Despite our increasing attention to the provision of school based mental health services, barriers remain to our understanding of how mental health services may be effectively implemented, integrated and sustained in school settings. Part of this difficulty rests with the tremendous burden facing educators in high stakes school environments where performance accountability is at an all-time high. Equally contributing to this difficulty are barriers in implementation and the translation of programs from 'bench-side to bedside'that include not only issues of leadership and readiness for change, but also issues of professional competencies and training, and organizational and structural barriers to operation. In school settings organizational barriers are particularly salient, as mental health professionals and education professionals must address not only their own organizational barriers, but those of the other professional group as well. Therefore a necessary step in advancing the science of school based mental health involves a more thorough understanding how the organization of services in schools contributes to mental health service quality. The purpose of the proposed pilot study is to utilize a service systems research methodology, social network analysis, to assess and understand the nature of communication and role structures among school based mental health professionals and teachers. Because school based mental health services are inclusive of prevention oriented, targeted, intensive services, and crisis interventions, the network analysis includes all levels of service intensity. Based on the limited capacity of the funding mechanism and the pilot nature of the research, the study will be limited to middle school populations, which will allow a sufficient set of schools from which to choose appropriate samples, while maximizing the use of a population for whom mental health services are particularly relevant. The social network analysis will be used to identify the structure of communications and roles among all professional groups within schools. Differences within communication and role structures across service intensity will be compared, and the contribution these structures make to the quality of mental health integration will be assessed. This pilot study will be coordinated by an advisory team composed of the research team, school district student service leaders, and nationally recognized experts in school based mental health services and implementation science. Contingent on our findings, the research will be expanded through R01 funding mechanisms to more thoroughly assess how communication and role structures contribute to individualized mental health outcomes for children, how organizational structures contribute to efficiency and sustainability of school based mental health services, and through R34 funding, how schools may better encourage and facilitate the communication and role structures that are most conducive to effective services through training and professional development practices.
According to the Surgeon General, mental illness remains one of the most significant threats to a healthy society. Among children, most of those who need mental health services will receive them through the schools, yet significant difficulties arise in the successful implementation of school based mental health services. This pilot study assess the nature of organizational role and communications structures among teachers and mental health professionals, and the contribution these organizational factors make to the quality of mental health services with the results of this effort having immediate implications for improving the health and welfare of children and adolescents.