Abstract
This paper provides a synthetic review of research on school-based mental health services. Schools play an increasingly important role in providing mental health services to children, yet most school-based programs being provided have no evidence to support their impact. A computerized search of references published between 1985 and 1999 was used to identify studies of school-based mental health services for children. Study inclusion was determined by (i) use of randomized, quasi-experimental, or multiple baseline research design; (ii) inclusion of a control group; (iii) use of standardized outcome measures; and (iv) baseline and postintervention outcome assessment. The application of these criteria yielded a final sample of 47 studies on which this review is based. Results suggest that there are a strong group of school-based mental health programs that have evidence of impact across a range of emotional and behavioral problems. However, there were no programs that specifically targeted particular clinical syndromes. Important features of the implementation process that increase the probability of service sustainability and maintenance were identified. These include (i) consistent program implementation; (ii) inclusion of parents, teachers, or peers; (iii) use of multiple modalities; (iv) integration of program content into general classroom curriculum; and (v) developmentally appropriate program components. Implications of these findings and directions for future research are discussed.
Similar content being viewed by others
REFERENCES
Aber, J., Jones, S., Brown, J., Chaudry, N., & Samples, F. (1998). Resolving conflicts creatively: Evaluating the developmental effects of a school-based violence prevention program in neighborhood and classroom context. Development and Psychopathology, 10, 187-213.
Adelman, H. S., & Taylor, L. (1998). Mental health in schools. Moving forward. School Psychology Review, 27, 175-190.
Adelman, H. S., & Taylor, L. (1999). Mental health in schools and system restructuring. Clinical Psychology Review, 19, 137-163.
Allen, J., Philliber, S., Herrling, S., & Kuperminc, G. (1997). Preventing teen pregnancy and academic failure: Experimental evaluation of a developmentally based approach. Child Development, 64, 729-742.
Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57-87.
Angold, A., Costello, E. J., & Worthman, C. M. (1998). Puberty and depression: the roles of age, pubertal status and pubertal timing. Psychological Medicine, 28, 51-61.
Battistich, V., Schaps, E., Watson, M., & Solomon, D. (1996). Prevention effects of the Child Development Project: Early findings from an ongoing multisite demonstration trial. Journal of Adolescent Research, 11, 12-35.
Bickman, L. (1999). Practice makes perfect and other myths about mental health services. American Psychologist, 54, 965-979.
Bierman, K., Miller, C., & Stabb, S. (1987). Improving the social behavior and peer acceptance of rejected boys: Effects of social skill training with instructions and prohibitions. Journal of Consulting and Clinical Psychology, 55, 194-200.
Botvin, G., Baker, E., Dusenbury, L., Tortu, S., & Botvin, E. (1990). Preventing adolescent drug abuse through a multimodal cognitive-behavioral approach: Results of three studies. Journal of Consulting and Clinical Psychology, 58, 437-446.
Botvin, G., Schinke, S., Epstein, J., & Diaz, T. (1994). Effectiveness of culturally focused and generic skills training approaches to alcohol and drug abuse prevention among minority youths. Psychology of Addictive Behaviors, 8, 116-127.
Botvin, G., Baker, E., Dusenbury, L., Botvin, E., & Diaz, T. (1995a). Long-term follow-up results of a randomized drug abuse prevention trial in a white middle-class population. Journal of the American Medical Association, 273, 1106-1112.
Botvin, G., Schinke, S., Epstein, J., Diaz, T., & Botvin, E. (1995b). Effectiveness of culturally focused and generic skills training approaches to alcohol and drug abuse prevention among minority adolescents: Two-year follow-up results. Psychology of Addictive Behaviors, 9, 183-194.
Brandenburg, N. A., Friedman, R. M., & Silver, S. E. (1990). The epidemiology of childhood psychiatric disorders: Prevalence findings from recent studies. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 76-83.
Braswell, L., August, G., Bloomquist, M., Realmuto, G., Skare, S., & Crosby, R. (1997). School-based secondary prevention for children with disruptive behavior: Initial outcomes. Journal of Abnormal Child Psychology, 25, 197-208.
