Chapter 4

4.0 Staff Providing Mental Health Services in Schools

One of the primary goals of this study was to gain a better understanding of the numbers and types of personnel providing mental health services in schools. The questionnaire included the following types of staff: school counselors, mental health counselors, school psychologists, clinical/Ph.D.-level psychologists, social workers, substance abuse counselors, school nurses, and other staff such as outreach workers and behavioral aides. This study sought to identify the types and qualifications of staff providing mental health services in schools, determine how much of the staff provider’s day is devoted to mental health service provision, describe staff distribution and qualifications, and identify the most common staff combinations in schools. ¹³

4.1 Characteristics of Staff Providing Mental Health Services

Almost all schools providing mental health services reported having at least one staff member whose responsibilities included providing mental health services to students (96 percent). Based on weighted estimates of schools’ responses, during the 2002–2003 school year, at most 358,000 staff, including both professional and support staff, were providing some degree and type of mental health service to students in their schools. (This is probably an overestimate due to the limitations of the survey—see note in Exhibit 4.1). Exhibit 4.1 shows the number of each type of staff in U.S. public schools and the average percent of time each type of staff spent providing mental health services, relative to other duties. These estimates pertain only to school or district-based staff, rather than outside staff providing mental health services via contractual arrangements.

Exhibit 4.1 Number of Staff and Percentage of Time Spent Providing Mental Health Services in U.S. Schools, 2002-2003

Type of Staff Providing Mental Health Services	Number of Staff *	Percent of Time Spent Providing Mental Health Services**
School Counselors	110,967	52
School Psychologists	63,169	48
School Social Workers	41,423	57
School Mental Health Counselors	17,372	68
Substance Abuse Counselors	10,353	61
Counselors	7,832	48
Psychiatrists	1,927	40
School Nurses	63,661	32
Other School Staff (e.g., Outreach Workers, Behavioral Aides)	41,025	58
Total	357,729
Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. School Questionnaire, Item 13, Appendix C, School Table 10B Notes: * National estimates of the number of each type of staff were calculated by applying final sampling weights to the total number of each staff type reported by schools in the sample. These national estimates may overestimate the number of staff since school respondents from the same district may have double counted any staff working in more than one school in the district. The term “staff” should not be construed as full-time employees of the school. ** One limitation of this survey is that the respondents, and thus the unit of analysis, represented schools, rather than staff. Thus, we were not able to estimate the number of full-time equivalents (FTEs) in the U.S. using the survey data because a) the number of staff may be double counted by schools within the same school district, b) we attempted to get schools to estimate the number of full-time and part-time staff but many respondents gave invalid responses because they misunderstood the question (this type of information can be more accurately estimated using a workforce survey of staff); and c) schools were asked to estimate the average percent of time each type of staff spends providing mental health services rather than how much time each individual staff person spends.

The most common types of staff providing mental health services in schools were school counselors, followed by nurses, school psychologists, and social workers (Exhibit 4.2).Three quarters of schools had at least one school counselor on staff, over two thirds had a school psychologist and/or a school nurse, and 44 percent had a school social worker. Other mental health staff members, such as mental health and substance abuse counselors, clinical psychologists, and psychiatrists, were available in less than 20 percent of schools.

percentage of schools with various types of staff who provide mental health services, 2002-2003

It is notable that such a large proportion of schools reported that nurses were providing mental health services, and that over one third of their time was devoted to mental health service provision. The data indicate that nurses were considered by the majority of schools to be mental health providers. Nurses, as well as counselors, are likely to have very high caseloads and may provide services that are more informal in nature than traditional counseling. These findings also suggest that if nurses are, in fact, playing a key mental health role in schools, more work should be done to better understand the training and support needs of this type of staff. Psychiatrists were estimated to spend only 40 percent of their time on mental health service provision, which seems somewhat low, but the survey did not ask how the remainder of their time was spent.

The proportion of time spent providing direct mental health services to students varied by staff type. School counselors, substance abuse and mental health counselors, and social workers were spending half to two thirds of their time providing mental health services to students during the 2002–2003 school year, while school psychologists, clinical psychologists, and psychiatrists were spending less than half of their time doing so. S chools reported that nurses spent one third of their time 14 and that other school staff such as behavioral aides spent 58 percent of their time providing mental health services. Mental health counselors and substance abuse counselors, although they were less commonly on staff in schools than other mental health providers, were reported to spend over 60 percent of their time providing mental health services.

