Toward collaboration in the growing education-mental health interface

Perceptions of mental health services among the children who are in conflict with the law in Jammu and Kashmir

Background: Due to the Jammu and Kashmir conflict, many teenagers are involved in disputes with the law. The conflict made generations suffer for decades. Such children made the mobs; being involved in life-threatening situations and the risk they confront develop psychiatric disorders. As a result of the various tense conditions when applied in multiple anti-social activities, aberrant children sent to correctional homes have to encounter numerous psychological disorders. Aim: The motive of the study is to explore the level of awareness, availability of services, stigma and obstacles to seeking assistance. Method: Due to the open-ended interview questions and a small sample size of 15 respondents, this study employed a qualitative methodology - a thematic analysis was done. Results: The findings revealed that, although the stigma is not publicly acknowledged, children who break the law and seek mental health services (MHS) are stigmatised. It was also shown that minor offenders fear that when they receive services provided by the staff of the observation home (OH), there will be a violation of their privacy and fear unforeseen repercussions. Conclusion: Collaborative action must proactively raise appropriate awareness to lessen the stigma linked with mental health problems, especially regarding MHS among these teenagers.

Implementation of a School Mental Health Learning Collaborative Model to Support Cross-Sector Collaboration

Facilitating success for students with behavioral health challenges requires effective collaboration among professionals from traditionally disparate systems (e.g., education, health, and mental health). The current investigation describes a case-study implementation of a school-based learning collaborative model and explores its effectiveness in promoting knowledge, skill, efficacy, and systems-related improvements in cross-sector collaboration. The learning collaborative (LC) was offered to school teams over the course of a year and consisted of a combination of didactic and experiential learning opportunities, guest speakers, district-specific improvement goals, peer learning and support, and individualized consultation support. Evaluation efforts included evidence demonstrating the efficacy of the LC, improvement in person-centered knowledge skills and competencies, and generation of concrete changes in school systems. Respondents consistently shared that the quality of the LC was high that the topics were highly useful for their day-to-day practice, and that they would recommend the LC to their colleagues and peers. In turn, this process fostered improvement in educators' knowledge, skills, and confidence, and generated systemic improvement in districts to support children with behavioral health needs and their families. Specific components of this model that best account for changes are discussed, along with implications for application and next steps.

Research on the influence mechanism of university-enterprise collaboration: Evidence From five southern coastal provinces in China

Taking university-enterprise collaborative innovation in five southern coastal provinces of China as subjects, empirical research is implemented by constructing a theoretical model of the effects of interface resource integration, interface conflict management, interface connection mechanisms, and enterprise absorptive capacity on the university-enterprise collaborative innovation performance with the partial least squares structural equation modeling and fuzzy-set qualitative comparative analysis. A total of 245 valid questionnaires were collected from five coastal provinces in south China. The research results show that the interface resource integration, interface connection mechanisms, and enterprise absorptive capacity has direct significant positive impacts on the collaborative innovation performance. Interface conflict management has no significant impact on school-enterprise collaborative innovation performance. Moreover, the interface connection mechanism acts as an intermediary. Therefore, it is suggested that university-enterprise should integrate resources with complementing, interacting, and sharing resources; construct the profit and risk-sharing mechanism, communication and trust mechanism, and organizational learning mechanism.

Research on the influence mechanism of university-enterprise collaboration: Evidence From five southern coastal provinces in China

Taking university-enterprise collaborative innovation in five southern coastal provinces of China as subjects, empirical research is implemented by constructing a theoretical model of the effects of interface resource integration, interface conflict management, interface connection mechanisms, and enterprise absorptive capacity on the university-enterprise collaborative innovation performance with the partial least squares structural equation modeling and fuzzy-set qualitative comparative analysis. A total of 245 valid questionnaires were collected from five coastal provinces in south China. The research results show that the interface resource integration, interface connection mechanisms, and enterprise absorptive capacity has direct significant positive impacts on the collaborative innovation performance. Interface conflict management has no significant impact on school-enterprise collaborative innovation performance. Moreover, the interface connection mechanism acts as an intermediary. Therefore, it is suggested that university-enterprise should integrate resources with complementing, interacting, and sharing resources; construct the profit and risk-sharing mechanism, communication and trust mechanism, and organizational learning mechanism.

