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October 1, 2015
Vol. 73
No. 2

Rx for Mental Health

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Suppose that, browsing through Educational Leadership, you came across the following news: A low-cost, evidence-based approach has been shown to boost overall school achievement by 11 percentile points (even more for the lowest-performing students) while improving school climate, student behavior, and teacher satisfaction. How would you react? I imagine most of us would be somewhat skeptical, but intrigued.
In fact, there are many such programs. Operating under a variety of names, they're all comprehensive school efforts to promote the mental, emotional, and behavioral well-being of students. But judging by the underutilization of schoolwide mental health programs in our schools, the effectiveness of this approach appears to be a well-guarded secret.

A Growing Awareness

Each year, about 20 percent of students experience some kind of emotional or behavioral problem (Perou et al., 2013). Some of these students will develop persistent dysfunction, at a high cost of suffering and lost opportunity for themselves, their families, and their communities. These students' behavioral problems also adversely affect their classmates' learning and their teachers' morale.
Fortunately, research has begun to document the fact that many mental health problems can be prevented with early intervention (Hawkins et al., 2015; National Research Council & Institute of Medicine, 2009). In response to such research, schools are providing more extensive mental health services than they did just a few years ago. Traditional services for students who exhibit mental health problems—often provided by school psychologists, counselors, and social workers under the aegis of special education—have been expanding for decades, but a more recent development has been the expansion of mental wellness services to the entire student body. These services aim to prevent problems by promoting self-awareness, self-management, social skills, and responsible decision making.
It probably comes as no surprise to educators that schoolwide mental health programs improve social, emotional, and behavioral outcomes for students. It may surprise some, however, that students exposed to these programs also do better academically. Research has found that schools with such programs have average achievement test scores 11 percentile points higher than those that don't provide these programs (Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011). Education is all about outcomes these days, and academic gains of this magnitude make schoolwide mental health programs worth looking at.

Creating Successful Schoolwide Programs

I've worked my entire professional life to promote student mental health, through teaching, consulting, and counseling students along the entire continuum of mental, emotional, and behavioral wellness and illness. When I listen to colleagues who are successfully implementing schoolwide mental health programs, I consistently hear them use three words to describe their approach: comprehensive, integrated, and authentic.
To see these three characteristics in action, consider Long Lots School in Westport, Connecticut, one of the schools in which I work. Long Lots is a suburban elementary school serving 375 K–5 students in an upper-middle-class community. A higher percentage of students in the district perform above goal on statewide testing than in most other districts in Connecticut. Approximately 98 percent of the district's high school students graduate, with nearly all going on to some kind of higher education. Both the school and the Westport School District place a priority on student mental health, including strong schoolwide interventions.

Comprehensive Mental Health Services

Comprehensive mental health programs include a multitiered system of supports: (1) a solid base of schoolwide services, (2) targeted small-group programs for at-risk students, and (3) intensive services for students with significant needs. The most important tier of this framework is the first one: schoolwide services delivered to all students. Long Lots School provides a variety of interventions for all students, whether they show signs of social, emotional, and behavioral problems or not. Here's a brief rundown of the school's programs:
Social skills instruction. All homeroom teachers provide 12–14 social skills lessons a year in areas that include expressing emotions, making and keeping friends, dealing with negative situations, building awareness of body language, and practicing assertive communication. Teachers reinforce these skills in everyday classroom life.
Responsive Classroom. All teachers are trained to use Responsive Classroom principles in their classrooms. This approach includes morning meetings and common rules and expectations. Classrooms actively promote positive relationships and collaborative problem-solving; students receive specific instruction in personal responsibility, self-control, cooperation, and assertive communication. A recent study found that students whose teachers more consistently followed the Responsive Classroom principles showed significantly more improvement in math and reading than did students whose teachers were less consistent in their application. The students who were initially the lowest performing showed the biggest improvement (Rimm-Kaufman et al., 2014).
Lunch Bunch. All students participate in group meetings with a school psychologist about six times a year, developing a personal connection with an adult who serves as a consistent presence throughout the student's time at the school. The meetings reinforce students' skills in cooperation and peer interaction and also provide an informal screening process for early detection of social or emotional problems.
Town hall meetings. Several times a year, students and staff members gather for whole-school meetings to discuss schoolwide issues (for example, how end-of-year misbehavior of older students affects everyone). These meetings often feature skits, videos, or other activities conducted by students.
Parent education groups. A school psychologist offers Positive Youth Development meetings to all parents about six times a year. Some sessions are devoted to explaining developmental expectations for students at different ages; others are on topics generated by the parents (for instance, setting up home routines or helping children negotiate friendships). The school offers additional sessions to parents of children with disabilities.
Support for transition to middle school. A variety of programs and activities are offered to parents of students transitioning to middle school. The Positive Youth Development program offers a special session with middle school staff on the social and emotional development of middle school students, social considerations unique to middle school, and how parents can set up home routines to support their children.
Staff development. Formal and informal staff training in promoting student mental health occurs at faculty meetings, grade-level meetings, and professional development days, as well as through informal collegial consultation.
Comprehensiveness also refers to consistency across classrooms, grades, and schools in a district. Throughout the Westport School District, all elementary schools use essentially the same programs and practices, and many of these approaches extend to middle and high school. When all staff members and students have a common vocabulary, common expectations for behavior, and a common problem-solving approach, these shared understandings create a norm for behavior and expedite communication and problem solving. Rather than simply being a set of programs, promoting mental wellness becomes a schoolwide approach.

