Collaborative relationships: school counselors and non-school mental health professionals working together to improve the mental health needs of students.
In an effort to provide a broad array of services that will assist students in dealing with the social and emotional issues they bring to the classroom, schools and community mental health agencies have begun to implement collaborative partnerships (Walsh & Galassi, 2002). Walsh and Galassi asserted that if we are to successfully intersect the complicated in-school and out-of-school lives of children, we must focus on the development of the whole child. Doing so will require "collaborations that span the boundaries of professions and agencies" (p. 680). Expanded school mental health programs are a growing movement in the United States, which represents partnerships between schools and community mental health agencies. In these programs, school-hired mental health professionals (MHPs) provide a myriad of services, which emphasize effective prevention, assessment, and intervention (Weist, Lowie, Flaherty, & Pruitt, 2001). This collaborative effort is intended to lessen the burden and liabilities of the educational system while improving the fragmented and incomplete delivery of services to school-aged children and youth. Research has indicated that less than one-third of youth who are candidates for mental health services receive the care they need (U.S. Department of Health and Human Services, 1999).
Given the importance and acceptance of multisystem collaboration in improving child and youth mental health, the perceived efficacy of these collaborative partnerships is what drives this research agenda. Precisely, we are interested in the perceptions held by school counselors, school principals, and vice principals as related to school-community agency collaboration. In addition, we sought to understand what school counselors and their hiring principals/vice principals regard as the roles and responsibilities of school counselors and the scope of school counselor training.
Although many school counselors may feel adequately trained to deal with the personal, social, and psychological needs of their students and in some cases expect that is how they will spend their time, in reality school districts are working collaboratively with non-school MHPs to respond to the mental health needs of students. Some of the positions are paid, in part, by the school district. As such, we were particularly interested in the viewpoints of those professionals who are stakeholders in these collaborative relationships. In other words, what thoughts do school counselors hold about their school districts contracting to hire non-school MHPs, namely licensed clinical social workers and psychologists, to provide mental health services to school-aged students? What are the experiences of school counselors as they define their roles and interact with non-school personnel to meet the mental health needs of students?
Participants and Procedure
Participants were 53 school counselors and administrators (33 school counselors, 20 principals/vice principals) employed in middle and high school settings located in the Midwest region. Among the 21 female and 12 male school counselors, 29 were certified and 4 were provisionally certified. School counselors ranged in age from 31 to 65 with a mean age of 47.38 (SD = 10.9). The number of years they were employed as a school counselor ranged from 1 to 40 with a mean of 9.95 (SD = 9.5). Nine principals and 11 vice principals represented the administrator group, of which 13 were male and 7 were female. Administrators ranged in age from 30 to 57 with a mean age of 46.2 (SD = 8.4). The mean number of years that administrators reported being employed as principals and vice principals was 5.26 (SD = 4.1) with a range of 1 to 18. Participants were recruited from six school districts representing two Midwestern states. Participants completed either an online survey or a paper survey, including demographic information.
The School Counselor Roles and Responsibilities Survey is a 25-item scale designed by the authors to gather information on participants' thoughts about the roles and competencies of school counselors and the collaborative relationships among school counselors and non-school MHPs. Respondents indicated the extent to which they agreed or disagreed with each statement using a 4-point Likert scale ranging from 1 for "disagree" to 4 for "agree." Means and standard deviations are available from the first author upon request. Four open-ended questions requested participants' viewpoints regarding (a) schools contracting with non-school MHPs; (b) the perceived responsibilities of school counselors; (c) suggestions for the dialogues needed among principals, school counselors, and non-school MHPs to effectively treat the mental health needs of the student body; and (d) parameters of the contract between schools and non-school MHPs.
Utilizing t-test analyses, the administrator (n = 20) and school counselor (n = 33) groups were compared on each of the 25 scaled items. A Bonferroni correction was employed to control overall error rate and resulted in an adjusted significance level of .002. Findings revealed that school counselors agreed to a much greater extent than did school administrators that they (a) were adequately trained to provide group counseling to students (t = 3.22, p = .002, Cohen's d effect size = .67); (b) were able to identify students who are in need of mental health services (t = 3.43, p = .001, Cohen's d effect size = .66); and (c) were mental health professionals (t = 3.95, p = .000, Cohen's d effect size = 1.17). The effect sizes of these differences are of moderate to large magnitude (Cohen, 1988), which means that counselors and administrators expressed a fairly large difference in their reported scores.
Responses to the four open-ended questions were sorted into categories of best fit. A simplified version of the constant comparison method was utilized (Strauss, 1987). Specifically, two raters independently sorted the responses into categories of best fit. Each response then was selected into the category of best fit by two additional raters until agreement was reached. A table summary of responses to these questions is available from the first author upon request.
