MCH Student:
Amy Parsons
Date of Defense:
October 20, 2017
Abstract:
Introduction
I completed my field experience during the 2012-13 academic year with Watercourse
Counseling, a community-based mental health agency that provides school-based mental
health services at Andersen United Community School in Minneapolis (Andersen). The
experience was a Master of Social Work field placement that fulfilled the requirements of my
Master of Social Work/Master of Public Health dual degree program. Although my experience
was largely clinical, children’s mental health is an important public health issue. Approximately
20% of children 13- to 18-years- old have a severe and debilitating mental health disorder
(Merikangas, et al. 2011). Furthermore, children from families with adverse life experiences and
living in poverty are at greater risk to have a mental health disorder (Porche, et al. 2016).
Children living in poverty tend to have the highest barriers to accessing mental health care and
are thus the most underserved population, as only 36% of children living with a mental health
disorder receive services (Merikangas, et al. 2011). The impact of children not receiving
services is significant; children and youth with mental health issues are more likely to fail or drop
out of school and have greater involvement in the criminal justice system (Stagman & Cooper,
2010). Furthermore, mental health conditions were the most costly childhood condition in terms
of direct medical expenditures in 2011 (Soni, 2014).
School-based mental health programs are a public health response to children’s mental health
needs, as they reduce barriers and increase access to convenient, cost-effective services with
opportunities to directly intervene in a child’s environment. A recent study by Wilder Research of
school-based mental health programs in Minneapolis reveals that 98% of school staff viewed
students as more likely to receive mental health services when programs are school-based, and
82% of school staff and 94% of parents and caregivers agreed that it is easy for students to
receive mental health care at school (Wilder Research, 2016). A systematic review indicates
that in both primary and secondary schools, students with government-based or no insurance
made up a higher portion of users of mental health services in school-based health centers
(Mangat Bains & Diallo, 2016).
Experience
I provided school-based mental health services at Andersen, including individual therapy for
children, family/parenting therapy, consultation, and care coordination with staff. I provided
services in Spanish and English. Most children utilizing school-based mental health services
were identified as having struggles in the classroom that impact learning. The student body of
Andersen is very diverse, with the following demographics: 53% Hispanic, 35% Black, 5%
American Indian, 4% White, 2% Asian, and 2% Two or more Races. Of my caseload, over 50%
were Spanish-speaking. Approximately 97% of students qualify for free and reduced lunch,
indicating that students come from families with low incomes. Students generally do not meet
achievement standards according to standardized state tests (Minnesota Department of
Education, 2017).
Nonetheless, I observed numerous strengths in the school community,
including involved parents, resilient students, and a safe and stable school environment.
The primary objectives for the public health component of my field experience were: (1)
Understanding how culturally appropriate assessments and interventions specific to children’s
and community mental health impact program effectiveness by challenging systems of privilege
oppression and (2) Reviewing the role of standardized assessments in ensuring adequate
service provision for children’s mental health programs. I achieved the first objective by
examining how power, privilege, oppression, culture, and identities affect client outcomes and
create barriers for students to access and maintain mental health treatment. By administering,
scoring, and communicating results of the Strengths and Difficulties Questionnaire (SDQ) and
the Child and Adolescent Service Intensity Instrument (CASII) I observed how these self-assessment tools inadequately captured the experience of non-majority populations. This then
impacts how programs are designed and implemented and how funds are distributed.
Organization
Watercourse Counseling is a nonprofit organization established in 1999, whose mission is to
strengthen the Minneapolis community by supporting people in the journey toward emotional
well-being. It strives to improve community wellness by creating equitable access to mental
health services, bringing services into the community, building partnerships to address
community issues impacted by mental health, and mentoring mental health trainees
(Watercourse Counseling). Watercourse Counseling provides school-based mental health
services to 12 schools in South and North Minneapolis, in addition to providing office-based
therapy. There are 22 staff members, as well as a board of directors and clinical trainees. My
field experience fit within this agency’s overall mission by increasing access to mental health
services through providing school-based therapy at Andersen, as well as receiving mentoring as
a clinical trainee.
