Tricia K. Berger. Submitted in Partial Fulfillment. of the. Requirement for the Degree. Doctor of Education. Supervised by. Professor Kathryn Douthit

Transcription

1 School Counselors Perceptions Practices and Preparedness Related to Issues In Mental Health by Tricia K. Berger Submitted in Partial Fulfillment of the Requirement for the Degree Doctor of Education Supervised by Professor Kathryn Douthit Margaret Warner Graduate School of Education and Human Development University of Rochester Rochester, New York 2013

2 Abstract This dissertation attempted to ascertain how school counselors, working in a county located in the northeastern United States, perceived their own preparation and training regarding the management of mental health issues. It also attempted to gain an understanding of how school counselors managed mental health issues involving students grades K-12. This research was relevant and necessary, as recent research has shown there has been a significant increase in the numbers of children and adolescents suffering from mental health issues. This study was completed via an internet survey of 60 school counselors, eliciting information in order to understand the evolution of school counseling programs and focused on the current status of the school counselor in regard to student mental health. I discovered significance in three realms. First, I anticipated that my findings could be helpful to inform curriculum in school counselor education. Second, findings captured various conceptualizations of school counselor professional development. Third, outcomes could aid school counselors, and the profession more generally, to reconceptualize their role in the management of mental health and other psychosocial issues. ii

3 Dedication Dedicated to Susan Reynolds, a dear and beloved friend, who taught me the true meaning of tenacity and continues to dance in the hearts of all who loved her. iii

4 Acknowledgements To my husband, Glenn, thank you for the continued love and support throughout my academic and professional endeavors. I am so fortunate to have you in my life. To my children Caitlynn and Brandon, thank you for your patience, excitement, love and support. I am very proud of both of you and the kind and compassionate individuals you have both become. To my parents Judith Kelly and Christopher Kelly, thank you for the encouragement, and guiding me down the right path when I strayed. I love you both very much. To my friends and family, thank you for your encouragement, patience and support throughout this process. To my Dissertation Committee Chair, Dr. Kathryn Douthit, your support and confidence in me, to move forward was monumental. I do not have the words to express my gratitude for the time and dedication you provided. I am so honored you were a part of this journey with me. I will miss our conversations! To Dr. Karen Mackie, thank you for participating as a member of this dissertation committee, and encouraging me throughout this process. Your insight and expertise was instrumental in the successful outcome of this study. To Dr. Susan Denslow, thank you for participating as a member of this dissertation committee. Your insight and expertise as a school counselor enhanced this study immensely. Thank you for your friendship, encouragement and guidance throughout this process. iv

5 To Kelley Bennett, thank you for you friendship, professional input and support. You have been there to celebrate success and commiserate when things got tough. Without your encouragement I would not have been able to finish. You are a remarkable individual. A special thank you, to the Warner faculty and staff, for your patience and understanding during the times when my anxiety and frustration got the best of me. Your dedication to your profession and the students at the Warner School are impeccable. v

6 Contents Abstract... ii Dedication... iii Acknowledgements... iv Table of Figures... ix List of Tables...x Chapter I: Introduction...1 Background and Context...1 Problem Statement...5 Purpose of the Study...5 Research Questions...6 Research Approach...6 Researcher Assumptions...6 Significance of the Study...7 Chapter II: Literature Review...8 History of School Counseling...8 ASCA...11 Education Trust Act...15 Counsel for the Accreditation of Counseling and Related Education Programs...16 UCLA Center for Mental Health in Schools...20 Counselor Preparation...22 Mental Health training for School Counselors: A National Survey and vi

7 Implications for School Counselor Curriculum...24 Conclusion...26 Chapter III: Methodology...29 Research Design...29 Benefits of Survey Design...30 Survey Content...31 Research Instrument...33 Data Collection Procedures...33 Participants...34 Sample Selection...42 Chapter IV: Findings...42 Overview...42 Analysis...42 Data Analysis of Research Questions...43 Chapter V: Conclusion...63 Potential Reforms of Pre-Service Training...66 A Functional Model for Wider Implementation...66 Strengths...68 Limitations...70 Future Area of Inquiry...71 References...73 Appendix A:...79 vii

