Outcomes for students in special education continue to be
disappointing and those having emotional disturbances (ED) continue to
lag behind the other disability groups. In this study, school reform
activities and the effects on students who are educated in special
education programs for students who have ED were examined.
Demographically similar elementary, middle, and high schools in urban
communities were classified as either actively engaged in (HI) or not
very engaged in (LO) reform activities. Findings indicated students with
ED in the HI schools spent more time in academic general education
classes with non-handicapped peers; had significantly higher achievement
scores in math; and were more likely to receive mental health services
from community agencies compared to students in the LO schools.
Implications are discussed in terms of current developments in the
school-based mental health services research and provider communities to
refocus interventions on learning, the core function of schools.
KEYWORDS: Emotional disturbance, school reform, mental health
service use, urban, special education
Although there is concern about improving the achievement and
functioning of all students who have disabilities, a review of the
literature reveals the critical need to focus on youth who have
emotional disturbances (ED). For example, in a series of studies
beginning in the late 1990s and continuing to the present, Wagner and
her colleagues (Blackorby & Wagner, 1996; Wagner, Kutash,
Duchnowski, Epstein, & Sumi, 2005; Wagner et al., 2006) concluded
that outcomes for students who have ED were the poorest compared to the
other disability groups. Results from Wagner's studies revealed
average academic achievement for these students was below the 25th
percentile; they had the highest dropout rate compared to all disability
groups; and half of these students were involved with the justice system
two years after separating from school. In spite of their disabilities,
students with ED received minimal amounts of psycho-social support,
scant support for their families, little in the way of accommodations in
instruction, and spent the least amount of time with non-handicapped
peers compared to students who had other types of disabilities (Wagner
et al, 2006). Students who have ED and are placed in special education
programs may be considered a top priority for school reform efforts
targeting special education programs for improvement and increasing
mental health support services.
Better integration of the education and mental health systems has
the potential to increase the capacity for school based mental health
services for children with ED (Kutash, Duchnowski, & Lynn, 2006;
U.S. Department of Education, 2002; U.S. Department of Health and Human
Services, 2003; 1999). However, many barriers to system collaboration
have been identified, including different theoretical foundations and
training, different language, different goals (academic vs. emotional
functioning), different methods of assessment, and a limited empirical
base to guide practice (Atkins et al., 2010; Kutash et al, 2006;
Hoagwood & Erwin, 1997; Rones & Hoagwood, 2000).
A re-examination of the models and procedures that guide systems
integration and service delivery may contribute to increasing the
capacity for the provision of school-based mental health services and
improved student outcomes. For example, the special education system
needs to develop more effective procedures that would provide needed
mental health services to students who have ED, as only one-third of
students receive needed services (Wagner et al., 2006). In an attempt to
understand the lack of related services for these students, Minow (2001)
concluded that "many school systems resist the provision of related
services on the theory that they are not educational but medical or
psychological, even though these services are required under the act
(i.e., IDEA) where necessary to enable the student's free,
appropriate education. Provision of related services often fails when
school districts and other agencies disagree over who should provide and
pay for them" (p. 4).
From the mental health perspective, the relationship between
effective related services and improved academics has not always been
clearly articulated. This issue is being addressed by proposing models
that will refocus school-based mental health services on the core
function of schools to promote learning. Adelman and Taylor (2006) have
proposed that interventions to remove the psycho-social barriers to
learning must become part of a school's comprehensive effort at
reform and improvement. Atkins and colleagues (2010) foresee a paradigm
shift in which mental health professionals become "educational
enhancers" providing support to teachers in effective instruction
and classroom management. Recognizing the inherent capacity of schools
to bridge school, home, and neighborhood, Cappella and colleagues (2008)
have proposed an ecological model that aligns mental health intervention
goals with school goals through the development of partnerships with
professionals and parents.
In this paper we present a brief description of comprehensive
school reform in order to establish a context for an exploratory study
examining the relationship between school reform activities, outcomes,
and mental health services for students who are identified as having ED
and placed in special education programs. We present the results of a
study comparing schools that are highly engaged versus schools that are
less engaged in reform activities, and the academic and emotional
functioning of their students who have ED. We also discuss implications
for the integration of education and mental health systems in schools.
The Current Context of Schools: Comprehensive School Reform
With the re-authorization of the Elementary and Secondary Education
Act (ESEA) in 2002 as the No Child Left Behind Act (NCLB), major changes
in federal policy occurred. For example, Title I of ESEA was transformed
from a supplemental remedial reading program to a major influence in the
standards-based school reform movement. With the passage of NCLB,
federal policy was extended to support Comprehensive School Reform
Programs (CSRP) to improve low-performing, high-poverty schools (Borman
et al., 2002). The federal CSRP initiative has promoted, through a large
grant program, the adoption of externally developed school-wide reform
programs or models that are considered to be scientifically-based and
meet federally developed criteria for a school-wide model (Borman, et
al., 2002). Borman and his colleagues (2002) have conducted an extensive
meta-analysis of 29 CSRPs, identifying three promising programs: Direct
Instruction (e.g., Gersten & Keating, 1987); Comer School
Development Program (e.g. Comer, 1987); and Success for All (e.g.,
Slavin & Madden, 2000).
Briefly, Direct Instruction encompasses methods developed by
Siegfried Engelmann and his colleagues (e.g., Adams & Engelmann,
1996) aimed at promoting reading and math competencies in elementary age
students. A strong evidence base supports the use of techniques such as
homogeneous grouping, planned sequences of activities, scripted lessons,
and a fast pace of instruction in order to increase the active
engagement of learners and to keep them focused. The "Comer
Process" is a K-12 system of managing, organizing, coordinating and
integrating the components of a comprehensive school plan by three
teams. The School Planning and Management Team is comprised of
parents/families, teachers, administrators and support staff (and middle
and high school students); this team develops the comprehensive school
plan and evaluates and modifies strategies every quarter. The Student
and Staff Support Team, comprised of staff who have expertise in child
development and mental health, coordinates and integrates mental health
support for students through individual therapy or with groups. The
Parent/Family Team is comprised of parents and other family members, and
develops activities that enable them to support the overall development
of all the children in the school. The Comer Process uses collaboration,
consensus decision-making, and no-fault, no blame problem solving with
extensive communication between teams to achieve the goals of the school
plan. Success for All is a series of standards-based curricula that
include reading, writing, and oral language for students in pre-K to
eighth grade. Students are grouped by reading ability and receive
instruction in 90-minute reading blocks. Certified teachers serve as
tutors for students who are having difficulties. The program aims to
emphasize early intervention in order to prevent failure.