Burns, B. J., Costello, E. J., Angold, A., Tweed, D., Stangl, D., Farmer, E., & Erkanli, A. (1995). Children's mental health service use across service sectors. Health Affairs, 14, 147-159.
Burns, B. J., Hoagwood, K., & Mrazek, P. (1999). Effective treatment for mental disorders in children and adolescents. Clinical Child and Family Psychology Review, 2, 199-254.
Catron, T., Harris, V., & Weiss, B. (1998). Posttreatment results after 2 years of services in The Vanderbilt School-Based Counseling project. In M. Epstein & K. Kutash (Eds.), Outcomes for children and youth with emotional and behavioral disorders and their families: Programs and evaluation best practices (pp. 633-656). Austin, TX: Pro-Ed, Inc.
Catron, T., & Weiss, B. (1994). The Vanderbilt School-Based Counseling Program: An interagency, primary-care model of mental health services. Journal of Emotional and Behavioral Disorders, 2, 247-253.
Cecil, M., & Forman, S. (1990). Effects of stress inoculation training and coworker support groups on teacher's stress. Journal of School Psychology, 28, 105-118.
Clarke, G., Hawkins, W., Murphy, M., & Sheeber, L. (1993). School-based primary prevention of depressive symptomatology in adolescents: Findings from two studies. Journal of Adolescent Research, 8, 183-204.
Clarke, G., Hawkins, W., Murphy, M., Sheeber, L., Lewinsohn, P., & Seeley, J. (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of a group cognitive intervention. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 312-321.
Conduct Problems Prevention Research Group (1992).A developmental and clinical model for the prevention of conduct disorder: The FAST Track Program. Development and Psychopathology, 4, 509-527.
Conduct Problems Prevention Research Group (1999). FAST Track update. National Institute of Mental Health, Rockville, MD.
Conduct Problems Prevention Research Group (1999a). Initial impact of the Fast Track prevention trial for conduct problems: I. The high-risk sample. Journal of Consulting and Clinical Psychology, 67, 631-647.
Conduct Problems Prevention Research Group (1999b). Initial impact of the Fast Track prevention trial for conduct problems: II. Classroom effects. Journal of Consulting and Clinical Psychology, 67, 648-657.
Costello, E. J. (1989). Developments in child psychiatric epidemiology: An epidemiological study of behavior characteristics in children. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 836-841.
Costello, E. J., Angold, A., Burns, B. J., Stangl, D. K., Tweed, D. L., Erkanli, A., & Worthman, C. M. (1996). The Great Smoky Mountains Study of Youth: Goals, design, methods and the prevalence of DSM-III-R disorders. Archives of General Psychiatry, 53, 1129-1136Cunningham, C., Cunningham, L.,Martorelli, V., Tran, A., Young, J., & Zacharias, R. (1998). The effects of primary division, student-mediated conflict resolution programs on playground aggression. Journal of Child Psychology, Psychiatry, and the Allied Disciplines, 39, 653-662.
Dent, C., Sussman, S., Stacy, A., Craig, S., Burton, D., & Flay, B. (1995). Two-year behavior outcomes of a Project Towards No Tobacco Use. Journal of Consulting and Clinical Psychology, 63, 676-677.
Dielman, T., Shope, J., Butchart, T., & Campanelli, P. (1986). Prevention of adolescent alcohol misuse: An elementary school program. Journal of Pediatric Psychology, 11, 259-282.
Dolan, L., Kellam, S., Brown, C., Werthamer-Larson, L., Rebok, G., Mayer, L., Laudolff, J., Turkkan, Ford, C., & Wheeler, L. (1993). The short-term impact of two classrooms-based preventive interventions on aggressive and shy behaviors and poor achievement. Journal of Applied Developmental Psychology, 14, 317-345.
Dupper, D., & Krishef, C. (1993). School-based social-cognitive skill training for middle school students with school behavior problems. Children and Youth Services Review, 15, 131-142.
Ellickson, P., Bell, R., & McGuigan, K. (1993). Preventing adolescent drug use: Long-term results of a junior high program. American Journal of Public Health, 83, 856-861.
