THE IMPACT OF MENTAL HEALTH ISSUES ON ACADEMIC

California State University, San Bernardino California State University, San Bernardino

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THE IMPACT OF MENTAL HEALTH ISSUES ON ACADEMIC THE IMPACT OF MENTAL HEALTH ISSUES ON ACADEMIC

ACHIEVEMENT IN HIGH SCHOOL STUDENTS ACHIEVEMENT IN HIGH SCHOOL STUDENTS

Patricia Lea Sutherland

CSUSB

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THE IMPACT OF MENTAL HEALTH ISSUES ON ACADEMIC ACHIEVEMENT

IN HIGH SCHOOL STUDENTS

A Project

Presented to the

Faculty of

California State University,

San Bernardino

In Partial Fulfillment

of the Requirements for the Degree

Master of Social Work

Patricia Lea Sutherland

June 2018

THE IMPACT OF MENTAL HEALTH ISSUES ON ACADEMIC ACHIEVEMENT

IN HIGH SCHOOL STUDENTS

A Project

Presented to the

Faculty of

California State University,

San Bernardino

Patricia Lea Sutherland

June 2018

Approved by:

Dr. Gretchen Heidemann, Faculty Supervisor, Social Work

Dr. Janet Chang, M.S.W. Research Coordinator

iii

ABSTRACT

An adolescent’s time in school is not merely academic; they are

developing socially, physically, and emotionally. Prior research has demonstrated

a correlation between a student’s poor academic performance and his/her need

for emotional and mental health support. This research project sought to answer

the following research questions: 1) Do mental health services in a high school

setting help facilitate students’ academic achievement? and 2) Does a focus on

mental health issues improve overall health and well-being in high school

students? Participants for this study are 10 staff members (including teachers,

administrators, counselors, and others) of a high school in San Diego, California.

Qualitative data in the form of interviews was collected for this study, and

subsequently transcribed and analyzed using a “bottom up” approach. Results of

this study indicate adolescents have many challenges to their emotional health

during their high school years and staff have unique access to assist youth in

navigating these challenges. The study describes the need for more mental

health professionals to be available in schools. Implications for micro include the

need for more mental health staff including counselors and school social workers

and the implications for macro practice include the need more staff and teacher

training on how to better support students.

iv 
 
TABLE OF CONTENTS 
ABSTRACT .......................................................................................................... iii 
CHAPTER ONE: ASSESSMENT 
Introduction ................................................................................................ 1 
Research Focus and Research Question .................................................. 1 
Paradigm and Rationale for Chosen Paradigm .......................................... 2 
Literature Review ....................................................................................... 3 
Adolescent Development and Mental Health Challenges: .............. 3 
Mental Health Services in Schools: ................................................. 5 
Theoretical Orientation............................................................................... 7 
Contribution of Study to Micro and/or Macro Social Work Practice ............ 8 
Summary ................................................................................................... 9 
CHAPTER TWO: ENGAGEMENT 
Introduction .............................................................................................. 10 
Engagement Strategies for Gatekeepers at Research Site ..................... 10 
Self Preparation ....................................................................................... 11 
Diversity Issues ........................................................................................ 11 
Ethical Issues ........................................................................................... 12 
Political Issues ......................................................................................... 13 
The Role of Technology in Engagement .................................................. 13 
Summary ................................................................................................. 14 
CHAPTER THREE: IMPLEMENTATION 
Introduction .............................................................................................. 15 

v 
 
Research Site .......................................................................................... 15 
Study Participants .................................................................................... 16 
Selection of Participants .......................................................................... 17 
Data Gathering ........................................................................................ 18 
Phases of Data Collection ........................................................................ 19 
Data Recording ........................................................................................ 20 
Data Analysis Procedures ........................................................................ 20 
Summary ................................................................................................. 22 
CHAPTER FOUR: EVALUATION 
Introduction .............................................................................................. 23 
Data Analysis ........................................................................................... 23 
Student Emotional Wellness ......................................................... 23 
Support Systems in Place in School ............................................. 28 
Support Systems Needed in School .............................................. 30 
Data Interpretation ................................................................................... 35 
Implications of Findings for Micro and/or Macro Practice......................... 37 
Summary ................................................................................................. 38 
CHAPTER FIVE: TERMINATION AND FOLLOW-UP 
Introduction .............................................................................................. 39 
Termination of Study ................................................................................ 39 
Communicating Findings to Study Site and Study Participants ............... 40 
Limitations ................................................................................................ 40 
Ongoing Relationship with Study Participants ......................................... 40 
Dissemination Plan .................................................................................. 41 

vi 
 
Summary ................................................................................................. 41 
APPENDIX A INTERVIEW QUESTIONS ........................................................... 42 
APPENDIX B INSTITUTIONAL REVIEW BOARD APPROVAL ......................... 44 
APPENDIX C INFORMED CONSENT ............................................................... 46 
APPENDIX D DEBRIEFING STATEMENT ........................................................ 48 
REFERENCES ................................................................................................... 50 
 

CHAPTER ONE:

ASSESSMENT

Introduction

Chapter one describes the research focus for this study, which is how

mental health services provided in high schools can improve adolescent mental

health and academic performance. It explains the use of the post positive

research paradigm in conducting this study. Chapter one also offers a literature

review on the topic of adolescent mental health. This chapter addresses how this

information could improve micro and macro social work practice among

adolescents.

Research Focus and Research Question

The research focus is exploring the possible impact when all members of

the academic team in a high school understand mental health concerns

experienced by adolescents. The research questions are: 1) Do mental health

services in a high school setting help facilitate students’ academic achievement?

and 2) Does a focus on mental health issues improve overall health and well-

being in high school students? While looking at the development of the whole

child, an adolescent’s time in school is not merely academic. They are

developing socially, physically, and emotionally. Most school districts require 180

days of instruction, which is about half a calendar year. On any given school day,

an adolescent will be processing a myriad of personal experiences, such as

communication problems with family or friends, identity exploration, and

hormonal changes. If students feel that school is a safe place to process their

emotions, perhaps the learning will come easier. Conversely, students who have

no means to feel heard often develop problematic or attention seeking behaviors.

