Teachers' Endorsement of Referral to School-Based Mental Health Services and Intent to Contact Parents/Guardians: A Vignette-Based Study

Background and Purpose: Teachers are often the first to identify and refer youths in need of mental health (MH) services. Teachers also collaborate with youths’ caregivers to provide necessary supports for youths and their families. Little is known about the factors that affect teachers’ decision-making in school MH. The current study explored if a youth’s race affected teachers’ perceptions of girls with co-occurring depression and anxiety symptoms. Factors that affect teacher referral for mental health services and their intent to contact parents/guardians were also explored.

Method: Experimental vignette methodology was used. Secondary teachers (n = 239) completed an online survey and were randomly assigned to read a vignette about either a Black or white female youth experiencing symptoms of moderate co-occurring depression and anxiety. After reading the vignette, teachers rated their perception of the problem’s seriousness, concern for the youth, likelihood of contacting the youth’s parent/guardian, and likelihood of making a school-based mental health referral. Teachers also reported on their mental health literacy and perceptions of student mental health supports using existing measures of each construct. A series of independent samples t-tests were used to examine differences in teacher ratings based on vignette condition. Hierarchical linear regression was used to identify factors that predicted teachers’ likelihood of contacting parents or endorsing a school-based MH referral.

Results: Most teachers felt high levels of concern for the youth (M = 8.49 out of 10, SD = 1.35) and identified a high level of problem seriousness (M = 8.12 out of 10, SD = 1.31). Nearly all teachers endorsed contacting the youth’s parents/guardians and making a MH referral (87.9% and 96.2%, respectively). There were no differences in teacher ratings of concern (t(237) = -0.22, p = 0.83), perception of problem seriousness (t(237) = 0.15, p = 0.25), likelihood of parent contact (t(237) = -1.26, p = 0.21), or endorsement of referral (t(237) = 0.52, p = 0.60) based on vignette condition (youth’s race). Teacher concern for youth, perceptions of problem seriousness, and teachers’ mental health literacy positively predicted teachers’ endorsement of school-based mental health referral. Perception of seriousness was the greatest predictor in this model and together these variables accounted for 26% of the variance. No variables significantly predicted the likelihood of contacting parents/guardians.

Conclusion and Implications: Teachers are likely to endorse initiating MH services for girls with moderate levels of co-occurring depression and anxiety. Teachers’ concern for youth, perception of problem seriousness, and mental health literacy are likely important variables in their decision-making related to school MH. Raising teachers’ perceptions of problem seriousness and their level of concern for youth might enhance teachers’ referral to MH services. This study underscores the importance of investigating teachers as frontline professionals in school MH. No factors predicted teachers’ intent to contact parents/guardians. Future research should examine the role of teachers in engaging parents/guardians about the MH needs of youths.