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Mental health service delivery systems and perceived qualifications of mental health service providers in school settings

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Title:
Mental health service delivery systems and perceived qualifications of mental health service providers in school settings
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English
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Dixon, Decia Nicole
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University of South Florida
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Tampa, Fla
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Subjects / Keywords:
Mental well-being
School psychologist
School counselor
School social worker
School mental health
Dissertations, Academic -- Psychological and Social Foundations -- Doctoral -- USF   ( lcsh )
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non-fiction   ( marcgt )

Notes

Summary:
ABSTRACT: Latest research on the mental health status of children indicates that schools are key providers of mental health services (U.S. Department of Health and Human Services, 2003). The push for school mental health services has only increased as stakeholders have begun to recognize the significance of sound mental health as an essential part of academic success (Adelman & Taylor, 2002). However, while schools are recognized as playing an important role in the delivery of mental health services, it is not well understood about the types of mental health services provided, qualifications of providers, and the link to student outcomes (United States Department of Health and Human Services, 2003). The present study examined Florida school mental health service providers' perceptions about the types of mental health services provided in schools and school mental health service providers' qualifications to provide such services.Additionally, the study investigated the agreement about providers' qualifications to provide mental health services between providers, supervisors, and directors. Finally, this study investigated the perceptions of providers regarding the impact of mental health services on student outcomes. Results revealed that school mental health service providers considered several services, such as family counseling and mental health consultation, to be school mental health services. Services typically not viewed as mental health services were assessments, consultation improving academic concerns, early-intervention, universal screenings, and specialized intervention. School psychologists were the only mental health professional to receive a unanimous agreement from school mental health providers that they were most qualified of the three professionals to deliver a service (e.g., assessment).Additionally, with the exception of school psychologists, there was no consistency reported between administrators and school mental health service providers about providers' qualifications to deliver services. The following variables moderated perceptions about the qualifications of school mental health service providers: school level, SES status of school, and degree level. Lastly, school level and SES status of the school did not moderate perceptions about the impact of mental health services on academic and behavioral outcomes.
Thesis:
Dissertation (Ph.D.)--University of South Florida, 2009.
Bibliography:
Includes bibliographical references.
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Mode of access: World Wide Web.
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System requirements: World Wide Web browser and PDF reader.
Statement of Responsibility:
by Decia Nicole Dixon.
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Title from PDF of title page.
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Document formatted into pages; contains 285 pages.
General Note:
Includes vita.

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University of South Florida Library
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University of South Florida
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aleph - 002063192
oclc - 555953045
usfldc doi - E14-SFE0002991
usfldc handle - e14.2991
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i Mental Health Service Delivery Systems and Percei ved Qualifications of Mental Health Service Providers in School Settings by Decia Nicole Dixon A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy 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. Richard B. Weinberg, Ph.D. Date of Approval: April 20, 2009 Keywords: mental well-being, school psychologist, school counselor, school social worker, school mental health Copyright 2009, Decia Nicole Dixon

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i DEDICATION This dissertation is dedicated to my amazi ng family and friends wh o have supported me on this journey of enlightenment. I could not have endured this long road without your support, encouragement, and prayers. To God, who has always guided my footsteps towards my destiny. To my mother, Donna G. Dixon, who has provi ded me with unconditiona l support, financial resources, and encouragement, without you, I woul d not be where I am today. This moment is as much yours as it is mine. To my father, Thomas D. Dixon Jr., I thank you for your advice, wisdom, and support throughout this graduate pro cess. I am appreciative that you have always been in my corner. My paternal grandmother, Marjorie Dixon, your character of strength and tenacity is what fueled my desire to achieve my highest dreams. Thank you for being a role model. To three of my close friends, Vikki Bar no, Tori Watley, and Jerry Minor-Gordon, I thank you for your daily, weekly, and/or bi-weekly ca lls of encouragement. You endured the many moments of graduate school with me from afar a nd your constant words of love helped me to successfully complete this process. To my othe r friends from undergraduate and graduate school, my maternal and paternal family---past and present, and those individuals that I have met along lifes journey, I thank you as well. Each of you ha ve touched and shaped my life in some way and has brought me to this moment.

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i ACKNOWLEDGEMENTS The author would like to express her thanks to those organizations and individuals that were essential in the completion of this dissertation. I am grateful to the Florida Department of Education Student Support Services Network, Fl orida Association of School Psychologists, Florida School Counselors Association, and Florida Association of School Social Workers for providing me with the necessary information needed to create my databases. Special thanks to Dr. George Batsche, my advisor and dissertation chair, for his steadfast support and guidance throughout graduate school and th e dissertation process. I respect his vision and leadership in the field and I hope to emulate his dedication to improving the lives of children and families. Dr. Michael Curtis, whose commitment, leadership, a nd expertise in the profession have inspired me to reach beyond my highest professional goals while possessing an attitude of humility and gratefulness. Dr. Constance Hines, for her dedicati on to students, her statistical expertise, and her unwavering support and encourag ement throughout my graduate school process. Dr. Richard Weinberg, whose support of my professional growth and introduction to my previous clinical practicum setting, Directions for Mental Health Ce nter, has helped to enhance my clinical skills and broaden my professional goals.

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i TABLE OF CONTENTS List of Tables vi List of Figures xi Abstract xii Chapter One: Introduction 1 Statement of Problem 1 School-Based Mental Health Service Delivery System 8 Theoretical Basis of Study 8 Rationale 10 Purpose of Study 13 Research Questions 13 Significance of Study 14 Definition of Terms 15 Mental Health 15 School Mental Health Services 15 School Mental Health Service Providers 16 Qualified 16 Chapter Two: Review of the Literature 17 Introduction 17 Conceptualizing Mental Health and Mental Health Services 17 Historical Background of Child Mental Health 20 Mental Health Needs of Children and Adolescents 22 The Relationship between Mental Health and Student Ou tcomes 24 The Impact of Student Performance on Mental Health 25 The Impact of Mental Health on Student Performance 26 Importance of Mental Health Services in Schools 28 Mental Health Services in K-12 Settings 29 School-Based Mental Health Service Providers and Mental Health Services in Schools 31 School Psychologist 32 School Counselor 36 School Social Worker 38 Summary 41 Chapter Three: Method 43 Purpose of Study 43 Target Population 43 Sample 43 Mental Health Service Providers 44 Directors and Supervisors of Student Services 44 Research Design 44

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ii Instrumentation 45 Perception of School Mental Health Services survey (PSMHS): Practitioner Version 45 Perception of School Mental Health Services survey: Director (Version A) and Supervisor (Version B) Version 46 Data Collection Procedure 47 Step One: Participant Selection 47 Step Two: Data Management 47 Data Analysis Procedures 48 Research Question 1 48 Research Question 2 49 Research Question 3 50 Research Question 4 51 Research Question 5 52 Research Question 6 53 Delimitations of Study 54 Limitations of Study 55 Chapter Four: Results 56 Survey Response Rate 57 School Mental Health Service Providers 57 Student Services Directors and Supervisors 58 Description of Sample 59 School Mental Health Service Provider Sample 60 School Psychologist Demographics 60 School Counselor Demographics 61 School Social Worker Demographics 61 Student Services Directors and Supervisors Sample 62 Student Services Director Demographics 62 Student Services Supervisor Demographics 63 School Mental Health Service Providers Employment Conditions 65 Level of Mental Health Service Provision 66 Overview of Statistical Analyses for Research Question 1 69 Research Question 1 69 Summary of Results for Research Question 1 71 Overview of Statistical Analyses for Research Questions 2 through 6 76 Research Question 2 76 School Mental Health Service Providers Ratings of School Psychologists 76 School Mental Health Service Providers Ratings of School Counselors 78 School Mental Health Service Providers Ratings of School Social Workers 78 Test of Differences in Perceptions between School Mental Health Providers 83 Role x Provider x Service Interaction Effect 85 School Psychologists Ratings of Mental Health Professionals 85 School Counselors Ratings of Mental Health Professionals 88

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iii School Social Workers Ratings of Mental Health Professionals 88 Summary of Results for Research Question 2 89 Research Question 3 90 Qualification of School Psychologist 90 Qualification of School Counselor 92 Qualification of School Social Worker 94 Test of Differences in Perceptions between Directors, Supervisors, and School Mental Health Service Providers 98 Role x Provider x Service Interaction Effect 100 Directors Ratings 100 Supervisors Ratings 100 School Mental Health Service Provi ders Ratings 101 Summary of Results for Research Question 3 102 Research Question 4 105 District Size 105 Ratings of School Psychologists 105 Ratings of School Counselors 106 Ratings of School Social Workers 109 Test of Differences in Perceptions between School Mental Health Service Providers Employed in Different District Sizes 111 Employment Location 113 Ratings of School Psychologists 113 Ratings of School Counselors 113 Ratings of School Social Workers 113 Test of Differences in Perceptions between School Mental Health Service Providers Employed in Elementary, Middle, High, or Multiple School Settings 117 School Level x Provider x Service Interaction 117 Elementary School Level 119 Middle School Level 119 High School Level 122 Multiple School Levels 122 Socioeconomic Status (SES) of Students Served by Respondents 123 Ratings of School Psychologists 123 Ratings of School Counselors 124 Ratings of School Social Workers 125 Test of Differences in Perceptions between School Mental Health Service Providers Employed in Title I or Non-Title I Settings 127 SES x Provider Interaction 128 Summary of Results for Research Question 4 129 Research Question 5 131 Years of Professional Work Experience 131 Ratings of School Psychologists 131 Ratings of School Counselors 131 Ratings of School Social Workers 132

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iv Test of Differences in Perceptions between School Mental Health Service Providers by Years of Experience 134 Highest Degree in Discipline 138 Ratings of School Psychologists 138 Ratings of School Counselors 140 Ratings of School Social Workers 140 Test of Differences in Perceptions between School Mental Health Service Providers by Highest Degree Earned 143 HD x Provider Interaction 145 Summary of Results for Research Question 5 147 Research Question 6 148 Test of Differences in Ratings of Impact between School Mental Health Service Providers by School Level and SES 148 Academic Outcomes 148 Service Main Effect 150 Behavioral Outcomes 152 Service Main Effect 154 Summary of Results for Research Question 6 155 Academic Outcome 155 Behavioral Outcomes 155 Chapter Five: Discussion 156 Research Question 1 157 Research Question 2 159 School Psychologists 159 School Counselors 160 School Social Workers 161 Research Question 3 161 School Psychologists 161 School Counselors 162 School Social Workers 163 Research Question 4 163 District Size 164 School Level 164 SES Status of School 167 Research Question 5 168 Years of Professional Work Experience 168 Degree Level 169 Research Question 6 170 Limitations 171 Implications for Practice 173 Implications for Future Research 176 Conclusion 178 References 180 Appendices 196 Appendix A: School Mental Health Service Provider Demographic and Professional Characteristics 197

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v Appendix B: Perception of School Mental Health Services Survey (Practitioner Versions (1, 2, & 3)) 198 Appendix C: Informed Consent for Practitioners 225 Appendix D: Data Requests 228 Appendix E: Perception of School Mental Health Services Survey (Version A) 240 Appendix F: Perception of School Mental Health Services Survey (Version B) 250 Appendix G: Informed Consent for Directors of Student Services (Version A) 259 Appendix H: Informed Consent for Supervisors of Student Services (Version B) 263 Appendix I: Pilot Study Cover letter and Review Form (Version A) 267 Appendix J: Pilot Study Cover letter and Review Form (Version B) 276 About the Author End Page

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vi LIST OF TABLES Table 1 Response Rate of School Me ntal Health Service Providers by Role 58 Table 2 Response Rate of Student Services Supervisors and Directors by Role 59 Table 3 Demographic and Professional Characteristics of School Psychologist (AY 2007-2008) 60 Table 4 Demographic and Professional Characteristics of School Counselor (AY 2007-2008) 61 Table 5 Demographic and Professional Characteristics of School Social Worker (AY 2007-2008) 62 Table 6 Demographic and Professional Characteristics of Supervisors and Directors (AY 2006-2007) 64 Table 7 Employment Conditions of School Mental Health Service Providers (AY 2007-2008) 65 Table 8 Level of Mental Health (MH) Service Provision by District Size 67 Table 9 School Mental Health Serv ice Providers Ratings of MH Services (N=358) 72 Table 10 School Psychologists Ratings of MH Services (n =167) 73 Table 11 School Counselors Ratings of MH Services (n =143) 74 Table 12 School Social Workers Ratings of MH Services (n = 48) 75 Table 13 Mean and Standard Devi ation of Ratings of Level of Qualifications of School Psychologists to Provide MH Services as Perceived by Indi vidual School MH Service Providers 77 Table 14 Mean and Standard Devi ation of Ratings of Level of Qualifications of School Counselors to Provide MH Services Perceived by Indivi dual School MH Service Providers 79

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vii Table 15 Mean and Standard Devi ation of Ratings of Level of Qualifications of School Social Workers to Provide MH Services as Perceived by Indi vidual School MH Service Providers 80 Table 16 Analysis of Variance of Ratings of Perceived Qualifications of MH Service Providers to Provide MH Services by Professional Role 84 Table 17 Mean and Standard Devi ation of Ratings of Perceived Level of Qualifications of Service Providers to Provide MH Services by Professional Role 86 Table 18 Mean and Standard Devi ation of Ratings of Level of Qualifications of School Psychologists to Provide MH Services as Perceived by Directors, Supervisors, and School MH Service Providers 91 Table 19 Mean and Standard Devi ation of Ratings of Level of Qualifications of School Counselors to Provide MH Services as Perceived by Directors, Supervisors, and School MH Service Providers 93 Table 20 Mean and Standard Devi ation of Ratings of Level of Qualifications of School Social Workers to Provide MH Services as Perceived by Directors, Supervisors, and School MH Service Providers 95 Table 21 Analysis of Variance of Ratings of Perceived Qualifications of MH Service Providers to Provide MH Services by Professional Role 99 Table 22 Mean and Standard Devi ation of Ratings of Perceived Level of Qualifications of Service Providers to Provide MH Services by Professional Role 104 Table 23 Mean and Standard Devi ation of Ratings of Perceived Level of Qualifications of School Psychologists to Provide MH Services as Reported by School MH Service Providers by Size of District 107 Table 24 Mean and Standard Devi ation of Ratings of Perceived Level of Qualifications of School Counselors to Provide MH Services as Reported by School MH Service Providers by Size of District 108 Table 25 Mean and Standard Devi ation of Ratings of Perceived Level of Qualifications of School Social Workers to Provide MH Services as Reported by School MH Service Providers by Size of District 110

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viii Table 26 Analysis of Variance of Ratings of Perceived Qualifications of MH Service Providers to Provide MH Services by District Size 112 Table 27 Mean and Standard Devia tion Ratings of Perceived Level of Qualifications of School Psychologists to Provide MH Services as Reported by School MH Service Providers by Level of Employment 114 Table 28 Mean and Standard Devia tion Ratings of Perceived Level of Qualifications of School Counselors to Provide MH Services as Reported by School MH Service Providers by Level of Employment 115 Table 29 Mean Ratings of Perceive d Level of Qualifications of School Social Workers to Provide MH Services as Reported by School MH Service Providers by Level of Employment 116 Table 30 Analysis of Variance of Ratings of Perceived Qualifications of MH Service Providers to Provide MH Services by School Level 118 Table 31 Mean of Ratings of Percei ved Level of Qualifications of Service Providers to Provide MH Services by School Level 121 Table 32 Mean Ratings of Perceive d Level of Qualifications of School Psychologists to Provide MH Services as Reported by School MH Service Providers by the SES of Students Served 124 Table 33 Mean Ratings of Perceived Level of Qualifications of School Counselors to Provide MH Services as Reported by School MH Service Providers by the SES of Students Served 125 Table 34 Mean Ratings of Perceived Level of Qualifications of School Social Workers to Provide MH Services as Reported by School MH Service Providers by the SES of Students Served 126 Table 35 Analysis of Variance of Ratings of Perceived Qualifications of MH Service Providers to Provide MH Services by SES School Status 128 Table 36 Mean and Standard De viation Ratings of School MH Providers in Title I and NonTitle I Schools of Perceived Qualifications of Service Providers to Provide MH Services 129

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ix Table 37 Mean of Ratings of Percei ved Level of Qualifications of School Psychologists to Provide MH Services as Reported by School MH Service Providers by Years of Experience 133 Table 38 Mean of Ratings of Percei ved Level of Qualifications of School Counselors to Provide MH Services as Reported by School MH Service Providers by Years of Experience 134 Table 39 Mean and Standard Deviati on of Ratings of Perceived Level of Qualifications of School Social Workers to Provide MH Services as Reported by School MH Service Providers by Years of Experience 135 Table 40 Analysis of Variance of Ratings of Perceived Qualifications of MH Service Providers to Provide MH Services by Years of Experience in Position 137 Table 41 Mean Ratings of Perceived Level of Qualifications of School Psychologists to Provide MH Services as Reported by School MH Service Providers by Degree Level 139 Table 42 Mean Ratings of Perceived Level of Qualifications of School Counselors to Provide MH Services as Reported by School MH Service Providers by Degree Level 141 Table 43 Mean Ratings of Perceived Level of Qualifications of School Social Workers to Provide MH Services as Reported by School MH Service Providers by Degree Level 142 Table 44 Analysis of Variance of Ratings of Perceived Qualifications of MH Service Providers to Provide MH Services by Degree Level 144 Table 45 Mean Ratings of Perceived Le vel of Qualifications of Service Providers to Provide Overall MH Services by Respondents Degree Level 147 Table 46 Mean and Standard Devi ation of Ratings of Perceived Impact of Mental Health Services on Academic Outcomes by School Level and SES Status of School 149 Table 47 Analysis of Variance about the Perceived Impact of Mental Health Services on Academic Outcomes by School Level and SES 150 Table 48 Mean and Standard Deviati on of Ratings of Perceived Impact of Mental Health Services on Academic Outcomes 151

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x Table 49 Mean and Standard Deviati on of Ratings of Perceived Impact of Mental Health Services on Behavioral Outcomes by School Level and SES Status of School 153 Table 50 Analysis of Variance about the Perceived Impact of Mental Health Services on Behavioral Outcomes by School Level and SES 154 Table 51 Mean and Standard Devi ation of Ratings of Perceived Impact of Mental Health Services on Behavioral Outcomes 155

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xi LIST OF FIGURES Figure 1 Level of MH Service Provision by District Size 68 Figure 2 Matrix of Perceptions of School Psychologists, School Counselors, and School Social Workers Regarding Qualifications of School Mental Health Providers to Provide MH Services with No/Minimal Supervision 82 Figure 3 Interaction Effect of Role and Provider and Service on the Mean Ratings of the Qualifications of MH Service Providers to Provide MH Services 87 Figure 4 Matrix of Perceptions of School Psychologists, School Counselors, and School Social Workers Regarding Qualifications of Directors, Supervisors, and School Mental Health Providers to Provide MH Services with No/Minimal Supervision 97 Figure 5 Interaction Effect of Role and Provider and Service on the Mean Ratings of the Qualifications of MH Service Providers to Provide MH Services as Reported by Directors, Supervisors, and School Mental Health Providers 103 Figure 6 Interaction Effect of School Level by Provider by Service on the Mean Ratings of the Qualifications of MH Service Providers to Provide MH Services as Reported by School Mental Health Providers 120 Figure 7 Interaction Effect of SES and Provider on the Mean Ratings of the Qualifications of MH Service Providers to Provide MH Services as Reported by School Mental Health Providers 130

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xii MENTAL HEALTH SERVICE DELIVERY SYSTEMS AND PERCIEVED QUALIFICATIONS OF MENTAL HEALTH SERVICE PROVIDERS IN SCHOOL SETTINGS Decia Nicole Dixon ABSTRACT Latest research on the mental health status of children indicates that schools are key providers of mental health services (U.S. Depart ment of Health and Human Services, 2003). The push for school mental health services has only in creased as stakeholders have begun to recognize the significance of sound mental health as an ess ential part of academi c success (Adelman & Taylor, 2002). However, while schools are recognized as playing an important role in the delivery of mental health services, it is not well unders tood about the types of mental health services provided, qualifications of providers, and the lin k to student outcomes (United States Department of Health and Human Services, 2003). The present study examined Florida school mental health service providers perceptions about the types of mental health services provi ded in schools and school mental health service providers qualifications to pr ovide such services. Additionally, the study investigated the agreement about providers qualifications to pr ovide mental health services between providers, supervisors, and directors. Finally, this study i nvestigated the perceptions of providers regarding the impact of mental health services on student outcomes. Results revealed that school mental health service providers considered several services, such as family counseling and mental health cons ultation, to be school mental health services.

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xiii Services typically not viewed as mental health services were assessments, consultation improving academic concerns, early-intervention, universal screenings, and specialized intervention. School psychologists were the only mental health professional to receive a unanimous agreement from school mental health providers that they were mo st qualified of the three professionals to deliver a service (e.g., assessment). Additionally, with th e exception of school psychologists, there was no consistency reported between ad ministrators and school mental health service providers about providers qualifications to deliver services. Th e following variables moderated perceptions about the qualifications of school mental health servi ce providers: school level, SES status of school, and degree level. Lastly, school level and SES stat us of the school did not moderate perceptions about the impact of mental health services on academic and behavioral outcomes.

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1 CHAPTER ONE INTRODUCTION Statement of the Problem Reform movements and recent policy and le gislation have created an educational climate that is driven by accountability, demons trated through positive student outcomes (U.S. Dept. of Education, 2001). Services and program s must demonstrate data-based, student-driven outcomes of success, in order to be supported by district and school leaders (U.S. Dept. of Education, 2001; Pub L. No. 108-446). Policy and legislation changes have supported a more ecologically oriented approach to student con cerns to ensure that we meet the social, emotional, and behavioral needs of children and adolescents and promote school success. For example, legislation such as The Elementary an d Secondary Education Act of 2001, No Child Left Behind (NCLB) (U.S. Department of E ducation, 2001) holds schools accountable for creating environments in which all students can succeed, academically and behaviorally. The No Child Left Behind (NCLB) Act of 2001 (U.S. Dept. of Education, 2001) provides schools with the flexibility to use their resources wher e they are needed most to improve schooling. These resources may include universal mental health services for improving educational outcomes. The Individuals with Disabilities Education Improvement 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 health 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. Traditionally, mental health services have not been linked to the promotion of successful educational outcomes (School Mental Health Allia nce, 2005). Educators in the past and present

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2 have viewed school mental health services and staff (i.e., social workers, psychologists, and counselors) as add-ons or optional supplement s (School Mental Health Alliance, 2005). This view of school mental health, as being non-academ ic has been strengthened in light of NCLB and IDEIA 2004, Just Read, Florida!, Reading First, adequate yearly progress, and school grades, all of which have narrowed the focus of school -based activities to promoting student academic performance (Batsche, Beam, Castillo, & Dixon, 2005 ). In order for school mental health services and staff to be seen as a valuable asset to the educational system, school mental health service providers must demonstrate competence and skills in the provision of services which are believed to be linked to student outcomes (Dixon, 2007). However, to increase the perceived effectiveness of school-based mental health services, school mental health service providers must do more than just demonstrate a level of competence to provide those services that are linked to student outcomes. School mental health service providers must also assess district and school leaders beliefs about the qualifications of school mental health service providers (based on their training and skills) to deliver services which impact st udent outcomes. Research by Joyce and Showers (1988) has suggested that the beliefs of educator s about their own or others social competence, impacts the ease with which knowledge is transferre d to actual practice. Thus, the beliefs held by district and school leaders about the qualifications of school mental health service providers to deliver services which address the mandates of legislation will ultimately impact the actual practices of school mental health service providers. In the study by Dixon (2007) district leader s identified effective mental health services (e.g., interventions) that were recognized in r esearch as improving student outcomes. However, these were not the mental health services that district leaders perceived school mental health service providers as qualified to provide. Instead, di strict leaders believed that the mental health services that school mental health service providers were qualified to provide were those that were not strongly linked to improving student outcomes (D ixon, 2007). Interestingly, however,

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3 what was observed in the investigation (Di xon., 2007) was that there may have been a relationship between district leaders percepti ons about providers qua lifications to deliver services (e.g., normative assessments) and the servi ces that were actually provided in their district. It seems as though school mental health service providers, in some cases, only delivered those services which district leaders believed they were qualified to provide, despite the fact that it may not have been linked to improving student outcomes. Thus the results from the study suggested that district leaders beliefs about school mental health service providers qualifications to deliver mental health services may have been related to the actual delivery of mental health services in school settings (Dixon, 2007). Research has also shown that district leader s beliefs about school mental health services impacts how those services are prioritized in school settings (Adelman & Taylor, 2002). Literature has shown that district and school leaders place a low priority on addressing the mental health needs of students (Adelman & Taylor, 2002). It can be hypothesized from the Dixon (2007) study that based on the beliefs district leaders have about school mental health service providers qualifications to deliver services and th e impact of those services on student outcomes, that the word school mental health service conveys a non-academic focus to service delivery (Dixon, 2007). Therefore, it can be understood wh y school mental health services are believed to not address the mandates of legislation of improve d student outcomes and thus are often at the bottom of the priority list for district mandates (Adelman & Taylor, 2002). What research (Adelman & Taylor, 2000) has indicated, however, is that effective school mental health services have the potential to address the mandates of NCLB and IDEIA. Research has suggested that there is a strong relationship between effective school mental health services and student outcomes (Adelman & Taylor, 2000). In addition, student mental health problems can serve as a barrier to student learning (Adelman & Taylor, 1999). This is problematic because the mental health needs of our children are increasing. This escalation is particularly evident for

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4 children, specifically minority children, from lo w-income, urban or rural environments. Adelman and Taylor (2006) suggested that children of lowincome status from urban or rural settings are less likely to have access to mental health care th an other groups of children. When these children do receive services, they are often of poorer qua lity than those received by children of middle class parents (U.S. Department of Health and Human Services, 1999). Thus this escalation in child mental health needs requires mental health professionals (i.e., school psychologists, school counselors and school social workers) in schools to identify effective mental health services that promote both academic and behavioral success. Research consistently demonstrates that im provement in the social, emotional, and behavioral well-being of a child is significantly related to higher levels of academic achievement, as well as lower rates of aggression, criminality and mental illness (Owens & Murphy, 2004). Further, according to Owens and Murphy (200 4) universal, school-based intervention programs that teach positive social, emotional, and behavior al skills have been foun d to improve students academic performance and social adjustment (e .g., decline in office referrals and disruptive behaviors). Mash and Barkley (2003) state that when children are not successful in school they are at risk for a variety of mental health problems. Willcutt and Pennigton (2000) examined the mental health outcomes of children who read on grade level compared with those who did not read on grade level. They found that children who had a reading disability presented significantly higher levels of anxiety and depression, compared with children who read on grade level. Kellam, Re bok, Mayer, Ialongo, and Kalodner (1994) found that a failure to master core developmental tasks, such as reading, in the early primary grades contributed to higher levels of depression in individuals. It is hypothesized that when a child fa ils to meet his or her expected developmental norms, distress or unhappiness, peer rejection, poor academic perfo rmance, school dropout or delinquency emerge (Masten & Curtis, 2000). Schools have the poten tial, however, to help children and youth to

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5 develop the competencies to be successful and to ameliorate many of the problems that are associated with adaptational failure (Mash & Barkley, 2003). Mental health issues which adversely imp act childrens academic performance include internalizing problems (e.g., depression and anxiet y) and externalizing problems (e.g., conduct disorder, oppositional defiant disorder, and atten tion deficit hyperactivity disorder). Ecological factors such as family issues (e.g., domestic violen ce, child abuse, and divorce), substance abuse, stress, and lack of family and school support also impact children. Finally, a lack of behavioral, emotional, and/or social skills needed to su cceed in schools adversely impact student academic performance (Florida Department of Education, 2000; Kestenbaum, 2000). In fact, current studies report that roughly 18% to 22% of children and adolescents experience serious difficulty in their psychosocial functioning at any given time in th e United States (Dore, 2005). In addition, 5% to 8% of these children experience difficulties serious enough to be considered a mental illness. Thus, it is estimated that 4 million children and adolescents in the Unites States are in need of mental health services and treatment (Dore, 2005). Although there are many children and adolescents in need of mental health treatment, research has shown that 79% of children aged 6 to 17 years-old with mental disorders do not receive mental health care in a school or co mmunity setting (Katoaka, 2002). Evidence provided by the World Health Organization (2005) stat es that by the year 2020, childhood psychiatric disorders will rise by over 50 percent. Childhood ps ychiatric disorders are expected to become one of the five most common causes of morbidity, mortality, and disability among children (Shaffer et al., 1996). The societal cost of untreated mental health problems among our children and adolescents is immense. 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). It is estimated that nearly 38% of the nations students withdraw from school every year

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6 (Freudenberg & Ruglis, 2007). Early withdrawal from school is a loss for both the individual and the community. Adverse, long-term outcomes for high school dropouts include a reduced potential to be successful contributors to soci ety and increased potential for unemployment, welfare, poverty, imprisonment, and other social services (Bridgeland, Dilulio, & Morison, 2006). In economic terms, Cohen (1998) estimated that a single high school drop out can cost as much as $243,000 to $388,000 in tax-based support over a lifetime. The aforementioned data explain why schools should not ignore the mental and physical health factors which impact academic and behavioral outcomes of students. To address students academic needs schools must reorganize to meet th e needs of the whole child (Fine & Gardner, 1997). Thus, a paradigm shift is required of all prof essionals in schools. It is important that school leaders and personnel recognize that schools are the most logical site for the delivery of mental health services (Weist, Paskewitz, Warner, & Fl aherty, 1996). Children and youth spend a great deal of time in school settings and schools are one of the few stable institutions that exist in impoverished, rural, and underserved areas (Weist et al., 1996). Services offered in schools are more accessible and affordable than off-site centers, such as community-based mental health centers (Weist et al., 1996). Although research has shown that schools reduce many of the barriers (e.g., transportation and financial problems) that limit access to mental health care to those children who need them the most (Weist et al., 1996), school district stakeholders (e.g., school boards) are often still reluctant to provide mental health ser vices to children and youth. Many schools leaders do not believe that schools are in the business of pr oviding mental health care. Rather schools are in the business of ensuring academic achievem ent (Adelman & Taylor, 2002). However, according to the Center for Mental Health in Schools (2002), a school-based mental health need is any concern or problem that produces a barri er to learning. Mental health services in schools

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7 are the services that remove those barriers to learning and address the primary concern of the school, student achievement School-based mental health services are not lim ited to only counseling, consultation, and services traditionally affiliated with mental health Mental health services in schools also include time management or study skills sessions, which address educational difficulties that impede a students learning and mental health (Center fo r Mental Health in Schools, 2002). As schools move forward to address the challenge establishe d by NCLB (U.S. Department of Education, 2001), important questions should be raised regarding the most effective strategies that promote school success. How schools choose to define and deliver mental health services ultimately will determine the relationship between mental hea lth services and student academic and behavioral outcomes. Traditional mental health services include in tervention services (e.g., individual or group counseling, crisis intervention, family services) th at address behavioral and/or emotional issues of students. These services typically are not provide d until a student demonstrates behavior that precipitates referral (i.e., wait to fail model). In contrast, non-traditional mental health services take more of a prevention focus to service deliver y and seek to provide all students with critical skills needed to be successful in an educationa l environment. Non-traditional mental health services are any services which improve student academic or behavioral outcomes, thus preventing mental concerns related to academic or behavioral failure. Non-traditional mental health services include services such as acad emic assessment (e.g., curriculum based measurement) and intervention or behavioral assessment or inte rventions (e.g., social skills training) (Batsche, Castillo, Dixon, & Beam, 2005). School psychologists, school social workers, and school counselors are the providers of these traditional and non-traditional mental health services in school settings (Koller & Bertel, 2006). The professional standards developed by each of their respective professional associations

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8 support their role in the delivery of mental h ealth services (Koller & Bertel, 2006). In addition, each of the school mental health service provide rs professional associations have established provider to student ratios which maximize their ab ility to provide adequate services to students. The recommended school psychologist to student ratio is 1:1000, the recommended school counselor to student ratio is 1:560, and the recommended school social worker to student ratio is 1:2000 (Kestenbaum, 2000; Curtis, Grier, Abshier, Sutton, & Hunley, 2002; Franklin, 2000). When the school mental health service provider to student ratio exceeds the recommended ratios, it becomes challenging for the school mental health service provider to deliver effective services for students. School-Based Mental Health Service Delivery System Theoretical Basis of Study Checkland (1997) defines a system as a collection of organized parts or subsystems that function together in order to accomplish an ove rall goal. A system is composed of various interrelated, interdependent parts or subsystems each of which contributes to the functioning of the overall system. If there is any disconnect in th e effectiveness or efficiency within or across subsystems then there will be consequences in othe r parts of the system and for the system as a whole (Brown & Harvey, 2006). In a school mental health system some of the subsystems are: 1) mental health service providers, 2) mental health services delivered, 3) educational legislation, related to school mental health, and 4) student outcomes as a result of the delivery of school mental health services. Legislation such as IDEIA and NCLB have impacted the school mental health system by emphasizing the importance of meeting the social, emotional, and behavioral needs of youth to promote school success (U.S. Department of Education, 2001; IDEIA 2004; Pub.L.No.108-446). In addition, legislation a nd reform movements have placed an emphasis on utilizing trained mental health professionals who have the skills and knowle dge to provide mental health services which will meet childrens diverse needs (U.S. Department of Education, 2001).

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9 However, according to the Center for Mental Hea lth in Schools (2002) only those mental health services that are perceived by the school system to be linked to academic and behavioral outcomes will be emphasized for delivery. An important principle of systems theory states that: .a systems overall objectives are more important than the objectives of its elements [or subsystems] and thus conflicting objectives of subsystems are de-emphasized (Brown & Harvey, 2006, p.40) Therefore, the mental health services which a dist rict believes are related to successful student academic and behavioral outcomes will be the mental health services that are supported in a school-based mental health service delivery system Additionally, those are the services that school mental health professionals are expected to be qualified to provide. A finding in the Dixon (2007) study indicated that district administrato rs consistently rated consultation as a mental health service that strongly impacted student outcomes. Thus, consultation was also the service most frequently provided in school districts and that which hired mental health service providers, were expected to be qualified to provide. It is important to identify both the beliefs of the individuals who influence the system (i.e., district administrators of mental hea lth services) and the school mental health service providers who are responsible for the delivery of these services. Identifying the beliefs of district leaders is important because they provide the li nk between mental health services and student outcomes. They also are expected to influence the job descriptions and priorities of school-based mental health service providers. Identifying the beliefs of school-based mental health service providers is important because they reinforce the link between school-based mental health services and student outcomes.

