School-based mental health services cover a wide range of process and participitants. The School Nurse plays many roles in this description. The Texas law requires minum masters degree in the pyschology field to function independently.

Protocol

TITLE: Supporting Mental Health in the School Classroom

INVESTIGATORS: Molly Toon, DNP, RN, CPNP-PC- Principal Investigator (PI)

Rosemary Walulu, PhD, RN, ACRN – CO - PI

Sharon B. Cannon, Ed. D, RN, ANEF

Joyce Miller, DNP, APRN, WHNP-BC, FNP-BC

Abstract/Project Summary:

The purpose of the study is to explore how the school nurses view the nurse’s role in supporting mental health within school community, their self-efficacy in performing the role they identify in supporting student’s mental health. The Qualtrics survey link populated with the Mental Health Needs and Practices in Schools Survey questions will be sent out to school nurses identified by public data available on the internet. Convenience sampling will be used to recruit subjects for participation in the study.

Aims/Objectives:

The aim of this study is to explore how school nurses view the school nurse’s role supporting mental health within the school community, their self-efficacy in performing the role, and barriers they identify in supporting students’ mental health. The objective is the information will assist in describing current school environments and making comparisons looking for common themes and challenges.

INTRODUCTION/BACKGROUND/SIGNIFICANCE:

The pandemic has pointed out the need for action by health-care professionals, schools, and agencies to partner together and support the emotional and behavioral health of children of all ages. According to the CDC, “mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions, causing distress and problems getting through the day” (Centers for Disease Control and Prevention, 2022). The percentage of children diagnosed with mental health disorders has increased, with 49.5% of adolescents having some form of mental health disorder and 22% experiencing severe impairment (National Institute of Health, 2022). The CDC reports that ADHD, behavior problems, anxiety, and depression are the most commonly diagnosed childhood disorders.

• 9.8% of children aged 3-17 years have received an ADHD diagnosis.

• 8.9% of children aged 3-17 years have a diagnosed behavior problem.

• 9.4% of children aged 3-17 years have diagnosed anxiety.

• 4.4% of children aged 3-17 years have diagnosed depression (Centers for Disease Control and Prevention, 2022)

Suicide is the second leading cause of death in youth age 14-18 years after unintentional injuries (Ivey-Stephenson, et al., 2020). Data obtained from United States students in grades 9-12 from the CDC 2019 Youth Risk Behavior Surveillance Survey (YRBS) reveals:

• 18.8% of students reported having seriously considered suicide, and

• 8.9% reported having attempted suicide (Ivey-Stephenson, et al., 2020).

According to a national survey conducted in October 2020 of a cross-section of households with at least 1 child < 18 years of age, 26. 9% of parents reported worsening of mental health and 14.3% reported worsening in their children’s behavioral health (Patrick, et al., 2020). This reported decline in mental health for parents and behavioral health for children were similar across most racial, ethnic, income, and education groups, and US Census Regions. This survey was completed more than a year ago and pandemic-specific stressors have not resolved. On December 7, 2021, the US Surgeon General declared a youth mental health crisis (U.S. Department of Health & Human Services, 2021).

Mental health resiliency in children can be engendered and fostered through supportive care of families. This includes encouraging family engagement with school and community and by the provision of accessible resources to strengthen the family. The school community is essential in supporting children’s mental health resiliency. School nurses, counselors, teachers, parents and all the staff in the school contribute to the environment and are very influential in the daily life of a child. Children spend much of their time in school and now, after the COVID-19 disruption, must transition to school attendance with their peers in a somewhat unsettled environment.

Recognizing the influence of the school experience on children, resources that inform and reinforce the positive impact of the school community are essential to building children’s mental health resiliency. The purpose of this study is to explore how school nurses view the school nurse’s role supporting mental health within the school community, their self-efficacy in performing the role, and barriers they identify in supporting students’ mental health. This information will assist in describing current school environments and making comparisons looking for common themes and challenges.

RESEARCH QUESTIONS:

1. How will the mental health needs of students be supported by school nurses in urban, metropolitan or rural settings?

2. How will student mental health needs be supported by school nurses in charter schools compared to non-charter schools?

METHODS:

Convenience sampling will be used to recruit subjects for participation in the study. A minimum of 890 school nurses from the total of 6,242 school nurses in Texas will be recruited to meet the required power for analysis. Subjects will receive the survey questionnaire via email using the qualtrics. The details of the study, research purpose and questions will be sent to all eligible subjects on the compiled email list. Ten $100 gift cards will be offered as incentives to encourage more participation in the study. The link for the raffle registration will be provided on the last page of the qualtrics survey.

