Abstract
Across the United States, the number of children with mental health conditions has continued to rise. However, access and utilization of mental health services vary greatly. School-based mental health complements comprehensive school counseling and provides an opportunity for K–12 students to receive needed treatment they may not otherwise have access to. School counselors are well positioned to support the development, implementation, and sustainability of effective school-based mental health programming. We provide an overview of implementation science and case examples that detail the school counselor’s role in this work.
Introduction
The COVID-19 pandemic exacerbated mental health issues for K–12 students. The pandemic disrupted many facets of their lives through isolation from peers, sickness, and family hardship (United States Department of Education, 2023). During this period, the Office of the Surgeon General (2021) reported that youth experienced increases in trauma, stress, and mental health conditions such as depression and anxiety; suicide attempts and completions also rose. When left untreated, these issues can result in poor academic performance, involvement with the juvenile justice system, and increases in high school dropout rates (American School Counselor Association [ASCA], 2020; Kern et al., 2017). School counselors, as leaders, advocates, and consultants, are primed to collaborate with teachers, parents, and mental health professionals to address this ongoing mental health crisis (ASCA, 2020, 2022, 2023).
A data query of the 2022 National Survey of Children’s Health (Maternal and Child Health Bureau, nd) suggested that more than 25% of youth across the United States experienced emotional, mental, behavioral, or developmental problems. The data indicated that male youth tend to experience these issues more readily than females. Common mental health conditions among youth include anxiety and behavior disorders while major depression is experienced by more than 2.7 million school-aged children, according to the State of Mental Health in American 2023 Report (Reinert et al., 2022). As mental, emotional, and behavioral health issues of school-aged youth continue to rise each year, so do the number of students who can benefit from mental health services (Appling et al., 2020; Child and Adolescent Mental Health, 2023).
Although many school-aged children and their families lack access to mental health services (Atkins et al., 2017), when services are accessible, they are utilized in various ways. Malhotra et al. (2015) examined the differences in utilization of inpatient and outpatient mental health services among White, African American, and Latinx youth. Their analysis of the data from the 2007–2010 National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration, 2011) suggested that when inpatient and outpatient mental health services were available, Black and Hispanic children were less likely to utilize them as compared to their White counterparts.
Over the next decade, African American youth mental health service utilization decreased; Hispanic children’s use increased but at half the rate of White youth (Rodgers et al., 2022). More recently, Ali et al. (2022) and Chang and Slopen (2024) reported that children from historically underrepresented backgrounds remain disproportionately impacted by a lack of mental health services. Although access and utilization remain a concern, Ali et al. (2019) found that youth were most likely to utilize mental health services in a school if they were from historically underrepresented backgrounds, lived in households that were considered low income, and had subsidized insurance. Results from a meta-analysis conducted by Duong et al. (2021) supported the notion that schools are an ideal setting for youth to receive mental health services.
To address increasing mental health issues experienced by children and adolescents and their lack of access to treatment, many school systems have employed models of school-based mental health (Lakind et al., 2023). Because access to mental health services is paramount for a population in desperate need of services, according to Kern et al. (2017), schools must strive to facilitate efficient and effective implementation of school-based mental health. Given their position, school counselors can play an integral role in ensuring that mental health services are accessible and implemented to best meet the needs of the students and families they serve (ASCA, 2020). School-based mental health, when implemented with intention, can complement school counselors’ efforts to close gaps and support students and families (ASCA, 2023; Golberstein et al., 2024).
As described by Warren and Mauk (2019), implementation science is a viable framework school counselors can use to ensure mental health services are implemented as intended. Implementation science is described as the study and deliberate use of strategies and methods to systematically deliver interventions and programs (Blase et al., 2015). As implementation specialists, school counselors are uniquely qualified to ensure that the mental health needs of students are properly identified and serviced through comprehensive programming (Warren & Mauk, 2019). Failure to use an implementation science framework and strategies can undermine the success of school-based mental health services, leading to subpar effects on student success and the school ecosystem (Yaros et al., 2017). School counselors can use implementation science to facilitate the design and implementation of intentional school-based mental health services. Due to the interconnectedness of a school’s various subsystems, this approach will benefit many aspects of the school (McMahon et al., 2014).