Forty-seven participants provided responses to the following: "Please indicate your thoughts about schools contracting or hiring outside mental health professionals to deliver mental health services to students." Four meaningful categories emerged: (a) Agree with hiring outside MHPs (n = 32; 68%); (b) agree with hiring outside MHPs if they are qualified and if clear roles are defined (n = 11; 23%); (c) disagree with current school counselor role (n = 3; 6%); and (d) disagree with hiring outside MHPs (n = 2; 4%).
Nineteen counselors and 13 administrators indicated agreement with schools contracting or hiring MHPs. For example, one counselor wrote,
They provided a needed service to the students for several reasons: (1) Volume of students that need counseling support; (2) Misunderstanding of school counselor job description by administrative staff always limits the ability of school counselors to provides services they are trained for and expected to perform by students and community; and (3) Counseling centers are understaffed. Clinical, noncounseling/administration tasks are always forced on school counselors.
Similarly, one administrator wrote, "A necessary development--schools are held more responsible for mental health, and counselors do not have the time nor the training."
Seven counselors and 4 administrators indicated they agreed with schools contracting or hiring MHPs if these professionals are qualified and if clear roles are defined. For example, one counselor wrote, "In my experience some have been highly qualified and others have not. Those who have been highly qualified are invaluable. Those who were not increased my workload and probably damaged the students." One administrator commented, "Outside mental health professionals need to thoroughly understand how schools operate and the restrictions schools have on them."
Three counselors indicated that they disagreed with the current role as defined for school counselors, as indicated by the following response: "If school counselors were free from the clerical work they do, they could adequately deliver mental health services." Two administrators disagreed with hiring outside MHPs as indicated by the response "Not affordable."
Forty-eight participants provided their perceptions about the roles and responsibilities of school counselors, as reflected by two meaningful categories: (a) mental health and academic counseling, and (b) academic and career counseling services. Specifically, 23 counselors and 13 administrators (75%) perceived the role of school counselors to include treatment of the whole person, including academic, career, personal, and mental health issues, which include support to students in crisis as well as assessing/determining students who need mental health services outside of the school environment. Seven administrators and 5 counselors (25%) perceived the role of the counselor to focus primarily on academic, mediation, and career counseling services.
Suggestions for dialogues that are needed among principals, school counselors, and non-school MHPs included 38 responses, resulting in five meaningful categories:
1. School counselor role definition and clarification. This was indicated by 13 counselors and 5 administrators (47%) who believed that it would be helpful to negotiate noncounseling tasks such as scheduling and to have in-depth discussions with counselors and MHPs about the role and involvement of MHPs in school and student-related issues.
2. Increased opportunity for dialogue. This was reported by 6 counselors and 2 administrators (21%) who noted their limited time as a barrier to opportunities for dialogue.
3. Referral/triage procedures. This was suggested by 3 counselors and 3 administrators (16%) who expressed a need for dialogues regarding the triage procedures and process for addressing student issues.
4. Little dialogue is needed. This was indicated by 4 counselors (11%).
5. Turf war dialogues. This was expressed by 2 counselors (5%) who emphasized that school counselors must give up turf issues and recognize that a variety of resources are needed to best serve children and their families.
Eleven counselors and 5 administrators (55%) indicated that they were aware of parameters that define the types of non-school MHPs who are either contracted or hired in their schools, and 9 counselors and 4 administrators (45%) indicated that they were unaware of the contractual agreements/parameters.
Of considerable interest is the finding that school counselors and administrators had different perceptions regarding the competence of school counselors to provide group counseling and to identify students in need of mental health services. Historically, the primary role of the school counselor was to perform vocational assessment and provide testing on aptitude, ability, and interests to assist students (Flaherty et al., 1998). Presently, that focus has changed to a more proactive model, with an emphasis on prevention. Although the extent of training varies, it appears that many present school counselors are gaining more knowledge about providing individual and group counseling to students, using short-term models of intervention.
Perhaps school administrators are keenly aware of the school counselor's assigned duties and large caseloads and, in recognizing the growing mental health needs of students, are more comfortable with utilizing non-school MHPs to provide such necessary and time-consuming student services. We believe it is possible that the continued confusion regarding role definition and clarification of all participants affects the school administrator's understanding of the pivotal role the school counselor must play in such collaborations. It is often the school counselor who is most knowledgeable about the students and their families, including treatment histories. Moreover, the school counselor's roles of liaison, referral participant, and intervention partner might be unrecognized or underutilized.