Ennett, S., Tobler, N., Ringwalt, C., & Flewelling, R. (1994). How effective is drug abuse resistance education? A meta-analysis of project DARE outcome evaluations. American Journal of Public Health, 84, 1394-1400.
Federal Interagency Forum on Child and Family Statistics. (1998). America's Children: Key National Indicators of Well-Being. Washington, DC: U.S. Government Printing Office.
Friedman, R. M. (1992). Mental health and substance use services for adolescents: Clinical and service system issues. Administration and Policy in Mental Health, 19, 191-206.
Friedman, R. M. (1999). The practice of psychology with children, adolescents and their families: A look to the future. In J. Hughes, J. Conoley, & A. La Greco (Eds.), Handbook of psychological interventions for children and adolescents (pp. 1-34). Oxford: Oxford Press.
Friedman, R. M., Katz-Leavy, J. W., Mandersheid, R. W., & Sondheimer, D. L. (1996). Prevalence of serious emotional disturbance in children and adolescents. In Center for Mental Health Services. Mental Health, United States, 1996 (p. 83).
Manderscheid, R. W. & Sonnenschein, M. A. (Eds.). DHHS Pub. No. (SMA) 96-3098. Washington, DC: Supt. of Docs., U.S. Government Printing Office.
Fuchs, D., Fuchs, L., & Bahr, M. (1990). Mainstream assistance teams:Ascientific basis for the art of consultation. Exceptional Children, 57, 128-139.
Gillham, J., Reivich, K., Jaycox, L.,& Seligman, M. (1995). Prevention of depressive symptoms in school children: Two-year follow-up. Psychological Science, 6, 343-351.
Gottfredson, D., Gottfredson, G., & Hybl, L. (1993). Managing adolescent behavior: A multiyear, multischool study. American Educational Research Journal, 30, 179-215.
Greenbaum, P. E., Prange, M. E., Friedman, R. M., & Silver, S. E. (1991). Substance abuse prevalence and comorbidity with other psychiatric disorders among adolescents with severe emotional disturbance. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 575-583.
Greenberg, M., Kusche, C., Cook, E., Quamma, J. (1995). Promoting emotional competence in school-aged children: The effects of the PATHS curriculum. Development and Psychopathology, 7, 117-136.
Grossman, D., Neckerman, H., Koepsell, T., Liu, P., Asher, K., Beland, K., Frey, K., & Rivara, F. (1997). Effectiveness of a violence prevention curriculum among children in elementary school: A randomized controlled trial. Journal of the American Medical Association, 277, 1605-1611.
Hawkins, J. D., Catalano, R. F., Kosterman, R., Abbott, R., & Hill, K. (1999). Preventing adolescent health-risk behaviors by strengthening protection during childhood. Archives of Pediatric and Adolescent Medicine, 153, 226-234.
Henderson, P., Kelbey, T., & Engerbreston, K. (1992). Effects of a stress-control program on children's locus of control, self-concept, and coping behavior. The School Counselor, 40, 125-130.
Hoagwood, K., & Koretz, D. (1996). Embedding prevention services within systems of care: Strengthening the nexus for children. Applied and Preventive Psychology, 5, 225-234.
Hostetler, M., & Fisher, K. (1997). Project C.A.R.E. substance abuse prevention program for high-risk youth: A longitudinal evaluation of program effectiveness. Journal of Community Psychology, 25, 397-419.
Hudley, C., & Graham, S. (1993). An attributional intervention to reduce peer-directed aggression among African-American boys. Child Development, 64, 124-138.
Huffman, L. C., Mehlinger, S. L., Kerivan, A. S. (1999). What are the risk factors for academic and behavioral problems at the beginning of school? Science and Policy for Young Children: Social and Emotional School Readiness. Monographs of the Foundations and Agencies Network. In press.
Journal of the American Academy of Child and Adolescent Psychiatry. (1997). Practice parameters for the assessment and treatment of children and adolescents with conduct disorder. 36, 122S-139S.
Journal of Clinical Child Psychology. (1998). Special issue on empirically supported psychosocial interventions for children. 27, 138-226.
