Effect of school based mental health program on emotional intelligence social behaviors psychopathology and academic performance of inner city at risk African American adolescents

¶ … school-based mental health program on emotional intelligence, social behaviors, psychopathology and academic performance of inner- city [at -risk / African-American] adolescents

The need for school-based mental health programs in inner-city schools.

The issue of the need for school-based mental health programs in schools, and particularly in inner-city schools, is an issue that has raised a wide range of views, research and opinions. There are many variables to consider in this context, such as race and ethnicity as well as social environment and a host of other concomitant aspects. As a study by Nabors, Reynolds and Weist, (2000) in this area states;

Expanded school mental health (ESMH) programs, involving the provision of comprehensive mental health services for youth in special and regular education, are growing progressively throughout the United States. These programs typically include prevention activities; evaluation; individual, group, and family therapies; case management; and staff consultation. (Nabors, Reynolds and Weist, 2000, p. 1)

The need for ESMH programs is predicated on a number of facets that have come to the fore in recent research and which are extensively discussed in the literature. Furthermore, studies note that the evidence for the viability and success of evidence-based and verifiable mental health programs in schools is growing and has grown considerably during the past decade. (Weist, Sander, Lowie & Christodulu, 2002)

As the study by Weist et al. (2002) states, there is now and extensive literature on this subject which is an indicator that school-based interventions and programs can lead to positive outcomes for students in many respects. (Weist, Sander, Lowie & Christodulu, 2002) This is a view that is supported by numerous studies, such as the prevention of mental health disorders in school-aged children: Current state of the field by Greenberg, Domitrovich, and Bumbarger (2001).

These studies stress that mental health programs at schools are also effective in dealing with emotional as well as behavioral problems, which many children in schools experience - and consequently impacts positively on academic performance.

Therefore, a central reason and rationale behind the implementation of school-based mental health programs is that they generally have been found to be an effective tool in dealing with many emotional and behavioral problems that occur among at-risk students. However, this view must also take into account other aspects, such as the urban environment. This leads to an extensive discourse in the literature on the extent of the mental health problems in inner-city schools, and how these problems impact on issues such as emotional stability and academic performance.

There are a number of studies that view recent data and research findings as indicators of the necessity for evidence-based and school-based mental health program and initiatives and see these as an integral part of contemporary healthcare. An article that deals extensively with this central aspect of the need for mental health care programs is Bringing Evidence-Based Child Mental Health Services to the Schools: General Issues and Specific Populations by Masia-Warner et al. (2006). This article echoes the research findings of other studies, which reveals the high rate of psychiatric disorders among young children and adolescents.

Epidemiological research indicates a high prevalence of psychiatric disorders among children and adolescents. Approximately 21% of children and adolescents, ages 9 to 17, have a diagnosable psychiatric disorder... And additional youngsters experience social and emotional difficulties that do not meet symptom criteria for a disorder but cause considerable distress and impairment in functioning. (Masia-Warner, Nangle and Hansen, 2006, p.165)

Findings such as the above immediately make the need for health programs at school level understandable. The need for these programs is also emphasized by studies which focus on the significant disparity between the many youths who are in need of treatment and those who actually receive mental health care. This aspect is dealt with in Children's mental health service use across service sectors by Costello et al. (1995).

Furthermore, this need for more extensive and optimized mental health care and programs is stressed by many other studies and reports; for example, the U.S. Department of Health and Human Services (999) has stated that "...emotional problems are not receiving the help they require" and" the failure to provide treatment to youth represents a major public health concern (U.S. Public Health Service, 2000; Masia-Warner, Nangle and Hansen, 2006)

The literature is replete with studies that echo the above views and opinions. The feeling is also expressed in many of these articles that in terms of adolescent mental health care, schools are theoretically a perfect avenue for dealing with these mental health problems. (Masia-Warner, Nangle and Hansen, 2006) This has led in recent year to many initiatives to improve mental health facilities at schools and to focus attention on the various barriers and obstacles to mental health provision - especially in the urban environment where these problems is often exacerbated by factors such as crime and poverty. The study by Masia-Warner, Nangle and Hansen, (2006) states that;

Offering services in a familiar setting like schools may make treatment more acceptable... since many children already receive school-based services for non-mental health concerns. On a related note, school programs reduce barriers common to treatment in community mental health services such as cost, transportation, and family and demographic factors... And thus, may offer opportunities that would otherwise be unavailable.