A student’s grades or academic performance is only one measure of success;

however, a correlation can often be found between a student’s poor academic

performance and his/her need for emotional and mental health support. As this

topic is explored, a theory will be developed regarding the need for and the

benefit of mental health services in high schools.

Paradigm and Rationale for Chosen Paradigm

This study used a post positivist approach to research. This paradigm

used an objective with observable regulatory mechanisms view of the nature of

reality (Morris, 2013). There was no beginning hypothesis, as ideas and themes

slowly emerged through the interviews. Data was gathered qualitatively, in

naturalistic settings to get a clear picture of students’ and educators’ experience

with mental health issues. The rationale for choosing this paradigm was to allow

for theories about the need for mental health services to form as each piece of

data was collected and evaluated. Gathering data in the high school, a

naturalistic setting, provided a breadth and depth of information that could be

gained in no other way. Teachers who spend hundreds of hours with students,

counselors who each have caseloads of more than 500 students, and

administrators who work to establish the best school infrastructure, are those

with “boots on the ground.” Interviews with these educators provided many

genuine experiences that allowed the researcher to build theory.

Literature Review

The developmental stage of adolescence and the need for support and

mental health services in school settings is discussed. Adolescent physical,

emotional, and social development is explored as it interacts with a child’s formal

education or school setting. Mental health challenges specific to adolescents are

also explored. Studies conducted with high school students and in high school

settings were evaluated based on how they apply to the precious growing up

years of adolescence.

Adolescent Development and Mental Health Challenges:

Santrock (2007) defines adolescence as the period of transition between

childhood and adulthood that involves biological, cognitive, and socioemotional

changes. The age range can vary based on cultural context, however, in the

United States adolescence begins at approximately 10 to 13 years old and ends

between the ages of about 18 and 22. This is a time where humans face many

transitional experiences such as evaluation, decision making, commitment, and

finding their place in the world. Adolescence is thought of as the time when youth

prepare for adulthood and the success with which they navigate this brief

transitory period can set the course for the rest of their lives. Larson et al (2002)

suggests the future of any culture hinges on the effectiveness of this preparation.

A study conducted by Ball (2016) explained that more than twenty percent

of children in the United States has a mental health disorder. The American

Academy of Pediatrics (AAP) maintains our current health care system does not

adequately address the needs of children with mental health disorders, citing 1 in

5 children in the United States is affected by a diagnosable mental health

disorder, but only 21% of children in need are able to access treatment. The

AAP’s policy asserts “mental illness is like any other disease; the earlier it is

identified and treated, the better the health outcomes” (American Academy of

Pediatrics, para 1). For example, Cheung et al (2018) described that only half of

adolescents identified with depression receive that diagnosis before reaching

adulthood, and as many as 2 in 3 youth with depression are not diagnosed by

their primary care clinicians and subsequently fail to access any kind of

intervention or treatment.

The National Institute of Mental Health (NIMH) has identified a dramatic

upward trend in adolescent suicide in recent years. Suicide “is the third leading

cause of death among individuals between the ages of 10 and 14, and the

second leading cause of death among individuals between the ages of 15 and

34” (National Institute of Mental Health, 2018, p. 1). To put this in context, The

NIMH cites “in 2015 there were more than twice as many suicides (44,193) in the

United States as there were homicides (17,793)” (NIMH, 2018, p. 1). In addition,

the APA reports that within the United States, up to two-thirds of youth have

experienced some form of trauma before age 16 (American Psychological

Association, 2008). A study by Martin et all (2017) found all children experience

mildly stressful events, but many children also experience extremely stressful

events such as exposure to violence, including violent victimization. Further,

some populations of youth such as LGBTQ youth, foster youth, and adolescents

of color seem to be at greater risk of victimization. Unaddressed, these

experiences can lead to mental health challenges resulting in short term

problems in school and with peers, and much more serious long-term problems

because the foundation of knowing how to face difficulties was never formed

Mental Health Services in Schools:

Dunn (2016) asserts that schools play an important role in determining the

mental health of adolescents because they serve more than 95% of the nation's

young people for nearly 6 hours per day (which equates to 40% of students'

awake time throughout the school year) for at least 11 years of their lives. Atkins

(2010) states the concern for children’s social and emotional growth has been an

ongoing concern for both mental health professionals and schools as they realize

the impact the school setting has on children’s social and cognitive development.

Multiple studies show strong associations between school achievement

and markers of mental health throughout the adult years. (Galanti, 2016).

Teachers work to increase student proficiency and are the first responders for

their students. When students have a mental health issue, the teachers are

usually the ones who refer them to counselors or administrators for help. Berzin

(2012) found regardless of their professional experience or educational

background, teachers find themselves as proxy mental health service providers

and they feel largely unprepared to help in these instances. Further, teachers are

an underutilized resource due mostly to lack of training even though they play a

critical role in serving students’ mental, social, and behavioral needs. Ball (2016)

found mental health concerns can cause a student to have difficulty in school

with poor academic performance, even chronic absenteeism, and disciplinary

concerns. Weist (2005) notes that in the prior two decades, “school mental health

programs have increased due to the recognition of the crisis in children's mental

health—with many students in need of services but not accessing them” (Weist,

2005). In a later study, Weist (2012) asserted that schools offer the best access

to youth for influencing their educational, behavioral, emotional, and

developmental needs. In addition to administrators and teachers, most high

schools have high school counselors. However, mental health services for

students continue to be marginalized because schools are asked to improve

student academic outcomes with fewer resources provided especially in the

context of complicated issues such as family concerns, poverty, and substance

abuse, that affect the social context of education (Weist, 2012). Some schools

employ school social workers who focus primarily on support of mental health

issues. Many schools partner with community organizations to provide a range of

mental health services, but this is inadequate. Weist (2012) suggests that mental

health services in schools should be an integrated enterprise where schools,

families, and community systems work together to create a climate of success for

youth. This would include promoting mental health with prevention, early

intervention, and any needed treatment. The National Association of Social

Workers (NASW) reports that about 5% of the nation’s approximately half a

million social workers work in schools (NASW 2000). Unfortunately, most school

districts do not employ social workers and the mental health needs of students

are instead spread out between support staff who are responsible for too many

tasks. As a result, students’ needs often go unmet.

