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Responding to today's mental health needs of children, families and schools: revisiting the preservice training and preparation of school-based personnel.


With the alarming increase in the mental health needs of youth today, traditional preservice preparation training programs for school-based personnel in the area of mental health are overwhelmingly insufficient. While school professionals often lack basic specific evidence-based knowledge and skills to identify and intervene with students at risk for mental illness, they also lack the personal resources to understand their own mental health concerns which include how to effectively cope with job stress, while increasing teaching effectiveness and job satisfaction. Therefore, there is a call for a paradigm shift A dramatic change in methodology or practice. It often refers to a major change in thinking and planning, which ultimately changes the way projects are implemented. For example, accessing applications and data from the Web instead of from local servers is a paradigm shift. See paradigm.  at the preservice level to better prepare all school-based personnel, including teachers, administrators, counselors, psychologists, social workers and nurses to proactively confront the mental health challenges of today's youth and the difficulties they face in serving those students. In this article, the authors provide evidence to illustrate the need for training in the area of preventative strengths-based mental health. Traditional training programs designed for school-based personnel are discussed, followed by suggestions for the implementation of strengths-based performance standards for all individuals preparing to work in the school environment. Finally, an innovative online graduate degree program, located at a unique university-based center dedicated to implementing a prevention, strengths-based mental health approach to educating school personnel, is discussed.


Increasingly, school-based personnel are faced with students who present with growing mental health concerns. While the rate of mental illness in youth continues unabated in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area.  (Morris, 2002), and, with the contributing etiological etiological

pertaining to etiology.

etiological diagnosis
the name of a disease which includes the identification of the causative agent, e.g. Streptococcus agalactiae mastitis.
 factors many and varied, questions are raised about the training adequacy of school-based personnel to combat this growing concern in today's school environment. To illustrate, Rones and Hoagwood (2000) suggest that university-based preservice educational training programs do not adequately prepare and thus provide sufficient knowledge, skill, or field experience to work with children in schools who present with mental health problems. If this is true, then what training do school-based personnel actually receive at the preservice level? To elaborate, is preservice training focused on a strengths-based prevention model or one focusing on traditional broad and global standards that emphasize pathology and mental illness?

In order to address these growing concerns, this article will first provide a rationale indicating the need for specific competency-based prevention training in the area of children's mental health for school-based personnel. Secondly, to increase student achievement in the classroom, while fostering mental health in the learner, the authors will present examples of traditional preservice training models and offer suggested modifications. Finally, the authors will discuss the application of a unique university-based preservice training program designed from a proactive, strengths-based prevention model. This model is dedicated to advancing the preparation of school-based personnel to proactively meet the mental health challenges of today's youth.

The Need for Mental Health Training

Of growing concern, a significant number of youth in the United States experience mental health problems to a degree that impairs daily functioning. For example, between five and nine percent of children can be classified with a diagnosis of a serious emotional disturbance This article requires authentication or verification by an expert.
Please assist in recruiting an expert or [ improve this article] yourself. See the talk page for details.
, requiring substantive mental health support in the school setting (Friedman, Katz-Leavy, Mandersheid, & Sondheimer, 1996; Morris, 2002; New Freedom Commission on Mental Health, 2003). In addition, approximately one in five children, or 15 million in the United States, experiences significant symptoms of a diagnosable mental disorder mental disorder

Any illness with a psychological origin, manifested either in symptoms of emotional distress or in abnormal behaviour. Most mental disorders can be broadly classified as either psychoses or neuroses (see neurosis; psychosis). Psychoses (e.g.
 during the course of any one year (Adelman & Taylor, 2000a). Conversely, while these are clearly alarming statistics, the number of youth with sub-threshold mental health problems remains unidentified, thus supporting the critical need for prevention and early intervention ear·ly intervention
n. Abbr. EI
A process of assessment and therapy provided to children, especially those younger than age 6, to facilitate normal cognitive and emotional development and to prevent developmental disability or delay.
 efforts before problems develop or escalate es·ca·late  
v. es·ca·lat·ed, es·ca·lat·ing, es·ca·lates
To increase, enlarge, or intensify: escalated the hostilities in the Persian Gulf.

 to a diagnostic level.

Increasingly, more children with a variety of emotional needs are included in the general classroom setting, placing increased demands on both the special education and general education teacher. The educator's challenge then, is to not only teach content driven academic pedagogy required by the school district, but also the ability to create a classroom environment where all learners' needs are addressed. This includes the development of a positive self-concept. The recent report of President Bush's New Freedom Commission (2003) formally recommends that all "Federal, State, and local child-serving agencies fully recognize and address the mental health needs of youth in the educational system" (p. 62), thereby clearly placing emphasis on the involvement of schools in the promotion of mental health services health services Managed care The benefits covered under a health contract . According to according to
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

 the report:
  Schools are where children spend most of each day. While schools are
primarily concerned with education, mental health is essential to
learning as well as to social and emotional development. Because of this
important interplay between emotional health and school success, schools
must be active partners in the mental health care of our
children. (p. 58)

In addition, Surgeon General The U.S. Surgeon General is charged with the protection and advancement of health in the United States. Since the 1960s the surgeon general has become a highly visible federal public health official, speaking out against known health risks such as tobacco use, and promoting disease  David Satcher David M. Satcher (b. March 2, 1941) was the 16th Surgeon General of the United States from 1998 to 2002 and the Assistant Secretary for Health from 1998 to 2001. He was the first African American male to serve as Surgeon General. Early years and career
 stated that the U.S. is currently facing a public crisis in mental health for today's youth. According to Satcher's National Action Agenda for Children's Mental Health (2001), 1 in 10 youth in the United States suffers from a mental disorder severe enough to limit daily functioning in the family, school, and community setting. Although federal and state government agencies are increasingly aware of the prominence and depth of this problem, to date, no universal systemic changes have been made to mandate preservice teacher competency in the recognition and early intervention of specific mental health needs of youth in schools (Burke, personal communication, as cited in Koller & Svoboda, 2002).

