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Mental Health First
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Mental Health First
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Content
1
Final Draft of Capstone Proposal- Mental Health First
Elizabeth Rendon
In Partial Fulfillment for the Degree
Doctor of Social Work
Suzanne Dworak-Peck School of Social Work
University of Southern California
August 2020
2
Contents
Executive Summary 3
Conceptual Framework 4
The Grand Challenge and the Problem 4
Research Assessment 5
Factors that hold the problem in place 6
Addressing Racial Injustice and Sexual Identity Discrepancies 8
Social Significance 9
Theory of Change 12
Logic Model 13
Problems of Practice and Innovation 15
Proposed Innovation 15
School-based therapists 15
Response to intervention 17
Bringing additional professionals into the school setting 19
Connecting the Innovation with the Grand Challenge 20
Stakeholder Perspective 20
Evidence to Support the Treatment Environment 23
Overall Likelihood for Success 24
Project Structure, Methodology, and Action Components 25
Prototype Overview 25
Market Analysis 26
Involvement of Stakeholders and Essential Constituencies 28
Financial Plan 28
Assessment of Impact 30
Quantitative data 31
Qualitative data 32
Communication Strategy 32
Ethical Concerns and Possible Negative Consequences 34
Conclusions, Actions, and Implications 34
Vision for the Future and Implications for Practice 34
Limitations and Barriers 35
Advancing Next Steps 36
Conclusion 36
References 37
Appendices 45
3
Executive Summary
Youth are not having their mental health needs met in an effective and efficient way
which results in a negative impact on their overall development. Eighty percent of the youth in
the United States who are in need of mental health treatment do not obtain it (Youth, 2019).
Without being able to access the help they need, youth spiral downward. These untreated youth
often end up without a high school diploma, unable to secure a job, homeless, or in the welfare,
medical, or justice systems (Bowman, McGorry, & McKinstry, 2016). The social problem of
inadequate access to mental health treatment for youth is one that desperately needs to be
addressed.
There are several barriers in place that prevent youth from accessing treatment including
stigma around mental health care, absence of parental support, financial limitations, and a lack of
quality providers. The proposed solution to this problem titled, “Mental Health First” is a state-
of-the-art framework that provides early identification and treatment for youth in need through
the implementation of a new system within the public-school setting. Mental Health First is
comprised of three essential components: employing an appropriate number of school-based
therapists, utilizing a reconceptualized version of the current Response to Intervention model,
and bringing community-based therapists along with virtual psychiatrists into the school setting
to provide services on a regular basis.
The first step of implementation is for schools to be properly staffed with mental health
professionals. The current recommendation by the National Association of School Social
Workers is for the average school to employ one full time mental health professional for every
250 students (Willingham, 2018). Many schools across the United States do not meet this
criterion. It is typical for schools to have one full time therapist for up to 1,000 students or more
4
with some districts failing to employ any therapists at all (Carrell, 2006). In order to provide
caseloads that can be effectively managed and proper implementation of Mental Health First,
schools must hire adequate numbers of school-based clinicians.
The next implementation step is for schools to employ a modified version of the research-
based Response to Intervention (RTI) model. This model provides a multi-tiered framework for
both academic and behavioral interventions utilizing evidence informed disciplines (Constable,
Kelly, & Massat, 2016). The RTI model was initiated in 2004 and is currently apprised of three
tiers (Cheney, Flower, & Templeton, 2008). The proposed modified version of the RTI model
adds on an additional tier: tier four. The top two percent of students who have the most intensive
mental health needs within the school would make up this tier.
The final step of implementation would require a community-based therapist to come into
the school setting on a regular basis to work with the identified students with tier four needs. The
treatment could include individual therapy, family therapy, group therapy, and/or virtual
psychiatric care. The length and mode of treatment would be individualized based on data
collected to determine progress and student needs. This program bridges the gap between school
and community therapists and ensures that students have access to mental health services.
Conceptual Framework
The Grand Challenge and the Problem
The 13 Grand Challenges identify the leading problems in today’s society. The
introduction of these challenges transformed the social work profession along with social work
education. The unveiling of the Grand Challenges marks a critical moment in the profession of
social work; they were launched with the goal of improving humanity for all and establishing an
5
enhanced quality of life for our world (Williams, 2016). This paper will focus on the first of the
13 Grand Challenges; Ensuring the Healthy Development of All Youth.
Ensuring the Healthy Development of All Youth is a crucially important challenge; the
objective of this challenge is to protect our youth and the future of our society is this challenge’s
objective. It seeks to address the issues of addiction, regulating emotions, participation in risky
behaviors, and mental illness (Jenson & Hawkins, 2018). Youth are generally ill equipped to
manage these issues resulting in a grave impact on their advancement as productive members of
society. Another goal of this Grand Challenge is to advance behavioral health efforts and address
socioeconomic and racial inequalities in young people (Uehara et al., 2017). These inequalities
frequently leave children with an increased susceptibility to mental illness, behavior difficulties
and likelihood to engage in risk taking behaviors (Denois et al., 2018). The problem is that
youth do not have access to mental health services in an effective and efficient way. The fact
that youth do not have adequate access to services and treatment in the areas of social/emotional
and behavioral health in a timely manner, further contributes to the problems that the established
Grand Challenge set out to address.
Research Assessment
Further examination of the identified problem reveals the magnitude of the demand to
address it. Half of all lifetime cases of mental illness begin before the age of 15 (National
Alliance of Mental Illness [NAMI], 2019). Even though 50% of young people start to
experience evidence of mental illness at a young age, they fail to access treatment in a timely
fashion. The average length of time between the start of mental illness symptoms and the
beginning of treatment is 11 years (NAMI, 2019). Current efforts to address this problem are
not working. In 2017, the average length of time between the start of symptoms and the start of
6
treatment was nine years marking a two-year increase and illustrating that the problem is getting
worse not better (NAMI, 2018). This means that on average a 10-year-old who begins to suffer
from a mental illness will not receive any treatment until they are 21 years old. Before
addressing the problem, it is important to further understand the factors that prevent youth from
accessing the treatment they need.
Factors that hold the problem in place. There are several factors that hold the problem
of youth not having access to treatment in place. The major obstacles that prevent youth from
obtaining services are stigma, finances, lack of parental support, and shortage of providers. It is
essential to take a closer look at each of these barriers and the role they play in the identified
problem.
The stigma around seeking services and treatment is a major social norm that contributes
to the problem. According to research reviewed by Sumskiene (2017), there is a compelling
pervasiveness of stigmatization at each and every stage of seeking mental health care. There is a
dominant, informal, and invisible shared code in society affirming that if a person needs mental
health services, they are ill-equipped to manage problems on their own and that they are weak.
