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Perceptions of school based mental health services by directors and supervisors of student services

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Perceptions of school based mental health services by directors and supervisors of student services
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Dixon, Decia N
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Education
School psychology
School counseling
School social work
Educational administration
Dissertations, Academic -- School Psychology -- Specialist -- USF   ( lcsh )
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theses   ( marcgt )
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ABSTRACT: Key stakeholders in schools must be educated about the importance of increasing access to mental health services in schools. School-based mental health services are designed to increase children's competence and help them meet the societal expectations of school success. The present study examined types of mental health services provided to students in school districts throughout Florida; the extent to which those services were provided to children and families; the beliefs of student services directors and supervisors regarding qualifications of school mental health service providers to provide mental health services; and their beliefs about the impact of mental health services on student academic and behavioral outcomes. Participants in this study included 90 student support services administrators (student services directors, supervisors of psychology, social work, and counseling).Descriptive analyses revealed that the three most commonly provided mental health services were consultation, normative assessment, and authentic assessment. Interestingly, no mental health service providers (school psychologists, school counselors, school social workers) were considered by student services directors and supervisors as qualified to highly qualified to provide intervention services with minimal to no supervision. Results of this study suggest that student services directors and supervisors have significantly different perceptions about the level of qualifications of mental health providers to provide mental health services. Specifically, the type of credential (teaching only vs. student support) which the director or supervisor held impacted their beliefs about the school psychologists level of qualification to provide mental health services.Finally, directors and supervisors, combined, had significantly different ratings about the types of mental health services which impacted academic and behavioral outcomes. Directors and supervisors ratings of impact of mental health services on academic and behavioral outcomes were moderated by the type of credential held. Implications of such results may be that mental health providers are only encouraged to provide those services which they are perceived to be qualified to provide; training programs may need to develop models which promote collaboration and partnership amongst mental health professionals to increase shared skills; and administrators may place an emphasis or de-emphasis on mental health services based on credential and training background.
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Thesis (Ed.S.)--University of South Florida, 2007.
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by Decia N. Dixon.
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Perceptions of School Based Me ntal Health Services by Dir ectors and Supervisors of Student Services by Decia N. Dixon A thesis submitted in partial fulfillment of the requirements for the degree of Education Specialist Department of Psychological and Social Foundations College of Education University of South Florida Major Professor: George M. Batsche, Ed.D. Michael J. Curtis, Ph.D. Constance V. Hines, Ph.D. Date of Approval: June 29, 2007 Keywords: education, school psychology, school counseling, school social work, educational administration Copyright 2007, Decia N. Dixon i

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Table of Contents List of Tables iii List of Figures vi Abstract vii Chapter One: Introduction 1 Statement of Problem 1 Rationale 9 Purpose of Study 10 Research Questions 11 Significance of Study 12 Definition of Terms 12 Chapter Two: Review of the Literature 14 Introduction 14 Defining Mental Health Services 14 The Historical Background of Child Mental Health 16 Lack of Mental Health Services for Children 18 Mental Health and Student Outcomes 20 Importance of Mental Health Services in Schools 24 Role of School Psychologist, Counselor and Social Worker and Mental Health in Schools 26 Summary 34 Chapter Three: Method 36 Participants 36 Selection of Participants 36 Research Design 37 Instrumentation 37 Procedure 39 Step One: Selection of Participants 39 Step Two: Data Collection 40 Step Three: Data Management 40 Data Analysis 41 Chapter Four: Results 48 Survey Response Rate 49 Description of the Sample 51 Description of Districts 54 Research Questions 58 Research Question 1 58 Research Question 2 63 i

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Research Question 3 81 Research Question 4 91 Research Question 5 103 Chapter Five: Discussion 115 Summary and Discussion of Findings 116 Limitations 125 Implications for Practice and Future Research 127 Conclusion 131 References 133 Appendices 145 Appendix A: Perception of School Mental Health Services Survey (Version A) 146 Appendix B: Perception of School Mental Health Services Survey (Version B) 156 Appendix C: Informed Consent for Directors of Student Services (Version A) 165 Appendix D: Informed Consent for Supervisors of Student Services (Version B) 169 Appendix E: Pilot Study Cover Letter and Review Form for Student Services Direct ors (Version A) 173 Appendix F: Pilot Study Cover Letter and Review Form for Student Services Supervisors (Version B) 182 iii

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List of Tables Table 1 Response Rate of Sample Participants by Role 50 Table 2 Academic and Professional Credentials of Directors 52 Table 3 Academic and Professional Creden tials of Supervisors 53 Table 4 Number and Percent of Students by Demographic Ca tegory 55 Table 5 Ratio of FTE Student Services Personnel: Student by Size of District 57 Table 6 Level of Mental Health Se rvice Provision by District Size 59 Table 7 Mean Ratings of Perceived Qualifications of School Psychologists to Provide MH Services by Professional Role 65 Table 8 Mean and Standard Deviations of Ratings of Level of Qualifications of School Psychologists to Provide MH Services as Perceived by Directors and Supervisors 66 Table 9 Mean Ratings of Perceived Qu alifications of School Counselors to Provide MH Services by Professional Role 66 Table 10 Mean and Standard Deviations of Ratings of Level of Qualifications of School Counselors to Provi de MH Services as Perceived by Directors and Supervisors 68 Table 11 Ratings of Perceived Qualific ations of School Social Workers to Provide MH Services by Profe ssional Role 71 Table 12 Mean and Standard Deviations of Ratings of Level of Qualifications of School Social Workers to Provide MH Services as Perceived by Directors and Supervisors 72 Table 13 Analysis of Variance of Ratings of Perceived Qualifications of Service Providers to Provide MH Serv ices by Professional Role 76 Table 14 Means of Ratings of Perceived Level of Qualificat ions of Service Providers to Provide MH Services by Professional Role 79 Table 15 Analysis of Variance of Ratings of Perceived Qualifications of School Psychologists to Provide MH Services by Professional Role and Type of Credential 83 iv

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Table 16 Means of Ratings of Perceived Level of Qualifications of School Psychologists to Provide MH Services by Professional Role and Type of Credential 84 Table 17 Means and Standard Devi ations of Qualifications of School Psychologists to Provide MH Services 86 Table 18 Analysis of Variance of Ra tings of Perceived Qualifications of School Counselors to Provide MH Services by Professional Role and Type of Credential 87 Table 19 Mean and Standard Deviation of Perceived Qualifications of School Counselors to Provide MH Services 88 Table 20 Analysis of Variance of Ratings of School Social Workers Based on Perceptions of Their Qualifications to Provide MH Services by Professional Role and Type of Credential 89 Table 21 Mean and Standard Deviati on of Perceived Qualifications of School Social Workers to Provide MH Services 90 Table 22 Beliefs about the Impact of Mental Health Services on Academic Outcomes by Professional Role 92 Table 23 Beliefs about the Impact of Mental Health Services on Academic Outcomes by Professional Position 93 Table 24 Analysis of Variance of Perceived Qualifications about the Impact of Mental Health Services on Academic Outcomes by Professional Role 96 Table 25 Mean and Standard Deviati on of Ratings of Perceived Impact of Mental Health Services on Academic Outcomes 97 Table 26 Beliefs about the Impact of Me ntal Health Services on Behavioral Outcomes by Professional Role 98 Table 27 Beliefs about the Impact of Me ntal Health Services on Behavioral Outcomes by Professional Position 99 Table 28 Analysis of Variance of Pe rceived Qualifications about the Impact of Mental Health Serv ices on Behavior Outcomes by Professional Role 102 Table 29 Mean and Standard Deviati on of Ratings of Perceived Impact of Mental Health Services on Behavioral Outcomes 103 v

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Table 30 Means of Ratings of Perceived Impact of Mental Health Services on Academic Outcomes by Role a nd Type of Credential 105 Table 31 Analysis of Variance of Per ceived Qualifications about the Impact of Mental Health Services on Academic Outcomes by Professional Role and Type of Credential 106 Table 32 Means of Ratings of Perceive d Impact of Mental Health Services on Behavioral Outcomes by Role a nd Type of Credential 110 Table 33 Analysis of Variance of Percei ved Qualifications about the Impact of Mental Health Services on Be havioral Outcomes by Professional Role and Type of Credential 111 Table 34 Means and Standard Deviations of Ratings of Perceived Impact of Mental Health Services on Behavioral Outcomes 113 vi

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List of Figures Figure 1. Level of Mental Hea lth Service Provision by District Size 60 Figure 2. Profile of Mental Health Servi ce by District Size 62 Figure 3. Matrix of Perceptions of Directors and Supervisors Regarding Qualifications of Stude nt Support Personnel to Provide MH Services with No/Minimal Supervision 74 Figure 4. Interaction E ffect of Role and Provider and Service on the Mean Ratings of the Qu alifications of Service Providers to Provide MH Services 78 Figure 5. Role and Credential Interacti on Effect of Mean Ratings about the Impact of Overall Mental Health Services on Academic Outcomes 108 Figure 6. Role and Credential Interacti on Effect of Mean Ratings about the Impact of Overall Mental Health Services on Behavioral Outcomes 114 vii

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Perceptions of School Based Me ntal Health Services by Di rectors and Supervisors of Student Services Decia N. Dixon ABSTRACT Key stakeholders in schools must be edu cated about the importance of increasing access to mental health servic es in schools. School-based mental health services are designed to increase childrens competence and he lp them meet the societal expectations of school success. The present study examined types of mental health services provided to students in school districts throughout Florida; the extent to which those services were provided to children and families; the beliefs of student services directors and supervisors regarding qualifications of school mental health servic e providers to provide mental health services; and their beliefs about the im pact of mental health services on student academic and behavioral outcomes. Participants in this study included 90 student support services administrators (student services directors, supervisors of psychology, social work, and counseling). Descriptive analyses revealed that th e three most commonly provided mental health services were cons ultation, normative assessment, and authentic assessment. Interestingly, no mental health servic e providers (school psychologists, school counselors, school social work ers) were considered by student services directors and supervisors as qualified to hi ghly qualified to provi de intervention services with minimal to no supervision. Results of this study suggest that student services directors and supervisors have significantly different perceptions about th e level of qualif ications of mental health providers to provide mental health services. Specifically, the type of viii

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credential (teaching only vs. student support) which the director or supervisor held impacted their beliefs about the school ps ychologists level of qua lification to provide mental health services. Finally, directors and supervisors, combined, had significantly different ratings about the types of mental h ealth services which impacted academic and behavioral outcomes. Directors and supervisors ratings of impact of mental health services on academic and behavioral outcomes were moderated by the type of credential held. Implications of such results may be that mental health providers are only encouraged to provide those services which they are perceived to be qualified to provide; training programs may need to develop models which promote collaboration and partnership amongst mental health profe ssionals to increase shared skills; and administrators may place an emphasis or de-e mphasis on mental health services based on credential and tr aining background. ix

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Chapter One Introduction Statement of the Problem Schools are expected to educate all st udents (U.S. Dept. of Education, 2001) including a growing populati on of students whose mental health problems often impede or interfere with their learning. Conditions contributing to student mental health problemssubstance abuse, povert y, homelessness, community violence, and physical abuseare rapidly becoming a part of the normal family culture within which many students grow and develop (Na tional Advisory Mental Health Council, 1990). These conditions do not foster an envi ronment in which a child can meet the expected developmental, cognitive, social and emotional demands (Mash & Barkley, 2003). Failure to meet these demands may lead to adaptational failu re, which is the inability to meet the task demands or de velopmental norms that are a part of the expression of the normal developmental pr ogress (Mash & Barkle y, 2003). Typically, developing children who experi ence adaptational failure of ten display high rates of maladaptive behaviors (Mash & Barkley, 2003) Schools, however, are expected to provide a wide range of general, special, and alternative education programs to meet the needs of diverse learners, including thos e with significant ment al health problems (U.S. Dept. of Education, 2001). The Elementary and Secondary Educa tion Act of 2001, No Child Left Behind (U.S. Department of Educa tion, 2001), expects schools to create environments in which all students can succeed. Providing mental health services in the school is a way 1

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that schools can create this type of successful environment. According to the Center for Mental Health in Schools (2002) a school-based mental health need is any need or problem, which produces a barr ier to learning. Mental hea lth services in schools are those services that seek to remove those ba rriers to learning (Center for Mental Health in Schools 2002) and thus address the pr imary concern of the school system, the childs ability to learn. Mental health se rvices in the school are not limited to only counseling, consultation, and other services tr aditionally affiliated with mental health. These services may also include time ma nagement or study skills sessions, which address academic difficulties that impede a students learning (Center for Mental Health in Schools, 2002). As schools m ove forward to address the challenge established by the No Child Left Behind Ac t of 2001 (U.S. Department of Education, 2001), of success for all, important questions must be asked about how schools choose to define mental health services, who is be st qualified to provide these services and which mental health services result in improved academic outcomes. Mental health issues which adversely affect childrens academic performance include: internalizing problem s (e.g., depression and anxiet y), externalizing problems (e.g., conduct disorder, oppositional defiant diso rder, and attention deficit hyperactivity disorder), family issues (e.g., domestic viol ence, child abuse, a nd divorce), substance abuse, anger, poor social skills, stress, lack of family and school support and lack of behavioral, emotional and/or academic skills needed for successful school readiness (Florida Department of Education, 2000; Kestenbaum, 2000). Given the many challenges that children face in the school today, how can schools best meet the needs of the 2

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students they serve? What services ought they to provide? Which professionals are qualified to provide these se rvices in school settings? Legal mandates such as the No Child Left Behind Act of 2001 (U.S. Dept. of Education, 2001) ensures that schools are he ld accountable for providing students with quality instruction that is delivered by hi gh quality teachers. The No Child Left Behind Act of 2001 (U.S. Dept. of Education, 2001) allo ws schools to have the flexibility to use resources where they are needed most and th is may include the provision of universal preventative mental health services for gene ral education students. The Individuals with Disabilities Education Impr ovement Act (IDEIA 2004; Pub. L. No. 108) ensures that children with disabilities receive a free and appropriate education. It also requires schools to provide mental heal th services to students in special education when those services are necessary for a student with a disability to profit from his or her educational experience. Finally, in the stat e of Florida, the Florida legislature in 1972 enacted the Florida Mental Health Act which is now referred to as the Baker Act (State of Florida Department of Children and Families Mental Health Program Office., 2002). The Baker Act helps ensure that adults and children, with a severe mental health condition, that has made them dangerous to themselves or others are provided a reasonab le and just process for involuntary commitment into a mental health facility. Its intent was to encourage individuals to seek mental health care through voluntary commitment, but only when they are able to understand th eir decision and its consequences. It also separates the process of hospitalization from legal competency and seeks to facilitate a persons return to normal community life (State of Florida Department of Children and Families Mental Health Program Office, 2002). The Baker Act pr ovides schools with a formal process for 3

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providing community mental health care to ch ildren with severe mental health problems who may harm themselves or others in the schools. Although legal mandates encourage schools to provide mental health services to the students they serve, addressing the mental health needs of stude nts typically is not a top priority in school settings (Adelman & Taylor, 1998). The irony of this practice is that educators expect children to succeed academically even when they lack the behavioral, emotional or physical skills required for academic success. Furthermore, the mental health needs of children are increasi ng (Adelman & Taylor, 1998). This escalation requires mental health professionals (e.g., school psychologists, school counselors and school social workers) to identify effectiv e mental health services that promote both academic and social success. A report from the National Institute of Medicine (National Advisory Mental Health Council, 1990) estimates that 15% to 22% of the nations 63 million children have mental health problems that are severe enough to warrant further treatment. Unfortunately, 79% of children aged 6-17 y ears with mental disorders do not receive mental health care (Katoaka, 2002). Evidence provided by the World Health Organization (2005) indicates that by the y ear 2020, childhood psychiatric disorders will rise by over 50 percent. Childhood psychiatric di sorders are expected to become one of the five most common causes of morbidit y, mortality, and disa bility among children (Shaffer et al., 1996). Research suggests that ch ildren with mental health issues are much less likely to achieve academic success and have higher rates of school drop out (Adelman & Taylor, 2001). Early withdrawal fr om school is a loss for both the individual and the community. Adverse, long term outcomes for high school dropouts include, a 4

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reduced potential to be successf ul contributors to society and increased potential for unemployment, welfare, and other social services (Cohen, 1998). In economic terms, Cohen (1998) estimated that a single high school drop out can cost as much as $243,000 $388,000 in tax-based support over a lifetime. According to the Center for Disease Cont rol (CDC), the overall rate of suicide among youth has declined slowly since 1992, but remains unacceptably high at 9.5 per 100,000 suicides a year (CDC, 2004). Suicide is the third leading cause of death among young people ages 15 to 24 years. In 2001, 3,971 suicides were reported in this group (CDC, 2004). Homicide also remains a l eading cause of death for young people (CDC, 2001). In the United States, 71% of all deaths among persons aged 10-24 years result from only four causes: motor-vehicle crashes, other unintentional in juries, homicide, and suicide (CDC, 2003). Among youth in the United States between the ages of five and 19, there were 16 homicides that occurred at school in the years 1999-2000 and 2,124 homicides away from school during the same period (U.S. Department of Education and Justice, 2003). The National Crime Victimization Survey (Bureau of Justice Statistics, 2004) reported that the average annual rate of violent crime con tinues to be highest among youth between the ages of 16 and 19 years who were victimized at a rate of 55.6 per 1,000 persons in 2002-2003 (Bureau of Justice Statistics, 2004). All of these alarming statistics indicate a pressing need for mental health services in the schools, particularly for those youth who are unde rserved in our society. Low-income minority children are less lik ely to have access to mental health services than other groups of children (Adelman & Taylor 1998). When these children do receive services, they are of poorer qual ity than those receive d by children of middle 5

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class parents (U.S. Department of Hea lth and Human Services, 1999). HispanicAmerican children and teenagers are the le ast likely of all minority groups to access mental health care, even though Hispanic-Ame rican and African-American children have the highest rates of need for mental health services (U.S. Department of Health and Human Services, 1999). Children from all racial groups that come from impoverished, low-income backgrounds also are not provided with adequa te mental health care services (Barnett, 1998). This is unfortunate, because 50% of impo verished children are at risk for mental health problems (Adelman, & Taylor, 1998) Impoverished children are also at heightened risk for poor academic performance due to differences in physical health, the quality of emotional and cognitive stimula tion received at home, parenting, and their early childhood education e xperiences (Barnett, 1998). Academic failure puts these children at risk for experienci ng later mental health problems. Unfortunately their mental health needs may go untreated because access to mental health services for low SES families is quite limited (Barnett, 1998). Schools are the most likely setting in wh ich low SES minority children receive mental health care (Weist, Paskewitz, Wa rner, & Flaherty, 1996). Children and youth spend a great deal of time in school sett ings, and schools are one of the few stable institutions that exist in impoverished, rural, and underserved areas (Weist, Paskewitz, Warner, & Flaherty, 1996). Services offered in schools are more accessible, affordable, and less stigmatizing than off-site centers, such as community-based mental health centers. Research has shown that schools reduce barriers to mental health care (e.g., 6

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transportation, financial problem s) that constrain the provis ion of services to those children that need them the most (Wei st, Paskewitz, Warner & Flaherty, 1996). When the educational system of the state or district decides to serve as a provider of mental health services, in addition to a provider of e ducational services, the system must assure that it has the commitment fr om its individual schools, as well as the financial and personnel resources. School psyc hologists, school social workers, and school counselors are the primary providers of mental health services in school settings. The recommended school psychologist to st udent ratio is 1:1500, the recommended school counselor to student ra tio is 1:560, and the recommende d school social worker to student ratio is 1:2000 (Keste nbaum, 2000; Curtis, Grier, Abshier, Sutton, & Hunley, 2002; Franklin, 2000). When the mental heal th provider to student ratio exceeds the recommended ratios mentioned above, it becomes challenging for the mental health provider to offer helpful services for stude nts. Providing effective services becomes difficult when mental health providers have caseloads that restrict the amount of time available for serving a student. Research consistently shows that impr ovement in the social, emotional, and behavioral well-being of a child is significan tly related to higher levels of academic achievement, as well as lower rates of aggression, criminality, and mental health problems (Owens & Murphy, 2004). Universal, school-based intervention programs that teach positive social, emotional, and behavior al skills have been shown to also improve the academic performance and social adjust ment (e.g., decline in office referrals and disruptive behaviors) of the students in t hose school environments (Owens & Murphy, 2004). Finally, there is empirical literature which supports the relationship between 7

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student mental health development and academic school success. When children are not successful in school then they have failed to adapt to the school environment and are at risk for a variety of mental hea lth problems (Mash & Barkley, 2003). Willcutt and Pennigton (2000) documented this finding in their investigation, which examined the mental health outcom es of children who read on grade level compared to those who did not read on grad e level. These research ers found that children who failed to read on grade level, because of a reading disability, exhibited significantly higher levels of anxiety and depression, as co mpared to children who read on grade level. Kellam, Rebok, Mayer, Ialongo, and Kalodner (1994) found a similar outcome when the results of their study indicated that failure to master core developmental tasks such as reading in the early primary grade could actua lly contribute to higher rates of depression among some individuals in schools. These af orementioned findings support the idea that schools are an important environment for producing effective st udent outcomes and contributing to the reduction of adaptationa l failure in childhood (Adelman & Taylor, 2001). It is hypothesized that when a child fails to meet his or her expected developmental norms, problems emerge, such as distress or unhappi ness, peer rejection, poor academic performance, school dropout or delinquency (Masten & Curtis, 2000). Schools have the ability to help kids to b ecome competent and successfully meet their expected developmental norms of childhood. When children are ma de competent through the provision of school servic es, we are able to ameliorate many of the problems in psychopathology that are associated with ad aptational failure (Mash & Barkley, 2003). Rationale Although studies have been found which examine administrators beliefs of the roles of mental health service providers and the services they provi de (Agresta, J., 2004; 8

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Burnham, J. J., & Jackson, C. M., 2000; Hartshorne, T.S., & Johnson, M.C., 1985; Lockhart, E. J., & Keys, S. G., 1998; Thomas, A., Levinson, E. M., Orf, M. L., & Pinciotti, D., 1992), a literature search found no previous studies which examined administrators beliefs regarding the relations hip between mental health services and who is best qualifie d to provide these services. The beliefs of district and state school administrators, regarding what is important for childrens educational success, help to shape the values and mission of the educational system, which are later esta blished by school boards and communities (Leadership Training: Continuing Education for Change, 2003). Thus, it is critical to know the beliefs of student services direct ors and supervisors of student services regarding mental health servic es in the school as well as their beliefs about who they believe ought to be the provide r for different types of mental health services in schools. Knowledge of these beliefs can provide stud ent services directors and supervisors of student services with opportunities for prof essional development in areas which will benefit childrens mental health. This study examined the beliefs of student services directors and supervisors of student services about whom they believe ought to be the provider for different types of mental health services in schools. Research has indicated that educators perceive the school psychologist as being i nvolved in mostly assessment-related activities and some counseling, and consultation (Fag an & Wise, 2000). The school counselor is perceived as providing mainly individual and group counseling, guidance programs, helping with school-wide testing and academic scheduling as well as helping school staff with children who have behavior or academic problems (Agresta, 2004). Finally the school social 9

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worker is viewed as a provider of children and families, an informant on childrens social histories, and an organizer w ho is able to bring in community resources (Agresta, 2004). An analysis of the beliefs student services directors and supervisors of student services about mental health services, who is qualified to provide thos e services and the impact of those services on academic and behavioral outco mes, can help to bridge the gap in goals established by mental health professionals in the school and other personnel in the educational system. Purpose of Study The purpose of this study was to determin e the types of mental health services provided to students in school districts throughout Florida and to what extent they are provided to children and families. In addition, the purpose of this study was to investigate the perceptions held by student services di rectors and supervisor s about school mental health providers qualifications to provide ment al health services a nd whether the type of credential held by directors a nd supervisors moderated these beliefs. Finally, this study examined the perceptions held by student se rvices directors and supervisors about the impact of specified mental health services on student academic and behavioral outcomes and whether the type of credential held by directors and supervisors moderated these beliefs. Research Questions The following research questions we re addressed in this study: 1. (a) What is the nature and extent of ment al health services provided to students by school districts in the state of Florida? 10

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(b) Is there a difference in the profile of mental health services provided by school districts based on district size? 2. To what extent do student services direct ors beliefs about the qualifications of student services personnel to provide mental health serv ices differ from those of student services supervisors (i.e., supervis or of psychological services, supervisor of guidance and counseling services, and s upervisor of social work services)? 3. To what extent does the credential he ld by student services directors and supervisors moderate their beliefs about qualifications of individual student services providers to provide mental health services to students and their families? 4. To what extent do student services di rectors and supervisors differ in their perceptions of the perceived impact of specified mental health services (e.g., counseling, consultation, interventions) on students academic and behavioral outcomes? 5. To what extent does the type of credentia l held by student services directors and supervisors moderate their be liefs regarding the impact of mental health services on academic and behavioral outcomes of students? Significance of Study It was anticipated that findings from this study would make a significant contribution to the field of school psychology, education, and to the school mental health service delivery system in several ways. Firs t, this study can provide information for preservice training programs for mental health professionals, with information about how student services directors and supervisors of st udent services view me ntal health services in the schools. Second, this study can offer info rmation to national and state professional 11

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associations about the types of mental health services that need to be addressed with regard to training, research, and professional practice. Thir d, this study may provide the district and the state personnel information regarding whether a dir ectors prioritization of mental health services is dr iven by tradition or whether it is closely tied to the mission of the district. Finally, this study can assist in policy develo pment, that supports efforts, which assist in increasing academic competency (e.g., curriculum based measurement and DIBELS), to be seen as a part of the mental health service deliver y in school settings. Definition of Terms Mental Health Mental health issues embody thos e characteristics and factors, which closely relate to mental well-being. Th e lack of mental wellbeing is characterized by an inability to adapt to ones environm ent and regulate behavior (Websters, 2002). Mental health issues that adversely aff ect childrens academic performance include: internalizing problems (e.g., depression and anxiety), externalizing problems (e.g., conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder), family issues (e.g., domestic viol ence, child abuse, a nd divorce), substance abuse, anger, poor social skills, and stre ss (Florida Department of Education, 2003; Kestsenbaum, 2000). Services that are considered to be Mental Health Related (Luis, Curtis, & Powell 2005): Individual therapy/counse ling Crisis intervention Family therapy/counseling Prescrib ing medication/Medication management Group therapy/counseling Designing/administering individual service plans Substance abuse counseling Program development and administration Early intervention servi ces Personnel training Family/Child advocacy Research and evaluation Behavior management consultation 12

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Supervisors of Student Services. These individuals are the supervisors housed under the department of student services (p sychology, social work, and counseling). The student services staff helps to facilitate the development of cri tical support services programs so that observable and measurable indicators of succe ss for students are achieved (Florida Departme nt of Education, 2003). Administrators. These individuals are also known as Directors of Student Services and they supervise the Supervisors of Stude nt Services (psychology, social work, and counseling). 13

