IES Blog

Institute of Education Sciences

Delivering Mental Health Supports to Adolescents in School Settings

Mental Health Awareness Month was established in May of 1949 to increase awareness of the importance of mental health and wellness in Americans’ lives and to celebrate improvements in mental health treatment. Nearly 75 years later as we honor mental health awareness in this country, we are confronted with an alarming rise in mental health needs among America’s youth that the U.S. Surgeon General advises could be helped in part with school-based prevention and intervention supports.

One approach to school-based mental health is being tested in an IES-funded efficacy replication study called School Adolescent Mood Project: Efficacy of IPT-AST in Schools. This project is being led by Dr. Jami Young, associate chair of research in the Department of Child and Adolescent Psychiatry and Behavioral Sciences, faculty member in the PolicyLab at the Children’s Hospital of Philadelphia (CHOP), and professor of psychiatry at the University of Pennsylvania Perelman School of Medicine. Dr. Young was interviewed by Rebecca Sun, IES Intern, to help us learn more about conditions on the ground in her study and how telehealth-delivered Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) is working in these schools.

Tell us about the schools you are working in and the different mental health needs you are seeing. How do you think the pandemic influenced what you are seeing now? 

In the School Adolescent Mood Project (SAM project), we have been working closely with 16 schools in Pennsylvania and New Jersey that serve 9th and 10th grade students. Over the past three years, what we are seeing in these 16 schools is very different than what we are used to seeing in our past two decades of school-based depression prevention work. Compared to our earlier studies (see this one for example), in the current SAM project, the rate of teens with elevated scores on our depression screening has more than doubled, as has the percentage of students with scores indicating more significant depression.

The increases we have seen in the SAM project mirror increases in depression and anxiety that have been reported by others during the pandemic, including the most recent findings reported by the CDC. Our still unpublished screening data from the SAM project suggest that there are a substantial number of adolescents who are experiencing mental health difficulties and would benefit from services in schools and/or the community. There is much work that needs to be done, including increases in funding and workforce expansion, to grow and sustain school-based services to support these students. Additionally, establishing connections between schools and mental health agencies is essential, so students who need more intensive services can receive timely care.

What do the youth in your study say are their biggest concerns? 

We are seeing many adolescents who are reporting significant issues with depression and anxiety. Unfortunately, we have also seen an increase in adolescents who report suicidal thoughts and behaviors. The pandemic was difficult for many adolescents as they experienced school closures, loss of loved ones to COVID-19, and feelings of loneliness and social isolation. Even with the return to in-person learning and afterschool activities in the 2021-2022 school year that allowed many students to regain a sense of normalcy, other adolescents found the return to school to be a challenging adjustment. In the SAM project, we saw an increase in the number of adolescents who reported serious thoughts of wanting to kill themselves or who had made a suicide attempt from the 2020-2021 school year when most schools were virtual or hybrid to the 2021-2022 school year when schools were back to in person learning. Unfortunately, we have continued to see an increase in the percentage of adolescents reporting thoughts of wanting to kill themselves this academic year.      

Our school partners have also noted a significant increase in students with suicide-related concerns. One school counselor shared, “I think we have done more suicide risk assessments this year than the past 5 years combined.” This points to a critical need to fund and implement evidence-based screening, assessment, and prevention initiatives for youth suicide.

What have you learned so far about the feasibility and effectiveness of providing the IPT-AST intervention in a telehealth format?

We needed to think creatively about how to ensure that students received the support that they needed and to consider how we could promote continuity of care if schools needed to close again. We made the decision to deliver IPT-AST through telehealth. We thought the COVID pandemic was an important opportunity to capitalize on the recent growth and innovations in digital health and to study the acceptability and efficacy of IPT-AST when delivered through telehealth.

We’ve interviewed a subset of adolescents who participated in our IPT-AST groups to get their feedback about the program, including how they felt about IPT-AST being delivered through telehealth. We are still analyzing these interviews and looking at our other data on acceptability and feasibility, including attendance and satisfaction data. Anecdotally, we have noticed a change in the acceptability of telehealth over the course of our study. In our first year, providing our group online meant that students could receive services and interact with their peers even when school was closed. As we have moved further from school closures, more adolescents have expressed a desire to return to in-person groups. Several adolescents have suggested we consider hybrid models that incorporate both in-person and virtual sessions. One positive benefit of running IPT-AST groups online is that we have been able to include students from different schools in the same group. If we find positive benefits of telehealth-delivered IPT-AST, it will be interesting to see whether some schools and districts prefer to continue this approach as it will enable providers to deliver these services outside of the school day.

Do you think the pandemic has eased the stigma surrounding seeking mental health?

We do not measure stigma specifically in our study but hope that all the attention around mental health has been beneficial. As May is Mental Health Awareness Month, we think it is important to emphasize that mental health is health. If we can continue to spread this message, stigma around mental health will continue to decrease. We are hopeful that the increased focus on youth mental health, decreases in stigma, and proposed policy solutions to increase access to mental services will mean that more adolescents will be able to get the care they need.


This blog was produced by Emily Doolittle (Emily.Doolittle@ed.gov), NCER team lead for social behavioral research.