Integrating Behavioral Health in Primary Care: Lessons from Interdisciplinary Collaboration in School Mental Health

Integrating behavioral health care into pediatric primary care (PPC) settings can increase access to behavioral health promotion services and treatment. Efficient models for integrated PPC are emerging. Recent reviews call for integrated PPC research to better identify efficient teaming and processes, particularly in areas of building integrated PPC team member capacity and adopting practices that promote "upstream" behavioral wellness specific to community needs. Research in integrating behavioral health in schools has identified key practices relevant to these gaps in integrated primary care (IPC) research. This article discusses possibilities to apply findings from integrated school behavioral health research to IPC settings.

Promoting educator social emotional competence, well-being, and student-educator relationships: A pilot study

Educator mental health and well-being have received increased attention in response to the additional stress experienced during the coronavirus pandemic. Cultivating mental health and well-being can be facilitated by enhancing adult social emotional competencies. However, relatively limited research has explored how prevention programs promoting social emotional competencies have enhanced educator well-being and related attributes of self-care, efficacy, and skillful interactions with students. In this pilot study, we implemented and evaluated an innovative prevention program called Resilience in Schools and Educators (RISE) in eight Colorado schools with 53 educators. RISE builds knowledge and skills that promote educator social-emotional competencies, trauma responsivity, cultural responsivity, resilience, and well-being. The first study aim was to explore the fidelity and feasibility of the RISE program implemented in a school-based context. The second study aim was to explore whether RISE is associated with increases in educators' self-reported social emotional competencies, well-being, self-care practices, self-efficacy, and quality of interactions with students. As compared to field standards, facilitators reported high levels of fidelity and feasibility of RISE. Educators' pre- and post- self-report measures indicate significant improvements in social emotional competencies (emotional awareness, emotional clarity, non-reactivity, nonjudging), self-care practices, well-being, and student-educator conflict, with effect sizes indicating small to medium impacts. No findings emerged for self-efficacy or perceived closeness of student-teacher relationships. Theoretical and practical implications are discussed.

Can We Move the Needle on School Mental Health Quality Through Systematic Quality Improvement Collaboratives?

Learning collaboratives (LCs) have often been used to improve somatic health care quality in hospitals and other medical settings, and to some extent to improve social services and behavioral health care. This initiative is the first demonstration of a national, systematic LC to advance comprehensive school mental health system quality among school district teams. Twenty-four districts representing urban, rural, and suburban communities in 14 states participated in one of two 15-month LCs. Call attendance (M = 73%) and monthly data submission (M = 98% for PDSA cycles and M = 65% for progress measures) indicated active engagement in and feasibility of this approach. Participants reported that LC methods, particularly data submission, helped them identify, monitor and improve school mental health quality in their district. Qualitative feedback expands quantitative findings by detailing specific benefits and challenges reported by participants and informs recommendations for future research on school mental health LCs. Rapid-cycle tests of improvement allowed teams to pursue challenging and meaningful school mental health quality efforts, including mental health screening in schools, tracking the number of students receiving early intervention (Tier 2) and treatment (Tier 3) services, and monitoring psychosocial and academic improvement for students served.

Youth Depression in School Settings: Assessment, Interventions, and Prevention

In this article, the authors make a compelling case that all clinicians who treat youth with depressive disorders should embrace strategies to engage with school staff to best serve their patients in the classroom. Because these disorders have a high incidence in the school population (13% of US teens experienced at least 1 major depressive episode in 2016), this can affect learning, social interactions, and classroom engagement. Several approaches are highlighted for assessment of depressive symptoms, intervention and treatment in school settings, and prevention strategies, including depression education curricula and programs promoting subjective well-being, such as positive psychology and mindfulness.

Understanding Expanded School Mental Health Services in Baltimore City

This article explores the nature of expanded school mental health (ESMH) services in Baltimore City, which at the time of the study were incorporated into 40% of the city’s public schools. A provider survey was distributed to ESMH clinicians to gather information on the characteristics of service providers and recipients, types of services being provided, and their proposed outcomes. Provider reports indicated an impressive service capacity, augmentation of traditional school-based services, and the continual need for increased mental health service hours in their buildings. In addition, the most frequently voiced benefits of the ESMH programs were increased mental health awareness and improved school climate. Implications of the findings for future programming development and research are discussed.