This research study asked how mental health services or lack thereof

impact a student’s academic ability and performance, and overall emotional

health. The literature indicated negative outcomes for adolescents who have

mental health needs that go unaddressed, and positive outcomes for those who

have the needed support.

Theoretical Orientation

The theoretical orientation for this study is cognitive developmental theory

by Piaget and sociocultural cognitive theory by Vygotsky. Santrock (2007)

asserts both theories suggest that adolescents use reason in more abstract,

idealistic and logical ways. And that development is a function of culture and

social interaction. Piaget proposed that individuals actively construct their

understanding of the world as they go through four stages of cognitive

development. The sensorimotor stage is from birth to two years of age, when an

infant constructs his understanding of the world by combining sensory

experiences with physical actions. The second stage is the preoperational stage

from age two to seven where a child begins to interact with the world using words

and images, increasing symbolic thinking. The concrete operational stage is from

age seven to eleven, where the child will reason logically and classify his events

and experiences. Finally, Piaget’s fourth stage is the formal operational stage

from age eleven through adulthood where the adolescent reasons in more

abstract, idealistic, and logical ways. Vygotksy’s theory emphasizes how culture

and social interaction guide cognitive development. This means that knowledge

is obtained collaboratively, through interaction with others and the culture in

which a person lives. Considering both of these theories, an adolescent has

many factors that determine what type of person he or she will be. Strong mental

health support in a school setting is an additional, necessary protective factor in

an adolescent’s growth and cognitive development. School systems can be an

extension of the family and have a strong influence on the student’s success.

Contribution of Study to Micro and/or Macro Social Work Practice

The information obtained through this study has the potential to improve

both micro and macro social work practice among adolescents. On the micro

level, this research can increase awareness among teachers, administrators, and

school counselors. These team members were able to articulate the need for

mental health support for each student. They treat each student as a separate

and distinct person with different experiences and individual needs. On a macro

level, this study can create awareness that schools need to make systemic

changes. All staff aware of the study saw a heightened need for professionals

who can support the social and emotional needs of growing adolescents.

Summary

This chapter introduced the research topic of this study and why this

research was conducted using the Post Positivism approach. A literature review

described research about adolescent development, mental health issues faced

by adolescents, schools’ responses to mental health needs, and the outcomes

when those needs are addressed. Cognitive developmental theories were

described as the theoretical orientation behind this research study. Finally, it was

asserted that micro social work can be improved by the awareness of specific

needs of this population, and macro social work practice can be improved by

making systemic changes to address mental health needs, thus improving

academic outcomes for students.

CHAPTER TWO:

ENGAGEMENT

Introduction

This chapter addresses the study site where the research took place. It

describes the population that was studied and those who influence and help that

population. It also addresses the need for preparation to understand specifics

about the population, including diversity. Ethical and political issues were also

evaluated in this chapter. Finally, the role of technology in the research is

discussed.

Engagement Strategies for Gatekeepers at Research Site

The strategies for engaging the gatekeepers at the research site were to

first make an appointment with the principal to explain the study and the purpose

of the study. An explanation was given of the purpose of the study, which was to

open a discussion about the mental health needs of the students, and determine

what improvement was needed. The principal was asked to allow a select

number of the staff to be interviewed. The interviews included administrators,

counselors, school psychologist, special education teachers, general education

teachers, and support staff. Once approved, the researcher engaged the staff by

email, requesting an interview for the research project, and then followed up with

an in-person request. The email explained the research was for a master’s thesis

project where mental health needs of students will be explored. Their

professional opinions and personal experiences were requested and studied.

Appointments were made for the interviews based on the staff members’

schedules.

Self Preparation

Bias had to be kept in check throughout the research process. During the

literature review and staff interviews, theories and ideas began to emerge.

Different aspects and perspectives of the interviewees were considered against

potential personal bias. One bias that emerged was socio-economic. The study

body contains children from affluent, middle-class, and low-income families. The

income disparity among families is large and some staff demonstrated bias

toward students of means. Another bias that emerged was regarding LGBTQ

students. The campus does not have many LGBTQ students, and these students

tend to stand out. One last bias that emerged was staff belief that their role

should be focused on academics, that mental health services should be handled

at home and not at school. In requesting interviews, the researcher was neutral

in discussion of the topic of mental health. The researcher prepared a script to

prevent bias in the interview requests.

Diversity Issues

The different backgrounds of those being interviewed was considered.

The interviewees were not all aware of what mental health services are available

to students. Although they work with students every day, they were not fully

aware of all the differences in the student body such as culture, gender identity,

etc. However, those being interviewed were free to answer the questions as they

chose, which allowed for genuine and authentic dialogue.

Ethical Issues

A consent form was requested from each staff participant after providing

them information about the purpose of the study. One ethical issue that came to

light was staff members’ concerns that what they said in the interview may have

an impact on their job standing. They feared the information would get back to

the administrators. The teachers were assured that the specifics of their

interviews would only be known to the researcher, and only generalities would be

included in the final product provided to the principal. Another ethical issue that

appeared was the need to protect students’ stories and information, as shared in

personal experiences during the interviews. A reminder was given to those being

interviewed to only speak of specific students in anonymity. Permission from the

school principal was obtained to interview staff members. No student information

was used in the study. Staff members shared experiences with specific students

during the interviews. This information was analyzed for content, and student

names have remained confidential. Written information was collected and kept in

journals, digital interview recordings were conducted, and computer data has

been kept securely with the researcher. After the final presentation is offered,

data will be destroyed.

Political Issues

The political issues that arose were conflicts between what the research

site implements in terms of mental health services and what the school district

promotes. For example, the school district does not employ school social

workers, however this research site (high school) has trained mental health

professionals on staff whose job classifications are not mental health. In addition

to four administrators, there are four high school counselors whose focus is on

academic progress and college preparation. There is an additional counselor

whose title is “intervention counselor” and her responsibility is to work with the

underperforming students to help them improve their grades. There is also a

student support specialist who connects students to outside resources when

needed. When a student is found to need more mental health services than can

be provided by existing staff, they are referred to the district office, who then

refers the student and family to an outside agency. Schools do not want to admit

that student needs are not being met. The study has shown that teachers need

more mental health training because they are the first line of defense for students

in crisis. The study also demonstrated that this high school’s mental health

services could use some improvement.

