外文翻译---心理健康.docx

Mental healthAcknowledgments are in order for the many faculty and family members who have provided support, guidance, and encouragement throughout this process. I am appreciative of the help that each person has given. I wish to thank those faculty members who each contributed to my increased understanding of this process, the subject matter, and the importance of rigorous research. I am especially thankful for the consistent support and guidance from my advisor, Dawn Anderson-Butcher. She spent many hours steering my efforts and providing me quality feedback that always allowed me to think critically and push myself further than I ever imagined. I would also like to thank Tamara Davis for her encouragement, enthusiasm, and ongoing support for not only this thesis but for my professional development as well. Additionally, thanks are in order to Jerry Bean for his always refreshing perspectives and solid technical support. I would also like to thank Tony Amorose for stepping in to provide even further assistance and contributing greatly to my understanding of data analysis. Finally, many thanks go to my family who has provided endless support from begi- nning to end. My mother, Sholeh Mesbah, and step-father, William Stone, have de- monstrated their love for me by answering the phone at all hours, allowing me to talk through all frustrations, and encouraging me to keep moving forward. Also, my fat- her, Mark Ball, and step-mother, Nilsa Ramirez , consistently kept me grounded by reminding me that, thesis or not, everyday life continues. Last but not least, I would like to thank my sister, Amanda Ball. Her optimism, support, and love were unwavering. According to the most recent Surgeon Generals Report on Mental Health , 9 to 13 percent of all U.S. children and adolescents have serious emotional disturbances. Moreover, 21 percent of U.S. children have diagnosable mental or addictive disorders. Unfortunately, most of these children never receive adequate care. Seventy-nine percent of children ages 6 to 17 with mental disorders do not receive care. Additionally, uninsured and minority children have higher rates of unmet need than those who are insured or non-minority. Much of this unmet need can be attributed to the significant shortage in the childrens mental health workforce. Considering that 49.6 million students are enrolled in public elementary and secondary schools, it is evident that many of these childrens mental health needs manifest at school, often leading to such pressing concerns as violence in schools or significant behavior disruptions. Schools are often placed in the position to not only educate children but to also support those children who bring their mental health issues to school. To meet these changing needs, school improvement efforts must focus on standards-based accountabilities but also prioritize strategies related to addressing students barriers to learning, including mental health-related needs. Research provides strong evidence for this relationship noting, (1) that students mental health concerns can drastically impact academic success and healthy development (Becker & Luther, 2002) and, (2) that interventions addressing students social-emotional skills can positively impact academic achievement. Given this relationship, academic success for all students is dependent upon student social-emotional well being, particularly in those communities at highest risk. Additionally, children are not the only ones affected by these non-academic barriers to learning. Student mental health needs create increasing demands on educators who must create and manage effective classroom learning environments. For instance, discipline and classroom management for students with emotional and behavioral disorders have been found to be particularly stressful for educators. As such, schools are increasingly faced with student mental health needs. As the demand for mental health services in schools has grown dramatically in the past 30 years, school support services now include a broader range of services than in the past. As such, schools are now in some cases considered the “de facto mental health care system for children”. In spite of this de facto system, childrens mental health needs remain unmet. As a result, schools are beginning to see the ramifications of these unmet needs as they pertain to poor academic achievement among students. Essentially, schools have been unable to fully address students mental health needs through traditional practices and traditional means. A national survey of school mental health services recently reported that, generally, funding for school mental health has decreased in the past 5 years while demand for services has increased in most districts. Additionally, districts also reported that referrals to community-based mental health providers have increased but the availability of these practitioners to provide services has decreased. As student academic success is closely tied to social-emotional well being, school change efforts must begin to address these needs if they are to meet their accountabilities. Doing so requires schools to consider new models of school improvement that include social-emotional development along with traditional standards-based accountabilities. To meet the needs of children today and to improve academic outcomes for all children, it is imperative that schools utilize new models of school improvement that include effective methods to address mental health needs. This process, however, will involve a cultural shift in educational systems that have historically focused on traditional forms of school improvement. Most traditional school improvement often focuses on “walled in approaches” such as enhanced curriculum alignment, improved instructional methods, and standards-based accountabilities. In addition, most current school improvement models are narrowly focused on result-oriented