Type of Study:

Comparative study between urban, metropolitan, rural, charter and non-charter schools will be done. A 42 questionnaire tool will be used to collect data from licensed school nurses.

Subjects:

All licensed school nurses working in the state of Texas and on the email list will be invited to participate in the study. Recruitment will be supported through email blasts and an informative announcement in the Texas School Nurses Association newsletter

Inclusion Criteria:

The inclusion criteria are licensed school nurses employed in the state of Texas and are listed on the compiled email listserv.

Exclusion Criteria:

All licensed nurses who are not school nurses.

Site of Study:

The Qualtrics survey will be sent to all nurses who meet the inclusion criteria within the state of Texas.

Design:

The study will consist of a convenience sample of one group of subjects of all licensed school nurses in Texas. The Qualtrics survey link will be sent out to school nurses compiled from publicly available information and invited to complete the questionnaire. The survey will take 15-20 minutes.

Materials, Instruments or Measurements:

Data will be collected from school nurses using Mental Health Needs and Practices in Schools Survey; which has 42 questions (Stormont, Reinke, & Herman, 2011). The instrument has established reliability and validity and permission to use the tool for the current study was obtained from the instrument developer.

Analysis

Data analysis will be done by a statistician using the SPSS program software. No identifying data will be collected. Multivariate Analysis of Variance (MANOVA) and Multiple Logistic Regression techniques will be used to analyze and determine the impact of setting and type of school on the needs and barriers to mental health services in Texas schools.

Justification for Sample Size: 890 subjects to respond in order to have a power of 90% with 5% error margin.

Risks:

There are no potential risk for the subjects completing the survey.

Benefits:

Findings from the study will help create resource tools to support school nurses identify health needs in the schools.

Confidentiality:

Data collected through the Qualtrics system will be de-identified before being downloaded. The data will be reported in aggregate format. The data will be maintained on password secured computers. The results from the study will kept for 3 years, per institutional policy, before it’s destroyed.

Reimbursement;

Ten $ 100 gift cards will be offered as incentives to encourage more participation in the study. This will be awarded through a raffle process. Subjects interested in participating in the raffle will send their email to the principal investigator through a blinded process.

Funding:

Funds for the study are provided by the TTUHSC School of Nursing Center of Excellence In Evidence-Based Practice.

Consent Form:

A cover letter will be included in the Qualtrics file for the subjects’ intent to participate in the study. Before proceeding to the survey questionnaire; subjects will be asked to respond to a “YES” or “NO” consent question to participate in the study. Selecting the “YES” will be a consent to participate in the study and they will proceed to complete the survey questions. The subjects may refuse or withdraw participation at any stage during the survey process.

References

Centers for Disease Control and Pevention. (2020, August 21). Morbidity and Mortality Weekly Report. Retrieved from https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2019/su6901-H.pdf

Centers for Disease Control and Prevention. (2022, March 4). Children's Mental Health. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/childrensmentalhealth/data.html

Ivey-Stephenson, A. Z., Demissie, Z., Crosby, A. E., Stone, D. M., Gaylor, E., Wilkins, N., . . . Brown, M. (2020, Aug 21). Suicidal ideation and behaviors among high school students-Youth Risk Behavior Survey, United States, 2019. MMWR, pp. 47-54.

National Institute of Health. (2022, Jan). Mental Health Information. Retrieved from National Institute of Mental Health: https://www.nimh.nih.gov/health/statistics/mental-illness

Patrick, S. W., Henkhaus, L. E., Zickafoose, J. S., Lovell, K., Halvorson, A., Loch, S., . . . Davis, M. M. (2020, October). Well-being of parents and children during the COVID-19 pandemic: A National survey. Pediatrics, 146(4). doi:Https://doi.org/10.1542/ped.2020-016824

Stormont, M., Reinke, W., & Herman, K. (2011). Teachers' knowledge of evidence-based interventions and available school resources for children with emotional and behavioral problems. Journal of Behavioral Education, 20, 138-147. doi:10.1007/s10864-011-9122-0

U.S. Department of Health & Human Services. (2021, Dec. 7). U.S. Surgeon General issues advisory on youth mental health crisis further exposed by COVID-19 pandemic. Retrieved from HHS.gov: https://www.hhs.gov/about/news/2021/12/07/us-surgeon-general-issues-advisory-on-youth-mental-health-crisis-further-exposed-by-covid-19-pandemic.html