In addition, it is interesting that school counselors see themselves as MHPs to a much greater extent than do their administrators. Perhaps this difference is accounted for by the many counseling degree programs in which school counseling students may be required to complete the same core course work as students who intend to become licensed counselors and both are awarded the same counseling degree.
Interestingly, only two participants expressed disfavor with schools hiring outside MHPs to deliver mental health services to students. We interpret the high percentage of participants who support this hiring decision to mean that both counselors and administrators are well aware of the growing mental health needs of students and, therefore, value the benefit of collaboration when clear roles are defined and prescribed.
As indicated by the open-ended questions within the survey, 75% of the sample of participants defined the school counseling role as a combination of both mental health and academic counseling. This finding suggests that it is important for school counselors and their administrators to reach agreement regarding the school counselor's roles and work responsibilities, which should be informed by the ASCA National Model[R] (American School Counselor Association, 2005).
Our sample participants regarded role definition as an important dialogue that needs to occur. In defining these roles, we recommend that focus be placed on the complementary nature of the goals for each professional. Moreover, a description of the responsibilities of the different disciplines and examples of how interdisciplinary teams can operate effectively and in the students' best interest would prove helpful (Weist et al., 2001). Providing such clarification augments service delivery by allowing all parties to share in the responsibility of the collaborative relationship.
Dialogue focusing on an agreed-upon procedure for referring students to non-school MHPs was considered necessary by some participants. Porter, Epp, and Sharronne (2000) suggested that school counselors and non-school MHPs meet on a weekly basis to establish and review a triage and referral process, to discuss interventions, and to work through critical issues of confidentiality and mandated reporting.
Leaders and service providers from school and community mental health agencies should be involved in developing the parameters of the contract for the collaboration. The contract should describe provider roles and responsibilities, including any legal and ethical responsibilities that might arise through record keeping or service delivery. Most importantly, all parties must recognize that a degree of flexibility and adaptability is necessary in maintaining the collaborative relationship.
To conclude, schools are in need of myriad services in order to address the emotional, behavioral, and social needs of their student body, and the collaborative partnerships of schools and mental health agencies appear to be a step in the right direction. We believe that the success of this needed collaboration is contingent upon leaders and supervisors from within the school and community mental health agency who can model effective collaboration and leadership. Fiester, Nathanson, Visser, and Martin (1996) emphasized that support from principals and other key school leaders helps to encourage collaboration among school staff. Furthermore, it is helpful when the school principal lends aid in resolving any logistical conflicts (Flaherty et al., 1998).
Leaders from the school and the community agency should spearhead meetings among professionals to establish procedures (e.g., referral process, record keeping, and program evaluation) and to encourage opportunities for interdisciplinary training. Cross training helps in developing a common language and often evens any hierarchy that might exist (Porter et al., 2000). Such cross training also could enhance trust among professionals and provide a mutual understanding about the legal and ethical challenges for each discipline (Weist et al., 2001). We encourage future research to consider both qualitative and quantitative investigations designed to reassess the extent to which participant roles have been clearly defined, and the extent to which schools and community mental health agencies are successfully implementing their collaborative partnerships.
American School Counselor Association. (2005). The ASCA national model: A framework for school counseling programs (2nd ed.). Alexandria, VA: Author.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.
Fiester, L., Nathanson, S. P., Visser, L., & Martin, J. (1996). Lessons learned from three violence prevention projects. Journal of School Health, 66, 344-346.
Flaherty, L.T., Garrison, E. G., Waxman, R., Uris, P. F., Keys, S. G., Glass-Siegel, M., et al. (1998). Optimizing the roles of school mental health professionals. Journal of School Health, 68, 420-424.
Porter, G., Epp, L., & Sharronne, B. (2000). Collaboration among school mental health professionals: A necessity, not a luxury. Professional School Counseling, 3, 315-322.
Strauss, A. L. (1987). Qualitative analysis for social scientists. New York: Cambridge University Press.
U.S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General. Rockville, MD: Author.
Walsh, M. E., & Galassi, J. P. (2002). An introduction: Counseling psychologists and schools. The Counseling Psychologist, 30, 675-681.
Weist, M. D., Lowie, J. A., Flaherty, L.T., & Pruitt, D. (2001). Collaboration among the education, mental health, and public health systems to promote youth mental health. Psychiatric Services, 52, 1348-1351.
Chris Brown, Ph.D., # an associate professor and David T. Dahlbeck is a graduate student with the University of Missouri-Kansas City. E-mail: email@example.com Lynette Sparkman-Barnes is a clinical psychologist with the University of Saint Mary, Leavenworth, KS.
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|Title Annotation:||PERSPECTIVES FROM THE FIELD|
|Publication:||Professional School Counseling|
|Date:||Apr 1, 2006|
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