The estimated prevalence of one or more mental health disorders among children and adolescents between the ages of 9 andi/is 21% (Satcher, 2001). Similarly,researchbyGreenberg et al., (2003) estimated that 2O%of schoolage youth experience mental health problems during the course of any school year. Despite these high prevalence rates, the majority of students with mental health needs do not receive appropriate treatment and services. According to Greenberg et al. (2003), about 80% of youth who have mental health problems do not receive the intervention services needed. According to Hoagwood and Ervin (1997), of the minority of students who are fortunate enough to receive mental health services, approximately 75% of them receive these services in the context of a school setting.
MENTAL HEALTH IN THE SCHOOLS
Even though most schools are not structured to be providers of intensive mental health services, research has shown positive effects when students' social and emotional needs are met (Malecki & Elliott, 2002; Najaka, Gottfredson, & Wilson, 2001). For example, Malecki and Elliott (2002) tracked 149 fourth-grade students longitudinally over the course of ? academicyear. They measured achievement with the Iowa Test of Basic Skills and social skills with the Academic Competence Evaluation Scales in the fall and spring. The authors found that social skills, measured in the fall, significantly predicted achievement gains over the course of the year. As another example, Naj aka et al. (2001) found in ameta-analysis of 87 studies that teacher-reported and student-reported positive social skills were significantly predictive of school-based delinquent behavior (r = -.60).
When mental health concerns are typically discussed, it is often in reference to student functioning within the school environment. In addition, the substantial length of time a student operates within such a setting makes schools an ideal setting to implement prevention and intervention with precision and consistency (Nelson, Hurley, Epstein, Stage, & Buckley, 2009). Furthermore, Doll and Lyon (1998) suggested that the majority of schools have the capacity to promote competence across all domains of student well-being: academic, personal, and social.
The No Child Left Behind legislation has put schools under pressure to ensure all students are successful and making academic progress. Now, with the reauthorization of the Individuals with Disabilities Education Act (IDEA 2004), educators no longer have to wait for a student to fail before providing them with the necessary service(s) needed (Reschly & Hosp, 2004). IDEA now gives states the option to use response to intervention (RTI) to qualify students for special education. Many of the theoretical underpinnings of RTI for academics apply to mental health and the RTI assessment alternative can be applied to behavioral systems (Sugai, Horner, & Gresham, 2002). For example, after evidence-based preventive measures have been applied, such as in the domains of resiliency building, aggression, or emotional awareness, failure to respond to these measures can indicate a need for more intensive services, such as small-group or individual therapy.
Student mental health problems that are not addressed early in development can lead to substantially more significant problems that require proportionally more intensive remediation, much like the Matthew Effect often cited for reading problems (Stanovich, 1986). The Matthew Effect states that advantaged students are subjected to appropriately scaffolded enriching environments, while those with behavioral deficits - academic or otherwise- will continue to suffer in proportion to the delay in needed and appropriate services. The l