Appendix B:

Summary of Open-Ended Responses

The survey included two open-ended questions:

School Questionnaire, Question 37:

“Please tell us what you think is the most successful approach or strategy that your school is using to improve the mental health of students?”

District Questionnaire, Question 17:

“If you have any comments you would like to make about this survey or about funding mental health services, please use the space below.”

The following is a summary of the responses to these questions; the responses were organized into categories with common themes.

School Questionnaire

Approximately 800 respondents provided 1,100 examples of approaches or strategies described as being “most successful” in improving the mental health of students at their schools. These approaches were classified into 22 categories.

Respondents most frequently named approaches that fell into five distinct categories. In order of frequency, these are summarized as follows:

The availability of in-school mental health services through guidance counselors, mental health counselors, social workers, and psychologists employed by the school or school district. Many respondents noted that the ability to refer students to these professionals was critical to student mental health and that the provision of services within the school had several advantages in that it avoided the transportation, insurance payment problems, and perceived stigma that counseling outside of school presented. Many also noted that onsite mental health resources were severely strained and inadequate in their schools.
The provision of curriculum-based programs and classroom guidance to enhance social and emotional functioning, focusing on a variety of mental health and life skills topics such as anger management, prevention of violence and bullying, conflict resolution, problem solving, resisting peer pressure, communication skills, substance abuse prevention, and character education (e.g., developing citizenship skills, responsibility, honesty, fairness, patience). Several programs were named repeatedly, including “Responsive Classroom,” the “Second Step” program, and DARE.
Collaboration with and referral to outside agencies to provide mental health services, particularly for students with more intensive needs. Especially valued were partnerships with agencies that provided services in the school, which enhanced communication and collaboration and diminished transportation problems.
The ability to refer students experiencing mental health problems to interdisciplinary “student assistance” or “student service” teams. These teams were described as composed of school principals, assistant principals, resource specialists, psychologists, community outreach workers, social workers, teachers, and school counselors. The multidisciplinary teams meet regularly and provide referrals, intervention, monitoring, and support through a collaborative process. With the input of parents, they develop strategies to improve specific behaviors, and they seek additional resources and community services.
Counseling and support provided in individual or small group therapy sessions, as well as support groups designed to assist with specific issues such as social skills, self-esteem, and depression surrounding issues such as divorce or bereavement.

Less commonly cited strategies (reported by between 20 and 70 respondents) were:

Parent involvement and communication, and provision of family support
Developing a nurturing school environment with caring and involved staff who know their students well, develop trusting relationships, and promote respect for all members of the school community
Good communication and collaboration among teachers, staff, administration, and mental health staff
Early identification of problems and a proactive approach when problems are first identified or suspected
Peer support and mediation
Teacher and staff training on mental health issues
Creating a high level of comfort in seeking mental health services

The remaining strategies were mentioned between 2 and 20 times:

Use of adult advisors or mentors
Crisis counseling
Behavior management programs
Creating a safe, controlled environment, with clear rules
Anger management training and/or classes
Substance abuse education/treatment/support groups
Unspecified prevention programs
Early intervention programs
Alternative settings for students needing intensive mental health assistance
Provision of mental health services in homes

It is worth noting that 41 respondents (approximately 5 percent) wrote that their school did not have any successful strategies. Comments from these respondents frequently cited funding issues leading to understaffing and compounded by limited community resources. Several respondents noted that counseling staff are overburdened, with responsibility for as many as 1,000 students each, and that other duties prevented them from providing anything other than the most cursory attention to mental health needs.

These respondents also noted they perceived increasing mental health needs in the student population―in the number of students, the severity and complexity of problems presented, and in the limitations of family resources.

District Questionnaire

Analysis of Responses by Districts to Question 17: “If you have any comments you would like to make about this survey or about funding mental health services, please use the space below.”

Approximately 330 districts responded to the final question on the survey, a request for comments about the survey or the funding of mental health services. Information on mental health services was classified into six general categories.

Representatives from 103 districts used the opportunity provided by the open-ended question primarily to clarify previous survey question responses and to furnish additional information about the mental health services in their school districts, such as the number and type of mental health professionals employed, the types of collaborations they were engaged in, and their sources of funding. Nine of these districts reported that the survey was not applicable to them because their district did not provide any mental health services to students.

Approximately 100 comments were received related to concerns about lack of funding for mental health services, many indicating a problem of crisis proportions. Decreases in state budgets were projected to result in dramatic losses in the area of school-based mental health in 2003–2004. Inadequate insurance coverage and low reimbursement for mental health services were also cited as problematic, especially in prevention/screening and early intervention. Ten districts stated that they were seeking Medicaid reimbursement for mental health services, but several noted that rates for reimbursement are so low that they do not cover the cost of billing.

Many noted that with the necessity for academic spending related to the No Child Left Behind (NCLB) legislation, public schools are struggling to fund mental health services. Funding is sometimes shifted to NCLB programs, and school counselors have to assume more testing responsibilities. Respondents also noted that with the push towards measurable accountability (defined as test scores), programs that have no obvious link to academic standards are frequently the ones to be cut when budgets are overwhelmed.

The second most common concern voiced in the responses was the inadequacy of available mental health services both on site and in the community. Fifty districts voiced concerns about the lack of treatment options in the community, particularly facilities for students who need to be out of their home environment. One district commented that there are only 18 inpatient beds available to all adolescents in their entire State. Thirty districts complained that mental health services within their schools were also inadequate. School counselors spend increasing amounts of energy on student scheduling and special education eligibility issues and have limited time for counseling students.

The third most common response, noted by 41 districts, was that mental health needs are increasing dramatically, with many students presenting more serious mental health issues and presenting them at an earlier age than previously seen. Several districts reported that they increasingly find that mental health issues are interfering with the daily operations and instruction for students and that the need for mental health services was seen as increasing for both general and special education students. One respondent said that the number of children seen as significant suicidal risks has doubled in the past year in their district, that hurtful sexual behavior among younger children is up dramatically, and that the number of acting out/aggressive/depressive students is on the rise.

The concern about increasing mental health needs is paired with an awareness that families of students are struggling and under significant multiple pressures (noted by 13 districts). The downturn in the economy has affected parents’ ability to pay out-of-pocket expenses and unemployment has increased the number of uninsured. Many linguistic minority immigrant students are not able to access services in the community because of insurance and language barriers. This fact was also noted by several districts, with counseling and interventions provided by the school often the only service available to the student. Even the purchase and administration of essential medications was noted to be problematic because of income limitations. One district noted that the high number of mentally ill or developmentally disabled parents makes it difficult to get the more intensive community-based services students need because the parents frequently do not have the mental, emotional, or financial resources to follow through.

Finally, 18 respondents wrote about their belief that mental health issues must be given a higher priority within the educational system, and that mental health services within the schools should not be seen as a luxury or convenience, but as a necessity.

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