The application of a strengths-based mental health approach in schools.

The mental health needs of children and adolescents in the United States have received increased attention over the course of the last decade. Emerging evidence strongly suggests that a greater number of the nation's youth are experiencing significant mental health problems. In fact, Surgeon General David Satcher (2001), in the report titled National Action Agenda for Children's Mental Health, stated that the United States is currently facing a public crisis in mental health for children and adolescents. According to this report, 1 in 10 children and adolescents in the United States suffers from mental illness severe enough to cause some level of impairment. Even more disconcerting, an overwhelming 70 percent of children today reportedly receive inappropriate mental health services, or do not receive services at all (Tashman, Waxman, Nabors, & Weist, 1998). While the prevention of mental disorders in children and adolescents has become a concern for federal and state agencies (Greenberg, Domitrovich, & Bumbarger, 2000), the gap between children who need mental health services and those that receive services remains large (Weist, 1999).

With this recognition, coupled with the fact that many of these individuals fail to receive appropriate intervention services before their problems escalate, state and national policymakers and mental health professionals alike are searching for ways to bring about change. One such movement involves a paradigm shift from mental illness (pathology) to mental health (a strengths-based approach)--in other words, focusing on what is "right" with the child versus what is "wrong." They are also exploring how to construct a positive environment that allows not only learning, but also mental health to flourish. Given that the typical child spends the majority of his or her day in school, this paradigm shift must involve the school. Increasingly, school personnel, including general education teachers, are being recognized as people who can help bring preventive mental health services to children in need.

According to Doll (1996), a school of 1,000 students could be expected to have between 180 and 220 students at any given time with diagnosable psychiatric disorders. In a survey completed by over 100 principals in 1994, an overwhelming 88 percent of the respondents indicated that their school served students with special needs. Of this percentage, an alarming 94 percent reported that children in their schools had mental health problems (Heneghan & Malakoff, 1997).

Although it is debatable whether most school administrators recognize the mental health concerns of their students as a problem that needs to be addressed on a par with other education issues (Heneghan & Malakoff, 1997), teachers, who engage in more direct and daily contact with students, are increasingly concerned (Adelman & Taylor, 2000). Teachers are asking for help in dealing with potential mental health problems on a daily basis before they escalate (Adelman & Taylor, 2000). At stake here is the issue of prevention for all children, not just those placed in special education. How prepared, however, are teachers to recognize signs of impending mental health problems? Has their undergraduate training prepared them to be effective advocates? Do they really want to deal with mental health issues? Aside from teaching academic content, are teachers, both at the preservice and inservice levels, knowledgeable about applying psychosocial research to the situations they face in today's troubled society? Are school administrators any more knowledgeable? Can they offer useful advice? According to a recent survey, 91 percent of master level teachers sampled did not feel their own undergraduate education prepared them well enough to handle both classroom and other work-related situations in their school environment, aside from their own specific teaching content specialty (Cramer & Paris, 2001).

There also is a growing concern that teachers are unprepared to deal effectively not only with their students' mental health needs, but also with their own or their colleagues' needs. For example, teachers' mental health, particularly in the area of stress and burnout, recently has been cited in the research literature as a major contributor to drop-out rates from the profession. This may seem obvious, as an estimated 70 to 80 percent of all disease and illness is stress-related (Seaward, 1997). Nevertheless, such statistics point to the urgency that something must be done.

According to the University of Missouri College of Education Dean Richard Andrews (personal communication, July 30, 2001), an estimated 34 percent of teachers leave the profession, for a variety of reasons, within three to five years of initial employment. As a result, state departments of education are forced to hastily fill teaching slots. The people who are hired often do not have much training (or it is tied to a specific content skill, such as math); others enter the profession after being laid off from jobs in other professions. Not only are these individuals usually poorly prepared to teach children, they are also unlikely to understand and be able to implement current research-based strategies in the classroom regarding their students' personal, social, and emotional growth.

Recognizing that the roots of psychopathology start early in life, the long-term costs of poor mental health are high, for both students and teachers. Certainly, then, the need for innovative solutions to help improve mental health services for youth and those who serve them is essential.

The Need for Systems Change

In Missouri, state officials are confronting the challenges of increased mental health problems among their youth. For example, according to Dorn Schuffman, Director, Missouri Department of Mental Health (DMH) (personal communication, October 13, 2001), 97,000 children in the state currently have identifiable serious emotional disorders. Of this population, 65 percent function academically below grade level, an estimated 64 percent will fail to graduate from high school, and 35 percent will be arrested within a few years of leaving high school prematurely.