 

Integrating Intervention Systems to Address Student Mental Health and Social-Emotional-Behavioral Functioning

In honor of Mental Health Awareness Month, NCSER is featuring an IES-funded study on student behavioral supports and interventions that best address the mental health needs of students. Positive Behavioral Interventions and Supports (PBIS) and school mental health (SMH) are both evidence-based interventions that provide student mental health support independent of one another. For this blog, we interviewed Dr. Brandon Schultz, principal investigator of a current study investigating the integration of both PBIS and SMH into a comprehensive school intervention. In the interview below, he discusses the differences between PBIS and SMH, how this research contributes to equity and inclusion in the classroom, and his research journey.

Your study is comparing schools that integrate PBIS and SMH into the enhanced version of the Interconnected Systems Framework (ISF) to schools that implement these as separate, parallel systems. Can you describe PBIS and SMH, and explain the key differences between the integrated framework and parallel systems?

Headshot of Dr. Brandon Schultz

PBIS is a tiered prevention system that addresses student behavioral needs. It provides universal support (Tier 1) to all students, including clear schoolwide behavioral expectations and a rewards system for desired behaviors. For students who do not respond to these efforts, Tier 2 provides targeted help through classroom-level or small group interventions, such as teacher consultation or student mentoring/counseling. For students who need intensive support, Tier 3 provides specialized one-to-one behavioral services. SMH, in contrast, focuses specifically on mental illnesses (for example, anxiety, trauma, depression) and, in some cases, involves community-based therapists working contractually with schools. Typically, PBIS and SMH function separately as co-located services, but there is a growing recognition that student needs are best met when these efforts are meaningfully integrated. Integration, however, is challenging because it requires educators to rethink their teaming and progress monitoring practices and include different stakeholders in critical decision-making processes. This study tests innovations to the ISF model, designed by my co-PI, Dr. Mark Weist (University of South Carolina), to meet the challenges of integrating these systems in two diverse school districts.

How did you become interested in this area of research?

My previous research was mostly focused on school-based interventions for students with ADHD, but it became clear that without systems-level change, interventions meant to help students with ADHD are unlikely to be implemented or sustained effectively, no matter how well they are designed. So, I became interested in understanding school systems and identifying the elements, processes, and resources that are critical for student support services of all kinds. 

How does your research contribute to equity and inclusion in education?

Part of my current study is focused the degree to which innovations to the ISF model can reduce racial inequities in school disciplinary actions. Research shows that Black students receive higher rates of exclusionary punishments (for example, suspensions and expulsions) than their White counterparts, even after controlling for the type of infraction. The modified ISF model aims to reduce the overall need for exclusionary punishments, especially among students of color. By improving team functioning, ISF allows educators to identify systemic problems that lead to racial inequities in disciplinary referrals and to generate new strategies to address student needs in a fair and equitable manner. With this model, we anticipate increased support for students of color that obviates disciplinary referrals. We are working with school districts now to examine disciplinary data before, during, and after the implementation of the enhanced ISF. Our hope is to identify strategies that close race-related gaps and share the lessons learned broadly.

Have you encountered any challenges in studying this integrated framework in elementary schools?

Yes, absolutely. Systems-level change in general is difficult, as it requires change agents to overcome structural inertia rooted in local norms, routines, and expectations. Those challenges have been exacerbated by the COVID-19 pandemic and preexisting trends in childhood mental illnesses. 

During the pandemic, student progress in mathematics and reading have dramatically declined. Meeting these academic needs, a priority for teachers, can divert attention away from student mental health needs. For example, all teachers in one of our states are required to take a year-long online course in reading instruction, partly to address student learning loss. Although commendable, this requirement creates a significant burden for teachers that can leave little room for other concerns. 

Preexisting mental health trends demonstrate that mental illness was increasing sharply among school-age children; by 2018, nearly 15% of all K-12 students experienced a psychiatric condition each year. Then, with the onset of the pandemic, indicators of childhood mental illness (for example, emergency room visits for suicidal behavior) spiked. Childhood anxiety and depression doubled worldwide from pre-pandemic estimates, and it is unclear whether those rates will return to baseline.

Together, these events have created real challenges, not just for our research, but for student support services in general.

What is currently the greatest area of need in studying school-based systems that support student mental health, particularly for those students with or at risk for emotional and behavioral disorders?

Perhaps the greatest area of need for supporting students with emotional and behavioral disorders is understaffing in critical school mental health positions. There is a significant shortage of school psychologists, counselors, social workers, and nurses nationwide. In North Carolina, the current ratio of school psychologists to students is 1:2,527, five times higher than recommended. This understaffing hinders schools’ ability to provide high-quality services and complicates efforts to test and refine innovative practices because field-based practitioners are unable to collaborate on research efforts. Researchers have had to hire individuals to fulfill critical roles, such as behavioral consultants, that might otherwise have been assigned to district-employed staff. Trained personnel then exit the school district when the research project ends and that skillset is lost. We hope that states prioritize the hiring of school mental health practitioners in the coming years to ensure optimal student support services and that university-school research collaborations can reliably lead to sustainable innovations.

NCSER looks forward to seeing the results of this efficacy trial and will continue to fund research aimed at supporting the mental health and social-emotional-behavioral needs of students with or at risk for disabilities.

This blog was authored by Isabelle Saillard, student volunteer for NCSER and undergraduate at the University of Virginia.