While no exact number is available, it is estimated that perhaps as
many as three to four thousand schools are engaged in implementing a
CSRP (Borman et al., 2002), a fraction of the approximate 100,000
schools in the country. The majority of schools are in engaged in reform
activities that have been developed internally at the school or district
level. Examples of these locally developed efforts include the
following: site-based management strategies (Cawelti, 1994, Malen,
1994); increasing the use of scientifically supported curriculum and
instruction (Borman, 2000; Wong & Meyer, 1998); increasing parent
involvement (Jeynes, 2005; 2007); and the inclusion of all students,
including those students who have disabilities, in reform activities
(Sailor, 1991). Locally developed reform activities are the focus of the
present study.
Purpose of the Present Study and Focus on Students Who Have ED
The purpose of the present study is to examine school improvement
activities in urban communities, determine if there are meaningful
differences in the amount of reform activities operating in schools and
examine how these activities affect the academic and emotional
functioning of students who have ED, their educational program, and the
mental health services they receive. Urban schools were chosen to
participate in this study because they typically serve children whose
families are from diverse ethnic and cultural backgrounds and have high
instances of poverty, factors that present some of the greatest
challenges facing schools in their efforts to improve student outcomes
(Kutash & Duchnowski, 2004).
The specific research questions in the study were: (1) Can schools
be classified in terms of their level of engagement in reform
activities?; (2) Are greater levels of school reform activity related to
improved functioning for students with ED?; (3) Is parent involvement
related to the level of school reform in their child's school?; and
(4) Are school reform activities related to the amount of mental health
services received by students who have ED?
Method
Participants
Schools. A national recruitment effort was undertaken to identify
schools whose staff believed they were excelling in their efforts to
implement school improvement activities. This multi-step process began
with an invitation mailed to approximately 200 members of various
child-serving organizations (e.g., National Association of State
Directors of Special Education, Federation of Families for
Children's Mental Health, National Association of State Mental
Health Program Directors) asking for nominations of any school perceived
as actively engaged in restructuring efforts to better serve children
and youth with serious emotional disturbances. This process resulted in
the nomination of 37 schools located in 13 states. During the next step,
all nominated schools were asked to complete a questionnaire about their
school, including enrollment demographics, type of setting (urban,
suburban, rural), number of students receiving free or reduced lunch (a
commonly used proxy for SES), the school's current restructuring
activities, and the school's relationship with community agencies.
Schools continued in the process by completing a follow-up questionnaire
if they met the following criteria: a) they served students formally
identified as having emotional and behavioral disabilities, b) they were
located in an urban area (as defined by the National Center for
Education Statistics), c) they were identified as a regular public
school as opposed to a special education center or day treatment
facility, and d) they served at least 40% of its student body from
ethnically and culturally diverse backgrounds. Additionally, these
schools had to e) describe evidence of involvement of parents who have
children with ED, and f) have been involved in school reform activities
for a minimum of 2 years. Fifteen schools completed and returned the
first questionnaire and of those, nine schools met study criteria and
were sent the follow-up survey designed to gather more complete
information on the nature of restructuring and reform activities taking
place in the schools. Seven schools returned the follow-up survey and
were deemed eligible for site visits from study personnel. Site visits
by study staff were conducted with district personnel and building
administrators to finalize participation in the study.
In an effort to include comparison schools, study staff interviewed
district staff using a structured screener to identify schools in the
same district that were demographically similar to nominated schools,
and were perceived as less engaged in school improvement activities.
District staff supplied the same information for these comparison
schools that was collected on the schools nominated as being highly
engaged in reform activities. As a result of this process, a total of
seven nominated schools (three elementary, two middle and two high
schools) were paired with seven comparison schools serving
demographically similar (e.g., age, race/ethnicity, free/reduced lunch)
Students, for a total of 14 participating schools. Using census data
descriptors, these schools were located in four mid-size urban
communities in four states (Missouri, Florida, Ohio, and Maryland). All
14 schools completed the School Improvement Index (Duchnowski, Kutash,
and Oliveira, 2004), described below, in order to confirm their level of
engagement in reform activities.
Students and parents. To ensure that the participating schools were
serving similar students, data were collected from parents and students
with ED regarding the students' current level of impairment and
emotional and academic functioning. The protocol for recruiting parents
involved designating a liaison staff member from each participating
school who identified potential student participants for the study based
on the following eligibility criteria: (a) the student was formally
identified as having an emotional or behavioral disability and served in
special education, (b) the student was over 4 years of age, (c) the
student had been actively attending school for the 30-day period prior
to data collection, (d) the student had been enrolled in the school for
a minimum of half the school year, and (e) the student and parent spoke
English or Spanish. The school liaison invited the parents/caregivers of
eligible students to attend an information meeting about the study or
parents were sent information about the study to their homes.
Parents/caregivers interested in participating in the study were
interviewed either at the information meeting or at a time and place
convenient for them and given a stipend of $50 for their time.
Overall, 328 student-parent/caretaker dyads from 14 schools were
eligible for participation and 199 consented to participate, for a 61 %
participation rate. Student participants (n = 199) and eligible
non-participants (n = 129) did not significantly differ on gender
[[x.sup.2](l/ 328) = 0.05, p =.82] or race [[x.sup.2](l, 328) = 0.30, p
=.58]. Participants did differ from non-participants on age [t(326) =
-2.67, p<.01 ] and on lunch status [[x.sup.2](l, 328) = 4.46,
p<.05]. These findings suggest that student participants (M = 12.5
years old, SD = 3.2) were significantly older than non-participants (M =
11.5 years old, SD = 3.3) and had higher family incomes.
Measures
School reform activities. The School Improvement Index (SII)
(Duchnowski et al., 2004) was used to evaluate the degree to which
schools engaged in reform activities. The SII has demonstrated
reliability in classifying schools along a continuum of engagement in
school reform and improvement activities. The SII measures constructs
that are consistent with criteria proposed in the federal CSRP. These
include site-based management the use of scientifically supported
curriculum and instruction, parent involvement, and the inclusion of all
children in reform activities (Borman et al., 2002).