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10 Therefore, based on what is mentioned above, the effectiveness of the school-based mental health services system declines when: a. School-based mental health service providers within the system are not qualified to provide the mental health services which district leaders perceive as impacting student outcomes. This was found in the Dixon (2007) study, where administrators rated intervention services as strongly impacting student outcomes, yet, none of the school-based mental health service providers were rated as qualified to provide this service. b. The mental health services that providers are rated as most qualified to provide are those services which are considered to not impact student outcomes. Dixon (2007) found that administrators rated normative assessments as a service which was not related to student outcomes; however, school psychologists were seen as most qualified to provide this mental h ealth service versus other services. c. The mental health services that a school system believes impact student outcomes are those services that the school-based mental health service provider believes they are not qualified to provide based on their training and skills. Rationale Research suggests that school psychologists, school counselors, and school social workers play an important role in ensuri ng the success of children and adolescents (see for example, Gibelman, 1993). A closer examination of the qualifications of the school psychologist, school counselor, and school social worker rev eals many similarities in job responsibilities and overarching competencies between the groups (G ibelman, 1993). However, as schools continue to make budgetary cuts, school mental health prof essionals are seeking ways to define the scope and sequence of their training and their qualifica tions to provide mental health services in an effective and efficient manner (Gibelman, 1993).

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11 Previous research has indicated that the school psychologist provides primarily assessment-related services, some counseling, and consultation (Fagan & Wise, 2000). The school counselor provides indivi dual and group counseling, gui dance programs, assists with school-wide testing and academic scheduling, an d helps school staff with children who have behavior or academic problems (Agresta, 200 4). The school social worker provides support services for children and families, conducts social histories, and links families to community resources (Agresta, 2004). Although previous research has examined the perceptions of school psychologists, school social workers, and school counselors regarding ro le preferences (Fagan & Wise; Nastasi, Varjas, Bernstein, & Pluymert, 1998; Curtis et al., 2002; Agresta, 2004; Burnham & Jackson, 2000; Franklin, 2000), a literature search found no previous studies which examined school-based mental health service providers beliefs about their own qualifications to provide school-based mental health services or their perception regarding the impact of mental health services on student outcomes. As stated earlier, school-based mental health service providers reinforce the link, established by district leaders, between sc hool mental health services and student outcomes. School-based mental health service providers that believe they are only qualified to provide services that district leaders believe do not im pact student outcomes, jeopardize the future existence of school-based mental health services. In addition, they also increase the likelihood that district leaders will not see the importan ce of their role because of the nonexistent relationship between the services which they provide and improved student outcomes. Previous research (Dixon, 2007) has been conducted to examine the beliefs held by directors and supervisors of student services re garding school mental health service providers qualifications to provide mental health services and the impact of such services on student academic and behavioral outcomes. The results of the Dixon (2007) study revealed that directors and supervisors perceived school psychologists as being qualified to provide those mental health

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12 services which are traditionally reported in the lite rature as aligning with their roles (Fagan & Wise; Nastasi et al., 1998; Curtis et al., 2002; Agresta, 2004; Burnham & Jackson, 2000; Franklin, 2000). More specifically, school psyc hologists were consistently perceived to be qualified to provide both normative assessment a nd consultation services. Surprisingly, however, for school counselors and school social workers, there was no consistency amongst the directors and student services supervisors regarding the ment al health services which they were considered qualified to provide. In addition, they did not consider any school-based mental health service provider as qualified to provide intervention servi ces. Interestingly, however, the study revealed that intervention services were perceived to have a strong impact on student outcomes. In conclusion, the results of the study by Dixon (2007) provided an illustration about a growing concern in the field of school mental health. The growing concern is whether district leaders believe school-based mental health service provi ders possess the needed skills, based on their training, to deliver services related to improved student outcomes. From this study, it was determined that the school-based mental health ser vice providers were perceived to be qualified to provide mental health services which have not b een found to directly impact student outcomes. It was concluded from this study, that future research was needed to investigate whether school based mental health service providers also believe d that the services they were most qualified to provide, were services which did not impact student outcomes. Thus, it was beneficial to examine the simila rities and differences in the beliefs between school-based mental health service providers and sc hool mental health district administrators regarding school mental health service providers qua lifications to provide mental health services. Examination of the consistency between the per ceptions of these groups regarding the perceived impact of those services on student outcomes is also warranted. If school mental health service providers held similar beliefs as district leaders, then this would suggest evidence of a possible problem within the field of school-based mental health. To resolve this problem, school mental

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13 health service providers would need intensive trai ning and supervision in those areas, that impact student outcomes, but which they believed they were not qualified to provide independently. Providing training that addresses specific skills needed would be critical to the continued existence of the role of the school psychologist, school counselor, and school social worker. In addition, it would result in the delivery of an e ffective school mental health service system that resulted in improved student outcomes and addressed the mission of the educational system. Lastly, the results of this current study pr ovided additional information about the current emphasis which was placed on school-based mental health services in Florida. Purpose of Study The purpose of this study was to investig ate the perceptions of Florida school-based mental health service providers about which services are school mental health services and who (i.e., the school psychologist, the school counselor, and the school social worker) was perceived to be qualified to provide the specified services. Additionally, the study i nvestigated the level of agreement between school-based mental health service providers, school-based mental health service supervisors, and directors regarding school mental health service providers qualifications to provide specified mental health services. Fi nally, this study examined the perceptions of school-based mental health service providers rega rding the impact of specific mental health services on student outcomes. Research Questions The following research questions were addressed in this study: 1. What is the level of agreement within an d across school-based mental health service providers (i.e., school psychologists, school counselors, and school social workers) regarding what they believe to be a mental health service in K-12 school settings? 2. To what extent do school-based mental health service providers concur about who is best qualified to provide specified mental health services in K-12 school settings?

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14 3. What is the level of agreement between school-based mental health service providers, school-based mental health service supervisors, and directors of student services/special education regarding who is best qualified to provide specified mental health services in K-12 school settings? 4. To what extent do district size, school level in which a provider is employed (i.e., primarily elementary schools, primarily middle schools, etc.), and SES status of school (Title I or Non Title I) moderate school me ntal health service providers perceptions about who is best qualified to provide specified mental health services in K-12 school settings? 5. To what extent do years of professional work experience and highest degree in discipline moderate school mental health service pr oviders perceptions about who is best qualified to provide specified mental health services in K-12 school settings? 6. Does the school level and SES status of a school in which school-based mental health service providers practice modera te their beliefs about the impact of specified mental health services on student (a) academic outcomes and (b) behavioral outcomes? Significance of Study Findings from this study are expected to make a potential contribution to the field of school psychology, school counseling, and school social work and to the delivery of mental health services for students in several ways. First, findings of this study would lead to suggestions for training programs for school-based mental hea lth service providers about the perceived skills and qualifications which school psychologists, school counselors, and school social workers believed they possessed and how similar or dissimila r those beliefs were in comparison to beliefs held by district administrators and/or supervisors of mental health services. Second, information from this study provided insight into the types of mental health services which were believed to be linked to student outcomes and thus had a highe r priority in the mental health service delivery

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15 system in schools. Third, this study offere d information to national and state professional associations about mental health issues that need ed to be addressed with regard to training, research, and professional practice. Fourth, it was impo rtant to compare the results of this study to the outcome of the previous study by Dixon, 2007 which examined the beliefs of administrators for several reasons. Comparing beliefs of admi nistrators and school mental health service providers, informed whether the two groups (i.e., administrators and school mental health service providers) possessed similar or dissimilar beliefs about qualifications of school-based mental health service providers and the impact of mental health services on student outcomes. Knowledge about the similarities or differences in beliefs provided information about the impact which this has on the school mental health service delivery system Finally, this study had the potential to inform stakeholders who could influe nce policy about the delivery of mental health services to students in school settings. Definition of Terms Mental Health Mental health issues embody those characteris tics and factors, which closely relate to mental well-being. The lack of mental well-bei ng is characterized by an inability to adapt to ones environment and regulate behavior (Webster s, 2002). Mental health issues that adversely affect childrens academic performance include : internalizing problems (e.g., depression and anxiety), externalizing problems (e.g., conduc t disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder), family issues (e.g., domestic violence, child abuse, and divorce), substance abuse, anger, poor social skills and stress (Florida Department of Education, 2003; Kestsenbaum, 2000). School Mental Health Services School mental health services refer to services designed to ensure academic and behavioral success and also promote healthy c ognitive, social, and emotional development and

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16 resilience (including promoting opportunities to enhance school performance and protective factors). In addition school mental health services foster development of assets (e.g., responsibility, integrity, self-efficacy, social a nd working relationships, self-evaluation and selfmonitoring, emotional and physical health main tenance) and personal well-being. The ultimate goal in providing school mental health services shou ld be to address barriers to student learning and performance and provide support to assist stude nts in being successful in their educational environment (Policy Leadership Cadre for Mental Health in Schools, 2001). School Mental Health Service Providers Professionals in schools who provide mental health services to students. The individuals were school psychologists, school counselors, a nd school social workers and are housed in the department of student services. Qualified Professional In this study, a qualified professional or service provider was defined as one needing minimal to no supervision to provide a mental health service based on their skills and knowledge acquired through their educational training.

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17 CHAPTER TWO LITERATURE REVIEW Introduction The purpose of this chapter is to review rele vant, existing research literature. This chapter explores the types of mental health services pr ovided in schools and the relationship between mental health services and student outcomes. Th e perceptions regarding school-based mental health service providers and their roles in the mental health service delivery system are also examined. First, a review of the literature defi ning mental health services will be presented. Next, the history of child mental health services w ill be examined. The relationship between mental health and student outcomes will then be introd uced. An examination of the role of school systems in mental health service will be presented. Finally, the role of the school psychologist, school counselor, and school social worker in the school-based mental health system will be examined. Conceptualizing Mental Health and Mental Health Services The United States Surgeon General defined mental health as the successful performance of mental function, resulting in productive activ ities, fulfilling relationships with other people, and the ability to adapt to change and cope w ith adversity (U.S. Department of Health and Human Services, 2001). Specifically, mental health in childhood and adolescence is defined by achieving expected developmental cognitive, so cial, and emotional milestones and developing secure attachments with others, having satisfying social relationships, and effective coping skills (Hoagwood et al., 1996). Thus, when a person has positiv e mental health they are able to use their interpersonal strengths and skills to function in their daily life. It is only when these skills deteriorate, that mental health needs emerge a nd result in a struggle to cope with the challenges

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18 and responsibilities of life. Eventually these diffi culties can result in the person displaying an inability to perform the daily activities expected of them (U.S. Department of Health and Human Services, 2001). Besides having an understanding of the defin itions of mental health and mental health needs, schools, school staff, and community organi zations must also have an understanding of the definition of a school based mental health need The Center for Mental Health in Schools (2002) states that a school-based mental health n eed is any need or problem, which produces a barrier to learning. Mental health services in sc hools are those services that seek to remove those barriers to learning (Center for Mental Health in Schools 2002). Traditional mental health services include counseling, consultation, psycholog ical skills training and crisis intervention. However, if mental health needs is defined as any problems that produce barriers to learning, then a broader view of mental health services might be necessary. This more expansive term of mental health services might include school based problem solving and/or intervention teams, academic tutoring, academic or behavioral interv entions or study skills sessions, all of which are provided to improve a childs competence. Clearly, defining school mental health services is difficult when such a broad definition of school-based mental health need is posited. The Policy Leadership Cadre for Mental Health in Schools (2001) has recognized this difficulty and stated, ...even with a dictionary-type definition, individual interpreta tions would likely generate a hodge-podge of approaches (p.3). Several professional associations have provided policy statements addressing mental health services in schools. In a position statement titled, Mental Health Services in the Schools, the National Association of School Psychologists (NA SP) provided its perspective on mental health service delivery in schools: The National Association of School Psychologists recognizes that school success is facilitated by factors in students lives such as psychological health, supportive social

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19 relationships, positive health be haviors, and schools free of violence and drugs. Mental or psychological health in childhood and ad olescence is defined by achieving expected developmental cognitive, social, and emotional milestones. Mental health is shown by the students forming secure attachments, deve loping satisfying social relationships, and demonstrating effective coping skills. Menta lly healthy children 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 con ceptual overview of what defines mental health in children and adolescents, it does not speci fically state what services should be provided. However, this position statement advocates for the inclusion of effective, comprehensive mental health services in the schools, emphasizing preven tion and early intervention. Many national health and mental health organizations (U.S. De partment of Health and Human Services (HHS), 1999; Center for Mental Health in Schools, 2002) have stated that mental health services must be included in school reform efforts to help student s overcome barriers to learning. These barriers to learning may result from poverty, difficulties in th e family, and/or social and emotional needs. The HHS position recognized that school systems are not responsible for meeting every need of students. When those needs adversely impact learning, however, schools must make every attempt to meet students needs to facilitate ac ademic progress (U.S. Department of Health and Human Services (HHS), 1999). Health and human service provider organizati ons are not the only professional groups to recognize the relationship of mental health n eeds and school performance. The National School Board Association (1991) emphasized the important relationship of collaborative mental health services and its impact on learning: Childrens learning directly benefits from ade quate social services and suffers when such services are not forthcoming. If the schools are to be held accountable for students

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20 academic achievement and preparation for the workplace, they have to have a vested interest in other factors that impact learning (p.16). Thus, although there is no agreed upon definition of school-based mental health services, there is agreement that students have mental health need s which interfere with school performance. There is also agreement that schools must address those needs and that a cadre of strategies and delivery systems exist to accomplish that goal. Historical Background of Child Mental Health The United States, similar to the Western European nations, developed child-focused services to address what they considered to be child mental health needs, during the latter half of the 19th century and the beginning of the 20th century (Pumariega & Vance, 1999). The combination of compulsory school attendance in the 1860s, the large numbers of immigrant children in the country, and poor child health a nd hygiene led to increased pressure on schools to provide children with psychological ser vices (Hoagwood & Erwin, 1997, p.436). The establishment of child abuse laws in the 1880s an d juvenile courts in the 1890s helped policy leaders to recognize the existing child mental hea lth services which previously had been in place in society, were no longer adequate to address the needs of the complex and growing childrens population of the United States (Pumariega & Vance, 1999). Counseling school-aged children who were juve nile offenders in juvenile court clinics was one of the earliest child mental health servi ces. Before this, juveniles were imprisoned with adult offenders without any counseling services provided to them (Pumariega & Vance, 1999). The first mental health clinic for children w ith 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 characteristics. In response to th e survey, the school board authorized for the development of a

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21 psycho-physical laboratory to be open on Sa turdays. 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, ranging from pediatricians to psychologists (Pumariega & Vance, 1999). In 1930, the Pennsylvania State Department of Education de veloped the model for certification of school psychologists, whose primary purpose was to desi gnate pupils as candidates for special education. By the 1950s schools began to provide physical and mental health services in addition to the standard guidance and vocational services. Prof essionals responsible for the delivery of these services refocused their efforts toward providing th erapeutic and clinical services to students on a case by case basis. Later, in the 1960s educa tional value was tied to these services through the emphasis which was placed on physical and mental services in state mandates, increased funding, and professional goals and objectives. However, desp ite the growth of school-based mental health services, there was still little effort to fully inte grate mental health and physical health programs in schools (Flaherty, Weist, & Warner, 1996). In 1975 with the congressional passing of the Education for All Handicapped Children Act (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 education services, related services (e.g., psychological services) were to be provided by the school district. These related ser vices ranged from consultation to individual, group, or family counseling to speech/language, physical, and o ccupational therapy (Hoagwood & Erwin, 1999). In the 1970s, the related ser vices being provided to students with disabilities began to be viewed more broadly (outside of PL 94-142) to include general education students (Hoagwood & Erwin, 1999). The provision of comprehensive services increased during the 1980s with the initiation of school based health clin ics. Legislative changes were also influential

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22 because they extended the availability of services to children from birth to age 5, as well as elementary, middle, and high school students. The historical overview of child mental health services illustrates how both the educational system and the community have often ma de attempts to meet the mental health needs of students. However, as the mental health needs of students and families have grown and become more complex, the existing models of me ntal health service delivery have remained the same. As a result, the mental health needs of children and youth increasingly have been unmet (Hoagwood & Erwin, 1999). Mental Health Needs of Children and Adolescents As a nation, we are in amidst of a public crisis in caring for our children and their emotional, behavioral, and psychological needs. 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 suffe r from a serious emotional disturbance. However, 79% of children aged 6-17 with mental disorder s do not receive mental health care (Katoaka, 2002). It is reported, Most children with mental health problems fail to receive appropriate 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 inappr opriate for their situation (Flaherty, Weist & Warner, 1996, p. 342). Statistics report that more children will be at-risk for social, emotional, and academic problems than ever before (Adelman & Taylor, 1998). For example, according to the Center for Disease Control (CDC), although the overall rate of suicide among youth has declined slowly since 1992, it remains unacceptably high at 9.5 per 100,000 suicides a year (CDC, 2007). 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, 2007) Homicide also remains a leading cause of

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23 death for young people (CDC, 2007). In the United States, 71% of all deaths among people aged 10-24 years resulted from only four causes: motor vehicle crashes, other unintentional injuries, homicide, and suicide (CDC, 2007). 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. There were also 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 the average annual rate of violent crim e continues to be highest among youth between the ages of 16 and 19 years. These youth were vict imized at a rate of 55.6 per 1,000 people in 2002-2003 (Bureau of Justice Statistics, 2004). These alarming statistics signal a pressing need for mental health services in the schools for tho se youth that are underserved in our society. It is reported that 21 percent of low-in come children and adolescents ages 6-17 have mental health problems (Howell, 2004). HHS (1999) also reported that minority children are less likely to have access to mental h ealth services than other groups of children. If they do receive services, they are often of poorer quality. For exam ple, it is reported that 88% of Latino children do not receive needed mental health care treatment. Further, although Latino youth have the highest rate of suicide they are also less likel y than other ethnic groups to be identified by a primary care physician as having a mental disorder. Similarly, African-American youth, who also have high rates of need, are more likely to be sent to the juvenile justice system for behavioral or emotional problems than placed in a mental h ealth facility for treatment (US Department of Health and Human Services, 2000). Finally, child ren from all racial groups that come from impoverished, low income backgrounds are often not provided with adequate mental health care services, even though 50% of impoverished childre n are at risk for mental health problems (Adelman, & Taylor, 1998).

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24 The Relationship between Mental Health and Student Outcomes There has been a demonstrated relations hip between early academic difficulties and mental health outcomes (Stipek, 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 learni ng and general health and that fostering social and emotional health in children as a part of hea lthy 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 youth-centered ment al health services into all systems that serve youth (U.S. Department of Health & Human Servic es, 1999, p. 124). One of these systems is the school, which is the sole, but presently inadequate source of mental health service delivery 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 known as Individuals with Disabilities Education Improvement Act of 2004 (IDEIA 2004; Pub. L. No. 10846). This legal mandate states that school districts must provide a free and appropriate educational pr ogram to all handicapped children in the most least restrictive environment. The mandate also st ates that school districts should provide related services (e.g., counseling) to students who exhibit em otional or behavioral disorders and need the services to benefit from their education. This la w has helped to strengthen the obligation of schools to provide appropriate educational service s to children with emotional problems, leading to an expansion of mental health services in the schools (Flaherty, Weist, & Warner, 1996). One way that schools can address the obligations 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 childho od that they are expected to m aster, then many of the mental

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25 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 adaptational failure. According to Mash & Barkley (2003), adaptational failure involves the exaggeration or diminishment of normal de velopmental expressions, interference in normal developmental progress, and failure to master de velopmental 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 expectations in school or society they often have elevated rates of maladaptive behaviors. The Impact of Student Performance on Mental Health Research studies have shown that students e xperiencing academic and behavioral failure often have internal and external stressors (Po licy for Leadership Cadre for Mental Health in Schools, 2001). Examples of such outcomes were documented in an empirical investigation by Willcutt & Pennigton (2000) that found children w ho failed to read at grade level, because of a reading disability, exhibited signifi cantly higher levels of anxiet y and depression, compared with children who read on grade level. Similar results we re found in the study by Arnold et al. (2005), in which greater internalizing and externa lizing behaviors and inattention existed among adolescents with poor reading ability relative to th eir typical reading ability peers. Another study by Tremblay et al. (1992) examined the relationship between student academic performance and conduct behavior problems. Tremblay et al. (199 2) 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 behavior disorders. Petras et al. (2004) had similar findings in their study which investigated reading achievement and criminal behavior. The results from this study showed that students who were on a pathway to wards increasing aggression and had high reading achievement in the first grade were less likely to exhibit criminal behaviors. They were also less

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26 likely to have a criminal arrest than those with low levels of reading achievement and increasing aggressive behaviors. Research has also shown that increasing a ch ilds academic competency can significantly decrease their maladaptive behaviors. Scott & Shearer-Lingo, (2002) investigated whether increasing the reading achievement of students in a self-contained EBD classroom would simultaneously increase the students behavior. The r esults of this study i ndicated that facilitating reading fluency in self-contained classrooms for st udents with serious emo tional and behavioral disorders had positive effects on both their reading achievement and on-task behavior. In a study by Ginnsburg-Block and Fantuzzo (1998) they found that when low achieving and performing third and fourth grade students were taught ma thematics problem solving skills (e.g., strategies for solving problems and using manipulatives for math problems) and reciprocal peer tutoring was implemented, their academic motivation along with their levels of social competence was increased. The Impact of Mental Health on Student Performance School mental health services have also been shown to impact individual student-level outcomes (e.g., grades, retention, attendance, graduation) and system-level outcomes (e.g., reduction of inappropriate special education re ferrals, suspension/expulsion rates) (Bruns, Walrath, Glass-Siegel, & Weist, 2004). In an era of school accountability, school leaders often encourage services, which assist in the reduction of barriers to learning, in order to advance positive educational outcomes. Providing 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 et al. (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 behavioral difficulties than when they were in a school that did not provide comprehensive

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27 mental health services. When mental health services were implemented in the Baltimore 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 employed at the school rather than refer them to a special education problem solving team. Mental health services in schools have also b een found to have a positive impact on the rate at which students are suspended from school (A tkins, et al, 2002). While suspension is used as a mechanism to maintain a safe school envir onment, suspensions are usually a result of aggregated minor offenses, which do not involve dangerous harm to any of the parties involved (Bruns, Moore, Stephan, Pruitt, & Weist, 2005). In fact, research has documented that suspension can make behavior problems worse because student s may prefer to be out of school and therefore exhibit behaviors that ensure suspension (Atk ins, et al., 2002). Unfortunately, schools often suspend the students who are in greatest academic emotional, and economic need. Rather than finding services which promote the behavior cha nge that these 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 community agencies in a school did not decrease the overall suspension rates of students. However, providing school-based clinic al mental health services alongside systematic interventions for behavior problems helped to re duce the rate of suspensions in schools. Such reductions were achieved by using targeted and well-implemented interventions such as classroom behavior management, social skills trai ning, providing alterna tives to suspension, and individual and group prevention programs for students at risk for suspension (Bruns et al., 2005) It is important to note that previous resear ch has shown that district administrators do recognize the positive impact which mental health services have on both student academic and behavioral outcomes. Dixon (200 7) found that student services di rectors and supervisors rated consultation and counseling as mental health ser vices which had the most impact on improving

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28 both academic and behavioral outcomes. While authentic assessments, as a mental health service, was rated as having a strong impact on student academic outcomes and intervention services was rated as having a strong impact on student behavioral outcomes. Importance of Mental Health Services in Schools For children that have mental health needs, schools can serve as the ideal location for the provision of mental health services. All child ren, youth, and families have access to school settings, regardless of socioeconomic status. Providing mental health services in the schools eliminates many of the barriers (e.g., accessib ility, acceptability, and funding), which keep children from receiving mental health services (Amb ruster, Gerstein, & Fallon, 1997). Ambruster, Gerstein, and Fallon (1997) suggested that the negative stigma of receiving mental health services in communities decre ases when services are offered at a school versus a clinic setting. However, students that receive services at school may also be placed at risk for a different form of stigmatization, that is, stigmatization by their peers. The issue of peer stigmatization, however, can be addressed through the implementation of programmatic safeguards (e.g., discretion, strategic scheduling of appointments, intervention implementation, private areas) (Taras et al., 2004). Additional benefits of providing mental health services in school versus clinic settings are that school-based mental health services eliminate the need for transportation of students to and from off-site appointments. This convenience facilita tes parent participation in mental health appointments because many parents live within walking distance of neighborhood schools. These advantages may encourage more parents to seek mental health treatment for their children. The convenience and comfort of accessing school mental health services may also promote a longerlasting commitment to following through with all recommended treatment (Taras et al., 2004). Of note, the provision of mental health services in schools provides school-based mental health service providers with th e opportunity to improve accuracy of problem identification, as

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29 well as assessment of progress after implementation of treatment (Taras et al., 2004). It has been noted that a major challenge in providing mental health services to students is accessing information about the students functioning in diverse settings. Schools are an optimal setting for obtaining this information, because informati on can be acquired about how children deal with physical and social stressors, and how they perform in the academic setting. Also, we can examine students engagement with non-academic activities (e.g., in sports, clubs, mentorship, etc), and their interpersonal relationships with others (e.g., adults, peers) (Taras et al., 2004). Finally, many of the school mental health clinics accept Medicaid for eligible children and services such as counseling and social skills tr aining can be provided for free to the child (Ambruster, Gerstein, & Fallon, 1997). Schools have also been shown as the most optimal place for developing psychological competence a nd teaching children to make informed and appropriate choices concerning their health, edu cation, and many other aspects of their lives (NASP, 2003). Mental Health Services in K-12 Settings Even though some district leaders recogni ze that mental health services can have a positive impact on student outcomes, there conti nues to be an ongoing debate about whether schools should have to provide mental health services to meet all the mental health needs of children. According to the Policy Leadership Ca dre for Mental Health in Schools (2001), the schools focus is education, not mental health. The results of the studies by Scott and ShearerLingo, 2002; Ginnsburg-Block and Fantuzzo, 1998; Arnold et al., 2005; Tremblay et al., 1992; and Petras, et al., 2004 suggest, however, that increasing academic competencies increases mental health outcomes and the studies by Bruns et al., 2005 and Bruns et al., 2004 suggest that increasing students mental health has a positiv e impact on student outcomes. These results suggest that schools should focus on providing me ntal health services in the school because the

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30 school mental health service delivery outcomes are linked to the mission of education, which is increased academic competency. The Leadership Training: Continuing Education 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 services are not just about diagnosing students with problems, providing therapy and behavior change, connecting co mmunity school-based mental health service providers with schools or even just about empi rically supported treatments. Rather, effective mental health services encompass other services such as, programs which promote socialemotional development, increase academic and be havioral competence, prevent mental health problems, enhance resilience, and increase prot ective buffers (Policy Leadership Cadre for Mental Health in Schools, 2001). To this end, school-based mental health assessment and intervention are undergoing significant transformation. Traditionally, the assessment and intervention of emotional and behavioral problem s has been what some call the wait-to-fail model of assessment and intervention (Kratochw ill, 2007). This means that children first must show signs of academic delay or failure before they are assessed for contributory factors, including social and emotional problems. A new framework, Response to Intervention, has been advanced as an alternativ e to the traditional approach. In stead of waiting for children and adolescents to demonstrate significant problems, this model emphasizes early detection and early intervention before the problems become serious (Shirk & Jungbluth, 2008). Early intervention is successful, in that it addresses mild psychosocial problems quickly and thereby prevents unnecessary entry into special education (Foste r, Rollefson, Doksum, Noonan, & Robinson, 2005). Addressing psychosocial problems early will allow students to be successful in the classroom and decrease or eliminate the occurren ce of secondary problems related to mental

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31 health such as learning, attention, attendan ce problems, and the rate of student drop-outs (Leadership Training: Continuing Education for Change, 2003). Early intervention services, such as bullyi ng prevention programs, conflict resolution, positive behavioral support, and character educa tion are universal prevention services, which are expected to meet the needs of most of the school population. These universal prevention services use the available resources of the school to prom ote a learning environment in which the 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 expectations, and high personal and academic standards paired with essential resources and supports (Leadership Training: Continuing Education for Change, 2003). The secondary leve l of effective mental health services addresses individual differences in motivation and developm ent of each particular student, so students can succeed in the positive environment, which has been established for them. The more a school provides a comprehensive range of services and interventions, the more likely the learning, emotional, and behavioral problems will be preven ted 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. School-Based Mental Health Service Provid ers and Mental Health Services in Schools It is critical for the implementation of effec tive mental health services, that mental health practitioners are confronted about the current fragmentation of services, which marginalize mental health services in schools. There is a n eed for collaboration and professional teamwork among the three mental health professional gr oups that are housed under the student support services: school psychologists, school counselors, and school social workers (Center for Mental

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32 Health in Schools, 2002). The role of each school-based mental health practitioner will be examined 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 (Education for All Handicapped Children Act; P.L. No. 94-142), the provision of psychological services became mandatory in the schools (Thom as, Levinson, Orf, & Pinciotti, 1992). These services have typically been provided in most schools by school psychologists (Thomas, Levinson, Orf, & Pinciotti, 1992). Early history has depicted the school psychologists 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 assess 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 consultati on, counseling and behavior modifications, and research and evaluation (Nastasi, Varjas, Bernstein, & Pluymert, 1998). Despite the opportunities for role expansion, Fagan and Wise (2000) report that assessment -related duties still occupy much the school psychologists time. A study conducted by Curtis, Grier, Abshier, Sutton, and Hunley (2002) revealed that, school psychologists spend r oughly 41% of their time in assessment, 25% in report writing, 25% in meetings, and 8% in other activities. The National Association of School Psychologists (NASP) establishes standards for credentialing and training in school psychology. According to NASP the current roles of a school psychologist include: (a) assessment, (b) consultatio n, (c) prevention, (d) education, (e) health care provision, (f) research and planning, and (g ) intervention. Interv ention includes mental

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33 health services such as so cial skills training, crisis intervention, mediation, counseling, and consultation (NASP, 2003). School psychologists can assume key roles in the development, implementation, and evaluation of school-based mental health programs (Nastasi, Varjas, Bernstein, & Pluymert, 1998). Nastasi, et al (1998) identified seven ke y roles the school psychologist can assume in delivering mental health services in schools. These key roles are: (i) prevention specialists who help teachers and school administrators foster the development of competent (mentally healthy) individuals. (ii) Child advocates who assist schools in establishing mechanisms for identifying and treating students with psychiatric disorders. (ii) Direct service providers to help children with emo tional disorders such as depression and to families who have preschoolers that are at risk or have disabilities. (iv) Trainers of teacher consultants that will extend the scope of consultation services in schools. (v) Health care service providers; (vi) system-level interventionists, and (vii) organizational facilitators in school reform and interagency collaboration. (p. 217-218). Clearly, school psychologists can provide ment al health services in addition to traditional assessment. Studies have investigated administrators views on the role of school psychologists in providing mental health services. In a study conducted by Cheramine and Sutter (1993), 80 special education directors evaluated the role of the school psychologist, the effectiveness of mental health service delivered by school psychol ogists, and the job activities in which school psychologists were expected to be involved. The results of the study revealed that consultation was the most common function of school psycholo gists. The mental health services that they believed school psychologist commonly provided were assessment, consu ltation, and handling crises. However, the directors believed that school psychologists should become more involved in the areas of counseling and consultation services. Similar results were found in the study conducted by Hartshorne and John son (1985) which revealed that administrators wanted school

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34 psychologists to engage in more counseling services. It was hypothesized that school psychologists were not engaging in the services expected of them because of lack of training and time (Hartshorne and Johnson, 1985). Many of the st udies in the last 30 years have attempted to determine the role and qualifica tions of school psychologists. What the results overwhelmingly reveal is that school psychologists are often viewed as psychometricians but that school psychologists would prefer a role expansion (Fagan, 1986; Fisher, Jenkins, & Crumbley, 1986; Cheramine and Sutter, 1993; Curtis et al., 2002; Curtis, Hunley, Walker, & Baker, 1999; Gilman & Gabriel, 2004). In another study by Gilman and Gabriel (2004) 1,710 teachers, school psychologists, and administrators were surveyed about the school psychologists role as a mental health professional. The results of the study revealed that more t eachers, school psychologists, and administrators desired school psychologists to be more involved in individual counseling, group counseling, and crisis intervention. They also desired that sc hool psychologists have an increased involvement with regular education students parent consultation, and pare nt workshops. However, although teachers and administrators desired more involve ment in these different 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 the results of this study revealed that teachers perceived the role of the sc hool 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 the school psychologists role is actually to provide more traditional assessment services. Dixon (2007) investigated the perceived qualifications of school psychologists to provide mental health services, as reported by Florida directors and supervisors of student services (i.e., psychology, counseling, and social work). The results revealed that school psychologists were perceived by student services directors and superv isors as being somewhat qualified to qualified

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35 to provide a number of different mental health services. However, similar to previous studies about the role of school psychologists, director s and supervisors both rated school psychologists as having the highest qualificati ons to provide normative assessments. What is promising, however, was that student services directors a nd supervisors perceived school psychologist as being qualified (needing only minimal supervisi on) to provide services in addition to normative assessment such as consultation, counseling, and Other services (e.g., behavioral observations). When the perceptions of administrators and school psychologists are compared about the actual role of school psychologists, we find similar trends. Hosp & Reschly (2002) cite that school psychologists report that they actually spend approximately one half to two thirds of their time involved in eligibility activities such as assessment, IEP meetings, and other assessmentrelated conferences. However, school psychologists report that they would prefer to engage in equal amounts of assessment, direct intervention, consultation, and research. Similarly, Roberts and Rust (1994), found the school psychologists revealed spending 66.8% of their time involved in assessment activities and approxima tely 17.6% of their time w as spent engaged in providing intervention services. In addition, the desired ment al health role of school psychologists was to spend more time engaged in intervention based activities and less time involved in assessment (Roberts & Rust, 1994). This is interesting, wh en we compare this result to the finding from Dixon (2007) which revealed that directors and s upervisors of student services did not rate school psychologists (or school counselors and school social workers) as qualified enough to provide intervention services without supervis ion or minimal supervision. Thus the perceptions of the school psychologist, as an expert of assessment, could serve as a barrier to the school psychologists expanded role as a mental health service provider. To overcome this barrier, research must identify whet her school psychologists believe they have the necessary skills to be successful in roles outsi de assessment. If they believe they possess those critical skills, then school psychologists will need to sell their expanded skills as mental health

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36 professionals. Lastly, they will need to help teacher s 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 problems (Agresta, 2004). Though ser vices vary by school and by region, school counselors typically provide individual and gr oup counseling, guidance programs, help with school-wide testing and academic scheduling, as we ll as help school staff with children who have behavior or academic problems (Agresta, 2004). According to the American School Counselor s Association (ASCA), the focus of school counseling is to promote student learning through an interconnection of student development. The areas of student development 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 people by assisting them in making decisions and changing behavior. School counselors work with a ll students, school staff, families, and members of the community as an integral part of the education program. School counselors promote school success by focusing on academic achievement, pr evention, and intervention activities, advocacy, and social/emotional and career developm ent (Campbell & Dahir, 1997, p.8). Similar to other mental health profession als in schools, school counselors in the new millennium have been left questioning and refining their roles. Historically, there has been a need for school counselors to balance the long-term vo cational needs and emotional needs of students. However with changes in legislation, school counselors are being called on to place more emphasis on their current roles (e.g., vocationa l and emotional support), while adding new responsibilities to the role of the school counselor. School counselors for example, should possess a specific set of skills which will address the gr owing needs of a diverse student population and

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37 they must have an understanding of program ev aluation, data collection, and accountability. Additionally, the current skill set of school counsel ors must be clearly linked to the improvement of student academic and behavioral outcomes (Adelman & Taylor, 2002; Borders, 2002; Herr, 2002). Burnham & Jackson (2000) cite (a) individual counseling, (b) small group counseling, (c) classroom guidance, and (d) consultation as the pr imary roles of the school counselor. However, as demographics change and the needs of stude nts evolve, school counselors may have to determine whether the services they offer meet a ll 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 counseling. Coun selors 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 counseling as a mental health service, they would like to beco me even more involved in this and provide more consultation and parent training services which w ill benefit children in schools. Interestingly, although school counselors report desiring to spend more time engaged in counseling and consultation, Dixon (2007) found that directors and supervisors of psychology and social work rated school counselors as only somewhat qualified (needing supervision) to provide counseling and consultation. In contrast supervisors of counseling services rated school counselors as qualified (needing minimal supervision) to prov ide services in counseling and consultation, as well as Other services. These results are consistent with previous studies which suggest that professionals in the field of school counseling ( both supervisors of school counseling and school counselors) often have perceptions about their rol es which are not parallel to the perceptions held by other professionals (Burnham & Jackson, 2000).