To illustrate, regardless of an apparent increase in children's mental health needs in schools, an overwhelming 70% of children with a diagnosable mental illness do not receive treatment, or receive inadequate treatment (Tashman, Waxman, Nabors, & Weist, 1998). As a result, teachers are increasingly faced with students who lack the optimal social and emotional resources to focus and, therefore, benefit from academic instruction in the classroom (Koller, Osterlind, Paris, & Weston, 2004). In fact, according to the Florida Commission on Mental Health and Substance Abuse (2001), "The major barrier to school readiness for children is often not the lack of appropriate cognitive skills but rather the absence of needed social and emotional skills" (p. 8). Therefore, with such a large gap existing between children who need mental health services and those who actually receive services, coupled with an increasing national emphasis on the prevention of mental illness, the critical importance of competency-based training of all school-based personnel at the preservice level has assumed paramount importance.

To compound the problem, a substantial number of youth with mental health concerns are at risk for school dropout (1) On magnetic media, a bit that has lost its strength due to a surface defect or recording malfunction. If the bit is in an audio or video file, it might be detected by the error correction circuitry and either corrected or not, but if not, it is often not noticed by the human  (Koller & Svoboda, 2002; Svoboda, 2001). In fact, while an estimated 550,000 individuals fail to complete high school each year, (National Center for Educational Statistics, 1998) roughly 45 percent of the one million individuals who took the General Educational Development (GED GED
1. general equivalency diploma

2. general educational development

GED (US) n abbr (Scol) (= general educational development) →
) high school equivalency equivalency

the combining power of an electrolyte. See also equivalent.
 test in 2001 reported mental health concerns as contributory con·trib·u·to·ry  
1. Of, relating to, or involving contribution.

2. Helping to bring about a result.

3. Subject to an impost or levy.

n. pl.
 factors to school failure and dropout (GEDTS GEDTS General Educational Development Testing Service , 2001).

While the etiological factors contributing to students at risk for school dropout are many and varied (Alexander, Entwisle, & Horsey hors·y also hors·ey  
adj. hors·i·er, hors·i·est
1. Of, relating to, or resembling horses or a horse.

2. Devoted to horses and horsemanship: the horsy set.

, 1997), a number of precipitating factors are clear. These include student lack of attachment to school and school rules, poor student relations with school-based personnel, especially the teacher, ongoing inconsistent parental support, and student self-concept deficits fraught with feelings of inferiority, isolation, lack of resiliency, anxiety, and depression (Alexander, Entwisle, & Kabbani, 2001; Hess & Copeland, 2001; Marcus & Sanders-Reio, 2001).

In addition, of growing concern nationally, is the apparent rapid escalation es·ca·late  
v. es·ca·lat·ed, es·ca·lat·ing, es·ca·lates
To increase, enlarge, or intensify: escalated the hostilities in the Persian Gulf.

 of school dropouts with comorbid mental illness who end up referred to the juvenile justice system (Brogan, 2004). Apparently, the rate of increase continues unabated. For example, in 2002 an estimated 40 to 70 percent of the roughly one million youth referred for incarceration Confinement in a jail or prison; imprisonment.

Police officers and other law enforcement officers are authorized by federal, state, and local lawmakers to arrest and confine persons suspected of crimes. The judicial system is authorized to confine persons convicted of crimes.
 were suspected of comorbid mental illness disorders significant enough to warrant a DSM-IV-TR diagnosis (Kessler, 2002). To confound con·found  
tr.v. con·found·ed, con·found·ing, con·founds
1. To cause to become confused or perplexed. See Synonyms at puzzle.

 this problem, however, the literature suggests that, traditionally, mental illness in school age youth often goes undiagnosed and untreated once an offense has been committed and referral is made to the juvenile courts for adjudication The legal process of resolving a dispute. The formal giving or pronouncing of a judgment or decree in a court proceeding; also the judgment or decision given. The entry of a decree by a court in respect to the parties in a case.  (Boesky, 2001).

However, for those identified with mental illness, several personality patterns are emerging from the research literature. For example, while youth with internalizing symptoms (i.e., depression, social withdrawal and suicidal ideation suicidal ideation Suicidality Psychiatry Mental thoughts and images which hinge around committing suicide. See Suicide. ) are less likely to be identified than those with externalizing symptoms, gender difference do exist as incarcerated incarcerated /in·car·cer·at·ed/ (in-kahr´ser-at?ed) imprisoned; constricted; subjected to incarceration.

Confined or trapped, as a hernia.
 males are more likely to receive school-based mental health services (Atkins, Showden, & Libby, 2002). Yet, of adolescent females who drop out of school almost 60 percent end up in the juvenile system within one year (Svoboda, 2001).