The SII requires a minimum of five school staff members (i.e.,
principal, special education teacher, general education teacher, school
advisory committee member, and key informant) to rate the school on the
following six areas that are supported by the literature as describing
school reform and improvement activities: (1) Governance: how the school
is managed and governed (Cawalti, 1994; Newman, King, & Rigdon,
1996); (2) Accountability: how academic results are used to inform
instruction (NCLB, 2002; Rothman, 1995); (3) Curriculum and Instruction:
the use of innovative curriculum and instructional techniques
(Bybee,1997; Corcoran & Goertz, 1995; NCLB, 2002); (4) Includedness:
the availability of an array of environments to meet the needs of
students with special needs (Hocutt & McKinney, 1995; Sailor 1991);
(5) Parent Involvement: the amount and type of parent involvement
(Jeynes, 2005; 2007; Turnbull & Turnbull, 1997); and (6) Pro-Social
Discipline: whether discipline incidents are handled in a pro-active
educational manner (Adelman & Taylor, 2006; Carr et al., 2002). Each
of the six topic areas is composed of four parts or indicators for a
total of 24 indicators (items). Each of these indicators ranges from -3
to +3. Total scores on the SII can range from a high of +72, indicating
greater levels of school reform activity, to a low of -72, indicating
lower levels of school reform efforts. The SII has been shown to be a
reliable and valid measure of the degree to which a school is engaged in
reform and improvement activities. Intraclass correlation coefficients
are above the desirable level of.80 (Landis & Koch, 1977). In
addition, test-retest reliability was evidenced by ratings remaining
relatively unchanged after a 6-month delay. Discriminate validity was
established by determining that the SII could differentiate between
schools active in reform efforts and those schools less active in reform
efforts (Duchnowski et al., 2004).
Student demographic and mental health service use. Parents were
asked to report their income, their child's age when problems
related to his/her disability were first noticed, when their child first
received professional help for his/her disability, and when their child
first began a special education program for students with ED. Data
collected from school files included student age, gender, free/reduced
lunch status, the amount of time each student spent in special education
settings per day, and any mental health services the student received at
school from either school personnel or community agency personnel during
the school day. These services included individual or group counseling,
case management, medication management, or other services designed to
help the student with his or her behavioral or emotional functioning.
In order to capture any mental health services the student received
outside the school, parents completed the parent version of the Service
Assessment for Children and Adolescents (SACA) (Stiffman et al., 2000).
This questionnaire is designed to assess the utilization of mental
health services by children and adolescents. Service utilization is
examined by the SACA across two service categories: inpatient (e.g.,
psychiatric hospital, residential treatment center) and outpatient
(e.g., community mental health centers, day treatment facilities). The
SACA provides information on service utilization during the youth's
lifetime (including age when services were received) as well as recent
use of services. This instrument has excellent test-retest reliability
for both lifetime and previous 12-month service use (Stiffman et al.,
2000).
Student functioning. To document student academic functioning, an
academic achievement assessment was administered to all students by
study staff. The Wide Range Achievement Test-3 (WRAT3; Wilkinson, 1993)
was administered to each student participant at the end of the school
year to measure achievement levels in reading and mathematics. The
psychometric properties of the WRAT-III have been well established
(Smith, Smith, & Smithson, 1995; Wilkinson, 1993).
In order to capture the emotional functioning and level of
impairment experienced by the students, the Child Behavior Checklist
(CBCL; Achenbach, 1991) was completed by parents. The CBCL is a widely
used instrument designed to measure behavioral and emotional problems
for youth ages 4 to 18 years and yields total, internalizing, and
externalizing behavior problem T-scores. The psychometric properties of
the CBCL have been supported in several studies (e.g., Achenbach, 1991).
The Columbia Impairment Scale (CIS; Bird et al., 1993) was also
completed by parents and provides a global assessment of functional
impairment across four major functional areas: interpersonal relations,
certain broad areas of psychopathology, functioning at school, and use
of leisure time. The CIS yields a total impairment score that can range
from 0 to 52. A score of 16 or above is considered to be in the clinical
range of impairment. Psychometric properties have been validated in
several studies (Bird et al., 1993; Bird et al, 1996).
Parent involvement. The Parent Involvement Opinionnaire was
developed specifically for this study and asks parents to assess the
degree of parental involvement for all parents at the school, as well as
their own personal level of school involvement. The measure assessing
perceived involvement of all parents includes 3 questions on a scale
from 1 (low parental involvement) to 5 (high parental involvement). The
measure assessing personal parental involvement includes eight questions
on a scale from 1 (no involvement) to 5 (high involvement). Internal
consistency reliability for both parent involvement measures, perceived
involvement of all parents and personal involvement, was acceptable
(Cronbach's alpha=0.81 and 0.71). Items from both measures were
summed individually to provide a score for the perceived involvement of
all parents and a score for personal parental involvement. Parent
involvement scores for all parents can range from 3 (indicating low
parental involvement) to 15 (indicating high parental involvement).
Personal parental involvement scores can range from 8 (low parental
involvement) to 40 (high parental involvement).
Results
School Reform
The first topic addressed by this study was the varying amount of
school reform operating in each school. The SII Total Scores for the
fourteen schools participating in this study ranged from -12,2 to 38.8.
When schools were rank ordered, the six schools scoring the highest on
the SII were categorized into the group that was highly engaged in
reform (HI) and the six schools scoring the lowest were categorized into
the group not very engaged in reform (LO). The remaining two schools
scored in the middle of the scale, indicating neither high nor low
engagement in reform activities, and were eliminated from subsequent
analyses. The HI and LO schools were equivalent in terms of grade
levels. There were two high schools, two middle schools, and two
elementary schools in each group. The two schools that scored in the
middle range of the scale and not included in the data analysis were
both elementary schools.