This article provides an overview of school-based mental health and challenges to the implementation of these services. We discuss the role school counselors play in school-based mental health within the context of a comprehensive school counseling program. The two case examples further exemplify how implementation science can strengthen the provision of school-based mental health services.
School-Based Mental Health
Embedding mental health programming in schools is generally accepted as a beneficial and effective approach to supporting students (Hoover & Bostic, 2021). A trailblazer in these efforts, Baltimore City Public Schools (BCPS) established school-based mental health services 4 decades ago to increase access to care and remove barriers to treatment (Kronsberg & Bettencourt, 2020). Trained mental health clinicians provided a variety of services including assessment, consultation, and counseling. These services extend beyond and often complement comprehensive school counseling programs as part of a tiered system of support (ASCA, 2021; Martinez et al., 2020). Hodges et al. (2021) suggested that these services can positively impact both the mental health of students and the overall climate of the school.
Results from numerous studies suggest that school-based mental health services reduce absenteeism, increase access to care, facilitate mental health treatment, and lead to more favorable mental health outcomes (see Ballard et al., 2014; Fazel et al., 2014; Gall et al., 2000; Hoover & Bostic, 2021). Other studies have found that school-based mental health treatment is effective for treating youth disorders including anxiety, oppositional defiant disorder, and attention deficit hyperactivity disorder (Centers for Disease Control and Prevention, 2023; Danielson et al., 2020; Franklin et al., 2012; Owens et al., 2014). Given the positive outcomes noted in the literature, many school systems have employed models of school-based mental health to address the increasing mental health issues and subsequent lack of access to care, especially for children and youth from underserved populations (Panchal et al., 2022).
In school-based mental health, schools serve as the primary access and entry point for students to receive mental health services from trained clinicians (Alegria et al., 2012; Hoover & Bostic, 2021). There are three major models of school-based mental health as described by Kutash et al. (2015). The Spectrum of Mental Health Interventions and Treatments (Mrazek & Haggerty, 1994; Weisz et al., 2005) model of school-based mental health includes a broad range of prevention and intervention strategies. Depending upon the need, students considered at risk or diagnosed with a mental health disorder may receive universal services or more intensive treatment, including in-patient care (Kutash et al., 2015). Alternatively, Interconnected Systems for Meeting the Needs of All Children (Adelman & Taylor, 2006) emphasizes a balanced and integrated approach to school-based mental health. Offering support to all students, this model includes prevention and early intervention, and more intensive services such as hospitalization or foster care (Kutash et al., 2015).
The third major model of school-based mental health, according to Kutash et al. (2015) is Positive Behavior Supports to Reduce Challenging Behaviors in School (Horner et al., 2005). Referred to today as Positive Behavioral Interventions and Support (PBIS), its use in pre-K–12 schools across the country continues to grow (Center on PBIS, 2024). PBIS is a multitiered approach designed to provide the optimal level of support (i.e., universal, targeted, or individualized and intensive) to students through evidence-based practices. ASCA (2021) considers school counselors as integral “stakeholders in the development and implementation of multitiered system of supports (MTSS),” such as PBIS (para. 1). Taking an active stance in school-based mental health is imperative for school counselors; doing so aligns with their role and directly impacts the success of the students and families with whom they work.
School Counselor’s Role in Student Mental Health
School counselors are uniquely positioned in schools as both educators and counselors. The central focus for school counselors who embody this educator–counselor identity is the promotion of a comprehensive program that fosters academic, social/emotional, and career development for all students (Levy & Lemberger-Truelove, 2021). School counselors utilize the ASCA National Model (ASCA, 2019b) to define, deliver, manage, and assess their comprehensive school counseling programs. The ASCA National Model (ASCA, 2019b) recommends that school counseling services are data based and evaluated for effectiveness. To promote student success, school counselors deliver research-based prevention and intervention programs to close academic, discipline, opportunity, and resource gaps (Warren et al., 2020).
As part of a comprehensive program, school counselors emphasize wellness, mental health awareness, and healthy emotional and behavioral development (ASCA, 2020). These efforts include the tiered delivery of direct services, such as classroom instruction, small groups, and short-term individual counseling, according to ASCA (2023). Other components of the school counseling program include consultation, collaboration, and partnering; these functions engage teachers, administrators, parents, and the community and extend beyond the services provided directly to students (ASCA, 2019b). The positive effects of school counselors on student mental health and wellness outcomes are well documented through numerous anecdotal reports and empirical studies (see ASCA, nd -a; n.d.-b).
