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Rates of mental health problems and disorders in children and youth have been increasing for at least three decades, and these have escalated due to the pandemic and multiple other societal stressors. It is increasingly recognized that students and families frequently struggle to receive needed care through traditional locations such as specialty mental health centers. Upstream mental health promotion and prevention strategies are gaining support as a public health approach to supporting overall population well-being, better utilizing a limited specialty workforce, and reducing illness. Based on these recognitions, there has been a progressive and escalating movement toward the delivery of mental health support to children and youth "where they are," with a prominent and more ecologically valid environment being schools. This paper will provide a brief review of the escalating mental health needs of children and youth, advantages of school mental health (SMH) programs in better meeting these needs, example model SMH programs from the United States and Canada, and national and international SMH centers/networks. We conclude with strategies for further propelling the global advancement of the SMH field through interconnected practice, policy, and research., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study reviews findings for the first randomized controlled trial (RCT) on the Interconnected Systems Framework (ISF) for school mental health (SMH) and Positive Behavioral Interventions and Supports (PBIS). Since its development in the late 2000s, the ISF has been supported by federally funded centers for SMH and PBIS, and, guided by a national workgroup, is being implemented in >50 communities in the United States. This experimental evaluation of the ISF involved an RCT implemented in 24 schools in two southeastern states, with the ISF implemented in eight schools, PBIS alone implemented in eight schools, and typically co-located PBIS+SMH implemented in eight schools. Related to very poor implementation, documented by two sources of fidelity data, two ISF schools were dropped from major analyses; hence, the study used a treatment on the treated (ToT; Rubin, 1974) as compared to a more traditional Intent-to-Treat approach (ITT; Lachin, 2000). This is the first paper from this large study, with emphasis here on proximal variables and school discipline. Within schools' multi-tiered systems of support (MTSS), ISF schools delivered more Tier 2 (early intervention) and Tier 3 (treatment) interventions to a greater proportion of students than the other two conditions by the second year of the intervention. There was also a dramatic difference in the provision of interventions by community mental health clinicians in ISF schools (almost half of interventions delivered) as compared to PBIS+SMH schools (around 3% of interventions delivered), underscoring the critical role of the ISF in integrating clinicians into MTSS teams and core school functions in SMH. As compared to the other two conditions, ISF schools also had reduced office discipline referrals (ODRs) and in-school suspensions, as well as reduced ODRs and out-of-school suspensions for African American students. Findings are discussed in relation to future directions of education-mental health system partnerships in improving the delivery and impact of SMH programs and services, demonstrated in the ISF., (Copyright © 2022 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.)

Schools and research partners are increasingly implementing complex, multicomponent interventions and school-wide frameworks to better meet students' social, emotional, behavioral, and academic needs; however, in the research and real-world contexts, implementation is often fraught with many challenges and barriers to success. This study explores implementation barriers encountered during a randomized controlled trial testing effects of one complex intervention strategy-the Interconnected Systems Framework-from the lens of a practical model for conceptualizing organizational readiness-the Interactive Systems Framework for Dissemination and Implementation. Implementation of the Interconnected Systems Framework was explored via focus group and key informant interviews with school and mental health professionals, and research team members responsible for implementing the intervention in randomly assigned study schools. Results from inductive thematic analysis of verbatim transcripts identified three primary implementation challenges: staff turnover, inadequate leadership buy-in, and insufficient time for training/planning. Each challenge is explored from interview participants' perspectives and the extant literature, then connected to recommendations from implementation science to help others avoid similar challenges in their well-intentioned efforts to address the mounting concern for students' wellbeing., (© 2022 Wiley Periodicals LLC.)

Background: Improving child and adolescent mental health requires states and jurisdictions to invest in school mental health efforts. In recent years, there has been notable expansion and improvement in school mental health services in the state of South Carolina related to a number of investments that are cumulatively promoting capacity building., Methods: This narrative overview examines the history of the school mental health movement in one southern state and details efforts by multiple key stakeholders that have coalesced to form a strong system for advancing school mental health., Results: Resting on a strong university-community partnership, five separate initiatives are described that together provide enhanced workforce training and support and expansion of school mental health services. Themes of this work are identified with a goal of supporting and advancing the development of school mental health systems in the United States., Conclusion: Strong collaborations and communication efforts both within the university setting and between partners in education and community settings, along with engaged funders keen to enhance well-being of children, youth, and families statewide have set the stage for the growth and expansion of school mental health services., (© 2020 Association for Child and Adolescent Mental Health.)