School-based suicide prevention: content, process, and the role of trusted adults and peers

Suicide is a leading cause of preventable death in youth, and numerous curricula and other prevention and intervention programs have been developed in the last 15 years. Comprehensive suicide prevention planning should include the 4 components of health promotion, prevention/education, intervention, and postvention. School-based suicide prevention and mental health education programs have become more common as an efficient and cost-effective way to reach youth. Process considerations that are based on the principles of therapeutic engagement with patients and families can provide mental health professionals with strategies that can assist education professionals, students, and the larger school community simultaneously.

SBIRT for adolescent drug and alcohol use: current status and future directions

Adolescence is a period of rapid biological, psychological, and social development in the human life cycle. Drug and alcohol misuse during this critical period poses substantial problems for individual and public health, yet is highly prevalent in the United States and elsewhere. The screening, brief interventions, and referral to treatment (SBIRT) model may be well-suited for identifying and intervening with adolescents who are at-risk of developing substance use disorders and those adolescents whose substance use puts them at risk for injury or illness. This article reviews the literature on SBIRT for adolescent populations, focusing on findings from randomized controlled trials. The limited evidence suggests that brief interventions may be effective with adolescents, but a number of gaps in the literature were identified. Considerations for implementing SBIRT with adolescent populations are discussed. Randomized trials are needed that have adequate statistical power, employ longer-term follow-ups, and test the effectiveness of SBIRT for adolescents in various service delivery settings.

Developing an online learning community for mental health professionals and service users: a discursive analysis

BACKGROUND

There is increasing interest in online collaborative learning tools in health education, to reduce costs, and to offer alternative communication opportunities. Patients and students often have extensive experience of using the Internet for health information and support, and many health organisations are increasingly trying out online tools, while many healthcare professionals are unused to, and have reservations about, online interaction.

METHODS

We ran three week-long collaborative learning courses, in which 19 mental health professionals (MHPs) and 12 mental health service users (MHSUs) participated. Data were analysed using a discursive approach to consider the ways in which participants interacted, and how this contributed to the goal of online learning about using Internet technologies for mental health practice.

RESULTS

MHSUs and MHPs were able to discuss issues together, listening to the views of the other stakeholders. Discussions on synchronous format encouraged participation by service users while the MHPs showed a preference for an asynchronous format with longer, reasoned postings. Although participants regularly drew on their MHP or MHSU status in discussions, and participants typically drew on either a medical expert discourse or a "lived experience" discourse, there was a blurred boundary as participants shifted between these positions.

CONCLUSIONS

The anonymous format was successful in that it produced a "co-constructed asymmetry" which permitted the MHPs and MHSUs to discuss issues online, listening to the views of other stakeholders. Although anonymity was essential for this course to 'work' at all, the recourse to expert or lay discourses demonstrates that it did not eliminate the hierarchies between teacher and learner, or MHP and MHSU. The mix of synchronous and asynchronous formats helped MHSUs to contribute. Moderators might best facilitate service user experience by responding within an experiential discourse rather than an academic one.

Developing an online learning community for mental health professionals and service users: a discursive analysis

BACKGROUND

There is increasing interest in online collaborative learning tools in health education, to reduce costs, and to offer alternative communication opportunities. Patients and students often have extensive experience of using the Internet for health information and support, and many health organisations are increasingly trying out online tools, while many healthcare professionals are unused to, and have reservations about, online interaction.

METHODS

We ran three week-long collaborative learning courses, in which 19 mental health professionals (MHPs) and 12 mental health service users (MHSUs) participated. Data were analysed using a discursive approach to consider the ways in which participants interacted, and how this contributed to the goal of online learning about using Internet technologies for mental health practice.

RESULTS

MHSUs and MHPs were able to discuss issues together, listening to the views of the other stakeholders. Discussions on synchronous format encouraged participation by service users while the MHPs showed a preference for an asynchronous format with longer, reasoned postings. Although participants regularly drew on their MHP or MHSU status in discussions, and participants typically drew on either a medical expert discourse or a "lived experience" discourse, there was a blurred boundary as participants shifted between these positions.

CONCLUSIONS

The anonymous format was successful in that it produced a "co-constructed asymmetry" which permitted the MHPs and MHSUs to discuss issues online, listening to the views of other stakeholders. Although anonymity was essential for this course to 'work' at all, the recourse to expert or lay discourses demonstrates that it did not eliminate the hierarchies between teacher and learner, or MHP and MHSU. The mix of synchronous and asynchronous formats helped MHSUs to contribute. Moderators might best facilitate service user experience by responding within an experiential discourse rather than an academic one.