While there is little argument that suspected comorbid mental health problems must be identified upon referral to the juvenile justice system prior to incarceration and treatment, in actuality ac·tu·al·i·ty  
n. pl. ac·tu·al·i·ties
1. The state or fact of being actual; reality. See Synonyms at existence.

2. Actual conditions or facts. Often used in the plural.
, this process should begin much earlier--while youth are still in school. As well, as significant progress continues to empirically identify early developmental patterns predictive of long-term failure, the teacher, who is the first adult role model in the classroom must be able to apply basic mental health principles to foster positive personal, social and emotional growth (Koller et al., 2004). Regardless, without appropriate early identification and treatment, incarcerated school-aged youth with mental health concerns will continue to demonstrate dysfunction well into their adult years (Cellini, 2001).

Preservice Training Programs: Lacking a Curricular Mental Health Training Component

The growing mental health concern among today's youth, in addition to the overwhelming school dropout rate, supports the need for revisiting the training of preservice school-based personnel relating to relating to relate prepconcernant

relating to relate prepbezüglich +gen, mit Bezug auf +acc 
 mental health principles and practices. The inadequacy of specific competency-based preservice training in prevention-based mental health is apparent when examining university-based curricula and certification requirements mandated by various accrediting bodies, such as the National Council for Accreditation of Teacher Education (NCATE NCATE National Council for Accreditation of Teacher Education ), National Association of School Psychologists (NASP NASP National Association of School Psychologists
NASP National Aerospace Plane
NASP National Association of Safety Professionals
NASP National Application Service Provider
NASP National Association for Shoplifting Prevention
NASP National Airport System Plan
), Council on Social Work Education The Council on Social Work Education (CSWE) is the national association for social work education in the United States of America.

The CSWE sets and maintains standards of courses and accreditation of bachelor's degree's and Master's degree programs in social work.
 (CSWE CSWE Council on Social Work Education
CSWE Certificate in Spoken and Written English
CSWE Center for Student Work Experience
), The Council for Accreditation of Counseling and Related Educational Programs (CACREP CACREP Council for Accreditation of Counseling and Related Educational Programs ), and the Interstate New Teacher Assessment and Support Consortium (INTASC INTASC Interstate New Teachers Assessment and Support Consortium ).

Currently at the preservice level, teachers and administrators receive little, if any, specific competency-based training regarding their role in knowing how to identify a wide variety of precipitant mental health issues facing students today (e.g., depression, stress, anxiety, school violence, and bullying). For example, teachers typically complete a basic general psychology course that has little, if any, relevant practical application to the classroom. In addition, they may be required to take a basic educational psychology course that focuses essentially on instructional theory Instructional theory is a discipline that focuses on how to structure material for promoting the education of humans, particularly youth. Originating in the United States in the late 1970s, instructional theory  to the exclusion of application, particularly learning constructs related to mental health. As Oddone (2002) states, in reviewing curricular mental health pedagogical ped·a·gog·ic   also ped·a·gog·i·cal
1. Of, relating to, or characteristic of pedagogy.

2. Characterized by pedantic formality: a haughty, pedagogic manner.
 content in several current popular educational psychology textbooks, it is apparent that "information about mental health (as well as the related areas of social-emotional development and personality) has steadily declined since the 1950's." As well, regarding in-service assistance for teachers already employed, Greenburg, Domitrovich, and Bumbarger (2000) found inadequate assistance to combat today's behavioral and mental health problems found in schools. That is, most school-based efforts are reactive rather than proactive. Thus, as training standards for teachers which are typically established by state accrediting agencies and/or national professional organizations and teacher quality becomes ever more narrowly defined by subject matter pedagogical skills, the development of positive social and emotional skills of youth are left to chance or not addressed. According to Oddone (2002), "pressures to demonstrate progress in school performance, as illustrated by improved test scores, threaten to relegate rel·e·gate  
tr.v. rel·e·gat·ed, rel·e·gat·ing, rel·e·gates
1. To assign to an obscure place, position, or condition.

2. To assign to a particular class or category; classify. See Synonyms at commit.
 mental health, safety, and other issues that reflect overall student well-being to the sidelines, as though these concerns are not relevant to the mission assigned to schools" (p. 274). In addition, due in part to the federal enactment of the No Child Left Behind Act The No Child Left Behind Act of 2001 (Public Law 107-110), commonly known as NCLB (IPA: /ˈnɪkəlbiː/), is a United States federal law that was passed in the House of Representatives on May 23, 2001 , schools, and as a result, teachers, are increasingly pressured to demonstrate student academic progress. This is especially apparent in the mandates to increase student state and local achievement test scores. In the process, however, this pressure has had a negative effect on the classroom teacher by raising his or her stress level to improve student performance by increasing the focus on academic achievement.