This study examined associations between teacher-student relationship quality at school and teachers' responsiveness to students' emotional concerns in a classroom and (a) students' intention to seek help at school for mental health concerns and (b) mental health-related service use. Data for analyses came from the School Mental Health Survey, a cross-sectional survey of 31,120 grade 6-12 students, in 1968 classrooms, attending 248 schools in Ontario, Canada. Three-level (student, classroom, school) binary logistic regression was used to address the study objectives. Student ratings of the quality of teacher-student relationships and teachers' responsiveness were included as predictors, both at the individual student level and aggregated to represent a contextual level characteristic at the school and classroom level, respectively. At the student level, both teacher-student relationship quality and teacher responsiveness were positively associated with intentions to seek help at school among both elementary and secondary students (ORs ranged from 1.14-1.19 for relationships and 1.06-1.08 for responsiveness). Aggregated to the school level, teacher-student relationship quality was positively associated with mental health service use for secondary students (OR = 1.36, 95% CI [1.10, 1.69]). Positive and responsive teacher-student relationships were associated with help-seeking behaviors among students. Longitudinal studies are warranted to disentangle the temporality of these associations., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.)

Background: Integrated healthcare delivered by work groups in nontraditional service settings is increasingly common, yet contemporary implementation frameworks typically assume a single organization-or organizational unit-within which system-level processes influence service quality and implementation success. Recent implementation frameworks predict that inter-organizational alignment (i.e., similarity in values, characteristics, activities related to implementation across organizations) may facilitate the implementation of evidence-based practices (EBP), but few studies have evaluated this premise. This study's aims examine the impact of overlapping organizational contexts by evaluating the implementation contexts of externally employed mental health clinicians working in schools-the most common integrated service delivery setting for children and adolescents. Aim 1 is to estimate the effects of unique intra-organizational implementation contexts and combined inter-organizational alignment on implementation outcomes. Aim 2 is to examine the underlying mechanisms through which inter-organizational alignment facilitates or hinders EBP implementation., Methods/design: This study will conduct sequential, exploratory mixed-methods research to evaluate the intra- and inter-organizational implementation contexts of schools and the external community-based organizations that most often employ school-based mental health clinicians, as they relate to mental health EBP implementation. Aim 1 will involve quantitative surveys with school-based, externally-employed mental health clinicians, their supervisors, and proximal school-employed staff (total n = 120 participants) to estimate the effects of each organization's general and implementation-specific organizational factors (e.g., climate, leadership) on implementation outcomes (fidelity, acceptability, appropriateness) and assess the moderating role of the degree of clinician embeddedness in the school setting. Aim 2 will explore the mechanisms through which inter-organizational alignment influences implementation outcomes by presenting the results of Aim 1 surveys to school-based clinicians (n = 30) and conducting semi-structured qualitative interviews. Qualitative data will be evaluated using an integrative inductive and deductive approach., Discussion: The study aims are expected to identify intra- and inter-organizational constructs that are most instrumental to EBP implementation success in school-based integrated care settings and illuminate mechanisms that may account for the influence of inter-organizational alignment. In addition to improving school-based mental health, these findings will spur future implementation science that considers the relationships across organizations and optimize the capacity of implementation science to guide practice in increasingly complex systems of care.

The No Child Left Behind Act of 2001 was signed into law by President George W. Bush in January 2002 and is regarded as the most significant federal education policy initiative in a generation. The primary focus of the No Child Left Behind Act is on promoting educational success for all children; however, the legislation also contains opportunities to advance school-based mental health. Unfortunately, the complexities of the provisions of the No Child Left Behind Act have made it difficult for educators, stakeholders, and mental health professionals to understand the legal and practical interface between No Child Left Behind and the school mental health movement. Therefore, the goals of this article are to (1) raise awareness about the challenges educators and school mental health professionals face as a result of the implementation of No Child Left Behind and (2) provide ideas and recommendations to advance the interface between No Child Left Behind and school mental health, which will support key provisions of the act and the growth of the field.

