Wednesday, February 13, 2013

Mental Health Services and School Psychologists



According to the U.S. Surgeon General, over the course of a year, approximately 20% of children and adolescents in the U.S. experience signs and symptoms of a mental health problem and 5% experience “extreme functional impairment.” Although more than 2 million adolescents aged 12 to 17 suffered a major depressive episode in the past year, nearly 60% of them did not receive treatment. Statistics also suggest that the dropout rate for students with severe emotional and behavioral needs is approximately twice that of other students. 

Most children with mental health problems receive no services and of those who do, 70 to 80% receive them from school-based providers. School psychologists are among the school-based personnel (e.g., guidance counselors, school social workers) who are typically called upon to provide mental health services. In order for school psychologists to be effective mental health service providers, they must be competent to fulfill that role and function. This article discusses education and training issues, and related ethical and professional practice issues associated with school psychologists’ role in providing mental health services in the schools.
 Role and Function of School Psychologists
Surveys consistently indicate that school psychologists spend a majority of their time in assessment activities rather than delivering direct mental health services (e.g., counseling) to students. This includes determining special education eligibility and working with youth within the context of special education. Indeed, the majority of school psychologists report spending less than 10% of their time per week providing evidence-based mental health services to children and adolescents. Despite the limited amount of time devoted to mental health service delivery, school psychologists are increasingly being called on to serve in this role.  Moreover, school psychologists themselves report wanting to spend more time doing activities such as counseling and direct intervention, further supporting the profession’s desire to serve in the mental health service provider role. However, role expansion may prove to be problematic due to training issues and lack of administrative support.
 Training and Preparation
Research suggests that training in the diagnosis and treatment of mental disorders and counseling are determinates of the provision of mental health services by school psychologists. According to National Association of School Psychologists (NASP), the term “child psychologist” refers to doctoral-level clinical psychologists who specialize in children. “School psychologist” specifically refers to professionals who bridge psychology and education to address school related issues, including those that concern children, teachers, parents and families, as well as school organizations. School psychologists' training includes study in education and special education, but compared to clinical psychology, there is less emphasis on psychopathology and counseling. The majority of states require the completion of a 60 graduate semester master’s or specialist-level program in school psychology, including a 1200-hour internship, along with passing a Teacher Certification Test, which has a specialty component for school psychology. In contrast, a doctoral degree (e.g., PhD) generally requires about 5 years of full-time graduate study, culminating in a dissertation based on original research. Doctoral programs in child clinical-school psychology usually include further training and coursework and preparation in child and adolescent psychopathology, behavioral and child therapy, pediatric pharmacology, neuropsychology, advanced research, and a clinical practicum.
Ethical Considerations
Ethical issues are especially important in this discussion. School psychologists must be familiar with the ethical codes that apply to their specialization, as well as to psychology in general. For example, school psychologists must practice within the boundaries of their experience and training. Professional competency standards require school psychologists to recognize the strengths and limitations of their training and experience, and only practice in areas for which they are "qualified." In fact, the issue of practitioner competence is paramount in the ethics codes of the American Psychological Association (APA), American Counseling Association (ACA), and National Association of School Psychologists (NASP). The parameters of competence involve (a) recognizing one's professional limitations and needs, (b) understanding one's professional strengths, (c) confining consultation practice to one's competence, (d) knowing when to decline work and when to refer to other professionals, (e) ensuring that recommended interventions have an empirical basis, and (f) maintaining a high level of professionalism. Practitioners should seek continuing education and training in areas in which they lack competence and experience and refer to colleagues with the requisite experience and/or community resources.
 Implications
While the domains of professional school psychology practice include competencies in "prevention, wellness promotion, and crisis intervention," most school-based practitioners have not received intensive training in child and adolescent psychopathology, counseling and therapeutic intervention. Nor are most school psychologists licensed in another mental health specialty. Consequently, it is especially important for administrators, teachers, and parents to understand the limitations and parameters of school psychology practice and not assume that school psychologists possesses the clinical training to assess and intervene with complex childhood disorders. Schools often do not draw a distinction made between the specialist and the doctoral level school psychologist. Distinctions may not be critical when school psychologists are performing psychoeducational assessment services, as both sub-doctoral and doctoral level school psychologists receive comparable preparation for these important services. However, the academic and professional preparation of doctoral level school psychologists typically emphasizes clinical issues important to children's mental health, including methods for working with children and youth, their parents and teachers. In fact, research suggests that school psychologists with a specialist degree provide fewer mental health services than individuals with doctorates.
Recommendations
The educational setting is the most likely setting for students to receive mental health services. Unfortunately, a majority of children and youth who are in need of mental health services do not actually receive them.  If psychological services are to be expanded in schools to include a major focus on mental health services, school psychologists must be trained as broadly as possible, so that they are capable of working in different settings and prepared to address a range of issues.  In this regard, changes must be made in the graduate-level curriculum of school psychology programs. For example, graduate training programs should provide additional preparation in evidence based mental health services, including individual and group counseling, to ensure school psychologists have the tools they need to help students be successful. Training programs also need to provide practice experiences in the application of evidence-based therapeutic interventions, with a practicum supervised by school psychologists who are competent in the application of these services. A viable service model may call for subdoctoral school psychologists to assume leadership for continuing to provide psychoeducational assessment services for special education and for doctoral level school psychologists to assume leadership for initiatives aimed at promoting children's mental health. While students in nondoctoral programs may receive a basic introduction to mental health services, they will likely need to pursue further postgraduate training and continuing education/professional development in mental health services. Simply stated, school psychologists cannot be expected to provide mental health services without adequate, appropriate training.
Perfect, M. M., & Morris, R. J. (2011). Delivering school-based mental health services by school psychologists: Education, training, and ethical issues. Psychology in the Schools, 48, 1049–1063. doi: 10.1002/pits.20612

Lee A. Wilkinson, PhD, NCSP,CCBT is a nationally certified school psychologist, licensed school psychologist and certified cognitive-behavioral therapist. He is also a university educator and serves on the school psychology faculty at Nova Southeastern University. His research and professional writing has focused primarily on behavioral consultation and therapy, and children and adults with autism spectrum disorders. He has published widely on these topics, both in the US and internationally. Dr. Wilkinson is the author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also the editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHis latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

1 comment:

Lauren said...

As a 2nd year school psychology student, this is a little worrying. While it would be fantastic if every person delivering mental health services were trained at the doctoral level, the reality is that there aren't enough programs out there to provide that training to all the people we'd need in order to deliver those services to every child in need of them. And there's no way that most schools would be able to pay for one psychologist to do testing and another to do counseling (too many schools don't even have a single in-school psychologist!). They'd probably end up either having the doctorate-level people do both, or reverting the school psychologist position to being just an overtrained psychometrician. I suspect the latter, since the salary would be lower. Another option would be to assign each person to multiple schools, but anyone who's had a job like that knows it's not as useful to the students or the teachers when they're not always available at the school.

I do, however, think that school psychology graduate programs should teach more counseling. Mine requires three courses in counseling, but I know others in my area only require two. We also provide counseling at our practicum sites (besides the 1200 hour internship, we also have a mandatory 150 hour pre-practicum in year 1 and 600 hour practicum in year 2), and receive supervision. However, I certainly want to keep learning more about counseling. I feel that I'll be prepared for a school psychology once I finish my internship, but I also think I need more direct instruction in evidence-based therapeutic interventions. My peers seem to feel the same, and we've requested another counseling course to be designed for later groups that focuses on evidence-based interventions.

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