Equitable Practices in School Mental Health
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| Title: | Equitable Practices in School Mental Health |
|---|---|
| Language: | English |
| Authors: | DeBoer, Jacob L. (ORCID |
| Source: | Psychology in the Schools. Jun 2022 59(6):1222-1238. |
| Availability: | Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us |
| Peer Reviewed: | Y |
| Page Count: | 17 |
| Publication Date: | 2022 |
| Sponsoring Agency: | Substance Abuse and Mental Health Services Administration (DHHS/PHS) |
| Contract Number: | SAMHSAFOASM18006 |
| Document Type: | Journal Articles Reports - Descriptive |
| Descriptors: | Mental Health, School Role, Student Diversity, Access to Health Care, School Health Services, Barriers, Student Needs, Cultural Relevance |
| DOI: | 10.1002/pits.22678 |
| ISSN: | 0033-3085 |
| Abstract: | Given the prevalence and negative outcomes associated with untreated mental health concerns, there is an urgent need for schools to enhance their capacity to prevent, identify, and address these needs. This is particularly important for students from culturally and linguistically diverse backgrounds, who are more likely to be underserved and face barriers to mental health treatment. Current methods of addressing mental health at school are reactive and insufficient, failing to address the needs of all students. Without an explicit focus on dismantling systemic racism and inequity within schools, our society will continue to underserve those already disenfranchised. As such, this paper outlines the challenges as well as the importance of incorporating culture into a conceptualization of universal mental health in schools. We include state-, district-, and school-level solutions in this conceptualization. Specifically, we propose sample solutions to the implementation of equity-focused, comprehensive mental health practices within a multitiered system of support, focusing predominantly on universal (i.e., tier 1 level) practices. |
| Abstractor: | As Provided |
| Entry Date: | 2022 |
| Accession Number: | EJ1334313 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwHP-S5tKwbypyr5toIPHqdxAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDFWAyYENS8qptgyzFwIBEICBmy2hZ6bHhFfthpoYpvw-mQA-z0CaOT9pSWeiXuo1gemjNaj4_eyycQjeuUR_d51m1_EMIXkBsRQZEoycVkwqKgiud9jR2ANDceBWqffkQ8nO9OHBHrsnUqKzEpZOMMSHkdqWFOosg8L6EFpg6GszimzpyEMuxpYbMaK00dfXBVqEKsZkfjolSS8HvDNm2lkcOGmd-nNS97Az5IIB Text: Availability: 1 Value: <anid>AN0156658980;pis01jun.22;2022May05.09:21;v2.2.500</anid> <title id="AN0156658980-1">Equitable practices in school mental health </title> <p>Given the prevalence and negative outcomes associated with untreated mental health concerns, there is an urgent need for schools to enhance their capacity to prevent, identify, and address these needs. This is particularly important for students from culturally and linguistically diverse backgrounds, who are more likely to be underserved and face barriers to mental health treatment. Current methods of addressing mental health at school are reactive and insufficient, failing to address the needs of all students. Without an explicit focus on dismantling systemic racism and inequity within schools, our society will continue to underserve those already disenfranchised. As such, this paper outlines the challenges as well as the importance of incorporating culture into a conceptualization of universal mental health in schools. We include state‐, district‐, and school‐level solutions in this conceptualization. Specifically, we propose sample solutions to the implementation of equity‐focused, comprehensive mental health practices within a multitiered system of support, focusing predominantly on universal (i.e., tier 1 level) practices.</p> <p>HIGHLIGHTS: 1.Schools must enhance their capacity to prevent, identify, and address mental health concerns for all students. This cannot be effectively addressed without an explicit focus on dismantling systemic racism and inequity within the school system.2.This paper provides several specific recommendations for the implementation of culturally responsive school mental health practices. These recommendations were organized into three overarching themes: cultivating cultural humility, developing a culturally responsive school climate, and conducting culturally responsive assessment.3.These recommendations are not intended to be exhaustive; rather, the recommendations are intended to be critiqued, amended, and expanded upon by future researchers and stakeholders invested in the implementation of equitable school mental health services.</p> <p>Keywords: equity; multitiered system of support; research‐to‐practice; school mental health; tier 1 services</p> <hd id="AN0156658980-2">INTRODUCTION</hd> <p>It is estimated that approximately 17% of school‐aged youth (ages 6–17) have a mental health disorder (National Alliance on Mental Illness NAMI, 2019). When untreated, early mental health concerns are associated with many negative life outcomes including, school failure, job insecurity, chronic pain, and further mental health concerns as adults (NAMI, 2019). Yet, previous research shows that only a small proportion of children with a diagnosable mental health problem receive treatment (Merikangas et al., 2011).</p> <p>Barriers at the individual and structural levels contribute to this lack of treatment. Individual barriers encompass attitudes, knowledge, and beliefs that impede treatment, whereas structural barriers encompass those that are practical or logistical (e.g., inability to afford treatment, insurance restrictions, or lack of transportation). Although structural barriers can present as obstacles for all youth seeking services, they disproportionately affect culturally and linguistically diverse (CLD) youth (Atdjian &amp; Vega, 2005; Desai et al., 2021). Structural barriers not only affect CLD youth in the seeking of treatment but also contribute to the need for treatment in the first place. Specifically, identifiable risk factors for mental illness include poverty, food insecurity, exposure to violence, and increased rates of isolation, (Alegria, Vallas, et al., 2010), all of which disproportionately affect CLD youth. Thus, the youth that are most susceptible to mental health concerns are often the least likely to access appropriate services.