University of Southern California Dissertations and Theses

Adolescent mental health disorders and school-based supports pre- and during COVID-19

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Adolescent mental health disorders and school-based supports pre- and during COVID-19

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Adolescent Mental Health Disorders and School-Based Supports Pre- and During
COVID-19
by
Christine Matos

Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education

May 2022

© Copyright by Christine Matos 2022
All Rights Reserved

The Committee for Christine Matos certifies the approval of this Dissertation

David Cash
Margaret Chidester
Kim Hirabayshi, Committee Chair

Rossier School of Education
University of Southern California
2022

iv
Abstract
High school-age students' mental health has emerged as an increasing area of importance for
educators, policymakers, parents, and communities. Complicating the increase in and treating
adolescent mental health disorders is a worldwide health pandemic, COVID-19. The purpose of
this study was to learn more about the perceived causes of the increase in adolescent mental
health needs from the perspective of high school principals. Additionally, the study sought to
identify school-based initiatives for increasing mental health supports for high school students
before and during COVID-19. The study interviewed eight high school principals from a region
in Southern California that participated in the California Healthy Kids Survey during the 2017-
2019 period. Of the eight participants, four served students from higher socioeconomic levels
(SES) and four served students from lower socioeconomic levels. The findings indicate the
notable difference between principals’ perceptions of student mental health needs based on
environmental conditions determined by students’ SES. High school principals serving students
at higher-SES campuses reported the environmental conditions of school stress related to the
pressure to perform, overloaded schedules, competitive culture and workload, and college
acceptance increased behavioral mental health needs, including anxiety and depression.
Principals who serve students of lower SES discussed environmental conditions of poverty
related to insecurities of resources, traumatic experiences, and lack of academic self-efficacy
impact mental health needs. Principals from lower-SES schools reported that the environmental
conditions of school closures, quarantine, and access to resources during the COVID-19
pandemic increased students’ maladaptive behavioral changes and mental health needs.
Principals from higher-SES schools did not report significant changes in students’ mental health
needs during COVID-19.

v
Acknowledgements
Thank you to my family, my friend tribe, and my dissertation chair for their on-going
assistance of pulling me out of what felt like quicksand during this dissertation process. The
literature review started by examining the role that school accountability systems play on high
school students mental well-being. With the onset of COVID-19, the topic no longer seemed
relevant. A larger, more significant impact to study was the influence of a pandemic on
adolescent mental health. When changing the research topic and questions, I optimistically
retitled the dissertation to pre- and post-COVID-19. Unfortunately, at the time of publication,
COVID-19 has not ended. More research around the impact of mental well-being during and
post-pandemic need to occur for the world to ever recover.

vi
Table of Contents
Abstract .......................................................................................................................................... iv
Acknowledgements ..........................................................................................................................v
List of Tables ............................................................................................................................... viii
List of Figures ................................................................................................................................ ix
Chapter One: Introduction to the Study ...........................................................................................1
Context and Background of the Problem .............................................................................1
Purpose of the Project and Research Questions ...................................................................3
Importance of the Study .......................................................................................................3
Overview of Theoretical Framework and Methodology .....................................................4
Definitions............................................................................................................................4
Organization of the Dissertation ..........................................................................................5
Chapter Two: Literature Review .....................................................................................................6
Factors Contributing to Adolescent Mental Health .............................................................6
Mental Health Disorders Contribution to Risky Adolescent Behaviors ............................10
COVID-19 Pandemic .........................................................................................................13
Strategies to Improve Adolescent Mental Health ..............................................................16
Conceptual Framework ......................................................................................................19
Summary ............................................................................................................................21
Chapter Three: Methodology .........................................................................................................23
Research Questions ............................................................................................................23
Overview of Design ...........................................................................................................23
Data Sources ......................................................................................................................26

vii
Data Collection Procedures................................................................................................27
Data Analysis .....................................................................................................................28
Validity and Reliability ......................................................................................................28
Ethics..................................................................................................................................29
The Researcher...................................................................................................................29
Limitations and Delimitations............................................................................................30
Chapter Four: Findings ..................................................................................................................31
Participants .........................................................................................................................31
Research Question 1 ..........................................................................................................33
Research Question 2 ..........................................................................................................45
Research Question 3 ..........................................................................................................54
Summary of Findings .........................................................................................................65
Chapter Five: Recommendations ...................................................................................................67
Discussion of Findings .......................................................................................................67
Recommendations for Practice ..........................................................................................71
Limitations and Delimitations............................................................................................75
Recommendations for Future Research .............................................................................76
References ......................................................................................................................................78
Appendix A: Interview Questions .................................................................................................92
Appendix B: Protocols ...................................................................................................................94

viii
List of Tables
Table 1: Data Sources 25
Table 2: Participant Demographics 32

ix
List of Figures
Figure 1: Conceptual Framework 21

1

Chapter One: Introduction to the Study
High school-aged students’ mental health has emerged as an area of increasing
importance for educators, policymakers, parents, and communities. School and societal stressors
diminish mental health, resulting in depression, anxiety, and suicidal ideation (Suldo et al.,
2015). Between 2008 and 2015, pediatric suicide ideation or attempt nearly doubled, with a
higher increase in children ages 15 to 17 (Plemmons et al., 2018). Complicating the increase in
and treatment of adolescent mental health disorders is a worldwide health pandemic due to the
novel coronavirus disease, or COVID-19 (World Health Organization [WHO], 2020). According
to Golberstein et al. (2020), COVID-19 may increase mental health problems due to social
isolation and lack of school-based counseling services. Schools must prepare for and respond to
COVID-19’s mental health impact (Singh et al., 2020). The purpose of this study was to learn
more about the causes perceived to increase mental health disorders from the perspective of high
school principals. The study also sought to identify school-based initiatives for decreasing
mental health disorders in high school students and identify approaches to supporting students
before and during the COVID-19 pandemic.
Context and Background of the Problem
High schools must balance preparing students for college acceptance and courses’
rigorous demands while supporting their mental well-being. High school students’ diagnoses of
psychiatric disorders, including depression, anxiety, eating disorders, and substance abuse,
continue into adulthood (Conner et al., 2014; Feurer & Andrews, 2009; Knopf et al., 2009).
According to Shankar and Park (2016), 83% of high school students identify the school
environment and expectations as a significant cause of stress. High school students’ expectations
to excel inside and outside the classroom to meet graduation requirements and build the optimal
2

college application resumes are primary causes of student mental distress (Luthar et al., 2013).
United States teenagers experience greater levels of stress than adults, resulting in a variety of
maladaptive behaviors, including violence, binge drinking, marijuana use, obesity, anxiety,
depression, and suicide (Benbenishty et al., 2018; Brackett, 2019; Desautels & McKnight, 2019;
Kann et al., 2018; Pope et al., 2015). Educational institutions recognize the importance of
adolescent support and interventions to curb the rise in mental health disorders (Conner & Pope,
2013).
Educational reform to better support student mental well-being presents a challenge for
educators trained to provide subject-area content, not socio-emotional well-being (Brackett,
2019). Complicating school administrators’ and school leaders’ work to improve students’
mental health is the COVID-19 pandemic (Kohli, 2020). Pandemics are associated with
increased depression, anxiety, and post-traumatic stress disorder (PTSD; Guessoum et al., 2020).
On a smaller scale than COVID-19, the 2006 severe acute respiratory syndrome (SARS)
pandemic resulted in increased depression and PTSD diagnoses due to social isolation and
degradation in physical and mental well-being (Douglas et al., 2009). Research on the impact of
COVID-19 on adolescent mental health is limited. However, emerging reports indicate schools
need to prepare to respond to students with mental health support. A study of Chinese youth
identified a rise in children diagnosed with psychological problems of 40% following the peak of
COVID-19 in their community (Liang et al., 2020).
This dissertation focused on high schools located in a region of Southern California. The
selected region consists of approximately 15 school districts with 60 high schools serving 40,000
students. According to the 2019 California Healthy Kids Survey (CHKS; WestEd, 2021), 48% of
the region’s students are Hispanic, with 47% reporting their parents graduated from college. The
3

region’s 11th graders report strong academic motivation and high expectations to achieve
academic success (WestEd, 2021). Survey results identified that 35% of 11th-grade students
described their school grades as mostly As and Bs; conversely, 2% represented grades earned as
Ds and Fs (WestEd, 2021). Also, 35% of students reported they had experienced chronic sadness
and hopelessness, with 15% considering suicide (WestEd, 2021).
This researcher selected this Southern California region due to its high school students’
high-level performance and their experiences of sadness, hopelessness, and suicide ideation.
Purpose of the Project and Research Questions
The purpose of this dissertation was to learn more about the perceived causes of mental
health disorders in high school students and school-based initiatives to decrease these before and
during COVID-19. The study provides insight into what environmental factors influence mental
health disorders in high school-aged students. This study addressed the following research
questions:
1. What are high school principals’ perceived causes for the increase in mental health
disorders in high school students?
2. What are high school principals’ perceptions of student mental health changes related to
high school students since the COVID-19 pandemic?
3. What are formal initiatives already in place or emerging strategies and best practices to
respond to increased student mental health disorders?
Importance of the Study
This problem is critical to address because of the relationship between childhood mental
health and adulthood health, economic levels, and social behaviors (Delaney & Smith, 2012).
Adolescent mental health diagnoses, such as depression, substance abuse, and suicidal ideation,
4

manifest into various adult experiences, such as low income, unemployment, substance abuse,
and violence (National Center for Children of Poverty, 2010). Educational institutions’ failure to
intervene may result in a continuing trend of increased suicide rates, substance abuse, poverty,
and other maladaptive behaviors (Conner & Pope, 2013).
Overview of Theoretical Framework and Methodology
Social cognitive theory (SCT), developed by Albert Bandura in the 1960s, framed this
dissertation. The theory identifies the reciprocal relationship among an individual, their
environment, and their behavior (Bandura, 2005). It supports the research in determining the
impact of students’ environmental conditions on their behavior. The theory expands further to
connect behavior and potential interventions to change it, which are interrelated to environmental
conditions (Bandura, 2005).
Two central tenets of SCT are self-efficacy and outcome expectation (LaMorte, 2016).
Self-efficacy is one’s belief in one’s ability to master a task or skill (Bandura, 2001). Outcome
expectation is the belief that a particular behavior will result in inevitable outcomes (Anderson et
al., 2007). Thus, SCT supported this dissertation to determine the relationship among students’
internal beliefs, mental health, outcome expectations, and environmental conditions that
influence the increase in high school students’ mental health disorders.
Definitions
The following is a list of key terms and definitions for the study:
Anxiety disorders: intense, persistent, and excessive worry about typical, everyday
situations. Adolescent anxiety disorders include overanxious, avoidant, panic, and social phobias
(Bernstein & Borchardt, 1991).
5

Depression: a mood disorder caused by maladaptive cognitive factors and environmental
stressors, resulting in persistent sadness, helplessness, and negative self-perceptions (Jacobs et
al., 2008).
Mental illness: refers to unfavorable conditions that affect emotion, cognition, and
behavior (Manderscheid et al., 2010).
Post-traumatic stress disorder (PTSD): a medical diagnosis for an individual who
experienced an actual or threatened death or serious injury resulting in a long-term sense of fear,
helplessness, or horror (Benight & Bandura, 2004).
Substance abuse: heavy substance use over time (Rehm et al., 2013).
Wellness: the degree to which a person feels enthusiastic and optimistic about one’s life
and self (Manderscheid et al., 2010).
Organization of the Dissertation
The dissertation is organized into five chapters. Chapter One provides an introduction
and overview of the significance of the problem. Chapter Two synthesizes empirical literature
relevant to the problem and provides a rationale for the study. Chapter Three outlines the
quantitative methods used for this study, including the setting, sampling, collection methods,
analysis, limitations and delimitations, and summary. Chapter Four provides the findings and
significant themes of the study. Chapter Five provides recommendations for educators and future
researchers.

6

Chapter Two: Literature Review
American high schools are experiencing an increase in the number of students diagnosed
with psychiatric disorders, including depression, anxiety, eating disorders, and substance abuse
(Conner et al., 2014; Conner et al., 2010; Feurer & Andrews, 2009; Knopf et al., 2009). The
following literature review frames the recent history of high school students’ mental health and
the implications of COVID-19 on their mental well-being. The literature review is organized to
outline the factors impacting adolescent mental health, including the role of unhealthy school-
related stress and the influence of peer and parent pressures. Next, the literature review identifies
how mental health disorders contribute to risky adolescent behaviors, including suicidal ideation,
self-injurious behaviors, and substance abuse. Lastly, the literature review identifies school-
based initiatives and best practices emerging in response to increased student mental health
disorders.
Factors Contributing to Adolescent Mental Health
Educational researchers have given considerable effort to examining the perceived
causes, increasing trends, and long-term impact of mental health disorders in adolescents.
According to Knopf et al. (2009), 25% of American youth experience emotional distress
symptoms, such as depression, anxiety, academic stress, and substance abuse. According to
Shankar and Park (2016), 83% of high school students identify school as a significant cause of
stress. In 2018, 38% of Orange County, California, 11th graders self-reported experiencing
chronic sadness or feelings of hopelessness within 12 months on the CHKS (CalSCHLS, 2021).
The survey also revealed that 17% of 11th graders seriously considered attempting suicide, and
18% participated in maladaptive behaviors of drug and alcohol use.
7

The United Nations Children’s Fund (2021) ranks United States youth in the bottom
quartile among developed nations in well-being and life satisfaction. United States teenagers
experience greater stress levels than adults, resulting in violent behaviors, binge drinking,
marijuana use, obesity, anxiety, and depression (Brackett, 2019; Desautels & McKnight, 2019;
Pope et al., 2015)
Unhealthy School-Related Stress
Students report school-related stress, such as excessive school workloads, grades,
extracurriculars, and pressures to perform, trigger their emotional distress (Conner & Pope,
2013). In 2015, the Robert Wood Johnson Foundation and Born This Way Foundation
administered a survey to 22,000 teenagers from across the United States to assess how they
describe their school (Brackett, 2019). The results highlighted that three-quarters of students
represent school negatively, with words like tired, bored, and stressed used most frequently
(Brackett, 2019). Feurer and Andrews (2009) identified that students with unhealthy school-
related stress are more likely to experience higher depression levels. Adolescents’ school
experiences directly impact their mental well-being. High school students’ expectations to excel
inside and outside the classroom toward strong college application resumes are primary causes of
mental distress (Clark, 2010; Luthar et al., 2013). According to Shankar and Park (2016), 83% of
high school students identify school as a significant cause of stress. The literature revealed four
primary causes of their unhealthy stress: pressures to perform, a narrow definition of success,
peer competition, and relationships with parents (Clark, 2010; Luthar et al., 2013; Spencer et al.,
2018).
Chronic stress to perform undermines academic achievement, compromises mental
health, and increases risky behavior (Conner et al., 2010; Leonard et al., 2015). Chronic stress
8

differs from infrequent short-term stress, leading to greater adaptability in adulthood (Clark,
2010). High school students report grade point averages, rigorous course loads, career and
technical pathway completions, extracurriculars, and after-school activities as significant factors
impacting their mental health (Conner et al., 2010; Ramirez et al., 2014). Admission to select
colleges is a primary stressor for high school students, directly influencing their choice in
academic course load and participation in elite extracurricular activities (Kretchmar & Farmer,
2013; Kumar & Akoijam, 2017; Luthar et al., 2013). High school students report spending 3.07
hours nightly on homework and 2 hours per weeknight in extracurricular activities, and 60%
have dropped an action of pleasure because of schoolwork and other demands (Conner et al.,
2010).
The percentage of U.S. students experiencing unhealthy stress in school is higher than
international averages. According to Shankar and Park (2016), 48% of high school students
experience unhealthy stress, and the percentage increases with age. These students respond to
pressures to perform by cheating, sleepless nights, self-mutilation, cutting, drug use, and suicide
(Conner et al., 2010). Kar (2017) determined a negative correlation between academic anxiety
and academic achievement due to the impact of pressure on memory and focus. According to
Kar (2017), stress occurs when a desire to do something requires more extraordinary skills or
knowledge than one has. The pressure increases day-to-day for high school students (Kar, 2017;
Robotham & Julian, 2006; Stecker, 2004). The negative correlation between academic stress and
achievement increases with pressure, frustration, and conflict (Kar, 2017). For affluent students,
stress is perceived as normalized and required for success (Spencer et al., 2018).
The narrow construction of success is perceived as progressive, from high school
completion to an elite college and into a high-paying profession (Spencer et al., 2018). The
9

narrow definition results in maladaptive perfectionist youth with higher anxiety and depression
(Luthar & Becker, 2002; Lyman & Luthar, 2014). Sanders (2013) identified that the primary
stressor for high school students is academic pressure to do well in school and get into an elite
college. Students build resumes for college that reflect over-involvement in extracurriculars,
weighted academic courses, and high athletic performance (Luthar et al., 2013). Competition
among students to secure college enrollment is another factor increasing in the number of
California high school students diagnosed with psychiatric disorders including depression,
anxiety, eating disorders, and substance abuse (Conner et al., 2014; Feurer & Andrews, 2009;
Knopf et al., 2009).
Peer and Parent Influences
Peer competition to outperform in classes, elite teams, and college admissions is one of
four significant youth stressors (Spencer et al., 2018). Peer competition negatively impacts self-
efficacy and academic achievement (Kiran-Esen, 2012). In the late 1980s, high school students
suffered social rejection for seeking academic achievement over social acceptance (Foust et al.,
2008). Research by Foust et al. (2008) found, in the 2000s, that they were more likely to be
socially isolated by peers for choosing a less rigorous academic load. Bursztyn and Jensen
(2015) found that peers and public knowledge heavily influence students’ educational
engagement levels. Students enrolled in honors classes were 8% more likely to participate in
rigorous opportunities if their choice was publicly known (Bursztyn & Jensen, 2015). Students
reported concerns about social sanctions or gaining social approval based on the rigor of their
academic selections (Bursztyn & Jensen, 2015). Moldes et al. (2019) found that students report
needing their friends to succeed and meet academic demands.
10

