Skip to main content
Log in

School Principals’ Perceived Barriers and Facilitators to the Normalization of School-Based Mental Health Services: A Multimethod Investigation

  • Original Paper
  • Published:
School Mental Health Aims and scope Submit manuscript

Abstract

Schools have become primary providers of mental health services for children and adolescents (Kern et al. in School Mental Health 9:205–217, 2017). Within schools, school principals play a significant role in the implementation of school-based mental health (SBMH; Langley et al. in School Mental Health 2:105–113, 2010). This multimethod study aimed to investigate school principals’ perceptions of SBMH, specifically in how they view SBMH and what barriers and facilitators they identify to successful implementation. School principals from 244 public schools in the United States completed a survey, and 19 principals also participated in semi-structured interviews. Data from a quantitative measure based on Normalization Process Theory (NPT; Finch et al. in BMC Med Res Methodol 18(1):1–13, 2018) indicated that while principals strongly believe SBMH will become a normal part of their work in the future, their responses to whether they are familiar with SBMH and see it as a normal part of the current work were less robust. Results from a framework analysis of the qualitative results identified barriers and facilitators to the implementation of SBMH within and outside of schools, thus aligning with implementation science frameworks such as the Exploration, Preparation, Implementation, and Sustainment (EPIS; Moullin et al. in Implement Sci 14:1–1, 10.1186/s13012-018-0842-6, 2019) framework. The findings may inform SBMH policy in light of the increasing number of children and adolescents with mental health needs (Hoover and Bostic in Psychiatr Serv 72(1):37–48, 2021).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  • Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38, 4–23.

    Article  PubMed  Google Scholar 

  • Baker, E. A., Brewer, S. K., Owens, J. S., Cook, C. R., & Lyon, A. R. (2021). Dissemination science in school mental health: A framework for future research. School Mental Health, 13, 791–807.

    Article  PubMed  PubMed Central  Google Scholar 

  • Baweja, S., Santiago, C. D., Vona, P., Pears, G., Langley, A., & Kataoka, S. (2016). Improving implementation of a school-based program for traumatized students: Identifying factors that promote teacher support and collaboration. School Mental Health, 8(1), 120–131.

    Article  Google Scholar 

  • Bharadwaj, P., Pai, M. M., & Suziedelyte, A. (2017). Mental health stigma. Economics Letters, 159, 57–60. https://doi.org/10.1016/j.econlet.2017.06.028

    Article  Google Scholar 

  • Birken, S. A., Lee, S. Y. D., & Weiner, B. J. (2012). Uncovering middle managers’ role in healthcare innovation implementation. Implementation Science, 7, 1–12.

    Article  Google Scholar 

  • Blackman, K. F., Powers, J. D., Edwards, J. D., Wegmann, K. M., Lechner, E., & Swick, D. C. (2016). Closing the gap: Principal perspectives on an innovative school-based mental health intervention. The Urban Review, 48(2), 245–263.

    Article  Google Scholar 

  • Bowers, H., Manion, I., Papadopoulos, D., & Gauvreau, E. (2013). Stigma in school-based mental health: Perceptions of young people and service providers. Child and Adolescent Mental Health, 18(3), 165–170.

    Article  PubMed  Google Scholar 

  • Briesch, A. M., Cintron, D. W., Dineen, J. N., Chafouleas, S. M., McCoach, D. B., & Auerbach, E. (2020). Comparing stakeholders’ knowledge and beliefs about supporting students’ social, emotional, and behavioral health in schools. School Mental Health, 12, 222–238.

    Article  Google Scholar 

  • Bruns, E. J., Parker, E. M., Hensley, S., Pullmann, M. D., Benjamin, P. H., Lyon, A. R., & Hoagwood, K. E. (2019). The role of the outer setting in implementation: Associations between state demographic, fiscal, and policy factors and use of evidence-based treatments in mental healthcare. Implementation Science, 14, 1–13.