Lessons Learned
I learned a number of lessons that reinforce my public health training. I witnessed how the
school-based mental health model enables access to services by overcoming multiple barriers
that would make other mental health services inaccessible. I saw the importance of engaging
non-majority populations in the design, development, and implementation of survey tools.
Without such engagement, these tools may mischaracterize the needs of underserved
populations, and thus negatively impact program outcomes. At a micro level, there were a
number of inefficient processes and procedures that impacted service delivery and staff
satisfaction. In addition, because therapy practice was not systematically evaluated, it was
difficult to identify and address weaknesses in program design, policies, and procedures. While
there is a heavy reliance on client feedback, because it is gathered in an ad hoc basis, there is
no way to systematically analyze feedback data. Finally, I observed how co-located and
integrated services can facilitate team (i.e., school, family, student, and mental health provider)
communication and reduce duplication of efforts, enabling more effective services to diverse
populations.
Recommendations
At an agency level, I recommend more formalized procedures and policies to more clearly
define the school-based mental health program for both clinicians and school staff, and develop
concrete ways to support clinicians who are working within schools. I recommend that
Watercourse Counseling, as well as other agencies, have program evaluations conducted for
their services. Wilder Research’s Evaluation of School-based Mental Health Services in
Hennepin County in 2016 included 34 schools; however, I am not aware of a formal program
evaluation at an agency level. This could be a collaborative opportunity for Social Work and
Public Health fields to partner together to improve programs and services. Additionally, I would
recommend increased efforts to recruit more bilingual clinicians and clinicians of color to be able
to serve more students in a culturally relevant way.
Conclusion
This field experience provided a valuable learning opportunity that fostered self-reflection, self-
advocacy, skill development, and an opportunity to greater understand the intersection of social
work and public health as it relates to children’s mental health. I witnessed firsthand how school-
based mental health services reduce barriers to children’s mental health care and significantly
impact their lives, helping to improve the overall school environment. It has been an experience
that has informed my career as I develop as a social work and public health professional.
References
Mangat Bains & Diallo (2016). Mental health services in school-based health centers:
Systematic review. The Journal of School of Nursing. 32(1), 8-19. DOI:
10.1177/1059840515590607 jsn.sagepub.com.
Merikangas, K. R., He, J. P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., … Olfson, M.
(2011). Service utilization for lifetime mental disorders in U.S. adolescents: Results of the
national comorbidity survey-adolescent supplement (NCS-A). Journal of the American Academy
of Child and Adolescent Psychiatry, 50, 32–45. doi:10.1016/j.jaac.2010.10.006
Minnesota Department of Education (2017). MN Report Card.
http://rc.education.state.mn.us/#demographics/orgId– 30001190000__p– 3
Mom, S. & Atella, J. (2016). Evaluation of school-based mental health services in Hennepin
County: Understanding the impact of services on students. St. Paul, MN.: Wilder Research.
https://www.wilder.org/Wilder-
Research/Publications/Studies/Hennepin%20County%20Children's%20Mental%20Health%20C
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%20Understanding%20the%20Impact%20of%20Services%20on%20Students.pdf
Porche, M.V., Costello, D.M., & Reynoso-Rosen, M. (2016). Adverse family experiences, child
mental health, and educational outcomes for a national sample of students. School Mental
Health. 8(1), 44-60. https://doi.org/10.1007/s12310-016- 9174-3
Soni, A. (2014, April). The five most costly children’s conditions, 2011: Estimates for U.S.
civilian noninstitutionalized children, ages 0–17. (No. Statistical Brief #434). Rockville, MD.:
Agency for Healthcare Research and Quality
Stagman, S., & Cooper, J. L. (2010, April). Children’s mental health; what every policymaker
should know. (Policy brief). Mailman School of Public Health, National Center for Children in
Poverty, Columbia University. http://www.lacdcfs.org/ katiea/practices/docs/Childrens_MH.pdf
Watercourse Counseling. https://watercoursecounseling.org/