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School Based Mental Health Services Reduce School Violence

We live in​ a​ complicated world requiring complex skills. We must prepare our children to​ cope and to​ compete. They need reading,​ social studies,​ science and math more than ever,​ but they also need social skills,​ problem solving,​ superior reasoning and good mental health. There is​ a​ societal need to​ reduce the​ incidence of​ violence in​ our schools,​ as​ well.

When children and teens are focused on​ problems at​ home or​ within themselves,​ they often do not do well in​ school. School success and good mental health are intrinsically tied together. Additionally,​ school success and good mental health are linked to​ life success. Identifying those youth who are in​ need of​ help can reduce suffering and improve mental health,​ school success,​ and life success. Good mental health aids development,​ learning,​ interpersonal relationships,​ and the​ ability to​ cope with stress more effectively.

Approximately 1 in​ 5 children & adolescents (20%) experience the​ signs and symptoms of​ a​ mental health disorder during the​ course of​ a​ year. These children are estimated to​ have severe emotional or​ behavioral problems that significantly interfere with their daily functioning. Yet,​ less than one-third of​ the​ children under the​ age 18 with a​ serious disturbance receive any MH Services. Often the​ services they do receive are inadequate or​ inappropriate (Children’s Defense Fund). Ten percent of​ children in​ any given classroom (3/30) are ready to​ learn at​ the​ curriculum level (Dr. Adleman & Dr. Taylor UCLA School Mental Health Project).Only 16% of​ all children receive any mental health services. Follow through for children receiving mental health services in​ school is​ much greater than those referred to​ community services. of​ the​ 16% that receive MH services,​ 70-80% receive that care in​ a​ school setting (healthinschools.org),​ yet less than 10% of​ all school districts in​ the​ United States currently have an​ established School Based Mental Health Program (Center for School Mental Health Assistance,​ Dr. Mark Weist 2001,​ University of​ Maryland).

To assess the​ effectiveness of​ school based mental health (SBMH) services in​ reducing emotional,​ school,​ home,​ and behavioral problems of​ youth,​ Robert Schmidt,​ MA and Kathryn Seifert,​ Ph.D. collaborated on​ the​ evaluation of​ outcomes for a​ SBMH program for a​ rural mid-Atlantic School district. Coordination of​ mental health services with educators,​ Department of​ Social Services,​ the​ Department of​ Juvenile Services,​ and the​ Development Disabilities program contributed to​ the​ program’s success.

The project began in​ 1999 with a​ Federal grant to​ the​ school district and the​ project is​ ongoing. Youth were referred to​ the​ project from teachers,​ guidance counselors,​ parents,​ student self-referrals and other agencies such as​ the​ Departments of​ Social Services and Juvenile Services and Law Enforcement. the​ student’s scores on​ the​ Devereaux,​ BASC,​ CARE and several school measures such as​ absenteeism,​ disciplinary referrals,​ violence related suspensions,​ and other suspensions were measured at​ the​ beginning of​ services and at​ the​ beginning and end of​ each school year.

From 1999 to​ 2004,​ 36% youth were referred because of​ symptoms of​ depression,​ 26% because of​ family problems,​ and 24% because of​ behavior problems. Examples of​ reasons for referral to​ the​ program included: crying in​ class,​ child can’t stay focused,​ student found out mom is​ terminally ill,​ youth’s parents going through divorce,​ and recent sexual abuse. There were 84 referrals to​ the​ program in​ 1999,​ compared to​ 437 students in​ 2002 and 239 students in​ 2003. Peak referral times were in​ October and February. Youth in​ the​ transition years of​ sixth and ninth grades were referred to​ the​ program most often. in​ 2000,​ 2,​132 mental health sessions were provided,​ in​ contrast to​ an​ amazing 15,​763 sessions in​ 2003.

A group of​ 632 students who participated in​ the​ program showed significantly improved attitudes toward teachers and school,​ mental health symptoms,​ and self-esteem during and after services. Students participating in​ SBMH in​ years one and two had significantly better school attendance (56 and 57% increase) when compared to​ non-participants (66 and 59% decrease). Additionally for the​ group of​ participants,​ absenteeism increased 44% before participation and decreased 53% during participation.

Students had a​ significant (40%) decrease in​ disciplinary referrals when compared to​ non-participants (20% decrease). Participants in​ years one and two had a​ significant decrease in​ suspensions (32% and 27%) from school when compared to​ non-participants (33 and 16% increases). Parents reported that their children were having significantly fewer problems after receiving services. Youth self-reported significantly improved commitment to​ school,​ interpersonal relationships and self-esteem,​ as​ well as​ fewer stress related problems. Students reported significantly reduced school maladjustment and clinical maladjustment and improved attitude toward parents and emotional well-being.

Evaluation of​ the​ success of​ the​ program revealed several key components. One important component was having a​ central school/mental health coordinator to​ be an​ organizer,​ ombudsman,​ problem solver,​ program evaluator,​ and coordinator of​ the​ two systems. Additionally,​ the​ mental health service must be an​ integral part of​ the​ school system,​ not just an​ adjunct or​ add-on. Mental health staff need to​ communicate and attend meetings with school personnel. Mental health professionals can provide workshops and consultation to​ teachers,​ guidance counselors,​ and administrative staff.

Funding for the​ project came from mental health third party billing and grant funding. Supplemental funds allowed mental health professionals to​ attend meetings,​ consult with school personnel,​ and provide services for children and youth who do not meet medical necessity criteria of​ their insurance companies. it​ is​ also important to​ include families as​ an​ essential part of​ the​ program.

In a​ time when all programs are struggling to​ cope with funding cuts,​ collaborative programs,​ such as​ this one can make services more efficient and cost effective. Many families of​ troubled youth are involved in​ more than one service,​ in​ addition to​ the​ school. Coordination of​ multiple services is​ beneficial to​ the​ families and helps improve outcomes for youth.

This project demonstrated that school based mental health services improved student well-being,​ behavior and school success,​ while showing a​ significant decrease in​ violence and other behavior problems at​ home and at​ school. the​ study is​ ongoing and a​ second site has been added.

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