The supply of school mental health (SMH) providers and services cannot meet the demand of students in-need, and this gap is expected to widen in coming years. One way to increase the reach of helpful services for youth is to grow the SMH workforce through task-shifting to paraprofessionals. Task-shifting could be especially promising in expanding Motivational Interviewing (MI) interventions, as MI can be molded to target a number of academic and behavioral outcomes important to schools. However, no review of training exclusively paraprofessional samples in MI has yet been conducted. The current paper provides a scoping review of 19 studies of training paraprofessional providers to use MI to evaluate trainee characteristics, training content and format, and outcomes. Of these 19 studies, 15 reported that paraprofessionals improved in using MI following training. Nine studies reported that task-shifting MI was positively received by clients and/or providers. Six studies examined task-shifting MI in youth-serving contexts, and four examined the practice in traditional school contexts, suggesting its potential for use in SMH. Other findings and implications, such as client behavior change and provider fidelity, are shared, along with ideas for advancing research, practice, and policy in this subfield.

Despite a high dropout rate and poor educational and posteducational outcomes, limited evidence-based practices have been validated with students at the high school level who have emotional and behavioral problems. The purpose of this study was to evaluate the impact of a multitreatment, assessment-based intervention package. Participants were 647 high-school-age students with both emotional/behavioral problems and impairment in school functioning. Using a randomized controlled trial, the intervention group showed significantly fewer disruptions, measured using direct observation. No significant differences were found in directly observed engagement or on standardized measures. However, in general, interventions were implemented with low frequency. Dosage effects were examined for classroom interventions and a social skills intervention (Interpersonal Skills Group [ISG]). Results indicated a dosage effect for ISG, reflected in standardized measures. Although implementation was low, teachers and staff rated practices that they implemented highly favorably.

It is imperative that educators take a positive and preventive approach to support students and promote school safety. This article addresses the importance of identifying students who need additional mental health support and providing the highest quality support. These include best practices of emphasizing strength-based approaches, working with students and families as collaborators, integrating strategies into schools' multi-tiered systems of support, using data for decision making, implementing and refining evidence-based practices, and conducting ongoing evaluation. This article reviews specific examples of positive approaches to promoting student mental health funded by the National Institute of Justice Comprehensive School Safety Initiative. These real-world research initiatives provide examples of how multi-tiered systems of support for student mental health can serve as a mechanism to promote school safety.

In this article, we follow up on recommendations from the Division for Emotional and Behavioral Health (DEBH) for providing school mental health (SMH) services by offering additional implementation suggestions for teachers and school staff. We highlight the need for and urgency of SMH services, particularly during and after the pandemic, and also consider broad issues that interfere with the success of SMH. We then provide a number of specific recommendations for integrating the delivery of SMH services within a tiered system of supports that are intended to empower school staff to move toward implementation. Last, we address how effective implementation can be facilitated by strong administrative support along with capacity building.

Nearly 14% of all youth display disordered eating patterns. Despite the prevalence of these disorders, there is limited literature on the integration of eating disorder support services in schools. Further, there is often limited eating disorder knowledge and training for school mental health (SMH) professionals. This paper describes a two-phase study involving qualitative and quantitative components examining the perspectives of adolescents in recovery from eating disorders, family members, and SMH professionals. Fourteen participants were recruited from an eating disorder treatment facility in the southeastern USA. Eight adolescent females who received treatment for disordered eating while in primary or secondary school and six of their mothers completed interviews. In addition, 720 SMH and allied professionals were surveyed on their knowledge and training in disordered eating identification and intervention and their perspectives on service provision, with 561 complete and usable surveys. Analyses of adolescent and family data revealed the following themes that hindered or helped recovery: "Isolation," "Perfectionism," "Difficulties with Self-Acceptance and Comparison to Others," "Uncertainty," "Teacher Identification," "Support in Recovery." Themes surrounding the benefits of including SMH services for this population included: "Increased Awareness," "Support in Recovery," "Family Involvement," and "Linking to Resources." Results revealed that the majority of SMH professionals did not receive training in the identification and/or intervention of disordered eating. Data suggested that lack of referrals and limited knowledge, skills, and time interfered with their ability to effectively identify and intervene. Findings provide a foundation for understanding the experiences of adolescents with disordered eating and the role of SMH programs in assisting them.

