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Addressing the mental health care gap in American youth: an evaluation study of character education
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Content
Running head: MENTAL HEALTH CARE GAP
1
Addressing the Mental Health Care Gap in American Youth:
An Evaluation Study of Character Education
by
Jay Crosby
A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION
August 2019
Copyright 2019 Jay Crosby
MENTAL HEALTH GAP
2
“I am not afraid of storms for I am learning how to sail my ship.”
-Louis May Alcott
Little Women
MENTAL HEALTH GAP
3
DEDICATION
If only there were a way to award this degree to my wife and children who endured years of seeing
the backside of a computer where my face was meant to be.
MENTAL HEALTH GAP
4
ACKNOWLEDGEMENTS
This study is not mine alone. While I may have dedicated endless hours to writing the
dissertation, countless others dedicated their valuable time to help me through this incredible
journey. Whether my family, whose patience and mercy tolerated my short-tempered frustration
and consistently dour mood, or students and colleagues who absorbed endless complaints about
there not being enough time in the day to complete it all – I am eternally grateful to you.
With all due respect to those who suffered me, I would also like to acknowledge those
who joined me on this ride; those who put their families second, their colleagues and friends
aside, to achieve the monumental task of earning three little letters at the ends of our names.
Without the support, encouragement, empathy, and amusement of the OCL Cohort 5 – this
would have been impossible. You are the kindest, wisest, and supportive group I have had the
unique pleasure of working alongside – it was an honor.
Above all else, however, I must thank the USC Rossier faculty, my dissertation
committee, and, in particular, my committee chair. The faculty and staff at USC never hesitated
to help and frequently reached out to offer kind words of advice and encouragement. The
lessons learned are life-long, and I am forever indebted. In particular, thank you to Dr. Jenifer
Crawford, who was not only my first professor within the OCL program but also served
tirelessly as one of my dissertation committee chairs. Your disarming warmth and Frozen sippy
cup of coffee allowed me to overcome my initial fears, and your guidance throughout the process
was irreplaceable. And to Dr. Holly Ferguson, who I was fortunate enough to learn from during
the critical stages of Chapter 3 and was my second committee member. While classes with you
were never dull (a much-underappreciated skill in distance learning), it was your patience and
MENTAL HEALTH GAP
5
explicit instruction that allowed me to complete this study. You are both true masters at your
craft, and I cannot thank you enough.
Finally, I owe tremendous gratitude to my professor and dissertation chair, Dr. Artineh
Samkian. Somewhere in the middle of this process, Dr. Samkian offered more of her time for a
one-on-one conversation about whatever roadblock I had encountered. After ending the call,
which was on speaker so I could take notes, my wife exclaimed, “That is the smartest person I
have ever heard speak,” and I could not agree more. Dr. Samkian, your advice was always clear,
specific, detailed, and reassuring. You never minced words but still found a way to make every
exchange a positive one, always providing supportive and encouraging advice. You gave of
yourself to help me achieve my dream, and I can never repay you for that.
MENTAL HEALTH GAP
6
TABLE OF CONTENTS
Dedication 3
Acknowledgements 4
List of Tables 9
List of Figures 10
Abstract 11
Chapter One: Introduction
Introduction to the problem of practice
Organizational context and mission
Organizational performance goal
Related literature
Importance of the evaluation
Description of stakeholder goals
Stakeholder group for the study
Purpose of the project and guiding questions
12
14
15
16
16
18
19
21
21
Chapter Two: Review of the literature
Influences on the problem of practice
Problem of practice
Current research on the mental health care gap in youth in the United States
Causes of the mental health care gap
The stigma of mental illness
Lack of self-awareness in youth
Effects on youth of the mental health care gap
Academic burnout
Youth suicide rates
Co-morbidity of drug and alcohol abuse
Importance of addressing the mental health care gap in schools
Schools’ unique access and familiarity with youth
School-based techniques and tools necessary to address the mental health
care gap
School-based youth mental health programs
History of school-based youth mental health programs
Outcomes of school-based youth mental health programs
Clark and Estes’s knowledge, motivation, and organizational influences framework
Knowledge and skills
23
23
23
24
25
27
27
29
30
31
31
32
33
34
34
37
38
MENTAL HEALTH GAP
7
Knowledge influences
Teachers need knowledge of principles and theories in youth mental
health needs
Teachers need to know how to create and implement a student
portfolio
Teachers need to evaluate their effectiveness with wellness planning
for students
Motivation
Utility value theory
Teachers need to recognize the utility value of the student
portfolios in providing mental health supports to students
Goal orientation theory
Teachers need to set benchmarks focused on improving
student character and mental health and not just on fulfilling
a mandate
Organization
Organizational cultural model influences
The organization needs to provide feedback to hold teachers
accountable for implementing new initiatives
The organization needs to reduce teacher fatigue from the
continual effort to introduce new programs, techniques, and
initiatives
Organizational cultural setting influences
The organization needs to provide formal or informal
mentoring programs or modeling, particularly in support of
new initiatives
Conceptual framework: The interaction of stakeholders’ knowledge and motivation
and the organizational context
Conclusion
39
40
43
45
47
48
49
50
51
53
56
57
58
60
61
62
66
Chapter Three: Methods
Participating stakeholders
Interview sampling criterion and rationale
Interview sampling (recruitment) strategy and rationale
Documents and artifacts strategy and rationale
Data Collection and Instrumentation
Interviews
Documents and artifacts
Data analysis
Credibility and trustworthiness
Ethics
Limitations and delimitations
Conclusion
69
71
71
73
74
77
77
79
82
84
85
MENTAL HEALTH GAP
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Chapter Four: Findings
Finding 1
Finding 2
Subtheme 1
Subtheme 2
Subtheme 3
Finding 3
Finding 4
Conclusion
86
87
94
95
97
99
102
106
113
Chapter Five: Discussion
Implications for practice
Recommendations for practice
Knowledge recommendations
Motivation recommendations
Organizational recommendations
Future research
Conclusion
115
116
118
118
123
125
131
133
References 136
Appendices
Appendix A: Interview protocol
Appendix B: KIPP Academies character growth card
Appendix C: KIPP Academies 24 character strengths
Appendix D: KIPP Academies seven keys to developing character
Appendix E: Personal journal of Elisif Bruun
Appendix F: Selection of art work by a teenager with depression, ADHD,
and bipolar disorder; accompanied by reflections of her father after her
death from a drug overdose.
170
173
174
175
176
184
MENTAL HEALTH GAP
9
List of Tables
Table 1. Organizational Mission, Global Goal, and Stakeholder Performance
Goals
20
Table 2. Knowledge Influences and Types for Gap Analysis
Table 3. Motivational Influences and Motivational Influence Assessments
Table 4. Assumed Organizational Influences and Assessments
47
53
62
MENTAL HEALTH GAP
10
List of Figures
Figure 1. Influences on how individuals visualize mental health from a perceived
public and personal perspective
26
Figure 2. Impact of context on program implementation 56
Figure 3. Student Mental Health KMO Conceptual Framework 65
MENTAL HEALTH GAP
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Abstract
Youth in the United States face an average 10-year gap between the onset of mental disorders
and diagnosis or treatment. These disorders in teenagers frequently lead to academic burn-out,
increased suicide rates, and substance abuse. Studies indicate that the ideal way to close this gap
is through education interventions to reduce stigma and provide literacy and skills necessary to
address problems when they occur. The purpose of this study was to evaluate the knowledge,
motivation, and organizational influences necessary in implementing a new character education
initiative, and whether or not mental health was an unintended consequence of character
education. The stakeholder group for this study were the teachers at Northeast Independent
School (a pseudonym). The study methodology was qualitative.
MENTAL HEALTH GAP
12
CHAPTER ONE: INTRODUCTION
My first experience with losing a family member occurred when I was 8; my father’s
mother, Alice, had died at the age of 60. While I was never told the cause of death, and I did not
know her well, I do have distinct memories of ice cubes clinking against a highball glass and the
smell of gin and tonic. It was not until I was in my 20s when I learned that she had committed
suicide by locking herself in the garage with the car running – a bottle of her favorite gin at her
side – and a suicide note that read, “Bless This Mess.” The years of depression, multiple failed
marriages, divorce, self-medicating alcoholism, and, ultimately, her final, abusive husband led
her to take her own life.
In 2016, my son was 11 when he first attempted suicide. He felt compelled to climb onto
the subway tracks in a Brooklyn station, overwhelmed with emotion, before his friends quickly
pulled him to safety. It was not until after he checked into Bellevue Hospital’s Pediatric
Psychiatric Inpatient program that we began to understand his problem. He demonstrated no
outward signs of mental illness – he was a straight A-student, a three-sport athlete, and was well-
liked and popular amongst his peers, teachers, and family. By all appearances, he had the
makings of a very happy kid – but he had voices in his head that had influence. He was not
depressed, but he did not understand his emotions and was scared to talk about them – afraid of
being stigmatized as that crazy kid. And, even if he did express his feelings, he did not have the
appropriate vocabulary to articulate his feelings.
My niece was 17 when she began experimenting with drugs and alcohol. Like so many
others, like my grandmother, she was self-medicating her undiagnosed bi-polar disease with
alcohol. By 20, it was OxyContin. When that became too expensive, she turned to heroin. For
MENTAL HEALTH GAP
13
two years she was in and out of rehab and once robbed a convenience store at gunpoint to pay for
her next score. The robbery finally convinced Elisif that she needed help, and she agreed to go
to a treatment facility and healing center in North Carolina – it was here where Elisif would
overdose at 24-years-old from a cocktail of cocaine and heroin that she had received from a
friend in the mail. Again, there was something missing. Signs not seen.
Finally, when my sister attempted suicide at 41, after years of suffering in silence, I
recognized the need for a study of this type. In speaking with her about her attempt, she
admitted that if she had some understanding, some knowledge about the signs, the literacy and
audience to openly discuss her feelings as early as middle school, she might never have followed
this path. She was one of the lucky ones. She found treatment after 41 years of fighting the
stigma of depression and learned to manage her disease with the right medication, therapy, and
family and friends who are a little wiser having learned the power judgement and stigma had on
her.
This study is obviously a personal one. It is driven by the passion to find a solution. The
one constant through all these experiences is the lack of understanding. The failure to recognize
what was wrong. Signs missed. There is a gap in understanding, diagnosing, and in treating the
mental health of people in the United States – specifically, youth.
MENTAL HEALTH GAP
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Introduction to the Problem of Practice
This study addresses the problem of the gap in mental health services for youth in the
United States. The Center for Disease Control identifies mental health in youth as hitting
developmental and emotional milestones, in addition to possessing healthy social and emotional
skills with positive relationships at school, home, and in their community (Perou et al., 2013).
Considering roughly half of American children under 18-years old have some form of a lifetime
mental disorder (Merikangas et. al., 2010), and there is an average of almost 10 years before
individuals receive treatment or diagnosis (ten Have, M., de Graaf, R., van Dorsselaer, S., &
Beekman, A., 2013), closing this gap in mental health services is essential for the prosocial well-
being of American youth.
Adolescence is an important stage in the social, emotional, and mental development of
youth. Hormonal changes and developing brains make adolescents and teenagers more
susceptible to mental illness, depression, and unsafe behaviors (Schwartz, 2009). The
importance of addressing this problem is amplified when you consider the onset of more than
half of all mental disorders is 14 years old (Kessler, Amminger, Aguilar-Gaxiola, Alonso, Lee, &
Ustün, 2007). However, stigma and a lack of vocabulary are major factors in under-reporting,
resulting in 70% of youth who have untreated mental health needs (Chandra & Minkovitz, 2006).
Schools have unique access and familiarity to youth and can be utilized to help provide the tools
to recognize and verbalize their mental health needs.
While pediatricians are often the first point of contact for young people with mental
disorders, approximately 60% of pediatricians are unprepared to diagnose mental illness (Romer
& McIntosh, 2005). Additionally, more than 50% of youth were embarrassed to discuss their
MENTAL HEALTH GAP
15
problems with someone they sometimes visit less than one hour a year (Chandra & Minkovitz,
2006). Considering that American teachers spend, at minimum, one thousand hours a year
working with students (OECD, 2014), they have unique access and familiarity with their students
that doctors lack. Schools have the unique opportunity to provide youth with the vocabulary and
skills to identify and speak about their health needs and allow them a safe space to share their
concerns. The gap in mental health services exists because youth lack the vocabulary and skills
for positive mental health and identification. We face a massive mental health care gap that, left
unaddressed, leaves children vulnerable to a lack of mental wellness and an increase in suicide
attempts, drug and alcohol abuse, and academic burnout.
To help address this problem of practice, my organization, Northeast Independent School
(pseudonym), implemented the Character Program (pseudonym), a character strengths initiative
designed to increase the character and leadership skills of its students. While the Character
Program was not intended to improve mental health, this study examined how unintended mental
health education could be woven into the Character Program.
Organizational Context and Mission
Northeast Independent School is an independent college preparatory day school in the
northeastern United States that provides a character-based education for students in pre-
Kindergarten through twelfth grade. Northeast Independent School serves almost 1000 students
over four divisions and multiple campuses. Classes average twelve students, the school features
a teacher to student ratio of one-to-six, and sixty-five percent of the staff have advanced degrees.
Northeast Independent School’s mission is to prepare its students for the rigors and challenges of
life. The school uses a whole child approach to education that, regardless of culture, religion, or
MENTAL HEALTH GAP
16
ethnicity, seeks to prepare its students to be 21
st
century leaders. Through the Character
Program, the school instills a genuine and lasting depth of spirit in its students and increased
sense of community that last beyond their time in the school.
Organizational Performance Goal
Northeast Independent School’s goal is that by 2021, 100% of its faculty and staff will
provide youth the skills necessary to identify, discuss, and implement character-based
vocabulary, behaviors, and skills, in addition to prosocial-emotional strategies. The headmaster
established this goal in the fall of 2015 through the implementation of the Character Program to
address the social, emotional, and character needs of the student body. This goal will ultimately
be measured by the organization through individual student evaluations, student and teacher
surveys, formal and informal interviews, and an increase in good-character related behaviors and
language.
Related Literature
In a nationally representative survey of over 10,000 youth in the United States aged 13-
18, roughly 50% had some form of mental illness, while nearly one-fourth of the youth surveyed
had a severe, lifelong mental illness, with the median age for onset between 6-13 years old
(Merikangas et al., 2010). A second survey of over 10,000 high school students demonstrated
80% had co-occurring mental disorders, 60% paired with depression which frequently leads to
suicidal thoughts (Andrews & Lewinsohn, 1992). Additionally, nearly three million youth aged
12-17 have co-occurring severe mental health disorders, twice the rate of the adult population
(Center for Behavioral Health Statistics and Quality, 2015). Finally, between 2007-2010, the
Center for Disease Control identified a 24% increase in mental health services and an 80%
MENTAL HEALTH GAP
17
increase in hospital stays for mood disorders in youth between 1997-2010 (Perou et al., 2013).
Staggering results that represent a major gap in mental health care and highlight the need for
proactive preventative strategies in youth.
Stigma is one of the leading barriers to seeking treatment – particularly in youth. In a
survey of almost 300 8
th
graders, roughly 60% were too embarrassed to discuss their problems
because of what their friends might say (Chandra & Minkovitz, 2006). Stigma is a formidable
obstacle to treatment, and early intervention strategies are a possible step towards reducing the
gap between diagnosis and treatment (Chandra & Minkovitz, 2006). A review of twenty-two
studies identified stigma as the leading cause for delay in seeking mental health treatment
(Gulliver, Griffiths, & Christensen, 2010). Stigma prevents youth from identifying mental health
needs and frequently leads to stereotyping within their social groups. Normalizing the language,
symptoms, and treatments is critical to reducing the gap in mental health identification and
treatment.
Mental health literacy involves the sharing of information and understanding how to
identify and deal with mental health (Jorm, 2000). Typically, a poor understanding of the
language and symptoms of mental illness lead to a lack of mental health literacy, resulting in
stereotyping and a reluctance to seek help (Gulliver et al., 2010; Jorm, 2000). Mental health
literacy is not only critical to reducing stigma, but it is also a stronger predictor of one’s health
status than education, race, ethnicity, employment, or income (World Health Organization,
2017), and it leads to a significant increase in early intervention (Jorm, 2000). Improved literacy
will result in greater understanding and a reduction in stereotyping that typically accompanies
individuals with mental health concerns.
MENTAL HEALTH GAP
18
Failing to provide early treatment and intervention has led to an increase in the
prevalence of mental illness in the United States (Wang et al., 2007). Increasing mental health
literacy, ideally in schools, provides youth greater understanding of the symptoms, reduces
mental health stigma and stereotyping, and provides youth with the knowledge to seek help and
provide support to peers (Jorm, 2000). Schools and after-school programs that incorporate
minimal mental health literacy programs have demonstrated a significant increase in
understanding and recognizing symptoms, reduced stigma, and improved attitudes towards
mental health (Bulanda, Bruhn, Byro-Johnson, & Zentmyer, 2014). People often know the
symptoms of poor physical health, know where to find help, and typically seek medical advice to
address their concerns; however, the same cannot be said for mental health (Jorm, 2012).
Schools provide a unique and effective opportunity to empower youth to understand their mental
health by reducing the stigma and stereotyping associated with mental illness, thus increasing
their willingness to be proactive.
Importance of the Evaluation
Seventy percent of youth who have mental health needs do not receive treatment
(Chandra & Minkovitz, 2006). It is necessary to close this gap in mental health care by
providing youth with the tools to recognize and verbalize their mental health needs. Suicide
among teenagers has tripled since the 1940s, is the second leading cause of death in youth
(Center For Disease Control, 2017), and 90% of youth who committed suicide suffered from
some form of mental illness (National Alliance on Mental Illness, 2016). Breaking down the
stigma and stereotypes of mental illness are critical to lowering these rates. Schools are the ideal
environment to affect positive attitudes towards mental health. Providing the language and skills
MENTAL HEALTH GAP
19
necessary to verbalize and understand mental illness will improve mental health and reduce
mental-health related risky behaviors (Kann, Telljohann, & Wooley, 2007). This study
emphasizes the need to reduce the stigma associated with mental health and improve students’
skills necessary to identify and discuss mental health, resulting in the reduction of suicide,
substance abuse, and academic burnout. By not providing this critical intervention, mental
illness will continue to go undetected further contributing to the already $247 billion spent on
mental health care in the United States (Perou et al., 2013) and more than 6000 annual youth
suicides (Center For Disease Control, 2017).
Description of Stakeholder Groups
The three key stakeholders at Northeast Independent School are the administration, the
teachers, and the students. The administration includes the headmaster, division heads, the dean
of academics, dean of faculty, and grade level deans. The administration is responsible for
executing the school’s mission through annual teacher meetings and evaluations, parent surveys,
and a comprehensive organizational self-assessment every ten years. The administration is
responsible for the hiring, evaluating, supporting, and firing of teachers. The administration is
also responsible for the well-being, safety, and academic performance of the students. Teachers
at the school are responsible for student achievement, well-being, and safety. Teachers serve as
advisors for approximately eight to twelve students, acting as the students’ primary advocate and
support network. Teachers measure student well-being through comment writing and triannual
character growth surveys. Teachers have a unique relationship with many of the students,
serving as teacher, coach, and mentor for multiple years. The student body is made up of
approximately 1000 students aged 4-19 years old. In order to graduate, students must fulfill
MENTAL HEALTH GAP
20
academic, social, service, and athletic responsibilities. Students face incredible pressure to
perform and are held to incredibly high academic, social, and emotional standards.
Table 1 below provides the organizational mission, organizational performance goal, and
the performance goals for each stakeholder group.
Table 1
Organizational Mission, Global Goal, and Stakeholder Performance Goals
Stakeholder’s Performance Goals
Organizational Mission
Northeast Independent School’s (pseudonym) mission is to prepare its students for the
rigors and challenges of life. The school uses a whole child approach to education that,
regardless of culture, religion, or ethnicity, seeks to prepare its students to be 21
st
century
leaders. Through the Character Program (pseudonym), the school instills a genuine and
lasting depth of spirit in its students and increased sense of community that last beyond their
time in the school. The Northeast Independent School philosophy is fulfilled as they build
students of character through the educational experiences that are uniquely Northeast
Independent School.
Organizational Performance Goal
Northeast Independent School’s goal is that by 2021, 100% of its faculty and staff will
provide youth the skills necessary to identify, discuss, and implement character-based
vocabulary, behaviors, and skills, in addition to prosocial-emotional strategies. The
headmaster established this goal in the fall of 2015 through the implementation of the
Character Program to address the social, emotional, and character needs of the student body.
This goal will be measured through student individual evaluations, student and teacher
surveys, formal and informal interviews, and an increase in good-character related
behaviors and language
MENTAL HEALTH GAP
21
Northeast Independent School
Administration
By the fall of 2021, Northeast
Independent School’s
administrators will schedule
meetings with teachers every
trimester to discuss student
character growth.
Northeast Independent
School Teachers
By the fall of 2021, teachers
will implement common
character and social-
emotional curricula.
Northeast Independent
School Students
By September 2021, 100%
of students will demonstrate
the vocabulary, behaviors,
and skills of character
growth.
Stakeholder Group for the Study
Although all stakeholders provided prosocial-emotional support to the student body, this
study focused on the role of the teachers to provide prosocial-emotional support to its students.
By the fall of 2021, teachers will implement common character and social-emotional curricula.
Considering their role as advisors, it was important to understand the teachers’ knowledge,
motivational, and organizational influences to implement the Character Program and what role, if
any, the program played in addressing the mental health of its student body even though that was
not the original intent of the Program. Failure to accomplish this goal would lead to increased
gaps in prosocial characteristics and mental illness resulting in a continued rise in suicide
attempts, substance abuse, and academic burnout.
Purpose of the Project and Guiding Questions
The purpose of this study was to examine whether and how Northeast Independent
School was meeting its goals of providing its students the skills necessary to identify and discuss
character and provide prosocial-emotional strategies to the student body as an outcome of the
Character Program and the impact these skills have on mental health literacy. The analysis
focused on the knowledge, motivational, and organizational influences related to achieving the
MENTAL HEALTH GAP
22
organizational goals and hoped to identify if mental health literacy was an unintended outcome
of character education programs. To clarify, character education is believed to be a pro-active
method for improving student and community well-being, one aspect of mental health, but it is
not a panacea for mental illness. This study seeks to evaluate the Character Program and how it
can be used as a tool to close the mental health gap.
While a complete evaluation would focus on all stakeholders, for practical purposes the
stakeholder of focus in this analysis was the teachers. The following questions guided this study:
1. What are the teachers’ knowledge and motivation related to identifying and discussing
mental health through the implementation of character education or student portfolios?
2. What is the interaction between organizational culture and context and teachers’
knowledge of and motivation to meet the stakeholder goal?
3. What are the recommendations for organizational practice in the areas of knowledge,
motivation, and organizational resources?
MENTAL HEALTH GAP
23
CHAPTER TWO: REVIEW OF THE LITERATURE
This study addressed the problem of a gap in mental health services for youth in the
United States. The United States faces a massive mental health care gap that, when left
unaddressed, leaves children vulnerable to poor mental health leading to an increase in suicide,
suicide attempts, drug and alcohol abuse, and academic burnout (Perou et al., 2013; Grant et al.,
2006; Ang & Huan, 2006). This study emphasized the need to reduce the stigma associated with
mental illness and improve students’ skills necessary to identify and discuss mental health.
Chapter 2 will review the literature on the mental health care gap in youth, its causes, and the
effects. Understanding why there is a need to address the gap will lead to a review of the
literature on how schools have unique access and familiarity with youth and can be utilized to
help provide youth with the tools to recognize and verbalize their mental health needs. Finally,
the literature review will examine school-based youth mental health intervention programs and
their results. Following the literature review, I will examine the role of Northeast Independent
School (a pseudonym), followed by an explanation of the Clark and Estes analytical framework
used to examine the role of teachers at Northeast Independent School and the knowledge,
motivation, and organizational influences that contribute to the performance gap.
Influences on the Problem of Practice
Problem of Practice
The Center for Disease Control identifies mental health in youth as hitting developmental
and emotional milestones, in addition to possessing healthy social and emotional skills with
positive relationships at school, at home, and in their community (Perou et al., 2013). However,
a multi-national, three-year study of over 60,000 adults across 14 nations in the Americas,
MENTAL HEALTH GAP
24
Europe, Africa, and Asia indicated that the United States has the highest prevalence of mental
illness and one of the lowest rates of treatment worldwide (Demyttenaere et al., 2004). The
Global Burden of Disease study involved eight different international regions, over 40-years of
working hours, more than 100 diseases, nearly 500 corollary diseases, and roughly 14 million
death certificates, approximated that mental health accounts for 11% of the international burden
on resources (Murray & Lopez, 1996). Burden, in this study, refered to lives lost, lives severely
affected by disability, and treatment costs. Mental health accounts for half of the top ten causes
of global disability, or 28% of all diseases, and by 2020, depression alone will be the 2nd
costliest disease – with an increase of 50%, it is the largest projected jump of any disease, while
suicide is expected to become the 14th deadliest (Murray & Lopez, 1996). As the risks
associated with mental health continue to increase, and with the United States leading the way,
the need to address this gap is more immediate than ever.
