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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.

A growing interest has been given to examining the heterogeneity of children's health to provide for their particular needs. This study examined subgroups of elementary school children's social, emotional, and behavioral functioning (SEB) using teacher ratings of children with the Behavioral and Emotional Screening System. A Latent Profile Analysis (LPA) was conducted with 5,150 students aged from kindergarten to fifth grade. Subscale scores in the areas of externalizing risk, internalizing risk, and adaptive skills risk were used to identify profiles. Students' grade level, sex, race, and status of receiving special education services were added to investigate the impact of covariates on the classification of latent profiles. Four profiles of risk were identified: Well Development (60.5%), Normal Development (25.8%), Externalizing and Adaptive Skills Risk (9.1%), and Elevated Risk (4.6%). Significant differences of covariates including sex, race, and status of receiving special education services were identified. Specifically, males and African American students were more likely to be classified into the "Elevated Risk" profile than other profiles. Students who did not receive special education services were more in the "Well Development" profile. The results may have important implications for the stakeholders to allocate intervention and treatment resources effectively and accurately.

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.

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.

"Put on your oxygen mask first, then you can help those around you." This common recommendation for managing stressors and well-being requires that we first take care of ourselves before we can begin to help others. This sentiment assumes a preexisting system that drops an "oxygen mask" for someone to access when in distress or crisis. What happens if the oxygen masks aren't dropping? What happens if your level of distress means you need help "putting on your own oxygen mask?" Who would come to your aid? School psychologists are well-positioned in schools and districts to work with leadership teams to support organizational changes in policies, practices, and systems to meet staff needs that reflect teacher preferences for well-being initiatives. Using positive behavioral interventions and supports provides school psychologists and educators with an efficient, effective method for instituting organizational change to deliver the oxygen needed to support and maintain a healthy workforce.

Peer victimization is a widespread and heterogeneous phenomenon, especially during the transition to middle school, and is associated with numerous negative consequences. However, previous research is limited by variable-centric analyses and data manipulations that either fail to capture or mask the complexity of peer victimization many students experience. We used person-centered analyses with continuous variables to detect patterns of peer victimization in a longitudinal sample from Grades 4 (n = 1,349), 5 (n = 1,352), and 6 (n = 1,098). We found five distinct profiles varying by victimization severity (i.e., none, some, pervasive) and form (i.e., relational, verbal, and physical) in each grade level. Female students and Black/African American students experience greater relational victimization during the middle school transition than their male or White peers, respectively, while students with disabilities experience all forms of victimization at greater levels than their non-disabled peers. Study limitations, future research, and practice implications are discussed, including the need for culturally responsive and victimization form-specific prevention and intervention strategies.

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.

As schools increasingly implement multitiered systems of support, there is a pressing need to develop psychometrically sound implementation fidelity measures. The interconnected systems framework (ISF) is a multitiered model blending systems of positive behavioral interventions and supports with promotion, prevention, and intervention strategies of school mental health. The ISF is being implemented in communities across the United States with ongoing evaluation in several randomized controlled trials. The ISF-Implementation Inventory (ISF-II) was developed to measure fidelity of the ISF within a school building. We conducted a national validation study including completion of the ISF-II by 398 educators in 49 schools, 16 school districts, and 9 states. Results indicate the ISF-II produces scores that are internally consistent and structurally valid when items are organized into a three-tiered model. Additionally, the ISF-II was rated as feasible, acceptable, and beneficial. Limitations of the study, including the need for additional psychometric testing, are discussed in light of these results that suggest educators and researchers, alike, should feel confident in using the ISF-II as a measure of ISF implementation quality.

This study examined the relational factors influencing school engagement for parents of high school youth with emotional/behavioral disorders. Fourteen parents of high school students (12 mothers, two fathers) who received special education services participated in semistructured interviews. Formal qualitative analyses of audiotaped phone interviews revealed some positive and some negative experiences by parents, the importance of coparenting to increase supportiveness to their child (and dimensions of effective coparenting), and recommendations from them for improving family engagement processes. In general, parents appreciated and recommended proactive and positive communication and collaboration with school staff emphasizing student strengths, being genuinely and meaningfully involved in the Individualized Education Program (IEP) process, with adequate time allowed for this involvement, and for staff to be organized and engaged in working with them. Findings are discussed in relation to ideas for practice and policy enhancement, and future research directions.

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.

