A randomized controlled trial on the interconnected systems framework for school mental health and PBIS: Focus on proximal variables and school discipline

Support staff distribution in K-12 US schools that experience shootings: A matched analysis

OBJECTIVE

To compare the presence and rates of school police officers, security guards, nurses, psychologists, social workers, and counselors between US K-12 schools that did and did not experience shooting incidents.

METHODS

School shootings were defined as any discharge of a live firearm round on school grounds, as documented by the press and recorded by the Everytown for Gun Safety between 2017 and 2019. Using Civil Rights Data Collection (2017-2018), we compared staffing patterns between 200 schools that experienced shootings and 86,079 schools without incidents during 2017-2019. Propensity score matching using 32 school-, district-, and community-level covariates yielded analytical samples of 180 shooting-affected schools and 11,063 matched controls. We examined the prevalence and per-1000-student rates of school police officers, security guards, nurses, psychologists, social workers, and counselors.

RESULTS

The 180 schools that experienced shootings showed higher prevalence of school police officers compared to matched controls (50.6 % vs 41.8 %; difference: 8.8 percentage points [95 % CI, 1.6-15.9]). However, these schools had significantly lower rates per 1000 students of nurses (1.37 vs 1.88; difference: -0.50 [-0.95 to -0.06]), psychologists (0.81 vs 1.44; difference: -0.63 [-0.98 to -0.28]), and counselors (2.94 vs 3.71; difference: -0.77 [-1.25 to -0.29]). These patterns remained consistent across multiple sensitivity analyses.

CONCLUSIONS

Schools that experienced shootings demonstrated lower rates of health and mental health staff but higher law enforcement presence compared to matched control schools. These findings suggest the need for increased investment in mental health resources and reevaluation of current school safety approaches.

The Perniciousness and Promise of School-Based Mental Health Service Delivery for Youth

Rates of child and adolescent mental disorder have risen sharply while access to community-based mental health care options continues to be elusive for many families. Substantial and persistent barriers to community-based mental health care have prompted multiple stakeholders to pursue an approach that emphasizes health promotion and intervention practices within the context of ecologically valid and more accessible environments. The most prominent of these environments has been schools that can serve as local and centralized access points to various services, including mental health care. The rapid expansion of school-based mental health service delivery systems, however, carries both risk of perniciousness as well as significant promise with respect to effective and equitable care. This article summarizes key concerns surrounding school-based mental health service delivery systems, including non-beneficence and harm, support disparities, unsustainable implementation, oppressive school climate, and linkage to punitive and discriminatory practices. Broad-based recommendations to help realize the promise of effective and equitable care for students with mental health and behavioral challenges are also presented vis-à-vis each of these concerns. At the same time, natural tensions between various mandates assigned to schools as well as between schools and their surrounding communities will need to be addressed to reach the full potential of school-based mental health service delivery systems.

Training School Staff to Support Students Returning to School After A Psychiatric Hospitalization

Supporting students returning to school after a mental health crisis often involves more training than many school staff members receive. With the increase in youth mental health diagnoses, there has also been an increase in the number of youth requiring psychiatric emergency department visits and hospitalizations. As such, this study employed a basic qualitative design to gather the perspectives of school staff who support students' mental health about their experiences and training needs related to supporting youth returning to school after psychiatric hospitalization. Semi-structured interviews were conducted with 10 school mental health professionals or administrators. Thematic analysis was used to analyze the data. Three themes were identified: 1) most participants received minimal formal training in graduate school on hospital to school transition, 2) most participants learned about hospital to school transition on the job, and 3) participants made recommendations and identified specific training needs. Implications for training are discussed including a need for variety (e.g., some practitioners need basic training while others need more advanced training) and different format preferences (in-person may be preferred but online asynchronous is more convenient).