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38 Fitch, Newby, Ballestero, & Marshall ( 2001) further supported this finding in their investigation of future school administrators perceptions of the professional role of school counselors. The results of the study indicated th at future school administrators rated crisis response, providing a safe environment, communicating with students, and helping students with transitions as important tasks to be performed by the school counselor. Future administrators also indicated that they believed the school counselor should be involved in discipline actions, record keeping, assisting with special education services, and testing of students (Fitch et al., 2001). The researchers believed the investigation was importa nt because the administrator of the school in which school counselors are housed often determin es the professional role of school counselors. Previous studies have found that administrato rs and school counselors may often disagree on the school counselors role and this source of di sagreement 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 et al., 2001). Add itionally, the results of this study are important because school counselors often perform duties that are unrelated to the role as defined by ASCA. As a consequence many students do not receive individual and group counseling or the guidance they need to remove classroom barriers to learning (Fitch et al., 2001). School Social Worker The profession of school social work bega n to emerge at the beginning of the 20th 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 school (Agresta, 2004). It was not until the 1940s and 1950s that the term visiting teacher was replaced with the title of school social worker. The role of the school social workers be came more defined as a result of PL 94-142. School social workers were now expected to co mplete social histories, counsel children and families, organize and bring in community resour ces, and work with all the ecological variables

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39 connected to the child to promote student adju stment (Agresta, 2004). In a survey by Agresta (2004), school social workers reported that they spent most of their time providing individual counseling, group counseling, conflict interventi on, consultation, and crisis resolution. The School Social Work Association of America (SSWAA) mission statement states the role of the school social worker as: The role of the school social worker is a specialized area of practice within the broad field of the social work profession. 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 th e schools, to provide a setting for teaching, learning, and for the attainment of competen ce and confidence. School social workers are hired by school districts to enhance the dist rict's ability to meet its academic mission, especially where home, school, and community collaboration is the key to achieving that mission (SSWAA, 2006, 1). Similar to the other mental health professionals, one of the major issues facing school social workers is the reconceptualization and rei nvention of their role. Since the early twentieth century, school social work has b een preoccupied with the question of Who is the school social worker? (Allen-Meares et al., 2000, p.47). Fra nklin (2000) stated there is a gap between what school social workers actually do in the mental health service delivery system and what their professional role is perceived to be. According to Franklin (2000) the role of the school social worker has expanded to include prevention specia list, crisis manager, assessment specialist, referral agent, and case manager. School social wo rkers may also find themselves responsible for carrying out interventions for children in the school s. As the school social workers role changes and is expanded, school social workers may need to collaborate even more with other school staff and school mental health professionals, to prom ote healthy development, which enhances school success (Franklin, 2000). Hare (1994) suggested that careful thought and consideration must be

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40 given to the role and qualifications of the school social worker so they may influence policy in the educational arena and increase the value of thei r role in the delivery of school-based mental health services. Agresta (2004) investigated school social wo rkers perceptions of their expected and desired roles in the provision of mental hea lth services. The averag e school social worker reported spending about 17 percent of time on indi vidual counseling, 10 percent of time in group counseling, and about 11 percent of time in admi nistrator and teacher consultation. Most social workers indicated that they desire to spend mo re time on individual and group counseling and they would like to dedicate less time to consulta tion. Another result from the study conducted by Agresta (2004) was that community outreach, an area that is more commonly identified with social work, was not viewed by social workers as taking up much of their professional time. The study by Dixon (2007) found that direct ors and supervisors of student services (e.g., counseling, social work, and psychology) percei ved school social workers to be qualified to provide a limited number of mental health services. Of note, across the individual supervisors of student services and the directors of student services, there was not one mental health service which they unanimously agreed school social workers were qualified to provide. However, directors of student services perceived school social workers as qualified to provide prevention services and supervisors of social work perceive d school social workers as qualified to provide counseling services. The investigation findings by Dixon (2007) differed somewhat from what was found by Agresta (2004). Agresta (2004) reported that school social workers perceived consultation as one of the mental health services wh ich was a part of their role function, however, in the study by Dixon (2007) consultation was not id entified by administrators as a mental health service which school social workers were qualified to provide. This difference illustrates the gap which often exists between what school social wo rkers view as their actual role function in the

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41 mental health service delivery system and the view held by other school professionals about their perceived role function. As educational legislation and policy require a shift in the school mental health field, school social workers will have to expand thei r skill set to include redefined roles such as prevention specialist, crisis manager, assessme nt specialist, referral agent, and case manager (Franklin, 2000). However, the results of the study by Dixon (2007) suggest that administrators have not developed a consensus about the qualifi cations of school social workers and the skills which they currently possess to meet the demands of their redefined roles. Summary Schools are expected to educate students whose social-emotional problems significantly interfere with their learning process in the school (Adelman & Taylor, 2000). However, schools are often reluctant to provide students with me ntal health services (Adelman & Taylor, 2000). Many schools and legislators believe that it is not the responsibility 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 Schools, 2001). What is problematic about this belief is that if district leaders believe it is the schools job to only educate and not to provide mental health services, then they may not recognize the strong impact which mental health services can have on student outcomes. Research suggests, however, that there is a relationship between mental health services and student outcomes (Willcutt & Pennigton, 2000; Arnold et al., 2005; Tremblay et al., 1992; Petras et al., 2004; Scott & Shearer-Lingo, 2002; Ginnsburg-Block and Fantuzzo, 1998). It may be hypothesized, based on the research by Dixon ( 2007) that district leaders deemphasize the importance of the school-based mental health sy stem because the mental health services provided are not perceived to impact academic or behavi oral outcomes. In addition, the services that district leaders perceive to be related to st udent outcomes are also those services which school-

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42 based mental health service providers are perceive d to not be qualified to provide. In order to develop an effective mental health system, only those services that positively impact student outcomes should be provided. This may require school mental health service providers to redefine their roles, if they already possess the skills to provide the services linked to student outcomes. If they do not possess the skills, then additional tr aining, practice, and supervision should be provided to deliver the necessary effective mental health services, thus increasing student outcomes.

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43 CHAPTER THREE METHOD The purpose of this chapter is to present the procedures that were used to conduct this study. The chapter begins with a description of the participants and the research design for the study. Next, a discussion of the instrument that w as utilized in this study is presented. The chapter ends with a description of the procedures that we re used for data collec tion and data analysis. Purpose of Study This study examined perceptions of Florida school mental health service providers about the types of mental health services provided in sc hools. More specifically, the study investigated a) perceptions about school mental health service providers qualifications to provide specified mental health services, b) the extent of agreement about school mental health service providers qualifications to provide mental health services between school mental health service providers, supervisors of school mental health service providers, and directors of student services/special education.; and c) the perceptions of mental h ealth service providers regarding the impact of school mental health services on student outcomes. Target Population Practicing school mental health service providers in the state of Florida was the target population in this current study. Sample The participants in this study were pr acticing school-based mental health service providers in the 67 counties in Florida during the 2007-2008 school year and directors and supervisors of student services in the state of Florida during the 2006-2007 school year.

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44 Mental Health Service Providers. Potential participants for this study were selected using two different methods. The first method was a random selection of 750 potential participants from both the membership rosters of the Florida Association of School Psychologists and the Florida School Counselor Association (Appendix D). However, due to the small membership population for the Florida Association of School Social Workers (N=121), the second method required the researcher to select all of the school social worker members for participation in this study. The total sample size selected to receive the survey, which included school psychologists, school counselors, and school social workers, were 871 potential participants. The final sample size from the originally recruited 871 school-based mental health providers consisted of 167 school psychologists (45% of original sample), 143 school counselors (38% of original sample) and 48 school social workers (40% of original sample). Directors and Supervisors of Student Service. Data from the school mental health service supervisors and directors of student services was drawn from an archival database. This sample consisted of 90 supervisors and directors of st udent services (58% of the total population) who responded to a survey administered during the 2006-2007 academic year (see Dixon, 2007). These respondents represented the final sample fro m the originally recruited population of 155 school mental health supervisors and directors employed in the 67 school districts in the State of Florida. The 155 individuals were recruited from a mailing list provided by the University of South Florida (USF) Student Support Services Project. Research Design This study employed a survey design in wh ich data were collected through a self-report questionnaire completed by school psychologists, school counselors, and school social workers. A survey design was also used to collect information for the archival database for school mental health supervisors and directors.

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45 Instrumentation Perception of School Mental Health S ervices survey (PSMHS): Practitioner Version The Perception of School Mental Health Services survey (PSMHS): Practitioner Version (see Appendix B) was the instrument used to gath er data from the mental health service providers (school psychologists, school counselors, and school social workers) who were participants in the study. The PSMHS: Practitioner Version was an adap tation of the two previous instruments used in a previous study by Dixon (2007). The researcher considered it important not to make major changes to the content of the current inst rument to allow for consistency in information between the previous and current instrument (Neuendorf, 2002). For the current study, minor changes were made to the PSMHS: Practitione r Version (Dixon, 2007). These minor changes included revisions to the demographic questions (i.e., primary employment location (survey item 2), school level (survey item 3), socioeconomic stat us of students served (survey item 4), gender (survey item 5), race (survey item 6), professional role (survey item 11)) and survey item 12 that assessed which school-based services are and are no t perceived to be school mental health services. Items 12, 14, and 15 on this survey were counterbalanced to e liminate the potential for confounding by disrupting any systematic effects from factors related to the order of items (Moore, 2001). The instrument was designed to gather info rmation on the demographic characteristics, employment conditions, primary employment locati on of mental health service providers, as well as the beliefs about their school mental health service delivery system. In addition, it gathered information regarding perceptions of level of qua lification of school-based mental health service providers to provide mental health services in school settings. The instrument consisted of a 5point response Likert scale and included a total of 15 items, 11 items (items 1-11) that assessed professional and district demographic informati on and 4 items (items 12-15) that gathered

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46 information relative to mental health services. More specifically, item 12 gathered information on the types of services that were perceived to be mental health services, item 13 obtained data on the types of mental health services provided to st udents and/or their families, item 14 gathered information on the professionals who were believed to be most qualified to provide these mental health services, and item 15 focused on the perceived impact of the services on student academic and behavioral outcomes. Perception of School Mental Health Services survey : Director (Version A) and Supervisor (Version B) Version In the previous study conducted by Dixon, (2007), a review of the existing literature did not result in the identification of any published instruments that could be used for data collection for the study of school based mental service deliv ery systems. Consequently, two instruments, PSMHS survey: Director and Supervisor Versions were used to collect data on the demographic and professional characteristics of directors a nd supervisors of school psychology, school counseling, and school social work, as well as their beliefs about the school mental health system. Items for this instrument were gleaned from a revi ew of the literature on mental health services. Content validity evidence was gathered thr ough the use of an expert review panel consisting of directors/supervisors of student services, school psychology, school counseling and school social work from three school districts in West Central Florida (Neuendorf, 2002). The expert panel was asked to used a review sheet (Appendices I and J), to provide feedback on the extent to which they considered the instrument to have adequate coverage of the domains it was intended to measure. A pilot study was conducted to elicit feedback on the clarity, structure, and response options for each question as well as on the ease of completion of the survey and amount of time required for instrument completion. Participants in the pilot study were directors/supervisors of student services from West Central Florida who were not participants in the Dixon, (2007) study.

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47 Data Collection Procedures Prior to initiating the data collection phase of the study, approval was obtained through the USF Institutional Review Board (IRB) in or der to ensure the ethical treatment of the participants in this study. Step One: Participant Selection The researcher mailed a packet to the school-b ased mental health service providers which contained: 1) a cover letter (see Appendix C) that informed the participants about the purpose of the study, solicited their participation in the study through completion of the survey, and discussed confidentiality; 2) a copy of the PSM HS: Practitioner Version survey; 3) the USF IRB consent form, which participants were asked to sign and return, and 4) a postage paid, preaddressed return envelope with an assigned c ode for follow up purposes. As an incentive to respond, potential participants were informed that four participants who returned the completed survey would be randomly selected to receive a $25.00 Visa Gift Card. Ten additional participants who returned completed surveys w ould also be randomly selected to receive the book, Response to Intervention:Policy Considerations and Implementation (National Association of State Directors of Special Education, 2005). Th ree weeks after the initial mailing of the survey packet, another survey mailing was sent out to non-respondents. Step Two: Data Management Each participant was assigned a code numb er that was written on a postage-paid, preaddressed envelope. The code number was assigned to 1) identify participants who had not responded for the purposes of subsequent maili ngs and 2) to provide a method by which participants that completed and returned survey s could be randomly selected to receive incentives (Fink, 1995). Returned surveys were immediately removed from the return envelope to protect the anonymity of the participant. Based on the code on the envelope, respondents names were checked off the mailing list and the return enve lope was placed in a separate location for the

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48 purpose of providing random incentives to particip ants. The participants data were entered into an Excel spreadsheet. To assess th e accuracy of the data entry, a second individual reviewed 20% of the data transferred into the computer spread sheet. An agreement of 100 % data entry accuracy was achieved before the data entry was complete. Data Analysis Procedure Data were analyzed using SAS software Version 9.1 (SAS Institute, 2002-2003). Summary data in the form of descriptive sta tistics (e.g., frequencies, means and standard deviations) are used to describe the respondent sample demographic and professional characteristics. In order to report the type of data analyses used in this study, each research question is presented and the data source is also reported. Fina lly, the statistical analysis that was used to answer each research question is explained. Research Question 1 What is the level of agreement within and across school-based mental health service providers (i.e., school psychologists, school coun selors, and school social workers) regarding what they believe to be a mental health service in K-12 school settings? Survey item 11 identified the professional role of the respondent. Survey item 12 identified the perceptions of school-based mental health service providers regarding what they believe are and are not mental health services in K-12 school settings. The individual services which were examined fell under the follo wing broad categories: (a) counseling; (b) consultation; (c) norm-referenced assessments; (d ) authentic assessments; (e) prevention services; and (f) intervention services. Frequencies and percentages were computed for each individual service (e.g., individual counseling, family counseling, academic consu ltation, and positi ve behavior support), as to whether a service was rated to be a mental health service or to not be a mental health service.

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49 Summary data of the descriptive statistics are pr ovided by school mental health service providers, as a combined group and by groups of individual school mental health service providers. Research Question 2 To what extent do school-based mental health service providers concur about who is best qualified to provide specified mental health services in K-12 school settings? Responses to survey item 11 and item 14 were used to answer research question two. Specifically, survey item 11 identified respondents professional role (i.e., school psychologist, school counselor, or school social worker) and survey item 14 provided data on the providers beliefs about their qualifications and other school mental health service providers qualifications to provide mental health services. Descriptive statistics (mean and standard devi ation) were used to report ratings about respondents beliefs regarding the perceived level of qualification of school mental health service providers to provide mental health (MH) services. Summary data of the descriptive statistics were provided for all school mental health service providers, as a combined group and by groups of individual school mental health service providers. To determine if there were significant differen ces in the perceived level of qualifications by school psychologists, school counselors, and school social workers to provide mental health services, a one betweentwo within-subjects an alysis of variance (ANOVA) procedure was conducted. The between-subjects factor was professi onal role (i.e., school psychologist, school counselor, or school social worker) and the within -subjects factors were type of service provider (i.e., the school psychologist, the school counselor, and the school social worker) and type of mental health service (i.e., counseling, consulta tion, normative assessment, authentic assessment, prevention, and intervention). The ANOVA was tested at an alpha level of .05. The Huynh-Feldt test determined statistical significance for with in-subjects effects. Post hoc analyses were

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50 conducted using the Dunns test for the within subjects factors as a follow-up to significant interaction effects in the ANOVA. Research Question 3 What is the level of agreement between school-based mental health service providers, school-based mental health service supervisors, and directors of student services/special education regarding who is best qualified to provide specified mental health services in K-12 school settings? To examine the combined perceptions of school psychologists, school counselors, and school social workers about their beliefs regardi ng the perceived level of qualification of school mental health service providers to provide mental health (MH) services, responses to survey item 11 and survey item 14 on the PSMHS: Practitioner Version were used. Specifically, survey item 11 identified respondents professional role (i.e., school psychologist, school counselor, or school social worker) and survey item 14 examined the providers beliefs about their qualifications and other school mental health service providers qualif ications to provide mental health services. To examine the beliefs of student services directors and supervisors regarding the perceived level of qualification of the school psychologist, the school counselor, and the school social worker to provide mental health servi ces, responses to survey item 7 (PSMHS: Director Version and PSMHS: Supervisor Version) and survey item 20 (PSMHS: Director Version)/ 9 (PSMHS: Supervisor Version) were used. Speci fically, survey item 7 identified respondents professional role (i.e., student services directors vs. supervisors) and survey item 20 (PSMHS: Director Version) & survey item 9 (PSMHS: Supe rvisor Version) examined their beliefs about the perceived level of qualification of school ment al health service providers to provide mental health services to students and families. Descriptive statistics (mean and standard de viation) reported the ratings about the perceived level of qualification of school mental h ealth service providers to provide mental health

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51 (MH) services. Summary data of the descriptive st atistics were provided by school mental health service providers and administrators, as a combined group and as individual groups. To determine if there were significant differences in the ratings of school psychologists, school counselors, and school social workers and student services directors and supervisors (i.e., supervisor of social work, psychology, or counseling) regarding the perceived level of qualifications of school mental health service providers to provide mental health services, a one betweentwo within-subjects analysis of va riance (ANOVA) procedure was conducted. The between-subjects factor was professional role (i.e ., school psychologist, school counselor, school social worker, student services director, supervisor of school psychology, school social work, or school counseling) and the within-subjects fact ors were type of service provider (the school psychologist, the school counselor, and the school social worker) and type of mental health service (i.e., counseling, consultation, normativ e assessment, authentic assessment, prevention, and intervention). The ANOVA was tested at an al pha level of .05. The Huynh-Feldt test was used to determine statistical significance for w ithin-subjects effects. Post hoc analyses were conducted using the Dunns test for the within-subjects factors. Research Question 4 To what extent do district size, school level in which a provider is employed (i.e., primarily elementary schools, primarily middle schools, etc.), and SES status of school (Title I or Non Title I) moderate school mental health service providers perceptions about who is best qualified to provide specified mental health services in K-12 school settings? The following demographic variables were individually examined in the study: district size (survey item 1), school level (survey item 3), and SES status of schools (survey item 4). Survey item 11 identified respondents professi onal role (i.e., school psychologist, school counselor, or school social worker) and survey item 14 examined the providers beliefs about

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52 their perceived level of qualification and other school mental health service providers qualifications to deliver mental health services. Descriptive statistics (mean and standard de viation) reported the ratings regarding perceived levels of qualification of school ment al health service providers to deliver mental health (MH) services by each of the independent va riables (e.g., differences in providers ratings by district size or school level or SES status of school). To determine if there were significant differen ces in the perceived level of qualifications of school psychologists, school counselors, and school social workers, combined, to provide mental health services based on selected demographic variables (i.e., district size, school level, or SES status of school) three separate one between two within-subjects analysis of variance (ANOVA) procedures were conducted. For each anal ysis, the between-subjects factor was one of the selected demographic variables. The within-subjects factors were type of service provider (i.e., the school psychologist, the school counselor, and the school social worker) and type of mental health service (i.e., counseling, consulta tion, normative assessment, authentic assessment, prevention, and intervention). To protect against violation of Type I error rate, the Bonferroni method was used and each ANOVA was tested at an alpha level of .01. Th e Huynh-Feldt test was used to determine statistical significance for w ithin-subjects effects. Post hoc analyses were conducted using the Dunns test for the within subjects factors as a follow-up to significant interaction effects in the ANOVA Research Question 5 To what extent do years of professional work experience and highest degree in discipline moderate school mental health service pr oviders perceptions about who is best qualified to provide specified mental health services in K-12 school settings? The following demographic variables were individually examined in the study: years of professional work experience (survey item 10) and highest degree in discipline (survey item 7).

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53 Survey item 11 identified respondents professi onal role (i.e., school psychologist, school counselor, or school social worker) and survey item 14 examined the providers beliefs about their perceived level of qualification and other school mental health service providers qualifications to deliver mental health services. Descriptive statistics (mean and standard de viation) reported the ratings regarding perceived levels of qualification of school ment al health service providers to deliver mental health (MH) services by each of the independent va riables (e.g., differences in providers ratings by highest degree in discipline or years of professional work experience. To determine if there were significant differen ces in the perceived level of qualifications of school psychologists, school counselors, and school social workers, combined, to provide mental health services based on selected demographic variables (i.e., years of professional work experience or degree level) two separate one be tweentwo within-subjects analysis of variance (ANOVA) procedures were conducted. For each anal ysis, the between-subjects factor was one of the selected demographic variables. The within-subjects factors were type of service provider (i.e., the school psychologist, the school counselor, and the school social worker) and type of mental health service (i.e., counseling, consulta tion, normative assessment, authentic assessment, prevention, and intervention). To protect against violation of Type I error rate, the Bonferroni method was used and each ANOVA was tested at an alpha level of .01. Th e Huynh-Feldt test was used to determine statistical significance for w ithin-subjects effects. Post hoc analyses were conducted using the Dunns test for the within subjects factors as a follow-up to significant interaction effects in the ANOVA Research Question 6 Does the school level and SES status of a school in which school-based mental health service providers practice modera te their beliefs about the impact of specified mental health services on student (a) academic outcomes and (b) behavioral outcomes?

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54 Survey item 11 and item 15 were used for the data analyses of research question five. Specifically, survey item 11 examined prof essional role. Survey item 15 examined beliefs regarding the strength of the impact (e.g., no imp act or strong impact) of specified mental health services on student academic and behavioral outcomes. Means and standard deviations of ratings of the perceived level of impact of the mental health service on students academic and behavi oral outcomes by school-based mental health service providers were computed. To determine if there were significant differences in the ratings of impact of mental health services on academic and behavioral out comes from the perspective of school mental health service providers by school level employ ed and SES status of school served, two separate two betweenone within-subjects analysis of variance (ANOVA) procedures were conducted. The between-subjects factors were school level (i.e., elementary, middle, high, and multiple school levels) and school SES status (Title I or Non-Title I) and the within-subjects factor was type of mental health service (i.e., counseling, consultation, normative assessment, authentic assessment, prevention, and intervention). To protect against violation of Type I error rate, the Bonferroni method was used and the ANOVA was t ested at an alpha level of .025. The HuynhFeldt test was used to determine statistical significance for within-subjects effects, as the sphericity assumption was violated. Post hoc an alyses were conducted using Tukeys HSD test for the within subjects factors as a follow-up to significant main effects in the ANOVA. Delimitations of Study A delimitation of this study was that only sc hool mental health administrators and schoolbased mental health service providers who we re employed in the state of Florida were participants in the current research study. Theref ore, the results of this study could only be generalized to school mental health professionals an d administrators employed within the state of Florida (Cozby, 2001). Another delimitation of th is study was that only school mental health

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55 service providers who had a professional association membership were included in this study. This study did not account for the possibility th at school-based mental health service providers who joined a professional association may have di ffered from those who did not join. Therefore the results from this sample could not be easily generalized to a larger target population of individuals who did not participate in the study (Cozby, 2001). Limitations of Study A potential threat to internal validity was th at participants may have been inclined to provide socially desirable responses (Cozby, 2001). By administering a survey about mental health service delivery in the schools, the resear cher was assuming that providers believed that mental health services were being provided at some level, within schools. If a district was providing few or no mental health services, res pondents may have been inclined to respond falsely in the survey about the range of mental health services offered to students. They may also have been inclined to falsely respond about wh ether they believed mental health services are linked to student outcomes (e.g., acad emic or behavior) (Cozby, 2001).

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56 CHAPTER FOUR RESULTS The present study examined views held by Fl orida school mental health service providers about the types of mental health services commonly delivered in schools and mental health service providers qualifications to provide t hose services. Also, the agreement about school mental health service providers qualifications to provide mental health services between school mental health service providers, supervisors of school mental health service providers, and directors of student services/special education w as examined. Finally, this study investigated views held by school mental health service provide rs about the impact of school mental health services on student academic and behavior outcomes. The specific research questions addressed in the study were: 1. What is the level of agreement within an d across school-based mental health service providers (i.e., school psychologists, school counselors, and school social workers) regarding what they believe to be a mental health service in K-12 school settings? 2. To what extent do school-based mental health service providers concur about who is best qualified to provide specified mental health services in K-12 school settings? 3. What is the level of agreement between school-based mental health service providers, school-based mental health service supervisors, and directors of student services/special education regarding who is best qualified to provide specified mental health services in K-12 school settings? 4. To what extent do district size, school level in which a provider is employed (i.e., primarily elementary schools, primarily middle schools, etc.), and SES status of school (Title I or Non Title I) moderate school me ntal health service providers perceptions

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57 about who is best qualified to provide specified mental health services in K-12 school settings? 5. To what extent do years of professional work experience and highest degree in discipline moderate school mental health service pr oviders perceptions about who is best qualified to provide specified mental health services in K-12 school settings? 6. Does the school level and SES status of a school in which school-based mental health service providers practice modera te their beliefs about the impact of specified mental health services on student (a) academic outcomes and (b) behavioral outcomes? The remainder of the chapter is organized as fo llows: First a report of the response rate to the survey is provided, followed by a description of demographic and professional characteristics of the respondent sample. Next th e results of the data analyses conducted to answer each research question are provided. Survey Response Rate The following section describ es the survey response rates for both the current school mental health service providers database and th e archival student services supervisors and directors database. School Mental Health Service Providers To create the database, 871school mental health service providers (375 school psychologists, 375 school counselors, and 121 school social workers) in Florida were mailed the survey. Based on the first mailing of 871 surveys to the original sample, 124 completed surveys were returned. One-hundred and seventy nine surv eys were rejected by the post office or the recipient for various reasons (e.g., retirement, d eceased, change of career, employed as a private practitioner or a professor, or returned address) The researcher removed those individuals from the participant list. In total, 358 out of a po ssible 692 respondents returned completed surveys

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58 representing a 52% response rate (see Table 1). A 50 % response rate is considered adequate for analysis of research results (Babbie, 1990). Table 1 Response Rate of School Mental Health Service Providers by Role Role Potential Participant Sample Final Participant Sample Response Rate (%) School Mental Health Service Provider School Psychology 302 167 55 Guidance and Counseling 286 143 50 School Social Work 104 48 46 Overall 692 358 52 Student Services Directors and Supervisors The researcher mailed 155 surveys to student services directors and supervisors in the state of Florida in 2007 (67 directors and 88 superv isors). Thirty-two surveys were returned after the first mailing and 58 surveys after the second maili ng. Ninety surveys were completed out of a possible 155, representing a 58% response rate.

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59 Table 2 Response Rate of Student Services Supervisors and Directors by Role Role Potential Participant Sample Final Participant Sample Response Rate (%) Directors 67 26 38 Supervisors School Psychology 43 29 67 Guidance and Counseling 24 19 79 Social Work 21 16 76 Total 88 64 72 Overall 155 90 58 Description of the Sample The final sample in this study consisted of 358 school mental health providers and 90 student services supervisors and directors. A breakdown of the demographic and selected professional characteristics of the final respondent sample is reported in Tables 3, 4, and 5. Race/ethnicity data were collected for the school mental health service providers in this study. Race/ethnicity was defined according to the criteri a used for the U.S. Census data. The U.S. Census defines race/ethnicity using six cat egories (White/Caucasian, Black/African-American, Latino/Hispanic, Asian/Pacific Islander, and Nativ e American/Alaskan Native); however, in this study the categories of Asian/Pacific Islander, Native American/Alaskan Native, and Mixed Race categories for school mental health service provi ders were collapsed because of small sample sizes and included under the category labeled Oth er. Area of degree in this study was the

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60 specific area of study in which the highest degree was earned. Area of credential was the area(s) in which the professional had received his or her professional certification(s). School Mental Heath Provider Sample A breakdown of the characteristics of the sample by type of service provider (school psychologist, school counselor, school social wo rker) follows. A breakdown of demographics for school mental health service providers, as a combined group, is reported in Appendix A. School Psychologist Demographics. Examination of Table 3 reveals that most school psychologists were female (80%), White/Caucasian (77%), held a specialist degree (68%), and had more than 15 years experience as a school psychologist in their district (45%). Table 3 Demographic and Professional Characteri stics of School Psychologist (AY 2007-2008) Characteristics n % Gender Male 3320 Female 13480 Race* White/Caucasian 12877 Latino/Hispanic 1811 Black/African American 106 Other 106 Highest Degree Earned Masters 2515 Educational Specialist 11468 Doctorate 2817 Years of Experience in Current Position* 1-5 years 3823 6-10 years 3823 11-15 years 179 More than 15 years 7345 *Note: n=167; however, not all participants provided responses for each characte ristic (e.g., only 166 out of 167 participants provided a response for the characte ristic Race).

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61 School Counselor Demographics. Data in Table 4 indicates that the majority of school counselors, unlike school psychologists, earned their highest degree at the masters level (83%) and were distributed somewhat evenly in their year s of experience in the district (1-5 years: 29%, 6-10 years: 26%, and 15+ years: 34%). However, school counselors had similar demographics as school psychologists for gender (Female: 87%) and race (White/Caucasian: 82%). School Social Worker Demographics. The demographics of school social workers closely resembled the demographics of school counselors. School social workers in this study were mainly female (75%), White/Caucasian (80%), and held masters degrees (89%). In terms of years of experience in their position, they clo sely resembled school psychologists, with the majority of school social workers in their current position for over 15 years (45%). Table 4 Demographic and Professional Characteristic s of School Counselor (AY 2007-2008) Characteristics n % Gender Male 1913 Female 12487 Race* White/Caucasian 11682 Latino/Hispanic 1410 Black/African American 86 Other 32 Highest Degree Earned Masters 11883 Educational Specialist 1812 Doctorate 75 Years of Experience in Current Position* 1-5 years 4129 6-10 years 3726 11-15 years 1611 More than 15 years 4834 *Note: n=143; however, not al l participants provided respons es for each characteristic (e.g., only 142 out of 143 participants provided a response for the characteristic Years of Experience).

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62 Student Services Directors and Supervisors Sample A breakdown of the final sample of student services directors and supervisors is reported in Table 6. Student Services Director Demographics. As shown in Table 6, 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 even ly distributed across school counseling, school psychology, social work, and administration (see Table 6). Directors were nearly equally credentiale d between teaching only (43%) and student support services (56%). Fifty-six percent of the di rectors were new to their current position (1-5 Table 5 Demographic and Professional Characteristic s of School Social Worker (AY 2007-2008) Characteristics n % Gender Male 12 25 Female 36 75 Race White/Caucasian 38 80 Latino/Hispanic 510 Black/African American 510 Other -------Highest Degree Earned* Masters 41 89 Educational Specialist 24 Doctorate 37 Years of Experience in Current Position* 1-5 years 10 21 6-10 years 511 11-15 years 11 23 More than 15 years 21 45 *Note: n=48 however, not all participants pr ovided responses for each characteristic (e.g., only 142 out of 143 participants provided a response for the characteristic Years of Experience

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63 years), while 40% had been in their positions fo r 11 years or more. Eighty-eight percent reported they had been in education for more than 11 y ears and 84 % reported being in the field for more than 15 years. Student Services Supervisor Demographics. As reported in Table 6, 44% of student services supervisors in the sample held a master s 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. Most supervisors (84%) held credentials in student support services and 16% held credentials in teaching only. In terms of the num ber of years spent in their current position, 38% of the supervisors were new to their current position (1-5 years), while around 43% had been in their current position for 11 years or more. In te rms of the number of years spent in education, 89% of the supervisors reported that they had been in education for more than 11 years; and 66% for more than 15 years.