South Carolina (SC) is a leading state for the delivery of comprehensive school mental health (SMH) services, involving mental health education system partnerships. Currently, more than 60% of SC schools include mental health clinicians from the state Department of Mental Health; there is a widely endorsed goal 100% of SC schools to have at least one SMH clinician within a few years. Leveraging SMH helps address the systemic barriers for youth access to behavioral health services, particularly the effects of federalism and segmentation of services. The present article will discuss background on the development of SMH in SC, major policy initiatives and communities of practice that are propelling the work forward, best practices, and guiding principles for addressing barriers related to youth behavioral health.

This study tested an integrated package for high-quality school mental health (SMH) services involving quality assessment and improvement, family engagement and empowerment, modular evidence-based practice, and implementation support. Within a two-year randomized controlled trial, 35 clinicians, who provided services to 529 students and their families, were randomly assigned to the enhanced quality assessment and improvement intervention condition and a comparison condition focused on promoting personal and staff wellness. Significant clinician-level findings were found for increased use and fidelity of evidence-based practices and greater use of structured assessments and sessions involving family members. Results are discussed in relation to needed methodological improvements in SMH treatment outcome research and increasing use of evidence-based practices by clinicians by adding accountability and incentives to training, coaching, and implementation support.

A recently defined interconnected systems framework (ISF) provides explicit guidance on steps to align positive behavioral interventions and supports (PBIS) and expanded school mental health (SMH) within the multitiered system of support (MTSS). As PBIS and SMH strategies align, there are opportunities to expand and improve effective programs and services for students at all tiers of the MTSS. A prominent need is to improve programs and services for students presenting "internalizing" disorders such as those related to trauma, depression, and anxiety. In this article, we discuss relevant issues involved in improving multitiered systems/interventions for students presenting internalizing problems and provide guidance for this work in dimensions of cross-system collaboration (with major emphasis on effective teams), implementing evidence-based practices, and data-based decision making/quality improvement. The article concludes with recommendations for practice, research, and policy to improve MTSS for students presenting internalizing problems.

This article reviews the development of the Southeastern School Behavioral Health Community (SSBHC), which began in 2013 to bring coherence to the school behavioral health (SBH) agenda in South Carolina and has since expanded to become a regional effort in the southeastern United States. The term SBH is used to convey community mental health systems joining with schools and school mental health (SMH) providers such as school psychologists to strengthen the depth and quality of programs and services within a multi-tiered system of support (MTSS). The article provides background on the interconnected systems framework (ISF), focused on effectively joining SMH and MTSS; reviews the history of the SSBHC; and discusses its work to date and plans for the future, including an emphasis on school safety and violence prevention.

Despite schools increasingly adopting multitiered systems of support (MTSS) for prevention and intervention of mental health concerns, many are slow to adopt universal mental health screening (UMHS), a core MTSS feature, due to concerns about their limited capacity to meet the needs of all identified. In this study, we examined differences in the number and characteristics of students who would be identified for intervention services when UMHS in an MTSS were added to those students already receiving social, emotional, and behavioral supports. In a sample of 3,744 students in Grades 1 to 5 from six schools, 679 (18.1%) additional students were identified by screening, representing a 180.1% increase in students identified with behavioral risk or need for mental health interventions. Using a series of stepwise logistic regression analyses, we identified significant predictors of newly identified students including gender, number of office discipline referrals, and externalizing, internalizing, and adaptive behavior ratings. Findings are discussed in relation to opportunities for prevention and the systems needed in an MTSS to meet the needs of newly identified students.

