The purpose of this study was to describe the impact that the school-based health center in Sneedville, Tennessee had on students who attended Hancock County High School. The study documented how the school-based health center affected students, families, and the community of Sneedville. Case study methodology was used to determine if the school-based health center impacted school attendance, mental and emotional health, sexual practices, and overall quality of life for students and their families. Data were collected through 25 interviews with health center stakeholders. The methodology included working with the staff at the school-based health center to identify the key players and key center users over the seven years of the center's existence. An interview protocol was designed for each of the seven groups that were interviewed. Data were collected from current and former students, parents of current and former students, school counselors, teachers, and the school nurse. Students who attended Hancock County High School as well as their parents were impacted by their direct access to primary comprehensive health care services. Benefits to parents included a reduction of time in missed work and lower medical care costs for students without health insurance. The center promoted and improved school attendance while distributing valuable health education information to students and parents. Because the city of Sneedville has only one medical center and no hospital, the school-based health center served the rural residents well. Beginning as one of only three such centers in the United States, the school-based health center endured and evolved into a full-service, comprehensive health care provider. The center is located in an isolated region of Northeast Tennessee; the location added to the center's impact on the residents. This study could provide a model for rural communities seeking ways to serve the health care needs of youth. In this time of economic instability and educational accountability, this school-based health center appeared to impact student care, thus allowing students to be more capable and ready to learn.

Systematic screening for social, emotional, and behavioral concerns (SEBC) identifies at-risk students and provides information to guide interventions that may prevent negative outcomes (Glover & Albers, 2006; Kauffman, 1999; Severson, Walker, Hope-Dolittle, Katochwill, & Gresham, 2007). However, the screening process may be influenced by the gender of the student (Young, Sabbah, Young, Reiser, & Richardson, 2010). This study further examined the influence of student gender on screening by assessing the congruency of gates one and two of a screening process based on student gender. Participants included 59 middle school teachers who nominated at-risk students on the Teacher Nomination Form (TNF; Davis, 2012) and then completed the Behavior Assessment System for Children, Behavioral and Emotional Screening System (BASC-2 BESS; Kamphaus & Reynolds, 2007) on each nominated student. A two-tailed z-score was calculated to see if the TNF predicted BASC-2 BESS T-scores better for one gender over the other. A z score of -0.63 (p > .05) was obtained in the internalizing category and a z score of 0.39 (p > .05) was obtained in the externalizing category; the difference between correlation coefficients for males and females was not statistically significant. While more males were nominated than females in both the internalizing and externalizing categories, the screening instrument does not measure differently for males and females according to the data analysis provided here. Disproportionate identification of males and females in the screening process may be explained by other factors that could be the focus of additional research.

Suicide is the third leading cause of death among youth and young adults ages 10--24. In 2001 the U.S. Surgeon General laid out a national strategic plan to more effectively address suicide prevention (United States Public Health Service, 2001). In 2008, Gene Cash, then president of The National Association of School Psychologists, made a "call to action" to prevent suicide. Although suicide prevention has been repeatedly identified as a priority in mental health care, the vast majority of interventions with suicidal youth are not evidence based due to a lack of research utilizing controlled studies (Daniel & Goldston, 2009). Unfortunately this leaves mental health professionals (MHPs) to routinely implement interventions that are not research based and not proven effective in deterring suicidal thoughts and actions. No-suicide contracts (NSCs), commonly used in clinical and medical settings, solicit a commitment from a suicidal individual, a promise not to complete suicide. The prevalence of school-based MHPs' use of NSCs with suicidal youth (SY) is unknown. Additionally, minimal feedback is available regarding MHPs' perceptions of and current practice regarding implementation of NSCs. Likewise, school policy directing MHPs' intervention when working with SY is neither well described nor understood. A brief survey was created to access these perceptions and practices. Of 326 MHPs attending a Utah Youth Suicide Prevention Conference, 243 completed a survey (74.5% participation rate). Half of participants intervening with SY reported using NSCs. Only 27 of the 243 participants indicated that their school's policy encouraged or required a NSC. Only 8 participants reported knowledge of a formal written school policy that specifically guided their intervention with SY. Reasoning underlying decisions to use or not to use NSCs were explored. Common explanations included attending to individual student needs, following perceived guidelines, building trust with SY and adapting contracts to fit student needs, and opening discussion about suicide. Several participants expressed a need for additional training with no-suicide contracting. A few participants called for either renaming NSCs or implementing a similar, but more positive, "commitment to treatment" strategy. Participants did not mention a need for additional research to explore the efficacy of NSCs. In fact, research was not mentioned. This reflects the gap between research and practice and the dependency on personal experience and going along with the status quo versus depending on research findings to dictate improvement and change in practice.