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Chapter Two Literature Review Introduction The purpose of this chapter is to review the existing research literature that explores the types of mental health services provided in schools and the relationship of those services to student outcomes. First, a review of the literature regarding the definition of mental health services will be presented. Next, the history of child mental health services will be examined. The rela tionship between mental health and student outcomes will then be introduced. An examinati on of effective mental health services in the schools will be presented. Finally, the role of the school psychologist, school counselor, and school social work er in mental health servic e delivery in the school will be examined. Defining Mental Health Services The Center for Mental Health in Schools (2002) states that a school-based mental health need is any need or problem, which produces a barrier to learning. Mental health services in schools are those se rvices that seek to remove those barriers to learning (Center for Mental Health in Schools 2002). Tr aditional mental health services include counseling, consultation, psychological skills tr aining and crisis intervention. However, if mental health needs are defined as any need that is a barrier to learning, then a broader view of mental health services might include problem solving, tutoring, academic interventions or study skills sessions, provided to improve a childs academic competence. Clearly, defining mental health services is difficult when such a broad definition of mental health need is posite d. The Policy Leadership Cadre for Mental 14

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Health in Schools (2001) has recognized th is difficulty and stated, ...even with a dictionary-type definition, i ndividual interpretations woul d likely generate a hodge-podge of approaches (p.3). A number of professional associatio ns have provided policy statements addressing mental health services in school s. In a position st atement titled, Mental Health Services in the Sc hools, the National Associa tion of School Psychologists (NASP) provided its perspective on mental health service delivery in schools: The National Association of School Psyc hologists recognizes that school success is facilitated by factors in students li ves such as psychologi cal health, supportive social relationships, positive health beha viors, and schools free of violence and drugs. Mental or psychological health in childhood and adolescence is defined by the achievement of expected developmental cognitive, social, and emotional milestones. Mental health is evidenced by the students forming secure attachments, developing satisfying soci al relationships, and demonstrating effective coping skills. Ment ally healthy child ren and adolescents enjoy a positive quality of life; function well at home, in school, and in their communities; and are free of disabling symptoms of psychopathology ( NASP, 2003, p.1). Although this position statement provides a conceptual overview of what defines mental health in children and adolescents, it does not state specif ically what services should be provided. However, this position st atement advocates for the inclusion of effective, comprehensive mental health serv ices in the schools, emphasizing prevention and early intervention. A number of nationa l health and mental health organizations (U.S. Department of Health and Human Servic es (HHS), 1999: Center for Mental Health 15

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in Schools, 2002) have stated that mental health services must be included in school reform efforts in order to help students overcome barriers to lear ning, which may result from poverty, difficulties in the family, and/ or social and emotional needs. The HHS position recognized that school systems are not responsible for meeting every need of their students, but when those needs adversel y impact learning, schools must then make every attempt to meet those needs in order to facilitate academic progress (U.S. Department of Health and Hu man Services (HHS), 1999). Health and human service provider orga nizations are not the only professional groups to recognize the relationship of mental health needs and sc hool performance. The National School Board Association (1991) em phasized the important relationship of collaborative services of mental he alth and its outcomes on learning: Childrens learning directly benefits from adequate social services and suffers when such services are not forthcoming. If the schools are to be held accountable for students academic achievement and prep aration for the workplace, they have to have a vested interest in other factors that impact learning. (p.16) Although no agreed upon definition of school-based mental health services exists, there is agreement that students have mental health needs that interfere with school performance, that schools must address those needs and that a cadre of strategies and delivery systems exist to accomplish that goal. The Historical Background of Child Mental Health The United States, similar to the West ern European nations, developed childfocused services to address what they consider ed to be child mental health needs, during the latter half of the 19 th century and the beginning of the 20 th century (Pumariega & 16

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Vance, 1999). The combination of compulsory school attendance in th e 1860s, the large numbers of immigrant children in the country and poor child health and hygiene led to increased pressure on schools to provide children with psychological services (Hoagwood & Erwin, 1997, p.436). The establis hment of child abuse laws in the 1880s and juvenile courts in the 1890s helped policy leaders to recognize the existing child mental health services which previously had been in place in society, were no longer adequate to address the needs of the complex and growi ng childrens population of the United States (Pumariega & Vance, 1999). Counseling school-aged children who were juvenile offenders in juvenile court clinics was one of the earliest child mental h ealth services. Prior to this, juveniles were imprisoned with adult offenders without a ny counseling services provided to them (Pumariega & Vance, 1999). The first mental health clinic for children with a focus on school problems was founded in 1896 at the University of Pennsylvania (Pumariega & Vance, 1999). Soon after, in 1898, the Chicago school board surveyed their children to determine the populations mental and physical ch aracteristics. In res ponse to the survey, the school board gave authorization for the development of a psycho-physical laboratory to be open on Saturdays. By 1914, about 20 such school-based clinics were thought to be in existence in the United States (Hoagwood & Erwin, 1997). In 1922, the Commonwealth Foundation conducted a study that recommended and funded the development of child guidance clinics throughout the United States of America. The clinics were initially staffed by social workers but soon attracted a wide variety of professionals, ra nging from pediatricians to psychologists (Pumariega & Vance, 1999). In 1930, the Pennsylvania State Department of Education developed the 17

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model for certification of school psychologists, whose primary purpose was to designate pupils as candidates for special education. In 1975 with the congre ssional passing of the Education for All Handicapped Children Ac t (Education for All Handicapped Children Act; P.L. No. 94-142), students with disabilities were entitled to a free, appropriate public education. Under the subsumed special e ducation services, related services (e.g., psychological services) were to be provided by the school district. Th ese related services ranged from consultation and individual, group or family counseling to speech/language therapy, physical and occupational thera py (Hoagwood & Erwin, 1999). In the 1970s, the related services being provided to students with disabilities began to be viewed more broadly (outside of PL 94-142) to incl ude general educati on students (Hoagwood & Erwin, 1999). Historically, both the educational system and the community have made attempts to meet the mental health needs of the student s. However, as the mental health needs of student and families have grown and become more complex, existing models of mental health service delivery have remained the same As a result, the mental health needs of children and youth increasingly have b een unmet (Hoagwood & Erwin, 1999). Lack of Mental Health Services for Children As a nation, we are in amidst of a public crisis in caring for our children and their emotional, behavioral, and psychological n eeds. The U.S. Department of Health and Human Services (HHS) (1999) report that 1 out of every 5 children has a diagnosable mental, emotional, or behavioral disorder and 1 in 10 children suffer from a serious emotional disturbance. However, 79% of child ren aged 6-17 with mental disorders do not receive mental health care (Katoaka, 2002). It is re ported, The majority of children with 18

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mental health problems fail to receive appropr iate treatment. Many of the six to eight million children in our nation who are in need of mental health interventions receive no care. For the children that receive services perhaps 50 percent of those in need of treatment receive care that is inappropriate for their situation (Flaherty, Weist & Warner, 1996, p. 342). HHS (1999) also reported that minority ch ildren are less likely to have access to mental health services than other groups of children. If they receive services, they are often of poorer quality. Hispanic -American children and teenagers are the least likely of all minority groups to access mental health care, even though it is repo rted that HispanicAmerican and African-American children have the highest need (U.S. Department of Health and Human Services, 1999). Children fr om all racial groups that come from impoverished, low income backgrounds are often not provided with adequate mental health care services, even though 50% of impov erished children are at risk for mental health problems (Adelman, & Taylor, 1998). For children that have mental health need s, schools can serve as the ideal location for the provision of mental he alth services. All children, youth, and families have access to school settings, regardless of socioeconomic status. Providing mental health services in the schools eliminates many of the barrier s (e.g., accessibility, acceptability and funding), which keep children from receiving mental health services (Ambruster, Gerstein, & Fallon, 1997). Ambruster, Gerstein, and Fallon (1997) suggest that the negative stigma of receiving mental health services in communitie s decreases when services are offered at a school versus a clinic setting. Finally, many of the school mental health clinics accept Medicaid for eligible children and services such as counseling and social skills training 19

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can be provided free to the child (Ambru ster, Gerstein, & Fallon, 1997). Schools have been shown as the most optimal place fo r developing psychological competence and teaching children to make informed and a ppropriate choices concerning their health, education and many other aspects of their lives (NASP, 2003). Mental Health and Student Outcomes There has been a demonstrated relations hip between early academic difficulties and mental health outcomes (Stip ek, 2001; Good, Simmons, & Smith, 1998). The U.S. Surgeon Generals report (U.S. Department of Health & Human Services, 1999) has also linked educational performance to mental health. The U.S. Surgeon General (1999) notes that mental health is a critical component of childrens learning and general health and that fostering social and emotional health in children as a part of healthy child development must be a national priority (U.S Department of Health & Human Services, 1999). The report also stated its commitment to integrating family, child, and youthcentered mental health services into all syst ems that serve youth (U.S. Department of Health & Human Services, 1999, p. 124). One of these systems is the school, which is the sole, but presently inadequate, source of me ntal health service de livery for a number of students (Burns et al, 1995). A legal mandate that has encouraged school mental health service delivery, is the Education for All Handicapped Children Act of 1975 (Education for All Handicapped Children Act; P.L. No. 94-142) which is presently known as Individuals with Disabilities Education Improvement Act of 2004 (IDEIA 2004; Pub. L. No. 108). This legal mandate states that school districts mu st not only provide a free and appropriate educational program to all hand icapped children in the most least restrictive environment 20

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but that school districts should provide rela ted services (e.g., counseling) to students who exhibit emotional or behavioral disorders and need the services to benefit from their education. This law has helped to strengthen the obligation of schools to provide appropriate educational services to childre n with emotional problems, leading to an expansion of mental health se rvices in the schools (Flahe rty, Weist, & Warner, 1996). One way that schools can address the obliga tions of school mental health service delivery is by making children competent and fostering resilience within them. If a child is made competent in the tasks of childhood th at they are expected to master, then many of the mental health problems that may arise later in life due to feelings of incompetence are ameliorated. Many of the behavioral and emotional problems experienced in childrens psychopathology are a result of ad aptational failure. According to Mash & Barkley (2003), adaptational failure involves the exaggeration or diminishment of normal developmental expressions, interference in normal developmental progress, and failure to master developmental tasks, and/or use of non-normative skills as a way of adapting to regulatory problems or traumatic experiences. When children fail to adapt and develop a sense of competency by meeting the expecta tions in school or society they often have elevated rates of maladaptive behaviors. Student performance and mental health. Research studies have shown that students experiencing academic and behavioral failure often have internal and external stressors (Policy for Leadership Cadre for Me ntal Health in Schools, 2001). Examples of such outcomes were documented in an empi rical investigation by Willcutt & Pennigton (2000), which found that children who failed to read at grade level, because of a reading disability, exhibited significantly higher levels of anxiety and depression, as compared to 21

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children who read on grade level. Another study by Tremblay et al. (1992) investigated the relationship between student academic pe rformance and conduct behavior problems. Tremblay et al. (1992) found that children who had experienced early academic failure were at a much higher risk for problems with delinquency regardless of whether the youth displayed disruptive beha vior disorders. Petras, Sch aeffer, Ialongo, et al. (2004) had similar findings in their study which inve stigated reading achievement and criminal behavior. The results from this study s howed that students who were on a pathway towards increasing aggression and had high read ing achievement in the first grade were less likely to exhibit criminal behaviors and have a criminal arrest than those with low levels of reading achievement and increasing aggressive behaviors. Research has also shown that increasing a childs level of academic competency can significantly decrease their levels of maladaptive behaviors. Scott & Shearer-Lingo, (2002) investigated whether increasing the reading achievement of students in a selfcontained EBD classroom woul d simultaneously increase th e students behavior. The results of this study indicated that fac ilitating reading fluenc y in self-contained classrooms for students with serious emoti onal and behavioral disorders had positive effects on both their reading achievement a nd on-task behavior. In a study by GinnsburgBlock and Fantuzzo, (1998) they found that when low achieving and performing third and fourth grade students were taught mathematics problem solving skills (e.g., strategies for solving problems and using manipulatives for math problems) and reciprocal peer tutoring was implemented, their academic motiv ation along with their levels of social competence was increased. 22

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Mental health on student performance. School mental health services have also been shown to affect individual student -level outcomes (e.g., grades, retention, attendance, graduation) and system-level outcomes (e.g., reduction of inappropriate special education referrals, suspension/expulsi on rates) (Bruns, Walrath, Glass-Siegel, & Weist, 2004). In an era of school accountabi lity, school leaders ofte n encourage services, which assist in the reduction of barriers to learning, in order to advance positive educational outcomes. The provision of mental health services in schools has been shown to decrease the rate of special education referrals for children suspected of having emotional or behavioral difficulties. Bruns, Walrath, Glass-Siegel, & Weist ( 2004), found that classroom teachers in expanded school mental health service schools were less likely to refer a student for special education because of emotional and beha vioral difficulties than when they were in a school that did not provide comprehensive mental health services. When mental health services were implemented in the Baltimor e city schools, the researchers found that teachers were more likely to refer a child with suspected emotional or behavioral difficulties to a mental health professional em ployed at the school rather than refer them to a special education problem solving team. Mental health services in schools have also been found to have a positive impact on the rate at which students are suspende d from school (Atkins, et. al, 2002). While suspension is used as a mechanism to mainta in a safe school environment, suspensions are usually a result of aggregated minor offenses, which do not involve dangerous harm to any of the parties involved (Bruns, Moor e, Stephan, Pruitt, & Weist, 2005). In fact, research has documented that suspension can make behavior problems worse because 23

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students may prefer to be out of school a nd therefore exhibit behaviors that ensure suspension (Atkins, et. al, 2002). Unfortunate ly, schools often suspend the students who are in greatest academic, emotional, and economic need. Rather than finding services which promote the behavior change that th ese students need, suspension often places them in unsafe settings or settings which are restrictive and do not address their mental health needs (Atkins, et. al, 2002). Bruns, et. al. (2005) found that just having the presence of clinical staff from co mmunity agencies in a school does not decrease the overall suspension rates of students. Howeve r, providing school-based clinical mental health services alongside system atic interventions for behavior problems helped to reduce the rate of suspensions in schools. Such re ductions could be achie ved by using targeted and well-implemented interventions such as classroom behavior management, social skills training, providing alternatives to suspension, a nd individual and group prevention programs for students at risk for suspension (Bruns, et. al., 2005) Importance of Mental Hea lth Services in Schools There is an ongoing debate as to wh ether schools should have to meet all of the mental health needs of children. According to the Policy Leadership Cadre for Mental Health in Schools (2001), the schools focus is education, not mental health and with accountability and reform that targets instruct ional outcomes. The results of the studies by Scott & Shearer-Lingo, 2002; Ginns burg-Block and Fantuzzo (1998); Tremblay et al., (1992); Petras, Schaeffer, Ialongo, et al. (2004) suggest that increasing academic competencies increases mental health outcomes and the studies by Bruns, Moore, Stephan, Pruitt, & Weist, 2005; Bruns, Walrat h, Glass-Siegel, & Weist, 2004 suggest that increasing students mental health has a positive impact on student outcomes. These 24

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results suggest that schools should be concer ned about providing mental health services in the school because the outcomes of school me ntal health service delivery are linked to the mission of education, which is increased academic competency. The Leadership Training: Continuing E ducation for Change (2003) states that school personnel and community members must view effective mental health services in schools differently. According to the Policy Leadership Cadre for Mental Health in Schools, (2001) effective mental health serv ices are not just a bout diagnosing students with problems, providing therapy and behavi or change, connecting community mental health providers with schools or even just about empirically supported treatments. Rather, effective mental health services encompa ss other services such as, programs which promote social-emotional development, incr ease competence, prevent mental health problems, enhance resilience and increase prot ective buffers (Policy Leadership Cadre for Mental Health in Schools, 2001). It is recommended these services be provided as early as possible before the ons et of severe learning, behavi oral, or emotional problems as services which are effective help school staff address barriers to learning and promote healthy development. Early intervention is successful, in that it addresses mild psychosocial problems quickly and thereby prevents unnecessary entry into special education (Foster, Rollefson, Doksum Noonan, & Robinson, 2005). Addressing psychosocial problems early will allow student s to be successful in the classroom and decrease or eliminate the occu rrence of secondary problems re lated to mental health such as learning, attention, and a ttendance problems and the rate of student drop-outs (Leadership Training: Continuing Education for Change, 2003). 25

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Early intervention services, such as anger management, conflict resolution, positive behavioral support, communication skills, and character education are universal prevention services, which are expected to m eet the needs of the majority of the school population. These universal preven tion services use the availabl e resources of the school to promote a learning environment in which th e teacher is able to effectively teach and the students are able to effectively learn. An environment that provides effective mental health services is characterized by a climate of mutual caring and respect, acceptance of responsibility, clear expe ctations, and high personal and ac ademic standards paired with essential resources and supports (Leadership Training: Continuing Education for Change, 2003). The secondary level of effective mental health services addresses individual differences in motivation and development of eac h particular student, so that students can succeed in the positive environment, which ha s been established for them. The more a school provides a comprehensive range of serv ices and interventions, the more likely the learning, emotional and behavior al problems will be prevente d or identified early after the onset. For those more serious problems which impede learning, the students will receive intensive, corrective interventions (Leadership Training: Continuing Education for Change, 2003). The emotional and academic success of our children in school depends on this type of effective mental health service delivery. Role of School Psychologist, Counselor and Soc ial Worker and Mental Health in Schools It is critical for the implementation of eff ective mental health services, that mental health practitioners are conf ronted about the current frag mentation of services, which marginalize mental health services in sc hools. There is a need for collaboration and professional teamwork among the three mental health professional groups that are housed 26

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under the student support services: school psyc hologists, school counselors, and school social workers (Center for Mental Health in Schools, 2002). The role of each schoolbased mental health practitioner will be ex amined separately and connected to their current role as a provider of mental health services in the school. School Psychologist. With the development of The Education for All Handicapped Children Act in 1975 (Educati on for All Handicapped Children Act; P.L. No. 94-142), the provision of psychological services became mandatory in the schools (Thomas, Levinson, Orf, & Pinciotti, 1992). Thes e services have typically been provided in most schools by school psychologists (Thomas, Levinson, Orf, & Pinciotti, 1992). Early history has depicted the school psychol ogists role as primarily assessment. The first psychologist, Arnold Gesell, was appointed with the title of school psychologist and hired in 1919 by a Connecticut school to asse ss children with need (Pumariega & Vance, 1999). After the enactment of P.L. No. 94-142, in 1975 school psychologists became more closely identified with testing and special education placements (Fagan & Wise, 2000). The role of the school psychologist has b een redefined and expanded over the past 20 years. This role expansion includes consultation, counseling and behavior modifications, and research and evaluation (Nastasi, Varjas, Bernstein, & Pluymert, 1998). Despite the opportunities for role expa nsion, Fagan and Wise (2000) report that assessment-related duties still occupy a large portion of the school psychologists time. A study conducted by Curtis, Grier, Abshier, Sutton, and Hunley (2002) revealed that, school psychologists spend approximately 41% of their time in assessment, 25% in report writing, 25% in meetings, and 8% in other activities. 27

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The National Association of School Psychologists (NASP) establishes standards for credentialing and training in school ps ychology. According to NASP the current roles of a school psychologist include: (a) assessm ent, (b) consultati on, (c) prevention, (d) education, (e) health care provision, (f) re search and planning, and (g) intervention. Intervention includes mental health services such as so cial skills training, crisis intervention, mediation, counseli ng, and consultation (NASP, 2003). School psychologists can assume key role s in the development, implementation, and evaluation of school-based mental health programs (Nastasi, Varjas, Bernstein, & Pluymert, 1998). Nastasi, et al (1998) id entified seven key roles that the school psychologist can assume in delivering mental health services in schools. These key roles are: (i) prevention specialists who help t eachers and school administrators foster the development of competent (mentally healthy) individu als. (ii) Child advocates who assist schools in establishing mech anisms for identifying and treating students with psychiatric diso rders. (ii) Direct service providers to help children with emotional disorders such as depression and to families who have preschoolers that are at risk or have di sabilities. (iv) Trainers of teacher consultants that will extend the scope of consultation services in schools. (v) Health care service providers; (vi) sy stem-level interventionists, and (vii) organizational facilitators in school reform and inte ragency collaboration. (p. 217-218). Clearly, school psychologist s can provide mental health services in addition to traditional assessment. Studies have investig ated administrators views on the role of 28

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school psychologists in provi ding mental health servic es. In a study conducted by Cheramine and Sutter (1993), 80 special educat ion directors evaluated the role of the school psychologist, the effec tiveness of mental health service delivery by school psychologists and the job activit ies in which school psycholog ists were expected to be involved. The results of the study revealed that consultation was the most common function of school psychologists. The mental health services that they believed school psychologist commonly provided were assessm ent, consultation, and handling crises. However, the directors believed that school psychologists should become more involved in the areas of counseling and consultation services. In another study by Gilman and Ga briel (2004), 1,710 teachers, school psychologists and administrators were surveyed about the school psyc hologists role as a mental health professional. The results of th e study revealed that more teachers, school psychologists, and administrators desired sc hool psychologists to be more involved in individual counseling, group couns eling, and crisis interventi on. They also desired that school psychologists have an increased invol vement with regular education students, parent consultation and parent work shops. However, although teachers and administrators desired more involvement in these differe nt areas of mental health service delivery, they still expected that the school psychologist would primarily be involved in assessment-related activities (Gilman & Gabriel, 2004). It is also notable that the results of this study revealed that teachers perceived the role of the school psychologist as less helpful to students than administrators (Gilman & Gabriel, 2004). This could be a result of teachers desiring school psychologists to be involved in more activities like consultation and counseling yet expecting that the school psychologists 29

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role is to actually provide more traditional assessment services. These perceptions of the school psychologist, as an expe rt of assessment, could serv e as barriers to the school psychologists role as a mental health provi der. School psychologist s will have to sell their skills as mental health professionals a nd help teachers become aware of the types of mental health services they are able to provide that will help students meet their educational needs for success in school. School Counselor. School counselors are assumed to be the experts in the roles of psychological adjustment and personal prob lems (Agresta, 2004). Though services vary by school and by region, school counselors typically provide individual and group counseling, guidance programs, help with school-wide testing and academic scheduling, as well as help school staff with children who have behavior or academic problems (Agresta, 2004). According to the American School Counsel ors Association (ASCA), the focus of school counseling is to promote student le arning through an interc onnection of student development. The areas of student developm ent are: (a) academic, (b) career, and (c) personal/social (ASCA, 2003). The definition of the current role of school counseling is as follows: Counseling is a process of helping peopl e by assisting them in making decisions and changing behavior. School counselors work with all students, school staff, families, and members of the community as an integr al part of the education program. School counselors promote school success by focusing on academic achievement, prevention, and intervention activities, advocacy, and social/emotional and career development (Campbell & Dahir, 1997, p.8). 30

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Burnham & Jackson (2000) cite (a ) individual counseling, (b) small group counseling, (c) classroom guidance, and (d) consultation as the primary roles of the school counselor. However, as demographics change and the needs of students evolve, school counselors may have to determine whethe r the services they offer meet all of the needs of the students in their schools. In a study by Agresta (2004) counselors reported spending at least 19 percent of their time in only one role, individual counsel ing. Counselors reported they would like to spend even more time in individual (26.2 %) and group (13.7 %) counseling. Finally, counselors reported that they would like to spend more time in parent education and consultation activities than they currently spend. This study suggested that although, school counselors are providing co unseling as a mental health service, they would like to become even more involved in this activity and also provide more consultation and parent training services which will benefit children in schools. Fitch, Newby, Ballestero, & Marshall (2001) conducted an investigation of future school administrators perceptions of the pr ofessional role of school counselors. The researchers believed the investigation was im portant because the administrator of the school in which school counselors are housed often determines the professional role of school counselors. Studies have found that administrators and school counselors may often disagree on the school counselors role and this source of disagreement may be a cause of frustration for the school counselo r and may serve as a barrier to the school counselor in the provision of mental health service deliv ery (Fitch, Newby, Ballestero, & Marshall, 2001). The results of the study indica ted that future school administrators rated crisis response, providing a safe environmen t, communicating with students, and helping 31

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students with transitions as important task s to be performed by the school counselor. Future administrators also indicated that th ey believed the school counselor should be involved in discipline actions, record keeping, assisting with special education services, and testing of students (Fitch, Newby, Ballestero, & Marshall, 2001). The results of this study are important because school counselors of ten perform duties that are unrelated to the role as defined by ASCA. As a conseque nce many students do not receive individual and group counseling or the guidance they need to remove classroom barriers to learning (Fitch, Newby, Ballestero, & Marshall, 2001). School Social Worker. The profession of School social work began to emerge at the beginning of the 20 th century. The school social worker was known as the visiting teacher because he or she was responsible for ensuring that children attended school and helping children acclimate and adjust in sc hool (Agresta, 2004). It was not until the 1940s and 1950s that the term visiting teacher was replaced with th e title of school social worker. The role of the school social workers b ecame more defined as a result of PL 94142. School social workers were now expected to complete social histories, counsel children and families, organize and bring in community resources and work with all of the ecological variables connected to the chil d in order to promot e student adjustment (Agresta, 2004). In a survey by Agresta (2004), school social workers reported that they spent the majority of their time providing individual c ounseling, group counseling, and conflict intervention an d crisis resolution. The School Social Work Association of America (SSWAA) mission statement states that the role of th e school social worker is: 32

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The role of the school social worker is specialized area of practice within the broad field of the social work profe ssion. School social workers bring unique knowledge and skills to the school system and the student services team. School social workers are instrumental in furthering the purpose of the schools, to provide a setting for teaching, learning, a nd for the attainment of competence and confidence. School social workers are hi red by school districts to enhance the district's ability to meet its academic mission, especially where home, school and community collaboration is the key to achieving that mission (SSWAA, 2006, 1). Agresta (2004) investigated school social workers per ceptions of their expected and desired roles in the provi sion of mental health servic es. The average school social worker reported spending about 17 percent of time on individual counseling, 10 percent of time in group counseling and about 11 perc ent of time in administrator and teacher consultation. Most social workers indicated that they desire to spend more time on individual and group counseling and they would like to dedica te less time to consultation. Another result from the study conducted by Agresta (2004) was that community outreach, an area that is more commonly identified with soci al work, was not viewed by social workers as taking up much of their professional time. Similar to the other mental health prof essionals, one of the major issues facing school social workers is the re conceptualization and reinventi on of the role of the school social worker. The role of the school soci al worker now includes prevention specialist, crisis manager, assessment specialist, referra l agent, and case manager. School social workers may also find themselves responsible for carrying out interventions for children 33