Current Research on the Mental Health Care Gap in Youth in the United States
Every year, millions of Americans are affected by mental illness. Youth, in particular,
face unique obstacles that, combined with age-related hormonal changes, lead to poor mental
health and gaps in identifying mental illness. The National Center for Children in Poverty at
Columbia University states that hormonal changes and developing brains make adolescents more
susceptible to depression and risky behaviors (Schwartz, 2009). According to the National
Alliance on Mental Health (2016), 20% of teenagers live with some form of mental illness and
50% of all lifetime cases start in the mid-teen years. Yet, there is an average 10-year delay
between the first signs of mental illness and treatment or even diagnosis (ten Have, de Graaf, van
Dorsselaer, Beekman, 2013). Combined with a proclivity towards high-risk behavior and the
MENTAL HEALTH GAP
25
typically low self-esteem of adolescents (Robins & Trzesniewski, 2005), youth are particularly
susceptible to substance abuse, leading to an average onset age of 15-years old for addictive and
potentially destructive behaviors (Merikangas et al., 2010). Adolescence is a critical stage in the
social-emotional and mental development of humans. Unfortunately, the unusual level of
hormonal changes and brain development make adolescents and teenagers more susceptible to
mental illness, depression, and unsafe behaviors (Schwartz, 2009). Between 2007-2010, youth
received a 24% increase in mental health services, an 80% increase in hospital stays due to
mental illness (Perou et al., 2013), and more than 6000 youth suicides (Center for Disease
Control, 2017). Calculating the overall cost to nearly $247 billion spent annually on mental
health care in youth (Perou et al., 2013), these independently staggering numbers add up to a
major gap in the care of our children and highlight the need for proactive preventative strategies
for youth.
Causes of the Mental Health Care Gap
The stigma of mental illness. Stigma is one of the leading barriers to seeking treatment.
In a survey of 274 eighth graders, more than two-thirds of respondents said they were
embarrassed to discuss mental health because of what their friends might say, and more than half
did not want to discuss their problems with anyone (Chandra & Minkovitz, 2006). Stigma is
commonly identified as the leading obstacle to seeking mental health support (Gulliver, Griffiths,
& Christensen, 2010). Many adolescents struggle to perceive how the public regards mental
health, often falling into one or more patterns of bias. Corrigan (2004) breaks stigma into three
separate biases based on how one perceives public beliefs and how one might see themselves
through a) stereotypes, b) prejudice, and c) discrimination. Figure 1 attempts to visually
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26
Figure 1. Influences on how individuals visualize mental health from a perceived public and
personal perspective
represent how students perceive public or self-stigma. While these categories of public and self-
stigma are displayed separately, it is not unusual for one to influence the other.
Adapted from Corrigan, P. (2004), p. 617
Figure 1 shows two possible perceptions – how one believes the world sees them and
how they see themselves. These implicit biases about mental health, whether perceived or real,
directly contribute to an avoidance of help-seeking strategies (Corrigan, 2004). While most of
these ideas are self-created, many of these prejudices, stereotypes, and discriminatory practices
are promoted and often supported by the media and entertainment industries (Corrigan, Watson,
Barr, 2006; Corrigan, 2004; Gulliver, Griffiths, Christensen, 2010). Even in the absence of
stigma, students often lack the vocabulary and mental health literacy to communicate their
feelings effectively.
Care
Avoidance
Avoid being
labled mentally
ill, avoid being
stigmatized
a) Sterotype - people with mental
illness are unstable
b) Prejudice - I am afraid of
people with mental illness
c) Discrimination - I don't want
to be near mentally ill people
Perceived
Public
Stigma
Deny the existence
of mental illness,
avoid self-
stigmatizing
a) Sterotype - all people with
mental illness are incapable
b) Prejudice - If I am mentally ill,
then I must be incapable
c) Discrimination - Since I am
incapable, why should I bother
getting better
Perceived
Self-
Stigma
MENTAL HEALTH GAP
27
Lack of self-awareness in youth. It is estimated that upwards of 70% of young people
with symptoms of mental illness do not seek or receive treatment (Chandra & Minkovitz, 2006).
Mental health literacy in youth is a significant factor in reducing stigma and improving mental
well-being. With an increase in mental health literacy, youth are more likely to understand their
symptoms, seek help when needed, and offer help to peers experiencing mental health problems
(Jorm, 2000). Mental health literacy is defined as having the knowledge and understanding of
mental health to help in the identification, care, and avoidance of mental disorders (Jorm, Korten,
Jacomb, Christensen, Rodgers, & Pollitt, 1997). Americans know all the warning signs of poor
physical health – stroke, heart disease, diabetes, etc. – and know how and where to seek
treatment, but few recognize the signs of mental illness or even possess a willingness to seek
help when it is identified (Jorm, 2000). When youth lack the skills and confidence to effectively
speak about mental health, combined with the fear of being judged by one’s peers, mental illness
repeatedly goes undetected and with dangerous results. Mental health literacy is a relatively new
concept, yet is one of the most critical steps to addressing the mental health gap (Jorm, 2012).
Improving self-awareness and reducing stigma are key to promoting positive mental health.
Effects on Youth of the Mental Health Care Gap
While suicide is a significant risk for youth suffering from mental disorders, it is not the
only risk. Poor mental health can lead youth to struggle academically and exhibit further risky
behaviors that are learned for life, including drug and alcohol abuse.
Academic burnout. Poor mental health can negatively affect student and peer learning
(Stephan, Sugai, Lever, & Connors, 2015; Yang, 2004). Students with poor mental health, low
self-efficacy, or a depressive affect typically demonstrate lower academic performance and
MENTAL HEALTH GAP
28
higher rates of burnout (Salmela-Aro & Upadaya, 2012). Historically, the term burnout referred
to the professional world and the pressures adults faced while on the job. These stressors
typically led to overwhelming emotional responses in the individual, including low self-
confidence, motivation, and performance. In the past two decades, burnout has been attached to
youth and school achievement (Lin & Huang, 2014). Today, it is used to describe students who
can no longer manage the workload or have become so overwhelmed by the social and academic
pressures of school that they avoid the responsibility or quit.
Adolescents typically have lower self-esteem before it strengthens into adulthood (Robins
& Trzesniewski, 2005). As a result, student self-efficacy is often low, leading to self-doubt and
poor academic performance. The pressures of home, school, and peer acceptance compile, and
those who lack the appropriate mental health literacy to combat these challenges often quit
before giving themselves a chance to succeed (Corrigan, 2004). Student burnout frequently
leads to low school commitment and motivation, resulting in truancy, school refusal, and drop
out (Mehdinezhad, 2015). However, Walburg (2014) notes that burnout and poor mental health
frequently feed one another. Students who suffer from high emotional stress often burnout out
more quickly leading to poor mental health and low self-esteem. Conversely, students with low-
self efficacy or poor mental health tend to give up before starting, leading to low-motivation and
commitment, identified here as academic burnout. Corrigan and Watson (2002) call this a
paradox of mental health. A student who lacks the mental health literacy to recognize or
understand their emotions frequently falls into a cycle of low self-esteem, depressive affect, and
poor academic performance which, in turn, restarts the cycle of low self-efficacy and self-
stigmatization. A study of more than 1100 international students aged 12-18 years old
MENTAL HEALTH GAP
29
demonstrated how academic burnout or school stress directly linked to depression and suicidal
ideation (Ang & Huan, 2006). While poor academic performance is not necessarily an indicator
nor a cause of mental illness (and vice versa), there are corollary links that still need further
research.
Youth suicide rates. Suicide is the number two cause of death in the United States for
individuals aged 10-35 years old, accounting for roughly 37 suicides per day (Center For Disease
Control, 2017). While the United States does not keep official records on suicide attempts and
cannot account for unreported suicides attempts, based on the type and severity of injuries
recorded in US hospitals, multiple reports estimate that the number of failed attempts is roughly
25 times the number of successful ones (Moscicki, O'Carroll, Rae, Locke, Roy, & Regier, 1989;
Suicide Statistic – AFSP, 2017). Since nearly ¼ of youth who successfully committed suicide
had attempted suicide at least once before (Perou et al., 2013), causes of suicidal ideation need to
be addressed early and often to improve mental health and ideally reduce suicidal ideation. In a
study of 1040 Pacific Northwest 1
st
graders who were surveyed, with 883 surveyed again
following their 12
th
grade year, approximately 8.5% reported attempting suicide. 40% of those
attempts occurred in elementary or middle school (Mazza, Catalano, Abbott, & Haggerty, 2011),
demonstrating how early mental health literacy needs to begin. However, suicidal ideation is not
the only outcome of poor mental health or academic stress. Youth who suffer poor mental health
typically seek alternatives for self-treatment, a salve to calm the inner dialog they struggle to
understand. Co-morbidity, or the presence of two diseases (in this case, substance abuse and
poor mental health), is prevalent among those suffering from mental disorders, and youth
represent some of the highest rates.
MENTAL HEALTH GAP
30
Co-morbidity of drug and alcohol abuse. Youth with mental disorders are almost
twice as likely to abuse drugs and alcohol than youth without mental illness. Nearly one-third of
all youth aged 12-17 years old with a mental disorder have a substance abuse disorder – or 1.5%
of the US adolescent population (Helzer & Pryzbeck, 1988). The single largest co-morbidity
study of its time examined roughly 45,000 individuals representative of the national population
over a 12-month period identified that 60% of illicit drug abusers and 41% of alcohol abusers
also sought treatment for mental disorders (Grant et al., 2006). A similar study (Turner, Muck,
Muck, Stephens, & Sukumar, 2004) revealed that as many as 80% of substance abusers also have
some form of co-occurring mental illness. The co-morbidity of mental illness and substance
abuse is familiar and obvious.
The gap in mental health services exists because youth lack the vocabulary and skills for
positive mental health literacy, advocacy, identification, and care (Nielson-Bohlman, 2004).
Adults present more distinguishable symptoms of mental illness than youth; thus, improving
mental health literacy at an early age will result in increased early diagnoses leading to a
reduction of the gap in mental health care (Mendenhall, Frauenholtz, & Conrad-hiebner, 2014).
Considering mental illness and substance addiction manifest in middle school at roughly the
same age when self-esteem is at its lowest, school pressures increase, and peer approval is
paramount – the need to improve student mental health is critical. As global suicide rates are
expected to climb to record levels, and with the United States leading the way (Murray & Lopez,
1996), the call for change must be immediate and far ranging.
MENTAL HEALTH GAP
31
Importance of Addressing the Mental Health Care Gap in Schools
In 2002, President George W. Bush announced the President’s New Freedom
Commission on Mental Health. The commission revealed that mental health care in the United
States was inconsistent and inadequate, but there was a bright side to this commission thanks to
one particular institution: schools. “While schools are primarily concerned with education,
mental health is essential to learning as well as to social and emotional development. Because of
this important interplay between emotional health and school success, schools must be partners
in the mental health of our children” (United States, 2003). The role schools could play is a vital
one. One of the leading causes in the development of mental illness is the delay prior to
receiving diagnosis or care – a common result of stigma. Failing to improve mental health
literacy through schools promotes stigma, allowing the gap to continue to grow. Implementing
new strategies in education to increase literacy and reduce stigma will reduce the gap and
improve overall mental well-being in youth (Wang, et al., 2007). School programs work and,
through improving social-emotional competencies, schools have a direct and positive impact on
student achievement, mental well-being, and behavior (Han & Weiss, 2005). Improving the
social-emotional and mental well-being of youth is a significant factor to academic and social
growth. Schools provide the unique and ideal setting for promoting positive mental health.
Schools’ Unique Access and Familiarity with Youth
Schools have unique access and familiarity to youth and can be utilized to help provide
youth the tools to recognize and verbalize their mental health needs. On average, teachers spend
roughly eight hours a day, 180 days a year with youth, and are in the optimal position to improve
access to mental health care (Stephan et al., 2015). In many cases, teachers spend incalculable
MENTAL HEALTH GAP
32
time with their students through coaching, tutoring, afterschool mentoring, and more, allowing
for a particularly unique bond to form. Moreover, those schools that focus on learner-centered
methods have an even greater personal and academic impact on their students (Cornelius-White,
2007). Schools are the primary setting where adolescents learn to navigate the social and
emotional elements of their world, with teachers and peers as their guide (Eccles & Roeser,
2011). Nowhere else do young people have access to trained adults whose primary purpose is to
see them through the already difficult world of adolescence. Combined with the appropriate
training, techniques, and tools, teachers are a powerful presence in the lives of youth.
School-Based Techniques and Tools Necessary to Address the Mental Health Care Gap
When skills for coping with stress and mental health are integrated into the regular
curriculum, studies show a reduction in stress, anxiety, depression, and far fewer behavior
concerns (Slavin, Schindler, & Chibnall, 2014; Ialongo, Poduska, Werthamer, & Kellam, 2001).
In reducing stigma, and, through improved mental health literacy, students will develop their
vocabulary and begin to connect self-awareness to their overall mental health. In using
metacognitive practices, such as self-reflection, students think about their own mental health and
can measure or assess their own mental health (Baker, 2006). Increased mindfulness and
strategies for reflection allow students to think before acting and apply specific techniques to
help them understand their internal dialog (Pintrich, 2002). Metacognition allows students to be
more engaged with their learning through knowing what motivates them to learn and the
strategies they can use to be successful. Additionally, a shared language and discourse about
cognition, mental health literacy, and learning among peers helps develop metacognitive
MENTAL HEALTH GAP
33
awareness allowing youth to compare strategies and judge the utility value of their practices
(Pintrich, 2002).
Despite escalating mental health concerns, the demands on youth continue to increase.
As such, educators must adapt their practices to focus on relevant skills that impact future
success. Creating student profiles to supplement summative testing as an authentic indicator of
student cognition and mental health awareness creates accountability for the student’s academic
and emotional progress, what Darling-Hammond, Wilhoit, and Pittenger (2014) call, “a strategic
investment in educational improvement” (p. 8). Schools are the ideal location for improving
student mental health literacy and reducing the stigma surrounding mental health. These are key
performance indicators for improving academic success and mental health literacy thereby
reducing suicidal ideation, substance abuse, and academic burn-out. Evidence notwithstanding,
many schools in the United States continue to ignore developing mental health curricula.
Forutnately, several international, and a handful of domestic private and charter schools,
implemented successful mental health initiatives with impressive results.
School-Based Youth Mental Health Programs
To improve mental health literacy and to reduce the stigma surrounding mental health,
schools need to be more involved. In 2000, the US Surgeon General identified teachers as the
“frontline” in youth mental health care (Stephan et al., 2015). In 1996, the World Health
Organization (WHO) promoted the implementation of health programs in schools worldwide,
with a specific focus on improved mental health (World Health Organization, 1996). Schools
have unusual access to and time with youth and must lead the way to improved mental health
MENTAL HEALTH GAP
34
literacy, reduced poor mental health, co-morbidity with substance abuse, and increased diagnoses
and treatment for mental illness.
History of School-Based Youth Mental Health Programs
Some schools, primarily international, already take proactive steps toward reducing the
mental health care gap. These schools recognized that positive mental health is a statistically
significant indicator for academic success and routinely demonstrated that reduced mental health
problems led to improved academic performance (Murphy et al., 2015). Historically, schools
only focused mental health supports on those students identified as having mental disorders or, in
some cases, regularly demonstrated poor behavior (Stephan et.al., 2015). More recently,
however, school systems like the Canadian Secondary School system implemented programs to
address mental health within the regular school curriculum to improve student mental health
while still providing further direct support to those who identify as having mental illness (Wei,
Kutcher, & Szumilas, 2011). Early intervention, increased literacy, and identification are
directly linked to higher academic achievement, allowing for fewer support services and higher
social and professional functioning (Stephan, 2015). Canada’s program is referred to as a model
program with decreased psychological distresses among its students and fewer burdens on the
national legal and health systems (Wei, Kutcher, & Szumilas, 2011). However, Canada
represents only one of many international programs aimed at improving mental health through
schools.
Outcomes of School-Based Youth Mental Health Programs
Various international studies reveal positive results from intra-curricular mental health
designed programs. A study of 120 British 14- & 15-year-olds suggested that at-risk middle
MENTAL HEALTH GAP
35
school students in an after-school program made statistically significant gains in their knowledge
of and attitudes toward mental health and stigma as a consequence of a minimal degree of
intervention (Bulanda, Bruhn, Byro-Johnson, & Zentmyer, 2014). That deserves repeating:
mental health in youth improved through little more than a simple stigma reduction program.
Multiple studies reveal similar results. School social groups focused on mental health using
increased and directed dialog and improved mental health literacy conclusively reduced stigma
(Pettigrew & Tropp, 2006; Murman et al., 2014; Bulanda et al., 2014). Chile’s national mental
health program, “Skills for Life,” served over one million Chilean students and was the world’s
largest school-based mental health program (Guzman et al., 2015). Multiple studies of the
program demonstrated its success. Results universally showed a significant reduction in mental
health problems, improved academic performance, and fewer behavioral problems (Murphy et
al., 2015; Guzman et al., 2015). Similarly, in 1998, a specialized mental health curriculum,
MindMatters, trialed in 24 of Australia’s public, private, and parochial schools, reinforced work
already done and took advantage of regular practices to meet the mental health needs of their
students had similar success. The program interweaved positive mental health and stigma
reduction into existing school programs, and the curriculum built a sense of community and
belonging among a majority of its participants (Wyn, Cahill, Holdsworth, Rowling, & Carson,
2000). Mental health programs, when incorporated into the regular classroom curriculum,
effectively reduced stigma and improved mental health (Wei et al., 2013; Meyers & Hickey,
2014; Ialongo et al., 2001; Durlak et al., 2011; Kutcher et al., 2015; Fazel et al., 2014). Positive
mental health learning outcomes fostered by the teacher and organizational culture have a
significant impact on youth mental health literacy (Wei, Kutcher, & Szumilas, 2011). Literacy
MENTAL HEALTH GAP
36
improved when incorporated into the regular curriculum both formally and informally, through
direct instruction, implied instruction, family and community engagement, and the development
of a safe classroom environment allowed for open, honest, and often, brave dialog (World Health
Organization, 1996). Classrooms became avenues for teachers to address mental health through
the literature, history, science, arts, and even mathematics curricula. Lesson plans highlighted
aspects of mental health, not just in the learned content, but also in the students’ approach to time
and stress management, the journaling process, metacognition, active learning, and increased
mastery while destigmatizing language around mental health. An international review of 23
studies indicated schools that incorporated mental health programs into their regular classroom
learning, as opposed to pull-out or separated programs, successfully taught positive mental health
literacy (Wei, Hayden, Kutcher, Zygmunt, & McGrath, 2013). Conversely, the more traditional
method of pull-out mental health support programs hurt academic achievement. Programs
incorporated into the regular curriculum improved both academic achievement and student
mental health (Weist, Goldstein, Morris, & Bryant, 2003). In promoting mental health literacy
alongside the regular curriculum, the knowledge of mental health information extended not just
to the students, but, by extension, to those parents involved in their child’s academics and
homework (Wei et al., 2011). Wei, et al. continued, for those who already sought treatment, the
regular use of terms and practices in mental health became destigmatized, allowing for more
seamless transitions to positive mental health treatments and social acceptance. Increased
facility with the language and practices of positive mental health raised the awareness of students
and their families, thus reducing stigma allowing for earlier identification of symptoms leading
to necessary interventions for those needing further support (Wei et al., 2011). While school
MENTAL HEALTH GAP
37
mental health programs are not a panacea, they are aimed at a majority of students as a way to
improve their overall mental health. Mental health literacy destigmatized mental illness allowing
for easier identification of problems and an increased willing to discuss them, and teachers who
identified special needs, referred students more readily and confidently. However, few
American schools incorporate mental health programs of any kind. Schools possess a unique
opportunity to improve student mental health and must be identified as keys to closing the gap.
Clark and Estes’s (2008) Knowledge, Motivation, and Organizational Influences
Framework
Clark and Estes (2008) provide a systematic, analytic framework that clarifies
organizational and stakeholder performance goals and identifies the gap between the actual
performance level and the performance goal. Once the gap is identified, this framework
specifically examines the stakeholder knowledge, motivation, and organizational influences that
may impact performance gaps (Clark & Estes, 2008). Knowledge and skills identified by
Krathwohl (2002) are divided into four types: (a) factual; (b) conceptual; (c) procedural; and (d)
metacognitive, which are used to determine if stakeholders know how to achieve a performance
goal. Teachers, who typically work in isolation, need to be assessed for what they know as a
prerequisite for organizational improvement (Elmore, 2002). This gap analysis established the
knowledge influences vital to the stakeholders’ understanding of how to develop positive
character and if it applied to student mental health and provides a framework for teachers to
work in coordination, rather than isolation. Implementation of new programming is a slow,
purposeful process. Before engaging teachers in any professional development, understanding
how to motivate and inspire them must first occur (Pearson, Chilton, Wyatt, Abraham, Ford,
MENTAL HEALTH GAP
38
Woods, & Anderson, 2015). Motivation energizes innovation. Without motivation, people
either avoid or reluctantly engage in tasks or accomplish activities with little to no enthusiasm or
effort (Clark & Estes, 2008). Motivation occurs in many forms, but without it, teachers are
unlikely to engage in professional development or implement new programming. Employee
motivation has three major influences: choice, persistence, and effort (Clark & Estes, 2008).
These influences can occur intrinsically or extrinsically but are necessary to creating a complete
gap analysis (Ryan & Deci, 2000). Finally, organizational influences on stakeholder
performance to consider may include work processes, resources, and workplace culture (Clark &
Estes, 2008).
Each of these elements of Clark and Estes’s (2008) gap analysis are addressed below in
terms of the teachers’ knowledge, motivation, and organizational needs to meet their
performance goal of implementing character education for all students by 2021 and if it can be
applied to mental health. The first section is a discussion of the assumed influences on the
stakeholder performance goal in the context of knowledge and skills. Next, assumed influences
on the attainment of the stakeholder goal from the perspective of motivation were considered.
Along with knowledge and motivation, the final factor in assessing an organizational
performance gap was an examination of the organization itself (Clark & Estes, 2008). These
three factors helped develop a complete understanding of organizational performance and
improvement
Knowledge and Skills
To develop student character, an analysis of the skills and knowledge of the teachers was
essential. It was determined how much teachers knew about the empirical evidence and
MENTAL HEALTH GAP
39
application of methods aimed at supporting student character and how it applied to mental health
if it was expected that they incorporate mental health literacy into their regular curricula. Clark
and Estes (2008) refer to this as a gap analysis, where the teachers are first evaluated for what
they know and do not know about the benefits of character education and student mental health.
Improving an organization includes systemic and synchronized change. Teachers, who typically
work in isolation, needed to be assessed, among several other things, for what they knew as a
prerequisite for organizational improvement (Elmore, 2002). This gap analysis established the
knowledge influences vital to the stakeholders’ understanding of how to develop character and,
hopefully, positive student mental health.
Knowledge influences. This study includes a literature review of the knowledge and
skills required of teachers to implement individualized student portfolios as a means of
supporting student social-emotional well-being and mental health. This review incorporated the
framework of Krathwohl’s (2002) adaptation of Bloom’s Taxonomy to examine three of the four
categories of the knowledge dimension: conceptual, procedural, and metacognitive types.
Factual knowledge influences. The first type, factual knowledge, was not examined in
this study since it covered the basic details of mental health which can include vocabulary and
definitions for the stakeholders. These specific details are addressed through the other
dimensions, as well.
The conceptual knowledge influences. The conceptual knowledge type explores the
interconnectedness of the basic details of a concept and reveals how they relate to one another
(Krathwohl, 2002). The main point in applying a conceptual understanding to this study targets
the effective application of factual knowledge. The more developed our conceptual
MENTAL HEALTH GAP
40
understanding, the more complex our thinking will become allowing for procedural knowledge
to develop (Carpenter, 1986). Deeper prior knowledge and understanding allows for the
development of steps or procedures to complete a task.
The procedural knowledge influences. The third dimension of knowledge, procedural,
reveals how something is done. Information on how to complete a task or practice a skill can be
considered part of the procedural type (Krathwohl, 2002). As strategies and skills are developed,
it becomes important to understand how and when to apply this knowledge (Pressley & Harris,
2009). Having a broad base of procedural knowledge allows teachers to apply different skills or
tasks necessary for student learning. Being able to identify which tasks are necessary and
understanding how to recognize the appropriate tasks is part of the metacognitive process.
The metacognitive knowledge influences. The metacognitive type refers to what one
knows or does not know about their thinking (Krathwohl, 2002). Self-knowledge and self-
awareness are critical to understanding when to apply certain strategies to various problems, how
effective the strategies are, and an understanding of which strategies work and why (Pintrich,
2002). Analyzing the dimensions of teacher knowledge identified areas where gaps existed that
prevented the organization from achieving its intended goal.
Teachers need knowledge of principles and theories in youth mental health. To
understand the complex issues around mental health, teachers needed a conceptual knowledge of
mental health and how it is connected to character education and academic performance.
Research on positive psychology regularly demonstrate the connection between mental health,
character, and academic excellence, arguing that character education improves behavior,
academic outcomes, engagement, and happiness (Seligman, Ernst, Gilham, Reivich & Linkins,
MENTAL HEALTH GAP
41
2009). Stakeholders must recognize the importance of mental health awareness, education, and
treatment and must have the knowledge of how to develop the non-cognitive learning of youth.
While teachers were not expected to diagnose students, there must be the expectation that they
understand elements of good mental health and how to support it. Mental health is not about
being mentally ill, it is about knowing what to do when you have a problem. Mental health
literacy includes awareness of the difference between mental distress and mental disorders and
stigma reduction to improve help seeking interventions (Kutcher, Wei, Costa, Gusmão,
Skokauskas, & Sourander, 2016). Without strong mental health literacy, youth are not well
prepared to transition through the social and emotional challenges of school or adulthood – a
goal of character education. A Canadian study of a simple mental health literacy guide,
implemented over 12 teaching hours to 175 students by regular classroom teachers, showed
significant improvement in student literacy (Kutcher, Wei, & Morgan, 2015). Even the smallest
measure of improved mental health in youth led to positive outcomes, including, as stated earlier,
improved social and academic success.