The SII Total Scores for the top six performing schools ranged from
23.6 to 38.8, and the SII Total Scores for the bottom six performing
schools ranged from -12.2 to 12.8, indicating variability between the
two groups in the amount of school reform activities. While the SII has
not been developed to the point where an absolute cutoff score can be
used to indicate reform activity, there was evidence supporting reform
for an average of 40% of the indicators for the HI schools and only 4%
for the LO schools. Of the six indicators of reform activity on the SII,
three showed the greatest difference between the HI schools and the LO
schools: Curriculum and Instruction (the use of innovative,
evidence-based curriculum and instructional techniques); Includedness
(the availability of an array of environments to meet the needs of
students with special needs); and Pro-Social Discipline (whether
discipline incidents were handled in a pro-active educational manner),
see Table 1.
Schools that were more actively engaged in reform (HI) appeared
committed to shared decision making by a more diverse group of
stakeholders. There were specific procedures in place for a formal
School Improvement Team to develop a plan and monitor the achievement of
short term objectives and goals. All schools in the study were in states
that required all students to take annual statewide achievement tests,
consequently there was no variability on this factor. However, there
were differences between schools in how they used achievement data. In
the HI schools, there were more instances of teams disaggregating the
data and identifying low performing students who needed extra help. At
the elementary level, the two HI schools used a direct instruction
program for reading and students who had ED were included in this type
of reading instruction. The LO schools used district selected commercial
reading programs that did not use a direct instruction approach.
At the middle school level, the two HI schools had evidence of
planning and input from stakeholder groups through the School
Improvement Teams resulting in a Team Teaching approach. Students were
divided into groups for the core subjects: language arts, math, science
and social studies. The four teachers of each of these subjects served
as a team for the students in each group, with common planning periods
enabling attention to individual students. This mechanism was helpful in
monitoring ED students who were placed in these academic classes. In the
LO middle schools, the traditional seven period day was used. The HI
high schools also re-organized the instructional day. They used a
block-schedule approach that provided 90 minute periods three times each
week for the core subjects of language arts, math, science, and social
studies. This approach is based on the premise that teachers can develop
learning themes with more depth given a longer time span. Such a program
requires a large commitment by administrators and staff to make it work.
In the HI schools we found evidence of school-wide, grade level, and
subject department level input to the School Improvement Team to make
block scheduling work. At the two LO high schools the traditional seven
period day schedules was used.
In summary, the schools in this study were all governed by state
and district level mandates and procedures. However, as depicted in
Table 1, they varied in the degree to which they engaged in core
activities aimed at school improvement.
Relationship between School Reform Activities and Study Variables
Demographics and background. The students participating in the
study were generally male (85.0%), Black (78.7%), around 14 years of age
(M = 14.0, SD = 2.9) and in the seventh grade (M = 7.4, SD = 2.7).
Eighty-three percent of these students were enrolled in the free/reduced
price lunch program. According to parents, nearly half of all
participants lived below the poverty level, with an average income of
$25,060 (Mdn = $20,000). Parents reported first noticing a problem
related to their child's disability at about age six (M = 5.9, SD =
2.6), and that their child first received professional help for his/her
disability at around eight years of age (M = 7.5, SD = 2.6). Parents
also reported that their child first received outpatient mental health
services at age eight (M = 8.3, SD = 3.0) and inpatient services one
year later at age nine (M = 9.0, SD = 3.0). In addition, parents
reported that their child spent on average 61% of their entire school
career in a special education program for students with ED (M = 60.9, SD
= 28.8).
Independent-samples t-tests and Pearson chi-square tests were
conducted to compare the demographic characteristics between students in
the HI schools and in the LO schools. Overall, the groups were quite
similar. There were no significant differences between the two groups in
student age [t(148) = -0.15, p =.88], gender [[x.sup.2] (1, 150) = 3.16,
p =.08], race [[x.sup.2] (h 150) = 0.69, p =.41], income [t(140) =
-1.59, p =.11], free/reduced lunch status [[x.sup.2] (l, 150) = 4.29, p
=.12], or poverty level [[x.sup.2] (l/142) = 0.49, p =.49]. No
significant differences were seen in the age parents first noticed a
problem with their child [t(143) = 0.06, p =.95], the age in which the
child first received professional help [t(138) = -0.35, p =.72], the
child's age when first received outpatient services [t(94) = -0.78,
p =.44], or the child's age when first received inpatient help
[t(44) = -1,35, p =.19]. No significant differences were found between
the two groups for the percentage of their school career spent in a
special education program for students with EBD [t(141) = -0.94, p-.35].
Academic and emotional functioning. Results from the administration
of standardized assessments revealed that the majority of parents from
both HI and LO schools rated student functioning in the clinical range,
or above a score of 63.0 (M = 66.7, SD = 9.0), on the Total Problems
score of the CBCL. Students scored in the clinical range of the
Externalizing Behaviors score (M = 66.9, SD = 9.4) and in the borderline
range (scores of 60 - 63) of the Internalizing Behaviors score (M =
62.0, SD = 11.2). The majority of students also scored in the clinical
range of impairment on the CIS, or a score of 16 or higher, indicating
significant levels of emotional and behavioral impairment. There were no
significant differences between the students in the HI vs. LO schools on
measures of child emotional impairment as measured by the CBCL ft(148)
=.90, p =.37, ES =.18], or CIS [ t(148) =.91, p =.36, ES =.15], see
Table 2.
Regarding academic functioning, students scored an average of 75.5
(SD = 13.0) on math achievement and 77.5 (SD = 17.6) on reading
achievement. Students in the HI schools had significantly higher math
scores than students in the LO schools, t(148) = -2.33, p = .02, ES =
.38. There was not a significant difference in the reading achievement
scores, t(148) = -1.56, p =.12, ES.25.
Time in special education settings. In the current school year,
students spent on average 36% of their week in general education
settings (M = 36.2%, SD = 27.6%) and 8% of their school week in academic
general education settings (M = 7.9%, SD = 17.2%). Students in the HI
schools spent significantly more of their week in general education
settings than their counterparts in the LO schools, t(148) = -3.48, p
=.00, ES =.57. Students in the HI schools also spent more of their
school week in academic general education settings than students in the
LO schools, t(133.5) = -3.16, p =.00, ES -.49, see Table 2.
Parent involvement. Parents rated two types of parental
involvement: their perceived involvement of all parents at their
child's school and their own personal involvement at their
child's school. The average score for parents' perceived
involvement of all parents at the school was 8.3 (SD = 3.4) on a scale
ranging from 3-15, with higher scores indicating greater involvement.