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in the schools. As the role changes for school social workers and it becomes more defined, school social workers may need to collaborate even more w ith other school staff and school mental health professionals, in order to promote healthy development, which enhances school success (Franklin, 2000). Summary Schools are expected to educate students whose social-emotional problems significantly interfere with the learning pro cess in the school (Ade lman & Taylor, 2000). Many schools and legislators believe that it is not the responsibili ty of the school to provide extensive mental health services, but that it is only their job to educate (Policy Leadership Cadre for Mental Health in Sc hools, 2001). However, research has shown the provision of mental health services in the schools, are essential to achieve positive educational outcomes (Adelman & Taylor, 200 0). Currently, in many schools there is a fragmentation of services amongst the different mental health servic e providers (Adelman & Taylor, 2000). There is also a misperception of the expected roles of mental health providers. This misperception of expected ve rsus desired roles serves as a barrier in mental health service delivery to child ren. In order to provide comprehensive, multifaceted and cohesive services which overcome the barriers of learning, professionals must not only redefine their roles and help school personnel unders tand their roles, but they must also collaborate with one another to meet their current population of students. Effective mental health services examin e systemic issues, which impact healthy development, and they increase the school academic climate (Leadership Training: Continuing Education for Change, 2003). Eff ective mental health services support students, families, and staff and rely on evidence-based practices which promote learning, 34

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which is found to be connected to healt hy social-emotional development (Leadership Training: Continuing Education for Change, 2003). The development of No Child Left Behind Act of 2001 (U.S. Dept. of Edu cation, 2001), with recommendation for expanding school-based mental health services to remove barriers to learning creates a need to assess attitudes and current practices of mental health services provided in schools. This act also provides the oppor tunity for school psychologists, school counselors, and school social workers to rede fine and expand their roles from what have been their previous roles in the schools. All three groups of mental health professionals have the ability to move beyond what has been known to be their more traditional roles in the schools. These roles have typically not addressed all of the growing mental health needs and demands of their changing student population. 35

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Chapter Three Method The study examined the types of mental he alth services provided to students in school districts throughout Florid a and to what extent they were provided to children and families. The study also investigated the ex tent to which student services directors perceived student services personnel to be quali fied to provide mental health services to students and families and how student services directors perceptions differed from those of student services supervisors (e.g., supervis or of psychological serv ices, supervisor of guidance and counseling services, supervisor of social work services). Finally, the study examined the perceptions held by student se rvices directors and supervisors about the impact of specified mental health services on student academic and behavioral outcomes. The purpose of this chapter is to present the procedures that were used to conduct this study. The chapter will begin with a description of the participan ts and the research design for the study. Next, a discussion of the inst rument that was utilized in this study is presented. The chapter will end with a descript ion of the procedures that were used for data collection and data analysis. Participants The recruited participants in this study were 155 student serv ices directors and supervisors of psychological services, school social work, and guidance and counseling employed in the 67 school districts in the St ate of Florida. The final sample from the original 155 consisted of 90 st udent support services administ rators (e.g., student services 36

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directors, directors/supervis ors of psychological services, school social work, and guidance and counseling) who were employe d throughout the State of Florida. Participants were provided an informed consent form (see Appendices C & D) containing information as to the purpose of the study. In addition, all potential participants had to meet the inclusion criteria set forth by the researcher to enroll in the study (participants must have been student suppo rt services administrators and they must have been employed in the State of Florida). Further, potential participants were informed as to the steps taken to ensure their confidentiality. Research Design This study was a survey design in which data were collected through a self-report questionnaire completed by student services directors, exceptional education directors and the supervisors of psychological servic es, school social work, and guidance and counseling. Instrumentation A review of the existing literature did not result in the identifi cation of any published instruments that could be used for data collection for this study. Therefore, the researcher developed for data collection purposes The Perception of School Mental Health Services (PSMHS) Survey (Versions A and B) (see Appendices A & B). The PSMHS Survey was designed to gather data on de mographic information of stud ent services directors and supervisors of student services (e.g., highest degree earned, year s of experience in current position), district demographic information (e.g., size of school district), the types of mental health services offered in the district (e.g., individual counseling, consultation, authentic assessment) and beliefs about which type of professional (i.e., school 37

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psychologist, school counselor, or school soci al worker) was qualifie d to provide various types of mental health services based on pr ofessional training. In addition, data were collected on the perceptions of administrators regarding which mental health services were related directly to student a cademic and behavioral outcomes. The PSMHS survey Version A was developed for administration to student services directors. It was composed of a total of 21 items, 7 items that collected professional demographics information (items 1-7), 11 items which related to district demographic information (items 8-18) and 4 items addressed issues related to mental health services, specifically, the types of mental health services provided to students and/or their families (item 19), the professiona ls who were believed to be most qualified to provide these mental health services (item 20), the perceived impact of the services on student outcomes (item 21), and the types of support services which we re utilized after a student returned to school after receivi ng an involuntary ex amination (item 22). The PSMHS survey Version B was develope d for administration to supervisors of student services. It was composed of a total of 11 items, 7 items which collect professional demographics information (items 1-7) and 4 items that address issues related to mental health services, specifi cally, the types of ment al health services provided to students and/or thei r families (item 8), the profes sionals who were believed to be most qualified to provide these mental hea lth services (item 9), the perceived impact of the services on student academic and beha vioral outcomes (item 10), and the types of support services which were utilized after a st udent returned to school after receiving an involuntary examination (item 11). 38

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Development of Instrument The researcher of this study developed the instrument. Items for this survey were gleaned from a review of the literature on mental health services. Content validity evidence wa s gathered through the use of an expert review panel consisting of di rectors/supervisors of student services, school psychology, guidance and counseling and social work from Hillsborough, Pasco and Polk Counties (Neuendorf, 2002). The expert panel used a review sheet, which accompanied the survey, to assess the extent to which the instrument had adequate coverage of the domains it was intended to measure. The instrument was pilot tested (Appendices E & F) to assist in assessing the scale for unders tanding of content and res ponse choices, wording of questions, and the total time n eeded to complete the survey. The information for the pilot test was gathered through the use of a panel, consisting of directors/supervisors of student services, school psychology, guidance a nd counseling and social work from Hillsborough, Pasco and Polk Counties (Neuendorf, 2002). Data Collection Procedures Prior to initiating the data collection phase of the study, approval was obtained through the USF Institutional Review Board (IRB) in order to ensure the ethical treatment of the partic ipants in this study. Step One: Data Collection. The procedures for this study were as follows: the researcher mailed to the student services directors and supervisors a packet which contained: 1) a copy of the PSMHS surv ey (version A or B), 2) a cover letter (Appendices C & D) which informed the par ticipants about the purpose of the study, and solicited their participation in completing th e survey, and information about the survey and information about confiden tiality; 3) the USF IRB consent form, which participants 39

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were asked to sign and return, and 4) a postage paid, pre-addressed re turn envelope with an assigned code for follow up purposes. As an incentive to respond, recipients were informed in the cover letter, that three part icipants who returned the completed survey would be randomly selected to receive a $25.00 American Express Gift Card. Ten additional participants who returned complete d surveys would also be randomly selected to receive the book, Response to Intervention:Policy C onsiderations and Implementation (National Association of State Dir ectors of Special Education, 2005). Four weeks after the initial mailing of the survey packet, a reminder email was sent out to all participants, asking all non-respondents to comp lete and return the survey and informed consent form. Two weeks following the first reminder emailing, another final reminder email was sent out to all remaining non-respondents. The final reminder emailing also included an email attachment with the informed consent and survey. Step Two: Data Management. Participants in the study who were mailed a survey were assigned a derived code number that was based upon the county in which they were employed and the order in which they appear ed on their counties page in the Florida Student Support Services Directory. For ex ample, if a participant was employed in Alachua County he or she would be assigned the code 01 because this county was the first to appear in the directory and then if that persons name was the first to appear on the Alachua County directory page then the number assigned to the person was 1, yielding an assigned code number -1. If the person was the third name to appear on the Alachua County page then the assigned number was -3. The code was assigned to each prospective participant and was record ed on return envelopes. The code was used to identify participants who had not responde d for the purposes of subsequent mailings 40

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(Fink, 1995). Once a completed survey was received, it was removed from the identifying envelope with the assigned code and placed in a box separate from the envelopes. This ensured that the identi ty of the participant remained anonymous relative to the selection of the reinforcement. All of the particip ants data were entered into a computer spreadsheet. To assess the accuracy of the data entry, a second coder was trained to understand the data code sheets and they used those sheets to review the data transferred into the computer spreadsheet. An agreement of 100 % accuracy was achieved before the data entry was completed. Data Analysis Data were analyzed using SAS software, Version 9.1 (SAS Institute, 20022003). Summary data in the form of descriptiv e statistics (e.g., frequencies, means and standard deviations were used to descri be the respondent samp le and the district demographic data. Descriptive statistics were used to report professional demographic information, using items 1-6 from survey ve rsions A & B and for district demographic information, using items 8-18 from survey version A. To analyze the data for this study, each research question will be presented and the survey item, which was used to answer each question, is also presented. Finally, the statistical analysis that was used to an swer each research question is explained. Research Question One. (a) What is the nature a nd extent of mental health services provided to students by school distri cts in the state of Florida? (b) Is there a difference in the profile of mental health services provi ded by school districts based on district size? 41

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Survey item 19 (Version A)/ 7 (Version B) was used to identify types of mental health services provided. Th e types of mental health se rvices, which were examined, included: (a) counseling; (b) consultation; (c) norm-referen ced assessments; (d) authentic assessments; (e) prevention services; (f) intervention services and (g) other. Descriptive statistics (e.g., mean and st andard deviation) were computed to describe the data for survey item 19 (Versi on A)/ 7 (Version B). For each service, means and standard deviations of ratings of exte nt of service provided were computed. Summary data on the nature of services provided and the extent to which each service is provided in a district were broken down by size of district (small, small/medium, medium, large, very large) (s urvey item 1, versions A and B), to provide a profile of services offered. Research Question Two. To what extent do student services directors beliefs about the qualifications of st udent services personnel to pr ovide mental health services differ from those of student services supervisors (i.e., supervisor of psychological services, supervisor of guidance and counseling services, and supervisor of social work services)? Survey item 7 (versions A and B) and item 20 (version A)/ 9 (version B) were used for the data analyses for research que stion two. Specifically, survey item 7 was used to identify respondents professional role (st udent services directors vs. supervisors). Each survey item was used to examine the differences between professional roles and the impact this variable (role) relative to belie fs of how qualified stude nt services personnel were to provide mental health services to students and families (item 20 (version A)/ 9 (version B)). 42

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Descriptive statistics (e.g., mean and standa rd deviation) were used to report the ratings of levels of qualification of the se rvice providers (school psychologists, school counselors, and school social workers) to provide mental health (MH) services as perceived by student services directors and supervisors as a combined group and by individual groups. To determine if there were significant differences in the perceived level of qualifications of school psychologists, school counselors, and school social workers to provide mental health services from the pe rspective of student se rvices directors and supervisors a one betweentwo-within subjects analysis of va riance (ANOVA) procedure was conducted. The between-subjects factor was professional role (i.e., student services directors versus supervisors) and the within-s ubjects factors were ty pe of service provider (i.e., school psychologists, school counselors, and school soci al workers) and type of mental health services (i.e., counseling, consultation, normative assessment, authentic assessment, prevention, and intervention). The ANOVA was tested at an alpha level of .05. The Huynh-Feldt test was used to determ ine statistical signi ficance for withinsubjects effects. Post hoc analyses were conducted using the Huynh-Feldt test for the within subjects factors as a follow-up to significant effects in the ANOVA. Research Question Three. To what extent does the credential held by student services directors and supervisors moderate their beliefs about qualifications of individual student services providers to provide mental health serv ices to stude nts and their families? Survey items 4 and 7 (versions A and B) and item 20 (version A)/ 9 (version B) were used for the data analysis of research question three. Specifically, survey item 4 was 43

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used to identify the area(s) in which a profe ssional is credentialed and survey item 7 was used to identify respondents professional role. Each survey item was used to examine the differences between professional roles and ar ea of credentialing a nd the impact of these two variables (role and credentialing) on hi s or her beliefs of how qualified student services personnel were to provide mental h ealth services to stude nts and families (item 20 (version A)/ 9 (version B)). To determine if there were significant differences in the perceived level of qualifications of individual service providers (school psyc hologists, school counselors, and school social workers) to provide mental health services from the perspective of directors and supervisors by type of credential held data were subjected to three separate two between one-within -subjects analysis of varian ce (ANOVA) procedures, one for each type of service provider. The between-sub jects factors were professional role (i.e., directors versus supervisors) and type of credential held (teaching only vs. student support) and the within-subjects f actor was type of mental he alth service (i.e., counseling, consultation, normative assessment, authentic assessment, prevention, and intervention). To protect against violation of Type I erro r rate, the Bonferroni method was used and each ANOVA was tested at an alpha level of .0167. The Huynh-Feldt test was used to determine statistical significance for within-s ubjects effects. Post hoc analyses were conducted using the Huynh-Feldt test for the within subjects factors as a follow-up to significant effects in the ANOVA. Research Question Four. To what extent do studen t services directors and supervisors differ in their perceptions of the perceived impact of specified mental health 44

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services (e.g., counseling, consultation, interventions) on students academic and behavioral outcomes? Survey items 7 (versions A and B) and item 21 (version A)/ 10 (version B) were used for the data analyses of research ques tion three. Specifically, survey item 7 was used to examine professional role. Survey item 21 (version A)/ 10 (version B) was used to examine beliefs regarding the impact of ment al health services on student academic and behavioral outcomes Each survey item was used to examine the differences between professional roles (directors versus supervisors) and their beliefs rega rding the impact of mental health services on academic and behavioral outcomes of students. Means and standard deviations of ratings of the perceived level of impact of the mental health services on students a cademic and behavioral outcomes by student services directors and supervisors as a combined and i ndividual group were computed. To determine if there were significant differences in the perceived level of impact of mental health services on academic outco mes from the perspective of directors and supervisors an analysis of variance ( ANOVA) procedure was conducted. The betweensubjects factor was professional role (i.e., student services directors versus supervisors) and the within-subjects factor was type of mental hea lth service (i.e., counseling, consultation, normative assessment, authentic assessment, prevention, and intervention). The ANOVA was tested at an alpha level of .05. The Huynh-Feldt test was used to determine statistical significance for within-subjects effects. Research Question Five. To what extent does the type of credential held by student services directors and supervisors mode rate their beliefs regarding the impact of mental health services on academic and behavioral outcomes of students? 45

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Survey items 4 and 7 (versions A and B) and item 21 (version A)/ 10 (version B) were used for the data analyses of research question five. Specifically, survey item 4 was used to identify the area in which a profe ssional was credentialed and survey item 7 was used to examine professional role. Survey item 21 (version A)/ 10 (version B) was used to examine beliefs regarding the impact of mental health services on student academic and behavioral outcomes Each survey item was used to examine the differences between professional roles and area of credentialing and the impact of these two variables (role and credentialing) on his or her beliefs regard ing the impact of ment al health services on academic and behavioral outcomes of students. To determine if there were significant diffe rences in the perceived level of impact of mental health services on academic and be havioral outcomes from the perspective of directors and supervisors by type of cred ential held two indivi dual two-between onewithin-subjects analysis of variance (ANOVA) procedure was conducted. The betweensubjects factors were professional role (i.e., directors versus superv isors) and type of credential (teaching only vs. student support) an d the within-subjects factor was type of mental health service (i.e., counseling, c onsultation, normative assessment, authentic assessment, prevention, and intervention). The ANOVA was tested at the alpha level of .05. The Huynh-Feldt test was used to dete rmine statistical significance for withinsubjects effects. Post hoc analyses were conducted using the Huynh-Feldt test for the within subjects factors as a follow-up to significant effects in the ANOVA. Delimitations of Study A delimitation of this study was that onl y educational administrators who were employed as student services directors and supe rvisors of student services in the state of 46

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Florida were participants in the current research study. Theref ore, the results of this study can only be generalized to stude nt services directors and supe rvisors of student services and not to other educational admini strators in Florida (Cozby, 2001). Limitations of Study A potential threat to internal validity was that participants may have been inclined to provide socially desirable responses (C ozby, 2001). By administering a survey about mental health service delivery in the schools, the researcher was assuming that educational administrators believe that mental health services are being provided at some level, within schools. If a district was providing few or no ment al health services, respondents may have been inclined to over-represent or under-represent the range of mental health services offered to students in their district. They also may have been inclined to misrepresent their beliefs a bout the link between specific mental health services and student outcomes (e.g., academic or behavior). Allowing participants to know the purpose of the study may have contribu ted to them providing inaccurate or false information about their actual perceptions of the relationship between mental health services and student outcomes (Cozby, 2001). 47

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Chapter Four Results The present study was designed to examine the types of mental health services provided to students in school districts throughout Florida and the extent to which those services were provided to children and families. The study also investig ated the beliefs of student services directors and supervisors regarding the qualifi cations of specific student services personnel to provide mental health services and extent to which those beliefs differed between student services director s and supervisors (i.e., supervisor of psychological services, supervisor of guidance and counseling services, and supervisor of social work services). Finally, the study exam ined the perceptions of student services directors and supervisors about the impact of specified mental health services on student academic and behavioral outcomes. The purpose of this chapter is to describe the results of the statistical analyses c onducted for this study. The chapter addresses and answers the following research questions: 1. (a) What is the nature and extent of ment al health services provided to students by school districts in the state of Florida? (b) Is there a difference in the profile of mental health services provided by school districts based on district size? 2. To what extent do student services direct ors beliefs about the qualifications of student services personnel to provide mental health serv ices differ from those of student services supervisors (i.e., supervis or of psychological services, supervisor of guidance and counseling services, and s upervisor of social work services)? 48

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3. To what extent does the credential he ld by student services directors and supervisors moderate their beliefs about qualifications of individual student services providers to provide mental health services to students and their families? 4. To what extent do student services di rectors and supervisors differ in their perceptions of the perceived impact of specified mental health services (e.g., counseling, consultation, interventions) on students academic and behavioral outcomes? 5. To what extent does the type of credentia l held by student services directors and supervisors moderate their be liefs regarding the impact of mental health services on academic and behavioral outcomes of students? Survey Response Rate A total of 155 surveys were mailed to stude nt services director s and supervisors in the State of Florida. Thirty-two surveys were received as a result of the first mailing and 58 on the second mailing. A total of 90 surveys were completed and returned (out of a possible 155), representing a 58.1% response rate. A 50% response rate is generally considered adequate for analysis of resear ch results (Babbie, 1982). Table 1 reports the number and percent of completed survey s for both directors and supervisors. 49

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Table 1 Response Rate of Sample Participants by Role Role Number of Surveys Mailed Completed Surveys Returned Response Rate Directors 67 26 38.8% Supervisors School Psychology 43 29 67.4% Guidance and Counseling 24 19 79.2% Social Work 21 16 76.2% Total 88 64 72.7% Overall 155 90 58.1% Data reported in Table 1 re veal that directors had the lowest response rate (38.8%) of all of the professionals in the sample; therefore, the result s from the directors should be considered preliminary and interpreted cautiously. Academic and Professional Cred entials of Respondent Sample Data regarding the academic and professi onal credentials of student services directors and supervisors in the respondent sample are re ported in Tables 2 and 3, respectively. 50

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Student Services Directors. As shown in Table 2, the majority (73%) of student services directors held masters degrees. Twenty-three percent held an educational specialist or doctoral degree. The areas in which directors predominantly earned their degree were in administration (42%) and special education (23%). This differs somewhat from the profile of supervisors whose degree areas were almost evenly distributed across counseling, school psychology, social wor k, and administration (see Table 3). Directors are approximately equally cr edentialed between teaching only (43%) and student support services (5 6%). Fifty-six percent of the directors are new to their current position (1-5 years), while 40% have b een in their positions for 11 years or more. Eighty-eight percent report they have been in the field of education for more than 11 years and 85 % reported being in the field for more than 15 years. Student Services Supervisors. As is reported in Table 3, 44% of student services supervisors in the sample held a masters degree, 31% held an educational specialist degree and 19% held a doctorate degree. Twenty-three percent of the supervisors had earned a degree in counseling, 20% in school psychology, 19% in social work, and 27% in administration. The majority of supervisors (84%) held cr edentials in student support services and 16% held credentials in teaching only. In te rms of the number of years spent in their current position, 38% of the supervisors are ne w to their current position (1-5 years), while approximately 44% have been in thei r current position for 11 years or more. In terms of the number of years spent in the field of education, 89% of the supervisors reported that they had been in the field of education for more than 11 years; and 66% for more than 15 years. 51

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Table 2 Academic and Professional Credentia ls of Directors (N=26) Credential n % Highest Degree Earned Bachelors 1 3.85 Masters 19 73.08 Educational Specialist 1 3.85 Doctorate 5 19.23 Area Degree Earned Special Education 6 23.08 General Education 1 3.85 Counseling 5 19.23 School Psychology 2 7.69 Social Work 1 3.85 Administration 11 42.31 Area in which Credentialed Teaching only 10 43.48 Student Services 13 56.52 Years of Experience in Current Position 1-5 years 14 56.00 6-10 years 1 4.00 11-15 years 6 24.00 More than 15 years 4 16.00 Years of Experience in Educational Setting 1-5 years 2 7.69 6-10 years 1 3.85 11-15 years 1 3.85 More than 15 years 22 84.62 52

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Table 3 Academic and Professional Credentials of Supervisors (N=64) N % Credential Highest Degree Earned Bachelors 4 6.25 Masters 28 43.75 Educational Specialist 20 31.25 Doctorate 12 18.75 Area Degree Earned Special Education 4 6.25 General Education 3 4.69 Counseling 15 23.44 School Psychology 13 20.31 Social Work 12 18.75 Administration 17 26.56 Area in which credentialed Teaching only 10 15.63 Student Services 54 84.38 Years of Experience in Current Position 1-5 years 24 37.50 6-10 years 12 18.75 11-15 years 11 17.19 More than 15 years 17 26.56 Years of Experience in Educational Setting 1-5 years 1 1.56 6-10 years 6 9.38 11-15 years 15 23.44 More than 15 years 42 65.63 53

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Student Enrollment by Size of District Table 4, provides summary data for student s enrolled in districts represented in the sample for the academic school year of 2005-2006, as reported by the student services directors. Minority Students. Minority students make up appr oximately 71% of the student population in the very large districts in the sample. The middle sized districts have the smallest overall percentage of minority students (23%). Free and Reduced Lunch. Although the very large dist ricts have the highest percentage of minority students, the small and large district s were observed to have the highest percentage (45% and 41%, respectivel y) of students who were from low income homes (on free and reduced lunch). Emotionally Handicapped/Severe Emotional Disturbance. Although all of the districts have few students being served in emotionally handicapped or severely emotionally disturbed classrooms, the very la rge districts serve the highest percentage (10%) of students in comparis on to the other districts. Suspensions. The highest rates of suspensions occurred in the small/middle (13%) and large (10%) sized districts. Expulsions and Alternative Education. Overall, very few students (<2%) were reported to be in alternative e ducation or expelled from school. Baker Acts. Very few directors reported the number or percent of students who were Baker Acted in their districts in th e 2005-2006 academic year. Thus, data reported on the number of students Baker Acted in Tabl e 4 are not representa tive of the student population in the districts included in this sample. 54

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Table 4 Number and Percent of Students by Demographic Category (AY 2005-2006) Demographics N n % Small Districts (n= 6) Total Enrollment 22706 Minority Students 9105 40.10 Students on Free Lunch 10018 44.12 Students in EH/SED 310 1.37 Students in Alternative School 278 1.22 Students Suspended 472 2.08 Students Expelled 64 0.02 Students Baker Acted 23 <0.001 Small/Middle Districts (n= 6) Total Enrollment 42846 Minority Students 19072 44.51 Students on Free Lunch 8364 19.52 Students in EH/SED 2297 5.36 Students in Alternative School 525 1.23 Students Suspended 5408 12.62 Students Expelled 43 0.03 Students Baker Acted 3 <0.001 ________________________________________________________________________ Middle Districts (n= 7) Total Enrollment 192096 Minority Students 45109 23.48 Students on Free Lunch 60012 31.24 Students in EH/SED 2644 1.38 Students in Alternative School 1004 0.52 Students Suspended 8024 4.17 Students Expelled 197 0.01 Students Baker Acted 20 <0.001 55

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Large Districts (n= 5) Total Enrollment 404933 Minority Students 199122 49.17 Students on Free Lunch 165654 40.90 Students in EH/SED 10571 2.61 Students in Alternative School 5224 1.36 Students Suspended 41728 10.30 Students Expelled 1223 0.03 Students Baker Acted 171 <0.001 Very Large Districts (n=5) Total Enrollment 777577 Minority Students 558713 71.85 Students on Free Lunch 175628 22.59 Students in EH/SED 75891 9.75 Students in Alternative School 15437 1.99 Students Suspended 41602 5.35 Students Expelled 7784 1.00 Students Baker Acted 300 <0.001 Ratio of FTE Student Services Personnel to Student by Size of District Data regarding the school personnel to stude nt ratio by district size are presented in Table 5. The district size (i.e., small, sma ll/middle, middle, large, and very large) was determined based on the criteria used by the Florida Department of Education. According to the professional associations representing the student serv ices professionals, the recommended school psychologist to stude nt ratio is 1:1500, the recommended school counselor to student ratio is 1:560, and the recommended school social worker to student ratio is 1:2000 (Curtis, Grier, Abshier, Sutton, & Hunley, 2002; Kestenbaum, 2000; Franklin, 2000). 56

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Table 5 Ratio of FTE Student Services Personnel: Student by Size of District (AY 2005-2006) Demographics Mean Ratio Range Small Districts (n= 6) School Psychologists 1:1747 1:1471-1:2500 School Counselors 1:541 1:439-1:871 School Social Workers 1:3515 a 1:3515-1:3515 ________________________________________________________________________ Small/Middle Districts (n= 6) School Psychologists 1:1785 1:1399-1:2400 School Counselors 1:481 1:399-1:541 School Social Workers 1:3713 1:3000-1:5596 ________________________________________________________________________ Middle Districts (n= 7) School Psychologists 1:2561 1:2443-1:3072 School Counselors 1:447 1:349-1:524 School Social Workers 1:4087 1:3413-1:7330 ________________________________________________________________________ Large Districts (n= 5) School Psychologists 1:1866 1:1359-1:2143 School Counselors 1:356 1:212-1:494 School Social Workers 1:3288 1:1286-1:3500 ________________________________________________________________________ Very Large Districts (n=5) School Psychologists 1:1637 1:572-1:1716 School Counselors 1:426 1:361-1:750 School Social Workers 1:2051 1:1809-1:5660 ________________________________________________________________________ Note: FTE=Full-Time Equivalent a There was only one small district out of six that had FTE school social workers 57

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Data from this current study reveal that the district school psychologist to student ratio is often over the recommended NASP ratio across district sizes, with the highest mean school psychologist to student ratio (M=1:2561) occurring in the middle sized districts. The mean ratios of school counsel or to student ratio are often within the recommended ratios. However, the ratio of school counselors to students in the small districts (Range= 1:439-1:871) a nd the very large districts (R ange= 1:361-1:750) districts have ratios that are above th e recommended ratios for school counselors. Finally, school social workers often have numbers that ar e much higher than the recommended ratios, with the highest mean ratio (M= 1:4 087) in the middle sized districts. Research Question 1: Mental Health Servic es Provided to Stude nts by their School District The first research question addressed the level of mental hea lth service provision by district size (small, small/medium, medium, large, and very large). To answer this question, means and standard deviations of pa rticipants ratin gs of the level of mental services provided were calculated. The ratings were based on a 5-point Likert-type scale (5= Provided to all student(s)/ families needing the service; 4= Provided to most student(s)/families needing the service; 3= Provided to some student(s)/families when the service in available; 2= Provided to student (s)/families on a very limited basis; 1= Not provided to student(s)/ families/service is unavailable). The types of mental health services which were examined included: (a) counseling, (b) consultation, (c) normreferenced assessments, (d) authentic a ssessments, (e) prevention services, (f) intervention services and (g) Other. Th e Other category included items such as 58

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59 behavior rating scales, clinic al interviews, case manageme nt, and research evaluation. The results are presented in Table 6 and Figure 1. Table 6 Level of Mental Health Service Prov ision by District Size Small Small/Middle Middle Large Very Large M M M M M MH Services (SD) (SD) (SD) (SD) (SD) Counseling 3.22 2.93 3.17 2.98 3.28 (1.07) (0.71) (1.02) (1.08 ) (0.71) Consultation 3.78 3.81 3.95 3.80 4.25 (1.02) (0.75) (0.94) (0.84 ) (0.67) Normative 4.81 4.54 4.15 4.34 4.67 Assessment (0.47) (0.73) (1.14) (0.64) (0.50) Authentic 3.88 3.97 3.93 4.00 4.29 Assessment (1.32) (1.01) (1.39) (0.97) (0.65) Prevention 3.59 3.58 3.54 3.48 3.87 (0.67) (0.58) (0.74) (0.77 ) (0.57) Intervention 2.93 2.81 3.23 3.33 3.16 (0.83) (0.58) (0.79) (0.72 ) (0.58) Other 2.82 3.44 3.57 3.18 3.91 (0.87) (0.69) (1.01) (0.63) (0.84) Note: Response Scale: 5: Provided to all student(s)/ families needing the service 4: Provided to most student(s)/families needing the service 3: Provided to some student(s)/families when the service in available 2: Provided to student(s)/fami lies on a very limited basis 1: Not provided to student(s)/ families/service is unavailable

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0 1 2 3 4 5 6 small small/middle middle large very large District SizeMean Rating of Level of Provision Counseling Consultation Normative Assessment Authentic Assessment Prevention Intervention Other 60 Figure 1 Level of Mental Health Servic e Provision by District Size

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61 All districts reported providi ng a variety of services to students, but to differing degrees. A closer examination of the data re veal (Table 6 and Figur e 1) that the three services most frequently provided across all districts were normative assessments, authentic assessments, and consultation. Norm ative assessments are the mental health service that is most likely to be provided to most students and families (Range= 4.154.81). In contrast, interventions (Range = 2.81-3.33) and counse ling (Range= 2.93-3.28) are the mental health services that are least likely to be provided to most students and families who need it. In fact, a closer examination of Table 6 reveals that the interventions and counseling services are prov ided to some families when the service is available or is provide d on a limited basis. In addition, Figure 2 reveals that the ve ry large districts provided consultation, authentic assessment, prevention and other services to most students and families that needed it. For normative assessments, small, small/middle and very large districts provided this service to most students and families that need ed it. Overall, both Figures 1 and 2 reveal that very large districts are most likely to provide a number of different mental health services to all or most students and families who need it, while smaller districts are less likely to pr ovide a number of mental hea lth services to all or most students and families that need it.