With an educator-counselor identity, school counselors also utilize their knowledge, attitudes, and skills to make appropriate referrals for mental health services when student needs extend beyond the scope of counseling services available through comprehensive programming (Levy & Lemberger-Truelove, 2021). School counselors often serve as liaisons between mental health professionals, educators, and parents in these instances. Appling et al. (2020) suggested that effective collaboration between school counselors and mental health clinicians serves to meet the ever-increasing mental health needs of K–12 students. Marsh and Mathur (2020) and Martinez et al. (2020) also highlighted the importance of school counselor collaboration and referral to mental health clinicians to address students’ mental health needs. While school counselors can and do provide counseling to address mental health concerns, a tiered system of support can guide service determination and ensure an appropriate level of care (ASCA, 2020).
School counselors support the mental health needs of their students in myriad ways through connecting with various subsystems of the school (McMahon et al., 2014). However, according to Kress and Elias (2006) and Noell et al. (2014), schools often lack the requisite knowledge and skills necessary for implementation of school-based mental health programs, which can be difficult to develop and maintain. These efforts must be intentional, consistent, and data informed; otherwise, many challenges arise.
Challenges to Implementing School-Based Mental Health Services
Although research indicates that school-based mental health services are effective in promoting well-being and student success (Hoover & Bostic, 2021), some complexities challenge the implementation of these services. For example, some school counselors may have reservations about the shared space school-based mental health occupies in student support services. Although school counselors provide counseling that is brief in nature to support student mental health, the ASCA National Model considers long-term counseling an inappropriate duty that necessitates referral (ASCA, 2019b). However, contrary to the sentiments of Lambie et al. (2019), school counselors remain invaluable advocates and supporters of student mental health, yet their broad role in schools hinders their ability to provide extensive therapy to all students who need it. As such, school counselors are encouraged to embrace efforts from other sources toward a common goal of promoting student success, despite any perceived threats.
Girio-Herrera et al. (2019) outlined several logistical barriers to implementing school-based interventions. These barriers included difficulty scheduling sessions, balancing confidentiality and safety concerns, and challenges locating space to deliver sessions. Communicating with parents also presented challenges. For example, paperwork sent home for parents to fill out, such as informed consent, often was not completed. Some parents had changed their phone numbers while others were surprised by their child’s need for mental health services (Girio-Herrera et al., 2019).
Public schools appear to experience a variety of challenges when delivering school-based mental health services. Based on the results of the School Pulse Panel (Institute of Education Sciences [IES], 2022), 43% of school administrators believed that their school could not adequately provide school-based mental health services to students in need. Impeding factors included an insufficient number of clinicians to manage caseloads, concerns related to parental beliefs, and a lack of community support. Schools also reported that staff were hesitant to support school-based mental health services due to the potential to label students with mental health disorders.
Schools also face inadequate access to qualified mental health professionals (IES, 2022). This concern is often amplified in rural communities and tends to exacerbate the racial disparities in mental health treatment received by youth (Chang & Slopen, 2024). As a result, schools are challenged to identify and employ a dedicated team of clinicians who operate from evidence-based treatment modalities. The lack of service providers also leads to inconsistencies in clinical practices such as screenings, referral procedures, and the provision of services (United States Department of Education, 2023). School counselors who understand IS can play a critical role in addressing these barriers to the effective implementation of school-based mental health.
School counselors can utilize implementation science to aid in the facilitation of effective school-based mental health services. Failure to consider factors that promote the successful implementation of programs can thwart students’ academic, social/emotional, and career development (Warren, 2017). As such, when schools implement a school-based mental health program, school counselors must collaborate with key stakeholders and seek ways to improve and sustain the program (Metz et al., 2015). School counselors are encouraged to leverage their relationship with their school’s administrator to establish expectations of the school-based mental health program in relation to their comprehensive school counseling program. School counselors also should play a critical role in connecting students and families to these ancillary school-based services (ASCA, 2019b); their knowledge of implementation science can significantly impact the success of these services within the school ecosystem. This article focuses on the establishment and maintenance of mental health service provision within the context of a school-based mental health model. We specifically explore how school counselors can assist in effectively developing and implementing practitioner-delivered mental health services within the school setting.