8 Appendix B:...80 Appendix C:...86 viii

9 List of Tables Table 1. School Counseling Activities...13 Table 2. Question Correlation...33 Table 3. Gender...35 Table 4. Age Distribution...36 Table 5. Ethnicity Distribution...37 Table 6. Undergraduate Majors...38 Table 7. Years of School Counseling Experience...39 Table 8. Student Population...40 Table 9. Experience and Student Population...41 Table 10. Priority or Services...43 Table 11. Knowledge of Common Mental Health Issues Related to Job Duties...44 Table 12. Interpretation of Student Records with Mental Health Language...45 Table 13. Communication with Other Mental Health Professionals...46 Table 14. Professional Development Opportunities in Management of Mental Health...47 Table 15. Professional Development Opportunities in Prevention of Mental Health...48 Table 16. Role as a System Consultant...49 Table 17. Development Opportunities Regarding Identification and Management of Mental Health Issues...50 Table 18. Development Opportunities Regarding Prevention of Mental Health Issues...51 Table 19. Education Experiences with DSM...53 Table 20. Familiarity with DSM...54 ix

10 Table 21. Importance of Management of Mental Health Training in Pre-Service... Programs...55 Table 22. Importance of Primary Prevention Approaches n Mental Health Training in Pre-Service Training Programs...56 Table 23. Respondents Theoretical Orientation...57 Table 24. Themes of Counselor Constraint and Resource...60 Table 25. Additional Comments...62 x

11 Chapter I This chapter introduces the rationale for this study, an inquiry into school counselors perceptions of their training in the area of mental health, and an exploration into how school counselors manage the mental health issues of their students. This chapter also includes a statement of the research problem, the purpose of the research, and the research questions. An introduction of the research methodology follows. Background and Context As we move through the second decade of the 21 st century, expectations for educational reform based on state and federal standards, accountability mandates, and academic achievement demands play a prominent role in academic policies. When these pressures are coupled with the changing make-up of student populations, the need for reassessment of counselor preparation programs becomes essential. In this spirit Martin (2002) asserts that we must engage in re thinking, re-framing, and transforming the role of school counseling in American schools in order to bring school counselor preparation programs forward so that they are compatible and aligned with 21 st century schools (p. 148). Change for school counselors, as explained by Martin (2002), is not optional it is mandatory for school counselors to survive in the rapidly changing environment of K 12 schools. An example of this change would include serving the needs of the increasing number of students suffering from mental health issues, particularly in relation to student achievement and education reform. Professional school counselors will likely be more valued when they demonstrate effectiveness in making systematic changes that afford all students, including those with mental health issues, access to rigorous academic programs and support for success (Erford, 2011). 1

12 Professional organizations in the field such as the American Counseling Association and the American School Counseling Association have published an abundance of literature related to the transformation of school counselor education. There is, however, a dearth of recommendations or proposed programs that relate to mental health training for school counselors. Most programs advocate redefining the internship and practicum for school counselors by creating a system of checks and balances to monitor ongoing academic progress of students (Jackson et al., 2002b). There appears to be a lack of material and training regarding mental health as a subject within school counselor education. Current definitions of the school counselor role emphasize a variety of functions but tend to omit reference to mental health. For example, Jackson et al. (2002b), in describing a transformed role for 21 st century school counselors, suggests the new vision for school counseling has extended the school counselor s role in the areas of leadership, advocacy, collaboration, brokerage of services and use of assessment data (p. 179). Jackson's list, although extensive, does not acknowledge the need for mental health training. In essence, the transformed school counselor will be working with a model that de-emphasizes preparation related to the mental health of the students they serve. As we move through the second decade of the twenty-first century, we are facing an alarming increase in the mental health needs of youth, and [t]raditional pervasive preparation training programs for school-based personnel in the area of mental health are overwhelmingly insufficient (Koller & Bertel, 2006, p. 197). Koller and Bertel (2006) indicate that between five and nine percent of children can be classified with a diagnosis of a serious emotional disturbance, requiring substantive mental health support in the school setting (p. 197). Additionally, Nemeroff et al. (2008) assert that approximately 20% of people under age 18 can be diagnosed with mental disorders and up to five percent experience significant dysfunction 2

13 because of their emotional difficulties. However, regardless of an apparent increase in some children s mental needs in school, an overwhelming 70% of children with a diagnosable mental illness do not receive treatment, or receive inadequate treatment (Koller & Bertel, 2006, p. 2). These statistics serve as a red flag to all professionals responsible for the well-being and success of children, especially school-based personnel such as school counselors. In this spirit, Paisley, Siomek-Daige, Getch and Baily (2008) assert that within the realm of a public school, buildingbased school counselors are often the only educationally certified mental health professionals on site. Thus, it is imperative that professional school counselors receive mental health training that will enable them to identify, assess and provide appropriate interventions within the boundaries of their professional domain. While the number of children diagnosed as suffering from mental illnesses steadily increases (UCLA Center for Mental Health in Schools [UCCMHS], 2009b), there is a need to redefine the role school counselors play in regard to assessing and addressing psychological barriers to learning and student success. The intent of this role redefinition is to ensure that school counselors take more of an active role as team members attending to existing mental health problems rather than remaining in their typical role as leaders in psycho-educational primary prevention. Additionally, if such expectations were implemented in pre-counseling training programs, new counselors would be able to better serve as a valuable resource for tenured counselors regarding students mental health needs. This is turn would allow the implementation, with maximum efficacy, of the American School Counseling Association (ASCA) national standards that relate to personal and social development (American School Counseling Association, 2008). 3