All four authors of this article are active in the movement toward more comprehensive school mental health (SMH) services involving community mental health staff joining school employees to increase the depth and quality of programs and services within the multitiered system of support (MTSS; Garbacz, 2019; Mellin & Weist, 2011; Weist, Lever, Bradshaw, & Owens, 2014). They represent disciplines of clinical psychology (MW), school counseling (EM), school psychology (AG), and social work (DAB), and they each have had concerns about problematic language that is used in SMH and in the broader field of mental health services for children and adults. The pervasive use of negative labels and pejorative language in child, adolescent, and school mental health systems increases stigma and reduces utilization of services that may help promote mental well-being. The authors argue that the SMH field must lead efforts to reduce the use and negative impact of language that stigmatizes students.

All around the world, partnerships among schools and other youth-serving systems are promoting more comprehensive school-based mental health services. This article describes the development of international networks for school mental health (SMH) including the International Alliance for Child and Adolescent Mental Health and Schools (INTERCAMHS) and the more recent School Mental Health International Leadership Exchange (SMHILE). In conjunction with World Conferences on Mental Health Promotion, SMHILE has held pre-conference and planning meetings and has identified five critical themes for the advancement of global SMH: 1) Cross-sector collaboration in building systems of care; 2) meaningful youth and family engagement; 3) workforce development and mental health literacy; 4) implementation of evidence-based practices; and 5) ongoing monitoring and quality assurance. In this article we provide general background on SMH in four nations, two showing strong progress (the United States and Canada), one showing moderate progress (Norway), and one beginning the work (Liberia). Following general background for each country, actions in relation to the SMHILE themes are reviewed. The article concludes with plans and ideas for future global collaboration towards advancement of the SMH field.

Positive behavioral interventions and supports (PBIS) and school mental health (SMH) are prominent initiatives in the United States to improve student behavior and promote mental health and wellness, led by education and mental health systems, respectively. Unfortunately, PBIS and SMH often operate separately in districts and schools, resulting in a number of missed opportunities for interconnecting programs and services and increasing their depth and quality within multi-tiered frameworks of prevention, support, and intervention. The current article details a necessary first step in the process of improved interconnection of these two frameworks by describing the development of a process and tool for schools/districts to assess readiness for connecting PBIS and SMH through a blended system. Relevant literature, pilot data, and methodology are discussed, in addition to psychometric properties of the survey and future applications of this instrument for practice, research, and policy.

This article presents the psychometric properties of the Expanded School Mental Health Collaboration Instrument [Community Version], a measure for assessing collaboration from the perspective of community-based mental health professionals working in schools. A three-scale instrument (Types of Collaboration, Influences on Collaboration, and Perceived Benefits of Collaboration) was developed based on findings from focus group interviews and a review of the literature. This instrument complements an existing measure of collaboration that considers the perspectives of school professionals involved in expanded school mental health (ESMH). Exploratory factor analyses were used to define a set of factors for each of the three scales. Preliminary psychometric examination suggests this is a promising instrument that should be studied further. Implications for ESMH practitioners and researchers are proposed.

School mental health (SMH) programs are gaining momentum and, when done well, are associated with improved academic and social-emotional outcomes. Professionals from several education and mental health disciplines have sound training and experiences needed to play a critical role in delivering quality SMH services. School psychologists, specifically, are in a key position to advance SMH programs and services. Studies have documented that school psychologists desire more prominent roles in the growth and improvement of SMH, and current practice models from national organizations encourage such enhanced involvement. This article identifies the roles of school psychologists across a three-tiered continuum of SMH practice and offers an analysis of current training and professional development opportunities aimed at such role enhancement. We provide a justification for the role of school psychologists in SMH, describe a framework for school psychologists in the SMH delivery system, discuss barriers to and enablers of this role for school psychologists, and conclude with recommendations for training and policy. (Contains 2 figures.)