Implementation Science
Implementation science is “the study of how a practice that is evidence-based or evidence-informed gets translated to different, more diverse contexts in the real world” (Metz et al., 2015, p. 1). In general, practitioners engaged in programming or delivery of interventions often do not implement the intervention as prescribed. According to Warren and Mauk (2019), “Barriers to effective implementation of interventions include a lack of organizational structure, lack of support from stakeholders, inadequate training and consultation, insufficient planning, and lack of funding” (p. 2). Implementation science strategies and frameworks are commonly used in healthcare settings as a means of delivering a program or intervention with fidelity or as prescribed. However, implementation science remains a relatively new concept in the field of education.
Implementation Science in Schools
The use of implementation science in schools has gained momentum over the past decade (see Rojas-Andrade & Leiva Bahamondes, 2018). Cook et al. (2019) explored the application of implementation science in schools, conducting a Delphi study to adapt healthcare implementation strategies outlined in the Expert Recommendations for Implementing Change (ERIC) project (Waltz et al., 2015) for use in schools. The resulting artifact was
Implementation Science in School Mental Health Practitioner Programs
School counselors are encouraged to consider the stages of implementation science when supporting the facilitation of a school-based mental health program. Of the several existing frameworks, Warren and Mauk (2019) advanced a concise, 6-stage implementation model adapted from Fixsen et al. (2005) that school counselors can utilize. School counselors can apply these stages to ensure that school-based mental health services are successfully embedded within the school ecosystem. When services are delivered with intention and scale-up efforts are deliberate, the quality of implementation is sustained, and students and the school succeed (Bradshaw, 2023). These efforts should not be made in isolation but as a collaborative effort between the school counselor and other pertinent stakeholders (e.g., administrator, clinician, agency director, teachers). The six stages of the implementation model comprise the following steps: (a) exploration, (b) installation, (c) initial implementation, (d) full implementation, (e) innovation, and (f) sustainability.
Exploration
School counselors often serve as a bridge between school-based mental health programs and the school. Prior to the implementation of a school-based mental health program, the school system and mental health agency must reach a consensus on myriad details of the arrangement. Given the position of school counselors, they play an essential role in coordinating these services across the ecosystem.
This stage may have already occurred; in most cases, the decision to employ a school-based mental health program does not rest with the school counselor. However, the school counselor should have ready access to data to inform decisions related to school-based mental health. For example, the school counselor can provide the number of potential referrals, demographics of students who can benefit from services, and student achievement-related data such as disciplinary referrals and absentee rates. The school counselor also can recommend the use of the Hexagon Tool (Metz & Louison, 2019) or the logic model advanced by Smith et al. (2020). These tools can guide planning and evaluation efforts to ensure the school ecosystem is equipped to successfully implement a school-based mental health program.
Installation
Similar to the exploration stage, the installation stage may have occurred by the time the school counselor becomes involved. Ideally, the school counselor will play a central role in this work given school-based mental health’s relationship to comprehensive programming. If this stage has not occurred, the school counselor is encouraged to advocate for the establishment of an implementation team. In line with an advisory council for a school counseling program, the implementation team should comprise key stakeholders such as an administrator, teacher, and parent, in addition to the school counselor. Developing an implementation team in this phase, if not prior to it, is critical; the team will lead the school-based mental health efforts and ultimately dictate the degree of success of the further stages of implementation. During the installation stage, policies and procedures are developed, including a referral system and measures for notifying parents and obtaining informed consent for school-based mental health. Flyers and other promotional materials should be considered to market the services as an extension of the comprehensive school counseling program.
In this stage, school counselors should ensure that consideration is given to logistics such as potential schedules for service provision, space allocation, collaborative meetings with the school-based mental health counselor, and consultation with teachers and parents. The clinician selected to deliver school-based mental health services should be representative of the student body in terms of race and ethnicity and qualified with a master’s degree and clinical license in counseling or a related field (e.g., social work, psychology); sufficient experience working with the designated age group is recommended. Further, the ability to operate successfully in a dynamic environment given the unique needs of the school and its community (e.g., rural, urban, suburban) is requisite, according to Michael et al. (2023). School counselors can propose the use of tools such as a hiring guide primer and interview guide suggested by Frey et al. (2023) to ensure the clinician possesses the knowledge, disposition, and skills necessary to deliver effective services. Similarly, it is important that the clinician’s theoretical orientation and counseling modality are evidence-based (e.g., cognitive-behavioral therapy) and applicable to counseling school-aged children. Arrangements and procedures for billing and payment also are considered during this phase. With involvement at this stage, the school counselor is set to facilitate the initial implementation to ensure the program is received positively by the subsystems of the school.
