Evidence In-Sight:
Effective community mental health agency
involvement in school-based services
Date:
March, 2012
www.excellenceforchildandyouth.ca ● www.excellencepourenfantsados.ca
School-based services
The following Evidence In-Sight report involved a non-systematic search and summary of the research and grey
literature. These findings are intended to inform the requesting organization, in a timely fashion, rather than
providing an exhaustive search or systematic review. This report reflects the literature and evidence available at the
time of writing. As new evidence emerges, knowledge on evidence-informed practices can evolve. It may be useful
to re-examine and update the evidence over time and/or as new findings emerge.
Evidence In-Sight primarily presents research findings, along with consultations with experts where feasible and
constructive. Since scientific research represents only one type of evidence, we encourage you to combine these
findings with the expertise of practitioners and the experiences of children, youth and families to develop the best
evidence-informed practices for your setting.
While this report may describe best practices or models of evidence-informed programs, Evidence In-Sight does not
include direct recommendations or endorsement of a particular practice or program.
This report was researched and written to address the following questions:
Is there research on positive outcomes that result from improved mental health and school functioning?
Are there specific evidence-informed practices that apply to models of partnership between community mental
health agencies and schools?
Is there literature that considers types of intervention and program models that demonstrate effective
outcomes for community agencies providing services for students?
What are key program components that lead to positive outcomes in this type of service?
We prepared the report given the contextual information provided in our first communications (see Overview of
inquiry). We are available at any time to discuss potential next steps.
We appreciate your responding to a brief satisfaction survey that the Centre will e-mail to you within two weeks. We
would also like to schedule a brief phone call to assess your satisfaction with the information provided in the report.
Please let us know when you would be available to schedule a 15-minute phone conversation.
Thank you for contacting Evidence In-Sight. Please do not hesitate to follow up or contact us at
[email protected] or by phone at 613-737-2297.
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1. Overview of inquiry
The requesting agency provides a spectrum of evidenced-informed mental health services including intensive mental
health student services. This program is in the development stages and is intended to be a service that is individualized
but that incorporates individual, family, and group treatment options. It is a collaborative undertaking between the
agency and two school boards. The intent is to provide services to children and youth ages 4-21 (18-21 if they are still
enrolled in school) who are experiencing significant emotional, social and/or behavioural problems which are interfering
with their educational progress and achievement of developmental potential.
Referrals come from the schools, and treatment staff are the relevant clinical workers in the various service streams.
There are three service streams for the new intensive mental health school supports:
1. Short Term/Crisis Response
Four week service which offers crisis response and intervention for families and students who are experiencing
significant situational, emotional, social and/or behavioural problems.
2. Intensive Services
Longer term service for students and their families, anywhere from 3 to 6 months, and includes planning with the
school, community based services, and other supports. Services are individualized for each student and family and are
responsive to their dynamic needs.
3. Group Services
Includes running of 6 therapeutic groups, (8 week sessions), throughout the year, specialized to address the needs of
children and youth.
The agency is looking for literature supporting treatment efficacy and positive outcomes related to improved mental
health and school functioning. Evidence-informed and evidence-based practice in school partnership mental health
programs would be helpful. Literature considering types of intervention (i.e. CBT, multiple family therapy groups, family
centered care, aggression management, problem solving, social skills training, self esteem and psycho-educational
intervention) and program models demonstrating effective outcome would be helpful. Also, key program components
leading to positive outcomes through this type of service would be helpful.
2. Summary of findings
Student mental health is a key issue for schools and mental health disorders in students are strongly associated
with impaired or academic performance.
School-based mental health programs have a positive impact across a number of emotional and behavioural
outcomes and educational outcomes in children and youth, including school attendance, grade point average,
social functioning, emotional wellness, and behavioural considerations.
The available evidence supports the need for a multitiered intervention approach to programs and practices that
target mental health and academic outcomes in schools, with varying levels of service intensity and duration.
Community mental health agencies are well positioned to provide services that are targeted and intensive and
that address the most complex and severe emotional and behavioural disorders in students.