Traditionally, the focus of state mental health agencies in the United States is on medical management, psychotherapy, or even institutionalization. In an effort to resolve this increasingly pervasive problem, however, the Missouri DMH has committed to a philosophic and programmatic shift to initiate a more proactive (versus reactive), strengths-based (versus pathology-based) approach to prevention. Thus, with funding from the state legislature, the Missouri DMH has radically moved to establish, at the University of Missouri-Columbia, a prevention-driven Center for the Advancement of Mental Health Practices in the Schools.

The Center will serve as a mechanism supporting the mental health needs of all students, their families, school personnel, and the entire surrounding community. The Center's mission is to: 1) promote the awareness of positive mental health practices that affect school systems; 2) increase the knowledge of school personnel and their role in preventing mental health problems through positive, research-based mental health practices; and 3) provide school personnel and other mental health providers the skills to problem solve mental health issues.

The Center, which is part of the University's Department of Educational and Counseling Psychology and the department's school psychology program emphasis area, is reportedly the only university-based program located in a college of education where both ongoing fiscal and programmatic resources have been combined with a state mental health agency to bring about this systemic change.

To help achieve its fundamental mission, the Center has redesigned the standard Psychology 101 course typically required of all education majors. The innovative "Introduction to Psychology in Education" course is designed to improve preservice teacher education by connecting current education and psychology theories to the mental health issues prevalent in schools, through both didactic and hands-on, experience-based training. The guiding philosophy is based on the premise that education professionals need to promote students' healthy intellectual, social, and emotional development, in addition to raising achievement test scores. Typically, more traditional introduction to psychology courses geared toward future educators have offered little insight for managing practical concerns that the teacher and administrator will face in the classroom, including student motivation, bullying, signs of depression, stress management, the effects of divorce on school performance, and conflict resolution. In fact, according to Robert Burke, Professor of Education at Ball State University (personal communication, September 4, 2001), no current, coherent theoretical or practical knowledge base exists nationally in preservice education training for the mental health needs of all children. In essence, therefore, the purpose of this course is to teach the fundamentals for creating a positive learning environment that will allow both the students' and teachers' mental health to flourish.

In addition to preservice course work, the Center also provides continuing education opportunities for inservice training. With the assistance of the University of Missouri's Regional Professional Development Center (RPDC), the Center has access to teachers throughout the state who are interested in gaining knowledge on mental health issues that affect the classroom while receiving ongoing continuing education credits (CEUs). Attending such inservices allows school administrators, teachers, and other school personnel the opportunity to learn about various issues in mental health that are relevant to improving the overall success of their students. The inservice training programs are tailored to meet the needs identified by the specific school district in question. Currently, the Center has designed specific workshops and individual follow-up consultation, for both the teacher and learner, regarding the recognition of individual stress, and focusing on stress-reduction strategies substantiated from the research literature. Other inservice instructional modules offered include: "How to effectively communicate with your principal," "How to effectively communicate with an aggressive parent," "How to recognize the precursors to teacher burnout," and "Identifying school violence predictors."

Furthermore, educators can receive assistance from university staff and advanced school psychology graduate students who specialize in mental health issues, and enjoy access to annotated bibliographies, published texts, articles, videos, and instructional modules on various mental health topics that pertain to students' development and academic performance. Each module contains current, comprehensive research, primarily from professional education and psychology journals. Modules then are constructed in a teacher-friendly format and can be used as direct or self-guided instruction in the classroom.

Teachers or other school staff may also pursue the newly developed Masters in Education degree with an emphasis in mental health. This advanced degree allows teachers and other education staff the opportunity to work side by side with advanced graduate students and faculty in the nationally ranked Department of Educational and Counseling Psychology. The American Psychological Association-approved school psychology doctoral program recently was revised to emphasize a more proactive approach for identifying students with mental illness as well as appropriate services.

In addition, the university is expanding its continuing education classes, to better meet the needs of the nontraditional student. By offering specified coursework through MU Direct, students nationwide are able to access current instruction and receive graduate university credit in a variety of areas within the mental health sector.

