Process
The initial convening of the group focused on establishing the committee’s purpose and identifying project outcomes. After researching, examining, and discussing the issues on school mental health, the committee than set out to prioritize the issues and begin the process of developing a proactive, state intervention model. As discussions evolved, the committee began to realize that the development of a school‐based model was far more complex than originally anticipated. The evolution of this process brought to light a clear recognition that there could be no one solution for the commonly shared problems that schools faced when addressing student mental health. The committee acknowledged that this was largely due to the vast differences between the school communities in Texas, but also was partly due to how committee members perceived and understood the fragmented and complex systems regulating eligibility for mental health services, how those services were funded, availability and access to the services, and the occupational requirements that governed the professionals providing those services.
Each stakeholder involved in the project held a very different perspective on the issues of school mental health, and each member’s understanding of those issues was directly influenced by how she/he perceived the eligibility determination process for services. This included how the need for services was established and how the minimum standard of care was determined and evaluated. Consequently, the varied perspectives on these issues (i.e., lack of a common perspective) resulted in members struggling with how they might arrive at a possible solution to the problem.
During the early phases of the project, a significant amount of time was devoted to increasing the committee’s understanding of school systems and public education laws, including special education laws. Several non‐school stakeholders and parents in the group expressed concern with public school processes for identifying students who might need mental health services. Several of these stakeholders felt schools were consistently denying services to children, despite many of these students being diagnosed with mental health conditions. However, when the school professionals in the group responded to this concern, they explained that schools were obligated to provide educational services, and, although some educationally related services might be considered mental health services, the eligibility criteria for those services were established by education laws, not mental health or healthcare laws. These school professionals described the special education eligibility process (using acronyms commonly used in the special education process) and the educational programs provided through special education. This helped the committee members differentiate and better understand the services provided in public schools from those provided in the private sector or through public health services.
It soon became obvious to everyone that the language used to describe educational services was very different from the language used to describe mental health services. Clearly, this was an area where misperception and misunderstanding seemed to be perpetuating the problems and, ultimately, preventing any possible solutions. The group quickly recognized that the language used among the stakeholders (e.g., school vs. non‐school) was distinctly different, and frequently focused on how children were diagnosed versus how they were categorized, how services were educationally relevant versus clinically relevant, and how credentials held by each professional were regulated differently. Ultimately, these discussions led to the realization that a common language was essential in order for the group to develop a common understanding and perspective on the issues, for without a common perspective, the group would have difficulty arriving at a common vision for developing viable solutions.
Critical Issues Identified
As a result of stakeholder input in the early phases of the project, the committee identified three critical issues that were preventing them from understanding the complex issues surrounding school mental health. After considerable discussion, it became clear that the group was “admiring the problem” and that these issues were creating barriers in their ability to move forward. Thus, the group recognized that if they were to achieve their goal of working cooperatively to develop a mental health model and guidance document for schools, they first had to understand the issues from one another’s perspectives. These three critical issues were:
1 The fragmented and complex mental health system that regulated eligibility for services was creating significant confusion for everyone. How those services were funded only added to the confusion.
2 Throughout the state, availability and access to mental health services were extremely limited, and many of the group’s members weren’t even aware that some of these services existed. This exacerbated the school mental health problem and may have contributed to why so much of the blame was being placed on schools.
3 The regulatory requirements that governed the professionals providing mental health services differed for professionals in the private or public sector compared to those in the educational sector.
Outcomes
The process for arriving at a common understanding and shared perspective on the problem of school mental health required the group to investigate all issues and conduct an in‐depth review of relevant data, including any procedures, policies, or regulations that might have created limitations, constraints, or unintended consequences for any of the sectors (i.e., private, public, or educational). After this thorough review process, all members of the group had an improved understanding of the issues underlying school mental health, as well as those factors driving the increased need for services. The three‐step process that guided the group toward a common vision also enabled them to work toward the goal of developing a school model for mental health support. Ultimately, the group agreed that a proactive approach not only was more effective at preventing social, emotional, and behavioral problems, but also would help reduce some of the stigma surrounding mental illness. So, the group agreed that the model should focus on promoting wellness, as opposed to focusing primarily on mental illness. The project culminated in the development of the Texas School‐Based Social/Emotional Wellness Model, which was based on a multitiered approach to prevention and intervention. A detailed description of the model can be found in Rapid Reference 1.5.
Rapid Reference 1.5 Texas School‐Based Social/Emotional Wellness Model
A description of the social‐emotional wellness model developed by the Texas Collaborative for Emotional Development in Schools (TxCEDS) was printed by the Region 4 Education Service Center in Houston, Texas, and was disseminated to the 20 education service centers throughout Texas in October 2010 (Texas Education Agency and Region 4 Education Service Center, 2010 ). The document describing the model was entitled “Social‐Emotional Wellness in Texas Schools: A Guide for Schools, Agencies, Organizations, Parents, and Communities.” A summary of the model is provided as follows.
The Texas School‐Based Social/Emotional Wellness Model was designed as a comprehensive service delivery model to promote collaborative and coordinated approaches for addressing whole student needs through a multitiered process. Improvements in student, system, and school outcomes, as well as improvements in the model itself, are informed by an ongoing and systematic review of data collected from five critical components of the model. Each of these components works in tandem with one another to ensure effectiveness and improve outcomes. The five components are:
1 Fundamental concepts
2 School‐based service delivery model
3 Student outcomes
4 System outcomes
5 Continuous improvement process
The foundation of the model is based on two fundamental concepts, psychological