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0 1 2 3 4 5 CounselingConsultationNormative Assessment Authentic Assessment PreventionInterventionOther Mental Health ServicesMean Rating of Level of Provision small small/middle middle large very large 62 Profile of Mental Health Service by District Size Figure 2

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Research Question 2: Perceived Qualifications of Student Services Personnel to Provide Mental Health Services The second research question sought to de termine the extent to which student services directors and supervisors (i.e. school psychology, counseling and guidance, and social work) perceived school psychologists, school counselors, and school social workers as qualified to provide specific mental health services. The ratings were based upon a 5-point Likert-type scale (5= highly qua lified no supervision needed; 4= qualified and minimal supervision needed; 3= somewhat qualified and supervis ion is needed; 2= minimally qualified and intense supervision needed; 1= Not qualified). The response scale was developed to reflect the level of qualification and supervision perceived necessary for the given student services provider to provide quality services. To answer the research question, means a nd standard deviations of ratings of levels of qualification as perceived by stude nt services directors and supervisors as a combined group and by individual groups were computed. Then data were subjected to analysis of variance procedures to determine if there were significant differences in perceptions between direct ors and supervisors. Mean ratings of the perceived level of qualifications of the service providers (school psychologists, school counselors, and sc hool social workers) to provide mental health (MH) services as perceived by stude nt services directors and all supervisors combined are reported in Tables 7, 9, and 11. Mean ratings by dire ctors and individual supervisors (school psychologists, school couns elors, and school social workers) are reported in Tables 8, 10, and 12. 63

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School Psychologist. Data reported in Tables 7 and 8 reveal that directors often rate school psychologists as be ing more qualified to provi de a number of individual mental health services in comparison to th e ratings of student services supervisors. Overall, the ratings from di rectors and supervisors, as a group, suggest that school psychologists are perceived as being qualified or somewhat qualified to provide most of the identified mental health services. As is shown in Table 7 re veals that directors perceived that school psychologists to be qualified (needing only minimal supervision) to provide normative assessment (M= 4.88), Oth er services (M= 4.50), consultation (M= 4.38), counseling (M= 4.26) and au thentic assessment (M= 4.10). Supervisors, as a group, rated school ps ychologists as qualified (needing only minimal supervision) to provide normative assessment (M =4.91), consultation (M= 4.20) and Other services (M= 4.07). School psychologists were rated by directors as somewhat qualified (needing supervision) to provide intervention (M= 3.83) and prevention (M= 3.67), while supervisors, as a group, rated them as somewhat qualified (needing supervision) to provi de services in intervention (M= 3.72), authentic assessment (M= 3.58), counseling (M= 3.47), and preventi on (M= 3.37). A closer examination of Table 8 reveals that supervisors of social work rated school psychologists as minimally qualified (needing intense s upervision) (M= 2.94) to provide counseling services. 64

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65 Table 7 Mean Ratings of Perceived Qualifications of School Psychologists to Provide MH Services by Professional Role ean Ratings of Perceived Qualifications of School Psychologists to Provide MH Services by Professional Role Directors Student Services Supervisors MH Services M SD M SD Counseling 4.26 0.78 3.47 1.28 Consultation 4.38 0.56 4.20 0.64 Normative Assessment 4.88 0.24 4.91 0.23 Authentic Assessment 4.10 0.94 3.58 1.29 Prevention 3.67 0.67 3.37 1.06 Intervention 3.83 0.83 3.72 0.87 Other 4.50 0.87 4.07 0.84 Overall Mental Health Service 4.23 0.70 3.90 0.89 Note: Response Sc ale: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified

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66 Table 8 Mean and Standard Deviations of Ratings of Level of Qualifications of School Psychologists to Provide MH Services as Perceived by Directors and Supervisors Directors Supervisors Supervisors Supervisors Student Services Psychology School Counseling Social Work M SD M SD M SD M SD MH Services Counseling 4.26 0.78 3.78 1.07 3.67 1.44 2.94 1.32 Consultation 4.38 0.56 4.19 0.64 4.22 0.73 4.27 0.54 Normative Assessment 4.88 0.24 4.91 0.21 4.92 0.24 4.93 0.25 Authentic Assessment 4.10 0.94 3.65 1.36 3.06 1.27 4.09 1.00 Prevention 3.67 0.67 3.58 1.02 3.46 1.12 3.01 1.03 Intervention 3.83 0.83 3.78 0.77 3.69 1.10 3.75 0.81 Other 4.50 0.87 4.21 0.73 3.95 1.03 4.01 0.79 Range of Ratings 3.67-4.88 3.65-4.91 3.06-4.92 2.94-4.93 Note: Response Scale: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified

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School Counselor. Data reported in Table 9 reveal that directors rated school counselors as qualified (needing only minima l supervision) to provide prevention services (M= 4.02) and somewh at qualified (needing supervis ion) to provide all other mental health services except normative assessments for which they are rated as minimally qualified (needing intense supervis ion; M=2.51). Services in prevention (M= 4.02), intervention (M = 3.90), and counseli ng (M= 3.79) were the top three mental health services which school counselors were considered to have the highest qualifications to provide. Supervisors, as a group, also rated school counselors as having highest qualifications to provide intervention and cons ultation services (M= 3.83 and 3.74, respectively). Supervisors, however, did not rate counsel ing as one of the top three services for school counselors, instead rati ng prevention (M =3.69) as one of the top three. Supervisors of guidance and counseling, in general, tended to rate the qualifications of school counselors higher on al l MH services than did directors and the supervisors of psychology and social work (see Table 10). Specificall y, they are seen by supervisors of school counseling as qualified (needing only minimal supervision) in the provision of intervention (M= 4.11), counse ling (M= 4.09), and consultation (M= 4.05) services, and they are seen as minimally qualified (needing intens e supervision) to provide normative assessments (M= 2.90). In contrast, supervisors of psychology and social work rate counselors as somewhat qua lified (needing supervis ion) to provide all mental health services except normative assessments for which they are rated as minimally qualified (needing intens e supervision; M=2.38 and 2.09). 67

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68 Table 9 Mean Ratings of Perceived Qualifications of School Counselors to Provide MH Services by Professional Role ean Ratings of Perceived Qualifications of School Counselors to Provide MH Services by Professional Role Directors Student Services Supervisors MH Services M SD M SD Counseling 3.79 0.74 3.53 0.87 Consultation 3.64 0.67 3.74 0.67 Normative Assessment 2.51 0.85 2.40 0.92 Authentic Assessment 3.60 1.16 3.46 1.22 Prevention 4.02 0.48 3.69 0.71 Intervention 3.90 0.63 3.83 0.82 Other 3.45 0.63 3.24 0.89 Overall Mental Health Service 3.56 0.74 3.41 0.87 Note: Response Scale: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified

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69 Table 10 Mean and Standard Deviations of Ratings of Level of Qualifications of School Counselors to Provide MH Services as Perceived by Directors and Supervisors Directors Supervisors Supervisors Supervisors Student Services Psychology School Counseling Social Work M SD M SD M SD M SD MH Services Counseling 3.79 0.75 3.20 0.75 4.09 0.73 3.56 0.97 Consultation 3.64 0.67 3.43 0.61 4.05 0.65 3.98 0.63 Normative Assessment 2.51 0.86 2.09 0.80 2.90 0.93 2.38 0.81 Authentic Assessment 3.60 1.16 3.45 1.28 3.56 1.29 3.47 1.07 Prevention 4.02 0.48 3.61 0.81 3.91 0.66 3.60 0.52 Intervention 3.90 0.63 3.72 0.96 4.11 0.73 3.76 0.52 Other 3.45 0.62 3.16 0.80 3.56 0.97 3.08 0.91 Range of Ratings 2.51-4.02 2.09-3.72 2.90-4.11 2.38-3.98 Note: Response Scale: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified

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Social Worker. Data reported in Table 11 reveal that directors and supervisors gave similar ratings of perceived qualifications of social workers to provide a number of individual mental health serv ices. For the most part, they were rated by directors and supervisors as a group and individuall y, as somewhat qualified (needing some supervision) to provide most mental health services and minima lly qualified (needing intense supervision) to provide normative and authentic assessment services. As is seen in Table 12, supervisors of social work rate school social workers as qualified (needing minimal supervision) to provide services in the area of counseling (M= 4.22). Directors rated them as qualified (needing only minimal s upervision) in the area of prevention (M= 4.02) and Other services (M= 4.02) a nd minimally qualified (needing intense supervision) in the provision of normative (M= 2.68) and au thentic (M= 2.53) assessments. Supervisors of psychology rated school social workers as somewhat qualified (supervision needed) to provide Other services (M= 3.88), counseling (M= 3.85), prevention (M= 3.77), consultation (M= 3.43) and interventions (M= 3.10) services; minimally qualified (intense supervision need ed) to provide normative assessments (M= 2.17), and not qualified to provide auth entic assessments (M= 1.92). Similarly, supervisors of guidance and counseling rate d social workers as qualified (needing only minimal supervision) to provide Other services (M=4.02), and somewhat qualified (supervision needed) to provide coun seling (M= 3.78), prevention (M= 3.77), consultation (M= 3.44), and intervention serv ices (M= 3.05); while minimally qualified (intense supervision needed) to provid e normative (M= 2.46) and authentic (M= 2.34) assessments. 70

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71 Table 11 Ratings of Perceived Qualifications of School Social Workers to Provide MH Services by Professional Role atings of Perceived Qualifications of School Social Workers to Provide MH Services by Professional Role Directors Student Services Supervisors MH Services M SD M SD Counseling 3.88 1.06 3.92 0.88 Consultation 3.53 1.11 3.53 0.94 Normative Assessment 2.68 0.94 2.42 1.11 Authentic Assessment 2.53 1.34 2.11 1.08 Prevention 4.02 0.61 3.86 0.75 Intervention 3.59 0.85 3.18 1.20 Other 4.02 0.76 4.00 0.76 Overall Mental Health Service 3.46 0.95 3.29 0.96 ote: Response Scal N e: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified

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72 Table 12 Mean and Standard Deviations of Ratings of Level of Qualifications of School Social Workers to Provide MH Services as Perceived by Directors and Supervisors Directors Supervisors Supervisors Supervisors Student Services Psychology School Counseling Social Work M SD M SD M SD M SD MH Services Counseling 3.88 1.06 3.85 0.58 3.78 0.93 4.22 1.15 Consultation 3.53 1.11 3.43 0.82 3.44 1.21 3.76 0.80 Normative Assessment 2.68 0.94 2.17 1.09 2.46 1.33 2.75 0.98 Authentic Assessment 2.53 1.34 1.92 0.85 2.34 1.45 2.17 1.07 Prevention 4.02 0.61 3.77 0.85 3.91 0.74 3.93 0.58 Intervention 3.59 0.85 3.10 1.20 3.05 1.48 3.46 0.79 Other 4.02 0.76 3.88 0.72 4.02 0.93 4.17 0.53 Range of Ratings 2.53-4.02 1.92-3.88 2.34-4.02 2.17-4.22 Note: Response Scale: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified

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73 Figure 3 provides a matrix showing a summ ary of the mental he alth services that student service providers are pe rceived by student services dir ectors and supervisors to be highly qualified or qualified to provide with l ittle/no supervision (i.e ., for mean ratings of 4 to 5). As is shown, school psychologists are consistently ra ted by directors and supervisors as being qualified, needing little supervision in the provision of normative assessments and consultation. A closer examination of the matrix reveals that directors and supervisors of social work also rated school psychologists as be ing qualified (needing minimal supervision) to pr ovide authentic assessments. In addition, directors and supervisors of psychology and social work rated them similarly to provide Other services (e.g., behavioral ratings). Directors al so provided high ratings of qualifications to school psychologists in the area of counseling. For school counselors and social worker s, there is no consistency amongst the directors and student services supervisors as to the MH serv ices which school counselors and social workers are highly qua lified or qualified to provide. It is interesting to note that none of the professional se rvice providers were rated as highly qualified or qualified (needing only minimal supervision) to provide intervention services.

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74 Figure 3 Matrix of Perceptions of Directors and Supervisors Regarding Qualifications of Stude nt Support Personnel to Provide MH Services with No/Minimal Supervision Directors Supervisor Psychology Supervisor Counseling Supervisor Social Work Directors Supervisor Psychology Supervisor Counseling Supervisor Social Work Directors Supervisor Psychology Supervisor Counseling Supervisor Social Work X X X XXXX X XXXX XX XX XX X X X XX School Counselor School Social Worker School Psychologist Prevention Intervention Other Counseling Consultation Normative Assessment Authentic Assessment Mental Health Service

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Test of Differences in Perceptions Between Directors and Student Services Supervisors. To determine if there were significant differences in the perceived level of qualifications of school psychologists, school counselors, and school social workers to provide mental health services from the pe rspective of student se rvices directors and supervisors, a one betweentwo-within -subjects analysis of variance (ANOVA) was conducted. The between-subjects factor was professional role (i.e., student services directors versus supervisors) and the within-s ubjects factors were ty pe of service provider (i.e., school psychologists, school counselors, and school soci al workers) and type of mental health services (i.e., counseling, consultation, normative assessment, authentic assessment, prevention, and intervention). The Other category was not included in these analyses as it covere d a range of services not cl early delineated. The ANOVA was tested at an alpha level of .05. The Huynh-Feld t test was used to determine statistical significance for within-subjects effects, as the sphericity assumption was violated. Examination of Table 13 reveals statistic ally significant interaction effects for Role x Provider x Service, F (10, 670) = 2.14, p <.05 and Provider x Service, F (10, 670) = 62.13, p < .001, employing the Huynh-Feldt adjust ment. Statistical significance was not observed for the Service x Role interaction effect, F (5, 335) = 0.42, p >.05, or Provider x Role interaction effect, F (2, 134) = 1.06, p > .05. Significant main effects were observed for the type of mental health service, F (5, 335) = 12.85, p <.05, and type of service provider, F (2, 134) = 28.50, p < .001, employi ng the Huynh-Feldt adjustment, the main effect for professional role (directors vs. supe rvisors) was not statistically significant F (1, 67) = 3.89, p > .05. 75

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Table 13 Analysis of Variance of Ratings of Perceived Qualifications of Service Providers to Provide MH Services by Professional Role ________________________________________________________________________ Source df SS MS F HF ________________________________________________________________________ Between Ss Role (A) 1 3.89 3.89 1.24 S/A (Error) 67 211.01 3.15 Within Ss Provider (B) 2 90.12 45.06 28.50 < .001* Provider*Role (AB) 2 3.35 1.67 1.06 ns S/AB (Error) 134 211.83 1.58 Service (C) 5 52.99 10.60 12.85 < .001* Service*Role (AC) 5 1.74 0.35 0.42 ns S/AC (Error) 335 Provider*Service (BC) 10 228.53 22.85 62.13 < .001* Role *Provider*Service (ABC) 10 7.89 0.79 2.14 .043* SC/AB (Error) 670 246.45 0.37 ________________________________________________________________________ Total 1241 1057.80 *p>.05 Note: Professional Role (Directors vs. Supervisors) 76

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77 Role x Provider x Service Interaction Effect. To determine the providers between which there were statistically significant diffe rences based on ratings of their perceived level of qualifications by student services directors and supervisors, post hoc analyses were conducted using Dunns test. Huynh-Feldt adjustment was employed for the withinsubjects factor since the sphe ricity assumption was violate d. A graph of the interaction effect is shown in Figure 4. The in teraction effect is disordinal. Results of the Dunns test indicate that for directors there were no significant differences in mean ratings of perceived qua lifications of the th ree service providers (school psychologist, school c ounselor, and school social work er) to provide services in counseling, consultation, prevention, and inte rvention. However, significant differences in qualification ratings were observed for services in normative and authentic assessments (see Table 14). In the area of normative assessments, directors rated school psychologists as significantly higher in terms of their qualifications to provide these services than both school counselors and social workers (see Table 14). No differences in ratings were observed between school counsel ors and social workers. For authentic assessments, directors rated school psychologists and school couns elors significantly higher (p < .05) in the level of qualifications to provide these services than social workers; there were no differences in mean ratings between school psychologists and school counselors.

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Interaction Effect of Role and Provider and Service on the Mean Ratings of the Qualifications of Service Providers to 0 1 2 3 4 5 Directors Supervisors Professional RoleMean Ratings of Mental Health Services 0 1 2 3 4 5 6 CounselingConsultationNRA AA PreventionIntervention Mental Health ServiceMean Ratings of MH Service School Psychology School Counseling School Worker 0 1 2 3 4 5 6 CounselingConsultationNRA AA PreventionIntervention Mental Health ServicesMean Ratings of MH Services by Providers School Psychologist School Counselor School Social Worker 78 Provide MH Services Figure 4

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Table 14 Means of Ratings of Perceived Level of Qua lifications of Service Providers to Provide MH Services by Professional Role Student Support Professionals School Psychology School Counselor School Social Worker Marginal Mean MH Service M M M M Directors Counseling 4.26 3.78 3.88 Consultation 4.39 3.64 3.53 Normative Assessment 4.88 2.51 2.68 Authentic Assessment 4.10 3.60 2.53 Prevention 3.67 4.03 4.02 Intervention 3.83 3.90 3.62 Marginal Mean 4.19 3.58 3.38 3.72 Supervisors Counseling 3.48 3.53 3.93 Consultation 4.21 3.74 3.53 Normative Assessment 4.92 2.41 2.41 Authentic Assessment 3.59 3.45 2.11 Prevention 3.37 3.69 3.86 Intervention 3.72 3.83 3.18 Marginal Mean 3.88 3.44 3.17 3.49 Overall MH Services 3.69 3.51 3.27 3.49 Note: Response Scale: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified Professional Role: (Directors vs. Supervisors) 79

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With respect to supervisors of student serv ices statistically significant differences were observed in their mean ratings of the pe rceived level of qualific ations of the school psychologists, counselors, and social worker s to provide services in the areas of consultation, normative assessments, authentic assessments, and interventions. More specifically, supervisors rated school psychologists as being more qualified to provide services in the area of consu ltation than social workers (p <.05); however, there were no differences in mean qualification ratings qua lifications between sc hool psychologists and school counselors or between school counsel ors and social workers to provide these services (see Table 14). Rela tive to normative assessments, school psychologists were rated by student services supervisors as being more highly qualified (p < .05) than school counselors and social workers to provide th ese services; no differences in perceived levels of qualifications to provide normative assessments were observed between school counselors and social workers. Supervisor s rated both school ps ychologists and school counselors as being more qualified than social workers to provide authentic assessments; no significant differences in ratings of qualifications we re observed between school psychologists and school counselors. In th e area of intervention, they rated school counselors as being more qualified than soci al workers to provide these services; no significant differences in perceived qua lifications were observed between school psychologists and school counselors or between school psychologist s and school social workers. Finally, in the areas of counseling and prevention, there were no differences in supervisors mean ratings of the percei ved level of qualifications among school psychologists, school counselors, and social workers. 80

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Of note, although school psychologists were rated significantly higher than school counselors and school social workers to pr ovide mental health services such as counseling, consultation, normative assessment, and authentic assessment, they were still perceived as needing at least minimal supervis ion to provide such services, and the most qualified to provide services in normative assessment. Research Question 3: Perceived Qualifications of Student Services Personnel to Provide Mental Health Services as Mode rated by Type of Credential Held The third research question sought to determine the exte nt to which the type of credential held by student servi ces directors and supervisors moderated their beliefs about qualifications of individual st udent services providers (sc hool psychologists, counselors, and school social workers) to provide ment al health services to students and their families. The ratings were based on a 5-point Likert-type scale (5= highly qualified no supervision needed; 4= qualified and mini mal supervision needed; 3= somewhat qualified and supervision is needed; 2= minimally qualifie d and intense supervision needed; 1= Not qualified). The response scal e was developed to reflect the level of qualification and supervision perceived necessary for the given student services provider to provide quality services. Data were subjected to three separate two between one-within-subjects analysis of variance (ANOVA) procedures, one for each type of service provider. The betweensubjects factors were professional role (i.e., directors versus superv isors) and type of credential held (teaching only vs. student support ), the within-subjects factor was type of mental health service (i.e., counseling, c onsultation, normative assessment, authentic assessment, prevention, and intervention). To pr otect against inflation of the Type I error 81

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rate, a Bonferroni adjustment was used and each ANOVA was tested at an alpha level of .0167. The Huynh-Feldt test was used to determ ine statistical signi ficance for withinsubjects effects, as the spheri city assumption was violated. School Psychologists. Examination of Table 15 reveals that for the withinsubjects effects, the Service x Role x Credential interaction was not statistically significant, F (5, 380) = .40, p> .05. Similarly, neither of the two-way interaction effects was statistically significant Service x Credential, F ( 5, 380) = 1.75, p > .05, and Service x Role, F (5, 380) = 1.04, p > .05. The main effect for type of mental health service, however, was statistically significant, F (5, 380) = 16.87, p < .001. For the between-subjects eff ects, the Role x Credential interaction was not statistically significant, F (1, 74) = .06, p > .05, neither was the main effect for professional role, F (1, 74) = 0.92, p > .05. The ma in effect for type of credential, was however, statistically significant, F (1, 74) = 9.45, p < .05. Thus, as is shown in Table 16, regardless of professional role (director vs. supervisor), those respondents who held a teaching only credential rated school psychologi sts as significantly more qualified to provide mental health services (M=4.22) th an did their counterpart s who held a student services support cr edential (M=4.09). 82

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Table 15 Analysis of Variance of Ratings of Perceived Qualifications of School Psychologists to Provide MH Services by Professional Role and Type of Credential ________________________________________________________________________ Source df SS MS F H-F ________________________________________________________________________ Between Ss Role (A) 1 1.73 1.73 0.92 Credential (B) 1 17.87 17.87 9.45* Role*Credential 1 0.11 0.11 0.06 S/AB (error) 76 143.71 1.89 Within Ss Service (C) 5 49.79 9.96 16.87 < .001* Service*Role (AC) 5 3.07 0.62 1.04 ns Service*Credential (BC) 5 5.15 1.03 1.75 ns Service*Role*Credential (ABC) 5 1.19 0.24 0.40 ns SC/AB (error) 380 224.28 0.59 _______________________________________________________________________ Total 479 446.84 *p<.0167 Note: Professional Role (Directors vs. Supervisors) ; Credential (T eaching only vs. Student Support) 83

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Table 16 Means of Ratings of Perceived Level of Qualifications of School Psychologists to Provide MH Services by Professional Role and Type of Credential Type of Credential Teaching Only Student Support Marginal Mean MH Service M M M Directors Counseling 4.53 4.16 Consultation 4.53 4.71 Normative Assessment 4.98 4.97 Authentic Assessment 4.55 4.64 Prevention 4.06 3.94 Intervention 4.06 3.86 Marginal Mean 4.45 4.38 4.42 Supervisors Counseling 4.03 3.37 Consultation 4.30 4.13 Normative Assessment 4.78 4.91 Authentic Assessment 3.81 3.44 Prevention 3.36 3.29 Intervention 3.64 3.71 Marginal Mean 3.99 3.80 3.90 Overall MH Services 4.22 4.09 4.15 Note: Response Scale: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified Professional Role: (Directors vs. Supervisors) ; Credential (Teaching only vs. Student Support) 84

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Service Main Effect. To determine the mental health services between which there were significant differences in mean ratings for school psychologists as perceived by directors and supervisors combined, Tukeys HSD post hoc test was employed. Results of these analyses revealed that across direct ors and supervisors, the mean qualification rating for normative assessment was significan tly higher than ratings for counseling, authentic assessment, preventi on, and intervention services (see Table 17). In addition, the qualification mean rating to provide servi ces in consultation was significantly higher than ratings for counseling, authentic asse ssment, prevention, and intervention. No significant differences were observed in ratings between counseling, authentic assessment, prevention and intervention. Thus school psychologists were considered by the directors and supervisors to be significantly bette r qualified to provide mental health services in the areas of normative as sessment and consultation (M=4.89 and 4.29, respectively) than in counseling, authentic assessment, preven tion, and intervention where they were considered to be somewhat qualified to provide these services with some supervision needed. 85