Meeting peers’ social expectations manifests in anxiety, worry, nervousness, depression,
and relational aggression (Björling & Singh, 2017). Peer comparisons and competition to
maintain academic standings in rigorous courses and college entrance increases the vulnerability
of anxiety and depression, especially in females (Björling & Singh, 2017). Students with learning
disabilities experience increased peer-comparison-related stress due to the impact of years of low
educational performance on self-concept (Feurer & Andrews, 2009).
Relationships with parents impact high school students’ mental health. Parents’
emotional support directly affects a child’s self-efficacy and mental health (Clark, 2010; Luthar
& Becker, 2002; Shin et al., 2016). Parent-child relationships impact a child’s positive outlook,
achievement, and experiences (Shin et al., 2016). Parental emotional support demonstrated
through high expectations of grades and inquiry regarding the child’s school experience
improves self-efficacy (Ramirez et al., 2014). Students who experience closeness to a parent
report less pressure to achieve academically (Clark, 2010). Also, parental criticism increases
nonsuicidal self-injury (NSSI) among high school students (Yates et al., 2008). In a study of
1,300 high school students, 14% reported NSSI after receiving a parental critique of school or
extracurricular performance, with females three times more likely to self-injure (Yates et al.,
2008).
Mental Health Disorders Contribution to Risky Adolescent Behaviors
The adverse effects of unhealthy school-related stress manifest in increased mental health
disorders and youth’s risky behaviors. Since 1990, the U.S. Centers for Disease Control and
Prevention (CDC) has administered the Youth Risk Behavior Survey to monitor health behaviors
contributing to death, disability, and social problems in youth and adults (CDC, n.d.). The
national survey content includes questions specific to behaviors that result in unintentional
11

injuries and violence, sexual behaviors, substance use, unhealthy diets, and physical activity
(CDC, n.d.). In 2017, 17.2% of teenage youth reported seriously considered attempting suicide
within the previous 12 months (CDC, n.d.). Given the negative correlation between unhealthy
school stress and mental well-being, state-level surveys further assess children’s well-being in
the school environment.
In California, state officials designed the Healthy Kids Survey in 1997 to provide schools
with data to improve students’ academic performance, physical, behavioral, and social-emotional
health (CalSCHLS, 2021). Survey data allow schools to compare results, analyze initiatives’
effectiveness, and improve educators’ understanding of factors impacting successful schools and
youth outcomes (CalSCHLS, 2021). The trends for the state’s 11th-graders between 2014 and
2019 illustrated an increase in academic motivation and students experiencing chronic
sadness/hopelessness (CalSCHLS, 2021). Results identified decreases in students’ connection
and having a caring adult relationship at school. These factors, along with others, increase
maladaptive behaviors.
Suicidal Ideation and Self-Injurious Behaviors
Suicidal ideation and self-injurious behaviors are increasing in the United States
(Benbenishty et al., 2018). In the United States, the suicide rate of teenage youth increased by
28% in the last 2 decades (Brackett, 2019). According to Kann et al. (2018), in 2016, 17% of all
young adults’ deaths were from suicide. A third of young adults nationwide reported feeling sad
or hopeless for 2 or more weeks, resulting in children stopping usual activities (Kann et al.,
2018). Also, 17.2% of young adults surveyed had seriously considered committing suicide in the
previous 12 months, and 13.6% made a suicide plan. Among them, 7.4% attempted suicide
12

(Kann et al., 2018). Females were more likely to consider committing suicide than males (Kann
et al., 2018).
In California, 20% of high school students report suicide ideation (Benbenishty et al.,
2018). Discrimination-based victimization, such as bullying, physical violence, and
discrimination based on race or and sexual minority status, is associated with suicidal ideation
(Benbenishty et al., 2018). A longitudinal school-based survey of 1,698 students at ages 11, 15,
and 19 provided data about suicide attempts. Risk is most significant at the age of 15, and
deliberate self-harm peaks at 19 (Young et al., 2011). The study found that low engagement in
school correlates with suicide risk, attempts, and self-harm (Young et al., 2011). Research
findings identify positive school climates as a protective factor of better health outcomes
(Benbenishty et al., 2018).
Substance Use
Elevated substance use correlates with depression and anxiety (Luthar et al., 2013). In
2018, the Center for Disease and Control reported 29% of youth nationwide have smoked
cigarettes, 42.2% have used an electronic vape, 35.6% have used marijuana, and 60.4% have
consumed alcohol (CDC, n.d.). Students from higher socioeconomic status (SES) homes are at a
higher risk for substance abuse (Luthar et al., 2013). Per Luthar et al. (2013), extreme drinking,
substance abuse, and mental health disorders are more significant in competitive school settings.
A study of 302 sixth and seventh graders from affluent neighborhoods found higher clinical
depression rates, especially in females (Luthar & Becker, 2002). Additionally, Luthar and Becker
(2002) identified a link between substance abuse and internalizing depression symptoms, self-
oriented perfectionism, and low self-efficacy.

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COVID-19 Pandemic
As this dissertation developed, so did the novel coronavirus (COVID-19) global
pandemic. First detected in Wuhan, Hubei Province, the People’s Republic of China in
December 2019, the novel coronavirus spread globally (WHO, 2020). The WHO (2020) declared
a pandemic on March 11, 2020. On March 13, 2020, the United States issued a national
emergency (White House, 2020). Consequently, California’s governor issued an executive order
on March 19, 2020, directing schools to close immediately and all citizens to stay home unless
they were essential workers (California State Government, 2020). According to Golberstein et al.
(2020), COVID-19 may increase mental health problems due to social isolation and lack of
school-based counseling services.
The existing literature on the impact of a pandemic and social isolation on adolescents is
minimal. Studies associate pandemics with PTSD, depression, and anxiety (Guessoum et al.,
2020; Neria et al., 2008). Exposures to disasters and PTSD increase the impact of social isolation
and degradation in mental and physical health (Galea et al., 2020; Guessoum et al., 2020).
Traumatic experiences such as mass shootings, natural disasters, and illness commonly result in
PTSD, substance use, depression, anxiety, and mental, behavioral disorders (Douglas et al.,
2009; Galea et al., 2020; Neria et al., 2008).
In the early 2000s, SARS resulted in the need for people in many regions to quarantine
indoors. Douglas et al. (2009) studied the impact of SARS quarantine in Canada. Findings
illustrated an increase of 28.9% of participants diagnosed with PTSD post-quarantine and 31.2%
diagnosed with depression. The implications of COVID-19-related quarantines on U.S.
adolescent mental health are unknown (Galea et al., 2020).
14

Based on studies from China, Italy, and Spain, which experienced an earlier onslaught of
COVID-19, adolescents are susceptible to increased mental health disorders due to the pandemic
(Liang et al., 2020; Orgilés et al., 2020; Zhou et al., 2020). California surgeon general Dr.
Nadine Burke Harris believed there would be an increase in stress-related cognitive impairment
due to the pandemic (Kohli, 2020). Dr. Harris’s predictions align with findings from other
countries’ studies on the impact of COVID-19. Caregivers of youth in Spain and Italy observed
changes in their children’s emotional well-being while in quarantine (Orgilés et al., 2020). In
Spain and Italy, respectively, 85.7% and 88.9% of children experienced more significant
irritability and increased anxiety and sadness (Orgilés et al., 2020). A study of 8,079 Chinese
adolescents identified a high prevalence of youth with depression (43%), anxiety (37%), and a
combination of both (31%) during the COVID-19 outbreak (Zhou et al., 2020). Zhou et al.,
(2020) research identified that females and those in higher grade levels experience a greater
prevalence of depressive and anxiety symptoms. Early studies indicate similar findings in the
change of mental well-being and psychological factors and attitudes for children in the United
States forced to quarantine (Oosterhoff & Palmer, 2020).
Preparation to resume normalcy post-COVID-19 will require significant mental health
support for U.S. citizens (Azevedo et al., 2020; Kohli, 2020). During quarantine, adolescents
experienced more considerable substance abuse, neglect, and violence within the home (Kohli,
2020). According to Kohli (2020), children who experience trauma have increased susceptibility
to depression, anxiety, and substance abuse as adults. In addition to the shelter in place
quarantine orders, the impact of school closures further exacerbated the effects of mental health
disorders, especially for marginalized groups, including students with disabilities, students of
low SES, and female students (Azevedo et al., 2020; Golberstein et al., 2020).
15

School closures resulted in the cessation of school-based counseling (Golberstein et al.,
2020). According to Golberstein et al. (2020), 35% of adolescents who received mental health
services between 2012 and 2015 did so at school. A disproportionate number of students
receiving school-based counseling services are members of marginalized groups due to a lack of
family resources (Ali et al., 2019). In the 2017–2018 National Survey of Children’s Health
(Child & Adolescent Health Measurement Initiative, 2020), 7.1% of California parent
respondents indicated their child received counseling treatment by a school-based mental health
specialist. During school closures, 2% of California parents representing 200,000 students
reported that their child needed mental health services and did not receive them (Kohli, 2020).
The impact of school closures and self-isolation may exacerbate the need for school-based
mental health and academic interventions.
School closures may impact mental health, physical well-being, and learning levels,
which may lead to worldwide fiscal harm. Azevedo et al. (2020) simulated the possible effects of
COVID-19 on school closures on schooling and learning outcomes. An analysis of the potential
impact of 3-, 5-, and 7-month school closures using data from 157 countries concluded students
might experience a learning loss of 0.3 to 0.9 years of schooling, impacting children of lower
SES, minority groups, and females (Azevedo et al., 2020). The pressure to recover learning loss
coupled with the impact of quarantine on mental health may result in greater unhealthy school-
based stress (Allensworth et al., 2018; Kohli, 2020; Zhou et al., 2020). According to Kohli
(2020), the return to in-person school will increase mental health support, and schools are not
prepared. The negative repercussions of COVID-19 demand educational institutions identify
mental health interventions to diminish the negative impact of quarantine and school closures on
adolescent youth (Lee, 2020).
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Strategies to Improve Adolescent Mental Health
Solutions to reduce anxiety and mental distress in high school students must address the
definition of success (Conner & Pope, 2013). The root cause of students’ mental health disorders
is the pressure to perform and compete with peers to make college admissions (Spencer et al.,
2018). Educational institutions have the ability and responsibility to address academic stressors
and school culture to promote balance and well-being by evaluating school systems, procedures,
and policies that unintentionally result in unhealthy stress, depression, and anxiety (Pope et al.,
2015).
High school principals and college administrators need to address the misconceptions of
college acceptance to reduce the resume-building culture of affluent high school students,
parents, and school staff (Kretchmar & Farmer, 2013). Educational leaders can reduce chronic
academic stressors by evaluating school climate and establishing healthy limits for course loads
and extracurricular opportunities (Mrowka, 2014). High school administrators need to set the
environment and culture of schools by their actions, structures, and systems to encourage balance
and social-emotional learning opportunities to assist youth in developing self-regulation, self-
efficacy, resiliency, and problem-focused skills (Conner et al., 2010; Kurian, 2012; Leonard et
al., 2015; Mrowka, 2014).
Challenge Success
Current mental health disorders evidence highlights a growing need for high school
administrators to identify systematic policies and practices to support their students’ health and
well-being. According to Marsh (2012), local education agencies benefit from developing
partnerships with intermediary organizations like non-profit agencies or universities to
implement cycles of improvement. Stanford’s Challenge Success program is an example of
17

secondary schools working alongside experts to identify and implement strategies to support
student well-being and engagement. The program emphasizes learning through analysis of
student survey data and educational practices that unintentionally lead to unhealthy stress for
children (Conner & Pope, 2013).
Intervention initiatives, such as encouraging dual enrollment, need to be broadly
evaluated for effective implementation and outcomes. Challenge Success’s continuous
improvement framework aligns with Marsh’s (2012) recommendations by using data analysis to
drive organizational change. The program provides schools with quantitative and qualitative
surveys and extensive data analysis support to identify the primary stressors impacting student
health. The program offers qualitative and quantitative data the schools utilize to review program
structure, policies, and practices aligned with or identified as primary stressors (Challenge
Success, n.d.). School administrators and stakeholders examine the primary stressor to identify
programmatic changes. This type of work reduces student workload, redefines success, reduces
pressure to compete with peers, and increases parental understanding of the college admissions
process will encourage healthier learning environments for high school students (Pope et al.,
2015).
School-Based Mental Health Programs
School closures due to COVID-19 highlighted the importance of non-academic support
provided at school, including physical health, mental health, food assistance, and child welfare
interventions (Hoffman & Miller, 2020). Hoffman and Miller (2020) argued for increased mental
health supports during and after the COVID-19 pandemic. School-based mental health programs
support adolescents in help-seeking behaviors, decrease stress levels, and improve learning
(Lester et al., 2013; Newcomb-Anjo, 2019; Yeager, 2017). School-based mental health programs
18

remove barriers of transportation, cost, insurance, and stigma often associated with traditional
counseling structures (Duong et al., 2020).
Kearney and Childs (2021) recommended schools develop multi-tiered systems of
support (MTSS) to improve mental health programs in schools. These systems provide schools
with a framework to align initiatives and resources to systematically address support for all
students and individual student needs (California Department of Education, 2021b). Tier 1 of a
school-based mental health program includes culturally responsive teaching practices and social-
emotional learning (SEL) opportunities for all students (CASEL, 2021; Darling-Hammond et al.,
2020; Kearney & Childs, 2021).
Culturally responsive teaching advances strong positive relationships between student
and teacher by affirming students’ cultural connections, expression of individual value, sense of
physical belonging, and safety (Darling-Hammond & Hyler, 2020; Darling-Hammond et al.,
2020). Explicit, direct classroom instruction in SEL competencies correlates to improved student
mental health (Salerno, 2016). This instruction develops students’ self-awareness, self-
management, self-regulation, social awareness, relationship skills, and responsible decision
making (CASEL, 2021). Competency in SEL skills predicts academic achievement and school
performance more than intelligence quotient and reduces delinquency and mental health
disorders (Duckworth & Seligman, 2005; Duckworth et al., 2010).
Tier 2 of school-based mental health programs provides specific classroom-level
interventions to address problems among a subset of students, such as social skill development
and anger management (Kearney & Childs, 2021). Tier 2’s mindfulness-based interventions,
such as mediation, decrease levels of anxiety and depression, reduce negative intrusive thoughts,
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and increase optimism, self-compassion, and life satisfaction in adolescents (Bluth et al., 2015;
Sapthiang et al., 2019; Sibinga et al., 2013; Zoogman et al., 2015).
The third tier of school-based mental health programs is the most intensive level of
intervention and offers individual direct mental health services through counseling and
therapeutic interventions delivered by a mental health specialist (Kearney & Childs, 2021).
Trauma-Informed Instruction
Traumatic experiences increase potential depression, PTSD, substance abuse, and a range
of other mental and behavioral disorders in children and adults (Galea et al., 2020). Trauma
produces alterations in mood, focus, memory, behaviors, emotions, and trust (CASEL, 2021). In
response to COVID-19, Darling-Hammond and Hyler (2020) recommended that schools invest
in mental health specialists and educator professional development in trauma-informed practices.
Trauma-informed practices and programs include cognitive-behavioral interventions for trauma
in schools, Support for Students Exposed to Trauma, Psychological First Aid-Listen, Protect,
Connect and Bounce Back (Baweja et al., 2016; Jorm et al., 2010; Treatment and Services
Adaptation Center, 2021).
Conceptual Framework
Social cognitive theory (SCT) framed this dissertation. The theory identifies the
reciprocal relationship among the individual, their environment, and their behavior (Bandura,
2005). This theory supports the research in determining the impact of a student’s environmental
conditions on his or her behavior. This study was structured to identify the causes perceived to
increase high school students’ mental health disorders and identify intervention initiatives to
combat the rise both before and during the COVID-19 pandemic. Thus, SCT framed the research
20

into the relationship among self-efficacy, outcome expectation, and environmental conditions
that result in increased anxiety, depression, substance abuse, and self-injurious behaviors.
Using the tenets of SCT, this dissertation’s conceptual framework (Figure 1) explores the
relationship among high school students’ school-related stressors as environmental factors, the
COVID-19 pandemic, and student behavior in the diagnosis of mental health disorders or
behavioral actions as a result of environmental conditions. The dissertation also sought to learn
about the effect of one’s self-efficacy and expected outcome beliefs on behaviors and response to
the environment.