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64*Note: Not all participants provided re sponses for each ch aracteristic Table 6 Demographic and Professional Characteristics of Supervisors and Directors (AY 2006-2007) Directors (n = 26) Supervisors (n = 64) Characteristics n% n% Highest Degree Earned Bachelors 1 4 4 6 Masters 19 73 2844 Educational Specialist 1 4 2031 Doctorate 5 19 1219 Area Degree Earned Special Education 6 23 4 6 General Education 1 4 3 5 Counseling 519 1523 School Psychology 28 1320 Social Work 14 1219 Administration 1142 1727 Area in which credentialed Teaching only 1043 1016 Student Services 1357 5484 Years of Experience in Current Position* 1-5 years 1456 2438 6-10 years 14 1219 11-15 years 624 1117 More than 15 years 416 1726 Years of Experience in Educational Setting 1-5 years 2 8 1 2 6-10 years 1 4 6 9 11-15 years 14 1523 More than 15 years 2284 4266

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65 Descriptive statistics on the employment cond itions (i.e., size of district employed and type of school(s) served) of the school mental health service providers is presented below, in Table 7. School Mental Health Service Provider Employment Conditions As is indicated in Table 7, most of the sc hool mental health providers were employed in either large (29%) or very large districts (38%). Also, the schools to which they were assigned were mainly elementary (47%) were evenly spread among large city (27%), small city (27%), or suburban area (32%) locations. Finally, the provide rs in this sample almost equally served both students who were low-income (45%) and those students who were not (54%). *Note: n=358; Not all partic ipants provided responses for each characteristic Table 7 Employment Conditions of School Me ntal Health Providers (AY 2007-2008) Demographics N % Size of District* Small 27 8 Small/Middle 39 11 Middle 49 14 Large 104 29 Very Large 135 38 Primary Employment Location of Schools* Large City 97 27 Small City 97 27 Suburban 115 32 Rural 46 14 Level of School Employed* Primarily Elementary School 164 47 Primarily Middle School 32 9 Primarily High School 63 18 Works Across Multiple Levels 89 26 Socio-economic Status of Majority of Students Served* Low Income 156 45 Not Low Income 187 55

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66 Level of Mental Health Service Provision Table 8 and Figure 1, below, present descriptive statistics for the perceived level of mental health service provision as a function of district size (small, small/medium, medium, large, and very large). The data revealed that school mental health service providers reported providing various services to students but to differing degrees. A closer examination of the data show (Table 8 and Figure 1) that the three servi ces most often provided across all districts were consultation, normative assessments, and authen tic assessments. Authentic assessments were the mental health service that was most likely prov ided to most students and families (range= 3.944.15). In contrast, counseling (range= 2.66-2.93) was the mental health service that was least likely provided to most students and families who needed it. Counseling services were provided on a limited basis (Table 8). Overall, except for counseling services, school mental health services in districts were typically provided to some or most students when the service was available (Table 8, Figure 1).

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67 Table 8 Level of Mental Health (MH) Service Provision by District Size Small Small/Medium Medium Large Very Large M (SD) M (SD) M (SD) M (SD) M (SD) MH Services Counseling 2.93 2.66 2.71 2.67 2.81 (0.89) (0.87) (0.83) (0.83) (0.99) Consultation 3.97 3.68 3.59 3.64 3.70 (0.86) (0.77) (0.73) (0.81) (0.88) Normative 3.89 4.17 3.75 3.77 3.94 Assessment (1.19) (0.78) (1.00) (1.01) (1.07) Authentic 4.17 3.94 3.98 3.98 3.96 Assessment (0.90) (0.86) (1.06) (1.03) (1.07) Prevention 3.21 3.08 3.07 3.18 3.22 (0.84) (0.82) (0.71) (0.77) (0.88) Intervention 3.34 3.00 3.08 3.27 3.23 (1.08) (0.73) (0.75) (0.82) (0.87) 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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68 Figure 1 Level of MH Service Provision by District Size 0 1 2 3 4 5 6 smallsmall/mediummediumlarge very large District SizeMean Rating of Level of Provision Counseling Consultation Normative Assessment Authentic Assessment Prevention Intervention

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69 Overview of Statistical Analyses for Research Question 1 To answer research question one, frequenci es and percentages were computed for each individual service (e.g., individual counseling, fa mily counseling, academic consultation, and positive behavior support), as to whether a service was rated to be a mental health service or to not be a mental health service. A summary of the results is provided at the conclusion of research question one. Research Question 1: Beliefs about Which Service s are School-Based Mental Health Services The first research question sought to find out the views of school-based mental health service providers regarding what they believed w ere and were not mental health services in K-12 school settings. The individual services examined fell under the following broad categories: (a) counseling; (b) consultation; (c) norm-referenced assessments; (d) authentic assessments; (e) prevention services; and (f) intervention services. Th e summary data of the descriptive statistics are provided by school mental health service providers, as a combined group and by individual school mental health service providers in Tables 9, 10, 11, and 12, and respectively. In Table 9 the perceptions of all school me ntal health service providers as a group, is reported. The majority of school mental health service providers did not report the following as being mental health services in schools: academ ic consultation (79%), intelligence assessment (63%), achievement assessment (58%), dynamic i ndicators of basic early literacy skills (92%), curriculum based measurement (93%), early intervention/school-wide screenings (64%), character education (57%), drop-out prevention (54%), and test-taking/study skills training (79%). The dynamic indicators of basic early literacy skills (DIBELS) and curriculum based measurement (CBM) were overwhelming reporte d as not being school based-mental health services. Notably, the services reported by the overwhelming majority as school-based mental health services were individual therapy/counseli ng (94.5%), family therapy/counseling (97%), group therapy/counseling (94%), and me ntal health consultation (94%).

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70 Tables 10, 11, and 12 report summary data on the perceptions of each of the three groups of school mental health service providers regardi ng what they considered to be mental health services. Reports of school psychologists percepti ons (Table 10) revealed that they believed the following services were not mental health servi ces: academic consultation (80%), intelligence assessment (60%), achievement assessment (57%), dynamic indicators of basic early literacy skills (93%), curriculum based measurement (92%), early intervention (57%), and test taking training (74%). The services which the majority of school psychologists reported to be mental health services were: individual (99%), family ( 99%), and group (99%) counseling, mental health consultation (94%), substance abuse counseli ng (92%), violence prevention (93%), suicide prevention (90%), anger control training (93%), and self-control training (90%). School counselors, unlike school psychologists, reported more services as not being mental health services. Besides the services reported by school psychologists as not being mental health services (see Table 10), school counselors also rated community outreach (56%), character education (73%), parent training (65%), dropo ut prevention (67%), positive behavior support (52%), and social skills training (56%) (see Table 11). The services rated by most school counselors as being mental health services include d family counseling (94%) and mental health consultation (93%). School social workers, similar to school counselors but different from school psychologists reported character education (50%) not to be a mental health service. School social workers also rated academic consultation (79%), intelligence assessment (65%), achievement assessment (51%), dynamic indicators of basic early literacy skills (85%), curriculum based measurement (91%), early intervention (52%), a nd test taking training (74%) as not being mental health services. These ratings from school social workers were similar to the responses of both the school psychologist and school counselor. Services that were rated by most school social workers as being mental health services included: individual (96%), fam ily (94%), and group

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71 (96%) counseling, mental health consultation (9 6%), substance abuse counseling (92%), violence prevention (94%), suicide prevention (96%), cris is intervention (94%), anger control training (96%), and self-control traini ng (96%) (see Table 12). Summary of Results for Research Question 1 In summary, the data suggest that school me ntal health professionals considered several services and programs, such as family counseling and mental health consultation to be school mental health services. Services typically not seen as mental health services were assessments (authentic and normative assessments), consulta tion related to improving academic concerns, early-intervention, universal screenings, and speci alized intervention programs such as study or test taking skills programs. School counselors reported fewer services as being school mental health services than school psychologists or school social workers. Counseling services, which were more likely reported by school mental health service providers as school-based mental health services, were reported as a service that was provided in schools to a lesser degree than authentic asse ssment, a service viewed by the overwhelming majority of respondents as NOT a school mental health service.

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72 Table 9 School Mental Health Providers Ratings of MH Services (N = 358) School Mental Health Service Not a School Mental Health Service Service n % n % Counseling Individual Therapy/Counseling 33695 195 Family Therapy/Counseling 34397 123 Group Therapy/Counseling 33594 206 Consultation Mental Health Consultation 33594 216 Behavior Management C onsultation 24570 10730 Academic Consultation 7521 27879 Norm-Referenced Assessments Intelligence Assessment* 12937 22463 Achievement Assessment* 15042 20458 Personality Assessment 27377 8223 Behavior Rating Scale 24168 11432 Authentic Assessments Dynamic Indicators of Basics Early Literacy Skills* 298 32292 Curriculum Based Measurement* 247 32993 Prevention Early Intervention Services/School-Wide Screenings* 12836 22564 Home Visitations/Community Outreach 19756 15644 Character Education* 15343 20157 Parent Training 19155 15745 Substance Abuse Prevention /Counseling 29985 5315 Violence Prevention/Counseling 29885 5315 Suicide Prevention 31289 3911 Pregnancy Prevention/Support 21962 13438 Bullying Prevention 22364 12836 Dropout Prevention* 16346 18954 Peer Mediation/Support Groups 22764 12736 Intervention Positive Behavior Support 20157 15043 Social Skills Training 21160 14340 Test Taking and Study Skills Training* 7521 28079 Crisis Intervention 29885 5415 Anger Control Training 30487 4713 Relaxation Training 29182 6218 Self-Control Training 29584 5716 indicates that a service has been rated by more than 50% of the sample as not a mental health service.

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73 Table 10 School Psychologists Ratings of MH Services (n = 167) School Mental Health Service Not a School Mental Health Service Service n % n % Counseling Individual Therapy/Counseling 16599 11 Family Therapy/Counseling 16599 11 Group Therapy/Counseling 16599 21 Consultation Mental Health Consultation 15895 95 Behavior Management C onsultation 12173 4427 Academic Consultation 3420 13280 Norm-Referenced Assessments Intelligence Assessment* 6740 10060 Achievement Assessment* 7143 9657 Personality Assessment 13178 3622 Behavior Rating Scale 12072 4728 Authentic Assessments Dynamic Indicators of Basics Early Literacy Skills* 117 15493 Curriculum Based Measurement* 148 15292 Prevention Early Intervention Services/School-Wide Screenings* 7143 9457 Home Visitations/Community Outreach 10463 6137 Character Education* 9055 7445 Parent Training 10866 5534 Substance Abuse Prevention /Counseling 15192 148 Violence Prevention/Counseling 15493 127 Suicide Prevention 15090 1610 Pregnancy Prevention/Support 11770 4930 Bullying Prevention 11570 5030 Dropout Prevention* 9154 7646 Peer Mediation/Support Groups 11871 4929 Intervention Positive Behavior Support 10162 6338 Social Skills Training 11670 4930 Test Taking and Study Skills Training* 4326 12374 Crisis Intervention 14890 1710 Anger Control Training 15493 127 Relaxation Training 14990 1710 Self-Control Training 14990 1610 indicates that a service has been rated by more than 50% of the sample as not a mental health service.

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74 Table 11 School Counselors Ratings of MH Services (n = 143) School Mental Health Service Not a School Mental Health Service Service n % n % Counseling Individual Therapy/Counseling 12589 1611 Family Therapy/Counseling 13394 86 Group Therapy/Counseling 12489 1611 Consultation Mental Health Consultation 13193 107 Behavior Management C onsultation 8762 5338 Academic Consultation 3122 10979 Norm-Referenced Assessments Intelligence Assessment* 4633 9467 Achievement Assessment* 5640 8460 Personality Assessment 10374 3726 Behavior Rating Scale 8661 5439 Authentic Assessments Dynamic Indicators of Basics Early Literacy Skills* 118 12892 Curriculum Based Measurement* 64 13496 Prevention Early Intervention Services/School-Wide Screenings* 3424 10676 Home Visitations/Community Outreach 6244 7856 Character Education* 3927 10373 Parent Training 4935 9065 Substance Abuse Prevention /Counseling 10475 3525 Violence Prevention/Counseling 10072 3828 Suicide Prevention 11685 2115 Pregnancy Prevention/Support 7151 6849 Bullying Prevention 7353 6647 Dropout Prevention* 4533 9267 Peer Mediation/Support Groups 7453 6547 Intervention Positive Behavior Support 6748 7252 Social Skills Training 6344 7956 Test Taking and Study Skills Training* 2014 12286 Crisis Intervention 10576 3424 Anger Control Training 10476 3324 Relaxation Training 10475 3525 Self-Control Training 10072 3928 indicates that a service has been rated by more than 50% of the sample as not a mental health service.

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75 Table 12 School Social Workers Ratings of MH Services (n = 48) School Mental Health Service Not a School Mental Health Service Service n % n % Counseling Individual Therapy/Counseling 4696 24 Family Therapy/Counseling 4594 36 Group Therapy/Counseling 4696 24 Consultation Mental Health Consultation 4696 24 Behavior Management C onsultation 3779 1021 Academic Consultation 1021 3779 Norm-Referenced Assessments Intelligence Assessment* 1635 3065 Achievement Assessment* 2349 2451 Personality Assessment 3981 919 Behavior Rating Scale 3573 1327 Authentic Assessments Dynamic Indicators of Basics Early Literacy Skills* 715 4085 Curriculum Based Measurement* 49 4391 Prevention Early Intervention Services/School-Wide Screenings* 2348 2552 Home Visitations/Community Outreach 3165 1735 Character Education* 2450 2450 Parent Training 3474 1226 Substance Abuse Prevention /Counseling 4492 48 Violence Prevention/Counseling 4494 36 Suicide Prevention 4696 24 Pregnancy Prevention/Support 3165 1735 Bullying Prevention 3574 1226 Dropout Prevention* 2756 2144 Peer Mediation/Support Groups 3573 1327 Intervention Positive Behavior Support 3369 15 31 Social Skills Training 3268 1532 Test Taking and Study Skills Training* 1226 3574 Crisis Intervention 4594 36 Anger Control Training 4696 24 Relaxation Training 3879 10 21 Self-Control Training 4696 24 indicates that a service has been rated by more than 50% of the sample as not a mental health service.

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76 Overview of Statistical Analyses for Research Questions 2 through 5 Means and standard deviations were computed, regarding the ratings of perceived qualifications of providers and perceived impact of services on student outcomes, for research question two through five. The ratings were b ased on responses to a 5-point Likert-type scale. Data were subjected to Analysis of Variance pr ocedures to determine if there were significant differences in the perceptions of the study par ticipants. The Huynh-Feldt test was used to determine statistical significance for within-subj ects effects. Post hoc analyses were conducted using the Dunns test for the within subjects factors as a follow-up to significant interaction effects in the ANOVA. A summary of the results for research questions two through five is provided at the conclusion of each statistical analysis description. Research Question 2: Perceived Qualifications of School-Based Mental Health Service Providers in the Mental Health Service Delivery System The second research question sought to dete rmine the extent to which school-based mental health service providers concurred about which school mental health service providers (i.e., school psychologists, school counselors, and school social workers) were best qualified to provide specific mental health services in K-12 school settings. School MH Providers Ratings of School Psychologists Data in Table 13 revealed interesting results in the ratings provided by each role group about the qualifications of school psychologists to provide mental health services. As shown, school psychologists were rated by all three groups as qualified to provide mental health services in the areas of normative assessment, consultation, authentic assessment, and intervention. School psychologists often rated school psychology prof essionals as having slightly higher levels of qualifications than did school counselors and school social workers.

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77 Table 13 Mean and Standard Deviation of Ratings of Level of Qualifications of School Psychologists to Provide MH Services as Perceived by Individual School MH Providers School Psychologists School Counselors School Social Workers MH Services M SD M SD M SD Counseling 3.97 0.85 4.04 1.08 3.67 1.13 Consultation 4.66 0.45 4.28 0.71 4.18 0.83 Normative Assessment 4.91 0.23 4.89 0.28 4.73 0.46 Authentic Assessment 4.48 0.79 4.07 1.04 4.01 1.04 Prevention 4.00 0.74 3.66 0.93 3.56 0.97 Intervention 4.41 0.59 4.10 0.83 4.05 0.87 Overall 4.41 0.61 4.17 0.81 4.03 0.88 Note : Response Scale: 5: highly qualified and 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

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78 School MH Providers Ratings of School Counselors Data about the qualifications of school coun selors to provide mental health services in K-12 settings are provided in Table 14. Examinati on of these data reveal that overall, both school psychologists and school social workers rated sc hool counselors as somewhat qualified (the need for some supervision) in the provision of me ntal health services. They considered school counselors to be most qualified to provide ser vices in prevention and intervention and least qualified in the area of normative assessment. In contrast, school counselors rated their level of qualifications in each service area higher than did sc hool psychologists and school social workers. School MH Providers Ratings of School Social Workers Examination of data reported in Table 15 rev ealed that across the three groups of mental health service providers, the mental health ser vices in which school social workers received the highest ratings for level of qualification were c ounseling, prevention, and intervention. As shown in Table 15 both the school psychologists and sc hool counselors rated school social workers as being only somewhat qualified with need for supervision to provide services in the areas of prevention, counseling, intervention, and consu ltation. Both groups perceived school social workers to be minimally qualified to provide services in the area of authentic and normative assessments. Overall, school psychologists reported slightly lower levels of qualifications for school social workers in comparison to the ratings provided by the school counselors and school social workers. In contrast, school social worker s in this study often rated individuals in their similar profession as having slightly higher levels of qualifications to provide most mental health services, in comparison to the ratings provided by school counselors and school psychologists. Specifically, only the school social workers in this study rated school social work professionals as qualified (needing minimal supervision) to provide named school mental health services such as counseling, prevention, intervention, and consultation.

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79 Table 14 Mean and Standard Deviation of Ratings of Level of Qualifications of School Counselors to Provide MH Services as Perceived by Individual School MH Providers School Psychologists School Counselors School Social Workers MH Services M SD M SD M SD Counseling 3.68 0.92 4.09 0.88 3.57 1.09 Consultation 3.60 0.82 4.25 0.66 3.79 0.75 Normative Assessment 1.71 0.82 3.27 1.00 2.33 1.08 Authentic Assessment 3.23 1.19 3.59 1.13 3.47 1.22 Prevention 3.98 0.67 4.25 0.60 3.81 0.69 Intervention 3.94 0.77 4.42 0.62 4.09 0.60 Overall 3.36 0.74 3.98 0.82 3.51 0.91 Note : Response Scale: 5: highly qualified and 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

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80 Table 15 Mean and Standard Deviation of Ratings of Level of Qualifications of School Social Workers to Provide MH Services as Perceived by Individual School MH Providers School Psychologists School Counselors School Social Workers MH Services M SD M SD M SD Counseling 3.73 0.98 3.90 1.21 4.57 0.59 Consultation 3.19 0.86 3.59 1.10 4.18 0.69 Normative Assessment 1.66 0.74 2.68 1.16 2.95 1.01 Authentic Assessment 2.06 1.22 2.60 1.16 2.57 1.18 Prevention 3.90 0.79 3.96 0.86 4.34 0.55 Intervention 3.53 0.98 3.84 1.01 4.36 0.55 Overall 3.01 0.93 3.43 0.89 3.82 0.76 Note : Response Scale: 5: highly qualified and 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

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81 Figure 2 provides a matrix that summarizes data from the school mental health service providers about the mental health services which mental health service providers are perceived as being highly qualified or qualified to provide (i.e., mean ratings of a 4 or 5). School psychologists were consistently rated across school mental h ealth service providers as being qualified, needing little supervision, to provide consultation, normative assessment, authentic assessment, and intervention services. There was no consistency among the school me ntal health provides about the mental health services which school counselors and social workers were highly qualified or qualified to provide. A closer examination of the ratings reveal ed that school psychologists did not rate school counselors as highly qualified or qualified to provide any of the school mental health services. However, both school counselors and school social workers in this study rated school counselors as qualified to provide intervention services. Figure 2 shows that school social workers were not rated as highly qualified or qualified to provide any of the school mental health services by both school psychologists and school counselors. School psychologists rated themselves qualifie d to provide all services except counseling, school counselors rated themselves as qualifie d to provide all services except normative assessment or authentic assessment, and school so cial workers rated themselves as qualified to provide all services except normative assessment or authentic assessment. In conclusion, the data show that the school counselors and school soci al workers reported higher ratings about their individual qualifications to provide mental health services than did school psychologists.

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82 Figure 2 Matrix of Perceptions of School Psychologists, School Counsel ors, and School Social Workers Regarding Qualifications of School Mental Health Service Providers to Provide MH Serv ices with No/Minimal Supervision School Psychologist School Counselor School Social Worker Mental Health Service School Psychologist School Counselor School Social Worker School Psychologist School Counselor School Social Worker School Psychologist School Counselor School Social Worker Counseling X X X Consultation X X X X X Normative Assessment X X X Authentic Assessment X X X Prevention X X X Intervention X X X X X X

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83 Test of Differences in Perceptions between School Mental Health Service Providers To determine if there were significant differe nces in the perceived level of qualifications of school psychologists, school counselors, and sc hool social workers to provide mental health services, a one betweentwo within-subjects an alysis of variance (ANOVA) procedure was conducted. The between-subjects factor was professi onal role (i.e., school psychologist, school counselor, or school social worker) and the within -subjects factors were type of service provider (i.e., the school psychologist, the school counselor, and the school social worker) and type of mental health service (i.e., counseling, consulta tion, normative assessment, authentic assessment, prevention, and intervention). Examination of Table 16 revealed that fo r the within-subjects effects the following interactions were statistically significant, Role x Provider x Service, F (20, 2990) = 5.64, p < .0001, Provider x Service, F (10, 2990) = 239.69, p< .0001, Role x Service, F (10, 1495) = 10.83, p < .0001, and Role x Provider F (4, 598) = 40.99, p < .0001. Additionally, the main effect for type of mental health service was statistically significant, F (5, 1495) = 105.33, p <. 0001 and the main effect for provider was also statistically significant, F (2, 598) = 144.73, p < .0001. Finally, for the between-subjects effect, the main effect for role was statistically significant, F (2, 299) = 12.39, p < .0001. Thus, the data suggest there were significant differences in the perceptions held by school psychologists, school counselors, and school social workers about school mental health service providers qualifications to deliver specific mental health services.

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84 Table 16 Analysis of Variance of Ratings of Perceived Q ualifications of MH Service Providers to Provide MH Services by Professional Role Source df SS MS F HF Between SS Role (A) 2 88.36 44.18 12.39* S/A (Error) 299 1066.33 3.56 Within SS Provider (B) 2 438.81 219.40 144.73 <.0001* A*B 4 248.57 62.14 40.99 <.0001* S/AB (Error) 598 906.56 1.52 Service (C) 5 411.71 82.34 105.33 <.0001* A*C 10 84.64 8.46 10.83 <.0001* S/AC (Error) 1495 1168.71 0.78 B*C 10 862.10 86.21 239.69 <.0001* A*B*C 20 40.59 2.03 5.64 <.0001* SC/AB (Error) 2990 1075.45 0.36 Total 5435 6391.83 *p<.05 Note : Professional Role (School Ps ychologists vs. School Counselors vs. School Social Workers)

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85 Role x Provider x Service Interaction Effect To determine the providers between which ther e were statistically significant differences based on ratings of their perceived level of qualifications of school psychologists, school counselors, and school social workers, post hoc analyses were conducted using Dunns test. Huynh-Feldt adjustment was employed for the within-subjects factor since the sphericity assumption was violated. A graph of the interaction effect is shown in Figure 3. The interaction effect is disordinal. School Psychologists Ratings of Mental Health Professionals. Results of the Dunns test indicate that for school psychologists, there were no significant differences in their mean ratings of perceived qualifications between the three service providers (school psychologist, school counselor, and school social worker) to offer ser vices in prevention. Significant differences in qualification ratings were observed for servi ces in counseling, consultation, normative assessments, authentic assessments, and intervention (see Table 17). School psychologists rated professionals in school psychology as having significantly higher qualifications to provide services in c ounseling, normative assessments, consultation, authentic assessment, and intervention than both school counselors and school social workers. There were no differences in ratings between school counselors and school social workers to provide the aforementioned services. Lastly, school psychologists rated school counselors as having significantly higher levels of qualificati on to provide services in consultation, authentic assessment, and intervention th an school social workers.

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86 Table 17 Mean and Standard Deviation of Ratings of Perceived Level of Qualifications 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 SD M SD M SD M School Psychologists Counseling 3.97 4.04 3.67 Consultation 4.66 4.28 4.18 Normative Assessment 4.91 4.89 4.73 Authentic Assessment 4.48 4.07 4.01 Prevention 4.00 3.66 3.56 Intervention 4.41 4.10 4.05 Marginal Mean 4.41 4.17 4.03 4.20 School Counselors Counseling 3.68 4.09 3.57 Consultation 3.60 4.25 3.79 Normative Assessment 1.71 3.27 2.33 Authentic Assessment 3.23 3.59 3.47 Prevention 3.98 4.25 3.81 Intervention 3.94 4.42 4.09 Marginal Mean 3.36 3.98 3.51 3.62 School Social Workers Counseling 3.73 3.90 4.57 Consultation 3.19 3.59 4.18 Normative Assessment 1.66 2.68 2.95 Authentic Assessment 2.06 2.60 2.57 Prevention 3.90 3.96 4.34 Intervention 3.53 3.84 4.36 Marginal Mean 3.01 3.43 3.82 3.42 Note : Response Scale: 5: highly qualified and 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

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87 Figure 3 Interaction Effect of Role and Provider and Service on the Mean Ratings of the Qua lifications of MH Service Providers to Provide MH Services 0 1 2 3 4 5 School PsychologistSchool CounselorSchool Social Worker Professional RoleM ean Rating of Qualifications 0 1 2 3 4 5 Counseling ConsultationNRAAAPreventionIntervention Mental Health ServiceMean Rating of Qualifications School Psychologist School Counselor School Social Worker 0 1 2 3 4 5 Counseling ConsultationNRAAAPreventionIntervention Mental Health ServiceMean Rating of Qualifications School Psychologist School Counselor School Social Worker 0 1 2 3 4 5 Counseling ConsultationNRAAAPreventionIntervention Mental Health ServiceRating of Qualifications School Psychologist School Counselor School Social Worker

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88 School Counselors Ratings of Mental Health Professionals. Professionals in school psychology, school counseling, and school social work were rated by school counselors as having statistically significant differences in their le vel of qualification to provide consultation, normative assessment, authentic assessment, pr evention, and intervention. There were no statistically significant differences in qualif ication ratings found among the three professional groups to provide services in counseling. For normative assessment a nd authentic assessment, school counselors rated school psychologists as ha ving significantly higher qualifications (p < .05), based on training and experience, than bot h school counselors and social workers. School counselors rated school counseling professionals as having significantly higher qualifications to provide normative and authentic assessments than did school social workers. They also rated school counselors as being significantly more qualified to provide services in prevention and intervention than school psychologists and school social workers. Furthermore, school social workers were rated as being more qualified th an school psychologists to provide prevention services, while school psychologists were rated as being more qualified than school social workers to provide intervention services. Lastly, there were no significant differences in level of qualification for the provision of consulta tion between school psychologists and school counselors; however, both school counselors and school psychologists were rated as being more qualified to provide consultation services than were school social workers. School Social Workers Ratings of Mental Health Professionals. With respect to school social workers, statistically significant differenc es were observed in their mean ratings of the perceived level of qualifications of school psychol ogists, school counselors, and social workers to provide services in the areas of counseling, no rmative assessments, auth entic assessments, and prevention. More specifically, school social workers rated school psychologists as being more qualified to provide normative assessments th an both school social workers and school

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89 counselors; there were no significant differences in levels of qualification between school social workers and school counselors to deliver normative assessments. Relative to counseling and prevention services, school social workers rated professionals in the field of school social work as having significantly higher qualifications than both school counselors and school psychologists. There were no significant differences perceived in levels of qualification between school psychologists and school counselors, with regard to counseling and prevention services. School social workers rated school psychologists as being more qualified than school counselors and school social workers to provide authentic assessments; school counselors were rated as more qualified to administer authentic asse ssments than school social workers. Lastly, no significant differences in qualification ratings we re found between the three mental health service providers in their qualifications to provi de consultation and intervention services. Summary of Results for Research Question 2 In sum, school mental health professional s often rated individuals in their same profession as being more qualified to provide a range of services. Across the three providers, school psychologists were rated as being qualifie d (needing minimal supervision) to provide normative assessments and authen tic assessments. School counselors did not receive consistent ratings across the three school mental health ser vice providers to provide any mental health services, however, school counseling professionals reported school counselors as being most qualified to provide prevention and intervention ser vices. School social workers, however, did not receive ratings of being qualified to provid e mental health services from either school psychologists or school counselor.

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90 Research Question 3: MH Providers, Directo rs, and Supervisors Perceived Qualifications of School-Based Mental Health Service Providers in the Mental Health Service Delivery System The third research question sought to determine the extent to which school-based mental health service providers, directors of student ment al health services, and supervisors of student mental health services concurred about which school mental health service providers (i.e., school psychologists, school counselors, and school social workers) were best qualified to provide specific mental health services in K-12 school settings. Qualification of School Psychologist School psychologists had the highest ratings for level of qualification, across all three respondents, in the areas of consultation and normative assessments. The service area in which school psychologists received the lowest rating across all three service provider groups was prevention. However it must be noted that even in the area of prevention, school psychologists were still perceived as somewhat qualified to de liver the service. When examining the typical response patterns of the three respondents, the r eader will see that school mental health service providers often reported the school psychologist as having the highest ratings for mental health service delivery, followed by directors of student services, and then supervisors of student services. On closer examination of each group of r espondents ratings, directors reported school psychologists as qualified to deliver most mental health services except prevention (M = 3.66) and intervention (M = 3.83) (somewhat qualified a nd supervision needed). School mental health service providers also reported school psycho logists as qualified and needing minimal supervision to provide most mental heath servi ces, except counseling (M = 3.95) and prevention (M = 3.81) (somewhat qualified and supervision n eeded). Lastly, supervisors of student services often rated school psychologists as only somewhat qualified to deliver those mental health services which were outside normative assessmen t (M = 4.91) and consultation (M = 4.20).

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91 Table 18 Mean and Standard Deviation of Ratings of Level of Qualifications of School Psychologists to Provide MH Services as Perceived by Directors, Supervisors, and School MH Providers Directors Supervisors School Mental Health Service Providers MH Services M SD M SD M SD Counseling 4.26 0.78 3.47 1.28 3.95 0.99 Consultation 4.38 0.55 4.20 0.63 4.45 0.66 Normative Assessment 4.88 0.24 4.91 0.23 4.88 0.29 Authentic Assessment 4.10 0.94 3.58 1.29 4.26 0.95 Prevention 3.66 0.82 3.37 1.06 3.81 0.87 Intervention 3.83 0.74 3.72 0.87 4.24 0.74 Overall 4.18 0.68 3.87 0.89 4.26 0.75 Note : Response Scale: 5: highly qualified and 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

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92 Qualification of School Counselor Data reported in Table 19 show there are no consistent ratings across the three service provider groups about which services school counsel ors are most qualified to deliver. Directors typically reported school counselors as qualified to provide services in the area of prevention (M = 4.03) and being somewhat qualified to pr ovide services in intervention, counseling, consultation, and authentic assessment. They pe rceived them as being minimally qualified to provide services in normative assessment (M = 2.51). In contrast, supervisors did not perceive school counselors as being qualified to provide ment al health services without some supervision. School counselors were reported by supe rvisors as only being somewhat qualified with supervision to provide mental health services in inte rvention (M = 3.83), prevention (M = 3.69), authentic assessment (M = 3.47), consultation (M = 3.74), and counseling (M = 3.53) and minimally qualified to administer normative asse ssments (M = 2.41). Finally, school mental health service providers reported school counselors as being qualified to provide prevention (M = 4.06) and intervention (M = 4.17), minimally qualified to administer normative assessments (M = 2.43), and somewhat qualified to deliver all other school mental health services.

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93 Table 19 Mean and Standard Deviation of Ratings of Level of Qualifications of School Counselors to Provide MH Services as Perceived by Directors, Supervisors, and School MH Providers Directors Supervisors School Mental Health Service Providers MH Services M SD M SD M SD Counseling 3.79 0.74 3.53 0.87 3.83 0.95 Consultation 3.64 0.67 3.74 0.68 3.89 0.81 Normative Assessment 2.51 0.86 2.41 0.92 2.43 1.18 Authentic Assessment 3.60 1.16 3.47 1.22 3.41 1.18 Prevention 4.03 0.48 3.69 0.71 4.07 0.66 Intervention 3.90 0.63 3.83 0.82 4.16 0.72 Overall 3.58 0.76 3.45 0.87 3.63 0.92 Note : Response Scale: 5: highly qualified and 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

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94 Qualification of School Social Worker Examination of data reported in Table 20, re veal no consistent ratings across respondents about which mental health services school social workers had the highest qualifications to provide. Directors reported school social workers as being not qualified to provide prevention services (M = 4.02). Additionally, they rated school social workers as being minimally qualified with need for intense supervision to provide services in normative assessment (M = 2.68) and authentic assessment (M = 2.53). For all other me ntal health services, directors reported school social workers as somewhat qualified, needing some supervision to provide those services. Supervisors rated school social workers as mini mally qualified with need for supervision to administer authentic (M = 2.11) and normative assessments (M = 2.42) and somewhat qualified to provide all other mental health services. Simi lar ratings were provided by school mental health service providers about the level of qualification of school social workers. School mental health service providers perceived school social workers as somewhat qualified to provide mental health services in the areas of counseling, consultation, prevention, and intervention. They considered them to be minimally qualified with need for intense s upervision the areas of authentic (M = 2.33) and normative (M = 2.23) assessment.

