Navigators and Negotiators: An Ecologically Informed Qualitative Study of Providers’ Perspectives on Their Roles in School-Based Mental Health Services

Abstract

School-based mental health services (SMHS) offer a unique opportunity to embed support within a key developmental context, yet little research has examined SMHS providers’ fit within schools’ complex ecologies. Using a social-ecological framework, this qualitative study draws on focus groups with 67 SMHS providers from two large mental health systems to examine how school setting characteristics and interactions with school actors influenced their experiences providing SMHS. Thematic analysis revealed the importance of feeling valued by and connected to school staff, which facilitated strong ongoing communication and more effective collaboration. Providers described a flexible approach to communication and collaboration, including leveraging opportunities for informal conversation (e.g., in hallways or classrooms) to overcome barriers and boost their perceived value and connectedness. Opportunities for communication and connectedness were enhanced when providers worked in fewer schools, held roles on interdisciplinary teams, spent time in common spaces, when school staff shared providers’ understanding of mental health and SMHS, and when school policies and structural features facilitated their inclusion. Providers also discussed the variety of factors, including their place in the school ecology, that informed student wellbeing (e.g., disciplinary versus supportive responses to challenging student behaviors). This study suggests potential mechanisms on individual, school, and district levels to strengthen SMHS providers’ value and connectedness within the school ecology, and the importance of these factors to maintain strong communication and collaboration and effectively support youth and families.