Additionally, the same message is reflected towards the individual’s family whom are often
looked down upon and blamed for their children’s mental health issues. It is common for
families to be shamed by others for not being able to solve problems independently; this further
discourages parents from recognizing and discussing their child(ren)’s mental illness (Lambert,
2018). The invisibility of mental illness further perpetuates the stigma because it cannot be seen
like other illnesses or physical injuries. People whom are suffering from a physical illness are
much more likely to pursue assistance while people with a mental illness more frequently feel
like seeking help is unnecessary (Wharton 2015). If a person were experiencing an issue with
7
their heart, they would be encouraged by their family to seek medical attention. Yet when a
person is experiencing mental illness, they are more likely to be discouraged from seeking
treatment due to the powerful stigma surrounding mental illness. Instead, when it comes to
mental illness there is an underlying message that individuals can choose to just “get over” it.
Families and young persons who manage to look past the stigma surrounding mental
health services are often met by other hurdles that prevent them from accessing the treatment
they need. Data was collected through the use of a survey by Hansen and Diliberti (2018); the
survey sought to identify the barriers that prevent youth from accessing mental health services
and it resulted in the identification of three major barriers: financial constraints, unsupportive
parents/guardians, and lack of qualified service providers. Seventy-five percent of survey
respondents named lack of funds as a major obstacle to procuring treatment (Hansen & Diliberti,
2018). Finances are often a limited resource for families; they have to make arduous decisions
on how to allocate their earnings. For families who are struggling to make ends meet, this is an
especially difficult decision. A study conducted from 2008-2012 revealed that 52% of families
identified monetary constraints as their reason for not accessing mental health services (Kamal,
2017). If families have to choose between meeting their basic needs such as putting food on
their table and keeping their lights on or paying for therapy, they will understandably choose to
meet their basic needs and forego the therapy.
Another obstacle preventing youth from accessing vital treatment is lack of parental
support. Seventy-one percent of survey respondents identified the absence of parental support as
a major barrier to accessing mental health services (Hansen and Diliberti, 2018). A parent’s
mental health status plays a critical role in weather or not they are able to meet their child(ren)’s
mental health needs. Fifty-nine percent of young people with a mental illness have at least one
8
parent with a mental illness (Foster, McPhee, Fethney, & McCloughen, 2016). Parents who are
dealing with their own mental health deficits frequently find themselves overwhelmed, and left
with reduced energy and a decreased capacity to assist their child(ren) in accessing the therapy
they need. Understanding the parallel relationship between a parent’s and a child’s mental
health status helps to understand and explain why there is a lack of parental support around
seeking treatment.
Even when parents can overlook the stigma, allocate the funds for treatment, and manage
their own shortfalls, they are still faced with challenges to accessing services. The third greatest
identified barrier according the survey by Hansen and Diliberit’s (2018) is the scarcity of
available qualified mental health providers; 64% of respondents identified this as an obstacle.
There is a colossal shortage of resources for youth in need of mental health treatment across the
country (Gross, 2015). Families who receive state medical insurance have an especially difficult
time accessing resources; these families are often placed on lengthy waitlists or never receive
treatment. Research conducted by the California Health Care Foundation concluded that there is
a decrease in the number of mental health professionals and an increase in the number of
individuals in need of care (Rinker, 2018).
Addressing Racial Injustice and Sexual Identity Discrepancies
It is essential to view the problem through the lens of racial injustice and discrepancies in
sexual identity in relation to mental health issues. Even though youth from non-white ethnic
groups are more likely to have a mental health condition, they are less likely to receive treatment
than their white counterparts (Garcia et al., 2019). Cultural discordance identifies that Non-
Hispanic whites are most likely to receive treatment compared to groups from other ethnic
backgrounds; at a rate of 49%. Thirty- two percent of Hispanics or Latinos with mental illness
receive treatment while 31% of struggling Non-Hispanic mixed/multiracial individuals access
9
treatment. Comparatively, 30% of African-Americans and 24% of Asians who are faced with
mental health issues receive treatment (NAMI, 2019). Treatment disparities are also present
among Lesbian, Gay, Bisexual, and Transgender (LGBT) youth; these youth are more likely to
struggle with partner violence, being bullied, depression, and suicidal thoughts (Attebaerry-Ash
et al., 2019). Forty-eight percent of LGBT individuals that struggle with mental health receive
treatment (NAMI, 2019). Youth from all backgrounds need and deserve to have equal access to
treatment.
Social Significance
The problem of youth not being able to access the mental health care they need is socially
significant, important to real people, and has applied implications due to its effect on not only the
youth that go untreated but on the other systems that they impact. The unmet mental health
needs of young people result in additional unwanted ramifications that should be considered.
There are multiple negative consequences when adolescence do not have their mental health
needs met. It negatively affects their physical and mental health, ability to be successful,
happiness, and overall quality of life. Young persons are more prone to making unhealthy
lifestyle choices, feeling worthless, and not performing well in school (Kids’ Mental Health,
2019). As they get older, these children are more likely to engage in risky behaviors and make
poor decisions in their adolescent years (Remschmidt, 2007). Individuals that struggle with
mental illness, will continue to have a difficult time as long as their mental health needs do not
get resolved (Souers & Hall, 2016). The problem of unmet childhood mental health issues
doesn’t’ go away; it is compounded as a person ages often leaving struggling young people
having thoughts of suicide and/or being a part of other systems such as our medical, justice, or
homeless population.
10
Elevated rates of depression coupled with the high probability of not accessing mental
health treatment frequently results in suicidal ideations as these struggling youth search for a way
to cope with the intense feelings of solitude and hopelessness they are facing. Sixty-two percent
of young people who meet the criteria for major depression do not receive any mental health
treatment (NAMI, 2019). During the time they are not receiving treatment, their symptoms
increase, they display poor judgement, and their decision-making skills become clouded or non-
existent. Over 90% of juveniles who die by suicidal means have displayed symptoms of a
mental health condition (NAMI, 2019). The increasing number of youths who are suffering from
unmet mental health needs without receiving proper treatment is resulting a rise in suicide rates
nationwide. In the United States, suicide rates have increased at a rate of two percent each year
(Kamal, 2017). Suicide marks the second leading cause of death for individuals between the ages
of 10 and 34 (NAMI, 2019). Society’s youth are killing themselves because their needs are not
being met; these untreated mentally ill youth do not see another way out.