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95 Table 20 Mean and Standard Deviation of Ratings of Level of Qualifications of School Social Workers to Provide MH Services as Perceived by Directors, Supervisors, and School MH Providers Directors Supervisors School Mental Health Service Providers MH Services M SD M SD M SD Counseling 3.88 1.06 3.93 0.88 3.92 1.07 Consultation 3.53 1.11 3.53 0.94 3.49 0.99 Normative Assessment 2.68 0.94 2.42 1.11 2.23 1.11 Authentic Assessment 2.53 1.34 2.11 1.09 2.33 1.22 Prevention 4.02 0.61 3.86 0.75 3.98 0.80 Intervention 3.62 0.87 3.18 1.20 3.76 0.96 Overall 3.38 0.99 3.17 0.99 3.29 1.03 Note : Response Scale: 5: highly qualified and 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

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96 Figure 4 shows a matrix in which summary data from the directors, supervisors, and mental health service providers about the mental health services for which school mental health service providers are perceived as being highly qualified or qualified to provide with little/no supervision (i.e., mean ratings of 5 or 4). As is shown, school ps ychologists are consistently rated by directors, supervisors, and school mental hea lth service providers as being qualified to provide normative assessments and consultation. Director s and school mental health service providers also rated school psychologists as being qualified to provide authentic assessments. For school counselors and social workers, th ere is no consistency in qualification rating among the directors, supervisors, and school me ntal health service providers about the MH services which school counselors and social worker s are highly qualified or qualified to provide. However, the reader will notice that school co unselors were rated by both directors and school mental health service providers as being qualifie d to deliver prevention services. Additionally, school mental health service providers rate d school counselors as qualified to deliver interventions. Finally, supervisors were the least likely of all the three respondents to rate a school mental health service provider as being highl y qualified to qualified to provide a range of mental health services.

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97 Figure 4 Matrix of Perceptions of School Psychologists, School Counsel ors, and School Social Workers Regarding Qualifications of Directo rs, Supervisors, and School Mental Health Service Providers to Provide MH Services with No/Minimal Supervision Director Supervisor School Mental Health Service Provider Mental Health Service School Psychologist School Counselor School Social Worker School Psychologist School Counselor School Social Worker School Psychologist School Counselor School Social Worker Counseling X Consultation X X X Normative Assessment X X X Authentic Assessment X X Prevention X X X Intervention X X

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98 Test of Differences in Perceptions between Directors, Supervisors, and School Mental Health Service Providers To determine if there were significant differen ces in the perceived level of qualifications of school psychologists, school counselors, and sc hool social workers to provide mental health services, a one betweentwo within-subjects an alysis of variance (ANOVA) procedure was conducted. The between-subjects factor was professi onal role (i.e., director, supervisor, and school mental health service provider) and the within-subjects factors were type of service provider (i.e., the school psychologist, the school counselor, and the school social worker) and type of mental health 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 statisti cal significance for within-subjects effects, as the sphericity assumption was violated. Examination of Table 21 reveals that for the within-subjects effects the following interactions were statistically significant, Role x Provider x Service, F (20, 3680) = 2.31, p < .05, Provider x Service, F (10, 3680) = 130.07, p < .0001, Role x Service, F (10, 1840) = 2.89, p < .05, and Role x Provider F (4, 736) = 2.54, p < .0001. Additionally, the main effect for service was statistically significant, F (5, 1840) = 35.12, p <. 0001 and the main effect for provider was statistically significant, F (2, 736) = 65.66, p < 0001. Finally, for the between-subjects effect, the main effect for role was statistically si gnificant, F (2, 368) = 3.80, p < .0001. Thus, the data suggest there were significan t differences in the perceptions held by directors, supervisors, and school mental hea lth service providers about the different school mental health service providers qualifications to deliver specific mental health services.

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99 Table 21 Analysis of Variance of Ratings of Perceived Q ualifications of MH Service Providers to Provide MH Services by Professional Role Source df SS MS F HF Between SS Role (A) 2 28.17 14.09 3.80* S/A (Error) 368 1365.70 3.71 Within SS Provider (B) 2 243.90 121.95 65.66 <.0001* A*B 4 18.84 4.71 2.54 <.05* S/AB (Error) 736 1366.97 1.86 Service (C) 5 146.00 29.20 35.12 <.0001* A*C 10 24.02 2.40 2.89 <.05* S/AC (Error) 1840 B*C 10 481.59 48.16 130.07 <.0001* A*B*C 20 17.14 0.86 2.31 <.05* SC/AB (Error) 3680 1362.49 0.37 Total 6677 5054.82 *p<.05 Note : Professional Role (Directors vs. Supervisor s vs. School Mental He alth Service Provider)

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100 Role x Provider x Service Interaction Effect To determine the providers between which there were statistically significant differences based on ratings of the perceived level of qualifi cations by directors, supervisors, and school mental health service providers, post hoc anal yses were conducted using Dunns test. HuynhFeldt adjustment was employed for the within-s ubjects factor since the sphericity assumption was violated. A graph of the interaction effect is shown in Figure 6. The interaction effect is disordinal. Directors Ratings. Significant differences in qualification ratings were observed for services in normative and authentic assessments. In the area of normative assessments, directors rated school psychologists significantly more qualified to provide these services than both school counselors and school social workers. There were no significant differences in mean ratings of perceived qualifications of the three service provi ders (school psychologist, school counselor, and school social worker) to provide services in counse ling, consultation, prev ention, and intervention (see Table 22). For authentic assessments, dir ectors rated school psychologists and school counselors significantly higher in the level of qualifications to provide the service than school social workers; there were no differences in mean ratings between school psychologists and school counselors. Supervisors Ratings. Statistically significant differences were observed in the supervisors mean ratings of the perceived level of qualifications of school psychologists, school counselors, and school social workers to provide services in the areas of consultation, normative assessments, authentic assessments, and interven tions (see Table 22). Specifically, supervisors rated school psychologists as being more qualified to provide services in the area of consultation than school social workers; however, there were no differences in mean ra tings of qualifications between school psychologists and school counselors or between school counselors and school social workers to provide these services. School psychologists were rated by supervisors as being

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101 more qualified to conduct normative assessment s than school counselors and school social workers; no differences in perceived levels of qualifications to provide normative assessments were observed between school counselors and so cial workers. Supervisors rated both school psychologists and school counselors as being more qualified than school social workers to provide authentic assessments; no significant di fferences in ratings of qualifications were observed between school psychologists and school c ounselors. In the area of intervention, they rated school counselors as being more qualified than social workers to provide these services; no significant differences in perceived qualificati ons were observed between school psychologists and school counselors or between school psychologists and school social workers. Finally, in the areas of counseling and prevention, there were no di fferences in supervisors mean ratings of the perceived level of qualifications among school psychologists, school counselors, and school social workers. School Mental Health Service Providers Ratings. Professionals in school psychology, school counseling, and school social work were rated by school mental health service providers as having statistically significant differences in thei r level of qualification to provide consultation, normative assessment, authentic assessment, prev ention, and intervention (see Table 22). There were no statistically significant differences found be tween the three types of professionals in their level of qualification to provide counseling. For normative assessment and authentic assessment, school mental health service providers rated school psychologists as having significantly higher qualifications, based on training and experience, than both school counselors and school social workers. School mental health service providers also rated school counselors as having significantly higher qualifications to provide normative and authentic assessment than school social workers. They also rated school counselor s as being significantly more qualified to provide services in prevention than school psychologists. There was no significant difference in the level of qualification between school counselors and schoo l social workers or school psychologists and

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102 school social workers and their ability to provide prevention services. Lastly, school mental health service providers rated school counselors and school psychologists as being more qualified to provide consultation and intervention servi ces than school social workers. There was no significant difference in the level of qualification between school psychologists and school counselors and their ability to provide intervention services and consultation. Summary of Results for Research Question 3 In conclusion, the data suggest that school mental health service providers did not perceive provider qualifications much differently th an directors and supervisors. All three mental health service provider groups reported that school psychologists were qualified to provide normative assessment. There were no consistent ratings among the three mental health service provider groups for school counselors and school soci al workers. Interestingly, the supervisors of the providers were the least likely of the three respondent groups to rate school mental health service providers as being qualified to provide mental health services.

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103 Figure 5 Interaction Effect of Role and Provider and Service on the Mean Ratings of the Qua lifications of MH Service Providers to Provide MH Services as Reported by Directors, Sup ervisors, and School Mental Health Service Providers 0 1 2 3 4 5 DirectorSupervisorSchool MH Provider Professional RoleMean Rating of Qualifications 0 1 2 3 4 5 Counseling ConsultationNRAAAPreventionIntervention Mental Health Servic e Mean Ratin g of Qualifications School Psychologist School Counselor School Social Worker 0 1 2 3 4 5 Counseling ConsultationNRAAAPreventionIntervention Mental Health ServiceMean Rating of Qualifications School Psychologist School Counselor School Social Worker 0 1 2 3 4 5 6 Counseling ConsultationNRAAAPreventionIntervention Mental Health ServiceRatin g of Qualifications School Psychologist School Counselor School Social Worker

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104 Table 22 Mean and Standard Deviation of Ratings of Perceived Level of Qualifications 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 SD M SD M SD M Directors Counseling 4.26 0.78 3.78 0.74 3.88 1.05 Consultation 4.39 0.56 3.640.67 3.53 1.10 Normative Assessment 4.88 0.24 2.510.86 2.68 0.93 Authentic Assessment 4.10 0.94 3.601.16 2.53 1.34 Prevention 3.67 0.82 4.030.48 4.02 0.60 Intervention 3.83 0.74 3.900.62 3.62 0.87 Marginal Mean 4.19 3.58 3.38 3.72 Supervisors Counseling 3.48 1.28 3.53 0.87 3.93 0.88 Consultation 4.21 0.63 3.740.67 3.53 0.94 Normative Assessment 4.92 0.23 2.410.92 2.41 1.11 Authentic Assessment 3.59 1.29 3.451.22 2.11 1.09 Prevention 3.37 1.06 3.690.71 3.86 0.75 Intervention 3.72 0.87 3.830.81 3.18 1.20 Marginal Mean 3.88 3.44 3.17 3.49 School Mental Health Service Providers Counseling 3.95 0.99 3.83 0.95 3.92 1.07 Consultation 4.45 0.66 3.890.80 3.49 0.99 Normative Assessment 4.88 0.30 2.431.19 2.23 1.11 Authentic Assessment 4.26 0.95 3.411.19 2.33 1.22 Prevention 3.81 0.87 4.070.67 3.98 0.80 Intervention 4.24 0.74 4.160.72 3.76 0.98 Marginal Mean 4.26 3.63 3.29 3.73 Note : Response Scale: 5: highly qualified and 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

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105 Research Question 4: District and School Char acteristics of School Mental Health Service Providers The fourth research question sought to determine the extent to which school district size and characteristics of the school (school level and SES) in which a mental health service provider was employed moderated their perceptions about the extent to which school psychologists, school counselors, and school social workers were qualif ied to provide school mental health services in K-12 settings. To determine if there were significant differences in the ratings of school mental health service providers, combined, based on their selected demographic variables, three separate one betweentwo within-subjects analysis of va riance (ANOVA) procedures were conducted. The between-subjects factors for the th ree separate analyses were a) size of district b) school level (primarily elementary, etc) and c) SES status of school (Title I vs. Non Title I). The withinsubjects factors were type of service provider (i.e., the school psychologist, the school counselor, and the school social worker) and type of mental health service (i.e., counseling, consultation, normative assessment, authentic assessment, prevention, and intervention). District Size A breakdown of mean ratings of the per ceived level of qualifications of school psychologists, school counselors, and school social workers as reported by school mental health service providers by district size (small, small/ medium, medium, large, and very large) are reported in Table 23, 24, and 25. Ratings of School Psychologists. Data reported in Table 23 suggest that school mental health service providers across the various sizes of district had very similar perceptions about the qualifications of school psychologists. School ment al health service providers across the different district sizes rated school psychologists as being qualified to provide consultation, normative assessment, authentic assessment, and intervention services. Lastly, regardless of the size of

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106 district in which a school mental health service provider was employed, school psychologists were rated as having the highest qualifications, b ased on their experiences and training, to provide normative assessment and least qualified to provide services in prevention. Ratings of School Counselors. Examination of data reported in Table 24 reveal that regardless of the size of the school district in which the mental health service providers were employed, school mental health service providers rated school counselors as being most qualified to provide intervention and prevention services. The service that school counselors were rated as minimally qualified to provide, by all district sizes except small districts, was normative assessments. Interestingly, school mental health service providers employed in small districts rated school counselors as being qualified to provide a range of mental services more often than school mental health professionals who were not employed in small districts. School mental health service providers employed in small distri cts reported that in addition to the prevention and intervention services, school counselors were also qualified to provide counseling and consultation services with minimal supervision.

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107 Table 23 Mean and Standard Deviation of Ratings of P erceived Level of Qualifications of School Psychologists to Provide MH Services as Reported by School MH Providers by Size of District Services M SD Small Districts Counseling 4.28 0.72 Consultation 4.41 0.70 Normative Assessment 4.91 0.26 Authentic Assessment 3.98 1.17 Prevention 3.78 1.02 Intervention 4.31 0.70 Small/Medium Districts Counseling 3.85 0.96 Consultation 4.44 0.58 Normative Assessment 4.94 0.25 Authentic Assessment 4.24 1.06 Prevention 3.71 0.89 Intervention 4.15 0.72 Medium Districts Counseling 3.86 1.22 Consultation 4.36 0.84 Normative Assessment 4.89 0.21 Authentic Assessment 4.35 0.74 Prevention 3.69 1.09 Intervention 4.09 1.06 Large Districts Counseling 3.98 0.97 Consultation 4.37 0.67 Normative Assessment 4.84 0.29 Authentic Assessment 4.26 0.97 Prevention 3.82 0.82 Intervention 4.27 0.66 Very Large Districts Counseling 3.94 0.97 Consultation 4.53 0.59 Normative Assessment 4.89 0.34 Authentic Assessment 4.26 0.94 Prevention 3.86 0.79 Intervention 4.29 0.69 Note : Response Scale: 5: highly qualified and 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

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108 Table 24 Mean and Standard Deviation of Ratings of P erceived Level of Qualifications of School Counselors to Provide MH Services as Reported by School MH Providers by Size of District Services M SD Small Districts Counseling 4.06 0.60 Consultation 4.17 0.58 Normative Assessment 3.03 1.09 Authentic Assessment 3.72 1.07 Prevention 4.07 0.78 Intervention 4.23 0.81 Small/Medium Districts Counseling 3.85 0.92 Consultation 3.79 0.89 Normative Assessment 2.38 1.23 Authentic Assessment 3.46 1.24 Prevention 4.10 0.66 Intervention 4.09 0.67 Medium Districts Counseling 4.01 0.97 Consultation 3.96 0.82 Normative Assessment 2.74 1.28 Authentic Assessment 3.65 1.01 Prevention 4.06 0.68 Intervention 4.14 0.74 Large Districts Counseling 3.85 0.89 Consultation 3.91 0.84 Normative Assessment 2.61 1.19 Authentic Assessment 3.50 1.20 Prevention 4.09 0.68 Intervention 4.25 0.77 Very Large Districts Counseling 3.73 1.03 Consultation 3.88 0.77 Normative Assessment 2.10 1.05 Authentic Assessment 3.22 1.19 Prevention 4.04 0.64 Intervention 4.11 0.69 Note : Response Scale: 5: highly qualified and 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

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109 Ratings of School Social Workers. Data in Table 25 revealed that school mental health service providers employed in small and medium si ze districts were most likely to rate school social workers as being qualified to provide coun seling services; this was in contrast to service providers in larger size districts who reported th at school social workers were only somewhat qualified to provide this service. School mental health service providers employed across all district sizes reported school social workers to be most qualified to provide services in the areas of counseling, prevention, and intervention ser vices. More specifically they were rated as somewhat qualified with need for some supervis ion to provide quality services in these areas. The service that school social workers were reported as least qualified to provide, by school mental health service providers across the district sizes, was normative and authentic assessment.

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110 Table 25 Means and Standard Deviation of Ratings of Percei ved Level of Qualifications of School Social Workers to Provide MH Services as Reported by School MH Providers by Size of District Services M SD Small Districts Counseling 4.11 0.66 Consultation 3.53 0.86 Normative Assessment 2.41 1.15 Authentic Assessment 2.42 1.03 Prevention 4.04 0.76 Intervention 3.79 0.83 Small/Medium Districts Counseling 3.74 1.35 Consultation 3.19 1.18 Normative Assessment 1.98 0.87 Authentic Assessment 2.06 1.10 Prevention 3.85 0.96 Intervention 3.52 1.16 Medium Districts Counseling 4.18 1.11 Consultation 3.85 0.90 Normative Assessment 2.67 1.19 Authentic Assessment 2.86 1.27 Prevention 4.16 0.84 Intervention 3.99 0.95 Large Districts Counseling 3.97 0.97 Consultation 3.47 0.91 Normative Assessment 2.26 1.10 Authentic Assessment 2.42 1.21 Prevention 4.05 0.72 Intervention 3.87 0.89 Very Large Districts Counseling 3.81 1.08 Consultation 3.47 1.04 Normative Assessment 2.14 1.11 Authentic Assessment 2.16 1.21 Prevention 3.90 0.79 Intervention 3.68 1.01 Note : Response Scale: 5: highly qualified and 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

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111 Test of Differences in Perceptions between School Mental Health Service Providers Employed in Different District Sizes To determine if school mental health service providers employed in different size districts differed in their perceptions regarding the level of qualifications of school psychologists, school counselors, and school social workers to provi de school mental health services, data were subjected to a one betweentwo within-subjects analysis of variance (ANOVA) procedure. The between-subjects factor was district size. The within-subjects factors were type of service provider (i.e., the school psychologist, the school counselor, and the school social worker) and type of mental health service (i.e., counseling, consultation, normative assessment, authentic assessment, prevention, and intervention). Examination of Table 26 reveals no statistically significant interaction effects for Size of District x Provider x Service, F (40, 2930) = 0.95, p >.05, Size of District x Service, F (20, 1465) = 1.10, p > .05, and Size of District x Provider, F (8, 586) = 2.22, p > .05, however, a significant interaction effect was observed for Provider x Service, F (10, 2930) = 198.74, p < .001, employing the Huynh-Feldt adjustment. Significant main effects were observed for type of service, F (5, 1465) = 83.60, p < .0001 and type of provider, F (2, 586) = 138.69, p < .0001, the main effect for size of district was not statistically significant, F (4, 293) = 1.89, p >.05. Since no interaction effect which included district size was statistically significant, it was determined that the size of the district in which a professional w as employed did not moderate their perceptions regarding the level of qualification of mental health service providers.

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112 Employment Location (School Level) of Respondent A breakdown of mean ratings of the per ceived level of qualifications of school psychologists, school counselors, and school social workers as reported by school mental health service providers that were employed at the elemen tary, middle, high, or multiple school levels is available in Tables 27, 28, and 29. Ratings of School Psychologist. Data reported in Table 27 suggest that the ratings provided by school mental health service provide rs about school psychologists qualifications Table 26 Analysis of Variance of Ratings of Perceived Q ualifications of MH Service Providers to Provide MH Services by District Size Source df SS MS F HF Between SS Size of District (A) 4 28.71 7.18 1.89 S/A (Error) 293 1113.94 3.80 Within SS Provider (B) 2 522.06 261.03 138.69 <.0001* A*B 8 33.41 4.18 2.22 ns S/AB (Error) 586 1102.92 1.88 Service (C) 5 345.23 69.05 83.60 <.0001* A*C 20 18.15 0.91 1.10 ns S/AC (Error) 1465 1209.99 0.83 B*C 10 737.93 73.79 198.74 <.0001* A*B*C 40 14.13 0.35 0.95 ns SC/AB (Error) 2930 1087.90 0.37 Total 5363 6214.37 *p<. 01

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113 were very similar despite their differences in employment settings. School mental professionals employed predominantly in elementary schools, middle schools, high schools, and multiple school levels all reported that school psychol ogists were qualified to somewhat qualified to provide mental health services in the schools. Finally, the service that school psychologists were rated as most qualified to provide, across res pondent groups from all employment settings, was normative assessments and consultation, followe d by authentic assessment and intervention. Ratings of School Counselors. Data in Table 28 suggest that school mental health service providers employed in different school setti ngs had diverse perceptions regarding the qualifications of school counselors. School ment al health service providers across all of the different employment settings rated school coun selors as being most qualified to provide services in prevention. They were rated as being least qualified to administer normative assessments. Interestingly, school mental health service pr oviders employed at the middle school and high school level reported school counsel ors more often as being qualified to provide selected mental health services than respondents employed at the other school levels. Ratings of School Social Workers. The school mental health service providers, across the different school levels, rated school social work ers as being most qualified to provide services in the area of prevention and counseling. Upon closer examination of Table 29, it shows that school mental health service providers employed in mi ddle school settings rated school social workers the highest in level of qualification in the area of prevention than did school mental health service providers employed in other settings. Finally, they were rated as least qualified across the different school levels to provide normative and authentic assessments.

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114 Table 27 Means and Standard Deviation Ratings of Percei ved Level of Qualifications of School Psychologists to Provide MH Services as Re ported by School MH Providers by Level of Employment Services M SD Elementary Counseling 3.91 0.99 Consultation 4.54 0.62 Normative Assessment 4.90 0.25 Authentic Assessment 4.39 0.85 Prevention 3.82 0.87 Intervention 4.28 0.75 Middle Counseling 3.89 1.07 Consultation 4.26 0.78 Normative Assessment 4.87 0.41 Authentic Assessment 4.00 1.09 Prevention 3.75 0.97 Intervention 4.21 0.84 High Counseling 4.19 1.05 Consultation 4.27 0.71 Normative Assessment 4.86 0.36 Authentic Assessment 4.04 1.12 Prevention 3.77 0.86 Intervention 4.14 0.75 Multiple Counseling 3.91 0.94 Consultation 4.48 0.62 Normative Assessment 4.87 0.27 Authentic Assessment 4.28 0.90 Prevention 3.86 0.88 Intervention 4.25 0.72 Note : Response Scale: 5: highly qualified and 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

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115 Table 28 Mean and Standard Deviation Ratings of Perceived Level of Qualifications of School Counselors to Provide MH Services as Reported by Sc hool MH Providers by Level of Employment Services M SD Elementary Counseling 3.87 0.93 Consultation 3.88 0.80 Normative Assessment 2.24 1.20 Authentic Assessment 3.41 1.23 Prevention 4.14 0.62 Intervention 4.28 0.71 Middle Counseling 3.89 1.07 Consultation 4.13 0.63 Normative Assessment 3.06 0.97 Authentic Assessment 3.47 0.94 Prevention 4.19 0.68 Intervention 4.24 0.73 High Counseling 3.87 0.86 Consultation 4.04 0.72 Normative Assessment 2.95 1.04 Authentic Assessment 3.38 1.16 Prevention 4.02 0.66 Intervention 4.15 0.68 Multiple Counseling 3.69 1.04 Consultation 3.71 0.90 Normative Assessment 2.16 1.09 Authentic Assessment 3.45 1.21 Prevention 3.91 0.72 Intervention 3.99 0.77 Note : Response Scale: 5: highly qualified and 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

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116 Table 29 Mean Ratings of Perceived Level of Qualificati ons of School Social Workers to Provide MH Services as Reported by School MH Providers by Level of Employment Services M SD Elementary Counseling 3.78 1.11 Consultation 3.35 1.01 Normative Assessment 2.00 0.99 Authentic Assessment 2.25 1.28 Prevention 3.94 0.84 Intervention 3.65 1.04 Middle Counseling 3.98 1.24 Consultation 3.67 1.13 Normative Assessment 2.66 1.09 Authentic Assessment 2.41 1.23 Prevention 4.14 0.91 Intervention 3.97 0.97 High Counseling 4.05 1.12 Consultation 3.69 0.92 Normative Assessment 2.75 1.19 Authentic Assessment 2.47 1.09 Prevention 3.95 0.77 Intervention 3.84 0.94 Multiple Counseling 4.08 0.89 Consultation 3.51 0.98 Normative Assessment 2.20 1.12 Authentic Assessment 2.39 1.24 Prevention 4.06 0.77 Intervention 3.86 0.93 Note : Response Scale: 5: highly qualified and 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

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117 Test of Differences in Perceptions between School Mental Health Service Providers Employed in Elementary, Middle, High, or Multiple School Settings To determine if school mental health service providers who were employed primarily in elementary, middle, high, or multiple school setti ngs differed in their pe rceptions regarding the qualifications of school psychologists, school counselors, and school social workers to provide mental health services, data were subjected to a one betweentwo within-subjects analysis of variance (ANOVA) procedure. The between-subjects factor was school level of employment. The within-subjects factors were type of service pr ovider (i.e., the school psychologist, the school counselor, and the school social worker) and type of mental health service (i.e., counseling, consultation, normative assessment, authentic assessment, prevention, and intervention). Examination of Table 30 reveals significant interaction effects for School Level (SL) x Provider x Service, F (30, 2920) = 2.20, p < .01 and Provider x Service, F (10, 2920) = 202.74, p < .001. No statistically significant interaction effects were observed for SL x Service, F (15, 1460) = 2.90, p > .05, and SL x Provider, F (6, 584) = 3.27, p > .05, employing the Huynh-Feldt adjustment. Significant main effects were observed for type of service, F (5, 1460) = 93.02, p < .0001 and type of mental health service provider, F (2, 584) = 143.07, p < .0001. For the between subjects effects, the main effect for school level w as not statistically significant, F (2, 296) = 2.16, p > .05. Thus, the school level in which a r espondent was employed served to moderate the perceptions about a school mental h ealth professionals qualifications. School Level x Provider x Service Interaction To determine the providers between which there were statistically significant differences based on ratings of their perceived level of qualif ications by professionals employed in different school settings, post hoc analyses we re conducted using Dunns test Huynh-Feldt adjustment was employed for the within-subjects factor since th e sphericity assumption was violated. A graph of the interaction effect is shown in Figure 6. The interaction effect is disordinal.

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118 Table 30 Analysis of Variance of Ratings of Perceived Q ualifications of MH Service Providers to Provide MH Services by School Level Source df SS MS F HF Between SS School Level A 3 24.89 8.29 2.16 S/A (Error) 292 1119.11 3.83 Within SS Provider (B) 2 539.33 269.66 143.07 <.0001* A*B 6 36.97 6.16 3.27 Ns S/AB (Error) 584 1100.76 1.88 Service (C) 5 382.08 76.42 93.02 <.0001* A*C 15 35.69 2.37 2.90 ns S/AC (Error) 1460 1199.36 0.82 B*C 10 747.36 74.74 202.74 <.0001* A*B*C 30 24.38 0.81 2.20 <.01* SC/AB (Error) 2920 1076.45 0.37 Total 5327 6286.38 *p<.01

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119 Elementary School Level. Results of the Dunns test indicate that for school mental health professionals employed primarily at the elementary level there were significant differences in mean ratings of qualifications of the three servi ce providers to provide services in consultation, normative assessment, authentic assessment, and intervention (see Table 31). No significant differences were observed for counseling and preven tion. School psychologists were rated to be significantly more qualified to provide consu ltation, normative assessment, and authentic assessment than both school counselors and school social workers. School counselors also had significantly higher qualification ratings to pr ovide consultation and authentic assessment than school social workers. Lastly, both school psychologists and school counselors were reported as having significantly higher qualifications than school social workers to provide intervention services. Middle School Level. For professionals employed primarily in middle schools, there were significant differences in mean ratings of qua lifications for the three service providers in consultation, normative and authentic assessment, and prevention (see Table 31). No significant differences were found for counseling and interventi on. In terms of consultation and prevention services, school mental health service providers employed primarily in middle schools rated both school psychologists and school counselors as having significantly more qualifications than school social workers. School psychologists were rated as having significantly more qualifications to administer normative and authentic assessments than both school counselors and school social workers, while school counsel ors were rated as having significantly more qualifications to deliver normative and authen tic assessment than school social workers.

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120 Figure 6 Interaction Effect of School Level by Provider by Service on th e Mean Ratings of the Qualifications of MH Service Providers to Provide MH Services as Reported by Sc hool Mental Health Service Providers 0 1 2 3 4 5 School LevelsMean Rating of Qualification of School Mental Health Provider 0 1 2 3 4 5 Counseling ConsultationNRAAAPreventionIntervention School Psychology School Counselor School Social Worker 0 1 2 3 4 5 Counseling ConsultationNRAAAPreventionIntervention School Psychology School Counselor School Social Worker 0 1 2 3 4 5 Counseling ConsultationNRAAAPreventionIntervention School Psychology School Counselor School Social Worker 0 1 2 3 4 5 Counseling ConsultationNRAAAPreventionIntervention School Psychology School Counselor School Social WorkerElementary High Middle Multiple

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121 Table 31 Means of Ratings of Perceived Level of Qualifications of Service Providers to Provide MH Services by School Level Student Support Professionals School Psychology School Counselor School Social Worker Marginal Mean MH Service M SD M SD M SD M Elementary Counseling 3.91 0.99 3.87 0.93 3.78 1.11 Consultation 4.54 0.62 3.88 0.81 3.35 1.01 Normative Assessment 4.90 0.25 2.24 1.20 2.00 0.99 Authentic Assessment 4.39 0.86 3.41 1.23 2.25 1.28 Prevention 3.82 0.87 4.14 0.63 3.94 0.87 Intervention 4.28 0.75 4.28 0.71 3.65 1.04 Marginal Mean 4.30 3.64 3.16 3.70 Middle Counseling 3.89 1.07 3.89 1.07 3.98 1.24 Consultation 4.26 0.79 4.13 0.64 3.67 1.13 Normative Assessment 4.87 0.41 3.06 0.97 2.66 1.09 Authentic Assessment 4.00 1.10 3.47 0.95 2.41 1.23 Prevention 3.75 0.84 4.19 0.69 4.14 0.91 Intervention 4.21 1.07 4.24 0.74 3.97 0.97 Marginal Mean 4.16 3.83 3.47 3.82 High Counseling 4.19 1.05 3.87 0.86 4.05 1.12 Consultation 4.27 0.71 4.04 0.73 3.69 0.92 Normative Assessment 4.86 0.37 2.95 1.04 2.75 1.20 Authentic Assessment 4.04 1.12 3.38 1.16 2.47 1.09 Prevention 3.77 0.87 4.02 0.67 3.95 0.77 Intervention 4.14 0.75 4.15 0.68 3.84 0.95 Marginal Mean 4.21 3.74 3.46 3.80 Multiple Counseling 3.95 0.94 3.69 1.04 4.08 0.89 Consultation 4.45 0.62 3.71 0.90 3.51 0.98 Normative Assessment 4.88 0.28 2.16 1.09 2.20 1.12 Authentic Assessment 4.26 0.90 3.45 1.21 2.39 1.24 Prevention 3.81 0.88 3.91 0.72 4.06 0.77 Intervention 4.24 0.72 3.99 0.77 3.86 0.93 Marginal Mean 4.27 3.49 3.35 3.70 Note : Response Scale: 5: highly qualified and 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

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122 High School Level. Statistically significant differences were observed in the mean ratings for school mental health professionals in coun seling, consultation, normative and authentic assessment, and intervention wo rking primarily in high schools (see Table 31). No significant difference was observed for services in prevention. School mental health professionals employed primarily in high schools rated school psychologists as significantly more qualified than school counselors to provide counseling services. School psychologists were also observed to have significantly higher ratings for the administra tion of normative assessments than both school counselors and school social workers. School psychologists and school counselors were rated as having significantly higher qualifications to pr ovide consultation and intervention services than school social workers. Lastly, school psychologi sts were rated as having significantly greater qualifications to administer au thentic assessments than both schoo l counselors and school social workers, while school counselors were observed to have significantly greater qualifications than school social workers to provide the service. Multiple School Levels. Ratings of school mental h ealth professionals who were employed in more than one setting were signifi cantly different in the areas of counseling, consultation, normative and authentic assessment, and intervention (see Table 31). No significant differences were found for prevention services. School psychologists were rated as having significantly higher qualifications than school counselors and school social workers to provide consultation and administer normative and authen tic assessments. School psychologists were also reported to have significantly higher qualificati ons to provide intervention services than school social workers. With respect to authentic assessments, sc hool counselors were rated as significantly higher in level of qualification than school social workers. Lastly, school social workers were reported to be significantly more qualified to provide counseling services than school counselors.

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123 Socioeconomic Status (SES) of Students Served by Respondents Tables 32, 33, and 34 provide a breakdown of the mean ratings of the perceived level of qualifications of school psychologists, school counselors, and school social workers as reported by school mental health service providers that ar e serving students in either predominantly lower income, Title I schools or non-Title I schools. Ratings of School Psychologists. Data reported in Table 32 suggest that the ratings provided by school mental health service provide rs about school psychologists qualifications were very similar, despite the differences in the economic status of the students that they serve. School mental professionals employed in school s that served predominantly lower income students and families, rated school psychologists qualifications a little higher than professionals in non-Title I schools. The mental health services which respondents from both Title I and nonTitle I settings reported school psychologists as most qualified to provide were normative assessment, consultation, and intervention servi ces and they were least qualified to provide prevention services.

