Bringing Together the Resources Students At Risk Need to Succeed

By JOHN D. TERRY and MARK D. WEIST

Educators labor for students to succeed in a context of significant pressure to achieve academic outcomes (Daly et al., 2006). Our work is often times made more difficult by personal and environmental risk factors in students’ lives. Specifically, students’ behavioral and emotional needs often significantly interfere with their educational success. This article presents one youth’s idea for helping students to cope with environmental and personal risk factors, briefly depicts current student mental health issues that our students face, and describes the second author’s work on policy change that emphasizes a systemic approach to addressing these complex issues.

Teachers as Mental Health Workers

Approximately 21% of the U.S. population is at school each day and about one out of four, nearly 14 million, students will experience both symptoms of and impairment from of an emotional/behavioral disorder (Merikangas et al, 2010; www.census.gov/hhes/school/). Teachers are on the front lines of addressing such student mental health issues, and in reality are “defacto” mental health providers. Mental disorders most prevalent in adolescents sitting in a typical classroom are anxiety disorders, disruptive behavior disorders, mood disorders, and substance abuse disorders (Merikangas et al, 2010). Federal education legislation categorizes students with more serious emotional and behavioral problems as students with Emotional Disabilities, or ED, (or the more pejoratively label “emotional disturbance”) who are then eligible for Individualized Educational Plans (IEP). Educational data indicates that, between 2001 and 2007, the number of IEPs for students in kindergarten to third grade increased from 6 percent of students to 8 percent, a rise of 1.2 million in the number of children with IEPs (www.childtrendsdatabank.org). In addition to those students with more serious mental health challenges, many others may not meet criteria for specific diagnoses are IEPs, but are dealing with significant stress and risk in their lives such as poverty, family distress, and negative peer influences. As most teachers are well aware, a substantial and growing number of youth will experience difficulties in school achievement due to personal risk factors in the form of an emotional or behavioral disorder, often co-occurring with significant life and environmental stress.

Footprints-One Youth’s Recommendations
We have recently had the opportunity to work with a youth that has first hand knowledge and unique incite on these difficult issues. “Footprints” is a program for middle and high school students shaped by understanding the importance of student mental health for school success. This program is guided by “Jermaine,” a 20 year-old young man who experienced severe life stress growing up in conditions of poverty and with very limited involvement from his father. Over the course of the past two years, Jermaine worked closely with the second author and improved his emotional/behavioral functioning and graduated from high school. However, after high school he was unable to reduce a significant risk factor in his life, a deviant peer group, and under the influence of these peers, was involved in a home burglary and is now incarcerated. Jermaine is now strongly motivated to help others and is working with us to develop the Footprints program. Jermaine has written a series of letters from jail describing his ideas, which map onto a large body of research on student risk and protective factors. However, he describes these ideas in ways that students can understand and serve to help other students by promoting and creating resilience-building activities.

In Jermaine’s language: “The ultimate goal of Footprints is to get kids to create their own way and not be so easily influenced by other people.” The next step in this process is to develop Footprints in a way that is feasible, effective, and targets the intervention area between schools and community organizations (e.g., mental health, schools, congregate care). For a doctoral dissertation, the first author is developing this program based on Jermaine’s ideas. Based on Jermaine’s ideas, Footprints will use research-supported common elements of evidence-based practice, motivational enhancement techniques, and a “developmental assets” framework in order for students to create and monitor their own plans. These plans target increased academic performance, self-confidence, life-satisfaction, and resiliency. Footprints will include approximately 10 sessions (feasible for a teachers to work through with a student within a school semester), emphasizing the most effective school-based strategies possible and simultaneously aim to reduce risk factors by enhancing protective factors in students’ lives. Jermaine’s own ideas along the current research on student mental health will be combined together to help students limit the effects of potential risk factors that they face.