The Role of Technology in Engagement

Technology was used in engagement. Email was used to ask for meetings

with gatekeepers, such as the principal and assistant principal. Email was also

used to request interviews with teachers and counselors. A voice recorder was

used to record interviews, and a computer was used to type up the transcripts of

the interviews.

Summary

This chapter described the study site that was used for this research. It

also addressed the location of the study site, the students who it serves, and the

gatekeepers who are the administrators (principal and assistant principal). It

described how the researcher engaged the gatekeepers and the preparation that

was necessary to carry out the study. Diversity issues were also described, such

as differences in culture, gender identity, and ethnicity, for the participants and

also for the students they serve. This chapter also addressed ethical and political

issues that arose in interviewing teachers of a public school system. Finally, the

role of technology used in the study was discussed. To engage the gatekeepers,

the researcher verbally asked for an appointment and then followed up with a

reminder email.

CHAPTER THREE:

IMPLEMENTATION

Introduction

This chapter explains how the research was implemented. Included is

specific information about the site location, the study participants and how they

were selected for the study. This chapter also describes how the data was

gathered, recorded and analyzed. Finally, it addresses how the research results

were provided to the participants and how termination and follow-up was

completed.

Research Site

The study site was a single high school located in California. It is a public

high school with 2,200 students, serving children in grades 9-12. The age range

for these students is between 14-18 years. The school population is diverse, with

students who are of white, Hispanic, Asian, Indian, African American, Indian, and

Pacific Island descent. The area consists of neighborhoods that are upper middle

class, and affluent. The area also has several low-income housing areas within

the middle-class suburban tracked housing developments. It has apartment

homes, condominiums, town homes, single family homes, and large estates. The

school offers a public-school curriculum and is approved by an elected school

board. It also offers special education services for resource students who spend

most of their time in general education classes. Special education services are

also offered for students with mild to moderate and critically severe disabilities.

The staff consists of administrators such as the principal, assistant principals, an

athletic director, and support staff. There are also four full time counselors, one

part-time intervention counselor, a school psychologist, a speech pathologist,

and support staff. The teaching staff consists of general education instruction,

and teachers who teach and case manage special education students. The

administrators, counselors, psychologist, and speech therapist all have graduate

degrees. Most of the teaching staff have graduate degrees. The staff ages vary

greatly, with some teachers just out of college in their twenties and others close

to retirement age in their sixties. The staff is as ethnically diverse as the student

population.

Study Participants

The study participants were various staff from one public high school in

California. The staff that were interviewed hold roles such as general education

teachers, special education teachers, an Associate Student Body (ASB) teacher,

a speech therapist, a school psychologist, school counselors, the principal and

assistant principals, and classified staff such as attendance clerks, school

registrar, and administrative assistants. These staff interact with students daily.

The general education teachers instruct students in their given subject areas, the

special education teachers teach subject areas to students who have an

Individualized Education Plan or IEP. The speech therapist and school

psychologist provide testing and services to students who need additional special

education services. School counselors focus on academic planning; however,

they also attend to the emotional needs of the students. The principal and

assistant principal are responsible for planning the school schedule,

implementing the curriculum adopted by the school district, and setting and

imposing any needed discipline strategies. The school registrar is responsible for

all the records and credits awarded by the school. Classified staff interact and

support student learning and activities. The staff members have a variety of

educational backgrounds, including bachelor’s and advanced degrees. The

undergraduate degrees are in single subjects such as English, History, and

Biology. The graduate degrees are in specific subject areas or Education,

Education Administration, Educational Technology, School Psychology, etc. Most

staff additionally hold California state credentials in their respective fields. They

are both male and female adults, representative of several different races and

cultures such as white, Hispanic, Asian, Indian, African American, Indian, and

Pacific Island descent. Their age range is from early twenties to late sixties.

There are 80 teachers on staff, and another 30 administrators and support staff.

Selection of Participants

Conducting basic research, our unit of analysis was the staff members of

the high school being studied. Using applied research, student behavior and staff

experiences with students are both the units of analysis. A portion of the more

than 100 staff members were selected for interviews. These selections were

made by requesting interviews and selecting those who responded. Using the

maximum variation sampling method, the researcher interviewed those who have

a wide range of experiences working with high school students. Another type of

sampling that used was snowball or chain sampling. During a couple of the

interviews, the researcher learned of other staff members who could add

valuable information to the study; thus, those persons were contacted and

included in the study.

The researcher prepared a brief description of the study that was included

in the initial email request. Prior to conducting interviews, the researcher

acquired knowledge from a thorough literature review on evidence of problems

and solutions in student mental health in school settings. Interview questions

were prepared, and common themes and patterns were found in the participants’

responses.

Data Gathering

The post positivist research paradigm relies on qualitative data gathering.

This was done through in-person interviews with school staff in a naturalistic

setting. After a thorough literature review, the researcher prepared interview

questions. The scripting of the questions was critical to the study’s success. The

beginning questions were engagement questions, such as “How is your class

going this semester?” There were essential questions that were specifically

related to student’s mental health and how students with emotional issues

perform in their respective classes. Throw away questions that contain

demographic questions or general questions were also used at the beginning of

the interview. There were descriptive questions such as, “Do you notice students

who are having emotional issues?” There were also a few probing questions

such as, “Tell me of a time when a student was unable to complete class work or

a test because of mental health related issues.” At the end of the interviews, the

researcher reviewed what was said and thanked the person for participating.

(See Appendix A and C)

Phases of Data Collection

Data collection was from personal interviews, which were recorded by a

voice recorder. The researcher first prepared for the interviews by reviewing the

literature and becoming oriented to the research site. Care was taken to build

rapport by securing the participants’ informed consent and ensuring

confidentiality. The researcher also allowed for necessary time to answer any

questions the interviewee had about the research and interview process. This

included multiple interactions including in-person conversations, emails, or phone

calls which helped the participant feel comfortable about the interview process.