A p.165)

Therefore, the literature with regard to the need for these programs covers a wide and broad range of issues and variables. Valuable and insightful resources can be found both online and offline. There is in much of the literature a consensus as to the increasing need for school-based mental health problems in many inner - city schools. A very useful starting point is an online resource entitled School-Based Mental Health Services: A Select Bibliography. This article provides a very useful bibliography of resources. The introduction to this article emphasizes some cardinal aspects, such as the fact that counselors, psychologists, clinical social workers, marriage and family therapists, and psychiatrists provide a variety of necessary services, which include;

prevention-focused activities to create a healthy school environment, selective interventions with groups of students whose circumstances place them at higher risk for emotional or behavioral health problems, as well as diagnosis and treatment of individual students with specific health needs.

School-Based Mental Health Services: A Select Bibliography)

Another general but insightful study which sheds light on important issues relating to the need for these services and programs is Brief Notes on the Mental Health of Children and Adolescent (1999) This article stresses the fact that, "The future of our country depends on the mental health and strength of our young people. However, many children have mental health problems that interfere with normal development and functioning." (Brief Notes on the Mental Health of Children and Adolescent) the article refers to the finding that in the United States one in ten children and adolescents suffer from mental illnesses which are severe enough to cause some level of impairment. Importantly, the article also points out that the need for mental health programs at school level is emphasized by the fact that studies have found that fewer than one out of every five of these children with mental health issues actually receives any treatment. (Brief Notes on the Mental Health of Children and Adolescent)

Furthermore, this study refers to data that has recently been compiled by the World Health Organization which indicates that "...by the year 2020, childhood neuropsychiatric disorders will rise proportionately by over 50%, internationally, to become one of the five most common causes of morbidity, mortality, and disability among children." (Brief Notes on the Mental Health of Children and Adolescent) the article is extensive in terms of dealing with the various types of mental disorders that are encountered. Another general and extensive source is Child and Adolescent Mental Health, from the United States Department of Health and Human Services.

A large section of the literature focuses on the particular need for these programs in inner-city schools. A paper by Jepson, Juszczak and Fisher (1998) discusses in detail the mental health services provided at a high school-based health center that integrates mental health and medical services. (Jepson, Juszczak and Fisher, 1998, p. 1) Among the findings of this study is that "Since the early 1970s, over 600 health centers have been established in American schools in order to assist with the management of medical and psychosocial problems of high-risk youth..." (Jepson, Juszczak & Fisher, 1998, p. 1) This article is relevant in terms of the fact that urban youth experience particularly complex biopsychosocial problems, which has promoted a multidisciplinary approach to deal adequately with these issues. (Jepson, Juszczak and Fisher, 1998, p. 1) This is also related to the issue accessibility and the need to provide programs of this nature for these student and adolescents who might not otherwise have access to mental -health care. The study therefore tends to emphasize the reason and need for programs of this nature.

One of the central issues that emerge from the literature is the fact that inner city schools and African-American students have suffered from certain cultural and racial inequalities which require attention from a mental health perspective. This is discussed at length by Fusick and Bordeau (2004) "...school-based counselors need to be aware of the disturbing inequities that exist in predominantly Afro-American urban school districts, where nearly 40% of Afro-American students attend school in the United States" (Fusick and Bordeau, 2004) This again places emphasis on the need for mental health programs in these areas of concern. This is also related to findings from a study by McDavis et al. (1995) Counseling African-Americans, which refers to research that stresses the "...widening achievement gap between Afro-American and Euro-American students." (McDavis, et al. 1995)

An important study Laura a. Nabors, Evaluation of Outcomes for Adolescents Receiving School-Based Mental Health Services (2002) refers to the particular issue and problems experience at inner-city schools. The author states that, "School mental health (SMH) programs are an important setting for providing mental health services to adolescents, especially urban youth who typically face in- creased exposure to risk factors." (Nabors, 2002, p.105) This study explores the fact that the youth in many urban areas are often deprived of adequate mental health care facilities, which can result in serious health risks.