Best practices in adolescent suicide prevention include teachers as major participants, because teachers are in a unique and frontline position to support students. Unfortunately, many teachers are unaware of their role in suicide prevention efforts. In addition to confusion about their roles, teachers may feel uncomfortable and/or lack confidence in their abilities to identify warning signs and intervene with suicidal students. This study assessed secondary teachers' (N = 74) perceptions of their role in suicide prevention as well as how they perceive their comfort and confidence levels in identifying and intervening with suicidal students. In addition, this study explored possible reasons teachers might feel uncomfortable assisting in suicide prevention. While teachers overwhelmingly agreed that they should have a role in adolescent suicide prevention, teachers also reported having limited confidence in their ability to identify or help potentially suicidal youth. Teachers also acknowledged limited training, fear of making the situation worse, and fear of legal repercussions as potential barriers to participating in suicide prevention efforts. Consequently, teachers will benefit from more direct training which clearly identifies their roles and allows opportunities for teachers to role play.

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Teamwork is essential to provide quality services to individuals with disabilities (Morrison & Gleddie, 2019). Deficits across a variety of domains make interprofessional practice even more crucial (Dobbs-Oates & Morris, 2016). Interprofessional education (IPE) provides preprofessionals the opportunity to gain experience collaborating with various disciplines, better preparing them for interprofessional practice (Anderson et al., 2011; Ruebling, et al., 2014). Most IPE research has been completed with preprofessionals engaged in medical cases. The existing evidence for IPE in school-based settings is limited, which creates a gap for speech-language pathologists (SLPs) who are pursuing work in school-based settings. The first purpose of this study was to examine the perceptions and attitudes of participants following an IPE experience of a medical case with both quantitative and qualitative data. The second purpose of this study was to determine if a case could be adapted to a school-based setting. Seventy-one participants completed a survey following an IPE experience with eight later participating in a focus group. Preprofessionals self-reported interprofessional learning from the experience and recognized the importance of team interactions. The IPE experience was successfully adapted to a school-based case and in an initial program evaluation, perception of teamwork and interactions were also important. In both settings, preprofessionals rated themselves as having less bias towards others than others have towards their own disciplines. This study provides essential information regarding IPE for school-based settings that will ultimately benefit children with disabilities by encouraging interprofessional practice.

Problem: A major gap in adolescent mental health services exists in the United States. Nearly 80% of children and adolescents who are defined as needing mental health services are not receiving mental health care. School-based services have demonstrated promise as a strategy to address this gap. The purpose of this dissertation is to determine how a large urban school system implemented and sustained an innovative service of care model in response to financial, human resource, and community constraints and opportunities. Methods: A case study of the San Diego Unified School District’s (SDUSD) Mental Health Resource Center (MHRC) was completed using Pettigrew and Whipp's Content, Context, and Process Model of Strategic Change (PWM) as the theoretical framework that guided the research. Three primary sources of evidence were collected covering a fifteen-year period of implementation (1999–2014): 1) documents; 2) archival records; and, 3) interviews. The interviews were conducted with local and state stakeholders (n=20) and with students who received MHRC services and their parents (n= 15). A chronological reconstruction was completed and all data underwent a content analysis to organize and identify emergent themes based on the PWM framework. Results: Eight factors were identified as critical to the implementation and sustainability of the MHRC: establishing the legitimacy of school as environment for the delivery of mental health services; aligning education and mental health policies; implementing cross systems collaboration; utilizing data to improve performance and prioritize services; strengthening parent and student involvement; commitment to lead; institutionalization of mental health training; and, investment in staff. Further analysis assessed potential system improvements and opportunities for new collaborations and produced sustainability recommendations for SDUSD and MHRC administration, staff, and stakeholders. Conclusion: The MHRC provides a unique systems model that can inform best practices and policy decisions regarding the implementation and sustainability of school-based mental health services. Lessons learned from the sustainability of the MHRC support schools as a legitimate environment for the delivery of mental health services and the integration of mental health services in schools as a feasible strategy to improve student academic and mental health outcomes.