However, according to the National Board for Professional Teaching (2003), a teachers' mission "extends beyond developing the cognitive capacity of their students" implying that teachers are also concerned with student development in other areas including the development of positive mental health and character. In addition, NCATE accreditation standards (2002) state that new teachers graduating from NCATE-accredited institutions "are able to handle the demands of a classroom on day one--not through on-the-job training" (p. 2). However, with the increasing prevalence of students with mental health concerns in schools today and the lack of specific preservice preparation in the area of mental health prevention, new teachers are not able to meet the overwhelming individual demands of all students in the classroom (Koller et al., 2004)

In fact, Koller and his colleagues (2004) found that, overall, both first-year baccalaureate teachers (both regular and special education) graduating from NCATE-approved colleges of education and their experienced mentors, many with graduate teaching degrees through the doctoral level, felt unprepared to recognize and/or intervene in typical mental health issues confronting today's teachers. This included daily problems such as identifying and assisting with an anxious student, recognizing potential signs of childhood depression and/or stress, or helping the friendless child. Yet, all teachers, both first-year graduates and their experienced mentors, regardless of their academic preparation, unanimously agreed that knowledge of the mental health needs of youth are critically important for all teachers to experience success in today's classroom. Interestingly, both the first-year and mentor teachers rated their own mental health (e.g., teacher stress, pressure to raise student achievement test scores, fear of classroom violence, or how to communicate with an irate i·rate  
1. Extremely angry; enraged. See Synonyms at angry.

2. Characterized or occasioned by anger: an irate phone call.
 parent) as being a significant concern, yet felt unprepared to recognize and manage the signs and symptoms of their own stress and burnout Burnout

Depletion of a tax shelter's benefits. In the context of mortgage backed securities it refers to the percentage of the pool that has prepaid their mortgage.

In addition, Morris (2002) reported that both preservice and inservice general elementary education elementary education
 or primary education

Traditionally, the first stage of formal education, beginning at age 5–7 and ending at age 11–13.
 teachers hold a strong interest and desire for more basic information regarding children's mental health issues, but this information is not typically offered in the regular or special teacher education program at a level requiring competence. The teachers questioned in this study came from two large Midwestern university-based NCATE-approved teacher education programs and the results defy common perceptions that only special education teachers need training in the area of mental health. In point of fact, the results strongly supported that special education trained teachers are not exempt from preservice instruction in mental health. This research further supports that many learners, regardless of their educational placement in the school setting, will likely exhibit mental health concerns, thereby requiring assistance from general and special education school personnel to effectively identify and intervene with the non-academic barriers that hinder optimal student learning.

As children are increasingly placed in the general education classroom setting, due, in part, to factors including mandated inclusion, an increased emphasis is placed upon the general education teacher to be prepared for issues other than academic content (Gable gable

Triangular section formed by a roof with two slopes, extending from the eaves to the ridge where the two slopes meet. It may be miniaturized over a dormer window or entranceway.
 & Van Acker, 2000). In addition, since children spend the majority of a school day in the classroom where the teacher is the only adult present, the teacher assumes an influential role in the development of the child from both an academic as well as personal, social and emotional perspective (Koplewicz, 1996). Hence, it is essential that teachers are equipped with a fundamental knowledge of factors that influence not only the development of mental illness in those they serve, but also those proactive strengths-based prevention efforts which promote mental health and resilience.

Similar to preservice teacher mandated requirements, preservice standards also lack for school administrators in the areas of student and staff mental health promotion. According to the National Policy Board for Educational Administration (2002), "successful educational leaders must be able to identify, clarify, and address barriers to student learning and communicate the importance of developing learning strategies for diverse populations" (p. 6). Although this standard states the importance of addressing barriers to student learning, specific issues related to the prevention of mental health problems are not recognized as one of these barriers. This suggests that administrators, who are the leaders of the school, may not be adequately prepared to identify, intervene or prevent the common mental health concerns of their students and staff. For example, a review of the research literature suggests that teachers who are isolated from other colleagues, who encounter difficult relationships with students and parents, who experience a lack of consistent support from parents, or who experience a lack of understanding, support, and leadership from administrators are at high-risk for burnout (Brock brock  
n. Chiefly British
A badger.

[Middle English brok, from Old English broc, of Celtic origin.]
 & Grady, 2000). In fact, teachers reported reluctance to confide in school administrators about their own stress problems for fear of reprisal reprisal, in international law, the forcible taking, in time of peace, by one country of the property or territory belonging to another country or to the citizens of the other country, to be held as a pledge or as redress in order to satisfy a claim. , and/or job loss (Koller et al., 2004). Without the support and endorsement of the school administrator, evidence-based practices in school are typically not integrated. Therefore, if the administrative leaders of the school have not been trained in, are not committed to, or do not know how to integrate mental health practices, it will be difficult to create a positive school environment that fosters the mental health of students and staff (Brock & Grady, 2000).

Global and/or Pathological Training Models

Adelman and Taylor (2000b) argue that schools are not traditionally viewed as being in the mental health or social service business. In other words Adv. 1. in other words - otherwise stated; "in other words, we are broke"
put differently
, the primary focus of schools is education based on content driven pedagogy. However, a review of the research indicates that children are poorly equipped to learn academic skills if their basic psychological needs are not met (Gable & Van Acker, 2000; Koplewicz, 1996; Morris, 2002). This implies that children who experience unresolved conflict in areas including personal, social, emotional and academic issues are at risk for problems focusing their attention on learning tasks in the classroom. In fact, if traditional preservice training programs focus on pathology (i.e., the identification of deficits or functional limitations to determine eligibility for placement in special education and/or a DSM-IV diagnosis) rather than requiring competence in evidence-based practices to prevent pathology, how can the educator be expected to recognize, let alone prevent those precipitating factors which lead to dysfunction? Further, the authors argue that integrating mental health training at the preservice level is no less important in its contribution to successful teaching and learning than is instruction on how to teach specific academic subject matter.

