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Bridging the Gap: Implementing a Multi-Stakeholder Approach to Enhance Mental Health
and Social Service Initiatives in a Rural School District
A Doctoral Capstone Project
Submitted to the College of Education, Arts and Humanities
Department of Education
In Partial Fulfillment of the
Requirements for the Degree of
Doctor of Education
Denelle R. Diehl
Pennsylvania Western University
July 2025
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Dedication
The public education system seeks to nurture one of the extraordinary forces
within this universe, the human mind. Careful care and cultivation of curiosity, creativity, and
critical thinking by educators have helped cured diseases, advanced society through innovation
and ingenuity, and even put a man on the moon. Beyond these complex formulas and
mathematical calculations, the essence of the human experience has been captured and replayed
in stories, music, screenplays and poetry. The human mind responsible for the creation of it all.
While this complex network is powered by impersonal compounds and mere electricity, it is
capable of housing the full spectrum of human emotions, from the bounty that love brings to the
depths of despair. From the impersonal, comes the idiosyncrasies of each individual and the
nuances of a unique personality.
Despite its near limitless potential, the human mind is equally as capable of limiting its
own possibilities. Without proper care, the human mind can extinguish the very gifts that make
this world a better place. This work is dedicated to those who bravely and diligently seek care to
protect this asset which is most dear to each of us, particularly students who face mental health
challenges in their formative years.
Throughout the course of this study, this purpose has not been forgotten, nor has the
memory of those gone too soon….
Help is available for those in crisis. If you or someone you know are experiencing
feelings of despair or suicidal ideation, please call or text the National Suicide Hotline at 988.
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Acknowledgements
I have learned that the simple practice of gratitude has a very profound and positive impact on
overall wellbeing. As this project draws to a close, my heart is full when I reflect upon the village who
have walked this path with me. In one way or another, you have each taught me how to better lead with a
tough skin and a tender heart…
To Dr. Mary Wolf, thank you for your careful and considerate guidance that you have provided
each step of the way on my leadership and doctoral journey. The care for your students and the betterment
of public education as a whole, is evident in all you do!
To Dr. Jerry Shoemake, thank you for giving of your time, knowledge and expertise in helping
me to realize the completion of this project and for the practical advice in helping me apply the lessons
learned each day at Tussey Mountain.
To Dr. Maria Scott-Bollman, thank you for, despite being firmly retired, agreeing to be my
“teacher” one last time. You continue to model what it means to be not only a caring educator, but what it
means to be a woman who leads with grace, confidence and intelligence in this industry.
To Bill Denny and Matt Goddissart, thank you for guidance and expertise with editing and
formatting and helping me to make this project the best it could be.
To Amy, thank you for walking with me from the darkness into light and continuously reminding
me that prioritizing self, enables care for others.
To Jacque, Robin and Brenda, thank you for the many pep-talks and days when we dared to
dream of something bigger for our students. I am lucky to have each of you as co-workers and even more
fortunate to count you as friends.
To my family, Mom, Dad, Darcee, Kyle, and Tera, thank you for always being my
cheerleaders, practical advice-givers, and a source of constant encouragement.
And to my JD, thank you for always reminding me to see that in every situation, even perceived
problems, flaws and insecurities that there is something to love and there is something to use. You bring
me (and Finn) joy, a sense of peace, and laughter each day. We love you dearly!
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Table of Contents
Signature Page
ii
Dedication
iii
Acknowledgements
iv
List of Tables
ix
List of Figures
x
Abstract
xi
CHAPTER I: Introduction
1
Background
2
New Mental Health Initiatives
3
Presentation of Research Questions
5
Data Collection & Participants
6
Financial Implications
7
Chapter Summary
8
CHAPTER II: Review of Literature
10
The Pennsylvania Youth Survey
10
Evolution of the Pennsylvania Youth Survey: History & Development
12
Pennsylvania Youth Survey: Purpose & Uses
The Impact of Risk & Protective Factors for Students
16
18
Relationship Between Risk Factors, Protective Factors & Student Outcomes
21
Impact of the COVID-19 Pandemic and Social Media on Risk and Protective
24
Factors
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Student Wellbeing, Challenges and Relationship to School Achievement
30
Debate: The School’s Role in Supporting Adolescent Mental Health
36
Current Challenges, Opportunities, Barriers and Programming Models
39
Parent Perspectives
45
47
CHAPTER III: Methodology
50
Study Purpose
51
Research Setting & Context
53
Chapter Summary
Student Risk & Protective Factors within the Tussey Mountain School District
Selection of Research Participants
54
62
Research Question One: Student Surveys
62
Research Question Two: Student Interviews
62
Research Question Three: Parent Surveys
63
63
Research Methods & Data Collection
Research Question One: Data Sources & Collection Methods
64
Research Question Two: Data Sources & Collection Methods
65
Research Question Three: Data Sources & Collection Methods
65
Fiscal Implications
66
Validity
66
67
CHAPTER IV: Data Analysis & Results
70
Use of Data Triangulation
70
Chapter Summary
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Research Question One: Data Analysis & Results
71
Results: PhenX School & Protective Factors Tool Kit
72
Results: Phen X School Social Factors Tool Kit
78
Results: Discipline Data
84
86
Research Question Two: Data Analysis & Results
88
Results: Quantitative & Qualitative Summary of Student Interviews
89
Results: Chill Room Usage Data
Research Question Three: Data Analysis & Results
92
Results: Parent Pre Surveys
93
Results: Parent Post Surveys
100
Comparison: Pre & Post Surveys
107
109
CHAPTER V: Conclusions & Recommendations
113
Research Question One: Conclusions
114
Impact on Risk Factors
115
Impact on Protective Factors
117
Recommendations for Future Research
119
Chapter Summary
Research Question Two: Conclusions
120
Student Reports of Awareness
121
Student Reports of Access
122
Student Reported-Barriers
123
Recommendations for Future Research
124
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Research Question Three: Conclusions
124
127
128
Recommendations for Future Initiatives at the Tussey Mountain School District
129
Financial Implications
130
Closing
132
References
134
Appendix A: Institutional Review Board Documentation
144
Appendix B: Survey Informed Consent Letter
145
Appendix C: Student Assent Statement (Surveys)
149
Appendix D: Informed Consent (Interviews & Surveys)
151
Appendix E: Student Assent Form (Interviews)
154
Appendix F: Student Interview Script
156
Appendix G: Informed Consent (Parent Surveys)
158
Appendix H: Parent Survey Questions
161
Appendix I: Thematic Coding, Research Question Two
165
Appendix J: Thematic Coding, Parent Pre Surveys
168
Appendix K: Thematic Coding, Parent Post Surveys
173
Recommendations for Future Research
Limitations
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List of Tables
Table 1. Depressive & Suicidal Ideation Reports in the Tussey Mountain School
District, 2021
55
Table 2. Depressive & Suicidal Ideation Reports in the Tussey Mountain School
District, 2023
56
Table 3. PhenX Protective Factors Pre and Post Survey Results
73
Table 4. PhenX School Drug Environment Pre and Post Survey Results
75
Table 5. PhenX School Social Factors Pre and Post Results
78
Table 6. Phen X School Social Factors Sub Domains
80
Table 7. Perceived Exclusion and Privilege
84
Table 8. School Disciplinary Data
86
Table 9. Chill Room Usage Data
87
Table 10. Parent Pre-Survey Mental Health Service Perceived Importance &
96
Accessibility
Table 11. Barriers Reported in Parent Pre Surveys
100
Table 12. Parent Post-Survey Mental Health Service Perceived Importance &
103
Accessibility
Table 13. Barriers Reported in Parent Post Surveys
106
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List of Figures
Figure 1. PAYS Risk & Protective Factors
22
Figure 2. CDC Tiered Service Model for Mental Health Services in Schools
41
Figure 3. Tussey Mountain School District, Risk Factors, 2023 Pennsylvania Youth
Survey
59
Figure 4. Tussey Mountain School District, Protective Factors, 2023 Pennsylvania
Youth Survey
60
Figure 5. Sources of Support for Tussey Mountain Students
61
Figure 6. Emotional Thermometer
86
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Abstract
This action research project explores the critical issue of student mental health challenges, which
have been exacerbated by the COVID-19 pandemic, within the Tussey Mountain School District,
in rural Pennsylvania. In this school and on the national scale, rising rates of depression, anxiety,
and suicidal ideation reported have negatively impacted student achievement as well as overall
wellbeing. This study aimed to investigate stakeholder perceptions regarding the efficacy and
accessibility of district-initiated mental health and social service programs (such as the Chill
Project), identify barriers to service delivery, and assess the school's role in supporting student
mental health. Specifically, this action research project investigated: 1) the impact on
self-reported risk and protective factors before and after program implementation; 2) effective
strategies and existing barriers for students accessing mental health services; and 3) the impact
on parent perceptions regarding program availability. A mixed-methods approach was utilized,
using surveys, interviews, discipline data, and Chill Room usage data. This research aimed to
inform programming improvements and refine the school's role in addressing adolescent mental
health needs in this rural Pennsylvania district. Findings of the study indicated a significant
reduction in student-reported risk factors, as well as an increase in positive connection to the
school community and other specific protective factors. Among the parent group, there was
significant variance in perceptions. Parent surveys indicated general support for mental health
services in schools but also highlighted concerns about communication and clarity regarding
program specifics. These results will be used to impact district programming recommendations
moving forward.
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CHAPTER I
Introduction
In the five-year period following the COVID-19 pandemic, most students have
returned to school. This transition, however, has not been without some challenges, with
many education and mental health professionals noting more prevalent and more
pronounced mental health needs and challenges within the student population. The
pandemic has exacerbated existing mental health concerns among students, while
simultaneously increasing the need for mental health services. In fact, at any given time
approximately 20% of school-age youth are actively meeting the criteria for a mental
health disorder (Garret et al., 2022). Moreover, by grade 7, up to 40% of students will
have experienced a mental health issue at some point in their lives.
Schools can play a vital role in addressing these challenges by providing universal
supports and targeted interventions. The National Alliance on Mental Illness (2024) has
identified schools as being well-positioned to improve student access to mental health
services by removing barriers to care such as transportation, scheduling, and stigma.
Currently, almost half of all students receiving mental health care are doing so at school.
The National Alliance on Mental Illness (NAMI) finds that schools can effectively
support mental health with staff and student training to recognize mental illness risk
factors; provide direct services with mental health professionals, such as counselors and
psychologists; and refer students and families to community-based resources.
Obstacles, however, such as limited resources, staff training, and parental
concerns hinder effective implementation of these programs. Productive collaboration
between schools and parents is crucial for successful mental health support programs,
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requiring open communication, shared decision making, and culturally sensitive
approaches. While research highlights the potential of schools to improve student mental
health, further research is needed to understand student and parent perspectives on the
accessibility and efficacy of these programs. There is also some question regarding the
school’s role in the delivery of these services, with some parents, community leaders and
even school administrators indicating that there are questions about how involved the
school should be when it comes to student mental health.
Background
Access to much needed mental and behavioral health services is limited for the
adolescent population, particularly in rural areas. The Tussey Mountain School District is
situated in rural Bedford and Huntingdon Counties in southwestern Pennsylvania.
Serving just over one-thousand students presents a unique challenge to school
administrators as community resources and partnerships may differ, depending on the
student’s county of residence. Furthermore, the school’s comprehensive plan from 2020
identifies limited community resources as a central challenge to student achievement
(Tussey Mountain School District, 2020).
In reviewing specific district challenges, student responses to the Pennsylvania
Youth Survey (PAYS) are of particular interest. During the 2020 administration of the
survey, 50-60% of students at the middle/ high school, “felt sad or depressed most days in
the past twelve months” (Pennsylvania Commission on Crime and Delinquency et al.,
n.d.). Even more concerning were the reports of students who considered, planned or
attempted suicide. During this administration of the PAYS, over 46% of the senior class
“seriously considered suicide”, 33% “planned an attempt”, and 25% “attempted suicide”.
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About 33% of sophomores participating in the survey also reported considering and
attempting suicide (Pennsylvania Commission on Crime and Delinquency et al., n.d.).
Student reports of substance abuse also exceeded the state averages for alcohol,
marijuana, abuse of prescription medications, use of over-the-counter medications (to get
high), cocaine, methamphetamines, hallucinogens, and other synthetic drugs. During this
administration of the PAYS survey, over 70% of seniors reported using alcohol at some
point in their lives (Pennsylvania Commission on Crime and Delinquency et al., n.d.).
Sadly, during the 2023-2024 school year, two students enrolled at Tussey
Mountain High School died by suicide. Since these tragic events, there has been renewed
public interest in support available to students through district programming, as well as
district initiatives (Watson, 2023). In reviewing these concerns, there is a perception
among many stakeholder groups that student needs are not being met through existing
social service programming, mental health programming, or behavioral health supports
available inside and outside of the school district.
New Mental Health Initiatives
During the 2024-2025 school year, several new mental and behavioral health
initiatives were implemented in the school district. The Tussey Mountain School District
used grant funding from the Pennsylvania Department on Crime and Delinquency to
partner with Allegheny Health Network (AHN) in order to bring the Chill Project to
students who were enrolled at the shared middle/high school. The Chill Project has
enabled the school district to provide students and staff with access to additional mental
health professionals, beyond those directly employed by the district. “The Chill Project
features dedicated professionals, a calming space, and regular instruction to help every
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member of a school’s community better handle pressure and anxiety” (Allegheny Health
Network, 2024, para. 1).
The district has also begun to implement a teen Mental Health First Aid (tMHFA)
program with select staff and all tenth-grade students. tMHFA is an evidence-based
program that teaches students in grades 10-12 “how to identify, understand, and respond
to the signs of mental health and substance abuse challenges among their friends and
peers” (National Council for Mental Wellbeing, n.d., p. 2).
Additionally, interest among the Tussey Mountain student body in raising
awareness of mental health issues, led to the inception of Students Empowering Mental
Health Awareness (SEMHA). In his presentation to the Tussey Mountain School Board
of Directors, SEMHA President, Barrett Brode (2024) said that:
The Tussey Mountain Student Empowerment of Mental Health Awareness Team
was formed by students for the betterment of student mental health by promoting
positive interactions and supporting students with opportunities to discuss their
mental health with peers and/or individuals that can further assist them in the
mental health journey. The Tussey Mountain Student Empowerment of Mental
Health Awareness Team works to promote good mental and physical health, as
well as good decision making. (slide 2)
This group of students hopes to impact their school in the following ways:
● “Making the school a brighter and more positive place to learn”
● “Educating students about good decision making”
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● “Educating parents, community members, and teachers about mental
health”
● “Supporting fellow students through their struggles”
● “Providing students with the space they need to get through the school
day”
● “Supporting teachers and school staff” (Brode, 2024, slide 3)
Presentation of Research Questions
The Chill Project, tMHFA, and SEMHA indicate the school district’s commitment
to provide students with quality services, an infrastructure of social support, and mental
health services through strategic partnerships with many community agencies. These
programs are aimed at connecting students with the resources they need to be successful,
academically, and otherwise. During the implementation of these programs, research was
and is needed to determine the perceived effectiveness, accessibility, and knowledge of
available resources among parent and student stakeholder groups.
As the district implemented programs such as Teen Mental Health First Aid and
the Chill Project, this research project endeavored to engage student and parent
stakeholder groups to study the impact of programming on risk and protective factors,
identify strategies for overcoming barriers to services, and the perception of parents on
program availability. Specifically, this research sought to answer these questions:
Research Question 1: What was the impact on self-reported risk factors and
protective factors before and after the implementation of mental and social service
programming initiatives?
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Research Question #2: What strategies, as reported by students, were effective for
helping students access mental and behavioral health services through their school, and
what barriers existed?
Research Question #3: What was the impact on parent perceptions regarding the
availability of mental health and social service programming?
Ultimately, the project aimed to assess the effectiveness of newly implemented
mental health and social service programs in the district. It also explored how these
programs can be improved to better meet student needs.
Data Collection & Participants
For this project a mixed-methods approach was utilized. Because there were
various stakeholder groups involved in this study, a mixed-methods approach assisted in
gaining a more comprehensive picture of the research topic among the various
stakeholder groups to identify common experiences, challenges, and perspectives, as well
as potential areas of divergence or disagreement. Use of quantitative data helped validate,
as well as challenge, existing perceptions. The collection and analysis of qualitative data
in this study also helped establish a more complete context for the research, while
providing a lens through which research findings and implications could be interpreted.
The use of quantitative data allowed for a straightforward report of the results.
For this research, two stakeholder groups of research participants were included:
high school students and parents. Parents and guardians were surveyed before and after
the implementation of mental and behavioral initiatives to assess their perceptions of
student services, as well as any potential change in perceptions over time.
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For the student participant group, students completed pre- and post-surveys to
assess various risk and protective factors. This methodology was selected to determine
whether there was a change in student perceptions of safety, support, and connectedness
after the mental health programming was introduced/presented to students.
Additionally, students were interviewed to collect more detailed information
about student perceptions of program accessibility, needs or short-comings, and barriers.
Data specific to barriers and successes of district programming was collected through 1:1
interviews with student participants using a survey instrument developed by the
researcher. These student interviews also explored the perception of stigma, usage of
services, and program strengths.
Both survey data and interview responses were analyzed quantitatively to assess
the prevalence of student perception regarding the impact of various barriers and
effectiveness of implemented strategies and programming to remove them. Participant
responses were also analyzed using the thematic coding process for quantitative analysis
and triangulation. Data triangulation was completed using pre- surveys, post surveys,
one-to-one interviews, school discipline data, and Chill Room usage data.
Financial Implications
The costs of administering the current study were minimal. However, the financial
implications associated with the studied programming were significant. Philanthropic and
other grant funding were applied to cover the cost of the aforementioned new initiatives
for the current school year. The availability of grant and philanthropic funding, in
conjunction with the proposed capstone research project, provided the district with a
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unique opportunity to learn about various stakeholders’ perceptions of efficacy and
barriers before committing local funds to sustain these programs. This capstone project
helped the district make informed decisions about the future of programs such as the
Chill Project based on their impact.
Furthermore, the provision of grant and philanthropic monies to fund the project
for one year could help the district assess if savings elsewhere by implementing these
preventative initiatives. This offered the school district the unique opportunity to assess
the human, as well as the financial impact of programming before committing to
spending local tax dollars.
Chapter Summary
This study investigated the effectiveness of mental health and social service
programs within the Tussey Mountain School District, a rural Pennsylvania school
district. The COVID-19 pandemic significantly impacted student mental health, with
many experiencing increased anxiety, depression, and suicidal ideation. The district faced
challenges in providing adequate mental health support, such as limited district resources,
a high student-to-clinician ratio, and a lack of community resources. Despite these
challenges, the district implemented new programs such as the Chill Project and Mental
Health First Aid to enhance mental health support.
This study investigated the impact of these programs on student mental health,
assessed the accessibility of services, and explored parental perceptions of these
programs. A mixed-methods approach was selected using surveys, interviews, and
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analysis of locally collected discipline and Chill Room usage data, to provide insight into
the effectiveness of mental health programs in a rural school district.
The findings of this study and implication of the research can better inform future
efforts to improve student mental health outcomes. Furthermore, the results of this study
will be used to inform programming as well as budgeting decisions moving forward.
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CHAPTER II
Review of Literature
The Pennsylvania Commission on Crime and Delinquency suggests that by
tracking changes in student reports of risk and protective factors, the Pennsylvania Youth
Survey (PAYS) helps communities allocate resources to address pressing issues facing
today’s youth (Pennsylvania Commission on Crime and Delinquency [PCCD], 2024a).
The 2021 administration of the Pennsylvania Youth Survey within the Tussey Mountain
School District indicated high rates of depression, suicidal ideation, and substance abuse
among the student body (Pennsylvania Commission on Crime and Delinquency [PCCD]
et al., n.d.). Two student suicides during the 2023-2024 school year heightened district
and community concerns regarding the accessibility of mental health services (Watson,
2023). Due to the school district’s rural location, the studied school district has limited
community resources (Tussey Mountain School District, 2020). The school and
community face profound challenges in providing adequate support services in the wake
of the COVID-19 Pandemic and ensuing mental health crisis. These are not unlike those
reported on a national, and even global, scale following the COVID-19 pandemic (Jones
et al., 2021). As school leaders look to build programming aimed at building
social/emotional skills and building adolescent mental health, debates have emerged
regarding the school’s role in the delivery of such programming (Abrams, 2023).
The Pennsylvania Youth Survey
Various agencies within the Commonwealth of Pennsylvania have been surveying
students to gather data on middle and high school students’ attitudes and behaviors
related to various risk factors since 1989 (PCCD, 2024a; PCCD, 2024b). These surveys
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have taken place approximately every two years and have aimed to understand trends,
identify risk factors, and inform effective prevention strategies (PCCD, 2024a).
Generation at Risk surveys were the previous iteration of this. (Pennsylvania
Commission on Crime and Delinquency [PCCD], 2024c). When the Pennsylvania Youth
Survey (PAYS) replaced Generation at Risk Surveys, the survey measured not only the
prevalence of substance abuse but began to more robustly assess risk and protective
factors that influence youth behavior (PCCD, 2024c).
The PAYS has evolved over time, incorporating questions from existing surveys
like the Communities That Care Youth Survey (CTCYS), which was based on the work of
Hawkins et al.(1992) (PCCD, 2024c). Hawkins et al.(1992) examined risk and protective
factors, to evaluate various prevention strategies for high-risk groups, and proposed
recommendations for future research and practical applications. They found that the best
way to prevent adolescent drug abuse is to focus on risk factors. This involves identifying
these factors and then finding effective ways to address them. Applying this methodology
to both high-risk and general populations was beneficial in their controlled studies.
As indicated, the present version of the PAYS incorporates the work of various
researchers to provide school and community leaders with student-reported data to
address areas of need in the school community and at large (PCCD, 2024a). Further
review of the historical development of this survey provides context for understanding
the literature base of the survey, as well as a conceptual framework for analyzing survey
results according to risk and protective factors. This also may provide some historical
context for school leaders within the Commonwealth of Pennsylvania who seek to better
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define the role of the school in supporting the aforementioned mental health concerns,
post COVID.
Evolution of the Pennsylvania Youth Survey: History and Development
In 1989, Pennsylvania launched a statewide survey of public and nonpublic
school students to assess their attitudes and behaviors towards alcohol and other drugs
(Pennsylvania Commission on Crime and Delinquency [PCCD], 2024d). Funded by the
federal Drug-Free Schools and Communities Act of 1986, the Generation at Risk Survey
was part of the PENNFREE initiative, Governor Robert P. Casey's plan for a drug-free
Pennsylvania. The Drug Policy Council initially administered this survey.
The first survey was administered, anonymously, to students in grades 6, 7, 9, and
12, using the Primary Prevention Awareness, Attitude, and Usage Scale (PPAAUS)
(PCCD, 2024d). During this administration of the survey, the goal was to gather data on
drug use patterns among Pennsylvania youth and inform the development of effective
prevention programs. The Pennsylvania Commission on Crime and Delinquency (n.d)
reports that, at the time, the survey filled a critical information gap, as federal youth
surveys at the time were limited to high school seniors with outdated data. By providing a
comprehensive and statistically valid assessment of drug use among Pennsylvania youth,
the survey helped policymakers and educators tailor prevention efforts to address specific
needs and challenges of Pennsylvania students (PCCD, 2024d).
The Generation at Risk Survey was repeated in 1991, with some minor revisions
(Pennsylvania Commission on Crime and Delinquency [PCCD], 2024e). The
Pennsylvania Department on Crime and Delinquency states that “the 1991 survey
basically used the same survey instrument as the 1989 survey with some modifications”
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(PCCD, 2024e, para. 1). The most notable changes were the inclusion of three
substances: crack cocaine, anabolic steroids, and over-the-counter medications
“specifically taken to get high” (PCCD, 2024e, para 1). The Pennsylvania Commission
on Crime and Delinquency (2024e) notes that the 1991 A Generation at Risk survey
instrument maintained “excellent statistical reliability and validity” (para 1).
Administration of the survey continued in 1993, with the Pennsylvania
Commission on Crime and Delinquency (2024f) reporting that the survey had been
“continuously refined” (para. 1) since its inception, but the basic elements and structure
of the survey still remained. In 1993, however, the survey also included items from the
Youth Risk Behaviors Survey which was developed by the Centers for Disease Control
(PCCD, 2024f). Administration of the survey continued in 1995, with additional
questions assessing violence added (Pennsylvania Commission on Crime and
Delinquency [PCCD], 2024g).
In 1997, the Pennsylvania Commission on Crime and Delinquency began
administering the survey under its current name, Pennsylvania Youth Survey, with the
Pennsylvania Commission on Crime and Delinquency (PCCD) administering all surveys
since this time (PCCD, 2024b). However, in 1999, they did not administer the
Pennsylvania Youth Survey as scheduled, as the instrument underwent significant,
comprehensive revision (PCCD, 2024c).
In 1999, an advisory group representing the Pennsylvania Departments of Health,
Education, and Public Welfare and other state agencies including the Governor’s
Policy Office, the Children’s Partnership, Juvenile Court Judges’ Commission,
and the PCCD, identified the need for a new statewide survey. This new survey
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would measure the prevalence of the use of alcohol, tobacco, and other drugs,
while also assessing additional risk and protective factors that help shape youth
behavior. The risk and protective data could then be used to guide prevention
efforts, to help address existing problems, and to promote healthy and positive
youth development (PCCD, 2024c, para. 1).
For the purposes of the present study, these changes are notable as they provide a
historical context, as well as a research-based practice framework, for further examining
risk and protective factors when developing targeted prevention programming for
adolescents. It should also be noted that the advisory group substantially moved the
survey beyond the assessment of alcohol, tobacco, and other drugs (ATOD) to include a
more thorough examination of other risk and protective factors impacting Pennsylvania
youth.
The Pennsylvania Commission on Crime and Delinquency reports that these
changes had two objectives: first, to “estimate the prevalence of ATOD use and other
delinquent behaviors among middle school and high school students” and, second, to
“identify risk and protective factors that correlate with ATOD use and other delinquent
behaviors in order to inform prevention planning” (PCCD, 2024c, para. 7).
Administration of the PAYS continued in 2003, with some additional changes. The
2003 youth survey was similar to the one conducted in 2001; however, to make the
survey shorter and provide more options, they offered two different versions (PCCD,
2024g). One version focused on family factors through the use of 40 questions, while the
other included only one question about families. Schools could choose which version to
give to their students. For the purposes of the current study, the inclusion of survey
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questions related to families is notable, as this study explores parent perceptions, in
addition to the impact of extenuating external risk and protective factors beyond the
school community
It should also be noted that, for the first time, the 2003 survey included questions
about feelings of sadness, hopelessness, and worthlessness (PCCD, 2024g). They did not
include the results for these questions in the 2003 summary report.
Questions regarding students’ emotional state were again included in the 2005
administration of the PAYS with the results being reported at the conclusion of the survey
(Pennsylvania Commission on Crime and Delinquency [PCCD], 2024h). Other notable
changes in the 2005 survey were the inclusion of questions about gambling and the use of
prescription drugs for non-medicinal purposes. Schools could also choose to administer
the survey on paper or online, with about 10% of the surveys completed online that year.
Administration of the PAYS continued in 2007; while minimal changes were noted
to the content of the survey, significant changes to the scoring process enabled better
analysis of risk and protective factors according to demographics and grade level (PCCD,
n.d.). The Pennsylvania Commission on Crime and Delinquency (n.d.) reported that these
updates included changes to several risk and protective factor scales, including, “the
introduction of a new normative database, and changes to grade-level scoring” (para. 3 ).
PAYS reports issued that year (and in subsequent years) recalculated historical data related
to risk and protective factors, so that schools and communities could compare results over
time (PCCD, n.d.). These were the last notable changes to the scoring of the PAYS survey,
with regular bi-annual administrations occurring in 2009, 2011, 2013, 2015, 2017, 2019,
2020, 2021, and 2023 (PCCD, 2024a).
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In 2013, however, they made permanent changes to the structure of the study to
address differences in response rates at the beginning versus end of the survey (PCCD et
al., n.d). These changes have facilitated greater participation and collection of dataThis
was the last major structural change to the survey however over time, they added or
reworded some questions for clarity,to obtain more specific data.
Throughout its thirty-five-year history, the PAYS (and the Generation at Risk
Surveys) has evolved from assessing emerging trends related to alcohol, tobacco, and
other drug usage to providing a comprehensive assessment of youth behavior and risk
factors, as well as the protective factors surrounding them in their schools, homes and
communities. Upon completion of the PAYS, school leaders are provided with a detailed
report of the results, specific to their school and student population (PCCD et al., n.d.).
Pennsylvania Youth Survey: Purpose and Uses
The Pennsylvania Commission on Crime and Delinquency (2024) reports that:
Thirty years of Prevention Research has shown that current problems have
precursors–signs that point to what is likely to happen. PCCD uses programs that,
supported by evidence, impact these precursors either by limiting risk factors or
strengthening protective factors as identified in local communities. (para. 3)
In addition to providing each participating school and community with a detailed
report and analysis of PAYS surveys results in their community, the Pennsylvania
Commission on Crime and Delinquency, partners with several other public and private
agencies, including the Pennsylvania Department of Human Services, the Pennsylvania
Department of Education, the Pennsylvania Department of Drug and Alcohol Programs
and the Edna Bennet Pierce Prevention Research Center, through PennState University’s
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College of Health and Human Development. This facilitates the identification and
implementation of evidence-based programming in response to identified areas of need
through its PAYS Guide (PennState College of Health and Human Development, 2020).
This guide provides structured discussion points to review and analyze student
data for school and community leaders and a framework for implementing
evidence-based action plans in identified areas (Penn State College of Health and Human
Development [HHD], 2020). By pairing an individual school or community’s PAYS
results with this guide, leaders can identify areas of need, develop targeted interventions,
evaluate the effectiveness of these interventions over time, and track trends in the data
(PCCD et al., n.d.; Penn State College HHD, 2020). Beyond programming decisions,
PAYS data could be used to advocate for additional resources, support existing
school-based prevention programs and provide data to inform policy decisions at local
and state levels.
The PAYS Guide provides school and community leaders a framework for
accomplishing these objectives through the completion of detailed steps identified within
six modules (PennState College HHD, 2020):
● Module 1- Form Your Team and Analyze Data
● Module 2- Determine Targets and Priorities
● Module 3- Conduct Resource Assessment
● Module 4- Explore Evidence Based Programs
● Module 5- Create an Action Plan
● Module 6- It PAYS to Know…It PAYS to Share (Resources for community
engagement and sharing of data)
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This framework provides school and community leaders with actionable and
evidence-based resources to be responsive to identified risk and protective factors in their
schools and communities, and engage other stakeholder groups, in response to the PAYS
(PennState College of Health and Human Development, 2020).
Understanding the development of the PAYS, its implications, and practical uses
are salient to the current research as it provides context to the studied school district as
well as the evolution of programming within the Commonwealth as a whole. It also
provides historical context as school leaders seek to define their role in supporting at-risk
youth for better outcomes, academic and otherwise. Both PAYS reports and the PAYS
Guide appear to be valuable tools for schools and communities to address mental health
and social service needs, improve student outcomes, and promote positive, adolescent
development. This is largely done by providing leaders with self-reported student data
related to risk and protective factors.
The Impact of Risk and Protective Factors for Students
As summarized in the previous section of this literature review, much of the
evolution of the PAYS has centered around the addition and more detailed analysis of risk
and protective factors in Pennsylvania youth. By understanding what risk and protective
factors are and how they have the potential to impact student outcomes (positively or
negatively), educators, parents, community members, and school and community leaders
can work together to create supportive environments that promote positive outcomes for
students (PCCD, 2024i).
Risk factors are conditions or experiences that increase the likelihood of negative
outcomes in students, such as academic difficulties, behavioral problems, or substance
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abuse (Fraser, 1997; Substance Abuse and Mental Health Services Administration
[SAMHSA], n.d.). Fraser (1997) notes that:
Risk factors that occur or exist at one moment in time, such as a stressful life
event, may be useful in determining the risk status in children, but provide little
information about how or why a child came to be at risk. (p. 13)
Examples of common individual risk factors for students may include learning
disabilities, substance abuse, mental health problems, and negative self-esteem (Fraser,
1997). Common family risk factors may include family dysfunction, parental substance
abuse, and lack of parental involvement. School risk factors include poor academic
performance, negative school climate, and lack of support services. Community factors
which place students at higher risk for negative outcomes include limited employment,
limited access to education, poverty, and discrimination.
Fraser (1997) also contends that identified risk factors can have a compounding
impact and makes the distinction between risk factors and risk processes. “Risk processes
refer to the mechanisms whereby a risk factor contributes overtime to heightened
vulnerability” (Fraser, 1997, p. 13). For risk processes, Fraser provides the example that
poor parenting practices or an inadequate supervision/response to a child’s behavior at
home may contribute to noncompliance or behavior issues in other settings.
Several studies have shown that the presence of a risk factor does not necessarily
mean a negative outcome for the student. In fact, supportive adults, both at home and
within the school system, can serve as protective factors which mitigate risk for students
(Masten et al., 2008; Vanderbuilt-Adriance & Shaw, 2008).
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Fraser (1997) identifies that some conditions or experiences can buffer the
potential impact of risk factors and increase the likelihood of positive outcomes. While
some scholars make a distinction between protective (external) and resilience (internal to
the child) factors, Fraser (1997) defines protective factors as “both the internal and
external factors that help children resist or ameliorate risk” (p. 16). Individual protective
factors for students include high intelligence, positive self-esteem, resilience, and strong
coping skills (Fraser, 1997).
SAMHSA (n.d.) identifies protective factors as “characteristics associated with a
lower likelihood of negative outcomes or that reduce a risk factor’s impact. Protective
factors may be seen as positive countering events” (SAMHSA, n.d., para. 4). The impact
of protective factors is the subject of much research.
Vanderbuilt-Adriance and Shaw (2008) found that supportive family
relationships, particularly in early childhood, in addition to parental involvement and
positive role models, improve the likelihood of positive outcomes for students. Their
study aimed to investigate the protective factors that help children from low-income
urban families overcome adversity and develop positive social adjustment. Specifically,
their study examined the impact of child IQ, parenting quality, parent-child relationship,
and parental relationship quality on children's social skills and antisocial behavior from
early childhood to early adolescence. Intelligence of the child, nurturant parenting, and
parent-child relationship quality were consistently associated with positive social
adjustment, even in the context of high neighborhood disadvantage
(Vanderbuilt-Adriance & Shaw, 2008).
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School systems may also offer protective factors to at-risk students. Masten et al.
(2008) found that schools with strong protective factors are characterized by positive
school climate, effective systems, and supportive teachers, and that these protective
factors can help students meet academic, physical and emotional needs. Masten et al.,
(2008) also noted that protective factors may also be found within the community.
Communities with robust proactive factors for children include strong social connections
and opportunities for community involvement.
These research studies provide specific examples of the interplay between risk
and protective factors. It is important to note that risk and protective factors interact in
complex ways and influence an individual's susceptibility to substance use and mental
health disorders (SAMHSA, n.d.). The presence of multiple risk factors can increase the
likelihood of developing these issues, while protective factors can mitigate their impact.
Each of these factors could influence one another (SAMHSA, n.d.).
Relationship Between Risk Factors, Protective Factors and Student Outcomes
By their very definition and as illustrated in the research reviewed in the previous
section, risk and protective factors are linked to student outcomes, academic and
otherwise. Fraser (1997), states that “no single event produces a negative outcome.
Rather, interactional processes shape behaviors and problems over time” (p. 13).
The Pennsylvania Commission on Crime and Delinquency also identifies the
relationship between risk factors to negative student outcomes and protective factors to
positive student outcomes (PCCD et al., n.d.). Figure 1, from PCCD illustrates these
relationships:
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Figure 1
PAYS Risk and Protective Factors
Note. This figure helps visualize the relationships between risk and protective factors to
various student outcomes, as illustrated by Pennsylvania Commission on Crime and
Delinquency, Pennsylvania Department of Drug and Alcohol Programs, & Pennsylvania
Department of Education. (n.d.)
At the federal level, government agencies have also sought to improve public
literacy and knowledge regarding the role and impact of risk and protective factors in
adolescents, as well as conceptualize the relationship between risk and protective factors
and the emergence of certain mental health conditions (youth.gov, n.d.). Youth.gov is a
U.S. government website created to support the development and well-being of
adolescents, by providing information from various government agencies and up-to-date
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research. When speaking of risk and protective factors and the relationship to positive
outcomes for adolescents, this resources identifies:
There are contextual variables that promote or hinder the process. These are
frequently referred to as protective and risk factors. The presence or absence and
various combinations of protective and risk factors contribute to the mental health
of youth. Identifying protective and risk factors in youth may guide the prevention
and intervention strategies to pursue with them. Protective and risk factors may
also influence the course mental health disorders might take if present.
(youth.gov, n.d., para. 1-2)
Youth.gov also provides a visual guide which identifies how various risk factors
(within the domains of the individual child; parent; or school, neighborhood, and
community) correlate to certain mental health conditions. For instance, risk factors such
as low self-esteem, family conflict, or school failure have been linked to anxiety
disorders; while poor social skills, parental depression, negative family environment, and
school violence have been linked to depression. A more comprehensive list of the
relationship of over sixty risk factors to the conditions of depression, anxiety, substance
abuse, schizophrenia, and conduct disorder can be found on the website (youth.gov, n.d.).
These resources provide a comprehensive review of various studies by various
government agencies and researchers of multiple risk and protective factors; however,
there are also numerous individual research studies which provide further insight into
how risk and protective factors relate to more specific student outcomes.
In a study exploring the relationship between risk and protective factors,
researchers analyzed data from 11,875 children aged 9 to 11 years and found that higher
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levels of mental health concerns in parents were strongly linked to increased mental
health concerns within their children (Zhang et al., 2020). Additionally, within this study,
higher socio-economic status was associated with better general cognition, executive
function, and lower behavioral inhibition in children. The study also noted that a positive
social environment and strong interactions were linked to better behavioral regulation
skills in children.
By understanding the interplay between risk and protective factors, school leaders
can develop more effective interventions to promote healthy child development, good
mental health and prevent substance use disorders (SAMHSA, n.d.). This is important,
especially in light of substantial changes to risk and protective factors for students in the
wake of the COVID-19 Pandemic.
