Student Mental Health Needs and Academic Achievement
When assessing the need for school-based mental health services, it is critical to consider the prevalence of mental health issues among children and adolescents. It is estimated that, in any year, about 5% of elementary school-aged children will experience moderate to severe emotional, behavioral, or developmental difficulties (Ghandour, Kogan, Blumberg, Jones, & Perrin, 2012). Even more alarming, approximately one out of every four youth between the ages of 5 and 18 in the United States have had a mental health condition during the last year, and one out of every three are anticipated to experience at least one mental health concern during the course of their lifetime (Merikangas, Nakamura, & Kessler, 2009). Some mental disorders, in particular generalized anxiety disorder and depression, commonly emerge in individuals as early as middle childhood (Merikangas et al, 2009; National Institute of Mental Health [NIMH], 2011).
A variety of individual and environmental characteristics may place a child at risk of developing mental health challenges. Individual-level factors including poor physical health, lower cognitive functioning, pre- or perinatal exposure to illness or harmful chemicals, and inadequate nutrition are predicted to increase the likelihood of developing mental health issues (Merikangas et al., 2009). In addition to individual characteristics, contextual factors in a child's environment also may increase the probability of developing a mental health condition. Experiences of family stress, trauma, neighborhood violence, and challenges deriving from low socioeconomic status during early childhood all may reduce the cognitive and socioemotional wellbeing of children, making them more susceptible to developing symptoms and exhibiting signs suggesting the presence of mental health problems (Merikangas et al.).
Despite the signs and symptoms of mental health conditions and a growing body of literature substantiating the prevalence of mental health conditions among children and adolescents (Committee on School Health, 2004; Merikangas et al., 2009), the majority of youth with mental disorders still do not receive adequate treatment or any treatment at all (Ghandour et al., 2012; Merikangas et al., 2009; Weissberg, 2000). Untreated mental health needs can have serious negative consequences on the life outcomes of children, increasing a child's probability for experiencing challenges across numerous life domains, including having greater difficulty in performing well academically.
Students who have not received adequate treatment to address their mental health conditions are at greater risk of experiencing various negative outcomes academically. According to the Center of Disease Control and Prevention, almost 10% of school-aged children were limited in their ability to perform academic tasks appropriate for their age group due to mental or emotional problems (Joe, Joe & Rowley, 2009). More specifically, untreated symptoms of mental disorders like Attention Deficit/Hyperactivity Disorder (ADHD), anxiety, and depression may affect concentration, comprehension, and communication skills, all of which may influence a student's ability to perform at the same level as his or her peers (Bussing, Porter, Zima & Mason, 2012). In addition to cognitive milestones and ability to focus in the classroom, untreated mental health conditions may also have negative impacts on more basic aspects of academic performance, including school enrollment, rates of absenteeism, school completion, and future educational attainment (Duchesne, Vitaro, Larose & Tremblay, 2008; Guzman, Jellinek, George, & Hartley, 2011; Joe et al., 2009). When facing these various threats to school success, students are likely to achieve lower scores in reading and demonstrate less fluency in reading, writing, and language (Bussing et al., 2012; Corkum, McGonnell, & Schachar, 2010; DeSocio & Hootman, 2004; Geary, Hoard, Nugent, & Bailey, 2012; Guzman et al., 2011).
Students who struggled with learning in early grades may have difficulty acquiring the basic skills necessary for the development of higher reading skills (Breslau et al., 2009; Geary et al., 2012). This may be further exacerbated as higher academic demands are placed on students with the progression through grade levels (Breslau et al., 2009). With the transition from primary schooling to higher grade levels, students with unmet mental health needs are at risk for other consequences of academic difficulties including lower high school grade-point-averages (GPA), higher retention rates, and greater probability of high school noncompletion or dropout (Bussing et al., 2012; DeSocio & Hootman, 2004; Guzman et al., 2011). Unfortunately, the persistence of academic failure in youth carries even greater negative consequences as adolescents transition into adulthood and unmet mental health needs hinder postsecondary educational attainment (Breslau et al., 2009).
Promoting Academic Success through School-Based Mental Health: A Multi-System Approach
Schools have a unique opportunity to meet the mental health needs of students through early intervention (Merikangas et al., 2009). Teachers spend five days per week with students providing school staff the ability to detect changes in the behavior, academic performance, attention, and engagement in the classroom in students and respond to them early on (Atkins, Hoagwood, Kutash, Seidman, 2010; Nemeroff et al., 2008). Schools also have specialists such as school psychologists, counselors, social workers, special education coordinators, and nurses on site who can provide services (Green et al., 2013; George et al., 2014). Lastly, schools have the benefit of using existing assessments that can be employed to measure the effectiveness of mental health services on student academic outcomes, such as standardized tests, report cards, and attendance records. These tools, in combination with the skills and knowledge of school personnel, provide strong support for the implementation of mental health services in this setting.
The SBS approach is based on a multi-system partnership between a school district, local mental health management entity (LME), and a local university in the Southeast region of the United States (Powers, Edwards, Blackman, & Wegmann, 2013). Initially, a school-based health center (SBHC) approach was considered, in which primary health and mental health care services are provided in clinical settings located in schools (Guo, Wade, Pan, & Keller, 2010). SBHCs have demonstrated numerous improvements to children's health, mental health, and general quality of life, including increased access to mental health care and narrowing of racial/ethnic disparities in access to care (Guo, Wade, & Keller, 2008; Guo, Wade, Pan, & Keller, 2010). Although SBHCs are associated with lowered health care and mental health care costs over time (Guo, Wade, & Keller, 2008), there are high costs associated with establishing and maintaining SBHCs. For example, it was estimated that operating seven SBHCs in Cleveland, OH cost $1,382,260 over a three-year period (Guo, Wade, Pan, & Keller, 2010). Despite the demonstrated success of SBHCs, the costs necessary to implement the approach were infeasible within the resource limits of the partnership.
The School-Based Support (SBS) Program was developed to improve student access to quality mental health care while keeping costs at a reasonable level. Formed in July of 2010, program creators adopted a Systems of Care (SOC) approach to promote the coordination of community-based services for meeting the needs of students and their families through the provision of comprehensive mental health services (Powers et al., 2013; Powers, Bower, Webber, & Martinson, 2011; Wegmann, Blackman, & Powers, 2013). In this collaborative partnership, the school district provided access to students and locations for the intervention, the LME provided expertise and mental health services, and the local university offered initial grant funding, training, and ongoing program evaluation (Powers et al., 2013). With a central focus on recognizing and addressing the unmet mental health needs of youth, the SBS program aims to "improve the academic trajectories and long-term prospects of students with mental health problems" (Wegmann, Blackman, & Powers, 2013, pp. 298).
The intervention revolves around placing SBS teams in six elementary schools identified as program sites. The SBS teams consist of three newly hired staff members; the SBS program manager, parent liaison and school psychologist. The program managers, all of whom are mental health professionals holding a Master of Social Work degree, provide direct services and case management to youth and their families. The SBS parent liaison's role is to strengthen the partnership between the home and school environments by conducting home visits, developing individualized behavioral plans with teachers and parents, and organizing...