In addition to preservice regular and special education teacher and administrator training programs, standards exist in other school disciplines, such as school psychology, school social work, school counseling and school nursing that promote vague or global mental health mandates often neglected or de-emphasized in the school setting. For example, one of the National Association of School Psychologists (2002) standards for school psychologists in training regarding prevention, crisis intervention crisis intervention Psychiatry The counseling of a person suffering from a stressful life event–eg, AIDS, cancer, death, divorce, by providing mental and moral support. See Hotline.  and mental health states: "School psychologists have knowledge of human development and psychopathology psychopathology /psy·cho·pa·thol·o·gy/ (-pah-thol´ah-je)
1. the branch of medicine dealing with the causes and processes of mental disorders.

2. abnormal, maladaptive behavior or mental activity.
 and of associated biological, cultural and social influences on human behavior. School psychologists provide or contribute to prevention and intervention programs that promote the mental health and physical well-being of students" (p. 16). As a result, although school psychology graduate programs typically provide students with basic training in the prevention and intervention of mental illness, the focus remains on pathology. However, the school psychologist in practice typically does not become involved in a case until significant problems already exist. Furthermore, in spite of their training, school psychologists are often underutilized in schools for this role. That is, activities revolving around conducting individual assessments to qualify students for special education services typically consume the role of the practicing school psychologist (Ehrhardt-Padgett, Hatzichristou, Kitson, & Meyers, 2003).

Regarding school counselor A school counselor is a counselor and educator who works in schools, and have historically been referred to as "guidance counselors" or "educational counselors," although "Professional School Counselor" is now the preferred term.  preparation, the Council for Accreditation of Counseling and Related Educational Programs Standards (CACREP) (2001) globally states that preservice school counselors possess the knowledge of, "The role of racial, ethnic, and cultural heritage, nationality, socioeconomic status, family structure, age, gender, sexual orientation sexual orientation
The direction of one's sexual interest toward members of the same, opposite, or both sexes, especially a direction seen to be dictated by physiologic rather than sociologic forces.
, religious and spiritual beliefs, occupation, physical and mental status and equity issues in school counseling; knowledge and understanding of community, environmental and institutional opportunities that enhance" (p. 1), as well as "barriers that impede student academic, career, personal/social success and overall development" (p. 2 ). Unfortunately, however, specific preservice prevention and early intervention techniques including the documentation of evidence-based practices designed to manage student mental health needs are often neglected in school counselor training programs (Keys, Bemak & Lockhart, 1998; Lockhart & Keys, 1998). In fact, Lockhart and Keys (1998) further argue that school systems continue to define the role of the school counselor through traditional guidance program models, despite the escalating mental health needs of students and their families. Similarly, preservice university-based training programs often neglect to provide future school counselors with competency-based training in areas such as crisis intervention and mental health prevention and intervention in schools.

Gysbers and Henderson (2000) have developed a National Comprehensive Guidance Program model that redefines the role of the school counselor to ensure that counselors' knowledge and skills are utilized in the school environment. The comprehensive guidance model is also designed to help control time management concerns by guaranteeing that counselors utilize time effectively on relevant guidance activities (i.e., implementing the school guidance curriculum and individual counseling), rather than on non-guidance activities (i.e., scheduling). This model provides a framework for the comprehensive school guidance program to make the counselors' duties concrete. More specifically, the authors suggest that counselors spend 80% of their time on direct services to students and 20% of their time on indirect services. In addition, to further expand the school counselor's ability to work with all students in the school environment, Lockhart and Keys (1998) recommend additional preservice training efforts in the area of mental health.

In the specialty area of school nursing, academic standards in the area of mental health are globally present; however, similar to school psychologists, the specific knowledge and skills of such professionals are often underutilized in the school environment (National Association of School Nurses [NASN NASN National Association of School Nurses
NASN North American Sports Network (TV channel)
NASN NOAA/CMDL Air Sampling Network
]). For example, school nurses typically receive substantial preservice training in mental illness and are in a position to promote the development of positive mental health with students in schools. However, the role of the school nurse is often dominated by the dispensing of medication and band-aids (Libbus et al., 2003). To illustrate, one nurse who was interviewed as part of a research project looking at how school nurses feel about their job duties stated, "I would like to be freed from band-aid duty to perform activities that require my nursing judgment" (p. 322).

In 2002, the National Association of Social Workers' (NASW NASW National Association of Science Writers
NASW National Association of Social Workers (Washington, DC)
NASW National Association of Social Workers
NASW National Association for Social Work (UK) 
) created the Standards for School Social Work Services. To work in the school environment, NASW requires a graduate degree from a program accredited accredited

recognition by an appropriate authority that the performance of a particular institution has satisfied a prestated set of criteria.

accredited herds
cattle herds which have achieved a low level of reactors to, e.g.
 by the Council on Social Work Education. Sample standards related to prevention-based mental health include the following: to promote collaboration among community health and mental health service providers while facilitating student access to such services, select effective prevention and intervention programs to enhance students' educational experiences and promote students' resolution of nonproductive non·pro·duc·tive  
1. Not yielding or producing: nonproductive land.