Interdisciplinary collaboration (IC) is a critically important theme generally, and of particular significance in school mental health (SMH), given the range of people from different disciplines who work in schools and the various systems in place. Reflecting the move to a true shared school-family-community system agenda, the collaborative context in schools includes school-employed mental health professionals (e.g., school psychologists, school counselors, school social workers), health professionals (e.g., school nurses, speech pathologists), special and general educators, collaborating mental health professionals from the community, school administrators, families and family advocates, resource staff, and others. Notably, as SMH is becoming an increasing force in the United States and in other countries, an expanded approach is being emphasized with community professionals joining those in schools to augment the work that is occurring, increasing the likelihood that community mental health will actually reach youth and families and that typically underresourced schools receive enhanced resources and support to offer the full intervention continuum of mental health promotion. In this article, a diverse team of professionals (early career psychologists, a social worker, a special educator, and faculty in psychology and special education) working on implementing a large-scale study presents study background and themes related to IC as the study plays out. First, the authors describe their interdisciplinary team's collaborative approach toward implementing a multicomponent mental health and classroom intervention package for high school youth with social, emotional, and behavioral disabilities (EBD) and their families. They then discuss obstacles in sustaining ICs with schools and present strategies for overcoming them.

This article provides background on school mental health (SMH) programs in Baltimore and efforts to integrate evidence-based preventive interventions into the schools served by these programs. We describe the triangular model of SMH promotion, building at the base from environment and relationship enhancement, followed by universal and selective prevention, efforts taken at each of these levels, challenges experienced, and ideas for overcoming challenges. The agenda to integrate evidence-based preventive interventions into schools offers much promise for improving valued outcomes for students and schools. This is a difficult agenda, however, with many dimensions, including program infrastructure, training, building and sustaining school administrator and staff support, and addressing competing contingencies and tendencies toward drift. Better linkage between SMH, prevention science, and implementation science is called for. (Contains 1 footnote and 1 figure.)

Background: This article discusses the importance of screening students in schools for emotional/behavioral problems. Methods: Elements relevant to planning and implementing effective mental health screening in schools are considered. Screening in schools is linked to a broader national agenda to improve the mental health of children and adolescents. Strategies for systematic planning for mental health screening in schools are presented. Results: Mental health screening in schools is a very important, yet sensitive, agenda that is in its very early stages. Careful planning and implementation of mental health screening in schools offers a number of benefits including enhancing outreach and help to youth in need, and mobilizing school and community efforts to promote student mental health while reducing barriers to their learning. Conclusions: When implemented with appropriate family, school, and community involvement, mental health screening in schools has the potential to be a cornerstone of a transformed mental health system. Screening, as part of a coordinated and comprehensive school mental health program, complements the mission of schools, identifies youth in need, links them to effective services, and contributes to positive educational outcomes valued by families, schools, and communities.

On the basis of activities of a federally funded national center for school mental health, review of literature on principles for best practice in child and adolescent mental health and school health, and consultation with national experts and family members, a set of 10 principles for best practice in school mental health was developed. A survey was developed enabling 1-6 point Likert ratings ("clearly unimportant" to "clearly important") for each of the 10 principles. With an original sample of 426 people involved in education, school health or mental health, all 10 principles were strongly endorsed, receiving mean ratings ranging between 5.10 and 5.75. On the basis of qualitative feedback from this survey and interactive forums, language for 9 of the 10 principles was revised and a survey reflecting these changes was developed and administered to a validation sample of 86 respondents. As with the original sample, endorsements of the principles were strong, with mean ratings ranging between 5.45 and 5.79. Findings are discussed in relation to advancing interconnected agendas related to quality assessment and improvement and empirically supported practice in school mental health.

Assessed the feasibility of the Australian MindMatters program, a whole school mental health promotion program for application in the United States (U.S.). Forty-two participants representing school and community stakeholder groups from four U.S. communities (urban, rural, suburban, small town) evaluated the program for application in their communities through a research process involving discussion and endorsement ratings of relevance and likely impact. The majority of participants (85%) indicated that the program would help students in their community schools feel safe and valued, and participants indicated strong endorsement for MindMatters curriculum units focusing on suicide prevention and addressing bullying and harassment. Participants rated their own stakeholder group (e.g., teacher, school administrator, and parent) as being most likely to support and implement the program, suggesting that providing qualitative feedback on a program may help to increase a sense of ownership over it. Ideas for tailoring programs developed in other settings for application in local communities are discussed.KEY WORDS: MindMatters; teacher; school administrator; prevention.