Counseling self-efficacy (CSE), defined as one's beliefs about his or her ability to effectively counsel a client, is an important precursor of effective clinical practice. While research has explored the association of CSE with variables such as counselor training, aptitude and level of experience, little attention has been paid to CSE among school mental health (SMH) practitioners. This study examined the influence of quality training (involving quality assessment and improvement, modular evidence-based practices, and family engagement/empowerment) versus peer support and supervision on CSE in SMH practitioners, and the relationship between CSE and practice-related variables. ANCOVA indicated similar mean CSE changes for counselors receiving the quality training versus peer support. Regression analyses indicated that regardless of condition, postintervention CSE scores significantly predicted quality of practice, knowledge of evidence-based practices (EBP) and use of EBP specific to treating depression. Results emphasize the importance of CSE in effective practice and the need to consider mechanisms to enhance CSE among SMH clinicians.

Mental health literacy (MHL) programs, which aim to improve knowledge, reduce stigma and promote help-seeking behavior, are a promising approach to meeting the growing mental and behavioral health needs of youth. This study aimed to understand the relational impacts of a MHL curriculum on students and teachers. A MHL curriculum was delivered in middle school classrooms across 11 schools in two diverse school districts in the Mid-Atlantic and Southeast regions. Fifteen teachers and counselors who delivered the MHL curriculum participated in focus groups to describe their experiences using the curriculum and perceptions of its impact. Qualitative focus group data were analyzed via team-based inductive thematic analysis following a grounded theory approach. Findings indicate that educators perceived the universal school MHL program to have a positive impact on relationships amongst students and between students and teachers. Participants reported that the MHL curriculum helped to open conversations about mental health and related topics by developing common language and providing an opportunity to model vulnerability. Having these conversations improved classroom rapport and helped teachers develop deeper connections with students. As a result, teachers and students achieved greater empathy and students advocated more for themselves and their peers. Implications for integrating MHL programs into multi-tiered frameworks in schools to expand access to mental health supports are discussed. [ABSTRACT FROM AUTHOR]

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.

Although it is known some youth access mental health services more readily than others, most service use studies used variable-centric approaches that produced heterogeneous groups and results that require parents and educators to understand diagnostic categories. Person-centered approaches group youth with similar patterns of behavioral and mental health concerns and thus are more homogenous and comparable to the presentation of behavioral and mental health problems noticed by parents and educators, who most typically facilitate access to care for those youth in need. We examined the behavioral and mental health symptom profiles, demographic characteristics and service use histories of youth referred for intervention in a multi-state, randomized controlled trial intervening in severe emotional/behavioral problems (n = 647; Kern et al. in Educ Treat Child 34(4):593-617, 2011). Latent profile analysis of parent-reported hyperactivity, aggression, and conduct, and adolescent-reported anxiety and depression on a broadband measure of student emotional and behavioral functioning was conducted. Model fit indices and theoretical interpretation supported five latent profiles; Class 1 showed severe externalizing behavior problems (7.18%, n = 45), Class 2 showed normative behaviors (37.78%, n = 237), Class 3 showed elevated internalizing behavior problems (12.76%, n = 80), Class 4 showed elevated externalizing behavior problems (33.01%, n = 207), and Class 5 showed elevated internalizing and externalizing behavior problems (9.25%, n = 58). We detected demographic and service use history difference between these profiles using multinomial logistic regression. Findings are discussed in relation to improving children's mental health services, including universal screening, training emphasizing recognition and concern for internalizing behavior problems, and increased availability of mental health professionals in school settings.

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.

The COVID-19 pandemic quickly and significantly impacted students, schools, and communities. As part of a larger multisite study, the present investigation aimed to understand the effect of the pandemic-related switch to virtual schooling and virtual mental health services on youth. Specifically, this study aimed to explore the impacts of the pandemic on school administrators and staff, students, and families invested in supporting youth mental health. Focus groups were held in two disparate communities within the United States. Participants were members of two school mental health coalitions acting as key informants and included mental health program directors, school clinicians, parents of students, and community leaders. Data were analyzed using iterative rapid qualitative analysis. Salient themes include the role of family characteristics, communication, and infrastructure on use of virtual learning and virtual mental health services. Study findings indicate that fostering trust and increasing communication between school districts and families may ameliorate challenging policy transitions in future crises. [ABSTRACT FROM AUTHOR]