Initial Implementation
The initial implementation phase is also known as the stage of change. During this stage, the school-based mental health program is launched, but not at full scale. For example, the service may be initially offered to a subset of the student population, such as only fourth- and fifth-graders at an elementary school. The school counselor can assist with the launch of the program and serve as a sleuth to identify areas of weakness in its delivery. The piloting or soft launch of the service allows the program to operate, but not fully, while errors in programming or oversights related to policies and procedures are corrected. Containing the program allows the implementation team to address barriers or challenges before a full, school-wide launch of the service in the school ecosystem.
Full Implementation
During this stage, the school-based mental health program is implemented school-wide and becomes a fully functional subsystem of the school ecosystem. Parents, students, teachers, and administrators realize the program’s value and expect its services. With the program as an extension of the comprehensive school counseling program, the school counselor collaborates with key stakeholders to ensure that data are maintained on the number of referrals, services provided, student demographics, outcomes, and perception data from parents. Ongoing data collection and analysis will help to determine implementation effectiveness and allow for continuous improvement of the services. The student and parent’s commitment or receptiveness to participate in the school-based mental health program is also measured, given that it accounts for 70% of social/emotional outcomes (Rojas-Andrade & Leiva Bahamondes, 2018). Achieving the next stage, innovation, requires a well-organized system that has collected implementation and outcome data during this stage of implementation.
Innovation
During the innovation stage, full implementation continues. The school counselor can assist the implementation team in analyzing the data collected and making data-informed recommendations for adjustments or modifications to the school-based mental health program. Although potentially an added burden, program assessment can lead to better implementation and more effective programming (Lyon & Bruns, 2019). A central goal of this stage is to further strengthen the program and maximize its potential for positive student outcomes that permeate throughout the school ecosystem. The school counselor plays a vital role in this stage by guiding and helping to strengthen the direction of the services delivered.
Sustainability
In the sustainability stage, the school counselor works to maintain stakeholder engagement as the school-based mental health services are fully delivered. The school counselor, in concert with the implementation team, can continue to ensure that quality services are provided. For the continuation of a successful school-based mental health program, positive sentiment among stakeholders is important and outcomes should remain favorable. Breaches of fidelity or instances when the program is not implemented as intended are detrimental to the services students receive.
Case Examples
School counselors are distinctly positioned with specialized knowledge in education and mental health to promote the success of students through their involvement with school-based mental health programming. As implementation specialists, school counselors can help facilitate the development and delivery of mental health services. We present two case examples centered on the induction of a mental health clinician in the school ecosystem. Our analyses explore how school counselors can assist in the implementation of these services.
A Program in Peril
Akosua, the school counselor at a large urban elementary school, was notified by her principal that Tamale Elementary School was granted permission by the system office to start a school-based mental health program. These services would begin at the outset of the new school year, which was only a week away. Akosua was not privy to initial discussions or the planning of the program. Given the time constraints and other beginning-of-the-year expectations, Akosua took a hands-off approach to the program. She had a basic understanding of the program and knew that the responsibility for providing mental health services would lie with a licensed clinician.
At the beginning of the school year, Jessica, a licensed professional counselor who works for a mental health agency, was assigned to provide school-based mental health services at Tamale Elementary School. Jessica scheduled an appointment with Akosua to notify her about the roles and responsibilities of providing mental health services to students at the school. The school counselor shared with Jessica that space was limited and a confidential location to meet with students and their families was not guaranteed. Jessica reported that she already had a small caseload and would provide mental health services on a bi-weekly basis at the school.
During the next visit, Jessica checked in at the front office and informed the secretary, who was unaware of the arrangement, that she was there to provide mental health counseling to several students. After clarifying the matter, the secretary called one of the students over the intercom to visit the office. Neither the student nor the classroom teacher was aware of the scheduled counseling session. The secretary suggested that space might be available in the school’s media center. Jessica was able to locate a space there to meet with the student, per the secretary’s recommendation. However, the space was not confidential, and the session was interrupted after 15 minutes due to a class visit to check out library books. Jessica was only able to meet without interruption with two of the four students on her caseload.