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Table 17 Means and Standard Deviations of Ra tings of Qualifications of School Psychologists to Provide MH Services to Dir ectors and Supervisors Combined ________________________________________________________________________ School Psychologist MH Service M SD Counseling 3.87 1.03 Consultation 4.29 0.60 Normative Assessment 4.89 0.24 Authentic Assessment 3.84 1.12 Prevention 3.52 0.87 Intervention 3.78 0.82 ________________________________________________________________________ Note: Response Scale: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified School Counselors. Examination of Table 18 reveal s that for the within-subjects effects the Service x Role x Credential intera ction was not statistically significant, F (5, 390) = 1.28, p > .05, nor were the interaction e ffects for Service x Credential, F (5, 390) = 1.75, p > .05 and Service x Role, F (5, 390) = 0.74, p > .05. However, there was a statistically significant main effect for type of mental heal th service, F (5, 390) = 28.85, p < .001. The between-subjects effects were not statistically significant, the Role x Credential interaction, F (1, 78) = .031, p > .05, the credential main effect, F (1, 78) = 2.72, p > .05 and role main effect, F (1, 78) = 0.61, p > .05. 86

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Table 18 Analysis of Variance of Ratings of Perceived Qualifications of School Counselors to Provide MH Services by Professional Role and Type of Credential ________________________________________________________________________ Source df SS MS F H-F Between Ss Role (A) 1 1.05 1.05 0.61 Credential (B) 1 4.68 4.68 2.72 Role*Credential 1 0.52 0.52 0.31 S/AB (error) 78 134.27 1.72 Within Ss Service (C) 5 79.76 15.95 28.85 <.001* Service*Role (AC) 5 2.06 0.41 0.74 ns Service*Credential (BC) 5 4.84 0.97 1.75 ns Service*Role*Credential (ABC) 5 3.53 0.71 1.28 ns SC/AB (error) 390 242.86 0.53 ________________________________________________________________________ Total 491 473.57 ________________________________________________________________________ *p<.0167 Note: Response Scale: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified Professional Role: (Directors vs. Supervisors) ; Credential (Teaching only vs. Student Support) Service Main Effect. To determine the mental health services between which there were significant differences in mean ratings for school couns elors (as perceived by directors and supervisors, combined) Tuke ys HSD post hoc test was employed. Results of these analyses revealed across directors a nd supervisors, the mean ratings of perceived qualifications of school counselor s to provide services in c onsultation were significantly higher (p<.05) than ratings for normative assessment no significant differences in 87

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qualification ratings were observed betw een consultation, and counseling, normative assessment, authentic assessment, preven tion, and intervention (see Table 19). Table 19 Mean and Standard Deviation of Pe rceived Qualifications of School Counselors to Provide MH Services ________________________________________________________________________ School Counselors MH Service M SD Counseling 3.90 0.83 Consultation 4.06 0.62 Normative Assessment 3.64 0.58 Authentic Assessment 3.78 1.08 Prevention 3.68 0.69 Intervention 3.83 0.83 ________________________________________________________________________ Note: Response Scale: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified School Social Workers. Examination of the data in Table 20 reveals that for the within-subjects effects, statis tical significance was observed for the main effect for type of mental health service, F (5, 320) = 38.41, p < .001. The Service x Role x Credential, F (5, 320) = 0.92, p > .05, Service x Credential interaction, F (5, 320) = 0.51, p > .05 and Service x Role interaction, F (5, 320) = 0.63, p > .05 effects were not statistically significant. No statistica l significance was found for the between-subjects effects. 88

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Table 20 Analysis of Variance of Ratings of School Social Workers Based on Perceptions of Their Qualifications to Provide MH Services by Professional Role and Type of Credential ________________________________________________________________________ Source df SS MS F__ H-F Between Ss Role (A) 1 0.09 0.09 0.03 Credential (B) 1 3.20 3.20 1.08 A*B 1 9.43 9.43 3.17 S/AB (error) 64 190.05 2.97 Within Ss MH Service (C) 5 96.13 19.22 38.41 <.001* MH Service*Role (CA) 5 1.57 0.31 0.63 ns MH Service*Credential (CB) 5 1.28 0.26 0.51 ns MH Service*Role*Credential (CAB) 5 2.31 0.46 0.92 ns SC/AB (error) 320 160.17 0.50 ________________________________________________________________________ Total 407 464.23 ________________________________________________________________________ *p<.0167 Note: Response Scale: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified Professional Role: (Directors vs. Supervisors) ; Credential (Teaching only vs. Student Support) Service Main Effect. To determine the mental health services between which there were significant differences in overall mean ratings for school social workers across directors and supervisors, Tukeys HSD pos t hoc test was employed. Results of these analyses revealed that mean ratings of per ceived qualifications of school social workers to provide services in counseling was signi ficantly higher than ratings for authentic assessment and intervention but not for the other mental heal th services, consultation, normative assessment, and prevention. Ratings for consultation were significantly higher 89

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than ratings for authentic assessment and intervention but not for normative assessment and prevention. The ratings for normative assess ment were significantly higher than that for authentic assessment but not for prevention and intervention. No differences in ratings were observed between prevention a nd intervention (see Table 21). Table 21 Mean and Standard Deviation of Pe rceived Qualifications of School Social Workers to Provide MH Services ________________________________________________________________________ School Social Workers MH Service M SD Counseling 4.09 0.83 Consultation 3.96 0.75 Normative Assessment 3.65 0.68 Authentic Assessment 3.11 1.01 Prevention 3.77 0.71 Intervention 3.47 1.02 _______________________________________________________________________ In sum, although there were overall differen ces in the ratings of qualifications of school psychologists by type of credential held, the type of credential held did not moderate the perceptions of directors vers us supervisors and the perceived level of qualification of the three serv ice providers (school psycholog ists, counselors, and social workers) to provide mental health serv ices to students and their families. Note: Response Scale: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified 90

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Research Question Four: To What Extent do Student Services Directors and Supervisors Differ in their Perceptions of the Impact of Mental Health Services on Students Academic and Behavioral Outcomes The fourth research question assessed dire ctors and supervisor s perceptions of the impact of specified mental health se rvices (i.e., counseling, consultation, normative assessment, authentic assessment, intervention, prevention) on students academic and behavioral outcomes and whether this differed by professional role of the rater (directors vs. supervisors). The ratings were based on a 5-point Likert-type scale (5= Very strong impact; 4= Strong impact; 3= Fairly strong im pact; 2= Minimal impact; 1= No impact). Means and standard deviations of ratings of the perceived level of impact of the mental health services on student academic and behavioral outcomes by student services directors and supervisors as a combined group and by individual groups were computed. Data were subjected to analysis of varian ce procedures to determine if there were significant differences in perceptions between directors and supervisors. Academic Outcomes. Mean ratings of the perceived level of impact of the mental health services (counseling, consultation, nor mative assessment, authentic assessment, prevention, and other) on student academic outcomes as perceived by student services directors and all supervisors combined ar e reported in Table 22 and by directors and individual service providers in Table 23. 91

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92 Table 22 Ratings of Perceived Impact of Mental Health Services on Academic Outcomes by Directors and Supervisors atings of Perceived Impact of Mental Health Services on Academic Outcomes by Directors and Supervisors Directors Student Services Supervisors MH Services M SD M SD Counseling 3.83 0.99 3.94 1.03 Consultation 4.00 0.87 3.68 0.88 Normative Assessment 3.38 1.04 3.17 1.11 Authentic Assessment 4.08 1.09 3.40 1.42 Prevention 3.77 0.78 3.34 0.70 Intervention 3.72 0.82 3.35 0.78 Other 3.46 1.18 3.11 0.98 ________________________________________________________________________ Overall Mental Health Services 3.74 0.97 3.43 0.99 ote N : Response Scale: 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact Professional Role (Directors vs. Supervisors)

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93 Table 23 Ratings of Perceived Impact of Mental Health Services on Academic Outcomes by Professional Position erceived Impact of Mental Health Services on Academic Outcomes by Professional Position Directors Supervisors Supervisors Supervisors Student Services Psychology School Counseling Social Work M SD M SD M SD M SD MH Services Counseling 3.83 0.99 3.69 1.00 3.84 1.21 4.58 0.49 Consultation 4.00 0.87 3.51 0.92 3.77 0.75 4.02 0.91 Normative Assessment 3.38 1.04 3.05 1.16 3.02 1.27 3.67 0.72 Authentic Assessment 4.08 1.09 3.66 1.31 2.83 1.72 3.78 1.09 Prevention 3.77 0.78 3.19 0.70 3.34 0.68 3.74 0.72 Intervention 3.72 0.82 3.19 0.69 3.47 0.91 3.64 0.83 Other 3.46 1.18 3.02 0.90 2.90 1.10 3.71 0.86 Range of Ratings 3.38-4.08 3.02-3.69 2.83-3.84 3.64-4.58 Note : Response Scale: 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact Professional Position (Directors vs. Supervisors of Psychology, School Counseling and Social Work)

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Examination of Table 22 reveals that di rectors rated consu ltation (M= 4.00) and authentic assessment (M= 4.08) as the two ment al health services which have a strong impact on academic outcomes. In contrast, s upervisors, as a combined group, rated all mental health services as having a fairly strong impact, in general, on academic outcomes with counseling and consultation as the se rvices that have the stronger impact. When the supervisors are partitioned by their individual roles (see Table 23), supervisors of psychology were found to rate all mental health services as having a fairly strong impact on academic outcomes. Supervis ors of guidance and counseling rated all mental health services, except authentic assessment and Other services as having a fairly strong impact on academic outcomes. Other services (M=2.90) and authentic assessments (M=2.83) were rated by supervisor s of guidance and counseling as having a minimal impact on academic outcomes. Finally, supervisors of social work rated counseling and consultation (M= 4.58 and 4.02, respectively) as having a strong impact on academic outcomes, while all other mental health services were rated as having a fairly strong impact on academic outcomes. Test of Differences in Perceptions between Directors and Student Services Supervisors. To determine if directors and supervis ors differed in their perceptions of the impact of mental health serv ices on student academic outcomes, data were subjected to a one betweenone-within subjects analysis of variance (ANOVA) procedure. The between-subjects factor was professional role (i.e., student services directors versus supervisors) and the within-subjects factor was type of mental health service (i.e., counseling, consultation, normative assessmen t, authentic assessment, prevention, and intervention). As was done in previous anal yses, the Other category was not included 94

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in these analyses as it covered a range of services not clearly delineated. The ANOVA was tested at an alpha level of .05. The Huynh-Feldt test was used to determine statistical significance for within-subjects factors, as the sphericity assumption was violated. Examination of Table 24 reveals no statistic ally significant interaction effect for Service x Role, F (5, 415) = 2.38, p >.05, however, a significant main effect was observed for type of mental health serv ice, F (5, 415) = 6.08, p < .001, employing the Huynh-Feldt adjustment. For the between-subjects effects, the main effect for type of professional role was not statistically signi ficant, F (1, 83) = 3.08, p > .05. Thus, the data suggest that there were no significant differences in perceptions about the impact of mental health services on academic outcomes between student services directors and supervisors. However, a main effect for type of mental health service was significant; it was observed that supervisors a nd directors combined, rated specific mental health services as having a significantly greater impact on student academic outcomes than other services. 95

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Table 24 Analysis of Variance of Perceived Qualific ations about the Impact of Mental Health Services on Academic Outcomes by Professional Role ________________________________________________________________________ Source df SS MS F Between Ss Role (A) 1 8.96 8.96 3.08 S/AB (error) 83 241.43 2.91 Within Ss MH Service (B) 5 17.88 3.58 6.08 <.001* MH Service*Role (BA) 5 6.99 1.39 2.38 ns SC/AB (error) 415 243.99 0.59 ________________________________________________________________________ Total 509 519.25 *p<.05 Note: Professional Role (Directors vs. Supervisors) Service Main Effect. To determine the mental health services between which there were significant mean differences in ratings by directors and supervisors (see Table 25), Tukeys HSD post hoc test was employed. Resu lts of these analyses revealed student services directors a nd supervisors rated c ounseling services as having a significantly stronger impact on student academic outcomes (p<.05) than normative assessment, authentic assessment, preventi on, and intervention services. Mean ratings for consultation were significantly higher than that for normative assessment, prevention and intervention services. In addition, mean ratings for nor mative assessment were significantly higher than that for authentic assessment. No signi ficant differences in ratings of impact on academic outcomes were observed between prevention and intervention. 96

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Table 25 Mean and Standard Deviation of Ratings of Perc eived Impact of Mental Health Services on Academic Outcomes ________________________________________________________________________ MH Service M SD Counseling 3.91 1.02 Consultation 3.77 0.88 Normative Assessment 3.23 1.09 Authentic Assessment 3.60 1.36 Prevention 3.47 0.75 Intervention 3.46 0.81 _______________________________________________________________________ Note : Response Scale: 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact Behavioral Outcomes. The mean ratings of the perceived level of impact of the mental health services (counseling, cons ultation, normative assessment, authentic assessment, prevention, and other) on student behavioral outcomes as perceived by student services directors a nd all supervisors combined ar e reported in Tables 26 and by directors and individual se rvice providers in Table 27. Data reported in Table 26 reveal th at both directors and supervisors rate counseling as having a strong impact on be havioral outcomes. Supervisors rated authentic and normative assessments as having a minimal impact on behavioral outcomes. Thus, directors and supervisors rated the impact of mental health services on behavioral outcomes as having a strong to minimal impact. 97

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98 Table 26 Ratings of Perceived Impact of Mental Health Services on Behavioral Outcomes by Directors and Supervisors atings of Perceived Impact of Mental Health Services on Behavioral Outcomes by Directors and Supervisors Directors Student Services Supervisors MH Services M SD M SD Counseling 4.13 0.86 4.28 0.93 Consultation 4.08 0.90 3.84 0.96 Normative Assessment 3.34 1.08 2.95 1.04 Authentic Assessment 2.88 1.18 2.58 1.07 Prevention 3.96 0.70 3.63 0.78 Intervention 4.08 0.80 3.93 0.70 Other 3.74 1.14 3.58 0.89 ________________________________________________________________________ Overall Mental Health Services 3.74 0.95 3.54 0.91 Note: Response Sc ale: 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact Professional Role (Directors vs. Supervisors)

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99 Table 27 Ratings of Perceived Impact of Mental Health Services on Behavioral Outcomes by Professional Position erceived Impact of Mental Health Services on Behavioral Outcomes by Professional Position Directors Supervisors Supervisors Supervisors Student Services Psychology School Counseling Social Work M SD M SD M SD M SD MH Services Counseling 4.13 0.86 4.00 0.97 4.34 1.04 4.77 0.42 Consultation 4.08 0.90 3.71 0.95 3.84 0.97 4.19 0.93 Normative Assessment 3.34 1.08 2.76 0.99 2.82 1.21 3.55 0.81 Authentic Assessment 2.88 1.18 2.64 0.88 2.17 1.22 3.19 1.81 Prevention 3.96 0.70 3.43 0.89 3.68 0.62 4.03 0.68 Intervention 4.08 0.80 3.84 0.81 4.03 0.68 4.11 0.58 Other 3.74 1.14 3.52 0.91 3.43 0.90 4.01 0.81 Range of Ratings 2.88-4.13 2.64-4.00 2.17-4.34 3.19-4.77 Note : Response Scale: 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact Professional Position (Directors vs. Supervisors of Psychology, School Counseling and Social Work)

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When the professionals are partitioned by their individual ro les (see Table 27), directors rated counseling (M = 4.13), intervention (M= 4.08), and consultation (M= 4.08) as having a strong impact on behavioral outc omes, while authentic assessment (M= 2.88) was rated as having a minimal impact. In co ntrast, directors perc eived prevention (M= 3.96), Other services (M= 3.74) and normative assessment (M= 3.34) as having a fairly strong impact on behavioral outcomes. Supervisors of psychology rated only counseling (M=4.00) as having a strong impact on behavioral outcomes and normative (M= 2.76) and authentic (M=2.64) assessments as having a minimal impact on behavioral outcomes. They rated mental health services such as intervention (M=3.84), consultation (M=3.71), Other services (M=3.52), a nd prevention (M=3.43) were al l rated as having a fairly strong impact on behavioral outcomes. Supervisors of guidance and counseling rated counseling and intervention (M=4.34 and 4.03, respectively) as having a strong impact on behavioral outcomes and consultation (M =3.84) and Other services (M=3.43) as having a fairly strong impact they rated both normative (M= 2.82) and authentic (M= 2.17) assessments as having a minimal impact on behavioral outcomes. Finally, supervisors of social work rated all mental health services except normative and authentic assessment as having a strong impact on be havioral outcomes. They rated normative (M=3.55) and authentic (M=3.19) assessments as having a fairly strong impact on behavioral outcomes. Thus, Table 27 reveal s a pattern which indicates that counseling and intervention are perceived to have a strong impact on behavioral outcomes, while normative and authentic assessments are perceived to have minimal impact on behavioral outcomes. 100

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Test of Differences in Perceptions between Directors and Student Services Supervisors. To determine whether directors and s upervisors differed in their perceptions of the impact of mental h ealth services on student beha vioral outcomes, data were subjected to a one betweenone within an alysis of variance ( ANOVA) procedure. The between-subjects factor was professional role (i.e., student services directors versus supervisors) and the within-subjects factor was type of mental health service (i.e., counseling, consultation, normative assessmen t, authentic assessment, prevention, and intervention). As in the previous analyses, the Other category was not included in these analyses as it covered a range of services not clearly delineated. The ANOVA was tested at an alpha level of .05. The Huynh-Feldt te st was used to determine statistical significance for within-subjects factor, as th e sphericity assumption was violated. Examination of Table 30 reveals no statistic ally significant interaction effects for Service x Role, F (5, 410) = 1.50, p >.05; however, a significan t main effect was observed for type of mental health servi ce, F (5, 410) = 54.74, p < .001. For the betweensubjects effects, type of professional role was not statistically si gnificant, F (1, 82) = 1.17, p > .05. Thus, data suggest there we re no significant differences in perceptions about the impact of mental health se rvices on behavioral outcomes between student services directors and supervisors. However, a main effect for type of mental health service was significant. It was observed th at supervisors and director s combined, rated specific mental health services as having a signifi cantly stronger impact on student behavioral outcomes than other services. 101

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Table 28 Analysis of Variance of Perceived Qualific ations about the Impact of Mental Health Services on Behavioral Outcomes by Professional Role ________________________________________________________________________ Source df SS MS F Between Ss Role (A) 1 3.38 3.38 1.17 S/AB (error) 82 237.62 2.90 Within Ss MH Service (B) 5 117.95 23.59 54.74 <.001* MH Service*Role (BA) 5 3.23 0.65 1.50 ns SC/AB (error) 410 176.69 0.43 ________________________________________________________________________ Total 503 538.87 *p<.05 Note: Professional Role (Directors vs. Supervisors) Service Main Effect. To determine differences in mean ratings of mental health services by directors and supervisors for beha vioral outcomes, Tukey's HSD post hoc test was employed. Results of these analyses revealed that supervisors and directors combined rated counseling as having a si gnificantly stronger impact on behavioral outcomes (p<.05) than consultation, normative assessment, authentic assessment, and prevention. Consultation was rated as having a significantly stronger impact on behavioral outcomes than normative assessment, authentic assessment, and prevention. There were no significant diffe rences in impact for consultation and intervention. Finally, normative assessment was rated as having a significantly stronger impact on behavioral outcomes than authentic assessment. Thus, s upervisors and director s rated counseling as having the stronger impact on st udent behavioral outcomes. 102

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Table 29 Mean and Standard Deviation of Ratings of Perc eived Impact of Mental Health Services on Behavioral Outcomes ________________________________________________________________________ MH Service M SD Counseling 4.23 0.92 Consultation 3.91 0.94 Normative Assessment 3.06 1.06 Authentic Assessment 2.67 1.11 Prevention 3.72 0.77 Intervention 3.97 0.73 _______________________________________________________________________ Note : Response Scale: 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact Research Question 5: Perceived Impact of Mental Health Services on Students Academic and Behavioral Outcomes by Professi onal Role and Type of Credential Held. The fifth research question sought to determ ine the extent to which the credential held by student services directors and supervisors moderate d their beliefs regarding the impact of mental health se rvices on academic and behavior al outcomes of students. The ratings were based on a 5-point Likert-type scale (5= Very strong impact; 4= Strong impact; 3= Fairly strong impact; 2= Minimal impact; 1= No impact). To determine if there were significant di fferences in the ratings of impact of mental health services on academic and behavioral outcomes from the perspective of directors and supervisors by type of creden tial held, two separate two betweenone within-subjects analysis of variance (ANOVA) procedures were conducted. The betweensubjects factors were professional role (i.e., directors versus superv isors) and type of 103

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credential (teaching only vs. student support) an d the within-subjects factor was type of mental health service (i.e., counseling, c onsultation, normative assessment, authentic assessment, prevention, and intervention). The ANOVA was tested at the alpha level of .05. The Huynh-Feldt test was used to dete rmine statistical si gnificance for withinsubjects effects, as the sphericity assumption was violated. Academic Outcomes. A breakdown of mean ratings by professional role (directors vs. supervisors), type of credential (teaching on ly vs. student support) and type of service (counseling, consultation, normative assessmen t, authentic assessment, prevention, and intervention) is reported in Table 30. Summary data for the two betweenone-within-subjects ANOVA for perceived impact on academic outcomes are reported in Table 31. Examination of this table revealed the interaction eff ects for Service x Role x Credential, F (5, 395) = 0.26, p > .05, Service x Credential, F (5, 395) = 0.86, p > .05, and Service x Role, F (5, 395) = 1.23, p > .05 were not significant. The main eff ect for Service was also not statistically significant, F (5, 395) = 2.20, p > .05. For the between-subjects fact ors the Role x Credential interaction effect was statistically significant, F ( 1, 79) = 5.62, p < .05; however, th e main effects for type of Credential held, F (1, 79) = 0.93, p > .05, and type of professional Role, F (1, 79) = 4.97, p > .05, were not significant. 104

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Table 30 Means of Ratings of Perceived Im pact of Mental Health Services on Academic Outcomes by Role and Type of Credential Type of Credential Teaching Only Student Support Marginal Mean MH Service M M M Directors Counseling 4.07 3.38 Consultation 4.27 3.21 Normative Assessment 3.88 3.16 Authentic Assessment 4.55 3.19 Prevention 4.19 3.35 Intervention 4.04 3.39 Marginal Mean 4.16 3.28 3.72 Supervisors Counseling 3.59 4.03 Consultation 3.74 3.75 Normative Assessment 3.13 3.17 Authentic Assessment 3.73 3.43 Prevention 3.78 3.34 Intervention 3.46 3.36 Marginal Mean 3.57 3.51 3.54 Overall MH Services 3.87 3.39 3.63 Note: Response Scale: 5: highly qualified; no supervision needed 4: qualified; minimal supervision needed 3: somewhat qualified; supervision is needed 2: minimally qualified; intense supervision needed 1: Not qualified Professional Role: (Directors vs. Supervisors) ; Credential (Teaching only vs. Student Support) 105

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Table 31 Analysis of Variance of Perceived Qualific ations about the Impact of Mental Health Services on Academic Outcomes by Professional Role and Type of Credential ________________________________________________________________________ Source df SS MS F Between Ss Role (A) 1 14.07 14.07 4.97 Credential (B) 1 2.62 2.62 0.93 Role*Credential (A*B) 1 20.53 20.53 5.62* S/AB (error) 79 223.60 2.83 Within Ss MH Service (C) 5 6.56 1.31 2.20 ns MH Service*Role (CA) 5 3.65 0.73 1.23 ns MH Service*Credential (CB) 5 2.57 0.51 0.86 ns MH Service*Role*Credential (CAB) 5 0.78 1.56 0.26 ns SC/AB (error) 395 235.41 0.59 ________________________________________________________________________ Total 497 509.79 *p<.025 Note: Professional Role (Directors vs. Supervisors) ; Credential (T eaching only vs. Student Support) 106

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107 Role x Credential Interaction. To determine whether the type of credential held influenced the ratings of directors and supe rvisors about the impact of mental health services on academic outcomes, post hoc anal yses were conducted using Dunns test. A graph of the interaction eff ect is shown in Figure 4. Results of these analyses reveal that for respondents who had a teaching only credential, there was a significant difference (p< .05) in mean ratings of impact on academic outcomes between directors and superv isors. More specifically, directors who had a teaching only credential rate d mental health services, overall, as having a stronger impact on academic outcomes (M= 4.09) than supervisors with a teaching only credential (M= 3.38). There were no signifi cant differences in the ratings of supervisors and directors with a student support credential. Consequently, type of credential held moderated the belief s of directors and supervisors relative to the degree of impact of mental health services on student academic outcomes.

