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Schools are well positioned to facilitate early identification and intervention for youth with emerging mental health needs through universal mental health screening. Early identification of mental health concerns via screening can improve long-term student development and success, but schools face logistical challenges and lack of pragmatic guidance to develop local screening policies and practices. This study summarizes mental health screening practices tested by six school districts participating in a 15-month learning collaborative. Qualitative analysis of 42 Plan-Do-Study-Act cycles revealed that districts tested quality improvement changes across seven screening practice areas, with all teams conducting at least one test to: 1) build a foundation; and 2) identify resources, logistics and administration processes. Quantitative data indicated that the average percentage of total students screened increased from 0% to 22% (range = 270 – 4,850 students screened at follow-up). Together, these results demonstrate how school districts not currently engaged in mental health screening can apply small, specific tests of change to develop a locally-tailored, practical and scalable process to screen for student mental health concerns. Lessons learned are provided to inform future directions for school-based teams.

School nurses play a key role in supporting student mental health, and many school nurses report the need for additional mental health education. The Mental Health Training Intervention for Health Providers in Schools (MH-TIPS) is a training and implementation support system for school nurses to enhance their skills in promoting student mental health. The current study evaluated the feasibility of the MH-TIPS online curriculum for school nurses, and its impact on their preparedness and ability to support student mental health. Participants included 1,282 registered nurses and nurse practitioners. Descriptive statistics indicated that MH-TIPS online was feasible, relevant, and accessible for school nurses and helped them support student mental health. School nurses reported significant improvements in their preparedness to conduct brief mental health interventions with students and motivate students to seek help. MH-TIPS online is a promising tool to increase the ability of school nurses to support student mental health.

There are racial and ethnic disparities in use of out-of-school suspensions within the United States. The present study assessed for the presence of disproportionate suspension by race, special edu...

Multidisciplinary teams of school- and community-employed mental health, health, and educational staff work together in schools to offer a full continuum of mental health promotion, prevention, early intervention, and treatment services and supports. Intentional teaming structures and practices are essential to ensure teams deliver effective, coordinated services and supports. The current study investigated the extent to which continuous quality improvement strategies improved school mental health team performance during a 15-month national learning collaborative for 24 school district teams. All teams significantly improved their average teaming performance from baseline to the end of the collaborative (t(20) = −5.20, p < .001). Plan-Do-Study-Act (PDSA) cycles allowed teams to rapidly evaluate specific quality improvement changes to improve their performance. Teams with the most improvement focused on increasing multidisciplinary team membership, avoiding duplication and promoting efficiency, and connecting to community mental health providers/resources.

Learning collaboratives (LCs) have often been used to improve somatic health care quality in hospitals and other medical settings, and to some extent to improve social services and behavioral health care. This initiative is the first demonstration of a national, systematic LC to advance comprehensive school mental health system quality among school district teams. Twenty-four districts representing urban, rural, and suburban communities in 14 states participated in one of two 15-month LCs. Call attendance (M = 73%) and monthly data submission (M = 98% for PDSA cycles and M = 65% for progress measures) indicated active engagement in and feasibility of this approach. Participants reported that LC methods, particularly data submission, helped them identify, monitor and improve school mental health quality in their district. Qualitative feedback expands quantitative findings by detailing specific benefits and challenges reported by participants and informs recommendations for future research on school mental health LCs. Rapid-cycle tests of improvement allowed teams to pursue challenging and meaningful school mental health quality efforts, including mental health screening in schools, tracking the number of students receiving early intervention (Tier 2) and treatment (Tier 3) services, and monitoring psychosocial and academic improvement for students served.

Schools across the United States are struggling with how to formulate comprehensive and effective programs to address the mental health needs of students and to promote school safety. This study, funded as part of the National Institute of Justice Comprehensive School Safety Initiative, employed a randomized controlled study design to evaluate the impact of a multi-component package of crisis prevention and response interventions on school safety and discipline outcomes, including suspensions, office discipline referrals, bullying reports, juvenile justice referrals, threat assessments, and follow-up procedures. Forty schools participated, all in a culturally diverse Mid-Atlantic, US school system spanning urban, suburban, and rural areas. The Emotional and Behavioral Health-Crisis Response and Prevention (EBH-CRP) intervention is a comprehensive training, organizational, and support protocol for school and community stakeholders aimed at increasing competence in preventing and responding to student EBH crises using multiple evidence-informed strategies that address emotional and behavioral health concerns across the continuum of supports. Results indicate that the EBH-CRP intervention had a significant positive effect on suspensions, office discipline referrals, and juvenile justice referrals for secondary schools. In addition, the intervention had positive effects on the number of bullying reports overall, with a particularly strong impact on primary schools. The intervention also had positive effects in maintaining more use of threat assessment and follow-up procedures. Although the intervention had a significant positive effect on secondary school-level suspensions, there was no impact on racial/ethnic disproportionality rates for this outcome. Implications for school safety prevention are discussed.