</p> <p>Alegria et al. (2015) described four mechanisms contributing to the disparities in mental health outcomes for CLD youth and adolescents. Mechanisms identified included the differential roles of (a) socioeconomic status (SES), (b) childhood adversities, (c) family structure, and (d) neighborhood‐level factors. More broadly, disparities in mental health reflect the intersections of inequity within our larger society (Alegria et al., 2015). For one example, Schwartz et al. (2015) found that adolescents identifying as Hispanic who recently immigrated to the United States, encountered cultural stressors that included perceived discrimination, negative context of reception (i.e., negative structure of opportunities available to immigrants within the receiving society), and bicultural stress (i.e., challenges balancing expectations/demands of U.S. culture and culture of origin) which negatively affected their mental wellbeing (e.g., decreased self‐esteem, decreased optimism, and increased depressive symptoms). These are not individual pathologies that the adolescents brought with them to the United States. Rather, these cultural stressors result from the adolescents encountering a system that constantly portrays them as an outsider. Relative to their white peers, previous studies have found that adolescents identifying as Hispanic reported higher levels of depressive symptoms (Kann et al., 2014; McLaughlin et al., 2007) and higher rates of suicidal ideation, planning, and attempts (Kann et al., 2014).</p> <p>Personal experiences of discrimination or microaggressions can have deleterious effects on subjective wellbeing, contributing to reduced confidence, decreased self‐esteem, and lowered performance on academic tasks (Price et al., 2019). Weeks and Sullivan (2019) found that, relative to youth who did not report past discrimination, youth reporting past discrimination were 3–4 times more likely to report mental health concerns. In a separate study, Estrada‐Martínez et al. (2012) revealed that higher levels of combined stress (i.e., financial, neighborhood, and racial discrimination stress) were associated with high levels of depressive symptoms for adolescents identifying as African American. Estrada‐Martínez et al. (2012) also found a linear relationship between the number of stressors and risk for depressive symptoms (e.g., adolescents reporting three stressors had a higher risk than those with two stressors). Additional studies have found similar negative effects of discrimination for youth identifying as Indigenous or Native American (Jaramillo et al., 2016), Asian American (Kiang et al., 2016), and LGBTQ+ (Russell &amp; Fish, 2016).</p> <p>Schools are uniquely placed to treat inequity; however, previous research has revealed a special kind of ineptitude in this area. School policies often reflect the larger societal systemic problems (Scott et al., 2017), with many policies (e.g., "zero‐tolerance," the use of office discipline referrals [ODRs], and school suspensions) exacerbating inequity rather than curtailing it (Stiffler &amp; Dever, 2015). Research shows that the percentage of K‐12 public schools with a majority population of students who are CLD is growing. Despite this growth in population, the resources remain stagnant, with these schools less likely to offer the services required for student success (e.g., courses focused on preparing students to succeed in math, science, and college; U.S. Government Accountability Office, 2016). Further, students attending these schools are more likely to encounter systematic and individual risk factors, such as chronic stress and trauma, which contribute to higher rates of mental health concerns (Arora et al., 2019; Hopson &amp; Lee, 2011).</p> <hd id="AN0156658980-3">Waiting to fail</hd> <p>The 2004 reauthorization of the Individuals with Disabilities Education Act called for school‐wide discipline reform with a focus on positive behavioral supports. Similarly, over a decade ago, the World Health Organization called for the development of evidence‐based programs encouraging skills, psychoeducation, resiliency, and psychosocial functioning in children and adolescents (World Health Organization [WHO] 2005). Both calls for reform were informed by previous research showing the positive benefits of preventative and proactive approaches in the school environment (Lewis &amp; Sugai, 1999). Despite this, many schools continue to follow a deficit or "wait to fail" model, which is a reactive and often punitive approach to students' emotional and behavioral concerns (Reinke et al., 2011).</p> <p>Reactive and punitive responses to problem behaviors at school are seen through zero‐tolerance policies, increased security (e.g., hiring security personnel or adding surveillance cameras and metal detectors), in‐ or out‐of‐school suspensions, and expulsions (Curran, 2016; Sugai &amp; Horner, 2002). These approaches are ineffective at causing lasting behavioral change, negatively affect school climate (e.g., strain student–teacher relationships; Sugai &amp; Horner, 2002), disproportionally impact students of color (Mitchell &amp; Bradshaw, 2013; Skiba et al., 2011), and place the source of the problem within the student while failing to examine the systems in place that exacerbate the problem (Herman et al., 2021).</p> <hd id="AN0156658980-4">MULTITIERED SYSTEM OF SUPPORT (MTSS)</hd> <p>As an alternative to the wait‐to‐fail model, schools have shifted toward a MTSS. MTSS is a framework rooted in the public health model of service delivery. Evidence‐based services are implemented along a continuum based upon student needs (Arora et al., 2019). Universal (tier 1) services are delivered to all students with the goal of prevention, selective (tier 2) services are delivered to students requiring supplemental services with the goal of remediation, and intensive (tier 3) services are delivered to students identified as having the highest level of need (Jimerson et al., 2015). While MTSS has the potential to reduce disparities in mental health, the framework is only as effective as the evidence‐based programs used within it (Fabiano &amp; Evans, 2019). Thus, despite improvement upon the "wait‐to‐fail" model, MTSS has problems needing to be addressed. Foremost is the limited amount of research explicitly examining the cultural responsiveness of MTSS frameworks and its effects on student wellbeing (Avant, 2016; Berger, 2019). The lack of research is especially problematic as it relates to school mental health, with extant research focusing on academic applications via culturally responsive curriculum, assessment in Response to Intervention, or addressing special education inequity via systemic change (e.g., Artiles et al., 2010; Sullivan et al., 2015).</p> <hd id="AN0156658980-5">PURPOSE</hd> <p>This conceptual paper expands upon past research examining the cultural responsiveness of MTSS, focusing primarily on school mental health. We begin with a description of challenges in implementation of equitable school‐based practices and describe the significance of schools' efforts to move toward a more equitable approach to mental health for CLD students. We then demonstrate the importance of incorporating culture into a conceptualization of comprehensive mental health supports for all students. We offer recommendations for state and district level approaches to enhance the equity of their schools' mental health systems. We conclude with several practical applications and recommendations of culturally responsive universal (i.e., tier 1 level) mental health practices.