Promising Systematic Approaches to Prevention and Wellness Promotion

Footprints will operate within the context of larger systems and frameworks. At present, students with need for additional support unfortunately receive services in a fragmented, incompatible, inefficient, and inadequate series of systems that often duplicate services. However, there is an increasing movement in school systems toward multi-tiered frameworks, frameworks that allow for more fluid adjustments in student services and emphasize continuous monitoring. These frameworks based on public health models, school-wide positive behavior support (SWPBS) programs are being implemented in schools to provide programs and services at Tier 1 (prevention and climate enhancement for all students), Tier 2 (prevention and early intervention for students showing early signs of or less severe problems), and Tier 3 (intervention and case management for students showing more significant challenges). SWPBS programs are prevention-focused, systematic, and comprehensive in emphasizing depth and quality when addressing student needs in the school building (Barrett, Eber, & Weist, 2012).

Lack of Collaboration with Community Resources
However, the expansion of SWPBS programs in schools usually does not fully bring together all actors interested in a child’s welfare (e.g., education, special education, school psychology, school counseling, child protective services, community mental health providers) in true collaboration, nor does it coordinate well with services youth receive in the community. In addition, educators and school mental health (SMH) professionals are confronting numerous operational challenges in promoting student mental health. These include severe restrictions on capacity, with inadequate numbers of SMH personnel facing funding challenges, high caseloads, and difficulties in implementing the effective yet labor-intensive evidence-based interventions. Moreover, unfortunately, some schools operate under the mindset that schools are a place for academic learning only, and may not see the value of SMH professionals, limiting students’ access to supportive services during the school day. As a result, youth are not receiving needed services, teachers are stressed and feel unsupported in the classroom. In such environments, schools do not achieve their potential level of success, as they fail to reduce barriers to student learning by promoting student mental health in a systematic and evidence-based way.

Expanded School Mental Health (ESMH)
The second author is at the forefront of a promoting policies aimed at the increasing focus on Expanded School Mental Health (ESMH) programs that involve schools, community systems, and family collaboration, is expanding effective mental health promotion and intervention programs for all students, including those in special and general education (Weist & Murray, 2007). Reflecting a “shared agenda” (Andis et al., 2002), these programs focus on addressing the complex problems that school-age children face, including seeking to reduce the impact of student risk factors. ESMH programs emphasize an ecological approach (Bronfenbrenner & Morris, 2006) and work at multiple levels — at the level of the school building, the classroom, the peer group, the family and the individual. Ideally, these ESMH programs are implemented in tandem with SWPBS, capitalizing on such advantages as forming strong and well-functioning teams, emphasizing data-based decision-making and functional behavioral analysis, and developing student and systems-level interventions (Barrett et al., 2012).

Enhancing Protective and Reducing Risk Factors
Teachers play a critical role in this work, as change agents in reducing the impacts of risk and enhancing protective factors operating in the lives of students. For example, a 40-year longitudinal study found that youth are more likely to experience problems as adults the more risk they encounter as children (Werner, 1993). Most children can manage one or two risk factors in their lives without it increasing their risk of negative outcomes. Yet, there is cumulative risk, as children and adolescents experience around four risk factors, the chances of a negative outcome increases exponentially (Rutter, 1979). Risk factors such as poverty, exposure to crime, violence, and substance abuse increase the likelihood of poor outcomes. However, enhancing factors that function to protect students, factors such as spirituality, extracurricular involvements, or environmental support (e.g., school connectedness, connections to nurturing and positive adults) can increase the likelihood of positive outcomes.

Teachers can reduce risk factors and enhance these protective factors and the developmental asset theory provides a very useful framework for doing so. Extensive research has documented 40 developmental assets. Twenty of these are classed as external assets, categorized into four groups: support, empowerment, boundaries and expectations, and constructive use of time. Another twenty are internal assets, again categorized into four groups: commitment to learning, positive values, social competencies, and positive identity. Any protective factor that teachers can identify and enhance could serve to increase the likelihood of a student doing well (Benson, Scales, & Syversten, 2011). For example, by encouraging a student to participate in an extracurricular activity, a teacher enhances one protective factor, and a corresponding potential risk factor may also be decreased or eliminated (e.g., basketball practice reduces the amount of time spent in a stressful family environment).