14 Some school counseling professionals believe that a number of barriers presently exist and continue to be major obstacles in providing a comprehensive program that addresses the increasing mental health needs of students (Sink, 2011). Salient among these barriers are expectations that counselors will manage all dimensions of student problems, and overwhelming caseloads, which often discourage even the seasoned school counseling professional from taking a leadership role in reform movements. Increases in the number of children diagnosed with mental health issues and increases in school violence also present daunting challenges for the school counseling professional. The ASCA (2008) National Model, which provides a template for contemporary school counselor education, outlines a developmental school counseling model that stresses the importance of a well-developed curriculum that is organized (data-driven) and sequential, but also adjustable given the fact that all children do not develop cognitively and emotionally at the same rate. The ASCA model was also developed to allow school counselors to implement a framework to create a school-counseling program that is empirically supported. The ASCA standards offer a window of opportunity for school counselors and other stakeholders to discuss expectations for students academic success and the role of counseling programs regarding student performance. This model has specific standards that address students academic, career, personal and social development. Additionally, this model expands the definition of what it means to be a well-trained professional by being able to furnish specialized counseling services and interventions. However, the question remains, does this specialized training that the transformed school counselor receives elicit enough knowledge and experience on the part of the school counselor to enable them to navigate within the mental health arena? It is my contention that school counselors need to be able to evaluate their strengths and weaknesses and develop a 4

15 collaborative relationship with other school professionals regarding the mental health needs of their students. Whether school counselors operate from a comprehensive school counseling model or various other models (Sink, 2011), we need competent responsive mental health services, in that they are essential to the welfare of student and their families. It is important to note that school-counselors are not mental health counselors and their first priority must be the educational needs of their students. However, they are in a unique position within the school setting to be the primary providers of assessment, prevention and intervention services to students plagued with mental health issues. Problem Statement Although previous research conducted by organizations such as ASCA and the American Counseling Association (ACA) have identified various school counseling models and practices, many believe these models are ambiguous and ineffective given the diverse role of the school counselor. To further complicate the situation, the scope of students psychosocial concerns appears to be growing (UCCMHS, 2009b). How can school counselors effectively serve the mental health needs of their students? Purpose of the Study The purpose of this study was to learn whether school counselors feel prepared to manage the increasing number of mental health issues that their students face. More specifically, I wished to know if, as systems consultants, school counselors felt that they have the skills to include the realm of mental health in their pivotal consultant role. This study also attempts to gain some insight into the ways school counselors currently see their role in managing existing student mental health issues. 5

16 Research Questions The following research questions will guided this study: 1. Do practicing school counselors think that topics in mental health are an important area of pre-service training or professional development? 1.a. What are some of the mental health topics that practicing school counselors feel are important? 2. What specific mental health knowledge did school counselors acquire in their pre-service training programs and/or in their professional development activities? 2.a. Do school counselors feel their counselor education programs provided them with the necessary tools to address the prevention and early intervention of mental health issues? 3. How do school counselors manage mental health issues? Research Approach This study used a survey methodology, which included a series of semi-structured openended questions. Survey analysis involved the use of descriptive statistics and the analysis of open-ended questions utilized a qualitative coding method. The survey was distributed electronically to all K-12 school counselors currently employed in school districts located in an urban-suburban county in the northeastern United States. Researcher Assumptions Based on my experience as a certified school counselor and licensed mental health counselor working with school-aged children, I have formed several thoughts regarding the training of school counselors and the degree to which they utilize mental health practices with their students. These assumptions were investigated and formulated through an unpublished research study conducted by Douthit (2009) titled Mental Health Training for School Counselors: A National Survey and implications for School Counselor Curriculum. Based on the work of Douthit, as well as my own experiences, I am entering this study with the following 6

17 assumptions: 1) school counselor curriculum should include some training in managing mental health problems, 2) by increasing their mental health literacy and comprehension skills, school counselors will be able to efficiently bridge the communication gap between the educational and clinical realms, 3) school counselors with clinical training will be more prepared to aid in the prevention and early intervention of mental health issues, and 4) some school counselors may not be comfortable dealing with student mental health issues due to their lack of training. Significance of the Study The purpose of this study was to understand the evolution of school counseling programs and to focus on the current status of the school counselor in regard to student mental health. I anticipated significance in three realms. First, I anticipated that my findings would help to inform curriculum in school counselor education. Second, my findings could inform conceptualization of school counselor professional development. Third, my outcomes could help school counselors, and the profession more generally, to reconceptualize the role of the counselor in the management of mental health and other psychosocial issues. 7

