All posts by: janinefischer

Who Would Have Guessed That Research Methods Would Get Me All Excited?

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Weist, M. D., Youngstrom, E. a, Stephan, S., Lever, N., Fowler, J., Taylor, L., … Hoagwood, K. (2014). Challenges and ideas from a research program on high-quality, evidence-based practice in school mental health. Journal of Clinical Child and Adolescent Psychology, 43(2), 244–55. doi:10.1080/15374416.2013.833097

 

Two weeks ago I wrote about a study completed on school mental health (SMH) in two schools in Baltimore, MD. That study was conducted by Mark D. Weist, who I’m learning is THE man for SMH theory and practices. He has his hands in just about everything I come across. This week I took a look at another study he recently published, “Challenges and Ideas From a Research Program on High-Quality, Evidence-Based Practice in School Mental Health” (Weist et al., 2014).

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In this study, Weist, et al. (2014) discuss their findings from two separate research projects funded by the National Institute of Health. Well… they sort of discuss their results. They give some information about what the studies found, but this article is really more about the process of collecting and analyzing the data. (I am already seeing my brain change… If you had told me 6 weeks ago that I would get so excited when I came across clarifying research methods, I would have thought you were crazy!)

Ultimately, they determined that some of the same things are always a problem for program pilots: practitioners trying to learn too much in too short a time and not enough follow-up coaching to carry out the skills with fidelity. In the past, they relied on manuals provided to each clinician. These manuals were nice because they covered many areas, but there were  “concerns about their perceived ‘one size fits all’ approach, and associated concerns about the rigid need for adherence in spite of changing presentations in students and their circumstances” (Weist et al., 2014). This time, they attempted modular evidence-based practices, which allow for more flexible training opportunities in the specified areas. These were somewhat successful, but there were SO. MANY. To get through that the participants often felt overwhelmed with the requirements. The researchers also met some of the concerns last time, such as, “competing responsibilities (of clinicians), lack of support from school administration and teachers, lack of family engagement, (and) student absenteeism (Weist et al., 2014, p. 253).

They also ran into difficulty with their statistical models. I’m in the middle of my statistics class, so I wasn’t able to understand all the problems they mentioned, but I definitely understood the things they mentioned as problematic. Anytime there was a change in a practitioner or family leaving, it messed things up statistically (as well as in the children’s lives, I imagine). They ran into difficulties of statistical power (because it was an inherently small sample size), reliability, missing data and even what type of analysis they were doing.

At this point I have read a lot of articles with Dr. Weist’s involvement. I don’t know if it’s really his doing or not, but I am consistently pleased with the way these articles are set up. He uses a lot of headings and subheadings that make it easy to follow and find information I read earlier. I have also really appreciated the apparently high level of transparency in his writing. He is explicitly up-front with the funding sources for the projects; they aren’t just hidden in the fine print or buried on the title page. That information is in the body of the introduction and he explains his own ties to SMH. Given that he is so closely involved with so many SMH projects, I am really impressed with his transparency about what has gone well and what has not. I’m sure there are ethical rules about these sorts of things, but I feel like I come across studies periodically in which I don’t really trust the findings because I don’t think they’re giving all the information. For these SMH articles, though, I do. They are very honest with the things that haven’t worked, and their problems tend to match the problems I have met implementing other programs.

One last thing I enjoyed about this particular article was that the two studies mentioned were both Randomized Control Trials. I have read a few other articles that use this method, but it’s hard to carry out in a school setting with real students. How do you say to one family, “Sorry; you are still in the study but you don’t actually get help for your kid.” Who would sign up for that? Also, would it actually pass an IRB committee? (An IRB is an Institutional Review Board, which acts as an ethics committee for all biomedical and behavior research completed on humans.) In this case, though, they were able to give Personal Wellness training to the control group. So even though they weren’t specifically addressing mental health, they were not just leaving the kids to fend for themselves. The other problem with randomization they addressed was how to set up the randomized parts. Rather than randomize the students (you can’t make a kid go to a different school just because they are in the control group), they randomized the clinicians. Brilliant!

The only mildly annoying thing was the amount of acronyms. We have a lot in special education, so I recognize how helpful they are to people who use them a lot. But it was a little tedious at first to have to keep checking what various ones stood for. I ended up making a list on a note I kept to the side while reading. This helped and by the end I was hardly looking at it. So it was a little annoying at first, but not overbearing and I’m not sure that I would recommend spelling the words out, as they were used  A LOT (and that would be annoying, too!).