2. Not engaged in the direct production of goods: nonproductive personnel.

 encounters in school (NASW, 2002). On one hand, these standards appear to be positive performance-based mental health competencies, rather than solely focused on pathology. However, the required academic content and skills for school social workers are determined by specific university-based graduate degree programs which offer school social work as a specialization, in accordance with the mandates of the program's state board of education (Council on Social Work Education, 2004). In addition, regardless of their extensive training in mental health, many social workers struggle with an accreditation identity to practice in the school setting and are often confronted with problems in state certification. Thus, according to NASW (2004), only 5% of the nation's approximately half-million social workers work in the schools.

Implications for Designing Prevention-based Training Models for School Personnel

In order for systemic change to occur from a traditional deficit-driven model of mental illness or pathology, to a strengths-based model focusing on prevention, a collaborative, inter-disciplinary effort must exist. This effort must not be in name only. That is, understanding, managing and predicting human behavior is far too complex to relegate to a single professional discipline or to naive lists of 'do's and don'ts' as if the development of positive behavior is parallel to following a recipe in a cookbook.

Given that the foundation for many personality traits start early in life and are developmental in nature, an active participation on the part of all stakeholders Stakeholders

All parties that have an interest, financial or otherwise, in a firm-stockholders, creditors, bondholders, employees, customers, management, the community, and the government.
 is required. This collaborative effort will likely produce a diversity of opinions, practices and regulations necessitating the breaking of barriers existing between the family, the school, various community public mental health service agencies, traditional medical models of illness or pathology, the state and national accrediting agencies who govern school accreditation and certification, as well as the training of professionals who staff front line services in schools. As Rowling and Weist (2004) state, "to date, mental health is a field that has been seen as primarily the domain of health specialists, not the concern of teachers, parents and police" (p. 7). Thus, for a sustainable systems change to occur, the recognition of a paradigmatic See paradigm.  shift must occur not only in attitude, i.e., reducing the stigma of mental illness and philosophy, but also at the interdisciplinary preservice and inservice content knowledge levels derived from evidence-based practices.

In order to better prepare preservice education teachers and other school-based personnel for employment in today's school environment fraught with escalating mental health concerns, several concerns must be addressed. In response to the unclear and insufficient standards of many preservice programs designed for school personnel, the development and implementation of specific competency-based objectives for all persons preparing to work in the school environment must be instituted. For example, there is a great need for state and national certification agencies to mandate specific and performance-based requirements for all school personnel so that universities are required to provide future school-based personnel with the specific knowledge and skills necessary for coping with the needs of today's youth. To illustrate, The Interstate New Teacher Assessment and Support Consortium (INTASC) has created core standards, currently adopted by forty-two states, dedicated to the preparation, licensing and on-going professional development of teachers (INTASC, 1995). More specifically, INTASC standards specify what all beginning teachers "should know, be like, and be able to do in order to practice responsibly, regardless of the subject matter or grade level being taught" (p. 1). These standards are based on the following premise: "An effective teacher must be able to integrate content knowledge with the specific strengths and needs of students to assure that all students learn and perform at high levels" (p. 1). In addition, INTASC (1995) believes teachers "must be able to create learning experiences that are responsive to students' social, emotional, physical and cognitive development, their cultural and community experiences and their interests, talents and learning styles" (p. 2).

Recently, the American Psychological Association's National Coalition for Psychology in Schools and Education has also taken steps toward enhancing the training of school-based personnel (P. P. Heppner, personal communication, December 28, 2004). For example, the Coalition is in the developmental stages of creating a model to improve collaboration among psychologists, K-12 teachers and school districts. Members are hopeful this model will eventually be used as a diagnostic tool to assist school personnel identify strengths and weaknesses with respect to teachers' pedagogical practices and desired student outcomes which includes mental health, academic achievement and life skills. Although this model views the psychologist as the primary mental health professional responsible for the early identification and intervention of children's mental health and academic needs, the psychologist's treatment recommendations should be directly related to the input of teachers and other knowledgeable personnel personally involved with students.

In general, teachers spend the majority of their day with students and an unwritten LAW, UNWRITTEN, or lex non scripta. All the laws which do not come under the definition of written law; it is composed, principally, of the law of nature, the law of nations, the common law, and customs.  rule in a teacher's job description entails that he or she assumes the status of a positive role model for all students. Therefore, it is logical to assume that a teacher who is better prepared to influence the development of positive student mental health should be in a better position to assist students in meeting the multiple demands of school and developing them into emotionally healthy learners. Hence, formal, specific competency-based instruction to address the mental health needs of all youth should be required during all teacher preparation programs to enable teachers to help students overcome those non-academic barriers that hinder learning in the classroom. In the process, teachers in training should also be better equipped to proactively identify and intervene with their own mental health concerns, as these issues have been identified to be of paramount importance to teachers employed in the school setting (Koller et al., 2004).

Koller and his colleagues (2004) state that all preservice teachers should know and be able to demonstrate the following concepts upon completion of their preservice requirements: (a) Understand the specific role that all teachers have in the prevention of mental health problems (e.g., creating positive classroom environments, promoting healthy peer relationships, and enhancing students' self-concept) from a knowledge of current evidence-based practices; (b) Know how to identify students who may have or who may be headed toward a mental health problem (e.g., preventing bullying behavior, or working with the depressed or anxious child); and (c) Know how to create a positive, strengths-based learning environment where learning academic content (e.g., math) can occur, while the development of a positive self-image in the learner flourishes.