Each week Jessica visited the school to deliver mental health services she was met with similar experiences. The school counselor and clinician communicated very little, except in passing. They were unable to discuss cases because the students had not returned the signed consent forms Jessica sent home with them during her first visit. As the weeks passed, the students on Jessica’s caseload began to complain about leaving their classrooms at unscheduled times. Teachers expressed concerns that students were called out of the classroom during core instruction. Parents also grew impatient as they saw no academic, behavioral, or social/emotional growth in their children. Jessica’s caseload failed to increase and the success of the school-based mental health program was questioned by the administrators and other stakeholders.
Case Analysis
The exploration and installation stages appear to have occurred without the school counselor’s involvement. The status of the relationship between the school counselor and principal is unclear; however, a strong relationship would likely have led to collaboration early on and involvement in these stages. Regardless, the school counselor could have advocated for a delayed start and/or a pilot program with specific grade levels. A delay could have allowed the school counselor and clinician to address logistical issues, procedures, and systems. For example, the installation stage is ideal for engaging stakeholders who are not directly involved in the program, such as the secretary and media center coordinator. Teacher training could have occurred at this time as well. A pilot program during the initial implementation stage would have allowed the program to launch as scheduled but under constraints, while refining policies and procedures based on stakeholder feedback, among other data.
During full implementation, the parents, teachers, and students were not engaged in the program. As a result, these stakeholders experienced frustration with the services. The school counselor was limited in the data she collected during this phase because parental consent forms were not completed; this hindered the school’s communication with the clinician. Since the initial stages of implementation were poorly applied, there was little opportunity for innovation as the program quickly began to falter. The program in its current form is not sustainable given the lack of clear procedures, questionable outcomes, and waning sentiment from stakeholders.
The Laudable Launch
Afua is the school counselor at Elmina High School, a relatively small rural school. She was informed by the school’s principal that her school was selected by the local management entity (LME) to receive school-based mental health services for the upcoming academic school year. She met with the principal to explain the importance of being involved in the launch of this program, given its relationship to her comprehensive school counseling program. Afua helped to organize regular meetings with the school’s student services personnel and a representative of the LME. She also invited a teacher, a parent, and the school’s principal to participate in these meetings. At the outset of the meetings, the school counselor gathered data such as historical disciplinary and mental health referrals disaggregated by demographics to present to the team. This helped to inform the stakeholders of the need for and potential use of services. The principal allowed the group to design a timeline that would enable a successful launch of the program.
The team also generated and prioritized a list of concerns that might impede school-based mental health services at Elmina. They discussed logistics such as meeting space and times; the referral process; marketing; communication channels including the exchange of informed consent; and training for teachers, administrators, and parents. Based on a review of the data and feedback from stakeholders and team members, the team identified desirable characteristics (e.g., race/ethnicity, theoretical orientation) of the mental health clinician servicing the school and shared these with the LME. To streamline the process, the team decided that Afua would be the liaison between the school (e.g., teachers and parents) and the LME. Initial service inquiries would route through Afua, allowing her the opportunity to track and screen referrals.
The team elected to launch the school-based mental health program with a focus on 11th and 12th grades, beginning 1 month after the start of the school year. This timeline accounted for beginning-of-year festivities and allowed time to finalize policies and procedures, including a program review and comment period by teachers and staff at a school retreat and by parents at the open house. Just before the implementation of the program, Afua, joined by other team members at her request, provided in-service training that outlined the policies and procedures of the school-based mental health program. The training included resources and information regarding how teachers, school administrators, and parents can make referrals, logistical matters, stages of service, and how to appropriately address concerns. After a few months of implementation, the team made modifications based on feedback and collected data. In early spring, the school-based mental health program also became available to ninth- and 10th-graders. The school counselor continued to monitor the program and make slight modifications and adjustments as the program’s first year of implementation ended.
