Graduation Year

2013

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Public Health

Major Professor

Bruce Lubotsky Levin

Co-Major Professor

Julie Baldwin

Keywords

Children, Evidence-Based Practice, Implementation, Translational Research

Abstract

ABSTRACT

Purpose of the study. Through secondary data analysis of results from the School Mental Health Services Integration Survey (SMHSIS), this study describes indicators of school mental health integration preparedness, including role identification, willingness to engage in tasks associated with mental health services integration and implementation facilitators. The study also investigated the utility of a modified version of the Evidence-Based Practice Attitude Scale (EBPAS) for use with school staff.

Study rationale. With as many as 20% of children meeting criteria for mental disorders that cause impairment, the gaps in mental health services delivery to this special needs population are evident and persistently problematic. Less than a third receive the services they need due to structural as well as attitudinal barriers to accessing services. Trends toward delivering services where children are located are noted and schools have emerged as de facto provider of mental health services to children. Yet, schools are not traditionally arranged or organized toward mental health services delivery, and though school-based mental health innovations are emerging there is no agreed upon unifying framework for integration of mental health services into school settings. Whereas school-based mental health is connecting to the evidence-base more often, evidence-based practices remain under-utilized. The present study examines school mental health services integration readiness in a large urban school district in central Florida.

Methods. The SMHSIS was conducted by email and participants included seven group of professional staff, including principals and assistant principals, teachers, guidance counselors, social workers, psychologists, school resource officers, and school health staff. Data analysis involved exploratory factor analysis (EFA) of survey sections, in an effort to uncover indicators of readiness for school mental health integration preparedness in three domains, role identification, willingness, and implementation facilitators. One-way analysis of variance (ANOVA) and post hoc tests were conducted to examine differences in perspectives on these domains, by professional group. Finally, a multiple regression model was used to examine the relationship between 6 predictor variables and a single continuous dependent variable, mean scores on the EBPAS.

Results. EFA resulted in the identification of 6 variables in the domains of role identification, willingness, and implementation facilitators. Analysis of variance demonstrated significant differences by professional group in perspectives on these variables. In the role identification domain, social workers, school psychologists, and guidance counselors endorsed adoption of a provider role, and school principals and assistance principals as a group adopted a facilitator role. Social workers and psychologists were uniquely high and emerged as leaders in endorsing willingness to engage in tasks associated with mental health services delivery. However, it was noted that no group endorsed a non-willing, or non-participant role. Implementations facilitators were identified in the areas of overall organizational structure, individual support, and shared professional responsibility. Finally, a summary of the regression showed that indicates that 29.0% of the variance in EBPAS scores was explained by the 6 predictor variables. The Willingness variable made the strongest unique contribution to predicting EBPAS outcomes. One other variable, Shared Professional Responsibility also made a significant unique contribution to the variance in the dependent variable, and none of the remaining four variables approached statistical significance.

Conclusions and implications. Taken together, these outcomes form the basis for a better understanding the current environment for integration of mental health services delivery in a large urban school district, and indicators for readiness to adopt evidence-based practices. Survey outcomes provide useful information to school administrators and EBP developers on characteristics that can facilitate services integration, and call attention to training and policy needs. More broadly, outcomes potentially contribute to the development of a formalized framework for mental health services delivery in schools. Finally, areas of divergence in beliefs about services delivery, as well as congruence in the attitudes of groups of professional staff have been examined. By engaging various levels and types of school staff simultaneously on a single survey, the survey design has the added value of addressing the need for more complex research methods in the investigation of mental health services in schools.

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