Schools: Central to Providing Comprehensive CAMH Services in the Future?

It is now widely agreed that meeting the mental health needs of children and young people is a task only possible if all children's services work together. Recent epidemiological data indicate that schools are a key entry point to mental health services for children and young people, and have an important role in the assessment and management of children with neurodevelopmental disorders. This paper explores the rationale for collaborative working between health and educational professionals, examines some examples of good practice, explores factors contributing to their success or failure and considers future developments.

Enhancing schools' capacity to support children in poverty: an ecological model of school-based mental health services

School based mental health services for children in poverty can capitalize on schools' inherent capacity to support development and bridge home and neighborhood ecologies. We propose an ecological model informed by public health and organizational theories to refocus school based services in poor communities on the core function of schools to promote learning. We describe how coalescing mental health resources around school goals includes a focus on universal programming, mobilizing indigenous school and community resources, and supporting core teaching technologies. We suggest an iterative research-practice approach to program adaptation and implementation as a means toward advancing science and developing healthy children.

The Effectiveness of a School-Based Adolescent Depression Education Program

In an effort to decrease the suicide rate in adolescents, many interventions have focused on school-based suicide prevention programs. Alternatively, depression education in schools might be effective in decreasing the morbidity, mortality, and stigma associated with adolescent depression. The Adolescent Depression Awareness Program (ADAP) developed a 3-hour curriculum to teach high school students about the illness of depression. The purpose of this study was to assess the effectiveness of the ADAP curriculum in improving high school students’ knowledge about depression. From 2001 to 2005, 3,538 students were surveyed on their knowledge about depression before and after exposure to the ADAP curriculum. The number of students scoring 80% or higher on the assessment tool more than tripled from pretest to posttest (701 to 2,180), suggesting the effectiveness of the ADAP curriculum. Further study and replication are required to determine if improved knowledge translates into increased treatment-seeking behavior.

Use of brief interventions for drug abusing teenagers within a middle and high school setting

BACKGROUND

Promising and encouraging results have been recently reported on the use of briefer interventions for adolescent drug abusers. Because middle- and high-school-based drug abuse intervention programs have grown in popularity over the past several decades, the use of brief interventions (BIs) in school settings merits consideration.

METHODS

We review several clinical and school contextual issues pertaining to the scientific efficacy, feasibility, and application of BIs for students who are abusing drugs.

RESULTS

Several advantages for employing BIs in a school setting are identified, including the relatively high base rate of students with mild-to-moderate drug involvement and the likelihood that school counselors can readily learn BI techniques. Caveats of implementing BIs include practical, systemic, and clinical barriers.

CONCLUSIONS

Despite concerns, schools are a viable setting in which to screen youth for drug abuse problems and to conduct a BI.

Blending education, research, and service missions: the Arkansas model

Creating school and community partnerships with academic health centers (AHC) offers one strategy for initiating and sustaining broad-based change in health systems. This article describes the development, initial evaluation, and current iteration of the Arkansas Partners in Behavioral Health Sciences Model, a collaboration between personnel from an AHC and K-12 schools to address behavioral health issues in children. The model's focus on education, research, and service provides an opportunity for AHC faculty and school personnel to collaborate to promote mental health in school-aged youth. Quantitative and qualitative methods have been used to inform development and confirm effectiveness of the program. From 2001 through 2005, more than 2,700 school personnel from 72 of the 75 counties in Arkansas participated in more than 30,000 hours of continuing education. The programs have also targeted students using interactive televideo presentations, supplemental classroom curricula, and an exhibit in a state science museum, resulting in an outreach to more than 2,500 youths. Results of longitudinal and randomized studies also show changes in knowledge, attitudes, and behaviors. In an era of extraordinary need and finite resources for school systems, AHCs are poised to provide the critical link to improve the scientific knowledge and understanding of behavioral health conditions. The current program targets behavioral health, but AHCs also can incorporate other health conditions, scientific topics, and medical interventions to provide a important service for the public and to accomplish an important mission toward health leadership in the community.