Parents rated their own personal involvement with an average score of
23.9 (SD = 7.0) on a scale ranging from, 8-40, with higher scores again
indicating greater involvement. When reporting on the involvement of all
parents at their child's school, no significant differences were
seen between the groups, t(110) = 1.66, p =.10, ES =.32. However,
parents of students in the HI schools rated their individual involvement
levels as significantly lower than parents of students in the LO
schools, t(146) = 2.70, p =.01, ES =.45, see Table 2.
Mental health services. Data were collected on the amount of
services provided in schools and who provided the services. Mental
health services provided in the schools were classified as being
provided by either school personnel (employed by the school) or
community agency personnel (contracted by the school to provide services
in the school). Overall, 56.0% of students participating in the study
received services from either school providers, community agency
personnel, or both. Of those students who received services, 46.4%
received services solely from school personnel; 22.6% received services
solely from community agency personnel operating in the schools; and
31.0% received services from both types of providers.
The percentage of students receiving mental health services in the
HI and LO schools did not differ, % (1, N = 150) = 2.20, p =.14, OR
=.61. However, more students in the LO schools received services solely
from school providers than students in the HI schools, [x.2.sup] (1, N =
84) = 10.77, p<.01, OR= 4.50. Conversely, significantly more students
in the HI schools received services solely from community agency
personnel operating in the schools than students in the LO schools,
[x.2.sup] (l, N = 84) = 19.66, p<.01, OR = 30.75, see Table 3.
Mental health service use was also examined in terms of service
units received per month. A service unit was defined as an occurrence of
any mental health service provided to a student, and could include group
or individual counseling, medication management, or case management.
Overall, students received an average of 17.7 service units per month
from either school personnel, community agency personnel, or both. Among
students who received services, students received an average 14 service
units per month (M = 14.1, SD = 9.6) from school personnel and 18
service units per month (M = 18.1, SD = 7.5) from community agency
personnel operating in the schools.
There were no significant differences in the service units received
per month from any source between the HI and LO schools t(77) = -79, p
=.43, ES =.17. In addition, the two groups did not differ in services
received solely from school personnel, t(37) = 0.99, p =.33, ES =.34,
However, of students who received services solely from community agency
personnel operating in the schools, students in the HI schools received
19 service units per month while only one student in the LO schools was
included in this category and that student received less than 1 service
unit per month (see Table 3).
Discussion
In this study we described locally developed school reform
activities, their relationship to the inclusion of students who have ED
in the general education environment, and associations between these
strategies and levels of academic and emotional functioning for students
who have ED. Urban school districts were targeted for participation in
the study as students who have ED in such districts have been identified
as having serious academic and behavioral challenges requiring schools
to develop specific strategies to meet student needs (e.g., Kutash &
Duchnowski, 2004).
Schools were classified along a continuum of their engagement in
school reform and improvement activities. The reform used in these
schools was internally developed as opposed to external models supported
in the federal CSRP. However, these schools reported activities aimed at
achieving factors such as decentralized site-based management, the use
of scientifically supported curriculum, and parent involvement, which
are consistent with the criteria proposed by the federal CSRP (Borman,
et al., 2002).
On measures of emotional functioning of youth, the CBCL and the
CIS, the average scores of study participants were well in the clinical
range. In addition, the students have had their emotional and behavioral
problems for a long time. Although the average age of the participants
was 14, parents reported first noticing a problem before age six. On
average, students received outpatient therapy started at age 8 years and
inpatient service occurred at age 9 years. In addition, they spent 61%
of their school careers in special education. Currently, 63% of their
day was being spent in special education classes and only 8% percent in
a general education academic class.
A major aim of this study was to contribute information about
current school reform activities and potential effects on students in
special education programs who were identified as having ED. Although
results of the study are mixed, some encouraging results emerged. First,
the S1I was verified as able to cluster the schools into two distinct
groups that clearly differed in the amount of school reform and
improvement activity that was reported in the interviews. While there
was a range of scores within each group, the average for HI schools was
28.9 and the average for LO schools was 2.8. Further, the lowest score
for HI schools was 23.6 and the highest score for LO schools was 12.8,
indicating that schools may be identified in terms of their level of
engagement in reform activities. Our results suggest that schools
engaging in higher levels of school reform may also be collaborating
more frequently with community agencies to increase the capacity to
provide mental health services for students who have ED, Mental health
service providers may increase their opportunities for establishing
partnerships with schools by becoming familiar with reform activities
and supporting them where possible. For example, agency staff can
volunteer to serve on School Improvement Teams that are part of the
shared decision making process. Agency staff can offer school staff
professional development opportunities with evidence-based practices
focused on challenging behavior and other pro-social discipline
strategies. Finally, provider agencies could provide parent support
programs. All of these activities are consistent with reform goals
identified in this study.
The demographic characteristics of the students in each group did
not differ and neither did their scores on the CBCL and the CIS,
indicating comparable levels of emotional functioning. There were,
however, differences in measures of academic characteristics. Students
who had ED in the HI schools spent significantly more time in general
education classes with peers who did not have disabilities. They also
spent a significantly greater time in academic general education classes
than students with ED in the LO schools. The math scores for the HI
schools were significantly higher than for the LO schools, though both
were still below expected grade level. Reading scores were in the same
direction, but not statistically significant.
The results of the measures of parent involvement were not
consistent and are indicative of the complexity of parent involvement
and the need for more comprehensive measure of this construct. For
example, some of the questions about parent involvement concerned
attending meetings in school. Debriefing with principals suggested that
most of the meetings with parents were negative and concerned discipline
issues. It may be that with no differentiation of the content of the
meetings, parents in the LO schools reported attending more meetings
than parents in the HI schools, and thus received a higher score on the
involvement domain.
There were differences in mental health services between the two
groups. The LO schools received more mental health services from school
staff, while the HI schools received more services from community agency
staff who delivered services in school during the school day.
Importantly, students in the HI schools who received services from
outside agencies received an average of 19.0 mental health service units
per month, while students in the LO schools received 0.4 service units
per month, less than once a week. It may be that pupil services staff in
both sets of schools are typically understaffed, and therefore have to
provide many ancillary services that are not directly aimed at
psycho-social support and intervention, leaving less time to provide
mental health services. However, schools engaged in more reform may have
greater interaction with members of the community, facilitating the
development of inter-agency agreements and increasing the units of
mental health services their students receive with the addition of
agency personnel.