Teachers with a deeper understanding of the theories and principles are better able to
create plans that fit their students’ individual needs (Mishra & Koehler, 2006). The andragogical
teacher recognizes the need to continually hone her craft, seeking out conceptual and empirical
knowledge so she can identify the most effective way to communicate appropriate strategies and
techniques to her students (Knowles, 1984). Teachers can act as gatekeepers to mental health.
In teaching teachers to understand and recognize mental health symptoms, they can provide
youth the vocabulary to express their emotions and possibly recognize symptoms leading to early
diagnoses (Han & Weiss, 2005; Weist et al., 2003). Teachers must also be able to answer their
MENTAL HEALTH GAP
42
students’ questions not only about factual content but also conceptually how mental health
literacy helps them (Shulman, 2013). Teachers with strong self-efficacy are more likely to
remain engaged in and seek information on change initiatives, leading to greater success of
mental health literacy programs (Han & Weiss, 2005). Gatekeeper programs work as mental
health programs (Isaac et al., 2009). Gatekeeper training has to address all manner of mental
health and teachers with strong procedural knowledge can identify risk factors. In recognizing
teachable moments in mental health without pausing to look up a term or concept and
understanding how to provide instant, proactive feedback is key to the success of any gatekeeper
program. Students, especially younger students, with focused social and behavioral instruction,
demonstrate significantly improved future academic performance (Jennings & DiPrete, 2010).
Additionally, teachers’ unique and extended access to youth gives them a clear and consistent
picture of their students in a controlled environment, allowing for the opportunity to recognize
changes in behavior and affect (Han & Weiss, 2005). Teachers with robust conceptual and
procedural knowledge about mental health literacy can create flexible and adaptable lesson plans
that meet the needs of their students, rather than offering a one-size-fits-all, repetitive mental
health program that typically focuses on only the neediest students (Huang, Stroul, Friedman,
Mrazek, Friesen, Pires, & Mayberg, 2005). Each classroom is different. Each school year brings
new students with a different social dynamic as developed by the external factors in each of their
lives. With the appropriate training, support, and resources, teachers can adjust to their students,
creating lesson plans that cater to their specific needs while maintaining the core principles of the
regular classroom curriculum.
MENTAL HEALTH GAP
43
Teachers need to know how to create and implement a student portfolio. Failure to
make prompt initial treatment contact is a pervasive aspect of unmet need for mental health care
in the United States. Interventions to speed initial treatment contact are likely to reduce the
burdens and hazards of untreated mental illness (Wang et al., 2007). Possessing procedural
knowledge provides teachers effective implementation strategies necessary for improved mental
health and earlier identification, including the creation of student wellness plans or portfolios.
Prevention, early identification, and education are keys to the success of mental wellness
programming. Teachers must continually refine their practices to meet the demands of an ever-
changing student body. Howard Gardner (2011) stated that, “only if we expand and reformulate
our view of what counts as human intellect will we be able to devise more appropriate ways of
assessing it and more effective ways of educating it” (p. 4). As the need for mental health
literacy increases, and the understanding of what that looks like develops, effective methods in
education must be devised to meet the demand. Student portfolios supplement summative
testing as an authentic indicator of student cognition and metacognition, focusing on the whole
child and seeking to understand the true score of student learned knowledge (Darling-Hammond,
Wilhoit, & Pittenger, 2014). Portfolios have no specific purpose and are therefore flexible
enough to provide evidence of learning (Davies & Le Mahieu, 2003). Portfolios allow for
instruction and assessment to be intertwined. A portfolio is a purposeful collection of student
work to measure the student’s understanding, progress, and effort. It is a metacognitive process
that tells a story. It reveals the character and heart of the person who created it and can provide a
window inside the person’s head. A portfolio is a vehicle used to express student thought,
growth, self-reflection, independence, and control (Paulson, Paulson, & Meyer, 1991). Through
MENTAL HEALTH GAP
44
the use of portfolios teachers encourage triple-loop learning. Typically used in organizational
leadership, portfolios can be applied to the educational context, because it includes feedback and
an action plan for improvement. Wellness plans are meant to allow students and teachers to
reflect on the learning process (Tosey, Visser, & Saunders, 2012). Reflection improves literacy,
increases help-seeking behaviors, and reduces stigma; studies indicate removing stigma as one of
the principle strategies for early identification and understanding mental health in youth
(Chandra & Minkowitz, 2006; Murman, Buckingham, Fontilea, Villanueva, Leventhal, &
Hinshaw, 2014; Pescosolido, Jensen, Martin, Perry, Olafsdottir & Fettes, 2008; Schomerus,
Schwahn, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2012). Developing teacher
procedural knowledge on creating an individualized mental health program in schools lead to the
destigmatizing of mental illness. A review of 22 studies identified perceived stigma as the
leading obstacle to seeking mental health support and a leading cause of poor mental health
literacy, and concluded increased mental health literacy incorporated into the regular curriculum
significantly reduced stigma in youth (Gulliver, Griffiths, & Christensen, 2010). Portfolios that
are passed along track and promote longitudinal individual learning in students and inform
teachers about the students they are teaching. Portfolios document student skills, understanding,
experiences, and are only limited by the student’s experiences and imagination. Portfolios
provide students the opportunity to reflect on social and academic interactions (Johnson,
Renzulli, Bunch, & Paino, 2013) thereby learning how to process and reduce the impact of
stigma by finding meaning in their experiences (Fink, 2013). Teachers act as coaches and
mentors in learning. Teachers help students set personal goals and encourage them to reflect
upon their work, thoughts, and ideas with continuous feedback provided.
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Adolescents typically demonstrate high instances of depression, anxiety, and academic
burnout (Slavin, Schindler, & Chibnall, 2014). In most academic settings, mental health
supports are available as services. However, these services require students to self-enroll or they
are involuntarily enrolled because they present symptoms or behaviors of mental illness. Slavin,
Schindler, & Chibnall (2014) reveal how incorporating preventative mental health and awareness
into their regular curricula had positive results on their students’ mental health due to early
recognition and intervention, pro-emotional literacy, and stigma reduction. The Mental Health
on Campus Improvement Act proposed by Congress, stressed the need for further mental health
programs on academic campuses to address the rising number of cases of anxiety, depression,
burnout, and substance abuse – specifically citing stigma reduction as one of the keys to
improved mental health and increased support seeking behaviors (Civic Impulse, 2017). Dual
purpose lesson plans (lesson plans that seek multiple learning outcomes) focused on content and
mental health led to a reduction of stress, depressed feelings, and anxiety, in addition to
increased group cohesiveness (Slavin, Schindler, & Chibnall, 2014). Creating and implementing
a mental health program, alongside the regular curriculum, effectively supported student mental
health without changing course content.
Teachers need to evaluate their effectiveness with wellness planning for students.
Teachers need to reflect on what they know and do not know, including their biases and
predispositions. Metacognitive knowledge of the processes increase teacher understanding and
awareness (Krathwohl, 2002). Adult learners, even when required to learn new material, must be
responsible for their own learning. There comes a point when individuals stop receiving
information and need to actively seek it to improve metacognitive self-knowledge (Pintrich,
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2002). This usually occurs when adults identify a weakness in their knowledge, and they take
steps to increase their understanding (Knowles, 1984). To best prepare effective lesson plans
and mental health supports, teachers need to openly reflect on their work and examine the
application of various strategies to different classroom tasks (Pintrich, 2002). Teachers should
be comfortable with the research but must also recognize why improved mental health is
valuable and how it can impact their students’ academic success (Shulman, 2013). Teachers with
a deep understanding of planning know how and when to apply strategies that fit with the class
content and share their successes and failures with their peers to routinely improve their practice
(Mishra & Koehler, 2006). Through self-reflection, evaluation, and observation, teachers reflect
on the effectiveness of their practices and routinely improve their understanding by recognizing
gaps in knowledge aiming to fill those gaps with empirically supported strategies. This
metacognitive process allows stakeholders to apply learned practices and assess effectiveness
while still improving the mental health and character of their students. Because student
portfolios are regularly evaluated at specific points in the year and can serve as formal reflective
evaluations built into the curriculum as formative assessments, teachers also readily measure
their ability as educators. Portfolios measure growth against their creator and are not normed to
any age group or grade level, providing teachers the opportunity to reflect on their own teaching
and how their students learn (Davies & Le Mahieu, 2003). Portfolios seek continuous
improvement through evaluation, corrective action, and problem solving (Darling-Hammond,
Wilhoit, & Pittenger, 2014) – triple loop learning. Students’ mental health and academic success
cannot be separated. Cognitive and non-cognitive skills are all part of the learning process
(Farington et al, 2012), thus, greater investment in non-cognitive skills would result in greater
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cognitive performance in the classroom context. Learning comes from unforeseen events as
much as from predicted outcomes. Portfolios help teachers seek constant improvement by, “co-
inventing and [in creating] a collective mindfulness. Members discover how they and their
predecessors have facilitated or inhibited learning, and produce new structures and strategies for
learning” (Snell & Chak, 1998; P. 340). Assumptions about student and teacher mental health
and literacy are checked and re-checked, allowing for a routine and practiced means for
community-wide mental health advancement.
Table 2 provides the knowledge influences and types provided to better understand what
will be required of teachers, and the influence assessments used to guide them through the
practice of creating independent wellness plans.
Table 2
Knowledge Influences and Types for Gap Analysis
Knowledge Influence Knowledge Type
Teachers need knowledge of mental health principles and
theories in youth
Conceptual
Teachers need to know how to create and implement a
student wellness plan
Procedural
Teachers need to self-evaluate their effectiveness with
wellness planning for students
Metacognitive
Motivation
Implementation of new programming is a slow, purposeful process. Before engaging
teachers in any new initiative, understanding how to motivate and inspire teachers must first
occur (Pearson et al., 2015). Motivation energizes innovation. Without motivation, people
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either avoid or reluctantly engage in tasks or accomplish activities with little to no enthusiasm or
effort (Clark & Estes, 2008). Motivation occurs in many forms, but, without it, teachers are
unlikely to engage in professional development to support the implementation of new
programming. Employee motivation has three major influences: choice, persistence, and effort
(Clark & Estes, 2008). These influences can occur intrinsically or extrinsically but are necessary
to creating a complete gap analysis (Ryan & Deci, 2000). Along with knowledge, motivation is
critical in assessing an organizational performance gap and helps develop a more complete
understanding of organizational performance and improvement.
This study reviewed two motivational theories to achieve Northeast Independent School’s
goal: utility value and goal orientation theories, because of their relevance to this study. Utility
value is used to establish whether or not something matters to a person (Eccles, 2006).
Depending on an individual’s personality, life goals, and other motivating factors, utility value
explores why someone would want to accomplish a task (Eccles, 2006). Goal orientation theory
focuses on the setting and achieving of goals to accomplish mastery by assigning specific value
to a task (Yough & Anderman, 2006). These goals are used to motivate people to accomplish
specific tasks through intrinsically applied rewards (Pintrich, 2003).
Utility Value Theory. Expectancy Value Theory (EVT) focuses on the motivation of an
individual to succeed at a task. Eccles (2006) hypothesizes that a positive response to two
questions form the basis of EVT. The first, “can I do the task?”, explores whether or not an
individual has confidence in their ability to accomplish a task. The later, “do I want to do the
task?”, focuses on whether or not one sees value or utility in accomplishing the task (Eccles,
2006). EVT involves four theories of motivation. The first, intrinsic value, places value in
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learning for the sake of learning (Eccles, 2006). Those who are intrinsically motivated genuinely
enjoy the material and are driven to understand content at a mastery level. Intrinsic enjoyment
has two possible origins: is it situationally appropriate or personally interesting (Eccles, 2006)?
The intrinsically motivating factors include a preference for challenging tasks, material that is
interesting, or mastery (Eccles, 2006). Situational learning places greater emphasis on time and
place, exploring whether the material is appropriate to what you want to accomplish or avoid
(Eccles, 2006). The second factor in expectancy value theory is attainment value. The core
principle of attainment value revolves around how individuals perceive themselves and the
opinions they were raised to believe (Wigfield & Eccles, 2000). A person raised with certain
core principles or responsibilities places greater value in those notions and seeks out information
to support these ideals (Wigfield & Eccles, 2000). Third, utility value, places emphasis on the
usefulness of an idea and how accomplishing a task can benefit the learner (Wigfield, 1994).
Finally, people are motivated by the perceived cost of a task. Individuals place greater value in
those tasks where the reward is greater than the expense or effort (Eccles, 2006). The cost of a
task varies depending on many factors including how an individual identifies, where they place
value, self-confidence and competence, and perceived fear or failure (Eccles, 2006). Teachers
recognition for the utility value of student mental health was essential to addressing the gap in
this study.
Teachers need to recognize the utility value of the student portfolios in providing
social-emotional support to students. Teachers who know and understand how emotional health
supports students engage more in their students’ learning and can explain to them why mental
health matters. Additionally, teachers who use mindful mental health teaching practices
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demonstrate greater patience, better student-teacher relations, improved classroom atmosphere,
and improved self-mental health (Meyers & Hickey, 2014). If a teacher cannot identify the
utility or benefit of learning student mental health, that teacher is not incentivized to learn about
student wellness (Pajares, 2006). People are more likely to succeed when they apply purpose to
their learning objectives. Students exhibit greater success in accomplishing a task by applying
purpose to that task (Hulleman, Godes, Hendricks, & Harackiewicz, 2010). By connecting work
to an individual’s personal gains and interests, tasks are accomplished more successfully and
with greater mastery than if externally motivated (Pintrich, 2003). Teachers are more willing to
learn and apply new classroom strategies when they know it will benefit them and their students
(Tin, Hean, & Leng, 1996; Lortie, 2002; Roy & Sengupta, 2013). Students, especially younger
students, with focused social and behavioral instruction, demonstrate significantly improved
future academic performance (Jennings & DiPrete, 2010). In recognizing the benefits of a
portfolio, including improved student behavior, character growth, and academic performance,
teachers’ intrinsic buy-in to the program and desire to engage in professional development
increases.
Goal Orientation Theory. Goal orientation introduces why one engages in a task
(Pintrich, 2003). The three principles of motivation begin with active choice (Clark & Estes,
2008). Together with persistence and mental effort, goal setting increases motivation and, when
combined with effective knowledge and skills, improves overall performance (Clark & Estes,
2008). In goal orientation, individuals establish goals to pursue and take steps towards actively
achieving these goals (Clark & Estes, 2008).
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Four factors influence goal setting, persistence, and achievement: confidence,
organizational support, culture, and values (Clark & Estes, 2008). Personal and organizational
confidence is critical to setting and achieving goals. In setting goals that are unattainable, people
are unlikely to attempt the task, lacking the self-confidence to engage in the process (Clark &
Estes, 2008). Goals may be challenging, but they must be realistic. Next, people have to believe
that the organization is on their side. Support networks and opportunities for growth need to be
available to help remove real and perceived organizational policies or behaviors that create
obstacles (Clark & Estes, 2008). Third, the culture surrounding organizational improvement
needs to be positive and proactive. A culture of support and engagement is necessary to create a
positive learning environment where people remain motivated to achieve their goals (Clark &
Estes, 2008). Finally, teachers need to feel as if the work they are doing is productive and
useful; they need to see the utility value of the organizational goals (Clark & Estes, 2008).
Goal orientation has two measures: mastery and performance (Yough & Anderman,
2006). Mastery measures task completion against oneself by increasing one’s own awareness
and understanding (Dweck, 1986). Performance goals focus on a comparison of self to others.
Performance goals seek to avoid embarrassment or prove intelligence against that of one’s peers
(Dweck, 1986). Gaps in measuring teacher motivation must be understood and addressed to
achieve the organizational goals (Clark & Estes, 2008). This study explored how mastery could
be achieved through goal orientation.
Teachers need to set benchmarks focused on improving student character and mental
health and not just on fulfilling a mandate. In goal orientation, mastery reflects self-
improvement (Yough & Andermann, 2006). The most effective goals are those that are
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concrete, challenging, and current (Clark & Estes, 2008). To maintain motivation, goals must be
difficult but achievable, easy to understand and measure, and short term. To achieve mastery,
teachers need to set learning goals and self-improvement benchmarks (Pintrich, 2003). Through
the use of peer support groups, teachers gain the opportunity to set and reflect upon personal and
group goals (Pintrich, 2003). However, teachers must be careful to avoid comparing their
learning against one another to avoid rote performance knowledge (Yough & Anderman, 2006).
Engaging in feedback and reflection allows teachers to build on knowledge and maintain
enthusiasm for the project (Pearson et al., 2015). Teachers need to avoid meeting the basic
minimum by applying self- and peer-directed goals. In holding one another responsible, peer
support groups motivate teachers to learn and attempt empirically supported strategies while
sharing their successes and failures.
It has been stated that students perform better when they have teachers who model the
types of goal orientation strategies they want to see in their students (Ames, 1992). Teachers
who are invested in setting goals to achieve mastery in mental health literacy demonstrate
effective learning strategies for their students, improving their overall academic performance and
commitment. Additionally, an international study of 320 teachers demonstrated that teachers
who recognized the impact of their newly learned teaching strategies reflected in their students’
success often seek further learning goals as a way of demonstrating mastery not just for
themselves but also to appear more competent to their peers (Butler, 2007). Butler’s study
(2007) also demonstrated a clear connection between teacher help-seeking strategies and
improved teacher collegiality, followed by improved student performance as a result of self-
determined standards and goals. If the evidence that supports the use of portfolios in measuring
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student success is accurate, and we know that teachers improve their craft when they set goals
and seek help, the connection between these strategies seems apparent. Goal orientation is an
effective strategy for teacher motivation to improve mental health literacy through the character
education by modeling the behaviors teachers want to see in their students.
Utility value and goal orientation theories are important to this study to understand the
strategies necessary for the stakeholders to address the mental health care gap in youth. It is
important to identify the necessary stakeholder motivating factors, highlighted below in Table 3.
Table 3 provides the assumed motivation influences to better understand what will be required
for teacher motivation, and the influence assessments used to motivate them through the practice
of creating independent wellness plans.
Table 3
Motivational Influences and Motivational Influence Assessments
Assumed Motivation Influences
Utility Value – Teachers need to recognize the usefulness of the student portfolios in teaching
character education and providing mental health support to students
Goal Orientation – Teachers need to set benchmarks that are focused on improving student
character and mental health and not just on fulfilling a mandate
Organization
Organizations are defined by their culture, yet, the culture of an organization is often
unseen, and a definition is rarely agreed upon (Rueda, 2011). Culture is something that is shared
by everyone in the institution, designed by its accumulated history, knowledge, emotions, and
behaviors, among other things, of all its members over its existence (Rueda, 2011). Culture is
something that gets passed to all new members of the organization who may, in turn, add their
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own unique characteristics, leading to constant change (Schein, 2004). Culture and leadership
are inextricably linked since culture often defines the type of leader in an organization or, where
culture is absent or weak, the leader is responsible for helping to define the culture (Schein,
2004). It is the leader’s responsibility to create a culture and climate that promotes
organizational growth (Haque, TitiAmayah, & Liu, 2016). Deprived visionary and charismatic
leadership, organizational change is likely to founder.
The culture of an organization is defined by its core values and principles – what the
school believes itself to be (Schneider, Brief, & Guzzo, 1996). Individuals have little control
over the culture of an organization, but it weighs heavily on how they perform (Bandura, 2005).
The core values of an organization are understood as being central to the school (Schein, 2004).
They are often unstated and permeate the behavior of the school community. Multiple studies
indicate that the culture of an organization has a significant impact on how people learn and
work (Bandura, 2005; Alexander, Schallert, & Reynolds, 2009; Rueda, 2011) and the culture is
central to how the organization operates (Berger, 2014). Gallimore and Goldenberg (2001)
conclude that the most effective way to analyze gaps in organizational culture is through two
lenses: cultural models and cultural settings, which I will explore further below.
Teachers, like students, need support networks. School and team leaders need to create
an environment of support, access, and open communication to avoid frustration and
motivational barriers (Barrett, Eber, & Weist, 2013). Improved teacher support networks
provide the opportunity for reflection and improved teacher practices and effectiveness (Graham,
2007). Tickle, Change, & Kim (2011) demonstrate in a study of almost 40,000 teachers that
organizational support is critical to teacher job satisfaction, effectiveness, and retention.
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Teachers who are good at their job and love what they do demonstrate a greater willingness to
follow and trust in the administration’s decision-making processes when the organization
provides resources, feedback, and open communication. Much like the burnout students face,
teachers are inundated with repeated attempts to improve techniques and performance creating
low self-efficacy and limited understanding of the concepts resulting in a lack of incentives to
learn the skills necessary to improve student mental health. The administration must create a
shared acceptance in the usefulness of a new program (Belsky, 2012). The administration needs
to tell a story to help create a vision and “focus and motivate a collective action” (Burke, 2002).
In creating this vision, the administration guides teachers through the program and invites them
into collegial conversations about organizational change.
Administrators can help facilitate change by creating a culture of open communication
through face-to-face conversations with leadership (Berger, 2014; Burke, 2002). Northeast
Independent School teachers can become more engaged and informed in the program, and
administrators can learn what is important to the teachers and weave the values of the teachers
with those of the organization (Berbarry & Malinchak, 2011; Burke, 2002). In making the case
for change, the administration can create teacher allies who can be cheerleaders for the program
(Agócs, 1997). These allies can help spread the word and can act as guides, motivators, and
mentors.
If it is assumed that organizational influences at Northeast Independent School led to
teacher fatigue, evaluating these influences was crucial to understanding the effectiveness and
unintended mental health outcomes of the Character Program. According to the literature below,
without the full support of the administration, including, but not limited to, performance
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accountability, teacher mentoring, and building trust, teachers would remain fatigued and
unengaged by new programs (Stephan, Sugai, Levers, & Connors, 2015).
In the next section, I review the literature on the organizational cultural model and setting
influences that serve as obstacles to teacher implementation of new programming.
Organizational cultural model influences. Cultural models, as defined by Gallimore
and Goldenberg (2001), are unseen and difficult to define. These are the values and behaviors
that define an organization, its policies, and attitudes, among many things (Rueda, 2011). It is
often the invisible force that might be explained as, “the way we do things here.” Good cultural
models are often difficult to maintain, and they require constant vigilance on the part of
leadership (Lencioni, 2002). Figure 2, taken from Stein et al. (2008), demonstrates how culture
and context play a role in the adoption of new initiatives.
Figure 2: Impact of context on program implementation (Stein et al., 2008. Pg. 371)
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The setting context, in this case the cultural model influences, impact implementation and the
success of the program at all levels of the school’s culture. Initiatives in schools, as in many
institutions, tend to echo the social reforms of the time (Levin, 1974; Gallimore, & Goldenberg,
2001; Sarason & Klaber, 1985). As society changes, so do schools and their cultures. These
influences have a major impact on the success or failure of program implementation and,
unfortunately, poor cultural model influences can act as impediments to achieving organizational
goals.
The organization needs to provide feedback to hold teachers accountable for
implementing new initiatives. Feedback is integral to holding individuals accountable and to the
process of learning. When implementing new initiatives, clear and structured feedback that
encourages progress and success is critical (American Psychological Association, 2015).
Feedback and accountability make up essential elements of self-efficacy (Bandura, 2000). In
providing feedback, teachers are asked to reflect on their practice and engage in an exploration of
their work (Charteris, 2016), holding them accountable for what and how they teach. Positive
feedback leads to greater self-efficacy and a desire, by teachers, to improve their techniques.
Evaluations and observations need to specifically speak to the new initiative. Together, these
can create a greater picture of teacher performance, improved self-efficacy, and greater
educational outcomes. Feedback is critical to teacher improvement (Skeff, 1983). Teaching is
more than just a job, and it requires constant adaptation and growth (Farrington et al., 2012).
Teachers need to develop an academic mindset which is validated by positive results in student
performance. Without organizational support or feedback, a negative mindset leads to a self-
fulfilling prophecy of failure and unestablished programs (Organisation for Economic Co-
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operation, and Development, 2009). Feedback is the best tool in terms of change acceptance and
performance allowing for a self-sustaining feedback loop for effective implementation (Han &
Weiss, 2005). Through regular interviews and structured conversations aimed at holding
teachers accountable, Northeast Independent School would support its teachers’ implementation
of the new initiative and promote teacher self-efficacy leading to greater performance. Creating
low-stakes standards that get self-assessed also provide accountability (Sayavedra, 2014).
Teacher modeling improves professionalism and creates a professional atmosphere where
teachers are responsible not just to the students but to each other, making teachers accountable
professionally, not just institutionally (Darling-Hammond, Wilhoit, & Pittenger, 2014).
Teachers evaluating how they are implementing the Character Program and setting goals for
continuing to improve is in line with theories expressed earlier on reflective practices leading to
greater intrinsic buy-in and improved self-efficacy through goal orientation. Evaluations and
observations need to specifically speak to the new initiative creating a more accurate picture of
teacher performance allowing for greater educational outcomes.
The organization needs to reduce teacher fatigue from the continual effort to introduce
new programs, techniques, and initiatives. The school needed to get all of its stakeholders on
board and build the belief that the organizational goal of improving students’ mental health was
worthwhile. Northeast Independent School was eager to place itself on the cutting edge of
education. While it was a traditional school, its values and teachers tended to be more
progressive – particularly in the middle, lower, and pre-schools. As a result, the organization
frequently introduced new initiatives leaving many teachers wary of, and unsure about, any new
programs. Unfortunately, simply going through the motions and applying rote styles to new
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techniques does not lead to effective learning (Kirkpatrick, 2006). Teachers who feel burned out
have lower self-efficacy. Teachers do not always see compatibility with new initiatives to their
style of teaching or anticipated effectiveness. Historically, evidenced based practices do not
always remain in schools, and while teachers may embrace them at first, they often fall into old
habits and revert back to their established style (Stein et al., 2008). Teachers need to be made
aware about the effectiveness of an initiative before implementation, since teacher attitudes
around program implementation are critical to its success (Han & Weiss, 2005). Teachers need
support, just as students do. Schools that focus on teacher preparation, support, and motivation
through modeled behaviors and an open platform to discuss issues with the initiative were more
successful in developing specific mental health programs (Katz & Shahar, 2015). School leaders
need to look at implementing new initiatives in the same way that teachers approach students
learning new material. Through networks of support, encouragement, feedback, and
communication, the school can improve their chances for the successful implementation of any
new initiative.