Impact of the COVID-19 Pandemic and Social Media on Risk and Protective Factors
The impact of risk and protective factors became even more apparent in the
aftermath of the COVID-19 Pandemic. Changes associated with the pandemic
significantly impacted the lives of students worldwide, exacerbating existing risk factors,
and challenging the effectiveness of existing protective factors (Shah et al., 2020). Prior
to the pandemic, many students were already facing challenges such as poverty, family
dysfunction, and limited access to resources. When the pandemic introduced students to
new risk factors, such as isolation, economic hardship, and disruptions to education, Shah
et al. (2020) found that these factors appear to have exacerbated existing challenges,
impacted the social development of students, and led to negative mental health outcomes.
Furthermore, the pandemic strained existing protective factors, as families faced financial
difficulties, schools closed, and social connections were limited (Shah et al., 2020).
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When these risk and protective factors are considered within the greater context of
the COVID-19 Pandemic, there is evidence to suggest a profound impact on adolescent
mental health with increased rates of adolescent mental health disorder reported around
the globe as one of the most common changes to overall student well-being following the
pandemic (Chavira et al., 2022).
Jones et al. (2021) conducted a systematic review of sixteen peer-reviewed
research studies and found that the COVID-19 pandemic had pronounced, negative
impacts on adolescent mental health. The research team found that pandemic-related
stressors, such as social distancing and uncertainty, have been difficult for adolescents to
process, leading to increased rates of anxiety and depression. It was also noted that
pandemic limited social interactions, which led to decreased social support and
exacerbated feelings of loneliness and isolation. Moreover, the pandemic has placed
certain vulnerable groups at further risk for mental health challenges faced by
adolescents.
The literature review also indicated a more pronounced impact for those from
historically marginalized demographics, such as LGBTQ+ youth and those with
pre-existing mental health conditions (Jones et al., 2021). Since the start of the pandemic,
these individuals have experienced additional stressors related to discrimination,
isolation, and uncertainty about their future. Moving forward, the research suggests that
increasing access to mental health services, promoting social support networks, and
teaching effective coping strategies can help students face these increased challenges and
increase the likelihood of positive outcomes in the future (Jones et al., 2021).
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Additional studies suggest that other vulnerable populations may be at greater risk
for the emergence of mental health concerns, such as anxiety and depression, which
impact academic opportunities (Totsika et al., 2024). Totsika et al. (2024) investigated
school absence among children with neurodevelopmental conditions (intellectual
disability and/or autism) in the UK following the initial COVID-19 outbreak. A
significant portion of these children, 32%, missed 10% or more of school days. School
refusal and illness were the primary reasons for absence, with COVID-19-related
absences being less common. The study found that child anxiety was a significant factor
contributing to both overall absenteeism and school refusal, while hyperactivity was
associated with lower levels of school refusal but higher levels of school exclusion. A
positive relationship between parents and teachers was found to be protective against
various types of absence, indicating that adults in the school, home, and community can
help students through these challenges.
As the study concluded, the authors identified a path forward with these research
considerations in mind, “as we enter the post-pandemic recovery era, findings from the
present study would indicate a need to focus on child mental health, in particular anxiety,
and perceived level of unmet need as potentially substantial barriers to regular school
attendance. At the same time, findings highlight the potentially protective role of
parent-teacher relationships” (Totsika et al., 2024, p. 3006).
In addition to further exacerbating student risk factors, while simultaneously
disrupting the social safety networks which offer protective factors, the pandemic’s
impact on social media usage and habits has also had a pronounced impact on adolescent
mental health. The COVID-19 pandemic significantly increased social media usage, with
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a 61% rise in engagement during the initial wave (Fullerton & Anderson, 2021). During
the pandemic, many used social media to restore a sense of connection to others;
however, experts say that its usage had the opposite effect, contributing to depression and
anxiety.
Fullerton and Anderson (2021) report that frequent social media usage can
exacerbate a negative self-image by fostering comparison and perfectionism due to the
curated nature of social media, where users often present idealized versions of
themselves. This can lead to feelings of inadequacy and low self-esteem. Additionally,
the constant exposure to perfectly edited photos and seemingly flawless lives can
contribute to unrealistic expectations and negative body image (Fullerton & Anderson,
2021).
Beyond concerns with negative self-image, Fullerton and Anderson (2021) also
noted that misinformation propagated on social media increased stress and anxiety, as
users were faced with a near constant barrage of conflicting news and opinions, making it
difficult to discern fact from fiction, which led to confusion and fear.
Young et al. (2024) reported similar findings when analyzing recent data
published within the Centers for Disease Control’s 2023 Youth Risk Behavior Survey
(YRBS). With the inclusion of a question about social media usage, results of the survey
were able to provide the first national prevalence estimate of social media use among US
high school students (Young et al., 2024). Using additional data collected on the YRBS,
researchers were able to extrapolate additional data regarding the impact of social media
usage on student mental health.
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The survey data indicated that 77% of US high school students access social
media accounts multiple times a day (Young et al., 2024). Furthermore, frequent social
media use was linked to increased bullying victimization, mental health issues, and
suicide risk. These associations were particularly strong for female students and
heterosexual students. It was, however, noted that, for some marginalized groups,
especially LGBTQ+ students, social media can provide a sense of community and
support, potentially mitigating negative impacts (Young et al., 2024).
This analysis of the impact of social media usage is also consistent with research
which investigated longitudinal impact of the COVID‑19 pandemic on adolescents'
mental health/social emotional status, substance use, and digital media use (Shoshani &
Kor, 2024; Young et al., 2024). Shoshani and Kor (2024) found that over the course of
the pandemic, daily video game usage increased from 1.72 to 2.81 hours; total daily
screen time increased from 7 hours 25 minutes to 8 hours 32 minutes; and a large
proportion of participants (75%) were spending more than 5 hours a day on social media.
As the pandemic progressed and media usage increased, they observed significant
increases in reports of depression, anxiety, somatization (presentation of perceived
physical symptoms in response to psychological symptoms), and general distress
(Shoshani & Kor, 2024).
The study also showed there were significant increases in the prevalence of
tobacco, alcohol, and cannabis use among the participants. Overall, this research
indicates that the pandemic seems to have had a negative impact on the mental health and
digital media habits of the study participants, which showed a strong correlation to
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increased rates of substance use and problematic digital media consumption (Shoshani &
Kor, 2024).
Research surrounding the relationships between adolescent social media usage
and mental health is also drawing the attention of government officials (Arkin, 2024). In
2023, Surgeon General Vivek Murthy issued a warning about the link between social
media and mental health issues like depression and anxiety, advocating for a warning
label on social media platforms similar to those on tobacco products. In 2024, the United
States Senate Judiciary Committee held hearings regarding the safety of social media
usage and potential mental health harm to children. Further public concern was noted
earlier this year, when fourteen attorney generals (representing California, Illinois,
Kentucky, Louisiana, Massachusetts, Mississippi, New Jersey, New York, North
Carolina, Oregon, South Carolina, Vermont, Washington state and Washington, D.C.)
filed suit against TikTok, citing concerns that the company harms adolescent mental
health, collects data without appropriate consent, and uses such to build “addictive
features” into their platform. (Arkin, 2024, para. 4)
From the reviewed literature thus far, it is evident that pandemic and changes in
social media habits that followed have exacerbated mental health challenges among
students, increasing rates of depression, anxiety, and stress. Garret et al. (2022) reviewed
recent incidence and prevalence data and reported that between 2016-2020, the rate of
depression increased by 27% for students aged 13-17, while the rate of anxiety grew by
29% for students of the same age. Additionally, from 2019-2020, behavior and conduct
problems increased by 21%.
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The National Alliance on Mental Illness [NAMI] (2024) reports similar statistics
while also raising concerns about critical challenges for adolescents accessing care. They
report that one in six American teens experience a mental health disorder, with half of all
mental health conditions beginning by the age of 14.
Root causes of these increases are likely multi-faceted, such as increased risk
factors, diminishment of established protective factors, and ongoing changes in student
habits which do not promote mental health, such as social media usage. The reviewed
research indicates that there is some evidence to suggest that promoting positive
school-home connections, implementing programming that facilitates the development of
social-emotional skills, and increased access to mental health services in the school
system may each be a means of addressing these growing needs (Jones et al., 2021;
Totsika et al., 2024).
Student Wellbeing, Challenges and the Relationship to School Achievement
As schools look to address changing needs within their student populations
following the COVID-19 Pandemic, understanding the relationships between student
well-being, mental health challenges and student achievement/school performance is
important. Understanding these relationships can help school leaders provide focus to
educational programming initiatives and better define the school’s role and purpose in
supporting adolescent mental health.
Researchers have found links between student mental health and emotional
well-being to their overall academic success. A meta-analysis, which included fifty-one
existing studies was conducted to better understand the relationship between emotional
intelligence skills and academic performance (Somaa et al., 2021). The study specifically
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investigated three hypotheses: “ H1: There is a positive association of emotional
intelligence with academic performance” (p. 4); “H2: Academic performance is strongly
predicted by ability-based emotional intelligence” (p. 5); and “H3: There is a strong
association of emotional intelligence with academic performance at a younger age” (p. 5).
At the conclusion of this meta-analysis, a significant positive correlation was
found, indicating that higher emotional intelligence is associated with better academic
performance. Statistical analysis indicates support for all three hypotheses, with the
strongest effect size noted for hypothesis one. While there is much evidence to suggest
that emotional intelligence is just one factor impacting academic achievement, at the
conclusion of the study the authors stated, “to date, there is ample evidence suggesting
that academic performance and emotional intelligence are intimately connected” (Somaa
et al., 2021, p. 13)
The Chicago Longitudinal Study (CLS) also found strong evidence that early
social-emotional skills, such as self-regulation, are powerful predictors of later academic
achievement, even after controlling for socioeconomic status and cognitive abilities, over
the course of a child’s entire educational experience (Reynolds, 1999). The CLS followed
a cohort of 1,539 students presenting with various risk factors such as neighborhood
poverty, low family socioeconomics, and other educational hardships from early
childhood into adulthood.
Within this study, researchers collected data on a variety of factors, including
cognitive development, social-emotional skills, academic achievement, and family
characteristics. The longitudinal design of the study allowed researchers to track changes
in children's development over time and to identify the factors that contribute to positive
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32
or negative outcomes. At the conclusion of the study, researchers found that
social-emotional skills are strong predictors of academic achievement (Reynolds, 1999).
Children who were able to regulate their emotions, pay attention, and get along
with others were more likely to succeed in school during the multi-year study (Reynolds,
1999). During this study, Reynolds (1999) also identified that high-quality early
childhood programs can have a significant positive impact on children's academic and
social-emotional development. These programs can help children develop important
skills like self-regulation, problem-solving, and social competence, which are crucial for
success in school and beyond.
In a separate longitudinal study, over 750 participants were studied using data
from a non-intervention group of high-risk children and a normative group of low-risk
children starting when the children were in kindergarten, with outcomes being assessed
over the next thirteen to nineteen years (Jones et al., 2015). Upon entry into the study,
kindergarten teachers were provided with ratings scales for each participant, measuring
the student’s social and self-regulation skills using an eight-item Likert scale. The
findings of this study indicated that there is a statistically significant positive correlation
between social emotional skills observed in kindergarten and outcomes in young
adulthood across all domains that were measured in the study, including, educational
attainment and success, employment, criminal activity, substance abuse and overall
mental health.
In this study, Jones et al. (2015) found that students who presented with better
prosocial skills in kindergarten were approximately 50% more likely to graduate on time
and 100% more likely to complete a college degree. The research team also found that
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the ratings scales completed by the teachers provided more significant predictive value of
future outcomes, compared to other metrics included in the study (Jones et al., 2015).
Furthermore, in a two-wave longitudinal study, aimed at understanding how
subjective well-being (life satisfaction, positive emotions, and low negative emotions)
affects academic engagement in high school students, researchers noted a connection
between higher life satisfaction and lower negative emotions with increased academic
engagement over time (Datu & King, 2018). Datu and King (2018) also found that initial
academic engagement was found to positively influence subsequent well-being. This
suggests a mutual relationship between student well-being and academic performance.
These longitudinal studies allowed researchers to observe and understand the
development of risk factors and impact of protective factors over time. However, it is also
valuable to review research which provides targeted and in-depth investigation into the
various stages of student development in a more focused manner. A review of data
collected in Baltimore City Schools, indicates that students in kindergarten who presented
with social or behavior deficits were significantly more likely to be suspended or
expelled, retained in a grade, or receive support through an Individualized Education
Program or 504 plan (Bettencourt et al., 2016). In this data review, Bettencourt et al.
(2016) reported concern that social or behavioral deficits were far more likely to impact
boys than girls and stated concern about possible inequities.
While most of the reviewed research thus far has studied the relationship between
social skills, emotional regulation, behavior, or student overall well-being on academic
performance, there is also a growing body of research to suggest that school-based
interventions, aimed at developing social emotional and coping skills may be effective in
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facilitating improvements in academic areas as well. In a meta-analysis of school-based
social and emotional learning programs reviewing data from 213 studies (which
researched over 270,000 students), researchers indicated that students who participated in
social-emotional learning programs improved standardized test scores by 11 percentile
points compared to those who did not (Durlak et al., 2011). The researchers in this
program stated that several programs or studies were excluded from the meta-analysis, as
they did not have systematic monitoring of program fidelity or student check-ins built
into their programming, suggesting a need for improvement in these areas
Furthermore, in a longitudinal study aimed at exploring program efficacy and the
relationship between social and emotional risk factors and academic performance during
the transition to secondary school, researchers specifically examined the relationships
between conduct problems and academic performance, the impact of depressive
symptoms versus the impact of anxiety symptoms on academic performance, and how
these factors may impact a student’s attitude toward school (Riglin et al., 2013). The
study also sought to identify specific actionable areas for improvement in the established
school-based programming.
Riglin et al. (2013) selected research participants in their first year of secondary
school for inclusion in this study, as they identified that this is often a significant period
of adjustment for students, which can be accompanied by increased psychological
difficulties and a decline in academic performance. Data was collected regarding
identified emotional problems (such as depression, general anxiety, and school anxiety);
student affect towards school (school liking and school concerns); and conduct problems
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35
or concerns. These data points were selected to better factors that could be targeted in
school interventions to optimize student academic potential.
The researchers found that, while existing interventions focused on bridging the
gap between primary and secondary education or supporting vulnerable students,
research data suggested the need to address additional risk factors (Riglin et al., 2013). In
this study, conduct problems, school liking, and school concerns emerged as key areas for
intervention. Conduct problems, particularly at the beginning of secondary school, were
strongly linked to later deficits in academic achievement. The study also found that
depressive symptoms, though not directly predictive of poor academic performance, may
be an early indicator of a downward trajectory, especially for boys.
At the conclusion of the study, Riglin et al. (2013) suggested that in addition to
universal support provided to all students may hold some benefit, there is a need to also
review student needs and offer tailored programming. The research team identified that,
while conduct problems and school liking may be universal targets, depressive symptoms
and school concerns could be more specific to boys, requiring tailored support for better
outcomes (Riglin et al., 2013).
Similarly, Hudesman et al. (2013) conducted a three-year longitudinal study with
students to learn more about the role of self-regulated learning and formative assessment
in student achievement.. At the conclusion of the study, there was a marked improvement
in student achievement for research participants who received interventions to improve
metacognition and self-regulation (Hudesman et al., 2013).
When the results of each of these studies are considered in relation to one another,
it is evident that strong social-emotional skills are a critical factor in academic success.
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The summarized research suggests that identifying and addressing mental health
challenges early on may hinder the development of more serious problems or mental
health, while improving academic outcomes. These skills may help students manage
stress, build positive relationships, and stay focused on their studies, even in the presence
of other challenges and risk factors.
On the other hand, mental health issues, such as depression and anxiety, can
significantly hinder academic performance. School-based interventions that promote
social-emotional learning are effective in improving both mental health and academic
performance.
Debate: The School’s Role in Supporting Adolescent Mental Health
Despite overwhelming evidence of the impact of risk and protective factors
(inside the school system), as well as a robust body of data suggesting more prevalent and
complex mental health needs in the adolescent population today, there is still
considerable debate among stakeholder groups regarding the school’s role in facilitating
access to mental/behavioral health and social services (Abrams, 2023). Therefore, it is
important to explore the perceptions of some stakeholder groups in supporting adolescent
mental health as well as the school’s responsibilities to students to ensure accessible
education services, according to historical precedents and current practices.
The relationships between risk and protective factors and academic outcomes
raises societal questions regarding how a school should respond to factors directly
impacting the accessibility and effectiveness of a child’s education, their chief role. After
studying the impact of social emotional learning programs and the relationship to student
achievement and exploring the school system at large, Durlak et al. (2011) stated:
ENHANCING MENTAL HEALTH PROGRAMMING
37
There is broad agreement among educators, policy makers, and the public
that education systems should graduate students who are proficient in core
academic subjects, able to work well with others from diverse
backgrounds in socially and emotionally skilled ways, practice healthy
behaviors, and behave responsibly and respectfully. (para. 3)
Current policies and practices within Pennsylvania, as well as on the national
scale suggest some expectation that schools are to be responsive to student mental health
concerns in their program design, which is consistent with Durlak et al. 's characterization
of “broad agreement among educators, policy makers, and the public”.
Within the Commonwealth, the Pennsylvania Department of Education has
released the Pennsylvania Career Readiness Skills and Continuum. This is a framework
designed to help students develop the social and emotional career skills they need to be
successful in the 21st-century workforce (Pennsylvania Department of Education,
2024a). Specific skills are identified on the continuum according to three broad areas:
self-awareness and self-management (skills related to understanding and managing
emotions, setting goals, and responding effectively to challenges; social awareness and
interpersonal skills (skills related to building and maintaining positive relationships,
communicating effectively, and resolving conflicts; and responsible decision-making
(skills related to making informed choices, problem-solving, and critical thinking).
This framework indicates that schools in Pennsylvania have a responsibility to
their students to provide instructional services and programming to develop skills in these
areas to promote social-emotional skills which lead to employment following graduation.
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Beyond direct instruction and programming to help students meet the standards
listed on the continuum, there is a historical precedent for working collaboratively with
community and government agencies to bolster protective factors to mitigate risk through
collaboration and supportive programs. The evolution of the PAYS survey in Pennsylvania
and the school’s continuous role in administering it, strongly suggests that schools play a
crucial role in supporting adolescent mental health, wellbeing, and healthy development
and has for nearly forty-years (PCCD, 2024a).
As discussed earlier, the PAYS Guide provides evidence-based identifying trends
and patterns school-specific data to tailor support services to address the specific needs of
their students (PennState College of Health and Human Development, 2020).
Administration of similar surveys and resources, at the federal level also suggest some
precedent for the school system playing a valuable role in supporting adolescent mental
health on the national scale as well (Young, 2024; youth.gov, n.d.).
Considering this, it should be noted that during the 2021-2022 school year, 49%
of public schools reported providing some form of assessment or diagnostic service for
mental health to their students and 38% reported offering some form of mental health
treatment (National Center for Education Statistics [NCES], 2022). Schools report
offering more services at the secondary level, compared to the elementary level.
Additionally, higher numbers of urban and suburban schools were able to provide
assessments or diagnostic services to their students, compared to rural schools (NCES,
2024).
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Current Challenges, Opportunities, Barriers and Programming Models
Early intervention is key to effectively treating mental health conditions in young
people (NAMI, 2024). The sooner a young person receives treatment, the better the
long-term outcomes and the lower the overall costs (NAMI, 2024). However, there is a
critical shortage of mental health professionals available to address a growing mental
health crisis. Even before the start of the pandemic, just half of the 77 million children
with treatable mental health conditions were receiving treatment. (Whitley & Peterson,
2019). Currently 70% of counties in the United States do not have any child
psychologists, with urban and rural counties being disproportionately impacted by this
shortage (McBain et al., 2018).
Quite often these critical shortages cause significant delays in accessing care,
with many young people waiting months or even years to receive help (NAMI, 2024).
Individuals aged 15-40 experiencing psychosis wait as long as a year and half before
receiving treatment. These delays can lead to worsening symptoms, making treatment
more challenging and expensive.
Schools can be exceptionally effective in providing more expedient delivery of
mental health services. NAMI (2024) identifies that “by removing barriers such as
transportation, scheduling conflicts and stigma, school-based mental health services can
help students access needed services during the school-day” (para. 3). Currently nearly
half of all students who are receiving mental health care do so in their school (NAMI,
2024).
The National Alliance on Mental Illness (2024) indicates that there are several
ways through which schools can support the mental health of their student population.
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Schools can support screening and early intervention efforts by training staff and students
to recognize risk factors, warning signs and symptoms of mental illness (NAMI, 2024).
Some schools may also opt to provide direct mental health services to their students by
hiring school counselors, school social workers, school psychologists, and school nurses.
Alternatively, or in conjunction with direct services provided by school staff, the school
district may refer students and families to community resources. The National Alliance
on Mental Illness (2024) reports that this collaborative approach between schools and
mental health providers can significantly improve access to care and ultimately, enhance
the mental well-being of young people.
The recommendations by the National Alliance on Mental Illness represent
various levels of intervention, as well as skill level to implement them, as they range
from screening efforts by teachers and peers to direct services provided by credentialed
mental health professionals (NAMI, 2024). Riglin et al. (2013) identifies universal
measures such as SEL instruction may not be enough to meet the needs of all students.
While studying psychological functioning and academic attainment, their research team
found that “there is great potential for schools to deliver interventions to support pupils
with psychological problems. Nevertheless, universal programs based in schools that aim
to prevent the development of psychological problems have had only limited success”
(Riglin et al., 2013, p. 41).
In fact, interventions are most effective when they are tailored to the specific
needs of the target population (SAMHSA, n.d.). The Substance Abuse and Mental Health
Services Administration (n.d.), identifies various types of prevention interventions that
may address various levels of need within the student population, including universal
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prevention interventions,which are designed for the general population to prevent
problems before they occur; selective prevention interventions, which target specific
groups at increased risk; and indicated prevention interventions which focus on
individuals already showing signs of a problem by providing counseling or therapy.
The Centers for Disease Control [CDC], 2024.) has identified a similar model,
based on tiered services of which school leaders and educators may have some level of
familiarity. Figure 2 from the CDC illustrates a tiered service model for mental health
supports in schools:
Figure 2
CDC Tiered Service Model for Mental Health Services in Schools
Note. In their action guide, (https://www.cdc.gov/healthyyouth/mental-health-action-guide/
index.html) aimed at assisting schools with developing programming to promote student
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mental health and wellbeing, the CDC identifies programs such as these that can be embedded
with existing MTSS framework that a school may already have implemented.
The Chill Project offers a tiered approach to providing social/emotional support
services, much like those described, to be implemented in schools (Allegheny Health
Network, 2024). Allegheny Health Network (2024) indicates that by providing a shared
language and practical skills, this program helps individuals identify, discuss, and
respond positively to stress, to reduce negative reactions which hinder learning and
growth.
Dedicated mental health professionals, calming spaces, and regular instruction are
key components of this initiative. Schools participating in The Chill Project have reported
decreased behavioral health incidents among students, improved well-being for educators
and parents, and enhanced mindful awareness and resilience across the entire school
community (Allegheny Health Network, 2024)
The program offers a range of services, including one-on-one counseling, support
groups, medication management, school-based outpatient services, school-wide
preventive services, professional development opportunities, social-emotional
curriculum, classroom consultations, and specialized support for student athletes
(Allegheny Health Network, 2024).
In an action-research study conducted at Northgate Middle/High School in
Pennsylvania, the Chill Project was identified as one of the primary interventions during
the study (Smith, 2022). This action-research project assessed the impact of
implementing social-emotional learning programs. The study aimed to determine if these
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interventions could improve the school's ability to address the needs of the whole child
and reduce the negative effects of childhood trauma and adversity (Smith, 2022).
The study involved administering surveys to teachers before and after the
implementation of the interventions. The surveys measured teachers' perceptions of the
school's implementation of whole-child design principles, their own ability to use
trauma-informed practices, and their overall satisfaction with the school climate (Smith,
2022). Additionally, data from Allegheny Health Network's CHILL Project was analyzed
to assess changes in faculty attitudes and practices related to student mental health. In this
study, the researchers hypothesized that the interventions would lead to increased faculty
capacity to implement trauma-informed practices, improved ability to meet the needs of
the whole child, and a more positive school climate.
At the conclusion of the study, it was determined that the interventions
administered within AHN’s Chill Project, could be effective in creating a positive school
climate and addressing the mental health needs of students. The study found that the
implementation of Whole-Child Design principles, an advisory program, and the Chill
Project led to increased alignment with Whole-Child Design practices. Additionally,
teachers perceived an increase in their ability to use trauma-informed practices, as well as
an improvement in the school's ability to meet the needs of the whole child (Smith,
2022).
While initiatives such as the Chill Project increase access to licensed
professionals and evidence-based programming, other intervention techniques aim to
build student capacity at a universal (or tier one) levelTeenage Mental Health First Aid
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(tMHFA) is an evidence-based program that teaches students in grades 10-12 “how to
identify, understand, and respond to the signs of mental health and substance abuse
challenges among their friends and peers” (National Council for Mental Wellbeing, n.d.,
p. 2). This program is based on the notion that adolescents more often reach out to peers
than adults for support (National Council for Mental Wellbeing, n.d.).
In a randomized controlled trial of nearly two-thousand students, across four
schools, which evaluated the effectiveness of tMHFA compared to traditional Physical
First Aid (PFA) training, it was found that tMHFA was significantly more effective in
improving students' intentions to help peers with mental health issues, increasing their
confidence in providing support and reducing stigmatizing beliefs. These findings
suggest that tMHFA is a valuable tool for promoting mental health literacy and
encouraging help-seeking behavior among adolescents (Hart et al., 2018).
While evidence suggests that schools serving as an access point for varying levels
of mental health services or social/emotional interventions may help many students
overcome the barriers to care, school leaders report challenges associated with providing
mental health services within the school settingIn a 2021-2022 survey, half of public
school officials cited lack of access to licensed professionals or inadequate funding as
barriers to providing mental health services to their students (NCES, 2024). These appear
to be the most common barriers from the perspective of school officials. Policy and legal
disputes, concerns about parent reactions, lack of community support, and reluctance to
label students (for fear of stigmatization) were also reported as concerns (NCES, 2024).
These concerns and barriers may impact the extent to which a school is able or willing to
provide mental health services to its students.
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Parent Perspectives
While school leaders reported that inadequate access to mental health
professionals and funding concerns were their biggest barriers to offering mental health
programming to students, nearly ten percent of public schools surveyed cited concerns
about the reactions of parents as a factor that limited their ability to provide programming
to students in a more impactful way (NCES, 2024). In an article published to members of
the American Psychological Association, Abrams (2023), discusses the controversy
surrounding Social-Emotional Learning (SEL) programs in schools.
Lawmakers have proposed bills in at least eight states seeking to limit
social-emotional programming in schools, with many parents supporting this movement
(Abrams, 2023). Abrams (2023) identifies that, while SEL programs aim to teach
students interpersonal skills and emotional regulation, they have been targeted by
conservative groups who falsely associate social emotional programs with political
issues, such as critical race theory and gender diversity initiatives.
To address the concerns raised by critics, Abrams (2023) suggests several
strategies such as using clear, jargon-free communication and familiar terms when
communicating with parents about initiatives. Offering explanations of what SEL
programs are and how they benefit students can help resolve misunderstandings.
Abrams (2023) also identifies that focusing on practical outcomes, such as the
long-term benefits of social emotional programming (i.e. improved academic
performance and better social relationships) and including parents in the conversation, by
providing opportunities for dialogue and feedback could also be helpful in facilitating
productive school-parent relationships.
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There are several research studies which also suggest that when parents have a
clear picture of what social emotional programming or mental health services looks like
in their child’s school, oftentimes there is overwhelming support for these types of
initiatives (Searcy van Vupen et al., 2018).
Searcy van Vupen et al. (2018) studied over 600 parents to investigate their
perceptions on mental health services in rural schools in counties along the Eastern shore
of Maryland, noting that in their study, over 78% of parents agreed that schools should
address student mental health issuesIn this study, parents cited anxiety, depression, and
bullying were the top concerns for their children's mental health. Parents reported that a
lack of support for them along with a lack of mental health awareness, and programs
were key obstacles to delivering effective mental health support to students in schools. It
is important to note that this research study was prior to the COVID-19 pandemic.
Additional studies have indicated similar support for programs that support
adolescent mental health and social/emotional skills, while also underscoring the need for
dialogue between the school and parents (Longhurst et al., 2021). In a research study
exploring the perceptions of parents and caregivers of students who participated in a
school-based counseling program in the UK, several central themes emerged from the
interviews with parents and caregivers.
Longhurst et al. (2021) found that parents and caregivers generally appreciated
the school-based setting for counseling as it was convenient and familiar for their child.
However, many parents said that they wished for better communication from the school
regarding the program and their child’s progress. Confidentiality was also very important
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to parents whose children participated in the program. At the conclusion of the program,
many parents reported positive outcomes for their students.
When considering parent perceptions in the context of the school’s role in
supporting adolescent mental health, it is also important to consider the impact of culture
(Roy & Giraldo-García, 2018). Carefully and thoughtfully navigating these
considerations may help school officials and parents achieve better outcomes for
students. Roy and Giraldo-García (2018) found that parents who are involved in their
children's education and social-emotional learning tend to have children who do better in
school, especially when schools actively work to include parents in a culturally informed
way.
Despite these findings, there is limited empirical research available regarding
parent perceptions of social emotional learning and school-based mental health initiatives
post-Covid, as well as research centering on best practices to engage school-parent teams
that support adolescent mental health.
Chapter Summary
Many researchers have documented the correlation between certain internal and
external (or environmental) factors and their potential relationship to positive or negative
student outcomes. These are frequently referred to as risk and protective factors.
Understanding the interplay between risk and protective factors and processes may help
schools, families and communities partner together to build a network of protective and
resilience factors for better outcomes. Tools such as the Pennsylvania Youth Survey and
accompanying resources provide a framework for assessing and understanding risk and
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protective factors, within the context of a given school or community and equip schools
to more comprehensively understand the challenges faced by youth in their communities.
Following the COVID 19 pandemic, many students have continued to face
challenges related to academic loss, mental health issues, and economic hardship.
Furthermore, adolescent mental health concerns have increased since the COVID-19
pandemic for a variety of reasons. This has been coupled with a critical shortage of
mental health providers and services available to students.
Students face additional barriers in accessing mental health services such as
stigmatization, transportation concerns, lack of awareness of services, scheduling issues,
and financial complications. In the presence of these challenges, protective factors, such
as resilience, strong social supports, and access to mental health services can play a
crucial role in helping students recover from the pandemic's effects.
Research also found that schools can play a critical role in removing some of
these barriers by not only providing universal support to students, but by serving as an
access point for more intensive programming for students who are exceptionally at-risk.
There is evidence to suggest that more schools are offering some level of assessment or
even intervention to students to support their mental well-being.
As the needs of student populations are evolving and more schools implement
such programming, this has left many stakeholder groups such as school leaders, parents,
and students questioning the extent of the schools’ role in supporting adolescent mental
health. School leaders have cited insufficient access to trained professionals, funding,
outdated policies, parental reactions, community support and stigmatization as frequent
concerns.
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Currently, there is a limited body of literature regarding parent and student
perceptions of social-emotional learning and mental health program initiatives in schools
post-Covid. There are some reports that suggest that some parents may have
misconceptions about social/emotional learning or mental health services in schools,
associating these programs with other controversial topics. Parents may worry that
social/emotional learning programs are designed to indoctrinate students with specific
beliefs or values.
However, research clearly indicates better outcomes for students when parents
and schools work collaboratively to meet student needs. To achieve a healthy
working-relationship schools should provide clear and accurate information programming
to parents, involve them in decision-making processes, provide regular communication
about district initiatives and opportunities for parents to elicit feedback. Being mindful of
cultural differences can ensure that programs are culturally sensitive and inclusive.
Although experts have recognized the potential of the school system to act as an
access point for students to access needed mental health services, there is limited data
available regarding student and parent perspectives of program accessibility and efficacy.
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CHAPTER III
Methodology
From the review of literature, it is evident that various researchers have identified
well-established correlations between certain internal and external (or environmental)
factors and their potential relationship regarding positive or negative student outcomes.
These are frequently referred to as risk and protective factors (Fraser, 1997).
Understanding the interplay between risk and protective factors and their associated
processes may help communities and school leaders build a network of protective factors
to achieve better outcomes for students. In Pennsylvania, tools such as the PAYS and
accompanying resources provide a framework for assessing and understanding risk and
protective factors, within the context of a given school or community and equip schools
to more comprehensively understand the challenges faced by youth in their communities
within the state of Pennsylvania (PennState College of Health and Human Development,
2020).
These tools are particularly useful in addressing challenges following the
COVID-19 pandemic. Many students have continued to face challenges related to
academic loss, mental health issues, and economic hardship (Shah et al., 2020). Increased
instances of mental health concerns have emerged since the pandemic. This has been
coupled with a critical shortage of mental health providers and services available to
students (Whitley & Peterson, 2019). Students may face additional barriers in accessing
mental health services such as stigmatization, transportation concerns, lack of awareness
of services, scheduling issues, and financial complications (NCES, 2022).
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As indicated, protective factors (such as resilience, strong social supports, and
access to mental health services) play a crucial role in helping students recover from the
pandemic's effects. Research has determined that schools can play a critical role in
removing some of these barriers through not only providing universal support to students,
but by serving as an access point for more intensive programming for students who are
exceptionally at-risk (CDC, 2024). Furthermore, there is evidence to suggest that more
schools are offering some level of assessment or even intervention to students to support
their mental well-being.
As the needs of student populations evolve and more schools implement such
programming, many stakeholder groups such as school leaders, parents, and students
have begun to question the school’s role in supporting adolescent mental health. School
leaders have cited limited access to trained professionals, funding, outdated policies,
parental reactions, community support and stigmatization as frequent concerns. These
research findings reported within currently available literature are consistent with
contextual factors also observed and noted within the Tussey Mountain School District in
rural Pennsylvania.
Study Purpose
Currently, there is a limited body of literature regarding parent and student
perceptions of social-emotional learning and mental health program initiatives in schools
post-Covid. Some reports suggest that some parents may have misconceptions about
social/emotional learning or mental health services in schools, associating these programs
with other controversial topics. Parents may worry that SEL programs are designed to
indoctrinate students with specific beliefs or values (Abrams, 2023).
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This research project sought to investigate stakeholder perceptions regarding
perceived efficacy and accessibility of district-initiated programming and community
partnerships, to address limited access to mental healthcare and social services within the
Tussey Mountain School District. Furthermore, this action-research project sought to
identify barriers to service delivery among various stakeholder groups (parents and
students) in order to implement solutions, ultimately helping them achieve better
outcomes. This research also sought to investigate parent perceptions regarding the role
of the school district in assisting students with accessing these services. The Institutional
Review Board at PennWest University approved this study in October 2024 (Appendix
A).
The following research questions were developed for this capstone project to
serve as a lens through which data would be critically examined, provide a focus for
interpretation of this data, and serve as a metric for which results would be measured:
Research Question 1: What was the impact on self-reported risk factors and
protective factors before and after the implementation of mental and social service
programming initiatives?
Research Question #2: What strategies, as reported by students, were effective for
helping students access mental and behavioral health services through their school and
what barriers existed?
Research Question #3: What was the impact on parent perceptions regarding the
availability of mental health and social service programming?
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Answering these research questions provided a benchmark within this study to
evaluate the success of the research, as well as district-initiated mental and
behavioral-health programming to draw meaningful conclusions. Findings of this
research can help equip school leaders to improve programming initiatives as well as
better define the school’s role in helping students overcome risk factors for better overall
well-being, as they seek to meet a seemingly changing set of needs regarding adolescent
mental health.
Research Setting & Context
A review of enrollment data indicates that in recent years, the Tussey Mountain
School District typically serves just over 900 students in grades K-12, with 18-20%
receiving special education services (Pennsylvania Department of Education, Bureau of
Special Education, 2024). Over sixty percent of students are identified as economically
disadvantaged (Pennsylvania Department of Education, 2024b). Demographic data from
the Pennsylvania Department of Education also identifies that there is little diversity in
terms of race or ethnicity, with over 97% of students being identified as white.
The Tussey Mountain School District currently employs several mental health
professionals of various credential levels. Included on the district’s mental health team
are: three school counselors serving at each building level (elementary, middle and high),
one school psychologist (who serves all students K-12, hired in 2020) and one school
social worker (who also serves all students K-12; hired in 2021).
In 2024, the National Association of School Psychologists recommended a
student-to-school psychologist ratio of 500:1, indicating that the current school
psychologist at the Tussey Mountain School District is serving a caseload that is
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significantly higher than the national recommendation (National Association of School
Psychologists, 2024). Additionally, the School Social Work Association of America
recommended a student-to-social worker ratio of no more than 250:1. However, the
Association also identified that this ratio should be lower for populations with higher
needs (School Social Work Association of America, n.d.). Given the rate of economic
disadvantage and self-reported risk factors by students on the PAYS, the student
population should be considered “high need”, also indicating a much higher
student-to-clinician ratio than recommended.
Student Risk & Protective Factors within the Tussey Mountain School District
Within the Tussey Mountain School District various stakeholder groups have
noted concerns and challenges which mirror those noted in the peer-reviewed literature.