18 Chapter II Literature Review The purpose of this chapter is to provide a critical analysis of the research that is pertinent to the study of the skills school counselors utilize to effectively assist students with mental health issues. This chapter will explore the field of school counseling, the history and development of the models utilized in school counseling, the research that explores the effectiveness of these models, and the current needs and trends in school counseling that have guided this research. The literature reviewed for this study includes internet resources, peer reviewed journals, books, and unpublished survey results in a study conducted by Douthit (2009). This review will demonstrate the limited collection of knowledge and research available as well as highlight a significant gap in the literature that supports the pursuit of this study. History of School Counseling Historically school counseling programs have been based on a comprehensive, developmental model supported by various stage theories of human development (Greene, 2006, p. 34). Brewer (1942) discerned that there were four distinguishing circumstances that proliferated the original guidance and counseling movement. These circumstances include: 1) division of labor, 2) the growth of technology, 3) extension of vocational education, and 4) spread of modern forms of democracy (Brewer, 1942; Greene, 2006). In 1895, George Merrill developed the first identified standardized guidance program in the United States, which was located in San Francisco. During the early 1900 s, school counseling was known as vocational guidance. Frank Parsons, often referred to as the father of guidance developed this term. Parsons' focus was on supporting young men s transition into suitable vocational placement based on a mutually beneficial match between the young person s 8

19 aptitude and abilities and an occupation s requirements and environment (Lambie, 2004, p. 125). By the 1920 s, John Dewey introduced his theoretical perspective, postulating that all people move through stages of hierarchical development. Dewey s theory developed popularity and was eventually included in the curriculum of school counselor training programs. Approximately ten years later, E. G. Williamson expanded Parson s theory of vocational guidance and developed the guidance and counseling theory referred to as Trait and Factor Theory (Lambie, 2004, p. 125). By the 1940 s, Carl Roger s theoretical perspectives emerged and gained popularity among school counselors. Rogers, in contrast to Parson and Williamson, rejected the idea that clients should be reduced to a collection of drives or discrete behaviors. Rather he argued that a counselor should empathize with a client s experience of the world and provide a safe environment that facilitates the client s movement towards self-actualization; the counselor should assist clients in the growth process, improving their abilities to cope with current problems and future challenges (Lambie, 2004, p. 125). Rogers provided a foundation for the school counselor ideology that counselors must see students as people, not problems. By the 1950 s school counseling formalized its professional status with the development of American Personnel and Guidance Association (APGA). Today, the APGA is known as the American Counseling Association (ACA). In 1952, the American School Counseling Association (ASCA) was founded as a division of APGA. In addition, the Association for Counselor Education and Supervision (ACES) has worked collaboratively with ASCA to develop a comprehensive school counseling training program. Through the late 1950 s and 1960 s historical events such as SPUTNIK (the earth s first artificial satellite) and the science race dictated the need for more guidance counselors to help students succeed academically, 9

20 which in turn elicited a new and complete set of professional standards. Traxler and North (1966) contend that the increase in the guidance movement could be attributed to the following five notions: philanthropy or humanitarianism, religion, mental hygiene, social change, and movement to get to know children as individuals. Money poured into the profession with the expectation that guidance counselors would work diligently to identify those students with superior social, emotional and academic qualities and nurture them through the academic environment (Erford, 2011). A large amount of money was also available to improve and focus on the area of career guidance. However, by the 1970 s, the nation saw a decrease in the population, and the guidance counseling profession was hit hard. Existing counselors scrambled to justify their positions by taking on additional administrative tasks in order to avoid termination amidst necessary budget cuts. By the mid 1970 s and early 1980 s the nation was addressing civil rights, which included fair treatment for all developmentally disabled individuals. Guidance counselors were once again called upon to redefine their professional role, this time as advocates for the disabled. The tasks that school counselors acquired during the early 1970 s to maintain their employment, remained in their job description. In addition, they acquired additional responsibilities, which included assisting in the development of Individual Educational Plans (IEP s) to ensure appropriate school placements, maintain accurate records, and act as consultants to families, students, and other school personnel. This pattern of additional counselor responsibilities has set a precedent to which many school districts and their administrators currently adhere and has contributed to the issue of role ambiguity that surrounds school counseling. 10