Communication is the key to accomplishing this goal. By facilitating conversations
about organizational change and student mental health, teachers gain a voice and can influence
the culture of the organization (Berger, 2014; Clark & Estes, 2008) creating agency and
ownership for teachers. An organization with open communication and understanding is able to
adapt to challenges more fluidly without leaving teachers feeling like they are being told what to
do (Berger, 2014). Teachers are more likely to be engaged in new initiatives if they feel they
have a voice, they know why they are implementing new methods, and feel as if their work is
valued (Berger, 2014; Berbarry & Malinchak, 2011). Through these conversations, trust in the
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program is established. Trust, like culture, is deeply entrenched in schools, and it can take years
for school administrators to build; when schools lack trust, change is often seen as fixing
something that is wrong leading to fatigue for the new initiative (Louis, 2007). In building trust
and creating the belief that the program works, teachers will become effective and efficient in
what they do (Rath & Conchie, 2009; Burke, 2002). In overcoming these cultural model
influences, Northeast Independent School can implement its new programming without being
plagued by many of the same organizational influences that have restricted it in the past.
Organizational cultural setting influences. Cultural setting influences are more
concrete and identifiable than model influences; a school schedule, an honor code, or lesson
plans are a few examples (Rueda, 2011). Cultural setting influences typically occur over time
and set out to accomplish an objective (Gallimore and Goldenberg, 2001). Cultural settings,
originally defined by Seymour Sarason (1972), a pioneer in the study of educational settings, are
outcomes achieved by two or more people. According to Sarason (1972), an example outcome
of a setting occurred famously in 1787 during the United States Constitutional Convention.
Since only White males represented the fledgling nation in the writing of the Constitution, the
impact on the rights of Blacks and women in American society continue to be an issue of great
contention. The influence of who is represented and how they are represented is important in
establishing new programs. While teachers would undoubtedly benefit from more time to
collaborate and share ideas about new initiatives, the school day and one’s personal life place too
much demand on any individual’s time to accomplish such tasks (Gallimore and Goldenberg,
2001). There are a variety of organizational settings that influence the way initiatives are
implemented at schools, both formally and informally.
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The organization needs to provide formal or informal mentoring programs or
modeling, particularly in support of new initiatives. Mentoring and modeling promote and
support creativity and engagement (Bandura, 2005). Northeast Independent School can create
greater teacher self-efficacy and promote collaboration through mentoring and modeling (Luke,
Baumann, Carothers, Landsverk, & Proctor, 2016). In highlighting teachers who are doing the
work effectively and by recognizing or sharing their lessons with the entire teaching community,
Northeast Independent School would develop a cultural setting of collegiality and idea sharing
(Belsky, 2012). Mentoring is meant to support, not to judge (Han & Weiss, 2005). Mentoring
also supports the observing teacher as new strategies and techniques are shared among
colleagues, inspiring new approaches and ideas. Peer mentoring should be focused and specific.
Combined with self-evaluations, teachers can identify specific activities they want observed for
help in achieving goals set during self-assessment (Sayavedra, 2014). These strategies help to
create a more highly trained and supported faculty, including how they evaluate, model, and
promote consistency and understanding (Farington et al, 2012). Teachers are not only “providers
of support, but consumers of support” (Katz & Shahar, 2015). The organizational setting aims to
support its students almost without fail, yet there is no culture of supporting faculty
implementation of new initiatives.
Table 4 provides the assumed organizational cultural model and setting influences
necessary to provide adequate teacher support and improved positive organizational change
around student emotional well-being.
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Table 4
Assumed Organizational Influences and Assessments
Assumed Organizational Influences
Cultural Model Influence 1:
The organization needs to hold teachers accountable for implementing new initiatives
Cultural Model Influence 2:
The organization needs to reduce teacher fatigue from the continual effort to introduce new
programs, techniques, and initiatives
Cultural Setting Influence 1:
The organization needs to provide formal or informal mentoring programs or modeling,
particularly in support of new initiatives
Conceptual Framework: The Interaction of Stakeholders’ Knowledge and Motivation and
the Organizational Context
A conceptual framework provides the context, understanding, and the underlying and
overt causes of a study (Merriam & Tisdell, 2016) – it forms the skeleton for the body of work
presented in a study. The conceptual framework is a critical piece of the study that is far too
often overlooked (Merriam & Tisdell, 2016) and ignoring it can lead to an incomplete or
misunderstood study. However, a well-developed framework digs deeply into the study,
discussing why it is important (Rocco & Plakhotnik, 2009). According to Maxwell (2013), the
framework is made up of four elements: one’s experiential knowledge, existing theories and
research, pilot and exploratory research, and thought experiments. These elements allow the
author to review previous studies, fill in any gaps or contradictions, and present the study as an
original piece of work (Maxwell, 2013).
While this study presented each of the potential influences independent of one another, I
understand that they were not in isolation from one another. The purpose of this study was to
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examine Northeast Independent School teachers’ knowledge and motivation to provide their
students the skills necessary to identify, discuss, and implement character-based vocabulary,
behaviors, and skills, in addition to prosocial-emotional strategies. Additionally, this study
examined what organizational factors influenced teachers’ knowledge and motivation. As stated
earlier, teachers often work in isolation, thus, the knowledge and motivational influences needed
to be uniformly addressed for organizational change to occur (Elmore, 2002). Teachers, like
students, need support networks. School and team leaders needed to create an environment of
support, access, and open communication to avoid frustration and motivational barriers (Barrett,
Eber, & Weist, 2013). Improved teacher support networks provide the opportunity for reflection
and improved teacher practices and effectiveness (Graham, 2006). Tickle, Change, & Kim
(2011) demonstrate that administrative support is critical to teacher job satisfaction and
effectiveness. The cultural settings and models at Northeast Independent School did not provide
adequate teacher support and needed improvement in order to affect positive organizational
change around character education and mental health.
To develop student character and its impact on mental health, an analysis of the skills and
knowledge of the teachers was essential. It was necessary to determine how much teachers knew
about the empirical evidence and application of methods aimed at supporting student mental
health and character development. Clark and Estes (2008) refer to this as a gap analysis, where
the teachers were first evaluated for what they knew and did not know about character education
and how it linked to mental health literacy. Improving an organization includes systemic and
synchronized change. Teachers, who typically work in isolation, needed to be assessed for what
they know as a prerequisite for organizational improvement (Elmore, 2002). This gap analysis
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established the knowledge influences vital to the stakeholders’ understanding of how to develop
character education and its connection to positive student mental health and provided a
framework for teachers to work in coordination, rather than isolation. Implementation of new
programming is a slow, purposeful process. Before engaging teachers in any professional
development, understanding how to motivate and inspire them must first occur (Pearson et al.,
2015). Motivation energizes innovation. Without motivation, people either avoid or reluctantly
engage in tasks or accomplish activities with little to no enthusiasm or effort (Clark & Estes,
2008). Motivation occurs in many forms, but without it, teachers were unlikely to engage in
professional development or implement new programming. Employee motivation has three
major influences: choice, persistence, and effort (Clark & Estes, 2008). These influences can
occur intrinsically or extrinsically but are necessary to creating a complete gap analysis (Ryan &
Deci, 2000). Along with knowledge and motivation, the final factor in assessing an
organizational performance gap was an examination of the organization itself (Clark & Estes,
2008). Teachers at Northeast Independent School were fatigued by the administration’s
continual effort to introduce new programs, techniques, and initiatives. Without the full support
of the administration, including but not limited to performance accountability, teacher mentoring,
and continued professional development, teachers continued to fatigue and remained unengaged
by new programs. This conceptual framework tied the organizational culture, teacher
knowledge, and teacher motivation together to develop a complete understanding of
organizational performance and improvement. Figure 3 below represented the KMO influences
and how they interacted. In looking at Figure 3, one can see how the school structure supported
its faculty and the students while at the same time the organization was motivated by the needs
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and gaps in student learning. Effectively, any student need belonged at the top of Figure 3, but
the systems necessary to affect positive student change must be aware of what those needs were
and provide the resources to supplement or override those influences that either impeded or
promoted the success of any initiative.
Figure 3. Student Mental Well-being KMO Conceptual Framework
Figure 3 is a theoretical representation of how the organization and stakeholders
supported the students. It portrays the interactive framework of how the organizational cultural
models and settings impacted the stakeholders’ knowledge and motivation to achieve the
organizational goal of improved student character and its impact on mental health. Teachers
Student
mental well-being,
reduced stigma, &
pro social-emotional
support
Stakeholders: Identify utility value and
goal orientation towards improved mental
health through self-evaluation,
professional development, improved
knowledge of youth mental wellness, and
portfolio development
Organization: reduce teacher fatigue around new initiatives,
improve teacher accountability, and implement teacher
mentoring/modeling programs
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needed to know the basic character education principles and theories in youth, how they related
to mental health literacy, and they needed to be able to reflect on and self-evaluate their
effectiveness with implementing the initiative. It was necessary for teachers to recognize the
usefulness of character education and mental health and to establish goals for students to realize
their growth potential in an effort to improve overall student mental health, rather than just
fulfilling a mandate established by the school.
Students are often seen as the bottom of the hierarchy when in fact they should be the top.
The focus of the organization needed to be on the success and mental health of its students. In
Figure 3, the base represented the school, and, without improved cultural models and setting
influences, teachers would not attain the necessary skills or motivation to achieve the
organizational goals of providing pro social-emotional support to its student body through
improved character and mental health portfolios and open dialog. The arrow demonstrated how
each level interacted with one another. Through student and teacher reflection and assessment,
the organization would better understand student mental health and adjust accordingly to provide
greater support. The students informed the teachers and the organization of their needs, and the
organization, in turn, supported the students with the necessary skills by improving teacher
development of the knowledge and motivation factors necessary to create greater student mental
health.
Conclusion
This literature review addressed the problem of a gap in mental health services for youth
in The United States. The United States faced a massive mental health care gap when left
unaddressed, left children vulnerable to poor mental health and an increase in suicide attempts,
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drug and alcohol abuse, and academic burnout (Perou et al., 2013; Grant et al., 2006; Ang &
Huan, 2006). This chapter reviewed the literature on the mental health care gap in youth, its
causes, and the effects. Understanding why there was a need to address the gap led to a review
of the literature on how schools have unique access and familiarity with youth and can be
utilized to help provide youth with the tools to recognize and verbalize their mental health needs.
Finally, the literature review examined school-based youth mental health intervention programs
and their results.
Following the literature review, I provided an explanation of the Clark and Estes
analytical framework that examined the role of teachers as stakeholders at Northeast Independent
School and the knowledge, motivation, and organizational influences that contributed to the
performance gap. Teachers at Northeast Independent School demonstrated a lack of conceptual
knowledge of mental health principles and theories to understand the elements of strong mental
health. Teachers also lacked the procedural awareness of how to integrate theories on character
education and positive mental health into their curriculum and how to design the appropriate
support methods, including portfolios. Finally, teachers lacked the metacognitive knowledge to
evaluate the effectiveness of their curricular planning as it related to positive student character
and mental health. The motivational influences included teacher understanding of the utility
value of character education and goal orientation on how to set and achieve student mental health
goals. Finally, the organizational influences that contributed to the gap including the school’s
cultural models and settings. Teachers were rarely held accountable for implementing new
initiatives and often faced fatigue from having to learn and adapt to the many new theories
implemented by the school. Teachers did not feel incentivized by the new programs and lacked
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the appropriate support measures peer groups and mentoring programs provide when instituting
new initiatives.
Chapter 2 concluded with the conceptual framework of how the knowledge, motivation,
and organizational influences interacted and how they would be studied in the context of
Northeast Independent School. Chapter 3 presents my research design and the methods used for
data collection and analysis.
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CHAPTER THREE: METHODS
Since research indicated the median age for the onset of mental illness as approximately
14 years of age (American Psychiatric Association, 2000), this study would naturally assume to
target those stakeholders who worked primarily with this age group and older. However, all
teachers at Northeast Independent School needed to be studied for how they worked to meet the
organizational goal. Mental health literacy impacts all ages (Farrer, Christensen, Leach,
Griffiths, & Jorm, 2006), not just those age groups when mental illness typically manifests.
Mental health literacy is not about having a problem, it is about knowing what to do when you
have one.
Measurement is key to the success of any new program. Small, measurable goals provide
change leaders the information to identify the value of change to the organization and its people.
Tangible goals increase motivation and tracking the results celebrate milestones and sustain
change (Moran & Brightman, 2000). A convergent parallel mixed methods design was initially
considered to examine how Northeast Independent School teachers met the mental health needs
of its student body and optimally provided a complete picture to understand a problem and
possibly its solutions (Ames, Cunradi, & Moore, 2007; Creswell, 2014; Johnson &
Onwuegbuzie, 2004). Unfortunately, the administration would not permit a quantitative analysis
of the stakeholders and there was no time to complete a thorough mixed methods analysis. As
such, qualitative, semi-structured interviews were conducted. Interviews included two teachers
at each of the lower, middle, and upper school divisions. To ensure a broad representation of
how the program was implemented and to determine where gaps or overlap existed (Merriam &
Tisdell, 2016), I used maximum variation purposive sampling to determine my selections.
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Because of the amount of time it would take to gather satisfactory data, one-on-one
interviews worked best to produce the necessary evidence. I gathered information about what
the teachers knew and how the administration held them accountable to the organizational goals.
A qualitative study allowed for a timely study to effectively understand the gaps in teachers’
knowledge and motivation and the organizational factors Northeast Independent School teachers
experienced in preparing youth for mental health challenges. Separately analyzing and
comparing each interview and the documents provided a clear understanding of the structures in
place (Creswell, 2014) and the gaps that needed to be addressed to provide better mental health
support systems within the school. Using a detailed qualitative study provided insight into the
gaps allowing for a more in-depth understanding of teacher’s knowledge, motivation, and
organizational factors creating what Gobble (2014) calls a “knowledge funnel” of if mental
health was supported at Northeast Independent School.
Participating Stakeholders
While Northeast Independent School had many stakeholders for the purposes of this
study, its teachers were the stakeholder group of focus. The teachers were responsible for
several aspects of the students’ well-being, including their mental health and character growth, as
an expectation of the school’s Character Program. Since the Character Program was a school-
wide initiative, I interviewed two teachers at each division of the school: pre/lower, middle, and
upper.
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Interview Sampling Criterion and Rationale
Criterion 1. One participant in each division must have volunteered to serve on the
Character Program committee.
Criterion 2. One participant in each division will have spent no time volunteering or
working with the Character Program committee.
Criterion 3. Participants were classroom teachers who did not teach seventh-grade.
Criterion 4. Participant pairs represented each of the school’s three divisions. Six
interviews total.
Interview Sampling (Recruitment) Strategy and Rationale
I conducted six total interviews comprised of two teachers from each of the three
divisions in the school: pre/lower, middle, and upper. In designing this study, I originally
planned to use maximum variation purposive sampling by grouping teachers by performance.
Since no such measure of performance existed, this proved too difficult to accomplish and risked
upsetting or even compromising the participants’ identity, in addition to the possible
embarrassment of being identified as “low performing.” Instead, I surmised that faculty who
volunteered to serve on the Character Program Committee demonstrated a greater level of
commitment to the initiative, effectively creating two pools of teachers from which to choose
(see the next paragraph for more on this process). While this method of selection did not
guarantee variance, it increased the likelihood and offered the greatest opportunity for
trustworthiness and credibility.
In using maximum variation purposive sampling, I needed to identify two separate and
distinct groups for the interviews (Merriam & Tisdell, 2016). I randomly selected
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representatives from two pools of candidates: the first group was developed using a list of all
volunteer teachers who served on the Character Program Committee, provided by the Character
Program Coordinator. The second group was created using those teachers who never
participated in the design, development, coordination, or otherwise offered input into the
Character Program. While not a perfect strategy, it was the closest I could come to identifying
self-selected and independent groups using behavior (in this case, volunteering to participate at
any stage of the initiative) as the criteria.
I entered the two groups into a Google Sheet, divided them by school division, and sorted
the names alphabetically. I cross-checked the lists for names appearing in both groups, multiple
divisions, repetition, and spelling. Any errors in the sort were corrected using the "undo"
function, and edits were made to the original, pre-sorted list. The corrected list was again sorted
and checked using the same method until I was satisfied that all names were listed correctly, in
the appropriate division, and in the correct group. Typical sort errors included removing blank
spaces (which altered the next step of randomizing the list), repeat names, misspellings, and so
forth. I also had a list of pre-determined names that needed to be eliminated from both groups,
including all administrators and my seventh-grade team peers, as identified in the criteria and
explained later in the Ethics section of this chapter. The groups were randomized using Google
Sheets "Randomize Range" tool.
Following the random sort, I selected the first name listed in each group (“volunteer” and
“non-volunteer”) and each division (pre/lower, middle, and upper) – for six total. The first “non-
volunteer” pre/lower school representative had, in fact, been involved in the Program despite not
being originally listed as a member of the committee – as a result, the next name on the list was
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selected. The first two middle school teachers from the “non-volunteer” group were eliminated
from consideration since they did not meet the criteria of being classroom teachers and because
they co-taught the same subject matter, which I determined might cause overlapping data. The
third name from this list was selected. The first “non-volunteer” upper school selection no
longer taught in the classroom, and the next name in the list was selected. No such complications
arose from the “volunteer” group; however, my first two lower school “volunteer”
representatives were either unable or unwilling to meet, and I had to move down the list to the
next participant. The selected names were sent emails inviting them to participate and the
interviews were scheduled.
To protect the confidentiality of the respondents, I created pseudonyms for each
interview participant. Finally, in selecting representatives from independent groups, I
maximized variation.
Documents and Artifacts Strategy and Rationale
Documents and artifacts provided a valuable context for many aspects of this study
(Merriam & Tisdell, 2016). The documents used in this study include an example of a model
character growth chart taken from the Knowledge Is Power Program (KIPP) Academy’s online
portfolio.
KIPP Academies are a national network of free tuition, public charter schools. Founded
in 1994, KIPP schools focus on building an educational foundation for their students through a
developed character curriculum (FAQ | KIPP Public Charter Schools.). The character growth
chart is used to measure each student’s character growth as they progress through the
Academies. The chart is the model that hundreds of public and private schools across the United
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States adapted to match their own needs as character education providers. The chart gives the
study the context to understand what character elements are taught without revealing the identity
of the organization of study. Northeast Independent School used a chart very similar to that used
by KIPP. This chart helped inform how the school assessed character growth and was examined
for any incidental measure of mental health.
Data Collection and Instrumentation
Interviews
I conducted face-to-face, audio recorded interviews to examine the differences in how
teachers approached the material depending on the needs of their students and how the
organizational goals fit within the content-specific curricular goals. Interviews took
approximately one-to-two hours and were conducted in the respondent’s classroom to maximize
their comfort and familiarity with the surroundings (Bogdan & Biklen, 2007). The interviews
were scheduled as one-time, semi-structured, formal interviews, and I followed up with member
checks to ensure accuracy. Two interviews went longer than intended, and second interviews
were arranged. Each interview lasted between one and two hours for a total of eight hours of
interview data.
Since this study evaluated an incidental outcome of a program, interviewing teachers
examined the extent to which the Northeast Independent School stakeholders’ knowledge,
motivation, and organizational influences of the Character Program had on the positive mental
health outcomes in youth, stakeholders’ knowledge and motivation of the Character Program and
mental health in youth, in addition to their perception of the organizational influences impacting
their ability to teach character and positive mental health or seek professional
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development. Interviews gathered information which I could not observe (Patton, 2002). While
I had specific methods and approaches to teaching the curriculum, I wanted to remove personal
bias and gain a better understanding of individual approaches through peer interviews about how
the curriculum was taught across all three divisions which extend beyond my limited purview.
The interview style allowed for a common set of questions to be addressed with each
respondent, but the semi-structured nature of the interview allowed for a more open dialog to
learn about each individual’s approach (Merriam & Tisdell, 2016) to the teaching of character
and how that reflected on mental health. Because I was a teacher who worked on a separate
campus from many of my peers, and, since I did not share my room with colleagues, I had a very
myopic view of how content is taught. The interviews provided insight and understanding to the
problem of practice from a perspective other than my own (Patton, 2002). By including multiple
perspectives in the study, I developed a richer and broader understanding (Weiss, 1994) of how
mental health was or was not considered in the use of our character curriculum. The open-ended,
conversational nature of the questions allowed for a greater exploration and deeper
understanding of the responses through probing (Patton, 2002). Probing allowed for the standard
questions to be followed up with questions that dug deeper into the thought process of the
respondent, leading to a more authentic exploration of how mental health was an outcome of the
Character Program.
To reduce bias, I followed a neo-positivist approach to the interviews (Merriam &
Tisdell, 2016). My questions were non-leading, open-ended, and invited each respondent to
reveal their individual feelings and thought processes regarding pro-mental health curricula. I
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aimed to conduct the interviews after school to allow for flexibility of time. The interviews
supplemented my opinions and the literature, improving triangulation and validity.
The interviews attempted to shed light on whether the school was achieving its goal of
improving the character of its students and what role mental health played in that goal – I wanted
to know if the system was working (Weiss, 1994). The interviews also examined the construct
of the conceptual framework which identified a bottom-up support network in the organization
with students receiving the appropriate tools from the teachers to enhance student mental health.
By interviewing the respondents in their classroom setting, I evaluated how and if they supported
their teaching with supplemental posters, artwork, and guides, providing me critical
documentation in addition to the personal, first-hand experience of the teacher’s thought process
in teaching the Character Program and the impact it had on the positive mental health of their
students.
Finally, teachers’ classrooms reflect their personality and what is important to them. In
many cases, as teachers, we spend more time in our classroom than we spend in our own
homes. As a result, we decorate our rooms to highlight those elements we find important to
supporting student achievement. One commonly cited study using control and experimental
classrooms demonstrated positive academic student improvement in classrooms that included
posters and materials supplementing the curricula (Kephart & Floyd, 1954). Posters, charts, and
student work observed (or not) during the interviews helped inform this study about how
teachers used classroom manipulatives to provide additional support to student learning as it
related to mental health and the Character Program.
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Documents and Artifacts
Documents and artifacts helped communicate the goals established by the organization
and provided context for mental health within a high income, independent school
culture. Documents and artifacts are real-world, physical items that represent a form of
communication regarding this study (Merriam & Tisdell, 2016). Documents and artifacts offered
context (Merriam & Tisdell, 2016) for how the school attempted to address mental health but did
not serve as data that were analyzed to help answer the research questions.
Documents and artifacts are objective examples, free of researcher bias, or what Merriam
and Tisdell (2016) call, unobtrusive and nonreactive – they are untouched by the researcher’s
influence and therefore without bias. Examination of documents and artifacts naturally occurred
during the interviews (Merriam & Tisdell, 2016) in the teacher’s classroom. The documents and
artifacts offered many advantages to a gap analysis by providing a “slice of life” (Bogdan &
Biklen, 2007) description of the teacher’s classroom. While observation was not formally used
in this study, observation of teacher materials, decorations, and so on provided me a better
understanding of each teacher’s motivations behind teaching the Character Program. This study
looked expressly at what teachers knew about mental health and how it fit into the organizational
goal of character education. Thus, any observation of documents and artifacts that took place
during the interviews were incorporated into the appendices as a separate source of context rather
than data intended to answer the research questions.
Data Analysis
Data analysis first began informally. Before conducting my interviews, but after
beginning this study, I casually observed my colleagues’ interactions between them and their
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students, in addition to their classroom setup. Although not formally included in this study, these
observations, inspired by the Clark and Estes (2008) framework, helped guide my thinking as I
commenced the interviews and formally reviewed the data. These informal observations allowed
me to understand classrooms beyond my own, while also encouraging me to think
metacognitively about my practices, how I teach the Character Program, and mental health.
Formal analysis commenced with the first interview. I was incredibly impressed and
inspired by each of the interview participants and greatly appreciated and enjoyed the
opportunity to learn about their personal pedagogy and application of the Character Program. I
recorded the audio for each interview on my computer using Audacity, a computer-based
software, while also keeping reflective notes, unscripted questions, and observations in a
separate notebook. These notes and interviews were then transcribed by Rev.com, an online,
paid service that transcribes audio recordings. I listened to the recordings while reading the
transcripts to ensure accuracy and uploaded them to Atlas.ti, a computer program used to aid and
support qualitative coding, where they were reviewed multiple times. Using Atlas.ti, I was able
to create several a priori codes based on the ideas from the literature review and conceptual
framework; applying them quickly and easily by highlighting sections of interview text that fit
the coding, with many sections having multiple codes assigned to them. Additionally, I
maintained an open mind as I reviewed the transcripts, looking for emergent themes and
potential in vivo codes. Carefully keeping the a priori and in vivo codes separate, I also kept
note of overlap between what I expected to learn and that which was revealed through the
interviews. Throughout the process, I would routinely refer back to my research questions and
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framework to ensure the focus of the coding and to identify patterns and themes to ensure
alignment.
In reorganizing the data into themes, I was able to thin out what I had previously valued
and identify new findings by carefully reviewing the participants’ language use to describe
certain experiences. During the initial phase of cleaning and coding the text, I identified several
themes, far too many in fact. However, after re-reading the data, in the context of coded groups, I
not only recognized repetition in the quotes, which needed the aforementioned culling, but more
importantly, the lexicology and semantic features called for deeper in vivo cataloging and re-
coding; effectively using what Glaser and Strauss (1967) call, the constant comparative method
in an effort to identify a grounded theory.