When young people do not access needed mental health services, their symptoms worsen,
they find themselves in a crisis situation, and they saturate the medical system in search of
assistance. There is a steady increase in the number of parents coming to the hospital emergency
room (ER) in search of treatment for their child’s mental illness; a 25% increase in the number of
youths going to the ER in search of mental health treatment between 2012 and 2016 was
recorded (Newman, 2018). Hospitals are not adequately staffed nor equipped to meet the mental
health needs of the elevated number of individuals seeking treatment from them. Eighty-six
percent of hospitalized adolescents meet the criteria for one or more diagnosable mental illness
(Atkins et al., 1999). Additionally, individuals seeking assistance through the medical system
are not able to obtain the services that they are in desperate need of. Typically, emergency room
11
physicians who are treating individuals for a mental health issue screen them for immediate
suicidal and homicidal thoughts keeping them there until they pass the screening and then they
will discharge them with a referral to follow up with their primary care physician (Novotney,
2018). Youth experiencing a mental health crisis and seeking services through the medical
system wind up with a referral to another provider where the previously identified obstacles to
treatment (funding, lack of support from parents, and scarcity of providers) continue to prevent
them from obtaining the help they need. This is a vicious ineffective cycle and not a feasible
solution.
The juvenile justice system is also overloaded with young people who are grappling with
mental illness and not receiving treatment. In fact, it is more probable that youth who are
battling mental illness will end up in the justice system than any other system. The Treatment
Advocacy Center revealed that an individual who is struggling with an acute mental illness is
five times more likely to end up in the justice system than in the medical system (Gross, 2015).
The National Alliance on Mental Illness (2019) completed a research study of inmates in the
juvenile justice system; the results revealed that 70% of incarcerated youth had at least one
diagnosable mental illness. Similar to our medical system, our justice system is not set up to
handle the needs of these youth who continue to contend with mental health issues while
imprisoned and upon their release. Instead, these mentally ill youth return to society after
serving their sentence, but they soon return back to the justice system without ever receiving the
treatment they so desperately need. Half of all youth who are released from the juvenile justice
system are reincarcerated before their 18
th
birthday (The National Reentry Resource Center
[NRRC], 2018). After they turn 18, there is a high likelihood that these same youth will be jailed
as adults. Furthermore, adults who are released from the prison system experience recidivism
12
rates that are even greater than those of juveniles. Across the nation, 83% of adults who are
released from prison are reincarcerated (National Institute of Justice, 2019). Individuals that do
not access needed mental health services are often stuck in the justice system cycle and are left
without receiving the treatment that they are in serious need of.
Individuals with a psychiatric condition are not only more likely to commit suicide, seek
help through the medical system, and be incarcerated; they are also at an increased risk of
homelessness. Mental illness is the third leading cause of homelessness across the nation
(National Coalition for the Homeless, 2009). Without a high school diploma and often limited
coping skills, mentally ill persons frequently end up living on the streets. Approximations range
from 33% to over 50% of people who are both habitually homeless and suffering from a severe
mental illness (Treatment Advocacy Center, 2018). This further illustrates the applied
implications and the need for improved interventions to address and treat youth mental illness. If
youth were able to access treatment early on, they could avoid ending up in other systems.
Theory of Change
Systems Theory can be used to identify how the problem impacts various components of
the complex school system. Systems Theory explains that the system as a whole is greater than
the sum of its individual parts. Altering one part of the system can have a ripple effect
throughout the entire system resulting in both anticipated and unanticipated consequences on the
system as a whole. Considering the identified problem using systems theory, it becomes
apparent that when youth are dealing with undiagnosed and untreated mental health conditions it
has a negative impact on other parts of the school system. The school system plays a major role
in a young person's life because this is where they spend a majority of their time. Youth who are
struggling with mental health deficits are more likely to demonstrate inappropriate behaviors and
13
earn failing grades in school which negatively impacts school achievement, teachers, students
and the overall school climate and in turn their community. Likewise, when youth have their
mental health needs met it can be beneficial to their own lives, various components of the school,
as well as the system as a whole. These youth are more likely to demonstrate appropriate
behaviors, earn passing grades, and have a positive impact on school achievement, teachers, their
classmates, and the overall school climate which in turn can positively affect the community.
By improving access to mental health services for our youth, a positive ripple effect can
be created to impact each of these parts. Systems theory is not a perfect fit for the intervention,
this is because while the new program could show a correlation between its implementation and
a positive impact on the system as a whole, it is not possible to show direct causality of these
results. A logic model has been developed and will subsequently be reviewed to provide details
on how the proposed project can impact the school environment on various levels connecting
systems theory to the innovation.
Logic Model
The objective to Ensure the Healthy Development of All Youth can only be met if young
people have adequate access to mental health care services in a timely and effective manner.
Clearly there is a need for the creation and implementation of an improved system to do so.
Making counseling services more accessible begins with rethinking how youth are initially
identified for treatment. Early identification is an essential determinant to successful treatment.
Following the timely identification of youth in need, it is imperative that a streamlined process to
access the treatment exists while the previously discussed barriers that contribute to keeping the
problem in place are diminished.
14
A logic model that clarifies that Systems Theory can be employed to delineate the desired
long-term goals of the new system and then work backwards to highlight the medium and short-
term goals of the project along with its outputs and inputs effecting the system as a whole on
many different levels. The long-term goals of a new and improved system are to decrease crisis
calls, self-harm, and suicide rates, reduce the number of youths with mental health needs in the
medical, justice, and homelessness systems as well as decrease alcohol and drug use as a form of
self-medication. Medium- term outcomes include improved school performance in the areas of
academics, graduation rates, attendance, and behavior since there is a correlation between mental
health and school performance which will subsequently be discussed. Short-term expectations
are to increase the number of youths who receive mental health services, show a marked
improvement according to the evaluation tool that will be utilized, improvements in the results of
the universal social/emotional screener, and secure positive feedback about the new system from
participants and stakeholders.
While details regarding the new system will be made clear in the subsequent section of
the paper, the logic model emphasizes that the outputs have a direct influence over the outcomes.
The project’s outputs identify the following stakeholders: children, parents/guardians, school
staff, community-based therapists, virtual psychiatrists, and county health departments. These
participants will depend upon school-based therapists to identify the youth with the most
intensive need, community mental health professionals and psychiatrists to provide care, and
children and their families to engage in treatment as active participants. These stakeholders are
a vital resource along with physical space and funds to support the program’s implementation. A
detailed illustration of the logic model representing this Theory of Change can be found in
Appendix A.
15
Problems of Practice and Innovation
Proposed Innovation
The urgent need to improve access to mental health services for youth with a new
innovation is clear. The proposed solution titled “Mental Health First” is a new system to better
meet the mental health needs of youth by providing early identification and streamlined
treatment through the public-school system. Mental Health First bridges the gap between school
and community based mental health providers to ensure that they are working together to meet
the mental health needs of youth in an efficient and effective way.