Following the COVID-19 Pandemic, data sources have indicated an increase in the
prevalence of various risk factors impacting students in the district. Table 1 summarizes
data related to self- reports of depression, suicidal ideation, and other risk factors such as
self-harm during the 2021 Pennsylvania Youth Survey among middle and high school
students in the Tussey Mountain School District (Pennsylvania Commission on Crime
and Delinquency et al., n.d.):
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Table 1
Depressive & Suicidal Ideation Reports in the Tussey Mountain School District, 2021
2021 Pennsylvania Youth Survey
Survey Item:
Felt depressed or sad most days in the past 12
GR 6
GR 8
GR 10
GR 12
50%
42.2% 59.6%
47.8%
11.8%
3.3%
32.4%
16.7%
Agree with the statement “Sometimes I think that 19.4%
25%
39.6%
35.6%
23.5%
13.3% 35.8%
35.6%
57.1%
24.4% 50%
37.8%
GR 8
GR 10
GR 12
Students who “seriously considered suicide”
10%
33.3%
46.2%
Students who planned suicide
6.7%
27.5%
33.3%
months
Engaged in self-harm in the past 12 months
life is not worth it”
Agree with the statement “All in all, I am
inclined to think I am a failure”
Agree with the statement “At times I think I am
no good at all”
Student Reports - Suicide
Survey Item:
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Students who attempted suicide
6.7%
56
33.3%
25%
Note. This table summarizes data collected by the Pennsylvania Commission on Crime
and Delinquency et al. (n.d.).
The 2023 administration of the PAYS indicated improvement in some of these
areas but also indicated that many students continue to struggle with depressive
symptoms, among other concerns. This data is summarized in Table 2:
Table 2
Depressive & Suicidal Ideation Reports in the Tussey Mountain School District, 2023
2023 Pennsylvania Youth Survey
Survey Item:
GR 6
GR 8
GR
GR 12
10
Felt depressed or sad most days in the past 12
46.2%
41.2% 38.6% 47.2%
Engaged in self-harm in the past 12 months
4.0%
24.5% 15.5% 18.5%
Agree with the statement “Sometimes I think
18.4%
32.0% 26.8% 22.6%
23.5%
13.3% 35.8% 35.6%
months
that life is not worth it”
Agree with the statement “All in all, I am
inclined to think I am a failure”
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Agree with the statement “At times I think I am
35.4%
35%
57
34.9% 37%
no good at all”
Student Reports - Suicide
Survey Item:
GR 8
GR
GR 12
10
Students who “seriously considered suicide”
15.7% 22.8% 23.1%
Students who planned suicide
12.2% 12.3% 17.3%
Students who attempted suicide
8.2%
7.0%
7.7%
Note. This table summarizes PAYS risk factor data reported by PCCD et al., n.d.
In addition to these reported values, during the most recent administration of the
PAYS, students in the Tussey Mountain School District reported engaging in the following
risky behaviors at rates which exceeded the state average in the following areas (PCCD et
al. ,n.d.):
● Vaping/use of e-cigarettes
● Lifetime AND 30-day use of marijuana
● Lifetime use of over-the-counter drugs to get high
● Required medical care after a suicide attempt
● Made a suicide plan in the past year
● Felt sad or hopeless almost every day to the point that they stopped doing regular
activities
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58
● Gambling (lifetime, past 30 days, and lying about gambling habits)
● Bullying
Tussey Mountain Middle and High School Students were also at higher risk for
negative outcomes based on their reports of social acceptance and interaction with their
peers and their community (PCCD et al., n.d.). Tussey Mountain students reported higher
levels of acceptance by their peers of risky behaviors than other students in the
Commonwealth. Students also reported higher levels of acceptance among adults in the
community of illegal behaviors. Furthermore, students also reported that they were more
likely (or willing) to experiment with drugs and other substances than other students in
Pennsylvania if presented by someone else. Students also reported that community
members were willing to provide alcohol at rates which were noted to be far higher than
the state average. Tussey Mountain students were also far more likely to take alcohol
from adults without permission (PCCD et al., n.d.).
When the PAYS results are considered holistically, low school commitment
(58.7%), parental attitudes favorable towards antisocial behavior (51.2%), and perceived
low risk in drug use (46.4%) emerge as some of the most significant risk factors
impacting the student population within the Tussey Mountain School District. Figure 3
illustrates the prevalence of various risk factors within the Tussey Mountain School
District and is organized by community, family, school, and individual/peer domains:
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Figure 3
Tussey Mountain School District, Risk Factors, 2023 Pennsylvania Youth Survey
Note. Figure 3 summarizes student self-reported risk factor data from PCCD et al. (n.d.).
There is limited data available regarding parent perspectives on programming
needs, perceived effectiveness, or the school’s role in implementing services to support
adolescent mental health. However, student-reported data on the PAYS provides some
information regarding student attitudes toward protective factors in their school and
community for students in the Tussey Mountain School District.
Student reports on the PAYS provide insight into their perspectives regarding
protective factors in their school and community (Pennsylvania Commission on Crime
and Delinquency et al., n.d.). A significant portion of students report having strong family
attachments, opportunities for prosocial involvement within their families, and a belief in
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a moral order. However, lower levels of religiosity, community rewards for prosocial
behavior, and school opportunities for prosocial involvement are areas of concern (PCCD
et al., n.d.). This is illustrated in Figure 4. This figure reflects the percentage of students
in grades 6, 8, 10 and 12 who reported having at least three protective factors in each of
the identified domains (community, family, school and individual/ peer).
Figure 4
Tussey Mountain School District, Protective Factors, 2023 Pennsylvania Youth Survey
Note. Data was collected and reported by PPCD et. al (n.d.) during the 2023 PAYS.
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During the 2023 administration of the PAYS, students in the Tussey Mountain
School District viewed one another as one of the most common means of support. This
data provided school stakeholders with an important consideration when selecting and
designing supports such Teen Mental Health First Aid (tMHFA), as students reported
they were more likely to reach out to a peer when they were sad or upset than any other
group of people. This is important contextual data to consider with regard to the current
study when investigating the student perception of program efficacy. Figure 5 further
illustrates this by comparing student reports of sources of support:
Figure 5
Sources of Support for Tussey Mountain Students
Note. Figure 5 from PCCD et al. (n.d.) illustrates where students in the Tussey Mountain
School District are turning for support.
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Selection of Research Participants
High school students represent a critical population for understanding the
effectiveness and perception of mental health services, within the Tussey Mountain
School District. Their direct experiences with, and perspectives on, available mental
health resources are invaluable when considering programming needs in a school.
Therefore, Tussey Mountain High School students represented a critical population for
inclusion in this capstone project. Additionally, due to the research gap regarding parent
perception of mental and behavioral health programming, parents and guardians of
middle and high school students were also selected to participate to achieve more
in-depth understanding.
Research Question One: Student Surveys
Research question one studied subjects enrolled in grades 9-12 at Tussey
Mountain High School. Student enrollment at Tussey Mountain High School (grades
9-12) was just over three hundred students during this capstone project. An informed
consent letter (Appendix B) describing the research study was sent home with all students
in grades 9-12. Interested students/families returned the letter to a secure drop box
located in the district office to indicate their interest. Once the consent form was returned,
students were read the assent to research statement (Appendix C) and then completed the
pre and post surveys.
Research Question Two: Student Interviews
At the high school, there is a voluntary club called Student Empowerment of
Mental Health Awareness (SEMHA). The inception of this club was student-driven, and
its members have an interest in learning about and promoting mental health awareness at
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Tussey Mountain High School. There are currently twenty-two student members in this
organization.
Student members of SEMHA were recruited for this part of the study, as this
group possessed a distinct understanding of their school environment, peer relationships,
and the challenges they faced. Student participants were recruited with parent consent
from fall 2024 through spring 2025, using announcements at SEMHA meetings. The
informed consent document (Appendix D) was provided for students to take home to their
parents to review and sign. Interested students/families returned the informed consent to a
secure drop box in the district office. Once the consent form was returned, students were
read the assent to research statement (Appendix E) prior to completing the interview.
During the interviews, the researcher used an interview script (Appendix F).
Insights from research participants in this group provided crucial information about the
acceptability, accessibility, and effectiveness of mental health services from a student's
viewpoint.
Research Question Three: Parent Surveys
The survey and all informed consent information (Appendix G) and survey
questions (Appendix H) were available electronically. Participants were recruited via
district social media. To be eligible to participate in this part of the study, the participants
had to have had a child enrolled in the middle/high school and be at least 18 years of age.
Research Methods & Data Collection
When designing this research study, the researcher relied heavily on data from
The Pennsylvania Youth Survey (PAYS) due to its comprehensive collection of risk and
protective factor data. The two most recent administrations (in 2021 and 2023) of the
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PAYS provided a robust understanding of the contextual factors surrounding the research
questions within the Tussey Mountain School District. Historic PAYS data also
established a baseline for comparison when assessing the efficacy of district-initiated
programming on risk and protective factors. Like its predecessors, the next administration
of the PAYS in fall 2025 will undoubtedly help paint an inclusive picture of how risk and
protective factors are changing over time in the Tussey Mountain School District.
Due to the timing of the current study and the bi-annual administration of the
Pennsylvania Youth Survey, use of this data to study the research questions was not
feasible. Therefore, to study the impact of district-initiated programming on student risk
and protective factors, to learn more about barriers to student support and explore parent
perceptions, the researcher utilized a mixed-methods to answer the three research
questions. This mixed methods study used student survey data, student interview
responses, parent survey data, student discipline data Chill Room usage to answer the
three research questions.
Research Question One: Data Sources & Collection Methods
This research question focused on the impact on self-reported risk factors and
protective factors before and after the implementation of mental and social service
programming initiatives. To explore this research question, quantitative data was
collected using the PhenX: School & Protective Factors ToolKit and School Social
Environment ToolKit, which were administered to students at the beginning and end of
the study. Pre-surveys were administered in February-March 2025, with post-surveys
occurring in May 2025.
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Disciplinary data from the previous and current school year was also used to
assess the impact of district programming on student risk factors. Chill Room usage data
was also analyzed to assess the efficacy of district programming.
Research Question Two: Data Sources & Collection Methods
The second research question explored what strategies, as reported by students,
were effective for helping students access mental and behavioral health services through
their school and what barriers existed. Both quantitative and qualitative data were
collected through student interviews. The interviews assessed student perceptions of
access to mental health services, effective strategies for accessing services, and barriers to
accessing services. The interview questions were designed by the researcher. Participants
were recruited in February-March 2025, and interviews were conducted in March-April
2025, with analysis following the interviews.
Research Question Three: Data Sources & Collection Methods
The third research question examined the impact on parent perceptions regarding
the availability of mental health and social service programming. Quantitative and
qualitative data were collected using a researcher-designed survey instrument. The survey
assessed parent/guardian perceptions of adolescent mental health, the school's role in
service delivery, efficacy of existing programming, barriers to accessing programming,
referral processes, and other related information. This survey instrument was designed by
the researcher. The survey was administered at the start and close of the study, and preand post-surveys were compared.
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Participants for the pre-survey were recruited with consent, and the survey was
administered in December 2024-January 2025. Recruitment for the post-survey, as well
as the administration occurred in May-June 2025.
Fiscal Implications
The implementation of this research study presents minimal direct costs to the
Tussey Mountain School District, a factor largely attributed to the strategic utilization of
existing resources and external funding. The core data collection tools (PhenX toolkits,
disciplinary records, Chill Room usage reports, student interviews, and parent survey) do
not result in any additional financial costs to the district. The PhenX toolkits were
available online at no cost and disciplinary records were already maintained by the
district within the student information system, a necessary budget expense. Student
interviews were conducted by the researcher, minimizing labor costs. The parent surveys
were distributed electronically, to eliminate printing and mailing expenses. The district's
existing infrastructure, including meeting spaces, was used for data collection.
The primary financial consideration involves the researcher's time, which can be
viewed as an indirect cost. Indirect costs, such as staff time allocated to the project, are
those that are necessary for the study. In this case, the researcher's time is factored into
the overall operational expenses of the district.
Validity
It is important for researchers to take measures to ensure high-quality data
collection for several reasons. First and foremost, taking quality data can help ensure that
the data which has been collected is valid. Validity is a critical component to any quality
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research. Ensuring that the data is accurate, unbiased, reliable, and well-aligned to answer
the research question can increase validity of any given study. Furthermore, taking
measures to ensure high quality data will provide credibility to the research. When data is
collected with fidelity and the study is well-designed, other professionals in the field can
take confidence in the results.
In qualitative research, Mertler (2022) states that generally, the inductive analysis
process is used. Inductive analysis usually follows three steps: organization, description,
and interpretation. This framework was used for analyzing qualitative data collected in
the present study.
Mertler (2022) notes that qualitative research can provide more descriptive
information than quantitative studies. By providing narrative accounts of observation,
researchers are able to identify characteristics important to the research that are not easily
expressed by data sets or numbers. Additionally, qualitative research lends itself to
answering “how” and “why” questions by studying the process itself. While correlation
may be easily identified by qualitative studies, quantitative studies may provide some
insight into causation, etc. For these reasons, qualitative data sources were selected for
collection and review when seeking to learn more about student and parent perceptions
regarding the school’s role in supporting adolescent mental health, as well as the
successes and barriers of programming specific to the Tussey Mountain School District.
Chapter Summary
In the aftermath of the COVID-19 pandemic, schools nationwide have faced a
concerning surge in student mental health challenges, with a significant portion of the
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student population experiencing mental health challenges. Recognizing their pivotal role
in addressing these needs, schools are striving to provide accessible mental health
services. However, obstacles such as limited resources, insufficient staff training, and
parental concerns often hinder the effective implementation of such programs. This study
focused on the Tussey Mountain School District, a rural district located in southwestern
Pennsylvania, where the challenges cited elsewhere in the literature are particularly
evident.
The district is faced with alarmingly high rates of student depression, suicidal
ideation, and substance abuse, as evidenced by concerning data from the Pennsylvania
Youth Survey. Recent tragic student suicides have underscored the urgent need for
effective mental health interventions. In response to this crisis, the district is
implementing several new initiatives, including the Chill Project, a partnership with
Allegheny Health Network designed to provide students and staff with access to mental
health professionals and calming spaces; teen Mental Health First Aid (tMHFA), an
evidence-based program aimed at equipping students and staff to identify and respond to
mental health and substance abuse challenges; and Students Empowering Mental Health
Awareness (SEMHA), a student-led initiative focused on raising mental health awareness
and providing peer support.
The core purpose of this study was to evaluate the effectiveness, accessibility, and
perceived impact of newly implemented mental health and social service programs within
the Tussey Mountain School District. Specifically, the research aimed to understand how
these programs impacted student risk and protective factors, identify strategies for
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overcoming barriers to service access, and assess parental perceptions of program
availability and efficacy.
Student and parent research participants were crucial stakeholders, and their
selection as research participants was paramount to the present study. The students, as the
primary recipients of the mental and social service programs, held unique insights into
the effectiveness and accessibility of these initiatives. Gathering their perspectives
through surveys and interviews allowed the research to capture firsthand experiences,
perceived barriers, and suggestions for improvement. Similarly, parents played a pivotal
role in their children's well-being and school involvement. Their perceptions of the
existing programming, referral processes, and overall state of adolescent mental health
provided essential context. By including both students and parents, the research aimed to
obtain a holistic understanding of the program's impact, address potential discrepancies in
viewpoints, and ultimately, tailor the initiatives to better meet the needs of the entire
school community. Their inclusion ensured that the study reflected the realities of those
most affected by the programs, making the findings more relevant and actionable for the
school district.
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CHAPTER IV
Data Analysis & Results
To gain an in-depth and comprehensive understanding of each research question,
a mixed-methods approach was used, combining quantitative and qualitative data
collection and analysis to ensure a comprehensive understanding of the contextual issues
surrounding the research. By using multiple data sources (student surveys, parent
surveys, interviews, discipline data, and Chill Room usage records), the study benefited
from data triangulation. This strengthened internal validity by providing multiple
perspectives on the research questions and reduced the risk of bias from any single data
source. To enhance the validity and credibility of this study, data triangulation was used.
Triangulation allowed for a more nuanced and detailed understanding of the research
questions. This is a technique that involves using multiple data sources, methods, or
perspectives to examine a research question (Mertler, 2022).
Use of Data Triangulation
Within the present study, data triangulation was used across all three research
questions. For research question one, data triangulation was achieved by combining
student survey data (PhenX toolkits) with disciplinary data and Chill Room usage data.
This allowed for a multi-faceted view of changes in risk and protective factors.
Methodological triangulation was also achieved by using both pre and post surveys
(within the same group of research participants), along with disciplinary data, and Chill
Room usage reports.
Data triangulation was achieved in research question two, by combining
quantitative data (frequency tables from survey elements within the interviews) with
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qualitative data (thematic coding of interview responses). This allowed for a deeper
understanding of student experiences regarding access and barriers.
For research questions three, a methodological triangulation was achieved through
the use of pre and post surveys. This allowed the researcher to measure changes in parent
perception over time. Within the present study, use of data triangulation helped the
researcher capture subtle details and complexities, providing a nuanced and detailed
picture of each research question in this study. The subsequent subsections of this
chapter describe the data analysis methods, as well as the specific results in more depth.
In addition to triangulating data within each research question, the results were
compared to one another using coding practices as well as comparing quantitative and
qualitative data between stakeholder groups. Triangulating the data across research
questions helped achieve a stronger and more reliable evidence base by cross-referencing
information from various sources and perspectives. This helped ensure a well-rounded
and comprehensive understanding of various stakeholder perspectives and how they may
interact.
Research Question One: Data Analysis & Results
Research question one aimed to determine the impact on self-reported risk factors
and protective factors before and after the implementation of mental and social service
programming initiatives. To analyze this, quantitative data was collected using the PhenX
School & Protective Factors ToolKit and the School Social Environment ToolKit, which
were administered to students at the beginning and end of the study. The School
Protective Factors ToolKit provided a detailed analysis protocol for assessing school
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environment, risk and protective factors according to the domains of School
Opportunities for ProSocial Involvement, School Rewards for ProSocial Involvement,
Academic Performance, Commitment to School, School Alcohol Environment, School
Tobacco Environment, School Marijuana Environment, General Protective School
Environment (a general summary scale), and General School Drug Environment (a
general summary scale). The researcher then used an average of domain scores to report
results.
In addition to the established test protocols, the student responses from these
surveys were analyzed using descriptive statistics to summarize the data and provide an
overview of the findings, including calculating the prevalence of students reporting
various risk and protective factors. Frequency tables (reported as percentages) were
created to analyze how often different categories of responses occurred. Trend analysis
was then employed to examine if and how the data changed throughout the project's
duration.
Disciplinary data from the previous school year (as a control year) was also
reviewed and compared to the current year to determine the impact on risk and protective
factors. Additionally, Chill Room usage data was reviewed to learn more about the
potential impact of this intervention.
Results: PhenX School & Protective Factors ToolKit
Eight students completed pre and post surveys, using the PhenX School &
Protective Factors ToolKit. Individual student results were tabulated for each sub domain,
as well as the General School Protective Environment. Results in each of the subdomains
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were then averaged to obtain aggregate scores in each domain, for the research
participants as whole.
Table 3 summarizes an aggregate view of these results:
Table 3
PhenX Protective Factors Pre and Post Survey Results
Domain:
Pre:
Post:
School Opportunities for ProSocial Involvement
2.91
2.86
School Rewards for ProSocial Involvement
2.64
2.86
Academic Performance
3.08
2.56
General School Protective Environment
2.79
2.97
Note. Results reported represent an average of participant responses for questions in the
respective subdomains. In each sub domain a range of scores from 1-4 could be reported,
with scores closer to 4 indicating a more protective environment for students.
Before the intervention or period of observation (“pre" results), the students'
perceptions of School Opportunities for ProSocial Involvement averaged 2.91, suggesting
a moderate but improvable sense of available pro-social avenues. Their feeling of School
Rewards for ProSocial Involvement was slightly lower at 2.64, indicating room for
growth in how positive behaviors are acknowledged. Academic Performance registered
an average of 3.08, suggesting a relatively positive perception in this area. Overall, the
General School Protective Environment stood at an average of 2.79.
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After the administration of the post survey, some notable shifts occurred. School
Opportunities for ProSocial Involvement saw a slight decrease to 2.86, suggesting a
minor dip in perceived opportunities. However, the students' perception of School
Rewards for ProSocial Involvement improved to 2.86, indicating a positive change in
how they felt their pro-social actions were recognized. In the subdomain of Academic
Performance, a more significant positive shift was noted, improving to 2.56. This
suggests a more protective academic environment was perceived. Most encouragingly,
the General School Protective Environment showed a positive upward trend, increasing
to 2.97.
In summary, while there was a minor decrease in perceived opportunities for
pro-social involvement, the research suggests an overall positive movement towards a
more protective school environment for these eight students, particularly in how they felt
rewarded for pro-social behavior and in the general sense of a protective atmosphere.
This indicates that efforts to enhance the school environment may be having a beneficial
impact on students' perceptions of safety and support.
The PhenX School and Protective Factors Toolkit also provided a framework for
assessing the impact of district initiated programming on risk factors such as alcohol,
tobacco and drug use in the student population. Research participants answered questions
related to their perceptions of student acceptance and prevalence of alcohol, tobacco and
drug use within their school. Once again, individual student results were tabulated for
each sub domain (School Alcohol Environment, School Tobacco Environment, and School
Marijuana Environment) and the General School Drug Environment. Results in each of
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the subdomains were then averaged to obtain aggregate scores in each domain, for the
research participants as whole.
Table 4 summarizes an aggregate view of these results:
Table 4
PhenX School Drug Environment Pre and Post Survey Results
Domain:
Pre:
Post:
School Alcohol Environment
2.81
2.38
School Tobacco Environment
2.15
2.23
School Marijuana Environment
General School Drug Environment
3.04
2.97
2.52
2.79
Note. For this portion of the survey instrument, a range of scores from 1-5 could be
reported, with scores closer to 5 indicating more prevalent use or risky behaviors
associated with alcohol, tobacco and drug use reported.
These results suggest a generally positive shift in students' perceptions of the
school's drug environment following the intervention or observation period. While there
was a minor uptick in perceived tobacco risk, significant improvements were seen in the
perceived alcohol and, particularly, marijuana environments. The overall decrease in the
General School Drug Environment score indicates that students perceive a less prevalent
or risky drug environment within their school, suggesting that efforts aimed at addressing
drug use and associated behaviors may be yielding positive results.
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Specifically, prior to the intervention or observation period ("pre" results), the
students' average score for the School Alcohol Environment was 2.81. This suggests a
moderate perception of alcohol prevalence or associated risk behaviors within the school
setting. The School Tobacco Environment registered a lower average of 2.15, indicating a
comparatively less perceived presence of tobacco use or risk behaviors. The School
Marijuana Environment had the highest pre-score at 3.04, suggesting a relatively higher
perceived prevalence of marijuana use or associated risks among the students. Overall,
the General School Drug Environment stood at an average of 2.97.
Following the observation period or intervention ("post" results), significant and
largely positive shifts were observed. The School Alcohol Environment score decreased to
2.38, indicating a perceived reduction in alcohol prevalence or risk behaviors. The School
Tobacco Environment saw a slight increase to 2.23, suggesting a marginal rise in
perceived tobacco use or risk behaviors, though still remaining relatively low. Most
notably, the School Marijuana Environment experienced a substantial decrease to 2.52,
suggesting a significant improvement in students' perceptions of marijuana prevalence or
associated risks. Consequently, the General School Drug Environment also showed a
positive trend, decreasing to 2.79.
Results: PhenX School Social Factors ToolKit
The PhenX School Social Factors ToolKit was also used as a pre and post survey
instrument to assess the impact on student perception of protective factors. Eight students
participated in these surveys. The survey instrument contained 39 questions to assess
students’ feelings related to their sense of connectedness and pride of their school and
school community. Students were able to select from five multiple choices (“Strongly
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Disagree,” “Disagree,” “Neither Agree nor Disagree,” “Agree,” or “Strongly Agree”).
The survey asked questions within the following subsections:
● Teacher Relationships
● School Connectedness
● Academic Support
● Order and Discipline
● School Physical Environment
● School Social Environment
● Academic Satisfaction
● Perceived Exclusion and Privilege
Within the subdomains of Teacher Relationships, School Connectedness,
Academic Support, Order and Discipline, School Physical Environment, School Social
Environment, and Academic Satisfaction student responses indicating “agreement” or
“strong agreement” with the survey item indicated student agreement or strong agreement
with feelings of connectedness or pride to the school or school community.
Table 5 utilizes a stacked bar graph to illustrate the change in student perceptions
related to school social factors, over time, during the course of this research:
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Table 5
PhenX School Social Factors Pre and Post Results
Note. This table illustrates the number of times participants selected each response during
each administration of the Phen School Social Factors Survey for the indicated
sub-sections. Figures reported are reflected as percentages.
As illustrated by Table 5, at the start of this research project, students' responses
indicated a varied perception of protective factors within their school environment. A
significant portion of responses fell into the "Agree" category at 40.50%, suggesting a
baseline level of positive feelings. However, a combined 23.97% (7.44% Strongly
Disagree + 16.53% Disagree) expressed negative sentiments, while a substantial 28.93%
remained neutral ("Neither Agree nor Disagree").
At the end of this project, there was a noticeable shift towards more positive
perceptions among the students. The percentage of responses indicating "Agree"
increased substantially to 50.64%, and "Strongly Agree" also saw a rise to 8.58%. This
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means that the combined positive sentiment (Agree + Strongly Agree) increased from
47.11% pre-survey to 59.22% post-survey. Conversely, negative sentiments decreased,
with "Strongly Disagree" falling to 3.43% and "Disagree" to 11.16%. The neutral
"Neither Agree nor Disagree" responses also saw a slight decrease to 26.18%.
When the survey data is considered according to sub sections, there is a clear
trend towards improved student perceptions of protective factors, particularly in Teacher
Relationships, School Connectedness, Academic Support, Order and Discipline, and
School Social Environment subsections of the survey. These areas show a decrease in
negative sentiments and a noticeable increase in agreement or strong agreement. The
most significant positive shifts were observed in Teacher Relationships and the School
Social Environment, where previously high levels of dissatisfaction or neutrality
transitioned into predominantly positive views.
However, the School Physical Environment remained relatively stable with no
significant increase in positive perception. More notably, Academic Satisfaction indicated
that students held decreased positive feelings about their academic experiences as the
project progressed.
Table 6 disaggregates these results according to survey sections:
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Table 6
Phen X School Social Factors Sub Domains
This data indicates that, initially, perceptions of teacher relationships were mixed.
While a significant portion of students (44.1%) agreed, indicating positive sentiments, a
considerable number also disagreed (33.9%) or remained neutral (33.9%). Notably, no
students strongly agreed, and a small percentage (3.4%) strongly disagreed. At the end of
the survey, there was a marked improvement in student perceptions of teacher
relationships. The percentage of students who agreed or strongly agreed significantly
increased to a combined 75.0% (64.3% Agree, 10.7% Strongly Agree). Disagreement
plummeted to a mere 5.4%, and strong disagreement was no longer reported (0.0%). The
neutral category also saw a substantial reduction to 19.6%. This suggests a strong
positive shift towards more supportive and positive teacher-student interactions.
Students' sense of school connectedness at the start of the study showed room for
improvement, with only 23.7% (15.8% Agree, 7.9% Strongly Agree) expressing positive
feelings. A notable 39.5% remained neutral, and a combined 36.8% (10.5% Strongly
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Disagree, 26.3% Disagree) held negative views. At the conclusion of this project,
perceptions of school connectedness generally improved. The percentage of students
agreeing or strongly agreeing increased to 43.9% (36.6% Agree, 7.3% Strongly Agree).
While there was still a substantial neutral segment (29.3%), both strong disagreement
(7.3%) and disagreement (19.5%) saw decreases. This indicates a moderate but positive
trend towards a stronger sense of belonging among students.
Students largely perceived high levels of academic support at the beginning of the
project, with a combined 81.0% (52.4% Agree, 28.6% Strongly Agree) indicating
positive feelings. Only 14.3% disagreed with survey questions related to a positive
academic support environment, and none strongly disagreed. As this project progressed,
positive perceptions of academic support further solidified. The combined percentage of
students agreeing or strongly agreeing rose to 86.5% (62.2% Agree, 24.3% Strongly
Agree). Disagreement decreased to 5.4%, and the neutral category slightly increased to
8.1%. This suggests that students continued to feel well-supported academically, with an
even greater proportion expressing positive sentiments.
In terms of order and discipline, students had a generally positive view of order
and discipline, even at the start of this project, with 52.4% agreeing and no one strongly
agreeing. However, a significant 33.3% remained neutral, and 25.0% (8.3% Strongly
Disagree, 16.7% Disagree) expressed negative views. Despite this generally positive
view at the start of the study, perceptions of order and discipline, there was notable
improvement in student responses in these areas. The percentage of students agreeing or
strongly agreeing increased to 64.2% (62.2% Agree, 2.0% Strongly Agree). Strong
disagreement significantly dropped to 2.0%, and disagreement also decreased to 10.2%.
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The neutral category slightly increased to 38.8%. This indicates a more positive and
secure feeling regarding the school's structure and enforcement of rules.
Throughout the course of this project, students generally felt positive about the
school's physical environment, with 50.0% agreeing to positive statements about the
school’s physical environment. A substantial 35.7% reported neutral feelings, and 14.3%
(3.6% Strongly Disagree, 10.7% Disagree) held negative views. Perceptions of the school
physical environment remained largely stable with some minor shifts. The percentage of
students agreeing or strongly agreeing slightly decreased to 46.2% (46.2% Agree, 0.0%
Strongly Agree). There was a slight decrease in disagreement (7.7%) but a noticeable
increase in the neutral category (42.3%). Strong disagreement remained similar (3.8%).
This suggests that while dissatisfaction slightly decreased, there wasn't a significant
increase in strong positive feelings.
In terms of the school social environment, the pre-survey revealed a challenging
perception of the school social environment, with a high percentage of students strongly
disagreeing (30.8%) or disagreeing (7.7%), totaling 38.5% negative sentiment. A large
42.6% remained neutral, and only 15.4% agreed. This sub-section of the survey
ultimately indicated a significant positive turnaround. The combined percentage of
students agreeing or strongly agreeing surged to 46.7% (40.0% Agree, 6.7% Strongly
Agree). Strong disagreement dramatically decreased to 13.3%, and the overall negative
sentiment (Strongly Disagree + Disagree) was reduced to 40.0%. The neutral category
saw a sharp decline to 13.3%. This suggests substantial improvement in students'
perceptions of the social interactions and atmosphere within the school.
Academic satisfaction was relatively high at the beginning of this project, with a
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combined 64.2% (57.1% Agree, 7.1% Strongly Agree) of students expressing positive
feelings. However, a notable 21.4% strongly disagreed, and 7.1% disagreed. During the
course of this study, perceptions of academic satisfaction experienced a decline. The
combined percentage of students agreeing or strongly agreeing fell to 33.3% (33.3%
Agree, 0.0% Strongly Agree). Conversely, disagreement significantly increased to 22.2%,
and the neutral category rose to 33.3%. Strong disagreement also decreased to 11.1%.
This suggests a decrease in the overall satisfaction students felt with their academic
experiences, possibly indicating a shift in their perceptions of curriculum, workload, or
learning outcomes.
For the Perceived Exclusion/ Privilege of the PhenX School Social Factors
Toolkit, “strong disagreement” or “disagreement” indicated a belief among students that
they are being treated equally and fairly. For these reasons, this subsection of the toolkit
was analyzed separately. At the start of this research project a combined 28.57% of
students expressed a positive perception of fairness and equality, with 9.52% strongly
disagreeing and 19.05% disagreeing with statements of exclusion or privilege. A
substantial 47.62% of students held a neutral stance, indicating neither strong agreement
nor disagreement with feelings of exclusion or privilege. Meanwhile, a combined 23.81%
of students (19.05% Agree, 4.76% Strongly Agree) perceived some level of exclusion or
privilege. At the conclusion of this action research project, there was a noticeable positive
shift in students' perceptions of fairness. The percentage of students who disagreed or
strongly disagreed with statements of exclusion/privilege significantly increased to a
combined 47.62% (9.52% Strongly Disagree, 38.10% Disagree). This indicates a stronger
belief among students that they are being treated equally and fairly. The neutral category
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also saw a decrease to 33.33%. Additionally, the percentage of students who agreed or
strongly agreed with perceptions of exclusion/privilege slightly decreased to a combined
19.05% (14.29% Agree, 4.76% Strongly Agree).
Table 7 illustrates these results using a stacked bar-graph:
Table 7
Perceived Exclusion and Privilege
Note. The results for the "Perceived Exclusion/Privilege" sub-section demonstrate a
positive trend from the pre- to the post-survey. The increase in "disagree" and "strongly
disagree" responses suggests that students' perceptions of being treated equally and fairly
within the school environment have improved. While nearly half of the students still hold
a neutral or positive (perceiving exclusion) stance in the post-survey, there is a significant
shift away from neutrality and towards the positive perception of fairness.
Results: Discipline Data
During the study, the file "Action Code Usage Report" was used. This report from
the student information system provides a breakdown of disciplinary actions within the
Tussey Mountain School District during the 2023-2024 school year. The report focuses
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on high school students (grades 9-12) and categorizes disciplinary actions using specific
codes. Below a summary has been provided for each of the following discipline codes:
● Warnings: When student behavior was escalated to the office-level, there was
little change from the previous to current school year, in terms of warnings issued
by the principal (57 to 62). This represents a slight increase in less severe,
verbal/minor interventions.
● Referral to SAP, Counseling, Other Agency: There was a moderate decrease in the
number of principal-initiated referrals to outside programming outside of the
discipline process (from 11 to 6).
● Detention: Increased significantly (from 121 to 149). This is a substantial rise in a
mid-level disciplinary action.
● In-School Suspension (ISS): In school-suspensions increased from (7 to 16). This
is a notable increase in more severe disciplinary measures.
● Out-of-School Suspension (OSS): Out-of school suspensions) decreased
significantly (from 9 to 4). This is the only clear positive trend, indicating fewer
instances of the most severe disciplinary action.
Table 8 provides a visual representation of this data, frequency counts and a frame
of reference for comparing disciplinary data from the previous to current school year:
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Table 8
School Disciplinary Data
Results: Chill Room Usage Data
Chill Room usage data was also used to assess the impact of district initiated
programming on student risk and protective factors. Upon checking in and out of the
Chill Room, students are asked to rate their mood and ability to engage in school tasks in
a healthy way, using an emotional thermometer. This visual tool helps students visualize
their feelings, as well as their strength. Figure 6 provides an example of an emotional
thermometer, similar to the one used in the Chill Room:
Figure 6
Emotional Thermometer
Note. The emotional thermometer also provides a data point to determine the efficacy of
Chill Room interactions, according to student perception.
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Table 9 summarizes data collected related to Chill Room usage by students and its
impact:
Table 9
Chill Room Usage Data
December 2024
January 2025
February 2025
● Drop ins: 10
● Drop ins: 29
● Drop ins: 34
● Average Rating In:
● Average Rating In:
● Average Rating In:
3.5
3.3
● Average Rating
● Average Rating
Out: 2.2
March 2025
3
● Average Rating
Out: 1.6
April
Out: 1.2
May
● Drop ins: 35
● Drop ins: 38
● Drop ins: 11
● Average Rating In:
● Average Rating In:
● Average Rating In:
2.9
● Average Rating
Out: 1.6
3.5
● Average Rating
Out: 1.8
3.2
● Average Rating
Out: 1.8
When this data is reviewed to determine trends, it is notable that the number of
student "drop-ins" to the Chill Room showed a consistent and significant increase from
December 2024 (10 drop-ins) to April 2025 (38 drop-ins). This could suggest a growing
awareness and utilization of the Chill Room as a resource among students over these
months. May 2025 saw a sharp decrease to 11 drop-ins, likely correlating with the end of
the school year or reduced student presence.
Additionally, the "Average Rating In" generally hovered in the moderate to
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somewhat intense range (between 2.9 and 3.5). This rating showed a slight downward
trend (indicating calmer entry moods) from December (3.5) to March (2.9), suggesting
that students might have been seeking the Chill Room for slightly less intense emotional
states as the months progressed, or perhaps for proactive regulation. However, during the
month of April, an increase (back to 3.5), was noted, indicating students entering with
higher intensity, before dropping to 3.2 in May. Even with the fluctuation between
“Average Rating In,” the "Average Rating Out" was significantly lower than the "Average
Rating In", consistently for each month during this action research project. The " Average
Rating Out" consistently fell into the calm to mostly calm range (between 1.2 and 2.2).
The lowest "Rating Out" was observed in February (1.2), indicating students were
leaving the Chill Room feeling very calm and ready to learn after their visit. The average
reduction in intensity (difference between "Rating In" and "Rating Out") ranged from 1.3
points (December) to 1.9 points (February), consistently demonstrating a substantial
positive shift in student mood and readiness for school tasks.
Research Question Two: Data Analysis & Results
Research question two explored the strategies students reported as effective for
accessing mental and behavioral health services through their school as well as the
barriers to accessing services. For this research question, both quantitative and qualitative
data were collected. Participants were recruited through the student mental health team
for interviews. The interviews aimed to assess student perceptions of access to mental
health services, effective methods for accessing these services, and the barriers that
existed. Once consent and assent were obtained, student interviews were conducted.
Student responses were recorded in written format for further analysis.
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The analysis of student interview responses involved both qualitative and
quantitative methods. Frequency counts (reported as percentages) were used to quantify
how often different categories of responses occurred. For the qualitative portion, thematic
coding was employed to identify specific aspects of the discussion that were most
relevant to the research question. The researcher’s notes have been included as Appendix
H. By assigning and reassigning codes, the research aimed to help the Tussey Mountain
School District gain a greater understanding of the perceived efficacy of district-initiated
programming, identify barriers to accessing said programming, and determine effective
strategies to improve accessibility.
Through the coding process, eight central themes emerged in student responses.
These included:
● The prevalence of mental health challenges within the Tussey Mountain
School District
● Awareness and utilization of resources
● Perception of the sufficiency of resources
● Channels of information about services
● Effective strategies for accessing mental health services
● Barriers to accessing services
● Opportunities for improvement
Results: Quantitative and Qualitative Summary of Student Interviews
A total of eight students participated in interviews with the researcher. Upon
completion and analysis of student responses, it was notable that 100% of those
interviewed indicated that they have felt “stressed, anxious, or depressed while at
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school.” Of these students, 87.5% of respondents reported that they were aware of
resources to help them cope with these feelings while at school. Of the students who
reported being aware of district resources to help them 67% of respondents noted the
Chill Room being a helpful resources, 33% noted access to the school-based therapist
through Allegheny health network being helpful, and 33% of students noted the school
counseling/ guidance office being a place they would turn for help when needed.