One further anti-bias thought: I routinely discarded statements that, at the time of the
interviews, I thought were foundational findings. Unfortunately, many of these statements were
discarded because they confirmed my suspicions, which my use of questioning as an analytical
tool, may have encouraged. In reviewing the tapes, I was relieved to observe that I never led the
participants, but my questions may have implicitly included some confirmation bias.
Fortunately, in reviewing the responses, and using analytical tools, I was able to identify the
tendency and disregarded those responses.
Credibility and Trustworthiness
The interviews, documents, and artifacts created triangulation, thereby increasing validity
(Merriam & Tisdell, 2016). In analyzing multiple sources of data, I provided greater depth,
context, and a more trustworthy evaluation (Maxwell, 2013) of the organization and how the
stakeholders used the Character Program to affect positive mental health learning in their
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students, if at all. Merriam and Tisdell (2016) highlight several strategies for establishing the
trustworthiness of a qualitative study, including, but not limited to triangulation and member
checks. Triangulation is the collection of data from multiple sources (Clark,
2017). Triangulation is a means of looking at something from multiple perspectives; it brings
validity by observing the same conclusions drawn from varied data collection, rather than
offering a single point of view (Merriam & Tisdell, 2016). Triangulation allowed me to cross-
check my data to determine if my interviews matched what the documents and artifacts
represented, allowing for a more credible study.
I also shared the interview transcripts with each respondent to have them examine the
accuracy of our interviews. These member checks allowed for feedback from those I
interviewed. Maxwell (2013) calls this, “the single most important way of ruling out the
possibility of misinterpreting the meaning of what participants say and do and the perspective
they have on what is going on” (p. 126). This feedback ensured that I reported my findings
accurately and without bias.
Because the issue of mental health in youth is incredibly personal to me, I needed to be
very careful to not ask leading questions or make judgments about my participants or their
responses. While it was difficult to avoid my own bias, I attempted to take a neo-positivist
approach to the interviews by keeping my questions neutral, allowing the participant to respond
without me leading them to an answer (Merriam & Tisdell, 2016). To further maintain
neutrality, I focused on the purpose of the interview as a collection of data and not a judgement
of the respondents (Patton, 2002).
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My goal was to not only find rich, detailed explanations and evidence to support the
qualitative process, but also the personal experiences shared with this study. The personal nature
of this study provided me a unique trustworthiness that only a teacher and parent of a troubled
youth could possess. However, to avoid bias and to provide a full picture, I also sought to
provide as much opposing evidence to confirm my conclusions (Maxwell, 2013). A
contradictory account offered a more realistic version of the study since not all evidence lines up
in the real world (Creswell, 2014). I needed to look at all the possible alternatives the data led to
and eliminated that which did not make sense, rather than try to create a neat package that fit my
thesis. Constant reflection, review, and validation kept me focused and unbiased. Respondent
checks and the advice of the Character Program Director, called “peer review” in qualitative
approaches, ensured that I maintained my focus and did not allow my personal biases to
influence the study.
According to Merriam and Tisdell (2016), rigor is defined by rigorous thinking. It is
rigor that leads to rich data; along with tireless research and critical thinking. To best synthesize
and understand all the data that resulted from rigorous thought, self-reflection and organization
were essential tools to maintaining credibility. Rich data and rigorous thought can fill
volumes. Without reflection and organization, the details were a jumbled mess of non-
sequiturs. To allow for reflection, I kept a research journal and frequently reviewed it to
maintain the purpose of the study and not let the details get buried in volumes of irrelevant
detail. The challenge was not in finding rich data. The challenge was in synthesizing the
research data to provide the reader a clear picture of the study in a sensible and believable way.
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Ethics
To inform this study, I used a qualitative approach to understand the teachers’ knowledge
of and motivation to teach character education at Northeast Independent School with the hope of
reducing the mental health care gap in American youth. It was essential to maintain ethical
practices within the organization and amongst my stakeholders, not only because we were
colleagues in a small, tight-knit community, but also because, as a researcher, my participants
came first (Merriam & Tisdell, 2016). Research can be intrusive (Maxwell, 2013), and I asked
my stakeholders to be open and honest. To avoid concern, I took steps to ensure the security of
their identity and confidentiality.
First and foremost, each participant was informed of the goals of the study. I also
provided information about the study’s use and what their participation meant, in addition to
outlining their participation as voluntary and their right to withdraw themselves or their
contribution, without risk, from the study at any time (Glesne, 2011). I recorded each interview,
including permission from each participant at the start of every session and stored all of my
interview data in a password protected folder on my personal computer (Rubin & Rubin, 2012).
I delivered a clear and detailed vision for this study, outlining not only its purpose, but also the
rights of the respondents, as a critical first step in gaining the stakeholders’ trust, safeguarding
their confidentiality, and ensuring maximum participation (Maxwell, 2013). I wanted my
stakeholders to have a clear and accurate picture of this study. Ideally, I painted a vivid picture
that encouraged participation, as well as an open and honest interview.
As stated earlier, I collected data from my colleagues. As seventh-grade dean at
Northeast Independent School, I had no direct supervision over any teacher, but to ensure the
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integrity of the study, I did not interview those peers I worked closest with on the seventh-grade
teaching team. As grade-level dean, my responsibility was to the seventh-grade students. I had a
global perspective of their development that participating teachers did not. I observed them in
class, I read their teacher reports, and communicated regularly with the advisors, parents, tutors,
and guardians who made up a student’s support team. I worked very closely with my seventh-
grade team to ensure the success of our students, and I knew their teaching styles and approach
quite well, enough that it could have led me to unintended biases about their ability as educators.
My familiarity with their practices may have led to biases or leading questions, thus removing
my neutrality (Patton, 2012). Additionally, since my team peers also knew my views on mental
health, it could have led them to have biased responses that attempted to offer what I wanted to
hear and not their true opinion (Merriam & Tisdell, 2016). Finally, I made sure that
compromising or embarrassing details were shared without exposing the respondent by
synthesizing responses, omitting names, and excluding specific details that could identify the
teacher (Rubin & Rubin, 2013) such as a unique expression or jargon. Ethically, I had no role or
responsibility as to how these teachers performed, and my judgments did little to change that.
As a matter of course, and to further protect the security of my participants, I submitted
my study to the University of Southern California Institutional Review Board (IRB) and applied
their feedback accordingly. The IRB’s primary function is to verify that I protected from harm
and informed my respondents about the study’s purpose and their rights as interview subjects
(Krueger & Casey, 2009). This review supported or clarified the steps necessary to safeguard
my participants and minimized the likelihood that this study would harm any individual
involved.
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Finally, after each interview, the respondents had the opportunity to review the written
transcript, if they elected to do so, to confirm that their words were accurately represented and
that I did not make assumptions or inferences from our conversations (Patton, 2002).
Limitations and Delimitations
As a full-time teacher, researcher, parent, and husband, time was a critical limitation of
this study. While one could observe the practice of teaching character, the time necessary to
study its impact on the mental health of youth was too time consuming and lengthy. This was
not a longitudinal study; therefore, conclusions are limited and causal outcomes could not be
determined due to its qualitative, descriptive nature. Additionally, the time required to complete
this study was short and mistakes may have been made. Since no research is perfect, I relied on
various measures and protocols to ensure the credibility and trustworthiness of this study.
Ideally, this would be a longitudinal study that included regular observation of teaching
implementation of the Program and student growth. Since that was not feasible, I decided not to
include observation as part of my data collection. I was unable to observe the day-to-day cross-
curricular instruction of content and character education over a sufficient period of time which
would have offered valuable data to this study, but was, unfortunately, impractical.
Other important limitations to consider included the honesty, reliability, and
forthrightness of my interview and survey respondents. While the protocols were meant to
alleviate these limitations, the possibility still existed. There were those who, despite the
protocols, might have believed this study was an assessment of their skills and may have
exaggerated or contrived responses. The interviews also required the valuable, and closely
guarded time of my colleagues. The temptation to fabricate, rush, or avoid responses did exist. I
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also studied peers, colleagues, and friends. While I expected certain attitudes and approaches,
the reality of dismissive behavior was a limitation that led to one apparent refusal to participate.
Research is a process that takes years of work and experience (Salkind, 2017), neither of
which I have. It was impossible for me to think of everything. I know there are questions that I
did not ask, concepts I failed to explore, conclusions I missed, and I made choices that did not
work out or fit the study. That said, I did everything in my power to make, what I believed at the
time, the right decisions. There were other limitations which I did not identify, which was, in
and of itself, a limitation.
Conclusion
Chapter 3 offered insight into the methodological approach of this study. I focused on
the stakeholder population and the various roles of the participants involved in this study. I
identified the sampling criteria and rationale for the interviews and discussed the importance of
including documents and artifacts as context. This chapter also discussed the protocols and
instruments used to collect data and its analysis (see Appendix A for the full protocol). Finally,
Chapter 3 highlighted the strategies used to ensure the credibility, trustworthiness, and ethics of
this study, while also acknowledging its limitations and delimitations.
Chapter 4 shares the findings and analysis of the data collected, giving this study and its
participants’ responses purpose.
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CHAPTER FOUR: FINDINGS
In this section, I presented the findings and themes that emerged from the analysis of the
interviews, organized according to the knowledge, motivational, and organizational influences
identified by the Clark and Estes’s (2008) gap analysis, in relation to the conceptual framework
(Figure 3), and research questions: What are the teachers’ knowledge and motivation related to
identifying and discussing mental health through the implementation of character education or
student portfolios?; and what were the interactions between organizational culture and context
and teachers’ knowledge of and motivation to meet the stakeholder goal?
Findings
Northeast Independent School’s organizational goal was to provide youth the skills
necessary to identify, discuss, and implement character-based vocabulary, behaviors, and skills,
in addition to positive mental health strategies. This study examined the efficacy of student
portfolios which included an analysis of the conceptual and procedural knowledge and
motivation of the teachers, alongside the organizational influences on their work with students.
Four findings emerged, with three subthemes under the second finding: 1) teachers at Northeast
Independent School lacked the conceptual and procedural knowledge of mental health principles
and theories despite strong metacognitive practices; 2) The second finding: Teachers recognized
the utility value of a common vocabulary to reduce stigma and improve student mental health;
however, few could justify the time necessary to implement a mental health program had 3
subthemes: 2a) teachers recognized the utility value of a common vocabulary related to character
education 2b) Teachers recognized the utility value of a common vocabulary to reduce stigma
and improve student mental health. 2c) The cultural model influence of teacher fatigue
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remained, despite the perceived utility value of character education; 3) Teachers set and reflected
upon goals for student learning but not student mental health; 4) The organization supported self-
motivated accountability and professional development and had no formal mentoring programs.
The findings revealed overlapping and intersecting knowledge, motivation, and organization
influences.
It is important to point out that mental health literacy was not a part of the organizational
goal, per se. However, the overlaying and unintended consequences of the Character Program
and mental health literacy must be considered as factors in highlighting and identifying areas of
coordination. It was hoped that the Character Program would enable the space for a more
concerted effort towards mental health education; however, I found no evidence regarding the
use of student plans, portfolios, or even benchmarking character growth. This section presented
the findings and how they related to the research questions and conceptual framework.
Finding 1: Teachers lacked the conceptual and procedural knowledge of mental health
principles and theories despite strong metacognitive practices
In order to discuss mental health with their students, teachers needed knowledge of
mental health principles and theories. Teachers at Northeast Independent School struggled to
demonstrate a clear conceptual understanding of mental health theories and principles. When
asked to provide a definition of mental health, five of the six respondents struggled to provide a
succinct and accurate definition. An upper school teacher named Heather
1
, stated:
1
To protect the confidentiality of respondents, pseudonyms were used. And because the
divisions of the school were very gender homogenous (the lower and pre-schools were primarily
female, the upper school primarily male), all respondents were referred to as female.
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I guess it would just be, mental health, your emotional well-being, your levels of stress,
and your kind of your outlook on life. If you have a negative one or a positive one or
kind of how you view certain situations. Depending on how you view it I guess that
would actually be more of a measure of your mental health. I don't know. That's a really
hard question.
While Heather’s response demonstrated some elemental knowledge of mental health, she failed
to discuss the developmental or relational elements of mental well-being. Heather’s focus
aligned with character and developing a growth mindset, not mental health. Managing stress and
developing a positive outlook are good skills to have; however, Heather’s statement overlooked
the innate aspects of good mental health. In discussing student stresses further, she added,
“when their head gets out of control, and they start to like spiral downward into the pit that
they're all in after exams, kind of teach them ways they can help that stress and refocus and put
everything in perspective.” Although Heather alluded to the procedural knowledge needed to
help students, the focus was again on stress, not mental health. She seemingly placed blame on
academic stressors as a challenge to mental health. While it is normal for youth to feel upset or
anxious around an exam or formal assessment, attributing related behaviors to mental health falls
short of adequate conceptual understanding. Stress as a contributing factor to poor mental health
is often misunderstood, frequently focusing on the outcomes of a poor academic results rather
than on the causes of stress which must include environmental factors and the individual
psychological make up of each student (Lazarus, 2006). Tying academic failure to mental health
failed to recognize how the organization and teachers supported and prepared the student body
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for academic rigor and how the school prepared the social and familial environments of the
individual student.
Uncharacteristic, overwhelming, or long-term stress can be an indicator of mental illness;
however, attributing mental illness to the stress and anxiety of a test ignores the cognitive and
congenital background of the individual, leading to a slippery slope of misdiagnosis and
increased stigma. A similar error was made by Sara, a lower school teacher, who said, “[Mental
health] is all about how you see yourself, you know what I mean? Stress happens. Everybody
has stress. It's not about whether you have a completely un-stressful life, which I don't think
anyone does, but whatever. It's how you deal with it. Are you equipped emotionally to deal with
it?” Like Heather, Sara focused was on dealing with stress as the defining characteristic of
mental health. There was no reference to the social or emotional aspect of mental health or the
achieving of social and emotional milestones as defined by the Center for Disease Control (Perou
et al., 2013). Lacking a nearly universal common definition demonstrated an organizational
culture gap or what Poland & Pederson (1998) call, an enculturated silence. The bulk of
respondents did not appear to possess a comfortable awareness of mental wellness. The
enculturated silence left the teachers to create individual definitions and resulting solutions,
including Heather’s understanding of how to incorporate mental health literacy into her
classroom: “[e]veryone gets stressed, and everyone should learn the same tactics.” Heather
expressed a universal approach to mental health, ignoring the individual needs and make-up of
each student. In considering my experiences as a member of the community, this was fairly
typical both at the school and in the greater school community. This is not to say that teachers at
Northeast Independent School did not care or were not capable of learning, it was merely one
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indication that the Character Program, as established by the organizational goal, was not
providing its teachers the conceptual knowledge of principles or theories necessary to teach
mental health literacy to youth.
Even if the conceptual knowledge of the teachers was improved, there was no guarantee
their procedural knowledge would also improve without routine practice and reinforcement.
Barbara, a middle school teacher, exclaimed about the Character Program, “If we're talking about
character, it's hard to teach character if you don't have it.” Like students, teachers possess unique
social emotional skills. Teachers are required to have content-specific conceptual and procedural
knowledge to teach their subject matter. Lacking character, particularly as defined by the
Character Program, demonstrates a gap in content-specific (in this instance, character education)
knowledge. Barbara highlighted the requirement to have character to teach it, thus alluding to
the fact that procedural knowledge can only follow conceptual knowledge. If you don’t have the
latter, you won’t know how to teach the former.
Contextually, the KIPP Character Growth Card and Supporting Materials (Appendices B-
D) represent the type of resources available to the teachers at Northeast Independent School.
There were no other supporting documents to supplement the teachers’ knowledge, empirical or
otherwise, and nothing connected character to mental health. To teach character, or mental
health, teachers must have not only conceptual knowledge, but also need to understand how to
apply that knowledge.
Developing teacher knowledge is especially important with regard to mental health; not
grasping a student’s needs or misreading a student’s emotional outbursts can lead to grave
consequences. Kit, a lower school teacher shared her concern:
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I think for us, we need more instruction with it [mental health]. It's one of those things
that, I understand the concept of what it is but then again, that doesn't make me a teacher
of it. I need to not only understand it, but I need to understand how to then teach it, share
it, and get students involved in it, in a way that's going to potentially be successful.
The scaffolding matters. Kit alluded to it directly when she said, “I need to understand how to
then teach it, share it….” Teachers can receive all the conceptual knowledge available, the KIPP
Seven Keys to Developing Character (Appendix C), for example, but if they are unable to apply
it in an authentic setting or if they lack the scaffolding to teach it, they are likely to fail.
Teachers at Northeast Independent School took great pride in their work. In sharing her feelings
about teaching mental health, “I need to understand how to then teach it, share it, and get
students involved in it...,” Kit highlighted how she did not want to engage in a process where she
could not guarantee “potential” success. Teaching mental health literacy is difficult, and Kit was
reluctant to engage in an ill-prepared process. She reinforced this notion, “[h]ow are we then
expected to help a student understand how they're feeling, given that we have 20 more years of
life experience, and we still can't correctly verbalize how we're feeling? So, I think for us as a
faculty, we need more information on that.” Kit struggled to navigate her own mental health
with 20 years more experience than her students and expressed her difficulty “verbalizing how
[she’s] feeling;” the expectation to teach mental health literacy appeared to be very farfetched.
Mental health education requires routine reinforcement and practice of the various knowledge
types; without that scaffolding, mental health education will not “potentially be successful,” as
Kit expressed.
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Understanding the procedural knowledge related to mental health can be especially
difficult. Mental health is an incredibly personal journey. Teachers may have no idea about
their students’ genetic mental background, family life, or possible trauma. It is not possible to
know every students’ triggers or history and, in some cases, students and families may not even
be aware of the symptoms considering the critical timing of onset and delays in diagnosis due to
factors like brain development and external influences. Lily, a middle school teacher expressed
this very concern:
I think that some faculty may feel uncomfortable speaking about certain parts of
wellness. I think it can be challenging, possibly, if the delivery isn't effective that the
students might not take it seriously. I think it can be challenging that because wellness
and mental health are such a personal thing, if something is taken out of context or not
said carefully enough it could upset a student, or a parent and create administrative
challenges.
By saying, “it could upset a student, or a parent and create administrative challenges,” Lily was
suggesting that it was possible that in an attempt to address the organizational gap, the
administration could create a different and potentially worse situation for themselves and the
students. Without preparing the teachers to manage new and unpredictable scenarios, they were
likely setting the teachers, and themselves, up for failure. No one can predict how the personal
journey of mental health will develop in adolescents, and the potential harm of an inaccurate or
poorly understood response could create problems for the school. Lily continued, “[I]f a student
asks a seemingly innocent question and the teacher doesn't handle it well, or answers a question
that might be best answered at home... I feel like that could open up doors that would be
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challenging to close up.” Parents, teachers, and youth have differing opinions about what they
know and learn, alongside what behaviors are suitable to their age group. Adolescent
physiological and psychological maturity varies greatly, particularly in teenagers who undergo
drastic emotional and physical changes. The adults in a child’s life may have varying opinions
about what is appropriate, and the maturity of youth has a significant impact on meaning-making
(Roeser & Eccles, 1998). The personal nature of mental health and differing opinions on how to
address each child’s needs made for a very treacherous journey that the teachers at Northeast
Independent School appeared reluctant to embark upon. The message a teacher intended to
deliver may not be the message received by the student or how it was interpreted at home.
However, Kit, Lily, and to an extent, Heather identified and demonstrated the
fundamental metacognitive practice of recognizing what you do not know. Kit shared how she
felt the teachers needed more training with mental health, admitting gaps her understanding.
Lily spoke about how uncomfortable many teachers would be addressing mental health without
the proper training, potentially with disastrous consequences. And while she expressed some
comfort with the definition, she admitted that was only because her life experiences gave her
insight many of her peers lacked. In stating “that’s a hard question,” Heather revealed an
awareness about what she did not know.
The evidence presented in this finding revealed a lack of knowledge by the teachers at
Northeast Independent School but not for a lack of caring. First, teachers both demonstrated and
were honest about their lack of conceptual and procedural knowledge to teach students about
mental health, but they were upfront and unashamed to admit it. Additionally, teachers showed
an ambivalence to and expressed concern about teaching mental health due to its deeply personal
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nature. In reflecting on their understanding of the complex issues around mental health, they
worried about not being successful, or worse yet, saying something that might create more issues
than solve. Finding 2 outlines that while teachers recognized the utility value of mental health
literacy, they felt it may be too difficult to fully embrace.
Finding 2: Teachers recognized the utility value of a common vocabulary to reduce stigma
and improve student mental health; however, few could justify the time necessary to
implement a mental health program
Teachers at Northeast Independent School recognized the utility value of a common
vocabulary in their Character Program and easily connected the benefit a shared language would
have on the reduction of stigma and improved student mental health; however, few could justify
the time necessary to implement a mental health program. Multiple studies identify mental
health literacy as foundational to positive mental health care (Jorm, 2000; Jorm, 2012; Jorm et
al., 1997; Kutcher et al., 2015; World Health Organization, 1996). Youth struggle to recognize
signs of mental illness, distress, and rarely exhibit help-seeking behaviors (Whitley, Smith,
Vaillancourt, & Neufeld, 2018). Stigma and a lack of vocabulary are major factors in under-
reporting (Chandra & Minkovitz, 2006), and recently, schools have begun to address the gap in
mental health literacy because of their access to children, connection to the community,
familiarity, and professional practice communicating ideas (Kutcher, Bagnell, & Wei, 2015).
I elected to separate the second finding presented here into subthemes around the utility
value of language as it related first to character education, then to how teachers saw the value of
language connected to mental health, and finally to how teachers, despite acknowledging the
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utility of a shared vocabulary, could not justify supplementing character education with mental
health.
Subtheme 1: Teachers recognized the utility value of a common vocabulary related
to character education. The Character Program at Northeast Independent School placed
tremendous value on a shared vocabulary. Teachers received training at the onset of The
Program, and new teachers were asked to complete online (MOOC) lessons on character
education. Resources similar to that of the KIPP Academies Growth Card and Supporting
Materials (Appendices B-D), provided a word bank with definitions and suggested methods for
teaching character. Words matter. A shared understanding for what the words mean and how
they are used is a significant issue in any organizational change (Proctor, Landsverk, Aarons,
Chambers, Glisson, & Mittman, 2009). The shared vocabulary at Northeast Independent School
provided a cohesive and collective language to an organizational culture that was spread out over
four divisions where communication was often difficult. Teachers were motivated by reported
improvements in the character language of students and demonstrated behaviors often linked to
good character. Lily, the middle school teacher, shared:
I think [the Character Program] does help, because the [students] are hearing [a shared
character lexicon] more often than they would without [The Program]. They're seeing it
more often than they would without [The Program]. I think that reinforcement has a
positive impact.
The routine use and “reinforcement” of the language normalized character terms – what “the
students are hearing” – making it easier to discuss and identify good character. It stands to
reason that the same would be true for a mental health vocabulary, although it is important to
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note that the participants did not mention a shared vocabulary for mental health, specifically.
Developing a universal vocabulary, in this case for character education, was necessary for
motivating common organizational practices. The scaffolding of age-appropriate character
language lessons across divisions supported the character of the students and ensured the entire
community spoke the same language. With the language of character reinforced at all levels,
Lily recognized how it allowed the teachers to identify gaps in student knowledge, and it
modeled the appropriate use of language further reinforcing lifelong learning. Kit, a lower
school teacher, expressed how critical a common vocabulary was, particularly in young learners.
I definitely think that having a shared vocabulary between the different grade levels is
very useful...They could get in their homeroom. They could get in PE class. It doesn't
matter. It's a shared language. And I think that's kind of what the [Character Program] is
starting to really catch on, is that shared vocabulary that we can use... I think that's been
one of the most useful parts of it is that everyone is using it so that it's not like, I'm the
only one that's saying adaptability and it's not something they're not hearing in their
homeroom. They're hearing it there as well. I think that's been very helpful.
Kit’s opinion reflected the utility value of how helpful it was to have a community-wide
vocabulary. She identified it as, “one of the most useful parts...is that everyone is using it.” The
character lexicon made it easier for teachers to have discussions with students. In not being the
“only one that’s saying adaptability,” the language was understood by everyone, and teachers
could use the appropriate terms without stopping to explain or clarify meaning, for example.
Barbara, also in the middle school, added, “I think that having one language to use...both
internally and externally, is a benefit.” With a shared vocabulary, teachers could teach dual-
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purpose lesson plans incorporating character and content using specific language to support both
aspects of student learning. The teachers at Northeast Independent School recognized the utility
value of a shared vocabulary within the framework of character education, and I wondered how
that might motivate teachers to use a similar approach in teaching mental health.