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2.5 3 3.5 4 4.5 Teaching Student Support Type of Crdential HeldMean Ratings of Impact of Mental Health Services on Academic Outcomes 108 Figure 5 Role by Credential Interaction Effect of Impact of Overall Mental Health Services on Academic Outcomes Supervisors Directors Directors Supervisors

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Behavioral Outcomes. A breakdown of mean rati ngs by professional role (directors vs. supervisors), type of credential (teaching only vs. student support) and type of service (counseling, cons ultation, normative assessment, authentic assessment, prevention, and intervention) is reported in Table 32. Table 33 provides summary data for the two betweenone-within-subjects ANOVA for perceived impact of mental health services on behavioral outcomes as a function of professional role and type of cred ential held. As is shown, the main effect for type of service is statistically significa nt, F (5, 390) = 30.74, p < .001. However, none of the interaction effects associated with th e within-subjects factors is significant For the between-subjects fact ors, the Role x Credential interaction effect is statistically significant, F (1, 78) = 5.51, p < .05; the main eff ects for type of credential held, F (1, 78) = 0.71, p > .05 and professional role, F (1, 78) = 2.75, p > .05, were not significant. 109

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Table 32 Means of Ratings of Perceived Im pact of Mental Health Services on Behavioral Outcomes by Role and Type of Credential Type of Credential Teaching Only Student Support Marginal Mean MH Service M M M Directors Counseling 4.25 3.63 Consultation 4.33 3.50 Normative Assessment 3.88 2.91 Authentic Assessment 3.55 2.63 Prevention 4.20 3.49 Intervention 4.34 3.73 Marginal Mean 4.09 3.31 3.70 Supervisors Counseling 3.97 4.37 Consultation 3.30 3.90 Normative Assessment 3.13 2.96 Authentic Assessment 2.35 2.58 Prevention 3.78 3.65 Intervention 3.77 3.96 Marginal Mean 3.38 3.57 3.48 Overall MH Services 3.74 3.44 3.59 Note : Response Scale: 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact Professional Role (Directors vs. Supervisors) ; Credential (Teaching only vs. Student Support) 110

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Table 33 Analysis of Variance of Perceived Qualific ations about the Impact of Mental Health Services on Behavioral Outcomes by Professional Role and Type of Credential ________________________________________________________________________ Source df SS MS F H-F Between Ss Role (A) 1 7.77 7.77 2.75 Credential (B) 1 1.99 1.99 0.71 Role*Credential (A*B) 1 15.55 15.55 5.51* S/AB (error) 78 220.24 2.82 Within Ss MH Service (C) 5 64.22 12.84 30.74* < .001 MH Service*Role (CA) 5 1.59 0.31 0.77 ns MH Service*Credential (CB) 5 5.45 1.09 2.61 ns MH Service*Role*Credential (CAB) 5 0.56 0.11 0.27 ns SC/AB (error) 390 162.95 0.42 ________________________________________________________________________ Total 491 480.32 *p<.05 Note: Professional Role (Directors vs. Supervisors) ; Credential (T eaching only vs. Student Support) Service Main Effect. To determine the mental h ealth services between which overall mean ratings for directors and supervis ors combined, were sta tistically significant, Tukeys HSD post hoc test was employed (alpha level= .05). Results of these analyses revealed that mean ratings of directors and supervisors on the perceived impact of counseling on behavioral outcomes was signi ficantly stronger (p < .05) than that of consultation, normative assessment, authentic assessment, and prevention. In addition, directors and supervisors rated services in consultation as ha ving a significantly stronger impact on behavioral outcomes than normative assessment, authentic assessment, and prevention. The ratings for normative assessm ent were rated as having a significantly stronger impact on behavioral outco mes than authentic assessment. 111

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Role x Credential Interaction. To interpret the significa nt of role by credential interaction effect, Dunns post hoc test (alpha level= .05) was employed. A graph of the disordinal interaction effect is shown in Figure 6 and releva nt cell means are reported in Table 32. Results of Dunns test reveal that in the case of respondents who had a teaching only credential, there was a si gnificant difference between the mean ratings of directors and supervisors. Directors who had a teachi ng only credential were found to rate mental health services as having a stronger impact on behavior outcomes (M=4.09) than supervisors with a teaching only credential (see Table 32). There were no significant differences in the mean ratings of supervis ors and directors who held a student support credential (M=3.31 and 3.57, respectively). Consequently, the type of credential held moderated the beliefs of directors and supervisors relative to the degr ee of impact of mental health services on student behavior outcomes. More specifically, differences ex isted between individuals with a teaching only credential while no diffe rences existed between those with a student support credential. 112

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113 Table 34 Mean and Standard Deviation of Ratings of Perc eived Impact of Mental Health Services on Behavioral Outcomes ________________________________________________________________________ ean and Standard Deviation of Ratings of Perc eived Impact of Mental Health Services on Behavioral Outcomes ________________________________________________________________________ MH Service M SD MH Service M SD Counseling 4.23 0.92 Consultation 3.91 0.94 Normative Assessment 3.06 1.06 Authentic Assessment 2.67 1.11 Prevention 3.72 0.77 Intervention 3.97 0.73 _______________________________________________________________________ Note : Response Scale: 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact

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Role by Credential Interaction Effect of Impact of O verall Mental Health Servic es on Behavioral Outcomes 2.5 2.7 2.9 3.1 3.3 3.5 3.7 3.9 4.1 4.3 Teaching Student Support Type of Credential HeldMean Rating of Impact of Mental Health Services on Behavioral Outcomes Supervisors Supervisors Directors Directors 114 Figure 6

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Chapter Five Summary, Discussion, Implicat ions, and Recommendations for Future Research Educational reforms which are high-st akes and accountability-driven have brought a renewed sense of urgency to assist students with and wit hout disabilities to achieve better outcomes (Bradley, Henders on, & Monfore, 2004). Schools are expected to provide a range of general, special, and alternative education programs which will meet the needs of diverse learners, includi ng those with signifi cant mental health problems (U.S. Dept. of Education, 2001). Ment al health service providers, such as school psychologists, school counselors, and sch ool social workers provide services that are necessary for the educational success of diverse learners. However, research has shown that it is the beliefs of district and stat e school administrators that actually determine the mental health services which are valued a nd provided in public school settings (Leadership Training: Con tinuing Education for Change, 2003). The purpose of this study was to examin e the types of mental health services provided to students in school di stricts in Florida and the exte nt to which those services were provided. In addition, the study investigated the beliefs of student services directors and supervisors about the qualif ications of school mental he alth service providers to provide mental health servi ces and their beliefs about th e impact of mental health services on academic and behavioral outcomes. 115

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The participants in this study were student services directors and supervisors of psychological services, school social work, and guidan ce and counseling employed throughout the 67 school distri cts in Florida. For the purpose of this study, the participants were asked to complete The Perception of School Mental Health Services (PSMHS) Survey (Versions A and B; see appendices A & B). The PSMHS Survey (Dixon, 2006) was designed to gather data on demographic information of student services directors a nd supervisors of student services (e.g., highest degree earned, years of experience in current position), district demographic information (e.g., size of school district), the types of mental health services offered in the district (e.g., individual counseling, consultation, authentic assessm ent) and perceptions of the level of qualification of school psychologi sts, school counselors, and/or school social workers to provide a number of different mental health services. In addition, da ta were collected on the perceptions of administrators regarding which mental health services were related directly to student outcomes. Summary and Discussion of Findings Demographic Characteristics This study was exploratory in nature due to the limited literature base regarding the relationship between admini strator beliefs about school-bas ed mental health services, school mental health providers qualificati ons to provide such services, and the link between mental health services and st udent outcomes. Based on the demographic information that was obtained from this study, it can be concluded that the sample of student services directors had most often ea rned a degree in administration and special education and they were somewhat split between teaching only and student support 116

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services credentials. In contrast, student serv ices supervisors earned degrees in a number of areas, which reflected the diversity of their roles and training for their specific credential. Student services supervisors earned degrees in the area of psychology, counseling, social work and administration and were most likely to have a student support services credential. Clearly, there were differences between directors and supervisors in their training a nd degree/certification areas. Di rectors had either teaching or administrative preparation whereas supervisors had degrees in specific mental health service delivery areas. Thus, it may be plausibl e that this difference in preparation might account for differences in perceptions. The majority of student serv ices directors in the sample had been in the field of education for more than 15 years and more than 50% were appointed to their current position in the last 1 to 5 years. The majority of student services s upervisors had been in the field of education for over 15 years and 44% reported being in their current position as a supervisor for over 11 years. This is of significance, because th e length of time in the field may have influenced their understandi ng and acceptance of the many changes in the mental health field and education which support the expansion of the mental health service provider roles. The data collected about th e school districts revealed interesting results in both the large and small districts in Florida. Larg er districts served higher numbers of minority students, students who were emotionally handicapped/or with severe emotional disturbances, and they had high rates of students that were suspended. Smaller districts, however, served higher numbers of students fr om low-income households and also high rates of students who were suspended. These results are congruent with the research on 117

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school suspension, which suggests that schools often have higher rates of suspension when serving students who are in greatest academic, emotional, and economic need (i.e., high rates of poverty or minority populations ). Rather than finding services which promote the behavior change that these stude nts need, suspension usually places them in unsafe settings or settings wh ich are restrictive and do not address their mental health needs (Atkins, et. al, 2002). In order for school districts to provide students with effective mental health services, resources, time, and staff must be available. The professional associations representing school psychologist s, school counselors, and school social workers have recommended staff to student ratios to ensu re the effectiveness of service delivery (Curtis, Grier, Abshier, Sutton, & Hunle y, 2002; Kestenbaum, 2000; Franklin, 2000). In this study, the school personnel to student ratio by district size for school psychologists and social workers were often over the reco mmended ratios. This is not surprising as Curtis, Grier, & Hunley, 2004 noted that the exiting of school psychologists from the field due to retirement and attrition resulted in a projected shortage of school psychologists through 2010, with the shortage then continuing but declining through 2020. The majority of school districts maintained the appropriate recommended ratios for school counselors, with the exception of sm all and very large districts, which were over the recommended ratios. Mental Health Services Pr ovided by School Districts Findings indicated that the three most frequently provided services across all districts were normative assessments, authen tic assessments, and consultation. Normative assessments were the mental health service that was most likely to be provided to 118

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students and families. Counseling and interven tion services were least likely to be provided to students and families. It is not surprising that normative assessments were the most frequently provided service in the schoo ls in Florida. These results are similar to previous literature which reported that a pproximately 87 percent of the nations schools listed assessment as a frequently provided service for mental hea lth problems (Foster, Rollefson, Doksum, Noonan, & Robinson, 2005). It was suggested that schools are more likely to provide services such as assessmen t rather than counseling or academic and/or behavioral support because the latter services are perceived as needing more resources and requiring a longer length of time to provi de to students than assessment (Foster, Rollefson, Doksum, Noonan, & Robinson, 2005). Perceived Qualifications of Student Serv ices Personnel to Provide Mental Health Services School Psychologists. Descriptive data revealed th at school psychologists were perceived by student services directors and supervisors as being somewhat qualified to qualified to provide a number of different mental health services. Directors and supervisors both rated school psychologists as having the highest qualifications to provide normative assessments. Previous st udies found that despit e the opportunities for role expansion, school psychologists still devote a large portion of their time to assessment-related duties (Fagan & Wise, 2000) It is promising, however, that student services directors and supervisors perceive school psyc hologist as being qualified (needing only minimal supervision) to provide services in addition to normative assessment such as consultation, counseli ng, and Other services (e.g., behavioral observations). Interestingly, directors of stude nt services were more likely to rate school 119

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psychologists as being qualified to provide a range of mental health services than any of the supervisors of student services, including supervisor s of school psychology. This result is surprising because it is often those that are within the field of school psychology that perceive school psychologists to have more skills to provide mental health services than those who are out of the field (Nasta si, Varjas, Bernstein, & Pluymert, 1998). School Counselors. The results of this study suggest that school counselors are perceived by student services directors and supervisors as qualified to minimally qualified to provide a number of mental health services. For example, results from previous studies indicate that school counselor training typi cally prepares counselors to provide students with indi vidual counseling, small group co unseling, classroom guidance and consultation (Burnham & Jackson, 2000). In the present study, directors and supervisors of psychology and social work rated school counselors as somewhat qualified (needing supervision) to provide counseling and consultation. In contrast, supervisors of counseling services rated school counselors as qualified (needing minimal supervision) to provide services in counseling and consultation, as well as O ther services. These results are consistent with previous studies which suggest that profe ssionals in the field of school counseling often have perceptions about th eir role which are not parallel to the perceptions held by other prof essionals (Burnham & Jackson, 2000). In fact, studies have found that administrators and school counsel ors may often disagree on the role of the school counselor. This difference in percep tion may be a cause of frustration for the school counselor and may serve as a barrier to the school counselor in the provision of mental health service delivery (Fitch, Newby, Ballestero, & Marshall, 2001). 120

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School Social Workers. Directors and supervisors rated school social workers as most qualified to provide: 1) prevention, 2) Other, and 3) counseling services. The services which school social workers were seen as least qualified to provide were normative assessment and authentic assessment. Supervisors of school psychology rated school social workers as not qualified to provide authentic assessments. In a previous study, Agresta (2004) reported that school social workers sp ent their time engaged in counseling and consultation. Sc hool social workers indicated that they would like to spend more time engaged in individual and group counseling (Agresta, 2004). However, as the field of school social work changes to meet the demands of educational legislation and policy, school social worker s will be called upon to expand their skill se t to include roles such as prevention specialist, crisis ma nager, assessment specialist, referral agent, and case manager (Franklin, 2000). The results of this study suggest that administrators may not perceive school social workers to have the skills to meet the demands of their redefined roles without some degree of supervision. Finally, no mental health service provide rs were rated as highly qualified or qualified enough to provide interv ention services with minimal to no supervision. This is problematic because IDEIA (2004) allows schools to use a Response to Intervention [RtI]) model to deliver services to at-risk children and youth. In this model, school psychologists, school counselors, and school social workers may find themselves responsible for carrying out or assisting with the implementation of interventions for children in the schools. In addition, NCLB ( 2001) and IDEIA (2004) require that states and school districts demonstrate that the se rvices they provide lead to academic competence and improved achievement for a ll students. The successful implementation 121

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of this model is dependent on the availabil ity of service providers who are qualified to provide interventions or to train other personnel in the implementation of interventions Differences in Perceptions of Qualifications between Directors and Supervisors by Role and Credential Student services directors rated school psychologists as being more qualified than school counselors and social workers to provide normative assessments. A plausible explanation for these results is that school psychologists, despite the urgency for role expansion, often spend a large portion of their pr ofessional time engaged in normative assessments for special education eligibil ity determination (Fagan & Wise, 2000). In addition, directors of student services perceived school psychologists and school counselors as having significantly higher quali fications to provide authentic assessment than school social workers. Supervisors of student se rvices rated school psychologi sts as more qualified than school social workers to provide consultati on. School psychologists were also rated as most qualified to provide normative assessm ents. These results reflect outcomes of previous research which indica ted that the tradi tional roles of school psychologists have been to provide normative assessment and c onsultation (Nastasi, Varjas, Bernstein, & Pluymert, 1998). Similar to the ratings of directors, supervisors rated school psychologists and school counselors as most qualified to provide authentic assessment. Lastly, school counselors were rated as mo re qualified than school social workers to provide intervention services, althou gh with some supervision necessary. When examining whether the type of cr edential held moderated the beliefs of directors and supervisors, re lative to qualific ations of school psychologists, counselors, 122

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and school social workers to provide mental health services results revealed that for school psychologists the main effects for servi ce and type of credential were significant. For school counselors and social workers, only the main effect of service was significant. An examination of the credential main effect for school psychologists indicated that professionals (directors and supervisors) with a teaching only credential rated school psychologists as being more quali fied to provide mental health services than those with a student support credential. These results may suggest that professionals who are outside of the field (teaching) either believe ment al health providers (school psychologists) should have a specific set of skills and qualificat ions based on professional title/role alone and thus rate them as being qualified to provide ment al health services based on these beliefs. Another explanat ion for this result may be th at professionals outside the field (teaching) recognize and/or have witn essed mental health professionals (school psychologists) delivering eff ective mental health services and are less likely than professionals with mental health training, to underreport the skills which they believe exist for these providers. Impact of Mental Health Services on Academic and Behavioral Outcomes Academic Outcomes. The top three services rated by directors and supervisors as having the most impact on academic outco mes were consultation, counseling, and authentic assessment. The majority of mental health services were rated as having a strong to fairly strong impact on academ ic outcomes. The once exception was by supervisors of school counseling who rated authentic assessment as having minimal impact on academic outcomes. 123

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Behavioral Outcomes. The top three services rated by directors and supervisors as having the most impact on behavioral outcomes were counseling, consultation, and intervention. Counseling was reported as ha ving the highest rating compared to other mental health services (strong impact) for st rength of impact on behavioral outcomes. This is interesting, as counseling was reported as the service which was least likely to be provided to children and families. One explan ation for this result could be that school districts recognize the importance of counselin g, but do not have the personnel to deliver the counseling services (Foster, Rolle fson, Doksum, Noonan, & Robinson, 2005). Differences in Perceptions between Directors and Supervisors by Role and Credential. For academic outcomes, counseling and consultation were rated as having a significantly stronger impact than normative and authentic assessment, prevention and intervention. Counseling and c onsultation were rated as havi ng a significantly stronger impact on behavioral outcomes than normative and authentic assessment, prevention and intervention. In addition, counseling was rated as having a si gnificantly stronger impact than consultation. This is an interesting resu lt, as consultation services have been found in the literature to be a highly effective serv ice delivered to students and families and can impact a larger number of students at once than one on one direct counseling (Kratchowill, Elliott & Busse, 1995). It is plausi ble that the perceptions in this current study exist because administrators may be unfamiliar with how effective consultation services can be for students and families. Perhaps they are unaware of the literature which demonstrates the effectiveness of c onsultation and how it is an evidenced-based practice which can produce long-lasting results for both behavior and academics. 124

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Student services directors with a teaching only creden tial rated mental health services as having a higher impact on academic outcomes than student services supervisors with a teaching only cred ential. No differences in ratings existed between supervisors and directors who held a student support credential. For behavioral outcomes it was observed that directors with a teaching only credential rated ment al health services as having a significantly higher impact on beha vioral outcomes than student services supervisors with a teaching onl y credential. In ad dition, there were no differences in ratings between directors and supervisors with a student support credential. The implication of such results are that in districts where mental health providers have student services supervisors with a teaching only credential, they may have to be stronger advocates about the relationship between ment al health services and student outcomes. Additionally, these results may sugge st that in districts where the student services supervisors have a teaching only credential, mental health providers may receive less support for the delivery of a wide range of mental health serv ices, because there is not a strong and established understanding of the relationship betw een mental health services and student outcomes (Flaherty, Weist, & Warner, 1996). Limitations There were several limitations to the present study. One limitation was sampling bias. The sample that was used was only educational administrators (directors and supervisors) who were employed as student services director s and supervisors of student services in the state of Florid a. Therefore, the results of th is study can only be generalized to student services directors and supervisors and not to other educational administrators in Florida or outside of Florida (Cozby, 2001). 125

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A second limitation was that participants may have been inclined to provide socially desirable response s (Cozby, 2001). By administerin g a survey about mental health service delivery in the schools, the researcher was assuming that educational administrators believe that me ntal health services are be ing provided at some level, within schools. If a district was providing few or no mental health services, respondents may have been inclined to over-represent or under-represent the range of mental health services offered to students in their distri ct. They also may have been inclined to misrepresent their beliefs about the link be tween specific mental health services and student outcomes (e.g., academic or behavi or). Allowing particip ants to know the purpose of the study may have contributed to them providing inaccurate or false information about their actual perceptions of the relationship between mental health services and student outcomes (Cozby, 2001). The third limitation is related to the in strument used and represents a potential threat to internal validity. The survey had a specific question in which it asked student service directors to recall the mental hea lth services which were provided in their districts. This approach in troduces the problem of recall bias (Johnson & Christensen, 2004). Student services directors may not have accurately recalled the types of services that their districts provided. They had to re flect back on their prev ious experiences or knowledge and this may have resulted in inaccurate information being provided. The fourth limitation poten tially impacting this st udy was the somewhat low response rate of student servic es directors. According to Ba bbie (1990), a response rate of at least 50% is generally considered adequa te for the analysis and reporting of survey information. This survey achieved a 38.8% respon se rate from student services directors, 126

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therefore, the results from the directors shoul d be considered preliminary and interpreted cautiously. Implications for Training and Practice and Future Directions for Research Presently no research has been f ound regarding the relationship between administrator beliefs about school-based ment al health services, school mental health providers qualifications to provide such se rvices, and the link between mental health services and student outcomes as moderate d by the professional role (directors and supervisors) and type of credential held by th e administrator. The fi ndings of this study indicate that directors and supervisors reported significan tly different ratings about the level of qualifications of school psychologist s, school counselors, and school social workers to provide mental health services. Th e implications of such results may be that mental health service providers are encour aged to deliver only those mental health services which they are perceived by administrators to be qualified to provide, even if, they have the skills and training to provide other services. This is supported by the results in the present study. The results reveal th at the mental health services which administrators perceive school psychologists, school couns elors, and/or school social workers as most qualified to provide (normative assessment, authentic assessment and consultation), based on their skills and training, are also the services in the district which are most frequently provided. Thus, perceptions about the types of me ntal health services which mental health service providers are qual ified to provide is li nked to the range of mental health services offered in districts (Adelman & Taylor, 1998). It is important based on the results in the current study that if mental health providers are actually qualified to provide more mental health services than what is 127

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perceived, that the mental health service prov iders advocate more to administrators about their additional skills and qualif ications. Also the implications of these results for training are that mental health service providers s hould advocate for traini ng program models of practice and research which include cross-disc iplinary partnerships (Fantuzzo, McWayne, & Bulotsky, 2003). The development of such training models will promote collaboration amongst mental health service providers and ensure that they have shared skills and qualifications in the school mental health service delivery system. In addition, the type of credential held by directors and supervisors moderated their beliefs about the impact of mental he alth services on academic and behavioral outcomes. This result is significant because it reveals that it is not only the type of administrative position which is held (dir ector or supervisor) which influences perceptions, but it is also the preparation and the type of cr edential held (teaching only or student support) which matters. It is impor tant that when districts are appointing individuals to administrative positions they examine the training and background of these professionals. For example, in this study the t ype of credential held moderated the beliefs of directors and supervisors about the impact of mental heal th services on academic and behavioral outcomes. These resu lts suggest that the type of credential held by a student service director or supervisor may influence a districts emphasis or de-emphasis which is placed on the relationship between mental health services and academic and/or behavioral outcomes. For students and families, this influences whether their environment provides services that seek to increase academic or behavioral competence and promote positive mental health or whether it emphasizes immediate placement in restrictive settings (e.g., special education) as a result of academic, behavior, and/or 128

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emotional failure. Therefore, districts mu st emphasize that the specific training and preparation of their leadership staff align wi th the goals and policy of the district, with respect to providing school-bas ed mental health services. Based on the current research, there are several recommendations which are suggested for future research. One suggestion for future research is that this instrument be used repeatedly in other states to compare the consistency of results about school mental health services across states. Research has s hown that there are diffe rences in service use and unmet need for childrens mental health se rvices across states a nd that many of those differences are driven by stat e-level factors, such as pol icy, legislation, and funding for childrens mental health car e (McDaniel & Edwards, 2004). In addition, repeated usage of the instrument could allow the researcher to make changes to the instrument, such as modifying questions, or changi ng the order of the questions to ensure the best possible results. Another possible suggestion for futu re research using the instrument, involves changing the format of administration. In th e current study, the researcher used both a paper-based version of the survey which was mailed and an email attachment version of the survey. It was found that the response rate for the pape r-based version was slightly lower (21%) than the response rate for the ema il attachment version (3 7%). Literature has indicated that there is an in creasing popularity and wide ava ilability of the World Wide Web in schools and web-based surveys provide educational researchers with a vehicle for lowering the cost of and easing the effort required to collect and analyze data (Lang, Raver, White, Hogarty & Kromrey, 2000). Th erefore, future research may involve administering the instrument as a web-based survey. 129

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Second, future research should further explore the ratings of student service directors and supervisors about the qualifications of mental health service providers to provide mental health servi ces. It was found in the current study that directors and supervisors did not rate any of the mental health service prov iders as highly qualified or qualified to provide interventions without minimal/no supervision. Schools are being encouraged by recent legislation and polic y to use evidenced-based practices and interventions to promote student success and achievement in schools. However, if service providers are perceived as not highly qualifie d or qualified to provide interventions or train other personnel in the implementation of interventions, then the treatment fidelity of this approach will be immensely impacted. Qualitative research should be conducted to explore who are the professionals which directors and supervisors believe are qualified to highly qualified to provide intervention servic es in schools. In addition, future research should further explore directors and supervisor s perceptions and belie fs about the training and skills needed, for current school mental health providers, to become qualified enough to provide intervention services. Third, future research should examine the relationship between student mental health services and student outcomes (academic and/or behaviorally). In the current study a number of mental health services were endorsed as having an impact on students academic and behavioral outcomes. Future re search should examine the actual impact of a mental health service and changes in acad emic or behavioral outcomes. In addition, future research should examine the difference in levels of distressing mental health symptoms of students who recei ve or do not receive a mental health service to increase their academic or behavioral competence. 130

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Finally, future research should examine Florida school psychologists, school social workers, and school counselors ratings of mental health provider qualifications to provide mental health servi ces and their ratings about th e impact of mental health services on student academic and behavioral out comes. These future results could then be contrasted to the results in this current study. The mental health service providers (school psychologists, school counselors, and school social worker s) should be administered questions from the current instrument to investigate the consistency in ratings by administrators and mental heal th service providers. Results from this future investigation could provide information about the current st ate of school based mental health services in Florida and the specific areas or sets of skills for future training (i.e. intervention support) which are needed for school based ment al health providers to adequately provide mental health services in schools. Conclusion The present study examined the types of mental health services provided to students in school districts thr oughout Florida and the extent to which those services were provided to children and families. In addition, th e beliefs of student services directors and supervisors regarding qualifica tions of school mental health service providers to provide mental health services and their beliefs about the impact of mental health services on student academic and behavioral outcomes we re explored. Directors and supervisors reported significantly different ratings a bout the level of qualifications of school psychologists, school counselors, and school social workers to provide mental health services. In addition, directors and supervisors, combined al so had significantly different ratings about the types of mental health services which impa cted academic and 131

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behavioral outcomes. Limitations that are im portant to consider when interpreting the results of this study were noted. Implications of the findings are discussed and finally suggestions are offered for areas of future study related to school-based mental health services. 132

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Lang, T. R., Raver, R. A., White, J. A., Hogarty, K. Y., & Kromrey J. D. (2000, November). Survey data collection strategies: Re sponse differences between webbased and paper-based methods. Paper presented at the annual meeting of the Florida Educational Research Asso ciation, Tallahassee, Florida. Lazega, B, (2003). Factors associated with mental health services delivered by school psychologists, 1-53. Leadership Training: Continuing Edu cation for Change. (2003, September). Addressing Barriers to Learning: A Comprehensive Approach to Mental Health in Schools. (pp. 1-283) Los Angeles, CA: Center for Mental Health in Schools. Lockhart, E. J., & Keys, S. G. (1998). The mental health counseling role of school counselors. Professional School Counseling, 1 (4). 1-4. Luis, E., Curtis, M., Powell-Smith, K. (2005) School-based mental health services provided by school psychologists, 1-89. Mash, E.J. & Barkley, R.A. (2003). Child Psychopathology. New York: Guilford Publications. Masten, A.S. & Curtis, J.W. (2000). Integrating competence and psychopathology: Pathways toward a comprehensive science of adaptation in development. Development and Psychopathology 12(3), 529-550. Maxwell, J.A. (1996). Applied social research methods series: Vol. 41. Qualitative research design: An interactive approach Thousand Oaks, CA: SAGE. McDaniel, L. & Edwards, S. (2004). Mental health care disparities among youths vary by state. Changes in Health Care Financing, 7 (6), 1-3. 139

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Nastasi, B. K., Varjas, K., Bernstein, R ., & Pluymert, K. (1998). Mental health programming and the role of school psychologists. School Psychology Review, 27(2), 217-232. National Advisory Mental Health Council. (1990). National plan for research on child and adolescent mental disorders Washington, DC: National Institute of Mental Health. National Association of School Psychologist. (2003 ). Position Statement on Mental Health Services in the School Retrieved March 19, 2005, from http://www.nasponline.org/information/pospaper_mhs.html National Association of Sc hool Psychologist. (1998). Position Statement on HIV/AIDS Retrieved March 17, 2005, from http://www.nasponline.org/information/pospaper_aids.html National Association of Sc hool Psychologists. (2000). Standards for training and field placement programs in school psychology: Standards for the credentialing of school psychologists. Bethesda, MD: NASP Professional Standards Revision Committee. Retrieved March 20, 2005, from http://www.nasponline.org National Association of Sc hool Psychologists. (2003). What is a school psychologist? Bethesda, MD: Author. Retrieved March 20, 2005, from http://www.nasponline.org National Center for Education in Child and Maternal Health. (2002) Mental Health. In Maternal and Child Health Bureau. Washington, DC: Georgetown University. Retrieved January 19, 2005, from http://www.ncemch.org 140