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Social and emotional learning is associated with improved social and emotional skills, attitudes, behaviour, and
academic performance. Skill-building components via direct intervention (group or individual) include:
o Self-awareness
o Self-management
o Social awareness and skills
o Relationship skills
o Responsible decision making
For children and youth with complex mental health needs, the best overall outcomes are achieved when
individual treatment is augmented with significant outside support from the family, community, outpatient
mental health, and other institutions such as probation if there is a justice element.
Effective programs for high risk youth include a skill development focus, problem-solving focus, continuous
assessment of progress, home work to encourage out-of-session work, and a therapeutic relationship that is
characterized by good rapport, the creation of a safe environment, and the provision of consistency and warmth
that may not be available elsewhere.
Analyses of research on school-based interventions to address student aggression and disruptive behaviour
found four common treatment modalities that are effective:
o Cognitive-behavioural therapy
o Behavioural strategies
o Social skills training
o Evidence-informed counseling and therapy approaches for individuals, groups, and families
Important moderators of program success are the application of implementation best practice and using four
practices in program design and delivery (sequenced, active, focused, and explicit program elements)
For the highest risk or highest need students, including those suspended or expelled from school, a strong
evidence base exists for these programs:
o Multi-systemic therapy
o Brief strategic family therapy
o Dialectical behaviour therapy
o Motivational enhancement therapy
o Brief strategic family therapy
o Trauma focused cognitive behaviour therapy
o Family effectiveness training
o Multidimensional treatment foster care
o Multidimensional family therapy
o Functional family therapy
3. Answer search strategy
Where we looked for information: Cochrane Library; Campbell Library; EBSCOhost (Medline, PsycInfo,
Psychology and Behavioural Science Collection, Biomedical Reference Collection), Google Scholar
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Search terms used: mental health; psychopathology; school; academic; review; meta-analysis; expanded school
mental health
4. Mental health services for students
In an environment of limited time and resources, school sites can be used as central locations to deliver coordinated
services for children, youth, and their families. In this regard, school boards can establish partnerships with community
service agencies to provide additional support to children, youth, and families that extend beyond what the school itself
can provide. The benefits of step-up services include (Morrison & Kirby, 2010):
Provision of accessible services without the need to travel to attend appointments
Reduction in missed school time usually associated with accessing additional supports or services
Coordination of services and supports
The recent literature on school-based mental health often refers to community agency involvement in student mental
health services as a component of “expanded school mental health” (ESMH). Expanded school mental health uses interprofessional collaboration to implement learning supports and mental health promotion and intervention strategies in
schools (Mellin et al., 2010), and can involve community members, teachers, school nurses, school-based mental health
professionals, and community agency practitioners working together to support students.
Partnerships between schools and community mental health agencies present an opportunity to strengthen mental
health services and supports for students, but they also complicate the working realities for those who provide services.
This report is intended to answer several questions about what the literature indicates is effective practice when
community-based agencies provide mental health services for students with a high level of need that exceeds what the
school is able to provide. It begins with a summary of information on outcomes related to improved mental health,
notes some evidence-informed programs that may be appropriate, and finishes with suggestions of core program
components. As the questions posed are quite broad, this report is only a summary and more in-depth research on each
topic of interest may be required for longer term planning of a sustainable partnership.
4.1 Improved mental health and positive academic outcomes
Persistent mental health problems are associated with academic underachievement, behaviour problems, and erratic
school attendance (DeSocio & Hootman, 2004), and a growing body of research is linking student mental health to
academic success. A policy document that includes the findings of an international survey and scan of Ontario school
boards found that mental health problems are a key issue and that mental health disorders are highly associated with
declining academic performance (Santor, Short, & Ferguson, 2009).
The research literature indicates that school mental health programs have a positive impact across a number of
emotional and behavioural outcomes and educational outcomes in children and youth. Broadly speaking, a summary of
select research by the University of Maryland Center for School Mental Health (2012) shows that school-based mental
health programming contributes to:
Improved behavioural and emotional symptoms
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Increased social competency
Increased standardized reading and math test scores
Improved commitment to school
Increased school attendance
Increased grade point average
Many students lack social-emotional competencies and disconnect from school as they progress from elementary to
middle to high school. This lack of connection negatively affects their behaviour, health, and academic performance
(Blum & Libbey, 2004). A 2011 meta-analysis of student social and emotional learning (SEL) found strong empirical
evidence linking SEL with improved social and emotional skills, attitudes, behaviour, and academic performance (Durlak
et al., 2011).