Teachers are integral to addressing children's mental health needs in schools, and they are often members of child-serving teams focused on school mental health. Still, teachers report limited training in mental health and behavior management in the classroom. This study used content analysis procedures to examine state K-12 teaching standards in the United States to understand the extent to which standards reflected teacher competencies for school mental health. Results revealed that all states included content on school mental health, yet the content and extent of the content varied considerably across the country. Implications are suggested for teaching policy, practice, and training.

Education and primary care sectors have been called upon to attend to shortages in access to mental health services among children and adolescents. In response, these settings have increasingly attempted to address this need, though research exploring such collaborative efforts remains limited. The current special issue features research examining collaborations between school and paediatric primary care settings, bringing original research and clinical examples to bear on partnerships which leverage opportunities to improve access to high-quality mental health care. Articles in this special issue underscore the positive youth outcomes associated with effective collaboration across these systems and augment the literature describing innovative and successful approaches to this work. Further, articles in this issue identify barriers to collaborative efforts and present opportunities for future research and practice.

School nurses encounter many students presenting with mental health needs. However, school nurses report that they need additional training and resources to be able to support student mental health. This study involved a multilevel, stakeholder-driven process to refine the Mental Health Training Intervention for Health Providers in Schools (MH-TIPS), an in-service training and implementation support system for school health providers, including school nurses, to increase their competence in addressing student mental health concerns. Findings highlighted the importance of mental health content including assessment, common factors of positive therapeutic mental health interactions, common elements of evidence-based mental health practice, and resource and referral mapping. Additionally, multifaceted ongoing professional development processes were indicated. Study findings indicate that, with recommended modifications, the MH-TIPS holds promise as a feasible, useful intervention to support school nurse practice and ultimately impact student mental health and educational outcomes.

School nurses play a critical role in the provision of mental health services in the school environment and are valuable members of the coordinated student mental health team. They possess expertise to navigate in today's complicated educational and health care systems, and it is estimated that school nurses spend 33% of their time addressing student mental health issues. Despite their role and expertise, school nurses are often not recognized as part of the school mental health team and, thus, their role in student mental health care and the full collaboration and coordination with other education and mental health professionals in the school has yet to be fully realized. This article reviews school nurse mental health expertise, models of mental health service provision, and current mental health practices as reported by national stakeholders. In addition, it highlights school nurse barriers and additional training needs related to student mental health care and provides concrete recommendations for building strong collaborations between school nurses and other education and mental health professionals to support student mental health.

Evidence-based assessment (EBA) has been shown to improve clinical outcomes, but this practice is frequently not implemented in school mental health practice. This article reviews potential barriers to implementation and offers practical strategies for addressing these challenges. Several valid and reliable tools for assessment are reviewed, and information is provided on clinical use. Case examples of EBA implementation in school mental health settings are provided to illustrate how these tools can be used in everyday practice by school mental health clinicians.

Hierarchy development is an integral component of graded exposure therapy for anxiety disorders. A hierarchy, often referred to as a “fear ladder” (e.g., Kendall & Hedtke, 2006), is a list of anxiety-provoking situations, or stimuli that a child avoids, organized in order of increasing difficulty. Hierarchies can take numerous forms, such as a written list, drawing of a ladder (e.g., Kendall & Hedtke, 2006), picture of a pyramid, or a map of different sized “islands” based on the level of anxiety provoked by each situation (e.g., March & Mulle, 1998). The hierarchy is developed in the beginning sessions of therapy and is used as an assessment tool to aid in case conceptualization and treatment planning. Hierarchies are also guides for determining graduated exposure or desensitization exercises to conduct in therapy.