21

Figure 1
Conceptual Framework

Note. Adapted from “Social Cognitive Theory of Organizational Management” by R. Wood and
A. Bandura, 1989, The Academy of Management Review, 14(3), 361–384.
(https://doi.org/10.5465/AMR.1989.4279067)

Summary
The literature review illustrates the increasing mental health diagnoses of high school
students and their implications for these students’ current and future well-being. Factors
impacting adolescent mental health include unhealthy school-related stress, pressures to perform
for college resumes, and parent and peer influences. Research on the impact of COVID-19 on
mental health highlights the future need for mental health assistance for youth who experienced
isolation due to school closures, quarantine, possible substance abuse, and loss of family
22

members. This dissertation sought to identify school-based initiatives to improve adolescent
mental health before and during the COVID-19 pandemic.

23

Chapter Three: Methodology
The following chapter frames the design and purpose of the study, outlines the protocol
and instruments used to conduct research, and clarifies how data were collected and analyzed.
The purpose of this dissertation was to learn more about what participants believed was behind
the increase in mental health disorders in high school students and school-based initiatives for
decreasing these before and during the COVID-19 pandemic.
Research Questions
This study addressed the following research questions:
1. What are high school principals’ perceived causes for the increase in mental health
disorders in high school students?
2. What are high school principals’ perceptions of student mental health changes related to
high school students since the COVID-19 pandemic?
3. What are formal initiatives already in place or emerging strategies and best practices to
respond to increased student mental health disorders?
Overview of Design
This dissertation utilized qualitative research methods. Qualitative research enhances the
researcher’s awareness of the problem from the perspective of the people directly involved
(Maxwell, 2013). The qualitative method of interviews provided the opportunity to identify the
causes perceived to increase mental health disorders from the perspective of high school
principals. Interviews allowed the researcher to learn about initiatives schools implemented
before and during the COVID-19 pandemic to improve students’ mental health. Through
interviews, the study aimed to collect data on respondents’ perceptions, opinions, and
knowledge, providing each interviewee an opportunity to contribute to the understanding of the
24

complexity of student mental health. Qualitative research provides the researcher with an
opportunity to learn the perspective of its population (Maxwell, 2013).
The research included interviews with high school principals. Due to the current
constraints of the COVID-19 pandemic, the research consisted of eight participants. This study
utilized a convenience sampling approach for participants to discover, understand, and gain
insight into what interviewees perceived to be the causes of mental health disorders in high
school students and school-based initiatives for decreasing these (Merriam & Tisdell, 2015).
Since more than eight high school principals volunteered, the researcher prioritized participants
who lead schools where a greater percentage of students were either from higher or lower SES.
The researcher selected four principals serving higher-SES students and four principals serving
lower-SES students.
A semi-structured interview protocol was utilized for the interviews. The semi-structured
format allows the researcher to maintain and redirect the interview as necessary (Merriam &
Tisdell, 2015). According to Merriam and Tisdell (2015), the semi-structured interview
establishes a guiding framework of pre-determined questions to ensure consistency yet also
allows the researcher to ask follow-up questions that provide clarity and a deeper understanding
of the respondent. According to Brown and Danaher (2019), semi-structured interviews allow for
rapport-building and respectful and reciprocal relationships with the participants. In this study,
the 10 guiding or general questions were shared with the participants prior to the interview,
which allowed them to lower their affective filter to comfortably share, in a narrative format,
their experiences with students’ mental health.
The semi-structured interviews allowed the researcher to gather data that reflect the
respondents’ perceptions, knowledge, and opinions on the complex topics of student mental
health. Semi-structured interviews allowed for follow-up questions, which allowed the
25

respondents to participate in developing and understanding the circumstances that influence their
perceptions and responses to student wellness (Merriam & Tisdell, 2015).
The 10 interview items were written to align with the research questions and the
conceptual framework. Question types were designed to elicit responses to improve
understanding of the participants’ behaviors, experiences, opinions, and feelings about the
increase in student mental health disorders, strategies to improve student well-being, and the
impact of the COVID-19 pandemic.
In addition to interviews, the researcher conducted a document analysis of the CHKS.
Unfortunately, the CHKS document analysis was publicly available for district-level reports, not
school-level. Therefore, the analysis did not yield support for participant responses. Table 1
presents the data sources pertaining to the research questions.

Table 1
Data Sources
Research question Interviews Document analysis
What are high school principals’ perceived causes
for the increase in mental health disorders in
high school students?

X X
What are high school principals’ perceptions of
student mental changes related to high school
students since the COVID-19 pandemic?

X
What are formal initiatives already in place or
emerging strategies and best practices to respond
to increased student mental health disorders?
X

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For this study, purposeful sampling was utilized. According to Maxwell (2013),
purposeful selection allows the deliberate selection of respondents, particular settings, and
people. The identified respondents were high school principals responsible for mental health
program development and implementation.
Data Sources
This study’s data sources were interviews of high school principals and a document
review of the 2017–2019 CHKS results. The first was a primary source of semi-structured
interviews of high school principals. After conducting interviews, it was necessary for the
researcher to understand the interviewee’s school in the CHKS survey findings. The researcher’s
second data source was the findings of the 2017–2019 CHKS to understand how students at
interviewees’ high school self-reported their mental health. Unfortunately, the CHKS document
analysis was publicly available for district-level reports, not school-level. Therefore, the analysis
did not yield support for participant responses.
Participants
The participants were high school principals in a region of Southern California that
participated in the CHKS during the 2017–2019 period. The region consists of 27 public high
schools. Participant recruitment included personalized email invitations to high school principals.
School principals’ names and email addresses were collected from high school websites. The
email explained the topic, the purpose of the study, and the virtual format due to the COVID-19
pandemic. All participants were informed that the study was voluntary, and all participants
remained anonymous. Schools, districts, and participant names were not used in the study to
protect participants’ anonymity. Once an appointment was made, the researcher provided the
27

questions and USC Institutional Review Board (IRB) information sheet in advance of the
meeting.
Instrumentation
The interview questions were written based on the research questions and conceptual
framework. The interview protocol was semi-structured with 10 primary questions. The protocol
allowed the researcher to ask follow-up questions. An interview protocol was adhered to,
ensuring consistency in the follow-up questions asked to gain clarity or a deeper understanding
of the respondent (Merriam & Tisdell, 2015). Appendix A presents the interview protocol.
A document analysis of the CHKS was conducted. The CHKS is a statewide student
survey of resiliency, risk behaviors, social and physical health, and school climate (CalSCHLS,
2021). The survey is optional for students in grades 5 through 12. It provides data on student
engagement, school connectedness, and the development of social-emotional competencies,
which are linked to increased positive personal, health, and academic outcomes (CalSCHLS,
2021). Unfortunately, the CHKS document analysis was publicly available for district-level
reports, not school-level. Therefore, the analysis did not yield support for participant responses.
Data Collection Procedures
Interview participants were contacted via email, providing a summary of the study and a
request for an interview appointment. The interviews were conducted virtually through Zoom.
Each interview took approximately an hour. With the permission of the participant, interviews
were recorded for later transcription utilizing Rev transcription services.
The document analysis of the secondary source of the CHKS 2017–2019 results was
conducted by accessing information via the CalSCHLS website.

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Data Analysis
The interview protocols and document analysis were linked directly to the three research
questions. The researcher followed expert recommendations (Maxwell, 2013; Merriam &
Tisdell, 2015) to make every effort to initiate data analysis immediately following data
collection.
The interview data analysis protocol aligned with Creswell and Creswell’s (2017) six-
step framework. The first step was to review the literature related to each research question. The
second step was to obtain and transcribe interview data. The third step was to identify initial
impressions of the data. The fourth through sixth steps involved organizing and coding the data
in relation to the three research questions to identify major trends and themes. The inductive
process of analysis allowed the researcher to identify findings and themes relative to how
interviewees perceive and respond to the increase in student mental health disorders. The sixth
was to develop descriptive illustrations and a narrative outline of the findings per research
question to develop a theory (Creswell & Creswell, 2017). Thematic data analysis protocols were
applied to the CHKS to identify patterns and themes in student responses (Bowen, 2009).
Validity and Reliability
The interview questions were designed specifically for this study based on a review of
literature and current research. Each interview question aligned directly to a research question
and one area of the conceptual framework. A gap was identified in the research on school
leaders’ insights regarding the root cause of students’ mental health disorders and successful
initiatives to improve mental wellness before and during pandemics. The interview protocol was
field-tested to test for biases and question clarity and reliability. Based on the field test, the
interview protocol was revised to improve validity and reliability outcomes.
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Ethics
During the design of the study, all procedures and guidelines for the University of
Southern California IRB were followed to meet all ethical considerations. The purpose and
nature of the study were provided to all participants prior to interviews. Participants signed an
informed consent form, ensuring voluntary participation and anonymity. The researcher
requested permission to record the interview and described the future storage and security of the
interview transcripts.
The Researcher
Professionally, the researcher, at the time of this study, was an assistant superintendent of
educational services in a Kindergarten through 12th-grade public school district within the
region. The researcher’s professional background includes 30 years of service, with 20 of those
as an administrator. The researcher was responsible for the district’s educational programs,
student services, and research and evaluation department. To mitigate positionality and power,
the researcher’s school district was excluded from the study.
The researcher did hold assumptions and bias. The researcher assumed all high schools in
Southern California enrolled students who struggle with mental health due to excessive demands
of college-level coursework. The researcher held a bias that high schools and colleges are
creating competitive, unhealthy expectations of students to perform at the highest levels in
academics and extracurriculars in the pursuit of the ultimate college application resume. Also,
the researcher’s experiences as a parent of sons who experienced the pressures of academic and
extracurricular performance create bias.
The researcher designed interview questions to discover what high school principals
perceive as the causes of increased mental health disorders as individuals responsible for social-
30

emotional initiatives on their campuses. Primarily, the interviews were guided by a list of pre-
written questions followed by unstructured questions designed for clarification (Merriam &
Tisdell, 2015). The protocol was designed to be unbiased and open to collect candid viewpoints.
Throughout the design and implementation of the study, careful ethical considerations
were taken to ensure positionality, power, and ethical guidelines are adhered to based on the
IRB’s guidelines and requirements. All participants were volunteers informed of the purpose of
the study and assured of their anonymity prior to participation.
Limitations and Delimitations
Limitations are beyond the researcher’s control. Conducting research during a pandemic
is a limitation of this study. School leaders may also have been experiencing lower self-efficacy
due to not having prior experiences to balance the demands of educational reform in a pandemic.
This may have impacted the number of participants willing to be vulnerable with questions
related to a new situation. Other limitations include the reliance on self-reporting by students on
the CHKS and inconsistent evaluation tools to measure an initiative’s effectiveness.
Delimitations are items within a researcher’s control. One delimitation is the selection of
participants based on whether their schools participated in the 2017–2019 CHKS and, if
necessary, the narrowing of interviewees based on that survey’s findings. Due to the COVID-19
pandemic, the interviews were conducted virtually, which may have influenced their format.
Virtual meetings may have impacted the natural flow of dialogue and limited the researcher’s
ability to take note of non-verbal cues.

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Chapter Four: Findings
The purpose of this study was to learn more about the perceived causes of the increase in
adolescent mental health needs from the perspective of high school principals. An additional
purpose of the study was to identify school-based initiatives for increasing mental health
supports for high school students and identify approaches to supporting students before and
during the COVID-19 pandemic. This study utilized SCT (Bandura, 2005) to determine the
perceived causes of high school students’ increasing mental health needs and identify
intervention initiatives to combat the rise before and during the pandemic. Eight interviews were
conducted in a semi-structured format, allowing for collecting qualitative and open-ended data
and exploring participants’ perceptions, opinions, and knowledge. The interviews also provided
each interviewee an opportunity to understand the complexity of student mental health. The
interviews sought to identify themes among data pertaining to three research questions:
1. What are high school principals’ perceived causes for increased mental health needs in
high school students?
2. What are high school principals’ perceptions of student mental health changes since the
COVID-19 pandemic?
3. What school-based formal initiatives are in place or emerging in response to increased
student mental health needs?
Participants
The researcher utilized purposeful sampling to select the participants. Principals were
selected based on their school’s participation in the CHKS in 2017–2019 and each school’s
student body’s SES, which is determined by the percentage of students qualifying for free or
reduced-price lunch based on family income. In 2021–22, California families of four annual
32

earning $34,450 qualify for free school meals (California Department of Education, 2021a).
Eight principals from high schools located in a region of Southern California participated in this
research. The participants’ high school principalship experience ranged from 1 year to 17 years.
Three participants were female, and five were male. Table 2 identifies the participant’s years of
principalship experience, years of service at their current high school, high school SES, and
whether students attended school in person after the stay-at-home order was lifted.

Table 2
Participant Demographics
ID Years of exp Years at school Poverty level Returned to in-
person 20/21
Principal 1 6 6 23.8% Yes
Principal 2 5 2 30.7% Yes
Principal 3 16 5 11.6% Yes
Principal 4 7 5 30.1% Yes
Principal 5 8 5 83.2% No
Principal 6 4 1 93.7% No
Principal 7 13 3 86.4% No
Principal 8 17 4 71.5% Yes

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Research Question 1
The first research question asked, “What are high school principals’ perceived causes for
increasing mental health needs in high school students?” Initially, the respondents lacked
confidence and demonstrated hesitancy in their response to why students are experiencing more
significant mental health needs. Principal 4 stated, “Yeah. That’s dangerous to kind of link it to
causation, but I think elements that we’re seeing are reported, right?” Principal 2 responded,
“Honestly, I don’t think it would be fair to kind of designate a root cause to that.” Principal 3
stated, “I am hesitant to answer because I think I am part of the problem. As the school leader,
have I created an unhealthy environment by allowing and celebrating achievement over health?”
Principal 8 responded, “My answer will sound like I am passing the buck to a societal problem,
not a school-induced cause.”
After the initial hesitations, interviewees revealed their perceived cause for the increase
in mental health needs. Students’ SES emerged as one central theme. Principals 1, 2, 3, and 4
serve higher-SES student bodies, while Principals 5, 6, 7,8 serve lower-SES communities.
Increased Mental Health Needs
Principals interviewed were asked to recall students’ mental well-being before March
2020, when schools closed due to COVID-19. The principals reported increased mental health
needs, including depression, anxiety, stress, self-harm, drug abuse, and suicidal ideation.
Principals reported anecdotal experiences of more students qualifying for Section 504 plans or
special education, increases in risk assessments, re-entry plans for students experiencing anxiety
and depression, and suicide ideation or attempts. Principal 4 described the increase not
associated with mental health but with learning disabilities:
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It’s just ballooned, right? And most of them are linked or attached to mental health. They
are not connected to a learning disability. Most of them are linked to families and
students saying that they are impeded from their access to education because of anxiety
or a depressive disorder.
Principal 2 described the increase as pervasive:
I think we saw them [students with mental health needs] in a percentage of our students,
but I don’t know. I don’t remember being as pervasive as it is. Like, I think there’s been a
growing level of the pervasiveness of anxiety.
Principals 3 and 5 referred to the increase in mental health needs as an epidemic.
Principal 3 said, “With that, we even used the word pandemic differently, right? But, previously,
we were to use it or epidemic, right? Of mental health issues.”
Three of the eight principals reported that their schools collect student mental health
status anonymously outside of the CHKS. Principal 3’s school administers a “co-volatility”
screening to be “very proactive in gauging student issues and their well-being. Our co-volatility
screening efficiently puts students, based on their responses in colored tiers.” The tiers align with
the school’s academic MTSS. The tier determines the level of intervention or supports a student
needs with green as Tier 1, which provides universal or core instruction. Yellow identifies Tier 2
needs for targeted or strategic instruction or intervention. Red represents the Tier 3 level of
intensive intervention. Principal 3 shared that students receive varying support or intervention
based on their tier placement:
We respond to the students in the red and yellow tiers based on their responses. And,
sometimes, it was a touch base who might say, “Yeah. I was just having a bad window of
time. I’m good now.” I let them know of the resources available to them. And then the
35

other, more challenging cases, we are like, “Okay. We have some support groups you are
going to participate in. We’re going to follow up with you.” Sometimes, it results in a
referral to a mental health specialist.
Principal 2 stated, “We do data collection surveys every year about where we can focus
our counseling programs. So, it’s data-driven in that way. They keep data obviously on the things
they’re seeing in terms of social, emotional support.”
Principal 4 reported their school follows the American School Counselor Association’s
(ACSA) model that requires data-guided counseling.
We employ the ACSA model for counseling, and a big portion of ASCA is that data-
guided counseling and instruction and supportive pre-and post-survey data. They give
overarching general risk assessment that, then, they’re able to go through, and then get
initial data of how kids are reporting their own perception of their mental health and well-
being.
Although Principals 2, 3, and 4 collected data, none of them linked the data to their
interview responses. The responses by all participants were based on anecdotal observations and
experiences.
Perceived Causes
When asked, “Why do you think students experience mental health challenges?”
interviewees’ responses varied between principals. Principals reported different causes based on
students’ SES. The four principals serving higher-SES schools and with high student academic
performance reported the increased mental health needs resulting from the pressures to perform,
overloaded schedules, competitive culture and workload, and college acceptance. An analysis of
interview responses of the four principals serving more significant percentages of
36

socioeconomically disadvantaged students identified family resources, traumatic experiences,
self-efficacy, and stigma associated with mental health needs as factors contributing to the
increase in students’ mental health needs.
Higher Socioeconomic Levels
Pressures to Perform
Principals serving higher-SES schools reported pressures to perform academically and in
extracurriculars as a cause for the increase in mental health needs. Principals 3 and 4 reported
that students lack the resilience and self-management skills to address failure. Principal 3 stated,
I’d say general causes. Anytime you’re in a higher, highly rigorous, high-performing
environment, I think that kids just get the feeling that when they fail, that it’s a missed
opportunity, and now they’re behind the curve versus when they fail, like “Hey, what can
I learn from that? How can I be better?’ It’s kind of a collection of things. It’s what our
kids have navigated in their young adult life and what they’ve seen and who they’re
surrounded by and what bumper stickers are on the parent’s car and what license plate
frames say where they went to school, and all those things.
Similar to Principal 3, Principal 4 reported a “lack of resilience is causing their anxiety. Students
don’t have the skills and arsenal for them to respond to different types of situations, like their
first F on a test or not winning the ASB president election.”
Principal 1 reported the pressures are a result of parental expectations:
The parental expectations of students are out of control. Kids are expected to be perfect in
everything they do. Must be earning a 5.0 GPA, music chairs in the orchestra, and
Division 1 CIF tennis or golf champion. It is an insane amount of pressure on teenagers.
37