    Article  Google Scholar 

  • Carlson, C., Namy, S., Nakuti, J., Mufson, L., Ikenberg, C., Musoni, O., Hopson, L., Anton-Erxleben, K., Naker, D., & Wainberg, M. L. (2021). Student, teacher, and caregiver perceptions on implementing mental health interventions in Ugandan schools. Implementation Research and Practice, 2, 263348952110512. https://doi.org/10.1177/26334895211051290

    Article  Google Scholar 

  • Castillo, J. M. (2020). The intersection between systems change, implementation science, and human beings: A call to investigate people and context in future systems-level consultation research. Journal of Educational and Psychological Consultation, 30(4), 402–411.

    Article  Google Scholar 

  • Connors, E., Lawson, G., Wheatley-Rowe, D., & Hoover, S. (2021a). Exploration, preparation, and implementation of standardized assessment in a multi-agency school behavioral health network. Administration and Policy in Mental Health and Mental Health Services Research, 48, 464–481.

    Article  PubMed  Google Scholar 

  • Connors, E. H., Prout, J., Vivrette, R., Padden, J., & Lever, N. (2021b). Trauma-focused cognitive behavioral therapy in 13 urban public schools: Mixed methods results of barriers, facilitators, and implementation outcomes. School Mental Health, 13, 772–790.

    Article  PubMed  PubMed Central  Google Scholar 

  • Conoley, J. C., Powers, K., & Gutkin, T. B. (2020). How is school psychology doing: Why hasn’t school psychology realized its promise? School Psychology, 35(6), 367–374.

    Article  PubMed  Google Scholar 

  • Cook, B. G., & Cook, L. (2008). Nonexperimental quantitative research and its role in guiding instruction. Intervention in School and Clinic, 44(2), 98–104.

    Article  Google Scholar 

  • Cook, C. R., Lyon, A. R., Locke, J., Waltz, T., & Powell, B. J. (2019). Adapting a compilation of implementation strategies to advance school-based implementation research and practice. Prevention Science, 20, 914–935.

    Article  PubMed  PubMed Central  Google Scholar 

  • Crable, E. L., Lengnick-Hall, R., Stadnick, N. A., Moullin, J. C., & Aarons, G. A. (2022). Where is “policy” in dissemination and implementation science? Recommendations to advance theories, models, and frameworks: EPIS as a case example. Implementation Science, 17(1), 80.

    Article  PubMed  PubMed Central  Google Scholar 

  • Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 1–15.

    Article  Google Scholar 

  • DiGirolamo, A. M., Desai, D., Farmer, D., McLaren, S., Whitmore, A., McKay, D., Fitzgerald, L., Pearson, S., & McGiboney, G. (2021). Results from a statewide school-based mental health program: Effects on school climate. School Psychology Review, 50(1), 81–98.

    Article  Google Scholar 

  • DiLeo, L. L., Suldo, S. M., Ferron, J. M., & Shaunessy-Dedrick, E. (2022). Three-wave longitudinal study of a dual-factor model: Mental health status and academic outcomes for high school students in academically accelerated curricula. School Mental Health, 14, 1–17.

    Article  Google Scholar 

  • Dillman, D. A., Smyth, J. D., & Christian, L. M. (2014). Internet, phone, mail, and mixed-mode surveys: The tailored design method. New York: Wiley.

    Google Scholar 

  • Doll, B., Cummings, J. A., & Chapla, B. A. (2014). Best practices in population-based school mental health services. In P. L. Harrison & A. Thomas (Eds.), Best practices in school psychology. National Association of School Psychologists.

  • Doll, B., Nastasi, B. K., Cornell, L., & Song, S. Y. (2017). School-based mental health services: Definitions and models of effective practice. Journal of Applied School Psychology, 33(3), 179–194.

    Article  Google Scholar 

  • Eccles, M. P., & Mittman, B. S. (2006). Welcome to implementation science. Implementation Science, 1(1), 1–3.

    Article  PubMed Central  Google Scholar 

  • Edwards, L. M., & Sullivan, A. L. (2014). School psychology in rural contexts: Ethical, professional, and legal issues. Journal of Applied School Psychology, 30(3), 254–277.

    Article  Google Scholar 

  • Ehrhart, M. G., Aarons, G. A., & Farahnak, L. R. (2015). Going above and beyond for implementation: The development and validity testing of the Implementation Citizenship Behavior Scale (ICBS). Implementation Science, 10(1), 1–9.