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National School Boards Association. (1991). LINK UP: A resource directory. Alexandria, VA: ERIC Document Reproduction Service No. ED339782. National Association of State Direct ors of Special Education. (2005). Response to intervention: Policy consideration and implementation. Alexandria, VA: National Association of State Directors of Special Education, Inc. Neuendorf, K.A. (2002). The content analysis guidebook. Thousand Oaks, CA: Sage. Office of Special Education Program. (2002, Se ptember). Full service schools' potential for special education. In US Department of Special Education (chap.) Retrieved January 30, 2005, from http://ericec.org/osep/topical/fullsvc.html Onwuegbuzie, T.J. (2003). Expanding the framew ork of internal and external validity in quantitative research. Research in the Schools 10 (1), 71 89. Owens, J.S. & Murphy, C.E. (2004). Effectiven ess research in the context of schoolbased mental health. Clinical Child and Family Psychology Review, 7 (4), 195209. Petras, H., Schaeffer, C.M., Ialongo, N., Hubbard, S., Muthen, B., Lambert, S.F., Poduska, J., & Kellam, S. (2004). When th e course of aggre ssive behavior in childhood does not predict antisocial outcomes in adolescence and young adulthood: An examination of pot ential explanator y variables. Development and Psychopathology, 16 (4) 919-941. Policy Leadership Cadre for Mental Health in Schools. (2001, May). Mental health in schools: Guidelines, models, resources & policy considerations. In Los Angeles, California: Center for Mental Health in Schools. (chap.) Retrieved February 24, 2005, from http://smhp.psych.ucla.edu 141

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Pumariega, A. J., & Vance, H. R. (1999). School based mental h ealth services: The foundation of systems of care fo r children's mental health. Psychology in the Schools, 36(5), 371-389. School Social Work Association of Ameri ca. (2006). School Social Work. Northlake, IL:Author. Retrieved January 8, 2006, from http://www.sswaa.org Scott, T.M., & Shearer-Lingo, A. (2002). The e ffects of reading fluency instruction on the academic and behavioral success of middle school students in a self-contained EBD classroom. Preventing School Failure, 46 (4), 167-173 Shaffer, D., Fisher, P., Dulcan, M. K., Da vies, M., Piacentini, J., Schwab-Stone, M. E., Lahey, B. B., Bourdon, K., Jensen, P. S., Bird, H. R., Canino, G., & Regier, D. A. (1996). The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): Description, acceptability, prev alence rates, and performance in the MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35(7) 865-877. Short, R. J., & Rosenthal, S. L. (1995). Expa nding roles or evolving identity: Doctoral school psychologists in school vs. non-school settings. Psychology in the School, 32(4) 296-305. State of Florida Department of Children a nd Families Mental Health Program Office. (2002). Florida Mental Health Act, F.S. 394, Part I Retrieved March 22, 2005, from http://www.dcf.state.fl.us/mentalhealth/laws/index.shtml Statistical Analysis of Software. (2002-2003). Retrieved date 2006. http://www.sas.com 142

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Stipek, D. (2001). Pathways to construc tive lives: The importance of early school success. In A.C. Bohart & D.J. Stipek (Eds.), Constructive & destructive behavior: Implications for family, school, & society. Washington, D.C.: American Psychological Association Talemaitoga, G. (2001). Pathways to health and well-being. East Perth, WA: Department of Education. Thomas, A., Levinson, E. M., Orf, M. L., & Pinciotti, D. (1992). Administrators' perceptions of school psychologists' roles and satisfaction with school psychologists. Psychological Reports, 71, 571-575. Tremblay, R.E., Masse, B., Perron, D., Lebl anc, M., Schwartzman, A.E., & Ledingham, J.E. (1992). Early disruptive behavior poor school achievement, delinquent behavior, and delinquent persona lity: Longitudinal analyses. Journal of Consulting and Clinical Psychology, 60 (1), 64-72. U.S. Department of Education. (2001). No Child Left Behind Act 2001. Retrieved May 18, 2005 from http://www.nochildleftbehind.gov U.S. Departments of Educa tion and Justice. (2003). Indicators of School Crime and Safety: 2003. Washington, D.C. U.S. Department of Health and Huma n Services, Children's Bureau. (2002). Child maltreatment 2002. Washington, DC: U.S. Government Printing Offices. U.S. Department of Health and Human Services. (1999). Executive Summary. In Mental Health: A Report of the Surgeon General. 143

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Walrath, C.M., Bruns, E.J., Anderson, K.L., Glass-Siegel, M., & Weist, M.D. (2004). Understanding expanded school mental he alth services in Baltimore city. Behavior Modification 28(4), 472-490. Webster, M. (2002). Websters New Riverside Dictionary NY, NY. Houghton Mifflin Company. Weist, M.D., Myers, C.P., Danforth, J., McNe il, D.W., Ollendick, T.H., & Hawkins, R. (2000). Expanded school mental health services: Assessing needs related to school level and geography. Community Mental Health Journal 36(3), 259-273. Weist, M.D., Paskewitz, D.A., Warner, B.S., & Flaherty, L.T. (1996) Treatment outcome of school-based mental health services for urban teenagers. Community Mental Health Journal 32(2), 149-157. Westefeld, J. S., Range, L. M., Rogers, J. R ., Maples, M. R., Bromley, J. L., & Alcorn, J. (2000). Suicide: An overview. The Counseling Psychologist 28(4), 445-510. Willcutt, E.G. & Pennington, B.F. (2000). Psychiatric comorbidity in children and adolescents with reading disability. Journal of Child Psychology and Psychiatry 41(8), 1039-1048. World Health Organization (2005). World health report 2005: Make every mother and child count 144

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145 Appendices

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Appendix A: Perception of School Mental Health Services Survey (Version A) Section I: Demographic Information For each item below please check the opti on that best corresponds to your response: 1. Size of school district (FL DOE designation): 1.____Small 2.____Small/Middle 3.____Middle 4.____Large 5.____Very Large 2. Your highest degree earned: 1.____ Bachelors Degree 2.____ Masters Degree 3.____ Specialist Degree 4.____ Doctoral Degree 3. Area in which you earned your highest degree: 1.____ Special Education 2.____ General Education 3.____ Counseling 4.____ Psychology 5.____ Social Work 6.____ Administration 4. Area(s) in which you are credentialed: 1.____ Special Education 2.____ General Education 3.____ Counseling 4.____ Psychology 5.____ Social Work 6.____ Administration 5. Your years of experience in current position: 1.____ 1-5 2.____ 6-10 3.____ 11-15 4.____ More than 15 6. Your total years of experien ce in educational setting: 1.____ 1-5 2.____ 6-10 3.____ 11-15 4.____ More than 15 146

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Appendix A (Continued) Student Services Directors, please an swer the following questions based upon information from your school district during the 2005-2006 school year: 13. Total number (or per cent) of students on free/reduced lunch: Number______Percent______ 14. Total number (or percent) of students who are enrolled in EH/SED programs: Number______ Percent______ 15. Total number (or percent) of students who are enrolled in alte rnative education programs: Number______Percent______ 16. Total number (or percent) of students suspended: Number______ Percent______ 17. Total number (or percent) of students expelled: Number______ Percent______ 18. Total number of Baker Act referrals (including cases of students with multiple referrals): __________ 7. Check the one that best describes your professional role: 1.____ Student Services Director 2.____ Student Services Director/ESE Director 8. Number of FTE* schoo l/licensed psychologists employed/contracted in district: ___________ 9. Number of FTE* school counselors employed in district: ___________ 10. Number of FTE* school social workers employed in district: ___________ 11. Total number of student s enrolled in district: ___________ 12. Total number (or percent) of students that are minority or non-white: Number______ Percent______ Full-Time Equivalent 5 days a week= 1 FTE 1 day a week= .2 FTE 147

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Appendix A (Continued) Section II: Information on Mental Health Services 19. For each of the following mental health services listed below, please rate the level at which the service is provided to students/families in your district. Use the following response scale: 5=Provided to all student(s)/families who need the service 4=Provided to most students/f amilies who need the service 3=Provided to some student(s)/families when the service is available 2=Provided to student(s)/fam ilies on a very limited basis 1=Not provided to student(s)/families/Service is unavailable Please circle the rating that be st represents your response. Service Level Provided Counseling 1. Individual therapy/counseling 5 4 3 2 1 2. Family therapy/counseling 5 4 3 2 1 3. Group therapy/counseling 5 4 3 2 1 Consultation 1. Mental health consultation 5 4 3 2 1 2. Behavior management consultation 5 4 3 2 1 3. Academic consultation/interventions 5 4 3 2 1 Norm-Referenced Assessments 1. Intelligence Assessment 5 4 3 2 1 2. Cognitive Assessment 5 4 3 2 1 3. Personality Assessment 5 4 3 2 1 148

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4. Behavior Rating Scale 5 4 3 2 1 Authentic Assessments 1. Dynamic Indicators of Basics Early Literacy Skills 5 4 3 2 1 2. Curriculum Based Measurement 5 4 3 2 1 Prevention 1. Early intervention services/School -wide screenings 5 4 3 2 1 2. Home Visitations/Community Outreach 5 4 3 2 1 3. Character Education 5 4 3 2 1 4. Parent Training 5 4 3 2 1 5. Substance Abuse Prevention/Counseling 5 4 3 2 1 6. Violence Prevention/Counseling 5 4 3 2 1 7. Suicide Prevention 5 4 3 2 1 8. Pregnancy Prevention/Support 5 4 3 2 1 9. Bullying Prevention 5 4 3 2 1 10. Dropout Prevention 5 4 3 2 1 11. Peer mediation/support groups 5 4 3 2 1 Intervention 1. Positive Behavior Support 5 4 3 2 1 2. Social skills training 5 4 3 2 1 3. Test taking and study skills training 5 4 3 2 1 4. Crisis intervention 5 4 3 2 1 5. Anger Control Training 5 4 3 2 1 6. Relaxation Training 5 4 3 2 1 Other 1. Clinical Interviews 5 4 3 2 1 2. Behavioral Observations 5 4 3 2 1 3. Case Management (coordination of services ) 5 4 3 2 1 4. Research and Evaluation 5 4 3 2 1 5. Other (Please Specify): 5 4 3 2 1 149

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Appendix A (Continued) 20. For the following mental health services offered in your district, please rate the extent to which you believe school psychologists, social workers, and school counselors are qualified to provide each service, based on their educational and professional training. Use the following response scale: 5= highly qualified no supervision needed 4=qualified and minimal supervision needed 3=somewhat qualified and supervision is needed 2= minimally qualified and intense supervision needed 1=Not qualified Please circle the rating that best represents your respons e for each service provider. Service School Psychologist School Counselor Social Worker Counseling 1. Individual therapy/counseling 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Family therapy/counseling 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 3. Group therapy/counseling 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Consultation 1. Mental health consultation 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Behavior management consultation 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 3. Academic consultation/interventions 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Norm-Referenced Assessments 1. Intelligence Assessment 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Cognitive Assessment 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 3. Personality Assessment 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 4. Behavior Rating Scale 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 150

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Authentic Assessments 1. Dynamic Indicators of Basics Early Literacy Skills 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Curriculum Based Measurement 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Prevention 1. Early intervention services/Sc hool-wide screenings 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Home Visitations/Community Outreach 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 3. Character Education 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 4. Parent Training 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5. Substance Abuse Prevention/Counseling 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 6. Violence Prevention/Counseling 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 7. Suicide Prevention 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 8. Pregnancy Prevention/Support 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 9. Bullying Prevention 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 10. Dropout Prevention 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 11. Peer mediation/support groups 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Intervention 1. Positive Behavior Support 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Social skills training 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 3. Test taking and study skills training 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 4. Crisis intervention 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5. Anger Control Training 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 6. Relaxation Training 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 7. Self Control Training 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Other 1. Clinical Interviews 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Behavioral Observations 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 3. Case Management (coordination of serv ices) 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 4. Research and Evaluation 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 151

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Appendix A (Continued) 21. For each of the following mental health services please rate the degree of impact that you believe the service has in a) academic and b) behavioral outcomes of students? Using the following rating scale for each outcome (academic and beha vioral), please circle the best rating that best represents your response. 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact Please circle the rating that best represents your response as shown in the example below. Example Academic Behavior Item 1 5 4 3 2 1 5 4 3 2 1 Service Academic Behavior Counseling 1. Individual therapy/counseling 5 4 3 2 1 5 4 3 2 1 2. Family therapy/counseling 5 4 3 2 1 5 4 3 2 1 3. Group therapy/counseling 5 4 3 2 1 5 4 3 2 1 Consultation 1. Mental health consultation 5 4 3 2 1 5 4 3 2 1 2. Behavior management consultation 5 4 3 2 1 5 4 3 2 1 3. Academic consultation/interventions 5 4 3 2 1 5 4 3 2 1 152

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Appendix A (Continued) Norm-Referenced Assessments 1. Intelligence Assessment 5 4 3 2 1 5 4 3 2 1 2. Cognitive Assessment 5 4 3 2 1 5 4 3 2 1 3. Personality Assessment 5 4 3 2 1 5 4 3 2 1 4. Behavior Rating Scale 5 4 3 2 1 5 4 3 2 1 Authentic Assessment 1. Dynamic Indicators of Basics Early Literacy Skills 5 4 3 2 1 5 4 3 2 1 2. Curriculum Based Measurement 5 4 3 2 1 5 4 3 2 1 Prevention 1. Early intervention services 5 4 3 2 1 5 4 3 2 1 2. Home Visitations/Community Outreach 5 4 3 2 1 5 4 3 2 1 3. Character Education 5 4 3 2 1 5 4 3 2 1 4. Parent Training 5 4 3 2 1 5 4 3 2 1 5. Substance Abuse Prevention/Counseling 5 4 3 2 1 5 4 3 2 1 6. Violence Prevention/Counseling 5 4 3 2 1 5 4 3 2 1 7. Suicide Prevention 5 4 3 2 1 5 4 3 2 1 8. Pregnancy Prevention/Support 5 4 3 2 1 5 4 3 2 1 9. Bullying Prevention 5 4 3 2 1 5 4 3 2 1 10. Dropout Prevention 5 4 3 2 1 5 4 3 2 1 11. Peer mediation/support groups 5 4 3 2 1 5 4 3 2 1 Intervention 1. Positive Behavior Support 5 4 3 2 1 5 4 3 2 1 2. Social skills training 5 4 3 2 1 5 4 3 2 1 3. Test taking and study skills training 5 4 3 2 1 5 4 3 2 1 4. Crisis intervention 5 4 3 2 1 5 4 3 2 1 5. Anger Control Training 5 4 3 2 1 5 4 3 2 1 6. Relaxation Training 5 4 3 2 1 5 4 3 2 1 7. Self Control Training 5 4 3 2 1 5 4 3 2 1 153

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Appendix A (Continued) Other 1. Clinical Interviews 5 4 3 2 1 5 4 3 2 1 2. Behavioral Observations 5 4 3 2 1 5 4 3 2 1 3. Case Management (coordination of services) 5 4 3 2 1 5 4 3 2 1 4. Research and Evaluation 5 4 3 2 1 5 4 3 2 1 22. For each support service listed below, pleas e indicate the extent to which it is actually utilized to monitor the progress of students who have returned to school af ter receiving an involuntary examinat ion according to Baker Act statutes. Use the following response scale: 5= Always used 4= Frequently used 3= Sometimes used 2= Seldom used 1= Not Used Please circle the rating that be st represents your response. Service Level Provided Intervention 1. Referred to school based intervention team 5 4 3 2 1 2. Referred to community based mental health service provider for counseling 5 4 3 2 1 3. Referred to school based psychologist for counseling 5 4 3 2 1 4. Referred to guidance counselor for counseling 5 4 3 2 1 5. Referred to social worker for counseling 5 4 3 2 1 6. Referred to school nurse 5 4 3 2 1 7. Referred to Safe and Drug Free School Staff 5 4 3 2 1 8. Home-school intervention/co llaboration. 5 4 3 2 1 154

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Assessment 1. Referred to student services personnel for special e ducation evaluation. 5 4 3 2 1 2. Referred to student services personnel for a Functi onal Behavior Assessment. 5 4 3 2 1 Consultation 1. Student service personnel assigned as case manager. 5 4 3 2 1 2. Consultation provided by community mental health provider. 5 4 3 2 1 3. Consultation provided to classroom teachers 5 4 3 2 1 155

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Appendix B: Perception of School Mental Health Services Survey (Version B) Section I: Demographic Information For each item below please check the opti on that best corresponds to your response: 1. Size of school district (FL DOE designation): 1.____Small 2.____Small/Middle 3.____Middle 4.____Large 5.____Very Large 2. Your highest degree earned: 1.____ Bachelors Degree 2.____ Masters Degree 3.____ Specialist Degree 4.____ Doctoral Degree 3. Area in which you earned your highest degree: 1.____ Special Education 2.____ General Education 3.____ Counseling 4.____ Psychology/School Psychology 5.____ Social Work 6.____ Administration 4. Area(s) in which you are credentialed: 1.____ Special Education 2.____ General Education 3.____ Counseling 4.____ Psychology/School Psychology 5.____ Social Work 5. Your years of experience in current position: 1.____ 1-5 2.____ 6-10 3.____ 11-15 4.____ More than 15 6. Your total years of experien ce in educational setting: 1.____ 1-5 2.____ 6-10 3.____ 11-15 4.____ More than 15 7. Check the one that best describes yo ur professional role: 1.____ Director/Supervisor of Psychological Services 2.____ Director/Supervisor of Guidance and Counseling Services 156

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Appendix B (Continued) Section II: Information on Mental Health Services 8. For each of the following mental health services listed below, please rate the level at which the service is provided to students/families in your district. Use the following response scale: 5=Provided to all student(s)/families who need the service 4=Provided to most students/f amilies who need the service 3=Provided to some student(s)/families when the service is available 2=Provided to student(s)/fam ilies on a very limited basis 1=Not provided to student(s)/families/Service is unavailable Please circle the rating that be st represents your response. Service Level Provided Counseling 1. Individual therapy/counseling 5 4 3 2 1 2. Family therapy/counseling 5 4 3 2 1 3. Group therapy/counseling 5 4 3 2 1 Consultation 1. Mental health consultation 5 4 3 2 1 2. Behavior management consultation 5 4 3 2 1 3. Academic consultation/interventions 5 4 3 2 1 Norm-Referenced Assessments 1. Intelligence Assessment 5 4 3 2 1 2. Cognitive Assessment 5 4 3 2 1 3. Personality Assessment 5 4 3 2 1 4. Behavior Rating Scale 5 4 3 2 1 157

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Appendix B (Continued) Authentic Assessments 1. Dynamic Indicators of Basics Early Literacy Skills 5 4 3 2 1 2. Curriculum Based Measurement 5 4 3 2 1 Prevention 1. Early intervention services/School -wide screenings 5 4 3 2 1 2. Home Visitations/Community Outreach 5 4 3 2 1 3. Character Education 5 4 3 2 1 4. Parent Training 5 4 3 2 1 5. Substance Abuse Prevention/Counseling 5 4 3 2 1 6. Violence Prevention/Counseling 5 4 3 2 1 7. Suicide Prevention 5 4 3 2 1 8. Pregnancy Prevention/Support 5 4 3 2 1 9. Bullying Prevention 5 4 3 2 1 10. Dropout Prevention 5 4 3 2 1 11. Peer mediation/support groups 5 4 3 2 1 Intervention 1. Positive Behavior Support 5 4 3 2 1 2. Social skills training 5 4 3 2 1 3. Test taking and study skills training 5 4 3 2 1 4. Crisis intervention 5 4 3 2 1 5. Anger Control Training 5 4 3 2 1 6. Relaxation Training 5 4 3 2 1 7. Self-Control Training 5 4 3 2 1 Other 1. Clinical Interviews 5 4 3 2 1 2. Behavioral Observations 5 4 3 2 1 3. Case Management (coordination of services ) 5 4 3 2 1 4. Research and Evaluation 5 4 3 2 1 5. Other (Please Specify): 5 4 3 2 1 158

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Appendix B (Continued) 9. For the following mental health services offered in your district, please rate th e extent to which you believe school psychologists, social workers, school counselor are qualified to provide each service, ba sed on their educational and professional training. Use the following response scale: 5= highly qualified no supervision needed 4=qualified and minimal supervision needed 3=somewhat qualified and supervision is needed 2= minimally qualified and intense supervision needed 1=Not qualified Please circle the rating that best represents your respons e for each service provider. Service School Psychologist School Counselor Social Worker Counseling 1. Individual therapy/counseling 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Family therapy/counseling 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 3. Group therapy/counseling 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Consultation 1. Mental health consultation 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Behavior management consultation 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 3. Academic consultation/interventions 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Norm-Referenced Assessments 1. Intelligence Assessment 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Cognitive Assessment 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 3. Personality Assessment 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 4. Behavior Rating Scale 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 159

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Appendix B (Continued) Authentic Assessments 1. Dynamic Indicators of Basics Early Literacy Skills 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Curriculum Based Measurement 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Prevention 1. Early intervention services/Sc hool-wide screenings 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Home Visitations/Community Outreach 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 3. Character Education 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 4. Parent Training 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5. Substance Abuse Prevention/Counseling 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 6. Violence Prevention/Counseling 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 7. Suicide Prevention 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 8. Pregnancy Prevention/Support 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 9. Bullying Prevention 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 10. Dropout Prevention 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 11. Peer mediation/support groups 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Intervention 1. Positive Behavior Support 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Social skills training 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 3. Test taking and study skills training 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 4. Crisis intervention 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5. Anger Control Training 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 6. Relaxation Training 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 7. Self Control Training 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Other 1. Clinical Interviews 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 2. Behavioral Observations 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 3. Case Management (coordination of serv ices) 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 4. Research and Evaluation 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 160

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Appendix B (Continued) 10. For each of the following mental health services please rate the degree of impact that you believe the service has in a) academic and b) behavioral outcomes of students? Using the following rating scale for each outcome (academic and beha vioral), please circle the best rating that best represents your response. 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact Please circle the rating that best represents your response as shown in the example below. Example Academic Behavior Item 1 5 4 3 2 1 5 4 3 2 1 Service Academic Behavior Counseling 1. Individual therapy/counseling 5 4 3 2 1 5 4 3 2 1 2. Family therapy/counseling 5 4 3 2 1 5 4 3 2 1 3. Group therapy/counseling 5 4 3 2 1 5 4 3 2 1 Consultation 1. Mental health consultation 5 4 3 2 1 5 4 3 2 1 2. Behavior management consultation 5 4 3 2 1 5 4 3 2 1 3. Academic consultation/interventions 5 4 3 2 1 5 4 3 2 1 161

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Appendix B (Continued) Norm-Referenced Assessments 1. Intelligence Assessment 5 4 3 2 1 5 4 3 2 1 2. Cognitive Assessment 5 4 3 2 1 5 4 3 2 1 3. Personality Assessment 5 4 3 2 1 5 4 3 2 1 4. Behavior Rating Scale 5 4 3 2 1 5 4 3 2 1 Authentic Assessment 1. Dynamic Indicators of Basics Early Literacy Skills 5 4 3 2 1 5 4 3 2 1 2. Curriculum Based Measurement 5 4 3 2 1 5 4 3 2 1 Prevention 1. Early intervention services 5 4 3 2 1 5 4 3 2 1 2. Home Visitations/Community Outreach 5 4 3 2 1 5 4 3 2 1 3. Character Education 5 4 3 2 1 5 4 3 2 1 4. Parent Training 5 4 3 2 1 5 4 3 2 1 5. Substance Abuse Prevention/Counseling 5 4 3 2 1 5 4 3 2 1 6. Violence Prevention/Counseling 5 4 3 2 1 5 4 3 2 1 7. Suicide Prevention 5 4 3 2 1 5 4 3 2 1 8. Pregnancy Prevention/Support 5 4 3 2 1 5 4 3 2 1 9. Bullying Prevention 5 4 3 2 1 5 4 3 2 1 10. Dropout Prevention 5 4 3 2 1 5 4 3 2 1 11. Peer mediation/support groups 5 4 3 2 1 5 4 3 2 1 Intervention 1. Positive Behavior Support 5 4 3 2 1 5 4 3 2 1 2. Social skills training 5 4 3 2 1 5 4 3 2 1 3. Test taking and study skills training 5 4 3 2 1 5 4 3 2 1 4. Crisis intervention 5 4 3 2 1 5 4 3 2 1 5. Anger Control Training 5 4 3 2 1 5 4 3 2 1 6. Relaxation Training 5 4 3 2 1 5 4 3 2 1 7. Self Control Training 5 4 3 2 1 5 4 3 2 1 162

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Appendix B (Continued) Other 1. Clinical Interviews 5 4 3 2 1 5 4 3 2 1 2. Behavioral Observations 5 4 3 2 1 5 4 3 2 1 3. Case Management (coordination of services) 5 4 3 2 1 5 4 3 2 1 4. Research and Evaluation 5 4 3 2 1 5 4 3 2 1 11. For each support service listed below, pleas e indicate the extent to which it is actually utilized to monitor the progress of students who have returned to school af ter receiving an involuntary examinat ion according to Baker Act statutes. Use the following response scale: 5= Always used 4= Frequently used 3= Sometimes used 2= Seldom used 1= Not Used Please circle the rating that be st represents your response. Service Level Provided Intervention 1. Referred to school based intervention team 5 4 3 2 1 2. Referred to community based mental health service provider for counseling 5 4 3 2 1 3. Referred to school based psychologist for counseling 5 4 3 2 1 4. Referred to guidance counselor for counseling 5 4 3 2 1 5. Referred to social worker for counseling 5 4 3 2 1 163

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Appendix B (Continued) 6. Referred to school nurse 5 4 3 2 1 7. Referred to Safe and Drug Free School Staff 5 4 3 2 1 8. Home-school intervention/co llaboration. 5 4 3 2 1 Assessment 1. Referred to student services personnel for special e ducation evaluation. 5 4 3 2 1 2. Referred to student services personnel for a Functi onal Behavior Assessment. 5 4 3 2 1 Consultation 1. Student service personnel assigned as case manager. 5 4 3 2 1 2. Consultation provided by community mental health provider. 5 4 3 2 1 3. Consultation provided to classroom teachers 5 4 3 2 1 164