</p> <hd id="AN0156658980-6">CHALLENGES IMPLEMENTING EQUITABLE SCHOOL‐BASED MENTAL HEALTH SERVICES</hd> <p>Ostensibly, MTSS is a framework that provides a continuum of supports offering success to all students. However, this is not always the case for CLD students. These students regularly do not receive culturally responsive interventions or assessments, and the evaluation of MTSS is rarely conducted in a culturally sensitive manner (Li &amp; Vazquez‐Nuttall, 2009). Complicating matters further, the long‐standing demographic pattern of the U.S. school workforce continues to be predominantly white and middle class working with a majority non‐White student population (Bates &amp; Glick, 2013; Berchini, 2015; Townsend, 2000). Given the discrepancy between the school workforce and its students, traditional school practices and MTSS frameworks are largely presented as culturally neutral. However, these practices are not in reality "neutral," as most current norms, values, and expectations of the educational system lean towards white cultural norms and practices (Caldera et al., 2020). Without multicultural awareness, knowledge, and skills, school professionals can inadvertently harm CLD students through promoting culturally inappropriate curricula and assessment procedures; interacting with CLD students in an oppressive way; or misdiagnosing normal adaptive behaviors as disorders (Avant, 2016). Thus, using a culturally neutral MTSS framework with CLD students force us to question whether, in its current form, MTSS is truly advantageous for all students.</p> <hd id="AN0156658980-7">Ambiguity of cultural responsiveness</hd> <p>In theory, culturally responsive practices improve CLD students' educational experiences, particularly those who have experienced racial and social injustices in the school system (Gay, 2018). However, the evidence‐base for what is considered best practice in cultural responsiveness is still in its early stages. The reality is that no one intervention or curriculum can appropriately address the needs of all students. Failing to understand this results in a stagnant and unresponsive application of MTSS, which has the underlying assumption that a one‐size‐fits‐all approach should work for most students.</p> <p>Cultural responsiveness in MTSS is often indirectly emphasized through the frameworks of a given evidence‐based program (e.g., Positive Behavior Intervention Support [PBIS] system; Sugai et al., 2000), with no direct focus on culture. For instance, PBIS is claimed to encompass universal behavioral principles applicable to all students regardless of race. However, behavioral "appropriateness" is influenced by cultural expectations; What is considered inappropriate, or undesirable, differs across cultures (Obiakor, 2012). Given this, when school staff implement PBIS without consideration for the role of culture, they ultimately ignore the racial, ethnic, and cultural aspects of their students. Another evidence‐based program implemented within an MTSS framework is Social Emotional Learning (SEL). Yet, SEL is frequently taught outside the larger sociopolitical context, without direct discussions of systemic racism, power, privilege, white supremacy, and societal inequity (Drake &amp; Oglesby, 2020; Simmons, 2019). By ignoring sociocultural context, SEL risks turning into another deficit‐based approach for CLD students that reinforces white Eurocentric norms and devalues those of CLD youth (Malone et al., 2021). Advertising these programs as universal or applicable to all students misleads educators and school administrators who may have the desire to abolish inequities but do not have the awareness or knowledge of the best practices and pathways to achieve equitable outcomes.</p> <hd id="AN0156658980-8">CULTURALLY RESPONSIVE PRACTICES</hd> <p>The following sections describe culturally responsive practices shown to improve upon the typical MTSS framework. These examples are not intended to be exhaustive but instead facilitate further discussion, inquiry, and action. It should be noted that whenever groups of people are being defined on factors such as race, culture, ethnicity, or SES, it is essential to keep in mind that there are often as many within‐group differences as between‐group differences (Owens et al., 2013). Given this, the following recommendations should not be viewed as a checklist approach to culturally responsive school mental health. Instead, what follows are general techniques for the consideration of school systems, stakeholders, and practitioners.</p> <hd id="AN0156658980-9">DISTRICT AND STATE LEVEL—CULTURALLY RESPONSIVE PRACTICES</hd> <p></p> <hd id="AN0156658980-10">Involve key stakeholders</hd> <p>Systemic support is vital to the sustainability of any nascent school program or intervention. Therefore, infusing culturally responsive school mental health practices into a MTSS framework should include active involvement from stakeholders at the state‐, district‐, and school‐levels; all of whom bring necessary knowledge, resources, and buy‐in that help facilitate change (Serpell et al., 2013). At the state‐ and district‐levels, stakeholders have the primary role of ensuring schools have the necessary resources and technical support to make organizational change possible (Alegria, Vallas, et al., 2010). Through leadership, these individuals facilitate buy‐in from other stakeholders by supporting necessary structural (e.g., changes in policy, engagement with culturally based community resources, diversity in hiring practices), and operational (e.g., implementing culturally responsive school‐based programs; Alegria, Atkins, et al., 2010) changes. At the school‐level, administrators elicit buy‐in through demonstrating support for changes, soliciting community involvement, and modeling a willingness to take risks (Sullivan et al., 2015). School administrators possess essential knowledge regarding resources available to the school (i.e., human, financial, and material), educational policy, and competing initiatives that could derail any new program implementation. Teachers and other service providers (e.g., school psychologists, counselors, office staff, school nurse) bring a multitude of perspectives and expertise that are essential to understanding the current school climate (e.g., aspects of the learning environment, classroom management practices, family engagement, attitudes towards evidence‐based practices, and perceptions of current disparities; Sullivan et al., 2015). All stakeholders should make an open commitment to the involvement of families and students of varying cultural background and make sure everyone feels welcome in their schools (Banks &amp; Obiakor, 2015).