The potential relationship between school reform and mental health
services for students is important because as noted, there is interest
in and research on refocusing mental health services to be more
compatible with primary school goals (Adleman & Taylor, 2006; Atkins
et al., 2010; Cappella, et al., 2008; Weist, 2005). School
administrators are beginning to realize the link between psychosocial
barriers to learning and scores on achievement tests (Adelman &
Taylor, 2006). If mental health services researchers and providers
develop a more in-depth understanding of school reform, they may be more
effective in facilitating the provision of school-based mental health
services, especially for students who have ED and who are served in
special education programs. In the emerging role of "educational
enhancers," mental health service providers need to become more
focused on supporting teachers, both general education and special
education, in providing effective instruction to students and
effectively managing classroom discipline. Strategies to engage
families, especially those who have a child with ED, are needed and are
a natural area for mental health professionals to serve as a bridge
between school and home.
Limitations
Although the results of this study may be encouraging to the
practice field and informative to researchers who are investigating
school-based mental services, there are several factors that narrow the
overall impact of the study findings. First, the small sample of
convenience limits the generalizability of results; although it should
be noted that demographic characteristics of the students are very
similar to those in studies that have used nationally representative
samples of participants. Second, the design employs a case study
approach and there are no causal inferences possible from the results.
Third, the SI1 is an instrument that classifies schools at a very broad
level. As Borman, et al. (2002) point out, there is much variability
found when investigating school reform. There are unknown school
specific and program specific factors operating in the sample under
investigation. A particular challenge in studies such as the current
study is the possibility that results can be nested as a result of
unknown school factors. When the student is used as the unit of analysis
and multiple schools are examined, violation of the independence of
error assumption may occur (Kutash, Banks, Duchnowski, & Lynn,
2007). Kutash and her colleagues found that variables focusing on
emotional disturbance are less affected by nesting but school-related
variables such as academic functioning are more affected. Since studies
of school reform investigate student outcomes that vary across schools,
it is important to identify these factors and to measure the fidelity of
program implementation. In addition, we do not know the quality of the
mental health services implemented in the schools and the degree to
which they were evidence-based.
Nevertheless, the current study has identified a relatively low
cost instrument, the SII, which may be a potential asset in studies of
school reform. We have also produced results that offer some cause for
optimism to those involved in educating students with ED.
Characteristics of schools that are considered to be more engaged in the
reform and improvement process appear to be related to more positive
academic functioning for students with ED. Given the long history of
poor progress for these students and the paucity of research that
directly focuses on outcomes of students who have ED and their
experience with the general education curriculum (Simpson, 2004), this
study is a note of hope for this under-served and ineffectively served
group of youth with disabilities.
Conclusion
In this era of high stakes testing and mandated school improvement,
individual schools and school districts continue to anxiously engage in
school improvement activities. This may offer an opportunity for the
mental health system to contribute to improving outcomes for students by
being cognizant of the requirements and mechanisms of school reform.
Students who have disabilities and who are educated in special education
programs present a new source of concern for school administrators as
NCLB requires all students to take part in testing and all scores are
calculated in a school's report card. Increasing access to mental
health services for their students continues to be a challenge for
schools. Effective school reform activities may provide an important
facilitator of improved collaboration between the education and mental
health systems, resulting in improved outcomes for students if effective
interventions are used. As the role of mental health services becomes
refocused on the core function of school, mental health professionals
need to understand how factors related to school reform such as
evidence-based instruction, effective classroom management and
pro-social discipline can be supported through their expertise. A
research agenda is needed that will support the development of this new
role for school-based mental health services. As schools face continued
awareness of the need to address psychosocial barriers to learning in
their students, effective collaborative programs with community-based
mental health service providers can provide a welcome support.
References
Achenbach, T. M. (1991). Manual for the Child Behavior
Checklist/4-18 and 1991 profile. Burlington: University of Vermont,
Department of Psychiatry.
Adams, G., and Engelmann, S. (1996). Research in direct
instruction: 20 years beyond DISTAR. Seattle, WA: Educational
Achievement Systems.
Adelman, H. S., & Taylor, L. (2006). The school leader's
guide to student learning supports: New directions for addressing
barriers to learning. Thousand Oaks, CA: Corwin Press.
Atkins, M., Hoagwood, K., Kutash, K., & Seidman, E. (in press
and online as of March 2010). Toward the integration of education and
mental health in schools. Administration and Policy in Mental Health
Services Research, doi: 10.1007/s10488-010-0299-7
Bird, H. R., Andrews, H., Schwab-Stone, M., Goodman, S., Dulcan, M,
Richters, J., et al. (1996). Global measures of impairment for
epidemiologic and clinical use with children and adolescents.
International Journal of Methods in Psychiatric Research, 6, 295-307.
doi:10.1002/(SICI)1234-988X(199612)6:4<295::AID-MPR173>3.3.CO;2-5
Bird, H. R., Shaffer, D., Fisher, P., Gould, M. S., Staghezza, B.,
Chen, J. Y., et al. (1993). The Columbia Impairment Scale (CIS): Pilot
findings on a measure of global impairment for children and adolescents.
International journal of Methods in Psychiatric Research, 3,167-176.
Blackorby, J., & Wagner, M. (1996). Longitudinal post-school
outcomes of youth with disabilities: Findings from the National
Longi-tudinal Transition Study. Exceptional Children, 62(5), 399-414.
Retrieved from http://www.cec.sped.org/content/Navigation-Menu/Publications2/exceptionalchildren/
Borman, G. D. (2000). Title I: The evolving research base. Journal
of Education for Students Placed At Risk 5(1 & 2), 27-45. doi:
10.1207/s15327671espr0501&2_3
Borman, G. D., Hewes, G. M., Overman, L. T., & Brown, S.
(2002). Comprehensive school reform and student achievement: A
meta-analysis (Report No. 59). Baltimore: Johns Hopkins University,
Center for Research on the Education of Students Placed At Risk.