This article was a little different than the others ones I’ve posted about because it wasn’t as focused on the findings as it was the process. I have thought more about my action research and how I will actually be able to put something into place. Obviously it won’t be on this scale. But I am considering using some of the methods discussed in this article. Will randomized control trials be an option? I’m not sure, but before reading this I hadn’t even considered them. The authors reference a tension I am just starting to think about myself:

Is the primary “participant” the clinician or the students? From a policy and public health standpoint, student-level outcomes are imperative. However, the intervention of interest manipulates the training and support for clinicians, and our hypotheses emphasize effects on clinicians’ attitudes, knowledge, and behavior. (Weist et al., 2014, p. 249)

Finally, they referenced a questionnaire they used to help measure participants’ attitudes toward, understanding of, and implementation of SMH. Specifically, they used the School Mental Health Quality Assessment Questionnaire (SMHQAQ; (Weist, Stephan, Lever, Moore, & Lewis, 2006). While I don’t think this particular questionnaire will be helpful yet (there needs to be at least a semblance of SMH in order for answers to be helpful), it did give me some ideas for other types of questionnaires I can look for, or create myself if necessary.

 

 

Weist, M. D., Stephan, S., Lever, N., Moore, E., & Lewis, K. (2006). School Mental Health Quality Assessment Questionnaire. Baltimore: Center for School Mental Health Analysis and Action.

Weist, M. D., Youngstrom, E. a, Stephan, S., Lever, N., Fowler, J., Taylor, L., … Hoagwood, K. (2014). Challenges and ideas from a research program on high-quality, evidence-based practice in school mental health. Journal of Clinical Child and Adolescent Psychology, 43(2), 244–55. doi:10.1080/15374416.2013.833097

Not So Easy To Do In Real Life

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It’s the age-old question: “Should we track them or should we mix them?” (Pivovarova, 2014). Usually, this question pertains to student placement in classrooms, especially in regards to academic achievement levels. For me, this is both a philosophical question and a real life one.

Philosophically, I believe mixing kids is a good thing. I agree that higher student models are necessary for lower kids, and sometimes peers are able to explain things in a way that makes more sense. I also try to remember that students are more than just their academic abilities. They bring so many more things to the table! They have artistic talent, leadership skills, social know-how, persistence, calmness… We need students with all these skills in a classroom so that they can all be models and can learn from one another. We would never dream of putting all the “leaders” in one class and the “followers” in another – no one would want to be in either room!

But in life, it is much harder to make heterogeneous classes happen. To start, in Arizona, English Language Learners (ELL) students are put in a separate ELD (English Language Development) class depending on their score on the ELL test. No English-only students are placed in an ELD class, so these kids are essentially tracked. (They are usually lower academically, because they are still learning the language.)

Then there are the gifted kids. My district changed the way it enriches gifted students a couple of years ago. They used to be mixed throughout all the classes, and the gifted teacher pulled them out once or twice a week. Now each grade level has a class with all the gifted kids. This, too, creates tracks, because they tend to do well academically (even though gifted does not necessarily mean high academics).

And then there are all the other kids in the middle. They’re not gifted and they only speak English. They have to be divided up among the rest of the teachers. When we create class lists each year, we try to even out the number of boys vs. girls, the number of students with special education, the number of well-behaved students with the ones who have more trouble. But it’s hard when the classes are already half-determined!

In my school, they have utilized both models as best they can in the younger grades. Classes are, as much as possible, heterogeneous. This allows for mixed groups, differentiated instruction, and hopefully lots of peer modeling. But for 45-60 minutes a day, all the kids at a certain grade level (say, 2nd grade) are mixed up and move to homogeneous groups during part of their reading block. The kids who are above grade level get extension activities, and the below grade level ones can focus on the parts of reading that are hardest. It has worked pretty well at my school, and helps to off-set some of the drawbacks to heterogeneous classes.

In her article, Pivovarova (2014) found that “peer group composition matters.” She compared low, marginal, average and high students. She found that all groups benefit from being placed with high students, and low students generally didn’t impact the other groups (aside from bringing down marginal learners). She also found that all groups did better when placed with others of their own level. As I mentioned earlier, this philosophically makes sense to me. For her research, though, Pivovarova (2014) only examined academic ability as measured by a specific test. I would love to see something like this completed for other qualities, like leadership or social skills or behavior. I think that if we focused on improving other areas, like the ability to get along in groups or problem-solve in real-time, academic achievement would ultimately go up, too.

 

Pivovarova, M. (2014). Should We Track or Should We Mix Them? Mary Lou Fulton

Teachers College. Tempe: Arizona State University.