</p> <p>Across all levels, there must be an active commitment to diversity in hiring practices. When creating an inclusive school environment, districts should strive to hire school staff that are reflective of the students' ethnicity and race. Carter Andrews et al. (2019) offered recommendations for increasing the diversity of the teacher workforce. Their recommendations included involving CLD teachers in the recruitment of new hires, examining policies that limit diversity in hiring (e.g., lack of loan forgiveness and lack of mentoring), offering opportunities for teachers to develop supportive communities of practice, and acknowledging the insider/outsider position of historically marginalized teachers (Carter Andrews et al., 2019). Notably, a commitment to diversity in hiring should not be considered a panacea to the inequity present in the school system nor should teachers of color be expected to take on the burden of improving the cultural responsiveness of a school (Sevon et al., 2021). Rather, systemic change is accomplished collaboratively, with a diverse group of stakeholders developing a coherent and evolving agenda to implementing comprehensive, culturally responsive school mental health services.</p> <hd id="AN0156658980-11">Establish community partnerships</hd> <p>Although school mental health professionals can provide a range of services, limited staffing and resources often prohibit these individuals from meeting the full continuum of student needs (Vaillancourt &amp; Amador, 2014). Given this reality, schools and districts must form partnerships with community supports (e.g., universities, community mental health providers) to enhance their capacity to meet the mental health needs of all students. Past research has shown that equitable partnerships across systems help to address many of the challenges associated with implementing evidence‐based interventions within at‐risk communities (Shapiro et al., 2010). In examining various models for forming effective partnerships in the literature, Shapiro et al. (2010) found key characteristics that fostered collaboration across systems. These characteristics included emphasizing strengths (rather than deficits), focusing on building trusting long‐term relationships, sharing ownership across systems, and building the capacity for sustainability. School‐community mental health partnerships can be funded in various ways, including, but not limited to, legislative authorizations and federal block/project grants (e.g., Project AWARE), state or county funding (e.g., local taxes), fee‐for‐service revenue from third‐party payers (e.g., Medicaid), and/or private individual donors/foundations (e.g., Annie E. Casey Foundation; National Association of School Psychologists NASP &amp; National Center for School Mental Health NCSMH, 2021).</p> <hd id="AN0156658980-12">SCHOOL LEVEL—TIER 1 CULTURALLY RESPONSIVE PRACTICES</hd> <p>Too often, schools implement MTSS through the lens of tier 2 or tier 3, without considering the quality of tier 1. Yet, when implemented correctly, it is estimated that approximately 80% of students respond effectively to tier 1 practices (O'Connor et al., 2017). In contrast, overlooking tier 1 services can result in time, materials, and human resources being exhausted before addressing the needs of most students (Sullivan et al., 2020). Given the effects that the current sociocultural climate and the COVID‐19 pandemic are likely to have on the mental health of students, particularly those who are the most vulnerable, it is more important than ever to ensure that universal, evidence‐based tier 1 services are implemented with fidelity. To accomplish this task, teachers and other school staff must be supported by all stakeholders in the delivery of evidence‐based services at the universal level. Support of school staff is not only imperative for reducing inequities related to mental health services, which serve as barriers to academic achievement, but it is also imperative to improving the self‐efficacy of these individuals (Roffey, 2012).</p> <p>There is a significant evidence‐base supporting the use of proactive school‐based classroom and mental health supports to address both internalizing and externalizing behaviors (Arora et al., 2019; Salerno, 2016; Simonsen et al., 2015). However, these approaches alone will not be sufficient at closing the gap for CLD students (Vincent et al., 2011). These services must be implemented in a culturally responsive manner by culturally humble practitioners. In the following sections, we present several recommendations on how schools can work towards this goal. Readers can refer to Figure 1 for an outline of these recommendations.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/PIS/01jun22/pits22678-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="pits22678-fig-0001.jpg" title="1 Components of culturally responsive school mental health practices at tier 1. Figure 1 organizes recommendations for culturally responsive practices in school mental health. The recommendations encompass three overarching themes: cultural humility, culturally responsive school climate, culturally responsive assessment" /> </p> <p></p> <hd id="AN0156658980-14">Cultivate cultural humility</hd> <p>Practitioners striving for equity in school mental health (e.g., psychologists, social workers, educators, and administrators) must simultaneously strive for cultural humility. Cultural humility (Tervalon &amp; Murray‐Garcia, 1998) builds upon the previously accepted model of cultural competency (Sue et al., 1982) by considering the fluidity of culture and the systems that contribute to inequity. Specifically, cultural humility stresses self‐reflection of one's own cultural identity relative to other cultural identities, understanding the dynamic nature of culture, and accountability at the individual and institutional levels (Fisher‐Borne et al., 2015). As a systemic approach, cultural humility includes advocating to change the power imbalances that sustain inequity and injustice for CLD students (Haynes‐Mendez &amp; Engelsmeier, 2020).</p> <p>Development of cultural humility is a lifelong and ongoing process; it should not be thought of as an intended outcome or achieved after a single event (Fisher‐Borne et al., 2015). Cultural humility encompasses a system wherein institutions and individuals engage in ongoing critical reflection and cultural learning that does not end with mastery of a given cultural skill (Haynes‐Mendez &amp; Engelsmeier, 2020). Despite this, multicultural trainings are often supplemental to the core preservice training for teachers and school personnel (Benton‐Borghi &amp; Chang, 2012). When limited attention and resources are dedicated to improving cultural responsiveness, there arises a problematic implication that participation in a single workshop or class is sufficient. Trainings should occur multiple times throughout the year and combine experiential learning and critical reflection practices (Haynes‐Mendez &amp; Engelsmeier, 2020).