Pre-service teachers should also be able to recognize and apply evidence-based practices relating to issues of teacher stress and burnout, in addition to knowing who to seek consultation from within the school setting for support. In addition, as stress is influenced by the climate of the school and classroom (Brock & Grady, 2000), the incidence of teacher stress and burnout may be dramatically reduced if teachers are better prepared to face issues that contribute to the school climate, including student bullying, defiance, stress, anxiety and depression--all of which relate to mental health promotion.

Additional suggestions for training include requiring specific coursework coursework

work done by a student and assessed as part of an educational course

Noun 1. coursework - work assigned to and done by a student during a course of study; usually it is evaluated as part of the student's
 objectives designed for persons working in the school environment. For example, university trainers should require that all preservice teachers and administrators demonstrate competencies that focus primarily on the classroom application of basic psychological theories and principles associated with the specific mental health needs of children and adolescents, rather than just a basic understanding of global psychological principles. Important competencies include an understanding of the following topics: what is mental health and why does it belong in schools,, mental health vs. mental illness, school violence and bullying, the importance of social emotional health, creating the emotionally healthy classroom, mental health interventions in schools, crisis intervention (individual and group), building resiliency in students, and teacher-wellness management.

In order to continue advocacy efforts toward integrating mental health in preservice training programs, the following recommendations are suggested: (a) Continue aggressive research efforts toward the identification of evidence-based practices and how to implement these practices into preservice training programs; (b) Develop community interagency policy initiatives with schools as equal partners concerned about the emotional health of the learner; (c) Encourage proponents of prevention-based mental health services to demonstrate to school personnel, school district boards, as well as credentialing state and professional agencies that proactive mental health services are directly linked to the educational outcome of the learner; and (d) In spite of the merits to the federal enactment of the No Child Left Behind mandate, the need exists to develop state and federal policies which extend beyond student academic performance. That is, as long as federal legislation mandates improved student academic achievement without recognizing the link between positive mental health and academic achievement, substantive issues including mental health will remain on the backburner, regardless of school personnel preservice preparation.

In an effort to break traditional practices and thus barriers to the typical training of university-based school personnel, the following section highlights the development of a unique university-based interdisciplinary center The Interdisciplinary Center (IDC) (Hebrew: המרכז הבינתחומי‎) is a private college located in Herzlia, Israel.  which is devoted to the promotion of a strengths-based prevention model.

University of Missouri Center for the Advancement of Mental Health Practices in Schools

In part because of the escalating mental illness seen in today's youth, the Missouri Department of Mental Health, through funding from the state legislature A state legislature may refer to a legislative branch or body of a political subdivision in a federal system.

The following legislatures exist in the following political subdivisions:
, entered into a cooperative relationship with the University of Missouri-Columbia to initiate a more proactive (vs. reactive) strengths-based (vs. pathology based) approach to prevention. The result has been the formulation of the Center for the Advancement of Mental Health Practices in Schools (Center).

Intentionally designed in a relatively backwards fashion from traditional models of preservice curriculum building, the Center was constructed solely upon the specific needs determined by practitioners in the field--not mandated by an accrediting body at the state or national level with vague, often subjectively determined, non-essential, purely theoretical knowledge that may or may not have direct implications for working with today's youth and those who serve them.

As such, the Center is committed to serving as a mechanism which supports the mental health needs of ALL students, their families and the school based personnel who serve them. The Center's mission is to (a) Promote the awareness of positive mental health practices impacting school systems; (b) Increase the knowledge of school personnel and their role in preventing mental health problems through evidence-based practices; and (c) Provide school personnel and other mental health providers the skills to problem-solve mental health issues.

Organizationally, the Center is uniquely located in the nationally recognized University of Missouri-Columbia College of Education where all teachers and school administrators are trained at the undergraduate and graduate levels, as well as administratively responsible to the Department of Educational, School and Counseling Psychology Counseling psychology as a psychological specialty facilitates personal and interpersonal functioning across the life span with a focus on emotional, social, vocational, educational, health-related, developmental, and organizational concerns. , which prepares school psychologists, and counselors for school-based service. The Department and Center benefit from two doctoral level training programs which are nationally accredited by the American Psychological Association and collaborate with the University of Missouri's School of Nursing and School of Social Work in the promotion and training of nurses and social workers for school-based practice, respectively.

Operationally, extensive field-based research efforts, including numerous focus groups were conducted to collect autonomous information from school personnel across all professions and levels of employment. This information provided consistent and concrete evidence as to their expressed needs which were not met or inadequately met through either their academic preservice preparation or current inservice continuing educational development. Examples of knowledge-based skill level deficits identified by practitioners included the following: How to address student barriers to learning, how to effectively manage teacher stress and burnout, how to identify and work with the anxious or depressed child in the classroom, how to detect and intervene with suicidal su·i·cid·al
1. Of or relating to suicide.

2. Likely to attempt suicide.
 students, how to communicate with an irate parent, how to prevent violence and bullying in the classroom, how to solicit help on mental health issues for students in need outside the confines con·fine  
v. con·fined, con·fin·ing, con·fines
1. To keep within bounds; restrict: Please confine your remarks to the issues at hand. See Synonyms at limit.
 of the school environment, etc.