The Trajectory of Mental Health Services

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Tegethoff, M., Stalujanis, E., Belardi, A., & Meinlschmidt, G. (2014). School Mental Health Services: Signpost for Out-of-School Service Utilization in Adolescents with Mental Disorders? A Nationally Representative United States Cohort. PloS One, 9(6), e99675. doi:10.1371/journal.pone.0099675

 

This article, “School Mental Health Services: Signpost for Out-of-School Service Utilization in Adolescents with Mental Disorders? A Nationally Representative United States Cohort”, looked at how school mental health service providers, such as school psychologists, serve as a guide to out-of-school medical or mental health providers (Tegethoff, Stalujanis, Belardi, & Meinlschmidt, 2014). They used data collected from the National Comorbidity Survey Replication Adolescent Supplement (NCS- A), which is an incredibly in-depth study of children and adolescents with mental illnesses completed between 2001 and 2004. The NCS-A study included data from interviews with the child/adolescent, rating forms completed by the child/adolescent and a parent/guardian, and detailed demographic information. This data is available for other researchers to use to complete their own research. For this study, lots and lots of statistical analyses were used by the authors on the data collected in the NCS-A study order to make their final conclusions.  Overall, the researchers found that school-based mental health services due typically guide families to out-of-school medical service providers, such as pediatricians or emergency rooms. Less often, school-based mental health services guide families to mental health specialists, such as psychiatrists or outpatient mental health clinics.

What was interesting to me, and what I’m still having a hard time understanding, was the “hazard ratios” computed by the researchers. I was able to learn that a hazard ratio is a statistical analysis that tells the amount of time between Situation A and Situation B happening. The statistical analysis did not necessarily look at whether or not (for example) school psychologists encouraged parents to go to the pediatrician or psychiatrist, but how long it took before the family sought those services. (At least, I think that’s what it was saying!) Also, despite my cursory knowledge of statistics and research on hazard ratios, I was unable to understand what a hazard ratio (HR) of 1.17 or 3.15 really meant. I did figure out that HR=3.15 takes about 3 times longer than HR= 1.17, but I can’t turn that into raw numbers. (I mean… three times longer than what? What does 1 equal? A week? A month? Some theoretical amount of time that is never really determined? Argh!)  The article doesn’t really explain it, though it may be because their usual audience would already know.

The authors organized the article in an easy-to-read format, and I really appreciated that the tables were embedded into the article instead of attached as appendices. I think it just makes it a lot easier to read that way. I enjoyed how they used end notes and not parentheticals, too – I know it’s just a personal preference (and I have made my peace with APA style, since that’s the preferred format for educational research), but I do think end notes allow for more fluid reading. There was not a specific literature review included, though the authors did reference many studies previously conducted to support their reasons and findings along the way.

Some of the data reported in the tables was interesting, but I’m not sure how necessary or useful it was. For example, I found it really interesting to see that nearly 50% of the children and adolescents in the total sample cited 3 or more siblings, and that over 35% of the total sample were first-borns. Though I am not a fan of birth-order theories, I had a mental jaunt about this. Does a bigger family simply increase your chances of at least one child having a mental illness? Are first-borns more susceptible to mental illness? Or is it just that parents need more support recognizing mental illness in their first-born, and are more likely to seek outside services for later children without the school initially intervening? Interesting questions – right?? Well, they are to me. But even though this information is given in the article, it was not referenced anywhere in the text. I’m a fan of visuals, but only when the pertinent information is provided and explained within the article. Otherwise, it just appears to be fluff and can overwhelm the reader.

According to the article, “this is the first comprehensive study of the role of the school mental health sector as a guide to mental health care in out-of-school sectors” (Tegethoff, Stalujanis, Belardi, & Meinlschmidt, 20149, p. 6). It did not explore whether school mental health providers caused students to seek outside mental health support, but did look for a temporal relationship (i.e. that the school-based referral came before seeking outside help). The next step would be to look at causality. The authors note that this will be really difficult to do, though, because of the size of the sample needed to make it representative of the entire population.

In some ways, I was pretty bummed to realize this article didn’t explore causality. I mean – was this really necessary to prove? Did anyone NOT think the school-based referrals came first?? But then I remembered one of the basic tenets of research the way it exists in the world: if it hasn’t been proven, then it can’t be used to support your theory. I also thought about how a handful of my students who I don’t realize have any mental illnesses until their psychiatrist sends a script requesting testing or a 504 Plan. So there are times that the school is not the first one to find a problem.

Additionally, even though this information cannot be used to show causality, it did have interesting findings. It implies that school psychologists and other school-based mental health professionals are doing well at referring to pediatricians and emergency rooms, but less well at connecting directly with community-based mental health service providers such as psychiatrists and therapists. I would say I find that to be true in my district. We (school psychologists) shy away from making recommendations about medical diagnoses because we are not doctors. I think it’s because of this that we are also wary of sending parents to mental health providers and instead suggest they check our results with their primary care physician first. And when we have a child in extreme crisis, we tend to recommend the emergency room to families and not the psych ward. I’m not sure how much is due to our desire to be “PC,” how much is due to a hesitancy to suggest medical diagnoses, and how much is pragmatically due to insurance requirements (i.e. many insurances need a formal referral from a primary care physician before paying for specialist services like a psychiatrist).