With Mental Health First, the school-based therapist is responsible for utilizing data-
based decision making and research-based interventions to identify the top two percent of youth
with the most intensive mental health needs. The community-based therapists’ responsibilities
are to provide services to the identified youth within the school setting. These services could
include individual counseling, family therapy, and or tele-psych treatment. The recommended
program is comprised of three essential components: employing an appropriate number of
school-based therapists, utilizing a modified version of the current Response to Intervention
(RTI) model, and bringing community-based therapists and virtual psychiatrists into the school
setting to provide services on a regular basis to identified students. Each of these components
will be explained and discussed in the next several pages of this document.
School-based therapists. The first step of implementation is for schools to ensure that
they are properly staffed with mental health professionals. As previously discussed, The National
Association of School Social Workers recommends that schools are staffed with one full time
mental health professional for every 250 students (Willingham, 2018). However, many schools
across the country fail to meet this recommendation. It is common for schools to employ one
16
full time therapist for up to 1,000 students or more with some districts failing to hire any social
workers at all (Carrell, 2006). A report compiled by The National Association for College
Admission Counseling and the American School Counselor Association compiled was released
to advocate for additional funds to employ, develop and supply additional school counselors
within the public education system (National Association for College Admission Counseling
[NACAC], 2016). It is essential that schools are adequately staffed with mental health
professionals so that they are able to devote time to their role in implementing Mental Health
First.
School based therapists have many responsibilities including: providing staff trainings,
coordinating school wide interventions, meeting IEP minutes, and running social emotional
instructional groups for students with less intensive needs. It is not possible for school-based
therapists to meet these requirements and also provide intensive interventions for children and
their families. Schools that fail to properly staff themselves with the appropriate number of
mental health professionals have staff with caseloads that are unmanageable resulting in
ineffective, disjointed services (NACAC, 2016). With the proposed innovation, a school
therapist would additionally be responsible for implementing a data-based decision process to
screen all students and identify the top two percent of students with the most intensive mental
health needs.
To identify the students with the most intensive mental health needs they will compile
various school wide data by noting the students with the most absences, the lowest grades,
frequent behavior referrals, and teacher input through the use of the school wide universal
screener and face to face communication. The school-based therapist will correlate all of these
data sets and use their clinical skills to identify the students that are most at risk and in need of
17
mental health intervention. The hiring of an adequate number of school-based clinicians is
imperative to ensure that their caseloads remain manageable allowing them time for the proper
implementation of Mental Health First. The new proposed system first requires that school
districts hire an adequate number of therapists based on the population of their district.
Response to intervention. The next implementation step is for schools to employ a
reconceptualized version of the research-based Response to Intervention (RTI) model. In 2004,
the present RTI model was initiated in schools succeeding revisions to the Individuals with
Disabilities Education Act (Cheney, Flower, & Templeton, 2008). This design utilizes evidence
informed practices providing a multi-tiered framework for both behavioral and academic
interventions (Constable, Kelly, & Massat, 2016). RTI is a school-wide structured model that is
based on research and data to provide each individual student with the proper level of support
they need to ensure that they attain their highest level of achievement (Constable, Kelly, &
Massat, 2016). Mental Health First reconceptualizes the current RTI model producing a new
innovation to best meet the mental health needs of youth.
Figure 1 represents the current three-tiered RTI model being used in schools across the
country. The image in figure one depicts the three tiers along with the percentages of students
who with the proper support are successful at each tier. Tier one curriculum is provided to all
students in the school building and 80% of these students will be successful without the need for
additional interventions. Data is collected and reviewed to determine which students are
successful and which students require additional intervention. Pupils who are unsuccessful with
the tier one curriculum will receive additional instruction at the next level: tier 2. Fifteen percent
of children will be successful with this level of intervention. Five percent of students will need
additional interventions; these children are classified as students with tier three needs.
18
Figure 1: Current RTI Model:
Figure 2 represents Mental Health First, the reconceptualized Response to Intervention
model. This innovative solution adds on an additional tier: tier four. This level represents the
top two percent of students with the most intensive mental health needs (shown through
attendance, grades, behavior, results of the universal social/emotional screener and use of clinical
skills). It also alters the percentage of students with tier three needs from five percent to three
percent. In the new program the school-based therapist would provide school wide supports to
all teachers and students while working specifically with students at the tier two and three levels.
They would utilize school wide screening tools and data-based decision making to ensure early
identification of students within each tier. They would distinguish which students fit into tier
four and facilitate services for them through the Mental Health First program.
Figure 2 Mental Health First model:
19
Bringing additional professionals into the school setting. In the Mental Health First
model, a community mental health provider will come into the school building to provide
intensive support to the top two percent of students who are screened and identified by the
school-based therapist. The community mental health providers could provide individual and/or
family therapy as necessary. They would also have the means to provide psychiatric care
through the use of a tele psych services if the student were in need of a psychiatric evaluation,
and/or medical management. Although, therapy can be extremely effective, some students
require medication as part of their treatment plan (Butler, Grey, & Hope, 2018). By allowing
some flexibility in services, they can be individualized to meet the specific and inclusive needs
of each students. The school and community therapists would also collaborate when permission
was given to do so allowing for a coordination and continuum of care for the child.
This innovation bridges the services between school and community-based therapists
while removing the barriers of lack of parental support, funds, transportation, and lack of access
to qualified mental health professionals. It also helps to reduce the stigma around receiving
mental health services because students would receive them within the familiar school setting
where they, and their parents are already comfortable. This is an innovative solution because it
20
provides a reconceptualization of the model that is currently being used in the school setting and
also provides early identification and encompassing treatment for youth in need.
Connecting the Innovation with the Grand Challenge
The proposed innovation disrupts the social norms that prevent youth from accessing
mental health services. Society can not address the Grand Challenge of Ensuring the Healthy
Development of All Youth without providing young people with access to the mental health
services they need. Without treatment, struggling youth are sent down a challenging path of,
adversity, solitude, and desperation. Young people are unable to thrive while they are grappling
with a mental illness. Mental Health First provides children with the support they need by
identifying and meeting their needs in an effective way.
Stakeholder Perspective
Internal and external stakeholders have a vested interest in the proposed innovation.
Internal stakeholders include: school administrators, the school board, community-based
therapists, and school staff particularly school-based therapists. School districts and community
agencies across the United States are searching for new methods to manage both the established
and developing mental welfare of children and families (Elliot, 2018). Because of this, schools
have a particularly important stake in Mental Health First.
School staff recognize the challenges that educating children who have significant mental
health needs presents. Teachers and administrators are provided with nominal guidance on how
to manage students that are struggling with mental illness yet they are expected to supervise and
educate them daily. This challenge is coupled with the increased demand for academic rigor.
