Introduction: The Future Is Now—Challenges in the New Age of Psychological Practice




© Springer Science+Business Media New York 2015
Rosemary Flanagan, Korrie Allen and Eva Levine (eds.)Cognitive and Behavioral Interventions in the Schools10.1007/978-1-4939-1972-7_1


1. Introduction: The Future Is Now—Challenges in the New Age of Psychological Practice



Judith Kaufman 


(1)
School of Psychology, Fairleigh Dickinson University, Teaneck, NJ, USA

 



 

Judith Kaufman





Do not confine your children to your own learning for they were born in another time.

Hebrew proverb


The real difficulty in changing any enterprise lies not in developing new ideas, but escaping old ones.” John Maynard Keynes


The Changing Landscape of School Psychology: Contributing Factors


Schools are microcosms of society at large, and as such, school personnel deal with the impact of social challenges and problems as they are reflected in the children they serve. Economic concerns, unemployment and underemployment, family and school violence, immigration, and acculturation have both direct and indirect impacts on learning and academic achievement. More and more children and adolescents are in need of mental health support, but are underserved (NAMI, 2013). While the current practice trend is directed at implementing a Public Health model of intervention in schools (Nastasi, 2004) (e.g., school-wide prevention programs, Response to Intervention (RTI) (Adelman & Taylor, 2010)), there are a large number of students who require individual and group intervention strategies.


Contemporary Risk Factors


There are more than 73 million children under the age of 18 living in the United States. This is expected to increase to 80 million by the year 2020 (Federal Interagency Forum on Child and Family Statistics, 2007). There is a steady increase in the public school population, with over 49 million children now attending public schools (the private school sector has remained constant, accounting for 11 % of school-aged population). There has been a significant increase in the minority population in the public schools, which is currently at approximately 42 % and growing. These increases reflect greater demographic shifts in the general population, with the largest growth in the Hispanic population. A related increase in the free and reduced lunch program nationwide further indicates increased levels of poverty in our public school youth, with an estimated 12.5 million children living in poverty in the United States today. Importantly, higher poverty rates exist among minority groups (Annie E. Casey Foundation, 2007). The consequences of poverty and minority group membership together predict greater risk for school failure, lack of completion of high school, and mental and physical health issues (Borman & Rachuba, 2001; Larson, Russ, Crall, & Halfon, 2008).

Recent national reports of the educational progress in the public schools indicate that a growing number of children have not met national proficiency levels (Hemphill & Vanneman, 2011; Lee, Grigg, & Donahue, 2007). The achievement gap is particularly evident in comparing Hispanic students to White students. While scores in mathematics have generally increased, the performance gap has remained the same when measured in fourth and eighth grades. Similar trends in reading were found as well (Hemphill & Vanneman, 2011). Academic performance is typically assessed through standardized achievement tests often referred to as high-stakes testing (Kruger, Wandle, & Struzziero, 2007). High-stakes testing can be viewed as a critical stressor for school administrators, their teachers, and pupils. There may be sanctions imposed on underachieving schools including school restructuring and removal of staff (Nichols, Glass, & Berliner, 2006). There has been some research suggesting that high-stakes testing might be a considerable source of stress for students (Cornell, Krosnick, & Chang, 2006). Students who do not meet the test standards may be particularly vulnerable leading to feelings of depression and anxiety and potentially have a negative impact on mental health (Cornell et al., 2006). For those individuals where there is an existing achievement gap, the consequences may be even greater. Grant et al. (2004) report that multiple stressful life events predict psychological problems in adolescents.

Approximately 12 % of children between the ages of 3 and 21 receive special education services under IDEA (http://​disabilitycompen​dium.​org/​compendium-statistics/​special-education. No date). About 80 % of these students spend more than 40 % of their time in regular classroom settings. Of the youth exiting IDEA services, 20 % dropped out of school compared to the 7 % in regular education. Providing effective and evidence-based interventions to students with special needs is an additional challenge for mental health providers within the school setting.