The study y places emphasis on the fact that "School mental health (SMH) programs may be an optimal avenue for providing services to these youth who other- wise might not receive treatment." (Nabors, 2002, p.105) This study was particularly interesting in terms of its results; which indicate that those adolescents in inner-city schools who received mental health care showed a significant improvement in their general academic and emotional functioning over a period of time. (Nabors, 2002, p.105) These findings also suggest that males tend to benefit in particular in terms of overall functioning. (Nabors, 2002, p.109)

There are a number or areas of this study that are of particular note and which tend to emphasize the necessity for mental health program in schools and among high-risk students. An important study that sheds light on the value and the need for these programs is Are School-Based Mental Health Services Effective? Evidence from 36 Inner City Schools (1999) by Armbruster and Lichtman. This study also indicates significant improvement among students in many developmental areas as a result of these programs.

A very useful resource in terms of understanding the general trends and areas that are in need of improvement in these programs is Educational Resilience in Inner-City America: Challenges and Prospects by Margaret C. Wang and Edmund W. Gordon (1994).This work make the following pertinent points.

The lives of many inner-city children and families across this country are indeed in disorder, and they are floundering, as are the community agencies to which they traditionally turn for help. As with all social problems and the modern morbidities of our time, children and youth in the inner cities are hit hardest. At a time when they should be learning more and developing broader competencies in better schools, the trend is disastrously otherwise. They should be provided with support for healthy development and constructively engaged in stimulating exchanges with the educational and cultural institutions of their community, but they are not.

Wang & Gordon, 1994, p. ix)

2. Problems faced by school-based mental health programs.

The literature on this aspect is extensive and is to be found in articles on general discussion on the subject, as well as in more specialized and focused studies. One of the central issues of concern in the literature is that there is evidence of possible negative stereotypes that exist within mental health programs that may impact on the efficacy of that program. As Fusick and Bordeau, state in their study, Counseling at- risk Afro-American Youth: An Examination of Contemporary Issues and Effective school-based Strategies (2004), multicultural counselor training programs face many challenges in actually enhancing multicultural competence; although multicultural training has been associated with counselors' self-perceived multicultural counseling competence and case-conceptualization abilities, little data currently exist to indicate whether and how this training impacts the actual work between counselors and diverse students (Fusick and Bordeau, 2004)

This problematic area also relates to studies that focus on accountability among counselors and effective measures to ensure positive results from programs. The verifiability of the results of these programs is another problem that is extensively discussed in the literature. These aspects are also linked in the literature to the problem of sensitivity to ethnic and cultural difference and to the social and historical context of many students. Fusick and Bordeau (2004) for example, refer to the many challenges that confront multicultural counselor training programs that are involved in enhancing multicultural competence. The training of counselors in various mental health programs is a cardinal problem area in the appropriate implementation of these programs. Furthermore, the comprehensive study by Fusick and Bordeau, citing research undertaken by Constantine (2001), states that, "... little data currently exist to indicate whether and how this training impacts the actual work between counselors and diverse students." (Fusick and Bordeau, 2004) it is enlightening to note that,

The ASCA National Model (2002) challenges school counselors and administrators to be accountable for their practice and to demonstrate the effectiveness of their work in "measurable terms," such as results reports, adherence to performance standards, and program audits." (Fusick and Bordeau, 2004)

The above references echo a general sentiment that is evident in much of the literature; which refers to the view that there is still a critical lack of sensitivity to ethical and cultural factors, as well as the social context of the students. As one study emphasizes, "To facilitate therapeutic relationships, competent Euro-American counselors serving Afro-American children must first be prepared to deal with their clients' historical hostility, feelings of mistrust, and fear resulting from 300 years of oppression." (Fusick and Bordeau, 2004) There is also, according to various studies, a need for the development of trust and for the reduction of any skepticism that might be felt or experienced by Afro-American students. (Harris, 1995)

Another important aspect noted in the above studies and in others is that while in theory many mental health counselors and professional are able to offer assistance and opportunities for at-risk students, yet in practice these counselors only make contact with these students after they have been in trouble and have been punished. The study by Fusick and Bordeau (2004) notes that this creates a problematic situation in that the mental health program takes effect at a stage which is sometimes too late in terms of the progression of the problem that the student might be experiencing. This study goes on to emphasize the point that mental health programs should implement a policy that facilitates interaction and rapport at an early stage with at-risk students.