</p> <hd id="AN0156658980-15">Increase self‐awareness of biases</hd> <p>Cultural humility requires a deeper understanding of self that includes an analysis of power and privilege (Fisher‐Borne et al., 2015). This encompasses gaining further insight into one's identity and questioning how it influences their position in society (Bender et al., 2010). White educators must understand their position within an educational system that has historically valued dominant white cultural norms over the norms of CLD students (La Salle et al., 2019). Regardless of race, however, all individuals bring their own biases into a given situation or environment. Implicit biases are subtle, automatic processes that result in stereotypical attitudes or associations that people make based about individuals from a different culture or group (La Salle, 2019). Within the school system, these biases may present themselves when addressing behavioral problems (e.g., engaging in disruptive behavior results in a warning for a white student, but the same behavior results in a detention or office referral for a Black student) or academics (e.g., holding lower academic expectations for Black or Latinx students, relative to the expectations for white students). Through the awareness and acknowledgement of these biases, school staff can begin the work to change the resulting behaviors (Sevon et al., 2021).</p> <hd id="AN0156658980-16">Reassess classroom norms</hd> <p>Classrooms are not culturally neutral; rather, they are constructed around a culturally bound set of norms, values, and expected behaviors. Historically, teachers and other school professionals have used a comparative lens centering white, middle‐class values such as individual praise, competition, individualism, and linear thinking as the norms and expectations for all students (Banks &amp; Obiakor, 2015). In contrast, culturally responsive practices incorporate the knowledge and experiences of CLD students to make the classroom more relevant for them. Building this relationship begins during the first correspondence with families and students. Given this, all school forms and communication should use inclusive language (e.g., respecting multiple family structures, asking for preferred pronouns, sending communications written in the home language of students; Human Rights Campaign Foundation, 2021). In addition, books and curricula must be reviewed to determine if they reflect the diverse lives of the student population (e.g., featuring single‐parent families, adoptive and foster families, two‐mom and two‐dad families, multiracial and multiethnic families; Human Rights Campaign Foundation, 2021). Teachers should attempt to understand the association between a student's culture and behavior (Cholewa &amp; West‐Olatunji, 2008) and integrate this culture into their practices (Gay, 2002, 2018). Given gaps exist between school and home behavioral expectations, culturally responsive strategies consider both environments. Teachers should strive to teach expectations for school behaviors while also validating cultural expectations that students bring with them from their communities (Banks &amp; Obiakor, 2015). To be successful with this endeavor, teachers and administrators should integrate cultural knowledge gained from discussions with students and their families into school‐wide plans. This includes holding events that recognize and celebrate family diversity, offering childcare at school events, having bilingual staff present to translate for families, and holding schooling meetings at accessible locations (e.g., community centers; Human Rights Campaign Foundation, 2021). This integration will enable the school to move away from a model of culturally bound school expectations on one that is culturally responsive and reflects the values and needs of a diverse school community (Banks &amp; Obiakor, 2015).</p> <hd id="AN0156658980-17">Culturally responsive school climate</hd> <p>School climate refers to the quality of the individual and group experiences of school life (DeLoach et al., 2013). For CLD students, their perception of school climate often reflects whether the school promotes an inclusive environment that values diversity (La Salle et al., 2019). School climate encompasses interpersonal relationships, intrapersonal processes, educational opportunities, norms, goals, values, and organizational/environmental structures (Cohen et al., 2009). While a positive school climate facilitates learning and is more conducive to students exhibiting positive behaviors, a negative school climate can decrease student and family engagement with the school (Harry, 1992). Therefore, schools should use discussions, curricula, and the physical school environment to convey to families that their needs, wants, and goals are valued (DeLoach et al., 2013). Culturally responsive school climates are free of race‐based discrimination and affirm the cultural identities of students (Nganga et al., 2019). Teachers and staff visibly confront inequitable, hostile, or biased behavior; use curricula that reflect diversity; and believe students when they report being targeted because of their identity (Malone et al., 2021).</p> <p>Student perception of school climate is especially important when considering its relationship to self‐esteem. For Black adolescents, previous studies show a positive relationship between self‐reported perceptions of school climate and self‐esteem (Bottiani et al., 2017; Fisher et al., 2020). Further research revealed that ethnic identity (i.e., one's exploration and participation in cultural activities and their feelings of affirmation and belonging in their ethnic group) moderated the relationship between school climate and self‐esteem (Fisher et al., 2020). Bottiani and colleagues (2017) reported that Black students' perception of equity affected the relationship between school connectedness and school safety and the students' self‐esteem. This same relationship (i.e., the significant influence of student perception of equity) was not present for white students. Taken together, a culturally responsive school climate must address the importance of affirming identity and belonging; confronting individual and systemic inequity and racism; and promoting an inclusive environment that values diversity.</p> <hd id="AN0156658980-18">Increase culturally responsive positive behavior supports</hd> <p>To counteract the cultural bias of reactive and punitive behavior management techniques, Banks and Obiakor (2015) proposed the Culturally Responsive Positive Behavior Intervention Support (CRPBIS) system. CRPBIS specifically acknowledges CLD students and the need to find relevant connections, integrating their culture, language, heritage, and experiences within behavioral goals and objectives. Rather than viewing the student as the problem to "fix," CRPBIS views environmental factors and lack of skills as parts of the problem and works to ameliorate them (Banks &amp; Obiakor, 2015). Vincent et al. (2011) similarly proposed the integration of culturally responsive practices within the existing primary components (practices, data, systems, and outcomes) of Schoolwide Positive Behavior Support (SWPBS). Specific culturally responsive practices recommended included involving adults from various cultural backgrounds to act as behavioral models for expected behavior, using culturally valid assessment tools, and investing in the school staff's acquisition of cultural knowledge and self‐awareness. In one example, Vincent et al. (2011) described fusing culturally responsive practices into a school district with a large Latinx population. Despite a long history of SWPBS implementation, when the discipline and academic data were disaggregated by ethnicity, results revealed that Latinx students were disproportionately overrepresented in ODRs, suspensions, and expulsions. Across 4 years of implementation, the district built upon the existing SWPBS structure in three primary ways: (a) expanding the knowledge base and cultural self‐awareness of the staff and securing a commitment to equitable outcomes, (b) formulating an action plan for the transformation to culturally responsive practices, and (c) building the capacity to further train and coach teachers in culturally responsive practices. Ongoing review of the data disaggregated by ethnicity revealed that, after the third year, there was a 5% decrease of Latinx students' disproportionate overrepresentation in expulsions and a 6% increase of Latinx students meeting state reading standards (Vincent et al., 2011).