Overloaded Schedules
Principals serving higher-SES schools reported the overscheduling of students as a cause
for mental health needs. Principals 3 and 4 reported cultural and societal pressures to overload
schedules. Principal 4 stated, “We lost the cultural acceptance for downtime, right? So, kids’
schedules are nuts. There’s no such thing as the kid that does school, does an activity, and then
just gets to go home and rest, eat and sleep, right?” Principal 3 reported the social pressures on
parents to overload their child’s schedules:
I hear from a lot of parents that they feel looked down upon or in their community they
feel guilty that if they say, “Oh, what do your kids do after school?” It’s like, “Oh, well,
they’re just home and do their homework and hang out.” And it’s almost like, What? It’s
like you’re neglecting your child.
Principals 1 and 2 reported the overloaded schedules are intentionally designed by
students for peer acceptance. Principal 1 said,
There’s this martyrdom of, “I do everything all the time. I play two sports. I work a job. I
volunteer. We travel. I have a blog. I do every AP class.” What is the schedule of a
typical teenager from 10 years ago and 20 years ago? You weren’t looked down upon if
you did school and went home.
Principal 2 reported, “Students feel like they are losers, in the eyes of their peers, if they don’t do
it all.”
Competitive Culture and Workload
Principals serving higher-SES communities reported the competitive culture and
workload of students’ classes, specifically Advanced Placement courses, as a cause for the
increase in mental health needs. Principals 1, 3, and 4 reported the challenge of educating parents
38

and students on the potential negative impact on students’ well-being of taking an excessive
number of Advanced Placement and college-level classes. Principal 4’s response questioned the
why behind the competitive edge and excessive workloads:
It’s kind of that chicken or the egg piece where there’s a perception of more
responsibility, more work, more time, more homework, more pressure, more stress upon
students, and perhaps, you can look at that by the increase of participation in honors and
AP courses and how once upon a time, at least at the high school level if a kid had two to
three AP, it’s like, “Wow, your stack.” And now, easily, I’ll have students have four to
five to somehow six, and they’re taking off-campus community college courses. And, so,
where did that come from? And that’s why I say chicken or egg. Did someone advise
them to that, or did they pursue that thinking it would give them a competitive edge?
Principal 3 described the futile efforts and the challenges their school takes to educate students
and parents on a balanced schedule:
Guidance counselors try to temper those workloads and say, “Hey, that’s a lot. You have
a very competitive schedule.” And we would get pressured to know, just put them in it.
And we would just put them in it. It’s hard to pinpoint the source. It’s like your
competitive students are chasing the most competitive students, and then you have that
domino effect, and then there becomes a perception that the school wants us to do it.
Principal 2 shared the school’s efforts to limit the number of Advanced Placement classes:
We put together a policy that limits the number of AP classes a student can take per year
that increases from freshman year to senior year. In order to add more AP classes, the
parents and students need to view an informational video explaining the research behind
healthy limits supporting the mental and physical well-being of students, meet with an
39

administrator, and sign a contract. You won’t believe the number of parents and students
seeking a waiver to add more AP classes. They are afraid if they don’t take all AP
courses offered that they will not be competitive against other students at our school and
other schools.
Principal 1 stated the competitiveness is a result of the misperception linking college
acceptance solely to the rigor of the academic transcript:
I think that we being in [this part of the] county and I think the level of competitiveness
in terms of students wanting to go to college. There is a growing level of the
pervasiveness of anxiety about competitiveness or college or workload. The kids are
afraid if they don’t do it all, they won’t get into college. We are working to change that
perception, but it is ingrained in my school’s community.
College Acceptance
Principals serving higher-SES populations reported college acceptance as a cause for
mental health needs. Principal 1 reported students’ need for perfectionism as driven by college
acceptance:
Students are overloaded in AP classes, extracurriculars, and pressure to be perfect for
their college applications. It is like they can’t just be kids. The competition between kids
and their parents is insane. And all geared toward college acceptance resulting in anxiety,
unhealthy stress, and depression.
Principal 2 shared a conversation with a student after an anxiety attack that illustrated a student’s
seeking perfectionism for college acceptance:
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I [student] have anxiety because I have to go in and take a test, and if I don’t do well on
the test, I feel like my high school career was going to be over, and I’m never going to go
to Harvard.
Principal 1 reported an increase in high school seniors’ struggling with anxiety and
depression during the application and acceptance to college months of October to April:
Every year, we experience an increase in risk assessments for self-harm and suicidal
ideation in our seniors. The application process, even though we try our best to offer
support, is extremely stressful and anxiety-producing. The anxiety continues after
application submission when they wait for acceptance or denial emails. Hearing of
others’ acceptances heightens their anxiety, and once that email arrives, depression hits if
denied.
Principal 4 reported a spike in the number of students experiencing depression from the
Class of 2021 due to college denials:
Because of COVID, colleges waived the SAT and ACT as a consideration in the
admissions process. Our students that typically perform very well on the SAT and ACT
due to expensive test prep companies did not have the leg up. Also, colleges accepted
grades of credit/no credit that did not impact a student’s GPA. Students could select
which courses they took letter grades and which ones they took for credit. That inflated
everyone’s GPA. Basically, any student could have a 4.0 or higher GPA for three
consecutive semesters. Kids just didn’t get accepted. Lots of counseling referrals were
made last March.

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Lower Socioeconomic Status
Principals serving higher percentages of socioeconomically disadvantaged students
recognized family resources, traumatic experiences, lack of self-efficacy, and the stigma
associated with mental health needs as contributing to the increase in student mental health
needs.
Family Resources
Principals serving lower-SES populations reported family resources, including food
insecurity, multi-family housing, and income, as causes for the mental health needs. Principal 5
reported, “The poorer students worry about surviving, family dynamics of abuse, and lack of
resources.” Principal 7 said the lack of family resources is resulting in teenagers assuming adult
stressors:
So, pre-pandemic, we saw, primarily, depression was probably the number one. A lot of
it has to do with family challenges, a lot of food insecurity that was happening. Teenagers
are taking on the responsibilities of the adult parents who are commonly out of the house
working three or more jobs. It is a lot for a child to take on.
Similar to Principal 7, Principal 8 stated, “My students are barely making it. Many of them are
responsible for younger siblings and generating income for the family. They are in survival mode
and under constant levels of unhealthy stress.”
Principals 5 and 6 reported that multi-family housing impacts their students’ mental well-
being. Principal 5 stated, “The impact of high-density and multi-family has an impact on a
teenager who seeks independence and privacy. Sleeping on the couch or, worse, floor in a room
with your parents and siblings doesn’t offer either.” Principal 6 reported, “Because students live
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in such crowded homes, I often see students alone on campus. They just want some private time
and some quiet space so they can de-stress.”
Traumatic Experiences
Principals serving lower-SES schools reported students’ traumatic experiences, including
abuse or persistent safety worry, as causes for mental health needs. Principal 6 reported an
increase in self-harm, specifically cutting, by students: “Almost always a student is cutting
themselves to release the mental pain from a traumatic event by transferring it to a physical
pain.” Principal 5 reported that during their weekly counseling team meetings, a school
psychologist runs a group therapy session to support the counselors in processing the information
and experiences shared by students: “No wonder why students are depressed, seeking numbing
with drugs, and suicidal based on their experiences of child abuse, sexual assault, and domestic
violence.”
Principal 7 reported safety concerns, specifically gang violence, as a cause for mental
health needs:
My students come from three different cities. Some have to walk through another school
district and dangerous areas to come to school. The geographic spread of my student
body brings with it competing gangs. They worry about safety at school and on their walk
to and from school.
Principal 8 reported the traumatic experiences of students as a cause for the increase in mental
health needs:
Students worry excessively about keeping safe in their gang-infested neighborhoods. So
many of my students experiencing mental health needs have witnessed or been the victim
of horrific events like shootings and stabbings. The pressure they feel as young adults to
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protect and provide for family members is extreme. When students are caught with
knives on campus, the reason for bringing them is almost always for safety when walking
home.
Self-Efficacy
Principal 6 reported self-efficacy and academic self-concept as contributing factors for
the increase of mental health needs:
It’s all about access for our students. This is an area where you have multiple families in
one household, and it’s in a lower socioeconomic area. The parents and kids are first-
generation; many of them are even newcomers. Many of them don’t speak English. So,
their social-emotional needs are different and often related to understanding how to
navigate school systems. They are depressed because they just don’t know what to do,
and it is scary and isolating.
Principal 7 reported students’ low academic and language levels impact their mental well-being:
“Social-emotional needs for our students stem from low academic and language levels. For many
of them, they stress and anxiety about being called on in class and embarrassing themselves in
front of their peers.”
Similar to Principals 6 and 7, Principal 8 identified self-confidence with mental health
needs:
It seems like some of my students struggling with mental health want to hide or be
invisible. They wear black hoodies covering their heads, walk with their eyes down, and
demonstrate disengagement in the classroom. I don’t know. Maybe there’s a correlation
between self-confidence and mental health needs.
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The Stigma Associated With Mental Health Needs
Principals 5, 6, 7, and 8 reported the stigma associated with mental health needs was a
cause for severe mental health needs. Principal 5 reported, “They [students and families] tend to
not speak about their mental suffering due to the stigma and limited access to resources. It’s like
a matter of shame and unspeakable admission for the poorer families.” Principal 6 said,
“We have a lot of resources available to students. Our counseling ratio is 250 students to 1
counselor. But the students and families will not access the available help.” Principal 7 reported
the school’s efforts to educate the students in monitoring their mental health:
We are trying to get more students aware of checking their own mental health before they
endeavor into something more academic. Just getting them comfortable talking about it. I
think there is a little stigma in the Latino community about mental health.
Principal 8 said, “The stigma of mental health for our poorer families is a challenge. We don’t
see the students until it becomes a crisis manifested by self-harm or suicidal ideation.”
Summary of Findings for Research Question 1
In summary, the causes these high school principals perceived as increasing mental
health needs varied by their student body’s SES. The four principals serving schools of higher
SES and high student academic performance reported these needs resulted from the pressures to
perform, overloaded schedules, competitive culture and workload, and college acceptance. An
analysis of interview responses of the four principals serving more significant percentages of
socioeconomically disadvantaged students identified family resources, traumatic experiences,
self-efficacy, and the stigma associated with mental health needs as contributing factors for the
increase in student mental health needs.