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124 Table 32 Mean Ratings of Perceived Level of Qualifications of School Psychologists to Provide MH Services as Reported by School MH Prov iders by the SES of Students Served Services M SD Title I Schools Counseling 4.00 0.97 Consultation 4.53 0.64 Normative Assessment 4.89 0.28 Authentic Assessment 4.34 0.94 Prevention 3.90 0.87 Intervention 4.35 0.71 Non-Title I Schools Counseling 3.92 1.03 Consultation 4.38 0.68 Normative Assessment 4.88 0.31 Authentic Assessment 4.19 0.97 Prevention 3.74 0.87 Intervention 4.16 0.78 Ratings of School Counselors. Data in Table 33 suggest that school mental health service providers employed in either Title I or non-T itle I schools considered school counselors for the most part as somewhat qualified to provide most of the services. The patterns in the respondents ratings reveal that for the most part school me ntal health service providers in both settings had similar responses about the qualifications of school counselors. They reported that school counselors were most qualified in prevention and intervention services. School counselors were rated as being least qualified to administer normative assessments. Note : Response Scale: 5: highly qualified and 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

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125 Table 33 Mean Ratings of Perceived Level of Qualifications of School Counselors to Provide MH Services as Reported by School MH Provid ers by the SES of Students Served Services M SD Title I Schools Counseling 3.81 0.96 Consultation 3.79 0.77 Normative Assessment 2.26 1.19 Authentic Assessment 3.48 1.20 Prevention 4.06 0.67 Intervention 4.18 0.72 Non-Title I Schools Counseling 3.85 0.96 Consultation 3.99 0.81 Normative Assessment 2.59 1.52 Authentic Assessment 3.36 1.16 Prevention 4.06 0.67 Intervention 4.15 0.73 Ratings of School Social Workers. Examination of data reported in Table 34 reveal that school social workers were rated by school mental health service providers, employed in Title I and non-Title schools, as ranging from qualified to mi nimally qualified to provide mental health services. More specifically, respondents in non-Title I schools rated school social workers as being qualified to provide prevention and counseli ng, while those in Title I schools reported that school social workers were only, at most, some what qualified to provide most mental health services. Lastly, school mental health service providers employed in both Title I and non-Title I schools rated school social workers as being least qualified with need for some supervision to provide normative and authentic assessments. Note : Response Scale: 5: highly qualified and 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

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126 Table 34 Mean Ratings of Perceived Level of Qualificati ons of School Social Workers to Provide MH Services as Reported by School MH Prov iders by the SES of Students Served Services M SD Title I Schools Counseling 3.83 1.09 Consultation 3.36 1.00 Normative Assessment 2.04 0.99 Authentic Assessment 2.19 1.20 Prevention 3.89 0.87 Intervention 3.67 1.02 Non-Title I Schools Counseling 4.00 1.07 Consultation 3.59 0.99 Normative Assessment 2.43 1.17 Authentic Assessment 2.49 1.23 Prevention 4.06 0.75 Intervention 3.87 0.94 Note : Response Scale: 5: highly qualified and 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

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127 Test of Differences in Perceptions between School Mental Health Service Providers Employed in Title I or Non-Title I Settings To determine if school mental health servi ce providers who were either employed in Title I or Non-Title I settings differed in their perceptions regarding the qualifications of school psychologists, school counselors, and school soci al workers, data were subjected to a one betweentwo within-subjects analysis of va riance (ANOVA) procedure. The between-subjects factor was SES status of the school. The within-subjects factors were type of service provider (i.e., the school psychologist, the school counselor, and the school social worker) and type of mental health service (i.e., counseling, consulta tion, normative assessment, authentic assessment, prevention, and intervention). Examination of Table 35 reveals no statistically significant interaction effects for Socioeconomic status (SES) x Provider x Service, F (10, 2890) = 0.67, p > .05, SES x Service, F (5, 1445) = 1.45, p > .05, employing the Huynh-Feldt adjustment. Significant interaction effects were observed for Provider x Service, F (10, 2920) = 202.74, p < .0001 and SES x Provider, F (2, 578) = 6.87, p < .01. Significant main effects were observed for type of service, F (5, 1445) = 139.35, p < .0001 and type of mental health service provider, F (2, 578) = 236.42, p < .0001. For the between subjects effects, the main effect for SES was not statis tically significant, F (1, 289) = 1.68, p >.05.

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128 SES x Provider Interaction To determine the providers between which there were statistically significant differences based on ratings of their perceived level of qualifi cations by professionals employed in Title I and Non Title I schools, post hoc analyses were conduc ted using Dunns test. Huynh-Feldt adjustment was employed for the within-subjects factor since the sphericity assumption was violated. A graph of the interaction effect is shown in Figure 7. Table 35 Analysis of Variance of Ratings of Perceived Q ualifications of MH Service Providers to Provide MH Services by SE S School Status Source df SS MS F HF Between SS Socioeconomic (SES) (A) 1 6.56 6.56 1.68 S/A (Error) 289 1127.09 3.89 Within SS Provider (B) 2 896.65 448.33 236.42 <.0001* A*B 2 26.07 13.04 6.87 <.01* S/AB (Error) 578 1096.08 1.88 Service (C) 5 581.95 116.39 139.35 <.0001* A*C 5 6.07 1.21 1.45 ns S/AC (Error) 1445 1206.94 0.84 B*C 10 1136.64 113.86 305.71 <.0001* A*B*C 10 2.51 0.25 0.67 ns SC/AB (Error) 2890 1076.45 0.37 Total 5237 7163.01 *p<.01

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129 For school mental health service providers employed in both Title I and non-Title I schools there were statistically significant differen ces in their ratings about the qualifications of school psychologists, school counselors, and school social workers (see Table 36). School mental health service providers in Title I and nonTitle I schools rated school psychologists as being significantly (p<.05) more qualified to provide me ntal health services, in comparison to school counselors and school social workers. Summary of Results for Research Question 4 In conclusion, the following results can be summarized for research question 4: 1) School mental health service providers employed in smaller districts often perceived both school counselors and school social workers as being qualif ied to deliver a wider range of mental health services to students and families than those respondents employed in larger districts, 2) Respondents employed at the middle school leve l provided higher ratings for school social workers than professionals employed in elementa ry, high, or multiple school levels for school social workers qualification in the area of prevention services; and 3) Finally, respondents employed in both Title I and non-Title I schools rated school psychologists as having the highest level of qualifications to provide school mental health services than school counselors or school social workers. Table 36 Mean and Standard Deviation Ratings of School MH Providers in Title I and Non-Title I Schools of Perceived Qualifications of Service Providers to Provide MH Services School Psychologists Qualifications School Counselors Qualifications School Workers Qualifications Marginal Mean M M M Title I Schools 4.34 3.59 3.16 Non-Title I Schools 4.21 3.67 3.41 Marginal Mean 4.28 3.63 3.29 3.73

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130 Figure 7 Interaction Effect of SES and Provider on the Mean Ratings of th e Qualifications of MH Service Providers to Provide MH Services as Reported by School Mental Health Service Providers 0 1 2 3 4 5 Title I SchoolNon Title I School SES Status of SchoolMean Ratings of Qualifications of School Mental Health Providers School Psychologist School Counselors School Social Workers

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131 Research Question 5: School Mental Health Service Provider Characteristics The fifth research question sought to determine the extent to which years of experience in a district and highest degree in discipline modera ted perceptions about the extent to which school psychologists, school counselors, and school soci al workers were qualified to provide school mental health services in K-12 settings. Years of Professional Work Experience A breakdown of mean ratings of the per ceived level of qualifications of school psychologists, school counselors, and school social workers as reported by school mental health service providers with varying years of work e xperience are reported in Tables 37, 38, and 39. Means of the ratings by work experience were grouped into four categories: 1-5 years, 6-10 years, 11-15 years, and more than 15 years. Ratings of School Psychologists. Data reported in Table 37 suggested that the ratings provided by school mental health service provide rs about school psychologists qualifications were very similar despite providers difference s in overall years of work experience. School mental health professionals across the different years of work experience reported that school psychologists were most qualified to provide services in normative assessments. Interestingly, school mental health professionals who had been in the fi eld between 6-15 years were more likely to rate school psychologists as qualified to provide more services than professionals who were new to the field (1-5 years) or were seasoned veterans in the field (15+ years). Lastly, although school psychologists were rated by most school mental health service providers as qualified to somewhat qualified to provide a range of mental health servi ces, school mental health professionals reported their lowest ratings for school psychologists in the provision of prevention services. Ratings of School Counselors. The pattern of responses in term s of level of qualifications of school counselors to provide quality services in K-12 schools was highly consistent across

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132 service provider groups. Service providers across differing years of work experience reported that school counselors were most qualified to provid e intervention and prevention services, followed by services in authentic assess ment, counseling and consulta tion. They reported school counselors as being least qualified, based on tr aining and experience, to administer normative assessments. Ratings of School Social Workers. As is shown in Table 39, school social workers were rated as most qualified to provide counseling, prevention, and intervention services. School mental health professionals across the different levels of work experience reported that school social workers were least qualified, based on th eir training and experience, to provide services in the areas of normative and authentic assessments. Interestingly, individuals across the differing levels of work experience for the most part held very similar perceptions about the levels of qualifications of school social workers.

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133 Table 37 Means of Ratings of Perceived Level of Qualific ations of School Psychologists to Provide MH Services as Reported by School MH Providers by Years of Experience Services M SD 1-5 years Counseling 3.74 1.09 Consultation 4.30 0.74 Normative Assessment 4.83 0.38 Authentic Assessment 4.28 0.97 Prevention 3.71 0.91 Intervention 4.11 0.80 6-10 years Counseling 4.07 0.96 Consultation 4.44 0.65 Normative Assessment 4.89 0.23 Authentic Assessment 4.32 0.92 Prevention 3.90 0.84 Intervention 4.27 0.76 11-15 years Counseling 4.08 0.94 Consultation 4.51 0.66 Normative Assessment 4.89 0.27 Authentic Assessment 4.21 0.84 Prevention 3.75 0.91 Intervention 4.29 0.78 15+ years Counseling 3.98 0.95 Consultation 4.53 0.60 Normative Assessment 4.90 0.28 Authentic Assessment 4.23 1.00 Prevention 3.84 0.86 Intervention 4.30 0.69 Note : Response Scale: 5: highly qualified and 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

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134 Table 38 Means of Ratings of Perceived Level of Qualific ations of School Counselors to Provide MH Services as Reported by School MH Providers by Years of Experience Services M SD 1-5 years Counseling 3.81 0.95 Consultation 3.85 0.87 Normative Assessment 2.59 1.19 Authentic Assessment 3.52 1.17 Prevention 4.05 0.66 Intervention 4.20 0.78 6-10 years Counseling 3.91 0.87 Consultation 3.97 0.73 Normative Assessment 2.43 1.19 Authentic Assessment 3.46 1.33 Prevention 4.14 0.62 Intervention 4.17 0.67 11-15 years Counseling 3.79 0.98 Consultation 3.89 0.84 Normative Assessment 2.26 1.18 Authentic Assessment 3.40 0.99 Prevention 4.04 0.65 Intervention 4.16 0.69 15+ years Counseling 3.83 0.99 Consultation 3.88 0.79 Normative Assessment 2.39 1.19 Authentic Assessment 3.34 1.14 Prevention 4.04 0.70 Intervention 4.13 0.72 Note : Response Scale: 5: highly qualified and 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

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135 Table 39 Means of Ratings of Perceived Level of Qualifica tions of School Social Workers to Provide MH Services as Reported by School MH Providers by Years of Experience Services M SD 1-5 years Counseling 3.85 1.07 Consultation 3.34 1.03 Normative Assessment 2.27 1.13 Authentic Assessment 2.37 1.27 Prevention 3.92 0.73 Intervention 3.71 0.89 6-10 years Counseling 3.75 1.18 Consultation 3.44 1.00 Normative Assessment 2.09 1.08 Authentic Assessment 2.52 1.32 Prevention 4.02 0.79 Intervention 3.74 1.04 11-15 years Counseling 4.10 0.97 Consultation 3.69 1.04 Normative Assessment 2.26 1.03 Authentic Assessment 2.18 1.07 Prevention 3.93 0.98 Intervention 3.79 1.15 15+ years Counseling 4.00 1.02 Consultation 3.54 0.94 Normative Assessment 2.29 1.13 Authentic Assessment 2.25 1.17 Prevention 4.02 0.81 Intervention 3.81 0.96 Note : Response Scale: 5: highly qualified and 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

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136 Test of Differences in Perceptions between School Mental Health Service Providers by Years of Experience To determine if school mental health service providers with varying years of work experience in their district (i.e., 1-5 years, 610 years, 11-15 years, and 15+ years) differed in their perceptions regarding the qualifications of school mental health service providers, data were subjected to a one betweentwo within-subjects analysis of variance (ANOVA) procedure. The between-subjects factor was years of experience in position. The within-subjects factors were type of service provider (i.e., the school psychologist, the school counselor, and the school social worker) and type of mental health service (i.e ., counseling, consultation, normative assessment, authentic assessment, prevention, and intervention). Examination of Table 40 reveals no statistically significant interaction effects for Years x Provider x Service, F (30, 2960) = 0.62, p >.05, Years x Service, F (15, 480) = 1.13, p > .05, and Years x Provider, F (8, 586) = 0.79, p > .05, however, a significant interaction effect was observed for Provider x Service, F (10, 2930) = 267.87, p < .001, employing the Huynh-Feldt adjustment. Significant main effects were observed for type of service, F (5, 1480) = 125.07, p < .0001 and type of provider, F (2, 592) = 194.83, p <.0001, the main effect for years of experience was not statistically significant, F (3, 296) = 0.56 p >.05. Thus, the years of experience that a professional had in the field did not moderate th eir perceptions regardi ng perceived levels of qualifications of school mental health service providers.

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137 Table 40 Analysis of Variance of Ratings of Perceived Q ualifications of MH Service Providers to Provide MH Services by Years of Experience in Position Source df SS MS F HF Between SS Years (A) 3 6.45 2.15 0.56 S/A (Error) 296 1137.54 3.84 Within SS Provider (B) 2 752.18 376.09 194.83 <.0001* A*B 5 9.20 1.53 0.79 ns S/AB (Error) 592 1142.77 1.93 Service (C) 5 517.52 103.50 125.07 <.0001* A*C 15 14.02 0.93 1.13 ns S/AC (Error) 1480 1224.81 0.83 B*C 10 996.87 99.69 267.87 <.0001* A*B*C 30 6.88 0.23 0.62 ns SC/AB (Error) 2960 1101.56 0.37 Total 5398 6909.80 *p<.01

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138 Highest Degree in Discipline A breakdown of mean ratings of the per ceived level of qualifications of school psychologists, school counselors, and school social workers as reported by school mental health service providers with different degree leve ls are reported in Table 41, 42, and 43. Ratings of School Psychologists. Data reported in Table 41 suggest that the ratings provided by school mental health service provide rs about school psychologists qualifications were very similar, despite their differences in level of degree. School mental professionals across the different degree levels reporte d that school psychologists had their highest qualifications to provide normative assessments and consultation. Inte restingly, school mental health professionals that had a specialist degree were more likely to rate school psychologists as qualified to provide a wider range of mental health services than prof essionals that had a masters or doctoral degree. This outcome may be the result of the large num ber of school psychology respondents which held specialist degrees (see Table 3).

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139 Table 41 Mean Ratings of Perceived Level of Qualifications of School Psychologists to Provide MH Services as Reported by School MH Providers by Degree Level Services M SD Masters Degree Counseling 3.91 1.02 Consultation 4.29 0.75 Normative Assessment 4.88 0.30 Authentic Assessment 4.12 1.00 Prevention 3.69 0.95 Intervention 4.11 0.83 Specialist Degree Counseling 4.00 0.87 Consultation 4.64 0.49 Normative Assessment 4.89 0.25 Authentic Assessment 4.47 0.79 Prevention 3.97 0.73 Intervention 4.39 0.59 Doctoral Degree Counseling 3.99 0.92 Consultation 4.54 0.56 Normative Assessment 4.89 0.23 Authentic Assessment 4.22 0.97 Prevention 3.85 0.89 Intervention 4.35 0.73 Note : Response Scale: 5: highly qualified and 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

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140 Ratings of School Counselors. Data in Table 42 show that across all school mental health service groups, school counselors were rated as being more qualified to provide services in intervention, prevention, and consultation as comp ared to other services. School social workers were rated as minimally qualified to provide services in normative assessment. In sum, the ratings provided across the three different groups about school counselors qualifications were fairly consistent. Ratings of School Social Workers. As is shown in Table 43, ra tings were not consistent across the three different service provider groups for school social worker qualifications. However, the pattern of response was similar for school mental health professionals with masters and doctoral degrees. Respondents with masters a nd doctoral degrees rated school social workers as being most qualified to provide prevention servi ces and they were rated as being least qualified to provide authentic assessments. Notably, although the pattern of response was similar for the two groups, respondents with masters degrees provi ded higher ratings of qualifications in the individual service areas than respondents with doctoral degrees. For school mental health service providers with specialist degrees they rated school social workers to have the highest qualifications in counseling and the least qualifications in normative assessments.

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141 Table 42 Mean Ratings of Perceived Level of Qualifications of School Counselors to Provide MH Services as Reported by School MH Providers by Degree Level Services M SD Masters Degree Counseling 3.94 0.97 Consultation 4.06 0.73 Normative Assessment 2.83 1.14 Authentic Assessment 3.49 1.14 Prevention 4.14 0.64 Intervention 4.29 0.64 Specialist Degree Counseling 3.75 0.89 Consultation 3.69 0.86 Normative Assessment 1.95 1.03 Authentic Assessment 3.35 1.24 Prevention 3.95 0.68 Intervention 4.00 0.77 Doctoral Degree Counseling 3.60 1.02 Consultation 3.79 0.85 Normative Assessment 2.09 1.18 Authentic Assessment 3.26 1.19 Prevention 4.07 0.69 Intervention 4.03 0.83 Note : Response Scale: 5: highly qualified and 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

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142 Table 43 Mean Ratings of Perceived Level of Qualificati ons of School Social Workers to Provide MH Services as Reported by School MH Providers by Degree Level Services M SD Masters Degree Counseling 4.01 1.13 Consultation 3.65 1.06 Normative Assessment 2.58 1.14 Authentic Assessment 2.47 1.18 Prevention 4.05 0.77 Intervention 3.91 0.96 Specialist Degree Counseling 4.00 0.76 Consultation 3.86 0.99 Normative Assessment 1.84 0.83 Authentic Assessment 2.29 1.28 Prevention 3.96 0.74 Intervention 3.67 0.91 Doctoral Degree Counseling 3.69 1.04 Consultation 3.22 0.90 Normative Assessment 1.96 1.21 Authentic Assessment 1.89 1.08 Prevention 3.81 1.09 Intervention 3.42 1.19 Note : Response Scale: 5: highly qualified and 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

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143 Test of Differences in Perceptions between School Mental Health Service Providers by Highest Degree Earned To determine if school mental health service pr oviders differed in their perceptions of the qualifications of school psychologists, school counselors, and school social workers, as a function of their educational level (i.e., highest degree ear ned), data were subjected to a one betweentwo within-subjects analysis of variance (ANOVA) procedure. The between-subjects factor was degree level. The within-subjects factors were type of service provider (i.e., the school psychologist, the school counselor, and the school social worker) and type of mental health service (i.e., counseling, consultation, normativ e assessment, authentic assessment, prevention, and intervention). Examination of Table 44 reveals no statistically significant interaction effects for HD x Provider x Service, F (20, 2980) = 1.47, p > .05, and HD x Service, F (10, 1490) = 4.50, p > .05. However, significant interaction effects were observed for Provider x Service, F (10, 2980) = 225.73, p < .0001 and HD x Provider, F (4, 596) = 12.93, p < .0001, employing the Huynh-Feldt adjustment. Significant main effects were observed for type of provider, F (2, 596) = 209.03, p < .0001, however, statistically significant main e ffects were not found for type of service, F (5, 1490) = 108.45, p > .05. For the between subjects effects, the main effect for degree level was statistically significant, F (2, 296) = 4.58, p <.05.

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144 Table 44 Analysis of Variance of Ratings of Perceived Q ualifications of MH Service Providers to Provide MH Services by Degree Level Source df SS MS F HF Between SS Highest Degree (HD) (A) 2 33.85 16.92 4.58* S/A (Error) 296 1102.23 3.69 Within SS Provider (B) 2 743.65 371.82 209.03 <.0001* A*B 4 91.99 22.99 12.93 <.0001* S/AB (Error) 596 1060.18 1.78 Service (C) 5 442.26 88.45 108.45 ns A*C 10 36.74 3.67 4.50 ns S/AC (Error) 1490 1215.24 0.82 B*C 10 834.54 83.45 225.73 <.0001* A*B*C 20 10.90 0.54 1.47 ns SC/AB (Error) 2980 1101.73 0.37 Total 5415 6673.31 *p<.01

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145 HD x Provider Interaction To determine whether the type of degree held influenced the ratings of school mental health service providers about the qualifications of school psychologists, school counselors, and school social workers, post hoc analyses were conducted using Dunns test. A graph of the interaction effect is shown in Figure 8. Results of these analyses revealed that there were significant differences in the perceived level of qualifications of school psychologists, school counselors, and school social workers by school mental health service providers with a sp ecific degree level. School mental health service providers who held masters degrees rated school psychologists as having significantly higher qualifications than school social workers to pr ovide mental health services. Respondents with specialist and doctorate degrees reported that school psychologists were more qualified to provide mental health services than both school counselors and school social workers. In conclusion, across the three categories of degree levels, school psychologists were perceived as having the highest qualifications to provide mental health services. Consequently, the type of degree earned moderated the beliefs of school mental health service providers relative to the level of qualifications of school psychologists, school counselors, and school social workers.

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146 Figure 8 Interaction Effect of Respondents Degree Level and the Type of Service Provider on the Mean Ratings of the Qualifications of M H Service Providers to Provide MH Services 0 1 2 3 4 5 MastersSpecialistDoctorate School Mental Health ProvidersMean Rating of Qualifications of School MH Providers School Psychologist School Counselor School Social Worker

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147 Summary of Results for Research Question 5 In summary, the following conclusions can be made for research question 5: 1) For school psychologists, school mental health service providers that had been in the field between 615 years often reported school psychologists as bei ng qualified to provide more mental health services than those respondents who were new to th eir professions (1-5 years) and those that were veterans (15+ years). However, school mental health service providers with differing years of experience provided a consistent pattern of res ponses about school counselors and school social workers levels of qualification to provide mental health services, and 2) Interestingly, across the three different degree level types, school me ntal health service providers rated school psychologists as having the highest qualifications based on training and experience, to provide school mental health services. Table 45 Mean Ratings of Perceived Level of Qualifications of Service Providers to Provide Overall MH Services by Respondents Degree Level Masters Degree Specialist Degree Doctoral Degree Marginal Mean M M M M School Psychologist Overall MH Service 4.16 4.39 4.31 School Counselor Overall MH Service 3.79 3.44 3.47 School Social Worker Overall MH Service 3.44 3.27 2.99 Marginal Mean 3.79 3.70 3.59 3.69

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148 Research Question 6: School Level and SES of School and School MH Providers Perceived Impact of MH Services on Students Academic and Behavioral Outcomes The sixth research question sought to determin e the extent to which the school level in which a school mental health service provider was employed and the SES status of the school served to moderate school mental health service providers perceptions regarding the impact of mental health services on the academic and behavioral outcomes of students. Test of Differences in Ratings of Impact betw een School Mental Health Service Providers by School Level and SES To determine if there were significant differences in the ratings of impact of mental health services on academic and behavioral out comes from the perspective of school mental health service providers by school level and SES status of school served, two separate two betweenone within-subjects analysis of va riance (ANOVA) procedures were conducted. The between-subjects factors were school level (i.e., elementary, middle, high, and multiple school levels) and school SES status (Title I or Non-Title I) and the within-subjects factor was type of mental health service (i.e., counseling, consulta tion, normative assessment, authentic assessment, prevention, and intervention). Academic Outcomes A breakdown of mean ratings by school leve l, school SES status, and type of service (counseling, consultation, normative assessme nt, authentic assessment, prevention, and intervention) is reported in Table 55. The data from Table 55 show that school mental health service providers across the different school leve ls and SES status of schools perceived school mental health services as having a strong to fairly strong impact on academic outcomes. Interestingly, respondents that were employed primarily in Title I middle schools reported the greatest number of ratings that indicated that school mental health services had a strong impact on

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149 academic outcomes. The service reported as having the least impact on academic outcomes, across all school levels in Title I and non-T itle I settings, was normative assessment Table 46 Mean and Standard Deviation of Ratings of P erceived Impact of Mental Health Services on Academic Outcomes by School Level and SES Status of School School Level Title I Non-Title I Marginal Mean MH Service M SD M SD M Elementary Counseling 4.00 0.81 3.93 0.96 Consultation 4.07 0.71 4.13 0.74 Normative Assessment 3.48 1.08 3.41 1.14 Authentic Assessment 4.11 0.97 3.81 1.07 Prevention 3.72 0.75 3.72 0.84 Intervention 3.87 0.71 3.86 0.79 Marginal Mean 3.88 3.81 3.85 Middle Counseling 4.29 0.86 4.10 0.85 Consultation 4.19 0.74 4.07 0.80 Normative Assessment 3.43 1.41 3.82 0.86 Authentic Assessment 4.25 0.83 4.25 0.87 Prevention 4.08 0.81 3.99 0.76 Intervention 4.19 0.71 3.88 0.82 Marginal Mean 4.07 4.02 4.04 High Counseling 3.75 0.93 4.01 0.91 Consultation 4.16 0.62 4.06 0.74 Normative Assessment 3.00 1.29 3.49 0.90 Authentic Assessment 4.19 0.96 4.09 0.98 Prevention 3.93 0.75 3.85 0.69 Intervention 3.80 0.82 3.87 0.69 Marginal Mean 3.81 3.89 3.85 Multiple Counseling 3.95 0.85 3.70 1.06 Consultation 3.96 0.64 4.01 0.69 Normative Assessment 3.36 0.95 3.26 1.10 Authentic Assessment 4.00 0.95 4.03 0.92 Prevention 3.74 0.76 3.67 0.84 Intervention 3.84 0.84 3.76 0.83 Marginal Mean 3.81 3.74 3.77 Note: Response Scale: 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact

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150 Summary data for the two betweenone-within-subjects ANOVA for perceived impact on academic outcomes are reported in Table 47. Examination of this table reveal that the interaction effects for Service x SL x SES, F (15, 1605) = 0.55, p > .05, Service x SES, F (5, 1605) = 0.95, p > .05, and Service x SL, F (15, 1605) = 0.71, p > .05 were not statistically significant. The main effect for service, however was statistically significant, F (5, 1605) = 26.13, p < .05. For the between-subjects factors the SL x SES in teraction effect was not statistically significant, F (3, 321) = 0.17, p > .05; nor were the main effects for SES, F (1, 321) = 0.13, p > .05 and SL, F (3, 321) = 1.52, p > .05. Thus, the school level in which a school mental health service provider was employed and the SES status of the school did not serve to moderate school mental health providers perceptions regardi ng the impact of mental health services on the academic outcomes of students. Table 47 Analysis of Variance about the Perceived Impact of Mental Health Services on Academic Outcomes by School Level and SES Source df SS MS F Between Ss School Level (A) 3 10.73 3.57 1.52 SES (B) 1 0.32 0.32 0.13 A*B 3 1.21 0.40 0.17 S/AB (error) 321 755.75 2.35 Within Ss MH Service (C) 5 58.11 11.62 26.13 <.0001* C*A 15 4.71 0.31 0.71 ns C*B 5 2.10 0.42 0.95 ns C*A*B 15 6.63 0.44 0.99 ns SC/AB (error) 1605 713.80 0.44 Total 1973 1553.36 *p<.025

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151 Service Main Effect. To determine which mental health services the school mental health service providers rated as statistically significant, Tukeys HSD post hoc test was employed (alpha level = .05). Results of these analyses revealed that school mental health service providers perceived counseling, authentic assessment, preven tion, intervention, and consultation as having a significantly stronger impact (p <.05) on academ ic outcomes than normative assessments. School mental health service providers also reported th at both consultation and authentic assessments had a significantly stronger impact on academic outco mes than prevention services (see Table 48). Table 48 Mean and Standard Deviation of Ratings of P erceived Impact of Mental Health Services on Academic Outcomes MH Service M SD Counseling 3.93 0.92 Consultation 4.06 0.71 Normative Assessment 3.42 1.05 Authentic Assessment 4.04 0.96 Prevention 3.75 0.77 Intervention 3.83 0.76 Note : Response Scale: 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact

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152 Behavioral Outcomes A breakdown of mean ratings by school leve l, school SES status, and type of service (counseling, consultation, normative assessme nt, authentic assessment, prevention, and intervention) is reported in Table 49. The data from Table 49 indicated that school mental health service providers across the different school leve ls and SES status of schools perceived school mental health services as having a strong to minimal impact on behavioral outcomes of students, depending on the service. The service that was ra ted across the different school levels as having a minimal impact on behavior was authentic assess ment. Interestingly, respondents that were employed primarily in non-Title I middle and high schools reported that all school mental health services had a strong to fairly strong impact on behavioral outcomes. Table 50 provides summary data for the two betweenone-within-subjects ANOVA for perceived impact of mental health services on be havioral outcomes as a function of school level and SES of school served. As is shown, for the w ithin subjects factor the interaction effects for Service x SL x SES, F (15, 1560) = 1.07, p > .05, Service x SES, F (5, 1560) = 0.61, p > .05, Service x SL, F (15, 1560) = 1.81, p > .05 are not significant. The main effect for type of service is statistically significant, F (5, 1560) = 141.83, p < .001. For the between-subjects factors, the SL x SES interaction effect is not statistically significant, F (3, 312) = 0.16, p > .05; the main effects for SES, F (1, 312) = 0.05, p > .05 and school level, F (3, 312) = 0.60, p > .05, also were not significant.

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153 Table 49 Mean and Standard Deviation of Ratings of P erceived Impact of Mental Health Services on Behavioral Outcomes by School Level and SES Status of School School Level Title I Non-Title I Marginal Mean MH Service M SD M SD M Elementary Counseling 4.28 0.81 4.35 0.74 Consultation 4.36 0.89 4.52 0.72 Normative Assessment 3.11 1.14 3.16 1.05 Authentic Assessment 2.66 1.16 2.37 1.17 Prevention 4.00 0.79 4.05 0.79 Intervention 4.18 0.63 4.22 0.71 Marginal Mean 3.77 3.78 3.78 Middle Counseling 4.46 0.86 4.40 0.68 Consultation 4.45 1.04 4.30 0.86 Normative Assessment 3.08 1.06 3.39 1.07 Authentic Assessment 2.92 1.29 3.03 1.31 Prevention 4.10 0.83 4.20 0.64 Intervention 4.43 0.53 4.12 0.76 Marginal Mean 3.91 3.90 3.91 High Counseling 3.81 1.16 4.31 0.74 Consultation 4.50 0.75 4.16 0.93 Normative Assessment 3.13 1.30 3.33 0.96 Authentic Assessment 2.81 1.56 3.25 1.13 Prevention 4.20 0.63 4.06 0.67 Intervention 4.12 0.84 4.21 0.71 Marginal Mean 3.76 3.89 3.83 Multiple Counseling 4.27 0.69 4.17 0.95 Consultation 4.16 0.72 4.38 0.87 Normative Assessment 3.15 0.76 3.08 1.11 Authentic Assessment 2.95 1.00 2.85 1.27 Prevention 4.06 0.68 3.92 0.84 Intervention 4.13 0.71 4.09 0.71 Marginal Mean 3.79 3.75 3.77 Note : Response Scale: 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact

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154 Table 50 Analysis of Variance about the Perceived Impact of Mental Health Services on Behavioral Outcomes by School Level and SES Source df SS MS F Between Ss School Level (A) 3 4.50 1.50 0.60 SES (B) 1 0.11 0.11 0.05 A*B 3 1.19 0.39 0.16 S/AB (error) 312 783.57 2.51 Within Ss MH Service (C) 5 348.60 69.72 141.83 <.0001* C*A 15 13.34 0.89 1.81 ns C*B 5 1.49 0.29 0.61 ns C*A*B 15 7.87 0.52 1.07 ns SC/AB (error) 1560 766.86 0.49 Total 1919 1927.53 *p<.025 Service Main Effect. To determine which mental health services the school mental health service providers rated as statistically significant, Tukeys HSD post hoc test was employed. Results of these analyses reveal ed that school mental health service providers perceived counseling, prevention, intervention, and consultation as having a significantly stronger impact on behavioral outcomes than normative assessments. However, normative assessments were reported as having a significantly stronger impact on beha vioral outcomes than authentic assessments. Additionally, consultation, counseling, preventi on, and intervention were also rated as having a significantly stronger impact on behavioral outco mes than authentic assess ments (see Table 51).