The interview began with an initial engagement phase, and continual effort was

made to be comfortable and natural. The researcher respectfully reflected

participant’s answers and invited more thorough answers by being relaxed and

interactive. During each interview, the researcher observed the participant’s body

language. Post positivism allowed for adjustments during the process, and the

researcher adjusted based on the participant’s need. Once recorded, the

interviews were transcribed into data to be analyzed. Data was taken through

observation of each office and classroom by watching, listening, and learning

from the physical environment. The termination of the interview contained a

summary of what had been discussed. The participant was asked if there were

any further questions or concerns. The interviewer used nonessential questions

and comments to ease out of the interview. (See Appendix B.)

Data Recording

The interviews were recorded using a digital voice recorder. The

researcher transcribed the recordings into a written format. After the interview,

the researcher recorded additional observations and impressions in a research

journal. This information included impressions about the classroom or office, and

perceptions about the participant and his/her answers to the interview questions.

The transcripts of the interviews and the research journal assisted the researcher

to determine the effectiveness of the questions. Researcher also reviewed

journals for potential bias in thoughts and impressions. Improvements to the

interview questions and process were fully explored.

Data Analysis Procedures

Data collection and some data analysis happened simultaneously. As data

was collected and analyzed, the next round of collection was adjusted.

Information was gathered in the form of words and was analyzed qualitatively. As

suggested by Morris (2013), data was analyzed using a “bottom up” approach

that was used to both test theory and create theory. Using the interview

transcripts, the researcher used open coding where the information was broken

down into basic themes. Some of the themes that emerged were student

emotional wellness and specific mental health challenges faced by adolescents.

Other themes were support that currently exists for students and the need for

additional mental health resources. The researcher recorded these themes and

looked for them throughout each interview. The researcher asked staff for their

experiences with students. Microanalysis of the information included the

researcher exploring why a teacher may have responded in a certain way, or

when a particular incident occurred, or examining the events leading up to a

particular incident.

Next, the researcher used axial coding, where relationships between

themes were identified. These themes were tested throughout the interviews. For

example, teachers cited various examples of working with students having

emotional difficulty, and the result was noted when the teacher responded in a

supportive way. A different result was noted when the teacher responded in a

punitive way. Then, through selective coding, the researcher began to develop

theory. Tools to identify core categories included: telling the story of a teacher or

student’s experience, entering information into a spreadsheet to determine

similar findings throughout the interviews, and continually reviewing the research

journal for patterns. This continual data analysis allowed the researcher to

recognize and refine the emerging theory. Categories that had very little

substantiation were eliminated and categories that have robust data were

expanded. The data was then compared to the data found in the literature review

and validated and offered explanations for data that seemed to stand alone. Of

note were specific interactions between teachers and students. For example, as

teachers offer support, and different kinds of support, do students respond

positively? Do some students improve after one support offered by staff, or

many? Do staff members feel qualified to help students when emotional support

is needed? How do staff members respond when a student expresses a need

that staff do not feel prepared to handle? Are there norms for all teachers’

responses to student’s problems? These are data that can be tested to develop

theory throughout the data collection process.

Summary

This chapter briefly described the study site. Also included was a

description of the study participants for the research project and how they were

selected. Data gathering for the research study was explained including the

phases of data gathering and how the data was recorded. Finally, this chapter

described the procedures for data analysis.

CHAPTER FOUR:

EVALUATION

Introduction

This chapter explains the participants in the study and their roles in

working with adolescents. Also explained is how data was analyzed, what

themes and subthemes emerged, and how research evolved and changed during

data collection.

Data Analysis

There were ten participants in the study. Nine were female and one was

male. Eight were Caucasian, one was Hispanic, and one was African American.

All ten of the participants have graduate degrees and have been working with

adolescents from four to twenty-seven years. The participants’ roles in education

are as teachers, counselors, student services staff, and administrators.

Student Emotional Wellness

A major theme began to emerge in response to the question regarding

student emotional wellness. Responders unilaterally agreed that student success

depended on student emotional wellness. Further, they felt there are many

barriers to success when emotional wellness is in jeopardy. Three of the

respondents stated that emotional wellness or lack thereof impacted student

learning. For example, one respondent said, “It’s a basic need, as basic as food

and water” (Participant 7, personal communication, June 2017) . Another

respondent cited Maslow’s Hierarchy of Needs, stating, “We can’t expect them to

perform well if they aren't feeling safe and secure, mentally and physically well”

(Participant 1, personal communication, June 2017). Respondents correlated

building rapport and having healthy relationships with students to emotional

wellness. One teacher shared her philosophy that students “have to feel safe and

loved” (Participant 2, personal communication, June 2017). Another teacher said

she makes sure to build connections with her students, stating “if they know that

I’m invested in them as a person, they’re going to be more interested in the

course” (Participant 3, personal communication, June 2017). Another teacher

mentioned the importance of being flexible with what a student may need and

understanding when they are having a hard day “because I know that whatever is

going on is probably bigger than what’s going on in my class” (Participant 4,

personal communication, June 2017). The respondents who are high school

counselors agreed that students struggling with emotional distress have a very

hard time coming to school, and they frequent their offices “with sick stomachs,”

as well as anxiety and panic attacks. One respondent who is an intervention

counselor on campus explained that many students are “just trying to hold it

together on their own and they don’t come forward” (Participant 6, personal

communication, June 2017). One teacher who also has experience as a high

school counselor stated, “When students have emotional issues it is more taxing

on them in terms of time, in terms of emotion, in terms of process and in the

worst case scenario, it can completely inhibit them from being successful in the

classroom” (Participant 1, personal communication, June 2107)

A minor theme emerged regarding specific mental health challenges staff

are seeing in students. Table 1 lists the mental health challenges uncovered, and

the number of times participants stated each particular challenge. Anxiety was

cited most frequently, and depression and overall life stress were second and

third. Most respondents also referred to students’ difficulty in responding to

increased academic pressures. One teacher suggested, “They are so focused on

keeping up and competing with their peers for opportunities in college”

(Participant 4, personal communication, June 2017). Another added, “I see a lot

of perfectionism and competition rather than a love of learning” (Participant 10,

personal communication, June 2017). One high school counselor noted she has

seen a “shift” in the way adolescents deal with challenges, stating,

I would say the majority of the students that are struggling with mental

health issues, it is primarily depression and anxiety, a lot of panic attacks

and suicide ideation. It used to just be about peer relationships and drama

with friends (Participant 5, personal communication, June 2017).