The Center for School Mental Health Assistance at the University of Maryland recently completed a review of evidence-based prevention and treatment programs that can be used by school mental health clinicians. Based on the review, a school-based program operating in 22 Baltimore City schools has purchased and trained clinicians in a number of protocols for evidence-based interventions. We present findings from this review and make pragmatic recommendations for school mental health programs to overcome the challenges associated with the use of evidence-based interventions.KEY WORDS: evidence-based prevention; treatment programs; school mental health.

Reviews the need for and development of expanded school mental health (ESMH) programs, which provide a continuum of mental health promotion and intervention through school-community partnerships. Since ESMH is a relatively new, but increasingly prominent field, countless issues are being addressed in practice and research and in efforts to bridge practice and research. We review particular content and context dimensions of ESMH in need of development including quality assessment and improvement, empirically supported practice, improving assessment and outcome evaluation, involving educators in the work, understanding school environments, and tailoring programs through qualitative research. Summaries of articles that amplify these themes are provided.KEY WORDS: expanded school mental health; health care; quality assessment and improvement.

A survey was made of the leaders in the Latino community from four East coast cities on the mental health, academic, and behavioral needs of Latino youth, services available to them, and recommendations to better address their needs. Of the 112 Latino leaders recruited, 46 responded to the survey, expressing their views that Latino youth experience significant stress in the United States, present behavioral and academic adjustment problems, and generally have difficulty accessing appropriate services and resources. Programs for these youth were presented as limited in number and lacking in cultural sensitivity. Community leaders endorsed the development of comprehensive and culturally sensitive programs for Latino youth in schools that address their psychosocial and academic needs.

School mental health programs are increasingly prominent in the United States and in other countries, but funding remains tentative. This article describes a partnership between a school mental health program and an outpatient mental health center, and considers the larger goal of promoting sustainability and increasing revenue. Issues related to using fee-for-service revenue to support school mental health are explored, and strategies for promoting effective partnerships are discussed. Recommendations for programs facing the challenge of incorporating fee-for-service activities into their current model of service provision are provided.

The promotion of evidence-based practice (EBP) has become a dominant discussion in mental health and education, and in school mental health, which reflects attempts to integrate these (and other) systems. Research in this area is advancing, and there are increasing examples of school-based programs built on scientific findings of effectiveness. The work remains in the very early stages, and there is a tendency to view the challenge simplistically. In their article, Mattias Elias et al. (2003) forcefully articulated the full array of challenges that will be confronted in moving toward EBP in schools, with the most significant challenges being at the paradigmatic level. In this commentary, the author expands on two of the Elias et al. article's prominent themes. These themes include: (1) Bridging the vision-reality gap between implementation of social and emotional learning programs in schools and the reality of the school setting; and (2) Promoting paradigmitic change. (Contains 1 table.)

Describes an expanded school mental health framework and its goal of improving the mental health status of children and adolescents through collaboration. Addresses current challenges including building advocacy, improving funding, increasing capacity, enhancing quality, and using and expanding the evidence base for mental health in schools. (SD)

Explores the response of school mental health to terrorism and disaster, reviewing literature on child and adult reactions to trauma, discussing the development of crisis response teams, and presenting strategies for schools to respond to crises and disaster. One elementary school's experiences in response to the September 11th attacks are presented, noting challenges facing school mental health programs in improving their ability to respond to significant crises. (Contains references.) (SM)

Describes School Health Policies and Programs Study 2000 findings about state- and district-level policies and practices related to mental health and social services issues (organization, staffing, and facilities; required services; school based health clinics and services at other sites; professional preparation; collaboration; and evaluation); also addressing mental health and social services provided by schools and related school practices. (SM)

Describes the expanded school mental health (ESMH) programs that have developed over the past decade. These programs augment existing services provided by schools and help assure that a comprehensive range of services (assessment, prevention, case management, and treatment) are available to youth in special and regular education. Shares experiences associated with the growth of ESMH programs in Baltimore. (Author/JDM)

Provides suggestions for phases and objectives for quality assurance (QA) programs in expanded school mental health programs. Suggests that important QA activities include examining staff training activities, assessment of stakeholder perceptions of services, conducting satisfaction surveys, examining therapy process, and investigating treatment outcomes. Results of QA evaluations should be used to inform policy and enhance quality of care. (Author/JDM)