In the past, many measures have been taken in the Dominican Republic to address the functional outcomes of a school-aged child with a disability. However, none of these measures have explored or addressed function within context. Under the current paradigm used in the Dominican Republic, similar to the medical model, provision of therapy services in the Dominican Republic would be designed to remain outside of the educational context. The Centro de Atencion Integral Para la Discapacidad (CAID), a government initiative set by the first lady of the Dominican Republic and the Dominican Association of Rehabilitation (ADR), a pioneer non-profit organization, are the first organizations to offer comprehensive rehabilitative services and treatment for children with disabilities. The services delivery model used in the ADR removes the child from their natural school environment (M. Paniaguas, personal communication, July 17, 2014). This is further impacted by a lack of professional training to enable practitioners to treat children in context (M. Paniaguas, personal communication, July 17, 2014), making occupational therapy service provision (or any other related service) in schools virtually non-existent (M. Paniaguas, personal communication, July 17, 2014). Educational inclusion is presented as a goal. The availability of continuing professional education is presented as a solution to the problem. Many factors affecting the implementation of inclusion in developing countries are explored. The recommendation is given for a training/certificate program focused on the inclusion framework. The design is developed and catered to aid in enabling occupational therapists in the DR with skillsets in three major areas: standardized evaluations, service delivery, and ongoing staff development and training. Recommendations are to deliver the program through three one-week courses. The theory is that post-professional training closes gaps in the pediatric care of the Dominican Republic and shifts how occupational therapy services are delivered by Dominican occupational therapists in the Dominican Republic.

The school-based occupational therapy practitioner's role is to support children and youth's participation in the school environment (Cahill, 2020). To do this, practitioners must use evidence-based practice, which includes being up to date and knowledgeable with current strategies, interventions, and understanding how to implement those with the resources available. Although the literature provides guidelines for the core components of evidence-based practice in the school setting (Cahill & Beisber, 2020), occupational therapists continue to face barriers with putting the evidence into practice (Seruya & Garfinkel, 2020; McCluskey & Lovarini, 2005). Barriers include time, access to paid journal articles, administrators' support, and knowledge of evidence- based practice (Seruya & Garfinkel, 2020; McCluskey & Lovarini, 2005). To overcome the barriers, occupational therapy practitioners need access to professional development courses that support knowledge translation. Research shows that often times practitioners rely on traditional professional development courses, however, little research supports these formats in translating knowledge into practice. To support knowledge translation for occupational therapy practitioners who represent nearly one-fourth of all occupational therapists, professional development workshops need to move away from a traditional workshop format. The course Knowledge to Practice: Supporting School-Based Occupational Therapy Practitioners (KTTPSOTP) is a cutting-edge professional development course, incorporating the most current adult learning principles (Dionyssopoulos, Karalis, & Panitsides, 2014; Duman, 2010; Gozuyesil & Dikici, 2014). The course's critical elements include brain-based learning techniques, peer interaction and collaboration, and hybrid format. By participating in this course, school-based occupational therapy practitioners will receive ongoing support, access to current literature supporting best practices, and crucial peer connections. This course will provide needed support to school-based practitioners while also serving as a blueprint to other professional development courses interested in evolving beyond the traditional format.

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