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155 Table 51 Mean and Standard Deviation of Ratings of P erceived Impact of Mental Health Services on Behavioral Outcomes MH Service M SD Counseling 4.28 0.79 Consultation 4.34 0.84 Normative Assessment 3.17 1.04 Authentic Assessment 2.77 1.19 Prevention 4.02 0.75 Intervention 4.15 0.69 Summary of Results for Research Question 6 Academic Outcomes. In conclusion, it can be suggested that school mental health service providers perceived school mental health servi ces as having a strong to fairly strong impact on academic outcomes. Although school mental health service providers did not consistently rate which service had the strongest impact on acad emic outcomes, school mental health service providers unanimously rated, normative assessment as having the least impact on academic outcomes across school levels and SES of the schools. However, it should be noted that normative assessments, although rated as having the least impact on academic outcomes of all of the services, was still perceived as having a fairly strong impact on academic outcomes. Behavioral Outcomes. Examination of previous data in Table 49 shows that there was no consistent response pattern among school mental health service providers employed in the four school level categories, in either Title I or non-T itle I settings, about the impact of mental health services on behavioral outcomes. However, authen tic assessment was reported by school mental health service providers in both Title I and nonTitle I settings and across the four school levels, as having the least impact on behavioral outcomes. The majority of school mental health service providers rated authentic assessments as having a minimal impact on behavioral outcomes. Note : Response Scale: 5= Very strong impact 4= Strong impact 3= Fairly strong impact 2= Minimal impact 1= No impact

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156 CHAPTER FIVE SUMMARY, DISCUSSION, IMPLICATIONS, AND DIRECTIONS FOR FUTURE RESEARCH Providing school-based mental health services is indicative of an advanced industrial society; however, school systems and school ment al health service providers often struggle to make it a reality (Cooper, 2008). School-based mental health services continue to be fragmented, even with the push from the Presidents New Fr eedom Commission Report to incorporate schoolbased mental health services into the wider pub lic health and educational agenda (Adelman & Taylor, 2002; Cooper, 2008). Despite the existe nce of evidence indicati ng the need for school based mental health services (Adelman & Taylor, 2000; Owens & Murphy, 2004; U.S. Department of Health and Human Services, 1999), many schools still do not have access to prevention and intervention programs (Cooper, 2008). Of those schools that do have access to services there is little evidence of the effectiven ess, with respect to improving academic and behavioral student outcomes (Cooper, 2008). In this era of accountability it is imperative that services are linked to data-driven student outcomes in order to receive continued support, in the form of federal and state funding. Since school mental health service providers are often the primary individuals delivering the school mental health services, they are also the professiona ls expected to provide data demonstrating the effectiveness of the services. Therefore, it is cr itical that school mental health service providers are the driving force behind this accountability movement and demonstrate competence and skills in the provision of services which are believed to be linked to student outcomes. Lastly, it is important that district leaders are made aware of the impact of school mental health services on student academic and behavioral outcomes. Specifically, district leaders perceptions about the

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157 impact of school mental health services on student outcomes influence the school mental health service providers job descriptions and priorities of school-based mental health service providers (Dixon, 2007). The purpose of this chapter is to provide a summary of the findings for this study, explanations for the findings, limitations, and to describe practice and research implications. The chapter is organized first by a response to the research questions and then a summary of the findings of the research questions are presented with in the context of previous literature on school based mental health. Then major design a nd methodological limitations are discussed. The chapter concludes with a discussion about the imp lications for practice and future directions. Research Question 1 According to Rones & Hoagwood (2000), sc hool-based mental health services include a broad spectrum of assessment, prevention, interv ention, postvention, counseling, consultation, and referral activities and services. The findings from this present study suggest that school mental health professionals (i.e., school psycho logists, school counselors, and school social workers) considered several services and programs, such as counseling, suicide prevention, crisis intervention, and mental health consultation to be school-based mental health services. However, it was less likely that school mental health professionals perceived services that were directly linked to removing barriers to academic learning and measured academic progress, such as DIBELS (dynamics indicators of early basi c literacy skills), CBM (curriculum based measurement), school-wide screenings/early inte rvention, academic consultation, or test taking/study skill training to be school-based mental health services. This finding is important in light of the fact that approximately 25% of all 10 to 17 year olds in the United States are behind their grade le vel in school (Dryfoos, 1990) and up to 20% of all students are retained at least once in thei r academic careers (Durlak, 1995). These academic problems, which can be detected by services like DIBELS, CBM, or through academic

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158 consultation, have been shown to be predictors for a variety of emotional and behavioral difficulties (Eccles, Lord, Roeser, Barber, & Jozefowicz, 1997). In addition, these findings are consistent with previous research that exam ined school-based mental health services. Other studies have found that school professionals and school mental health service providers often reported the more traditional services and prog rams (i.e., counseling, prevention, and intervention) as being school mental health services, while non-traditional services and programs were often not perceived to be school mental health services (Adelman & Taylor, 2000; Roeser, Eccles, & Strobel, 1998). The Policy Leadership Cadre for Mental Health in Schools (2001) defined school mental health services as programs or supports that addressed barriers to student learning and performance and provided support to assist stude nts in being successful in their educational environment. Upon closer examination of the overall findings from research question one, it is revealed that school psychologists, school counselors, and school social workers were not in complete agreement about which services were and were not school mental health services. More specifically, school counselors reported, to a lesser degree than both school psychologists and school social workers, services (e.g. individual therapy, family therapy, mental health consultation, and parent training) as being mental health services. Similar findings were found in earlier research, indicating that school mental hea lth professionals often could not agree about the types of services that were mental health ser vices in schools (Charles, 1987). This finding of incongruence among school mental health professi onals is important because according to the American Academy of Pediatrics (2004) Policy Statement on School Based Mental Health, in order to have an effective school-based mental service delivery system, all school mental health professionals need to agree upon and understa nd which services are school-based mental health services. By understanding which services are and are not school mental health services, school mental health service providers are better able to define their roles within the school mental

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159 health system so that they are understood not only by the school mental health professional themselves but also by students, families, and all school staff members (American Academy of Pediatrics, 2004). Research Question 2 School Psychologists For more than 50 years, leaders in the field of school psychology have called for changes in the role of the school psychologist (Bradley-Johnson & Dean, 2000). School psychologists have expressed a desire that school staff see th em as qualified to provide a wider range of services other than just assessment. However, in this current study the consensus across all three school mental health service provider groups was th at school psychologists were most qualified, based on training and experience, to provide no rmative and authentic assessments. These results are congruent with previous literature that has found that despite the opportunities for role expansion, school psychologists still are perceived to be most qualified to provide assessment and thus the actual practice of school psychologists in many parts of the country is that they devote a large portion of their time to assessment-related duties (Fagan & Wise, 2000). It is important to mention, however, that upon closer examination of the results for school psychologists that it was the school social worker that defined school psychologists as having the narrowest professional role. Results provided by school counselors indicated that school psychologists had more training qualifications and experience than school social workers to provide intervention services and consultation in sch ools, in addition to normative and authentic assessment. Furthermore, school psychologists provided ratings which suggested that they perceived themselves as having a broad professional ro le. In addition to normative and authentic assessment, they rated themselves as being most qualified of the three providers to deliver counseling services, consultation, and intervention. This result is not surprising as it is often those that are within their identified field that perceive themselves to have more skills to provide mental

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160 health services, than those whom are outside of the field (Nastasi, Varjas, Bernstein, & Pluymert, 1998). School Counselors According to a report by the American School Counselor Association (Scarborough, 2002), the school counseling professional associati ons, their accreditation bodies, and the training programs have made great strides in defining th e role and duties of school counselors; however research continues to indicate that there is conf lict between the actual role functions of school counselors and what has been identified as best practice role functions, based on training and experience (Scarborough, 2002). A plausible explanati on for this role conflict is, in part, due to the lack of clarity in the beliefs held by ot her school professionals outside of school counseling about the qualifications of school counselors (Scarborough, 2002). In this current study school counselors reported that they had higher qualifications than school social workers to provide normative and au thentic assessment and consultation. They also rated themselves as more qualified than both school psychologists and school social workers to provide prevention and intervention. However, acr oss the three different service provider groups, school counselors were only consistently rate d as being more qualified to provide authentic assessment than school social wo rkers. Interestingly, authentic assessment is not a service in which previous literature has repor ted to be a part of the school counselors role. Typically school counselors have been reported as most qualified to provide students with individual counseling, small group counseling, classroom guidance, and consultation (Burnham & Jackson, 2000). Perhaps this current finding is a reflection of the expanded service delivery of school counselors in light of educational reform movements such as Response to Intervention (RtI). Finally it is important to mention that wh ile school social workers reported authentic assessment as the only service which school counselors had the highest qualifications to provide, school psychologists also reported school counsel ors as having more qualifications to provide

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161 intervention and consultation than school social workers. Thus these findings, which are similar to previous research, highlight the disagreements held by school professionals about the actual role and qualifications of the school counselor (Fitc h, Newby, Ballestero, & Marshall, 2001). School Social Workers Until the late 1990s school so cial workers in some states held the title of visiting teacher and were given the status of guest in sc hool settings (Weiner, 2006). This perceived role as a school guest has often left school social workers with an ambiguous role identity. According to recent research, there is a dichotomy be tween school social workers and other school professionals groups (e.g., administrators, school mental health professionals) about the perceptions of school social workers roles a nd qualifications (Weiner, 2006). An earlier finding (Dane & Simon, 1991) attributed this dichotomy to the lack of clarity about which tasks belong to school social workers or members of other disciplines (e.g., school counselor or school psychologist) (Dane & Simon, 1991). A previous study by Agresta (2004), reported that school social workers spent their time engaged in coun seling and consultation and that they indicated that they would like to spend more time engaged in individual and group counseling. In this current study, no consistent ratings were found across the three groups of school mental health providers regarding the qualificati ons of school social workers to provide mental health services. However, school social workers perceived themselves as be ing the most qualified to provide counseling and prevention services in the schools, while school counselors reported that the school social workers only were more qualified than school psychologists to provide prevention services in schools. Notably, school psyc hologists did not report school social workers as being significantly more qualified than school counselors or school psychologists to provide any of the school mental health services. Thus th ere appears to be some variability about what services the school social worker is indeed most qualified to provide in schools.

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162 Research Question 3 School Psychologists Almost 30 years ago, a study (Hughes, 1979) was conducted that investigated the consistency of perceptions held amongst admi nistrators (directors of student services and superintendents) and school psychologists a bout the role of the school psychologist. Administrators perceived school psychologists as best serving in the role as diagnostician, however, the school mental health service providers in this study believed that based on training and experience, the school psychologist would al so be best qualified to provide intervention services, such as counseling and consultation. When the results of the Hughes (1979) study are compared to the current study, the findings are strikingly similar to previously held beliefs about the perceived qualifications of school psychologists. In the current study, across the three provider groups (i.e., directors of student services, supervisors, and school mental health service providers) school psychologists were reported to be more qualif ied than school counselors and school social workers to provide normative assessments. Directors and supervisor s also reported that school psychologists had higher qualifications than school social workers to deliver authentic ass essments. Therefore, as the results of research question three suggested administrators still held views about school psychologists which were much mo re limited and traditional. In contrast, school mental health service providers perceived school psychologists as having a wider range of skills and qualifications. School mental health service pr oviders reported that not only did school psychologists have higher qualifications to deliver assessments, but that when compared to school social workers they had higher qualifications to deliver intervention services and consultation. School Counselors School counselors, similar to school psychol ogists, were viewed as having a limited professional role regarding which services they we re best qualified to provide across the three

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163 provider groups. All three provider groups reported that school counselors had higher qualifications than school social workers to pr ovide authentic assessment. Supervisors reported that, in addition to authentic assessment, school counselors were more qualified than school social workers to provide intervention services. Sc hool mental health service providers stated that in addition to authentic assessme nt and intervention, school coun selors were more qualified than school social workers to provide normative asse ssment and consultation and they were more qualified than school psychologists to provide prevention services. Notably, both supervisors and directors rated to a lesser degree than did school mental health service providers, school counselors as being most qualified to provide the majority of school mental health services. In sum, these results support previous re search (Paisley & Border, 1995) about the perceptions of school counselors qualifications. The previous study (Paisley & Border, 1995) indicated that there were often inconsistencies about school counselors ideal and actual roles and qualifications. This is due perhaps to the influence of individuals without a background in school counseling, to whom school counselors are directly accountable (i.e., directors of student services and supervisors). These directors and superv isors may hold views that are different than those of school counselors, have their own agend as, and as suggested in the current study, have little knowledge of the school counseling profession and the qualifications of counselors to provide mental health services (Paisley & Border, 1995). School Social Workers Since the seventies, the school social work pr ofession has sought to answer the question, Who is the school social worker? (Allen-Meares, 1977). This ambiguity about who the social worker is has led to a gap between what school so cial workers actually do in the mental health service delivery system and what their professional role is perceived to be (Franklin, 2000). In this era of accountability and standards, school so cial workers are struggling to determine how their professional work in the schools translates to increased student outcomes (Weiner, 2006).

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164 The current study indicates that administrators (directors and supervisors) and school mental health professionals are unable to report a clear definition about the func tioning and qualifications of the school social worker. Ac ross the three provider groups, sch ool social workers were not rated as having significantly more qualifications or training experiences than school psychologists or school counselors to provide any of the ment al health services. Thus, approximately 30 years later there still exists confusion about the definition, role, and qu alification of the school social worker (Allen-Meares, 1977). Research Question 4 An examination of district and school characteristics, such as district size, school level (elementary, middle, high, and multiple schools), and SES status of the school served (Title I or Non-Title I) revealed that some of the variab les moderated perceptions about who is best qualified to provide specified mental health services. District Size Previous research found that the size of a school district impacted the need for mental health services and the role of mental health service providers (U.S. Department of Health and Human Services, 2003). Larger districts reported that they had a higher need for mental health services because of a higher level of student ment al health concerns and a shortage of school mental health staff (U.S. Department of H ealth and Human Services, 2003). Additionally, a previous study (Overbay, 2003) showed that smaller school districts often had increased attendance, lower discipline referrals for behavi or, and lower dropout rates (Overbay, 2003) and they often employed sufficient mental health st aff to meet the needs of their children. Based on the previous literature regarding the different mental health needs by district size (U.S. Department of Health and Human Serv ices, 2003; Overbay, 2003), it was surprising that in this current study the main effect and inte raction effect for district size was not significant. The data reported that district size was not a vari able that moderated school mental health service

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165 providers perceptions about the le vels of qualification of school mental health service providers. An explanation for this result could be the di stribution of the sample sizes across the different district sizes. The majority of participants in th is study were employed in either large or very large districts (see Table 7). School Level The United States Department of Health and Human Services (2003) conducted a study that examined mental health service use by school level. The results of that study suggested that there was a difference in the mental health need s of students at the elementary, middle, and high school level. Mental health services provided at the elementary school level often addressed aggressive and disruptive behavior problems, while at the middle school level it addressed interpersonal, social, and family issues and aggr ession and disruptive beha vior problems, and at the high school level it addressed issues related to depression, anxiety, substance abuse, interpersonal/social issues, and aggression and disr uptive behaviors (United States Department of Health and Human Services, 2003). Therefore, it w as hypothesized that becau se the mental health needs of the students differed by school level then the perceptions about the mental health staff qualifications would also differ depending upon the school level in which the respondent was employed. The data from the current study found that th e perceived qualifications of school mental health service providers did differ based upon the school level in which the school mental health service providers were primarily employed. For ex ample, school mental health service providers employed at the elementary school level perceive d the role of the school psychologist and the school counselor to be quite similar, with th e exception of normative assessments, which the respondents reported the school psychologist as being the most qualified to provide. At the elementary school level, school psychologists and school counselors were perceived to be most qualified in service areas such as consultati on, assessment, and intervention. These services

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166 reflect the kinds of needs typically addressed at th e elementary level. This result is not surprising as the mental health services actually provided at the elementary level include assessment for emotional and behavioral problems, behavior ma nagement consultation, behavior intervention, and referral for specialized programs (United Stat es Department of Health and Human Services, 2003). The typical elementary school was found to provide very little counseling and prevention services and it was reported that services were primarily delivered by the school counselor or school psychologist, with very little involvemen t from the school social worker (United States Department of Health and Human Services, 2003). Th erefore, it can be suggested that there is a reciprocal interaction between the actual services that are provided at the elementary school level and the perceptions held regarding school ment al health service providers qualifications to provide those services. Studies about the types of mental health services provided at the middle school level revealed similar findings as those at the elem entary school level (e.g., consultation, assessment, and intervention), with the inclusion of s ubstance abuse prevention and counseling being delivered in middle schools (United States Depa rtment of Health and Human Services, 2003). The qualifications of both school psychologists a nd school counselors were perceived to be very similar to one another. School psychologists were seen as most qualified to provide normative and authentic assessment and more qualified than school social workers to implement prevention programs and consult with individuals in and out side of the school. School counselors were seen as being more qualified than school social workers to provide the same services (e.g., consultation, prevention, normative and authentic assessment). It makes sense that respondents at the middle school level, unlike at the elementary school level, reported school psychologists and school counselors as being qualified to provide prevention services. At the middle school level there is an increased focus on prevention ser vices such as substance abuse prevention and

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167 counseling, which is often not present in elementa ry settings (United States Department of Health and Human Services (2003). Respondents at the high school level indicated that school psychologists were qualified to provide a wider range of services (e.g., counseling, assessment, consultation, intervention) when compared to the ratings of respondents employed at the other school levels. However, school counselors were perceived as having a more lim ited role in regards to qualifications (e.g., consultation and intervention) when compared to the ratings of respondents employed in levels other than the high school level. The findings from this study are consistent with previous results that examined the level of involvement of school mental health service providers at the high school level. Direct mental health services at the high school level are typically less likely to be provided by school counselors, while school psychologists at the high school level often become more involved in providing additional direct ser vices (United States Department of Health and Human Services (2003). This may explain why resp ondents at the high school level rated school counselors as having qualifications to a lesser de gree than school psychologists to provide a number of mental health services (e.g., c ounseling, consultation, intervention). Lastly, respondents employed across multiple school levels held similar perceptions about school psychologists as those employed at the elementary school level. However, for school counselors, respondents employed at multiple school levels stated that school counselors were only more qualified than school social work ers to provide authentic assessment. Notably, it was only the individuals employed at multiple school levels that reported school social workers as more qualified than another mental health pr ofessional (i.e., school counselors) to provide a particular mental health service (i.e., counseling) This finding is more likely because many of the respondents in this study employed across multip le school levels were school social workers.

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168 SES Status of School More than 50% of impoverished children are at -risk for mental health problems (Howell, 2004). Unfortunately, children from low-income backgrounds often are not provided with adequate mental health care services (Adelman, & Taylor, 1998). When these children do receive mental health services in the community or school, those services are often of poorer quality when compared to those students who are not from low-income backgrounds and/or attend predominantly low-income schools (Howell, 2004). Based on previous literature about disparities in mental health by income level (Howell, 200 4; Adelman & Taylor, 1998), it was expected that the SES status of the school in which a res pondent was employed would moderate their perceptions about mental health service providers qualifications. In the current study, the data suggested that school mental health service providers in both Title I and Non Title I schools perceived school psychologists, in comparison to school counselors and school social workers, as being significantly more qualified overall to provide school-based mental health services. However, it is important to note that providers reported previously in this study that school psychologist s were typically rated to be most qualified to provide the service of normative assessment. Thus, if school psychologists were seen as most skilled to provide normative assessment then perh aps, instead of being qualified to provide students with a wide range of services to treat me ntal health needs, they are evaluating students for special education. This is a plausible e xplanation, considering that neither the school counselor nor the school social worker were re ported by respondents employ ed in Title I and nonTitle I schools as being significantly more qualified to provide any of the mental health services. Research Question 5 An examination of provider characteristics, such as years of professional work experience and highest degree in discipline revealed that some of the variables held by the respondents

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169 moderated their perceptions about who is best qualified to provide specified mental health services. Years of Professional Work Experience Previous research found that the number of years of experience a school mental health professional had was related to the type of prof essional activities in which they were engaged (Agresta, 2002; Curtis, Hunley, & Grier, 2002; Pope, 2007). Research has shown that school psychologists with more years of experience pe rformed more special e ducation re-evaluations, served more students through consultation, and provided more in-service programs than their peers with less experience (Curtis, Hunley, & Grie r, 2002). School counselors with more years of experience were more likely to spend more hours engaged in primarily academic advisement and less time providing intervention, prevention, or consultation with teachers and parents than their peers with fewer years of experience (Agresta, 2002). Finally, research (Agresta, 2002) has reported that the educational training of new school social workers is evolving to meet the changing educational climate (e.g., intervention, prevention). As a result, it would be expected that school social workers with fewer years of experience would be trained to provide a wider range of services than their more experienced colleagues (Pope, 2007). Consequently, it is hypothesized that the newer school social workers would attempt to be involved in providing intervention, prevention, and consultation, in a ddition to the services typically provided by more experienced colleagues such as outr each and counseling (Pope, 2007). Based on previous results (Agresta, 2002; Cu rtis, Hunley, & Grier, 2002; Pope, 2007) it would be expected that the respondents would per ceive the qualifications of school psychologists, school counselors, and school social workers differe ntly as a result of the respondents years of experience. However, this study found that the number of years of district experience of the respondents did not moderate their perceptions regarding the perceive d level of qualifications of school mental health service providers. This finding may be the result of the disproportioned

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170 samples sizes across the number of years of distri ct experience. The majority of respondents in the school mental health service provider sample had been the field for more than 15 years (see Appendix A). Degree Level Similar to previous research (Agresta, 2002: Curtis, Hunley, & Grier, 2002; Pope, 2007), in this study it was hypothesized that respondent s degree level would mode rate their perceptions about school mental health service providers qualific ations to deliver mental health services. It was expected that school mental health professiona ls with higher degree leve ls would be qualified to engage in a wider range of mental health ser vice delivery based upon their advanced training in more concentrated and specialized areas (Cimino, 2007). The results of this study concluded that across the three different degree levels (masters, specialist, and doctoral) respondents perceived school psychologists as having the highest qualifications, overall, to provide mental health services. More specifically, respondents in the st udy with specialist and doctoral degrees reported that school psychologists had more qualifications than both school counselors and school social workers to provide mental health services, while respondents in the study with masters degrees reported school psychologists were only more qualified than school social workers to provide mental health services. Research Question 6 Previous research demonstrated that a relationship exists between mental health services and student outcomes (Willcutt & Pennigton, 2000; Arnold et al., 2005; Tremblay et al., 1992; Petras et al., 2004; Scott & Shearer-Lingo, 2002; Ginnsburg-Block and Fantuzzo, 1998). In this study, the researcher examined whether respondent s employed at different school levels and that worked in either Title I or non-Title I schools reported significant differences regarding the impact of mental health services on student outcom es (academic and behavior). Previous research (United States Department of Health and Human Services, 2003) demonstrated that the types of

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171 mental health services provided differ based on wh ether it is an elementary, middle, or high school (United States Department of Health a nd Human Services, 2003). Additionally, previous research reported that impoverished schools are often overburdened and stressed with a number of mental health concerns and are more likely to provide less efficient services that are not linked to measurable student outcomes (Howell, 2004; Adelman & Taylor, 1998). Schools are struggling to fund mental health services given the current budget constraints of our public education system. Sp ending related to the No Child Left Behind (NCLB) legislation has pushed school systems to implement accountab ility measures to establish the link to increased academic and behavioral outcomes. If the providers of mental health services, across all school levels and in both Title I and Non-Title I schools, cannot demonstrate that the services increase educational outcomes, then those services are at risk during budget reductions (Foster, Rollefson, Doksum, Noonan, Robinson 2005). Overall, the findings revealed that the sc hool level and SES status of the school served did not moderate perceptions regarding the impa ct of mental health services on student academic and behavioral outcomes. However, it was found th at the school mental health service providers, regardless of the school level or the SES status of the school served, reported that most of the mental health services they provided were pe rceived to increase academic and behavioral outcomes. Normative assessment was the only service reported to have the least impact on academic outcomes. Authentic assessment was perceived to have the least impact on behavioral outcomes. Overall, school mental health service pr oviders reported that the school mental health services in schools had a strong to fairly strong impact on student academic and behavioral outcomes.

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172 Limitations The first limitation of this study was the par ticipants in this study were employed only in the state of Florida. The results of this stud y can be generalized to school mental health professionals and administrators employed with in the state of Florida (Cozby, 2001). A second limitation of this study again relat es to the participant sample. This is a limitation because only school mental health service providers who had a professional association membership were included in this study. This study did not account for the possibility that school-based mental health service providers w ho joined a professional association may have differed from those who did not join. Therefore, th e results from this sample could not be easily generalized to a larger target population of i ndividuals who did not participate in the study (Cozby, 2001). A third limitation is related to the data collection measures. The instrument asked directors, supervisors, and school mental health service providers to recall the qualifications of school mental health service providers to deliver a number of services. Potentially, there was a problem of recall bias (Schweigert, 1994). The instrument did not provide a specific criterion regarding levels of qualification for the school-b ased mental health providers. Therefore, it is possible that the respondents held different belie fs from one another about what made a school mental health professional highly qualified versus qua lified versus not qualified. This would be particularly true if the respondents used their perceived qualifications of specific professionals with whom they were in contact with in their district to rate school mental health professionals overall. As a result, it is possible th at directors, supervisors, and school mental health service providers may have incorrectly recalled the actual degree of qualification of a school mental health service provider. A fourth limitation was the potential threat to internal validity. It is possible that the participants may have provided socially desi rable responses (Cozby, 2001). By administering a

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173 survey about mental health service delivery in the schools, the researcher was assuming that providers believed that mental health services were being provided at some level, within schools. If a district or school mental health service provider was providing few or no mental health services, respondents may have been inclined to inflate the range of mental health services offered to students. They may also have been inclined to inflate their perceptions of the relationship between mental health services and student outcomes (e.g., academic or behavior). Allowing participants to know the purpose of the study may have contributed to inaccurate or false information about the relationship between mental health services and student outcomes (Cozby, 2001). A fifth limitation of this study is the time pe riods for the data collection for directors and supervisors and school mental health providers Data were collected for the directors and supervisors during the academic year of 2006-2007, while the data were collected for the school mental health providers the following academic year of 2007-2008. Therefore it is possible that certain issues or events may have arisen over the course of the two different time periods that impacted respondents ratings. For example, nationally improving K-12 pub lic education was one of lawmakers top priorities for the 2007-2008 legislative sessions. On a national level, legislators boosted k-12 funding by 15%, provided $15 million for the creation of drop-out prevention programs, and boosted disadvantaged student supplemental f unding (DSSF) by $ 6 million to allow local education agencies to meet the needs of at-risk students (Luebke, 2008). More specifically, in the state of Florida there were political changes that occurred during the two different data collection periods. In 2007-2008 Charlie Crist was elected to the position of Governor. The previous Governor during the year of 2006-2007 was Jeb Bush who had served a term of 8 years in Florida. Although Jeb Bush and Charlie Crist we re members of the Republican Party, Charlie Crist expressed a stronger commitment to incr eased funding for k-12 education. Additionally,

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174 Charlie Crists role on the Commissioners Blue Ribbon Committee on Education Governance informed him of the many challenges that the e ducational system faced and caused him to be a stronger advocate for educational reform. As a resu lt of his commitment to education, early on his term Charlie Crist increased educational fundi ng by more than 7%, reduced class sizes, and requested a 14% increase in the educational fu nding to promote a stronger reading initiative (Crist, 2007). Thus it is possible that because duri ng the 2007-2008 year there were changes in both the political climate and the national and state commitment to increased student resources, that the respondents from the two different time periods (2006-2007 and 2007-2008) held beliefs which reflected those changes and events. Implications for Practice The concept of role theory states that professionals will experience conflict if they believe they are qualified to perform one set of ro les but in fact others around them perceive them to be qualified, or in many cases, require them to perform a different set of roles in their actual practice (Pope, 2007). This current study was conduc ted as an expansion of a previous study by Dixon (2007) which examined the beliefs of dist rict leaders regarding school mental health service providers qualifications (Dixon, 2007). Th e previous study by Dixon (2007) found that school mental health service providers were more likely encouraged to deliver only those mental health services which they were perceived by admi nistrators to be qualified to provide, even if they perceived that they possessed the skills and training to provide other services (Dixon, 2007). For example, in the previous study the results revealed that the mental health services which administrators perceived school psychologists, sc hool counselors, and/or school social workers as most qualified to provide (normative assessmen t, authentic assessment and consultation) were also the services in the district which were most frequently provided. Thus, perceptions about the types of mental health services which school ment al health service providers were qualified to

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175 provide was linked to the range of mental health services offered in districts (Adelman & Taylor, 1998). Dixon (2007) assumed that if school mental health service providers perceived themselves as having more qualifications to deliver a wider range of services than what administrators believed they possessed, then school mental health service providers would experience role conflict regarding their actual a nd ideal qualifications and roles. The results of this current study indicated that in the case of school psychologists, school mental health service providers perceived school psychologists as bei ng more qualified to provide a wider range of services to students and families than what directors and supervisors believed. In the case of school counselors and school social workers the school mental health service providers, directors, and supervisors did not report c onsistent perceptions about school counselors and school social workers qualifications. This indicated that there was no clear understanding about what school counselors or school social workers were actua lly most qualified to provide in schools. This incongruence in the perceptions about the qualifications of school mental health service providers contributes to the ineffec tiveness (e.g., providing services that do not demonstrate improved student outcomes) within the school mental health system. The current study concluded that there is no consistent agre ement between district leaders and school mental health service providers about which specific ser vices school mental health service providers are most qualified to provide. Moreover, Dixon (2007) found that the few services which district leaders believed school mental health service providers were qualified (e.g., assessment) to provide were also the same services that were be lieved not to impact student outcomes. Lastly, district leaders believed no one was highly qualif ied to provide the services (e.g., counseling, interventions) that were believed to impact student outcomes. When school mental health service providers beliefs are examined, the data show that often the school mental health service providers are unclear as to which services they are most

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176 qualified to provide. However, school mental health service providers report that they believe that the majority of services which are provided in schools, positively impact student outcomes. School mental health service providers must clearly articulate and demonstrate to school staff and leaders which services they can provide and that the services which they are qualified to provide are linked to student outcomes. If they can not do this, then district leaders will never reconceptualize the role of school mental health service providers as valuable professionals that are qualified to provide services which significantly improve student outcomes. Legislation has emphasized the importance of promoting school success. It is expected that school mental health service providers will ha ve a clear understanding of what their role is within this mandate (U.S. Department of Edu cation, 2001). They are expected to be highly trained and qualified to deliver services that ar e linked to academic and behavioral outcomes. Additionally, federal and state laws emphasize school accountability (U.S. Dept of Education, 2001). Evidence of school accountability is demonstrated through positive student outcomes. Federal and state laws support accountability by providing funding for services and programs which are shown to positively influence student outcomes. Thus, it is alarming when the data shows that school mental health service providers and administrators seem to understand which services will demonstrate this accountability, but are unsure as to who is best qualified to provide those services. Funding for education has been drastically re duced and district leaders are making tough decisions about which programs and professional positions to cut. In light of this, it is problematic when school mental health providers report ambiguity about their professional identity and the significance of thei r role in meeting educational standards. School-based mental health services and the providers of those servi ces must positively demonstrate a positive impact on student academic and behavioral outcomes in order to receive continual district and school

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177 support. If they do not do so, the future of sc hool-based mental health services could possibly be at stake. Not only do the results of this study reveal the importance of school mental health service providers being able to articulate their qualifications amongst them selves and with other school staff or demonstrate the positive impact which school mental health services have on student outcomes, but the findings from the stud y also have implications for improving school mental health services. The results of this stud y demonstrate the importance of acknowledging the marginalized state of school mental health ser vices. Additionally, the results allude to the importance of developing an accountability system for school mental health providers. In order to increase providers mental health service deliver y, the districts and/or training programs may need to provide updated continuing education tr aining, support, and supervision for the services which school mental health service professionals will be required to deliver in schools. In addition to ensuring that school mental health service providers have the basic required skills, districts should, in consultation with the sc hool mental health service providers, develop professional plans that outline which provider(s) will deliver specified services in the schools. This will allow districts and schools to continu ously assess if the school mental health service providers are delivering, at minimum, the designated services. Also by developing a professional plan for mental health service delivery the distri cts can increase their chances that they will have a more widespread school mental health service delivery system. Implications for Future Research Based on the current research, there are seve ral recommendations that are suggested for future research. First, this study should be c onducted with a national sample to determine the consistency of results about school mental hea lth services across states. Research has shown that there are differences in service use and unmet n eed for childrens mental health services across states (McDaniel & Edwards, 2004). Many of those differences are driven by state-level factors,

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178 such as policy, legislation, and funding for child rens mental health care (McDaniel & Edwards, 2004). For example, in a district like the Memphis City Schools, funding is provided by the Tennessee Department of Education and the Depart ment of Health and Human Services and lead by the department of school mental health ser vices. The perceived qualifications of the school psychologist, school social worker, and school co unselor, as state licensed/ certified mental health clinicians, may differ drastically depending on the source of funding and the organizational structure of the school or agency (Paavola, Hannah, & Nichol, 1989). A qualitative study should be conducted to further explore the perceptions about qualifications of school mental health service pr oviders to provide mental health services. On some of the surveys returned, school mental health service providers commented on district sanctions that prohibited them from providing certain types of mental health services. Additionally, one school psychologist wrote that they were initially qualified to provide a wider range of services. However, the restriction imposed by the district on their actual activities (e.g., assessment) resulted in their belief that they we re less qualified to provide certain services. A school counselor wrote that although they were qua lified to provide more services, the principal of their school required that they perform more administrative duties and thus their role and perceived qualifications looked different dependi ng upon the school employed or their current principal. Additionally, a qualitative study could further examine the ambiguity which existed in the school mental health providers ratings about the qualifications of school mental health professionals. A qualitative study could pose ques tions which could examine the theme of professional reputation. It is possible that some of the ambiguity in the school mental health providers ratings may be attributed to the fact that each provider was trying to protect their individual professional reput ations. School mental health provi ders may have been hesitant to endorse the skills of others or report that school mental health providers could provide a similar service because of the perceived threat to job security. Conducting a qualitative study, using

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179 interviews or focus groups, would allow the r esearcher to further delve into these types of potential issues surrounding ratings of qualifications. Third, future research should include an ex amination of the relationship between student mental health services and actual student outcomes (academic and/or behavior). In the current study a number of mental health services we re endorsed as having an impact on students academic and behavioral outcomes. It would be beneficial to examine the actual impact of certain mental health services on student outcomes, particularly the services which district leaders and school mental health service providers reported that school mental health professionals were most qualified to provide. The study would look at the bi-directional relationship of increasing academic and behavioral competence, while decreasi ng emotional and social problems, using the mental health services endorsed by the respondents in this study as being most effective. Conclusion The present study examined perceptions of Florida school mental health service providers about the types of mental health services provided in schools. Moreover, the study examined perceptions regarding school mental health ser vice providers qualifications to provide the specified services. Additionally, the study inves tigated the level of agreement between schoolbased mental health service providers, supervisor s, and directors regarding school mental health service providers qualifications to provide mental he alth services. Finally, th is study investigated the perceptions of mental health service providers regarding the impact of school mental health services on student outcomes. School mental health service providers considered several services and programs, such as family counseling and ment al health consultation, to be school mental health services. Services typically not seen as ment al health services were assessments (authentic and normative assessments), consultation rela ted to improving academic concerns, earlyintervention, universal screenings, and specialized intervention programs such as study or test taking skill programs. School mental health professi onals often rated individuals in their same

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180 profession as having more qualifications to provide a wider range of services. Across the three school mental health service provider groups, school psychologists were rated as being qualified to provide normative assessments and consulta tion. There was no consistency across the three school mental health service provider groups a bout which services school counselors and school social workers were most qualified to provide. Wh en perceptions of school mental health service providers, combined, were contrasted to those held by directors and supervisors, the results were similar to the findings reported for the three school mental health service provider groups. The following variables served to moderate the percep tions about the qualifications of school mental health service providers: school level, SES status of school, and degree level. Lastly, the school level and SES status of the school, in which a respondent was employed, did not serve to moderate their perceptions about the impact of mental health services on academic and behavioral outcomes.