Integrated Mental Health Services

School districts with successful programs make mental health a priority. Schoolwide commitment, sufficient time to implement the program, an emphasis on positive relationships, and continuous professional development are hallmarks of a mental health program that is well integrated into the fabric of the school. Assistant principal Megan Clarke says,
You hold social-emotional skill development to the same standard that you hold math and English and sciences; they are of equal importance. We've learned that without social and emotional learning, the academic side isn't as successful.
The district builds the teaching of social and emotional skills into instructional time, and everyone is expected to buy in.
Crucial to the success of any program or practice in school is the active, visible support of administrators. Westport school administrators, from the superintendent to the curriculum directors to the principals, are clearly committed to ensuring that the district's approach to mental health is integrated into the fabric of the school. For example, principals are assigned as leaders for each district committee, including the social skills committee. Administrators conduct town hall meetings and lead school committees such as the safe school climate committee and the Response to Intervention team (including the behavioral part of that process). District administrators have taken leadership in developing the yearly school climate assessment and coordinating a system that requires teachers to be evaluated not only on their traditional academic teaching skills, but also on goals they have developed specifically for improvements in areas measured by the school climate survey.
As school psychologist Amy Glazer sees it, commitment to an integrated system "needs to come from the top down." When administrators visit a classroom specifically to observe a social skills lesson, it "sends a message that it's really critically important to the learning of the child."

Authentic Mental Health Services

When teachers describe a program or instructional approach as authentic, they mean that it enables students to employ that approach in personally meaningful ways. In the context of mental health, that means teaching real-world problem-solving skills.
Teacher Kerin Tighe reminds students throughout the day, as the appropriate contexts come up, to apply the social, emotional, and behavioral strategies and lessons that they've been taught. She asks, "How can you use these skills to solve this academic problem?" She sometimes stops everything to apply a previously learned lesson or strategy to a situation as it emerges, prompting students to use the skills they've learned in an authentic way.
When you walk into Ms. Tighe's classroom, don't be surprised to be greeted by a student: "Hello, my name is James. We're working on a science project. How can I help you?" A different student is assigned as greeter every week, providing authentic opportunities for students to practice the social skills they have been taught.
Stay to watch the science lesson, and you'll hear the teacher not only instruct the class on how to use a magnifying glass, but also coach them on how to use I statements and other skills appropriately to resolve any potential interpersonal conflicts in using it (such as who gets to go first). Any student feeling frustrated with the social or academic demands of the activity may go to a special chair in the classroom, use previously taught calming strategies that are listed in a poster on the wall, and return to the science lesson when ready to do his or her best work.
Across the curriculum, students receive reminders of appropriate behaviors (eye contact, active listening, disagreeing in a kind and respectful way, and so on). These routines are taught ahead of time. Kerin Tighe maintains that "if we act proactively, we don't have to respond reactively. We prevent problems from happening."