21 American School Counselor Association The role of the school counselor has evolved from a fairly narrow focus onto one that encompasses a wider range of services. However, presently the role of the counselor as defined by the ASCA discourages one-on-one mental health counseling with a clinical focus. The original concepts in the 2003 ASCA National Model for school counselors included designing, developing, implementing, and evaluating a comprehensive, developmental, and systematic school counseling program. ASCA has recently built on those original concepts and published a more recent edition of the Executive Summary in ASCA s Executive Summary has been described as a framework to give to states, districts, and individual schools [guidance] in designing, developing, implementing and evaluating a comprehensive, developmental and systematic school-counseling program (Lambie, 2004, p. 165). The ASCA model in essence provided the first uniform treatise defining the scope and content of a comprehensive schoolcounseling program. Through this model, counselors can be and have become a more integral part of making a difference in students lives. While the new standards encompass a much broader range of services than previously attributed to school counselors, they still do not address mental health issues in a comprehensive modality. The model consists of four components that are interrelated and is designed to support a school s overall mission. The components of the model include: 1) foundations, 2) delivery systems, 3) management systems and 4) accountability. These four interrelated parts form the basis for an effective school- counseling program. Starting with a strong foundation, incorporating beliefs, philosophy and a mission statement, a school counseling program should, according to ASCA, incorporate goals for student achievement and state what students should know and be able to accomplish. Following 11

22 the foundation, the model then provides for a delivery system, which describes the structure, interactions and methods to deliver the program (Lambie, 2004, p. 2). The delivery system includes, but is not limited to guidance, curriculum, individual student planning, responsive services and system support. The third component of the Model is the management system, which interacts with the delivery system. The management system incorporates processes and tools to ensure that the program is meeting the school's needs. This system includes agreements on how a program is implemented and advice for counselors related to review of, and recommendations for, counseling programs. In addition, the management component stresses the utilization of data to make a more effective program and the utilization of time to effectively maximize direct services to students. The Model has accountability as the final component. It is important that the effectiveness of both the school counselors and their programs be measurable. Again, the integration of data plays a role in that the data must be evaluated in such a way that links the school-counseling program to student achievement. This data includes, but is not limited to, results reports, program audits and school counselor performance standards. The ultimate goal is for program improvement resulting in improved performance for all students. The ASCA model, according to Dahir and Stone (2007), explains a shift in the role of professional school counselors from that of individual service providers to one of promoting optimal achievement for all students through a systematically delivered program of initiatives (p. 1). The goal is to help students succeed. As seen in Table 1, the four interrelated parts of the National Model form the basis for an effective school counseling program and specifically designates activities that school 12

23 counselors across the nation are performing as appropriate and inappropriate (ASCA, 2012, p. 21). Table 1 School Counseling Activities Appropriate Program planning Interpreting educational and psychological testing Counseling students regarding appropriate social / emotional issues Supervising the maintenance of school record Provide small and large group counseling Advocate for students Analyze statistical information and provide recommendation Inappropriate Registering new students Coordinating and administering testing Discipline of inappropriate behavior Maintaining student records Work with a student individually in a therapeutic mode Preparation of individual student academic plans, study teams and attendance review Data entry With the introduction of the ASCA National Model, the field of school counseling is undergoing a dramatic paradigm shift. Traditional school counselors are being challenged to implement a framework to create a school counseling program that is empirically supported. These national standards created by ASCA can offer a window of opportunity for school counselors, school administrators, faculty, parents, businesses, and the community to collaboratively process and discuss expectations for students success in school and the role of counseling programs regarding the knowledge and assessment of student performance. More specifically, the model specifies standards that will address students academic, career, personal and social development. 13

24 ASCA, as indicated in the table above, suggests that individual therapeutic counseling with students is not a role that school counselors should be filling. The intent of this position is not to discourage individual counseling but to aid school counselors in assessing differentiating between primary, secondary and tertiary prevention needs of children and families. This is ASCA s position in spite of the fact that the number of children diagnosed as suffering from mental illnesses steadily increases. It is unclear why ASCA does not feel compelled to redefine the role school counselor play in regard to assessing and intervening in the psychological barriers to learning and student success. School counseling professionals believe that barriers presently exist and continue to be major obstacles in providing a comprehensive program that addresses the increasing mental health needs of students (UCCMHS, 2009b). Job expectations and overwhelming case loads, coupled with the changing economy, can make this task, even for the seasoned school counseling professional, exhausting. As societal concerns increase, including those related to children developing and being diagnosed with mental health problems at a much younger age and increased school violence, it is difficult for the school counselor to combat these issues in the face of the myriad responsibilities articulated in the Model. Many students are not receiving the educational and mental health services needed to be successful (UCCMHS, 2009b). It is true that this new National Model stresses the importance of a well-developed curriculum that is organized, data-driven, and sequential, but one that is adjustable given the fact that all children do not develop cognitively and emotionally at the same rate. Additionally, this model requires well-trained professionals who will furnish specialized developmental counseling services and interventions. What is less clear is whether or not in this 14