A 2008 review (Payton et al.) looked at the effect of SEL programs on a variety of outcomes, in different settings. The
greatest effect was achieved in programs that were sequenced, active, focused, and explicit (see section 4.4).Of studies
conducted in after-school settings for children and youth, compared to students in control groups the participants in
after-school SEL programs experienced significantly higher mean effects in all five of the analyzed outcome categories:
Attitudes toward self and others
Positive social behaviour
Conduct problems
Emotional distress
Academic performance
A recent review of studies of interventions targeting both mental health outcomes and academic performance found a
sample of research with some useful findings but also noted that there are significant gaps in the overall available
research evidence (Hoagwood et al., 2007). In general, the literature is short on this type of focused, well designed
research that considers school performance as well as mental health status. The review identified 24 articles published
between 1990 and 2006 that typically studied social competence, aggression, problem behaviours, academic scores, and
school attendance. These outcomes, while important factors in the mental health and academic performance discussion,
reflect how little research has been conducted on interventions that target internalizing concerns in school-based
mental health, particularly those delivered by organizations partnered with the school. Only 15 of the 24 studies
demonstrated a positive impact on both educational and mental health outcomes, 11 of which included intensive
interventions targeting both parents and teachers. Less intensive interventions tended to only impact mental health
outcomes, and they typically had less family involvement. Overall, the review suggests the need for a multitiered
intervention approach to mental health and academic outcomes in schools, with varying levels of service intensity and
duration.
4.2 A common school mental health service framework
Research on school-based mental health has provided a common set of concepts and vocabulary that is helpful for
framing the role of community mental health agencies in providing services to students that are referred by schools,
although one challenge to this report was the difference in models and concepts between the mental health and the
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education literature. Within the school-based mental health literature, School Wide Positive Behaviour Supports (SWPBS), Social-Emotional Learning (SEL), Response to Intervention (RTI), and Systems of Care are beginning to merge into a
comprehensive vision. SW-PBS in particular has contributed to a broad range of work in schools. Positive Behaviour
Supports are also now used in schools in Canada and have been explored as an intervention strategy in other settings
including inpatient mental health, although research on suitability and effectiveness is limited.
SW-PBS has championed the use of a conceptual tiered system of interventions. Figure 1 illustrates how a continuum of
mental health interventions flows from broad (universal) to targeted (indicated/tertiary) supports and services. Note
that this summary is a significant oversimplification of the SW-PBS model and associated concepts, including the fact
that decision making is team based and community mental health agencies would need to have an active presence on
those teams. But the concept is illustrative of emerging interconnected systems frameworks for school mental health.
Figure 1 School-based mental health and learning supports pyramid (The Center For Community Solutions, 2008).
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Although terminologies vary, the essential point is that mental health services and supports for students range from
broad, universal programming for all students to very focused and individualized interventions at the point of the
pyramid. Ideally, Tier 2 and Tier 3 interventions are anchored in Tier 1 and are scaled-up or natural extensions of the
universal programming. The three tiers represent system structures for providing interventions, they do not represent
youth (Barrett et al., 2012). Interventions are not disorder or diagnosis specific but instead relate to the severity of
emotional and behavioural challenges that are present, with or without a formal diagnosis. Approximately 1-5% of
students require more than primary and secondary prevention efforts and have serious and complex emotional and
behavioural needs that require a comprehensive multiagency treatment approach (Kutash et al., 2008). One caveat is
that some studies have found that interventions that are integrated into the classroom curricula, as opposed to
adjunctively offered, are associated with more positive child outcomes and long-term sustainability (Hoagwood et al.,
2007). The implication of this is that an integrated continuum of supports and interventions in school-based mental
health is required, rather than sending children out for all services.
Within this tiered model, community mental health agencies are well positioned to provide Tier 3 services that are
targeted and intensive and that address the most complex and severe emotional and behavioural disorders. The term
“indicated” is commonly used to refer to the interventions that are delivered to students at this level. Indicated
interventions are provided for students who are identified as having the most severe, chronic, or pervasive concerns
that may or may not meet diagnostic criteria. Interventions are individualized and include evidence-informed individual
and family programs, comprehensive wraparound plans, and behaviour support plans (Barrett et al., 2012).