    Article  Google Scholar 

  • Eiraldi, R., Comly, R., Goldstein, J., Khanna, M. S., McCurdy, B. L., Rutherford, L. E., Henson, K., Bevenour, P., Francisco, J., & Jawad, A. F. (2023). Development of an online training platform and implementation strategy for school-based mental health professionals in rural elementary schools: A mixed-methods study. School Mental Health. https://doi.org/10.1007/s12310-023-09582-1

    Article  PubMed  PubMed Central  Google Scholar 

  • Eklund, K., Kilpatrick, K. D., Kilgus, S. P., & Haider, A. (2018). A systematic review of state-level social–emotional learning standards: Implications for practice and research. School Psychology Review, 47(3), 316–326.

    Article  Google Scholar 

  • Finch, T. L., Girling, M., May, C. R., Mair, F. S., Murray, E., Treweek, S., McColl, E., Steen, I. N., Cook, C., Vernazza, C. R., Mackintosh, N., Sharma, S., Barbery, G., Steele, J., & Rapley, T. (2018). Improving the normalization of complex interventions: Part 2-validation of the NoMAD instrument for assessing implementation work based on normalization process theory (NPT). BMC Medical Research Methodology, 18(1), 1–13.

    Article  Google Scholar 

  • Forman, S. G., Shapiro, E. S., Codding, R. S., Gonzales, J. E., Reddy, L. A., Rosenfield, S. A., Sanetti, L. M. H., & Stoiber, K. C. (2013). Implementation science and school psychology. School Psychology Quarterly, 28(2), 77–100.

    Article  PubMed  Google Scholar 

  • Frabutt, J. M., & Speach, G. (2012). Principals’ perspectives on school mental health and wellness in US Catholic elementary schools. School Mental Health, 4(3), 155–169.

    Article  Google Scholar 

  • Garbacz, S. A., Im, S., Young, K., Godfrey, E., Stelter, C., Twombly, T., Deng, X. F., & Albers, C. A. (2022). Promoting youth mental health in rural communities. School Mental Health, 14(4), 863–879. https://doi.org/10.1007/s12310-022-09526-1

    Article  Google Scholar 

  • Goforth, A. N., Farmer, R. L., Kim, S. Y., Naser, S. C., Lockwood, A. B., & Affrunti, N. W. (2021). Status of school psychology in 2020: Part 1, demographics of the NASP membership survey. NASP Research Reports, 5(2), 1–17.

    Google Scholar 

  • Green, J. G., Schneider, S. K., Oblath, R., Miller, M., & Koslouski, J. (2022). Challenges to measuring school provision of mental health programs, practices, and resources. Contemporary School Psychology, 1–10.

  • Hoover, S., & Bostic, J. (2021). Schools as a vital component of the child and adolescent mental health system. Psychiatric Services, 72(1), 37–48.

    Article  PubMed  Google Scholar 

  • Iachini, A. L., Pitner, R. O., Morgan, F., & Rhodes, K. (2016). Exploring the principal perspective: Implications for expanded school improvement and school mental health. Children and Schools, 38(1), 40–48. https://doi.org/10.1093/cs/cdv038

    Article  Google Scholar 

  • Kern, L., Mathur, S. R., Albrecht, S. F., Poland, S., Rozalski, M., & Skiba, R. J. (2017). The need for school-based mental health services and recommendations for implementation. School Mental Health, 9, 205–217.

    Article  Google Scholar 

  • Kern, L., Weist, M. D., Mathur, S. R., & Barber, B. R. (2022). Empowering school staff to implement effective school mental health services. Behavioral Disorders, 47(3), 207–219.

    Article  Google Scholar 

  • Kirchner, J. E., Smith, J. L., Powell, B. J., Waltz, T. J., & Proctor, E. K. (2020). Getting a clinical innovation into practice: An introduction to implementation strategies. Psychiatry Research, 283, 112467.

    Article  PubMed  Google Scholar 

  • Langley, A. K., Nadeem, E., Kataoka, S. H., Stein, B. D., & Jaycox, L. H. (2010). Evidence-based mental health programs in schools: Barriers and facilitators of successful implementation. School Mental Health, 2, 105–113.

    Article  PubMed  PubMed Central  Google Scholar 

  • Leeman, J., Birken, S. A., Powell, B. J., Rohweder, C., & Shea, C. M. (2017). Beyond “implementation strategies”: Classifying the full range of strategies used in implementation science and practice. Implementation Science, 12, 1–9.