Although the University of Missouri-Columbia and the Missouri Department of Mental Health recognize the importance of promoting awareness, knowledge, and skills in mental health to those who work in the school setting, promoting these principles to regular graduate students in training also is important. Graduate students in a variety of education professions (e.g., general and special education, administration, school counseling, and school psychology) are able to reap the benefits of the university's collaboration with the Missouri Department of Mental Health. Because of this unique collaboration through the Center, students are afforded the opportunity to gain extensive, practical knowledge in mental health through assistantships, outside practica in mental health settings, teacher training seminars, as well as direct access to an established speakers' bureau from such disciplines as psychiatry, social work, and law.

In addition, Center staff strive to become knowledgeable concerning the documented research literature on mental health, conduct original research, and substantiate proven strategies for direct application in the classroom. To illustrate, the Center is currently involved in a model statewide, community-based program to study students at risk of school drop-out who subsequently become wards of the juvenile court system and who exhibit multiple signs of mental health deviance.

Conclusion and Commentary

There is an old joke: Everyone talks about the weather, but no one does anything about it. Likewise, although the importance of mental health is widely recognized, especially as it pertains to the well-being of students, the question remains: Who is really going to change the system of providing mental health services? Is it even possible to change it? How do people rank the importance of this issue compared to other challenges facing educators (e.g., test scores, funding, etc.)?

The time has come to take a chance, even start over if that is what we have to do, in our efforts to reduce the escalating problems of mental illness in the student population. If we don't, mental health problems will continue unabated. The focus must be on prevention. The very fact that Childhood Education is devoting a special issue to this topic speaks volumes. While change often produces conflict, conflict can produce growth if we unite forces and systematically set out to achieve it.

The University of Missouri-Columbia's Center for the Advancement of Mental Health Practices in the Schools constitutes an attempt to confront some of the obstacles inherent in the current system. Time and space do not allow for an explanation of the obstacles the Center already has faced, even with the backing of the state legislature as well as a stream of continuous funding. Suffice it to say that for systems change to be effective, a number of problems need to be solved; namely, how do we inculcate mental health principles within an already overloaded teacher education program of study and how do we convince state departments of education, which control certification and district funding, that implementing proactive mental health content within the schools is as important as raising district test scores?

This project was designed to meet these challenges head-on. Whether or not it succeeds will be determined with time. While school systems in general, and university training programs in particular, do an exemplary job in preparing professionals in content areas, is it not time that we ensure competency of all school personnel by prioritizing mental health as a national and local concern as well? Is it not time that we do more than talk? While we may not be able to do anything about the weather, we certainly can do something about improving mental health in the classroom.

References

Adelman, H. S., & Taylor, L. (2000). Promoting mental health in schools in the midst of school reform. Journal of School Health, 70, 171-178.

Cramer, M., & Paris, K. (2001). [Teacher academic preparation on mental health questions]. Unpublished raw data administered to the MU Partnership for Educational Renewal.

Doll, B. (1996). Prevalence of psychiatric disorders in children and youth: An agenda for advocacy by school psychology. School Psychology Quarterly, 11(1), 20-46.

Greenburg, M. T., Domitrovich, C., & Bumbarger, B. (2000). Preventing mental disorders in school-aged children: A review of the effectiveness of prevention programs. State College, PA: Pennsylvania State University, College of Health and Human Development, Prevention Research Center for the Promotion of Human Development.

Heneghan, A. M., & Malakoff, M. E. (1997). Availability of school health services for young children. Journal of School Health, 67, 327-333.

Satcher, D. (2001). National action agenda for children's mental health. Washington, DC: U.S. Department of Health and Human Services.

Seaward, B. L. (1997). Managing stress: Principles and strategies for health and wellbeing (2nd ed.). Boston: Jones and Bartlett.

Tashman, N. A., Waxman, R. P., Nabors, L. A., & Weist, M. D. (1998). The Prepare approach to training clinicians in school mental health programs. Journal of School Health, 68, 162-172.

Weist, M. D. (1999). Challenges and opportunities in expanded school mental health. Clinical Psychology Review, 19, 131-135.

Authors' Note: Appreciation is extended to Dorn Schuffman, Director, Missouri Department of Mental Health. Without his creativity and support, the Center would still be a pipe dream.

James R. Koller is Professor, Department of Educational and Counseling Psychology, and Director, Center for the Advancement of Mental Health Practices in the Schools, University of Missouri-Columbia. Sara K. Svoboda is a doctoral student in School Psychology, Department of Educational and Counseling Psychology, University of Missouri, and a Graduate Research Assistant in the Center for the Advancement of Mental Health Practices in the Schools.