4.3 Potential evidence-informed interventions
Hoagwood et al.’s (2007) review of empirically based school interventions for mental health and academic outcomes
found that the evidence-based practice movement in mental health has typically operated in isolation from educational
research and from the important policy and practice issues that drive school environments. This may explain why there
is less mental health literature on the specific, indicated mental health interventions to apply in schools versus in
community outpatient settings. Effective mental health intervention research has been peripheral to school policy
making or practice, and the general vocabularies in the research literature even vary, making it difficult to bridge the
fields. Nonetheless, we did identify some good practice information on services that are proven effective with students.
Unsurprisingly, good practice in school mental health services are those found within community agencies.
Social and emotional learning (SEL) is a global approach to intervention with a good base of research to inform practice.
SEL is the process through which people acquire the knowledge, attitudes, and skills to recognize and manage emotions,
set and achieve positive goals, demonstrate caring and concern for others, establish and maintain positive relationships,
make responsible decisions, and handle interpersonal situations effectively (Payton et al, 2008). Social and emotional
learning research has identified five groups of inter-related social and emotional competencies that are related to
emotion regulation and conflict resolution:
Self-awareness
Self-management
Social awareness
Relationship skills
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Responsible decision making
Improvements in these competencies in students may in turn lead to improved adjustment and academic performance,
more positive social behaviours, fewer conduct problems, less emotional distress, and better grades and achievement
test scores. A review of studies looking at social and emotional learning programs for students identified as needing
indicated services found that programs served students with conduct problems, emotional distress, and problems with
peer relationships. Interventions included small group programming, parent sessions, and individual programming. Half
of the programs used non-school personnel exclusively to deliver services. The programs consistently found:
Improved attitudes toward self, school, and others
Improved social and emotional skills, such as problem solving skills and emotional regulation
Reduced conduct problems
Reduced emotional distress including measures of anxiety, depression, and social withdrawal
Improved standardized achievement test scores and grade point average
Payton et al.’s 2008 review also looked at after school programming and, similar to the indicated programs, it found
consistently improved outcomes for children who received targeted social and emotional learning services. After-school
programs occurred equally frequently at the school or in community agencies, and like the studies of indicated
programs, after-school programs achieved similarly improved outcomes.
One recent review from a researcher in Ontario focused on mental health services for a particularly challenging set of
students, those who have been suspended or expelled and require direct intervention supports (Goldenson, 2011).
Suspended and expelled students, regardless of ethnic, cultural or other diversity considerations, usually present with
extremely complex issues. System of Care and Wraparound are two established philosophies for providing interventions
for such challenging students. The System of Care model involves the coordination of crisis intervention, long-term
therapy, and family involvement. Wraparound focuses on the notion that the youth and family are central and that
services must be individually tailored to the strengths and needs of the youth, versus placing the youth in a particular
program due to diagnostic characterization.
In terms of therapy, several treatments have a base of evidence for effectiveness in working with high-risk youth such as
those who have been suspended or expelled, or who are in need of intensive outpatient mental health services. Note
that the Centre of Excellence has several available reports that discuss these therapies, and the Centre can direct
organizations to online repositories of information on the interventions including the evidence base and training
opportunities. A strong evidence base exists for these programs:
Multi-systemic therapy
Brief strategic family therapy
Dialectical behaviour therapy
Motivational enhancement therapy
An extensive 2006 policy document for school administrators and other decision makers summarized the literature on
school-based mental health, including listing evidence-based programs that are supported in the major evidence-based
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program online directories such as those from SAMHSA and the U.S. Department of Justice (Kutash et al, 2006).
Community-based programs for students with various intervention needs such as social/emotional disorders, trauma,
substance abuse, violence and aggression include:
Brief strategic family therapy
Family effectiveness training
Multidimensional treatment foster care
Multidimensional family therapy
Adolescent transitions program
Multi-systemic therapy
Trauma focused cognitive behaviour therapy
Functional family therapy
In terms of common intervention skills, cognitive-behavioural therapy and behaviour management strategies are
common across these programs, depending on whether they focus on aggression and violence (externalizing concerns)
or social and emotional regulation and functioning (internalizing concerns).