As I’ve mentioned before, I would love to see school-based mental health service providers working together with medical professionals. I would love to have wrap-around services provided within the school, including access to fully licensed psychiatrists and therapists. I think school psychologists have more training and expertise than we sometimes give ourselves credit for, and I want us to be part of a system that supports us using that expertise. This article helps clarify where we  land in the overall mental health trajectory for students, and I think it can speak to what our next steps should be (better awareness and better connections with outside providers).

Finally, on a completely separate note, I have recently read many articles about “outsiders” doing research on a particular culture or society, and how that framework is inappropriate. I have struggled to really understand the problem with it, because the “outsiders” have primarily been people who I identify with. But this study was completed by Swiss and German researchers on U.S. children and adolescents. Why? Why wouldn’t they study their own countries’ mental health trajectories (especially since they probably have a very different medical system than the U.S., so results would not be generalized to their countries)? Why wouldn’t U.S. researchers have been the ones to spearhead this study, or at least be involved?? Overall, I don’t see anything in the results that seems like they would be tainted by the nationality of the researchers, but I still questioned why. Ah… perhaps this is a small example of what those indigenous cultures have experienced!

Uncertainties at Camp

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This week I am blogging from Prescott, Arizona: land of cool breezes, tall pines, and intermittent wireless. Each year I have the amazing opportunity to act as dean for the 3rd through 6th graders at our church’s week-long camp. It is so much fun to see these desert kids experience squirrels and stars and nature for the first time. One of the biggest things I run into each year is helping kids learn how to work together. (And, yes, I am thankful when this is the biggest problem!) The kids aren’t used to solving problems on their own, or having to work with people they don’t know very well – especially when there isn’t a teacher walking around to guide every step. It is really fun to watch them realize that there are a lot of ways to solve problems. Sometimes there’s not a “right” or “wrong” way – they just need to find a solution.

So reading Jordan’s and McDaniels’s (2014) “Managing Uncertainty During Collaborative Problem Solving in Elementary School Teams : The Role of Peer Influence in Robotics Engineering Activity” was really timely!

In this article, Jordan and McDaniel explore how students display, react to, and resolve uncertainty in themselves and others, especially in situations where there aren’t right/wrong answers. They defined uncertainty as any time a student expressed doubt, was unsure of something, or wondered about something. They specifically watched how students express uncertainty to their peers, rather than to a teacher. They found that there tended to be two types of uncertainty: “content uncertainty (pertaining to the problem to be solved) and relational uncertainty (pertaining to interactional challenges and opportunities, including issues of identity related to one’s self and one’s partners)” (Jordan & Mcdaniel, 2014, p. 8).

In cataloging peer responses, Jordan and McDonald found that peers tended to respond in either a supportive or unsupportive way. When peers acknowledged their own uncertainties about the same question or were able to answer the question, it was considered supportive. Other times, peers made fun of the student expressing uncertainty or ignored the question. These were considered unsupportive, which makes sense!
With this in mind, I have been observing how students solve problems at camp. Sometimes these occur during group activities led by a leader. More often than not, though, I hear social uncertainties happening during unstructured times (i.e. free time, meals, etc).
One of the greatest parts of camp is trying new things and making new friends. But for kiddos who have difficulty building relationships, it’s often one of the most troubling parts. Every year there are students like Charlie* and Luis – best friends since forever. Another student, Mark, is also in their group. He is new to church and has really hit it off with Charlie. Yay! Except that Luis doesn’t make friends as easily, and has trouble handling more than one friend at a time. He is very uncertain as to his place in this new relationship dynamic. At times, he expresses himself quite plainly. He asks Charlie if they are still friends, or says to Mark, “I don’t like it that you’re at camp; you stole my best friend.” Inappropriate? Probably. But a pretty clear indication that he is uncertain of his part in the dynamic!

Other times it seems to be more subtle. Luis acts out more than usual, or he says passive aggressive things against Charlie and Mark during group discussions. Less direct, but as I considered “uncertainties,” it seems just as clear to me.

Keeping this idea in mind has helped me to better respond to these group dynamics. There are times that Mark and Charlie are actually really supportive – they want Luis to hang out with them (Luis just has a hard time with two people). Other times, especially as we move later into the week, they are getting more annoyed so their responses are less supportive. They are ignoring Luis or responding with unkind words.

I have found it helpful to reinforce their supportive responses when I hear them. And when I hear their not-so-supportive responses, I can suggest other ways they could be more kind. I have also been able to help identify with Luis why he might be acting this way. Not because he’s mad at Charlie, but because he’s just not sure what this means for his and Charlie’s friendship after camp. When I asked if that might be part of it, his eyes lit up and I could almost see the lightbulb go off. It opened a whole new conversation, and has really helped him in times of subsequent uncertainty.

At the end of their article, Jordan and McDaniel suggest some next steps to consider, and they were right in line with my questions as I was reading. I wondered if anyone has ever tried to specifically teach kids how to express and recognize uncertainties or how to handle it when they recognize it in someone else. It sounds like there have been some studies looking at individual pieces, but there hasn’t been one to see if teaching the whole “big picture” would be helpful in the long run.