Related to the above is the need for a development for ethnic identity and the "affirmation" of this identity. This is important as it is seen as a "...important correlate to academic achievement and social success..." (Fusick and Bordeau, 2004) There are many studies that emphasize the problematics of bias in mental health programs. A study by Bradley, C. (2001) entitled, a counseling group for African-American adolescent males. Professional School Counseling stresses the point that mental health counselors are often unaware of their biases.

In addition, there is another more general problematic area which is often cited in the literature. This refers to the social stigma that is still attached in some case to mental health problems. As Nabors, Reynolds and Weist, (2000) state in their study, Qualitative Evaluation of a High School Mental Health Program, (2000), "...the "stigma of being crazy" associated with treatment impedes student participation in therapy. "(Nabors, Reynolds & Weist, 2000, p. 1) This study therefore focuses on various ways and means of overcoming this stigma. There are also references to problem areas of a more practical nature, such as the incongruity between mental health programs and the environment and the context in which they function. A well written and insightful article in this regard is Commentary: Promoting Paradigmatic Change in Child and Adolescent Mental Health and Schools by Weist (2003).

Besides the literature that focuses on racial and ethnic aspects that can be problematic, there are also wide array of more practical aspects that have been identified in the literature as being problematic in the implementation of school-based mental health programs. One of these issues that is also emphasized by Fusick and Bordeau (2004) is the problem surrounding tracking. As this study points out, "School counselors also can assist at-risk students by consulting with other personnel to ensure that tracking practices, or placing students together in terms of academic ability, do not further discriminate and disenfranchise at-risk Afro-American youth." (Fusick and Bordeau, 2004) This also refers to a wide range of articles and studies that explore the debate surrounding tracking in the United States and the allegations that Afro-American students have been unfairly and disproportionately placed by school counselors into lower, remedial tracks, where they often remain and which also exacerbates mental health issues and program goals. (Thompson & O'Quinn, 2001).

There are a number of studies that focus specifically on the problems surrounding the implementation of this program at urban schools. Atkins et al. (2003) in an article entitled Toward a New Model for Promoting Urban Children's Mental Health: Accessible, Effective, and Sustainable School-Based Mental Health Services, states that there is an urgent need to include other players, such as families, in the implementation of mental health services at schools. This refers to the finding that these services are often complicated by dealing with the individual in isolation from the family and community in which they occur. The study also refers to a "... multitiered approach to service delivery, including the involvement of influential parents and teachers in the provision of mental health services." (Atkins, Graczyk, Frazier and Abdul-Adil, 2003, p.503) This is deemed to be important in terms of future developments in mental health care.

Another aspect that is noted and which is echoed in other related studies is the need to improve access to services. This is based on findings from various national surveys, which indicate that, " nearly 80% of youth ages 6-17 who were in need of mental health services did not receive services within the preceding 12 months, with rates approaching 90% for uninsured families... Furthermore, the assumption that there is sufficient knowledge regarding intervention effectiveness to transport evidence-based strategies to community settings is questionable." (Atkins, Graczyk, Frazier & Abdul-Adil, 2003, p.503)

Also of importance is the problem of sustainability of these programs. In other words, this refers to issue such as who will provide the service and how they will be funded.

A central problem that has also been identified with school-based mental health programs is inadequate verification of the results to show that these programs are in fact effective. A study that deals with this aspect is Qualitative Evaluation of a High School Mental Health Program by Nabors, Reynolds, and Weist (1999). This study concludes that, " Participants reported that therapy served as a protective factor, enhancing physical and mental health and reducing risk for teenagers. Ideas for improving clinical practice were developed from study results." (Nabors, Reynolds, and Weist, 1999, p. 1)

An article that deals with the various obstacles and barriers to adequate and successful mental health programs at schools is the Expanded School Mental Health Framework by Weist, Sander, Lowie, and Christodulu (2002).