4.4 Key program components
A review of mental health supports for the highest risk youth found that the best overall outcomes are achieved when
individual treatment is augmented with significant outside support (Goldenson, 2011). The wraparound concept is
particularly effective because it shores up support from the family, community, outpatient mental health, and
probation. Regardless of the modality, key ingredients for successful outcomes include intensity, consistency, and
accountability. Effective programs for this high risk, difficult to reach group include:
A skill development focus
A problem-solving focus
Continuous assessment of progress
Home work to encourage out-of-session work
A therapeutic relationship that is characterized by good rapport, the creation of a safe environment, and the
provision of consistency and warmth that may not be available elsewhere
A meta-analysis of 249 experimental and quasi-experimental studies of school-based interventions to address student
aggression and disruptive behaviour found a modest effect associated with a range of treatment approaches (Wilson &
Lipsey, 2007). Across the included studies the analysis identified four core treatment modalities. The most common
modality across successful programs was cognitively oriented, and it was the most common treatment practice
specifically for students in pull-out classrooms or special treatment circumstances.
Behavioural strategies: techniques such as rewards, token economies, and contingency contracts (note: these
are recommended for in-school classrooms but may not be relevant for treatment services delivered individually
or in the community)
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Cognitively oriented: focus on changing thinking or cognitive skills; social problem solving; controlling anger and
inhibiting hostile attributions (note: very relevant to evidence-based programs such as Coping Power and I Can
Problem Solve)
Social skills training: self explanatory, as found in evidence-informed social skills and conflict resolution training
programs
Counseling and therapy: common individual, group, and family therapies
Social and emotional-learning program research found that interventions that use four recommended practices for skill
training are most effective. Recommendations are (Payton et al., 2008):
Sequenced: activities within the program are applied sequentially in a step-by-step fashion
Active: the program uses active forms of learning such as role-plays and behavioural rehearsal, with feedback
Focused: the program devotes sufficient time exclusively to developing social and emotional skills
Explicit: the program targets specific social and emotional skills
Designing these four practices into a program is a key moderator that contributes to program success, with
implementation best practices as a second important moderator.
5. Partnerships between schools and community mental health agencies
School mental health services are delivered in a variety of forms and there is no explicit, accepted “best practice” model
(The Annapolis Coalition, 2006). However, models such as the previously mentioned expanded school mental health do
provide approaches that collect key elements into a coherent approach. Key elements include:
Family-school-community agency partnerships involving close collaboration between school-employed mental
health staff and community agency employed mental health professionals
A commitment to a continuum of mental health education, promotion, assessment, problem prevention, early
intervention, and treatment
Services for youth in general, and special education and intervention for students in need
With a view to improving access to and for clients, school boards and community agencies have developed the notion of
school-linked services (Adelman & Taylor, 2003) which are intended as coordinated linkages between schools and
agencies to support the needs of school-aged children and their families. There is empirical evidence for collaborations
to provide services in schools, and research has identified school mental health efforts as most effective when they
function in community contexts and partnerships (Powers et al., 2011).
5.1 Collaboration and partnership
Adelman and Taylor (2003) found that in spite of having declared partnerships, the majority of school and community
programs and services still function in relative isolation and services remain very fragmented. While community
programs and resources may be located on school sites, professionals from the school and agency often work in parallel
rather than together. Linkages are formed, but collaborative working connections are not made. Little effort is made to
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develop effective mechanisms to coordinate complementary programs and activities, so children and youth may remain
in multiple uncoordinated programs.
Mellin et al. (2010) summarized some of the literature and concluded that effective collaboration is often difficult to
achieve due to turf issues, pre-existing responsibilities, and a lack of understanding of the school culture among
community-based professionals. That last issue might be circumvented in the scenario of this current report as most
services will be occurring outside of the school, but these are still risks to sustainable and especially deepening
collaboration between schools and community mental health agencies. On the flip side, the Mellin paper identified
shared decision making and responsibilities, mutual respect, interdependence, and reflection as important elements of
collaboration.
