Academic journal article School Psychology Review

Toward a New Model for Promoting Urban Children's Mental Health: Accessible, Effective, and Sustainable School-Based Mental Health Services

Academic journal article School Psychology Review

Toward a New Model for Promoting Urban Children's Mental Health: Accessible, Effective, and Sustainable School-Based Mental Health Services

Article excerpt

Abstract. A program of research related to school-based models for urban children's mental health is described, with a particular focus on improving access to services, promoting children's functioning, and providing for program sustainability. The first study in this series responded to the urgent need to engage more families in mental health services, and results showed dramatically greater involvement of parents in school-based services relative to clinic-based services. To enhance teacher collaboration, the second study involved training teacher key opinion leaders (KOL) on selected classroom practices for children with ADHD. Classroom teachers with support from the KOL teachers reported significantly higher use of these practices compared to teachers receiving no KOL support. The third study is part of a recent collaboration with the Illinois Office of Mental Health and the Chicago Public Schools, and employs a multitiered approach to service delivery, including the involvement of influential parents and teachers in the provision of mental health services. Future directions for mental health practice and research are described.

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In this article three studies are described that are part of an ongoing program of research focused on the development of school-based models for mental health service delivery to inner-city children and families. These models are specifically designed in response to three concerns: (a) limited access for children and families in need, (b) limited effectiveness on children's real-world functioning, and (c) limited consideration of indigenous community resources as a means to foster sustainability. These foci have provided a framework to consider alternative mechanisms by which to engage families in services, to influence teachers towards accommodating children with ADHD, and to collaborate with policy officials at the Illinois Office of Mental Health and the Chicago Public Schools to develop a model with long-term sustainability.

The historic Surgeon General's report on mental health (U.S. Department of Health and Human Services, 2000) has, among many things, brought attention to the urgent call for a new understanding of children's mental health needs and for a broadening perspective on ways to address these needs. As noted in the report, and first noted by Weisz and colleagues (Weisz, Weiss, & Donenberg, 1992), there is a critical gap between university-based clinical trials and community-based mental health practice. A highly influential task force report by the National Institute of Mental Health (1999) also concluded that practice-oriented research was a high priority for future funding. Since the publication of these reports, closing the gap between university-based clinical trials and community practice has become a national concern (National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment, 2001).

For children and youth, this movement has focused primarily on improving the effectiveness of mental health services offered in community practice, largely through the dissemination of evidence-based practices (Weisz & Jensen, 1999). However, perhaps even more urgent is the need to improve access to services. A recent analysis of three national surveys indicated that nearly 80% of youth ages 6-17 who were in need of mental health services did not receive services within the preceding 12 months, with rates approaching 90% for uninsured families (Kataoka, Zhang, & Wells, 2002). Furthermore, the assumption that there is sufficient knowledge regarding intervention effectiveness to transport evidence-based strategies to community settings is questionable (Hoagwood, Burns, Kiser, Ringeisen, & Schoenwald, 2001). In fact, in many ways, recent efforts to transport evidence-based practices for children and youth are revealing as much about gaps in knowledge as about gaps in services offered in clinical practice with children and youth (Atkins, 2003b). …

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