Skip Navigation

Follow us on:

Ask A REL Response

February 2021


What research has been conducted on mental health strategies and interventions for students in small and rural school districts?


Following an established REL Southeast research protocol, we conducted a search for research reports as well as descriptive study articles on mental health strategies and interventions for students in small and rural school districts. We focused on identifying resources that specifically addressed mental health strategies and interventions for students in small and rural school districts. The sources included ERIC and other federally funded databases and organizations, research institutions, academic research databases, and general Internet search engines (For details, please see the methods section at the end of this memo.)

We have not evaluated the quality of references and the resources provided in this response. We offer them only for your reference. These references are listed in alphabetical order, not necessarily in order of relevance. Also, we searched the references in the response from the most commonly used resources of research, but they are not comprehensive and other relevant references and resources may exist.

Research References

  1. Albright, A., Michael, K., Massey, C., Sale, R., Kirk, A., & Egan, T. (2013). An evaluation of an interdisciplinary rural school mental health programme in Appalachia. Advances in School Mental Health Promotion, 6(3), 189-202.
    From the abstract: "School mental health (SMH) programmes serve as a necessary niche within rural communities and aim to bring accessible care to youth who may otherwise go without mental health services. The following study evaluated the impact of mental health treatment provided by the Assessment, Support, and Counseling (ASC) Center, an SMH health initiative located within a high school in rural western North Carolina during the 2011-2012 school year. Participants were high school students between 14 and 18 years of age, predominately Caucasian (91.3%) and female (65.5%). Treatment was evaluated based on score change on the Youth Outcome Questionnaire using the reliable change index (RCI; Jacobson & Truax, 1991) to track changes in symptomatology. Following ASC Center treatment, 63% of the clinical sample was deemed to have improved or recovered based on the RCI. While the study did not use an experimental design (with associated cautions regarding interpretation of findings), the results suggest that a moderate dosage of cognitive-behavioural therapy provided to adolescents in the context of a rural SMH programme is associated with reliable change for the majority of youth who take part in the treatment."
  2. Bartlett, N. A., & Freeze, T. B. (2019). Examining wraparound fidelity for youth with mental health needs: An illustrative example of two rural Canadian schools. International Journal of Special Education, 33(4), 846-868.
    From the abstract: "Addressing the mental health needs of children and youth is a priority. One way to operationalize the provision of support for children and youth with severe mental health needs is through the wraparound approach. Wraparound is a highly individualized person and family centred planning process which utilizes a clearly articulated practice model, and is led by trained wraparound facilitators. This research examined the fidelity of implementation of the wraparound approach for two youths with severe mental health needs in two rural schools in the province of Manitoba, Canada. Adherence to the guiding principles and primary activities of the wraparound approach were measured using the Wraparound Fidelity Index 4.0 (WFI-EZ), a self-report tool that was administered with caregivers, wraparound facilitators and team members. Facilitation skills and teamwork also were examined through the independent observation of wraparound planning meetings using the Team Observation Measure (TOM-2). These fidelity measures determine model adherence, which has been associated with improved behavioral outcomes for children and youth with severe mental health needs, and quality improvements in service provision. The findings of low average-to-average overall fidelity are encouraging given that these school-based settings are in the emergent stage of wraparound implementation, and demonstrate their ability of schools to adhere to many of the key elements of the wraparound approach. Areas of high fidelity and low fidelity are discussed, and recommendations for quality improvements in wraparound implementation in school-based settings are proposed."
  3. Evans, G. D., Radunovich, H. L., Cornette, M. M., Wiens, B. A., & Roy, A. (2008). Implementation and utilization characteristics of a rural, school-linked mental health program. Journal of Child and Family Studies, 17(1), 84-97.
    From the abstract: "We examined variables associated with treatment engagement in a real-world therapeutic setting. The model of care examined involved school-linked mental health care for children and their families in a rural county. Service utilization characteristics, as well as child- and treatment-specific variables were examined in relation to their impact on therapy length, missed appointments, and treatment outcome. A total of 168 students and their families participated in therapeutic services over a period of approximately 4.5 years. Overall, children who had less psychopathology and a higher level of clinician-rated functioning (GAF) at the start of therapy were more likely to successfully complete treatment. Parental involvement in therapy was associated with a longer course of therapy, as well as more missed appointments. Barriers to treatment and treatment engagement, as well as future directions of study, are discussed."
  4. Huber, B. J., Austen, J. M., Tobin, R. M., Meyers, A. B., Shelvin, K. H., & Wells, M. (2016). Overcoming barriers to rural children's mental health: An interconnected systems public health model. Advances in School Mental Health Promotion, 9(3-4), 219-241.
    From the abstract: "A large, Midwestern county implemented a four-tiered public health model of children's mental health with an interconnected systems approach involving education, health care, juvenile justice and community mental health sectors. The community sought to promote protective factors in the lives of all youth, while improving the capacity, accessibility and coordination of the continuum of care available to children and families. This article describes efforts to improve services for children in rural communities by connecting traditionally separated sectors and engaging doctoral psychology interns in the continuum of care. This article articulates lessons learned in practice, provides a case study and community outcomes; universal screening data, graduation rates and juvenile arrest rates suggest efforts are yielding positive results. Considerations for implementation in other rural communities are discussed."
  5. McDaniel, S. C., & Bloomfield, B. S. (2020). School-wide positive behavior support telecoaching in a rural district. Journal of Educational Technology Systems, 48(3), 335- 355.
    From the abstract: "Rural school districts are unique educational settings requiring efficient use of resources. Barriers to high-quality educational practices in rural settings include the distance from professional development expertise and limited funding. To address these potential obstacles for implementing School-Wide Positive Behavioral Interventions and Supports, we utilized telecoaching for providing monthly technical assistance. Results of this case study indicate that telecoaching in a rural school district across 1 academic year may be an effective alternative for in-person coaching. Descriptive statistics including implementation fidelity, discipline and attendance outcomes, and telecoaching treatment integrity are presented. Implications for practice and future directions are discussed."