improvements in instruction and behavior management rather than on system-wide efforts to address barriers to learning. As a result, these models often marginalize programs, services, and systems that address mental health-centered learning supports, resulting in fragmented services, isolated student support personnel, and ineffective planning models to address student needs. New models of school improvement are called for that focus on enhancing schools abilities to meet the mental health needs of all children. These models must be rooted in the fundamental work of educators and also consider the diversity of needs among school systems, staff, and students. Emergent Models Include School Mental Health Because of these emergent findings, schools have recently begun implementing school improvement initiatives that include specific areas related to school mental health. For instance, Positive Behavioral Interventions and Supports (PBIS), a system-wide prevention strategy targeting behavioral management, is becoming increasingly popular as a method of changing student behavior through alterations in systems and procedures. While focused primarily on behavioral management, PBIS includes a continuum of services consisting of universal, selected, and targeted supports and interventions ensuring that all students receive effective behavior management practices. As a system-wide strategy for behavior management, PBIS has demonstrated effectiveness for reducing discipline referrals and suspensions as well as improving overall school climate. However, the scope of PBIS is limited to behavioral concerns, focusing on the reduction of disruptive, externalized behaviors and leaving out students with more internalized behavior issues. While PBIS is limited to behavioral concerns, it offers an example of system-wide change to address students nonacademic needs and promote positive social-emotional development. Similarly, the Centers for Disease Control has been encouraging schools to explore various non-academic priorities through a Coordinated School Health Program (CSHP) that involves the interaction of multiple components all centered on promoting student well-being (Centers for Disease Control and Prevention CDC, 2007). The key CSHP components span health education and physical education, health services and nutrition services, counseling and psychological services, healthy school environment, and family/community involvement (CDC, 2007; Murray, Low, Hollis, Cross, & Davis, 2007). CSHP promotes the coordination of policies, activities, and services that address these components and, ultimately, provide for the health of school students and staff while strengthening schools to be “critical facilities” for service provision and coordination (CDC, 2007, n.p.). Rigorous evaluation of this model has been difficult in the past; however, evidence does support the positive effects of incorporating health education, parent involvement, nutrition services, and mental health programs into more traditional school improvement efforts. Finally, other models incorporate efforts to address system-wide concerns, individual academic, health, and mental health student needs, and community collaboration. The School Development Program (SDP), created by James Comer and the Yale Child Study Center, mobilizes schools to focus on students social-emotional and academic development through student-centered programming utilizing six developmental pathways: (1) physical; (2) ethical; (3) social; (4) language; (5) psychological; and, (6) cognitive (Yale Child Study Center, 2004). An SDP requires a management team, student and staff support team, and a parent team to operate through three guiding principles that steer their functioning no-fault (utilizing a problem-solving approach), consensus, and collaboration. Full-service schools offer another model of school improvement that fosters healthy physical, intellectual, and social-development. Dryfoos (1994) identifies full-service schools as community centers that meet the educational, health, mental health, and social-emotional needs of children. Through extensive collaborative efforts, these schools partner with local agencies to provide wide ranging services to impact youth development, including those services related to mental health. Integrated service delivery systems can increase access to services and improve service delivery . With an emphasis on prevention and collaboration, full-service schools are one example of broad school improvement efforts that work to meet childrens mental health needs. The Ohio Community Collaboration Model for School Improvement (OCCMSI) also provides an example of new models of school improvement focused on students nonacademic barriers to learning, including mental health issues. This model addresses the need for schools and educators to gain influence over students out-of-school time and on the need for schools to further utilize existing family and community resources to optimize student learning and healthy development through the use of systematic organization of numerous improvement components. Focused on building system capacity for improvement, the OCCMSI involves continuous planning and improvement processes that are evaluation-driven and anchored in “milestones” that mark developmental progress for school leaders (Anderson-Butcher et al., in review, p. 8). Additionally, the OCCMSI five content areas guide this expanded school improvement initiative academic learning, youth development, parent/family engagement and support, health and social services, and community partnerships. These more expansive school improvement strategies all offer a broadened view of school improvement and could positively impact the roles schools play in addressing student mental health needs. Unfortunately, these models and the programs and services they include are often considered ancillary to the academic work of schools