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Research Question 2
The second research question asked, “What are high school principals’ perceptions of
student mental health changes since the COVID-19 pandemic?” When asked about the changes
they perceived in student mental health since the pandemic, principals reported positive and
negative outcomes for students’ mental health needs since the onset of COVID-19. Principals
identified positive outcomes as minor changes in the number of students experiencing mental
health needs, social relationships, improved overall health, and an increase in school
engagement. Principals from higher-SES schools provided more examples of positive outcomes.
The negative outcomes of COVID-19 on students’ mental health include a significant change in
the number of students experiencing mental health needs, lower academic performance,
isolation, and an increase in student misconduct. Principals from lower-SES schools provided
more examples of negative outcomes, such as an increase in students requiring mental health
support.
Positive Outcomes From COVID-19
Minor Changes in Mental Health Needs
Principals reported minor changes in student mental health needs since the COVID-19
pandemic. COVID-19 did not eliminate students’ struggles; however, Principals 1, 3, and 4 did
not observe it compounding mental health problems. Principal 1 reported, “Students continue to
struggle with school performance-related anxiety and stress. We haven’t really seen any change.”
Principal 3 stated, “I would say there’s a little bit of a challenge adjusting back to normal school
life.” Principal 4 reported their return to in-person worries of increased student mental health and
misconduct did not occur:
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I’ve not seen anything drastic on my end. Now, I know that counselors, teachers, and
academic advisors are saying that they’re not seeing an uptick. I don’t think it’s as bad as
we thought it would be. I think we were all holding our breath, and we thought these kids
are going to come back after a year and a half and be a mess. I think there are some kids
that are probably worse off than they were, but we’re seeing some resilience that wasn’t
there before.
Principal 5 stated, “Not really. It is early in the school year may be more will emerge as students
become comfortable with the staff.”
Social Relationships
Principals serving higher-SES populations reported students maintained social
relationships and activities during school closures and stay-at-home orders. Principals 2 and 5
reported the development of pods of students and families who agreed to limit socialization to
pod members only. Principal 5 stated, “The wealthier families continued to socialize, creating
pods of friends. Taking virtual classes together. They basically created at-home classrooms for
their friends.” Principal 3 reported students with financial means maintained social relationships
and activities through travel to their second homes:
My students seem to be doing a really good job of staying social with their groups. And I
think we’re in a bubble within a bubble here where I think a lot of people took advantage
of the time, honestly. A lot of families that had the means had their school year in the
mountains in Colorado. They skied in Park City. They went to Europe. Families made the
best of what was ahead of them and the environment if they had the means.
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Improved Overall Health
Principals serving higher-SES schools reported improved health caused by an increase in
hobbies and downtime. Principal 4 stated the opportunities quarantine and school closures
provided to students:
Anecdotally hearing from kids, the hobbies they picked up when they were home. Kind
of non-social, but things you have to do on your own. Kids picked up crochet and how
that kind of became cool thinking to do and talking to some kids they said they were
tinkering around in their garage and fixing cars using YouTube videos because what do
you do? You can’t go away?
Principal 3 stated, “We are going to have an amazing surf team this year! During school closures,
we had students attending virtual classes from the beach. With the shortened school day, they
had more time to relax and do things they like.” Principal 1 reported, “During school closures
and stay-at-home orders, my students’ stress levels seemed to lighten. It’s just a guess, but I
think the closures forced them to slow down. They couldn’t overschedule themselves because
extracurriculars weren’t happening.”
School Engagement
Principals reported an increase in student engagement with school activities. Principals 1,
4, and 5 reported an increase in student attendance at athletic events and school dances. Principal
1 stated, “Our student engagement is beyond any other year. Student attendance at school-
sponsored events has tripled. Even with masks, students are attending athletic events and dances
like never before. I think students are more appreciative than before.” Similar to Principal 1,
Principal 4 reported their concerns about the potential loss of student section culture did not
occur:
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Participation, like our football games, we’re having sellout crowds with no particular
additional publicity. We’re not telling kids to come more than previously. They’re just
coming, and I remembered that was a concern of the wonderful home game student
section culture that had been built up would be gone because half of the student body
hasn’t ever been to campus.
Principal 5 stated, “Students returned to school excited to be here. Almost more appreciative of
the aspects lost in the 2020–21 school year, like homecoming, football games. They seem more
engaged in school spirit, but it is early in our return.”
Principal 2 reported on the increase of student involvement in school-approved clubs and
athletic tryouts:
Our club rush was today. We had 116 clubs. This is the most ever club applications
we’ve had. And all of our coaches are saying they’re having the largest try-out groups.
So, where is all this coming from? It’s like there was a pent-up demand; like kids realized
what they lost. They’re eager for these opportunities. So, I think those are all good signs
that they’re gravitating towards these healthy outlets, right? We know kids that are
involved in, engaged in extracurriculars have a far higher chance of doing well
academically, emotionally, and socially.
Negative Outcomes From COVID-19
A Significant Change in Mental Health Needs
Principals reported an increase in student mental health needs since the COVID-19
pandemic. Principals 2, 7, and 8 reported an increase in the number of students experiencing
mental health needs since COVID-19. Principal 7 reported the lack of school connectedness and
the students’ home environments as two causes for the increase in mental health needs:
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We see a real uprise. And I think a lot of that has to do, not only with parents losing their
jobs and that economic side, but not feeling a connectedness to their school community.
For so many of our students coming to school is a safer place to be than at home. It was
tough to see our kids in need because of the home environment that was just more
magnified, escalated, intensified. Since coming back to school, we’ve seen different
mental health issues, especially anxiety.
Principals reported an increase in student depression and attributed the increase to the
feelings of hopelessness for their futures due to credit deficiencies and incomplete grades. For
the Spring 2020 and the 2020–21 school year, the California Department of Education strongly
encouraged local educational agencies to approve no-harm policies by recommending student
choice on how they received grades, either traditional or credit/no credit that does not impact
overall grade point averages. Another no-harm policy implemented by Principal 8’s school
district was permitting teachers to issue Incomplete marks allowing students the opportunity to
complete the coursework during summer and the 2021–22 school year. Principal 8 reported a
large number of students returned to the 2021–22 school year, credit deficient with numerous
incompletes. Principal 8 attributes the credit deficiencies to their students demonstrating greater
signs of depression:
We have seen an increase in students with depression and apathy. Students lack any
belief or motivation to recover incomplete grades or missing credits. When provided
opportunities for alternative education opportunities, students decline them. It’s like they
just don’t care about high school graduation and their futures.
Principal 2 noted a change in the type of anxiety they are observing in students. Prior to
COVID, student anxiety was attributed to their fears of college acceptance, pressures to perform,
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and excessive workloads. While Principal 2 reported these reasons continue to cause mental
health needs, they also reported a shift in student anxiety from localized to more situational
anxiety.
I think there is a growing level of the pervasiveness of anxiety, but not just anxiety about
competitiveness or college or workload. I don’t remember observing just general anxiety
about being at school, which I think I see a little more of now. It is the shift from maybe
less anxiety that is more general or localized to situational. Before COVID, it was “I have
anxiety because I have to go in and take a test, and if I don’t do well on the test, I feel like
my high school career was going to be over and I’m never going to go to Harvard.” As
opposed to, like, I don’t want to go to school because it’s so overwhelming and there’s so
much there, and I’m just anxious about everything.
Academic Performance
Principals reported an increase in mental health needs among students of lower SES
related to academic performance. Principal 2 reported their socioeconomically disadvantaged
students returning to school feeling academically behind:
I think there’s an additional layer for our socioeconomically disadvantaged students.
COVID provided an additional layer of challenge for them as a group, I think they were
less successful academically, which makes sense. Then, I think that’s manifested itself
and then coming back here feeling, like, behind in terms of academic progress.
Principal 5 reported, “Our first quarter grades this year were horrific. We look at the grade
reports and found a larger portion of our poorer students to have failing grades. The pandemic
served to widen the achievement gap.” Principal 7 reported the return to traditional grading
policies is impacting students:
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During distance learning, we had no-harm grading. We had a pass/fail and issued
incompletes that were extended into this school year. So, students have been given a lot
of forgiveness in their grades. That’s not continuing. So, I think the catching up maturity-
wise and with student habits, the ongoing duration of COVID, and having that kind of
structure now resulting in a grade that’s not necessarily easily achieved has really
affected so many of our students’ ability to cope with not getting the grade that they
thought they were going to get.
Principal 8 reported credit deficient students have a sense of hopelessness and apathy:
We have so many students with incomplete grade marks from the last three semesters that
we are offering longer school days, Saturday school, and intersession during holiday
breaks. The problem is kids aren’t attending. So, now, the academic levels are so low,
and credit deficiencies are so high that we are creating a continuation high school
extension program on our campus. We need to lift them up. They seem so depressed.
Isolation
Principals reported isolation as one cause for the increase in lower-SES students
experiencing mental health needs. Principal 6 reported, “When we first started this school year,
the students were very timid. They were very scared. They weren’t too sure how to behave or
how to interact with other students or with the staff.” Principal 2 stated the shift back to a full
campus versus learning from home created anxiety for students:
We normally have a level of worry from ninth-graders coming from a middle school of
1,000 to a high school of 2,200. There’s that level of anxiety, but now you’re coming
from your bedroom of one, and you’re coming to a school of 2,000.
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Principal 7 reported, “Students who were outgoing, extraverts, returned to school withdrawn
with behaviors more associated with introverts. It’s hard to say if that is a result of school
closures and quarantine or if it is the masks.” Principal 6 shared, “Although we invited all of our
ninth and 10th-grade students to summer school, the majority did not show up because there’s
still a fear. They’re still not too sure if they are comfortable with being in person.” Principal 6
also reported a lack of social skills in students:
When students returned to school, they just kind of sit there with each other, but they’re
not really talking. When I approach them, it seems like I’m intruding on their personal
space. Before COVID, I saw groups of students. Now, I just see single students just
hiding.
Increase in Student Misconduct
Principals reported an increase in student misconduct. Principals serving lower-SES
schools reported misconduct has significantly increased in the number and severity of the
behavior since COVID-19. Principal 8 reported a rise in student misconduct.
Our students returned to school forgetting how to behave, and schools have rules to
follow. They just can’t keep their hands off of each other. We have a rise in behaviors
like drug use, fights, and use of weapons. Our expulsion data in August [to] October 2019
was zero. In the first two months of school, we expelled 10 students. I have never seen
this before.
Principal 5 said, “Student attendance is a huge issue for us. Kids just aren’t coming. It
doesn’t help that Assembly Bill 104 requires so few credits for graduation this year. Seniors are
cutting classes, disengaging, and disrupting classes not required for graduation.” Principal 6
reported an increase in students using drugs and vaping on campus:
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Kids are coming to school high. One student on suspension for lighting a fire in the
bathroom came to school high for special education assessments. He told me yesterday
that he has to smoke marijuana every day. He wakes up to smoke and continues his high
throughout the day.
Principal 7 reported, “We have had more fights this year from our freshman and sophomores.
When we investigate it, the conflict stems from unresolved problems from middle school. Really
immature behaviors.”
Principals serving higher-SES students reported students require more reminders and
redirection about minor behavioral infractions, including dress code and tardies to classes.
Principal 3 reported the need to educate freshman and sophomore students about appropriate
school behavior:
We’re having to revisit the low-hanging fruit. Sometimes for us, it’s as simple as like,
“Okay, I understand you wore that outfit for the last 18 months of distance learning, but
you can’t wear that to school.” Basically, when we think about kids that haven’t been on
school campuses for 18 months in a traditional sense, so it’s like, we’re educating our
freshmen and sophomores about what they can and can’t be doing, what they should and
shouldn’t be doing while you’re on campus.
Principals of higher-SES schools spoke about students with a positive and empathetic tone.
Principal 4 reported relief that student behavior was not what they feared the school would
experience upon student return:
Teachers are saying kids are doing pretty good. They’re acclimating. I think there was a
fear like, “Oh, my goodness, they’re all going to be feral and not know how to interact
with each other.” And I think sometimes, when you think about it logically, it’s like, well,
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most of these kids have been in school most of their lives. So, even though we had a hard
time where the schedules got messed up, most of their muscle memory is still at normal
school, right? So, it’s not a foreign concept for them.
Principal 2 reported the adult efforts to be mindful of the students’ habits that need to be
redeveloped:
I mean, those habits can be dropped very quickly if you’re not in a routine. So, throwing
a routine of school and bell schedule back at students, we’re trying to be mindful of what
we can do to remind them of how they’re going to be successful.”
In summary, high school principals’ perceptions of student mental health changes since
the COVID-19 pandemic reflect positive and negative outcomes. The positive outcomes,
experienced primarily by higher SES students include improved social relationships and overall
health as a result of increased family time and balanced schedules. School engagement upon
return is another positive outcome perceived by high school principals. Principals reported an
increase in student engagement in extracurricular activities such as school dances, athletics, and
clubs.
The negative outcomes, experienced primarily by lower SES students, include an
increase in mental health needs, widening of the achievement gap, social isolation, and an
increase in student misconduct.
Research Question 3
The third research question asked, “What school-based formal initiatives are in place or
emerging in response to increased student mental health needs?” When asked about what school-
based formal initiatives are in place or emerging in response to increased mental health needs,
principals reported few initiatives and identified more areas of need. Principals identified
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initiatives that included developing socio-emotional competencies, opening student wellness
centers, developing local partnerships with businesses, hospitals, and colleges, and increasing
professional development for staff on topics related to mental health. Principals identified areas
needing program development, including improving proactive systems, addressing the stigma of
mental health, increasing human resources to support initiatives and students, and a need to
improve parent education around mental health-related topics.
Initiatives
Building Socio-Emotional Competencies
Principals reported implementing school-wide practices to develop students’ social-
emotional competencies through intentional efforts of counseling departments, mental health
specialists, and other staff. For some schools, this looks like voluntary attendance at weekly
events on various topics related to mental well-being. Principal 1 reported, “The weekly events
are by choice for the students. It’s been interesting to watch student attendance increase since
COVID. I’m not sure if it is kids looking for connections and support or if we are reducing the
stigma linked to mental well-being. Either way, it’s cool to see.”
Principals are also implementing in-class instruction on mindfulness and the development
of SEL competencies during the regular school day. This strategy impacts all students as an
MTSS Tier I level of support for all. Principal 2 stated, “we dedicated a section for a teacher to
be a wellness coordinator. She goes into classrooms and coaches students on mindfulness
lessons, but also does lessons with teachers so that they can help reemphasize these skills and
breathing techniques.” Similar to Principal 2, Principal 3 reported, “The counselors do a site-
wide curriculum that’s specific by grade level. It follows the ACSA’s model for SEL
competencies.”
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Principal 7 stated that during their embedded intervention time, staff members provide
students with lessons dedicated to mental health issues and the importance of recognizing the
mental distress signs in yourself and others:
We have special dedicated lessons and videos, and outreach about mental health and
about coping mechanisms, and also the signs to be aware of when you or a friend or a
family member might be struggling with mental health. Because oftentimes, our students
don’t know what it looks like or feels like, they don’t know how to articulate that or just
accept it as normal and accepted. So, that has helped us keep that conversation going.
Strengthening Adult-to-Student Relationships
Principals stated the importance of building positive adult-to-student relationships and
school campuses that are safe, supportive, and welcoming. Principal 3 attributes their campus
culture that’s engaging to students and helping to build life skills. “You build a culture where
kids feel supremely connected and reliant on the adults on campus, which I think is healthy for
both the adults on campus and the kids.”
Principals 7 and 8 reported their school district offers professional development
opportunities specifically to help build and maintain positive relationships between adults and
students. Principal 7 described one strategy for developing relationships and intentionally having
students check their own mental health as a daily check-in with each student as they enter the
classroom environment. Principal 7 set the strategy as an expectation for all teachers to
implement:
I would say, organized, not in a formal way, more deliberate way. Baseline things from
having teachers start with a check-in like “How are you feeling today?” In French class, it
will be using the vocabulary, but in every classroom, we’ve encouraged starting
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everything off with an emotional check. Just trying to get students more aware of
checking their own mental health before they endeavor into something more academic.
Principal 8 explained their school-wide efforts to implement strategies learned through
the professional development offered by Capturing Kids Hearts. Capturing Kids Hearts focuses
on building student SEL through student connectedness and relationship-driven campus culture
between students and staff. Principal 8 reported, “Classrooms where staff really implement
Capturing Kids Hearts feel different when you enter. There is a different level of engagement by
everyone. It’s like there is a sense of belonging and structure that maintains positive
relationships.”
Similar to other principals, Principal 2 reported the importance of students feeling safe in
their learning environment:
So, acutely aware of our primary goal is to ensure that kids are learning and that they
graduate. Sometimes that can’t happen if kids’ mental health isn’t in a place where it
needs to be, we can have the most amazing intervention system ever academically, but if
a kid doesn’t feel safe and secure here, it doesn’t really matter. It’s not going to benefit
them, and, so, sometimes it’s just trying to get people to realize that too, I think.
Wellness Centers
Principals reported opening student wellness centers on campus to provide a safe, de-
escalating space for students. Principal 2 shared, “We have a soft, quiet space that is nicely
designed and furnished for kids to come in and kind of decompress.” Principal 5 shared the
opening of the Corner:
The goal of the Corner is to provide students with a safe space to regroup when feeling
overwhelmed, anxious, stressed. The intern counselors, under the guidance of a staff
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counselor, are housed in the Corner if students need to talk to someone or receive
assistance with mindfulness activities. So far, the Corner has been well-received by
students and staff.
Partnerships With Local Agencies, Colleges, Businesses, and Hospitals
Another initiative implemented by multiple principals is partnerships with local agencies,
hospitals, colleges, and businesses to support awareness, instructional resources, advice, and
policy and practices reviews. Principal 1 stated their partnerships with local agencies supported
their recent mental health fair:
They just held a Wellness Week mental health fair on campus, and local agencies joined
to share resources, swag, and information related to mental health. We had the Asian and
Pacific Islander Community Alliance, Families Together, Asian Pacific AIDS
Intervention Team, National Alliance on Mental Illness, and Western Youth Services
there.
Similar to Principal 1, Principal 6 school also held a mental health fair with community
organizations in attendance. Principal 6 reported, “We wanted to bring awareness that mental
health actually exists, and it’s something that we want to talk about. The fair helped us to remove
some of the stigma.”
Principals 1 and 3 reported their schools to participate in Stanford’s Challenge Success
program. Principal 3 stated, “The program is really helping us identify systems we put in place
that have unhealthy outcomes.” Principal 1 reported, “The partnership with Stanford has
impacted our parent and student community. It’s like if Stanford is saying to focus on student
well-being and balance, maybe it is okay to follow the advice of school counselors to watch
workloads.”
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Principal 5 reported the impact of the school’s partnerships helped in creating its wellness
center, the Corner, through collaborative efforts with community partnerships:
It was developed in partnerships with local community agencies and a local children’s
hospital. Using their expertise and research findings, the space emerged to be physically
appropriate. They gave us advice on everything from the wall colors, types of lighting,
furniture, and equipment like weighted blankets and soothing fidgets.
Principal 7’s school participates in the Disney ASPIRE program that provides social workers,
tutors, and a number of resources to support students academically and with their mental health.
Professional Development
Principals reported increasing professional development for staff on topics related to
student well-being and mental health. Principal 1 professional development for staff includes
monthly training and data analysis to learn why students are struggling:
Each month at our staff meeting, the mental health specialist shares information about
mental health to increase teacher awareness. Our Challenge Success team also presents
student survey data for us to try to address what kids are struggling with, like, homework
load or too many tests on one day.
Principal 2 shared their wellness coordinator coaches teachers, so they can help develop
social-emotional competencies and breathing techniques with students. Principal 5 stated, “We
began SEL professional development before COVID, which gave us a leg up when our students
returned. Teachers were ready to implement SEL and mindfulness strategies with students in
person.”