</p> <hd id="AN0156658980-19">Facilitate meaningful family engagement</hd> <p>Schools must attend to the needs and requests of families with diverse backgrounds. During initial contacts with families, school personnel should establish a mutually trusting relationship. For some youth and families, the initial contact is especially important. Black youth and families might possess a legitimate mistrust of institutions, such as schools, that have historically been hostile towards them (Terrell et al., 2009). In responding to this mistrust, school personnel could highlight the strengths of Black youth and families while also empathizing and validating the challenges they have been forced to endure (Thompson &amp; Alexander, 2006). Throughout all conversations with families, school personnel must assume the role of learner, rather than expert. Teachers must listen carefully without judgment, trusting that these families have the most insight and knowledge regarding the normality or abnormality of their children (Harris et al., 2013). Conversations should be approached with a caring attitude that displays a commitment to students through promoting teamwork, self‐direction, student involvement, and critical thinking (DeLoach et al., 2013). Meaningful engagement can be facilitated through the organization of learning communities for school personnel and family members (Avant, 2016). Before scheduling, common barriers must be addressed to maximize participation from all families (e.g., offering flexible meeting times/modalities, offering translated materials and meetings, providing childcare, and paying teachers for their time spent outside of school hours; Fallon et al., 2021). Through these events, schools can explain the main school policies using plain language that is positive, empowering, and respectful. Meaningful family engagement enhances the ability of families to assist their children in school‐related activities, levels the playing field between family members and educators, and addresses the power differential between the school and families (Carlson et al., 2020; Malone et al., 2021).</p> <hd id="AN0156658980-20">Create a space to talk about race</hd> <p>Aside from being sporadically addressed during a specific class (e.g., history) or timeframe (e.g., February), discussions of race and racism are not typically part of the school curriculum (National Education Association NEA, 2018). This is despite the fact that systemic racism and racial dynamics continue to permeate all aspects of society. Because of the complexity and contentiousness of racism, teachers and other school staff may fear bringing up the subject. There is a further misconception that younger children cannot, or do not, process information related to race (Sullivan et al., 2020). This misconception frequently results in the adults of a child's life furthering a color‐blind approach or emphasizing the commonalities between humans (e.g., humans are all the same on the inside). However, both approaches have been shown to have negative effects on race relations for both the child and adult (Apfelbaum et al., 2008a; Apfelbaum et al., 2008b). These misconceptions, coupled with the inherent fear and avoidance of discussing racism, not only invalidate the experiences of students of color but communicate to them that racism does not matter enough to warrant attention (National Education Association NEA, 2018).</p> <p>Teachers and school staff must help students think and talk about the various ways in which race can shape their lives (Sullivan et al., 2020). School personnel should first learn about the various effects and instances of systemic racism (e.g., slavery, Jim Crow laws, forced displacement, colonialism, police brutality, white supremacy) and then facilitate discussions with their students regarding these historical traumas. However, class discussions should not strictly focus on these traumas or be one‐dimensional (National Education Association NEA, 2018). Students should also be encouraged (i.e., not required) to share their own perspectives and experiences. Before beginning class discussions, teachers must establish a safe and brave environment for their students. A safe environment promotes safety both within oneself and from the risk of psychological harm from others, whereas a brave environment is one wherein everyone is willing to take risks to engage authentically (National Child Traumatic Stress Network NCTSN, 2017). These environments are created by highlighting that all students need to experience a sense of psychological safety to express their perspectives openly; validating and de‐escalating emotions when possible; and when the emotional responses appear overwhelming, setting up clear directions and options for managing those responses (e.g., permission to leave the room). Teachers should check‐in with students throughout the discussion to ensure psychological safety and that they are managing emotions in a healthy manner (National Child Traumatic Stress Network NCTSN, 2017). It is imperative that these class discussions not be a one‐time occurrence; ongoing critical self‐reflection is essential in the effort to engage students, embrace diversity, and foster belonging in the classroom (Center on Positive Behavioral Interventions and Supports, 2021). Teachers and school staff who would like additional resources related to facilitating these conversations can reference the following: (National Association of School Psychologists NASP, 2021; National Child Traumatic Stress Network NCTSN, 2017; National Education Association NEA, 2018; Northwest Evaluation Association, 2020; Simmons, 2019).