addressing barriers to learning and teaching, with school safety embedded in natural and authentic ways,

  2. Reframe interventions in-classrooms and school-wide – unifying the fragmented interventions used to address barriers to learning and teaching and promote healthy development under a framework that can guide development of a comprehensive system at every school,

  3. Reconceive infrastructure – reworking the operational and organizational infrastructure for a school, a family of schools, the district, and for school-family-community collaboration with a view to weaving resources together to develop a comprehensive system,

  4. Rethink the implementation problem – framing the phases and tasks involved in "getting from here to there" in terms of widespread diffusion of innovations in organized settings that have well-established institutional cultures and systems. .We have discussed each of these in detail in various publications and reports (some references are cited on page 5). Exhibits 1 and 2 are included here as a way of underscoring the type of cohesive and unifying policy and intervention frameworks that are needed.
Call to Action

If school improvement efforts are to be effective in enabling all students to have an equal opportunity to succeed at school, policymakers must move significantly beyond prevailing thinking. They must revise policy that perpetuates narrow-focused, categorical approaches since such policy is a grossly inadequate response to the many complex factors that interfere with positive development, learning, and teaching. Current policy promotes an orientation that overemphasizes individually prescribed treatment services to the detriment of prevention programs, results in marginalized and fragmented interventions, and undervalues the human and social capital indigenous to every neighborhood. School improvement policy must be expanded to support development of the type of comprehensive, multifaceted, and cohesive approach that can effectively address barriers to learning and teaching. To do less is to make values such as We want all children to succeed and No child left behind simply rhetorical statements.

Needed is a fundamental, systemic transformation in the ways schools, families, and communities address major barriers to learning and teaching. Such a transformation is essential to enhancing achievement for all, closing the achievement gap, reducing dropouts, and increasing the opportunity for schools to be valued as treasures in their neighborhood.

Given the current state of school resources, the transformation must be accomplished by rethinking and redeploying how existing resources are used and by taking advantage of the natural opportunities at schools for countering problems and promoting personal and social growth. Staff and students need to feel good about themselves if they are to cope with challenges proactively and effectively. Every school needs to commit to fostering staff and student strengths and creating an atmosphere that encourages mutual support, caring, and sense of community. For example, a welcoming induction and ongoing social support are critical elements both in creating a positive sense of community and in facilitating staff and student school adjustment and performance. School-wide strategies for welcoming and supporting staff, students, and families at school every day are part of creating a safe and healthy school – one where staff, students, and families interact positively and identify with the school and its goals.

All this, of course, involves major systemic changes. Such changes require weaving school owned resources and community owned resources together over time at every school in a district. And, it requires addressing the complications stemming from the scale of public education in the U.S.A.

The next decade must mark a turning point for how schools, families, and communities address the problems of children and youth. In particular, the focus must be on initiatives to transform how schools work to prevent and ameliorate the many problems experienced by too many students. There is much work to be done as public schools across the country strive to leave no child behind by meeting the needs of the many as well as the few.


Note: For more extensive discussions of the above matters, see:

Exhibit 1

A Proposed Policy Framework:
Establishing a School Improvement Policy Umbrella for
Addressing Barriers to Learning and Promoting Healthy Development

The figure below illustrates the notion that, from a policy perspective, all student/learning supports can be coalesced under a rubric such as addressing barriers to student learning. The resulting component is defined as a comprehensive system of learning supports designed to enable learning by addressing barriers. Once unified, the whole enterprise is in a better position to be recognized as a primary and essential component of an expanded policy for school improvement.

Exhibit 2

A Proposed Unifying Intervention Framework for Coalescing
a Comprehensive and Multifaceted Approach for the Many as Well as the Few

Given the need to coalesce an approach for the many as well as the few and given that the range of barriers to student learning is multifaceted and complex, reframing intervention efforts into a comprehensive and systemic approach is essential. Current descriptions of student/learning supports often amount to little more than itemizations of specific interventions and listings of various disciplines providing services.

One trend toward categorization has been to formulate a continuum of interventions. For example, a graphic some are using offers a pyramid-like triangle that outlines three tiers: "intensive interventions" (for a few), "supplemental interventions" (for some), and "universal interventions" (for all). Other formulations highlight a continuum encompassing prevention, early intervention, and treatment approaches. Still others emphasize a continuum encompassing an integrated set of intervention systems.

As those who follow our work know, we have called for formulation and operationalization of a comprehensive, multifaceted, and cohesive framework. The proposed framework delineates (1) an integrated and systemic continuum of interventions and (2) a multifaceted and cohesive set of content arenas. The continuum is conceived as an integrated set of three systems:

  • a system for promoting healthy development and preventing problems
  • a system for intervening early to address problems as soon after onset as is feasible
  • a system for assisting those with chronic and severe problems.
The continuum encompasses approaches for enabling academic, social, emotional, and physical development and addressing learning, behavior, and emotional problems and does so in ways that yield safe and caring schools. Such a range of interventions is intended to meet the needs of the many and the few and, properly implemented, should significantly reduce the number of students requiring individual assistance.

To enhance efforts across the continuum, pioneering work has begun to coalesce programs and services into a multifaceted and cohesive set of content arenas. In doing so, they have moved from a "laundry list" to a defined and organized way of capturing the essence of basic intervention domains. One example defines six content arenas. These encompass efforts to effectively:

  • Enhance regular classroom strategies to enable learning (i.e., improving instruction for students who have become disengaged from learning at school and for those with mild-moderate learning and behavior problems)
  • Support transitions (i.e., assisting students and families as they negotiate school and grade changes and many other transitions)
  • Increase home and school connections
  • Respond to, and where feasible, prevent crises
  • Increase community involvement and support (outreach to develop greater community involvement and support, including enhanced use of volunteers)
  • Facilitate student and family access to effective services and special assistance as needed.
Combining the continuum and the content arenas yields a 3 x 6 matrix that provides a unifying intervention framework to guide school improvement planning for developing a comprehensive and multifaceted system to address barriers to learning and teaching. This unifying framework facilitates mapping and analyzing the current scope and content of how a school, a family of schools (e.g., a feeder pattern of schools), a district, and the various levels of community address factors interfering with learning, development, and teaching.

This article was prepared by the School Mental Health Project/Center for Mental Health in Schools at UCLA. Comments can be sent to smhp@ucla.edu.

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