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Needs for Improvement
Need for Proactive School Systems
Principals reported the need to improve proactive school systems around students’ mental
health. Although schools implemented mental health workshops and direct instruction to build
SEL competencies, principals expressed frustration with the reactive approach to supporting
students. Principal 2 reported the need to establish proactive practices rather than reactive ones:
The general thought is that we are going to need more proactive solutions to be able to
address. Right now, we are reactive in supporting students. Yes, you’re going to put fires
out when they come up, but if we can take care of the dry brush, we can prevent fires
from starting overall.
Similar to Principal 2, Principal 6 reported a lack of procedures and systems to address student
needs. “We don’t have a multi-tiered system of support that has been implemented. So, without a
system, where do we start and how do we respond as a school?”
Dedicated Time for Mental Well-Being Instruction
Principals reported the need for dedicated time during the school day to support students’
needs by developing SEL skills before a student is in crisis. Principal 6 stated, “We try to
prioritize mental well-being during our school assemblies, tutorial times, homeroom, but it seems
like another priority always pops up that must be addressed during the same time.” Principal 2
stated a desire to have a required class dedicated to mental wellness:
It would be amazing to have a required class dedicated to mental wellness. I think,
ultimately, a class that we could help embed social-emotional competency skills by a
professional that could triage things as they arise and address them kind of in a
community thing would be awesome.
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Similar to Principal 2, Principal 4 reported efforts and challenges in writing a
mindfulness course that meets a-g requirements. “We are trying to write a mindfulness course,
but the A–G thing might be a little bit of a barrier. That’s definitely a challenge. We are thinking
of embedding it in PE if it doesn’t get approved.”
Recognizing the impacted course schedules, Principal 6 stated taking a different
approach, and rather than develop a class, they want to develop a social-emotional master
schedule:
I want to see social-emotional support like a master schedule. Monday, Tuesday,
Wednesday, Thursday, Friday at one o’clock, I know that this person is providing, let’s
say, self-esteem. And then at eight o’clock in the morning, I know that this person is
providing, I don’t know, gang calling or how to say no to a gang.
Principal 6’s goal of the social-emotional calendar is for the student who is struggling, on any
given day, to select to attend the mental wellness course aligned with their needs rather than the
academic course.
Need to Address the Stigma
Principals reported the need to address the stigma attached to mental health needs.
Principal 2 stated, “We are trying to talk about it as much as we can in classrooms, but for all the
progress I think we make, there’s still such a stigma around mental health.” Principal 5 reported,
“The stigma of mental health for our poorer families is a challenge. We don’t see students until it
becomes a crisis. We need to work on improving communication about resources available to
families.”
Similar to Principals 2 and 5, Principal 7 reported the school’s efforts to remove the
stigmas around mental health:
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So, it’s about promoting again. There could be a little of a stigma in the Latina
community about mental health. And, so, we’re trying to take away the stigma and
having mindful Mondays and doing much more overtly through our embedded
intervention during the day, we call it “Pack Time.”
Lack of Human and Fiscal Resources
Principals reported the lack of human and fiscal resources negative impact to support the
initiatives. Principals who serve schools that do not receive federal Title I funding or LCAP
funding based on the number of unduplicated students identified a lack of fiscal resources as a
barrier to supporting student needs. Principal 1 stated,
It just seems unfair. The state needs to have a line-item allocated per pupil to support all
kids’ mental well-being. My students deserve to have additional counselors and mental
health specialists like Title I schools get. The needs are the same, but the supports are not
available because I don’t serve enough unduplicated kids?
Principal 2 reported the challenge of budgetary resources requiring schools to make
difficult decisions on where to allocate the limited resources:
I mean, I think, ultimately, it’s costs. It’s resources, right? It’s either fiscal resources or
human capital or the combination of those two. Obviously, like any district, we have our
budgets and, anything that we do comes with a trade-off of something else, right?
Principals reported the lack of human resources as an area of need. The counseling to
student ratios was a theme expressed by the principals. ASCA’s recommendation for a student to
counselor ratio of 250:1. Principal 1 stated, “Our counseling department really tries to help, but
they have caseloads of 600 or more students per counselor. They also signed up for academic
counseling, not social-emotional counseling.”
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Principal 4 reported being “notoriously understaffed” in the school counselor to student
ratio of one counselor for every 1,500 students. Principal 4 stated,
We’re in the process, kind of a multi-year changeover from classified academic advisors
who right now do the academic planning, advising, college application process and two
credentialed counselors that do the socio-emotional support to a normative structure of
credentialed guidance counselors that would give both sides of the house, academic and
socio-emotional. When that happens, we’d be closer to 1 to 400 and something.
Principal 7 reported the challenge is not a fiscal one but is one of lack of workforce:
We have the money. How to spend it is another challenge because we don’t have the
people. So, even though we are increasing hourly rates and salaries, adding more
benefitted positions, we don’t have the personnel. It’s echoing very much the national
challenge of people not wanting to work.
Principals with funding resources that are either Basic Aid whose schools are funded
based on local property taxes or receive LCFF concentration grants reported not experiencing a
shortage in human or fiscal resources. Principal 6, whose school district receives LCFF
concentration grant funding, reported, “We have plenty of staff. We have a counselor for every
250 students. Our problem is what they do.” Principal 3, whose school district is Basic Aid,
reported having ample resources:
I don’t want to sound too braggadocious, but I feel like we are living our kind of dream
scenarios as it related to supporting kids. We have no shortage of resources. We have no
shortage of innovative thinkers. I think we’re doing okay with that. I don’t think it’s
perfect, but I mean, what is?
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Parent Education
Principals reported the need to increase parent education around mental health-related
topics. Principal 2 stated, “Our wellness coordinator is going to do some parent education
because I think our parents aren’t equipped to necessarily address what they’re seeing in their
homes as it’s come up either, right?” Principal 3 reported, “I mean, obviously, we’re in a pretty
affluent area, so a lot of it deals with educating parents, too, about how to build some character
in their students.” Principal 7 reported the missing piece in their support is offering services to
the entire family:
I think the piece for our particular community that’s missing is being able to offer
services and education to the entire family. And it’s not that we don’t want to; it’s having
the people. We have the space. We have the demand. The guardians of the students that
are struggling the most, so that we could get more of an emphasis on the family
counseling piece.”
In summary, schools are implementing a variety of initiatives in response to increased
student mental health needs. Initiatives that emerged from interviews include an emphasis on
building socio-emotional competencies in students so that they are equipped with some tools to
self-care and manage the situation. Principals reported the importance of building school cultures
that are relationship-driven and safe environments. Wellness centers are an example of a strategy
to develop safe environments for students to seek assistance or space to support themselves.
Participants’ statements about the positive impact community partnerships have on their ability
to implement desired initiatives such as mental health fairs, advisement from experts in the field,
and increased resources.
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Principals did express challenges they face in implementing these initiatives to include
the reactive nature of the school’s response to mental health needs. Principals identified the lack
of dedicated time, school MTSS, and human and fiscal resources negatively influencing their
efforts. Principals reported the need for more parent education on supporting their child’s mental
health and removing the stigma attached to seeking help.
Summary of Findings
The eight principal interviews yielded themes surrounding the impact of SES on the
perceived causes of the increase in mental health needs and positive and negative outcomes of
COVID-19 on mental health needs. The four principals serving schools of higher SES and
student academic performance reported the increased mental health needs resulting from the
pressures to perform, overloaded schedules, competitive culture and workload, and college
acceptance. An analysis of interview responses of the four principals serving more significant
percentages of students identified as socioeconomically disadvantaged identified family
resources, traumatic experiences, self-efficacy, and the stigma associated with mental health
needs as contributing factors for the increase in student mental health needs.
The impact of SES also emerged when seeking information about the perceived impact
on students’ mental health needs since COVID-19. In summary, high school principals’
perceptions of student mental health changes since the COVID-19 pandemic reflect positive and
negative outcomes. The positive outcomes, experienced primarily by higher-SES students,
include improved social relationships and overall health due to increased family time and
balanced schedules. School engagement upon return is another positive outcome perceived by
high school principals. Principals reported an increase in student engagement in extracurricular
activities such as school dances, athletics, and clubs. The negative outcomes, experienced
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primarily by lower-SES students, include an increase in mental health needs, widening of the
achievement gap, social isolation, and an increase in student misconduct.
In summary, schools are implementing a variety of initiatives in response to increased
student mental health needs. Initiatives that emerged from interviews include an emphasis on
building socio-emotional competencies in students to equip them with some tools to self-care
and manage the situation. Principals reported the importance of building school cultures that are
relationship-driven and safe environments. Wellness centers are an example of a strategy to
develop safe environments for students to seek assistance or space to support themselves.
Participants’ statements about the positive impact community partnerships have on their ability
to implement desired initiatives such as mental health fairs, advisement from experts in the field,
and increased resources.
Principals did express challenges they face in implementing these initiatives, including
the reactive nature of the school’s response to mental health needs. Principals identified the lack
of dedicated time, school MTSS, and human and fiscal resources negatively influencing their
efforts. Principals noted a need for more parent education on supporting their children’s mental
health and called for destigmatizing seeking help.

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Chapter Five: Recommendations
This chapter discusses the findings from Chapter Four and the importance of systemically
addressing students’ mental health needs. It will also provide recommendations for school
leaders to implement to support students’ mental health needs. Understanding the limitations of
this study, Chapter Five includes considerations for future research.
Discussion of Findings
As discussed in Chapter Four, this study identified many important findings regarding the
increase in students’ mental health needs from the perspective of high school principals. The
findings align with SCT, which framed the research. The theory identifies the reciprocal
relationship among the individual, their environment, and their behavior (Bandura, 2005). The
conceptual framework supports the study’s findings, specifically the relationship between
environmental conditions, self-efficacy, and behaviors. The findings identified the relationship
between an individual’s self-efficacy and their mental health behaviors. The findings also
identified the reciprocal relationship between an individual’s environmental conditions and their
mental health behaviors.
The data findings identified that students’ environmental conditions impact their mental
health behaviors. High school principals serving students at higher-SES campuses reported the
environmental conditions of school stress related to the pressure to perform, overloaded
schedules, competitive culture and workload, and college acceptance increased behavioral
mental health needs, including anxiety and depression. Principals who serve students of lower
SES discussed environmental conditions of poverty related to the insecurities of resources,
traumatic experiences, and lack of academic self-efficacy.
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The data findings identified the relationship between students’ self-efficacy and their
mental health behaviors. High school principals reported self-efficacy and self-confidence as
contributing to students’ mental well-being. Luthar and Becker (2002) identified a link between
internalizing depression symptoms, self-oriented perfectionism, and low self-efficacy with
substance abuse. This discussion of findings will focus on four significant points of discussion
which require additional considerations and action.
The first finding is the lack of data collection of the participants to support their
perceptions of the causes of the increase in mental health needs. Although national, state, and
regional data collection supports the principals’ claims of an increase in the need, only one
principal reported ongoing data collection of how individual students self-identify their mental
wellness conditions at the school-site level. According to Plemmons et al. (2018), between 2008
and 2015, pediatric suicide ideation or attempt nearly doubled, with a higher increase in children
ages 15 to 17. Further complicating the growth and treatment of adolescent mental health
disorders is a worldwide health pandemic due to COVID-19 (WHO, 2020). Schools must
prepare for and respond to COVID-19’s mental health impact (Singh et al., 2020). According to
Singh et al. (2020), an initial and important first step is to determine students’ needs, as the
research on their needs is merely a projection based on previous incidences of adolescent
quarantines and isolation.
The second finding is the notable difference between principals’ perceptions of student
mental health needs based on environmental conditions determined by students’ SES. High
school principals serving students from higher-SES families reported the environmental
conditions of unhealthy school-related stress related to the pressures to perform, overload
schedules, competitive culture and workload, and college acceptance to cause increased
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behavioral mental health needs. Although participants’ responses were not supported by their
school’s data collection on students’ mental health, they do align with literature findings.
According to Shankar and Park (2016), 83% of high school students identify school as a
significant cause of stress.
The literature revealed five primary causes of their unhealthy stress: pressures to perform,
a narrow definition of success, peer competition, college acceptance, and relationships with
parents (Brackett, 2019; Conner & Pope, 2013; Conner et al., 2010; Leonard et al., 2015). The
data findings identified students’ environmental conditions impact their mental health behaviors.
High school principals serving students of higher SES reported the environmental conditions of
school stress related to the pressure to perform, overloaded schedules, competitive culture and
workload, and college acceptance increased behavioral mental health needs, including anxiety
and depression.
Participants in this study who serve students from lower SES have environmental
conditions of poverty related to the insecurities of resources, traumatic experiences, lack of
academic self-efficacy, and lack of parental emotional and educational support as contributing
factors to the increase in student mental health needs. Although other data did not support
principals’ responses, the literature supports their perceptions of the causes of the rise in
students’ mental health needs. Parents’ emotional support directly affects a child’s self-efficacy
and mental health (Clark, 2010; Luthar & Becker, 2002; Shin et al., 2016). Parental emotional
support demonstrated through high expectations of grades and inquiry about the child’s school
experience improves self-efficacy (Ramirez et al., 2014). Although principals serving higher and
lower SES communities discussed parents’ role in influencing their children’s mental health and
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the need for parental education, none identified a method of increasing parental involvement,
education, or communication.
Bandura’s (2005) conceptual framework, SCT, support the findings. The theory identifies
the reciprocal relationship among the individual, their environment, and their behavior. The
environmental conditions impacted by SES directly influence the social-emotional behaviors of
students.
The third finding for discussion is the varied perceptions of principals to the change in
mental health needs since the onset of COVID-19. Principals from lower-SES schools reported
that the environmental conditions of school closures, quarantine, and access to resources during
the COVID-19 pandemic increased students’ maladaptive behavioral changes and mental health
needs. While the principals lacked data to support their statements, the literature and SCT align
with their responses. The impact of school closures during COVID-19 further exacerbates the
effects of mental health disorders, especially for marginalized groups, including disabled, low
SES home environments, and female students (Azevedo et al., 2020).
The literature does not support the perceptions of principals serving higher-SES
communities who reported limited changes in students’ mental health and possibly improved
overall health during COVID-19 due to maintaining social interactions and increased family time
and downtime. Further research and literature review are necessary to support this perception.
Based on studies from China, Italy, and Spain that experienced an earlier onslaught of COVID-
19, adolescents are susceptible to increase mental health disorders due to the pandemic (Liang et
al., 2020; Orgilés et al., 2020; Zhou et al., 2020). Caregivers of youth in Spain and Italy observed
changes in their children’s emotional well-being while in quarantine (Orgilés et al., 2020). In
Spain and Italy, respectively, 85.7% and 88.9% of children experienced more significant
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irritability, an increase in anxiety, and sadness (Orgilés et al., 2020). A study of 8,079 Chinese
adolescents identified a high prevalence of youth with depression (43%), anxiety (37%), and a
combination of both (31%) during the COVID-19 outbreak.
The fourth finding for discussion is that participants’ schools lacked a comprehensive
system to support students’ mental health needs. The findings reflect the schools’ reactive
response to mental health needs. The literature supports the need for schools to develop MTSS to
improve mental health programs in schools (CASEL, 2021; Darling-Hammond et al., 2020;
Kearney & Childs, 2021). Principals identified the wish for a system to improve their proactive
approach to addressing mental health issues yet did not offer specific plans, techniques, or
strategies to meet this increasing need.
Educational reform to better support student mental well-being presents challenges for
educational leaders trained in leadership and management skills to establish a school vision,
support staff, and make meaningful change in a school and organization, not social-emotional
well-being (Brackett, 2019). Principals reported developing partnerships with community
agencies, local hospitals, and universities to seek support to implement initiatives addressing
student mental health needs. Local education agencies benefit from developing partnerships with
intermediary organizations like non-profit agencies or universities to implement cycles of
improvement (Marsh, 2012).
Recommendations for Practice
The discussion findings determined the following recommendations.
Recommendation 1
The first recommendation is to increase the use of individual student mental wellness
screening tools and data analysis at the school site level to drive organizational change and
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improvements. The majority of the participants did not report the use of student mental wellness
data to support their school’s mental health interventions. Student achievement data are regularly
collected, analyzed, and responded to by changes in the curriculum and implementation of
interventions. The emphasis on mental wellness data needs to mirror that on achievement data.
Educational institutions have the ability and responsibility to address academic and societal
stressors and school culture to promote balance and well-being by evaluating school systems,
procedures, and policies that unintentionally result in unhealthy stress, depression, and anxiety
(Pope et al., 2015). Without frequent screening or surveying of students’ mental wellness,
schools are unequipped with the data to effectively provide targeted support to individual
students, subgroups of students, and the student body at large.
School leaders should seek the support of reputable organizations to assist in selecting the
appropriate screening tool for their student body. Recommended organizations include the
National Center for Healthy Safe Children, the National Council for Behavioral Health, the
School Health Assessment and Performance Evaluation System, the Substance Abuse and
Mental Health Services Administration, and the National Center for School Mental Health.
Schools should ensure, before undertaking screening, that they are connected to the
resources to address the student needs that the screening identifies, such as school counselors,
community-based mental health providers, and public agencies that can be readily accessed by
students and families. School districts should consider partnering with agencies like Care Sollace
that ensure that families connect to community-based services quickly while providing the
school with student updates on accessing and attending treatments.

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Recommendation 2
The second recommendation is to develop school-based mental health programs in
coordination with the local educational agency and utilize MTSS to improve the organization
and implementation of the coordinated services available to students. The lack of a
comprehensive, tiered system to address the increase and severity of student mental health needs
by the participants’ schools is a concern. The principals noted the environmental conditions
influencing students’ behavioral mental health yet failed to proactively implement systems to
support the behaviors or address the environmental conditions.
School closures from COVID-19 highlighted the importance of non-academic support
provided within the school setting, including physical health, mental health, food assistance, and
child welfare interventions (Hoffman & Miller, 2020). School-based mental health programs
support adolescents in help-seeking behaviors, decrease student stress levels, and improve
learning (Lester et al., 2013; Newcomb-Anjo, 2019; Yeager, 2017).
It is recommended that schools utilize the MTSS framework to structure their response to
students’ needs. MTSS provides schools with a framework to align initiatives, supports, and
resources to systematically address support for all students and individual student needs
(California Department of Education, 2021b). According to Darling-Hammond et al. (2020),
restarting schools and learning in the time of COVID-19 will require careful management and
aligning resources with student needs. MTSS systems coordinate services and support available
to students based on a level of need. Tier 1 services and resources are provided to all students
and should include explicit, direct classroom instruction in SEL competencies to improve student
mental health (CASEL, 2021; Darling-Hammond et al., 2020; Kearney & Childs, 2021; Salerno,
2016). Tier 2 interventions target students who need behavior or social-emotional support
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beyond the classroom; typically, a school counselor, social worker, or school nurse provides this
level of intervention. Tier 3 is the most intensive level of intervention for students who
demonstrate the most significant level of need. Tier 3 strategies generally consist of intensive
therapeutic one-on-one counseling by a licensed mental health provider, a collaboration of
service providers from the school staff and community agencies, and parental involvement.
School leaders should develop and identify resources available in their MTSS framework
by creating a community of practice group that includes members from the school staff and
district. School leaders should seek the assistance of their county offices of education and
reputable resources available from agencies. Recommended agencies are the Substance Abuse
and Mental Health Services Administration or the Center for Mental Health in Schools and
Student Learning Supports at UCLA.
Recommendation 3
The third recommendation is to develop partnerships at the school level with community
agencies, healthcare providers, and universities to support the design and implementation of
school-based mental health programs. Educational reform to better support student mental well-
being presents challenges for educational leaders trained in leadership and management skills to
establish a school vision, support staff, and make meaningful change in a school and
organization, not social-emotional well-being (Brackett, 2019). Current mental health needs
evidence highlights a growing need for high school institutions to identify systemic policies and
practices to support their students’ health and well-being. According to Marsh (2012), local
educational agencies benefit from developing partnerships with intermediary organizations like
non-profits or universities to implement cycles of improvement.
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Stanford University’s Challenge Success program is an example of secondary schools
working alongside experts to identify and implement strategies to support student well-being and
school engagement. The program emphasizes learning through data analysis of student surveys
and examining current educational practices that unintentionally lead to unhealthy stress for
adolescents (Conner & Pope, 2013). Challenge Success provides schools quantitative and
qualitative surveys and extensive data analysis support to identify the primary stressors
impacting student health. Stanford’s staff help school administrators and stakeholders examine
the primary stressors to identify programmatic changes (Pope et al., 2015).
Limitations and Delimitations
The lack of actual data to support the causes principals perceive for the rise in students’
mental health needs is a limitation of this research study. The literature and research findings on
the impact of COVID-19 on high school students’ mental health presented a limit to the study.
The instructional delivery format for participants’ schools was not a consideration in the
selection process. The instructional delivery format created a limitation because all higher-SES
schools returned to in-person instruction during the 2020–21 school year. In contrast, three
lower-SES schools maintained distance, virtual education during the 2020–21 school year. The
difference in the learners’ experience of school connectedness and isolation may have influenced
the participants’ responses.
The CHKS data was a delimitation of the study. When initially designing the study, the
researcher mistakenly believed the data available to the public would include school-level
reports. Unfortunately, the accessible data are district-level reports, not school-level. The data
available was unable to confirm or deny the findings from the interviews.