Minimal training is provided to teachers on how to manage students in their classrooms who
21
have social emotional difficulties. This situation is causing many teachers to relinquish their
teaching careers which is resulting in a national crisis in the education system.
Forbes Magazine highlights the catastrophe in today’s education system due to the
scarcity of teachers which has reached an unprecedented high, noting that more teachers are
withdrawing from the profession than ever before after their first year of teaching (Morrison,
2019). Even the teachers who survive their first year of teaching are vulnerable to leaving the
education system too. A quarter of all teachers leave the profession after being a teacher for
under six years (Mulvahill, 2019). Untrained staff are being required to manage high numbers
of mentally ill students in their classroom which is ultimately resulting in teachers making career
changes (Public Agenda, 2004). School administrators, boards and staff will all benefit from
implementing Mental Health First. Having a program in place to efficiently meet student mental
health needs will result in increased teacher success and improved classroom environments for
all.
The external stakeholders include: students, their parents/guardians, and the county health
department. From the students’ perspective, whether you are the child in the classroom
preoccupied with mental health struggles or the child sitting next to classmates who are
struggling with mental illness; it can be frustrating, overwhelming and negatively impact
learning for everyone. Colossal impediments to learning environments result when children are
struggling with complex, overwhelming issues in the classroom (Souers & Hall, 2016). An
overwhelming number of students are losing out on significant learning opportunities due to
unmet mental health needs (Public Agenda, 2004). When students struggle, their
parents/guardians are prone to stress and anger and they too have difficult time. An atmosphere
22
that makes learning difficult for everyone, further emphasizes the need for an improved system
to meet the mental health needs of young persons.
The county health department is another external stakeholder. Closer examination of one
health department in particular, reveals how the current problem of youth not having access to
mental health services impacts the county as a whole. An interview was conducted with
Michelle Esser, the Child and Behavior Services Coordinator for the Lake County Health
Department on February 13, 2019. Ms. Esser described Lake County as, “a child mental health
desert” explaining that they receive an average of 200 crisis calls per month and that there is a
desperate need for additional services (personal communication, February 13, 2019). The
Mental Health First program would reduce the strain on this county’s health department by
providing proactive services to youth before they were at the point of crisis. Detailed interview
notes can be found in Appendix B.
The school system’s complexity has been compounded by the growing requirements
placed on school staff by administrators, board members, and policy makers (Michel, 2016).
These requirements include escalating expectations for the growth of student achievement and
test scores (O’Brien & Draper, 2008). Additionally, the perspective of many school
administrators, board members, and policy makers considers academic achievement the top
priority and student mental health needs a low priority (Suldo, Friedrich, Michalowski,
2010). The attitude of school administrators toward mental health services is further illustrated
in the choices they make regarding funding. Askarinam (2016) evaluated reports identifying that
81% of school administrators spent funds that could have been used on mental health services on
other resources. The high demands placed on teachers coupled with the increase in students with
23
unmet mental health needs in the classroom and the reluctancy of administrators to recognize the
importance of mental health efforts results in a challenging learning environment.
Evidence to Support the Treatment Environment
Schools make a great treatment environment because this is where youth spend a
majority of their time and meeting their mental health needs creates an improved learning
climate for all. It’s common knowledge that youth spend most of their time either at home or at
school. It makes sense to focus interventions to assist them in the places that they spend most of
their time and feel most comfortable. Treatment models that address mental health through
school and community-based programs demonstrate effectiveness (Barry, Murphey, & Vaughn
2013). There is an inherent need for schools and community mental health professionals to
collaborate with one another to produce the best treatment outcomes for children (Vaillancourt
and Amador, 2014). This makes the school setting an ideal environment for the Mental Health
First initiative.
When children do not have their mental health, needs met it negatively impacts the
school environment for all including themselves, their peers, and their teachers. On average,
20% of students in a given classroom are grappling with a mental illness (NAMI, 2019).
Students who are struggling with mental illness are not available for learning (Souers & Hall,
2016). These students are predisposed to struggle with academic, behavior, and emotional
difficulties. Students who fail to have their mental health needs met are more susceptible to
falling behind in their studies and more inclined to display negative behaviors not only at school
but in their communities as well (Stephan, Weist, Kataoka, Adelsheim, & Mills, 2007). When
there is a considerable number of students struggling in the classroom academically, socially,
and emotionally the environment is disrupted for all making teaching and learning problematic
24
for everyone. By not meeting the mental health demands of students, productivity and academic
achievement are exponentially lowered for all.
Another consequence of youth who are struggling with a mental health condition in the
classroom is the likelihood that they will be identified for special education services, fail, or drop
out of school. Students who are wrestling with mental health deficits have a difficult time
staying focused, finishing work, and displaying appropriate behaviors is school. There is an
irrefutable correlation between a student’s mental health status and their academic attainment; a
child who is mentally healthy is much more likely to be academically successful (Borntrager &
Lyon, 2015). Students that continue to struggle with learning are prone to being evaluated for
special education services. When these learners are qualified as individuals with special
education needs, their mental health needs often continue to go unmet and they are predisposed
to dropping out of school all together. Students who receive special education services and have
a diagnosable mental illness have the highest dropout rate of all groups; 37% of these
adolescents will drop out of high school (NAMI, 2019). Students who do not have their mental
health needs met are inclined to fail classes and/or drop out of school entirely (Loverde,
2016). If students received adequate and timely mental health care, they would be more likely
to remain in regular education classes and graduate from high school making schools the most
viable treatment environment for the proposed innovation.
Overall Likelihood for Success
It is highly likely that Mental Health First will successfully improve access to mental
health services for youth through bringing school and community-based services together to best
meet the needs of young people. School mental health professionals working collaboratively
with community organizations will cultivate the most successful treatment outcomes (Wiest et
25
at., 2001). Mental Health First creates a system that merges the school therapists’ ability to
screen all students and identify those with the highest level of need with the community-based
therapists’ ability to meet the intense needs of individual students and their families. Youth
mental health care can be restored by constructing stable working relationships between
community and school counselors (Stephan et al., 2007). The proposed program creates an
improved system to ensure that school and community professionals are collaborating to provide
early identification and treatment for youth with mental health needs.
Project Structure, Methodology, and Action Components
Prototype Overview
The prototype for this innovation is a step-by-step detailed implementation manual. This
guidebook is comprised of a set of instructions to provide school districts with the necessary
information to put the Mental Health First program in place within their schools. The manual is
comprised of the eight chapters listed below:
1.) Youth Mental Health- the current situation
2.) Why Schools Should Care About Youth Mental Health
3.) The “Mental Health First” System
4.) Establishing a Foundation
5.) Implementation
6.) Program Evaluation Tools
7.) Budget
8.) Next Steps
The intention of the prototype is to furnish schools with a comprehensive guide to
implementing the Mental Health First program. The manual starts with establishing an
26
understanding of the prevailing youth mental health crisis by providing relevant statistical data to
support the need for implementing the program. Next, it supplies justification of the reasons that
schools should have a vested interest in providing their students with the mental health supports
that they need. Then, it gives detailed instructions on how to put the program into place.