Through the interviews, the researcher also sought to learn if students perceived
whether or not there were enough resources at school. When answering this question,
75% of students felt that there were adequate mental health resources at the school while
12.5% of respondents did not feel there were enough resources. One responder did not
provide a “yes” or “no” response to the question, but felt that things were “moving in the
right direction, but that more students needed to take it (the opportunities) up.”
Participants were also asked questions related to how they learned of district
resources. From these responses, 55.5% of student interview responses seeking
information about how students learned about services indicated that students most
frequently learn about services from talking with their teachers. Other means by which
students report being made aware of district services (though far less common) include:
● From conversations with the school/ guidance counseling office
● From SEMHA Team publications
● From school announcements
● Word of mouth (other classmates)
● Through school announcements
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These student interviews also sought to identify what strategies have been helpful
in assisting students with accessing mental health services. Seventy-five percent of
students who completed the interview reported that having an adult explain and walk
them through options was helpful to them. In subsequent interview questions, 33% of
participant responses indicated that Allegheny Health Network staff were particularly
helpful in walking them through this process. Interview participants equally identified
their teachers as helpful in this process (also 33% of responses). District
paraprofessionals were also identified as helpful to helping students access services
(22%), along with school counselors (11%).
Students in grades 10-12 also answered questions about how programming has
changed over time, since they started high school. During this interview question, many
students elaborated on the programs and strategies where they have observed positive
change during their high school careers. Eighty-eight percent of participants surveyed
indicated that they have observed much positive change since starting high school in
terms of the resources which are available to students. Participants most commonly cited
the Chill Room being on-sight as an effective strategy to help students access services.
Students reported that they liked the flexibility of this space and that it was effective in
helping them to find what worked for them. Less commonly, but still emerging as a
theme, participants also referenced SEMHA raising awareness to mental health concerns
and reducing stigma.
Students were also asked about the barriers to accessing services and support
within their school. When these student responses were analyzed 75% of students
reported that accessing services was “easy” and 25% of students reported that it was
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difficult. Students most frequently cited teachers not allowing them to access guidance/
school counselors or the Chill Room as one of the biggest barriers to accessing services.
Students also cited the Chill Room’s operating hours presented a barrier to accessibility.
(The Chill Room is currently only open to students Tuesday-Thursday). This lack of
availability creates a barrier to consistent service delivery.
Students were also asked a series of questions related to opportunities for
improvement. On these questions, students most frequently identified training for staff (to
help teachers better recognize the signs of a mental health problem) as one of the best
ways to improve district programming moving forward. Other suggestions included:
more advertisement of district programs and more consistency/ intentionality in the
schedule to help students access services.
Research Question Three: Data Analysis & Results
Research question three focused on the impact on parent perceptions regarding
the availability of mental health and social service programming, a survey instrument was
designed and used to gather data. This survey aimed to assess parent/guardian
perceptions of the overall state of adolescent mental health, the school’s role in service
delivery, the efficacy of existing programming, barriers to accessing programming,
referral processes, and other relevant information. The survey was administered at the
start and close of the study to determine if there was any change in parent perceptions of
programming before and after the implementation of new school initiatives. Descriptive
statistics were used to analyze participant responses and determine the community's
perception of the most prevalent barriers and most successful programming. Frequency
tables were created to show how often different categories of responses occurred within
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the community. Trend analysis was also employed to examine whether and how the data
changed during the six-month project period, comparing pre and post survey results.
Results: Parent Pre Surveys
During the pre-survey, parents within the Tussey Mountain Community
community overwhelmingly recognized the critical need for mental health and social
service. The first question in the survey asked parents to rate their agreement with the
statement, "mental health services are important for the overall well-being of students in
our school district.” Almost 90% of parents surveyed indicated some level of agreement
with this statement, with 77.8% selecting "Strongly Agree;” another 11.1% chose
"Agree;" and the remaining 11.1% responded "Neither agree nor disagree." This indicates
a very high consensus among parents regarding the critical importance of mental health
support for students in the district.
The second question on the parent survey asked parents to indicate their level of
agreement with the statement, "social service programs are essential in supporting
students facing challenges outside of school." A significant proportion of parents reported
that they, 66.7%, "Strongly Agree." Additionally, 11.1% selected "Agree," and 22.2%
chose "Neither agree nor disagree." This also demonstrates strong parental recognition of
the necessity of social service programs in addressing challenges students face outside the
school environment.
In response to the third question, "there is a growing need for mental health and
social service support in our rural community," parents again showed strong agreement,
with 77.8% selecting "Strongly Agreed." Another 11.1% chose "Agree," and 11.1% opted
for "Neither agree nor disagree." This consistent strong agreement across the first three
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questions underscores a widely perceived and increasing need for both mental health and
social service support within their rural community.
Despite these positive results, participating parents reported significant gaps in the
accessibility, awareness, and effectiveness of programming available during the
pre-survey, particularly those offered by or in collaboration with the school district. A
notable shift in sentiment occurred with the fourth question, "students in our school
district have easy access to mental health services when needed." A clear majority of
parents, 66.7%, "Disagreed" with this statement. Only 11.1% "Strongly Agreed," and
22.2% selected "Neither agree nor disagree." This indicated a strong perception among
parents that access to mental health services were not readily available for students in the
district, pointing to a significant accessibility barrier at the start of this project.
For the fifth question, "I am aware of the different types of social service and
mental health programs available to students and families in our community," responses
were quite varied. While 11.1% "Strongly Agreed" and 11.1% "Agreed," a combined
77.7% either chose "Neither agree nor disagree" (44.4%) or "Disagree" (33.3%). These
mixed responses indicated a discrepancy in awareness among parents regarding the
various support programs available in their community, at the start of this action research
project.
Regarding the sixth question, "the mental health services offered by the school
district are effective in addressing student needs," opinions leaned towards skepticism or
neutrality. 44.4% of parents "Disagree," and an equal 44.4% selected "Neither agree nor
disagree." Only 11.1% "Agreed," and no parents "Strongly Agreed." This indicates a
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prevailing sentiment that the school district's mental health services were either
ineffective or their efficacy was unclear to parents during the first administration of this
survey.
The seventh question, "The social service programs offered in collaboration with
the school district are helpful for students facing challenges," also presented mixed
responses. While 22.2% "Agreed," a combined 77.7% either chose "Neither agree nor
disagree" (33.3%), "Disagree" (33.3%), or "Strongly Disagree" (11.1%). Suggesting that
collaborative social service programs were not consistently perceived as beneficial or
helpful by parents during the pre-survey.
Concerning the eighth question, "School staff effectively communicate mental
health resources available to students to students and families, when needed," a
significant majority of parents expressed disagreement (55.6% "Disagree," and 11.1%
"Strongly Disagree," totaling 66.7%). Only 11.1% "Agreed," and 22.2% chose "Neither
agree nor disagree." This clearly indicates a perceived deficiency in how school staff
communicate mental health resources to families.
Finally, for the ninth question, "The school environment is supportive of students
seeking mental health help," a substantial proportion of parents expressed a lack of
support. 44.4% "Disagree," and 22.2% "Strongly Disagree," resulting in 66.6%
expressing negative perceptions. The remaining 33.3% chose "Neither agree nor
disagree," and no parents "Agreed" or "Strongly Agreed." This suggests that parents
generally do not perceive the school environment as conducive to students seeking
mental health assistance.
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Table 10 illustrates parental attitudes, toward mental health services, as well as
their perceived accessibility in a series of pie charts:
Table 10
Parent Pre-Survey Mental Health Service Perceived Importance & Accessibility
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To further explore parent concerns related to existing programming and barriers,
thematic coding was completed. The researcher’s coding notes have been included in
Appendix J, to summarize prevailing themes which emerged as a result of the coding
process.
Commonly, the biggest barriers to success from the perception of parents to
successful mental health programming were stigma and/ or confidentiality concerns, a
lack of awareness about available programs, and systemic issues within the school related
to communication, follow-through, and staff responsiveness. Parent responses also
indicated strong desire for more integrated, school-based mental health services,
improved staff training, and better communication to destigmatize and facilitate access to
care.
Concerns about school practices contributing to student stress also emerged as a
significant point. During the pre survey, parents expressed a clear desire for the school to
be more actively involved and to have more in-house resources rather than relying solely
on external referrals.
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In addition to the qualitative data obtained regarding parent reports of barriers, a
quantitative analysis was also completed for survey questions, 19-25 which asked
specific questions related to parent perception of commonly identified barriers within the
review of literature. Parents who completed this portion of the survey, reported seeking
mental health services for their child within the past calendar year from the date they
completed the pre-survey.
Regarding the cost of mental health programming or services, 20% of respondents
identified it as a "Major Barrier," while 40% found it "Somewhat of a Barrier," and
another 40% indicated it was "Not a Barrier." This suggested that while cost was a
significant impediment for a minority, it was a moderate concern for a larger group, and
not an issue for others.
Transportation to outside agency appointments was largely not a barrier, with
60% of participants reporting it as "Not a Barrier." However, 40% did experience it as
"Somewhat of a Barrier," indicating that while not a universal issue, it still posed
difficulties for a notable segment of families. Similarly, scheduling with outside agency
providers was also predominantly "Not a Barrier" for 60% of respondents, with 40%
finding it "Somewhat of a Barrier."
A more pronounced challenge emerged concerning awareness about available
mental health or social service programs in the community. Here, 20% of respondents
identified this as a "Major Barrier," and 60% as "Somewhat of a Barrier," with only 20%
reporting it as "Not a Barrier." This highlighted a significant need for improved
communication and outreach regarding existing resources within the community.
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Concerns about confidentiality or stigma proved to be a substantial deterrent.
While 40% of respondents indicated this was "Not a Barrier," 20% found it "Somewhat
of a Barrier," 20% a "Significant Barrier," and another 20% a "Major Barrier." This broad
distribution underscored the varying, but often impactful, role of stigma in preventing
families from seeking help.
Difficulties navigating the process of getting help, such as referrals and
paperwork, were also a notable obstacle. Forty percent of participants described this as a
"Significant Barrier," 20% as "Somewhat of a Barrier," and 40% as "Not a Barrier." This
suggested that administrative complexities created considerable hurdles for a notable
portion of families.
Finally, long wait times for appointments were identified as a critical barrier. A
significant 40% of respondents categorized this as a "Major Barrier," while 20% found it
"Somewhat of a Barrier," and 40% reported it as "Not a Barrier." This indicated that
delays in accessing timely appointments were a primary concern for a substantial number
of families seeking mental health support.
Table 11 illustrates these figures and parental attitudes surrounding each barrier:
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Table 11
Barriers Reported in Parent Pre Surveys
Results: Parent Post Surveys
A total of eleven parents participated in the post survey, which took place
approximately six months from the date of the pre-survey. It should be noted that due to
anonymity in the survey design, there is no way of knowing if this group of participants
participated in the pre-survey or not. The terms “pre” and “post” reflect a snap-shot in
time, at the beginning and end of this project, with near-identical questions being asked.
These terms are not necessarily indicative that a change in perspective occurred over time
within the same survey participant.
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During this administration of the survey, survey participants overwhelmingly
recognized the importance of mental health and social services for students, with 91% of
respondents either agreeing or strongly agreeing that mental health services were
important for overall well-being, and 91% similarly agreeing or strongly agreeing about
the essential nature of social service programs. A strong consensus once again emerged
regarding the increasing need for these services in the rural community, as 91% of
parents agreed or strongly agreed with this statement.
Once again, a notable divergence in opinion appeared when addressing the
accessibility of mental health services. Only 27% of participants agreed that students had
easy access to mental health services, while 45% disagreed or strongly disagreed, with
27% remaining neutral. Awareness of available programs was also a point of concern,
with 45% of parents disagreeing or strongly disagreeing that they were aware of different
program types, compared to 27% who agreed or strongly agreed and 27% who were
neutral.
Regarding the effectiveness of school district-offered services, only 27% believed
mental health services were effective, while 45% disagreed or strongly disagreed and
27% remained neutral. Social service programs offered in collaboration with the school
district fared slightly better, with 36% finding them helpful, 36% disagreeing, and 27%
remaining neutral.
Communication was once again reported as a concern by survey participants
during this administration of the survey. Seventy-three percent of respondents disagreed
or strongly disagreed that school staff effectively communicated these resources, with
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only 9% agreeing and 18% reporting neutral feelings about the issue. Opinions were also
mixed on the school environment's supportiveness of students seeking mental health help.
Only 27% of parents agreed that the environment was supportive, while 36% disagreed or
strongly disagreed, and 36% were neutral, indicating a lack of consistent positive
perception in this area. Table 12 appears on the next page and to illustrate the
proportionate responses to these survey questions.
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Table 12
Parent Post-Survey Mental Health Service Perceived Importance & Accessibility
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As with the first administration of this survey, parent concerns related to existing
programming and barriers were analyzed using thematic coding. The researcher’s coding
notes have been included in Appendix K to summarize prevailing themes which emerged
as a result of the coding process. Parents reported strong support with district initiatives
which support the growing need for mental health and social services for students.
However, from the parent’s perspective, the district faces significant challenges in terms
of accessibility, awareness, and perceived effectiveness. The most critical barriers
identified are stigma, coupled with perceived shortcomings in staff understanding,
communication, and accountability. Parents communicated a desire for improved
communication, comprehensive staff training with an emphasis on empathy and
accountability, and initiatives to increase awareness.
Once again, quantitative analysis was completed for survey questions, 19-25
which asked specific questions related to parent perception of commonly identified
barriers within the review of literature. This portion of the post survey was only
completed by parents who had sought mental health services for their student. Many of
these results are similar to those reported in the qualitative analysis.
In terms of financial accessibility, the cost of mental health programming or
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services was primarily perceived as either not a barrier or only somewhat of a barrier.
Specifically, 60% of parents indicated that cost was "Not a Barrier," while 40%
considered it "Somewhat of a Barrier."
Regarding logistical challenges, transportation to outside agency appointments
was largely not seen as a significant hurdle, with 80% of parents reporting it was "Not a
Barrier," and 20% perceiving it as "Somewhat of a Barrier." Similarly, scheduling
appointments with outside agency providers posed a barrier for a minority of parents,
with 60% stating it was "Not a Barrier" and 40% finding it "Somewhat of a Barrier."
However, awareness about available mental health or social service programs in
the community emerged as a more notable obstacle. While 60% of parents reported it was
"Not a Barrier," a substantial 20% identified it as a "Significant Barrier," and another
20% considered it "Somewhat of a Barrier."
Concerns about confidentiality or the stigma associated with seeking mental
health help represented the most pronounced barrier among these categories. For 60% of
parents, these concerns were "Not a Barrier." However, 20% indicated they were a
"Major Barrier," and another 20% viewed them as a "Significant Barrier."
Difficulties navigating the process of getting help, such as referrals and
paperwork, also presented a barrier for some parents. While 40% found this "Not a
Barrier," an equal 40% considered it a "Significant Barrier," and 20% identified it as
"Somewhat of a Barrier." Long wait times for appointments were also a notable concern,
with 20% of parents reporting them as a "Major Barrier," and 60% as "Somewhat of a
Barrier," while 20% found them "Not a Barrier."
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Table 13 illustrates these parent responses in proportionate pie charts:
Table 13
Barriers Reported in Parent Post Surveys
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Comparison: Pre and Post Surveys
As indicated, due to the anonymous nature of the surveys and their submissions,
there is no way of knowing if participants who completed the pre survey, at the beginning
of this action research project repeated the survey during the post administration. When
reviewing results, it is important to read the results as a snapshot of parental attitudes at
the time of the survey, rather than interpreting them as a change in perceptions over time
within the same research group. With this in mind, it is valuable to compare both the
qualitative and quantitative survey data during both administrations to gain a
comprehensive understanding of the parent perception district programming and
initiatives.
Parents in the Tussey Mountain community consistently recognized the vital
importance of mental health and social services for students, both at the start and end of
the project. In the initial pre-survey, an overwhelming 90% of parents agreed or strongly
agreed that mental health services were crucial for student well-being. This sentiment
remained strong in the post-survey, with 91% of respondents expressing similar
agreement.
Similarly, the essential nature of social service programs in supporting students
facing challenges outside of school was a point of widespread agreement. In the
pre-survey, 77.8% of parents agreed or strongly agreed that these programs were
essential. This consensus was maintained in the post-survey, with 91% of parents
agreeing or strongly agreeing. The perception of a growing need for both mental health
and social service support within the rural community was also a consistent theme, with
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77.8% of parents agreeing or strongly agreeing in the pre-survey, and 91% in the
post-survey.
Despite the strong recognition of need, both survey administrations highlighted
significant and persistent gaps in the accessibility, awareness, and effectiveness of
available programming, particularly those offered by or in collaboration with the school
district.
A notable area of continued concern was the accessibility of mental health
services. In the pre-survey, a clear majority of parents (66.7%) disagreed with the
statement that students had easy access to mental health services. This perception
remained largely unchanged in the post-survey, where only 27% of participants agreed
that students had easy access, while 45% disagreed or strongly disagreed.
Awareness of available programs also remained a significant issue. In the
pre-survey, a combined 77.7% of parents either chose "Neither agree nor disagree" or
"Disagree" when asked about their awareness of different program types. This lack of
awareness persisted in the post-survey, with 45% of parents disagreeing or strongly
disagreeing that they were aware of various program types.
Regarding the effectiveness of school-district offered mental health services,
opinions consistently leaned towards skepticism or neutrality across both surveys. In the
pre-survey, 88.8% of parents either disagreed or remained neutral about the effectiveness
of these services. The post-survey showed a similar trend, with 45% disagreeing or
strongly disagreeing, and 27% remaining neutral. Social service programs offered in
collaboration with the school district also presented mixed responses in both
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administrations, suggesting they were not consistently perceived as beneficial or helpful.
Finally, communication from school staff regarding available mental health
resources was a consistent area of concern. In the pre-survey, a significant majority of
parents (66.7%) expressed disagreement that school staff effectively communicated these
resources. This negative sentiment was even more pronounced in the post-survey, with
73% of respondents disagreeing or strongly disagree. The perception of the school
environment's supportiveness of students seeking mental health help also remained a
challenge. In the pre-survey, 66.6% of parents expressed negative perceptions in this area,
and in the post-survey, only 27% of parents agreed that the environment was supportive.
Chapter Summary
To thoroughly address each research question, a mixed-methods approach was
employed, integrating both quantitative and qualitative data collection and analysis. This
strategy ensured a comprehensive understanding of the contextual issues. The
action-research project leveraged data triangulation by utilizing multiple sources,
including student surveys, parent surveys, interviews, discipline data, and Chill Room
usage records. This approach enhanced the internal validity of the study by offering
diverse perspectives on the research questions and mitigating potential biases from any
single data source. The use of data triangulation allowed for a more nuanced and detailed
understanding of the research questions, a technique that involved examining research
questions through various data sources, methods, or perspectives.
Pre and post student survey data revealed a more protective school environment,
showing improvements in how pro-social behaviors were rewarded and in the general
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sense of safety and support. Perceptions of the school's drug environment also improved,
particularly regarding alcohol and marijuana. Furthermore, there was a noticeable
positive shift in students' perceptions of school social factors, especially concerning
teacher relationships, school connectedness, academic support, order and discipline, and
the school social environment. However, academic satisfaction showed a decline, while
the physical environment remained stable.
Discipline data revealed mixed trends, with slight increases in warnings,
detentions, and in-school suspensions, but a positive decrease in out-of-school
suspensions. Chill Room usage consistently increased, and data showed a significant
positive shift in student mood and readiness for school tasks after visits.
Student interviews revealed key strategies and challenges in accessing mental and
behavioral health services at Tussey Mountain Middle/High School. All interviewed
students reported experiencing stress, anxiety, or depression at school, with most (87.5%)
aware of available resources like the Chill Room (67%), the school-based therapist
(33%), and the counseling office (33%). Most students (75%) felt resources were
adequate, primarily learning about them from teachers (55.5%).
The most effective strategy reported was an adult explaining and guiding students
through options (75%), often by Allegheny Health Network staff and teachers. Students
noted significant positive changes since starting high school, especially praising the Chill
Room's onsite availability and flexibility.
However, barriers persisted, with 25% finding access difficult, largely due to
teachers not allowing access to resources and the Chill Room's limited operating hours.
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Students suggested staff training to better recognize mental health needs, increased
program advertisement, and greater scheduling consistency as crucial improvements.
Parents also completed surveys at two points during this action research project.
Parents overwhelmingly recognized the critical need for mental health and social services
for students, with over 90% consistently agreeing that these services were important for
well-being and that there was a growing community need. Despite this consensus,
significant and persistent gaps in accessibility, awareness, and effectiveness were
reported across both surveys. A majority of parents (66.7% pre, 45% post) disagreed that
students had easy access to mental health services. Awareness of available programs
remained a concern, with 77.7% of parents pre-survey and 45% post-survey indicating
mixed awareness or disagreement about program knowledge. The effectiveness of
school-district mental health services was consistently met with skepticism or neutrality
(88.8% pre, 72% post).
Communication from school staff about resources and the school environment
was also reported as a common concern among parents in both qualitative and
quantitative responses. Qualitative data also identified stigma, lack of awareness, and
systemic issues as major barriers.
While cost, transportation, and scheduling were less frequently major barriers,
they remained "somewhat of a barrier" for many. Parents expressed a strong desire for
more integrated, school-based services, improved staff training, and better
communication to destigmatize and facilitate access.
While this chapter focused on detailing these results, the subsequent chapter will
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transition to a deeper analytical discussion, interpreting these findings in relation to the
existing literature and addressing the overarching research questions.
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CHAPTER V
Conclusions & Recommendations
This action research project undertook a comprehensive investigation into the
effectiveness of interventions designed to enhance mental and behavioral health services
at Tussey Mountain Middle/High School. Using a robust mixed-methods approach, this
study triangulated quantitative data from student and parent surveys, discipline records,
and Chill Room usage logs with rich qualitative insights gleaned from student interviews
to obtain a comprehensive understanding into district programming.
This multifaceted strategy allowed for a nuanced understanding of the prevailing
contextual issues. The findings revealed significant positive shifts in student perceptions,
particularly concerning school safety, the supportive environment, and the school's
approach to drug-related concerns. Furthermore, improvements in social factors, such as
teacher relationships and a greater sense of school connectedness, were evident,
alongside the demonstrable value of the Chill Room, marked by its increased utilization
and positive impact on student well-being.
Despite these encouraging developments, the investigation also brought to light
persistent challenges. While a decrease in out-of-school suspensions was observed, an
increase in warnings, detentions, and in-school suspensions suggests areas warranting
further attention. Crucially, student perspectives highlighted barriers to accessing mental
and behavioral health resources, including limited operating hours for the Chill Room
and instances where access was restricted by staff. Parents, in parallel, consistently
reported significant gaps in the accessibility, awareness, and perceived effectiveness of
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existing services, coupled with concerns about communication from school personnel.
Qualitative data from parents further emphasized the role of stigma, lack of awareness,
and systemic issues as major impediments.
Moving forward, it is important to explore these results further to draw
meaningful connections to the established research questions. It is also important to
explore the limitations of this action research study, exploring how the research design,
methodology, or external factors may have influenced the interpretation of the findings.
Exploration in these areas will provide a context to provide recommendations for
future research, to identify areas that warrant closer examination to potentially. This
discussion will also facilitate actionable steps for further improvements to the
programming within the Tussey Mountain School District.
Research Question One: Conclusions
When studying the research question, “what was the impact on self-reported risk
factors and protective factors before and after the implementation of mental and social
service programming initiatives” many tangible improvements to district programming,
services and culture were realized. The action research project demonstrated several
tangible improvements. First and foremost, there were increased student perceptions of a
protective school environment. Students reported feeling a greater sense of overall safety,
support, and recognition for prosocial behaviors. Students also perceived a less prevalent
and risky drug environment within the school, particularly concerning alcohol and
marijuana.
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There is also much evidence of an enhanced school social climate. There was a
clear and measurable improvement in students' perceptions of teacher relationships, their
sense of school connectedness, the level of academic support, the effectiveness of order
and discipline, and the overall school social environment. Students also increasingly felt
they were being treated equally and fairly within the school.This was coupled with a
notable decrease in serious discipline infractions.
The Chill Room proved to be a highly effective and increasingly utilized resource
for students to manage their emotions and improve their readiness for learning. The
consistent and significant reduction in students' self-reported distress levels after using
the Chill Room is another clear and tangible outcome of this project.
Impact on Risk Factors
A reduction in self-reported risk factors was realized during this study. Data from
the PhenX School Drug Environment ToolKit reveals a generally positive shift in
students' perceptions of the school's drug environment, indicating a reduction in
perceived risk. Improvements were noted in these areas:
● General School Drug Environment: This overall summary scale decreased from 2.97
pre-intervention to 2.79 post-intervention (with scores closer to 5 indicating more
prevalent use or risk behaviors). This is a positive indicator that students perceive a
less prevalent or risky drug environment.
● School Alcohol Environment: A significant perceived reduction in alcohol
prevalence or risk behaviors was observed, with scores decreasing from 2.81 to 2.38.
● School Marijuana Environment: This saw the most substantial decrease, dropping
from 3.04 to 2.52, suggesting a significant improvement in students' perceptions of
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marijuana prevalence or associated risks.
● School Tobacco Environment: While overall positive, there was a minor uptick in
perceived tobacco risk (from 2.15 to 2.23), suggesting that tobacco use or risk
perceptions may not have responded as favorably to the interventions as alcohol and
marijuana.
School discipline data also provided some insight into the impact of district
initiated programming on student risk factors. Discipline data presents mixed trends,
indicating that while some severe risk behaviors decreased, others saw an increase.
Out-of-School Suspensions (OSS) saw a significant decrease from last school year to this
school year. This is a clear positive trend, suggesting that the most severe disciplinary
actions were less frequently necessary.
While there was a decrease in more severe disciplinary actions, low and mid-level
disciplinary actions remained relatively stable or increased, with warnings increasing
slightly, detentions increasing significantly, and in-school suspensions rising sharply.
Additionally, referrals to SAP, Counseling, or Other Agencies decreased.
When considered in context, these could indicate more minor behavioral issues
but also a shift in how less severe behaviors are being managed by the principal's office.
Coupled with fewer principal-initiated external referrals, there is some evidence that
proactive approaches such as use of district-initiated mental health programs are being
used to address behaviors before they escalate to more serious disciplinary infractions,
such as those which require out-of-school suspension.
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Impact on Protective Factors
Based on the quantitative data collected from the PhenX School & Protective
Factors ToolKit, the PhenX School Drug Environment surveys, the PhenX School Social
Factors ToolKit, disciplinary data, and Chill Room usage records, the implementation of
mental and social service programming initiatives at Tussey Mountain Middle/High
School demonstrated a mixed but generally positive impact on self-reported risk and
protective factors among students.
The aggregate data from the PhenX School & Protective Factors ToolKit indicates
an overall positive movement towards a more protective school environment for the eight
participating students. Specifically, improvements were noted in these areas:
● General School Protective Environment: This key summary scale showed a positive
upward trend, increasing from an average of 2.79 pre-intervention to 2.97
post-intervention (with scores closer to 4 indicating a more protective environment).
This suggests that students perceived a greater sense of overall safety and support
within the school following the initiatives.
● School Rewards for ProSocial Involvement: Perceptions significantly improved,
moving from 2.64 pre-intervention to 2.86 post-intervention. This indicates that
students felt their positive behaviors were better recognized and acknowledged after
the programming initiatives.
● Academic Performance: This subdomain also showed a positive shift, improving
from 3.08 pre-intervention to 2.56 post-intervention (where lower scores indicated a
more protective environment). This suggests a more supportive academic
environment was perceived.
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● School Opportunities for ProSocial Involvement: While the overall trend was
positive, there was a minor, albeit slight, decrease in perceived opportunities for
prosocial involvement (from 2.91 to 2.86). This suggests that while other protective
aspects improved, the perceived avenues for pro-social engagement may require
further attention.
Analysis of student responses reported using the PhenX School Social Factors
ToolKit also demonstrates a noticeable positive shift in students' perceptions of school
social factors, indicating an increase in protective elements related to their sense of
connectedness and pride. The combined percentage of responses indicating overall
positive sentiments increased from 47.11% at the start of the study to 59.22% at the end
of the study. Similarly, negative sentiments decreased from 23.97% to 14.59%. This
indicates a general improvement in students' perceptions of the school's social
environment.
The most notable improvements were observed in Teacher Relationships (which
improved from 44.1% reporting positive responses to 75.0% reporting positive
responses). Improvement was also noted in other sub domains. School Connectedness
(increased from 23.7% to 43.9%), Academic Support (further solidified from 81.0% to
86.5%), Order and Discipline (increased from 52.4% to 64.2%). Furthermore, School
Social Environment (combined positive sentiment surged from 15.4% to 46.7%).
There was also a positive shift in students' perceptions of fairness, with the
percentage of students disagreeing or strongly disagreeing with statements of
exclusion/privilege increasing from 28.57% to 47.62%. This indicates a stronger belief
among students that they are being treated equally and fairly. These shifts suggest that the
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programming initiatives fostered stronger relationships, a greater sense of belonging, and
a more positive and secure social atmosphere within the school.
While many areas improved, School Physical Environment remained relatively
stable with no significant increase in positive perception. More notably, Academic
Satisfaction indicated a decline in positive feelings (from 64.2% to 33.3%), suggesting
students felt less satisfied with their academic experiences as the project progressed. This
could be a critical area for future attention.
Additionally, data from the Chill Room strongly supports its role as a valuable
protective factor. This was evident through continued, increased utilization. "Drop-ins"
consistently and significantly increased from December to April, indicating growing
student awareness and willingness to utilize this resource for emotional regulation.
Additionally, the "Average Rating Out" was consistently and significantly lower than the
"Average Rating In" across all months (e.g., in February, the average reduction was 1.9
points from 3 to 1.2). This consistently demonstrates a substantial positive shift in student
mood and readiness for school tasks after visits, highlighting the Chill Room's
effectiveness in de-escalation and promoting well-being.
Recommendations for Future Research
While study of this research question yielded very positive results for the students
and school at large, during this action research project, several areas of further inquiry
have emerged which may assist in continuing to improve programming within the Tussey
Mountain School District and other schools.
Further study may be beneficial to determine why survey participants reported a
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decline in academic satisfaction during the course of this study and how this could be
addressed through targeted interventions. This could be achieved through conducting
qualitative interviews with students to delve deeper into their perceptions of curriculum,
workload, grading, instructional methods, and relevance of learning. Supplementing this
with teacher and parent focus groups could help gain a more comprehensive
understanding of this issue. This was identified as an important area for study, as a
limited number of parent respondents (in research question three) reported homework
stressors as a concern for their student.
Additionally, as indicated it is currently unclear why warnings, detentions, and
in-school suspensions increased and the number of external referrals decreased. As
discussed this could be evidence that addition of programming available within the
school has led to a more proactive approach but more research is needed at this time to
better describe and understand the relationship between mental health initiatives and
student discipline. Interviewing teachers and administrators to understand their
perceptions of behavioral trends and changes in disciplinary practices could help school
leaders better understand this relationship. Within the Tussey Mountain School District,
this data could also provide greater context to parent concerns reported in research
question three regarding staff misunderstandings of mental health disorders.
Research Question Two: Conclusions
Research question two sought to determine what strategies, as reported by
students, were effective for helping students access mental and behavioral health services
at Tussey Mountain Middle/High School and determine what barriers existed. Based on
the self-reported data from student interviews, the most effective strategy for helping
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students access mental and behavioral health services at Tussey Mountain Middle/High
School was direct, personalized guidance from a trusted adult, particularly teachers and
Allegheny Health Network staff, combined with the readily available and flexible Chill
Room. The tangible benefits of this and other district initiatives was evident in student
interview responses as well as the specific identification of successful strategies which
improved access and awareness of mental health resources in the school district.
Student Reports of Awareness
The overwhelming consensus among interviewed students (100%) that they have
experienced stress, anxiety, or depression at school underscores the critical need for
accessible mental and behavioral health services. A significant majority of students
(87.5%) are aware of available mental health resources. The high level of student
awareness of available resources indicates that initial efforts to inform students have been
largely successful.
The most frequently reported effective strategy (75% of students) was having an
adult explain and walk them through options. This highlights the crucial role of human
connection and personalized support over passive information dissemination. Students
benefit significantly when an adult not only informs them but actively assists them in
navigating the process of accessing help.
Teachers (33% of responses) and Allegheny Health Network staff (33% of
responses) were equally identified as particularly helpful in this "walking through"
process. This suggests that these groups are perceived by students as approachable and
instrumental in facilitating access. The role of paraprofessionals (22%) and school
counselors (11%) also indicates a multi-faceted network of support.
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Furthermore, the finding that 55.5% of students learned about services from
teachers reinforces their critical role not just as facilitators of access, but also as primary
disseminators of information. This underscores their direct and consistent contact with
students. Additionally, when triangulated with findings from research question one which
indicated marked improvement in the area of teacher relationships, there is strong
evidence to suggest that levering teacher relationships as part of the referral process and
providing additional systems of support for both teachers and students can continue to be
an impactful practice.
Student Reports of Access
The provision of the Chill Room and the on-sight therapist through Allegheny
Health Network proved to be an effective strategy at increasing student access to mental
health services. Throughout student interviews, students consistently identified the Chill
Room as a highly valued and effective resource. Students praised its flexibility and
effectiveness in helping them "find what worked for them," indicating it serves as a
low-barrier, self-directed support mechanism.
During the student interviews, nearly ninety percent of participants noted positive
change in available resources since starting high school, most commonly citing the Chill
Room being on-site as an effective strategy. The Chill Room was highly recognized (67%
of aware students) and appreciated by students for its flexibility and effectiveness in
supporting their well-being. One-third of students recognized the school-based therapist
(Allegheny Health Network) as a helpful resource.
As indicated, an overwhelming percentage of older participants (88%) noted
much positive change in available resources since they started high school. These
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students mentioned the Chill Room and SEMHA's efforts to reduce stigma, This a
successful cultural shift within the school regarding mental health openness and support
among the student body. While 75% of students felt resources were adequate, the
qualitative response indicating "things were moving in the right direction, but that more
students needed to take it up" suggests that perceived adequacy is tied to actual utilization
and awareness among the broader student body, not just those interviewed.
Student-Reported Barriers
Two barriers to accessing services emerged among students who stated they found
accessing services difficult, making them the most salient and actionable findings from
the student perspective, with regard to service access. While teachers were reported as a
valuable resource to helping initially connect students with resources, teachers not
allowing students access to the Chill Room was perceived as a barrier. A small number of
students who reported that accessing services was “difficult,” specifically mentioned
teachers preventing them from going to the guidance/school counselors or the Chill
Room. This barrier raises legitimate concerns regarding the balance between student well
being and the daily realities of classroom management, the school’s instructional purpose
and established procedures for accessing the Chill Room.
Students also explicitly cited that the Chill Room's operating hours (currently
Tuesday-Thursday) created a barrier to accessibility and consistent service delivery. Due
to staffing issues, similar to those noted in other settings in the review of literature, the
Chill Room is currently only staffed part time (Tuesday, Wednesday, and Thursday).
While the Chill Room is highly valued, its restricted availability means students
experiencing distress on Mondays or Fridays, or outside of those specific hours, do not
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have immediate access to this preferred resource. This inconsistency can make it
challenging for students to rely on the Chill Room.
Recommendations for Future Research
Investigation into this research question, further solidifies the benefits of schools
serving as access points for student mental health services, as also identified in the
literature review. As schools adapt to this changing role, more research may be needed to
determine the needs of teaching professionals. Further study may help school leaders and
researchers better understand teachers' perspectives on student mental health needs,
service access, and the challenges of allowing students to leave class. Additionally, as
more schools implement point-of-access models, similar to the one in this study, future
research may be needed to determine the long-term educational impact of programs such
as this.
Research Question Three: Conclusions
Research question three investigated the impact on community perceptions of
district-initiated mental health and social service programming. Two surveys (a pre and
post survey), with near-identical questions provided via district social media. Due to the
anonymous nature of the surveys and the online means of submission, there is no way to
determine if the same or different participants completed these surveys. Results should be
interpreted as collective parent perceptions at a particular point in time, rather than a
change in perception within the same group of research participants.
Both pre- and post-surveys demonstrated an overwhelming consensus among
parents regarding the critical importance of mental health and social services for student
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well-being, with approximately 90% of parents supporting or identifying a need for
mental health and social service programming within the school system. Survey results
indicated a disconnect between parents who had sought mental health services for their
students since the implementation of studied programming and those who did not.
Parents who had sought mental health treatment for their student, reported modest
improvements in logistical barriers. When the survey results were also compared to
student survey and interview results, there was also discrepancy between student and
parent perceptions of program efficacy, communication and the supportiveness of staff
and the school environment.
Among parents who reported that their child has received mental health services
during the study period, the cost of services appears to be perceived as less of a barrier.
Prior to the survey, 20% of parents considered cost a major barrier, 40% a somewhat
barrier, and 40% not a barrier. Post-survey, the perception of cost as a major barrier
dropped to 0%, with 40% still seeing it as somewhat of a barrier and 60% reporting it as
not a barrier. This suggests that while cost remains a concern for some, it is no longer
considered a major obstacle by any surveyed parents. The provision of free-access to the
Chill classroom educator may have helped improve parent perceptions in this area. The
provision of on-sight programming also seems to have impacted parent perception with
regard to transportation to and from appointments. In this area, there was a positive shift,
with 80% of parents reporting that transportation was "Not a Barrier" in the post-survey,
compared to 60% pre-survey. When viewed in the context of other parent responses,
citing the lack of resources in the rural area, there is further evidence to suggest that the
school as an access point for services offers other positive benefits for parents.
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Among the parent survey group as a whole, significant and persistent gaps in
perceived accessibility, awareness, effectiveness, communication from school staff, and
the supportive nature of the school environment remained largely unchanged and
revealed some areas for continued improvement and engagement within the parent
stakeholder group moving forward.