25 specialized training the reconstructed school counselor receives enough knowledge and experience to navigate within the mental health arena. Education Trust Act At the time ASCA was preparing their National Model, an alternative paradigm for school counselor practice was published by the Education Trust (Erford, 2011). More specifically, the Education Trust was initially developed in 1996 under a grant from the DeWitt Wallace Readers Digest Fund. Its main goal was to find ways for school counselors to help the wide diversity of students in their care. Dahir and Stone (2007) assert, The Education Trust challenged school counselors to commit and contribute to closing the opportunity and achievement gaps (p. 1). In 1997, The Education Trust developed a competitive grant program sending requests for proposals to transform the training of school counselors in counselor education programs (The Education Trust, 2009). Grants were awarded to six universities, which initiated the movement known as The Transforming School Initiative (The Education Trust, 2009). This movement engendered a new vision that called for a shift in the traditional role of school counselors. This new vision additionally focused on eliminating the achievement gap between minority and non-minority students. As part of this new vision, counselors would work in consultation with others to assist students in academic, social emotional and personal development. The Education Trust vision identified five domains as constructs for school counselor focus and provided strategies and techniques for implementation in each domain. The five domains identified are: 1) leadership, 2) advocacy, 3) teaming and collaboration, 4) counseling and coordination, and 5) assessment and use of data. 15

26 The Education Trust leadership also articulated eight essential elements for transforming counselor education as an important part of the new vision. These elements, as described by Perusse and Goodnough (2001), are part of a changing paradigm for school counselors and are outlined below: Criteria for selecting and recruiting candidates for counselor education programs Curricular content, structure, and sequences of courses Methods of instruction, field experiences, and practice Induction into the profession Working relationship with community partners Professional development for counselor educators University / school district partnerships University / state department partnerships. (p.102) In the study conducted by Perusse and Goodnough (2001), the domains and elements of the Education Trust Model were examined to determine counselor educators perception of the importance of the concepts defined by the Education Trust and the extent to which these concepts were reflected in master level school counseling programs. This study concluded that counselor educators perceived that the concepts defined by the Education Trust vision for school counseling such as education, equity access, and academic success should be incorporated in school counselor preparation programs. Authors dehass (2000) and Guerra (1998) argue that the ideas included in this new vision diminish the importance of the mental health role of the professional school counselor. 16

27 Counsel for the Accreditation of Counseling and Related Education Programs The practice of any profession is portrayed by a set of theoretical and practical understandings of that profession, as well as propositions on how to deliver services effectively. In the past twenty years, higher education stakeholders have been demanding quality education standards (McGlothlin & Davis, 2004). In order to ensure quality education and credible counselor credentials, professional standards and outcomes were developed by the Council for the Accreditation of Counseling and Related Education Programs ([CACREP], 2009). The original CACREP standards were developed as early as 1981 and were later updated with the defining of a mission statement in The most recent iteration of the CACREP standards was issued in (CACREP). McGlothlin and Davis (2004) assert that CACREP is the largest counseling related accreditation body, accrediting 389 master s-level programs and 45 doctoral programs (p. 1). As such, CACREP (2012b) has a vision dedicated to encouraging and promoting the continuing development and improvement of preparation programs and preparing counseling and related professionals to provide services consistent with the ideal of optimal human development ( 2). This vision statement sets the stage for a future discussion regarding the implementation for additional pre-service training in the realm of mental health. In March of 2002, the CACREP Board of Directors felt the need to clarify their existing mission and statement, thus creating the following CACREP (2012b) Core Values: advancing the counseling profession through quality and excellence in counselor education; ensuring a fair, consistent, and ethical decision process; Serving as a responsible leader in protecting the public; 17

28 promoting practices that reflect openness to growth, change and collaboration; and, creating and strengthening standards that reflect the needs of society, respect the diversity of instructional approaches and strategies, and encourage program improvement and best practices. ( 7) A study conducted by McGlothlin and Davis (2004) explored the understanding of counselor educators, mental health counselors and school counselors in regard to their understanding of the CACREP core curriculum standards. Initially, the researchers sought to determine the perceptions of how each professional group felt in regard to the eight core CACREP curriculum standards. Counselor educators recognized Career Development and Assessment as the least beneficial. Mental health counselors recognized Research and Program Evaluation and Career Development as the least beneficial and school counselors recognized Research and Program Evaluation and Assessment as the least beneficial. Uniformly, all three counseling groups perceived Helping Relationships as the most beneficial CACREP core curriculum standard relative to the other entire curriculum standards. Koller and Bertel (2006) assert that the inadequacy of specific competency-based preservice training in prevention-based mental health is evident when reviewing university-based curricula and certification requirements mandated by different recognized programs such as CACREP. Even though CACREP standards globally state that pre-service counselors posses the competencies to manage barriers that impede student academic, career, personal/social success and overall development, Keys, Bemak and Lockhart (1998) argue that school counselor roles continue to be defined based on the old guidance counselor model and completely neglect the increasing number of students suffering from mental health ailments. 18