Finally, it gives comprehensive information regarding the financial costs of the new system.
Lastly, the handbook gives specific action steps. The manual includes visual supports and
checklists for the reader to gain a firm understanding of how and why of the program with
regards to how it should be implemented, and measured.
The prototype implications establish clear guidelines to provide an implementation ready
program. When discussing putting the program into place with school boards and
administrators, the implementation guide will help walk these stakeholders through the process
and ensure that they have the necessary information and materials to implement the innovation
with fidelity. The guide provides common ground to understand the why, what, and how of the
innovation. The prototype also ensures consistency across schools and districts when it comes to
putting the program into place. The implementation guide provides detailed methodology of the
present state of youth mental health and a new conceptualization of the currently used Response
to Intervention (RTI) process.
Market Analysis
The current practices being used to assist youth in obtaining mental health treatment are
not working. As previously addressed, 80% of youth who are in need of mental health treatment
do not get it (Youth, 2019). There is a substantial discrepancy between the level of youth mental
health needs (which is extremely high) and the efficient treatment programs available (which are
27
very few) to meet their needs (Wiest, et al., 2001). Analyzing the market requires a taking a
closer look at what schools are currently doing in regards to students and mental health.
Presently, schools are attempting to meet the mental health needs of their students by
imploring one of two common methods. The first approach happens when school districts hire a
therapist to work as an employee of the school district and provide services to students directly.
The strength of this program is that it allows the therapist to collaborate with school staff since
they are all hired by and housed within the same school district (Osagiede et al., 2018). A
weakness of this method is that, as previously discussed, schools are usually understaffed with
mental health professionals whom have many responsibilities. When districts implore this
method and hire school-based professionals, they determine the therapist’s priorities which
typically include meeting mandated therapeutic minutes for special education students that are
dictated on a child’s Individualized Education Plan (IEP). This method is ineffective because the
therapist has little to no time to provide other supports such as: identifying students in need of
services, supporting the general education population, providing trainings staff, organizing
school wide programs, providing intensive interventions to students, and supporting parents.
The second method that is currently being utilized in school districts throughout the
country is for districts to hire a community mental health professional to come into the school
building and provide services instead of housing a clinician as a district employee. A strength of
this method is that the community mental health professional can provide more intensive
services to students because they do not have other responsibilities with in the school setting. A
Weakness in this method is that communication between the community therapist and the school
staff is limited or nonexistent; without collaboration the services are delivered in isolation
reducing their effectiveness (Osagiede et al., 2018). This results in siloed services that are
28
independent from one another. Another weakness of this technique is that it requires an
untrained school employee to identify the students in need of services often without the use of
screening tools and data-based decision making. This typically results in the students who
display the most disruptive behaviors in the classroom being referred for services while leaving
students who display more withdrawn behaviors being unidentified and untreated.
Involvement of Stakeholders and Essential Constituencies
The project’s plan to involve relevant stakeholders and essential constituencies is to
establish relationships and maintain frequent and consistent communication. Relationship
building and communication are essential to the success of any program and Mental Health First
is no different. The plan to provide these components is for the school and community-based
therapist to work together to produce monthly reports summarizing the status of the program.
These reports will include the number of students in the program, the pre and post data collected,
and specific feedback from participants and their parents. The program participants will be
numbered so that their names will not be disclosed in order to protect their confidentiality. The
rundown of the program’s current status will be presented at the monthly school board meetings
and shared via email. A more comprehensive report will be created and shared at the end of each
school year highlighting the programs strengths, effectiveness, and suggestions for improvement.
Stakeholders and essential constituencies will be encouraged to ask questions and give feedback.
Financial Plan
The plan for the first year of operations is to put the Mental Health First program into
place at Round Lake School District, which is located in Lake County, Illinois. This district was
chosen because it educates students from diverse, low socioeconomic backgrounds. Eighty-six
percent of the district’s student body self-identify as a minority (Public School Review, 2020).
29
Seventy-five percent of students attending Round Lake School District are currently living in
low income households (Illinois Report Card, 2019). The low socioeconomic status of families
in this district is important because a lack of financial resources makes it even more challenging
for students and families to find, access, and pay for needed services. The cost to start the
program and run it for a year in Round Lake School District is $425,000. The non-personnel
costs total $20,000. These funds will be used to purchase technology devices and office
supplies. The majority of the budget will be used for personnel costs totaling $405,000. These
staffing costs will be used to hire an additional social worker (to meet the student to social
worker ratio requirements), pay for the community therapists, and the virtual psychiatrist. The
breakdown of enrollment and the personnel costs can be found in Figure three while Appendix C
provides a comprehensive operating budget.
Figure 3
District
Name Enrollment
2%of
enrollment
# of = Cost of
Additional
Social Workers
needed @
$54,000/
year
# of outside
MH
professionals
needed
days/week
Cost of
outside MH
professionals
per year @
$200/day
# of virtual
psychiatric
appointments
per year.
Cost of tele-
psychiatric
care per
year @
$200/session
Round
Lake
CUSD 116 7198 144 1=$55,000 24 $250,000 499 $100,000
The revenue needed to put the program into action will be acquired through allocated
funds from the school district, the Lake County Health Department, corporate donors,
philanthropic foundations and grant monies. In its first year of implementation, the Mental
Health First program will provide proactive, timely, supportive, and encompassing mental health
services to a minimum of 145 students making the average per student cost of the program under
30
$3,000. This is a huge savings compared to the amount of money currently being spent
reactively on mental health services.
Each year, the United States loses out on $193.2 billion in spent wages on severe mental
illness making it the costliest medical ailment in the country (NAMI, 2019; Johnson & Meyer,
2019). The justice and medical systems also spend an overwhelming amount of money on youth
who are likely to have unmet mental health needs. The average cost of placing one young person
in the justice system for a single year is $148,767; this incurs governmental costs of up to $21
billion per year (Sneed, 2014). The medical system spends $89 billion each year on mental
health care treatment (Kamal, 2017). Each year, the government and taxpayers spend billions of
dollars in treating mental illness reactively.