Case Analysis
Although the decision was already made to offer a school-based mental health program, Afua still elected to gather data and share it with the implementation team during the latter stages of exploration. This effort helped to set the stage for the initial success of the program. The installation stage quickly followed as Afua set out to collaborate and partner with key stakeholders to develop protocols, policies, and procedures for the provision of mental health services. The school administrator appeared to understand the role of the school counselor and student support services in fostering student success, leading to the intentional implementation of the school-based mental health program. The timeline established by the team allowed for engagement with the school community; feedback led to further revisions before the launch of the program. Utilizing team members to deliver the training to stakeholders helped to facilitate inclusion, buy-in, and understanding, means for further strengthening program implementation.
A staggered launch of the program during the initial implementation stage allowed the school counselor to evaluate program procedures and gather additional insight from early adopters. These findings were used to further enhance the program as full implementation ensued. The school counselor continued to monitor the school-based mental health program as it was scaled up during the full implementation stage. To ensure that parents, teachers, students, and other stakeholders remained engaged in the program, Afua made additional modifications and slight adjustments to the program. The school counselor continued to monitor both implementation adherence and program outcomes, hallmarks of the innovation stage. Due to the school counselor’s initial efforts in planning for implementation, only minor adjustments were needed for an already sound school-based mental health program. After the first year, the program was a sustainable extension of the school counseling program and a viable component of the school’s ecosystem, poised for success in the years ahead.
Discussion
School-based mental health services can have a profound impact on student success and the school ecosystem. These services are complementary of school counselors’ efforts to address mental health issues and increase academic performance (Hodges et al., 2021; Hoover & Bostic, 2021). However, interventions and programs delivered in schools are frequently delivered inconsistently and indiscriminately and, as a result, not as intended (Burns et al., 2017; Sanetti & Collier-Meek, 2019). Girio-Herrera et al. (2019) highlighted some of the challenges specific to effectively implementing school-based mental health services. To overcome these challenges, we encourage school counselors to explore how they can become actively involved in school-based mental health programming if they are not already. School counselors who embrace school-based mental health and its complementary relationship with comprehensive school counseling can leverage implementation science through consulting, collaborating, and partnering with stakeholders to launch and sustain dynamic mental health services that meet the needs of students. Whether a school-based mental health program was recently approved or has existed for years, applying implementation science can significantly enhance program fidelity and student outcomes (Blase et al., 2015).
The case examples and analyses offer a glimpse into the application of implementation science in school-based mental health services. When the stages and strategies of implementation science are not considered, programming is less than optimal and subsequently does not meet the needs of the stakeholders and the ecosystem for which it is intended (Fixsen et al., 2005; Warren & Mauk, 2019). In these cases, time, energy, and money are wasted as expected outcomes do not materialize as the case example A Program in Peril demonstrated. Alternatively, as seen in The Laudable Launch, when implementation science guides the development and delivery of school-based mental health as an extension of a comprehensive school counseling program, services are inclusive of stakeholders, data informed, and geared for monitoring and continual improvement; the program is poised for success. As Warren and Mauk (2019) asserted, “Simply engaging in action (i.e., treatment or intervention) does not always yield desired results; intentional planning and delivery are required” (p. 7).
School counselor training includes the delivery of comprehensive school counseling programs to promote academic, social/emotional, and career development for all students (ASCA, 2022). ASCA offers several resources that can help facilitate the delivery of programs and interventions. For example, the
Implementation science is a viable tool school counselors can use to facilitate school-based mental health programming decisions that are intentional, data informed, and complementary to the goals of their comprehensive program. When interventions and programs, such as school-based mental health, are implemented as intended, they are more efficient and likely to result in positive student outcomes (Warren, 2017). Implementation science provides a guide for monitoring, evaluating, engaging, and modifying school-based mental health services to meet the mental health needs of the school and the students it serves. School counselors who embrace this framework for the delivery of programs and interventions position themselves as data-driven leaders, advocates, and agents of change (ASCA, 2023). In this vein, school counselors are poised to determine implementation effectiveness and its impact on student outcomes. Implementation science also can help to uncover problematic policies and procedures and generate ones that are more conducive to adherence and positive outcomes (Metz et al., 2015).
Although several available school-based mental health models can extend and complement comprehensive school counseling programming, implementation science remains a requisite for efficiently and effectively supporting student mental health and promoting students’ success. As state and federal governments provide funding to support school-based mental health initiatives in pre-K–12 schools, school counselors are encouraged to embrace their role in this work. Implementation science is essential to ensuring all students and families receive quality mental health services through comprehensive school counseling and school-based mental health.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