Negative school climate has been demonstrated to be a potential risk factor and can potentially contribute to the increase in bullying and victimization (Wilson, 2004). National data suggest that one in four children are either face-to-face or cyber bullied on a regular basis (http://​www.​bullyingstatisti​cs.​org/​content/​school-bullying-statis. No date). The long-term mental health consequences of being bullied have been well documented (Rigby, 2007). The confluence of changing demographics and poor academic and behavioral outcomes along with increased environmental stressors provide a strong argument for the need for quality psychological services in the schools, both within the regular education and special education frameworks.


Children and Mental Illness: Schools and Mental Health


Over four million children and adolescents, or 12–20 %, suffer from serious mental disorders (SED) that cause significant impairment at home, at school, and with peers (NAMI, 2011). The lifetime prevalence of mental disorders is 46 %, with no significant difference between males and females. The estimated cost of providing services is approximately $247 billion per year, although only 40 % of children and youth suffering with mental illness receive mental health services (NAMI, 2011).

About half of all lifetime cases of mental disorders begin by age 14. Approximately 50 % of students age 14 and older living with serious mental illness drop out of high school, the highest rate of any disability group (US Department of Education, 2006). While already alarming, these numbers and the magnitude of the problems keep increasing without a parallel increase in available services (Center for Disease Control and Prevention, 2013; US Department of Health and Human Services, 1999).

Gender differences exist when examining prevalence rates of mental disorders (Eaton et al., 2012). ADHD is the most prevalent diagnosis in children between the ages of 3 and 17, with males impacted at a higher prevalence rate than females (see Reddy et al. 2015). With the exception of autistic spectrum disorder (ASD), the number of children with mental health diagnoses increases with age (NAMI, 2013). Females present with internalizing disorders, while males exhibit more externalizing disorders (Eaton et al., 2012). By the age of 15, two times more girls than boys demonstrate symptoms of depression, generalized anxiety disorders, and eating disorders (NAMI, 2013). Boys demonstrate a greater percentage of antisocial behavior, aggression, and substance abuse (Eaton et al., 2012).

School is a natural environment for mental health service delivery. The majority of youth receiving such services do so within the school setting (Rones & Hoagwood, 2000). It has been noted that 96 % of families who were offered school-based mental health services followed through, while only 13 % referred to community-based clinics availed themselves of services (Mennuti & Christner, 2010). School-based health centers which encompass mental and behavioral health care are often operated in partnership with the community and have proven to be successful in addressing both the physical and mental health needs of children and youth (HRSA.gov retrieved, 1/27/14). School-based mental health services have received empirical support in demonstrating not only an increase in emotional well-being but also directly impacting on increased academic achievement (Research and Training Center for Children’s Mental Health, retrieved 1/29/14). There is an increasing emphasis on a tiered model of school-based mental health services, with the primary entry point being universal or systemic prevention/intervention (Nastasi, 2004), followed by targeted interventions addressing particularly at-risk populations. However, although prevention efforts have proven to be successful, there are significant numbers of children who require more intensive interventions (Mennuti & Christner, 2010). Such interventions are typically provided on an individual or small group basis and involve symptom reduction, enhancement of coping skills, building resiliency, and risk reduction (Compas et al., 2005; Smallwood, Christner, & Brill, 2007). Although it is essential to consider the broader role of the school psychologist in systems-level interventions, expanding the intensive intervention skill set is likewise imperative, as research supports the relationship between improved mental health and children’s academic competencies in the school context (Adelman & Taylor, 2010).