Subtheme 2: Teachers recognized the utility value of a common vocabulary to
reduce stigma and improve student mental health. Stigma is one of the leading causes of the
gap in diagnosis (Gulliver, Griffiths, & Christensen, 2010) and improved mental health literacy
is one leading strategy to reduce stigma (Wang et al., 2007). Literacy is widely cited as one of
the earliest and easiest steps to reducing the mental health care gap, with a common core
vocabulary and open dialog as mechanisms for normalizing mental health (World Health
Organization, 2003; Weare & Markham, 2005; Hinshaw, 2005; Hampson, Watt, Hicks, Bode, &
Hampson, 2018). While issues of stigma were never raised by those interviewed, creating a
school-wide lexicon, similar to that of the Character Program would be a crucial first step to
improved mental health. Because teachers understood the utility of a shared language in
discussing character education, it was easy for many to connect its value to improving mental
health. Barbara, a middle school teacher, shared, “to provide mental health...[we] have to have
sort of universal norms about what that language and what those expectations are. We need to be
backed up by the parents in doing that.” Barbara’s concern for developing common terms and
expectations highlighted the need for it to be a community-wide process. Northeast Independent
School had four divisions on three campuses; one of its greatest challenges was organizational
communication, let alone the demand of reaching beyond the students. Providing a common,
community-wide vocabulary was effective for the Character Program to be successful, and
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teachers reflected on how effective it could be with teaching mental health. From the lower
school, Kit emphasized the point:
Students at a young age, they lack the vocabulary. They lack the understanding of what
some of these things mean. All of a sudden we have a plan in place of the opportunity to
reflect on, "How am I feeling in this moment? How does this relate to previous moments
like this?" And, "How is that going to affect my decisions going forward?" Having that
as part of a plan I think again, would give it a concrete structure. We have the words, we
have the vocab, now we're implementing it. So now, similar type of structure, why don't
we say, "Okay, let's use this plan as a way to kind of give this mental health, emotional
intelligence, structure” in that we have something concrete the students can relate to, can
refer to and then, hopefully, learn from.
In identifying that, “we have the words, we have the vocab...,” Kit realized how the Character
Program provided individuals with the skills to develop habits, abilities, and effective resource-
seeking strategies that enabled them to develop their character and resulting self-efficacy. Kit
continued, “let’s use this plan as a way to kind of give this mental health...structure.” Kit
validated her approach to teaching character through building a common vocabulary and saw it
as potentially useful to mental health education. She even highlighted the metacognitive practice
of reflecting on language and using it in a “plan…to give mental health structure.” However,
considering the knowledge type deficits demonstrated by many of the stakeholders, training
teachers to provide youth the skills to adapt and apply positive mental health, Barbara identified
standard terminology as necessary: “to provide mental health, we would have to do a lot of
different things, we would have to have one, not only codification of what we already do but also
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training in what we don't do and need to.” Codifying what the teachers knew and did was named
as an important starting point to establishing the community-wide terms necessary to teach
mental health literacy, in addition to the need for professional development. Unfortunately, the
demand of learning, planning, and applying new programming and content could have been too
much for some teachers. Despite Kit’s metacognitive application of a shared lexicon, lacking
key knowledge types, Barbara worried, would create too great a demand on the already
overburdened faculty. In the next section, the third subtheme related to the time it takes for this
work is further presented.
Subtheme 3: The cultural model influence of teacher fatigue remained, despite the
perceived utility value of character education. Teachers at Northeast Independent School
taught a robust curriculum, particularly in the upper school where AP-level courses were offered.
The added programming of character education further burdened teachers with more
responsibility crammed into a fixed schedule, which already included, but was not limited to,
teaching, lesson planning, coaching, and professional development. Sara, a lower school teacher
expressed her concern:
I can completely understand the time issue. We're pulled in many different directions and
there's only so much time in a day. The old story is, you have everything that you do and
then you're given something else, and you're given something else but you never
necessarily take away anything that you already do.
Sara had multiple responsibilities and only so much time to complete them. The cultural model
of the school, identified here as “the old story,” allowed for the administration to add without
taking anything away. Marge, an upper school teacher felt the same way: “I'm just saying we
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could do a lot better job [with the Character Program]. Time always becomes a factor.” Both
Marge and Sara expressed deep concern about their teaching time. They were already
overburdened with their usual duties, but, as Sara shared, when “given something else” to do, the
school “never necessarily take[s] away anything.” Heather, expressed her perspective from the
upper school, "[I]f you throw too much at people at once they're gonna be resistant. Like, I don't
have time for this.” The cultural influence of the school did not remove responsibilities, rather it
added to the seemingly endless list of obligations, thereby creating a culture of teacher fatigue.
Heather highlighted the specific pressure she faced as an upper school teacher, “It's hard for me
[implementing the Character Program] …because I only see them for an hour, three or four times
a week.” As an Independent school with AP offerings, the time needed to address content, from
Heather’s perspective, was paramount to teaching character. The teachers expressed legitimate
concerns about getting everything done, and, as finding 4 will demonstrate, the character work
suffered for it, giving very little hope that mental health principles could be included and
highlighted in the existing program.
Teachers initially felt overwhelmed when the Character Program was implemented and,
while they recognized the utility value of a mental health program, the motivation to learn a new
curriculum was incredibly low. Kit, from the lower school, exclaimed, “it may be viewed as
like, okay, that means I now have less time for x, y, and z because they're coming in to do this.”
The responsibilities of teachers at Northeast Independent School included teaching content and
character, in addition to advising, coaching, and parent relations, among other things, expressed
here as, “x, y, and z” and identified by Kit as adding more responsibility without taking anything
away. A national study by the U.S. Department of Education (2018) revealed that over the past
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30 years, student time in schools increased by less than 6%, but the demand on teacher time
increased by almost 14%. Simply put, teachers are being asked to do more with less, and
Northeast Independent School teachers were no different than the national norm. Even though
the teachers recognized the importance of reducing stigma and improving the mental health
literacy of their students, they struggled to reconcile that with the demands already placed on
their time, as evidenced by Heather in the upper school, “if you ask some other teachers, their
first thing is, ‘well, what's gonna happen to my time with the content? What do I have to cut out
of the curriculum?’ For me, I'm like I'll find something to cut if I have to because that's [mental
health literacy] such an important thing for them to experience.” In the end, while Heather
valued mental health literacy, content was still king for her and many others. The organizational
culture, “the old story,” would add to the duties of teachers without taking anything away, and
the concern was apparent.
Clark and Estes (2008) wrote, “perceptions of reality control performance” (p. 42) and
later added, “the root motive influencing all human behavior is a desire to be effective” (p. 83).
Finding 2 and the subthemes represent a perfect example of how the influences in this study
intersect and overlap. The interviews revealed how utility value motivated Northeast
Independent School teachers to teach the Character Program; however, cultural systems, real or
perceived, clearly impacted their perceptions of new initiatives, including, but not necessarily
limited to, the Character Program. Marge provided the punctuation, “I think when this one (the
Character Program] came out, the first thought was…Is this just more things to press?’ They
compressed the amount of things [we already did].” The organization implemented the
Character Program in 2015, and the interviews for this study were conducted in the spring of
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2018. Cultural models take time to develop, and their meaning is made through shared
experiences and beliefs (Shore, 1996). In the three years between the introduction of the
program and the time of this study, the perception, or cultural model of frustration and fatigue,
seemed to triumph over the utility value.
Finding 3: Teachers set and reflected upon goals for student learning but not necessarily
student mental health.
As stated in the introduction to this chapter, I had hoped the Character Program would
enable the space for a more concerted effort towards mental health education; however, I found
little evidence regarding the use of student plans, portfolios, or even benchmarking, which would
serve as the cornerstone for such an initiative. While some individual teachers created portfolios
for student academic achievement and character growth, they did so with no organizational
direction or divisional consistency. There were some teachers who only tracked student
academic progress, while others had complex processes of measuring academic and social
growth over the course of their year together. There were also those who completed a Character
Growth Card similar to that of KIPP’s (Appendix B) but cited their motivation as simply
fulfilling the mandate to avoid administrative oversight. And, of course, there were teachers who
did none of the above.
In goal orientation, mastery reflects self-improvement (Yough & Andermann, 2006).
The most effective goals are those that are concrete, challenging, and current (Clark & Estes,
2008). However, reflection must accompany goal setting; the process of looking back at what
you set out to accomplish, your successes and failures, and the application of new goals – it must
inform not just the past but also the future (Galley, 2000). Portfolios assist the task of reflection
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by providing students and teachers concrete information to review and goal set not just
academically, but also socially and emotionally (York-Barr, 2006). The hope was that teachers
used the terms and character strengths, as defined by the Character Program and the attached
KIPP materials, to develop improved mental health through realistic goal setting and
achievement; but that hope would prove unfounded.
Students at Northeast Independent School had an academic file that followed them from
year-to-year, but the files were not shared across divisions. Although middle school teachers
could access middle school report cards, teacher comments, and behavioral incidents if they were
recorded; upper school teachers had no access to these files - this was true across all three
divisions. Additionally, while advisors physically held the file, there was no organizational
mandate to review the material, and teachers needed to take the initiative to analyze the
information. It was left up to each individual how or when to review, and Marge preferred to get
to know her advisees in other ways:
I’ve taught them before, I’ve coached them before. So I already know a little-bit about
them. But I’ll just kind of banter back and forth with them in the mornings or always ask
them how their tests are going and if they’re studying and stuff like that. So it’s very
informal because I feel like I can’t pull off anymore the formal way of interacting with
them.
Marge saw no benefit to reviewing the folder. It was not a practice she was comfortable with
and her self-efficacy around formally engaging with her students was non-existent: “I can’t pull
off…the formal way of interacting with them.” Marge was not a new teacher and admitted to
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being “stuck” in her ways. Her focus was academic, and her role as advisor was done through
role-modeling but not goal setting.
Sara, who advised in the upper school, shared a similar approach to advising, only with a
little more formal goal setting than Marge expressed:
I talk to them one-on-one. 14-year-olds don't want to talk one-on-one, but a little bit in
the beginning of the year. I have like a sheet that I print out, and twice a year I sit down
with them, whether they want to or not, and just ask basic questions like, "How's it
going? Are you worried about anything?" Things like that.
Although not new to teaching, Sara was a less experienced educator than Marge and likened her
role as advisor to that of a mother. She preferred a similarly whimsical approach to advising but
did not forego somewhat formal goal setting. She spoke about how, as advisor, it was easier to
track a student’s academic progress through teacher report cards and comments, but the social
emotional work was less formal with a written sheet to create openings to talk, but not much
more. The low self-efficacy in goal setting, “[I] just ask basic questions,” demonstrated a
significant organizational gap. Marge unknowingly admitted to a gap in her own understanding
by stating, “14-year-olds don’t want to talk.” Marge relied on them talking to assist in their goal
setting through the use of “basic questions.” Kids who resist speaking (see the chapter 2
literature review on stigma) are not likely to reveal much in the way of their mental health when
asked, “twice a year…’are you worried about anything?’’ Add to that a lack of mental health
literacy, and it was a model unlikely to succeed. For metacognitive strategies like goal setting
and reflection to work they must be routinely reviewed, otherwise attitudes and behaviors do not
change (Veenman, Van Hout-Wolters, & Afflerbach, 2006). If the organization’s stated goal
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was to improve student character, a gap in assessment and reflection would be less likely to
allow for authentic growth to occur.
Barbara, who had a lot to offer regarding portfolios, struggled similarly with the concept.
She spoke frequently about how all of the knowledge, motivation, and organizational influences
that existed would not allow for a formal portfolio process.
I don't feel trained enough myself to be able to come up with the language of how that is
to be written down in a formalized way. I can convey it but I don't know about writing
this stuff and passing it along to teachers from year to year. I think that in a classroom
setting, you know, we're talking about specific tasks in material and skills, that's finite.
Whereas, for my advisees it's much more broad and so, I find that, you know, while I
have high standards both in my class and of my advisees, that and they all know that I'm
not asking them I'm not assessing them as formally, for example, on a test in
advisory…The problem with formalization, and I think this is what some people's
problem with the [Character Program] is…I think that some people feel that when you
codify something like that, you run the risk of it becoming a pendulum. Because if you're
not talking about it with conviction, and you're just talking about it because you were told
to talk about it, then those skills in that individual piece with middle school [students]
becomes instantly fodder for ridicule. And so, the problem with codification is not
necessarily the codification but it's with the conviction with which that codification will
be followed.
Although Barbara took more time to specifically set and reflect upon goals, she shared the same
underlying concerns of self-efficacy that both Sara and Marge seemed to imply. Barbara’s
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concern with portfolios, despite her obvious use of goal setting and reflection, centered on the
formal organization of creating one and the efficacy necessary to complete the process; “I don't
feel trained enough myself to be able to come up with the language of how that is to be written
down in a formalized way.” Barbara tracked her students’ progress in her own way, but she had
concerns about how that would translate from teacher to teacher and, eventually, the students.
“The problem with codification is not necessarily the codification but it's with the conviction
with which that codification will be followed.” Barbara knew the school well enough to know
that the cultural models and settings were not defined clearly enough and that while she
employed her own methods of metacognition, she admitted that codifying student plans could
cause more problems than benefits, which included turning a codified program into a joke or
“fodder for ridicule.”
The interviews revealed no consistency or uniformity for goal setting and metacognitive
practices with each individual teacher free to employ whatever techniques worked for them and
no organizational influences. However, as expressed in Finding 1, metacognition was present in
each finding with teachers recognizing what they did not know, even if they could not or were
unwilling to fill those conceptual and procedural knowledge gaps. Considering Barbara’s
concerns, under the existing organizational structure, it would be a mistake to formalize the
Character Program any further, and the inclusion of mental health would likely fail as well. The
lack of uniformity led to the final finding about how teachers are not held accountable for the
organizational goal.
Finding 4: The organization supported self-motivated accountability and professional
development and had no formal mentoring programs
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Teachers initially received some training and support for teaching the Character Program,
including methods on improving the social and emotional wellness of the student body.
However, participants uniformly indicated that little follow-up occurred, including no
reinforcement of strategies or accountability for teaching the program. Barbara, from the middle
school, confessed, “at our school, we don't do a great job with accountability...I think that it's
only, you only take it [the Character Program] as seriously as you take it.” The organizational
culture allowed for independent teaching practices. Barbara expressed concern about how
teachers were not held accountable for teaching the Character Program. Without greater
accountability, teachers who did not feel comfortable teaching or did not value character
education would have the freedom to avoid teaching it. Finding 2 revealed how many of the
respondents identified the utility of a community-wide lexicon to the development of the
Character Program, yet the culture did not encourage faculty development or accountability
measures for those who were reluctant to teach the program and new teachers, thereby limiting
the depth and breadth of a common core vocabulary. Kit, from the lower school, shared, “part of
the challenge for me has always been trying to get everyone on board...and making sure that
people are following through with it [character education].” Kit expressed the same concerns as
Barbara: some teachers did not do what was asked of them, and the organization did not hold
them accountable for it. Kit, had no administrative role, but she was one of the few teachers who
worked with every student and, thus, a majority of the faculty. One of her roles was engaging
the whole lower school community in character education, but she struggled “to get everyone on
board.” The Character Program, which seemingly had significant initial buy-in, struggled to
achieve universal compliance, and those who eschewed the organizational directive were not
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counseled, coached, or corrected by the administration. Lily added, “[I]f I didn't explicitly say it
to anyone and just chose to not do it [teach character], I'm under the impression that as long as I
wasn't caught, nothing would really happen. As long as nobody saw me and the students didn't
say anything about it, I don't think there really would be any consequences.” Lily identified it as
a choice to teach the Character Program and how no one held her accountable for it “as long as
[she] wasn’t caught.” Holding oneself responsible requires time, reflection, and a willingness to
be self-critical; tasks in and of themselves that require routine metacognition and study
(Kelchtermans, 2009). Absent an organizational model of accountability, it seemed a big ask to
have teachers monitor themselves and expect them to address gaps in knowledge or motivation
to teach character.
In addition to a lack of accountability to develop the character education program,
professional development was not required of the teachers beyond the initial character training,
and new teachers were not required to pass the initial MOOC training which only applied to
those teachers employed at the time of roll-out in 2015. The expectation was that teachers would
seek out their own professional development but only if they felt inspired to do so. And while
the teachers were unanimous in complimenting a supportive and encouraging administration,
professional development was never required, and the decision to attend symposiums,
conferences, and the like was always left to the individual. At the middle school, Lily reflected,
“I should be more proactive about seeking out those opportunities.” Lily had a young family and
was well-respected as an educator, but because the organizational expectation was on her to seek
out professional development opportunities, she did not take advantage of opportunities despite
her apparent motivation. In the upper school, Heather expressed a similar feeling, “they've [the
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school] been really good about wherever you think the best place to go learn is, we [the school]
will find a way to make that happen.” In saying, “wherever you think the best place to go…,”
Heather not only reinforced the organizational culture of self-motivated training, she also
demonstrated the culture of self-accountability. “Wherever you think the best place to go learn,”
revealed the school’s willingness to support its teachers if the teacher demonstrated the
willingness, and no respondent mentioned organizational skill reinforcement of updated or
empirical pedagogy around character education.
Sara complicated matters in sharing, “I can't say there's direct training, but we brainstorm
all the time about how to do this stuff [character education]. If somebody has a good idea that I
can use, or you know? That's almost better than going to some seminar somewhere.” Sara
identified brainstorming as a valid substitute for professional development, “if somebody has a
good idea…that’s almost better than going to some seminar somewhere,” despite the evidence
that brainstorming encourages group think and productivity loss (Mullen, Johnson, & Salas,
1991). Sara’s misapplication led her to believe that she did not need professional development.
Because the organizational culture supported self-motivated accountability and professional
development, the school did not hold their teachers accountable or provide effective professional
development, and, as a result, the organization faced teacher fatigue and ineffective practices.
Marge’s frustration was obvious, “Sometimes…you're like, fuck, maybe the [Character Program]
is probably working as we're working with the kids, but we just check the boxes in the upper
school. I knew we would. We all talked about that…just one more thing to get done.” Having
been a teacher at the school for an extended time, Marge predicted fatigue for the new initiative.
In stating, “I knew we would [check the boxes],” Marge specifically expressed her concern about
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the program before its inception, but she was never held accountable and lacked the professional
development to convince her of its utility. Cognitive dissonance occurred for Marge when her
ideas about teaching character did not match the organization’s. Marge expressed it was not hers
alone. Without addressing the thought gap about how to teach character, fatigue and frustration
were inevitable (Ross & Hannay, 2001). In lacking accountability, professional development,
and reinforcement, cognitive dissonance among the teachers about how to teach character
demonstrated a significant road block.
Mentoring was one way I expected the organization to support and reinforce its faculty in
teaching character education. Without the full support of the administration, including, but not
limited to teacher mentoring and continued professional development, teachers could fatigue and
become unengaged by new programs (Stephan, Sugai, Levers, & Connors, 2015).
Unfortunately, Northeast Independent School had no formal or informal mentoring programs.
As a result, new teachers discovered the school’s culture on their own which took time and often
resulted in miscommunication or misunderstanding of how the school operated. Lacking a
mentoring program, teacher self-efficacy and collaboration suffered (Luke, Baumann, Carothers,
Landsverk, & Proctor, 2016). Lily addressed this problem early in our conversation:
I didn't have any formal mentorship my first year here. It was my third year teaching [in
general], so I wasn't totally new to it, but I remember my first year being frustrated many
times in feeling like I was figuring things out as deadlines were 10 minutes away. That's
not to say the fault is entirely the school's. I think I could have been better about being
proactive in asking for help when I was confused or when something was uncertain. I do
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distinctly remember having plenty of occasions when I was frustrated about feeling a bit
of a lack of mentorship.
Evidence suggests that young professionals in their first 5 years exhibit unusually high self-
efficacy which typically dissipates as they become more experienced and recognize gaps in their
practice before regaining their confidence (Sanchez & Dunning, 2018; Lemlech & Hertzog,
1998). Lily self-identified as a confident teacher in only her third year of teaching: “I wasn’t
totally new to it.” And while Lily’s teaching ability was without question, and her confidence
not unusual, the frustration she expressed was of particular concern. Nearly 1/3 of Independent
school teachers leave the profession after five years or fewer, typically because of a lack of
support (U.S. Dept. of Education, 2009). The importance of mentoring young teachers cannot be
over-stated considering mentor programs reduce teacher attrition by as much as 30% (Darling-
Hammond, 2003). Lily, who was one of the more respected teachers in the school, expressed
“plenty of…frustration” during those pivotal first few years of her career. Her experience
identified a significant gap in the cultural setting of how the organization supported its teachers
and created the potential for her frustrations, or lack of support, to take her down the familiar
path of leaving the profession.
Heather, also a young teacher, expressed that while she felt supported, the onus was on
her to seek assistance rather than have it pre-emptively provided.
I think it would just be when I seek it out, which I do all the time. I'm like I don't think I
really know exactly how to handle this. And the same thing, again if I found a problem
then I'd go find somebody who could help me through that and just using my colleagues
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as resources. I would consider everyone I work with, especially as a mentor because
they've all been teaching longer than I have. So, yes.
Heather seemed to be atypically pro-active about seeking help: “I seek [help] out…all the time.”
Unfortunately, Heather is more of an anomaly than the norm since many young teachers,
especially those with high self-efficacy, tend not to seek help due to the belief that they know
what they are doing (Rodríguez, Regueiro, Blas, Valle, Piñeiro, & Cerezo, 2014). Additionally,
a new teacher may not necessarily have the reflexive wherewithal to seek help and may not
necessarily know where or how to find it. Heather also stated that she had “everyone” as a
resource. During the interview, it was clear to me that Heather was a warm, out-going individual
with strong social skills and high self-confidence. But not everyone exhibits these strengths, and
a plurality of choices can have a paralyzing effect (Iyengar & Lepper, 2000). Lacking a
mentoring program, especially when implementing a new initiative, put young teachers at risk
for poor decision making or departure due to rapidly declining self-confidence and fatigue.
It is also not unusual for established teachers who are set in their ways and are reluctant
to accept change to need encouragement and support to try new programming or learn about
areas where they are not experts (Jewell, 2007). Mentoring experienced teachers leads to
improved metacognition, increased self-efficacy, improved professional capital, and a
willingness to try new ideas when engaged with a mentor (Pavia, Nissen, Hawkins, Monroe, &
Filimon-Demyen, 2003; Jewell, 2007; Nolan, Nolan, & Molla, 2017). The teachers interviewed
for this study had a variety of professional experience. Unfortunately, none of the experienced
teachers said much about mentoring since the practice is not typical for seasoned professionals,
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and it had been some time since anyone with more than 8 years of teaching experience had a
point of reference on which to comment; that does not mean the question was not asked.
The Character Program faced significant challenges by not holding teachers accountable
to implementation by providing feedback or opportunities for reflection and mentoring. For the
program to work, accountability and developed practices were necessary (Elmore, 2002). The
school’s cultural influences fell far short of expectations. The lack of accountability (self, peer,
or even administrative), teacher fatigue, and mentoring – combined with a dearth of reinforced
and empirical professional development - the practice of teaching character within the context of
the class content had not become enculturated, it was unlikely to be effective, and the school ran
the risk of letting the character initiative die, much less incorporating a supplemental mental
health initiative.
Conclusion
The purpose of this study was to identify the knowledge and motivational influences vital
to the stakeholders’ understanding of how to develop positive student mental health through a
character education program and to understand the interaction between the organizational culture
and context alongside those influences. The conceptual framework tied the organizational
culture, teacher knowledge, and teacher motivation together to help develop a complete
understanding of this topic.
The findings in this study identified four overarching findings: 1) teachers at Northeast
Independent School lacked the conceptual and procedural knowledge of mental health principles
and theories; 2) Teachers recognized the utility value of a common vocabulary to reduce stigma
and improve student mental health; however, few could justify the time necessary to implement a
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program; 3) Teachers set and reflected upon goals for student learning but not student mental
health; 4) The organization supported self-motivated accountability and professional
development and had no formal mentoring programs. In collecting data for this study, it quickly
became apparent that the development of student portfolios and teacher mentoring, as I had
initially expected, were not a part of the Character Program and questioning teachers about the
effectiveness of portfolios and training revealed little towards an effect on the social or emotional
support of the students. As a result, questions in the interview focused on the Character Program
as it was being implemented, asking as much as possible how the teachers viewed the possible
addition of these other elements, including mental health literacy.
It was clear from the findings that the teachers’ knowledge and motivation to teach
mental health literacy was understandably limited and that the organizational culture was a major
limiting factor. However, the purpose of the Character Program was not to teach mental health.
Elements of the Character Program teach, by default, aspects of mental health; specifically,
social-emotional learning; however, mental health literacy, the reduction of stigma, and student
portfolios did not figure into the teaching of character – though, this study would argue that it
could. While one might hope a student with good character would not stigmatize someone
struggling with their mental health, good character is not a guarantee for good mental health. As
such, the study explored the possibility for such a supplement to the existing program to be
feasible.
Next, in chapter 5, I will discuss the implications for practice, my recommendations to
the organization based on the findings, the limitations of this study, and future research to
consider.
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CHAPTER FIVE: DISCUSSION
Clark and Estes (2008) provide a systematic, analytic framework that clarifies
organizational and stakeholder performance goals and identifies the gap between the actual
performance level and the performance goal of an organization. In this study the goal was to
provide students the skills necessary to identify and discuss if mental health literacy to reduce the
stigma of mental illness and provide pro-social emotional strategies to the student body was an
outcome of the Character Program. Once the gap was identified, this framework specifically
examined the stakeholder knowledge, motivation, and organizational influences that impacted
performance gaps (Clark and Estes, 2008). To identify if mental health literacy was considered
an outcome of character education, it was necessary to understand how much teachers knew
about the empirical evidence and application of methods aimed at supporting student mental
health and well-being alongside character development, what did or did not motivate them to
teach mental health, and the organizational models and settings involved in accomplishing the
organizational goal of improving student character and the possibility of adding mental health to
the Character Education Program. Improving an organization includes systemic and
synchronized change. Teachers, who typically work in isolation, needed to be assessed, among
several other things, for what they knew as a prerequisite for organizational improvement
(Elmore, 2002). Chapter 4 of this dissertation established the knowledge, motivation, and
organizational influences vital to the stakeholders’ understanding of how to develop positive
student mental health through a character education program as guided by the following research
questions:
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1. What are the teachers’ knowledge and motivation related to identifying and
discussing mental health through the implementation of character education or
student portfolios?