The barriers noted in this article include, lack of understanding that these centers exist, transportation difficulties, the stigma of mental illness, payment problems, excessive bureaucracy, and centers' limited capacity (waiting times for first appointments can be two months or longer). As awareness of these barriers has increased, so has awareness of the importance of providing mental health care to youth "where they are" -- in school and other community settings. (Weist, Sander, Lowie & Christodulu, 2002. p.269)

However, the article also notes that there is a growing awareness of these barriers and problems and that expanded school mental health (ESMH) programs are being developed to deal with these issues.

These views are also supported by studies such as Bringing Evidence-Based Child Mental Health Services to the Schools: General Issues and Specific Populations by Masia-Warner et al. (2006) This work emphasizes the positive effect of these programs in terms of various disorders, such as anxiety disorders, depression, substance use, and conduct and emotional problems. (Masia-Warner, Nangle & Hansen, 2006) However, the study by Masia-Warner (2006) also reiterates a central problematic area and concern in that the overall, school-based programs have not been subjected to systematic evaluation, and surprisingly few studies target specific psychiatric disorders, utilize methodological controls, or implement well-articulated interventions and standard outcome measures." (Masia-Warner, Nangle & Hansen, 2006)

This is also a problem area that is noted in other studies and is related to the call for more extensive research in terms of the implementation of these schools-based programs.

A study by Weist, Sander, Lowie and Christodulu (2002) also adds to this discussion and states that there are many 'gaps" in the present system of mental health programs at schools. The authors refer to two central methods of application of these programs that are currently used; namely, broad-based prevention programs that are implemented school-wide and prescribed or interventions to address specific disorders in youth. (Weist, Sander, Lowie and Christodulu, 2002, p. 269) the study asserts that there are many aspects of this system that are problematic; for example, even given training and resources to implement a curriculum to increase life skills in students, teachers commonly will have many questions, such as "How do I know this program will work with students in this school?," "Can materials from this curriculum be adapted?," and "How will the skills trained in this program be supported throughout the school?" (Weist, Sander, Lowie and Christodulu, 2002, p. 269)

One of the most pertinent critiques of the present system of mental health services at schools is that it these services and programs are often not in step, as it were, with the context and environment in which they function. This is a central problem that is referred to in many studies, including a 2003 study by Weist entitled, Commentary: Promoting Paradigmatic Change in Child and Adolescent Mental Health and Schools. In this study, Weist states that the implementation of social and emotional learning (SEL) programs in schools is "...often a stark contrast with the reality of the school setting." (Weist, 2003, p.336) This relates the essential aspect of context, especially with regard to the urban and inner-city school. As Weist states,

In urban schools it is easy to succumb to feelings of defeatism, as educational, administrative, and mental health staff contend with high levels of problems in youth, too limited resources, and a confusing mishmash of disconnected and often severely limited "support" services. (Weist, 2003)

There aim of this study is to explore the problematics of health care services and program at schools.

The above references refer to only some of the major areas of study and research. A useful article that discusses the general barriers to successful mental health programs at schools is Barriers to School-Based Health Care Programs by Stock, Morse, Simon, Zeanah, Pratt and Sterne (1997). This study also refers to less obvious barriers, such as the opposition by religious groups.

3. How enhancing emotional intelligence through psychotherapy can enhance academic performance and various behavioral aspects.

There are a number of studies that link the enhancements of emotional intelligence to academic performance. An insightful study by Downey et al. (2008) entitled Emotional intelligence and scholastic achievement in Australian adolescents, examines this area. The study involved two hundred and nine secondary school students who had completed the Adolescent Swinburne University Emotional Intelligence Test (SUEIT). Academic achievement data was collected for all subjects. The findings of the study indicated a positive correlation between EI or emotional Intelligence and academic performance. One of the central findings was that, " Academic success was found to be associated with higher levels of total EI, via assessment of the EI of different academic levels (80th percentile, 20th percentile, and middle groups)." (Downey et al. 2008. p10) the results of this study indicate that the development of emotional intelligence offers significant opportunities to improve scholastic performance and emotional