Bybee, R. W. (1997). The role of curriculum in systemic reform. In
W. Clune, et al. (Eds.), Synthesis of the Second Annual National
Institute of Science Education Forum: Vol. 2. Research on systemic
reform: What have we learned? What do we need to know? (pp. 23-28).
Madison, WI: University of Wisconsin.
Cappella, E., Frazier, S. L., Atkins, M. S., Schoenwald, S. K.,
& Glisson, C. (2008). Enhancing schools' capacity to support
children in poverty: An ecological model of school-based mental health
services. Administration and Policy in Mental Health, 35(5), 395-409.
doi: 10.1007/s10488-008-0182-y
Carr, E.G., Dunlap, G., Horner, R.H., Koegel, R. L., Turnball, A.
P., Sailor,W., Anderson, J.L., Albin, R.W., Koegel, L.K., & Fox, L.
(2002). Positive Behavior Support: Evolution of an Applied Science.
Journal of Positive Behavior Interventions, 4, 4-16. doi:
10.1177/109830070200400102
Cawelti, G. (1994). High school restructuring: A national study.
Arlington, VA: Educational Research Service.
Comer, J. P. (1987). New Haven's School-Community Connection.
Educational Leadership, 44(6), 13-16. Retrieved from
http://www.ascd.org/publications/educational-leadership.aspx
Corcoran, T., & Goertz, M. (1995). Instructional capacity and
high performance schools. Educational Researcher, 24(9), 27-31.
Retrieved from http://www.aera.net/publications/?id=317
Duchnowski, A. J., Kutash, K., & Friedman, R. M. (2002).
Community-based interventions in a System of Care and outcomes
framework. In B. Burns & K. Hoagwood (Eds.), Community treatment for
youth: Evidence based interventions for severe emotional and behavioral
disorders, (pp. 16-37). New York: Oxford University Press,
Duchnowski, A. J., Kutash, K., & Oliveira, B. (2004).
Systematically examining school improvement activities including special
education. Remedial and Special Education, 25(2), 117-129. doi:
10.1177/07419325040250020601
Gersten, R., & Keating, T. (1987). Improving high school
performance of "at-risk" students: A study of long-term
benefits of direct instruction. Educational Leadership, 44(6), 28-31.
Retrieved from http://www.ascd.org/publications/educational-leader-ship.aspx
Hoagwood, K., & Erwin, H. D. (1997). Effectiveness of
school-based mental health services for children: A 10-year research
review, journal of Child and Family Studies, 6, 435-451. Retrieved from
http://www.springer.com/psychology/child+%26+school+psychology/journal/10826
Hocutt, A. & McKinney, D. (1995). Moving beyond the regular
education initiative: National reform in special education. In J. L.
Paul, H. Rosselli, & D. Evans (Eds.), Integrating school
restructuring and special education reform (pp. 43-62). Fort Worth, TX:
Harcourt Brace.
Jeynes, W. H. (2005). A meta-analysis of the relation of parental
involvement to urban elementary school student academic achievement.
Urban Education, 40(3), 237-269. doi: 10.1177/0042085905274540
Jeynes, W. H. (2007). The relationship between parental involvement
and urban secondary school student academic achievement: A
meta-analysis. Urban Education, 42(1), 82-110. doi:
10.1177/0042085906293818
Kutash, K., Banks, S., Duchnowski, A. J., & Lynn, N. (2007).
Implications of nested designs in school-based mental health services
research. Evaluation and Program Planning, 30(2), 161-171.
doi:10.1016/j.evalprogplan.2006.12.001
Kutash, K., & Duchnowski, A. J. (2004). The mental health needs
of youth with emotional and behavioral disabilities placed in special
education programs in urban schools. Journal of Child and Family
Studies, 13(2), 235-248. doi: 1062-1024/04/0600-0235/0
Kutash, K., Duchnowski, A. J., & Lynn, N. (2006). School-based
mental health: An empirical guide for decision-makers. Tampa: University
of South Florida, Louis de la Parte Florida Mental Health Institute,
Department of Child and Family Studies.
Landis, J. R. & Koch, G. G. (1977). The measurement of observer
agreement for categorical data. Biometrics, 33(1), 159-174. Retrieved
from http://www.biometrics.tibs.org/
Malen, B. (1994). Site-based management: A political utilities
analysis. Education Evaluation and Policy Analysis, 16(3), 249-267. doi:
10.3102/01623737016003249
Minow, M. L. (2001). Update on implementation of IDEA: Early
returns from state studies. Wakefield, MA: National Center on Accessing
the General Curriculum. Retrieved 9/20/08 from
http://www.cast.org/publications/ncac/ncac_update.html.
National Commission on Excellence in Education. (1983). A nation at
risk: The imperative for school reform. Washington, DC: U.S. Department
of Education. Retrieved from
http://www2.ed.gov/pubs/NatAtRisk/index.html.
Newman, EM., King, VLB., & Rigdon, M. (1996). Accountability
and school performance: Implications from restructuring schools.
Madison, WT: Center on Organization and Restructuring of Schools.
Rones, Mv & Hoagwood, K. (2000). School-based mental health
services: A research review. Clinical Child and Family Psychology
Review, 3(4), 223-241. doi: 10.1023/A:1026425104386
Rothman, R. (1995). Measuring up: Standards, assessment and school
reform. San Francisco: jossey-Bass.
Sailor, W.(1991).Specialeducationintherestructuredschool.R6?m^/a/and Special Education, 22(6), 8-22. doi:l0.ll77/074193259101200604
Simpson, R. L. (2004). Inclusion of students with behavior
disorders in general education settings: Research and measurements
issues. Behavioral Disorders, 30(1), 19-31. Retrieved from
http://www.ccbd.net/behavioraldisorders/journai/index.cfm
Slavin, R. E., & Madden, N. A. (2000). Research on Achievement
Outcomes of Success for All: A Summary and Response to Critics, Phi
Delta Kappan, 82(1), 38-40, 59-66.