In the short term, though, even just helping Luis recognize it is starting to help his relationship with Charlie and Mark!

*Names have been changed

Jordan, M. E., & Mcdaniel, R. R. (2014). Managing Uncertainty During Collaborative Problem Solving in Elementary School Teams : The Role of Peer Influence in Robotics Engineering Activity. The Journal of the Learning Sciences, 00(2002), 1–47.

Cue the Zoom on Baltimore

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Weist, M. D., Stiegler, K., Cox, J., Vaughan, C., Lindsey, M., & Ialongo, N. (2010). The Excellence in School Mental Health Initiative: Final Report (pp. 1–41).

 

Last week I looked at School Mental Health procedures in Australia. I was really jazzed to learn that the sort-of unformed ideas floating around in my head for the last year a) was already fleshed out and b) ACTUALLY EXISTED. And they have for over a decade! But I wanted to do more research about how we are addressing School Mental Health a little closer to home. Preliminary research suggested that Maryland is the place to be for this sort of thing, so that’s where I looked. If we were on YouTube, this is where we’d zoom out of Phoenix and pan over to the East Coast. Cue the Zoom on Baltimore:

In this report, completed by the University of Maryland, Center for School Mental Health, the authors reviewed data collected over two and a half years as two specific schools implemented the Excellence in School Mental Health Initiative (ESMHI). According to the report, “The overall goal of the project was to demonstrate the potential for a full continuum of environmental enhancement, stakeholder involvement and evidence-based mental health promotion and intervention integrated into two schools serving students in grades Kindergarten through 8th grade” (Weist et al., 2010).

I realize reading that might invoke a little of what I experienced earlier this week. Are you thinking, “Um, what? I think I know all of those words, but I when I read that sentence they just kind of glide right under me …” Here’s a picture that might help from (of course!) our friends over at MindMatters in Australia:

The Excellence in School Mental Health Initiative involved programs and staff to support all levels of the triangle:

  • They developed and ran parent groups to improve parent involvement and relationships with teachers
  • They implemented Paths to PAX, a universal/school-wide prevention program
  • They provided professional development to teachers to improve understanding of mental and behavioral health
  • They provided small group interventions for students struggling with behaviors, also known as “early intervention strategies”
  • And mental health clinicians held individual/group therapy sessions with students.

Many schools around the country have parts of this triangle in place, but it is rather rare to see the entire continuum fully supported. The purpose of the project was to find how well all these pieces fit together when they were all in place, including things like the parent involvement. The authors specifically noted that this study could not be used to make causal conclusions (i.e. saying that if your school does these things, it will get the same results), but could be used to make recommendations for the future or for other schools. The authors used descriptive, qualitative and quantitative data to both create and evaluate the initiative. This included a variety of demographic and school data, such as enrollment, attendance, discipline, etc.; surveys and interviews with students, staff, parents, and community members; treatment data collected by mental health providers; case studies; and focus groups.

The authors found that there were many gains, including better parent-school relationships, students receiving more mental health care, and improved teaching strategies in regards to behavior in the classrooms. They also found that while there are many reasons  to give mental health care within the school setting, there are a lot of things that can get in the way. Things like high teacher turnover rates, teachers being overwhelmed with everything else they are expected to do, and variable support from administration all impact the implementation and effectiveness of such programs. BUT!!! They did find that having significant supports – like great funding (described below), buy-in from higher levels, and University support – made it possible to face challenges head-on and overcome many barriers.

I was simultaneously disappointed and pleased with the results. This initiative had funding from a lot of different places, including the City of Baltimore, the University of Maryland, the Baltimore School District, and several public and private organizations. It seems like it would be a dream! But even with all that they ran into many of the same problems I have experienced in trying to carry out different layers of the triangle above. For example, I’ve been at a few schools that buy new programs to address the widest level of the triangle (Whole School Environment). Everyone is gung-ho for the first few weeks, but implementation falls off after a month or two. I would have thought that with so many resources and support staff promoting this initiative for 2.5 years, there would have been more buy-in and compliance from staff. But in reality, they dealt with the same problems I have seen, and for the same reasons: too many other things to focus on, too overwhelmed, high teacher mobility, lack of administrative support, and the program not meeting perceived expectations. While this was disappointing, it was also refreshing to know that simply implementing a new program or jumping on the next bandwagon of a particular intervention is not going to change the school culture. To really make a lasting impact on the school culture, it needs to happen slowly and over a long time.