Regarding stigma and confidentiality, the results suggest a polarization in parents'
views. Pre-survey, 20% saw it as a major barrier, 20% as significant, 20% as somewhat,
and 40% as not a barrier. Post-survey, while the "somewhat" category disappeared (0%),
the percentage of parents identifying it as a major barrier (20%) and significant (20%)
remained the same. This means 40% of parents still viewed stigma/confidentiality as a
significant or major hurdle, while 60% considered it not a barrier. This shift implies that
for a subset of parents, stigma and confidentiality continue to be substantial concerns,
even as others no longer perceive it as an issue.
Awareness of services also continued to be a significant issue. Before the survey,
20% of parents viewed awareness as a major barrier, 60% as somewhat of a barrier, and
20% as not a barrier. The post-survey data for awareness is less clear and presents some
inconsistencies. While 0% of parents considered awareness a major barrier post-survey,
20% reported it as somewhat and 20% as significant, totaling 40% who still saw it as a
barrier to some degree. The remaining 60% considered it not a barrier. The noted
discrepancy where 45% disagreed about awareness in another survey question further
highlights that, despite some improvements in the "major barrier" category, overall
awareness still remained a problem for a substantial portion of parents.
Qualitative analysis of parent responses indicates consistent concerns about a lack
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of easy access to mental health services and ability of school staff to communicate
opportunities. This finding would suggest that some parents remain unaware of on-sight
district programming. Within the pre-survey, a combined 77.7% of parents expressed
mixed awareness or disagreement about program knowledge. This persisted in the post,
with 45% disagreeing or strongly disagreeing that they were aware of different program
types. This would imply that the initiatives did not effectively bridge the awareness gap
for parents. While students reported learning about services from teachers, this
information did not consistently reach the parent community, indicating a disconnect in
communication strategies. Communication concerns also emerged as primary parent
concern in qualitative responses.
Recommendations for Future Research
These results are very similar to those noted by Longhurst et al. (2021) who found
that parents and caregivers generally supported mental health services in the school
system, as they are convenient to access and provide a familiar environment for their
child. Similarly, in this study, many parents said that they wished for better
communication from the school regarding the program and their child’s progress. Abrams
(2023) also communicates concerns about ineffective parent communication. Based on
each of these findings, it is recommended that more specific research be conducted on
how parents wish to receive information about programming.
Within the Tussey Mountain School District, it would also be beneficial to
explore the divergence in perceptions among parents who have sought treatment for their
student and those who have not, as well as the divergence from the perceptions noted in
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student surveys and interviews. Future research should also explore if differing
perceptions occur in other settings among these stakeholder groups and the potential root
causes for such divergence.
Limitations
When considering the limitations of this study, it is important to acknowledge that
a change in research methodology (PAYS data used to establish the context vs identified
data sources in the research methodology) limits the researcher’s ability to make direct
comparisons from the baseline data to the data collected. The shift away from relying
solely on PAYS data means that direct comparisons to broader state trends or historical
PAYS data within the district will be limited. This could affect the study's external
validity, or generalizability, as it may be harder to place the findings within a larger
context. While broader comparisons to PAYS data are limited, the researcher has chosen
methods to allow for a more focused evaluation of the specific district-initiated programs,
through use of both quantitative and qualitative data.
Another limitation of qualitative research identified by Mertler (2022) is that this
form of research, historically, has less participants. This was noted in the present study, as
limited sample sizes were noted for stakeholder surveys and interviews. A total of eight
students participated in the student surveys and interviews. In total, twenty parents
submitted survey data for analysis.
While thematic saturation might have been achieved for key themes, the small
number of participants potentially limits the generalizability of the findings to the entire
student population at Tussey Mountain Middle/High School. Perceptions might differ
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among a larger, more diverse group of students or parents
Additionally, much of the data in this survey relies on student and parent reports,
which can be subject to recall bias, social desirability bias, or a limited understanding of
all available services.
Recommendations for Future Initiatives at the Tussey Mountain School District
The positive shifts in student connection to the school, indicate that the current
mental and social service programming initiatives are having a beneficial impact,
particularly, the Chill Room. The increased Chill Room usage and its demonstrated
effectiveness in mood regulation are highly encouraging. Future improvements should
focus on ensuring consistent and optimal operating hours for the Chill Room, addressing
any barriers to access (e.g., teacher permission and staffing) and continuing to effectively
advertise its availability and benefits to all students and staff.
The slight increase in perceived tobacco risk and the decline in Academic
Satisfaction, reported on the student surveys highlight areas needing targeted
interventions. This could involve revised prevention programs for tobacco or a review of
academic support structures, curriculum, or instructional practices to enhance student
engagement and satisfaction. The district can use existing infrastructure within the
contracted programming through Allegheny Health Network to implement targeted
intervention and prevention programs in these areas.
Additionally, the positive impact on teacher relationships, reported by students
and parents, suggests that professional development focused on further building positive
student-teacher interactions and recognizing mental health needs is valuable and should
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be continued or expanded.
Furthermore, the increase in warnings, detentions, and ISS, while OSS decreased,
warrants a deeper dive. This could lead to a review of disciplinary policies to understand
if this reflects increased vigilance, a lower threshold for intervention, or if students are
needing more low-level support. Professional development for staff on de-escalation and
positive behavior interventions could be beneficial.
The continued parent concerns regarding accessibility, awareness, and
effectiveness, as well as communication from school staff, suggest a need for more
proactive and clear communication strategies regarding available mental health and social
services. This includes consistent outreach to parents and ensuring all staff are
well-informed and able to guide students and families to appropriate resources.
Conducting dedicated parent focus groups and surveys could help identify specific
communication preferences and barriers, as well as piloting new communication
strategies and assess their impact on parent awareness and engagement, based on these
results.
Financial Implications
This project, itself, was inexpensive to conduct, but the programs it evaluated
carried significant costs. These new initiatives for the current school year were entirely
funded by grants and philanthropic donations. This influx of external funding, combined
with the proposed capstone research project, gave the district a valuable chance to
understand how different groups viewed the effectiveness and challenges of these
programs. This capstone project has enabled the district to make data-driven decisions
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about the future of programs like the Chill Project, basing their choices on proven impact.
The Chill Project was consistently reported as one of the most impactful initiatives by
students. Furthermore, significant positive changes to reported risk and protective factors
indicate a significant, positive impact on the student body.
During this project, the researcher also evaluated options to sustain programming
for future years, in the absence of grant funding. These efforts have yielded an additional
year of services for the district for the upcoming school year (2025-2026), as the district
continues to seek means through which this program can be financially sustainable and
fiscally-responsible. This was achieved through a variety of means. First and foremost,
additional philanthropic funding has been obtained through the partnership with
Allegheny Health Network. The district’s rural setting and unique challenges provides an
environment where program efficacy of the Chill Project can be evaluated in a new
setting. Organizational interest and the potential to meet needs in a rural, rather than
suburban or urban setting helped facilitate the provision of continued philanthropic
donations, as educators and mental health providers, alike, seek to respond to the
adolescent mental health crisis in rural America.
Additionally, although staffing concerns created barriers to program access, as a
Chill classroom educator was only available part time, this reduction in cost did enable
the programing to continue for a longer period of time, due to grant funds not being
exhausted in one year. In addition to the Chill classroom educator, the current cost of
services from Allegheny Health Network also includes an on-sight school-based
counselor. The on-sight counselor for Allegheny Health Network currently carries a
caseload that is currently 64% funded through insurance billing. As the program grows
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and more students receive this service, the cost of services billed to the district through
Allegheny Health Network will decrease, making the program more sustainable.
Finally, school leaders, including the researcher, discussed additional available
funding streams. Through these discussions, it was discovered that, in some
circumstances, some of the services offered to students receiving special education
services from the Chill Room can be paid using funding from the Individuals with
Disabilities Education Act (IDEA) in very specific situations. Use of this additional
funding stream was instrumental in funding the programming for one additional year. The
provision of an additional year of program funding provides more opportunities for the
school district to pursue additional funding streams which could lead to improved
financial sustainability.
Closing
Amidst these very important fiscal conversations, it is essential not to overlook a
critical dimension, the profound human impact. Budgets for those in the public sector,
such as schools are not merely a ledger of expenses and revenues; they are a declaration
of values and a blueprint for the future of a community's children. Future school years
will provide the Tussey Mountain School District time to build on the successes and
tangible improvements realized within this action research project, as well as build
financial sustainability of programming to meet the challenging and evolving set of needs
which necessitated the need for this project and programming.
Ultimately, this project demonstrated significant strides in fostering a more
supportive and protective environment for students' mental and behavioral well-being
ENHANCING MENTAL HEALTH PROGRAMMING
133
within the Tussey Mountain School District. The consistent and enthusiastic utilization of
the Chill Room, paired with a notable positive shift in student mood and readiness for
learning, underscores the direct and beneficial impact of accessible in-school resources.
Furthermore, the overall improvement in student perceptions of school safety, prosocial
behavior recognition, and critical social factors like teacher relationships and school
connectedness, paint a compelling picture of a school community better equipped to meet
the holistic needs of its students. These positive outcomes reported by the student
stakeholder group, as well as the strong support for mental health programming reported
by parents, lay a strong foundation for continued growth and refinement of mental and
behavioral health initiatives within the district. The findings of this action research
project helped identify a path forward to better meeting student needs and the challenges
reported within the parent stakeholder group.
ENHANCING MENTAL HEALTH PROGRAMMING
134
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APPENDICES
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ENHANCING MENTAL HEALTH PROGRAMMING
Appendix A
Institutional Review Board Documentation
144
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145
Appendix B
Survey Informed Consent Letter
Dear Parent/Guardian,
A research study, Bridging the Gap: Implementing a Multi-Stakeholder Approach to
Enhance Mental Health and Social Service Initiatives in a Rural School District, an
Action-Research Project, is being conducted at our school to better understand students’
experiences and factors that contribute to their well-being and success in school. This
project has received approval from PennWest University Institutional Review Board
effective from 10/18/2024 through 10/17/2025.
This research will help us develop programs and supports to improve the school
environment for all students.
Your child is being invited to participate in a survey about student risk factor and school
connectedness among students in the Tussey Mountain School District. The purpose of
this survey is to gather information about students’ perspectives on the importance,
accessibility, and effectiveness of school services, as well as their potential impact on
student behaviors.
Your student is also being invited to participate in an interview about access to mental
health services. The purpose of this survey is to gather information about students’
perspectives on the importance, accessibility, and effectiveness of school services, as well
as their potential impact on student behaviors.
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Your student’s input will help inform the district’s programming to better meet the needs
of our student body, as a whole.
Participation- Surveys
Students in grades 9-12 are eligible to participate in this survey with parental consent.
Participation in this survey is entirely voluntary. The decision to participate or decline to
participate will not affect your or your child’s relationship with the school district in any
way.
If you consent to your child’s participation in this survey, your child will meet with the
researcher at the time of your choosing. During this time, your student will be provided
with two surveys to complete.
Your child will repeat these surveys again in the spring. Each administration of the survey
will take approximately 30 minutes. You or your child may choose to stop participating in
this study at any time without penalty. Just because your child has started the survey does
not mean he or she has to complete it.
Confidentiality
Your child’s responses to this survey will be completely anonymous. No identifying
information will be collected during the actual survey or interview. After your student has
completed the survey or interview, their responses will be stored in a locked file. There
will be no way of identifying your child’s survey once it has been completed and stored
with the remainder of the surveys.
ENHANCING MENTAL HEALTH PROGRAMMING
147
Potential Risks
While the risks associated with participation in this survey are minimal, some questions
may ask about sensitive topics such as their relationships with school staff members,
thoughts on discipline practices, and alcohol/ drug usage among teens in the community
which may cause emotional discomfort. If your child feels uncomfortable answering any
question, he or she may skip it or stop the survey altogether. We advise you to
thoughtfully consider these potential risks before consenting to your child’s participation
in this research study. Contact information for mental health agencies in our area is also
available for any participant or family who would like information on these resources.
Benefits
Select participants will be awarded a nominal gift card. Outside of this benefit, there is no
direct benefit to research participants. However, information collected will help the
school district better understand the needs of students when designing future programs.
The information collected will help our school district better understand risk factors
impacting our students and assess their overall connectedness to our school.
Questions
If you have any questions about the research, or a research-related injury, please contact
Denelle Diehl at die33397@pennwest.edu. If you have questions about your child’s rights
as a research participant that you need to discuss with someone, you can contact the
PennWest University Institutional Review Board at InstReviewBoard@Pennwest.edu.
Consent
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148
By completing this form, you are providing consent for your student to participate in the
surveys or interviews.
Student Name:__________________________________________________________
Parent Signature:________________________________________________________
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Appendix C
Student Assent Statement (Surveys)
You are being asked to participate in a research study. Your participation is voluntary and
you may stop at any time.
This research study is taking a look at how our students feel about our school and student
risk factors. We want to use this information to better meet the needs of our students.
Your part in this study will be to complete two surveys. These will take approximately
fifteen minutes each to complete. You will be provided with a private space to complete
the survey. Once you are finished you will place the surveys in the locked box you have
been shown. Because your name is not on either survey, no one will know how you have
responded.
The survey responses will only be seen by the researcher, Ms. Diehl. Your parents,
teachers and other school staff will not be shown the surveys.
Your parents or guardians have consented for you to participate in this interview,
however, you do not have to do this, and you can stop at any time and nothing bad will
happen to you. If you choose to not answer a question or stop the interview, no one will
be upset with you.
If you want to stop taking part in the study, you just need to tell Ms. Diehl that you want
to stop. If you have any questions about the study, you may ask now or at any point
during the survey.
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After the study if something is upsetting to you, you should speak with your parent(s) or
guardian(s).
I agree to be in this study, have had all my questions answered, and know I can stop at
any time.
____________________________
_________________
Student Participant Signature
Date
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151
Appendix D
Informed Consent (Interviews & Surveys)
Dear Parent/Guardian,
A research study, Bridging the Gap: Implementing a Multi-Stakeholder Approach to Enhance
Mental Health and Social Service Initiatives in a Rural School District, an Action-Research
Project, is being conducted at our school to better understand students’ experiences and factors
that contribute to their well-being and success in school. This project has received approval from
PennWest University Institutional Review Board effective from 10/18/2024 through 10/17/2025.
This research will help us develop programs and supports to improve the school environment for
all students.
Your child is being invited to participate in a survey about student risk factor and school
connectedness among students in the Tussey Mountain School District. The purpose of this
survey is to gather information about students’ perspectives on the importance, accessibility, and
effectiveness of school services, as well as their potential impact on student behaviors.
Your student’s input will help inform the district’s programming to better meet the needs of our
student body, as a whole.
Participation- Surveys
Students in grades 9-12 are eligible to participate in this survey with parental consent.
Participation in this survey is entirely voluntary. The decision to participate or decline to
participate will not affect your or your child’s relationship with the school district in any way.
If you consent to your child’s participation in this survey, your child will meet with the researcher
at the time of your choosing. During this time, your student will be provided with two surveys to
ENHANCING MENTAL HEALTH PROGRAMMING
152
complete.
Your child will repeat these surveys again in the spring. Each administration of the survey will
take approximately 30 minutes. You or your child may choose to stop participating in this study at
any time without penalty. Just because your child has started the survey does not mean he or she
has to complete it.
Participation- Interviews
Students in grades 9-12 are eligible to participate in this survey with parental consent.
Participation in this survey is entirely voluntary. The decision to participate or decline to
participate will not affect your or your child’s relationship with the school district in any way.
If you consent to your child’s participation in this survey, your child will meet with the researcher
at the time of your choosing. During this time, your student will meet with the researcher
individually, and complete an oral interview. You or your child may choose to stop participating
in this study at any time without penalty. Just because your child has started the interview does
not mean he or she has to complete it.
Confidentiality
Your child’s responses to this survey will be completely anonymous. No identifying information
will be collected during the actual survey or interview. After your student has completed the
survey or interview, their responses will be stored in a locked file. There will be no way of
identifying your child’s survey once it has been completed and stored with the remainder of the
surveys.
Potential Risks
While the risks associated with participation in this survey are minimal, some questions may ask
ENHANCING MENTAL HEALTH PROGRAMMING
153
about sensitive topics such as their relationships with school staff members, thoughts on
discipline practices, and alcohol/ drug usage among teens in the community which may cause
emotional discomfort. If your child feels uncomfortable answering any question, he or she may
skip it or stop the survey altogether. We advise you to thoughtfully consider these potential risks
before consenting to your child’s participation in this research study. Contact information for
mental health agencies in our area is also available for any participant or family who would like
information on these resources.
Benefits
There is no direct benefit to your child for participating in this survey. However, information
collected will help the school district better understand the needs of students when designing
future programs. The information collected will help our school district better understand risk
factors impacting our students and assess their overall connectedness to our school.
Questions
If you have any questions about the research, or a research-related injury, please contact Denelle
Diehl at die33397@pennwest.edu. If you have questions about your child’s rights as a research
participant that you need to discuss with someone, you can contact the PennWest University
Institutional Review Board at InstReviewBoard@Pennwest.edu.
Consent
By completing this form online, you are providing consent for your student to participate in the
surveys or interviews. Your consent will be verified via phone. You may also sign below:
Parent Signature:
Date:
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Appendix E
Student Assent Form (Interviews)
You are being asked to participate in a research study. Your participation is voluntary and you
may stop at any time.
This research study is taking a look at mental health services available in our school and what our
students’ needs are. Your part in this study will be to answer some interview questions about
your experiences at our school. This interview will take approximately 30 minutes.
During the interview, the researcher, Miss Diehl will be recording written notes about your
responses. Your name will not be placed on this note sheet. After you have finished, this note
sheet will be stored in a locked drawer with other interview note sheets. This will help protect
your privacy, as no one will know which note sheet records your answers. These note sheets will
not be seen by anyone but the researcher, Miss Diehl.
Additionally, your answers will not be shared with anyone else.
Your parents or guardians have consented for you to participate in this interview, however, you do
not have to do this, and you can stop at any time and nothing bad will happen to you. If you
choose to not answer a question or stop the interview, no one will be upset with you.
If you want to stop taking part in the study, you just need to tell Ms. Diehl that you want to stop.
If you have any questions about the study, you may ask now or at any point during the interview.
After the study if something is upsetting to you, you should speak with your parent(s) or guardian
(s).
ENHANCING MENTAL HEALTH PROGRAMMING
155
I agree to be in this study, have had all my questions answered, and know I can stop at any time.
____________________________
_________________
Student Participant Signature
Date
ENHANCING MENTAL HEALTH PROGRAMMING
156
Appendix F
Student Interview Script
Access to Mental Health Services
● Have you ever felt stressed, anxious, or depressed while at school? If so, what did you do
about it?
● Do you know of resources at our school that help students when they are experiencing
these feelings?
● How did you find out about the mental health resources available at our school?
● Was it easy or difficult to access these services? Why?
● (FOR STUDENTS IN GRADES 10, 11, 12) What grade are you in? _____ Think about
the services that were offered at the time you started high school in grade 9. Have the
services changed? How? If yes, how do you feel about these changes?
● Do you think there are enough mental health resources available at our school?
● Is there anything else you would suggest to improve student programs?
Effective Strategies
● If you or a friend did seek help, what was that experience like? What worked well?
● Were there any school programs or activities that helped you or a friend with mental
health?
● Who at the school has been helpful to you when you were struggling?
● What kind of support would have been most helpful to you?
Barriers to Access
● What prevented you or your friends from seeking help when you needed it?
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● Were there any stereotypes or stigmas about mental health that made it hard to ask for
help?
● What would make it easier for students to seek help?
● What would you change about the way mental health services are offered at our school?
Follow-up Questions
● Can you tell me more about that?
● How did that make you feel?
● What do you mean by [specific answer]?
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Appendix G
Informed Consent (Parent Surveys)
Welcome!
You are invited to participate in a research study about mental health and social services
for students in the Tussey Mountain School District.
The purpose of this survey is to gather information about parents’ perspectives on the
importance, accessibility, and effectiveness of these services. Your input will help inform
the district’s programming to better meet the needs of our students.
This study is being conducted by Denelle Diehl, who currently serves as the Director of
Education for the school district, in conjunction with coursework at PennWest University.
The title of this study is: Bridging the Gap: Implementing a Multi-Stakeholder Approach
to Enhance Mental Health and Social Service Initiatives in a Rural School District, an
Action-Research Project.
This study has received approval from the Institutional Review Board at PennWest
University. The effective date of approval is 10/18/2024. This approval expires
10/17/2025.
Participation & Withdrawal From The Study
All parents and guardians eighteen years of age and older with at least one student
enrolled in Tussey Mountain Middle or High School are eligible to participate in this
survey. Participation in this survey is entirely voluntary. You may choose to stop
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participating at any time without penalty. Your decision to participate or not will not
affect your or your child’s relationship with the school district. This survey will take
approximately forty minutes to complete.
Potential Risks
The risks anticipated with participating in this survey have been deemed to be minimal.
However, some questions may ask about sensitive topics such as mental health, which
may cause emotional discomfort. If you feel uncomfortable answering any question, you
may skip it or stop the survey altogether.
Benefits
There is no direct benefit to you for participating in this survey. However, your input will
help the researcher and the school district better understand the needs of students and
families regarding mental health and social services. This information will be used to
improve programs and support systems for students.
Confidentiality & Data Security
Your responses to this survey will be completely anonymous. You will not be asked to
provide any information that could be identify you (eg. name). The survey is NOT linked
to IP addresses. Individual responses will not be reported, just the aggregated data.
All information reported in this survey will be confidential within local, state, and federal
laws. The PennWest University Institutional Review Board (IRB) may review the
research records. The study's results may be shared in aggregate form at meeting or in a
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journal but your individual responses will not be revealed. Records from this study will
be kept by Denelle Diehl for at least (3) years after the study is complete.
Non-identifiable information collected as part of this research could be used for future
studies or distributed to another investigator with informed consent.
Questions
If you have any questions about the research, or a research-related injury, please contact
Denelle Diehl at die33397@pennwest.edu. If you have questions about your rights as a
research participant that you need to discuss with someone, you can contact the PennWest
University Institutional Review Board at InstReviewBoard@Pennwest.edu.
By clicking on the "I agree" box and continuing with the survey, you have acknowledged
that you have read the entire informed consent and are at least 18 years of age. You also
acknowledge that you agree to participate in the survey and have the right to not to
answer any or all of the questions in the survey. Finally, you understand that your
participation is completely voluntary and you may quit the study at any time without
penalty.
Thank you for your consideration!
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Appendix H
Parent Survey Questions
Part 1: Importance of Mental Health & Social Services
Instructions: Please rate your level of agreement with the following statements using the
scale provided.
● Strongly Disagree (1) Disagree Somewhat (2) Agree Somewhat (3) Strongly
Agree (4)
1. Mental health services are important for the overall well-being of students in our
school district.
2. Social service programs are essential in supporting students facing challenges
outside of school.
3. There is a growing need for mental health and social service support in our rural
community.
Part 2: Accessibility and Effectiveness
Instructions: Please rate your level of agreement with the following statements about the
current mental health and social service programs in the school district.
1. Students in our school district have easy access to mental health services when
needed.
2. I am aware of the different types of social service and mental health programs
available to students and families in our community.
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3. The mental health services offered by the school district are effective in
addressing student needs.
4. The social service programs offered in collaboration with the school district are
helpful for students facing challenges.
Part 3: Barriers and Suggestions
1. (Open Ended) In your opinion, what are the biggest barriers preventing students
from accessing mental health and social service programs in our school district?
2. (Open Ended) What suggestions do you have for improving the accessibility and
effectiveness of mental health and social service programs in our schools?
Part 4: Additional Information
(Open Ended) Please share any additional comments or suggestions you have regarding
mental health and social service support for students in our school district.
1. In the past year, has your student sought any mental health treatment or
services? (Yes/No)
○ If yes, please continue to question 2.
○ If no, please skip to question 5.
2. How did your student access mental health support? (Please select all that
apply)
○ Private therapist or counselor
○ School counselor
○ School psychologist
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○ School social worker
○ Telehealth services
○ Hospital emergency room/inpatient program
○ Other (Please specify)
3. During your search for mental health services, did the school provide any of
the following resources or assistance? (Please select all that apply)
○ Information on available mental health providers in the community
○ Support navigating the referral process
○ School-based mental health screening or assessment
○ Collaboration with outside providers
○ Assistance with scheduling (if needed)
○ Use of school facilities and technology to participate in teletherapy
programs
○ Other (Please specify)
4. (Open ended) How helpful was the school in assisting you in finding mental
health services for your student? Please elaborate on your experience.
5. (Strongly Disagree - Somewhat Disagree - Somewhat Agree - Strongly Agree)
The School staff effectively communicate mental health resources available to
students to students and families.
6. (Strongly Disagree - Somewhat Disagree - Somewhat Agree - Strongly Agree)
The school environment is supportive of students seeking mental health help.
7. (Open ended) What improvements could the school make to better support
students and families seeking mental health services?
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Part 2: Barriers to Access
Instructions: Please rate the extent to which the following factors would prevent you
from seeking mental health or social services for your child.
Scale: (Not a Barrier / Somewhat of a Barrier / Significant Barrier / Major Barrier)
1. Cost of mental health services or programs.
2. Availability of mental health services or programs after school hours or on
weekends.
3. Transportation difficulties in getting to appointments.
4. Lack of awareness about available mental health or social service programs
in the community.
5. Concerns about confidentiality or stigma associated with seeking mental
health help.
6. School not adequately informing parents about available resources.
7. Difficulties navigating the process of getting help (e.g., referrals, paperwork).
8. Long wait times for appointments.
9. Other (Please specify)
(Open Ended) Please share any additional thoughts or experiences you have had
regarding barriers to accessing mental health and social services for your student.
(Open Ended) If you found the efforts of the school helpful in coordinating care for your
student, please share what strategies or programs were successful and why:
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Appendix I
Thematic Coding, Research Question Two
Theme 1: Prevalence of Mental Health Challenges
● Universal Experience of Stress/Anxiety/Depression: 100% of students reported
feeling "stressed, anxious, or depressed while at school."
Theme 2: Awareness and Utilization of Resources
● High Awareness of Resources: 87.5% of respondents were aware of resources.
● Most Frequently Utilized/Noted Resources:
○ Chill Room (67% of aware students)
○ School-based therapist through Allegheny Health Network (33% of aware
students)
○ School counseling/guidance office (33% of aware students)
Theme 3: Perceptions of Resource Sufficiency
● General Adequacy of Resources: 75% of students felt there were adequate
mental health resources
● Perceived Insufficiency: 12.5% of respondents felt there were not enough
resources
● Engagement Gap: One respondent noted things were "moving in the right
direction," but emphasized the need for more students to "take it (the
opportunities) up."/ Also advertisement & awareness
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Theme 4: Channels of Information about Services
● Primary Information Source: Teachers: 55.5% of students learned about
services from talking with their teachers.
● Other Information Sources (less common):
○ Conversations with school/guidance counseling office
○ SEMHA Team publications
○ School announcements
○ Word of mouth (other classmates)
Theme 5: Effective Strategies for Accessing Mental Health Services
● Adult Guidance: 75% of students found it helpful to have an adult explain and
walk them through options.
○ Key Personnel Facilitating Access:
■ Allegheny Health Network staff (33% of responses)
■ Teachers (33% of responses)
■ District paraprofessionals (22% of responses)
■ School counselors (11% of responses)
Theme 6: Perceived Changes in Programming Over Time (Grades 10-12)
● Significant Positive Change: 88% of participants observed "much positive
change" in available resources since starting high school
● Most Common Positive Change: Chill Room: Participants most commonly
cited the Chill Room's on-site presence, flexibility, and effectiveness
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● Other Positive Changes: SEMHA raising awareness and reducing stigma
Theme 7: Barriers to Accessing Services
● Perceived Ease of Access: 75% of students reported accessing services was
"easy"
● Perceived Difficulty of Access: 25% of students reported accessing services was
"difficult"
● Primary Barrier: Teacher Discretion/Denial: Most frequently cited barrier was
teachers not allowing access to guidance/school counselors or the Chill Room
● Operational Barrier/ Limited Operating Hours: The Chill Room's limited
operating hours (Tuesday-Thursday) presented a barrier to consistent service
delivery
Theme 8: Opportunities for Improvement
● Top Suggestion/ Staff Training: Most frequent suggestion was training for staff
to help teachers better recognize signs of mental health problems.
● Other Suggestions:
○ More advertisements of district programs
○ More consistency/intentionality in scheduling to help students access
services
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Appendix J
Thematic Coding, Pre Parent Surveys
Theme 1: Perceived Importance vs. Actual Accessibility & Effectiveness of Services
● Strong Agreement on Importance: There was a near-universal consensus that
mental health services and social service programs are important and essential for
student well-being, especially in a rural community with a growing need. This was
evident in the repeated "Strongly Agree" responses to the opening survey questions.
● Disagreement/Neutrality on Accessibility and Effectiveness: In stark contrast to
the perceived importance, there was significant disagreement or neutrality regarding
the ease of access, awareness of programs, and effectiveness of existing mental
health and social service provisions.
○ Many parents "Disagree" that students have easy access to services.
○ Several parents "Disagree" or "Neither agree nor disagree" with being aware of
available programs.
○ Similarly, effectiveness of school district-offered mental health and social
service programs receives mixed to negative responses ("Disagree," "Neither
agree nor disagree," "Strongly Disagree").
○ Communication of resources by school staff and the supportive nature of the
school environment for seeking help also lean towards disagreement or
neutrality.
Theme 2: Key Barriers to Accessing Services
This theme emerges strongly from the open-ended questions and the scaled barrier
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questions.
● Stigma and Confidentiality Concerns:
○ "It is not confidential for where or when you’re going somewhere and therefore
they are further embarrassed and not seeking help."
○ "Concerns about confidentiality or stigma associated with seeking mental health
help" is frequently rated as a "Significant Barrier" or "Major Barrier."
○ One parent mentioned: "It's embarrassing and makes them not want to go to
their mental health appointments."
● Lack of Awareness and Communication:
○ Parents explicitly state "Lack of resources," "Lack of diversity," and "Lack of
support due to rural community."
○ "Awareness about available mental health or social service programs in the
community" is often cited as a "Somewhat of a Barrier" or "Major Barrier."
○ Repeated calls for "More awareness of services and availability with
confidential meetings" and "Better communication."
○ "School staff effectively communicate mental health resources available to
students to students and families, when needed" received significant
disagreement.
● Systemic and School-Specific Issues:
○ Lack of School Support/Trust: Several parents relayed negative experiences
they have had in the past
○ Follow-through and Effectiveness: Repeated responses regarding follow
through and communication were noted
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○ Cost/Financial Barriers: "Their ability to pay / with or without insurance" is
mentioned, and "cost of mental health programming or services" is rated as a
"Major Barrier" by some.
○ Navigation Difficulties: "Difficulties navigating the process of getting help
(e.g., referrals, paperwork)" is a recurring barrier.
○ Long Wait Times: "Long wait times for appointments" is also noted as a
barrier.
○ Attendance Policies: "For those who go to counseling once a week and to a
psychiatrist on a regular basis it is a pain to have to have student attendance
improvement meetings, especially when they have only had an absence or two
otherwise due to illness. It's embarrassing and makes them not want to go to
their mental health appointments."
Theme 3: Suggestions for Improvement
This theme synthesizes parents' recommendations for enhancing mental health and social
service support.
● Increased Communication and Awareness:
○ "More awareness of services and availability with confidential meetings."
○ "Talk about opportunities by making students aware and flyers/notifications to
parents."
○ "Provide more resources and education to parents in the rural community."
○ "Better communication."
● School-Based and Integrated Services:
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○ "School-based program incorporated," "incorporate more mental health
awareness into the school district," "incorporate more mental health lessons in
the school district for students."
○ "Have more mental health services available in the district, not just from outside
agencies."
○ Suggestions for hiring dedicated staff: "Social worker for elementary, middle
and high school. If funds are available, possibly look into hiring a mental health
worker as well for each school or work with contracting a school-based
program..."
● Improved School Staff Training and Responsiveness:
○ "More mental health training for staff members."
○ "Listen to what parents are saying. Parents know the children and what they hear
better."
○ "Re-educating staff on mental health. (Parents relayed negative experiences with
certain staff members)
● Addressing Systemic Issues (Stigma, Cost, Policy):
○ "I think students should have the ability to get services no matter if they can pay
for it or not."
○ Addressing the attendance policy for mental health appointments.
○ "Rule out mental health needs vs behavioral."
● Community Involvement:
○ "Involvement in more mental health community activities such as Out of
Darkness Walk (suicide)."
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Theme 4: School's Role in Supporting Students Seeking Help (Mixed Experiences)
● Limited Direct Assistance: When students did seek help, the school's direct
assistance in finding services was often "Not at all" or "Somewhat helpful not fully."
● Common School Resources Provided (When Available): "Information on
available mental health providers in the community" and "School counselor" were
the most common ways the school provided access or support.
● Desire for More Proactive and Integrated Support: Parents expressed a clear
desire for the school to be more actively involved and to have more in-house
resources rather than relying solely on external referrals.
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Appendix K
Thematic Coding, Parent Post Surveys
Theme 1: Perceived Importance and Growing Need for Services
● High Agreement on Importance: The vast majority of respondents strongly agreed
or agreed that "Mental health services are important for the overall well-being of
students" and "Social service programs are essential in supporting students facing
challenges outside of school." There was near-unanimous agreement that "There is a
growing need for mental health and social service support in our rural community."
This indicates a strong consensus among stakeholders about the critical role of these
services.
Theme 2: Gaps in Accessibility, Awareness, and Effectiveness
● Mixed Perceptions of Easy Access: Agreement was highly divided on the statement
"Students in our school district have easy access to mental health services when
needed." Many respondents disagreed or neither agreed nor disagreed, suggesting
that easy access is not consistently perceived across the district.
● Varying Awareness of Programs: Awareness of "different types of social service and
mental health programs" was also mixed, with responses ranging from "Strongly
Agree" to "Strongly Disagree," indicating inconsistent knowledge among the
community.
● Concerns about Effectiveness: A significant number of respondents disagreed with
the statement that "The mental health services offered by the school district are
effective in addressing student needs" and "The social service programs offered in
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collaboration with the school district are helpful for students facing challenges."
This points to a perceived lack of efficacy in current offerings.
● Communication Deficiencies: There was a strong tendency to disagree with the
statement that "School staff effectively communicate mental health resources
available to students and families, when needed," highlighting a critical
communication gap.
● Supportive Environment Doubts: The perception of the "school environment as
supportive of students seeking mental health help" also garnered mixed to negative
responses, with several disagreements and "neither agree nor disagree," suggesting a
less than fully supportive atmosphere.
Theme 3: Identified Barriers to Accessing Services
● Stigma and Bullying (Major Barrier): This emerged as a paramount concern.
Respondents explicitly mentioned "being bullied for seeking services," "fear of
being judged," and "being found out and bullied or harassed." The data on specific
barriers also showed that "concerns about confidentiality or stigma" were identified
as a "Major Barrier" by 20% of those who answered this question, and a "Significant
Barrier" by another 20%.
● Communication and Awareness (Significant Barrier): A lack of knowledge about
services ("knowledge of the services," "communication," "awareness of services")
was frequently cited. Specific barrier data revealed that "awareness about available
mental health or social service programs in the community" was a "Significant
Barrier" for 20% of respondents and "Somewhat of a Barrier" for 60%.
● Teacher/Staff Understanding and Support (Significant Barrier): Several comments
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highlighted concerns with a lack of staff awareness.
● Systemic and Practical Barriers:
○ Transportation and School Absences: Explicitly mentioned by some.
○ Cost: While not always a primary barrier, it was noted as "Somewhat of a
Barrier" (60%) or "Not a Barrier" (40%) among those who responded to this
specific question in this dataset.
○ Navigating the Process: "Difficulties navigating the process of getting help (e.g.,
referrals, paperwork)" was a "Significant Barrier" for 40% and "Somewhat of a
Barrier" for 20%.
○ Long Wait Times: This was identified as a "Major Barrier" by 20% and
"Somewhat of a Barrier" by 20%.
Theme 4: Suggestions for Improvement
● Increased Communication and Awareness: Suggestions repeatedly emphasized
"more knowledge and support from the school to let students know it is ok to seek
help," "electronic newsletter," and "agency fairs."
● Enhanced Staff Training:
● Better Follow Through: Many parents stressed the importance of consistent
follow-through to ensure every student receives the necessary assistance. Parents
expressed a strong desire for the school to take student needs seriously and prevent
any student from feeling overlooked, ensuring they receive the focused help they
deserve.
Theme 5: Experiences Seeking Help (Parents' Perspective)
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● Varied Access Points: For children who sought help in the past six months, access
primarily occurred via "Private therapist or counselor" and "Telehealth services."
One instance involved "onsite counseling through an outside facility" offered by the
school.
● Mixed School Helpfulness: The school's assistance in finding mental health services
was rated from "Not helpful" to "Very helpful." One positive experience highlighted
the university's free school-based counseling.
● Lack of School Resources Provided: Most parents indicated that the school provided
"None" of the listed resources during their search, though one mentioned "onsite
counseling through an outside facility" and another "information on available mental
health providers." This aligns with the perceived communication gap, as these
resources are available.
i
Bridging the Gap: Implementing a Multi-Stakeholder Approach to Enhance Mental Health
and Social Service Initiatives in a Rural School District
A Doctoral Capstone Project
Submitted to the College of Education, Arts and Humanities
Department of Education
In Partial Fulfillment of the
Requirements for the Degree of
Doctor of Education
Denelle R. Diehl
Pennsylvania Western University
July 2025
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Dedication
The public education system seeks to nurture one of the extraordinary forces
within this universe, the human mind. Careful care and cultivation of curiosity, creativity, and
critical thinking by educators have helped cured diseases, advanced society through innovation
and ingenuity, and even put a man on the moon. Beyond these complex formulas and
mathematical calculations, the essence of the human experience has been captured and replayed
in stories, music, screenplays and poetry. The human mind responsible for the creation of it all.
While this complex network is powered by impersonal compounds and mere electricity, it is
capable of housing the full spectrum of human emotions, from the bounty that love brings to the
depths of despair. From the impersonal, comes the idiosyncrasies of each individual and the
nuances of a unique personality.
Despite its near limitless potential, the human mind is equally as capable of limiting its
own possibilities. Without proper care, the human mind can extinguish the very gifts that make
this world a better place. This work is dedicated to those who bravely and diligently seek care to
protect this asset which is most dear to each of us, particularly students who face mental health
challenges in their formative years.