Distributional moderation analysis: Unpacking moderation effects in intervention research

Moderation and subgroup analyses are well-established statistical tools to evaluate whether intervention effects vary across subpopulations defined by participants' demographic and contextual factors. Moderation effects themselves, however, can be subject to heterogeneity and can manifest in various outcome parameters that go beyond group-specific averages (i.e., means) that are typically the focus of main and moderation effect analyses. The present study introduces distributional moderation analysis using the framework of inflated Generalized Additive Models for Location, Scale, and Shape (GAMLSS) that allows researchers to holistically characterize intervention effect modifiers through simultaneously modeling conditional mean-, variance-, skewness-, and kurtosis-based intervention effects, as well as moderated treatment effects located at the endpoints of the response scale (i.e., floor/ceiling effects). Data from a large-scale randomized controlled trial evaluating the effects of a teacher classroom management program on students' disruptive classroom behavior are used to provide a step-by-step guide for applying distributional moderation analysis in school-based intervention research. Although a traditional mean-focused analysis suggests that the intervention reduced students' average disruptive behavior only for students receiving special education, an evaluation of distributional treatment effects reveals a general decrease in the average disruptive behavior for at-risk students. In addition, distributional moderation analysis suggests that this average decrease is moderated by students' race and that the moderation effect of special education status initially seen in the traditional analysis is not located in the means, but in the chance to show no disruptive behavior patterns at all. Thus, we conclude that distributional moderation analysis constitutes a valuable complementary tool to provide a fine-grained characterization of treatment effect modifiers.

Amplifying School Mental Health Literacy Through Neuroscience Education

Children and adolescents face a wide variety of developmental changes and environmental challenges, and it is estimated that at least one in five children aged 3-17 will experience behavioral or mental health issues. This period of life coincides with major changes in brain structure and function that have profound long-term consequences for learning, decision-making (including risk taking), and emotional processing. For example, continued development of the prefrontal cortex in adolescence is a sensitive period during which individuals are particularly susceptible to risky behaviors, environmental stressors, and substance use. While recent advances in mental health literacy programs have paved the way for increased awareness of the benefits of mental health curricula in schools, these efforts could be greatly bolstered with support in basic neuroscience education in developmentally appropriate and area-specific content. Here, we provide a discussion on the basic structural and functional changes occurring in the brain throughout childhood, how this contributes to changes in cognitive function, and the risk factors posed by early life adversity, stress, and drug use. Finally, we provide a perspective on the benefits of integrating findings from the field of neuroscience and suggestions for tools to better equip students, teachers, administrators, and school mental health staff to provide new directions for addressing the mental health crises faced by millions of children and youth each year.

Early detection of students' mental health issues from a traditional daily health observation scheme in Japanese schools and its digitalization

Objective

The implementation of school-based mental health screening offers promise for early detection of mental health issues in children; however, various barriers hinder its widespread adoption. This study aimed to investigate the predictive value of digital data obtained from an established daily health observation scheme in Japanese schools to identify later mental health issues in children.

Methods

Data for the analysis were obtained from 2,433 students enrolled in five public schools. The data acquisition period spanned 76 school days, from September 1, 2022, to December 23, 2022, and student absences were recorded during this period. Depressive and anxiety symptoms were assessed in January 2023. The students' daily physical and emotional health status was recorded as "daily health issue" scores and group-based trajectory modeling was employed to classify the long-term trends in these scores. Additionally, rolling z-scores were utilized to capture variability in daily health issue scores, with z-scores above +1 considered unusual responses.

Results

After 4 months of daily health observations, students' response trends were classified into five trajectory groups. The group experiencing the highest number of daily health issues (Group 5; 5.4% of the sample) exhibited more subsequent depressive and anxiety symptoms compared to the group with fewer issues (Group 1; 47.5%) (incident rate ratio [IRR] = 5.17; 95% confidence interval [CI]: 3.82, 6.99). Group 5 also demonstrated significantly more days of absence than Group 1 (IRR = 2.14, 95% CI: 1.19, 3.85). The average daily health issue scores for the entire period were associated with both depressive/anxiety symptoms and the number of days absent from school (IRR = 1.59, 95% CI: 1.45, 1.73; IRR = 1.18, 95% CI: 1.04, 1.35, respectively). Furthermore, a higher number of unusual responses during the entire period was also associated with more depressive/anxiety symptoms (IRR = 1.10, 95% CI: 1.07, 1.12).

Conclusion

The current study is the first to demonstrate the predictive capability of a traditional daily health observation scheme to identify mental health issues in children. This study highlights the scheme's potential to screen and safeguard children's mental health, emphasizing the importance of digitalization and collaboration with various stakeholders.