I did have more criticisms of this report than I did last week’s. For the most part, the report was well-written and easy to follow. They used language that was easy for someone in the educational field to understand, and they gave so much data to support their conclusions. The difficulty was that there was So. Much. Data! And it was all in paragraph form, which meant it was nearly impossible to really get a good handle on it. They were using data from 2 schools and gave in-depth analysis of each type of data from each school. If it had been presented with visuals, like graphs and charts, it would have been so much easier to grasp. Throughout the report they did reference graphs and charts in the appendices… but there weren’t actually any appendices at the end. And the Appendices link provided in the Table of Contents was no longer active. I think I would have been better able to make connections to my own school if I could have seen the data differently.

As I am collecting these articles and reports, I am building this dream world in my head. I want these things in Phoenix, in Arizona. I want to be a part of building them, of making them actually happen. I want to see students in their classrooms more because they’re getting in trouble less. I want to see students that have a better quality of life because they understand what to do in the classroom or in social situations and they have the skills to do it. I want to see teachers who are less depressed and stressed out. I want to be in classrooms where teachers are able to focus on the things that made them want to be a teacher, not all the extraneous junk that keeps getting piled on their plates. (OK, mental health initiatives probably won’t actually affect that, but hey – it’s my dream world, I can make it look however I want!)

I really do want to see some of these initiatives in play, though, to see what they look like when they’re actually happening. Does it look, feel, and sound like any other school? Are culture changes only noticeable if you’re an insider, privy to all the inner-workings of a school? Or is it tangible? Noticeable to everyone who walks in? Do students and teachers enjoy being there because of the positive atmosphere? Or is it still a school, where kids complain about homework and teachers count down the days to summer break? I don’t have the answer yet, but I am doing what I can to find out!

Weist, M. D., Stiegler, K., Cox, J., Vaughan, C., Lindsey, M., & Ialongo, N. (2010). The Excellence in School Mental Health Initiative: Final Report (pp. 1–41).

It’s like learning a whole new language.

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It’s only when we have really mastered something that we can make it more accessible to others.

A big part of my job as a school psychologist is to explain test results to parents. It’s really important to me that they understand my results – how the information fits with what they already know about their child and how we can use the information to make school better for them.

And every time I get an intern, their first report looks something like this, “The Fluid-Crystallized Index (FCI), measures general intellectual ability, including both fluid and crystallized intelligence.  The FCI is obtained by combining the Sequential Index, the Simultaneous Index, the Learning Index, the Planning Index, and the Knowledge Index, and is considered the best measure of cognitive ability……

WHAT??? What does that even mean???

WHAT??? What does that even mean???

I know why this happens: at the beginning of the year interns don’t really understand what they’re saying, so they parrot what the professor or test-maker says. But by the end of the year, it starts to make more sense. They are able to make connections between the theory they’ve been taught and the real-life child sitting in front of them, and so they are able to use words that normal people actually understand.

It’s only when we have really mastered something that we can make it more accessible to others.

The articles and journals and book chapters I read last week knocked me on my butt. For one reading, I was on google every three minutes looking up words and phrases that I had never heard. Or I’d heard the words, but never together in that phrase. Or I’ve heard the phrase a hundred times and have always gotten by on just having a general understanding of it – but now I need to really grasp it to deepen my understanding of other concepts. Literally, I am not exaggerating – every three minutes.

It sucked.

I read several chapters from the Handbook of Critical and Indigenous Methodologies (Denzin, Lincoln & Smith, 2010), which explores ideas such as localized critical indigenous theory and critical indigenous pedagogy. (Click on the links. You’ll enjoy it.) Essentially, they make the case that non-indigenous peoples (i.e. white/Eurocentric scientists) should not be the ones researching indigenous peoples (people groups native to a land, such as Native Americans in the Americas or the Māori people in New Zealand). To explain, I will use the word “We” in place of “non-indigenous peoples”, because of all the people groups described in the book, that is the one with which I most closely identify.

When We go into a place to do research, complete anthropological studies, or collect information to better understand a people group, We are really imposing Our own thoughts and ideas on Their culture. They already understand Their culture, but We don’t accept that. We want to find things for Ourselves, and then let The Rest of the World know what We learned. Linda Tuhiwai Smith, a professor of indigenous education at the University of Waikato in Hamilton, New Zealand, is the leading expert in this field. She purports that They should be allowed to do Their own research within Their cultural norms and bounds, and the research should not necessarily satisfy the rules Our scientific method has put in place.

Smith and other experts in this field suggest several structures that would identify cultural and critical pedagogy, which they explain in the book. But I found a buried line from the critics that spoke to my soul, “Working class educators criticized the theory because they felt its language was elitist and created a new form of oppression.” (Denzin & Lincoln, 2010)

YES!!!!!

This is my frustration with peer-reviewed research and generally with people in graduate school (especially those in doctoral programs). We can be annoying when we talk to non-doctoral people. We are just starting to learn about these amazing new theories and ideas that are blowing our minds. We want to share them with the world, but we don’t actually understand them yet, not in a way that we can internalize what they mean and explain them in a way that general society can understand. So we parrot what the professor says, or what we read in books, or what that really cool blog said. We may sound smart to some people, but in real life most are just tuning us out.