Throughout the course of this study, this purpose has not been forgotten, nor has the
memory of those gone too soon….
Help is available for those in crisis. If you or someone you know are experiencing
feelings of despair or suicidal ideation, please call or text the National Suicide Hotline at 988.
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Acknowledgements
I have learned that the simple practice of gratitude has a very profound and positive impact on
overall wellbeing. As this project draws to a close, my heart is full when I reflect upon the village who
have walked this path with me. In one way or another, you have each taught me how to better lead with a
tough skin and a tender heart…
To Dr. Mary Wolf, thank you for your careful and considerate guidance that you have provided
each step of the way on my leadership and doctoral journey. The care for your students and the betterment
of public education as a whole, is evident in all you do!
To Dr. Jerry Shoemake, thank you for giving of your time, knowledge and expertise in helping
me to realize the completion of this project and for the practical advice in helping me apply the lessons
learned each day at Tussey Mountain.
To Dr. Maria Scott-Bollman, thank you for, despite being firmly retired, agreeing to be my
“teacher” one last time. You continue to model what it means to be not only a caring educator, but what it
means to be a woman who leads with grace, confidence and intelligence in this industry.
To Bill Denny and Matt Goddissart, thank you for guidance and expertise with editing and
formatting and helping me to make this project the best it could be.
To Amy, thank you for walking with me from the darkness into light and continuously reminding
me that prioritizing self, enables care for others.
To Jacque, Robin and Brenda, thank you for the many pep-talks and days when we dared to
dream of something bigger for our students. I am lucky to have each of you as co-workers and even more
fortunate to count you as friends.
To my family, Mom, Dad, Darcee, Kyle, and Tera, thank you for always being my
cheerleaders, practical advice-givers, and a source of constant encouragement.
And to my JD, thank you for always reminding me to see that in every situation, even perceived
problems, flaws and insecurities that there is something to love and there is something to use. You bring
me (and Finn) joy, a sense of peace, and laughter each day. We love you dearly!
ENHANCING MENTAL HEALTH SERVICES
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Table of Contents
Signature Page
ii
Dedication
iii
Acknowledgements
iv
List of Tables
ix
List of Figures
x
Abstract
xi
CHAPTER I: Introduction
1
Background
2
New Mental Health Initiatives
3
Presentation of Research Questions
5
Data Collection & Participants
6
Financial Implications
7
Chapter Summary
8
CHAPTER II: Review of Literature
10
The Pennsylvania Youth Survey
10
Evolution of the Pennsylvania Youth Survey: History & Development
12
Pennsylvania Youth Survey: Purpose & Uses
The Impact of Risk & Protective Factors for Students
16
18
Relationship Between Risk Factors, Protective Factors & Student Outcomes
21
Impact of the COVID-19 Pandemic and Social Media on Risk and Protective
24
Factors
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Student Wellbeing, Challenges and Relationship to School Achievement
30
Debate: The School’s Role in Supporting Adolescent Mental Health
36
Current Challenges, Opportunities, Barriers and Programming Models
39
Parent Perspectives
45
47
CHAPTER III: Methodology
50
Study Purpose
51
Research Setting & Context
53
Chapter Summary
Student Risk & Protective Factors within the Tussey Mountain School District
Selection of Research Participants
54
62
Research Question One: Student Surveys
62
Research Question Two: Student Interviews
62
Research Question Three: Parent Surveys
63
63
Research Methods & Data Collection
Research Question One: Data Sources & Collection Methods
64
Research Question Two: Data Sources & Collection Methods
65
Research Question Three: Data Sources & Collection Methods
65
Fiscal Implications
66
Validity
66
67
CHAPTER IV: Data Analysis & Results
70
Use of Data Triangulation
70
Chapter Summary
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Research Question One: Data Analysis & Results
71
Results: PhenX School & Protective Factors Tool Kit
72
Results: Phen X School Social Factors Tool Kit
78
Results: Discipline Data
84
86
Research Question Two: Data Analysis & Results
88
Results: Quantitative & Qualitative Summary of Student Interviews
89
Results: Chill Room Usage Data
Research Question Three: Data Analysis & Results
92
Results: Parent Pre Surveys
93
Results: Parent Post Surveys
100
Comparison: Pre & Post Surveys
107
109
CHAPTER V: Conclusions & Recommendations
113
Research Question One: Conclusions
114
Impact on Risk Factors
115
Impact on Protective Factors
117
Recommendations for Future Research
119
Chapter Summary
Research Question Two: Conclusions
120
Student Reports of Awareness
121
Student Reports of Access
122
Student Reported-Barriers
123
Recommendations for Future Research
124
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Research Question Three: Conclusions
124
127
128
Recommendations for Future Initiatives at the Tussey Mountain School District
129
Financial Implications
130
Closing
132
References
134
Appendix A: Institutional Review Board Documentation
144
Appendix B: Survey Informed Consent Letter
145
Appendix C: Student Assent Statement (Surveys)
149
Appendix D: Informed Consent (Interviews & Surveys)
151
Appendix E: Student Assent Form (Interviews)
154
Appendix F: Student Interview Script
156
Appendix G: Informed Consent (Parent Surveys)
158
Appendix H: Parent Survey Questions
161
Appendix I: Thematic Coding, Research Question Two
165
Appendix J: Thematic Coding, Parent Pre Surveys
168
Appendix K: Thematic Coding, Parent Post Surveys
173
Recommendations for Future Research
Limitations
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List of Tables
Table 1. Depressive & Suicidal Ideation Reports in the Tussey Mountain School
District, 2021
55
Table 2. Depressive & Suicidal Ideation Reports in the Tussey Mountain School
District, 2023
56
Table 3. PhenX Protective Factors Pre and Post Survey Results
73
Table 4. PhenX School Drug Environment Pre and Post Survey Results
75
Table 5. PhenX School Social Factors Pre and Post Results
78
Table 6. Phen X School Social Factors Sub Domains
80
Table 7. Perceived Exclusion and Privilege
84
Table 8. School Disciplinary Data
86
Table 9. Chill Room Usage Data
87
Table 10. Parent Pre-Survey Mental Health Service Perceived Importance &
96
Accessibility
Table 11. Barriers Reported in Parent Pre Surveys
100
Table 12. Parent Post-Survey Mental Health Service Perceived Importance &
103
Accessibility
Table 13. Barriers Reported in Parent Post Surveys
106
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List of Figures
Figure 1. PAYS Risk & Protective Factors
22
Figure 2. CDC Tiered Service Model for Mental Health Services in Schools
41
Figure 3. Tussey Mountain School District, Risk Factors, 2023 Pennsylvania Youth
Survey
59
Figure 4. Tussey Mountain School District, Protective Factors, 2023 Pennsylvania
Youth Survey
60
Figure 5. Sources of Support for Tussey Mountain Students
61
Figure 6. Emotional Thermometer
86
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Abstract
This action research project explores the critical issue of student mental health challenges, which
have been exacerbated by the COVID-19 pandemic, within the Tussey Mountain School District,
in rural Pennsylvania. In this school and on the national scale, rising rates of depression, anxiety,
and suicidal ideation reported have negatively impacted student achievement as well as overall
wellbeing. This study aimed to investigate stakeholder perceptions regarding the efficacy and
accessibility of district-initiated mental health and social service programs (such as the Chill
Project), identify barriers to service delivery, and assess the school's role in supporting student
mental health. Specifically, this action research project investigated: 1) the impact on
self-reported risk and protective factors before and after program implementation; 2) effective
strategies and existing barriers for students accessing mental health services; and 3) the impact
on parent perceptions regarding program availability. A mixed-methods approach was utilized,
using surveys, interviews, discipline data, and Chill Room usage data. This research aimed to
inform programming improvements and refine the school's role in addressing adolescent mental
health needs in this rural Pennsylvania district. Findings of the study indicated a significant
reduction in student-reported risk factors, as well as an increase in positive connection to the
school community and other specific protective factors. Among the parent group, there was
significant variance in perceptions. Parent surveys indicated general support for mental health
services in schools but also highlighted concerns about communication and clarity regarding
program specifics. These results will be used to impact district programming recommendations
moving forward.
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CHAPTER I
Introduction
In the five-year period following the COVID-19 pandemic, most students have
returned to school. This transition, however, has not been without some challenges, with
many education and mental health professionals noting more prevalent and more
pronounced mental health needs and challenges within the student population. The
pandemic has exacerbated existing mental health concerns among students, while
simultaneously increasing the need for mental health services. In fact, at any given time
approximately 20% of school-age youth are actively meeting the criteria for a mental
health disorder (Garret et al., 2022). Moreover, by grade 7, up to 40% of students will
have experienced a mental health issue at some point in their lives.
Schools can play a vital role in addressing these challenges by providing universal
supports and targeted interventions. The National Alliance on Mental Illness (2024) has
identified schools as being well-positioned to improve student access to mental health
services by removing barriers to care such as transportation, scheduling, and stigma.
Currently, almost half of all students receiving mental health care are doing so at school.
The National Alliance on Mental Illness (NAMI) finds that schools can effectively
support mental health with staff and student training to recognize mental illness risk
factors; provide direct services with mental health professionals, such as counselors and
psychologists; and refer students and families to community-based resources.
Obstacles, however, such as limited resources, staff training, and parental
concerns hinder effective implementation of these programs. Productive collaboration
between schools and parents is crucial for successful mental health support programs,
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requiring open communication, shared decision making, and culturally sensitive
approaches. While research highlights the potential of schools to improve student mental
health, further research is needed to understand student and parent perspectives on the
accessibility and efficacy of these programs. There is also some question regarding the
school’s role in the delivery of these services, with some parents, community leaders and
even school administrators indicating that there are questions about how involved the
school should be when it comes to student mental health.
Background
Access to much needed mental and behavioral health services is limited for the
adolescent population, particularly in rural areas. The Tussey Mountain School District is
situated in rural Bedford and Huntingdon Counties in southwestern Pennsylvania.
Serving just over one-thousand students presents a unique challenge to school
administrators as community resources and partnerships may differ, depending on the
student’s county of residence. Furthermore, the school’s comprehensive plan from 2020
identifies limited community resources as a central challenge to student achievement
(Tussey Mountain School District, 2020).
In reviewing specific district challenges, student responses to the Pennsylvania
Youth Survey (PAYS) are of particular interest. During the 2020 administration of the
survey, 50-60% of students at the middle/ high school, “felt sad or depressed most days in
the past twelve months” (Pennsylvania Commission on Crime and Delinquency et al.,
n.d.). Even more concerning were the reports of students who considered, planned or
attempted suicide. During this administration of the PAYS, over 46% of the senior class
“seriously considered suicide”, 33% “planned an attempt”, and 25% “attempted suicide”.
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About 33% of sophomores participating in the survey also reported considering and
attempting suicide (Pennsylvania Commission on Crime and Delinquency et al., n.d.).
Student reports of substance abuse also exceeded the state averages for alcohol,
marijuana, abuse of prescription medications, use of over-the-counter medications (to get
high), cocaine, methamphetamines, hallucinogens, and other synthetic drugs. During this
administration of the PAYS survey, over 70% of seniors reported using alcohol at some
point in their lives (Pennsylvania Commission on Crime and Delinquency et al., n.d.).
Sadly, during the 2023-2024 school year, two students enrolled at Tussey
Mountain High School died by suicide. Since these tragic events, there has been renewed
public interest in support available to students through district programming, as well as
district initiatives (Watson, 2023). In reviewing these concerns, there is a perception
among many stakeholder groups that student needs are not being met through existing
social service programming, mental health programming, or behavioral health supports
available inside and outside of the school district.
New Mental Health Initiatives
During the 2024-2025 school year, several new mental and behavioral health
initiatives were implemented in the school district. The Tussey Mountain School District
used grant funding from the Pennsylvania Department on Crime and Delinquency to
partner with Allegheny Health Network (AHN) in order to bring the Chill Project to
students who were enrolled at the shared middle/high school. The Chill Project has
enabled the school district to provide students and staff with access to additional mental
health professionals, beyond those directly employed by the district. “The Chill Project
features dedicated professionals, a calming space, and regular instruction to help every
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member of a school’s community better handle pressure and anxiety” (Allegheny Health
Network, 2024, para. 1).
The district has also begun to implement a teen Mental Health First Aid (tMHFA)
program with select staff and all tenth-grade students. tMHFA is an evidence-based
program that teaches students in grades 10-12 “how to identify, understand, and respond
to the signs of mental health and substance abuse challenges among their friends and
peers” (National Council for Mental Wellbeing, n.d., p. 2).
Additionally, interest among the Tussey Mountain student body in raising
awareness of mental health issues, led to the inception of Students Empowering Mental
Health Awareness (SEMHA). In his presentation to the Tussey Mountain School Board
of Directors, SEMHA President, Barrett Brode (2024) said that:
The Tussey Mountain Student Empowerment of Mental Health Awareness Team
was formed by students for the betterment of student mental health by promoting
positive interactions and supporting students with opportunities to discuss their
mental health with peers and/or individuals that can further assist them in the
mental health journey. The Tussey Mountain Student Empowerment of Mental
Health Awareness Team works to promote good mental and physical health, as
well as good decision making. (slide 2)
This group of students hopes to impact their school in the following ways:
● “Making the school a brighter and more positive place to learn”
● “Educating students about good decision making”
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● “Educating parents, community members, and teachers about mental
health”
● “Supporting fellow students through their struggles”
● “Providing students with the space they need to get through the school
day”
● “Supporting teachers and school staff” (Brode, 2024, slide 3)
Presentation of Research Questions
The Chill Project, tMHFA, and SEMHA indicate the school district’s commitment
to provide students with quality services, an infrastructure of social support, and mental
health services through strategic partnerships with many community agencies. These
programs are aimed at connecting students with the resources they need to be successful,
academically, and otherwise. During the implementation of these programs, research was
and is needed to determine the perceived effectiveness, accessibility, and knowledge of
available resources among parent and student stakeholder groups.
As the district implemented programs such as Teen Mental Health First Aid and
the Chill Project, this research project endeavored to engage student and parent
stakeholder groups to study the impact of programming on risk and protective factors,
identify strategies for overcoming barriers to services, and the perception of parents on
program availability. Specifically, this research sought to answer these questions:
Research Question 1: What was the impact on self-reported risk factors and
protective factors before and after the implementation of mental and social service
programming initiatives?
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Research Question #2: What strategies, as reported by students, were effective for
helping students access mental and behavioral health services through their school, and
what barriers existed?
Research Question #3: What was the impact on parent perceptions regarding the
availability of mental health and social service programming?
Ultimately, the project aimed to assess the effectiveness of newly implemented
mental health and social service programs in the district. It also explored how these
programs can be improved to better meet student needs.
Data Collection & Participants
For this project a mixed-methods approach was utilized. Because there were
various stakeholder groups involved in this study, a mixed-methods approach assisted in
gaining a more comprehensive picture of the research topic among the various
stakeholder groups to identify common experiences, challenges, and perspectives, as well
as potential areas of divergence or disagreement. Use of quantitative data helped validate,
as well as challenge, existing perceptions. The collection and analysis of qualitative data
in this study also helped establish a more complete context for the research, while
providing a lens through which research findings and implications could be interpreted.
The use of quantitative data allowed for a straightforward report of the results.
For this research, two stakeholder groups of research participants were included:
high school students and parents. Parents and guardians were surveyed before and after
the implementation of mental and behavioral initiatives to assess their perceptions of
student services, as well as any potential change in perceptions over time.
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For the student participant group, students completed pre- and post-surveys to
assess various risk and protective factors. This methodology was selected to determine
whether there was a change in student perceptions of safety, support, and connectedness
after the mental health programming was introduced/presented to students.
Additionally, students were interviewed to collect more detailed information
about student perceptions of program accessibility, needs or short-comings, and barriers.
Data specific to barriers and successes of district programming was collected through 1:1
interviews with student participants using a survey instrument developed by the
researcher. These student interviews also explored the perception of stigma, usage of
services, and program strengths.
Both survey data and interview responses were analyzed quantitatively to assess
the prevalence of student perception regarding the impact of various barriers and
effectiveness of implemented strategies and programming to remove them. Participant
responses were also analyzed using the thematic coding process for quantitative analysis
and triangulation. Data triangulation was completed using pre- surveys, post surveys,
one-to-one interviews, school discipline data, and Chill Room usage data.
Financial Implications
The costs of administering the current study were minimal. However, the financial
implications associated with the studied programming were significant. Philanthropic and
other grant funding were applied to cover the cost of the aforementioned new initiatives
for the current school year. The availability of grant and philanthropic funding, in
conjunction with the proposed capstone research project, provided the district with a
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unique opportunity to learn about various stakeholders’ perceptions of efficacy and
barriers before committing local funds to sustain these programs. This capstone project
helped the district make informed decisions about the future of programs such as the
Chill Project based on their impact.
Furthermore, the provision of grant and philanthropic monies to fund the project
for one year could help the district assess if savings elsewhere by implementing these
preventative initiatives. This offered the school district the unique opportunity to assess
the human, as well as the financial impact of programming before committing to
spending local tax dollars.
Chapter Summary
This study investigated the effectiveness of mental health and social service
programs within the Tussey Mountain School District, a rural Pennsylvania school
district. The COVID-19 pandemic significantly impacted student mental health, with
many experiencing increased anxiety, depression, and suicidal ideation. The district faced
challenges in providing adequate mental health support, such as limited district resources,
a high student-to-clinician ratio, and a lack of community resources. Despite these
challenges, the district implemented new programs such as the Chill Project and Mental
Health First Aid to enhance mental health support.
This study investigated the impact of these programs on student mental health,
assessed the accessibility of services, and explored parental perceptions of these
programs. A mixed-methods approach was selected using surveys, interviews, and
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analysis of locally collected discipline and Chill Room usage data, to provide insight into
the effectiveness of mental health programs in a rural school district.
The findings of this study and implication of the research can better inform future
efforts to improve student mental health outcomes. Furthermore, the results of this study
will be used to inform programming as well as budgeting decisions moving forward.
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CHAPTER II
Review of Literature
The Pennsylvania Commission on Crime and Delinquency suggests that by
tracking changes in student reports of risk and protective factors, the Pennsylvania Youth
Survey (PAYS) helps communities allocate resources to address pressing issues facing
today’s youth (Pennsylvania Commission on Crime and Delinquency [PCCD], 2024a).
The 2021 administration of the Pennsylvania Youth Survey within the Tussey Mountain
School District indicated high rates of depression, suicidal ideation, and substance abuse
among the student body (Pennsylvania Commission on Crime and Delinquency [PCCD]
et al., n.d.). Two student suicides during the 2023-2024 school year heightened district
and community concerns regarding the accessibility of mental health services (Watson,
2023). Due to the school district’s rural location, the studied school district has limited
community resources (Tussey Mountain School District, 2020). The school and
community face profound challenges in providing adequate support services in the wake
of the COVID-19 Pandemic and ensuing mental health crisis. These are not unlike those
reported on a national, and even global, scale following the COVID-19 pandemic (Jones
et al., 2021). As school leaders look to build programming aimed at building
social/emotional skills and building adolescent mental health, debates have emerged
regarding the school’s role in the delivery of such programming (Abrams, 2023).
The Pennsylvania Youth Survey
Various agencies within the Commonwealth of Pennsylvania have been surveying
students to gather data on middle and high school students’ attitudes and behaviors
related to various risk factors since 1989 (PCCD, 2024a; PCCD, 2024b). These surveys
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have taken place approximately every two years and have aimed to understand trends,
identify risk factors, and inform effective prevention strategies (PCCD, 2024a).
Generation at Risk surveys were the previous iteration of this. (Pennsylvania
Commission on Crime and Delinquency [PCCD], 2024c). When the Pennsylvania Youth
Survey (PAYS) replaced Generation at Risk Surveys, the survey measured not only the
prevalence of substance abuse but began to more robustly assess risk and protective
factors that influence youth behavior (PCCD, 2024c).
The PAYS has evolved over time, incorporating questions from existing surveys
like the Communities That Care Youth Survey (CTCYS), which was based on the work of
Hawkins et al.(1992) (PCCD, 2024c). Hawkins et al.(1992) examined risk and protective
factors, to evaluate various prevention strategies for high-risk groups, and proposed
recommendations for future research and practical applications. They found that the best
way to prevent adolescent drug abuse is to focus on risk factors. This involves identifying
these factors and then finding effective ways to address them. Applying this methodology
to both high-risk and general populations was beneficial in their controlled studies.
As indicated, the present version of the PAYS incorporates the work of various
researchers to provide school and community leaders with student-reported data to
address areas of need in the school community and at large (PCCD, 2024a). Further
review of the historical development of this survey provides context for understanding
the literature base of the survey, as well as a conceptual framework for analyzing survey
results according to risk and protective factors. This also may provide some historical
context for school leaders within the Commonwealth of Pennsylvania who seek to better
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define the role of the school in supporting the aforementioned mental health concerns,
post COVID.
Evolution of the Pennsylvania Youth Survey: History and Development
In 1989, Pennsylvania launched a statewide survey of public and nonpublic
school students to assess their attitudes and behaviors towards alcohol and other drugs
(Pennsylvania Commission on Crime and Delinquency [PCCD], 2024d). Funded by the
federal Drug-Free Schools and Communities Act of 1986, the Generation at Risk Survey
was part of the PENNFREE initiative, Governor Robert P. Casey's plan for a drug-free
Pennsylvania. The Drug Policy Council initially administered this survey.
The first survey was administered, anonymously, to students in grades 6, 7, 9, and
12, using the Primary Prevention Awareness, Attitude, and Usage Scale (PPAAUS)
(PCCD, 2024d). During this administration of the survey, the goal was to gather data on
drug use patterns among Pennsylvania youth and inform the development of effective
prevention programs. The Pennsylvania Commission on Crime and Delinquency (n.d)
reports that, at the time, the survey filled a critical information gap, as federal youth
surveys at the time were limited to high school seniors with outdated data. By providing a
comprehensive and statistically valid assessment of drug use among Pennsylvania youth,
the survey helped policymakers and educators tailor prevention efforts to address specific
needs and challenges of Pennsylvania students (PCCD, 2024d).
The Generation at Risk Survey was repeated in 1991, with some minor revisions
(Pennsylvania Commission on Crime and Delinquency [PCCD], 2024e). The
Pennsylvania Department on Crime and Delinquency states that “the 1991 survey
basically used the same survey instrument as the 1989 survey with some modifications”
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(PCCD, 2024e, para. 1). The most notable changes were the inclusion of three
substances: crack cocaine, anabolic steroids, and over-the-counter medications
“specifically taken to get high” (PCCD, 2024e, para 1). The Pennsylvania Commission
on Crime and Delinquency (2024e) notes that the 1991 A Generation at Risk survey
instrument maintained “excellent statistical reliability and validity” (para 1).
Administration of the survey continued in 1993, with the Pennsylvania
Commission on Crime and Delinquency (2024f) reporting that the survey had been
“continuously refined” (para. 1) since its inception, but the basic elements and structure
of the survey still remained. In 1993, however, the survey also included items from the
Youth Risk Behaviors Survey which was developed by the Centers for Disease Control
(PCCD, 2024f). Administration of the survey continued in 1995, with additional
questions assessing violence added (Pennsylvania Commission on Crime and
Delinquency [PCCD], 2024g).
In 1997, the Pennsylvania Commission on Crime and Delinquency began
administering the survey under its current name, Pennsylvania Youth Survey, with the
Pennsylvania Commission on Crime and Delinquency (PCCD) administering all surveys
since this time (PCCD, 2024b). However, in 1999, they did not administer the
Pennsylvania Youth Survey as scheduled, as the instrument underwent significant,
comprehensive revision (PCCD, 2024c).
In 1999, an advisory group representing the Pennsylvania Departments of Health,
Education, and Public Welfare and other state agencies including the Governor’s
Policy Office, the Children’s Partnership, Juvenile Court Judges’ Commission,
and the PCCD, identified the need for a new statewide survey. This new survey
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would measure the prevalence of the use of alcohol, tobacco, and other drugs,
while also assessing additional risk and protective factors that help shape youth
behavior. The risk and protective data could then be used to guide prevention
efforts, to help address existing problems, and to promote healthy and positive
youth development (PCCD, 2024c, para. 1).
For the purposes of the present study, these changes are notable as they provide a
historical context, as well as a research-based practice framework, for further examining
risk and protective factors when developing targeted prevention programming for
adolescents. It should also be noted that the advisory group substantially moved the
survey beyond the assessment of alcohol, tobacco, and other drugs (ATOD) to include a
more thorough examination of other risk and protective factors impacting Pennsylvania
youth.
The Pennsylvania Commission on Crime and Delinquency reports that these
changes had two objectives: first, to “estimate the prevalence of ATOD use and other
delinquent behaviors among middle school and high school students” and, second, to
“identify risk and protective factors that correlate with ATOD use and other delinquent
behaviors in order to inform prevention planning” (PCCD, 2024c, para. 7).
Administration of the PAYS continued in 2003, with some additional changes. The
2003 youth survey was similar to the one conducted in 2001; however, to make the
survey shorter and provide more options, they offered two different versions (PCCD,
2024g). One version focused on family factors through the use of 40 questions, while the
other included only one question about families. Schools could choose which version to
give to their students. For the purposes of the current study, the inclusion of survey
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questions related to families is notable, as this study explores parent perceptions, in
addition to the impact of extenuating external risk and protective factors beyond the
school community
It should also be noted that, for the first time, the 2003 survey included questions
about feelings of sadness, hopelessness, and worthlessness (PCCD, 2024g). They did not
include the results for these questions in the 2003 summary report.
Questions regarding students’ emotional state were again included in the 2005
administration of the PAYS with the results being reported at the conclusion of the survey
(Pennsylvania Commission on Crime and Delinquency [PCCD], 2024h). Other notable
changes in the 2005 survey were the inclusion of questions about gambling and the use of
prescription drugs for non-medicinal purposes. Schools could also choose to administer
the survey on paper or online, with about 10% of the surveys completed online that year.
Administration of the PAYS continued in 2007; while minimal changes were noted
to the content of the survey, significant changes to the scoring process enabled better
analysis of risk and protective factors according to demographics and grade level (PCCD,
n.d.). The Pennsylvania Commission on Crime and Delinquency (n.d.) reported that these
updates included changes to several risk and protective factor scales, including, “the
introduction of a new normative database, and changes to grade-level scoring” (para. 3 ).
PAYS reports issued that year (and in subsequent years) recalculated historical data related
to risk and protective factors, so that schools and communities could compare results over
time (PCCD, n.d.). These were the last notable changes to the scoring of the PAYS survey,
with regular bi-annual administrations occurring in 2009, 2011, 2013, 2015, 2017, 2019,
2020, 2021, and 2023 (PCCD, 2024a).
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In 2013, however, they made permanent changes to the structure of the study to
address differences in response rates at the beginning versus end of the survey (PCCD et
al., n.d). These changes have facilitated greater participation and collection of dataThis
was the last major structural change to the survey however over time, they added or
reworded some questions for clarity,to obtain more specific data.
Throughout its thirty-five-year history, the PAYS (and the Generation at Risk
Surveys) has evolved from assessing emerging trends related to alcohol, tobacco, and
other drug usage to providing a comprehensive assessment of youth behavior and risk
factors, as well as the protective factors surrounding them in their schools, homes and
communities. Upon completion of the PAYS, school leaders are provided with a detailed
report of the results, specific to their school and student population (PCCD et al., n.d.).
Pennsylvania Youth Survey: Purpose and Uses
The Pennsylvania Commission on Crime and Delinquency (2024) reports that:
Thirty years of Prevention Research has shown that current problems have
precursors–signs that point to what is likely to happen. PCCD uses programs that,
supported by evidence, impact these precursors either by limiting risk factors or
strengthening protective factors as identified in local communities. (para. 3)
In addition to providing each participating school and community with a detailed
report and analysis of PAYS surveys results in their community, the Pennsylvania
Commission on Crime and Delinquency, partners with several other public and private
agencies, including the Pennsylvania Department of Human Services, the Pennsylvania
Department of Education, the Pennsylvania Department of Drug and Alcohol Programs
and the Edna Bennet Pierce Prevention Research Center, through PennState University’s
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College of Health and Human Development. This facilitates the identification and
implementation of evidence-based programming in response to identified areas of need
through its PAYS Guide (PennState College of Health and Human Development, 2020).
This guide provides structured discussion points to review and analyze student
data for school and community leaders and a framework for implementing
evidence-based action plans in identified areas (Penn State College of Health and Human
Development [HHD], 2020). By pairing an individual school or community’s PAYS
results with this guide, leaders can identify areas of need, develop targeted interventions,
evaluate the effectiveness of these interventions over time, and track trends in the data
(PCCD et al., n.d.; Penn State College HHD, 2020). Beyond programming decisions,
PAYS data could be used to advocate for additional resources, support existing
school-based prevention programs and provide data to inform policy decisions at local
and state levels.
The PAYS Guide provides school and community leaders a framework for
accomplishing these objectives through the completion of detailed steps identified within
six modules (PennState College HHD, 2020):
● Module 1- Form Your Team and Analyze Data
● Module 2- Determine Targets and Priorities
● Module 3- Conduct Resource Assessment
● Module 4- Explore Evidence Based Programs
● Module 5- Create an Action Plan
● Module 6- It PAYS to Know…It PAYS to Share (Resources for community
engagement and sharing of data)
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This framework provides school and community leaders with actionable and
evidence-based resources to be responsive to identified risk and protective factors in their
schools and communities, and engage other stakeholder groups, in response to the PAYS
(PennState College of Health and Human Development, 2020).
Understanding the development of the PAYS, its implications, and practical uses
are salient to the current research as it provides context to the studied school district as
well as the evolution of programming within the Commonwealth as a whole. It also
provides historical context as school leaders seek to define their role in supporting at-risk
youth for better outcomes, academic and otherwise. Both PAYS reports and the PAYS
Guide appear to be valuable tools for schools and communities to address mental health
and social service needs, improve student outcomes, and promote positive, adolescent
development. This is largely done by providing leaders with self-reported student data
related to risk and protective factors.
The Impact of Risk and Protective Factors for Students
As summarized in the previous section of this literature review, much of the
evolution of the PAYS has centered around the addition and more detailed analysis of risk
and protective factors in Pennsylvania youth. By understanding what risk and protective
factors are and how they have the potential to impact student outcomes (positively or
negatively), educators, parents, community members, and school and community leaders
can work together to create supportive environments that promote positive outcomes for
students (PCCD, 2024i).
Risk factors are conditions or experiences that increase the likelihood of negative
outcomes in students, such as academic difficulties, behavioral problems, or substance
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abuse (Fraser, 1997; Substance Abuse and Mental Health Services Administration
[SAMHSA], n.d.). Fraser (1997) notes that:
Risk factors that occur or exist at one moment in time, such as a stressful life
event, may be useful in determining the risk status in children, but provide little
information about how or why a child came to be at risk. (p. 13)
Examples of common individual risk factors for students may include learning
disabilities, substance abuse, mental health problems, and negative self-esteem (Fraser,
1997). Common family risk factors may include family dysfunction, parental substance
abuse, and lack of parental involvement. School risk factors include poor academic
performance, negative school climate, and lack of support services. Community factors
which place students at higher risk for negative outcomes include limited employment,
limited access to education, poverty, and discrimination.
Fraser (1997) also contends that identified risk factors can have a compounding
impact and makes the distinction between risk factors and risk processes. “Risk processes
refer to the mechanisms whereby a risk factor contributes overtime to heightened
vulnerability” (Fraser, 1997, p. 13). For risk processes, Fraser provides the example that
poor parenting practices or an inadequate supervision/response to a child’s behavior at
home may contribute to noncompliance or behavior issues in other settings.
Several studies have shown that the presence of a risk factor does not necessarily
mean a negative outcome for the student. In fact, supportive adults, both at home and
within the school system, can serve as protective factors which mitigate risk for students
(Masten et al., 2008; Vanderbuilt-Adriance & Shaw, 2008).
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Fraser (1997) identifies that some conditions or experiences can buffer the
potential impact of risk factors and increase the likelihood of positive outcomes. While
some scholars make a distinction between protective (external) and resilience (internal to
the child) factors, Fraser (1997) defines protective factors as “both the internal and
external factors that help children resist or ameliorate risk” (p. 16). Individual protective
factors for students include high intelligence, positive self-esteem, resilience, and strong
coping skills (Fraser, 1997).
SAMHSA (n.d.) identifies protective factors as “characteristics associated with a
lower likelihood of negative outcomes or that reduce a risk factor’s impact. Protective
factors may be seen as positive countering events” (SAMHSA, n.d., para. 4). The impact
of protective factors is the subject of much research.
Vanderbuilt-Adriance and Shaw (2008) found that supportive family
relationships, particularly in early childhood, in addition to parental involvement and
positive role models, improve the likelihood of positive outcomes for students. Their
study aimed to investigate the protective factors that help children from low-income
urban families overcome adversity and develop positive social adjustment. Specifically,
their study examined the impact of child IQ, parenting quality, parent-child relationship,
and parental relationship quality on children's social skills and antisocial behavior from
early childhood to early adolescence. Intelligence of the child, nurturant parenting, and
parent-child relationship quality were consistently associated with positive social
adjustment, even in the context of high neighborhood disadvantage
(Vanderbuilt-Adriance & Shaw, 2008).
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School systems may also offer protective factors to at-risk students. Masten et al.
(2008) found that schools with strong protective factors are characterized by positive
school climate, effective systems, and supportive teachers, and that these protective
factors can help students meet academic, physical and emotional needs. Masten et al.,
(2008) also noted that protective factors may also be found within the community.
Communities with robust proactive factors for children include strong social connections
and opportunities for community involvement.
These research studies provide specific examples of the interplay between risk
and protective factors. It is important to note that risk and protective factors interact in
complex ways and influence an individual's susceptibility to substance use and mental
health disorders (SAMHSA, n.d.). The presence of multiple risk factors can increase the
likelihood of developing these issues, while protective factors can mitigate their impact.
Each of these factors could influence one another (SAMHSA, n.d.).
Relationship Between Risk Factors, Protective Factors and Student Outcomes
By their very definition and as illustrated in the research reviewed in the previous
section, risk and protective factors are linked to student outcomes, academic and
otherwise. Fraser (1997), states that “no single event produces a negative outcome.
Rather, interactional processes shape behaviors and problems over time” (p. 13).
The Pennsylvania Commission on Crime and Delinquency also identifies the
relationship between risk factors to negative student outcomes and protective factors to
positive student outcomes (PCCD et al., n.d.). Figure 1, from PCCD illustrates these
relationships:
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Figure 1
PAYS Risk and Protective Factors
Note. This figure helps visualize the relationships between risk and protective factors to
various student outcomes, as illustrated by Pennsylvania Commission on Crime and
Delinquency, Pennsylvania Department of Drug and Alcohol Programs, & Pennsylvania
Department of Education. (n.d.)
At the federal level, government agencies have also sought to improve public
literacy and knowledge regarding the role and impact of risk and protective factors in
adolescents, as well as conceptualize the relationship between risk and protective factors
and the emergence of certain mental health conditions (youth.gov, n.d.). Youth.gov is a
U.S. government website created to support the development and well-being of
adolescents, by providing information from various government agencies and up-to-date
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research. When speaking of risk and protective factors and the relationship to positive
outcomes for adolescents, this resources identifies:
There are contextual variables that promote or hinder the process. These are
frequently referred to as protective and risk factors. The presence or absence and
various combinations of protective and risk factors contribute to the mental health
of youth. Identifying protective and risk factors in youth may guide the prevention
and intervention strategies to pursue with them. Protective and risk factors may
also influence the course mental health disorders might take if present.
(youth.gov, n.d., para. 1-2)
Youth.gov also provides a visual guide which identifies how various risk factors
(within the domains of the individual child; parent; or school, neighborhood, and
community) correlate to certain mental health conditions. For instance, risk factors such
as low self-esteem, family conflict, or school failure have been linked to anxiety
disorders; while poor social skills, parental depression, negative family environment, and
school violence have been linked to depression. A more comprehensive list of the
relationship of over sixty risk factors to the conditions of depression, anxiety, substance
abuse, schizophrenia, and conduct disorder can be found on the website (youth.gov, n.d.).
These resources provide a comprehensive review of various studies by various
government agencies and researchers of multiple risk and protective factors; however,
there are also numerous individual research studies which provide further insight into
how risk and protective factors relate to more specific student outcomes.
In a study exploring the relationship between risk and protective factors,
researchers analyzed data from 11,875 children aged 9 to 11 years and found that higher
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levels of mental health concerns in parents were strongly linked to increased mental
health concerns within their children (Zhang et al., 2020). Additionally, within this study,
higher socio-economic status was associated with better general cognition, executive
function, and lower behavioral inhibition in children. The study also noted that a positive
social environment and strong interactions were linked to better behavioral regulation
skills in children.
By understanding the interplay between risk and protective factors, school leaders
can develop more effective interventions to promote healthy child development, good
mental health and prevent substance use disorders (SAMHSA, n.d.). This is important,
especially in light of substantial changes to risk and protective factors for students in the
wake of the COVID-19 Pandemic.
Impact of the COVID-19 Pandemic and Social Media on Risk and Protective Factors
The impact of risk and protective factors became even more apparent in the
aftermath of the COVID-19 Pandemic. Changes associated with the pandemic
significantly impacted the lives of students worldwide, exacerbating existing risk factors,
and challenging the effectiveness of existing protective factors (Shah et al., 2020). Prior
to the pandemic, many students were already facing challenges such as poverty, family
dysfunction, and limited access to resources. When the pandemic introduced students to
new risk factors, such as isolation, economic hardship, and disruptions to education, Shah
et al. (2020) found that these factors appear to have exacerbated existing challenges,
impacted the social development of students, and led to negative mental health outcomes.
Furthermore, the pandemic strained existing protective factors, as families faced financial
difficulties, schools closed, and social connections were limited (Shah et al., 2020).
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When these risk and protective factors are considered within the greater context of
the COVID-19 Pandemic, there is evidence to suggest a profound impact on adolescent
mental health with increased rates of adolescent mental health disorder reported around
the globe as one of the most common changes to overall student well-being following the
pandemic (Chavira et al., 2022).