2. What is the interaction between organizational culture and context and teachers’
knowledge of and motivation to meet the stakeholder goal?
This final chapter discusses the last project question from this study: What are the
recommendations for organizational practice in the areas of knowledge, motivation, and
organizational resources? Divided into four sections, chapter five will examine the implications
for practice, recommendations, future research opportunities, and a concluding paragraph.
Implications for Practice
This study highlights the need for comprehensive mental health literacy programs in
schools to reduce stigma and to improve the mental health of youth. This study also made clear
that while there are many positive outcomes from a character education program, it is not an
effective strategy for improving the mental health of students as an unintended consequence.
The implications for practice cannot be overstated. Youth continue to struggle with mental
health globally, and the United States is leading the way. Hospitalizations for suicidal ideation
and suicide attempts by youth doubled over the past decade with incident peaks in the fall and
spring months – September and October each had double the rate of incidents than that of June,
July, or August (Plemmons et al., 2018) – indicating a probable correlation to the fall start of the
school year and spring exams and college acceptance letters. While schools likely contribute to
the causes of stress and possibly exacerbate the symptoms of mental illness, they also have
regular access to youth in a safe learning environment.
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A clear illustration of the implications for practice and the opportunity educators possess
are presented in Appendices E and F: a father’s story of signs unseen and signals missed; a
teenager’s expressive screams for help and no one, including herself, available or informed
enough to listen; a young life cut short. These resources offer a lens on a terribly emotional and
heartbreaking series of events as told from two viewpoints and experiences of the same
tragedy. The documents offer a representative sample of the complex emotions experienced by
those suffering from mental illness and the impact it has on them and their family. The artifacts
reveal the hidden pain of teenage mental illness and lack of awareness or understanding. What is
missing is the solution. These documents expose a family’s naiveté and a student’s (Elisif’s)
unwillingness to engage in her own mental health despite the seemingly obvious signs. Schools
regularly provide students and families with lessons, lectures, resources, and support for
nutritional and physical health, and, while mental health programming is slowly appearing in
some public and private schools, mental health education is paltry in comparison to the demand.
I cannot make retroactive predictions about what might have happened to Elisif had her school
taught a mental health curriculum; however, Elisif and her father, Peter, repeat in both
documents elements of, “if only we had known more…” If only they had known more about the
signs of mental illness, what could have been done? What different steps could have been taken?
We know that when youth with mental illness engage with adults who are prepared for
conversations around mental health, there is a reduction in suicidality (King et al., 2019; Jorm,
Kelly, Wright, Parslow, Harris, & McGorry, 2006); if only Elisif’s teachers had the training,
resources, support, and understanding to talk to her or her family about her mental health. And
we know that youth with mental illness seek help when the perception of stigma is reduced (Jorm
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2012); if only Elisif were unafraid to express herself or accept her illness without the fear of
judgment. It is easy to see the signs in hindsight; Elisif literally and figuratively painted a picture
for all to see. Her portfolio told her teachers a story; unfortunately, the training was not there.
Teachers were not provided the tools to decode the deeper meaning of her work, and her doctor
did not have access to this free and creative expression. Even with access, approximately 60% of
pediatricians are unprepared to diagnose mental illness (Romer & McIntosh, 2005), and doctors
see their patients roughly once a year, if all is assumed to be going well. The training and access
to recognize the signs ahead of something catastrophic are simply not there for pediatricians,
teachers, parents, or peers.
Recommendations for Practice
Knowledge Recommendations
Knowledge and skills identified by Krathwohl (2002) are divided into four types: (a)
factual; (b) conceptual; (c) procedural; and (d) metacognitive, which are used to determine if
stakeholders know how to achieve a performance goal. This gap analysis established the
knowledge influences vital to the stakeholders’ understanding of how to teach character
education and to develop positive student mental health through a framework for teachers to
work in coordination, rather than isolation.
The conceptual knowledge influence recommendations. According to the study,
teachers at Northeast Independent school did not understand the complex issues around and
needed improved conceptual knowledge of mental health. This gap analysis established the
knowledge influences vital to the stakeholders’ understanding of how to develop positive student
mental health and provided a framework for teachers to work in coordination, rather than
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isolation. Studies indicate that teachers with a deeper understanding of the theories and
principles (literacy) in mental health are better able to create plans that fit their students’
individual needs (Mishra & Koehler, 2006). To support the mastery of the stakeholder
conceptual knowledge around mental health, teachers at Northeast Independent School needed
explicit support learning the definitions and concepts of mental health and guidance connecting
them to learned academic content and the Character Program. Information learned meaningfully
and connected with prior knowledge is stored more quickly and remembered more accurately
because it is elaborated with prior learning (Schraw & McCrudden, 2006). In defining, creating,
and sharing definitions of mental health, teachers will connect prior knowledge to learned
empirical evidence identifying where skills need introduction or strengthening. Teachers with
robust conceptual knowledge about mental health literacy can create flexible and adaptable
lesson plans that meet the needs of their students, rather than offering a one-size-fits-all,
repetitive mental health program that typically focuses on only the neediest students.
Good teaching is based on the knowledge of the subject matter, though it is often
believed that educators know what they are doing (Mosenthal & Ball, 1992). The uncertainty
and lack of readily available mental health literacy further demonstrated the need to further
teacher conceptual knowledge – despite best intentions, dedication, good metacognitive
practices, and intelligence of the interviewees. The study revealed how important a shared
vocabulary is to creating a school-wide lexicon that has everyone speaking the same language.
Teachers, students, parents, administrators, and so on can dialogue knowing they understand one
another
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The procedural knowledge influence recommendations. Teaching mental health is an
incredibly personal journey, and teachers at Northeast Independent School were anxious about
addressing issues parents, students, or administrators may find offensive or inappropriate.
However, this study also demonstrated how effective a shared vocabulary was to teaching
character education. Teachers needed to know how to create and implement a student wellness
plan and to perpetuate mental health literacy using a common, shared vocabulary through
professional development and reinforcement. To develop mastery, individuals must acquire
component skills and vocabulary, practice integrating them, and know when to apply what they
have learned (Schraw & McCrudden, 2006). It is critical that teachers engage students with a
common language aimed at reducing stigma and improved community character-based and
mental health literacy. This study revealed the impact of a shared vocabulary on program
implementation. The administration must equip teachers with a shared language aimed at
reducing the stigma of discussing mental health and provide students the opportunity to
accurately identify stressors and strategies, similar to how character education was taught at the
school.
Character education is not enough – we need explicit instruction on mental health.
Teachers at Northeast Independent School expressed their concern about teaching mental health
to their students, but also showed their skill in teaching character through dual-purpose lesson
plans. Youth, like Elisif, increasingly struggle with mental illness, particularly those in low-
income communities (Hoagland et al., 2018). Dual purpose lesson plans, like those used in the
Character Program, use literature, film, art, science, history and more to deliver a culturally and
emotionally literate curricula. In providing teachers the professional training and by creating
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teacher teams, the administration can provide teachers the opportunity to explore unique lesson
plans that address issues of mental health from a variety of perspectives. For example, literature
allows us to imagine mental health settings and to brainstorm solutions for fictional scenarios.
Non-fiction can be used to teach reflection, while the sciences and math teach lessons about
overcoming obstacles and applying complex problem solving (Richmond, 2014). Openly
discussing various mental health maladies and situations prepare learners for unpredictable
situations with room to safely discuss strategies for navigating mental health challenges.
A key to removing stigma is in normalizing behaviors and understanding labels.
Introducing mental illness and well-being through character study is one safe and effective way
to teach mental health literacy. Elisif shared a Holden Caulfield quote from the final line of J.D.
Salinger’s Catcher in the Rye, “Don’t ever tell anybody anything. If you do, you start missing
everybody.” The quote resonated enough with Elisif to find its way into a journal she admitted
to reluctantly writing. Serving as just one example of a multi-purpose opportunity, Salinger’s
novel reflects the trauma and repression of a teenager – traits with which Elisif identified – and
invites conversations on student mental health alongside the novel study. Teachers in this study
revealed their anxiety around implementing a mental health curriculum, but recognized how their
procedural skills benefited character education and, with support, could extend what they already
did well into this new arena. Teachers’ procedural knowledge to incorporate common vocabulary
into a mental health curriculum has the potential to de-stigmatize negative feelings, thus
hopefully giving youth like Elisif the ability to seek help.
The metacognitive knowledge influence recommendations. Those involved in the
study all spoke about how they reflect on their work in an effort to improve their craft, though,
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no formal reflective practices exist. Teachers needed to self-evaluate their effectiveness with
wellness planning for students and to engage in dialogue about their and their students’ social
and emotional wellness. Teachers also need to reflect on what they know and do not know,
including their biases and predispositions. Metacognitive knowledge of the processes will
increase teacher understanding and awareness (Krathwohl, 2002). Teachers need to self-evaluate
their effectiveness with wellness planning for students, and the administration needs to provide
them the opportunity to meet in teams or with a mentor, encouraging the metacognitive process
and improving their overall effectiveness as educators. Adult learners, even when required to
learn new material, must be responsible for their own learning. There comes a point when
individuals stop receiving information and need to actively seek it to improve metacognitive self-
knowledge (Pintrich, 2002). This usually occurs when adults identify a weakness in their
knowledge, and they take steps to increase their understanding (Knowles, 1984). The
administration can support a faculty who already feel as if they do too much by providing
opportunities to openly reflect and review the application of the learned strategies through peer
observation and dialogue allowing for the routine improvement of their practice. Additionally,
observing peers allows teachers to reflect upon their own practices and seek information to
further improve their understanding as they work towards mastery.
Baker (2006) suggests having individuals think aloud and talk through the process of
what they are doing in groups allowing for metacognition and the promotion of good behaviors
around self-evaluation. To reinforce learning and to promote mastery, the school must provide
regular opportunities to debrief the thought processes and assess teacher strengths and
weaknesses, especially because teachers were nervous about getting it wrong if they tried to
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implement a mental health literacy component into the Character Education Program. The
metacognitive knowledge principles offered by Baker, Krathwohl (2002), and others (Pintrich,
2002; Knowles, 1984) include reflection as a critical means to achieving proficiency at new tasks
because reflection is vital to understanding and growth. Peer dialogue and feedback reinforce
learned strategies toward improved performance and even mastery (Shute, 2008). In order to
achieve the stakeholder goal of improved student character and, ideally improved mental health
literacy, theory would support the notion that the organization should provide opportunities for
peer review, reflection, and feedback. Improved knowledge leads to facile practices by creating
concrete and researched methods to achieve the stakeholder goals and improve overall teacher
effectiveness.
Motivation Recommendations
This study reviewed two motivational theories to achieve Northeast Independent School’s
goal: utility value and goal orientation theories, because of their relevance to this study. Utility
value is used to establish whether or not something matters to a person (Eccles, 2006).
Depending on an individual’s personality, life goals, and other motivating factors, utility value
explores why someone would want to accomplish a task (Eccles, 2006). Goal orientation theory
focuses on the setting and achieving of goals to accomplish mastery by assigning specific value
to a task (Yough & Anderman, 2006). These goals are used to motivate people to accomplish
specific tasks through intrinsically applied rewards (Pintrich, 2003).
Utility value motivation influence recommendations. While teachers recognized the
utility value of a common vocabulary to reduce stigma and improve student mental health, few
could justify the time necessary to implement a mental health program. The school should
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provide opportunities for for teachers to review and recognize the benefits of mental health
literacy and use of portfolios as part of providing character education. By connecting work to an
individual’s personal gains and interests, tasks are accomplished more successfully and with
greater mastery than if externally motivated (Pintrich, 2003). To identify and discuss specific
ways teachers may achieve individual gains from the implementation of student portfolios in an
effort to improve student mental health, teachers need time and space to maintain their
motivation. Teachers are more willing to learn and apply new classroom strategies when they
know it will benefit them and their students (Tin, Hean, & Leng, 1996; Lortie, 2002; Roy &
Sengupta, 2013), but they need the time. Eccles (2006) rationalized that individuals must see the
benefit in a task. Without time to learn, practice, and review new information and techniques,
motivation to learn will remain low for adult learners, and initiatives will fail to take hold
regardless of its utility value. Longenecker and Abernathy (2013) identify eight prerequisites for
successful adult learning, the first having to do with utility value. They state how adult learners
want to know how and why a task will benefit them before engaging in learning and that failing
to create the link between individual utility and the desired organizational outcomes will likely
thwart learning and success. Northeast Independent School administrators needs to provide
opportunities for professional development, peer review, and self-reflection to help identify the
benefits of mental health programming on both the students and teachers leading to a successful
implementation. Absent the time to accomplish these tasks, teachers will continue to feel
fatigued.
Goal orientation recommendations. Teachers set and reflected upon goals for student
learning but not student mental health. The school should set benchmarks that focus on
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improved mental health and not just on fulfilling a mandate. Teachers must establish and share
goals that help them gain mastery through reflection and maintain enthusiasm for their efforts
and ability to improve student mental health. To achieve mastery, teachers need to set learning
goals and self-improvement benchmarks (Pintrich, 2003). To support benchmarking, it is critical
for school administrators to provide the time for feedback and reflection, thereby allowing
teachers to maintain motivation to build on knowledge and maintain enthusiasm for the project
(Pearson et al., 2015). With improved ability to recognize symptoms and the power to reduce
stigma, teachers who set learning goals around mental health literacy will create a shared
vocabulary providing youth one resource to effectively communicate their needs.
Multiple studies demonstrate the benefits of goal orientation theory and learning (Yough
& Anderman, 2006; Pintrich, 2003). Ford et. al (1998) identified how specific goals to trainings
are critical to their success, creating what they call “flexible and adaptable learning
environments” (p. 230). This study builds on the knowledge that providing goals increases
motivation. Northeast Independent School must have teachers identify goals around learning
new tasks that will ensure and maintain motivation and should engage teachers in feedback and
peer review to hold them accountable and to maintain enthusiasm.
Organizational Recommendations
Cultural models, as defined by Gallimore and Goldenberg (2001), are unseen and
difficult to define. These are the values and behaviors that define an organization, its policies,
and attitudes, among many things (Rueda, 2011). It is often the invisible force that might be
explained as, “the way we do things here.” Good cultural models are often difficult to maintain,
and they require constant vigilance on the part of leadership (Lencioni, 2002). The cultural
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model influences impact implementation and the success of the program at all levels of the
school’s culture. Initiatives in schools, as in many institutions, tend to echo the social reforms of
the time (Levin, 1974; Gallimore & Goldenberg, 2001; Sarason & Klaber, 1985). As society
changes, so do schools and their cultures. These influences have a major impact on the success
or failure of program implementation and unfortunately, poor cultural model influences can
unknowingly act as impediments to achieving organizational goals.
Cultural setting influences are more concrete and identifiable than model influences
(Rueda, 2011); Northeast Independent School’s schedule, honor code, and lesson plans are a few
examples. Cultural setting influences typically occur over time and set out to accomplish an
objective (Gallimore and Goldenberg, 2001). Cultural settings were originally defined by
Seymour Sarason (1972), a pioneer in the study of educational settings, as an outcome by two or
more people working together over time to accomplish a task. While teachers would no doubt
benefit from more time to collaborate, and share ideas about new initiatives, the school day and
one’s personal life place too much of a demand on any individual’s time to accomplish such
tasks (Gallimore and Goldenberg, 2001), and the school needs to be more aware of these
demands and build time into the workday to meet the organizational goals.
Cultural model 1. Accountability. The organizational influences supported self-
motivated accountability and professional development and had no formal mentoring programs.
Teachers need to be held accountable for implementing new initiatives. The interviews revealed
varying degrees of accountability, and, while every interview participant was widely considered
an excellent teacher by their peers, the Character Program was not administered with equal effort
or effect. When implementing new initiatives, clear and structured feedback that encourages
MENTAL HEALTH GAP
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progress and success is critical (American Psychological Association, 2015). Leaders create
effective accountability systems when they engage in the challenging but necessary process of
analyzing the complex social and political elements within an organization. Feedback is the best
tool in terms of change acceptance and performance, allowing for a self-sustaining feedback loop
for effective implementation (Han & Weiss, 2005). Considering the impact of feedback on self-
efficacy, administrators and peer teachers should observe, evaluate, and discuss teacher
effectiveness at implementing new programs. Given the finding that teachers identified time as
an inhibiting factor to implementing the Character Education Program, much less any mental
health literacy add-ons, the administration must also provide time in the regular work day to
engage in these discussions, to allow for observation, and to maintain enthusiasm. This may
mean a reduction of responsibilities for each teacher, an expensive and time-consuming task that
necessitates the hiring of more faculty, but the school must assess how important the
organizational goal is to their overall budget.
Elmore (2002) suggests that initiatives will fail if leaders simply push for change but
offer no feedback on how to accomplish the task. As it stands, it seems as though the school is
willing to suggest change, but feedback is not offered. Elmore continues to suggest that new
knowledge can only be achieved through practice and that practice must be system-wide, and, for
organizations to succeed in change initiatives, teachers must find agency in their work. As stated
earlier, metacognitive practices, informal and formal dialog, and modeled, practiced, and
observed behaviors hold teachers accountable to their actions leading to the successful
implementation of these initiatives. Northeast Independent School is not meeting the standards
established by Elmore, and, without more of an organizational commitment to achieving the
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goals, the school is likely to maintain the course of what has amounted to little more than lip-
service for character education with little to no effect on the mental health of the student body.
Mayer (2011) highlights how providing guidance, modeling, and coaching, along with
other scaffolding strategies during implementation and performance, boost information
processing, retention, and mastery, supporting guided practice and modeling through peer
observation and feedback. Kotter (2007) further established that empowering and training
individuals to be teacher-leaders is critical to the success of any change initiative. The school
must identify and train teachers to facilitate conversations about change that will lead to mastery
throughout the entire organization. Before long, the trainees will become the trained, allowing
for the practice of mental health education to flow seamlessly within the culture of the school.
The school must create teacher teams and provide the time for these teams to meet
quarterly to review and discuss student portfolios and student well-being, in addition to
discussing mental health literacy, its practice, and application. Social interaction, cooperative
learning, and cognitive apprenticeships (such as reciprocal teaching) facilitate the construction of
new knowledge (Scott & Palincsar, 2006). As such, teams led by faculty with supplemental
training as mentors, will help to solidify teacher procedural understanding.
A 30-year study of schools in Canada and the United States found that a leading
motivator behind effective educational change was the ability to socialize and share effective
strategies through conversations and informal mentoring. (Hargreaves & Goodson, 2006).
Whether new to the organization or an experienced teacher, the effect of peer observation and the
sharing of ideas is an effective means to improve teacher skills and implement change initiatives.
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Cultural model 2. Leadership. The cultural model influence of teacher fatigue
remained, despite the perceived utility value of character education. The organization needs to
reduce teacher fatigue from the continual effort to introduce new programs, techniques, and
initiatives. Teachers are more likely to be engaged in new initiatives if they feel they have a
voice, they know why they are implementing new methods, and feel as if their work is valued
(Berger, 2014; Berbarry & Malinchak, 2011). Administrators and teacher peer groups will
solicit and engage in informal and formal dialogue and feedback regarding new initiatives,
including suggestions for program improvement and shared best practices. Northeast
Independent School leadership must engage the community in regular dialogue around mental
health and need to lead the organization by example. The fatigue expressed by the faculty
identified how important engaging all stakeholders is to the success of any new program.
Organizational culture is established by leadership, particularly long-term leadership. And, as
expressed by Kit, if the teachers are just being told to do something it is likely they will do so
without conviction. Buy-in is critical, and an organizational culture setting of micro-management
led to fatigue towards the initiative regardless of its value.
According to Sarason (1972), an example outcome of a setting occurred famously in
1787 during the United States Constitutional Convention. Since only White males represented
the fledgling nation in the writing of the Constitution, the impact on the rights of Blacks and
women in American society continues to be an issue of great contention. The influence of who
is represented and how they are represented is important in establishing new programs. This
anecdote would suggest that inviting the opinions of all those represented or affected by the
change is critical to their buy-in and to avoid potential conflict. When initiatives continue to
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come from leadership without the input of those affected or the systems necessary to perform the
tasks, faculty will feel unvalued, lacking representation, and unsupported. The school needs to
create committees of teachers, students, parents, staff, and more to engage the whole community
in designing, building, and developing any new initiative to ensure every voice is heard and
provided for.
Cultural setting. Leadership. The organizational influence supported self-motivated
accountability and professional development and had no formal mentoring programs. The
organization needs to provide formal or informal mentoring programs and modeling
opportunities for teachers, particularly in support of new initiatives. Mentoring and modeling
promote and support creativity and engagement (Bandura, 2005). In highlighting teachers who
are doing the work effectively and recognizing or sharing their lessons to the entire teaching
community, schools develop a cultural setting of collegiality and idea sharing (Belsky, 2012).
Teachers at Northeast Independent School recognized the benefit of mentoring and highlighted
how the organization lacks this critical piece of educator support. By establishing peer
mentoring opportunities and in creating teaching teams, the organization will provide
professional development opportunities for teachers to share and discuss practices focused on
effective lesson planning informally and during scheduled quarterly meetings. This crucial
reinforcement will not only establish a new, and seemingly welcome, cultural setting, but will
also provide knowledge and motivation influences to the faculty.
According to Moorman and Grover (2009), leaders lead not just through words, but
through their actions. They are consistent and demonstrate integrity. Moorman and Grover
continue that integrity and virtuous deeds benefit the organization and instill in followers a sense
MENTAL HEALTH GAP
131
of trust in their leaders. With consistency and integrity, there is increased buy-in, leading to
greater social capital and commitment. It follows, then, that mentoring and formal dialogue
provide teachers the trust and team buy-in necessary for organizational growth.
Future Research
The demands on teachers have changed but the approach to education has not. To
address the needs of the 21
st
century learner, it is essential to change how teachers are prepared
and to address those aspects of student learning that are increasingly better understood. Pre-
service education needs to involve more empirical evidence about student learning, teacher
training, and even strategies aimed at supporting student, and teacher, mental health. Teachers
need to be better prepared to meet the growing demands placed on youth with more empirically
backed evidence about how the brain develops and absorbs, retains, and retrieves information –
be it content, good character, or positive mental health strategies.
Unfortunately, we have no concrete strategies or techniques to effectively measure
mental illness in youth with symptoms mimicking many other adolescent diagnoses including
Attention Deficit Hyperactivity Disorder or General Anxiety Disorder. As such, education needs
to work within the parameters of what we know rather than experimenting with best guesses and
untested theories on education. Future research should include studies on identifying mental
illness in youth and better treatment opportunities, alongside how to address those needs inside
the classroom. Finally, while poor academic performance is not necessarily an indicator nor a
cause of mental illness (and vice versa), there are corollary links that still need further research.
Fortunately, some schools and state programs have begun to develop mental health curricula and
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132
future research on the impact of mental health initiatives would include a review of these
wellness education programs in the United States.
A major consideration not addressed in this study deals with the impact of the Character
Program on students themselves. A future study on the unintentional consequences of character
education would lead to more concrete conclusions about the efficacy of the program and to
what extent it unintentionally addresses student mental health, if at all. It is antithetical to think a
study of this nature can be thorough without understanding the student perspective. As one of
several limitations, ignoring the voice of the students paints an incomplete picture of the
organization and its goals, and it is worthy of its own study.
Stigma and mental health surround every aspect of a student’s life and understanding
how those elements interact will be critical to gaining a complete understanding of how students
address mental health. Future research could also include an exploration of how mental health
literacy extends beyond a student’s school day, including friends, family, and community-based
programming and parent education. Multiple studies demonstrate that youth spend more time in
school than at home (Stephan et. al, 2015; Cornelius-White, 2007; Eccles & Roeser, 2011).
However, the widely-cited Equality of Educational Opportunity (Coleman, 1966), commonly
called The Coleman Report, highlights the importance of out-of-school time on student learning
and achievement. Contemporary reports, many of which cite Coleman, identify home and
community as a more significant influence on youth behaviors than school (Greenwald, Hedges,
& Lane, 1996; Alexander & Morgan, 2016). Schools need to be creative with how they re-think
the school day. Teachers need time for peer-to-peer dialog and reflection, lesson prep, and
professional development which they do not have in the typical school schedule (Collison &
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Cook, 2001). While this study intentionally sought to understand how schools internally address
mental health, efforts to support students without understanding the impact of their lives outside
school leaves a significant knowledge gap.
A study of this nature faces many limitations, least of all attempting to generalize the
results of this very small and focused study to that of all character education programs.
Additionally, the limitations we face due to the nature of mental health make understanding how
to close the gap even more difficult. What is clear from this study, despite the limitations or
challenges, is that failing to directly address the gap in mental health treatment is akin to
avoiding treatment. Without effective treatment, suicide in youth will continue to increase
alongside substance abuse and academic difficulty.
Conclusion
Life expectancy is widely considered a key measure of a nation’s health and well-being.
Absent a catastrophic war or pandemics like World War I and the Spanish flu, downward trends
in life expectancy are alarming and indicate a potential national health crisis. Research
highlights how the United States is unique in its decline because of how mortality has impacted
youth more than any other age demographic, with drug use and suicide identified as significant
factors in the current trend (Ho & Hendi, 2018). American youth who struggle with mental
health are not living as long as their neurotypical peers (Taksler & Rothberg, 2017) and an 18-
year-old diagnosed with mental illness can expect to live nearly 30 years shorter (Jia, Zack,
Thompson, Crosby, & Gottesman, 2015). We face a national health crisis and, unless it is
addressed effectively, using empirical evidence and research, these patterns and trends will
MENTAL HEALTH GAP
134
continue to reduce life expectancy in the United States, impacting youth more than any other age
demographic. Schools provide an opportunity to address the need.
