School-Based Mental Health Interventions and Teacher Involvement: A Systematic Review
Schools and school-based mental health professionals (SBMHP), such as school social workers, have become a primary service provider of mental health services for youth. Policy and research over the past 20 years have helped to evolve an intervention model known as Response to Intervention (RTI) to address various levels of identified social and behavioral student problems. Utilizing a systematic review approach, this paper sought to understand the extent to which teachers have become involved in the delivery of RTI school-based mental health services. Therefore, the purpose of this systematic review is: 1) to assess how often and at what level of intervention teachers may be involved in delivering mental health interventions using the framework of RTI, and 2) examine the efficacy of school mental health interventions implemented by teachers in conjunction with and comparison to school social workers and other professionals.
Databases (ERIC, PsycINFO, MEDLINE, CINHAL, & Social Science Abstracts) were searched using the following keywords: school*, children or adolescent* or youth, mental health or mental health service*, and outcome study or effective or efficacy. Study inclusion criteria included: (a) experimental and quasi-experimental designs (b) published between January 1999 and September 2010; (c) conducted in a school setting; (d) involved a mental health and behavioral services such as prevention, risk reduction, and intervention; (e) conducted in the U.S.; and (f) contained enough statistical information to calculate effect sizes. Two of the authors independently coded the final sample of studies (N=49) and compared their results for agreement. Effect sizes (Hedges’ g) were calculated for all outcome measures using Comprehensive Meta-Analysis software when not reported in the articles.
Results found that teachers were involved in 41% of mental health interventions evaluated and were the sole providers of interventions in 18% of the studies. Additionally, 41% of the school mental health interventions were tier 1 and occurred in the classrooms which also partly explain the active involvement of teachers in a relatively high percentage of these interventions.
Effect size results for the studies reviewed suggest that there is not wide variation in outcomes between different school mental health studies, regardless of which personnel may be implementing the interventions. In this regard, studies involving teachers as sole providers of mental health services, and those studies that involved teachers as collaborators on mental health teams, had fairly equivocal results with most studies having small effect sizes, and only a few studies offered medium and large effect sizes. The results from studies where teachers were involved in school mental health interventions were fairly equivocal to those delivered SBMHP.
Findings suggest that teachers have been actively involved in school mental health interventions, and they are more likely to work as a team with other professionals than as sole providers of these interventions. Therefore, it is important for SBMHP to prepare to empower teachers to participate in the delivery of efficacious mental health interventions. Additional research is needed to understand the most effective role teachers can play in mental health service delivery.