and thus hold limited potential for long-lasting change (Center for Mental Health in Schools at UCLA, 2005). More recent efforts in this area have been made to more closely align broader school improvement models with academic outcomes. There is preliminary support that broadened school improvement efforts can foster the integration of mental health and educational service. While comprehensive, coordinated school reform is a growing research area, studies have demonstrated improved academic outcomes, service integration, and overall capacity for addressing non-academic barriers to learning. Given these preliminary findings, the next step to improve social-emotional and academic outcomes for children is to systematically examine how schools adopt and implement such initiatives. Research in translational science and the diffusion of innovations can expand the existing knowledge on school change efforts. These areas have explored change processes within organizations to identify key components of successful change efforts. Additionally, translational science has specifically focused on disseminating research to the practice arena. A focus on readiness is one component of effective organizational change strategies that can lead to long-lasting school improvement. Organizational change research identifies readiness as a key construct related to the effective and efficient implementation of any innovation, including expanded school improvement models addressing school mental health. Readiness signifies that an organization or an organizations members feel willing to implement an innovation. A careful analysis of an organizations readiness for change can greatly impact innovation adoption and implementation and thus create long-lasting, successful school change. Furthermore, the collaborative use of readiness information can facilitate an empowerment process in which specific innovation champions are identified or, in cases where little variability exists, buy-in is generated as consistency in readiness is demonstrated across the school. As readiness is central to change efforts, a deeper understanding of those factors that most influence readiness can build organizational capacity to implement change effectively. The knowledge base on organizational change identifies a number of factors that impact readiness, including perceived ability to implement the innovation, value for the innovation, and effective communication channels . Much of this research on readiness, however, is conceptual and does not focus specifically on readiness in schools. Building from the existing research, a specific look at readiness to adopt school mental health approaches allows for a better understanding of what is needed to effectively implement approaches that meet students needs. At this point, more research is needed on school readiness to adopt innovations, specifically school improvement efforts focused on student mental health. To begin to impact school readiness to adopt mental health approaches, a closer look at the individuals involved in organizational change is critical. Organizational readiness for change is often significantly impacted by individual readiness for change. Therefore, research can start with a focus on individual factors that indicate readiness. As strong potential change agents and integral components of the education system, educators readiness for change can greatly contribute to an organizations readiness to adopt school mental health approaches. System-wide change to address student mental health needs often relies on educators as program-service providers for both practical and fiscal purposes, among others. As central players in school mental health approaches, it is important to study the pro- cesses that lead educators to implement programs and initiatives that address men- tal health. However, little research has examined educators involvement in school change, particularly with regard to mental health-education integration . Currently, research examining organizational change has only informed school improvement efforts in a limited way. Substantial research demonstrates the need for not only new models of school improvement but also new models that include emphases on stud- ent mental health needs. Educators hold a key role in school improvement and in the provision of a continuum of services to meet student needs. There are a number of variables related to educators roles in schools , particular ones of interest here are educator stress, teaching self-efficacy, professional support, and perceptions of stu- dent mental health needs. Educators perception of student mental health needs also is a potential factor related to readiness to adopt school mental health approaches. School mental health approaches may offer educators the opportunity to address increasing mental health needs among students. While this area has received little empirical study, some research indicates that educators perception of student mental health needs is also related to educator stress. Additionally, educators have reported feeling overwhelmed when confronted with student mental health needs. Therefore, educators ability to address student mental health needs could also reduce educator stress. Also, educators may be more ready to adopt school mental health approaches as they are faced with increased student mental health needs. Because the mental health and education systems have not been historically integrated, it is important to explore this area to better understand how mental health among students impacts teachers, students, and quality care for children. Furthermore, research has indicated that educator stress is related to student mental health needs and that professional support and teaching self-efficacy are also related to educator stress. There are no existing studies, however, that explore the interactions among all of these constructs. 心理健康根据最近期的外科医生一般的心理健康报告，9%