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Recommendations for Future Research
One recommendation for future research is a study on the impact of COVID-19 on
adolescents based on their SES. Data collection findings from principals of higher-SES schools
reported limited changes in students’ mental health needs since COVID-19 does not match the
existing research. An additional recommendation for future research is a comparison of student
mental wellness between schools with and without a comprehensive MTSS. Future research can
examine how schools within the same area, serving students with similar demographics, are
implementing MTSS.
School districts are beginning to track students’ social media posts to identify
intervention needs to prevent maladaptive behaviors of drug abuse, violence, and suicide
(McGuire et al., 2017). Future research is recommended to study school districts’ scope of
authority to surveil students and students’ rights to free speech and privacy. Tension exists
between whether a school’s social media monitoring is overstepping the role and responsibility
of an educational institution.
Conclusion
There are negative implications for future generations if schools fail to address the
heightened prevalence of self-reported depression and anxiety that a global pandemic
compounded. Before the onset of COVID-19, the research found U.S. teenagers experience
greater levels of stress than adults, which manifest in a variety of maladaptive behaviors,
including violence, binge drinking, marijuana use, obesity, anxiety, depression, and suicide
(Benbenishty et al., 2018; Brackett, 2019; Desautels & McKnight, 2019; Kann et al., 2018; Pope
et al., 2015). Pandemics are associated with increased depression, anxiety, and PTSD (Guessoum
et al., 2020). The research is clear. Will we ever recover if schools do not act to improve
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unhealthy stress resulting from school or societal reasons? Educational institutions’ failure to
intervene will likely result in a continuing trend of increased self-harm, suicide rates, substance
abuse, poverty, and violence.
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References
Ali, M. M., West, K., Teich, J. L., Lynch, S., Mutter, R., & Dubenitz, J. (2019). Utilization of
mental health services in educational setting by adolescents in the United States. The
Journal of School Health, 89(5), 393–401. https://doi.org/10.1111/josh.12753
Allensworth, E. M., Farrington, C. A., Gordon, M. F., Johnson, D. W., Klein, K., McDaniel, B.,
& Nagaoka, J. (2018). Supporting social, emotional, & academic development: Research
implications for educators. University of Chicago Consortium on School Research.
Anderson, E. S., Winett, R. A., & Wojcik, J. R. (2007). Self-regulation, self-efficacy, outcome
expectations, and social support: Social cognitive theory and nutrition behavior. Annals
of Behavioral Medicine, 34(3), 304–312. https://doi.org/10.1007/BF02874555
Azevedo, J., Hasan, A., Goldemberg, D., Iqbal, S., & Geven, K. (2020). Simulating the potential
impacts of COVID-19 school closures on schooling and learning outcomes: A set of
global estimates. The World Bank Research Observer, 36(1), 1–40.
https://doi.org/10.1093/wbro/lkab003
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice
Hall.
Bandura, A. (2005). The evolution of social cognitive theory. In K. G. Smith & M. A. Hitt
(Eds.), Great minds in management (pp. 9–35). Oxford University.
Baweja, S., Santiago, C. D., Vona, P., Pears, G., Langley, A., & Kataoka, S. (2016). Improving
implementation of a school-based program for traumatized students: Identifying factors
that promote teacher support and collaboration. School Mental Health: A
Multidisciplinary Research and Practice Journal, 8(1), 120–131.
http://dx.doi.org.libproxy1.usc.edu/10.1007/s12310-015-9170-z
79

Benbenishty, R., Astor, R. A., & Roziner, I. (2018). A school-based multilevel study of
adolescent suicide ideation in California high schools. The Journal of Pediatrics, 196,
251–257. https://doi.org/10.1016/j.jpeds.2017.12.070
Benight, C., & Bandura, A. (2004). Social cognitive theory of posttraumatic recovery: The role
of perceived self-efficacy. Behaviour Research and Therapy, 42(10), 1129–1148.
https://doi.org/10.1016/j.brat.2003.08.008
Bernstein, G. A., & Borchardt, C. M. (1991). Anxiety disorders of childhood and adolescence: A
critical review. Journal of the American Academy of Child and Adolescent Psychiatry,
30(4), 519–532. https://doi.org/10.1097/00004583-199107000-00001
Björling, E. A., & Singh, N. B. (2017). Anger without agency: Exploring the experiences of
stress in adolescent girls. Qualitative Report, 22(10), 2583–2599.
https://doi.org/10.46743/2160-3715/2017.2941
Bluth, K., Roberson, P. N., & Gaylord, S. A. (2015). A pilot study of a mindfulness intervention
for adolescents and the potential role of self-compassion in reducing stress. Explore,
11(4), 292–295. https://doi.org/10.1016/j.explore.2015.04.005
Bowen, G. (2009). Document analysis as a qualitative research method. Qualitative Research
Journal, 9, 27–40. https://doi.org/10.3316/QRJ0902027
Brackett, M. (2019). Permission to feel: Unlocking the power of emotions to help our kids,
ourselves, and our society thrive. Celadon Books.
Brown, A., & Danaher, P. A. (2019). CHE principles: Facilitating authentic and dialogical semi-
structured interviews in educational research. International Journal of Research &
Method in Education, 42(1), 76–90. https://doi.org/10.1080/1743727X.2017.1379987
80

Bursztyn, L., & Jensen, R. (2015). How does peer pressure affect educational investments? The
Quarterly Journal of Economics, 130(3), 1329–1367. https://doi.org/10.1093/qje/qjv021
California Department of Education. (2021a). Income eligibility scales for school year 2021–22.
https://www.cde.ca.gov/ls/nu/rs/scales2122.asp
California Department of Education. (2021b). Multi-tiered system of supports.
https://www.cde.ca.gov/ci/cr/ri/
California State Government. (2020). Current safety measures.
https://covid19.ca.gov/education/#k-12-guidance
CalSCHLS. (2021). https://calschls.org/reports-data/search-lea-reports/
Centers for Disease Control and Prevention. (2021). Mental health.
https://www.cdc.gov/nchs/fastats/mental-health.htm
Challenge Success. (n.d.). Schools. https://www.challengesuccess.org/schools/
Child & Adolescent Health Measurement Initiative. (2020). The national survey of children’s
health. https://www.childhealthdata.org/learn-about-the-nsch/NSCH
Clark, B. (2010). Achievement, pressure, closeness to parents and self-reported compensatory
behaviors in affluent adolescents (Publication No. 3424299) [Doctoral dissertation].
ProQuest Dissertations and Theses Global.
Collaborative for Academic, Social, and Emotional Learning. (2021).
https://casel.org/fundamentals-of-sel/what-is-the-casel-framework/
Conner, J., Miles, S., & Pope, D. (2014). How many teachers does it take to support a student?
Examining the relationship between teacher support and adverse health outcomes in high-
performing, pressure-cooker high schools. High School Journal, 98(1), 22–42.
https://doi.org/10.1353/hsj.2014.0012
81

Conner, J., & Pope, D. (2013). Not just robo-students: Why full engagement matters and how
schools can promote it. Journal of Youth and Adolescence, 2(9), 1426–1442.
https://doi.org/10.1007/s10964-013-9948-y
Conner, J., Pope, D., & Galloway, M. (2010). Success with less stress. In M. Scherer (Ed.),
Keeping the whole child healthy and safe: Reflections on best practices in learning,
teaching, and leadership (pp. 121–129). ASCD.
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed
methods approaches. Sage publications.
Damore, S. J., & Rieckhoff, B. S. (2019). School leader perceptions: Coaching tool and process.
Journal of Research on Leadership Education, 16(1), 57–80.
https://doi.org/10.1177/1942775119868258
Darling-Hammond, L., & Hyler, M. E. (2020). Preparing educators for the time of COVID…
and beyond. European Journal of Teacher Education, 43(4), 457–465.
https://doi.org/10.1080/02619768.2020.1816961
Darling-Hammond, L., Schachner, A., Edgerton, A. K., Badrinarayan, A., Cardichon, J.,
Cookson, P. W., Jr., & Martinez, M. (2020). Restarting and reinventing school: Learning
in the time of COVID and beyond. Learning Policy Institute.
Delaney, L., & Smith, J. (2012). Childhood health: Trends and consequences over the life-
course. The Future of Children, 22(1), 43–63. https://doi.org/10.1353/foc.2012.0003
Desautels, L., & McKnight, M. (2019). Eyes are never quiet: Listening beneath the behaviors of
our most troubled students. Wyatt-MacKenzie Publishing.
82

Douglas, P. K., Douglas, D. B., Harrigan, D. C., & Douglas, K. M. (2009). Preparing for
pandemic influenza and its aftermath: Mental health issues considered. International
Journal of Emergency Mental Health, 11(3), 137.
Duckworth, A. L., & Seligman, M. E. P. (2005). Self-discipline outdoes IQ in predicting
academic performance of adolescents. Psychological Science, 16, 939–944.
https://doi.org/10.1111/j.1467-9280.2005.01641.x
Duckworth, A. L., Tsukayama, E., & May, H. (2010). Establishing causality using longitudinal
hierarchical linear modeling: An illustration predicting achievement from self-control.
Social Psychological & Personality Science, 1(4), 311–317.
https://doi.org/10.1177/1948550609359707
Duong, M., Cook, C., Lee, K., Davis, C., Vázquez-Colón, C., & Lyon, A. (2020). User testing to
drive the iterative development of a strategy to improve implementation of evidence-
based practices in school mental health. Evidence-Based Practice in Child and
Adolescent Mental Health, 5(4), 414–425.
https://doi.org/10.1080/23794925.2020.1784052
Feurer, D., & Andrews, J. (2009). School-related stress and depression in adolescents with and
without learning disabilities: An exploratory study. The Alberta Journal of Educational
Research, 55(1), 92–108.
Flamini, M., Graham, J., Toledo, W., & Williams, S. M. (2020). School leaders, emotional
intelligence, and equitable outcomes in urban education. In C. A. Mullen (Ed.),
Handbook of Social Justice Interventions in Education (pp. 1–18). Springer.
Foust, R. C., Hertberg-Davis, H., & Callahan, C. M. (2008). “Having it all” at sleep’s expense:
The forced choice of participants in Advanced Placement courses and international
83

baccalaureate programs. Roeper Review, 30(2), 121–129.
https://doi.org/10.1080/02783190801955293
Galea, S., Merchant, R., & Lurie, N. (2020). The mental health consequences of COVID-19 and
physical distancing: The need for prevention and early intervention. JAMA Internal
Medicine, 180(6), 817–818. https://doi.org/10.1001/jamainternmed.2020.1562
Golberstein, E., Wen, H., & Miller, B. F. (2020). Coronavirus disease 2019 (COVID-19) and
mental health for children and adolescents. JAMA Pediatrics, 174(9), 819–820.
https://doi.org/10.1001/jamapediatrics.2020.1456
Guessoum, S. B., Lachal, J., Radjack, R., Carretier, E., Minassian, S., Benoit, L., & Moro, M. R.
(2020). Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown.
Psychiatry Research, 291, 113264. https://doi.org/10.1016/j.psychres.2020.113264
Hoffman, J. A., & Miller, E. A. (2020). Addressing the consequences of school closure due to
COVID‐19 on children’s physical and mental well‐being. World Medical & Health
Policy, 12(3), 300–310. https://doi.org/10.1002/wmh3.365
Jacobs, R. H., Reinecke, M. A., Gollan, J. K., & Kane, P. (2008). Empirical evidence of
cognitive vulnerability for depression among children and adolescents: A cognitive
science and developmental perspective. Clinical Psychology Review, 28(5), 759–782.
https://doi.org/10.1016/j.cpr.2007.10.006
Jorm, A. F., Kitchener, B. A., Sawyer, M. G., Scales, H., & Cvetkovski, S. (2010). Mental health
first aid training for high school teachers: A cluster randomized trial. BMC Psychiatry,
10(1), 51. https://doi.org/10.1186/1471-244X-10-51
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., Lowry, R.,
Chyen, D., Whittle, L., Thornton, J., Lim, C., Bradford, D., Yamakawa, Y., Leon, M.,
84

Brener, N., & Ethier, K. A. (2018). Youth risk behavior surveillance—United States,
2017. MMWR. Surveillance Summaries, 67(8), 1–114.
https://doi.org/10.15585/mmwr.ss6708a1
Kar, S. (2017). Academic stress as a determinant of academic achievement. Nurture, 11(1), 1–5.
Kearney, C. A., & Childs, J. (2021). A multi-tiered systems of support blueprint for re-opening
schools following COVID-19 shutdown. Children and Youth Services Review, 122,
105919. https://doi.org/10.1016/j.childyouth.2020.105919
Kiran-Esen, B. (2012). Analyzing peer pressure and self-efficacy expectations among
adolescents. Social Behavior and Personality: an international journal, 40(8), 1301–
1310. https://doi.org/10.2224/sbp.2012.40.8.1301
Knopf, D., Park, M., & Mulye, T. (2009). The mental health of adolescents: A national profile,
2008. National Adolescent Health Information Center.
Kohli, S. (2020, May 7). We need to prepare for the mental health impact of coronavirus on kids.
Los Angeles Times. https://www.latimes.com/california/story/2020-05-07/coronavirus-
anxiety-children-long-term-mental-health-impacts
Kretchmar, J., & Farmer, S. (2013). How much is enough? Rethinking the role of high school
courses in college admission. Journal of College Admission, 220, 28–33.
Kumar, K. S., & Akoijam, B. S. (2017). Depression, anxiety and stress among higher secondary
school students of Imphal, Manipur. Indian Journal of Community Medicine, 42(2), 94.
Kurian, N. (2012). Impact of resilience and role model influence on academic achievement of
low socio-economic status adolescent students. Indian Journal of Positive Psychology,
3(3), 250.
85

LaMorte, W. (2016). Behavioral change models: The social cognitive theory.
http://sphweb.bumc.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/
BehavioralChangeTherories5.html
Lee, J. (2020). Mental health effects of school closures during COVID-19. The Lancet. Child &
Adolescent Health, 4(6), 421. https://doi.org/10.1016/S2352-4642(20)30109-7
Leonard, N., Gwadz, M., Ritchie, A., Linick, J., Cleland, C., Elliott, L., & Grethel, M. (2015). A
multi-method exploratory study of stress, coping, and substance use among high school
youth in private schools. Frontiers in Psychology, 6, 1028.
https://doi.org/10.3389/fpsyg.2015.01028
Lester, L., Waters, S., & Cross, D. (2013). The relationship between school connectedness and
mental health during the transition to secondary school: A path analysis. Australian
Journal of Guidance & Counselling, 23(2), 157–171. https://doi.org/10.1017/jgc.2013.20
Liang, L., Ren, H., Cao, R., Hu, Y., Qin, Z., Li, C., & Mei, S. (2020). The effect of COVID-19
on youth mental health. The Psychiatric Quarterly, 91, 1–12.
https://doi.org/10.1007/s11126-020-09744-3
Luthar, S., Barkin, S., & Crossman, E. (2013). “I can, therefore I must”: Fragility in the upper-
middle classes. Development and Psychopathology, 25(4), 1529–1549.
https://doi.org/10.1017/S0954579413000758
Luthar, S., & Becker, B. (2002). Privileged but pressured? A study of affluent youth. Child
Development, 73, 1593–1610. https://doi.org/10.1111/1467-8624.00492
Lyman, E., & Luthar, S. (2014). Further evidence on the “costs of privilege”: Perfectionism in
high-achieving youth at socioeconomic extremes. Psychology in the Schools, 51, 913–
930. https://doi.org/10.1002/pits.21791
86

Manderscheid, R. W., Ryff, C. D., Freeman, E. J., McKnight-Eily, L. R., Dhingra, S., & Strine,
T. W. (2010). Evolving definitions of mental illness and wellness. Preventing Chronic
Disease, 7(1), A19.
Marsh, J. A. (2012). Interventions promoting educators’ use of data: Research insights and gaps.
Teachers College Record, 114(11), 1–48.
Maxwell, J. A. (2013). Qualitative research design: An interactive approach (3rd ed.). Sage
Publications.
McGuire, S. J., Zhang, Y., Jin, C., Tiwari, M., Gosalia, N., Dowiri, S., & Bhanidipati, V. (2017).
Geo listening at the Glendale Unified School District. Journal of Case Research and
Inquiry, 3, 188–215.
Merriam, S., & Tisdell, E. (2015). Qualitative research: A guide to design and implementation.
Wiley.
Moldes, V. M., Biton, C. L., Gonzaga, D. J., & Moneva, J. C. (2019). Students, peer pressure and
their academic performance in school. International Journal of Scientific and Research
Publications, 9(1), 300–312.
Mrowka, K. A. K. (2014). Academic stress in an achievement driven era: Time and school
culture (Publication No. 3609000) [Doctoral dissertation]. ProQuest Dissertations and
Theses Global.
National Center for Children of Poverty. (2010). Who are America’s poor children?: The official
story. https://www.nccp.org/publication/who-are-americas-poor-children-the-official-
story/
87