Impact of the Affordable Care Act (ACA)


The Affordable Care Act of 2010 (ACA) provides a major focal point for the change in the delivery of health services, particularly for children and youth. Children, in particular, will benefit as a result of ACA, as almost double the number (from about 7 million to 11 million) will be eligible to receive both physical and mental health care because of expanded coverage (Kaiser Family Foundation, 2010). Provisions of ACA encompass the funding for school-based health clinics (SBHC), expanding services, and the identification of new treatment sites. The ACA appropriated $50 million in competitive grant funds for each fiscal year from 2010 to 2013 to develop SBHCs (Section 4101a, The Patient Protection Act of 2010). SBHCs are typically located in schools or on school grounds and cooperate with the school and community to meet the unique needs of the community population. Currently, there are about 2,000 SBHCs in 46 states and the District of Columbia serving about two million children and youth (Strozer, Juszczak, & Ammerman, 2010).

If the potential of the ACA is realized, there are opportunities to significantly change mental health service delivery models. As an outgrowth of and in conjunction with ACA, Healthy People (2020) has as one of its primary goals to improve mental health through prevention and by ensuring access to appropriate quality mental health services (healthypeople.gov, retrieved 10/2013). A broader range of services and new approaches to treating complex problems can be offered to underserved populations (School Psychology in Illinois, 2013). With the expansion of mental health services to a broader population, mental health professionals will be compelled to expand their skill sets incorporating prevention and integrated primary care (Rozensky, 2012).

In order for school psychology to take advantage of ACA provisions, a reframing of role, and function is essential. A shift from primarily providing assessment and placement services to delivering intervention services is required (Mennuti & Christner, 2010). Included in this change of role would be the exploration of specific questions—for example, what are the competencies that would be required to offer integrated care in a school setting? What evidence-based services need to be available? How do we develop collaborative interdisciplinary working relationships?


The Ethics of Change: Professional Considerations


The practice of school psychology has undergone significant changes as a result of evolving social trends, federal legislation, and societal challenges. There has been increased attention to issues of social responsibility and the protection of the rights of children (McNamara, 2011). The prevailing influence of technology, security of records, and personal information, as well as storage and access to information, provide additional challenges in the protection of patient confidentiality.

New challenges raise new ethical considerations. School psychologists express concerns as to what appropriate services are to be provided in a school setting and what competencies are necessary to provide such services (Dailor, 2007). A critical ethical principle is that of “responsible caring,” requiring professionals “to attain and maintain competence in the delivery of professional services, and to guard against practices that may result in harmful or damaging consequences” (McNamara, 2011, pg 768). Among the conditions of responsible caring are that school psychologists must continually assess and maintain competency in their areas of professional practice, monitor their own practices and decisions, and assist in the identification and execution of evidence-based practices. Further, the school psychologist must consider the integrity or fidelity by which these practices are executed. An additional ethical consideration is how to protect confidentiality within the school system (Dailor, 2007). The National Association of School Psychologists in the Blueprint for Training and Practice (Ysseldyke et al., 2006) and the Ethical Principles and Code of Conduct of the American Psychological Association (2010) specify that psychologists must work within the bounds of their professional competence. With the critical need for evidence-based mental health services, it is essential that school psychologists have the necessary training to be effective therapists.

The “half-life” of specialty training is a concept used to indicate the amount of time that the acquired information can be considered current and relevant. Thus, the half-life of a doctorate degree in psychology is considered to be 10–12 years. The estimated half-life of knowledge in school psychology is 9 years and, with the proliferation of research and information, is moving to 8 years. In clinical child psychology, the half-life is 8 years with movement toward 6.75 years (Rozensky, 2012). Rozensky, a 2013 APA award winner for Distinguished Career Contributions to Education and Training in Psychology, states that “education and training in, and the practice of, professional psychology must adopt and adapt to changes in accountability and quality expectations in the evolving health care system brought about by the implementation of the Patient Protection and Affordable Care Act” (Rozensky, 2013 pg 703). “The ultimate contract is between society and the profession…a mature, autonomous self- regulating profession” (Belar, 2012 pg 548). While there is great importance in understanding the foundations of knowledge, it is critical to remain informed of contemporary issues and changing cultural and clinical concerns.

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Jun 29, 2017 | Posted by in PSYCHOLOGY | Comments Off on Introduction: The Future Is Now—Challenges in the New Age of Psychological Practice

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