The Right Kind of Investment

Westport School District has not expended a lot of money on buying programs; its investment has been in its people. The district starts by hiring the best people it can find, and then it provides systematic, sustained professional development for everyone.
With the exception of Responsive Classroom, all the social, emotional, and behavioral programs in this school and district are homegrown. Faculty members develop the programs and train one another, thus building and sustaining capacity. Megan Clarke explains the approach:
I think the misconception is that it costs money, and it doesn't. If you have one or two really great trained people in-house, you can train your own. Maybe up front it may take a little bit to get started, to learn more about it. But once you have those in-house trainers, the cost is minimal.
For example, every summer, teachers from the district provide four days of training in Responsive Classroom to all new teachers and lead workshops for veteran staff members who want an update or refresher. Teacher leaders in each school are available for coaching. School-employed mental health professionals (school psychologists, counselors, and social workers) receive specific training in social, emotional, and behavioral development on inservice training days.
Of course, there are real costs involved. For example, the district prioritizes its spending so that it can meet professional standards in staffing levels for mental health personnel. Each elementary school in the district has two school psychologists.
Westport Public Schools has been slowly building its capacity for more than a decade, and the district continues to refine its approach. Not every district will be able to move directly to this level of comprehensiveness, integration, and authenticity. Those who hope to move in this direction would need to make a long-term commitment. Megan Clarke says, "If it's important enough to the district and the parents and the other constituents, I really think that it can be done."

Mental Health as Part of the Curriculum

Mirroring the results so frequently reported in the research, Megan Clarke describes the outcomes of Long Lots Elementary School's commitment to social, emotional, and behavioral well-being:
It's not just about the students; it enhances the positive school culture among the teachers as well. In the old days, teachers operated on their own little islands. Now the school just seems like a happier place. People are encouraged because our behavior issues are down; there's more time to actually teach; and kids feel connected to their teachers, their school, and their administrators. You'll see more administrators and specialists interacting with kids outside of their classrooms or outside of their roles.
Research has shown that this connection to school is a powerful protector against mental, emotional, and behavioral problems (Resnick et al., 1997). The district enjoys very high academic outcomes, as evidenced by above-average test scores and high rates of graduation and postsecondary education. In the social, emotional, and behavioral realm, the district also gets high marks from parents, students, and staff on its yearly school climate survey.
There is no magic bullet, and it requires hard work. But when a school provides its students with comprehensive, integrated, and authentic mental health services, performance improves significantly across the board. Supporting students' mental wellness creates significant improvements in school climate, student behavior, and academic performance. It can also help prevent mental illness—and change children's and families' lives.
More and more schools are realizing that fostering mental wellness equips students with the skills they need to be successful in an increasingly competitive global environment. It's time to make mental wellness part of every school's curriculum. It can be done.
<ATTRIB> Author's note: Schools that want to start or expand schoolwide mental health programs can find evidence-based programs and practices, as well as additional resources, on the websites of the National Registry of Evidence-Based Programs and Practices and the Collaborative for Academic, Social, and Emotional Learning. </ATTRIB>
References

Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., &amp; Schellinger, K. B. (2011). The impact of enhancing students' social and emotional learning: A meta-analysis of school-based universal interventions. Child Development, 82(1), 405–432.

Hawkins, J. D., Jenson, J. M., Catalano, R., Fraser, M. W., Botvin, G. J., Shapiro, V., et al. (2015). Unleashing the power of prevention (Discussion Paper). Washington, DC: Institute of Medicine and National Research Council. Retrieved from http://nam.edu/wp-content/uploads/2015/06/DPPowerofPrevention.pdf

National Research Council &amp; Institute of Medicine. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: National Academies Press.

Perou, R., Bitsko, R. H., Blumberg, S. J., Pastor, R., Ghandour, R. M., Gfroerer, J. C., et al. (2013). Mental health surveillance among children—United States, 2005–2011. MMWR, 62(2), 1–35. Retrieved from www.cdc.gov/mmwr/pdf/other/su6202.pdf

Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., et al. (1997). Protecting adolescents from harm: Findings from the National Longitudinal Study on Adolescent Health. Journal of American Medical Association, 278(10), 823–832.

Rimm-Kaufman, S. E., Larsen, R. A. A., Baroody, A. E., Curby, T. W., Ko, M., Thomas, J. B., et al. (2014). Efficacy of the Responsive Classroom approach: Results from a 3-year, longitudinal randomized controlled trial. American Educational Research Journal, 51(3), 567–603.

Rones, M., &amp; Hoagwood, K. (2000). School-based mental health services: A research review. Clinical Child and Family Psychology Review, 3, 223–241.

U.S. Public Health Service. (2000). Report of the Surgeon General's conference on children's mental health: A national action agenda. Washington, DC: Department of Health and Human Services.

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