    Article  Google Scholar 

  • Lengnick-Hall, R., Willging, C., Hurlburt, M., Fenwick, K., & Aarons, G. A. (2020). Contracting as a bridging factor linking outer and inner contexts during EBP implementation and sustainment: A prospective study across multiple US public sector service systems. Implementation Science, 15, 1–16.

    Article  Google Scholar 

  • Locke, J., Olsen, A., Wideman, R., Downey, M. M., Kretzmann, M., Kasari, C., & Mandell, D. S. (2015). A tangled web: The challenges of implementing an evidence-based social engagement intervention for children with autism in urban public school settings. Behavior Therapy, 46(1), 54–67.

    Article  PubMed  Google Scholar 

  • Locke, J., Lee, K., Cook, C. R., Frederick, L., Vázquez-Colón, C., Ehrhart, M. G., Aarons, G. A., Davis, C., & Lyon, A. R. (2019). Understanding the organizational implementation context of schools: A qualitative study of school district administrators, principals, and teachers. School Mental Health, 11(3), 379–399.

    Article  PubMed  Google Scholar 

  • Lyon, A. R., & Bruns, E. J. (2019). From evidence to impact: Joining our best school mental health practices with our best implementation strategies. School Mental Health, 11(1), 106–114. https://doi.org/10.1007/s12310-018-09306-w

    Article  PubMed  PubMed Central  Google Scholar 

  • Maag, J. E., & Katsiyannis, A. (2010). School-based mental health services: Funding options and issues. Journal of Disability Policy Studies, 21(3), 173–180.

    Article  Google Scholar 

  • Massey, O. T., Vroom, E. B., & Weston, A. N. (2021). Implementation of school-based behavioral health services over time: A longitudinal, multi-level qualitative study. School Mental Health, 13, 201–212.

    Article  Google Scholar 

  • MAXQDA. (2020). MAXQDA, software for data analysis, 1989–2020. Berlin, Germany: VERBI Software.

  • May, C., & Finch, T. (2009). Implementing, embedding, and integrating practices: An outline of normalization process theory. Sociology, 43(3), 535–554. https://doi.org/10.1177/0038038509103208

    Article  Google Scholar 

  • May, C. R., Mair, F., Finch, T., MacFarlane, A., Dowrick, C., Treweek, S., Rapley, T., Ballini, L., Ong, B. N., Rogers, A., Murray, E., Elwyn, G., Légaré, F., Gunn, J., & Montori, V. M. (2009). Development of a theory of implementation and integration: Normalization process theory. Implementation Science, 4(1), 29. https://doi.org/10.1186/1748-5908-4-29

    Article  PubMed  PubMed Central  Google Scholar 

  • McClain, M. B., Shahidullah, J. D., Harris, B., McIntyre, L. L., & Azad, G. (2022). Reconceptualizing educational contexts: The imperative for interprofessional and interagency collaboration in school psychology. School Psychology Review, 51(6), 742–754.

    Article  Google Scholar 

  • McGuier, E. A., Aarons, G. A., Byrne, K. A., Campbell, K. A., Keeshin, B., Rothenberger, S. D., Weingart, L. R., Salas, E., & Kolko, D. J. (2023). Associations between teamwork and implementation outcomes in multidisciplinary cross-sector teams implementing a mental health screening and referral protocol. Implementation Science Communications, 4(1), 13. https://doi.org/10.1186/s43058-023-00393-8

    Article  PubMed  PubMed Central  Google Scholar 

  • McEvoy, R., Ballini, L., Maltoni, S., O’Donnell, C. A., Mair, F. S., & MacFarlane, A. (2014). A qualitative systematic review of studies using the normalization process theory to research implementation processes. Implementation Science, 9(1), 1–13.