The University of California, Los Angeles (UCLA) Center for Mental Health in Schools is one of two centres (the other is
the University of Maryland) in the United States that receives federal funding to act as a resource centre for schoolbased mental health. It has a tremendous repository of information and materials, so only select recommendations are
identified in this report. One extensive resource from UCLA is the monograph School-Community Partnerships: A Guide
(Center for Mental Health in Schools at UCLA, undated). In short, it summarizes the why, how, and trends in schoolcommunity agency partnerships to enhance student mental health services. To begin, effective partnerships require an
effective set of policies, and those policies must:
Move existing governance toward shared decision making on roles, supports, incentives, and training
Create change teams and change agents to carry out the daily activities that pertain to building support and
redesigning processes related to sustainable change
Define high level leadership assignments and guarantee essential leadership/management training that relates
to change and sustainability of change
Establish institutionalized mechanisms to manage and enhance resources for school-community partnerships
and related systems, with a focus on planning, coordination, integration, and evaluation
Provide funds for capacity building related to both accomplishing desired system changes and enhancing mental
health interventions over time
Use a sophisticated approach to accountability that includes short-term effective approaches for collaboration
and benchmarking and longer-term indicators of impact
In the model proposed by UCLA, community agencies provide a level of care for students at greatest need of services in
parallel to the school’s special education services for learning disabilities, emotional disturbance, and other health
impairments. On the community side, services are essentially their standard suite of supports that occur along a
continuum of intensity: emergency/crisis treatment, family preservation, long-term therapy, and other interventions
from brief to intensive individual therapy. When community agencies work with schools, four key areas for immediate
collaborative work are (Center for Mental Health in Schools at UCLA, undated):
Resource mapping and establishment of an integrated referral system
Providing staff development with respect to interventions
Creating guidelines that protect confidentiality while still allowing for communication between the family and
school
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Teaming with the family and key school and community staff
A recent qualitative study on implementation of an evidence-based program in a school identified barriers to successful
implementation. The most important facilitator was having support for the program from the school leadership and
from peers (Langley et al., 2010). The four main barriers to successful program implementation were:
Lack of parent engagement / participation
Competing responsibilities
Logistical barriers
Lack of support from school administrators and teachers
An interesting finding by Langley et al. was that community agency staff that went into schools to deliver the program
experienced fewer competing priorities, so they were more able to focus on implementation. However, they were not as
capable at handling the complexities of school and student logistics and working to manage student schedules, whereas
school staff were better at this. This finding points to the importance of collaborative relationships between community
practitioners and their peers in the school to ensure successful implementation and sustainable services.
Interprofessional collaboration in school mental health draws from a wide range of literature and cannot be summarized
in this report. However, Bronstein suggests a model for community social workers to use to conceptualize
interprofessional collaboration (Bronstein, 2003). The model uses five constructs that contribute to optimum
collaboration:
Interdependence: collaborators rely on interactions with other professionals to accomplish goals and tasks
Newly created professional activities: collaborative acts, programs, and structures that allow for the
accomplishment of goals that could not be achieved independently
Flexibility: the deliberate blurring of professional roles, related to but distinct from interdependence
Collective ownership of goals: share responsibility in the entire process of reaching goals that includes joint
design, definition, development, and achievement
Reflection on process: collaborators attend to the process of working together and the outcomes of their
efforts
5.2 Evaluation considerations
Mellin et al. (2010) built upon this model and developed an instrument to assess interprofessional collaboration in
expanded school mental health services. The instrument measures across four factors: Reflection on process;
Professional flexibility; Newly created professional activities; and Role interdependence. The 26-item instrument is a
brief tool that may be useful in evaluating the functioning of interprofessional teams in school-based mental health
services. Further information and support on evaluation is available from the Centre.