Another very useful study in this regard is Linking Emotional Intelligence and Performance at Work: Current Research Evidence with Individuals and Groups by Druskat, et al. (2006). This study notes that the concept of emotional intelligence is relatively new and there is an "overlap" in the definition of this term. (Druskat, Sala, and Mount, 2006, p. viii) However, there are more advances being made in terms of the understanding of the intersection between emotional intelligence and academic as well as behavioral aspects. "...we now have the tools to empirically demonstrate that emotional competence affects both relationships and performance at work." (Druskat, Sala, and Mount, 2006, p. viii) cogent study that examines the link between emotional intelligence and behavioral aspects in relation to Psychotherapy is Emotional Intelligence: A Transformative Theory and Applied Model of Positive Personal Change by Nelson, Low and Ellis (2007). This study refers to the aims of psychotherapy, which is to "...help the client make positive changes in the emotional system." (p. 30) the study deals ostensibly with the corporate setting but is equally applicable to the educational and school environment and to students from a less privileged background. The paper emphasizes the role of psychotherapy and its value in teaching, mentoring, counseling and coaching.

4. The relationship between psychiatric symptoms such as depression, anxiety etc. And its effect behaviors and academic performance in adolescents.

The literature shows evidence of a strong correlation between psychiatric problems and conditions, such as depression, and school performance and behavior among adolescents. A study that is enlightening in this regard is Depression and school performance in middle adolescent boys and girls by Sari et al. (2008). This study was aimed at the exploration of the relationship between different levels and degrees of depression and various aspects of school performance. The study found that depression was associated with, difficulties in concentration, social relationships, self-reliant school performance and reading and writing as well as perceiving schoolwork as highly loading. The school performance variables had similar associations with depression among both sexes when a wide range of depression was studied but gender (Sari et al., 2008, p. 485).

Significantly, the study also found that, "...Depressed young people had impaired abilities to cope with academic responsibilities. This emerges both in external evaluation and in subjective experience." (Sari et al., 2008, p. 496) the article therefore strongly suggests that psychological aspects such as depression play a major role in performance variables at school level.

An article entitled, Mental Health Problems and Symptoms among Male Adolescents Attending a Teen Health Clinic, by Smith et al. (2001) also indicated a strong correlation between mental health problems and school performance, as well as other related behavioral aspects. The study was focused on the frequency and the nature of these mental health issues and their symptoms among 51 inner-city male adolescents attending a teen health clinic at a large county hospital in the southwestern part of the United States.

The results of this survey indicated that, among others, young males experienced significant mental health problems and symptoms, which included relationship problems and symptoms of anger, depression, and aggression. This also correlates with school performance and related problems. (Smith, Buzi & Weinman, 2001, p. 323) the study refers to the fact that, "The lifetime prevalence rate of Major Depressive Disorder (MDD) in adolescents has been estimated to range from 15% to 20%.... between 2% and 5% of the general adolescent population experiences MDD at any given point in time." (Smith, Buzi & Weinman, 2001, p. 323)

This results of the study found that there was a correlation between aspect of emotions intelligence, mental health and academic, as well as other variables and that "The high prevalence of mental health problems among adolescent males and their potential persistence into adulthood underscore the benefits of early identification and treatment." (Smith, Buzi & Weinman, 2001, p. 323) it is also noteworthy that the study refers to a number of the barriers and problem areas that exist with regard to mental health problems. It found, for instance, that adolescent males were more reluctant to make use of mental health facilities. This was ascribed to cultural and peer influences and to stereotypes relating male role models and masculinity.

Among the literature on this topic is an insightful article entitled, the Role of Emotional Intelligence in Anxiety by Pizarro (2006) Pizarro examines the relationship between emotional intelligence, anxiety and depression among adolescents. This study involved two- hundred and fifty high-school students who were given self-report measures of emotional intelligence, along with measures of thought suppression, self-esteem, anxiety, and depression. The aim of the study was to test whether there was an expected correlation between emotional abilities and factors associated with poor adjustment such as self- esteem and thought suppression. The results of the study found that in the first instance, the ability among the students to regulate mood, also known as emotional repair, was positively correlated with to aspects of self-esteem. The second central finding of this study was that there was a negative correlation between emotional intelligence and levels of depression and anxiety. This is seen as further indication that high elves of emotional stability and control were positive for aspects such as academic performance and self-esteem. Emotional abilities are an important and unique contributor to psychological adjustment.