The President’s New Freedom Commission: Capitalizing on Opportunities to Advance School-Based Mental Health Services

The report from President George W. Bush's New Freedom Commission on Mental Health (NFC), Achieving the Promise: Transforming Mental Health Care in America(2003), proposes goals and recommendations for improving mental health services. This report has significant implications for the delivery of mental health services through the schools. A focused discussion of the potential opportunities and challenges of implementing NFC recommendations related to school-based mental health is presented. Strategies for addressing five key areas at the intersection of school mental health and the Commission's recommendations include: stigma reduction, suicide prevention, expansion and improvement of school mental health, and screening and treatment of co-occurring mental health and substance abuse disorders.

Enhancing No Child Left Behind-School mental health connections

The No Child Left Behind Act of 2001 was signed into law by President George W. Bush in January 2002 and is regarded as the most significant federal education policy initiative in a generation. The primary focus of the No Child Left Behind Act is on promoting educational success for all children; however, the legislation also contains opportunities to advance school-based mental health. Unfortunately, the complexities of the provisions of the No Child Left Behind Act have made it difficult for educators, stakeholders, and mental health professionals to understand the legal and practical interface between No Child Left Behind and the school mental health movement. Therefore, the goals of this article are to (1) raise awareness about the challenges educators and school mental health professionals face as a result of the implementation of No Child Left Behind and (2) provide ideas and recommendations to advance the interface between No Child Left Behind and school mental health, which will support key provisions of the act and the growth of the field.

Child and Adolescent Social-Emotional Development Within the Context of School

Children and adolescents exposed to violence may develop mental health problems, impacting their ability to develop appropriate social-emotional skills. Limited development of social-emotional skills has been associated with poor performance in school. A review of the literature was conducted to better understand social-emotional development in children and its role in a child's ability to function in the school setting. The developmental psychopathology framework is used to illuminate the dynamic relationship between children and their contexts. Specifically, the context of school is explored to identify its role in providing services that address the needs of children and adolescents with social-emotional limitations.

Early intervention for childhood anxiety in a school setting: outcomes for an economically disadvantaged population

OBJECTIVE

To evaluate a school-based early intervention program for the reduction of anxious symptoms in at-risk children from low socioeconomic status neighborhoods.

METHOD

A total of 425 children (8-11 years old) from nine schools in low socioeconomic status areas were screened to identify children with high-level anxious symptoms. Ninety-one children were selected, and schools were assigned to either an eight-session active intervention or a waitlist control. Active intervention was conducted in small groups during school time by both school and health personnel. Parents of children in active intervention were offered two information sessions.

RESULTS

Demographic data indicated a low socioeconomic status for the sample. Children assigned to active intervention demonstrated a significant reduction in symptoms of anxiety relative to children assigned to waitlist and differences were maintained 4 months after treatment according to both self-report (F287 = 6.73, p < 0.005, partial eta = 0.134) and teacher report (F 2,87 = 7.99, p = .001, partial eta = 0.155). Parents did not return sufficient data for meaningful statistical analysis.

CONCLUSIONS

School-based early intervention appears to offer an effective means of reducing anxious symptomatology in economically disadvantaged populations. The school environment offers promise as a means of extending the reach of efficacious interventions for mental health to underserviced populations.

Promoting Multidisciplinary Relationships: A Pragmatic Framework for Helping Service Providers to Work Collaboratively

Multidisciplinary teamwork is increasingly considered the ideal way to provide mental health services. This is especially the case when working with children or families. However, there is little easy-to-use information available to help practicing professionals recognize and overcome barriers to working in multidisciplinary settings. There are even fewer resources intended for use across disiplines. This paper offers a practical approach to help mental health professionals identify barriers to teamwork and create solutions to those barriers.

School Entry After a Community-Wide Trauma: Challenges and Lessons Learned from September 11th, 2001

The purpose of this paper is to describe the implementation of a school-based trauma-specific mental health program in New York City following the terrorist attacks on September 11, 2001. This program aimed to serve children most at risk for developing mental health problems as a result of physical proximity (e.g., evacuation from schools surrounding the World Trade Center) to the trauma. As we present the components of the program, we will review the literature that guided our decision making. The ongoing struggle between searching for answers from established science and immediate needs in a crisis is highlighted. Lastly, a discussion of the lessons learned and recommended next steps is presented.

Implementing school-based substance abuse interventions: methodological dilemmas and recommended solutions

AIMS

To review current knowledge about the most effective school-based interventions for child and adolescent problems, and to present dilemmas and potential solutions in mounting and evaluating school-based interventions for adolescent alcohol and other drug (AOD) use problems.