29 Holcomb-McCoy, Bryan, and Rahill (2002) assert that although there have been numerous studies that have assisted in developing the identity, role and responsibilities of the modern day school counselor, they believe that these descriptions have not included the knowledge and skills necessary for the actual practice of school counseling (p. 1). In their study, Holcomb-McCoy et al. (2002) inquired as to what the underlying factors are that aid in school counselors determining the value or importance of CACREP school counseling standards and second, [t]o what extent do professional school counselors rate these school counseling CACREP standards to be important to their actual work as school counselors (p. 1). The authors surveyed a random sample of 600 practicing school counselors developed from the members of ASCA. Out of the 600 surveys mailed, only 187 responded, allowing for a 31% response rate. The thirty-eight items asked in this study where directly related to the 2001 CACREP standards. School counselors identified the following four components: Foundations of School Counseling, Contextual Dimensions, Knowledge and Skills for the Practice of School Counseling and Skills for Specialized Assistance, to be an important part of their school counseling identity as well as key elements in their daily work. Results indicated that these where the only four components that aligned with the 2001 CACREP standards. It is difficult to ascertain if there is a relationship between these standards or if they improve the quality of work provided by school counselors. One significant knowledge area not included in the four core factors was school counselors understanding, skill and knowledge base necessary to mange and enact specific interventions for the increasing number of adolescents suffering from mental illness. This may be line with Holcomb-McCoy et al. (2002) speculation that perhaps school counselors are spending more time on tasks unrelated to programmatic issues or is it possible that school 19

30 counselors have been prepared more extensively in areas unrelated to program development? (p. 1). Another finding by Holcomb-McCoy et al. revealed that elementary and middle school level school counselors thought that Counseling and Guidance Knowledge and Skill was far more important than high school counselors did. The authors postulate elementary school counselors prefer doing more group work with the students to help them learn appropriate social skills, enhance their self-concept, and develop problem-solving skills. High school counselors performed more non-counseling activities (scheduling and testing) than counseling activities (Holcomb-McCoy et al., 2002, p. 4). It appears that school counselors are participating in activities at the elementary and middle school levels that are helpful in the prevention of psychological problems. However, the question still remains, are school counselors under the guidance of CACREP standards being provided with adequate training to identify students suffering from mental illness? In addition, do school counselors have the tools to provide appropriate interventions? Do CACREP standards, when addressing mental health concerns, need to be age-level specific in order to address and accommodate the various developmental and cognitive levels of student s school counselor service? UCLA Center for Mental Health in Schools The UCLA Center for Mental Health in Schools (UCCMHS, 2009d) estimates that 12% to 22% of youngsters under the age of 18 years old are currently diagnosed as needing services for mental, emotional or behavioral problems. These diagnosed children and adolescents are the ones who have received assistance. There are, however, an increasing number of youth that are not receiving assistance. UCCMHS (2009d) states, For general purposes it can be stressed that the number of such youngsters in many schools serving low income populations has climbed 20

31 over the 50% mark (p. 2). UCCMHS (2009d) also asserts that, It has long been acknowledged that a variety of psychosocial and health problems affect learning in profound ways and must be addressed if schools are to function satisfactorily and students are to succeed in school (p. 4). Schools must promote healthy environments and improve efforts to break down barriers to learning. In doing so, mental health needs in school must be attended to. As stated by UCCMHS (2009d), School systems are not responsible for meeting every need of their students. But when the need directly affects learning, the school must meet the challenge (p. 4). As such, it becomes increasingly important for mental health needs to be addressed in schools including issues related to access and availability of these services for students and families. By identifying barriers to mental health services, resolutions and interventions can be created and utilized in a school setting to encourage school administrators, and state and federal agencies to develop partnerships in order expand resources and enhance program approaches to combat mental health issues. School counselors would thus be in a unique position to be in the forefront of facilitating and collaborating with other service providers to establish necessary resources to combat the overwhelming increase of student suffering from mental health issues. The economic impact of such resources needs to be considered and may severely limit the number of mental health services available. Even though most school districts have services to address mental health needs, the majority are fragmented and only meet a portion of students psychosocial and mental health concerns. While the diversity of programs exist for the promotion of positive social and emotional development and well-being, the reality is that there are many stakeholders competing for the same pot of resources. Thus, the issue of securing resources to provide mental health services for students can lead to competition between schooland community-linked services advocating and prioritizing their own agendas. The result is a 21