The result of these efforts is a Center which has pioneered a number of programs designed to integrate innovative multidisciplinary approaches to mental health practices in schools. Included in these efforts is the development of competency-based graduate programs grounded in the Center mission relating directly to school-based mental health. For example, individual coursework or recognized graduate degrees are offered at the Master's of Education (M.Ed.) and Educational Specialist (Ed.S.) levels, with a focus in mental health. The curricular focus is based upon a preventative, strengths-based approach to mental health, utilizing available evidence-based practices. This unique program is offered entirely online and courses are taught by a variety of doctoral level professionals from around the United States and an even broader range of disciplines including medicine, nursing, law, psychology, psychiatry, special and general education and educational leadership. As a result, students enrolled in course-work benefit by continuous individual and group instruction and consultation from nationally recognized authorities in specific mental health content areas.

Examples of typical online course offerings include: Exploring Mental Health Issues in Schools, Child and Adolescent Mental Health, Building Resiliency and Optimism in Children and Adolescents, Wellness Management for School Personnel, Youth Violence and Bullying--Prevention and Intervention, and Psychiatric Disorders in the Classroom.

At the undergraduate level, specific coursework has been retailored from traditional general psychology courses to focus on school environmental applications of basic psychological theories and principles utilizing evidence-based practices devoted to the mental health of children and adolescents. Topics for discussion with preservice undergraduate teachers include: how to create a positive school and classroom atmosphere that promotes healthy psychological development for all students, how to collaborate with and empower families to promote positive psychological development in their children, how to identify warning signs of psychosocial psychosocial /psy·cho·so·cial/ (si?ko-so´shul) pertaining to or involving both psychic and social aspects.

Involving aspects of both social and psychological behavior.
 maladjustment maladjustment /mal·ad·just·ment/ (mal?ah-just´ment) in psychiatry, defective adaptation to the environment.

1. Faulty or inadequate adjustment.

 and mental health problems and how to adapt classroom instruction to meet the needs of students who suffer from potential or existing behavior or emotional problems.

The Center has also designed academic content-driven modules for delivery as part of continuing teacher inservice training or inclusion within traditional teacher preservice preparation training. All modules are referenced from evidence-based practices and are designed based upon identified teacher need. Examples include: anger management, attention problems and ADHD Attention-Deficit/Hyperactivity Disorder (ADHD) Definition

Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder characterized by distractibility, hyperactivity, impulsive behaviors, and the inability to remain focused on tasks or
, school violence and bullying, dropout prevention and building student resiliency. Finally, as part of the Center mission, extensive consultation, inservice training and program evaluation Program evaluation is a formalized approach to studying and assessing projects, policies and program and determining if they 'work'. Program evaluation is used in government and the private sector and it's taught in numerous universities.  services are available to schools, families and other child-serving organizations on a variety of topics ranging from identifying and intervening with at-risk students to recognizing comorbid psychiatric disorders in juvenile delinquents.

Currently, there are 64 students actively enrolled in the graduate degree programs. These students come from locations throughout the world including the United States, Germany, Australia and Canada and represent a variety of school-based professions including counselors, principals, teachers, nurses and social workers. With such diverse backgrounds, students share a variety of experiences which contribute to the overall instruction of the group. Independent evaluations conducted from students enrolled in the program have been exceedingly positive. Particular comments have centered on the accessibility and knowledge of a national faculty, relevant and practical application of evidence-based practices to the school environment and the opportunity to share similar experiences with colleagues worldwide.


To maximize the quality of educational services provided to today's youth, including those with mental health concerns, a paradigm shift is necessary to change the current preservice training trends in educating school-based personnel. Currently, traditional training programs typically neglect or de-emphasize the importance of student mental health, focus on pathology and illness rather than proactive prevention strategies, or state vague standards that may or may not be interpreted as mental health competencies. Addressing the mental health needs of children, adolescents and the school-based personnel who serve them are fundamental necessities for school success in today's classroom. Whereas efforts toward the prevention of mental illness and, thus, the promotion of resiliency and wellness will need to be systematic in order to be effective across all training and service delivery avenues at the university level, this paradigmatic shift from focusing on mental illness to the promotion of mental health must also occur at the certification and licensing levels. To encourage this paradigm shift in advancing school-based mental health practices, the following recommendations are suggested: Advance research literature on identifying evidence-based practices and how to implement these practices into preservice training programs, develop community interagency policy initiatives with schools as equal partners, introduce and encourage the adoption of prevention-based mental health services for school-based personnel, school district boards, as well as credentialing state and professional agencies and finally, develop state and federal policies which extend beyond student academic performance. The responsibility to ensure that youth are prepared to successfully navigate life's challenging experiences rests with us all.


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James R. Koller and Julie M. Bertel

University of Missouri-Columbia

Correspondence to James R. Koller, 16 Hill Hall, University of Missouri-Columbia, Columbia, Missouri
This article is about the U.S. city in the state of Missouri. For other uses, see Columbia (disambiguation).

Columbia (IPA: /kə.lʌə) is the fifth largest city in Missouri and the largest city in central Missouri.
 65211. E-mail:

The author's would like to acknowledge the support of Dorn Schuffman and the Missouri Department of Mental Health for their proactive efforts toward integrating mental health practices in schools.
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Author:Koller, James R.; Bertel, Julie M.
Publication:Education & Treatment of Children
Geographic Code:1USA
Date:May 1, 2006
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