  6. Michael, K. D., Albright, A., Jameson, J. P., Sale, R., Massey, C., Kirk, A., & Egan, T. (2013). Does cognitive behavioural therapy in the context of a rural school mental health programme have an impact on academic outcomes? Advances in School Mental Health Promotion, 6(4), 247-262.
    From the abstract: "Given the prevalence of mental health difficulties among children and adolescents, schools have become a suitable context for providing psychological services to those who may otherwise go untreated. The co-occurrence of mental health impairments and academic problems has been widely cited, and many school mental health (SMH) programmes have begun to assess academic variables in treatment outcome. The current study evaluated a rural SMH programme's success at treating symptoms of psychological distress among high school participants and the potential association with participants' attendance, grade point averages (GPAs) and discipline referrals. Participants were 58 high school students between 14 and 18 years old. Results indicate that non-manualized cognitive behavioural therapy administered for an average of 14.88 sessions was successful at treating mental health concerns, as measured by a self-report questionnaire collected several times throughout treatment. In addition, a large proportion of students demonstrated improvements or stability in attendance and discipline when comparing baseline and post-treatment data, though no differences emerged between the time points for the sample as a whole. Although the findings regarding academic outcomes were not impressive overall, individual outcomes varied widely, with slightly over half of the students recording higher GPAs than at baseline. Furthermore, the fact that stability rates across the variables were reasonably high might suggest that we consider widening the definition of success to include protection from decline, reserving expectations for improvement only for those who present with difficulties in that particular academic outcome. The findings documented here illustrate the need for more nuanced approaches to understanding the relationship between intervention and academic performance."
  7. O'Malley, M., Wendt, S. J., Pate, C. (2018). A view from the top: Superintendents' perceptions of mental health supports in rural school districts. Educational Administration Quarterly, 54(5), 781-821.
    From the abstract: "Purpose: A chasm exists between the expanding mental health needs of school-aged youth and the school resources available to address them. Education agencies must efficiently allocate their limited resources by adopting innovative public health models. The need for these effective approaches is acute in rural regions, where resources tend to be scarce. This mixed-methods study of school superintendents illuminates key opportunities to optimize access to care for students struggling with mental health needs in rural communities. Method: Superintendents serving rural California school districts were targeted for a web-based, mixed response-type, 53-item survey designed to examine their perceptions across three school mental health-related categories: (a) strengths and gaps in community ethos and district infrastructure, (b) school personnel groups' knowledge and skills, and (c) predominant barriers. Of the targeted respondents, 16.7% completed the survey (N = 62). Quantitative data were analyzed using a series of descriptive analyses and paired-sample "t" tests. Qualitative data were analyzed using a constant comparative method with an open-coding approach. Findings and Implications: Budget constraints and access to trained school-based and community-based mental health personnel are the most frequently cited barriers to addressing mental health in schools. Knowledge and skills related to mental health are perceived to be more pronounced in district and school leadership than in other personnel groups, including staff typically responsible for providing mental health services, such as school psychologists. Our findings suggest a need to improve superintendent knowledge of innovative public health models for delivering mental health services within the constraints of rural school district settings."
  8. van Vulpen, K. S., Habegar, A., & Simmons, T. (2018). Rural school-based mental health services: Parent perceptions of needs and barriers. Children & Schools, 40(2), 104-111.
    From the abstract: "The benefits of school-based mental health services have been supported in prior research and literature. Studies have shown that approximately one in five youths in schools today have diagnosable mental health disorders. However, research has identified that close to 70 percent of those youths do not receive the services they need. This gap in care has a significant impact on the academic, social, and emotional well-being of youths. Parent involvement is essential in bridging services. However, parents often face barriers in accessing mental health care for their child. The aim of this study was to explore parent perceptions of needs and barriers to school-based mental health services. This exploratory study included 607 parent and guardian respondents. Findings showed that parents were overwhelmingly in support of schools being involved in addressing the mental health needs of students. Anxiety, depression, and bullying were the top emotional and behavioral issues that parents recognized as the main challenge for their child. Lack of parent support, understanding that mental health issues even exist in youths, and lack of supportive school programs were identified as key factors that place youths at risk of not receiving the services they need."
  9. Wexler, L., Poudel-Tandukar, K., Rataj, S., Trout, L., Poudel, K. C., Woods, M., & Chachamovich, E. (2017). Preliminary evaluation of a school-based youth leadership and prevention program in rural Alaska native communities. School Mental Health, 9(2), 172-183.
    From the abstract: "Youth Leaders Program (YLP) is a health intervention implemented in a rural Alaskan school district, which utilizes natural helpers and peer leaders to increase protective factors such as school engagement and personal/cultural identities, and to reduce risks associated with drug/alcohol abuse, violence, and bullying. Through these means, the program aims to ultimately decrease the disproportionately high rates of indigenous youth suicide in the region. This paper describes process and outcome evaluation findings from the program during the 2013-2014 school year. Data collected include a survey for program participants done at the beginning and end of the study year (n = 61, complete pairs); pre- and post-intervention school data (attendance, GPA, and disciplinary actions) (n = 86); an all-school survey asking students at the participating schools about their experience with YLP and participating youth (n = 764); interviews with program advisors (n = 11) and school principals (n = 2); and focus groups with participating students at all eleven participating schools at the end of the year. Outcomes included increased school attendance (mean attendance increased from 146 to 155 days) and improved academic performance (mean GPA of 8th, 9th, and 10th graders increased from 3.01 to 3.14) of program participants; positive peer reviews of participating student interventions in cases of bullying, depression, and suicidality; and a reported increase in the sense of agency, responsibility, and confidence among participating youth. The YLP appears to improve school climate and increase school and other protective factors for participating students. Recommendations for program implementation in the future and implications for school health will be discussed."