</p> <hd id="AN0156658980-21">Conduct culturally responsive assessment</hd> <p>Mental health symptoms can be expressed differently for CLD students, making many of the diagnostic and assessment tools used in mental health treatment questionable for decision‐making practices (DeLoach et al., 2013). Individuals tasked with interpreting screening data must be cognizant of how various ideologies of deficit (e.g., racialized, gendered, and classed) can manifest and work to interrupt their presence in MTSS (Sabnis et al., 2019). When evaluating specific measurement tools, practitioners should examine existing evidence regarding test use among diverse cultural groups (e.g., reliability, validity, and measurement invariance across groups). If differences across groups (i.e., measurement variance) are revealed, practitioners need to determine if these differences are because of factors not related to the skills or construct being measured (Harris et al., 2013).</p> <p>School mental health professionals should supplement screening data with follow‐up conversations with the youth and family. Throughout these conversations, the school professional should mirror the language used by the youth and family to describe concerns, avoiding diagnostic labels of psychopathology or mental illness. The motivation behind conducting these conversations must always be to seek clarity from the youth and families regarding what they perceive to be happening in their lives and determine whether what is happening is common to members of a particular culture (DeLoach et al., 2013). Integration of knowledge regarding family circumstances, coupled with consideration of a given student's strengths and skills, could reduce the current over‐referrals and disproportional placement of CLD students in special education (Harris et al., 2013).</p> <hd id="AN0156658980-22">Emphasize student strengths</hd> <p>The traditional medical model of mental health is one‐dimensional (i.e., an individual has a mental health disorder or not) and views psychopathology as existing within the individual (Wang et al., 2011). Further, traditional assessment procedures in schools typically focus on the identification of deficits when determining special education eligibility. This focus on deficits not only risks using white middle‐class norms to determine what is considered a deficit, but also ignores ecological circumstances and student strengths (Harris et al., 2013). Alternatives to these traditional models include using strength‐based assessment tools (e.g., measure emotional and behavioral assets) and a dual‐factor model of mental health. In practice, the latter encompasses the former, with the dual‐factor model of mental health incorporating measures of positive indicators of wellness (e.g., subjective wellbeing) with traditional indicators of mental health concerns to represent mental health holistically (Suldo &amp; Shaffer, 2008).</p> <hd id="AN0156658980-23">Continuous progress monitoring</hd> <p>Continuous progress monitoring should occur not only at the individual level, but also at the group level. At the individual level, culturally responsive assessment tools can help determine if an intervention is working for a given child and aid in decision‐making throughout the MTSS process. Basing student progress on data will ensure educators limit the effects of their own implicit biases. Progress on student mental health functioning should be gathered regularly (e.g., two times a year—once in the fall and once in the spring; Miller et al., 2019) with outcome decision criteria rooted in research and established a priori. At the group level, discipline and referral data should be disaggregated by student race and ethnicity. The disaggregation of data will enable schools to monitor the overall effectiveness of their culturally responsive supports on decreasing bias in disciplinary actions and producing culturally equitable student outcomes (Vincent et al., 2011).</p> <hd id="AN0156658980-24">DISCUSSION AND CONCLUSION</hd> <p>CLD youth are more likely to live in poverty and suffer from food insecurity. They are also more likely to have limited childcare options, lack internet access, and experience limited social connections outside of school (Mersky et al., 2013). Although present before the pandemic, these problems have now been amplified and likely worsened by the current sociopolitical climate. Systemic change is needed with a focus on proactive and preventative care. According to Sullivan and colleagues (2015), disproportionality interventions focusing on narrowly defined problems are necessary but insufficient because they do not change the infrastructure that inhibit the opportunities of CLD students. Similarly, interventions or programs that do not directly address organizational, institutional, and societal forces that cause inequity will continue to fail. Sullivan and colleagues (2015) provided excellent recommendations on how to use systemic change to address special education inequity. While the entirety of their recommendations is outside the purview of this article, we believe that many of them, if implemented with fidelity, would not only improve special education inequity but also advance equitable school based mental health services. Schools have always had the responsibility to care for their student bodies, yet tackling these inequities is more urgent than ever. Schools are dynamic social organizations with diverse students, cultures, goals, and needs. Therefore, claiming to create a complete list of recommendations that would work for all schools and all students would be akin to the MTSS frameworks already in place. We understand that our recommendations are not exhaustive, nor do they effectively address all groups of marginalized students within the school system (e.g., LGBTQ+ youth). However, our primary intention with this paper was to advance a conversation regarding how we can do better as professionals in serving all students.</p> <p>We began the paper by discussing why this transformation is important and then transitioned into providing concrete recommendations on how to improve upon the usual MTSS framework. Our recommendations first focused on state‐, district‐, and school‐level administrator support. This included not only monetary support but also stakeholder support for structural and operational changes. Next, we focused the remaining recommendations on those that could be applied at the school level. Our school level recommendations can largely be described using three overarching themes: cultivating cultural humility, developing a culturally responsive school climate, and conducting culturally responsive assessment. Notably, we concluded our discussion at the universal tier 1 level and did not proceed onto recommendations for tiers 2 and 3. This decision was not meant to diminish the significance of the more intensive tiers. However, without a solid foundation of universal, culturally responsive school‐wide practices, tiers 2 and 3 practices will be unlikely to achieve their desired goals.