DESIGN

Two literature reviews were conducted: (1) a broad and encompassing review of English-language articles published from 1990 to the present concerning school-based interventions for child and adolescent problems and (2) an exhaustive review of articles concerning Student Assistance Programs, which are the most popular approach to school-based AOD intervention in the United States.

FINDINGS

Ten key components of effective school-based interventions were identified. In addition, six pervasive dilemmas in school-based AOD intervention research were discussed. Examples of potential solutions to these dilemmas were gleaned from an ongoing randomized clinical trial of a Student Assistance Program.

CONCLUSIONS

School-based AOD interventions have several potential advantages over more traditional clinic-based AOD interventions. Nonetheless, there are many challenges and dilemmas to conducting and evaluating interventions in school settings. With patience and guidance, these challenges can be addressed successfully.

Expanded school mental health: exploring program details and developing the research base

Expanded school mental health (ESMH) programs, the focus of this special issue, provide comprehensive mental health care to youth in general and special education through partnerships between schools and community mental health agencies and programs. As these programs progressively develop in the United States, there is a critical need to build the research and evidence base for them. This article presents background to the national movement toward ESMH and provides an overview of articles contained in this special issue, which provide in-depth details and early research findings on diverse aspects of mental health programs in schools. Advantages of greater involvement of behavioral professionals in ESMH are discussed.

School-based mental health services in Baltimore: association with school climate and special education referrals

This study investigated the association between school-based mental health services and two proposed but untested outcomes of these services: (a) school climate and (b) patterns of referrals to special education. Results from a climate survey found that teachers and staff in eight elementary schools with expanded school mental health (ESMH) services gave higher ratings on the survey's mental health climate subscale than respondents from schools in a matched comparison group. No differences were found for the General Climate subscale of the survey. Results also indicated that teachers in ESMH schools referred fewer students to the special education eligibility process because of emotional and behavioral issues and that fewer students in ESMH schools were found eligible for special education for emotional and behavioral disabilities. Results of this study provide beginning evidence for the positive impact of ESMH programs on these two schoolwide indicators of functioning.

Collaboration and social inquiry: multiple meanings of a construct and its role in creating useful and valid knowledge

The concept of collaboration in community research and intervention, although not new, has grown tremendously in importance in the past 20 years. Yet, it is both a contested concept in terms of its intent and a still evolving idea in terms of its meaning and implications. The purpose of this monograph is to begin to "unpack" the collaboration construct in terms of its many meanings, rationales, goals, models, dynamics, and accomplishments. Although models of collaboration are often well articulated there is "partial paradigm acquisition" (E. J. Trickett, 1984) in terms of understanding their behavioral and ethical implications. There is more theology than conclusion. The promise of collaboration, although considerable, is still in need of multiple and varied empirical examples of how collaboration contributes to both the process and goals of community research and intervention, however defined. The monograph closes with a brief overview of what we have learned from reviewing this literature, an articulation of the kinds of questions that need to be addressed, and a series of recommendations for how to increase our understanding of the collaboration construct in community research and intervention.

Funding a full continuum of mental health promotion and intervention programs in the schools

PURPOSE

To assess the availability of public and private financing sources to support comprehensive school mental health programs. The paper focuses on "expanded school mental health" (ESMH) programs, which provide a full array of mental health promotion and intervention services to youth in general and special education through school-community partnerships.

METHODS

A range of strategies to fund ESMH services are reviewed, including fee-for-service funding, as well as grants, contracts, and other mechanisms from federal, state, local, and private sources.

RESULTS

An objective national study of the characteristics and financing of ESMH programs has yet to be conducted. Existing evidence suggests that funding for these programs is patchy and tenuous. Many programs are being funded through fee-for-service programs, which generally only support the provision of more intensive services (e.g., assessment, therapy) and are associated with significant bureaucracy and other concerns (e.g., the need to diagnose students). As programs move to enhance funding for preventive and mental health-promoting activities and services, there is an increasing need for grants, contracts, and other sources of support.

CONCLUSION

Progress in the national movement toward ESMH will be promoted through an interconnected agenda of quality improvement, evaluation of program effectiveness, and the advancement of advocacy. These developments will facilitate policy improvements and increased funding for the full continuum of mental health promotion and intervention in the schools.