Goe, Bell, and Little (2008) identify a five-point definition for effective teaching in the
21
st
century: 1) Effective teachers have high expectations for all students and help students learn;
2) Effective teachers contribute to positive academic, attitudinal, and social outcomes for
students; 3) Effective teachers use diverse resources to plan and structure engaging learning
opportunities; monitor student progress formatively, adapting instruction as needed; and evaluate
learning using multiple sources of evidence; 4) Effective teachers contribute to the development
of classrooms and schools that value diversity and civic-mindedness; and 5) Effective teachers
collaborate with other teachers, administrators, parents, and education professionals to ensure
student success, particularly the success of students with special needs and those at high risk for
failure. Holding teachers to the measures of effectiveness according to Goe, Bell, and Little is a
proactive and applicable standard. Over the past decade, 21
st
-century learners experienced
significant increases in major psychological distress, depression, suicide, and suicide attempts
(Twenge, Joiner, Cooper, Duffy, & Binau, 2019). We have to change how and what we teach to
meet the needs of youth who face the greatest health threat to the United States since the Spanish
Flu of 1918. In focusing on being effective, teachers can adapt Goe, Bell, and Little’s (2008) list
to address mental health through: 1) helping students learn; 2) contributing to positive outcomes
for students; 3) adapting lesson planning, tracking student progress, and reflecting; 4) valuing
diversity and community; and finally, 5) collaboration. To do so, organizations need to provide
teachers with the time and resources, and ideally to explicitly teach about mental literacy that
than hope that it is a byproduct of this effective teaching.
MENTAL HEALTH GAP
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Teaching has evolved and teachers must evolve to meet the needs of our learners. Mental
illness is a familiar theme in the arts, literature, sciences, and social studies. Holden Caulfield,
Sylvia Plath, Vincent van Gogh, Ulysses S. Grant, among so many others, offer an opportunity
for dialogue, at least, or introspection, reflection, understanding, and help-seeking behaviors, at
best. However, mental health is not something that can be addressed by adding a program here
or there, especially when existing programs like Character Education are not implemented to
fidelity; it requires organizational and community-wide commitment.
MENTAL HEALTH GAP
136
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interview study. The Teacher Educator, 42(4), 289-303. Retrieved from
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Jia, H., Zack, M. M., Thompson, W. W., Crosby, A. E., & Gottesman, I. I. (2015). Impact of
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Jorm, A. F., Kelly, C. M., Wright, A., Parslow, R. A., Harris, M. G., & McGorry, P. D. (2006).
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APPENDIX A
Interview Protocol
I am conducting an evaluation of our character curriculum and the incidental
outcome of how it supports mental health. I would like to ask you some questions about
the character program and how you see it impacting the mental well-being of our
students. Before I start, here is a copy of the abstract to give you a brief overview of the
study, and a copy of the consent form which details that your involvement in this study is
entirely voluntary, and you may ask me to remove any or all of your testimony at any time.
With your permission, this interview will be recorded.
(Hit record button) Please state your name. Do I have your permission to record this
interview?
Thank you. Let’s get started.
1. In your own words, how would you define the Character Program? - Conceptual
2. Walk me through your typical dual-purpose lesson.
a. What would I see or feel? – Procedural
3. Walk me through how you get to know your advisees.
4. What role does the Character Program play in how you get to know them?
5. How do you measure student performance or advisee achievement? – Goal Orientation
6. What influences or outcomes have you seen in the boys from the program? – Utility
Value
a. Can you provide a specific example?
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b. In your opinion, what impact does the Program have on your students in your
classes?
c. What about in the long run?
d. What outcomes have you seen that you did not expect? – Metacognitive
e. In what ways do you use dual-purpose lesson plans?
i. Do you believe they are work as expected? – Procedural
7. Now, I want to gain your impression of how the school supports your work and your
feelings about that support.
8. Walk me through how the school supports your efforts to implement the program? –
Cultural Setting 1
9. Describe the trainings that have been offered to you?
a. How have you taken advantage of these offerings?
b. What sort professional development do you seek on your own?
10. What have been your feelings about the program?
a. In your opinion, does it work?
b. Why or why not? – Cultural Model 2
I want to change subjects for a second here.
11. What do you know about mental health? – Conceptual
Given what you just told me, I’d like to think about your response in the context of the
Character Program.
12. In your opinion, how does the program address the social-emotional needs of our
students, if at all? – Utility Value
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13. Can you share some ways in which you have purposefully incorporated mental health
into the program, if at all? – Metacognitive
14. How can the program be used to improve the social-emotional well-being of our students,
if at all? – Utility Value
15. Teachers are not generally seen as being the first line of defense in mental health.
However, considering how much time we spend with our students, can you tell me about
a time when you found yourself successfully supporting a student’s mental health? –
Cultural Model 1
a. Can you tell me about a time when you were unsuccessful in providing a student
with mental health support?
I just have two final questions,
16. What suggestions would you make to the school about how to improve the program? –
Cultural Setting 1
a. What would an ideal program for mental well-being look like to you?
17. Is there anything you would like to add regarding the program and mental health?
Thank you very much for your time. After I have had a chance to write the
transcript, I would be happy to offer you the chance to review the transcript and/or the
completed study. I will contact you after each stage is complete, and you can let me know
then if it is something you would like to review.
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APPENDIX B
KIPP Academies Character Growth Card
Retrieved from: Character Lab (2104) Character growth card KIPP Foundation
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APPENDIX C
KIPP Academies 24 Character Strengths
Retrieved from: Character Lab (2104) Character growth card KIPP Foundation
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APPENDIX D
KIPP Academies Seven Keys to Developing Character
Retrieved from: Character Lab (2104) Character growth card KIPP Foundation
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APPENDIX E
Personal journal of Elisif Bruun
Transcribed March, 2014 by Peter Bruun – Father of Elisif Bruun
April 27, 2005
“Okay here’s my attempt at being a girl.”
“Billy and I have a fight club… it’s great, seriously. You should try it. It’s so freeing and
fulfilling and addictive. Very addictive. Or maybe that’s just me and my addictive personality. I
am addicted to everything so easily.”
[A quotation]
“Don’t ever tell anybody anything. If you do, you start missing everybody.”
Catcher in the Rye
May 1, 2005
“Misfits concert was amazing. I should have been in the mosh pit though, I’m way too
masochistic to stay out of it. That was probably my only chance for a while to get the shit beat
out of me… seriously though, I’m so masochistic. It’s crazy.”
“It’s funny, I can’t decide if I’m depressed or not. Maybe I’m just a teenager and angst comes
with the status… I love this state of uncaring though. Love it. I would hate to live like everyone
else and caring about grades and shit. That would be terrible. I really do love this. I think. I wish
I could not care and work at the same time though life would be so much easier that way.”
May 7, 2005
“I don’t think I know how to have fun anymore. I like going to parties because I can worry about
different things than usual.”
May 15, 2005
“I feel really lame writing in this thing… I actually realized I don’t feel like writing anymore so
I’m gonna stop.”
Note on index card by Elisif Bruun to her parents
Transcribed March, 2014 by Peter Bruun – Father of Elisif Bruun
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May 11, 2006
“Hi, I’ve gone to sleep in my car so I won’t have to wake up too early to escape with it. Don’t
worry, I’m going to school tomorrow.
“PS – This isn’t destructive, I promise. It’s just the best way to get what we both want. I want
mobility and you want me to go to school on time. There’s less to distract me in my car.
“PPS – I also have my cell if you have questions.”
High School Paper on “Seductions of Crime” by Elisif Bruun
Transcribed March, 2014 by Peter Bruun – Father of Elisif Bruun
2008
“Rather than representing a criminal act as resulting from a lack of morality, Katz’s ‘criminal
project’ involves an emotional process based on personal interpretation of the common morality.
Katz proposes that this emotional process, a sort of conceptual evolution, is an integral step the
potential offender must go through in order to make the leap from non-offender to criminal. A
successful criminal project requires three individual conditions, which, when combined with the
right situational conditions, will culminate in a criminal act. The first requirement of the criminal
project is the availability of criminal opportunity. The second condition involves creating a
unique line of interpretation of the world or current situation as it relates to the subject’s sense of
self-image. The final condition is the emotional process that is catalyzed by a set of seductions
and compulsions based on the individual’s world view that interact with the subject’s sense of
self to define the moral right and wrong in a given situation. It is only after going through this
process of self-transcendence that the individual is able to carry through the act of crime.”
“Vandals and shoplifters taunt humiliation by involving themselves in action that could result in
the humiliation of being caught. For these adolescent offenders the threat of humiliation brings a
thrill to the action itself while reflecting on success after ‘getting away with it’ brings an
emotional high.”
“Those who carry out criminal acts do not have a different or lesser set of morals than law
abiding members of society, it just happens that their sense of self allows them to interpret the
same morality in a different way.”
Secret notes in journal and other material in notebook related to time spent living in
Woodstock, NY by Elisif Bruun
Transcribed March, 2014 by Peter Bruun – Father of Elisif Bruun
Fall 2012
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“Compulsive behavior – if I want something and am able to get it I will. Regardless of
consequences.”
“Physically – withdrawal, low energy, self-destructive, passive.
Mentally – mood swings, crying all the time, hate myself
Emotionally – sad all the time, guilty, depressed, etc…”
“I am still planning on getting high ASAP. Wish I weren’t but I am. That thing about not
forming close connections as a child (which I did to myself) I’m not close to any people. None.
And I don’t know how to be. The only people I’m interested in are fucked up like me. The brain
thing – I don’t get the ‘inner child’ thing.”
“Hi inner child. I don’t know if you’re still alive. I’m worried that I’ve killed you. I’m trying to
imagine or visualize you and it’s not working. I remember how excited I used to be about things
even as a teenager. I can’t remember the last time I felt like that.”
“Recovery, what a concept… my desire of certain things or not things is so much stronger than
my logic. Or I am too good at lying to myself into believing I am hurting nobody but myself.”
“Powerless – the emotions that I feel, the things I crave.”
“Gratitude List:
• Smooth withdrawal
• Love of parents
• Not having to put a lot of effort into looking good
• Natural talents
• Supportive parents in childhood
• Finances to support me medically
• Place to live
• Job I like
• Luda Cat”
“Fears:
• Success & failure
• Trusting people
• Honesty
• Letting anyone know what my real problems are
• People seeing through the persona I have been building since childhood
• Weakness
• Asking for help”
“Resentment:
MENTAL HEALTH GAP
179
Myself – for not caring
- not being motivated
- for not taking or wanting the easy path
- for hurting the people who love me most
My Parents – for caring so much about me and not letting me destroy myself
- for not believing me when I’m being honest
- for believing my lies
- for being overprotective of me when I was a child
- for loving me so much and doing so much for me”
“I feel guilty because I have lied to my parents so many times – about money, about getting high,
about how many cars I have wrecked while fucked up. They’re spending money on bullshit I told
them to cover up me getting high and I resent them for being so nice because I feel so guilty and
I don’t know how to stop.”
“I always think I can fix things later… or tell myself that anyway…”
“I.D. Feelings:
Can’t – fear, love, trust, any emotional pain
Can – guilty, lonely”
“Guilt – losing mom’s trust
- stealing from my parents and lying about it (didn’t think they’d notice)
- selling my stuff that was given by people I love
- lying about getting high
- repeatedly losing my independence due to drugs
- undeserved trust from dad”
“I’m afraid of emotions. I’m afraid of caring for something because I might lose it.”
“I haven’t let anyone or anything close. I’m afraid to have goals in case I don’t reach them, or if I
do, what then?”
Notes on workbook from St. Joseph’s Rehabilitation and Care Center by Elisif Bruun
Transcribed March, 2014 by Peter Bruun – Father of Elisif Bruun
October 2013
“Validate self:
1 – not get high
2 – not thinking how much I want to get high
3 – meditate
4 – workout
MENTAL HEALTH GAP
180
5 – hangout in sauna
6 – figure out the difference between who I am/want to be and who I think I am and make them
match
7 – hangout outside
“Friends and Family:
1 – going to rehab
2 – keeping in touch with family
3 – trying not to manipulate anyone anymore
4 – saying “I love you”
5 – express gratitude
6 – try to have a relationship w/ sisters
7 – invite people to do stuff besides get high
8 – try to learn more about people
“Creating validation (at St. Joseph)
1 – going to class even though I feel shitty
2 – drinking sippy bottle
3 – not looking for ways to cause trouble or break rules
4 – trying to do things that make me feel better
5 – let people tell me what to do
6 – stay upbeat with others here
7 – focus on future not past
8 – make effort to connect with people”
Answers to worksheet from St. Joseph’s Rehabilitation and Care Center by Elisif Bruun
Transcribed March, 2014 by Peter Bruun – Father of Elisif Bruun
2013
“If I have nothing I will have nothing to lose; security in emptiness.”
[Question: Can you identify any wounds to your Fire Element?]
“Lifelong certainty that I will die young.”
[Question: Can you identify any wounds to your Water Element?]
“Shock, trauma, devastation, exhaustion, grief; car accidents, having diabetes as a child.”
[Question: How do your feelings influence your feelings of intimacy?]
“Guilt or being afraid to trust people, or being afraid of hurting or getting hurt. I feel like I don’t
matter to people but then I keep them at arm’s length to make sure that is true.”
[Question: How do you feel about the [aftercare] option you are considering?]
MENTAL HEALTH GAP
181
“Ambivalent – don't want to waste my time and my parent’s money going thru another long-term
rehab experience if it’s not going to work.”
[Question: Are there any conflicting feelings within you?]
“Yes. I still love heroine. I just hate everything that comes with it. I’m definitely afraid of
success because without chaos and trouble in my life I have nothing to run away from so how
will I know where to go?”
[Question: Are the positive feelings strong enough to help you achieve the desired outcome?]
“Not sure.”
[Question: How will [aftercare] work?]
“My nature has always put me into pain and trouble. Voluntarily going to aftercare is going
directly against my nature so theoretically should lead me the opposite direction.”
[Question: What is your plan?]
“Take one day at a time.”
[Question: Are you ready to take the next step?]
“It’s that or slow, painful suicide by dope.”
[Question: Describe the state of your reasoning mind?]
“I use it to justify poor decisions instead of using it to make good decisions – decide then come
up with an excuse vs. thinking before I act.”
[Question: How does your Intuitive Mind contribute to the use of your will?]
“It tells my will what I should do, then my reasoning mind makes up reasons to do what I feel
like doing.”
Triggers worksheet from St. Joseph’s Rehabilitation and Care Center by Elisif Bruun
Transcribed March, 2014 by Peter Bruun – Father of Elisif Bruun
(Unknown Date)
“External triggers - see:
- veins
- Dunkin Donuts
- Hannafords
- Gas stations
- Walgreens/Rite Aid
- Parking lots
- Wal-Mart
External triggers – hear:
MENTAL HEALTH GAP
182
- flicking needle sound
- spoon on table sound
- rap music
External triggers – touch:
- veins
- wax paper
- plastic baggies
- gum wrappers
- cellophane
- cigarette filters
People: “Everyone I know.”
Places:
- Resiterstown Rd.
- Kingston, NY
- Oldtown, ME
- Kensington in Philly
- West Baltimore, MD
- Poughkeepsie, NY
- Woodstock, NY
- Roxbury, Boston, MA
- West Palm, FL
- North Lake, FL
Times: “All day, every day.”
[Question: What emotion do you associate with using?]
“Pain”
(Question: Discuss the circumstances under which you have impulsive behavior?]
“Pain”
[Question: What makes it difficult to exercise self-control?]
“Pain”
[Question: Name any important events that have caused emotional wounding?]
“My belief I could die at any moment – so why worry about the future?”
[Question: What I need to move toward]
“Friends who do not share my weaknesses.”
Only checked box on worksheet with 15 options of defense mechanisms:
“Compartmentalization: is a lesser form of dissociation, wherein parts of oneself are separated
from awareness of other parts and behaving as if one had separate sets of values. An example
MENTAL HEALTH GAP
183
might be an honest person who cheats on their income tax return and keeps their two value
systems distinct and un-integrated while remaining unconscious of the cognitive dissonance.”
MENTAL HEALTH GAP
184
APPENDIX F
Selection of art work by a teenager with depression, ADHD, and bipolar disorder; accompanied
by reflections of her father after her death from a drug overdose.
Elisif Janis Bruun
Untitled
Magic Marker, early 1990s
“Elisif as a little girl created all the time in all sorts of ways: she drew, sewed,
constructed, came up with endless stories and imaginary games. Her two younger sisters, once
old enough, were also always in on the act. Elisif was the eldest, and in many ways the role
model in the family. Diagnosed with juvenile diabetes at age 6, she was undeterred in grabbing
life with both hands. When she decided she’d never cry again at age 7 (‘crying is for babies’),
and stuck to that, it was eyebrow raising for us, but she was so normal and well-adjusted and
excelled in so many parts of life seemingly happily that we did not give it as much thought as
hindsight suggests we should have.”
MENTAL HEALTH GAP
185
Elisif Janis Bruun
Untitled
Oil, 2006
“Through early high school, Elisif did well academically, always had a small but tight
group of good friends, and excelled at all things visual arts. As an artist myself, I connected
closely with Elisif on this aspect of her identity. Though hugely experimental with almost any
media, she also had ‘chops’ academically, able to render in lifelike realism with the best of
them. This oil paint study was completed between 11
th
and 12
th
grade, when Elisif took a
portfolio development course at MICA. Her comfort and confidence in rendering and handling
oil paint is abundantly clear. At this point, we knew she was drawn to alcohol, but had no idea
how much she actually had begun drinking heavily.”
MENTAL HEALTH GAP
186
Elisif Janis Bruun
Untitled
Vine Charcoal, 2006
“Anyone who has ever been in MICA’s main building on Mount Royal Avenue is likely
to immediately recognize this marble stairway in the grand entrance lobby. Not intimidated by
its swooping majesty, Elisif captures the way in which hit flows into the space. Her pleasure in
engaging with the visual world – and interpreting it – is clear in this drawing. Note how even in
a realist work she plays up and plays down certain aspects (darker on the steps; lighter on the
surrounding architectural features), and feels free to distort form for expressive purposes. In all
aspects of life, she knew what interested her, and disregarded the rest. Always.”
MENTAL HEALTH GAP
187
Elisif Janis Bruun
Self-Portrait
Oil, 2006
“Also completed during a summer portfolio development course at MICA between
Elisif’s 11
th
and 12
th
grade years, this painting reveals much of Elisif’s affect at the time. On the
one hand, she looks out at the viewer, almost with a confrontational gaze. On the other hand,
that gaze is invisible, hidden behind the mirrored sunglasses she often sported. The blue of her
hair in this painting is not an abstraction but rather a true rendering of the blue of her hair; Elisif
dyed her hair different vibrant colors almost monthly for a time. So here we have her:
seemingly fully present, engaged, but also hidden from view. So much of Elisif (we did not
realize at the time) was persona… persona of invulnerability covering up a never- dealt-with
sense of vulnerability stemming from that early childhood diagnosis of diabetes (or so I have
come to believe).”
MENTAL HEALTH GAP
188
Elisif Janis Bruun
Untitled
Charcoal, 2005
“I believe it was between 10
th
and 11
th
grade that Elisif traveled on one of those
spectacular study abroad opportunities afforded those with the financial wherewithal to pay for
it. In this case, it was an art making and art viewing several weeks-long trip to Oxford,
England, Paris, France, and Florence, Italy. This focused and intimate charcoal drawing made
in Oxford speaks to Elisif’s native talent: note the brilliantly rendered sunlit bench, and the
unconventional composition so clearly decided upon (versus accidental). We received post
cards from Elisif, where she complained of terrible insomnia. We were concerned about her
sleepless ways, and just beginning to become aware of her having ADHD, but really thought
little of it. Too little: she was doing so well in so many other ways.”
MENTAL HEALTH GAP
189
Elisif Janis Bruun
Untitled
Watercolor & Ink 2005
“Elisif rarely worked in watercolor, but one would never think that from the mastery
displayed in this simple sketch, made by Elisif in Paris during a summer abroad study program
between 10
th
and 11
th
grade. Note how quick, confident, and dead-on each watercolor mark is,
especially in shaping the carousel and space around it, all free of preliminary pencil marks: this
is drawing on a tightrope without a net. And as a final demonstration of vision and confidence,
she draws right over her watercolor with fearless lines of ink, rendering the three trees in the
foreground. This final bold move makes the drawing. Shortly after this was completed, she was
caught drinking with a classmate at a Parisian bar, and sent home, never making it to the
Florence part of the program. Disappointed and angry at her? Yes. Fearful for her life? Not at
all. At the time, we chalked it up mostly to youthful indiscretion.”
MENTAL HEALTH GAP
190
Elisif Janis Bruun
Untitled
Oil, 2006/2007
“I’ve come to think of this painting by Elisif completed her senior year of high school as
her Utopian vision for how the world could be, or perhaps even was for her at certain times:
friends in congenial fellowship, at ease with one another, each engaged in a personally
engrossing activity; hanging out in comfort. But at the time this painting was made, things were
changing for Elisif. She had given up her old tried, true, and loyal friend group, and had started
spending time with peers we never really got to know or much less meet; her laissez-faire
academic attitude began to catch up with her, as we began to get notifications of concern from
teachers; she herself seemed somewhat more aloof, less interested in the things she used to be
interested in. But still, no overt signs to alarm us: she always remained pleasant to be with,
seemingly honest, and at this point still highly achieving in art. One downside of being the
parent of an incredibly bright child: she is better at playing you, and you are too easily taken in.
She kept well hidden feelings and behaviors that were they more visible would have been
obvious cries for help.”
MENTAL HEALTH GAP
191
Elisif Janis Bruun
Untitled (three drawings from a handmade artist book)
Charcoal and Pastel, 2007
“Almost all of Elisif’s art in this exhibition are from her high school days, this series of
drawings no exception. Partly out of her own interest, but certainly also a product of seeking to
please me (her artist father), Elisif applied to Cooper Union, one of the most competitive art
colleges to get into. The application process is unique: applicants are given a five-artwork
assignment to be completed and mailed in by a certain date. In the handmade artist book Elisif
made in response to one of the assignments, she reveals much about her not revealing much. A
sequence of drawings where she presents herself as shrouded behind and within a blanket: she
is there, but she is not. In many ways, this sequence of drawings echoes the blue-haired self-
portrait also in this exhibition. Upon Elisif’s passing, I found in one of her journals from rehab
the following expressed fear: ‘that people will see through the persona I have held on to for
years.’ (Elisif fell asleep the night before the Cooper Union admissions portfolio was due to be
postmarked, the fifth and final assignment incomplete at her side.)”
MENTAL HEALTH GAP
192
\Elisif Janis Bruun
Untitled
Pen and Ink, 2009
“Elisif attended the Museum School of Fine Arts in Boston for college, and did not like
it. I do not know to what extent that had to do with the school, or what by then had become a
growing addiction to substances. At any rate, by spring of sophomore year, she had dropped
out, much to our confusion and consternation (how easily parents don’t see what ought to be
abundantly obvious). It was not until her youngest sister came to us with the truth of Elisif’s
addiction to opiates in spring of 2009 that everything became clear: all the slipping and sliding
and failure to launch made sense in one anguishing moment of revelation. An intervention and a
few days later, Elisif is in rehab (as her drawing boldly proclaims). In the five years Elisif lived
with addiction, her art output diminished to an irregular trickle; in her senior year of high school
she produced more work than she did in the subsequent 7 years. But even in this image
(fundamentally no more than a doodle), we see alive her sense of play and adventure, and eye
for improvisation and composition. She was truly touched with fire.”
MENTAL HEALTH GAP
193
Elisif Janis Bruun
Untitled
Gouache, 2012
“Following a 30-day treatment program and 7-months of aftercare in a program in
Florida, Elisif spent the next several years not quite getting it together. In that time, she stole
from us (her family), crashed several cars (never always with permission to drive them), lied
chronically, and continued using drugs, moving on to shooting up with heroin, though we don’t
know when exactly that happened. At times, we would invite her under our roof; at times not.
Diabetes made any absolute shutting her out (when that otherwise might have been the healthiest
option for all) difficult at best. She almost died several times, be it from drugs or diabetic shock,
or another diabetic complication called ketoacidosis. This drawing was made in summer 2012,
when I had encouraged Elisif to make ‘tourist art’ for Martha’s Vineyard vacationers. Anxiety
overtook her in the few days she was there, and she completed only three drawings. By this time,
it had become clear that anxiety and depression were underlying conditions to her addiction.”
MENTAL HEALTH GAP
194
Elisif Janis Bruun
Self-Portrait
Charcoal and Pastel, 2014
“This drawing was completed 22 days before Elisif died of a heroin overdose. As far as
I know, it was the last work of art she ever made (and that she made it is a gift).
Look at this drawing: she presents herself almost as a child, wide-eyed, not hidden, and
innocent. She looks sweet, young. At the time she made it, she was in her third month at
CooperRiis Healing Community in North Carolina, there after one last breakdown (her
boyfriend arrested for burglary; Elisif broke and homeless). Elisif had come to CooperRiis
having declared (finally): ‘Every time I make my own decisions, it leads to pain and trouble; the
one thing I haven’t tried is letting others make decisions for me. I’m ready for that.’ And she
was. She was working her recovery, uncovering underlying unprocessed trauma from living
with diabetes, genuinely grappling with her mental health and substance use disorders. And
then something triggered her, she relapsed, she used, she died. Such can be the way with
addiction, especially with opiates
MENTAL HEALTH GAP
195
Abstract (if available)
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Crosby, John (Jay) Player
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Core Title
Addressing the mental health care gap in American youth: an evaluation study of character education
School
Rossier School of Education
Degree
Doctor of Education
Degree Program
Organizational Change and Leadership (On Line)
Publication Date
08/01/2019
Defense Date
08/15/2019
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Tag
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