Jones et al. (2021) conducted a systematic review of sixteen peer-reviewed
research studies and found that the COVID-19 pandemic had pronounced, negative
impacts on adolescent mental health. The research team found that pandemic-related
stressors, such as social distancing and uncertainty, have been difficult for adolescents to
process, leading to increased rates of anxiety and depression. It was also noted that
pandemic limited social interactions, which led to decreased social support and
exacerbated feelings of loneliness and isolation. Moreover, the pandemic has placed
certain vulnerable groups at further risk for mental health challenges faced by
adolescents.
The literature review also indicated a more pronounced impact for those from
historically marginalized demographics, such as LGBTQ+ youth and those with
pre-existing mental health conditions (Jones et al., 2021). Since the start of the pandemic,
these individuals have experienced additional stressors related to discrimination,
isolation, and uncertainty about their future. Moving forward, the research suggests that
increasing access to mental health services, promoting social support networks, and
teaching effective coping strategies can help students face these increased challenges and
increase the likelihood of positive outcomes in the future (Jones et al., 2021).
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Additional studies suggest that other vulnerable populations may be at greater risk
for the emergence of mental health concerns, such as anxiety and depression, which
impact academic opportunities (Totsika et al., 2024). Totsika et al. (2024) investigated
school absence among children with neurodevelopmental conditions (intellectual
disability and/or autism) in the UK following the initial COVID-19 outbreak. A
significant portion of these children, 32%, missed 10% or more of school days. School
refusal and illness were the primary reasons for absence, with COVID-19-related
absences being less common. The study found that child anxiety was a significant factor
contributing to both overall absenteeism and school refusal, while hyperactivity was
associated with lower levels of school refusal but higher levels of school exclusion. A
positive relationship between parents and teachers was found to be protective against
various types of absence, indicating that adults in the school, home, and community can
help students through these challenges.
As the study concluded, the authors identified a path forward with these research
considerations in mind, “as we enter the post-pandemic recovery era, findings from the
present study would indicate a need to focus on child mental health, in particular anxiety,
and perceived level of unmet need as potentially substantial barriers to regular school
attendance. At the same time, findings highlight the potentially protective role of
parent-teacher relationships” (Totsika et al., 2024, p. 3006).
In addition to further exacerbating student risk factors, while simultaneously
disrupting the social safety networks which offer protective factors, the pandemic’s
impact on social media usage and habits has also had a pronounced impact on adolescent
mental health. The COVID-19 pandemic significantly increased social media usage, with
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a 61% rise in engagement during the initial wave (Fullerton & Anderson, 2021). During
the pandemic, many used social media to restore a sense of connection to others;
however, experts say that its usage had the opposite effect, contributing to depression and
anxiety.
Fullerton and Anderson (2021) report that frequent social media usage can
exacerbate a negative self-image by fostering comparison and perfectionism due to the
curated nature of social media, where users often present idealized versions of
themselves. This can lead to feelings of inadequacy and low self-esteem. Additionally,
the constant exposure to perfectly edited photos and seemingly flawless lives can
contribute to unrealistic expectations and negative body image (Fullerton & Anderson,
2021).
Beyond concerns with negative self-image, Fullerton and Anderson (2021) also
noted that misinformation propagated on social media increased stress and anxiety, as
users were faced with a near constant barrage of conflicting news and opinions, making it
difficult to discern fact from fiction, which led to confusion and fear.
Young et al. (2024) reported similar findings when analyzing recent data
published within the Centers for Disease Control’s 2023 Youth Risk Behavior Survey
(YRBS). With the inclusion of a question about social media usage, results of the survey
were able to provide the first national prevalence estimate of social media use among US
high school students (Young et al., 2024). Using additional data collected on the YRBS,
researchers were able to extrapolate additional data regarding the impact of social media
usage on student mental health.
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The survey data indicated that 77% of US high school students access social
media accounts multiple times a day (Young et al., 2024). Furthermore, frequent social
media use was linked to increased bullying victimization, mental health issues, and
suicide risk. These associations were particularly strong for female students and
heterosexual students. It was, however, noted that, for some marginalized groups,
especially LGBTQ+ students, social media can provide a sense of community and
support, potentially mitigating negative impacts (Young et al., 2024).
This analysis of the impact of social media usage is also consistent with research
which investigated longitudinal impact of the COVID‑19 pandemic on adolescents'
mental health/social emotional status, substance use, and digital media use (Shoshani &
Kor, 2024; Young et al., 2024). Shoshani and Kor (2024) found that over the course of
the pandemic, daily video game usage increased from 1.72 to 2.81 hours; total daily
screen time increased from 7 hours 25 minutes to 8 hours 32 minutes; and a large
proportion of participants (75%) were spending more than 5 hours a day on social media.
As the pandemic progressed and media usage increased, they observed significant
increases in reports of depression, anxiety, somatization (presentation of perceived
physical symptoms in response to psychological symptoms), and general distress
(Shoshani & Kor, 2024).
The study also showed there were significant increases in the prevalence of
tobacco, alcohol, and cannabis use among the participants. Overall, this research
indicates that the pandemic seems to have had a negative impact on the mental health and
digital media habits of the study participants, which showed a strong correlation to
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increased rates of substance use and problematic digital media consumption (Shoshani &
Kor, 2024).
Research surrounding the relationships between adolescent social media usage
and mental health is also drawing the attention of government officials (Arkin, 2024). In
2023, Surgeon General Vivek Murthy issued a warning about the link between social
media and mental health issues like depression and anxiety, advocating for a warning
label on social media platforms similar to those on tobacco products. In 2024, the United
States Senate Judiciary Committee held hearings regarding the safety of social media
usage and potential mental health harm to children. Further public concern was noted
earlier this year, when fourteen attorney generals (representing California, Illinois,
Kentucky, Louisiana, Massachusetts, Mississippi, New Jersey, New York, North
Carolina, Oregon, South Carolina, Vermont, Washington state and Washington, D.C.)
filed suit against TikTok, citing concerns that the company harms adolescent mental
health, collects data without appropriate consent, and uses such to build “addictive
features” into their platform. (Arkin, 2024, para. 4)
From the reviewed literature thus far, it is evident that pandemic and changes in
social media habits that followed have exacerbated mental health challenges among
students, increasing rates of depression, anxiety, and stress. Garret et al. (2022) reviewed
recent incidence and prevalence data and reported that between 2016-2020, the rate of
depression increased by 27% for students aged 13-17, while the rate of anxiety grew by
29% for students of the same age. Additionally, from 2019-2020, behavior and conduct
problems increased by 21%.
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The National Alliance on Mental Illness [NAMI] (2024) reports similar statistics
while also raising concerns about critical challenges for adolescents accessing care. They
report that one in six American teens experience a mental health disorder, with half of all
mental health conditions beginning by the age of 14.
Root causes of these increases are likely multi-faceted, such as increased risk
factors, diminishment of established protective factors, and ongoing changes in student
habits which do not promote mental health, such as social media usage. The reviewed
research indicates that there is some evidence to suggest that promoting positive
school-home connections, implementing programming that facilitates the development of
social-emotional skills, and increased access to mental health services in the school
system may each be a means of addressing these growing needs (Jones et al., 2021;
Totsika et al., 2024).
Student Wellbeing, Challenges and the Relationship to School Achievement
As schools look to address changing needs within their student populations
following the COVID-19 Pandemic, understanding the relationships between student
well-being, mental health challenges and student achievement/school performance is
important. Understanding these relationships can help school leaders provide focus to
educational programming initiatives and better define the school’s role and purpose in
supporting adolescent mental health.
Researchers have found links between student mental health and emotional
well-being to their overall academic success. A meta-analysis, which included fifty-one
existing studies was conducted to better understand the relationship between emotional
intelligence skills and academic performance (Somaa et al., 2021). The study specifically
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investigated three hypotheses: “ H1: There is a positive association of emotional
intelligence with academic performance” (p. 4); “H2: Academic performance is strongly
predicted by ability-based emotional intelligence” (p. 5); and “H3: There is a strong
association of emotional intelligence with academic performance at a younger age” (p. 5).
At the conclusion of this meta-analysis, a significant positive correlation was
found, indicating that higher emotional intelligence is associated with better academic
performance. Statistical analysis indicates support for all three hypotheses, with the
strongest effect size noted for hypothesis one. While there is much evidence to suggest
that emotional intelligence is just one factor impacting academic achievement, at the
conclusion of the study the authors stated, “to date, there is ample evidence suggesting
that academic performance and emotional intelligence are intimately connected” (Somaa
et al., 2021, p. 13)
The Chicago Longitudinal Study (CLS) also found strong evidence that early
social-emotional skills, such as self-regulation, are powerful predictors of later academic
achievement, even after controlling for socioeconomic status and cognitive abilities, over
the course of a child’s entire educational experience (Reynolds, 1999). The CLS followed
a cohort of 1,539 students presenting with various risk factors such as neighborhood
poverty, low family socioeconomics, and other educational hardships from early
childhood into adulthood.
Within this study, researchers collected data on a variety of factors, including
cognitive development, social-emotional skills, academic achievement, and family
characteristics. The longitudinal design of the study allowed researchers to track changes
in children's development over time and to identify the factors that contribute to positive
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or negative outcomes. At the conclusion of the study, researchers found that
social-emotional skills are strong predictors of academic achievement (Reynolds, 1999).
Children who were able to regulate their emotions, pay attention, and get along
with others were more likely to succeed in school during the multi-year study (Reynolds,
1999). During this study, Reynolds (1999) also identified that high-quality early
childhood programs can have a significant positive impact on children's academic and
social-emotional development. These programs can help children develop important
skills like self-regulation, problem-solving, and social competence, which are crucial for
success in school and beyond.
In a separate longitudinal study, over 750 participants were studied using data
from a non-intervention group of high-risk children and a normative group of low-risk
children starting when the children were in kindergarten, with outcomes being assessed
over the next thirteen to nineteen years (Jones et al., 2015). Upon entry into the study,
kindergarten teachers were provided with ratings scales for each participant, measuring
the student’s social and self-regulation skills using an eight-item Likert scale. The
findings of this study indicated that there is a statistically significant positive correlation
between social emotional skills observed in kindergarten and outcomes in young
adulthood across all domains that were measured in the study, including, educational
attainment and success, employment, criminal activity, substance abuse and overall
mental health.
In this study, Jones et al. (2015) found that students who presented with better
prosocial skills in kindergarten were approximately 50% more likely to graduate on time
and 100% more likely to complete a college degree. The research team also found that
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the ratings scales completed by the teachers provided more significant predictive value of
future outcomes, compared to other metrics included in the study (Jones et al., 2015).
Furthermore, in a two-wave longitudinal study, aimed at understanding how
subjective well-being (life satisfaction, positive emotions, and low negative emotions)
affects academic engagement in high school students, researchers noted a connection
between higher life satisfaction and lower negative emotions with increased academic
engagement over time (Datu & King, 2018). Datu and King (2018) also found that initial
academic engagement was found to positively influence subsequent well-being. This
suggests a mutual relationship between student well-being and academic performance.
These longitudinal studies allowed researchers to observe and understand the
development of risk factors and impact of protective factors over time. However, it is also
valuable to review research which provides targeted and in-depth investigation into the
various stages of student development in a more focused manner. A review of data
collected in Baltimore City Schools, indicates that students in kindergarten who presented
with social or behavior deficits were significantly more likely to be suspended or
expelled, retained in a grade, or receive support through an Individualized Education
Program or 504 plan (Bettencourt et al., 2016). In this data review, Bettencourt et al.
(2016) reported concern that social or behavioral deficits were far more likely to impact
boys than girls and stated concern about possible inequities.
While most of the reviewed research thus far has studied the relationship between
social skills, emotional regulation, behavior, or student overall well-being on academic
performance, there is also a growing body of research to suggest that school-based
interventions, aimed at developing social emotional and coping skills may be effective in
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facilitating improvements in academic areas as well. In a meta-analysis of school-based
social and emotional learning programs reviewing data from 213 studies (which
researched over 270,000 students), researchers indicated that students who participated in
social-emotional learning programs improved standardized test scores by 11 percentile
points compared to those who did not (Durlak et al., 2011). The researchers in this
program stated that several programs or studies were excluded from the meta-analysis, as
they did not have systematic monitoring of program fidelity or student check-ins built
into their programming, suggesting a need for improvement in these areas
Furthermore, in a longitudinal study aimed at exploring program efficacy and the
relationship between social and emotional risk factors and academic performance during
the transition to secondary school, researchers specifically examined the relationships
between conduct problems and academic performance, the impact of depressive
symptoms versus the impact of anxiety symptoms on academic performance, and how
these factors may impact a student’s attitude toward school (Riglin et al., 2013). The
study also sought to identify specific actionable areas for improvement in the established
school-based programming.
Riglin et al. (2013) selected research participants in their first year of secondary
school for inclusion in this study, as they identified that this is often a significant period
of adjustment for students, which can be accompanied by increased psychological
difficulties and a decline in academic performance. Data was collected regarding
identified emotional problems (such as depression, general anxiety, and school anxiety);
student affect towards school (school liking and school concerns); and conduct problems
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or concerns. These data points were selected to better factors that could be targeted in
school interventions to optimize student academic potential.
The researchers found that, while existing interventions focused on bridging the
gap between primary and secondary education or supporting vulnerable students,
research data suggested the need to address additional risk factors (Riglin et al., 2013). In
this study, conduct problems, school liking, and school concerns emerged as key areas for
intervention. Conduct problems, particularly at the beginning of secondary school, were
strongly linked to later deficits in academic achievement. The study also found that
depressive symptoms, though not directly predictive of poor academic performance, may
be an early indicator of a downward trajectory, especially for boys.
At the conclusion of the study, Riglin et al. (2013) suggested that in addition to
universal support provided to all students may hold some benefit, there is a need to also
review student needs and offer tailored programming. The research team identified that,
while conduct problems and school liking may be universal targets, depressive symptoms
and school concerns could be more specific to boys, requiring tailored support for better
outcomes (Riglin et al., 2013).
Similarly, Hudesman et al. (2013) conducted a three-year longitudinal study with
students to learn more about the role of self-regulated learning and formative assessment
in student achievement.. At the conclusion of the study, there was a marked improvement
in student achievement for research participants who received interventions to improve
metacognition and self-regulation (Hudesman et al., 2013).
When the results of each of these studies are considered in relation to one another,
it is evident that strong social-emotional skills are a critical factor in academic success.
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The summarized research suggests that identifying and addressing mental health
challenges early on may hinder the development of more serious problems or mental
health, while improving academic outcomes. These skills may help students manage
stress, build positive relationships, and stay focused on their studies, even in the presence
of other challenges and risk factors.
On the other hand, mental health issues, such as depression and anxiety, can
significantly hinder academic performance. School-based interventions that promote
social-emotional learning are effective in improving both mental health and academic
performance.
Debate: The School’s Role in Supporting Adolescent Mental Health
Despite overwhelming evidence of the impact of risk and protective factors
(inside the school system), as well as a robust body of data suggesting more prevalent and
complex mental health needs in the adolescent population today, there is still
considerable debate among stakeholder groups regarding the school’s role in facilitating
access to mental/behavioral health and social services (Abrams, 2023). Therefore, it is
important to explore the perceptions of some stakeholder groups in supporting adolescent
mental health as well as the school’s responsibilities to students to ensure accessible
education services, according to historical precedents and current practices.
The relationships between risk and protective factors and academic outcomes
raises societal questions regarding how a school should respond to factors directly
impacting the accessibility and effectiveness of a child’s education, their chief role. After
studying the impact of social emotional learning programs and the relationship to student
achievement and exploring the school system at large, Durlak et al. (2011) stated:
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37
There is broad agreement among educators, policy makers, and the public
that education systems should graduate students who are proficient in core
academic subjects, able to work well with others from diverse
backgrounds in socially and emotionally skilled ways, practice healthy
behaviors, and behave responsibly and respectfully. (para. 3)
Current policies and practices within Pennsylvania, as well as on the national
scale suggest some expectation that schools are to be responsive to student mental health
concerns in their program design, which is consistent with Durlak et al. 's characterization
of “broad agreement among educators, policy makers, and the public”.
Within the Commonwealth, the Pennsylvania Department of Education has
released the Pennsylvania Career Readiness Skills and Continuum. This is a framework
designed to help students develop the social and emotional career skills they need to be
successful in the 21st-century workforce (Pennsylvania Department of Education,
2024a). Specific skills are identified on the continuum according to three broad areas:
self-awareness and self-management (skills related to understanding and managing
emotions, setting goals, and responding effectively to challenges; social awareness and
interpersonal skills (skills related to building and maintaining positive relationships,
communicating effectively, and resolving conflicts; and responsible decision-making
(skills related to making informed choices, problem-solving, and critical thinking).
This framework indicates that schools in Pennsylvania have a responsibility to
their students to provide instructional services and programming to develop skills in these
areas to promote social-emotional skills which lead to employment following graduation.
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Beyond direct instruction and programming to help students meet the standards
listed on the continuum, there is a historical precedent for working collaboratively with
community and government agencies to bolster protective factors to mitigate risk through
collaboration and supportive programs. The evolution of the PAYS survey in Pennsylvania
and the school’s continuous role in administering it, strongly suggests that schools play a
crucial role in supporting adolescent mental health, wellbeing, and healthy development
and has for nearly forty-years (PCCD, 2024a).
As discussed earlier, the PAYS Guide provides evidence-based identifying trends
and patterns school-specific data to tailor support services to address the specific needs of
their students (PennState College of Health and Human Development, 2020).
Administration of similar surveys and resources, at the federal level also suggest some
precedent for the school system playing a valuable role in supporting adolescent mental
health on the national scale as well (Young, 2024; youth.gov, n.d.).
Considering this, it should be noted that during the 2021-2022 school year, 49%
of public schools reported providing some form of assessment or diagnostic service for
mental health to their students and 38% reported offering some form of mental health
treatment (National Center for Education Statistics [NCES], 2022). Schools report
offering more services at the secondary level, compared to the elementary level.
Additionally, higher numbers of urban and suburban schools were able to provide
assessments or diagnostic services to their students, compared to rural schools (NCES,
2024).
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39
Current Challenges, Opportunities, Barriers and Programming Models
Early intervention is key to effectively treating mental health conditions in young
people (NAMI, 2024). The sooner a young person receives treatment, the better the
long-term outcomes and the lower the overall costs (NAMI, 2024). However, there is a
critical shortage of mental health professionals available to address a growing mental
health crisis. Even before the start of the pandemic, just half of the 77 million children
with treatable mental health conditions were receiving treatment. (Whitley & Peterson,
2019). Currently 70% of counties in the United States do not have any child
psychologists, with urban and rural counties being disproportionately impacted by this
shortage (McBain et al., 2018).
Quite often these critical shortages cause significant delays in accessing care,
with many young people waiting months or even years to receive help (NAMI, 2024).
Individuals aged 15-40 experiencing psychosis wait as long as a year and half before
receiving treatment. These delays can lead to worsening symptoms, making treatment
more challenging and expensive.
Schools can be exceptionally effective in providing more expedient delivery of
mental health services. NAMI (2024) identifies that “by removing barriers such as
transportation, scheduling conflicts and stigma, school-based mental health services can
help students access needed services during the school-day” (para. 3). Currently nearly
half of all students who are receiving mental health care do so in their school (NAMI,
2024).
The National Alliance on Mental Illness (2024) indicates that there are several
ways through which schools can support the mental health of their student population.
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40
Schools can support screening and early intervention efforts by training staff and students
to recognize risk factors, warning signs and symptoms of mental illness (NAMI, 2024).
Some schools may also opt to provide direct mental health services to their students by
hiring school counselors, school social workers, school psychologists, and school nurses.
Alternatively, or in conjunction with direct services provided by school staff, the school
district may refer students and families to community resources. The National Alliance
on Mental Illness (2024) reports that this collaborative approach between schools and
mental health providers can significantly improve access to care and ultimately, enhance
the mental well-being of young people.
The recommendations by the National Alliance on Mental Illness represent
various levels of intervention, as well as skill level to implement them, as they range
from screening efforts by teachers and peers to direct services provided by credentialed
mental health professionals (NAMI, 2024). Riglin et al. (2013) identifies universal
measures such as SEL instruction may not be enough to meet the needs of all students.
While studying psychological functioning and academic attainment, their research team
found that “there is great potential for schools to deliver interventions to support pupils
with psychological problems. Nevertheless, universal programs based in schools that aim
to prevent the development of psychological problems have had only limited success”
(Riglin et al., 2013, p. 41).
In fact, interventions are most effective when they are tailored to the specific
needs of the target population (SAMHSA, n.d.). The Substance Abuse and Mental Health
Services Administration (n.d.), identifies various types of prevention interventions that
may address various levels of need within the student population, including universal
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41
prevention interventions,which are designed for the general population to prevent
problems before they occur; selective prevention interventions, which target specific
groups at increased risk; and indicated prevention interventions which focus on
individuals already showing signs of a problem by providing counseling or therapy.
The Centers for Disease Control [CDC], 2024.) has identified a similar model,
based on tiered services of which school leaders and educators may have some level of
familiarity. Figure 2 from the CDC illustrates a tiered service model for mental health
supports in schools:
Figure 2
CDC Tiered Service Model for Mental Health Services in Schools
Note. In their action guide, (https://www.cdc.gov/healthyyouth/mental-health-action-guide/
index.html) aimed at assisting schools with developing programming to promote student
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42
mental health and wellbeing, the CDC identifies programs such as these that can be embedded
with existing MTSS framework that a school may already have implemented.
The Chill Project offers a tiered approach to providing social/emotional support
services, much like those described, to be implemented in schools (Allegheny Health
Network, 2024). Allegheny Health Network (2024) indicates that by providing a shared
language and practical skills, this program helps individuals identify, discuss, and
respond positively to stress, to reduce negative reactions which hinder learning and
growth.
Dedicated mental health professionals, calming spaces, and regular instruction are
key components of this initiative. Schools participating in The Chill Project have reported
decreased behavioral health incidents among students, improved well-being for educators
and parents, and enhanced mindful awareness and resilience across the entire school
community (Allegheny Health Network, 2024)
The program offers a range of services, including one-on-one counseling, support
groups, medication management, school-based outpatient services, school-wide
preventive services, professional development opportunities, social-emotional
curriculum, classroom consultations, and specialized support for student athletes
(Allegheny Health Network, 2024).
In an action-research study conducted at Northgate Middle/High School in
Pennsylvania, the Chill Project was identified as one of the primary interventions during
the study (Smith, 2022). This action-research project assessed the impact of
implementing social-emotional learning programs. The study aimed to determine if these
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43
interventions could improve the school's ability to address the needs of the whole child
and reduce the negative effects of childhood trauma and adversity (Smith, 2022).
The study involved administering surveys to teachers before and after the
implementation of the interventions. The surveys measured teachers' perceptions of the
school's implementation of whole-child design principles, their own ability to use
trauma-informed practices, and their overall satisfaction with the school climate (Smith,
2022). Additionally, data from Allegheny Health Network's CHILL Project was analyzed
to assess changes in faculty attitudes and practices related to student mental health. In this
study, the researchers hypothesized that the interventions would lead to increased faculty
capacity to implement trauma-informed practices, improved ability to meet the needs of
the whole child, and a more positive school climate.
At the conclusion of the study, it was determined that the interventions
administered within AHN’s Chill Project, could be effective in creating a positive school
climate and addressing the mental health needs of students. The study found that the
implementation of Whole-Child Design principles, an advisory program, and the Chill
Project led to increased alignment with Whole-Child Design practices. Additionally,
teachers perceived an increase in their ability to use trauma-informed practices, as well as
an improvement in the school's ability to meet the needs of the whole child (Smith,
2022).
While initiatives such as the Chill Project increase access to licensed
professionals and evidence-based programming, other intervention techniques aim to
build student capacity at a universal (or tier one) levelTeenage Mental Health First Aid
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(tMHFA) is an evidence-based program that teaches students in grades 10-12 “how to
identify, understand, and respond to the signs of mental health and substance abuse
challenges among their friends and peers” (National Council for Mental Wellbeing, n.d.,
p. 2). This program is based on the notion that adolescents more often reach out to peers
than adults for support (National Council for Mental Wellbeing, n.d.).
In a randomized controlled trial of nearly two-thousand students, across four
schools, which evaluated the effectiveness of tMHFA compared to traditional Physical
First Aid (PFA) training, it was found that tMHFA was significantly more effective in
improving students' intentions to help peers with mental health issues, increasing their
confidence in providing support and reducing stigmatizing beliefs. These findings
suggest that tMHFA is a valuable tool for promoting mental health literacy and
encouraging help-seeking behavior among adolescents (Hart et al., 2018).
While evidence suggests that schools serving as an access point for varying levels
of mental health services or social/emotional interventions may help many students
overcome the barriers to care, school leaders report challenges associated with providing
mental health services within the school settingIn a 2021-2022 survey, half of public
school officials cited lack of access to licensed professionals or inadequate funding as
barriers to providing mental health services to their students (NCES, 2024). These appear
to be the most common barriers from the perspective of school officials. Policy and legal
disputes, concerns about parent reactions, lack of community support, and reluctance to
label students (for fear of stigmatization) were also reported as concerns (NCES, 2024).
These concerns and barriers may impact the extent to which a school is able or willing to
provide mental health services to its students.
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Parent Perspectives
While school leaders reported that inadequate access to mental health
professionals and funding concerns were their biggest barriers to offering mental health
programming to students, nearly ten percent of public schools surveyed cited concerns
about the reactions of parents as a factor that limited their ability to provide programming
to students in a more impactful way (NCES, 2024). In an article published to members of
the American Psychological Association, Abrams (2023), discusses the controversy
surrounding Social-Emotional Learning (SEL) programs in schools.
Lawmakers have proposed bills in at least eight states seeking to limit
social-emotional programming in schools, with many parents supporting this movement
(Abrams, 2023). Abrams (2023) identifies that, while SEL programs aim to teach
students interpersonal skills and emotional regulation, they have been targeted by
conservative groups who falsely associate social emotional programs with political
issues, such as critical race theory and gender diversity initiatives.
To address the concerns raised by critics, Abrams (2023) suggests several
strategies such as using clear, jargon-free communication and familiar terms when
communicating with parents about initiatives. Offering explanations of what SEL
programs are and how they benefit students can help resolve misunderstandings.
Abrams (2023) also identifies that focusing on practical outcomes, such as the
long-term benefits of social emotional programming (i.e. improved academic
performance and better social relationships) and including parents in the conversation, by
providing opportunities for dialogue and feedback could also be helpful in facilitating
productive school-parent relationships.
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There are several research studies which also suggest that when parents have a
clear picture of what social emotional programming or mental health services looks like
in their child’s school, oftentimes there is overwhelming support for these types of
initiatives (Searcy van Vupen et al., 2018).
Searcy van Vupen et al. (2018) studied over 600 parents to investigate their
perceptions on mental health services in rural schools in counties along the Eastern shore
of Maryland, noting that in their study, over 78% of parents agreed that schools should
address student mental health issuesIn this study, parents cited anxiety, depression, and
bullying were the top concerns for their children's mental health. Parents reported that a
lack of support for them along with a lack of mental health awareness, and programs
were key obstacles to delivering effective mental health support to students in schools. It
is important to note that this research study was prior to the COVID-19 pandemic.
Additional studies have indicated similar support for programs that support
adolescent mental health and social/emotional skills, while also underscoring the need for
dialogue between the school and parents (Longhurst et al., 2021). In a research study
exploring the perceptions of parents and caregivers of students who participated in a
school-based counseling program in the UK, several central themes emerged from the
interviews with parents and caregivers.
Longhurst et al. (2021) found that parents and caregivers generally appreciated
the school-based setting for counseling as it was convenient and familiar for their child.
However, many parents said that they wished for better communication from the school
regarding the program and their child’s progress. Confidentiality was also very important
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to parents whose children participated in the program. At the conclusion of the program,
many parents reported positive outcomes for their students.
When considering parent perceptions in the context of the school’s role in
supporting adolescent mental health, it is also important to consider the impact of culture
(Roy & Giraldo-García, 2018). Carefully and thoughtfully navigating these
considerations may help school officials and parents achieve better outcomes for
students. Roy and Giraldo-García (2018) found that parents who are involved in their
children's education and social-emotional learning tend to have children who do better in
school, especially when schools actively work to include parents in a culturally informed
way.
Despite these findings, there is limited empirical research available regarding
parent perceptions of social emotional learning and school-based mental health initiatives
post-Covid, as well as research centering on best practices to engage school-parent teams
that support adolescent mental health.
Chapter Summary
Many researchers have documented the correlation between certain internal and
external (or environmental) factors and their potential relationship to positive or negative
student outcomes. These are frequently referred to as risk and protective factors.
Understanding the interplay between risk and protective factors and processes may help
schools, families and communities partner together to build a network of protective and
resilience factors for better outcomes. Tools such as the Pennsylvania Youth Survey and
accompanying resources provide a framework for assessing and understanding risk and
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protective factors, within the context of a given school or community and equip schools
to more comprehensively understand the challenges faced by youth in their communities.
Following the COVID 19 pandemic, many students have continued to face
challenges related to academic loss, mental health issues, and economic hardship.
Furthermore, adolescent mental health concerns have increased since the COVID-19
pandemic for a variety of reasons. This has been coupled with a critical shortage of
mental health providers and services available to students.
Students face additional barriers in accessing mental health services such as
stigmatization, transportation concerns, lack of awareness of services, scheduling issues,
and financial complications. In the presence of these challenges, protective factors, such
as resilience, strong social supports, and access to mental health services can play a
crucial role in helping students recover from the pandemic's effects.
Research also found that schools can play a critical role in removing some of
these barriers by not only providing universal support to students, but by serving as an
access point for more intensive programming for students who are exceptionally at-risk.
There is evidence to suggest that more schools are offering some level of assessment or
even intervention to students to support their mental well-being.
As the needs of student populations are evolving and more schools implement
such programming, this has left many stakeholder groups such as school leaders, parents,
and students questioning the extent of the schools’ role in supporting adolescent mental
health. School leaders have cited insufficient access to trained professionals, funding,
outdated policies, parental reactions, community support and stigmatization as frequent
concerns.
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Currently, there is a limited body of literature regarding parent and student
perceptions of social-emotional learning and mental health program initiatives in schools
post-Covid. There are some reports that suggest that some parents may have
misconceptions about social/emotional learning or mental health services in schools,
associating these programs with other controversial topics. Parents may worry that
social/emotional learning programs are designed to indoctrinate students with specific
beliefs or values.
However, research clearly indicates better outcomes for students when parents
and schools work collaboratively to meet student needs. To achieve a healthy
working-relationship schools should provide clear and accurate information programming
to parents, involve them in decision-making processes, provide regular communication
about district initiatives and opportunities for parents to elicit feedback. Being mindful of
cultural differences can ensure that programs are culturally sensitive and inclusive.
Although experts have recognized the potential of the school system to act as an
access point for students to access needed mental health services, there is limited data
available regarding student and parent perspectives of program accessibility and efficacy.
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CHAPTER III
Methodology
From the review of literature, it is evident that various researchers have identified
well-established correlations between certain internal and external (or environmental)
factors and their potential relationship regarding positive or negative student outcomes.
These are frequently referred to as risk and protective factors (Fraser, 1997).
Understanding the interplay between risk and protective factors and their associated
processes may help communities and school leaders build a network of protective factors
to achieve better outcomes for students. In Pennsylvania, tools such as the PAYS and
accompanying resources provide a framework for assessing and understanding risk and
protective factors, within the context of a given school or community and equip schools
to more comprehensively understand the challenges faced by youth in their communities
within the state of Pennsylvania (PennState College of Health and Human Development,
2020).
These tools are particularly useful in addressing challenges following the
COVID-19 pandemic. Many students have continued to face challenges related to
academic loss, mental health issues, and economic hardship (Shah et al., 2020). Increased
instances of mental health concerns have emerged since the pandemic. This has been
coupled with a critical shortage of mental health providers and services available to
students (Whitley & Peterson, 2019). Students may face additional barriers in accessing
mental health services such as stigmatization, transportation concerns, lack of awareness
of services, scheduling issues, and financial complications (NCES, 2022).
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As indicated, protective factors (such as resilience, strong social supports, and
access to mental health services) play a crucial role in helping students recover from the
pandemic's effects. Research has determined that schools can play a critical role in
removing some of these barriers through not only providing universal support to students,
but by serving as an access point for more intensive programming for students who are
exceptionally at-risk (CDC, 2024). Furthermore, there is evidence to suggest that more
schools are offering some level of assessment or even intervention to students to support
their mental well-being.
As the needs of student populations evolve and more schools implement such
programming, many stakeholder groups such as school leaders, parents, and students
have begun to question the school’s role in supporting adolescent mental health. School
leaders have cited limited access to trained professionals, funding, outdated policies,
parental reactions, community support and stigmatization as frequent concerns. These
research findings reported within currently available literature are consistent with
contextual factors also observed and noted within the Tussey Mountain School District in
rural Pennsylvania.
Study Purpose
Currently, there is a limited body of literature regarding parent and student
perceptions of social-emotional learning and mental health program initiatives in schools
post-Covid. Some reports suggest that some parents may have misconceptions about
social/emotional learning or mental health services in schools, associating these programs
with other controversial topics. Parents may worry that SEL programs are designed to
indoctrinate students with specific beliefs or values (Abrams, 2023).
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This research project sought to investigate stakeholder perceptions regarding
perceived efficacy and accessibility of district-initiated programming and community
partnerships, to address limited access to mental healthcare and social services within the
Tussey Mountain School District. Furthermore, this action-research project sought to
identify barriers to service delivery among various stakeholder groups (parents and
students) in order to implement solutions, ultimately helping them achieve better
outcomes. This research also sought to investigate parent perceptions regarding the role
of the school district in assisting students with accessing these services. The Institutional
Review Board at PennWest University approved this study in October 2024 (Appendix
A).
The following research questions were developed for this capstone project to
serve as a lens through which data would be critically examined, provide a focus for
interpretation of this data, and serve as a metric for which results would be measured:
Research Question 1: What was the impact on self-reported risk factors and
protective factors before and after the implementation of mental and social service
programming initiatives?
Research Question #2: What strategies, as reported by students, were effective for
helping students access mental and behavioral health services through their school and
what barriers existed?
Research Question #3: What was the impact on parent perceptions regarding the
availability of mental health and social service programming?
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Answering these research questions provided a benchmark within this study to
evaluate the success of the research, as well as district-initiated mental and
behavioral-health programming to draw meaningful conclusions. Findings of this
research can help equip school leaders to improve programming initiatives as well as
better define the school’s role in helping students overcome risk factors for better overall
well-being, as they seek to meet a seemingly changing set of needs regarding adolescent
mental health.
Research Setting & Context
A review of enrollment data indicates that in recent years, the Tussey Mountain
School District typically serves just over 900 students in grades K-12, with 18-20%
receiving special education services (Pennsylvania Department of Education, Bureau of
Special Education, 2024). Over sixty percent of students are identified as economically
disadvantaged (Pennsylvania Department of Education, 2024b). Demographic data from
the Pennsylvania Department of Education also identifies that there is little diversity in
terms of race or ethnicity, with over 97% of students being identified as white.
The Tussey Mountain School District currently employs several mental health
professionals of various credential levels. Included on the district’s mental health team
are: three school counselors serving at each building level (elementary, middle and high),
one school psychologist (who serves all students K-12, hired in 2020) and one school
social worker (who also serves all students K-12; hired in 2021).
In 2024, the National Association of School Psychologists recommended a
student-to-school psychologist ratio of 500:1, indicating that the current school
psychologist at the Tussey Mountain School District is serving a caseload that is
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significantly higher than the national recommendation (National Association of School
Psychologists, 2024). Additionally, the School Social Work Association of America
recommended a student-to-social worker ratio of no more than 250:1. However, the
Association also identified that this ratio should be lower for populations with higher
needs (School Social Work Association of America, n.d.). Given the rate of economic
disadvantage and self-reported risk factors by students on the PAYS, the student
population should be considered “high need”, also indicating a much higher
student-to-clinician ratio than recommended.
Student Risk & Protective Factors within the Tussey Mountain School District
Within the Tussey Mountain School District various stakeholder groups have
noted concerns and challenges which mirror those noted in the peer-reviewed literature.
Following the COVID-19 Pandemic, data sources have indicated an increase in the
prevalence of various risk factors impacting students in the district. Table 1 summarizes
data related to self- reports of depression, suicidal ideation, and other risk factors such as
self-harm during the 2021 Pennsylvania Youth Survey among middle and high school
students in the Tussey Mountain School District (Pennsylvania Commission on Crime
and Delinquency et al., n.d.):
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Table 1
Depressive & Suicidal Ideation Reports in the Tussey Mountain School District, 2021
2021 Pennsylvania Youth Survey
Survey Item:
Felt depressed or sad most days in the past 12
GR 6
GR 8
GR 10
GR 12
50%
42.2% 59.6%
47.8%
11.8%
3.3%
32.4%
16.7%
Agree with the statement “Sometimes I think that 19.4%
25%
39.6%
35.6%
23.5%
13.3% 35.8%
35.6%
57.1%
24.4% 50%
37.8%
GR 8
GR 10
GR 12
Students who “seriously considered suicide”
10%
33.3%
46.2%
Students who planned suicide
6.7%
27.5%
33.3%
months
Engaged in self-harm in the past 12 months
life is not worth it”
Agree with the statement “All in all, I am
inclined to think I am a failure”
Agree with the statement “At times I think I am
no good at all”
Student Reports - Suicide
Survey Item:
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Students who attempted suicide
6.7%
56
33.3%
25%
Note. This table summarizes data collected by the Pennsylvania Commission on Crime
and Delinquency et al. (n.d.).