Neria, Y., Nandi, A., & Galea, S. (2008). Post-traumatic stress disorder following disasters: A
systematic review. Psychological Medicine, 38(4), 467–480.
https://doi.org/10.1017/S0033291707001353
Newcomb-Anjo, S. (2019). Applying what is known about adolescent development to improve
school-based mental health literacy of depression interventions: Bridging research to
practice. Adolescent Research Review, 4(3), 235–248. https://doi.org/10.1007/s40894-
018-0083-6
Oosterhoff, B., & Palmer, C. A. (2020). Attitudes and psychological factors associated with news
monitoring, social distancing, disinfecting, and hoarding behaviors among US
adolescents during the coronavirus disease 2019 pandemic. JAMA Pediatrics, 174(12),
1184–1190. https://doi.org/10.1001/jamapediatrics.2020.1876
Orgilés, M., Morales, A., Delvecchio, E., Mazzeschi, C., & Espada, J. P. (2020). Immediate
psychological effects of the COVID-19 quarantine in youth from Italy and Spain.
Frontiers in Psychology, 11, 579038–579038. https://doi.org/10.3389/fpsyg.2020.579038
Plemmons, G., Hall, M., Doupnik, S., Gay, J., Brown, C., Browning, W., Casey, R., Freundlich,
K., Johnson, D. P., Lind, C., Rehm, K., Thomas, S., & Williams, D. (2018).
Hospitalization for suicide ideation or attempt: 2008–2015. Pediatrics, 141(6),
e20172426. https://doi.org/10.1542/peds.2017-2426
Pope, D., Brown, M., & Miles, S. (2015). Overloaded and underprepared: Strategies for stronger
schools and healthy, successful kids. John Wiley & Sons.
Ramirez, L., Machida, S., Kline, L., & Huang, L. (2014). Low-income Hispanic and Latino high
school students’ perceptions of parent and peer academic support. Contemporary School
88

Psychology, 18(4), 214–221. libproxy2.usc.edu/. https://doi.org/10.1007/s40688-014-
0037-3
Rehm, J., Marmet, S., Anderson, P., Gual, A., Kraus, L., Nutt, D. J., Room, R., Samokhvalov, A.
V., Scafato, E., Trapencieris, M., Wiers, R. W., & Gmel, G. (2013). Defining substance
use disorders: Do we really need more than heavy use? Alcohol and Alcoholism, 48(6),
633–640. https://doi.org/10.1093/alcalc/agt127
Robotham, D., & Julian, C. (2006). Stress and the higher education student: A critical review of
the literature. Journal of Further and Higher Education, 30(2), 107–117.
https://doi.org/10.1080/03098770600617513
Salerno, J. (2016). Effectiveness of Universal School‐Based Mental Health Awareness Programs
Among Youth in the United States: A Systematic Review. The Journal of School Health,
86(12), 922–931. https://doi.org/10.1111/josh.12461
Sanders, K. J. (2013). Annual report: Center for Academic Support and Assessment, AY 2012–
2013. Eastern Illinois University.
Sapthiang, S., Van Gordon, W., & Shonin, E. (2019). Mindfulness in schools: A health
promotion approach to improving adolescent mental health. International Journal of
Mental Health and Addiction, 17(1), 112–119. https://doi.org/10.1007/s11469-018-0001-
y
Shankar, N., & Park, C. (2016). Effects of stress on students’ physical and mental health and
academic success. International Journal of School & Educational Psychology, 4(1), 5–9.
https://doi.org/10.1080/21683603.2016.1130532
89

Shin, J., Seo, E., & Hwang, H. (2016). The effects of social supports on changes in students’
perceived instrumentality of schoolwork for future goal attainment. Educational
Psychology, 36(5), 1024–1043. https://doi.org/10.1080/01443410.2015.1072135
Sibinga, E. M., Perry-Parrish, C., Chung, S. E., Johnson, S. B., Smith, M., & Ellen, J. M. (2013).
School-based mindfulness instruction for urban male youth: A small randomized
controlled trial. Preventive Medicine, 57(6), 799–801.
https://doi.org/10.1016/j.ypmed.2013.08.027
Singh, S., Roy, M. D., Sinha, C. P. T. M. K., Parveen, C. P. T. M. S., Sharma, C. P. T. G., &
Joshi, C. P. T. G. (2020). Impact of COVID-19 and lockdown on mental health of
children and adolescents: A narrative review with recommendations. Psychiatry
Research, 293, 113429. https://doi.org/10.1016/j.psychres.2020.113429
Spencer, R., Walsh, J., Liang, B., Mousseau, A., & Lund, T. (2018). Having it all? A qualitative
examination of affluent adolescent girls’ perceptions of stress and their quests for
success. Journal of Adolescent Research, 33(1), 3–33.
https://doi.org/10.1177/0743558416670990
Stecker, T. (2004). Well‐being in an academic environment. Medical Education, 38(5), 465–478.
https://doi.org/10.1046/j.1365-2929.2004.01812.x
Suldo, S., Dedrick, R., Shaunessy-Dedrick, E., Roth, R., & Ferron, J. (2015). Development and
initial validation of the Student Rating of Environmental Stressors Scale: Stressors faced
by students in accelerated high school curricula. Journal of Psychoeducational
Assessment, 33(4), 339–356. https://doi.org/10.1177/0734282914552164
Treatment and Services Adaptation Center. (2021).
https://traumaawareschools.org/traumaInSchools
90

United Nations Children’s Fund. (2021). https://www.unicef.org/reports/state-worlds-children-
2021
WestEd. (2021). California Healthy Kids Survey 2019. https://www.wested.org/project/
california-healthy-kids-survey-chks/
White House. (2020). https://www.whitehouse.gov/presidential-actions/proclamation-declaring-
national-emergency-concerning-novel-coronavirus-disease-covid-19-
outbreak/#:~:text=1601%20et%20seq)
Wood, R., & Bandura, A. (1989). Social cognitive theory of organizational management.
Academy of Management Review, 14(3), 361–384. https://doi.org/10.2307/258173
World Health Organization. (2020). Rolling updates on coronavirus disease (COVID-19).
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-
happen
Yates, T. M., Tracy, A. J., & Luthar, S. S. (2008). Nonsuicidal self-injury among” privileged”
youths: Longitudinal and cross-sectional approaches to developmental process. Journal
of Consulting and Clinical Psychology, 76(1), 52–62. https://doi.org/10.1037/0022-
006X.76.1.52
Yeager, D. S. (2017). Social and emotional learning programs for adolescents. The Future of
Children, 27, 73–94. https://doi.org/10.1353/foc.2017.0004
Young, R., Sweeting, H., & Ellaway, A. (2011). Do schools differ in suicide risk? The influence
of school and neighbourhood on attempted suicide, suicidal ideation and self-harm
among secondary school pupils. BMC Public Health, 11(1), 874.
https://doi.org/10.1186/1471-2458-11-874
91

Zhou, S. J., Zhang, L. G., Wang, L. L., Guo, Z. C., Wang, J. Q., Chen, J. C., Liu, M., Chen, X.,
& Chen, J. X. (2020). Prevalence and socio-demographic correlates of psychological
health problems in Chinese adolescents during the outbreak of COVID-19. European
Child & Adolescent Psychiatry, 29, 749–758. https://doi.org/10.1007/s00787-020-01541-
4
Zoogman, S., Goldberg, S. B., Hoyt, W. T., & Miller, L. (2015). Mindfulness interventions with
youth: A meta-analysis. Mindfulness, 6(2), 290–302. https://doi.org/10.1007/s12671-013-
0260-4

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Appendix A: Interview Questions
Research Question 1: What are high school principals’ perceived causes of the increase in mental
health disorders in high school students?

1. Thinking pre-COVID 19, did students at your high school experience mental health
issues?
a. What were some of the more common mental health issues facing the students at
your school?
b. Have you seen a change in the number of students’ struggling with mental health
issues? How so?

2. Why do you think students experience mental health challenges?
a. Do you see any connection between student demographics and mental health
issues?
b. In your experience, is there a correlation between student course load and mental
health issues?
c. Socioeconomic status influence on mental health?
d. Do you see any trends between family structure and mental health challenges? Or
peer-influence?
e. What role do you think college admissions play in terms of student mental well-
being?

3. Does your school use any survey tools to assess current mental well-being challenges
experienced by your students?
a. If yes, What tool do you use?
b. If yes, how useful is it?
c. If yes, what has the data shown?
d. If yes, how has it been used?
e. If yes, who at your school is responsible for the development and implementation
of programs to respond to the data?

Research Question 2: What are high school principals’ perception of student mental health
changes related to high school students since the COVID-19 pandemic?

1. Have you seen a change in the mental health needs of the students at your school since
COVID?
a. If no, please explain.
b. If yes:
i. How have they changed?
ii. Do you have an example?
iii. What do you attribute the change to?

2. What do you think the impact of distance learning/hybrid learning is on student mental
well-being?

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Research Question 3: What are formal initiatives already in place or emerging strategies and best
practices to respond to increased student mental health disorders?

1. Tell me about some of the initiatives your school implemented before the COVID-19
pandemic to address the mental health needs of your students?

2. Tell me about any barriers or challenges your school faces in supporting student mental
health?

3. What has helped to support student mental health?

4. Of the mental health programs that were in place prior to COVID-19, what do you feel
was the most effective in supporting your students?

5. What are you doing during the pandemic to support your students’ mental well-being?
a. Do you have any plans to support students’ mental well-being post-pandemic?
b. What needs will you have going forward?

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Appendix B: Protocols
Study Title: Adolescent Mental Health Disorders and School-based Supports Pre- and
During COVID-19
Study Procedures
Background/Rationale (previously iStar section 11 (exempt) or 12 (expedited/full board)
Students experiencing mental health disorders, such as depression, anxiety, and suicidal
ideation have doubled since 2008 with a higher increase in children ages 15–17 (Plemmons et
al., 2018). Complicating the increase in and treating adolescent mental health disorders is a
worldwide health pandemic, COVID-19. According to Golberstein, Wen, and Miller (2020),
COVID-19 may increase mental health problems due to school isolation and lack of school-
based counseling services. Schools must prepare for and respond to COVID-19’s mental health
impact (Singh, 2020). This study will examine the perceived causes and school-based initiatives
for decreasing mental health disorders in high school students before and during COVID-19.
Purpose/Objectives/Aims/Research Questions (previously iStar section 11 (exempt) or 12
(expedited/full board)
The purpose of this study is to learn more about the perceived causes for the increase in
mental health disorders from the perspective of high school principals. The study will also
identify school-based initiatives for decreasing mental health disorders in high school students
and identify approaches to supporting students before and during the COVID-19 pandemic.
The following research questions will be addressed in this study:
1. What are high school principals’ perceived causes for the increase in mental
health disorders of high school students?
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2. What are high school principals’ perceptions of student mental health changes
since the COVID-19 pandemic?
3. What formal initiatives already in place or emerging strategies and best
practices to responds to increased student mental health disorders?
Participants (sample) (Consistent with iStar sections 10 (expedited and full board) and (for all
submission types)
Inclusion criteria for this study are high school principals in a region of Southern
California whose school participated in the CHKS during 2017–2021. The CHKS is a statewide
student survey of resiliency, risk behavior, social and physical health, and school climate. The
survey participation is optional for students in grades 5–12. It provides data on student
engagement, school connectedness, and the development of social-emotional competencies
which are linked to increased positive personal, health, and academic outcomes.
Principals of high schools that did not participate in the CHKS will be excluded. The
researcher’s school district will be excluded from the study.
The study does not include children as it is looking at the experiences of principals in a high
school environment.
Participants are high school principals in a region of Southern California. High school
principals are the focus of the study. To mitigate positionality and power, the research’s school
district will be excluded from the study. Therefore, the researcher has no authority nor is in a
position of power within the organization.

Recruitment/Screening Process (sampling strategy)
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Principals of schools within the region who participated in the California Healthy Kids
Survey will receive a personal phone call and email invitation to participate in the research study.
School principal’s names and email address will be collected from high school websites.
Recruitment will be conducted electronically via emails to identified eligible participants
via the high school websites.
The following email text will be sent out to high school principals to recruit study
participants:
You are invited to participate in a study to examine the perceived causes for the increase
in mental health disorders of high school students from your perspective. The study also seeks to
identify school-based initiatives for decreasing mental health disorders in high school students
and supporting students before and during the COVID-19 pandemic.
The study is being conducted by Christine Matos as part of her doctoral dissertation. Your
participation in the study is completely voluntary and participant identities will not be known to
the organization. The study includes voluntary interviews. If you are interested in participating
in this study, reply to this email.
The participants for the research will be high school principals in a region of Southern
California that participated in the California Healthy Kids Survey during 2017–2021. School
participation and survey findings are electronically available to the public on Calschol.org
website. Determined by the Calschol.org website, the region consists of 27 public high schools
that meet the criteria for inclusion. Recruitment of participants will include personal phone calls
and email invitations to solicit the participation of high school principals.

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Methods (previously iStar sections 9, 12, or 13, 16, 19, 20, and 21 depending on the type of
study/application)
This study will use a qualitative approach consisting of interviews. Interview participants
will be recruited based upon their high school being located in a region of Southern California
and their school’s participation in the California Healthy Kids Survey during 2017–2021. The
following steps will be followed in the study:
Once USC IRB approval is received, I will begin the recruitment process by sending an
email to qualifying participants.
Plan to reduce coercion: The recruitment email indicates that participation is completely
voluntary. Participant rights related to not answering some questions or discontinuing their
participation will also be presented via the IRB Information Sheet for Exempt Studies.
Interested participants will reply to the recruitment email expressing their interest in
participating and providing the researcher with their preferred method of scheduling an online
interview appointment.
The researcher will email the interview volunteers or their identified scheduling designee
and arrange for an online interview time. The IRB information sheet will also be provided during
the exchange.
During the interview, participants will be asked the questions on the uploaded interview
protocol in the IRB application.
All interview participants will be thanked for their time. No compensation will be
offered. All collected data will be analyzed. A brief summary of the study will be emailed to all
participants. This study does not include an intervention. This study is requesting an exempt
review.
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With participant permission, the interviews will be recorded for future transcription using
the Atlas.ti tools. Interview transcripts will be coded. Interview participants will be given a
pseudonym and identifying information will not be saved with the transcripts. The researcher
will use the USC Atlas.ti login, requiring the researcher to use their secure USC login to access
the survey data. Recorded interviews will be available only to the PI. Interview transcripts will
be saved in a password-protected computer and a password-protected cloud server.
Findings and results will be documented in my doctoral dissertation. A short summary of
findings will also be provided to the interview participants after the final defense and submission
of my dissertation to USC.
Instrumentation
Qualitative instruments
Semi-structured interviews will be conducted with 8–10 high school principals to share
their perceptions for the increase in mental health disorders and identify approaches to
supporting students before and during the COVID-19 pandemic. The interview protocol consists
of 10 open-ended questions and is anticipated to take 60 minutes.
Data Analysis
Thematic coding will be utilized to analyze the interview data.

Abstract (if available)

Abstract High school-age students' mental health has emerged as an increasing area of importance for educators, policymakers, parents, and communities. Complicating the increase in and treating adolescent mental health disorders is a worldwide health pandemic, COVID-19. The purpose of this study was to learn more about the perceived causes of the increase in adolescent mental health needs from the perspective of high school principals. Additionally, the study sought to identify school-based initiatives for increasing mental health supports for high school students before and during COVID-19. The study interviewed eight high school principals from a region in Southern California that participated in the California Healthy Kids Survey during the 2017-2019 period. Of the eight participants, four served students from higher socioeconomic levels (SES) and four served students from lower socioeconomic levels. The findings indicate the notable difference between principals’ perceptions of student mental health needs based on environmental conditions determined by students’ SES. High school principals serving students at higher-SES campuses reported the environmental conditions of school stress related to the pressure to perform, overloaded schedules, competitive culture and workload, and college acceptance increased behavioral mental health needs, including anxiety and depression. Principals who serve students of lower SES discussed environmental conditions of poverty related to insecurities of resources, traumatic experiences, and lack of academic self-efficacy impact mental health needs. Principals from lower-SES schools reported that the environmental conditions of school closures, quarantine, and access to resources during the COVID-19 pandemic increased students’ maladaptive behavioral changes and mental health needs. Principals from higher-SES schools did not report significant changes in students’ mental health needs during COVID-19.

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University of Southern California Dissertations and Theses

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Asset Metadata

Creator Matos, Christine Marie (author)

Core Title Adolescent mental health disorders and school-based supports pre- and during COVID-19

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2022-05

Publication Date 01/14/2022

Defense Date 12/14/2021

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag COVID-19,high school-age,Mental Health,OAI-PMH Harvest,socioeconomic status

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Hirabayshi, Kim (committee chair), Cash, David (committee member), Chidester, Margaret (committee member)

Creator Email cmatos@usc.edu,cupcakematos@yahoo.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC110520214

Unique identifier UC110520214

Legacy Identifier etd-MatosChris-10345

Document Type Dissertation

Format application/pdf (imt)

Rights Matos, Christine Marie

Type texts

Source 20220124-usctheses-batch-908 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given.

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA

Repository Email cisadmin@lib.usc.edu