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Appendix C: Informed Consent for Direct ors of Student Services (Version A) You are receiving this letter be cause you were selected from the Florida Student Support Services Dir ectory from the Florida Department of Education. As providers of students support services, we are sure you are well aware that conditions contributing to student mental health problemssubstan ce abuse, poverty, homelessness, community violence, and physical abuseare rapidly becoming a part of the normal family culture within which many students grow and develop. Th ese conditions do not foster an environment in which children can meet expected developmental, cognitive, social an d emotional demands. However, schools are expected to educate all students, including the growing population of studen ts whose mental health problems often impede or int erfere with their learning. According to the Elementary and Secondary Education Act of 2001, No Child Left Behind, schools are also expected to create environments in which all students can succeed and providing mental health services in the school is a way that schools can create this type of successful environment. Decia N. Dixon, a school psychology doctoral st udent at the University of South Florida is conducting a thesis study entitled Perceptions of School Based Mental Health Services by Directors and Supervisors of Student Services to determine the beliefs of directors/supervisors of student services as they relate to school based mental health services and de livery. The information in this letter is provided to help you decide whet her or not you want to take part in this research study. Please read this informatio n carefully. If you have any questions or concerns, pl ease contact the principal investigator (D ecia N. Dixon, School Psychology Doctoral Student). General Information about the Research Study You are being asked to complete a brief ( 15-20 minute) survey developed to acquire information about your beliefs of school bas ed mental health services. Mental health i ssues embody those characteristic s and factors, which closely relate to mental well-bein g. The lack of mental well-being is characterized by an inability to adapt to ones environment and regulate behavior (Websters, 2002 ). Your input is very important and it will be used to develop a st ate database regarding the range in types of mental health serv ices provided to students in school dist ricts throughout Florida. It will also be used to examine the impact of mental health servic es on student behavior and academic outcomes. The results from this study can be used in pre-serv ice training for mental health professionals, by providing information about ho w directors and supervisors of student services view mental health services in the schools. Secondly, your input can co ntribute to school based mental health policy literature. 165

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Appendix C (Continued) Plan of Study The enclosed survey contains 22 items, 18 items which are district demographic information and 4 items that collect data about the types of mental health services provided and the perceptions a bout those who provide these mental health services and the impac t of specified mental health services on academic and behavioral outcomes. The total time n eeded to complete this survey is estimate d be less than 30 minutes. Please make sure that all items are completed before submitting the survey. For your convenience, we have provided you with a postage-paid envelope to us e in returning the survey to us by Jan 5 th 2007. Compensation Three participants who return the completed su rvey will be randomly selected to receive a $25.00 American Express Gift Card which can be used virtually everywhere in the United States that welcomes American E xpress Cards. Ten additiona l participants who ret urn completed surveys will also be randomly selected to receive the newly published book by the Nati onal Association of State Direc tors of Special Education, Response to Intervention:Policy Considerations and Implementation Even though each participant will not receive direct personal benef its from this study, by participating in this study you may increase our overall knowledge of issu es surrounding the provision of school mental health services and its impact on student outcomes. Risks or Discomfort There are no known risks to those who take part in this study. Confidentiality of Your Records Your privacy and research records will be ke pt confidential to the extent of the law. Authorized research personnel, employees of the Department of Health and Human Services, and the USF Institutional Review Board, staff and other individuals acting on behalf o f USF may inspect the records from this research project. The resu lts of this study may be published. However, the data obtained from you will be combined with data from others. The published result s will not include your name or any other information that wou ld personally identify you in any way. 166

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Appendix C (Continued) Volunteering to Be Part of this Research Study Your decision to participate in this resear ch study is completely voluntary. You are free to participate in this research stud y or to withdraw at any time. There will be no penalty or loss of benefits you are entitled to receive, if you stop taking part in the study. If you have questions about your rights as a pe rson who is taking part in a study, call USF Division of Rese arch Compliance and Integrity at (813) 974-9343. If you have a ny questions about this research study, contact Decia N. Dixon, M.A. at 678-524-5325 or at dndixon@mail.usf.edu or George Batsche, Ed.D., NCSP at 813-974-9472 or batsche@tempest.coedu.usf.edu Thank you very much for your participation. Sincerely, Decia N. Dixon, M.A. & George M. Batsche, Ed.D. 167

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Appendix C (Continued) Consent to Take Part in this Research Study If you have agreed to take part in this study then please read the following statement and sign below: I freely give my consent to take part in this study. I understand that this is resear ch. I have received a copy of this conse nt form. ________________________ ________________________ ___________ Signature Printed Name Date of Person taking part in study of Person taking part in study ________________________ ________________________ ___________ [ Optional ] Signature of Witness Printed Name of Witness Date 168

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Appendix D: Informed Consent for Superv isors of Student Se rvices (Version B) You are receiving this letter be cause you were selected from the Florida Student Support Services Dir ectory from the Florida Department of Education. As providers of students support services, we are sure you are well aware that conditions contributing to student mental health problemssubstan ce abuse, poverty, homelessness, community violence, and physical abuseare rapidly becoming a part of the normal family culture within which many students grow and develop. Th ese conditions do not foster an environment in which children can meet expected developmental, cognitive, social an d emotional demands. However, schools are expected to educate all students, including the growing population of studen ts whose mental health problems often impede or int erfere with their learning. According to the Elementary and Secondary Education Act of 2001, No Child Left Behind, schools are also expected to create environments in which all students can succeed and providing mental health services in the school is a way that schools can create this type of successful environment. Decia N. Dixon, a school psychology doctoral st udent at the University of South Florida is conducting a thesis study entitled Perceptions of School Based Mental Health Services by Directors and Supervisors of Student Services to determine the beliefs of directors/supervisors of student services as they relate to school based mental health services and de livery. The information i n this letter is provided to help you decide whet her or not you want to take part in this research study. Please read this informatio n carefully. If you have any questions or concerns, pl ease contact the principal investigator (D ecia N. Dixon, School Psychology Doctoral Student). General Information about the Research Study You are being asked to complete a brief ( 15-20 minute) survey developed to acquire information about your beliefs of school bas ed mental health services. Mental health i ssues embody those characteristic s and factors, which closely relate to mental well-bein g. The lack of mental well-being is characterized by an inability to adapt to ones environment and regulate behavior (Websters, 2002 ). Mental health services are those services provided directly by a mental health profes sional (i.e. school psychologist, school c ounselor, school social worker), at the di strict, building, classroom, or i ndividual student level. These se rvices are targ eted at optimi zing developmental skills or behaviors that increase the probability of school success. Your input is very important and it will be used to develop a st ate database regarding the range in types of mental health serv ices provided to students in school dist ricts throughout Florida. It will also be used to examine the impact of mental health servic es on student behavior and academic outcomes. The results from this study can be used in pre-serv ice training for mental health 169

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professionals, by providing information about ho w directors and supervisors of student services view mental health services in the schools. Secondly, your input can co ntribute to school based mental health policy literature. Plan of Study The enclosed survey contains 11 items, 7 items which are district demographic information and 4 items that collect data about t he types of mental health services provided and the perceptions a bout those who provide these mental health services and the impac t of specified mental health services on academic and behavioral outcomes. The total time needed to complete this su rvey is estimated be less than 30 minutes. Please make sure that all items are complet ed before submitting the survey. For your convenience, we have provided you with a postage-paid envelope to use in returning the survey to us by Jan 5 th 2007. Compensation Three participants who return the completed su rvey will be randomly selected to receive a $25.00 American Express Gift Card which can be used virtually everywhere in the United States that welcomes American E xpress Cards. Ten additiona l participants who ret urn completed surveys will also be randomly selected to receive the newly published book by the Nati onal Association of State Direc tors of Special Education, Response to Intervention:Policy Considerations and Implementation Even though each participant will not receive direct personal benef its from this study, by participating in this study you may increase our overall knowledge of issu es surrounding the provision of school mental health services and its impact on student outcomes. Risks or Discomfort There are no known risks to those who take part in this study. Confidentiality of Your Records Your privacy and research records will be ke pt confidential to the extent of the law. Authorized research personnel, employees of the Department of Health and Human Services, and the USF Institutional Review Board, staff and other individuals acting on behalf o f USF may inspect the records from this research project. The resu lts of this study may be published. However, the data obtained from you will be combined with data from others. The published result s will not include your name or any other information that wou ld personally identify you in any way. 170

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Appendix D (Continued) Volunteering to Be Part of this Research Study Your decision to participate in this resear ch study is completely voluntary. You are free to participate in this research stud y or to withdraw at any time. There will be no penalty or loss of benefits you are entitled to receive, if you stop taking part in the study. If you have questions about your rights as a pe rson who is taking part in a study, call USF Division of Rese arch Compliance and Integrity at (813) 974-9343. If you have a ny questions about this research study, contact Decia N. Dixon, M.A. at 678-524-5325 or at dndixon@mail.usf.edu or George Batsche, Ed.D., NCSP at 813-974-9472 or batsche@tempest.coedu.usf.edu .). Thank you very much for your participation. Sincerely, Decia N. Dixon, M.A. & George M. Batsche, Ed.D. 171

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Appendix D (Continued) Consent to Take Part in this Research Study If you have agreed to take part in this study then please read the following statement and sign below: I freely give my consent to take part in this study. I understand that this is resear ch. I have received a copy of this conse nt form. ________________________ ________________________ ___________ Signature Printed Name Date of Person taking part in study of Person taking part in study ________________________ ________________________ ___________ [ Optional ] Signature of Witness Printed Name of Witness Date 172

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Appendix E: Pilot Study Cover Letter and Review Fo rm for Student Services Directors (Version A) You are receiving this letter be cause you were selected from the Florida Student Support Services Dir ectory from the Florida Department of Education. The purpose of this letter is to ask for your pa rticipation in the pilot vers ion of the Perceptions o f School Based Mental Health Services by Directors and Supervisors of St udent Services study. Decia N. Dixon, a school psychology doctoral student at the University of Sout h Florida and primary investigator of this study is conducting a thesis study. It is entitled Perceptions of School Based Mental Health Services by Directors a nd Supervisors of Student Servi ces. The purpose of this stud y is to find out the beliefs of directors/supervis ors of student services as they relate to school based mental health services and delivery and student academic and behavioral outcomes. Your role in this study is to evaluate the current survey for understanding of cont ent and clarity of response choices, wordin g of questions, and the total time needed to complete the survey. Y our feedback from the pilot study will be used to make changes to the survey, if needed. Your input w ill also assist the researcher in maximizing the response rate and error rate when beginning the larger final study throughout the state of Florida. To make this pilot study successful and effective, we ask that you complete the following steps when ev aluating the survey: 1) Complete the survey in its entirety, while paying close attention to the surveys directions, wording, response choices and content. 2) Using the attached pilot rating form entitled PSMHS Version A please follow the directions on the form and rate the items that you completed on the survey. Feel free to add suggestions/comments under the appropriate section. 3) Mail both the survey and the attached pilo t rating form in the pre-addressed, postage paid envelope to the following address by Nov. 15th, 2006. Your input is important and we appreciate your willingness to take part in this pilot study. If you have questions about your rights as a person who is taking part in a pilot study, call USF Division of Research Compliance and Integr ity at (813) 974-934 3. If you have any questions about this research study, contact Decia N. Dixon, M.A. at 678-524-5325 or at dndixon@mail.usf.edu or George Batsche, Ed.D ., NCSP at 813-974-9472 or batsche@tempest.coedu.usf.edu 173

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Appendix E (Continued) PSMHS Version A Section I. Questions 1-17. Please review each of the questions. Please determine if the question is clear or is unclear. If unclear, please make a suggestion or comment. Question Clear Unclear Suggestion/Comment 1. Size of school district: ___ ___ _________________________ 1.____Small 2.____Small/Middle 3.____Middle 4.____Large 5.____Very Large 2. Your highest degree earned: ___ ___ _________________________ 1.____ Bachelors Degree 2.____ Masters Degree 3.____ Specialist Degree 4.____ Doctoral Degree 3. Area in which you earned your ___ ___ _________________________ highest degree: 1.____ Special Education 2.____ General Education 3.____ Counseling 4.____ Psychology 5.____ Social Work 6.____ Administration 174

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Appendix E (Continued) Clear Unclear Suggestion/Comment 4. Area(s) in which you are ___ ___ _________________________ credentialed: 1.____ Special Education 2.____ General Education 3.____ Counseling 4.____ Psychology 5.____ Social Work 6.____ Administration 5. Your years of experience in ___ ___ _________________________ current position: 1.____ 1-5 2.____ 6-10 3.____ 11-15 4.____ More than 15 6. Your total years of experience ___ ___ _________________________ in educational setting: 1.____ 1-5 2.____ 6-10 3.____ 11-15 4.____ More than 15 7. Number of FTE* school/licensed ___ ___ _________________________ psychologists employed/contracted in district: ___________ 175

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Appendix E (Continued) Clear Unclear Suggestion/Comment 8. Number of FTE* school ___ ___ _________________________ counselors employed in district: ___________ 9. Number of FTE* school social ___ ___ _________________________ workers employed in district: ___________ 10. Total number of students ___ ___ _________________________ enrolled in district: ___________ 11. Total number (or percent) of ___ ___ _________________________ students that are minority or non-white: Number______ Percent______ 12. Total number (or percent) of ___ ___ _________________________ students on free/reduced lunch: Number______Percent______ 13. Total number (or percent) of ___ ___ _________________________ students who are enrolled in EH/SED programs: Number______ Percent______ 176

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Appendix E (Continued) Clear Unclear Suggestion/Comment 14. Total number (or percent) of ___ ___ _________________________ students who are enrolled in alternative education programs: Number______Percent______ 15. Total number (or percent) of ___ ___ _________________________ students suspended: Number______ Percent______ 16. Total number (or percent) of ___ ___ _________________________ students expelled: Number______ Percent______ 17. Total number of Baker Act ___ ___ _________________________ Referrals (including cases of students with multiple referrals): __________ 177

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Section II. 1. Are the instructions for completing the survey clearly written and understandable? Acceptable Needs modification Unacceptable Suggestions/Comments: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 2. In Section II, Mental Health Services ar e organized in seven areas. Please review each area an d the services provided under each area. Make a recommendation to include the specific service or exclude the specific service. If you be lieve that additional services should be included under the area, please suggest the service. Counseling Include Exclude Additional Service(s) 1. Individual therapy/counseling _____ _____ ________________ 2. Family therapy/counseling _____ _____ ________________ 3. Group therapy/counseling _____ _____ ________________ Consultation 1. Mental health consultation _____ _____ ________________ 2. Behavior management consultation _____ _____ ________________ 3. Academic consultation/interventions _____ _____ ________________ Norm-Referenced Assessments 1. Intelligence Assessment _____ _____ ________________ 2. Cognitive Assessment _____ _____ ________________ 3. Personality Assessment _____ _____ ________________ 4. Behavior Rating Scale _____ _____ ________________ 178

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Include Exclude Additional Service(s) Authentic Assessments 1. Dynamic Indicators of Basics Early Literacy Skills _____ _____ ________________ 2. Curriculum Based Measurement _____ _____ ________________ Prevention 1. Early intervention services/School-w ide screenings _____ _____ ________________ 2. Home Visitations/Community Outreach _____ _____ ________________ 3. Character Education _____ _____ ________________ 4. Parent Training _____ _____ ________________ 5. Substance Abuse Prevention/Counseling _____ _____ ________________ 6. Violence Prevention/Counseling _____ _____ ________________ 7. Suicide Prevention _____ _____ ________________ 8. Pregnancy Prevention/Support _____ _____ ________________ 9. Bullying Prevention _____ _____ ________________ 10. Dropout Prevention _____ _____ ________________ 11. Peer mediation/support groups _____ _____ ________________ Intervention 1. Time management training _____ _____ ________________ 2. Social skills training _____ _____ ________________ 3. Test taking and study skills training _____ _____ ________________ 4. Crisis intervention _____ _____ ________________ 5. Anger Control Training _____ _____ ________________ 6. Relaxation Training _____ _____ ________________ 8. Moral Reasoning Training _____ _____ ________________ Other 1. Clinical Interviews _____ _____ ________________ 2. Behavioral Observations _____ _____ ________________ 3. Case Management (coordination of se rvices) _____ _____ ________________ 4. Research and Evaluation _____ _____ ________________ 5. Other (Please Specify): _____ _____ ________________ 179

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3. In Section II Support Services are organi zed in three areas. Please review each ar ea and the services provided under each ar ea. Make a recommendation to include the specific service or exclude the specific service. If you believe that additional services should be included under the area, pl ease suggest the service. Include Exclude Additional Service(s) Intervention 1. Referred to school based intervention team _____ _____ ________________ 2. Referred to community based mental health service provider for counseling _____ _____ ________________ Appendix E (Continued) Include Exclude Additional Service(s) 3. Referred to school based psychologist for counseling _____ _____ ________________ 4. Referred to guidance counselor or social worker for counseling _____ _____ ________________ 5. Home-school intervention/collaboration _____ _____ ________________ Assessment 1. Referred to student services personnel for special education evaluation _____ _____ ________________ 2. Referred to student services personnel for a Functional Behavior Assessment _____ _____ _______________ Consultation 1. Student service personnel assigned as case manager _____ _____ ________________ 2. Consultation provided by community mental health provider _____ _____ ________________ 3. Consultation provided to classroom teachers _____ _____ ________________ 180

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Area 4. How long did it take to comp lete the entire survey? ______________________________________________ 5. Are there any recommendations for additi onal areas or sections in the survey that are currently not present? ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 181

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Appendix F: Pilot Study Cover Letter and Review Form for Student Services Supervisors (Version B) You are receiving this letter be cause you were selected from the Florida Student Support Services Dir ectory from the Florida Department of Education. The purpose of this letter is to ask for your pa rticipation in the pilot vers ion of the Perceptions o f School Based Mental Health Services by Directors and Supervisors of St udent Services study. Decia N. Dixon, a school psychology doctoral student at the University of Sout h Florida and primary investigator of this study is conducting a thesis study entitle d Perceptions of School Based Mental Health Services by Directors and Supervisors of Student Services to determine the beliefs of directors/supervisors of student services as they relate to school based mental health services and de livery and student academ ic and behavioral outcomes. The purpose of the pilot study is assess th e current scale for understa nding of content and res ponse choices, wording of questions, and the total time needed to complete the survey. Fee dback from the pilot study will be used to make changes to the scale, if needed. Input will also assist the researcher in maximizing the response rate and error rate when beginning the larger final study throughout the state of Florida. You are being asked to complete a brief survey developed to acquire information about your beliefs of school based mental health services. Mental health issues em body those characteristics and factors, which closely relate to mental well-being. The lack of mental well-being is characterized by an in ability to adapt to ones environment a nd regulate behavior (Websters, 2002). Menta l health services are those serv ices provided directly by a mental health professional (i.e. school ps ychologist, school counselor, school social worker), at the district, building, classroom, or individual student level. These services are targeted at optimizing de velopmental skills or behaviors that increase the probability of school success. The enclosed survey contains 11 items, 7 items which are district demographic information and 4 items that collect data about the types of mental health services provide d and the perceptions about those who provide these mental health services and the i mpact of specified mental health services on academic and behavioral outcomes. Please make sure that all items are completed before submitti ng the survey. For your convenience we have provided you with a postage-paid envelope to use in returning the survey to us. Your participation in this pilot study is crucial to the overall su ccess of this study. By partic ipating in the pilot study, yo u will assist the investigator(s) in assessing th e scale for understanding and the total time n eeded to complete the survey. Your feed back on the survey will also help to maximize the response rate for this study and minimize participan ts error rates on answers. 182

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Appendix F (Continued) In order to make this pilot study successf ul and effective, we ask that you comple te the following steps when completing and conducting the review of the survey: 4) Complete the survey in its entirety, while paying close attention to the surveys directions, wording, response choices and content. 5) Using the attached form entitled PSMHS Version B please follow the directions on the form and rate the items that you completed on the survey. Feel free to add sugge stions/comments under th e appropriate section. 6) Mail both the survey and the attached pilo t rating form in the pre-addressed, postage paid envelope to the following address by Nov. 15th, 2006. Mailing Address Decia Dixon, MA University of South Florida College of Education, Psychological and Social Foundations School Psychology Program, EDU 162, Suite 180 Tampa, FL 33162 27 Your privacy and research records will be ke pt confidential to the extent of the law. Authorized research personnel, employees of the Department of Health and Human Services, and the USF Institutional Review Board, staff and other individuals acting on behalf o f USF may inspect the records from this research project. The resu lts of the study may be published. However, the data obtained f rom you will be combined with data from others. The published results will not include your name or any other information that woul d personally identify you in any way. Your input is very important and we tha nk you in advance for your willingness to part icipate in this pilot study. If you have questions about your rights as a person who is taking part in a pilot study, call USF Division of Research Compliance and Integ rity at (813) 974-9343. If you have any questions about this research study, contact Deci a N. Dixon, M.A. at 678-524-5325 or at dndixon@mail.usf.edu 183

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Appendix F (Continued) PSMHS Version B Section I. Questions 1-7. Please review each of the questions. Please determine if the question is clear or is unclear If unclear, plea se make a suggestion or comment. Question Clear Unclear Suggestion/Comment 1. Size of school district: ___ ___ _________________________ 1.____Small 2.____Small/Middle 3.____Middle 4.____Large 5.____Very Large 2. Your highest degree earned: ___ ___ _________________________ 1.____ Bachelors Degree 2.____ Masters Degree 3.____ Specialist Degree 4.____ Doctoral Degree 3. Area in which you earned your ___ ___ _________________________ highest degree: 1.____ Special Education 2.____ General Education 3.____ Counseling 4.____ Psychology 5.____ Social Work 6.____ Administration 184

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Appendix F (Continued) Clear Unclear Suggestion/Comment 4. Area(s) in which you are ___ ___ _________________________ credentialed: 1.____ Special Education 2.____ General Education 3.____ Counseling 4.____ Psychology 5.____ Social Work 6.____ Administration 5. Your years of experience in ___ ___ _________________________ current position: 1.____ 1-5 2.____ 6-10 3.____ 11-15 4.____ More than 15 6. Your total years of experience ___ ___ _________________________ in educational setting: 1.____ 1-5 2.____ 6-10 3.____ 11-15 4.____ More than 15 185

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7. Check the one that best describes ___ ___ _________________________ your professional role: 1.____ Director/Supervisor of Psychological Services 2.____ Director/Supervisor of Guidance and Counseling Services 3.____ Director/Supervisor of Social Work Services Section II. 1. Are the instructions for completing the survey clearly written and understandable? Acceptable Needs modification Unacceptable Suggestions/Comments: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 2. In Section II, Mental Health Services ar e organized in seven areas. Please review each area an d the services provided under each area. Make a recommendation to include the specific service or exclude the specific service. If you be lieve that additional services should be included under the area, please suggest the service. Counseling Include Exclude Additional Service(s) 1. Individual therapy/counseling _____ _____ ________________ 2. Family therapy/counseling _____ _____ ________________ 3. Group therapy/counseling _____ _____ ________________ Consultation 1. Mental health consultation _____ _____ ________________ 2. Behavior management consultation _____ _____ ________________ 3. Academic consultation/interventions _____ _____ ________________ 186

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Include Exclude Additional Service(s) Norm-Referenced Assessments 1. Intelligence Assessment _____ _____ ________________ 2. Cognitive Assessment _____ _____ ________________ 3. Personality Assessment _____ _____ ________________ 4. Behavior Rating Scale _____ _____ ________________ Authentic Assessments 1. Dynamic Indicators of Basics Early Literacy Skills _____ _____ ________________ 2. Curriculum Based Measurement _____ _____ ________________ Prevention 1. Early intervention services/School-w ide screenings _____ _____ ________________ 2. Home Visitations/Community Outreach _____ _____ ________________ 3. Character Education _____ _____ ________________ 4. Parent Training _____ _____ ________________ 5. Substance Abuse Prevention/Counseling _____ _____ ________________ 6. Violence Prevention/Counseling _____ _____ ________________ 7. Suicide Prevention _____ _____ ________________ 8. Pregnancy Prevention/Support _____ _____ ________________ 9. Bullying Prevention _____ _____ ________________ 10. Dropout Prevention _____ _____ ________________ 11. Peer mediation/support groups _____ _____ ________________ Intervention 1. Time management training _____ _____ ________________ 2. Social skills training _____ _____ ________________ 3. Test taking and study skills training _____ _____ ________________ 4. Crisis intervention _____ _____ ________________ 5. Anger Control Training _____ _____ ________________ 6. Relaxation Training _____ _____ ________________ 8. Moral Reasoning Training _____ _____ ________________ 187

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Include Exclude Additional Service(s) Other 1. Clinical Interviews _____ _____ ________________ 2. Behavioral Observations _____ _____ ________________ 3. Case Management (coordination of se rvices) _____ _____ ________________ 4. Research and Evaluation _____ _____ ________________ 5. Other (Please Specify): _____ _____ ________________ 3. In Section II Support Services are organi zed in three areas. Please review each ar ea and the services provided under each ar ea. Make a recommendation to include the specific service or exclude the specific service. If you believe that additional services should be included under the area, pl ease suggest the service. Include Exclude Additional Service(s) Intervention 1. Referred to school based intervention team _____ _____ ________________ 2. Referred to community based mental health service provider for counseling _____ _____ ________________ 3. Referred to school based psychologist for counseling _____ _____ ________________ 4. Referred to guidance counselor or social worker for counseling _____ _____ ________________ 5. Home-school intervention/collaboration _____ _____ ________________ Assessment 1. Referred to student services personnel for special education evaluation _____ _____ ________________ 2. Referred to student services personnel for a Functional Behavior Assessment _____ _____ _______________ 188

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Include Exclude Additional Service(s) Consultation 1. Student service personnel assigned as case manager _____ _____ ________________ 3. Consultation provided by community mental health provider _____ _____ ________________ 4. Consultation provided to classroom teachers _____ _____ ________________ Area 4. How long did it take to comp lete the entire survey? ______________________________________________ 5. Are there any recommendations for additi onal areas or sections in the survey that are currently not present? ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 189


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ABSTRACT: Key stakeholders in schools must be educated about the importance of increasing access to mental health services in schools. School-based mental health services are designed to increase children's competence and help them meet the societal expectations of school success. The present study examined types of mental health services provided to students in school districts throughout Florida; the extent to which those services were provided to children and families; the beliefs of student services directors and supervisors regarding qualifications of school mental health service providers to provide mental health services; and their beliefs about the impact of mental health services on student academic and behavioral outcomes. Participants in this study included 90 student support services administrators (student services directors, supervisors of psychology, social work, and counseling).Descriptive analyses revealed that the three most commonly provided mental health services were consultation, normative assessment, and authentic assessment. Interestingly, no mental health service providers (school psychologists, school counselors, school social workers) were considered by student services directors and supervisors as qualified to highly qualified to provide intervention services with minimal to no supervision. Results of this study suggest that student services directors and supervisors have significantly different perceptions about the level of qualifications of mental health providers to provide mental health services. Specifically, the type of credential (teaching only vs. student support) which the director or supervisor held impacted their beliefs about the school psychologists level of qualification to provide mental health services.Finally, directors and supervisors, combined, had significantly different ratings about the types of mental health services which impacted academic and behavioral outcomes. Directors and supervisors ratings of impact of mental health services on academic and behavioral outcomes were moderated by the type of credential held. Implications of such results may be that mental health providers are only encouraged to provide those services which they are perceived to be qualified to provide; training programs may need to develop models which promote collaboration and partnership amongst mental health professionals to increase shared skills; and administrators may place an emphasis or de-emphasis on mental health services based on credential and training background.
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