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187 Freudenberg, N, & Ruglis, J. (2007). Reframi ng school dropout as a public health issue. Prevention of Chronic Disease, 4 (4), 1-11. Retrieved December 11, 2008 from http://www.cdc.gov/pcd/issues/2007/oct/07_0063.htm Garland, A. F., & Zigler, E. (1993). Adolescent suicide prevention: Current research and social policy implications. American Psychologist 48 (2), 169-182. Gibelman, M. (1993). School social workers, counselors, and psychologists in collaboration: A shared agenda. Social Work in Education, 15 (1), 45-53. Gilman, R. & Gabriel, S. (2004) Perceptions of school psychological services by education professionals: results from a multi-state survey pilot study. School Psychology Review, 33 (2) 271-287. Ginsburg-Block, M.D., & Fantuzzo, J.W. (1998). An evaluation of the relative effectiveness of NCTM standards-based interventions for low-achieving urban elementary students. Journal of Educational Psychology, 90 (3), 560-569. Good, R.H., Simmons, D.C., & Smith, S.B. (1998) Effective academic interventions in the United States: Evaluating and enhancing the acquisition of early reading skills. School Psychology Review, 27(1) 45-56. Hare, I.R. (1994). School social work in transition. Social Work in Education, 16 (1), 6468. Hartshorne, T.S., & Johnson, M.C. (1985). Th e actual and preferred roles of the school psychologist according to secondary school administrators. Journal of School Psychology, 23 (3), 241-246. Herr, E.L. (2002). School reform and perspec tives on the role of school counselors: A century of proposals for change. Professional School Counseling, 5 (4), 220-234. Hoagwood, K., & Erwin, H. D. (1997). Effectiven ess of school-based mental health services for children: A 10-year research review. Journal of Child and Family Studies, 6 (4), 435-451

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188 Hoagwood, K., Jensen, P. S., Petti, T., & Burns, B. J. (1996). Outcomes of mental health care for children and adolescents: A comprehensive conceptual model. Journal of the American Academy of Child and Adolescent Psychiatry, 35 (8), 1055-1063. Hosp, J. L. & Reschly, D. J. (2002). Regional differences in school psychology practice. School Psychology Review 31 11-29. Howell, E. (2004). Access to childrens mental health services under Medicaid and SCHIP Washington, D.C.: Urban Institute. Hughes, J.N. (1979). Consistency of administra tors' and psychologists' actual and ideal perceptions of school psychologists' activities. Psychology in the Schools, 16(2), 234239. Individuals with Disabilities Education Improvement Act of 2004, Pub. L. No. 108, 118 Stat. 328 (2004). Jennings, J., Pearson, G., & Harris, M. ( 2000). Implementing and maintaining school-based mental health services in a large, urban school district. Journal of School Health, 70 (5), 201-205. Johnson, B. & Christensen, L. (2004). Educational research: Quantitative, qualitative, and mixed approaches. Boston: Pearson Education. Joyce, B.R. & Showers, B. (1988). Student achievement through staff development. New York, NY: Longman Publishers. Kaplan DW, Calonge BN, Guernsey BP, Hanrahan MB. (1998). Managed care and school-based health centers: Use of health services. Archives of Pediatric Adolescent Medicine, 152 25 3 Katoaka, S. H., Zhang, L., Wells, K.B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159 (9), 1548-1555.

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195 Torres, S. (1996). The status of school social workers in America. Social Work in Education, 18 8-18. Tremblay, R.E., Masse, B., Perron, D., Leblanc, M., Schwartzman, A.E., & Ledingham, J.E. (1992). Early disruptive behavior, poor sc hool achievement, delinquent behavior, and delinquent personality: 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 Education and Justice. (2003). Indicators of School Crime and Safety: 2003. Washington, D.C. U.S. Department of Health and Human Services. (1999). Executive Summary. In Mental Health: A Report of the Surgeon General. U.S. Department of Health and Human Services. (2000) U.S. Public Health Service: Report of the Surgeon General's Conference on Children's Mental Health. Washington, DC: U.S. Government Printing Offices. U.S. Department of Health and Human Services. (2001). Report of the Surgeon Generals conference of childrens mental health: A national action agenda [Stock No. 017-02401659-4]. Washington, DC: Author. U.S. Department of Health and Human Services, Children's Bureau. (2002). Child maltreatment 2002. Washington, DC: U.S. G overnment Printing Offices. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2003). School Mental Health Services in the United States, 2002. Washington, DC: U.S. Government Printing Offices.

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196 Walrath, C.M., Bruns, E.J., Anderson, K.L., Glass-Siegel, M., & Weist, M.D. (2004). Understanding expanded school mental health services in Baltimore city. Behavior Modification 28 (4), 472-490. Webster, M. (2002). Websters New Riverside Dictionary NY, NY. Houghton Mifflin Company. Weiner, S.W. (2006). Role conflict, role ambiguity and self-efficacy among school social workers. Unpublished Dissertation, Adelphi University School of Social Work, Long Island, NY. 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

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197 APPENDICES

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198 APPENDIX A: SCHOOL MENTAL HEALTH SERVICE PROVIDER DEMORGRAPHICS AND PROFESSIONAL CHARACTERISTICS Personal and Professional Demographics of School Mental Health Service Providers (AY 2007-2008) Demographics N % Professional Role School Psychologist 16747 School Counselor 14340 School Social Worker 4813 Gender Male 6418 Female 29482 Race White/Caucasian 28279 Latino/Hispanic 3710 Black/African American 236 Other Race/Ethnicities 134 Highest Degree Earned Masters 18452 Educational Specialist 13438 Doctorate 3811 Area Degree Earned Special Education 21 General Education 134 Counseling 11534 School Psychology 15546 Social Work 3811 Administration 113 Area in which credentialed Psychology only 15444 Counseling only 13037 Social work only 4713 Multiple credentials 237 Years of Experience in Current Position 1-5 years 8925 6-10 years 8023 11-15 years 4412 More than 15 years 14240

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199 APPENDIX B: PERCEPTION OF SCHOOL MENTAL HEA LTH SERVICES SURVEY: PRACTITIONER VERSION (1) 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) in which you currently work: 1.____Small 2.____Small/Medium 3.____Medium 4.____Large 5.____Very Large 2. Primary employment location that best describes the majority of the school you serve: (Please check only one) 1. ____ Large City 2. ____ Small City 3. ____ Suburban 4. ____ Rural 3. School level: 1.____Works Primarily in Elementary School 2.____Works Primarily in Middle School 3.____Works Primarily in High School 4.____Works Equally Across Multiple Levels NOTE: If you are not a professional currently practicing in the schools, please do not complete this survey. Thank you. 4. Socioeconomic status of students/families that best describes the majority of schools you serve: 1.____ Title I School 2.____ Non Title I School 5. Your gender: 1.____ Male 2.____ Female 6. Race/Ethnicity: 1. ____White/Caucasian 2. ____Latino/Hispanic 3. ____Black/African-American 4. ____Asian/Pacific Islander 5. ____Native Ameri can/Alaskan Native 6. ____Other (Please Specify) 7. Your highest degree earned in your discipline: 1.____ Bachelors Degree 2.____ Masters Degree 3.____ Specialist Degree 4.____ Doctoral Degree 8. 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 9. Area in which you are credentialed: 1. ____ School Psychology 2. ____ School Guidance and Counseling 3. ____ School Social Work 10. Your years of experience in current position: 1.____ 1-5 2.____ 6-10 3.____ 11-15 4.____ More than 15 11. Check the one that best describes your professional role: 1.____ School Psychologist 2.____ School Guidance Counselor 3.____ School Social Worker

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20012. For each service listed, place a check mark ( ) in the column labeled Mental Health Service if you consider the service to be a mental health service ; if you do not consider the service to be a me ntal health service, place a checkmark in the column labeled Not a Mental Health Service. Example Mental Health Service No t a Mental Health Service Item X Item XX Service Mental Health Service Not a Mental Health Service Counseling 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. Achievement Assessment 3. Personality Assessment 4. Behavior Rating Scale Authentic Assessments 1. Dynamic Indicators of Basics Early Literacy Skills 2. Curriculum Based Measurement

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201Service Mental Health Service Not a Mental Health Service Prevention 1. Early intervention services/Sc hool-wide 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. Positive Behavior Support 2. Social skills training 3. Test taking and study skills training 4. Crisis intervention 5. Anger Control Training 6. Relaxation Training 7. Self-Control Training

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20213. For each of the following services listed below please rate the level at which the service is provided to students/families in your school 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. Achievement Assessment 5 4 3 2 1 3. Personality Assessment 5 4 3 2 1 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

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203Service Level Provided 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

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20414. For each service listed below, please rate th e extent to which you believe a) the school psychologist, b) the social worker, and c) the school counselor is qualified to provide the serv ice, based on their knowledge and skills acquired th rough their educational tr aining and experience. 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. Level of Qualification 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. Achievement 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

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205Service School Psychologist School Counselor Social Worker 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

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20615. For each of the following services please rate the degree of impact that you belie ve the service has in a) student academic and b) student behavioral outcomes of students. Using the following rating scale for each outcome (academic and behavioral), 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 Norm-Referenced Assessments 1. Intelligence Assessment 5 4 3 2 1 5 4 3 2 1 2. Achievement Assessment 5 4 3 2 1 5 4 3 2 1

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207Service Academic Behavior 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

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208 APPENDIX B: PERCEPTION OF SCHOOL MENTAL HEA LTH SERVICES SURVEY: PRACTITIONER VERSION (2) 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) in which you currently work: 1.____Small 2.____Small/Medium 3.____Medium 4.____Large 5.____Very Large 2. Primary employment location that best describes the majority of the school you serve: (Please check only one) 5. ____ Large City 6. ____ Small City 7. ____ Suburban 8. ____ Rural 3. School level: 1.____Works Primarily in Elementary School 2.____Works Primarily in Middle School 3.____Works Primarily in High School 4.____Works Equally Across Multiple Levels NOTE: If you are not a professional currently practicing in the schools, please do not complete this survey. Thank you. 4. Socioeconomic status of students/families that best describes the majority of schools you serve: 1.____ Title I School 2.____ Non Title I School 5. Your gender: 1.____ Male 2.____ Female 6. Race/Ethnicity: 1. ____White/Caucasian 2. ____Latino/Hispanic 3. ____Black/African-American 4. ____Asian/Pacific Islander 5. ____Native Ameri can/Alaskan Native 6. ____Other (Please Specify) 7. Your highest degree earned in your discipline: 1.____ Bachelors Degree 2.____ Masters Degree 3.____ Specialist Degree 4.____ Doctoral Degree 8. 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 9. Area in which you are credentialed: 4. ____ School Psychology 5. ____ School Guidance and Counseling 6. ____ School Social Work 10. Your years of experience in current position: 1.____ 1-5 2.____ 6-10 3.____ 11-15 4.____ More than 15 11. Check the one that best describes your professional role: 1.____ School Psychologist 2.____ School Guidance Counselor 3.____ School Social Worker

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20912. For each service listed, place a check mark ( ) in the column labeled Mental Health Service if you consider the service to be a mental health service ; if you do not consider the service to be a mental health service, place a checkmark in the column labeled Not a Mental Health Service. Example Mental Health Service No t a Mental Health Service Item X Item XX Service Mental Health Service Not a Mental Health Service Counseling 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. Achievement Assessment 3. Personality Assessment 4. Behavior Rating Scale Authentic Assessments 1. Dynamic Indicators of Basics Early Literacy Skills 2. Curriculum Based Measurement

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210 Service Mental Health Service Not a Mental Health Service Prevention 1. Early intervention services/Sc hool-wide 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. Positive Behavior Support 2. Social skills training 3. Test taking and study skills training 4. Crisis intervention 5. Anger Control Training 6. Relaxation Training 7. Self-Control Training

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21113. For each of the following services listed below please rate the level at wh ich the service is provided to students/families in your school 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. Achievement Assessment 5 4 3 2 1 3. Personality Assessment 5 4 3 2 1 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

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212 Service Level Provided 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

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21314. For each service listed below, please rate th e extent to which you believe a) the school psychologist, b) the social worker, and c) the school counselor is qualified to provide the serv ice, based on their knowledge and skills acquired th rough their educational tr aining and experience. 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. Level of Qualification 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. Achievement 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

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214 Level of Qualification Service School Psychologist School Counselor Social Worker 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

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21515. For each service listed below please rate the de gree of impact that you believe the service has on a) student academic and b) student behavioral outcomes. Using the following rating scale for each outcome (academic a nd behavioral), 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 XX 5 4 3 2 1 5 4 3 2 1 Level of Impact Service Academic Outcomes Behavioral Outcomes 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

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216Level of Impact Norm-Referenced Assessments Service Academic Outcomes Behavioral Outcomes 1. Intelligence Assessment 5 4 3 2 1 5 4 3 2 1 2. Achievement 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

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217 APPENDIX B: PERCEPTION OF SCHOOL MENTAL HEA LTH SERVICES SURVEY: PRACTITIONER VERSION (3) For each item below please check the opti on that best corresponds to your response: 1. Size of school district (FL DOE designation) in which you currently work: 1.____Small 2.____Small/Medium 3.____Medium 4.____Large 5.____Very Large 2. Primary employment location that best describes the majority of the school you serve: (Please check only one) 9. ____ Large City 10. ____ Small City 11. ____ Suburban 12. ____ Rural 3. School level: 1.____Works Primarily in Elementary School 2.____Works Primarily in Middle School 3.____Works Primarily in High School 4.____Works Equally Across Multiple Levels NOTE: If you are not a professional currently practicing in the schools, please do not complete this survey. Thank you. 4. Socioeconomic status of students/families that best describes the majority of schools you serve: 1.____ Title I School 2.____ Non Title I School 5. Your gender: 1.____ Male 2.____ Female 6. Race/Ethnicity: 1. ____White/Caucasian 2. ____Latino/Hispanic 3. ____Black/African-American 4. ____Asian/Pacific Islander 5. ____Native Ameri can/Alaskan Native 6. ____Other (Please Specify) 7. Your highest degree earned in your discipline: 1.____ Bachelors Degree 2.____ Masters Degree 3.____ Specialist Degree 4.____ Doctoral Degree 8. 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 9. Area in which you are credentialed: 7. ____ School Psychology 8. ____ School Guidance and Counseling 9. ____ School Social Work 10. Your years of experience in current position: 1.____ 1-5 2.____ 6-10 3.____ 11-15 4.____ More than 15 11. Check the one that best describes your professional role: 1.____ School Psychologist 2.____ School Guidance Counselor 3.____ School Social Worker

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21812. For each service listed, place a check mark ( ) in the column labeled Mental Health Service if you consider the service to be a mental health service ; if you do not consider the service to be a mental health service, place a checkmark in the column labeled Not a Mental Health Service. Example Mental Health Service No t a Mental Health Service Item X Item XX Service Mental Health Service Not a Mental Health Service Counseling 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. Achievement Assessment 3. Personality Assessment 4. Behavior Rating Scale Authentic Assessments 1. Dynamic Indicators of Basics Early Literacy Skills 2. Curriculum Based Measurement

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219Service Mental Health Service Not a Mental Health Service Prevention 1. Early intervention services/Sc hool-wide 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. Positive Behavior Support 2. Social skills training 3. Test taking and study skills training 4. Crisis intervention 5. Anger Control Training 6. Relaxation Training 7. Self-Control Training

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22013. For each of the following services listed below please rate the level at which the service is provided to students/families in your school 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. Achievement Assessment 5 4 3 2 1 3. Personality Assessment 5 4 3 2 1 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

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221Service Level Provided 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

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22214. For each service listed below, please rate th e extent to which you believe a) the school psychologist, b) the social worker, and c) the school counselor is qualified to provide the serv ice, based on their knowledge and skills acquired th rough their educational tr aining and experience. 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. Level of Qualification Service Social Worker School Psychologist School Counselor 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. Achievement 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

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223Service Social Worker School Psychologist School Counselor 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

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22415. For each of the following services please rate the degree of impact that you belie ve the service has in a) student academic and b) student behavioral outcomes of students. Using the following rating scale for each outcome (academic and behavioral), 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

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225Norm-Referenced Assessments 1. Intelligence Assessment 5 4 3 2 1 5 4 3 2 1 2. Achievement Assessment 5 4 3 2 1 5 4 3 2 1 Service Academic Behavior 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

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226 APPENDIX C: INFORMED CONSENT Dear [Insert School mental health service provider], You are receiving this letter be cause your name was randomly selected from the Florida Association of [Insert Mental Health Provider] database of "regular" members w hose membership registration indicates that they are practicing [insert mental health provider]. As providers of stude nts support services, we are sure you are well aw are that conditions cont ributing to student me ntal health problemssubstance abuse, poverty, homelessness, community violence, and physic al abuseare rapidly becoming a part of the normal family culture within which many students grow and develop. These conditions do not fo ster an environment in which children can meet expected developmental, cognitive, social and emotional demands. Howe ver, schools are expected to educate all students, including the growing population of st udents whose mental health problems ofte n impede or interfer e with their learni ng. According to the Elementary and Secondary Education Act of 2001, No Child Left Behind, schools ar e 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 cre ate this type of successful environment. Decia N. Dixon, a 4th year school psychology doctoral candidate at the Univer sity of South Florida is conducting a dissertation study entitled Mental Health Service Delivery Sy stems and Perceived Qualifications of School -based mental health service providers t o Provide Mental Health Services in School Settings to determine the beliefs of school-based mental health service providers as they relate to school based mental h ealth services and delivery. The information in this letter is provided to help you decide wheth er or not you want to take part in this research study. Please read this information carefull y. If you have any que stions or concerns, please contact the principal investig ator (Decia N. Dixon, School Ps ychology Doctoral Candidate). 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 envir onment and regulate behavior (Websters, 2002 ).

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227 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 school-based mental health service provide rs view mental health services in t he schools. Secondly, your input can co ntribute to school based mental health policy literature. Plan of Study The enclosed survey contains 12 items, 8 items which are district demographic information and 4 ite ms 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 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 DATE. Compensation Four participants who return the completed su rvey will be randomly selected to receive a $25.00 Visa Gift Card which can be used virtually everywhere in the United States th at welcomes Visa Cards. Ten additional participants who return completed surveys wi ll also be randomly selected to receive th e newly published book by the Na tional Association of State Di rectors of Special Educati on, Response to Intervention:Policy Considerations and Implementation Even though each participant will not receive direct personal benefits from this study, by participa ting in this study you may increase our overa ll knowledge of issu es surrounding the provi sion of school mental health services a nd 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, sta ff 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

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228you 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. 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, E d.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. 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 research 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

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229 APPENDIX D: DATA REQUESTS Ms. Kim Berryhill 270 Eagleton Estates Blvd. Palm Beach Gardens, FL 33418 Dear Ms. Berryhill, Introduction My name is Decia N. Dixon and I am a doctoral candidate at th e University of South Florida. I am currently involved in my dissertation research and wish to request a random computerized mailing labe l sample of your Florida membership. My dissertation topic examines the qualifications of school psychologists, school c ounselors, and school social workers to provide mental healt h services in the state of Florida. I am the primary lead research er for this project and my cont act information is as follows: Decia N Dixon 18107 Peregrines Perch, Pl #105 Lutz, FL 33558 678-524-5325 (cellular phone number) decianicole@gmail.com

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230Purpose of Research My dissertation study is entitled Mental Health Service Delivery Systems and Pe rceived Qualifications of School-based mental health service providers to Provide Me ntal Health Services in Sch ool Settings. The purpose of my research is to determi ne the beliefs of school-based mental health servic e providers as they relate to school base d mental health services and delivery. The input from your members is very important and it is expected that their input will be used to develop a state database regarding the range in types of mental health services provided to students in school districts throughout Florida. It wi ll also be used to examine th e impact of mental health services on student behavi or and academic outcomes. The results from th is study can be used in pre-service tra ining for mental health professionals, by providing information about how school-based mental health service providers view mental he alth services in the schools. Secondly, thei r input can contribute to school based mental health policy literature. Research Questions The following research questions wi ll be addressed in this study: 1. What is the level of agreement within and across school-based mental health service providers (i.e., school psychologists, school counselors, and school so cial workers) regarding wh at they believe to be a mental health service in K-12 school settings?

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2312. To what extent do school-based mental hea lth service providers concur about who is qualified to provide specified mental health services in K-12 school settings? 3. What is the level of agreement between sc hool-based mental health service supervis ors and directors and school-based mental health service providers regarding who is qualified to provide specified mental health services in K-12 school settings? 4. What is the relationship between the dist rict size (e.g., large or small) and the geographic location of schools (e.g., rural o r suburban) in which a mental health serv ice provider is employed, years of professi onal work experience, education (degree level and degree area), and gender and the mental health service provider s perceptions regarding whom is qualified to provide specified mental health serv ices in K-12 school settings? 5. To what extent do school-based mental health service providers concur regarding their perceptions of specified mental health services that have a strong impact on student academic outcome s and behavioral outcomes? FASP Data Requested I am asking for a random selection of at l east 120 individuals from your membership ro ster. Specifically I am asking to have d ata collected on members that are practitioners in the schools and are not employed in univ ersity settings or ar e retired. In addit ion, I am asking to receive the mailing addresses of the selected member s. I will collect data from a survey (see attached: Perception of School Mental

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232Health Services Survey: Practitioner Version ) that was created and piloted by the lead research er, in Jan.2007. The data collected from this survey will be anonymous (responses cannot be associated with the respondent). Documentation of Institutional Review Board Approval I have attached a copy of the confirmation letter from the Un iversity of South Florida Institu tional Review Board indicating t he approval of my study. Potential Publication Outlets It is expected that the data collected from this study will be beneficial for scholarly conference presentations at both the n ational and state levels for school mental health serv ice providers. In addition, it is anticipated that the outc omes from this study will result in the development of both technical assistance and refereed scholarly journal publications regarding the percepti ons of school based mental health service delivery systems.

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233Mr. Robert Lucio Lucior@pcsb.org Dear Mr. Lucio, Introduction My name is Decia N. Dixon and I am a doctoral candidate at th e University of South Florida. I am currently involved in my dissertation research and wish to request a random computerized mailing labe l sample of your Florida membership My dissertation topic examines the qualifications of school psychologists, school c ounselors, and school social wo rkers to provide mental healt h services in the state of Florida. I am the primary lead research er for this project and my cont act information is as follows: Decia N Dixon 18107 Peregrines Perch, Pl #105 Lutz, FL 33558 678-524-5325 (cellular phone number) decianicole@gmail.com

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234Purpose of Research My dissertation study is entitled Mental Health Service Delivery Systems and Pe rceived Qualifications of School-based mental health service providers to Provide Me ntal Health Services in Sch ool Settings. The purpose of my research is to determi ne the beliefs of school-based mental health servic e providers as they relate to school base d mental health services and delivery. The input from your members is very important and it is expected that their input will be used to develop a state database regarding the range in types of mental health services provided to students in school districts throughout Florida. It wi ll also be used to examine th e impact of mental health services on student behavi or and academic outcomes. The results from th is study can be used in pre-service tra ining for mental health professionals, by providing information about how school-based mental health service providers view mental he alth services in the schools. Secondly, thei r input can contribute to school based mental health policy literature. Research Questions The following research questions wi ll be addressed in this study: 1. What is the level of agreement within and across school-based mental health service providers (i.e., school psychologists, school counselors, and school so cial workers) regarding wh at they believe to be a mental health service in K-12 school settings?

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2352. To what extent do school-based mental hea lth service providers concur about who is qualified to provide specified mental health services in K-12 school settings? 3. What is the level of agreement between sc hool-based mental health service supervis ors and directors and school-based mental health service providers regarding who is qualified to provide specified mental health services in K-12 school settings? 4. What is the relationship between the dist rict size (e.g., large or small) and the geographic location of schools (e.g., rural o r suburban) in which a mental health serv ice provider is employed, years of professi onal work experience, education (degree level and degree area), and gender and the mental health service provider s perceptions regarding whom is qualified to provide specified mental health serv ices in K-12 school settings? 5. To what extent do school-based mental health service providers concur regarding their perceptions of specified mental health services that have a strong impact on student academic outcome s and behavioral outcomes? FASSW Data Requested I am asking for a random selection of at l east 120 individuals from your membership ro ster. Specifically I am asking to have d ata collected on members that are school social workers in the schools and are not employe d in university setti ngs or are retired. In addition, I am asking to receive the mailing addresses of the selected members. I will collect data from a survey (see attached: Perception of School

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236Mental Health Services Survey: Practitioner Version ) that was created and piloted by the lead re searcher, in Jan.2007. The data collected from this survey will be anonymous (responses cannot be associated with the respondent). Documentation of Institutional Review Board Approval I have attached a copy of the confirmation letter from the Un iversity of South Florida Institu tional Review Board indicating t he approval of my study. Potential Publication Outlets It is expected that the data collected from this study will be beneficial for scholarly conference presentations at both the n ational and state levels for school mental health serv ice providers. In addition, it is anticipated that the outc omes from this study will result in the development of both technical assistance and refereed scholarly journal publications regarding the percepti ons of school based mental health service delivery systems.

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237Dr. Madelyn Isaacs misaacs@fgcu.edu Dear Dr. Isaacs, Introduction My name is Decia N. Dixon and I am a doctoral candidate at th e University of South Florida. I am currently involved in my dissertation research and wish to request a random computerized mailing labe l sample of your Florida membership My dissertation topic examines the qualifications of school psychologists, school c ounselors, and school social wo rkers to provide mental healt h services in the state of Florida. I am the primary lead research er for this project and my cont act information is as follows: Decia N Dixon 18107 Peregrines Perch, Pl #105 Lutz, FL 33558 678-524-5325 (cellular phone number) decianicole@gmail.com

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238Purpose of Research My dissertation study is entitled Mental Health Service Delivery Systems and Pe rceived Qualifications of School-based mental health service providers to Provide Me ntal Health Services in Sch ool Settings. The purpose of my research is to determi ne the beliefs of school-based mental health servic e providers as they relate to school base d mental health services and delivery. The input from your members is very important and it is expected that their input will be used to develop a state database regarding the range in types of mental health services provided to students in school districts throughout Florida. It wi ll also be used to examine th e impact of mental health services on student behavi or and academic outcomes. The results from th is study can be used in pre-service tra ining for mental health professionals, by providing information about how school-based mental health service providers view mental he alth services in the schools. Secondly, thei r input can contribute to school based mental health policy literature. Research Questions The following research questions wi ll be addressed in this study: 1. What is the level of agreement within and across school-based mental health service providers (i.e., school psychologists, school counselors, and school so cial workers) regarding wh at they believe to be a mental health service in K-12 school settings?

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2392. To what extent do school-based mental hea lth service providers concur about who is qualified to provide specified mental health services in K-12 school settings? 3. What is the level of agreement between sc hool-based mental health service supervis ors and directors and school-based mental health service providers regarding who is qualified to provide specified mental health services in K-12 school settings? 4. What is the relationship between the dist rict size (e.g., large or small) and the geographic location of schools (e.g., rural o r suburban) in which a mental health serv ice provider is employed, years of professi onal work experience, education (degree level and degree area), and gender and the mental health service provider s perceptions regarding whom is qualified to provide specified mental health serv ices in K-12 school settings? 5. To what extent do school-based mental health service providers concur regarding their perceptions of specified mental health services that have a strong impact on student academic outcome s and behavioral outcomes? FSCA Data Requested I am asking for a random selection of at l east 120 individuals from your membership ro ster. Specifically I am asking to have d ata collected on members that are school counselor s in the schools and are not employed in university settings or are retired. In a ddition, I am asking to receive the mailing addresses of the selected me mbers. I will collect data from a survey (see attached: Perception of School

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240Mental Health Services Survey: Practitioner Version ) that was created and piloted by the lead re searcher, in Jan.2007. The data collected from this survey will be anonymous (responses cannot be associated with the respondent). Documentation of Institutional Review Board Approval I have attached a copy of the confirmation letter from the Un iversity of South Florida Institu tional Review Board indicating t he approval of my study. Potential Publication Outlets It is expected that the data collected from this study will be beneficial for scholarly conference presentations at both the n ational and state levels for school mental health serv ice providers. In addition, it is anticipated that the outc omes from this study will result in the development of both technical assistance and refereed scholarly journal publications regarding the percepti ons of school based mental health service delivery systems.

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241 APPENDIX E: 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/Medium 3.____Meium 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

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242 Student Services Directors, please an swer the following questions based upon information from your school district during the 2005-2006 school year: 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______ 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): __________ Full-Time Equivalent 5 days a week= 1 FTE 1 day a week= .2 FTE

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243Section 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. Achievement Assessment 5 4 3 2 1 3. Personality Assessment 5 4 3 2 1 4. Behavior Rating Scale 5 4 3 2 1

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244 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

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24520. For the following mental health services offered in your district, please rate th e 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. Achievement 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

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246Authentic 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

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247 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) beha vioral outcomes of students? Using the following rating scale for each outcome (academic and behavioral), 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

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248Norm-Referenced Assessments 1. Intelligence Assessment 5 4 3 2 1 5 4 3 2 1 2. Achievement 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

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249Other 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 after receiving an involunta ry examination 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

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250Assessment 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

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251 APPENDIX F: 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/Medium 3.____Medium 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

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252Section 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. Achievement Assessment 5 4 3 2 1 3. Personality Assessment 5 4 3 2 1 4. Behavior Rating Scale 5 4 3 2 1

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253Authentic 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

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2549. 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, 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. Achievement 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

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255Authentic 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

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25610. 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) beha vioral outcomes of students? Using the following rating scale for each outcome (academic a nd behavioral), 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

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257Norm-Referenced Assessments 1. Intelligence Assessment 5 4 3 2 1 5 4 3 2 1 2. Achievement 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

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258Other 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 after receiving an invol untary examination 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

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2596. 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

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260 APPENDIX G: INFORMED CONSENT FOR DIRECTORS OF STUDENT SERVICES (VERSION A) You are receiving this letter be cause you were selected from the Florida Student Support Services Dire ctory 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 expe cted 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 t hat schools can create this type of successful environment. Decia N. Dixon, a school psychology doctoral st udent at the University of South Flor ida 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 envir onment 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 me ntal health services in the schools. Secondly, your input can co ntribute to school based mental health policy literature.

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261Plan 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 5th, 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, sta ff 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.

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262Volunteering 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, E d.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.

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263Consent 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 research 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

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264 APPENDIX H: INFORMED CONSENT FOR SUPERVISORS OF STUDENT SERVICES (VERSION B) You are receiving this letter be cause you were selected from the Florida Student Support Services Dire ctory 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 expe cted 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 t hat schools can create this type of successful environment. Decia N. Dixon, a school psychology doctoral st udent at the University of South Flor ida 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 envir onment 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

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265professionals, by providing information about ho w directors and supervisors of student services view me ntal 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 ite ms 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 5th, 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, sta ff 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.

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266Volunteering 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, E d.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.

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267Consent 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

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268 APPENDIX I: PILOT STUDY COVER LETTER AND REVIEW FORM 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 th e form and rate the items that you completed on the survey. Feel free to add su ggestions/comments under th e 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 th is 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

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269PSMHS 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/Medium 3.____Medium 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

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270 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: ___________

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271Clear 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______

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272 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): __________

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273Section 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. Achievement Assessment _____ _____ ________________ 3. Personality Assessment _____ _____ ________________ 4. Behavior Rating Scale _____ _____ ________________

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274 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): _____ _____ ________________

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2753. In Section II Support Services are or ganized in three areas. Please review each area and the services provided under each area. 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 _____ _____ _______________ Consultation 1. Student service personnel assigned as case manager _____ _____ ________________ 2. Consultation provided by community mental health provider _____ _____ ________________ 3. Consultation provided to classroom teachers _____ _____ ________________

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276Area 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? ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________

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277 APPENDIX J: 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 resear cher 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 pr ofessional (i.e. school ps ychologist, school counselo r, 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.

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278Your 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. 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: 1) Complete the survey in its entirety, while paying close attention to the surveys directions, wording, response choices and content. 2) 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. 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 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, sta ff 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 Re search 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

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279PSMHS Version B Section I. Questions 1-7. Please review each of the questions. Pleas e 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

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280Clear 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

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2817. 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 _____ _____ ________________

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282Norm-Referenced Assessments 1. Intelligence Assessment _____ _____ ________________ 2. Achievement 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 _____ _____ ________________

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283Other 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 _____ _____ _______________ Consultation 1. Student service personnel assigned as case manager _____ _____ ________________

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2843. 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? ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________

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285 ABOUT THE AUTHOR Decia Nicole Dixon received her Bachelor of Arts Degree in Psychology from Spelman College on May 16, 2004. She entered the PhD program in School Psychology in August 2004, earning a Master of Arts degree in School Psychology in August 2005. While enrolled in the University of South Florida School Psychology Program, she specialized in school-based and community mental health. Decia also developed an interest in additional areas such as, response to intervention and advocacy for urban and disadvantaged youth and communities. Decia completed an APA-approved internship at the University of Tennessee Professional Psychology Internship Consortium in Memphis, Tennessee. She has experience providing psychological services to families, children, adolescents, and pare nts addressing a wide range of mental health concerns.


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Mental health service delivery systems and perceived qualifications of mental health service providers in school settings
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ABSTRACT: Latest research on the mental health status of children indicates that schools are key providers of mental health services (U.S. Department of Health and Human Services, 2003). The push for school mental health services has only increased as stakeholders have begun to recognize the significance of sound mental health as an essential part of academic success (Adelman & Taylor, 2002). However, while schools are recognized as playing an important role in the delivery of mental health services, it is not well understood about the types of mental health services provided, qualifications of providers, and the link to student outcomes (United States Department of Health and Human Services, 2003). The present study examined Florida school mental health service providers' perceptions about the types of mental health services provided in schools and school mental health service providers' qualifications to provide such services.Additionally, the study investigated the agreement about providers' qualifications to provide mental health services between providers, supervisors, and directors. Finally, this study investigated the perceptions of providers regarding the impact of mental health services on student outcomes. Results revealed that school mental health service providers considered several services, such as family counseling and mental health consultation, to be school mental health services. Services typically not viewed as mental health services were assessments, consultation improving academic concerns, early-intervention, universal screenings, and specialized intervention. School psychologists were the only mental health professional to receive a unanimous agreement from school mental health providers that they were most qualified of the three professionals to deliver a service (e.g., assessment).Additionally, with the exception of school psychologists, there was no consistency reported between administrators and school mental health service providers about providers' qualifications to deliver services. The following variables moderated perceptions about the qualifications of school mental health service providers: school level, SES status of school, and degree level. Lastly, school level and SES status of the school did not moderate perceptions about the impact of mental health services on academic and behavioral outcomes.
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