    Article  Google Scholar 

  • Moullin, J. C., Dickson, K. S., Stadnick, N. A., Albers, B., Nilsen, P., Broder-Fingert, S., Mukasa, B., & Aarons, G. A. (2020). Ten recommendations for using implementation frameworks in research and practice. Implementation Science Communications, 1(1), 42. https://doi.org/10.1186/s43058-020-00023-7

    Article  PubMed  PubMed Central  Google Scholar 

  • Moullin, J. C., Dickson, K. S., Stadnick, N. A., Rabin, B., & Aarons, G. A. (2019). Systematic review of the exploration, preparation, implementation, sustainment (EPIS) framework. Implementation Science, 14(1), 1. https://doi.org/10.1186/s13012-018-0842-6

    Article  PubMed  PubMed Central  Google Scholar 

  • Nardi, P. M. (2018). Doing survey research: A guide to quantitative methods. Routledge.

    Book  Google Scholar 

  • Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science, 10(53), 1–13. https://doi.org/10.1186/s13012-015-0242

    Article  Google Scholar 

  • Odom, S. L., Hall, L. J., & Suhrheinrich, J. (2020). Implementation science, behavior analysis, and supporting evidence-based practices for individuals with autism. European Journal of Behavior Analysis, 21(1), 55–73.

    Article  PubMed  Google Scholar 

  • Ohrt, J. H., Deaton, J. D., Linich, K., Guest, J. D., Wymer, B., & Sandonato, B. (2020). Teacher training in K–12 student mental health: A systematic review. Psychology in the Schools, 57(5), 833–846. https://doi.org/10.1002/pits.22356

    Article  Google Scholar 

  • Ormiston, H. E., Nygaard, M. A., & Carlock, K. (2023). Examining the implementation of school mental health services: A qualitative analysis of school principals’ perspectives (Manuscript submitted for publication).

  • Ormiston, H. E., Nygaard, M. A., Heck, O. C., Wood, M., Rodriguez, N., Maze, M., Asomani-Adem, A. A., Ingmire, K., Burgess, B., & Shriberg, D. (2021). Educator perspectives on mental health resources and practices in their school. Psychology in the Schools, 58(11), 2148–2174. https://doi.org/10.1002/pits.22582

    Article  Google Scholar 

  • Owens, J. S., Lyon, A. R., Brandt, N. E., Warner, C. M., Nadeem, E., Spiel, C., & Wagner, M. (2014). Implementation science in school mental health: Key constructs in a developing research agenda. School Mental Health, 6(2), 99–111.

    Article  PubMed  Google Scholar 

  • Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Proctor, E. K., & Kirchner, J. E. (2015). A refined compilation of implementation strategies: Results from the expert recommendations for implementing change (ERIC) project. Implementation Science, 10(1), 21. https://doi.org/10.1186/s13012-015-0209-1

    Article  PubMed  PubMed Central  Google Scholar 

  • Qualtrics XM. (2021). The leading experience management software. Qualtrics. https://www.qualtrics.com

  • R Core Team. (2022). R: A Language and Environment for Statistical Computing. Vienna, Austria. Retrieved from https://www.R-project.org/

  • Radaelli, G., & Sitton-Kent, L. (2016). Middle managers and the translation of new ideas in organizations: A review of micro-practices and contingencies. International Journal of Management Reviews, 18(3), 311–332.

    Article  Google Scholar 

  • Raines, J. C. (2018). School-based mental health providers. School Social Work Association of America.

  • Reid, D. B. (2021). US principals’ sensemaking of the future roles and responsibilities of school principals. Educational Management Administration and Leadership, 49(2), 251–267.

    Article  Google Scholar 

  • Reinke, W. M., Stormont, M., Herman, K. C., Puri, R., & Goel, N. (2011). Supporting children’s mental health in schools: Teacher perceptions of needs, roles, and barriers. School Psychology Quarterly, 26(1), 1–13.

    Article  Google Scholar 

  • Richter, A., Sjunnestrand, M., Romare Strandh, M., & Hasson, H. (2022). Implementing school-based mental health services: A scoping review of the literature summarizing the factors that affect implementation. International Journal of Environmental Research and Public Health, 19(6), 3489.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ritchie, J., Lewis, J., Nicholls, C. M., & Ormston, R. (Eds.). (2013). Qualitative research practice: A guide for social science students and researchers (2nd ed.). SAGE.

    Google Scholar 

  • Shapiro, V. B., Ziemer, K. L., Accomazzo, S., & Kim, B. E. (2020). Teachers’ assessment of “implementation leadership” during a new social emotional learning initiative. Contemporary School Psychology, 24, 174–180.