Kazdin, A. (1997). Practitioner review: Psychosocial treatments for conduct disorder in children. Journal of Child Psychology and Psychiatry, 38, 161-178.
Kellam, S., Rebok, G., Ialongo, N., & Mayer, L. (1994). The course and malleability of aggressive behavior from early first grade into middle school: Results of a developmental epidemiologically-based preventive trial. Journal of Child Psychology, Psychiatry, and the Allied Disciplines, 35, 259-281.
Kessler, R. C. (1994). The National Comorbidity Survey of the United States. International Review of Psychiatry, 6, 365-376.
King, C., & Kirschenbaum, D. (1990). An experimental evaluation of a school-based program for children at risk: Wisconsin early intervention. Journal of Community Psychology, 18, 167-177.
Klingman, A., & Hochdorf, Z. (1993). Coping with distress and self harm. The impact of a primary prevention program among adolescents. Journal of Adolescence, 16, 121-140.
Knoff, H., & Batsche, G. (1995). Project ACHIEVE: Analyzing a school reform process for at-risk and underachieving students. School Psychology Review, 24, 579-603.
Leaf, P. J., Alegria, M., Cohen, P., Goodman, S. H., Horowitz, S., Hoven, C. W., Narrow, W. E., Vaden-Kiernan, M., & Regier, D. A. (1996). Mental health service use in the community and schools: Results from the four-community MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 889-896.
Lewinsohn, P. M., Clarke, G. N., Hops, H., Seeley, J. R. (1996). A course in coping: A cognitive-behavioral approach to the treatment of adolescent depression. In Hibbs, E. D.,& Jensen, P. S. (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically-based strategies for clinical practice (pp. 109-135). Washington, DC: American Psychological Association.
Lochman, J., Coie, J., Underwood, M., & Terry, R. (1993). Effectiveness of a social relations intervention program for aggressive and nonaggressive, rejected children. Journal of Consulting and Clinical Psychology, 61, 1053-1058.
Lochman, J., & Curry, J. (1986). Effects of social problem solving training and self-instruction training with aggressive boys. Journal of Clinical Child Psychology, 15, 159-164.
Nastasi, B. (1998). A model for mental health programming in schools and communities: Introduction to the mini-series. School Psychology Review, 27, 165-174.
National Institutes of Health. (1996). A Plan for Preventive Research for the National Institute of Mental Health (NIH Publication No. 96-4093). Rockville, MD: Author.
National Institutes of Health. (1998). Diagnosis and treatment of attention deficit hyperactivity disorder (ADHD). NIH Consensus Statement, 16, 1-21.
Office of Juvenile Justice and Delinquency Prevention (1999): The Blueprint Programs.
Parish, T. B. (1996). Special education finance: Past, present, and future. Policy Paper Number 8. Center for Special Education Finance.
Pepler, D., King, G., Craig, W., Byrd, B., & Bream, L. (1995). The development and evaluation of a multisystem social skills group training program for aggressive children. Child and Youth Care Forum, 24, 297-313.
Perry, C., Williams, C., Veblen-Mortenson, S., Tommey, T., Komro, K., Anstine, P., McGovern, P., Finnegan, J., Forster, J., Wagenaar, A., & Wolfson, M. (1996). Project Northland: Outcomes of a community-wide alcohol use prevention program during early adolescence. American Journal of Public Health, 86, 956-965.
Quinn, K. P., & Epstein, M. H. (1998). Characteristics of children, youth, and families served by local interagency systems of care. In Epstein, M. H., Kutash, K., & Duchnowski, A. (Eds.), Outcomes for children and youth with behavioral and emotional disorders and their families (pp. 81-114). Austin, TX: Pro-Ed.
Reid, J., Eddy, M., Fetrow, R., & Stoolmiller, M. (1999). Description and immediate impacts of a preventive intervention for conduct problems. American Journal of Community Psychology, 27, 483-517.
Roberts, R. E., Attkinsson, C. C., & Rosenblatt, A. (1998). Prevalence of psychopathology among children and adolescents. American Journal of Psychiatry, 155, 715-725.