Student mental health issues are among the most important healthcare needs in the nation. Given the prevalence among students of both clinically diagnosable and subclinical problems, effective interventions that are brief, efficient, effective, feasible and readily implementable within an ESMH framework are sorely needed. Comprehensive system level responses and programs that emphasize a prevention focus are underway, however teachers and SMH personnel do not need to wait for them to be put into place. While system-level change is desirable, all too often the best an educator can do is work with the child directly in front of them. Systems, frameworks, and programs are tools to help educators; yet educators have the ability to prevent students from experiencing negative life events by identifying negative risk factors and replacing them with protective factors. Jermaine advises other students in order to avoid his situation to “pick and choose the people you hang around with wisely and be careful because one bad choice can change your life.”


References
Andis, P., Cashman, J., Oglesby, O., Praschil, R., Adelman, H., Taylor, L., & Weist, M. (2002). A strategic and shared agenda to advance mental health in schools through family and system partnerships. The International Journal of Mental Health Promotion, 4(4), 28–35.

Bronfenbrenner, U., & Morris, P. A. (2006). The Bioecological Model of Human Development. In R. M. Lerner, W. Damon (Eds.), Handbook of child psychology (6th ed.): Vol 1, Theoretical models of human development (pp. 793–828). Hoboken, NJ US: John Wiley & Sons Inc.

Barrett, S., Eber, L., Weist, M. (2012). Development of an Interconnected Systems Framework for School Mental Health. National Center for Positive Behavior Interventions and Supports, Eugene, Oregon. Retrieved on 12/17/2012 at (www.pbis.org).

Benson, P. L., Scales, P. C., & Syvertsen, A. K. (in press). The contribution of the developmental assets framework to positive youth development theory and practice. In R. M. Lerner, J. V. Lerner, & J. B. Benson (Eds.), Advances in child development and behavior: Positive youth development — research and applications for promoting thriving in adolescence. New York, NY: Elsevier.

Child Trends (2010). Individualized Education Plans. Retrieved from www.childtrendsdatabank.org/?q=node/95 Last update: August, 2010
Daly, B.P., Burke, R., Hare, I., Mills, C., Owens, C., Moore, E., & Weist, M.D. (2006). Enhancing No Child Left Behind — school mental health connections. Journal of School Health, 76, 446–451.

U.S Census School Enrollment Data. http://www.census.gov/hhes/school/ retrieved November 11th 2012.

Rutter, M. (1979). Protective factors in children’s responses to stress and disadvantage. In M.W.Kent & J.E.Rolf (Eds.), Primary prevention of psychopathology, Vol.3: Social competence in children (pp. 49–74). Hanover, NH: University of New England Press.

Merikangas, K., He, J., Burstein, M., Swanson, S., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., Swendsen, J. (2010). Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication– Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry. Vol 49 (10).

Weist, M.D., & Murray, M. (2007). Advancing school mental health promotion globally. Advances in School Mental Health Promotion, Inaugural Issue, 2–12.

Werner, E. E. (1993). Risk, resilience, and recovery: Perspectives from the Kauai Longitudinal Study. Development and psychopathology, 5, 503–503.


About the Authors

In 2008, John Terry became the first Assistant Program Director of the Challenging Horizons Program at the University of South Carolina afterschool programs at five elementary and middle schools with over 400 students. John has worked with the CHP for the past eight years since he was an undergraduate at USC. He has currently just begun his third year of graduate school enrolled in the Clinical-Community Psychology doctoral program.

Mark D. Weist is currently a Professor in the Department of Psychology at the University of South Carolina. He was on the faculty of the University of Maryland School of Medicine (UMSM) for 19 years where he helped to found and direct the Center for School Mental Health, one of two national centers providing leadership to the advancement of school mental health (SMH) policies and programs in the United States. He has led a number of federally funded research grants, has advised national research and policy oriented committees.

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