Other challenges mentioned were self-harm, eating disorders,

homelessness, and grief. One respondent described a situation where a student

was struggling with multiple issues, and she met with the student’s parents and

determined that the parent’s mental health issues were a precipitating factor to

the student’s problems. Another respondent discussed the socioeconomic

disparity between families whose children attend the high school and its impact

on attention to mental health. He/She felt that families where both parents have

demanding jobs often are too busy to notice a child’s mental health needs, while

families who are struggling to meet basic needs often are unable to afford mental

health services. Finally, one respondent added, “I think that there is a good

portion of the student population that are overdoing things, and over-stressed,

and are worried about their future at a much younger age than I recall in past

years” (Participant 10, personal communication, June 2017). One teacher

characterized it as having students who “put up a façade, pretending they’re

doing well when they actually have huge emotional problems” (Participant 4,

personal communication, June 2017). Another respondent cited social media as

contributing to students comparing themselves to one another, which increases

anxiety and depression, adding, “there’s a lot of negative self-talk that goes on,

and living up to expectations that often are not realistic expectations, or irrational

expectations leads to a negative mindset which causes the anxiety and

depression” (Participant 10, personal communication, June 2017). The

counselors also cited parenting as being “more hands on” now than what it used

to be, contributing to decreased resilience in students. One of the respondents

offered that school climate and community has a lot to do with student wellness,

stating, “I think schools reflect their communities, and the needs of their

communities, and unfortunately, I think there is more of a problem in our

community than is actually reported” (Participant 6, personal communication,

June 2017). One other challenge cited by respondents was “changes of life or life

transitions.” One of the teachers shared an experience when she discovered one

of her students had been suffering from abuse:

I had a girl in summer school and she had her body covered up and it was

hot outside! She seemed very withdrawn and I remember one time, going

to pass something out, and she wasn’t looking at me, and she, like, jerked

away. That was a huge red flag. I thought this girl is being abused. So, I

tried to talk to her a little more. She was really sweet, but she was like a

wilted bird. I don’t know how else to explain it. And then, she wrote in an

essay, I believe, because she felt safe with me, about when her father

abused her. And so I brought it up with her and called CPS. I was afraid I

would break her trust, but it worked out. The parents had to do anger

management classes. I saw her change from this, kind of, withdrawn girl,

into this girl who had life in her eyes. (Participant 9, personal

communication, June 2017)

All respondents could speak to the impact students’ mental health

challenges had on their academic performance. One respondent spoke of how

students who struggle with anxiety may hold it together during the day and then

are too exhausted to do any homework once home. Another respondent said

students with anxiety usually have problems with consistent school attendance.

Referring to students with mental health challenges one of the teachers stated, “I

see them not performing as well as they could because they're just not managing

themselves very well whether it's time, health, whatever” (Participant 5, personal

communication, June 2017). Another teacher believes, “Students don’t have the

skillset to overcome these on their own” (Participant 7, personal communication,

June 2017).

Support Systems in Place in School

The teachers stated many of the problems the students are having are

beyond their scope of knowing how to help, so they often look first for other

supports on campus. Teachers cited they can offer a “safe place” for students to

rest when they are having a bad day, and then they refer them to the school’s

counseling office or student services. One teacher stated, “I love that they feel

comfortable enough sharing with me, but [mental health] is not my expertise by

any means” (Participant 2, personal communication, June 2017). Another

teacher added, “students know I’m there for them, that’s just part of being a

teacher, but I’m not qualified to make a decision on a student’s mental health”

(Participant 8, personal communication, June 2017). One teacher stated she

feels a close relationship with the school administration and would feel

comfortable reaching out to an assistant principal for support. The counselors

explained special education services where students who qualify have an

Individualized Education Plan (IEP) with assigned case managers who support

their academic goals. If students do not meet the criteria for an IEP, they may

qualify for a 504 Plan, which allows academic accommodations to be put in place

such as extended time to take tests, or allow the student to test outside of the

classroom. Counselors explained that some IEPs specify the need and require

the student be seen by an ERMHS therapist (Educationally Related Mental

Health Services). This is for students who have behavioral needs specified in

their IEP that impact their learning. Students with IEPs also have access to the

school psychologist who may meet with them on a regular basis to check on their

academic progress, and provide minimal therapeutic intervention.

The high school counselor respondents said some students who have

mental health needs already see outside therapists. In those cases, one

counselor shared,

I often get consent from the therapist to share information so that we can

be prepared for what that student needs onsite. It is helpful when I am

engaged with the therapist directly, so I know of those strategies and we

have a plan on campus (Participant 7, personal communication, June

2017).

Another counselor stated the school district has a list of therapy

resources, which includes information regarding insurance, different specialties,

areas of focus, and what age they service. Once a resource list is given the

counselor continues to follow up with the student. The participant added, “If we

feel like the student needs extra help and the parents aren’t following through,

then we do follow up with CPS if necessary” (Participant 5, personal

communication, June 2017). The counselors stated they just try everything they

can to make sure that all students are getting the support they need.

The Student Services staff member explained her role at the school. She

supports the counseling team and offers individual meetings with students who

are struggling with any type of emotional need. However, she added, “I’m not

going to be able to diagnose or do on-site counseling” (Participant 7, personal

communication, June 2017). She stated she has had occasion to meet with

parents of students to explain their student’s needs and offer referrals for outside

providers. She also has partnerships with community resources (local churches

and food banks) for basic needs such as food and household goods.