</p> <p>Nothing in the above paper is new to the research base of school mental health. All the recommendations provided were adapted from various sources (e.g., academic journals, podcasts, blog posts, and policy statements) who have been advocating for the same reforms for years. Despite this, the recommendations have yet to reach the schools. In fact, throughout the country, there are individuals and groups actively fighting against discussing any changes or engaging in any societal self‐reflection. Recent examples of these avoidances can be seen in the intentional misrepresentation and political demonization of Critical Race Theory (e.g., Associated Press, 2021; Jamerson &amp; Zitner, 2021), the 1619 Project (e.g., Payne, 2021), and school mental health programs (e.g., Kingkade &amp; Hixenbaugh, 2021). Those opposing structural changes that place equity at the forefront frequently rationalize their actions by claiming that such changes would divide students or make white students feel guilty about their race. All school administrators, educators, support staff, mental health providers, and other individuals invested in the success of all students must be able to identify the hypocrisy of these rationalizations. They must be able to understand that, up to this point in our history, the curricula in our schools have been from a white, Eurocentric point of view. This white, Eurocentric point of view rarely presented robust positive narratives of Black or Indigenous people. And when the curriculum did discuss these people, it was frequently done in a one‐dimensional or demeaning way (Sevon et al., 2021). Yet, interestingly, there were not similar concerns raised regarding the division of students or how this historically whitewashed curriculum made CLD students feel. It is imperative that those tasked with supporting students in our schools not allow those opposing change and progress to set us back even further. We need to encourage and lead honest, respectful discussions about topics such as privilege, white supremacy, bias, and systemic racism in our schools. These forms of discussion facilitate critical thinking and offer a framework for students to understand how existing systems, structures, and policies create much of the inequity these students see daily (National Association of School Psychologists NASP, 2021). However, these conversations are only the beginning if we hope to enact systemic change and truly create more equitable school mental health practices.</p> <hd id="AN0156658980-25">CONFLICT OF INTERESTS</hd> <p>The authors declare no conflict of interest.</p> <ref id="AN0156658980-26"> <title> REFERENCES </title> <blist> <bibl id="bib1" type="bt">1</bibl> <bibtext> Alegria, M., Atkins, M., Farmer, E., Slaton, E., &amp; Stelk, W. (2010). One size does not fit all: Taking diversity, culture, and context seriously. 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| Items | – Name: Title Label: Title Group: Ti Data: Equitable Practices in School Mental Health – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22DeBoer%2C+Jacob+L%2E%22">DeBoer, Jacob L.</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-9051-8310">0000-0001-9051-8310</externalLink>)<br /><searchLink fieldCode="AR" term="%22Allouche%2C+Sam+F%2E%22">Allouche, Sam F.</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-7375-1580">0000-0002-7375-1580</externalLink>)<br /><searchLink fieldCode="AR" term="%22Vasquez%2C+Jennifer+I%2E%22">Vasquez, Jennifer I.</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-5108-3198">0000-0002-5108-3198</externalLink>)<br /><searchLink fieldCode="AR" term="%22Rhodes%2C+Judith%22">Rhodes, Judith</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-5366-7656">0000-0002-5366-7656</externalLink>) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Psychology+in+the+Schools%22"><i>Psychology in the Schools</i></searchLink>. Jun 2022 59(6):1222-1238. – Name: Avail Label: Availability Group: Avail Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 17 – Name: DatePubCY Label: Publication Date Group: Date Data: 2022 – Name: SourceSuprt Label: Sponsoring Agency Group: SrcSuprt Data: Substance Abuse and Mental Health Services Administration (DHHS/PHS) – Name: NumberContract Label: Contract Number Group: NumCntrct Data: SAMHSAFOASM18006 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Descriptive – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22School+Role%22">School Role</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Diversity%22">Student Diversity</searchLink><br /><searchLink fieldCode="DE" term="%22Access+to+Health+Care%22">Access to Health Care</searchLink><br /><searchLink fieldCode="DE" term="%22School+Health+Services%22">School Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Needs%22">Student Needs</searchLink><br /><searchLink fieldCode="DE" term="%22Cultural+Relevance%22">Cultural Relevance</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1002/pits.22678 – Name: ISSN Label: ISSN Group: ISSN Data: 0033-3085 – Name: Abstract Label: Abstract Group: Ab Data: Given the prevalence and negative outcomes associated with untreated mental health concerns, there is an urgent need for schools to enhance their capacity to prevent, identify, and address these needs. This is particularly important for students from culturally and linguistically diverse backgrounds, who are more likely to be underserved and face barriers to mental health treatment. Current methods of addressing mental health at school are reactive and insufficient, failing to address the needs of all students. Without an explicit focus on dismantling systemic racism and inequity within schools, our society will continue to underserve those already disenfranchised. As such, this paper outlines the challenges as well as the importance of incorporating culture into a conceptualization of universal mental health in schools. We include state-, district-, and school-level solutions in this conceptualization. Specifically, we propose sample solutions to the implementation of equity-focused, comprehensive mental health practices within a multitiered system of support, focusing predominantly on universal (i.e., tier 1 level) practices. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2022 – Name: AN Label: Accession Number Group: ID Data: EJ1334313 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1002/pits.22678 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 17 StartPage: 1222 Subjects: – SubjectFull: Mental Health Type: general – SubjectFull: School Role Type: general – SubjectFull: Student Diversity Type: general – SubjectFull: Access to Health Care Type: general – SubjectFull: School Health Services Type: general – SubjectFull: Barriers Type: general – SubjectFull: Student Needs Type: general – SubjectFull: Cultural Relevance Type: general Titles: – TitleFull: Equitable Practices in School Mental Health Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: DeBoer, Jacob L. – PersonEntity: Name: NameFull: Allouche, Sam F. – PersonEntity: Name: NameFull: Vasquez, Jennifer I. – PersonEntity: Name: NameFull: Rhodes, Judith IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 06 Type: published Y: 2022 Identifiers: – Type: issn-print Value: 0033-3085 Numbering: – Type: volume Value: 59 – Type: issue Value: 6 Titles: – TitleFull: Psychology in the Schools Type: main |
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