TPC-Journal-V4-Issue5

The Professional Counselor \Volume 4, Issue 5 468 youth who receive any mental health services obtaining them at school (Burns et al., 1995; Rones & Hoagwood, 2000). Therefore, attention must be paid to the quantity, quality and effectiveness of school mental health (SMH) services. School Mental Health In recent years, SMH programs, supported by both school staff (e.g., school psychologists, social workers, counselors) and school-based community mental health clinicians, have emerged as a promising approach to the provision of mental health services for students and families (Weist, Evans, & Lever, 2003). The growth of these programs has facilitated investigation of what constitutes high-quality SMH service provision (Nabors, Reynolds, & Weist, 2000; Weist et al., 2005). This work has been supported and furthered by the Center for School Mental Health, a federally funded technical assistance and training program to advance SMH programs within the United States. In collaboration with other SMH centers (e.g., UCLA Center for Mental Health in Schools) and interdisciplinary networks focused on school health, consensus was reached to develop a guiding framework defining best practices in SMH (Weist et al., 2005). These principles call for appropriate service provision for children and families, implementation of interventions to meet school and student needs, and coordination of mental health programs in the school with related community resources, among other things. For further explication of the framework and its development, see Weist et al. (2005). Simultaneously, research developments through the Center for School Mental Health facilitated implementation of modular evidence-based practices (EBP; see Chorpita, Becker & Daleiden, 2007; Chorpita & Daleiden, 2009). A modular approach for intervention involves training clinicians in core, effective strategies for disorders frequently encountered in children (e.g., attention-deficit/hyperactivity disorder [ADHD], anxiety, depression, disruptive behavior disorders [DBD]). This approach enables individualized, flexible implementation of evidence-based strategies without the constraints of a manualized approach (Curry & Reinecke, 2003). The third guiding component to enhance quality in SMH practices is development of strategies to effectively engage and empower families (see Hoagwood, 2005). Despite the development of such a framework, SMH clinicians often struggle to implement high-quality, evidence-based services (Evans et al., 2003; Evans & Weist, 2004). These clinicians are constrained by a lack of sufficient time, training in EBP, appropriate supervision, and internal and external resources (Shernoff, Kratchowill & Stoiber, 2003). For instance, a survey by Walrath et al. (2004) of Baltimore SMH clinicians suggested that the ratio of clinicians to students was 1:250, and in order to meet the mental health needs of students, clinicians would have to increase clinical hours by 79 per week to remediate student difficulties. Additionally, the school environment is often characterized as chaotic, hectic and crisis-driven (Langley, Nadeem, Kataoka, Stein, & Jaycox, 2010), with SMH clinicians citing difficulties implementing EBP given the schedules of students. As a result of the challenges limiting use of EBP in daily SMH practice, researchers are now evaluating the influences on successful delivery of EBP in schools, including the personal qualities of SMH professionals (e.g., attitudes, beliefs, skills, training; Berger, 2013), as well as environmental factors (e.g., school administrative support, access to community resources, sufficient space for practice; Powers, Edwards, Blackman & Wegmann, 2013) that may predict high-quality services (see Weist et al., 2014). Previous work examining factors related to the provision of evidence-based SMH services by SMH clinicians suggested that the highest-rated facilitators of effective SMH practice were personal characteristics (e.g., desire to deliver mental health services), attitudes and openness toward use of EBP, and adequate training (Beidas et al., 2012; Langley et al., 2010). Alternatively, SMH clinicians reported a number of administrative, school site and personal barriers as significant obstacles to appropriate service delivery; such barriers include