Support Systems Needed in School

One of the counselors believes prevention is key, stating, “I think that

prevention is an important piece to it, teaching resiliency skills, and definitely

dealing with it at an earlier age” (Participant 10, personal communication, June

2017). She further stated,

Mental health can often be very subtle, and then all of a sudden, it hits you

like a runaway train and it’s harder to treat when it’s at that point. Had it

been recognized earlier, then I think those crisis moments wouldn’t

happen quite as impactful as they do (Participant 10, personal

communication, June 2017)

One respondent stated at this high school special education identification

is on the rise, explaining,

I think we had probably 30 additional students qualify for IEPs just this

year, and many of those were mental health issues. What concerns me is

how did they get to this point without it happening sooner? Why weren’t

they identified at the elementary or middle school level? (Participant 5,

personal communication, June 2017)

Respondents also cited the need for low cost or free mental health

services. One counselor stated, “There are not a lot of free clinics out there that

kids can go to” (Participant 6, personal communication, June 2017). She also

expressed frustration at the limited availability of psychiatric hospitals for

teenagers. She shared an experience about one of her students who had

expressed suicide ideation,

I’ve had kids who, the families brought them to a hospital for an

assessment, and then they’re back at school 24 hours after, put right back

into their environment, which makes no sense to me. If you have a child

who’s asking for help, you’ve got to get them help right now, and not just

say ‘I don’t have a bed available to you (Participant 6, personal

communication, June 2017)

Another counselor stated, “Children who have had suicide ideation or an

attempt need ongoing support to be successful” (Participant 10, personal

communication, June 2017).

Many of the respondents pointed to “strong families” as being a huge help

in students’ success and prevention of future problems, so they make an effort to

communicate with parents when something seems amiss. One of the counselors

said she is “a big proponent of parental involvement” (Participant 6, personal

communication, June 2017) and when she discovers a student needs extra

support she will call a family meeting. She believes sometimes students simply

need someone to advocate for them even within their own families. One of the

teachers explained how important it is for parents to understand what kids are

going through. She shared an experience where a young man dropped out of her

class because of stress and “his Dad was not recognizing that he had an issue

and Mom was, but that disconnect or that lack of understanding on both sides

was hard” (Participant 3, personal communication, June 2017)

Teachers felt unprepared to assist their students with mental health

challenges. One teacher stated,

I think many students would say that they have a good relationship with

me, but there have been many, many times where they tell me stuff and I

don’t know what to do or what to say or who to refer them to or what’s the

right thing (Participant 2, personal communication, June 2017)

One teacher opined that, “Our on-campus system is a good first step

system,” however, “we don’t have people trained to provide therapy if needed”

Participant 8, personal communication, June 2017). The intervention counselor

supports teacher training to help teachers know “what to do to identify stressors

in students and what to do with that and how to triage it” (Participant 6, personal

communication, June 2017). She explained besides staff being trained on how to

help students, “the first line of defense could be their peer group” (Participant 6,

personal communication, June 2017). Many student leaders plan school wide

functions, but they could be the connection to help a lonely student feel

connected to the school community, like a family. The intervention counselor also

stated, “Ultimately, maybe they’ll take that information and help themselves and

just be a little more open to what others might be going through” (Participant 6,

personal communication, June 2017).

The staff rely heavily on the counselors on campus, each of whom have

large caseloads. One teacher stated,

I just think they need to hire more counselors like when I first started

teaching twenty-seven years ago. When I started teaching, each school

had between eight and nine counselors. And now we have twice as many

students and half as many counselors (Participant 4, personal

communication, June 2017).

One teacher cited another district, stating, “I know high schools in LA that

have 10 counselors; I think their ratios are 200 students to one counselor”

(Participant 7, personal communication, June 2017). One of the high school

counselors explained that special education supports for students who qualify is

federally mandated, and the student to case manager ratio is 28/1 compared to

the student to high school counselor ratio of 500/1, adding “I think the caseload

numbers are way too high on counselors; we are not equipped to provide therapy

or the necessary therapeutic help that the students really could benefit from”

(Participant 5, personal communication, June 2017). Another respondent

suggested every school should have school social workers because school

counselors are often focused on academic counseling and school social workers

are often licensed clinical practitioners. One of the respondents would like to see

mental health services in schools for students receiving more funding. The most

experienced high school counselor stated:

I’m a huge supporter in wanting to have mental health professionals on

the campus. School is their world. I think in an ideal world, that they would

have a regular caseload, that there are kids that could benefit from that on

a regular basis. Because even in the medical community, they’re not

getting the appointments with the frequency they need to get them

(Participant 10, personal communication, June 2017).

Additionally,

I think that licensed social workers or therapists would be, in an ideal

world, in schools. And I think being in a school environment, the adults

that are in the school environment understand the school environment and

can speak to students on their own turf. They can talk to them with an

understanding of what their environment entails (Participant 10, personal

communication, June 2017).

Another high school counselor concurred, “The pendulum is swinging,

where I think schools are needing to provide more with mental health for students

and for families, and the schools are in a position to provide more services

(Participant 5, personal communication, June 2017)” One of the high school

counselors believes “the decrease in vocational education has increased the

academic pressure to attend four-year colleges, and this is social pressure,

community pressure, stemming from the adults in their lives” (Participant 1,

personal communication, June 2017).

Table 1. Adolescent Mental Health Issues Identified

Mental Health Issues

Number of times cited

Anxiety

Depression

Stress (including academic pressure)

Suicide ideation

Physical/Emotional abuse

ADHD

Gender identity issues

Self harm

Panic attacks

Bipolar

Self deprecation

Life transitions

Cultural conflicts

Psychosis

Eating disorders

Homelessness

Lack of motivation

Grief and loss

Data Interpretation

This study identified student emotional wellness as vital to students’

success in and out of the classroom. This finding is consistent with Atkins (2010)

that showed a strong correlation between children’s overall mental health and

their school environment. The study also confirmed what was cited in Dunn

(2016) and Weist (2012) that schools have the very best access to kids,

explaining that schools serve more than 95% of the nation's young people for

approximately 6 hours per day (or upward of 40% of students' waking time during

the school year) and at least 11 continuous years of their lives. The current study

showed educational professionals build rapport with students, which affords a

trusting relationship with which to help adolescents in need. This study also

found that the need for mental health services in increasing. This aligns with the

American Academy of Pediatric research that 1 in 5 children have a diagnosable

mental health disorder, but only 21% ever receive treatment (American Academy

of Pediatrics, para. 1).