32 fragmented approach to mental health needs, which can result in a small population of students being serviced. Available resources are not utilized in a way that allows mental health services for a large proportion of students. In order for broader coverage to occur, it is imperative to end the fragmentation, marginalization, counter productivity, competition, and costly redundancy that characterizes what schools and communities do to address barriers to student learning (UCCMHS, 2009c). UCCMHS (2009c) asserts that systemic change must take place if psychological barriers to student learning are going to be effectively addressed. Efforts must be made that expand inclusive, cohesive approaches to combat learning difficulties directly affected by mental health issues. Schools need to develop systems to research and evaluate problems incurred by children and adolescents. This would in turn improve advocacy and sustainability of mental health programs within the school environment. It is critical to provide appropriate training for those involved in the systemic change. School counselors, as integral stakeholders in the system, need to rethink and reframe the manner in which mental health services are being provided. UCCMHS (2009c) recognizes the need for, appropriate training, incentives and safeguards for those who are expected to facilitate systematic change (p. 8). UCCMHS also believes that stakeholders, including school counselors, as they move forward must address four major concerns as they implement systemic change. These are infrastructure, leadership, bridging, and interweaving the resources available (2009c, p. 8). Thus, if the approach to meeting the mental health needs of students is to be successful, there needs to be a significant paradigm shift in policy and procedures. UCCMHS (2009c) asserts that given the complexity and range of problems that must be addressed, it appears clear that advancing the field requires adapting a unifying, comprehensive, multifaceted and cohesive intervention network (p. 9). To 22

33 accomplish this requires analyzing and implementing new strategies to affect change. School counselors, as a part of the infrastructure and as stakeholders must develop and implement strategies to actively participate in meeting the mental health needs of students in the 21 st century. Counselor Preparation Geroski, Rodgers and Breen (1997) assert that most traditional school counseling programs do not offer training that allows school counselors to improve their knowledge, understanding and assessment skills in relation to use of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Gerosky et al. claim that without the appropriate literacy and comprehensive training related to DSM, the school counselor s ability to fully participate in the implementation and coordination of effective delivery of appropriate mental health services to students and their families is inhibited. Furthermore, if school counselors had additional exposure in the diagnostic realm, they would be able to identify students in need of mental health treatment more rapidly and direct students and families to the appropriate service providers. Additionally, having an understanding of the DSM terminology and being able to communicate with other mental health service providers in a common language would aid in the process to ensure that the child is receiving the appropriate service. With the advent of managed care, it has become more imperative that school counselors play a role in educating students and families to utilize necessary skills to advocate through the child s primary care physician to receive appropriate referrals for mental health services, since the likelihood is high that they will receive mental health care from their primary care physicians (Groski et al., 1997). Akos and Scarborough (2004), in one of the few studies on the clinical training of school counselors, conducted a unique study that examined pedagogical practice in the clinical 23

34 preparation of school counselors. They investigated 59 school counseling internship syllabi. The authors believe that the lack of research in this area leaves school counselors, as well as their supervisors, with little guidance. Supervision remains the hallmark of any good counseling training program. However, it was not surprising to discover that the results regarding requirements for group and individual supervision in this study varied. Only 51 of the 59 syllabi reviewed contained information regarding supervision. Forty-one percent required 1.5 hours of group supervision per week, which meets the CACREP standard. Fourteen percent exceeded that limit, requiring 2.5 hours per week, and 10% went even further requiring 4-8 hours of group supervision weekly. Ninety-two percent of the syllabi indicated requirements for individual supervision. Seventy-two percent met the minimum standard of 1 hour per week outlined in the CACREP standards. It is important to review such findings because once school counselors have been through a basic understanding of the terminology and diagnostic criteria, it is imperative that they be able to put their knowledge into action in a clinical environment that requires a high level of participation and maximum supervision. At the same time, it seems a normative clinical training experience in school counseling is difficult to discern, and the training seems disconnected from current practice reform (p. 106). Although this study did not directly address mental health delivery, the factors that it did study are relevant to sufficient mental health training. This study revealed that for school counselors, individual on-site counseling was a low priority. These findings could be attributed to the numerous types of direct service a school counselor provides. A gap continues to exist between the clinical expectations of a school counselor, the education they are currently receiving, the pedagogical standards being set, and the realities of the actual job. The information derived from this study leaves us continuing to ask the question: How then do school counselors develop the necessary clinical skills to effectively 24