I have condescendingly called it “Drinking the Doctoral Kool-Aid,” and I have vowed not to do it.

But now I question my resolve. Language is truly acquired when we use it with understanding. I would never expect a child to wait until they could speak in full, understandable sentences before they talked to other people. And I would never expect someone practicing a second language to wait until they had fully mastered it before trying it out. In fact, it would be just the opposite – I applaud and praise their attempts, even when incorrect or incomplete. The only way they will learn and truly internalize this new language is by using it. Perhaps the same is true of doctoral students. We’re learning a new language, and we need to practice it. I give grace to my interns practicing their new language… perhaps I need to offer myself the same grace.

But I do still think that – at the end of the day, after we have mastered the concepts and the new language – we need to take it back down a notch. Research and innovations don’t create Access or Equity if they require rapid-fire google skills.

 

Denzin, N. K.,  Lincoln, Y. S., & Smith, L.T. (2010). Handbook of Critical and Indigenous Methodologies.  Los Angeles: Sage.

Denzin, N. K., & Lincoln, Y. S. (2010). Handbook of Critical and Indigenous Methodologies. In N. K. Denzin, Y. S. Lincoln, & L. T. Smith (Eds.), Critical Methodologies and Indigenous Inquiry (2nd ed., pp. 1–20). Los Angeles: Sage.

Turns Out Mental Health IS a World-Wide Issue

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Rowling, L. (2009). Strengthening “school” in school mental health promotion. Health Education, 109(4), 357–368.

Apparently Australia has been nationally focusing on improving mental health via schools since the early 2000’s. They have been implementing a program called MindMatters at their secondary level to improve mental health in a variety of ways. I was shocked – how have I never heard of this before??? It’s been going on for well over a decade, and Aussie Rules football is my favorite sport! You’d think I’d have stumbled across MindMatters at some point or another. Ah, well, chalk it up to not googling “school mental health in Australia,” I suppose.

Aussie Rules!!!

Aussie Rules!!!

In this article by Louise Rowling from the University of Sydney, she reviews nearly 10 years’ worth of research and writing collected since MindMatters began, and offers some suggestions on how to make even more progress. Her conclusion? They need to strengthen the “school” part of school mental health promotion.

As I mentioned before, I had never heard of MindMatters. I obviously did a quick little Google search when I began the article, but it was actually unnecessary. Rowling really does a great job of defining what MindMatters is and why it is important. She references that MindMatters is a federally funded program which incorporates a variety of strategies to promote mental health, including “mentoring, peer support programs, pastoral care practices and structures and with specifically designated teacher roles, as well as the provision of specialist educational personnel” (Rowling, p. 3, 2009) . Rowling also finds that these strategies are best implemented within the scope of a “whole school” approach. The whole-school approach means mental health is a holistic model promoted across grade levels and subject areas. It involves everyone, including administration, teachers, support staff, students, parents, and community members as active participants, and everyone is working cohesively to meet the same goal. It makes sense that this would be the best way to go!

But Rowling also describes key areas of concern, such as the tension between the educational and medical systems. Both want to achieve the same outcome, but not in the same way, and they use different data, language, and methods from one another. When these two entities come alongside each other to promote mental health in the same setting (schools), it sometimes gets wonky. It can result in parallel systems in which both agencies are working separately toward the same goal. Obviously this isn’t efficient, but it also leads to people stepping on one another’s toes – which I presume leads to hurt feelings, frustrated workers, and an eventual decline in their own mental health – which then leads to a decline for students as well. Rowling suggests that the best way to improve the efficiency and effectiveness of MindMatters is to use structures that the school already has in place. Since the educational system is hosting the medical system, the medical system should generally conform to the way the educational system is set up. Kind of like when we went to Grandma’s growing up and had to follow her rules during dinner.

Only Grandma puts out a white tablecloth when gravy is involved…

Only Grandma puts out a white tablecloth when gravy is involved…

Rowling also makes other suggestions to improve MindMatters, based on the schools that have implemented it well. She talks about supporting “distributed” leadership, meaning supporting principals as well as leaders at other levels within the school. She also found that better professional development led to better implementation of the programs. She suggests that when teachers do not have the training and resources to effectively implement and utilize strategies, they end up feeling overwhelmed and frustrated, which leads to low morale. (Hmmm… sound familiar at all?) Lister-Brown, et al, noted, “Staff who feel unsupported and under pressure are more likely to use dis-empowering methods of control such as shouting or humiliation in the classroom” (2010) . Which then goes back to ultimately decreased mental health for everyone!