Number of Staff and Staff Combinations

Most schools had between two and five staff providing mental health services, but the distribution was very broad, from no staff (3 percent) to 10 or more staff (6 percent) (Exhibit 4.3) . The most commonly reported number of staff was 3 (20 percent of schools). When schools had three staff, they were usually comprised of a school counselor, a nurse, and a psychologist. When schools had only two staff, they were usually a school counselor and a nurse; and when schools had four staff, staffing was most likely to include a school counselor, a nurse, a psychologist, and a social worker.

Percentage of Schools reporting the number of staff providing mental health services, 2002-2003

Although the majority of schools reported that they had more than one staff person of various types providing mental health services, 8 percent of schools reported that only one person in their school provided mental health services. Among the schools with only one staff person, the sole mental health provider was most likely to be a school counselor (50 percent), a school psychologist (20 percent), or a school social worker (18 percent) (Appendix C, School Table 9C). Only a small percentage of those schools reported that nurses were their only staff person providing mental health services. 15

The analysis of staffing configurations, regardless of number of staff, revealed no predominant combination. However, the most common staffing combination among all schools, reported in 13 percent of schools, was one or more school counselors, 16 school psychologists, and nurses. Another 11 percent of schools reported having one or more school counselors, school psychologists, social workers, and nurses. All other combinations accounted for 52 percent of schools, but each of these combinations occurred in 4 percent or fewer schools, and no particular patterns emerged (Exhibit 4.4).

Exhibit 4.4 Percentage of Schools Using Various Combinations of Staff To Provide Mental Health Services, U.S. Schools, 2002–2003

Staff Combination	Percent of Schools With Combination (%)
School Counselors + School Psychologists + Nurses	13
School Counselors + School Psychologists + Nurses + School Social Workers	11
School Counselors + Nurses	9
School Psychologists + Nurses + School Social Workers	5
School Counselors + Psychologists	4
All other combinations	52
Source: Source: School Mental Health Services in the United States, 2002–2003, Substance Abuse and Mental Services Administration, U.S. Department of Health and Human Services. School Questionnaire, Item 13, Appendix C, School Table 9D Note: Exhibit presents school-based or district-based staff combinations.

Staff Qualifications

The training qualifications of the staff who provide mental health services in schools were a focus of this study. Respondents were asked to indicate the number of each type of staff who held master’s degrees or higher in their field and who were licensed in their field. The survey found that a high percentage of staff providing mental health services held master’s degrees or higher (although not necessarily in a recognized mental health specialty) and were licensed or certified in their fields (Exhibit 4.5). 17 There is some consistency between holding a master’s degree and being licensed: the majority of psychologists, counselors, social workers, and mental health counselors held both qualifications. Substance abuse counselors and school nurses were more likely to be licensed (80 percent and 88 percent, respectively) than to hold master’s degrees (69 percent and 54 percent, respectively). With the exception of mental health and substance abuse counselors, however, this study does not show whether these qualifications, either the master’s degrees or the licenses, specifically qualify these staff in the provision of mental health services. A more detailed staffing survey would be needed to determine what proportion of various types of staff; for example, school counselors have specific background qualifications in providing mental health services.

percentage of staff providing mental health services with master's degree or higher and with licensure in their field

4.2 Summary

Almost all schools reported that they had at least one person hired by the school or the district who, for at least some portion of time during the week, provided mental health services to students. This person was most likely to be a school counselor, a nurse, or a school psychologist. Each of these providers spent one third to half of their time providing mental health services. Schools reported a wide range of numbers of staff providing mental health services in the school, but the most commonly reported number of staff was three. Although a high proportion of the individuals providing mental health services in schools had master’s degrees or higher in their fields, it was not discerned in this study how much of their training was specific to mental health.

These findings suggest that, given the amount of time these staff spend providing mental health services to students, more needs to be learned about their ongoing training, support, and professional development needs.

Previous | TOC | Next