The design of the proposed innovation seeks to allocate funds in a more preventative way
by utilizing the school system to provide early identification and treatment. Early identification
and treatment of mental health issues results in decreased detrimental consequences and
treatment time which saves a considerable amount of money (Kazdin, 1993). The sooner a
person is identified and treated for a mental illness, the less severe the illness becomes, and the
shorter their treatment time will be. Early intervention avoids detrimental future consequences
such as teen pregnancy, juvenile incarceration, drug addiction, self-harm, and adjustment
disorders (Remschmidt, 2007). The proposed innovation is fiscally advantageous and calls for a
shift in funding to a proactive approach.
Assessment of Impact
Appraising the effectiveness of Mental Health First is an essential component to the
program’s implementation. A quasi experimental design will be utilized to collect and assess
both quantitative and qualitative data for the participants in the program. Using both quantitative
31
and qualitative methods to evaluate the program provides essential insight on the effectiveness of
the capstone innovation.
Quantitative data. Several pieces of quantitative data will be collected using a Time-
Series Experimental Design. Each student’s academic achievement, attendance, behavior, and
social/emotional universal screener ratings will be collected by the school-based therapist as part
of the process to identify the youth with the most intensive needs. When possible, these
components will be identified retroactively going back at least one year prior (by month and
year) to the student’s participation in the program. This data is collected as part of the youth’s
school records and will be noted before during and after the student’s participation in the
program.
Program participants between the ages of three and 17 will have their parent and teacher
complete The Strengths and Difficulties Questionnaire (SDQ) as a pre-post-post assessment prior
to starting the program, at the time of discharge and again six months later. Additionally,
participants who are between the ages of 11 and 17 will complete the SDQ self-assessment form.
The SDQ is a research-based screening tool that is used universally to quantify psychopathology
and mental health difficulties in children by evaluating both internalizing and externalizing
problems while recognizing areas of strength and of difficulty (Croft, Maughan, Rowe, & Stride,
2015). The SDQ is a brief 25 item questionnaire that assesses young people in the areas of
emotional symptoms, conduct problems, hyperactivity/inattention, peer relationships, and
prosocial behaviors (Youth in Mind, 2012). The survey will be completed after the youth have
been identified to participate in Mental Health First but before their initial session with the
community-based therapist. Subsequently, they will again complete the same survey upon
successful discharge from the program. The data collected as part of their school performance
32
record along with the outcomes of the SDQ will be analyzed, compared, and utilized to rate the
effectiveness of the program and guide any need for improvements.
Qualitative data Prior to the student's participation in the Mental Health First program,
as part of the intake process, two interviews will be conducted. One interview will be with the
program participant and the other will be with the participant’s parent/guardian. Questions
during the interview will include topics such as main concerns, expectations of the program,
likelihood of seeking treatment outside of the school setting, willingness to participate, and
feelings about the program. This interview will be used to engage the parent, answer their
questions and clarify expectations. A second structured interview will take place, upon
discharge from the program. This interview will include questions on topics such as changes in
behavior, attitude, outlook, likelihood that services would have been received if not for the
program, and overall feedback about the program.
Communication Strategy
A new campaign is necessary to market, advertise, disseminate, educate, and inform mass
audiences about the Mental Health First program. Building a communication strategy to get the
word out about this new program, share the prototype, and elicit supporters and funders is
essential to the success of the program. The campaign to inform and educate the public about
Mental Health First will consist of launching a cumulative dose of advertisement. Multiple key
factors are essential for the campaign’s success in order to elicit attention and support for the
program's mission: to provide an improved system for meeting youth mental health needs.
Several components make up the campaign initiative including the use of various social media
platforms, in person and virtual community forums, and developing a cooperative partnership
with influencing organizations.
33
Social media plays an important role in today’s society. Utilizing social media is
essential for communicating with a large number of people from various locations and
backgrounds. Information regarding Mental Health First will be distributed across multiple
social media outlets including: youtube, facebook, linkedin, instagram, and twitter. Additionally,
an innovation portfolio will be created and posted on LinkedIn and Dworak-Peck Connect. The
materials to be distributed through these platforms will consist of an innovation resume,
infographic, short form videos, and a Technology, Entertainment, and Design (TED) talk.
Furthermore, this will give other professionals access to learning about the program and
encourage them to get involved.
In person and virtual community forums will play an essential role in the campaign’s
launch. Providing seminars both in person and virtually will give attendees options and
increased opportunities to attend and participate in the interactive seminars. Invitations to these
forums will be distributed to key stakeholders to elicit attendance and participation. These
invitations will be sent virtually, through the mail, and also hand delivered to select persons.
Participants can expect to spend the first portion of the forum learning about key goals and
components of the program and the later portion of the forum in a question and answer session
where they can get more specific information and share their impressions and reactions about the
program.
The development of a cooperative partnership with influencing organizations is another
key component of the campaign’s development. The main groups that have a strong influence
and an anticipated vested interest in the program are the Regional Office of Education, The
School Superintendents Association, the Illinois Association of School Social Workers, and the
National Association of School Social Workers. Eliciting the support from these organizations
34
would fuel the program's advancement and ensure its success. Developing partnerships with
these groups will happen by utilizing personal relationships that have been established with some
of the group’s leaders and presenting at the organization’s annual conferences.
Ethical Concerns and Possible Negative Consequences
The two main concerns in regards to implementing the Mental Health First program are
to maintain the protection of confidentiality of students and their families and to protect students
in the environment that they feel safe in. Seeking mental health services is often a private and
personal experience. By providing these services within the school setting, extra caution and
care need to be taken to ensure that the participants privacy is respected and preserved. This can
be especially challenging with students leaving class to receive services and parents coming into
the school building for family sessions. Extra precautions are needed to protect them. These
precautions could include: staff training on confidentiality, use of a number instead of a name on
all written materials except the personal therapy notes, and use of a separate entrance to the
therapy office when possible. Additionally, a possible negative consequence is that youth will
unwrap their trauma in their safe space. School is often the place where children feel the most
comfortable; providing intensive services within the school setting could result in students losing
this safe feeling resulting in the worsening of school problems before they get better.
Conclusions, Actions, and Implications
Vision for the Future and Implications for Practice
The Mental Health First model has the potential to inform future decisions and actions by
changing the way that mental health services are delivered to youth and ultimately change their
trajectory. Implementing the program in school districts across the country will change the face
of mental health services for youth by providing them with early identification and treatment.
35
Practice implications will alter the current role of both the school-based and community-based
therapists. The school-based mental health professional will be required to utilize their skills and
the systems in place to best identify youth in need while ensuring collaboration with community
providers. The community-based therapist will have to learn how to operate within the school
domain to make treatment more client centered.
Limitations and Barriers
There are two major anticipated limitations to implementation of the proposed solution.
One of these barriers is that some school staff believe that the main role of a school is to teach
academics and that students should not be missing class time to have their mental health needs
met during the school day. These individuals feel that it is the parent’s responsibility to address
their child’s mental health needs, it is not the school’s responsibility. The other barrier is the
belief that school and community based mental health professionals should operate in their own
domains.