    Article  Google Scholar 

  • Shelton, A. J., & Owens, E. W. (2021). Mental health services in the United States public high schools. Journal of School Health, 91(1), 70–76. https://doi.org/10.1111/josh.12976

    Article  PubMed  Google Scholar 

  • Smith, S. N., Almirall, D., Choi, S. Y., Koschmann, E., Rusch, A., Bilek, E., Lane, A., Abelson, J. L., Eisenberg, D., Himle, J. A., Fitzgerald, K. D., Liebrecht, C., & Kilbourne, A. M. (2022). Primary aim results of a clustered SMART for developing a school-level, adaptive implementation strategy to support CBT delivery at high schools in Michigan. Implementation Science, 17(1), 42. https://doi.org/10.1186/s13012-022-01211-w

    Article  PubMed  PubMed Central  Google Scholar 

  • Snyder, T. D., de Brey, C., & Dillow, S. A. (2019). Digest of Education Statistics 2017 (NCES 2018-070). National Center for Education Statistics, Institute of Education Sciences, U.S. Department of Education. https://nces.ed.gov/programs/digest/d17/index.asp

  • Suhrheinrich, J., Melgarejo, M., Root, B., Aarons, G. A., & Brookman-Frazee, L. (2021). Implementation of school-based services for students with autism: Barriers and facilitators across urban and rural districts and phases of implementation. Autism, 25(8), 2291–2304.

    Article  PubMed  PubMed Central  Google Scholar 

  • Suldo, S. M., Gormley, M. J., DuPaul, G. J., & Anderson-Butcher, D. (2014). The impact of school mental health on student and school-level academic outcomes: Current status of the research and future directions. School Mental Health, 6(2), 84–98.

    Article  Google Scholar 

  • van Vulpen, K. S., Habegar, A., & Simmons, T. (2018). Rural school-based mental health services: Parent perceptions of needs and barriers. Children & Schools, 40(2), 104–111.

    Article  Google Scholar 

  • Villarreal, V., & Castro-Villarreal, F. (2016). Collaboration with community mental health service providers: A necessity in contemporary schools. Intervention in School and Clinic, 52(2), 108–114. https://doi.org/10.1177/1053451216636047

    Article  Google Scholar 

  • Weist, M. D., Mellin, E. A., Chambers, K. L., Lever, N. A., Haber, D., & Blaber, C. (2012). Challenges to collaboration in school mental health and strategies for overcoming them. Journal of School Health, 82(2), 97–105.

    Article  PubMed  Google Scholar 

  • Williams, N. J., Hugh, M. L., Cooney, D. J., Worley, J. A., & Locke, J. (2022). Testing a theory of implementation leadership and climate across autism evidence-based interventions of varying complexity. Behavior Therapy, 53(5), 900–912.

    Article  PubMed  PubMed Central  Google Scholar 

  • Willis, A., Hyde, M., & Black, A. (2019). Juggling with both hands tied behind my back: Teachers’ views and experiences of the tensions between student well-being concerns and academic performance improvement agendas. American Educational Research Journal, 56(6), 2644–2673. https://doi.org/10.3102/0002831219849877

    Article  Google Scholar 

  • Wood, P. (2017). Overcoming the problem of embedding change in educational organizations: A perspective from normalization process theory. Management in Education, 31(1), 33–38.

    Article  Google Scholar 

  • Zhang, Y., Cook, C. R., & Lyon, A. R. (2022). A simple matter of time? School-level analysis of the relationship between time allocation, treatment integrity, and student outcome. School Mental Health, 14(1), 73–87.

    Article  Google Scholar 

Download references

Acknowledgements

The authors have no acknowledgments to report.

Funding

This work was supported by the U.S. Department of Education Mental Health Professional Demonstration Grant #S184X190033.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kane Carlock.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to report.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, [KC], upon reasonable request.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 78 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carlock, K., Nygaard, M.A. & Ormiston, H.E. School Principals’ Perceived Barriers and Facilitators to the Normalization of School-Based Mental Health Services: A Multimethod Investigation. School Mental Health 15, 940–954 (2023). https://doi.org/10.1007/s12310-023-09597-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12310-023-09597-8

Keywords

Navigation