The only real critique I had of this article was that it sometimes was difficult to read. The sentence structure and length, paired with fewer commas than I’m used to, meant I had to stop and read a few lines aloud (slowly… several times…) before I understood what Rowling was saying. But I imagine that is due to the tricky Australian-American language barrier, or possibly the fact that it’s been a few years since I’ve really read scholarly articles.

I loved reading this because it opened my eyes to the reality that the world is not just America. (Wait, it’s not???) I had wanted to eventually study what other countries were doing in the realm of school mental health, but imagined their models would be so different from the US model that it would be hard to draw parallels. Not so! It looks like Australia’s system is right alongside the few good school mental health systems in America (e.g. Maryland). Rowling also mentioned several other systems in this article, such as British Columbia, Great Britain and Germany, and I want to explore them, too. I am excited to know that school mental health is important to others and that there is a solid body of research out there. The idea of trying to implement some of these systemic changes in Arizona is really overwhelming, but MindMatters reinforced to me how incredibly important it is. Mental health and its corresponding illness impacts all of us, whether directly, in loved ones, or in the affects it has on society. By improving the microcosm of schools we can improve students’ (and staffs’) well-being, which can ultimately lead to an improved society. Overwhelming aside – how can we not pursue that?

Best, R., Lang, P., Lodge, C. and Watkins, C. (Eds) (1995), Pastoral Care and PSE: Entitlement and Provision, Cassell, London.
Rowling, L. (2009). Strengthening “school” in school mental health promotion. Health Education, 109(4), 357–368.

Rolling my eyes at Oppression?

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I’ll be honest: When I start to read about oppression of a particular culture – whether it is race, ethnicity, gender, religion, socioeconomic status, disability, sexuality – my immediate response is typically a roll of my eyes. I am white, middle-class, and heterosexual, which often puts me in the role of the “Oppressor”. But I am also a woman and I have a mild disability, which puts me in the role of the “Oppressed”. And I do not feel like I am either of those things. In my daily life, I do what I can to legitimize others’ feelings, and I think others I encounter do the same thing.  So often my first reaction when reading articles or blogs about a particularly oppressed group is to roll my eyes because it’s not something I encounter personally.

As I read through these articles, journals, and books, though, I found myself starting to shift my paradigm. I am a school psychologist so I actually see some forms of oppression on a pretty regular basis. It’s my job to advocate for children with disabilities; not just to make sure they get the special services they need, but also to take their perspective and share it with the adults in their lives. Frequently, this happens after a student has gotten in trouble for something. I process with them and get to hear their side of the story. Even when they have a really skewed perception of what happened, I help legitimize it to others.

For example, a few years ago I was working with a 5th grader, “Rob”, who had a fairly mild form of autism. He was academically gifted and verbally bright, but really struggled with social skills and coping strategies. On one occasion, he was in trouble because he got into an argument with another student, “Phil”. In processing with Rob, I realized he felt Phil had been picking on him. Phil had said something three or four days earlier in a joking way, and Rob had been stewing about it since. He finally couldn’t take it anymore and said some really nasty things to Phil. To all the witnesses, it looked like an unprovoked attack. But because I was able to get Rob’s side of the story I was able to be his advocate with administration. He obviously handled the situation poorly, but at least the principal understood  it wasn’t completely unprovoked and was also able to follow up with Phil.

Often it isn’t just what happened that is important, but the person’s perception of what happened. I may not feel like I encounter or participate in oppression, but if someone else feels it, then it is real.

As I was reading these pieces I realized: when I rolled my eyes and scoffed, I was becoming the Oppressor. I was becoming the one who wasn’t listening, who was delegitimizing another person’s point of view. That’s not who I am! So I started to read as a psychologist, as someone who not only fights against oppression but more importantly fights for the person hiding underneath.

In Medicine Stories (Morales, 1998), the author talks about restoring global context to history. She encourages the reader to think about what was happening in the entire world during a particular time, not just what was happening in Europe. Last summer, I was enthralled with a YouTube channel, Crash Course: World History, hosted by John Green. In several episodes, John Green steps outside Euro-centric history to explore what was happening elsewhere on the globe. Some of the connections I had previously made, but so many were brand new to me! As I move forward in my research on school mental health, I want to be cognizant of progress being made in places beyond America, and to use that progress to help here.

In another vein of the same thought, Garcia and Orbitz (2013, p. 43) discuss the researcher as an insider and an outsider in the groups they are researching. Whether because of my own mild disorder or because I have consistently fought for the rights of those with mental illnesses, I consider myself an insider. However, as I move into action research, I need to be aware that not everyone will recognize me in that role. I will need to earn their respect and trust before I am seen as someone to come alongside them as fighting against oppression.

 

Garcia, S. B., & Ortiz, A. A. (2013). Intersectionality as a Framework for Transformative Research in Special Education. Multiple Voices for Ethnically Diverse Exceptional Learners, 32-47.

Morales, A. L. (1998). Medicine Stories. Cambridge, MA: South End Press.