This study also showed that schools feel under-resourced and ill equipped

to help students with mental health challenges. This corresponds to a study by

Berzin (2012) that states teachers acting as proxy mental health providers feel

unprepared to help in instances where students are experiencing emotional

problems. The current study indicates that educational staff are more than willing

to assist as needed, however, would much prefer to be able to offer comfort and

then refer a student to a professional on campus that has the time and skills to

help the student overcome the challenge. This study also showed the number of

students who need help is increasing. This aligns with Weist (2005) who

recognized the crisis in children’s mental health is becoming more severe and

noted that school mental health programs have increased in the last two

decades. High school counselors feel they are pressured to focus on academic

planning and achievement, leaving little time for empathetic listening and

treatment of mental health challenges.

Implications of Findings for Micro and/or Macro Practice

Based on the results of this study, micro practitioners, such as high school

counselors, high school intervention counselors and student support specialists,

as well as teachers and administrators, must manage their caseloads as best

they can. The findings of this research point to a need for more mental health

professionals available to work with students, including, but not limited to

counselors and school social workers. Our data indicate students are facing

many challenges to their emotional wellness during their high school years.

Teachers are often forced to be micro practitioners and they want assistance to

know what to do for students who divulge difficult challenges they are facing in

their lives. This study indicated a need for better training for teachers and all staff

who have daily interaction with students. More implications were found for macro

practice, as school districts need to realize the mental health crisis we are

currently facing with adolescents. The data indicate the current mental health

resources are being stretched too thin, risking staff availability for students in

need. The school district needs to allocate more funding and resources to the

training of current employees and hiring of new employees who can share the

burden of assisting adolescents through this critical time of their development.

Decision makers need to consider hiring school social workers who are trained to

address the mental health need of students within the educational context.

Summary

In this section, data was presented that indicated the significance of

student emotional wellness on student’s academic achievement and overall

mental health. Data was also presented that indicated educational staff are

under-resourced and ill-prepared for the increased need of mental health

services in high school. The data was discussed within the context of prior

research. This chapter also included implications of the study and the findings of

the research indicate a need for further study on the topic of mental health

services in schools.

CHAPTER FIVE:

TERMINATION AND FOLLOW-UP

Introduction

This chapter explains how the study was terminated and how the findings

were disseminated to the research agency. Also included is a brief discussion on

how the limitations of the study may impact the researcher’s findings. This

chapter contains information regarding the presentation to the principal and high

school staff where the study was conducted. This chapter also explains the

ongoing relationship, if any, with the research participants.

Termination of Study

This study will be terminated when findings are presented to the school

principal. Study findings will also be offered to those who participated in the

interviews. Each participant was thanked at the completion of their interview.

Participants received a debriefing statement at the beginning of each interview.

The school site principal invited the researcher to present findings at a future

staff meeting, anticipated to take place fall 2018. A less formal termination will

occur in June 2018 at the study site as the researcher personally thanks each

participant. This will be done by inviting the study participants to the high school

counseling office and reviewing the completed project in person. The researcher

will present complete results to the school principal in June 2018 and discuss

them as appropriate. (See Appendix D)

Communicating Findings to Study Site and Study Participants

The principal of the high school where the study occurred has invited the

researcher to present the study findings in a future staff meeting anticipated to

take place in the fall of 2018. The results of the study will be presented to the

gatekeepers and the participants of the study. This will be done at a final meeting

where all staff are invited to attend. Food and beverages will be provided to

enhance the occasion.

Limitations

The limitations of the findings are that the data was collected in one high

school using maximum variation and snowball sampling methods. Given these

sampling methods and the small sample size, the data is not representative of

the general population and cannot be generalized to other locations. More robust

data would be obtained if the study was undertaken at multiple high schools in

various parts of the country. Future research should look at adolescents in other

locations, such as those who reside in urban and rural school districts. The short

timeline for this study, and the access to other high schools prohibited a more

extended study. Future research is needed with a larger sample size to allow for

the generalization of findings.

Ongoing Relationship with Study Participants

Any future relationship with study participants will be incidental and not

intentional. The researcher may have the opportunity to return to the research

site for substitute employment, which may allow for some interaction with the

study participants.

Dissemination Plan

The research participants were informed that the results will be given them

at the end of the study in June 2018. The researcher will present complete

results to the gatekeepers of the high school in June 2018 and discuss them as

appropriate. The final research project will also be presented at the California

State University San Bernardino Poster Day on June 12, 2018. The final project

will be provided to California State University San Bernardino.

Summary

This chapter described the conclusion of the research study, and briefly

highlights the major themes that emerged throughout the study. Also included in

this chapter were the limitations of the study and need for future research. This

chapter reviewed the process for termination and the dissemination of

information. It also described the researcher’s future relationship with the study

participants.

APPENDIX A

INTERVIEW QUESTIONS

Interview Questions Developed by Researcher Patricia Lea Sutherland

1. How long have you been a high school teacher?

2. What is your educational background?

3. What are some of your classroom methods to keep teenagers engaged?

4. Based on your experience as a teacher, what is your opinion on student

emotional wellness?

5. What is your experience with students in your class who are have emotional

problems?

6. Describe some of the types of problems you’ve been aware of?

7. How do these problems effect the student’s ability to perform in your class?

8. What resources do you help the students access for their problems, if any?

9. What differences do you see in students who have unmet emotional needs

versus those who don’t?

10. What types of support systems do your students have, those who seem to

have problems and those who don’t?

11. What correlation do you see between student’s who have emotional

problems and their academic achievement? Those who seem to not have

problems and their success in your class?

12. For those students who receive support at school, do you see a different in

their ability to be successful in your class?

APPENDIX B

INSTITUTIONAL REVIEW BOARD APPROVAL

APPENDIX C

INFORMED CONSENT

APPENDIX D

DEBRIEFING STATEMENT

School of Social Work

DEBRIEFING STATEMENT

This interview you have just completed was designed to investigate the

impact of mental health services on the well-being and academic achievement of

high school students. This study is interested in assessing the status of mental

health services in one high school and determining if the student’s needs are being

met. It will further explore mental health services as they relate to and help students

achieve positive academic results. This is to inform you that no deception is

involved in this study.

Thank you for your participation. If you have any questions about the study,

please feel free to contact Patricia Sutherland (858) 449-2239. If you would like to

obtain a copy of the group results of this study, please contact Patricia Sutherland

(email [email protected]) after September 2018.

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