Promoting equity and justice in school mental health

Advancing equity and justice in school mental health can address inequities in school-based services and outcome disparities. The purpose of this special issue is to promote equitable and just systems and practices in school mental health to promote change in institutional practices that have produced and reproduced inequities over time. The four articles in this special issue clarify a process for advancing equity in school mental health by addressing justice-centered variables to promote connections across and within systems to realize a vision of comprehensive and integrated school mental health.

Reframing family-school partnerships to disrupt disenfranchisement of Black families and promote reciprocity in collaboration

Research has long demonstrated the benefits of family-school partnerships. However, these benefits often fail to generalize to all families, especially Black families. A present and historical pattern of discrimination and exclusion has contributed to the lack of benefits yielded from Black family-school partnerships. A major contributing factor is the narrow way in which schools define family engagement. Such narrow definitions often marginalize families from non-dominant backgrounds, particularly Black families, and reinforce harmful narratives that Black parents and families are uninvolved in their children's education. The combination of continued discrimination and exclusion as well as harmful narratives has impacted Black family-school partnering. However, schools can work to repair harm and rebuild partnerships with Black families. In this article, we advance a framework for such work. After grounding the need for this framework in a historical context, we emphasize three essential components to forming equitable Black family-school partnerships: (a) grounding relationship building in social justice, (b) integrating reciprocity in family-school relationships, and (c) usage of multiple and non-dominant methods and modalities to build relationships.

An Empty Scoping Review of Emergency Department to School Transition for Youth with Mental Health Concerns

The number of youth Emergency Department (ED) visits due to mental health concerns has been steadily increasing with a large number of youth being referred from school. Despite the increase in ED visits, there has not been an increase in the number of students who are actually admitted to the hospital. Further, youth referred from school are more likely to be discharged from the ED. Given the unique relationship between school and ED referrals and the large number of youth who do not require hospitalization, this study sought to understand how schools are supporting students who return to school after an ED visit. We conducted a scoping review to identify programs and practices to support ED to school transition. Two reviewers screened 907 manuscripts, but none of the manuscripts met the inclusion criteria. We discuss the importance of supporting students returning to school from the ED and draw from the literature on hospital to school transition to make recommendations for educators.

Holistic Functioning from a Developmental Perspective: A New Synthesis with a Focus on a Multi-tiered System Support Structure

While research in specific academic disciplines has individually advanced knowledge and practice for promoting multiple aspects of health and well-being in children and adolescents, still missing is an understanding of the interconnectedness of many critical aspects of development and how to intentionally weave these factors to advance a more holistic approach. The need for a more holistic and inclusive approach to child and adolescent development is increasingly evident to promote long-term health and well-being as the overall percentage of children, adolescents, and adults who suffer from mental health disorders is increasing. To address this issue, our authorship team consists of researchers in the areas of developmental psychology, neuroscience, motor development, exercise science, and mental health. The collective ideas outlined in this paper are aligned to address the need to remove disciplinary-specific boundaries and elucidate synergistic linkages across multiple research domains that support holistic development and lifespan health and wellness. We propose a conceptual framework that comprehensively addresses the integration of physical, cognitive, psychological, social, and emotional domains of child and adolescent development. In addition, we also provide a holistic preventative approach that is aligned with a contemporary intervention structure (i.e., Multi-tiered Systems of Support) to promote, from a developmental perspective, positive trajectories of health and well-being across childhood and adolescence.

Using readiness to understand implementation challenges in school mental health research

Schools and research partners are increasingly implementing complex, multicomponent interventions and school-wide frameworks to better meet students' social, emotional, behavioral, and academic needs; however, in the research and real-world contexts, implementation is often fraught with many challenges and barriers to success. This study explores implementation barriers encountered during a randomized controlled trial testing effects of one complex intervention strategy-the Interconnected Systems Framework-from the lens of a practical model for conceptualizing organizational readiness-the Interactive Systems Framework for Dissemination and Implementation. Implementation of the Interconnected Systems Framework was explored via focus group and key informant interviews with school and mental health professionals, and research team members responsible for implementing the intervention in randomly assigned study schools. Results from inductive thematic analysis of verbatim transcripts identified three primary implementation challenges: staff turnover, inadequate leadership buy-in, and insufficient time for training/planning. Each challenge is explored from interview participants' perspectives and the extant literature, then connected to recommendations from implementation science to help others avoid similar challenges in their well-intentioned efforts to address the mounting concern for students' wellbeing.