6. Sample school-community mental health programs
The Beech Brook School-Based Community Support Program (SBCSP) in Ohio is a published example of collaboration
between an urban school board and a community mental health agency that achieved measurably positive mental
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health outcomes for students who received services from the agency. This study measured the longitudinal change in
psychiatric symptomology of a group of children in kindergarten through grade 5 who experienced severe emotional and
behavioural difficulties. The agency filled a service gap by bringing interventions into the school and working with the
most challenging cases, and they achieved reduced emotional and behavioural disorders such as attention deficit
hyperactivity disorder, depression, and conduct disorder (Hussey & Guo, 2003). Beech Brook clinical staff provide onsite
services in schools, including
(http://www.beechbrook.org/syncshow/uploaded_media/glmod_Modules_Knowledge-Center/SchoolBasedMentalHealthServices-1301332051.pdf)
Screening and assessment
Individual therapies
Family interventions
Crisis intervention
School-based support groups
Services in the home and community
Linkages to other services and supports
Within Canada, the Mental Health Commission of Canada is developing a database of existing programs across the
country that are models of school-based mental health service provision. The Centre of Excellence is involved as a
research partner and there is an extensive collection of contacts available, although the results are still to be finalized.
Nonetheless, we were able to identify several potential program of interest. The Centre can provide a list of programs
and contacts by email if interested.
7. Next steps and other resources
A 2001 article provides useful suggestions on high level topics to consider when community agencies join schools and
other organizations in planning and launching an expanded school mental health program. See Mental health, health,
and education working together in schools by Weist et al. at
http://online.missouri.edu/exec/data/courses2/coursegraphics/2226/L6-Weist.pdf
This report touches on implementation best practice multiple times as an important contributor to improved outcomes.
Knowing what works and receiving training on an evidence-informed practice or program is not sufficient to actually
achieve the outcomes that previous evaluations indicate are possible. A program that has been shown to improve
mental health outcomes for children and youth but that is poorly implemented will not achieve successful outcomes
(Fixsen et al, 2005). In order for a program to be evidence-informed, it needs to be applied with fidelity to the design
and it needs to be implemented using supportive “drivers” related to staff competency, organizational leadership, and
organizational capacity. Choosing a practice is an initial step toward implementation, but the implementation drivers are
essential to ensure that the program reaches appropriate clients, that outcomes are successful, and that clinical staff are
successful in their work.
The Mental Health Commission of Canada, with the Centre of Excellence as a partner, is finalizing a report and policy
paper on effective programs for school-based mental health service provision. It will include a database of effective
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programs in Canada and policy recommendations on what works in this context. The Centre can provide information on
this paper as requested.
The Ontario Centre of Excellence for Child and Youth Mental Health has a number of resources and services available to
support agencies with implementation, evaluation, knowledge mobilization, youth engagement and family engagement.
For more information, visit:
http://www.excellenceforchildandyouth.ca/what-we-do or check out the Centre’s resource hub at
http://www.excellenceforchildandyouth.ca/resource-hub.
For general mental health information, including links to resources for families:
http://www.ementalhealth.ca
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References
Adelman, H.S., Taylor, L. (2003). Creating School and Community Partnerships for Substance Abuse Prevention
Programs. The Journal of Primary Prevention, 23, 3, 329-369.
Barrett, S., Eber, L. Weist, M. (2012). Development of an Interconnected Systems Framework for School Mental Health
(a work in progress). University of Maryland Centre for School Mental Health and OSEP Centre on Effective
Schoolwide Interventions. Available at:
http://csmh.umaryland.edu/Resources/OtherResources/SMHPBISFramework.pdf
Blum, R. W., & Libbey, H. P. (2004). School connectedness - Strengthening health and education outcomes for teenagers.
Journal of School Health, 74, 229–299.
Bronstein, L. (2003). A model for interdisciplinary collaboration. Social Work, 48, 297-306.
Center for School Mental Health. (2012). The Impact of School Mental Health: Educational, Emotional, and Behavioural
Outcomes. University of Maryland, School of Medicine. Available at:
http://csmh.umaryland.edu/Resources/OtherResources/CSMHImpactofSMH.pdf
DeSocio, J., & Hootman, J. (2004). Children’s mental health and school success. The
Journal of School Nursing, 20, 189–196
Fixsen, D. L., Naoom, S.F., Blase, K.A., Friedman, R.M., & Wallace, F. (2005). Implementation research. A Synthesis of the
literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National
Implementation Research Network (FMHL Publication #231).
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