Smith, T. Dv Smith, B. L., & Smithson, M. M. (1995). The
relationship between the WISC-III and the WRAT 3 in a sample of rural
referred children. Psychology in the Schools, 32(4), 291-295. doi:
10.1002/1520-6807(199510)
Stiff man, A. R., Horwitz, S. M., Hoagwood, K., Compton,
Wv.,Cottier, Lv Bean, D. L., et al. (2000). The Service Assessment for
Children and Adolescents (SACA): Adult and child reports. Journal of the
American Academy of Child and Adolescent Psychiatry, 39(8), 1032-1039.
doi:l0.1097/00004583-200008000-00019
Turnbull, A.R, & Turnbull, H.R. (1997). Families,
professionals, and exceptionality: A special partnership (3rtt ed.).
Upper Saddle River, NJ: Merrill/Prentice Hall.
U.S. Department of Education, Office of Elementary and Secondary
Education. (2002). No Child Left Behind: A. desktop reference.
Washington, DC: Author.
U.S. Department of Health and Human Services (U.S. DHHS). (2003).
Achieving the promise: Transforming mental health care in America.
Report of the President's New Freedom Commission on Mental Health.
DHHS Publication No. SMA-03-3832; Rock-ville, MD.
U.S. Department of Health and Human Services. (U.S. DHHS). (1999).
Mental Health: A Report of the Surgeon General. Rockville, MD: Author,
Substance Abuse and Mental Health Services Administration, Center for
Mental Health Services, National Institutes of Health, National
Institute of Mental Health.
Wagner, M., Friend, M, Bursuck, W., Kutash, K., Duchnowski, A. J.
Sumi, W. C., et al. (2006). Educating students with emotional
disturbances: A national perspective on programs and services. Journal
of Emotional and Behavioral Disorders, 24(1), 12-30. do
1:10.1177/10634266060140010201
Wagner, M., Kutash, K., Duchnowski, A. J., Epstein, M. H., &
Sumi, W. C. (2005). The children and youth we serve: A national picture
of the characteristics of students with emotional disturbances receiving
special education. Journal of Emotional and Behavioral Disorders, 23(2),
79-96. doi:10.1177/10634266050130020201
Weist, M. D. (2005). Fulfilling the promise of school-based mental
health: Moving toward a public mental health promotion approach. Journal
of Abnormal Child Psychology, 33(6), 735-741. doi:
10.1007/S10802-005-7651-5
Wilkinson, G. S. (1993). WRAT3: Administration manual. Wilmington,
DE: Wide Range, Inc. Wong, K. K., & Meyer, S. J. (1998). Title 1
school wide programs: A synthesis of findings from recent evaluation.
Educational Evaluation and Policy Analysis, 20(2), 115-136. doi:l
0.3102/0162373702000211
A. J. Duchnowski and K. Kutash University of South Florida
Correspondence to Albert J. Duchnowski, Ph.D., University of South
Florida, 13301 Bruce B. Downs Blvd., Tampa, FL 33612; e-mail:
duchnows@usf.edu.
This study was funded in part by Grant H133B990022 from the
National Institute for Disability and Rehabilitation Research and the
Substance Abuse and Mental Health Services Administration.
Table 1 Mean, Standard Deviation, and range for Total SII
Score and Scale Scores for schools classified as engaged
in greater levels of reform (HI) and schools with low
(LO) levels of reform efforts.
Total Governance Accountability Curriculum Includedness
SII and
Score Instruction
HI Schools
Mean 28.9 3.6 5.6 7.2 3.8
SD 5.9 1.4 3.6 2.0 4.2
Range 23.6 1.4 to 5.0 1.2 to 10.4 3.2 to 8.8 -2.0 to 9.0
to
38.8
LO Schools
Mean 2.6 2.7 2.7 -1.0 -3.1
SD 9.1 2.9 3.2 1.7 3.5
Range
-12.2 -2.8 to -1.2 to 6.6 -2.8 to 1.2 -9.4 to 1.0
to 4.6
12.8
Parent Pro-Social
Involvement Discipline
HI Schools
Mean 1.4 6.1
SD 2.8 2.3
Range -1.2 to 4.8 3.2 to 9.2
LO Schools
Mean 0.3 1.1
SD 3.5 4.0
Range
-9.4 to 1.0 -4.0 to
7.6
Note: Scale scores on the SII can range from -12 to 12. Total
scores on the SII can range from a high of +72, indicating
greater levels of school reform activity/ to a low of -72,
indicating lower levels of school reform efforts.Table 2 Academic and emotional functioning, time spent in general
education settings, and parent involvement for students in LO
schools and HI schools
Academic LO Schools HI Schools Significance Effect
and Size
Emotional M(SD) M (SD)
Functioning
CBCL Total 62.4 57.8(26.1) p=0.29 g=0,18
Score (26.3)
n=67 n=83
CIS Score 19.0 (9.7) 17.5 (9.9) p=0.36 g=0.15
n=67 n=83
WRAT Math 72.8(11.8) 77.7(13.6) p=.02 g=0.38
Standard n=67 n=83
Score
WRAT 75.0 79.5(18.4) p=.12 g=0.25
Reading (16.3)
Standard n=67 n=83
Score
Percent of Week in General Education
Any genera] 27.8% 43.0% p=.00 g=0.57
education (21.9%) (29.9%)
setting n=67 n=83
Academic 3.4% 11.6% p=.0()2 g=0.49
general (11.3%) (20.1%)
education n=67 n=83
setting
Parent involvement
Involvement 9.0 (3.5) 7.9 (3.4) p=10 g=0.32
of all n=48 n=64
parents
Individual 26.6 (6.7) 22.6 (7.0) p=.008 g=0.45
involvement n=66 n=82Table 3 Percentage of students who received mental health
services by provider type and number of service units
received per month for students in LO schools and HI schools
% of LO HI Effect
Students Schools Schools Significance Size
who
Received
MH
Services
From any 62.7% 50.6% p=0.14 OR=0.61
source (n=67) (n=83)
From 64.3% 28.6% p<.01 OR=4.50
school (n=42) (n=42)
providers
only
From 2.4% 42.9% p<.01 OR=30.75
agency (n=42) (n=42)
personnel
only
Number of M (SD) M (SD)
Service
Units
Received
Per Month
Service 16.7 18.8 p=.43 g=0.17
units (10.4) (13.3)
from n=42 n=42
any
source
Service 15.1 11.8 p=.33 g=0.34
units (8.6) (11.7)
from n=27 n=12
school
personnel
only
Service 0.4 19.0 NA NA
units (NA) (6.4)
from n=l n=18
agency
personnel
only