Robins, L. N. (1981). Epidemiolocal approaches to natural history research: Antisocial disorders in children. Journal of the American Academy of Child and Adolescent Psychiatry, 20, 566-680.
Rosal, M. (1993). Comparative group art therapy research to evaluate changes in locus of control in behavior disordered children. The Arts in Psychotherapy, 20, 231-241.
Rosenbaum, D., Flewelling, R., Bailey, S., Ringwalt, C., & Wilkinson, D. (1994). Cops in the classroom: A longitudinal evaluation of Drug Abuse Resistance Education (DARE). Journal of Research in Crime and Delinquency, 31, 3-31.
Rosenbaum, D., & Hanson, G. (1998). Assessing the effects of school-based drug education: A six-year multilevel analysis of project D.A.R.E. Journal of Research in Crime and Delinquency, 5, 381-412.
Shaffer D., Fisher P., Dulcan, M. K., Davies, M., Piacentini, J., Schwab-Stone, M. E., Lahey, B. B., Bourdon, K., Jensen, P. S., Bird, H. R., Canino, G., & Regier, D. A. (1996). The NIMH Diagnostic Interview Schedule for Children Version 2/3 (DISC 2.3): Description, acceptability, prevalence rates, and performance in the MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 7, 865-877.
Stroul, B. A., & Friedman, R. M. (1986). A system of care for severely emotionally disturbed children and youth. Washington, DC: Georgetown University Child Development Center.
Stroul, B. A., & Friedman, R. M. (1996). The system of care concept and philosophy. In Stroul, B. A. (Ed.), Children's mental health: Creating systems of care in a changing society (pp. 3-21). Baltimore, MD: Paul H. Brookes.
Sussman, S., Dent, C., Stacy, A., Sun, P., Craig, S., Simon, T., Burton, D., & Flay, B. (1993). Project Towards No Tobacco Use: 1-year behavioral outcomes. American Journal of Public Health, 83, 1245-1250.
Suter, D., & Kehle, T. (1988). Evaluation of the Primary Mental Health Project model of early identification and prevention of school adjustment problems. Special Services in the Schools, 4, 89-107.
Tremblay, R., Pagani-Kurtz, L., Masse, L., Vitaro, F., & Pihl, R. (1995). A bimodal preventive intervention for disruptive kindergarten boys: Its impact through mid-adolescence. Journal of Consulting and Clinical Psychology, 63, 560-568.
Vitaro, F., & Tremblay, R. (1994). Impact of a prevention program on aggressive children's friendships and social adjustment. Journal of Abnormal Child Psychology, 22, 457-475.
Vitiello, B., Bhatara, V. S., Jensen, P. S. (1999). Current knowledge and unmet needs in pediatric psychopharmacology. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 501-502.
Weiss, B., Catron, T., Harris, V., & Phung, T. (1999). The effectiveness of traditional child psychotherapy. Journal of Consulting and Clinical Psychology, 67, 82-94.
Weisz, J. R., & Jensen, P. S. (1999). Efficacy and effectiveness of child and adolescent psychotherapy and pharmacotherapy. Mental Health Services Research, 1, 125-158.
Weisz, J. R., Weiss, B., & Donenberg, G. R. (1993). The lab versus the clinic: Effects of child and adolescent psychotherapy. Annual Progress in Child Psychiatry and Child Development, 47, 1578-1585.
Weisz, J. R., & Weersing V. R. (1999). Psychotherapy with children and adolescents: Efficacy, effectiveness, and developmental concerns. In Cicchetti, D., and Toth, D. L. (Eds.). Rochester symposium on developmental psychopathology, Vol. 9: Developmental approaches to prevention and intervention. Rochester, NY: University of Rochester Press.
Zahner, G., Pawelkiewicz, W., DeFrancesco, J. J., & Adnopoz, J. (1992). Children's mental health service needs and utilization patterns in an urban community: An epidemiological assessment. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 951-960.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rones, M., Hoagwood, K. School-Based Mental Health Services: A Research Review. Clin Child Fam Psychol Rev 3, 223–241 (2000). https://doi.org/10.1023/A:1026425104386
Issue Date:
DOI: https://doi.org/10.1023/A:1026425104386