Keywords and Search Strings
The following keywords and search strings were used to search the reference databases and other sources:

  • Mental health interventions, rural school districts
  • Rural school districts, mental health services
  • Rural schools, mental health programs

Databases and Resources
We searched ERIC for relevant resources. ERIC is a free online library of over 1.6 million citations of education research sponsored by the Institute of Education Sciences. Additionally, we searched Google Scholar and PsychInfo.

Reference Search and Selection Criteria

When we were searching and reviewing resources, we considered the following criteria:

  • Date of the publication: References and resources published for last 15 years, from 2003 to present, were include in the search and review.
  • Search Priorities of Reference Sources: Search priority is given to study reports, briefs, and other documents that are published and/or reviewed by IES and other federal or federally funded organizations, academic databases, including ERIC, EBSCO databases, JSTOR database, PsychInfo, PsychArticle, and Google Scholar.
  • Methodology: Following methodological priorities/considerations were given in the review and selection of the references: (a) study types - randomized control trials,, quasi experiments, surveys, descriptive data analyses, literature reviews, policy briefs, etc., generally in this order (b) target population, samples (representativeness of the target population, sample size, volunteered or randomly selected, etc.), study duration, etc. (c) limitations, generalizability of the findings and conclusions, etc.

This memorandum is one in a series of quick-turnaround responses to specific questions posed by educational stakeholders in the Southeast Region (Alabama, Florida, Georgia, Mississippi, North Carolina, and South Carolina), which is served by the Regional Educational Laboratory Southeast at Florida State University. This memorandum was prepared by REL Southeast under a contract with the U.S. Department of Education's Institute of Education Sciences (IES), Contract ED-IES-17-C-0011, administered by Florida State University. Its content does not necessarily reflect the views or policies of IES or the U.S. Department of Education nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.