Facilitators of the proposed solution include school staff and community members that
support mental health services and recognize their importance. These individuals can help
naysayers recognize and respect the importance of mental health as a top priority for students
and educate them on the previously discussed research findings. School staff need training to
help them understand that students will be more successful academically and behaviorally if they
have their mental health needs met. Additionally, schools and communities need to develop
improved relationships. If schools and agencies existing in the same community can improve
their working relationship, better results will be produced. Both of these organizations work
with the same population and often have the same goal. It is imperative that they join forces to
best meet the needs of the population they work with.
36
Advancing Next Steps
Next steps to advance the implementation of Mental Health First are to obtain funding,
launch the communication strategy, and begin the first year of implementation. The strategy
highlighted ideas to connect with funders and advertise the program. Specific focus will be
placed on connecting with superintendents across the county to share the implementation manual
and discuss putting the program into place in their district.
Conclusion
Youth are not having their mental health needs met in an effective and efficient way
resulting in detrimental consequences. These youth often end up in our justice, medical, and/or
welfare systems because they are not properly identified and are unable to access necessary
treatment. The Mental Health First program utilizes the school system and a reconceptualized
Response to Intervention (RTI) model to screen all youth and provide early identification and
treatment of mental health needs within the school setting. In order to ensure the healthy
development of all youth, it is essential that an improved system for meeting their mental health
needs is implemented.
37
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45
Appendix A
Logic Model
46
Appendix B
Interview Notes
Interview with Michelle Esser on February 13
th
2019
(Child and Behavior Services Coordinator for Lake County Health Department (LCHD)
1. Do you think there is a need to improve access to mental health services for youth?
“Yes. There is a lack of services. Lake county is a child mental health desert. All agencies have
waiting lists. Most agencies don’t accept Medicaid. Each year the number of kids coming in
through crisis is increasing, if these kids were getting services, they would not get to the point of
crisis. The LCHD receives 200 crisis calls/month. 80-90% of the calls are for new clients. We
take kids in crisis first and then try to squeeze in other kids off the waitlist. We cap our waitlist
off at 40, then we tell parents to call back on Mondays to see if they can get on the wait list.”
2. Do you think there is a need for schools to partner with outside service providers?
Why? Why not?
“Yes. we get a lot of crisis calls in schools. Schools have their own set of challenges going
on. Some districts have reduced their numbers of mental health professionals which has
increased the number of crisis calls. Partnering with schools would increase access to care.”
3. Would you be interested in partnering with a school to provide services to students and
their families on a weekly basis?
“Yes.”
4. What are your anticipated thoughts about and concerns around providing outside
services within the school setting?
“My main concerns would be funding, insurance, revenue and making sure the parents are
involved.”
5. What would the per day cost be for an outside provider to provide services within the
school setting?
“$160-$200/day”
6. What are your thoughts about the Mental Health First innovation?
“It’s a great idea! The tele-psych component at school is interesting.”
7. Do you have any other thoughts or ideas about improving mental health services for
youth?
“It would be great to have easy access and kids getting care. Worried about family involvement
and funding- it would have to be revenue producing. How would the program be sustained?”
47
Appendix C
Operating Budget
REVENUES
School District contributions $100,000
Health Department contributions $100,000
Corporate Donors & Philanthropic Foundation contributions $200,000
Grant Monies $50,000
Total Revenues: $450,000
EXPENSES
Personnel
Community Therapist $250,000 $200/day
Additional Social Worker $55,000
Virtual psychiatrist $100,000 $200/session
Total Personnel $405,000
Operating Expenses
Program Consultant $20,000 1 @ 2 days/month
Transportation $1,000 For parents/guardians
Evaluation activities $1,000
Office supplies $1,000
Snacks $1,000
Total Operating $20,000
Total Expenses $425,000
Surplus/Deficit $25,000
48
Abstract (if available)
Abstract
Youth are not having their mental health needs met in an effective and efficient way which results in a negative impact on their overall development. Eighty percent of the youth in the United States who are in need of mental health treatment do not obtain it (Youth, 2019). Without being able to access the help they need, youth spiral downward. These untreated youth often end up without a high school diploma, unable to secure a job, homeless, or in the welfare, medical, or justice systems (Bowman, McGorry, & McKinstry, 2016). The social problem of inadequate access to mental health treatment for youth is one that desperately needs to be addressed. ❧ There are several barriers in place that prevent youth from accessing treatment including stigma around mental health care, absence of parental support, financial limitations, and a lack of quality providers. The proposed solution to this problem titled, “Mental Health First” is a state-of-the-art framework that provides early identification and treatment for youth in need through the implementation of a new system within the public-school setting. Mental Health First is comprised of three essential components: employing an appropriate number of school-based therapists, utilizing a reconceptualized version of the current Response to Intervention model, and bringing community-based therapists along with virtual psychiatrists into the school setting to provide services on a regular basis. ❧ The first step of implementation is for schools to be properly staffed with mental health professionals. The current recommendation by the National Association of School Social Workers is for the average school to employ one full time mental health professional for every 250 students (Willingham, 2018). Many schools across the United States do not meet this criterion. It is typical for schools to have one full time therapist for up to 1,000 students or more with some districts failing to employ any therapists at all (Carrell, 2006). In order to provide caseloads that can be effectively managed and proper implementation of Mental Health First, schools must hire adequate numbers of school-based clinicians. ❧ The next implementation step is for schools to employ a modified version of the research-based Response to Intervention (RTI) model. This model provides a multi-tiered framework for both academic and behavioral interventions utilizing evidence informed disciplines (Constable, Kelly, & Massat, 2016). The RTI model was initiated in 2004 and is currently apprised of three tiers (Cheney, Flower, & Templeton, 2008). The proposed modified version of the RTI model adds on an additional tier: tier four. The top two percent of students who have the most intensive mental health needs within the school would make up this tier. ❧ The final step of implementation would require a community-based therapist to come into the school setting on a regular basis to work with the identified students with tier four needs. The treatment could include individual therapy, family therapy, group therapy, and/or virtual psychiatric care. The length and mode of treatment would be individualized based on data collected to determine progress and student needs. This program bridges the gap between school and community therapists and ensures that students have access to mental health services.
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Creator
Rendon, Elizabeth
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Core Title
Mental Health First
School
Suzanne Dworak-Peck School of Social Work
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Doctor of Social Work
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Social Work
Publication Date
01/24/2021
Defense Date
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Publisher
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adolescence,Mental Health,OAI-PMH Harvest,RTI,school districts,school social work,Schools,Social Work,Youth,youth mental health
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