The 2023 administration of the PAYS indicated improvement in some of these
areas but also indicated that many students continue to struggle with depressive
symptoms, among other concerns. This data is summarized in Table 2:
Table 2
Depressive & Suicidal Ideation Reports in the Tussey Mountain School District, 2023
2023 Pennsylvania Youth Survey
Survey Item:
GR 6
GR 8
GR
GR 12
10
Felt depressed or sad most days in the past 12
46.2%
41.2% 38.6% 47.2%
Engaged in self-harm in the past 12 months
4.0%
24.5% 15.5% 18.5%
Agree with the statement “Sometimes I think
18.4%
32.0% 26.8% 22.6%
23.5%
13.3% 35.8% 35.6%
months
that life is not worth it”
Agree with the statement “All in all, I am
inclined to think I am a failure”
ENHANCING MENTAL HEALTH PROGRAMMING
Agree with the statement “At times I think I am
35.4%
35%
57
34.9% 37%
no good at all”
Student Reports - Suicide
Survey Item:
GR 8
GR
GR 12
10
Students who “seriously considered suicide”
15.7% 22.8% 23.1%
Students who planned suicide
12.2% 12.3% 17.3%
Students who attempted suicide
8.2%
7.0%
7.7%
Note. This table summarizes PAYS risk factor data reported by PCCD et al., n.d.
In addition to these reported values, during the most recent administration of the
PAYS, students in the Tussey Mountain School District reported engaging in the following
risky behaviors at rates which exceeded the state average in the following areas (PCCD et
al. ,n.d.):
● Vaping/use of e-cigarettes
● Lifetime AND 30-day use of marijuana
● Lifetime use of over-the-counter drugs to get high
● Required medical care after a suicide attempt
● Made a suicide plan in the past year
● Felt sad or hopeless almost every day to the point that they stopped doing regular
activities
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58
● Gambling (lifetime, past 30 days, and lying about gambling habits)
● Bullying
Tussey Mountain Middle and High School Students were also at higher risk for
negative outcomes based on their reports of social acceptance and interaction with their
peers and their community (PCCD et al., n.d.). Tussey Mountain students reported higher
levels of acceptance by their peers of risky behaviors than other students in the
Commonwealth. Students also reported higher levels of acceptance among adults in the
community of illegal behaviors. Furthermore, students also reported that they were more
likely (or willing) to experiment with drugs and other substances than other students in
Pennsylvania if presented by someone else. Students also reported that community
members were willing to provide alcohol at rates which were noted to be far higher than
the state average. Tussey Mountain students were also far more likely to take alcohol
from adults without permission (PCCD et al., n.d.).
When the PAYS results are considered holistically, low school commitment
(58.7%), parental attitudes favorable towards antisocial behavior (51.2%), and perceived
low risk in drug use (46.4%) emerge as some of the most significant risk factors
impacting the student population within the Tussey Mountain School District. Figure 3
illustrates the prevalence of various risk factors within the Tussey Mountain School
District and is organized by community, family, school, and individual/peer domains:
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Figure 3
Tussey Mountain School District, Risk Factors, 2023 Pennsylvania Youth Survey
Note. Figure 3 summarizes student self-reported risk factor data from PCCD et al. (n.d.).
There is limited data available regarding parent perspectives on programming
needs, perceived effectiveness, or the school’s role in implementing services to support
adolescent mental health. However, student-reported data on the PAYS provides some
information regarding student attitudes toward protective factors in their school and
community for students in the Tussey Mountain School District.
Student reports on the PAYS provide insight into their perspectives regarding
protective factors in their school and community (Pennsylvania Commission on Crime
and Delinquency et al., n.d.). A significant portion of students report having strong family
attachments, opportunities for prosocial involvement within their families, and a belief in
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60
a moral order. However, lower levels of religiosity, community rewards for prosocial
behavior, and school opportunities for prosocial involvement are areas of concern (PCCD
et al., n.d.). This is illustrated in Figure 4. This figure reflects the percentage of students
in grades 6, 8, 10 and 12 who reported having at least three protective factors in each of
the identified domains (community, family, school and individual/ peer).
Figure 4
Tussey Mountain School District, Protective Factors, 2023 Pennsylvania Youth Survey
Note. Data was collected and reported by PPCD et. al (n.d.) during the 2023 PAYS.
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During the 2023 administration of the PAYS, students in the Tussey Mountain
School District viewed one another as one of the most common means of support. This
data provided school stakeholders with an important consideration when selecting and
designing supports such Teen Mental Health First Aid (tMHFA), as students reported
they were more likely to reach out to a peer when they were sad or upset than any other
group of people. This is important contextual data to consider with regard to the current
study when investigating the student perception of program efficacy. Figure 5 further
illustrates this by comparing student reports of sources of support:
Figure 5
Sources of Support for Tussey Mountain Students
Note. Figure 5 from PCCD et al. (n.d.) illustrates where students in the Tussey Mountain
School District are turning for support.
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62
Selection of Research Participants
High school students represent a critical population for understanding the
effectiveness and perception of mental health services, within the Tussey Mountain
School District. Their direct experiences with, and perspectives on, available mental
health resources are invaluable when considering programming needs in a school.
Therefore, Tussey Mountain High School students represented a critical population for
inclusion in this capstone project. Additionally, due to the research gap regarding parent
perception of mental and behavioral health programming, parents and guardians of
middle and high school students were also selected to participate to achieve more
in-depth understanding.
Research Question One: Student Surveys
Research question one studied subjects enrolled in grades 9-12 at Tussey
Mountain High School. Student enrollment at Tussey Mountain High School (grades
9-12) was just over three hundred students during this capstone project. An informed
consent letter (Appendix B) describing the research study was sent home with all students
in grades 9-12. Interested students/families returned the letter to a secure drop box
located in the district office to indicate their interest. Once the consent form was returned,
students were read the assent to research statement (Appendix C) and then completed the
pre and post surveys.
Research Question Two: Student Interviews
At the high school, there is a voluntary club called Student Empowerment of
Mental Health Awareness (SEMHA). The inception of this club was student-driven, and
its members have an interest in learning about and promoting mental health awareness at
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63
Tussey Mountain High School. There are currently twenty-two student members in this
organization.
Student members of SEMHA were recruited for this part of the study, as this
group possessed a distinct understanding of their school environment, peer relationships,
and the challenges they faced. Student participants were recruited with parent consent
from fall 2024 through spring 2025, using announcements at SEMHA meetings. The
informed consent document (Appendix D) was provided for students to take home to their
parents to review and sign. Interested students/families returned the informed consent to a
secure drop box in the district office. Once the consent form was returned, students were
read the assent to research statement (Appendix E) prior to completing the interview.
During the interviews, the researcher used an interview script (Appendix F).
Insights from research participants in this group provided crucial information about the
acceptability, accessibility, and effectiveness of mental health services from a student's
viewpoint.
Research Question Three: Parent Surveys
The survey and all informed consent information (Appendix G) and survey
questions (Appendix H) were available electronically. Participants were recruited via
district social media. To be eligible to participate in this part of the study, the participants
had to have had a child enrolled in the middle/high school and be at least 18 years of age.
Research Methods & Data Collection
When designing this research study, the researcher relied heavily on data from
The Pennsylvania Youth Survey (PAYS) due to its comprehensive collection of risk and
protective factor data. The two most recent administrations (in 2021 and 2023) of the
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PAYS provided a robust understanding of the contextual factors surrounding the research
questions within the Tussey Mountain School District. Historic PAYS data also
established a baseline for comparison when assessing the efficacy of district-initiated
programming on risk and protective factors. Like its predecessors, the next administration
of the PAYS in fall 2025 will undoubtedly help paint an inclusive picture of how risk and
protective factors are changing over time in the Tussey Mountain School District.
Due to the timing of the current study and the bi-annual administration of the
Pennsylvania Youth Survey, use of this data to study the research questions was not
feasible. Therefore, to study the impact of district-initiated programming on student risk
and protective factors, to learn more about barriers to student support and explore parent
perceptions, the researcher utilized a mixed-methods to answer the three research
questions. This mixed methods study used student survey data, student interview
responses, parent survey data, student discipline data Chill Room usage to answer the
three research questions.
Research Question One: Data Sources & Collection Methods
This research question focused on the impact on self-reported risk factors and
protective factors before and after the implementation of mental and social service
programming initiatives. To explore this research question, quantitative data was
collected using the PhenX: School & Protective Factors ToolKit and School Social
Environment ToolKit, which were administered to students at the beginning and end of
the study. Pre-surveys were administered in February-March 2025, with post-surveys
occurring in May 2025.
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Disciplinary data from the previous and current school year was also used to
assess the impact of district programming on student risk factors. Chill Room usage data
was also analyzed to assess the efficacy of district programming.
Research Question Two: Data Sources & Collection Methods
The second research question explored what strategies, as reported by students,
were effective for helping students access mental and behavioral health services through
their school and what barriers existed. Both quantitative and qualitative data were
collected through student interviews. The interviews assessed student perceptions of
access to mental health services, effective strategies for accessing services, and barriers to
accessing services. The interview questions were designed by the researcher. Participants
were recruited in February-March 2025, and interviews were conducted in March-April
2025, with analysis following the interviews.
Research Question Three: Data Sources & Collection Methods
The third research question examined the impact on parent perceptions regarding
the availability of mental health and social service programming. Quantitative and
qualitative data were collected using a researcher-designed survey instrument. The survey
assessed parent/guardian perceptions of adolescent mental health, the school's role in
service delivery, efficacy of existing programming, barriers to accessing programming,
referral processes, and other related information. This survey instrument was designed by
the researcher. The survey was administered at the start and close of the study, and preand post-surveys were compared.
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Participants for the pre-survey were recruited with consent, and the survey was
administered in December 2024-January 2025. Recruitment for the post-survey, as well
as the administration occurred in May-June 2025.
Fiscal Implications
The implementation of this research study presents minimal direct costs to the
Tussey Mountain School District, a factor largely attributed to the strategic utilization of
existing resources and external funding. The core data collection tools (PhenX toolkits,
disciplinary records, Chill Room usage reports, student interviews, and parent survey) do
not result in any additional financial costs to the district. The PhenX toolkits were
available online at no cost and disciplinary records were already maintained by the
district within the student information system, a necessary budget expense. Student
interviews were conducted by the researcher, minimizing labor costs. The parent surveys
were distributed electronically, to eliminate printing and mailing expenses. The district's
existing infrastructure, including meeting spaces, was used for data collection.
The primary financial consideration involves the researcher's time, which can be
viewed as an indirect cost. Indirect costs, such as staff time allocated to the project, are
those that are necessary for the study. In this case, the researcher's time is factored into
the overall operational expenses of the district.
Validity
It is important for researchers to take measures to ensure high-quality data
collection for several reasons. First and foremost, taking quality data can help ensure that
the data which has been collected is valid. Validity is a critical component to any quality
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67
research. Ensuring that the data is accurate, unbiased, reliable, and well-aligned to answer
the research question can increase validity of any given study. Furthermore, taking
measures to ensure high quality data will provide credibility to the research. When data is
collected with fidelity and the study is well-designed, other professionals in the field can
take confidence in the results.
In qualitative research, Mertler (2022) states that generally, the inductive analysis
process is used. Inductive analysis usually follows three steps: organization, description,
and interpretation. This framework was used for analyzing qualitative data collected in
the present study.
Mertler (2022) notes that qualitative research can provide more descriptive
information than quantitative studies. By providing narrative accounts of observation,
researchers are able to identify characteristics important to the research that are not easily
expressed by data sets or numbers. Additionally, qualitative research lends itself to
answering “how” and “why” questions by studying the process itself. While correlation
may be easily identified by qualitative studies, quantitative studies may provide some
insight into causation, etc. For these reasons, qualitative data sources were selected for
collection and review when seeking to learn more about student and parent perceptions
regarding the school’s role in supporting adolescent mental health, as well as the
successes and barriers of programming specific to the Tussey Mountain School District.
Chapter Summary
In the aftermath of the COVID-19 pandemic, schools nationwide have faced a
concerning surge in student mental health challenges, with a significant portion of the
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student population experiencing mental health challenges. Recognizing their pivotal role
in addressing these needs, schools are striving to provide accessible mental health
services. However, obstacles such as limited resources, insufficient staff training, and
parental concerns often hinder the effective implementation of such programs. This study
focused on the Tussey Mountain School District, a rural district located in southwestern
Pennsylvania, where the challenges cited elsewhere in the literature are particularly
evident.
The district is faced with alarmingly high rates of student depression, suicidal
ideation, and substance abuse, as evidenced by concerning data from the Pennsylvania
Youth Survey. Recent tragic student suicides have underscored the urgent need for
effective mental health interventions. In response to this crisis, the district is
implementing several new initiatives, including the Chill Project, a partnership with
Allegheny Health Network designed to provide students and staff with access to mental
health professionals and calming spaces; teen Mental Health First Aid (tMHFA), an
evidence-based program aimed at equipping students and staff to identify and respond to
mental health and substance abuse challenges; and Students Empowering Mental Health
Awareness (SEMHA), a student-led initiative focused on raising mental health awareness
and providing peer support.
The core purpose of this study was to evaluate the effectiveness, accessibility, and
perceived impact of newly implemented mental health and social service programs within
the Tussey Mountain School District. Specifically, the research aimed to understand how
these programs impacted student risk and protective factors, identify strategies for
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overcoming barriers to service access, and assess parental perceptions of program
availability and efficacy.
Student and parent research participants were crucial stakeholders, and their
selection as research participants was paramount to the present study. The students, as the
primary recipients of the mental and social service programs, held unique insights into
the effectiveness and accessibility of these initiatives. Gathering their perspectives
through surveys and interviews allowed the research to capture firsthand experiences,
perceived barriers, and suggestions for improvement. Similarly, parents played a pivotal
role in their children's well-being and school involvement. Their perceptions of the
existing programming, referral processes, and overall state of adolescent mental health
provided essential context. By including both students and parents, the research aimed to
obtain a holistic understanding of the program's impact, address potential discrepancies in
viewpoints, and ultimately, tailor the initiatives to better meet the needs of the entire
school community. Their inclusion ensured that the study reflected the realities of those
most affected by the programs, making the findings more relevant and actionable for the
school district.
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CHAPTER IV
Data Analysis & Results
To gain an in-depth and comprehensive understanding of each research question,
a mixed-methods approach was used, combining quantitative and qualitative data
collection and analysis to ensure a comprehensive understanding of the contextual issues
surrounding the research. By using multiple data sources (student surveys, parent
surveys, interviews, discipline data, and Chill Room usage records), the study benefited
from data triangulation. This strengthened internal validity by providing multiple
perspectives on the research questions and reduced the risk of bias from any single data
source. To enhance the validity and credibility of this study, data triangulation was used.
Triangulation allowed for a more nuanced and detailed understanding of the research
questions. This is a technique that involves using multiple data sources, methods, or
perspectives to examine a research question (Mertler, 2022).
Use of Data Triangulation
Within the present study, data triangulation was used across all three research
questions. For research question one, data triangulation was achieved by combining
student survey data (PhenX toolkits) with disciplinary data and Chill Room usage data.
This allowed for a multi-faceted view of changes in risk and protective factors.
Methodological triangulation was also achieved by using both pre and post surveys
(within the same group of research participants), along with disciplinary data, and Chill
Room usage reports.
Data triangulation was achieved in research question two, by combining
quantitative data (frequency tables from survey elements within the interviews) with
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qualitative data (thematic coding of interview responses). This allowed for a deeper
understanding of student experiences regarding access and barriers.
For research questions three, a methodological triangulation was achieved through
the use of pre and post surveys. This allowed the researcher to measure changes in parent
perception over time. Within the present study, use of data triangulation helped the
researcher capture subtle details and complexities, providing a nuanced and detailed
picture of each research question in this study. The subsequent subsections of this
chapter describe the data analysis methods, as well as the specific results in more depth.
In addition to triangulating data within each research question, the results were
compared to one another using coding practices as well as comparing quantitative and
qualitative data between stakeholder groups. Triangulating the data across research
questions helped achieve a stronger and more reliable evidence base by cross-referencing
information from various sources and perspectives. This helped ensure a well-rounded
and comprehensive understanding of various stakeholder perspectives and how they may
interact.
Research Question One: Data Analysis & Results
Research question one aimed to determine the impact on self-reported risk factors
and protective factors before and after the implementation of mental and social service
programming initiatives. To analyze this, quantitative data was collected using the PhenX
School & Protective Factors ToolKit and the School Social Environment ToolKit, which
were administered to students at the beginning and end of the study. The School
Protective Factors ToolKit provided a detailed analysis protocol for assessing school
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environment, risk and protective factors according to the domains of School
Opportunities for ProSocial Involvement, School Rewards for ProSocial Involvement,
Academic Performance, Commitment to School, School Alcohol Environment, School
Tobacco Environment, School Marijuana Environment, General Protective School
Environment (a general summary scale), and General School Drug Environment (a
general summary scale). The researcher then used an average of domain scores to report
results.
In addition to the established test protocols, the student responses from these
surveys were analyzed using descriptive statistics to summarize the data and provide an
overview of the findings, including calculating the prevalence of students reporting
various risk and protective factors. Frequency tables (reported as percentages) were
created to analyze how often different categories of responses occurred. Trend analysis
was then employed to examine if and how the data changed throughout the project's
duration.
Disciplinary data from the previous school year (as a control year) was also
reviewed and compared to the current year to determine the impact on risk and protective
factors. Additionally, Chill Room usage data was reviewed to learn more about the
potential impact of this intervention.
Results: PhenX School & Protective Factors ToolKit
Eight students completed pre and post surveys, using the PhenX School &
Protective Factors ToolKit. Individual student results were tabulated for each sub domain,
as well as the General School Protective Environment. Results in each of the subdomains
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were then averaged to obtain aggregate scores in each domain, for the research
participants as whole.
Table 3 summarizes an aggregate view of these results:
Table 3
PhenX Protective Factors Pre and Post Survey Results
Domain:
Pre:
Post:
School Opportunities for ProSocial Involvement
2.91
2.86
School Rewards for ProSocial Involvement
2.64
2.86
Academic Performance
3.08
2.56
General School Protective Environment
2.79
2.97
Note. Results reported represent an average of participant responses for questions in the
respective subdomains. In each sub domain a range of scores from 1-4 could be reported,
with scores closer to 4 indicating a more protective environment for students.
Before the intervention or period of observation (“pre" results), the students'
perceptions of School Opportunities for ProSocial Involvement averaged 2.91, suggesting
a moderate but improvable sense of available pro-social avenues. Their feeling of School
Rewards for ProSocial Involvement was slightly lower at 2.64, indicating room for
growth in how positive behaviors are acknowledged. Academic Performance registered
an average of 3.08, suggesting a relatively positive perception in this area. Overall, the
General School Protective Environment stood at an average of 2.79.
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After the administration of the post survey, some notable shifts occurred. School
Opportunities for ProSocial Involvement saw a slight decrease to 2.86, suggesting a
minor dip in perceived opportunities. However, the students' perception of School
Rewards for ProSocial Involvement improved to 2.86, indicating a positive change in
how they felt their pro-social actions were recognized. In the subdomain of Academic
Performance, a more significant positive shift was noted, improving to 2.56. This
suggests a more protective academic environment was perceived. Most encouragingly,
the General School Protective Environment showed a positive upward trend, increasing
to 2.97.
In summary, while there was a minor decrease in perceived opportunities for
pro-social involvement, the research suggests an overall positive movement towards a
more protective school environment for these eight students, particularly in how they felt
rewarded for pro-social behavior and in the general sense of a protective atmosphere.
This indicates that efforts to enhance the school environment may be having a beneficial
impact on students' perceptions of safety and support.
The PhenX School and Protective Factors Toolkit also provided a framework for
assessing the impact of district initiated programming on risk factors such as alcohol,
tobacco and drug use in the student population. Research participants answered questions
related to their perceptions of student acceptance and prevalence of alcohol, tobacco and
drug use within their school. Once again, individual student results were tabulated for
each sub domain (School Alcohol Environment, School Tobacco Environment, and School
Marijuana Environment) and the General School Drug Environment. Results in each of
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the subdomains were then averaged to obtain aggregate scores in each domain, for the
research participants as whole.
Table 4 summarizes an aggregate view of these results:
Table 4
PhenX School Drug Environment Pre and Post Survey Results
Domain:
Pre:
Post:
School Alcohol Environment
2.81
2.38
School Tobacco Environment
2.15
2.23
School Marijuana Environment
General School Drug Environment
3.04
2.97
2.52
2.79
Note. For this portion of the survey instrument, a range of scores from 1-5 could be
reported, with scores closer to 5 indicating more prevalent use or risky behaviors
associated with alcohol, tobacco and drug use reported.
These results suggest a generally positive shift in students' perceptions of the
school's drug environment following the intervention or observation period. While there
was a minor uptick in perceived tobacco risk, significant improvements were seen in the
perceived alcohol and, particularly, marijuana environments. The overall decrease in the
General School Drug Environment score indicates that students perceive a less prevalent
or risky drug environment within their school, suggesting that efforts aimed at addressing
drug use and associated behaviors may be yielding positive results.
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Specifically, prior to the intervention or observation period ("pre" results), the
students' average score for the School Alcohol Environment was 2.81. This suggests a
moderate perception of alcohol prevalence or associated risk behaviors within the school
setting. The School Tobacco Environment registered a lower average of 2.15, indicating a
comparatively less perceived presence of tobacco use or risk behaviors. The School
Marijuana Environment had the highest pre-score at 3.04, suggesting a relatively higher
perceived prevalence of marijuana use or associated risks among the students. Overall,
the General School Drug Environment stood at an average of 2.97.
Following the observation period or intervention ("post" results), significant and
largely positive shifts were observed. The School Alcohol Environment score decreased to
2.38, indicating a perceived reduction in alcohol prevalence or risk behaviors. The School
Tobacco Environment saw a slight increase to 2.23, suggesting a marginal rise in
perceived tobacco use or risk behaviors, though still remaining relatively low. Most
notably, the School Marijuana Environment experienced a substantial decrease to 2.52,
suggesting a significant improvement in students' perceptions of marijuana prevalence or
associated risks. Consequently, the General School Drug Environment also showed a
positive trend, decreasing to 2.79.
Results: PhenX School Social Factors ToolKit
The PhenX School Social Factors ToolKit was also used as a pre and post survey
instrument to assess the impact on student perception of protective factors. Eight students
participated in these surveys. The survey instrument contained 39 questions to assess
students’ feelings related to their sense of connectedness and pride of their school and
school community. Students were able to select from five multiple choices (“Strongly
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Disagree,” “Disagree,” “Neither Agree nor Disagree,” “Agree,” or “Strongly Agree”).
The survey asked questions within the following subsections:
● Teacher Relationships
● School Connectedness
● Academic Support
● Order and Discipline
● School Physical Environment
● School Social Environment
● Academic Satisfaction
● Perceived Exclusion and Privilege
Within the subdomains of Teacher Relationships, School Connectedness,
Academic Support, Order and Discipline, School Physical Environment, School Social
Environment, and Academic Satisfaction student responses indicating “agreement” or
“strong agreement” with the survey item indicated student agreement or strong agreement
with feelings of connectedness or pride to the school or school community.
Table 5 utilizes a stacked bar graph to illustrate the change in student perceptions
related to school social factors, over time, during the course of this research:
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Table 5
PhenX School Social Factors Pre and Post Results
Note. This table illustrates the number of times participants selected each response during
each administration of the Phen School Social Factors Survey for the indicated
sub-sections. Figures reported are reflected as percentages.
As illustrated by Table 5, at the start of this research project, students' responses
indicated a varied perception of protective factors within their school environment. A
significant portion of responses fell into the "Agree" category at 40.50%, suggesting a
baseline level of positive feelings. However, a combined 23.97% (7.44% Strongly
Disagree + 16.53% Disagree) expressed negative sentiments, while a substantial 28.93%
remained neutral ("Neither Agree nor Disagree").
At the end of this project, there was a noticeable shift towards more positive
perceptions among the students. The percentage of responses indicating "Agree"
increased substantially to 50.64%, and "Strongly Agree" also saw a rise to 8.58%. This
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means that the combined positive sentiment (Agree + Strongly Agree) increased from
47.11% pre-survey to 59.22% post-survey. Conversely, negative sentiments decreased,
with "Strongly Disagree" falling to 3.43% and "Disagree" to 11.16%. The neutral
"Neither Agree nor Disagree" responses also saw a slight decrease to 26.18%.
When the survey data is considered according to sub sections, there is a clear
trend towards improved student perceptions of protective factors, particularly in Teacher
Relationships, School Connectedness, Academic Support, Order and Discipline, and
School Social Environment subsections of the survey. These areas show a decrease in
negative sentiments and a noticeable increase in agreement or strong agreement. The
most significant positive shifts were observed in Teacher Relationships and the School
Social Environment, where previously high levels of dissatisfaction or neutrality
transitioned into predominantly positive views.
However, the School Physical Environment remained relatively stable with no
significant increase in positive perception. More notably, Academic Satisfaction indicated
that students held decreased positive feelings about their academic experiences as the
project progressed.
Table 6 disaggregates these results according to survey sections:
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Table 6
Phen X School Social Factors Sub Domains
This data indicates that, initially, perceptions of teacher relationships were mixed.
While a significant portion of students (44.1%) agreed, indicating positive sentiments, a
considerable number also disagreed (33.9%) or remained neutral (33.9%). Notably, no
students strongly agreed, and a small percentage (3.4%) strongly disagreed. At the end of
the survey, there was a marked improvement in student perceptions of teacher
relationships. The percentage of students who agreed or strongly agreed significantly
increased to a combined 75.0% (64.3% Agree, 10.7% Strongly Agree). Disagreement
plummeted to a mere 5.4%, and strong disagreement was no longer reported (0.0%). The
neutral category also saw a substantial reduction to 19.6%. This suggests a strong
positive shift towards more supportive and positive teacher-student interactions.
Students' sense of school connectedness at the start of the study showed room for
improvement, with only 23.7% (15.8% Agree, 7.9% Strongly Agree) expressing positive
feelings. A notable 39.5% remained neutral, and a combined 36.8% (10.5% Strongly
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Disagree, 26.3% Disagree) held negative views. At the conclusion of this project,
perceptions of school connectedness generally improved. The percentage of students
agreeing or strongly agreeing increased to 43.9% (36.6% Agree, 7.3% Strongly Agree).
While there was still a substantial neutral segment (29.3%), both strong disagreement
(7.3%) and disagreement (19.5%) saw decreases. This indicates a moderate but positive
trend towards a stronger sense of belonging among students.
Students largely perceived high levels of academic support at the beginning of the
project, with a combined 81.0% (52.4% Agree, 28.6% Strongly Agree) indicating
positive feelings. Only 14.3% disagreed with survey questions related to a positive
academic support environment, and none strongly disagreed. As this project progressed,
positive perceptions of academic support further solidified. The combined percentage of
students agreeing or strongly agreeing rose to 86.5% (62.2% Agree, 24.3% Strongly
Agree). Disagreement decreased to 5.4%, and the neutral category slightly increased to
8.1%. This suggests that students continued to feel well-supported academically, with an
even greater proportion expressing positive sentiments.
In terms of order and discipline, students had a generally positive view of order
and discipline, even at the start of this project, with 52.4% agreeing and no one strongly
agreeing. However, a significant 33.3% remained neutral, and 25.0% (8.3% Strongly
Disagree, 16.7% Disagree) expressed negative views. Despite this generally positive
view at the start of the study, perceptions of order and discipline, there was notable
improvement in student responses in these areas. The percentage of students agreeing or
strongly agreeing increased to 64.2% (62.2% Agree, 2.0% Strongly Agree). Strong
disagreement significantly dropped to 2.0%, and disagreement also decreased to 10.2%.
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The neutral category slightly increased to 38.8%. This indicates a more positive and
secure feeling regarding the school's structure and enforcement of rules.
Throughout the course of this project, students generally felt positive about the
school's physical environment, with 50.0% agreeing to positive statements about the
school’s physical environment. A substantial 35.7% reported neutral feelings, and 14.3%
(3.6% Strongly Disagree, 10.7% Disagree) held negative views. Perceptions of the school
physical environment remained largely stable with some minor shifts. The percentage of
students agreeing or strongly agreeing slightly decreased to 46.2% (46.2% Agree, 0.0%
Strongly Agree). There was a slight decrease in disagreement (7.7%) but a noticeable
increase in the neutral category (42.3%). Strong disagreement remained similar (3.8%).
This suggests that while dissatisfaction slightly decreased, there wasn't a significant
increase in strong positive feelings.
In terms of the school social environment, the pre-survey revealed a challenging
perception of the school social environment, with a high percentage of students strongly
disagreeing (30.8%) or disagreeing (7.7%), totaling 38.5% negative sentiment. A large
42.6% remained neutral, and only 15.4% agreed. This sub-section of the survey
ultimately indicated a significant positive turnaround. The combined percentage of
students agreeing or strongly agreeing surged to 46.7% (40.0% Agree, 6.7% Strongly
Agree). Strong disagreement dramatically decreased to 13.3%, and the overall negative
sentiment (Strongly Disagree + Disagree) was reduced to 40.0%. The neutral category
saw a sharp decline to 13.3%. This suggests substantial improvement in students'
perceptions of the social interactions and atmosphere within the school.
Academic satisfaction was relatively high at the beginning of this project, with a
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combined 64.2% (57.1% Agree, 7.1% Strongly Agree) of students expressing positive
feelings. However, a notable 21.4% strongly disagreed, and 7.1% disagreed. During the
course of this study, perceptions of academic satisfaction experienced a decline. The
combined percentage of students agreeing or strongly agreeing fell to 33.3% (33.3%
Agree, 0.0% Strongly Agree). Conversely, disagreement significantly increased to 22.2%,
and the neutral category rose to 33.3%. Strong disagreement also decreased to 11.1%.
This suggests a decrease in the overall satisfaction students felt with their academic
experiences, possibly indicating a shift in their perceptions of curriculum, workload, or
learning outcomes.
For the Perceived Exclusion/ Privilege of the PhenX School Social Factors
Toolkit, “strong disagreement” or “disagreement” indicated a belief among students that
they are being treated equally and fairly. For these reasons, this subsection of the toolkit
was analyzed separately. At the start of this research project a combined 28.57% of
students expressed a positive perception of fairness and equality, with 9.52% strongly
disagreeing and 19.05% disagreeing with statements of exclusion or privilege. A
substantial 47.62% of students held a neutral stance, indicating neither strong agreement
nor disagreement with feelings of exclusion or privilege. Meanwhile, a combined 23.81%
of students (19.05% Agree, 4.76% Strongly Agree) perceived some level of exclusion or
privilege. At the conclusion of this action research project, there was a noticeable positive
shift in students' perceptions of fairness. The percentage of students who disagreed or
strongly disagreed with statements of exclusion/privilege significantly increased to a
combined 47.62% (9.52% Strongly Disagree, 38.10% Disagree). This indicates a stronger
belief among students that they are being treated equally and fairly. The neutral category
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also saw a decrease to 33.33%. Additionally, the percentage of students who agreed or
strongly agreed with perceptions of exclusion/privilege slightly decreased to a combined
19.05% (14.29% Agree, 4.76% Strongly Agree).
Table 7 illustrates these results using a stacked bar-graph:
Table 7
Perceived Exclusion and Privilege
Note. The results for the "Perceived Exclusion/Privilege" sub-section demonstrate a
positive trend from the pre- to the post-survey. The increase in "disagree" and "strongly
disagree" responses suggests that students' perceptions of being treated equally and fairly
within the school environment have improved. While nearly half of the students still hold
a neutral or positive (perceiving exclusion) stance in the post-survey, there is a significant
shift away from neutrality and towards the positive perception of fairness.
Results: Discipline Data
During the study, the file "Action Code Usage Report" was used. This report from
the student information system provides a breakdown of disciplinary actions within the
Tussey Mountain School District during the 2023-2024 school year. The report focuses
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on high school students (grades 9-12) and categorizes disciplinary actions using specific
codes. Below a summary has been provided for each of the following discipline codes:
● Warnings: When student behavior was escalated to the office-level, there was
little change from the previous to current school year, in terms of warnings issued
by the principal (57 to 62). This represents a slight increase in less severe,
verbal/minor interventions.
● Referral to SAP, Counseling, Other Agency: There was a moderate decrease in the
number of principal-initiated referrals to outside programming outside of the
discipline process (from 11 to 6).
● Detention: Increased significantly (from 121 to 149). This is a substantial rise in a
mid-level disciplinary action.
● In-School Suspension (ISS): In school-suspensions increased from (7 to 16). This
is a notable increase in more severe disciplinary measures.
● Out-of-School Suspension (OSS): Out-of school suspensions) decreased
significantly (from 9 to 4). This is the only clear positive trend, indicating fewer
instances of the most severe disciplinary action.
Table 8 provides a visual representation of this data, frequency counts and a frame
of reference for comparing disciplinary data from the previous to current school year:
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Table 8
School Disciplinary Data
Results: Chill Room Usage Data
Chill Room usage data was also used to assess the impact of district initiated
programming on student risk and protective factors. Upon checking in and out of the
Chill Room, students are asked to rate their mood and ability to engage in school tasks in
a healthy way, using an emotional thermometer. This visual tool helps students visualize
their feelings, as well as their strength. Figure 6 provides an example of an emotional
thermometer, similar to the one used in the Chill Room:
Figure 6
Emotional Thermometer
Note. The emotional thermometer also provides a data point to determine the efficacy of
Chill Room interactions, according to student perception.
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Table 9 summarizes data collected related to Chill Room usage by students and its
impact:
Table 9
Chill Room Usage Data
December 2024
January 2025
February 2025
● Drop ins: 10
● Drop ins: 29
● Drop ins: 34
● Average Rating In:
● Average Rating In:
● Average Rating In:
3.5
3.3
● Average Rating
● Average Rating
Out: 2.2
March 2025
3
● Average Rating
Out: 1.6
April
Out: 1.2
May
● Drop ins: 35
● Drop ins: 38
● Drop ins: 11
● Average Rating In:
● Average Rating In:
● Average Rating In:
2.9
● Average Rating
Out: 1.6
3.5
● Average Rating
Out: 1.8
3.2
● Average Rating
Out: 1.8
When this data is reviewed to determine trends, it is notable that the number of
student "drop-ins" to the Chill Room showed a consistent and significant increase from
December 2024 (10 drop-ins) to April 2025 (38 drop-ins). This could suggest a growing
awareness and utilization of the Chill Room as a resource among students over these
months. May 2025 saw a sharp decrease to 11 drop-ins, likely correlating with the end of
the school year or reduced student presence.
Additionally, the "Average Rating In" generally hovered in the moderate to
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somewhat intense range (between 2.9 and 3.5). This rating showed a slight downward
trend (indicating calmer entry moods) from December (3.5) to March (2.9), suggesting
that students might have been seeking the Chill Room for slightly less intense emotional
states as the months progressed, or perhaps for proactive regulation. However, during the
month of April, an increase (back to 3.5), was noted, indicating students entering with
higher intensity, before dropping to 3.2 in May. Even with the fluctuation between
“Average Rating In,” the "Average Rating Out" was significantly lower than the "Average
Rating In", consistently for each month during this action research project. The " Average
Rating Out" consistently fell into the calm to mostly calm range (between 1.2 and 2.2).
The lowest "Rating Out" was observed in February (1.2), indicating students were
leaving the Chill Room feeling very calm and ready to learn after their visit. The average
reduction in intensity (difference between "Rating In" and "Rating Out") ranged from 1.3
points (December) to 1.9 points (February), consistently demonstrating a substantial
positive shift in student mood and readiness for school tasks.
Research Question Two: Data Analysis & Results
Research question two explored the strategies students reported as effective for
accessing mental and behavioral health services through their school as well as the
barriers to accessing services. For this research question, both quantitative and qualitative
data were collected. Participants were recruited through the student mental health team
for interviews. The interviews aimed to assess student perceptions of access to mental
health services, effective methods for accessing these services, and the barriers that
existed. Once consent and assent were obtained, student interviews were conducted.
Student responses were recorded in written format for further analysis.
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The analysis of student interview responses involved both qualitative and
quantitative methods. Frequency counts (reported as percentages) were used to quantify
how often different categories of responses occurred. For the qualitative portion, thematic
coding was employed to identify specific aspects of the discussion that were most
relevant to the research question. The researcher’s notes have been included as Appendix
H. By assigning and reassigning codes, the research aimed to help the Tussey Mountain
School District gain a greater understanding of the perceived efficacy of district-initiated
programming, identify barriers to accessing said programming, and determine effective
strategies to improve accessibility.
Through the coding process, eight central themes emerged in student responses.
These included:
● The prevalence of mental health challenges within the Tussey Mountain
School District
● Awareness and utilization of resources
● Perception of the sufficiency of resources
● Channels of information about services
● Effective strategies for accessing mental health services
● Barriers to accessing services
● Opportunities for improvement
Results: Quantitative and Qualitative Summary of Student Interviews
A total of eight students participated in interviews with the researcher. Upon
completion and analysis of student responses, it was notable that 100% of those
interviewed indicated that they have felt “stressed, anxious, or depressed while at
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school.” Of these students, 87.5% of respondents reported that they were aware of
resources to help them cope with these feelings while at school. Of the students who
reported being aware of district resources to help them 67% of respondents noted the
Chill Room being a helpful resources, 33% noted access to the school-based therapist
through Allegheny health network being helpful, and 33% of students noted the school
counseling/ guidance office being a place they would turn for help when needed.
Through the interviews, the researcher also sought to learn if students perceived
whether or not there were enough resources at school. When answering this question,
75% of students felt that there were adequate mental health resources at the school while
12.5% of respondents did not feel there were enough resources. One responder did not
provide a “yes” or “no” response to the question, but felt that things were “moving in the
right direction, but that more students needed to take it (the opportunities) up.”
Participants were also asked questions related to how they learned of district
resources. From these responses, 55.5% of student interview responses seeking
information about how students learned about services indicated that students most
frequently learn about services from talking with their teachers. Other means by which
students report being made aware of district services (though far less common) include:
● From conversations with the school/ guidance counseling office
● From SEMHA Team publications
● From school announcements
● Word of mouth (other classmates)
● Through school announcements
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These student interviews also sought to identify what strategies have been helpful
in assisting students with accessing mental health services. Seventy-five percent of
students who completed the interview reported that having an adult explain and walk
them through options was helpful to them. In subsequent interview questions, 33% of
participant responses indicated that Allegheny Health Network staff were particularly
helpful in walking them through this process. Interview participants equally identified
their teachers as helpful in this process (also 33% of responses). District
paraprofessionals were also identified as helpful to helping students access services
(22%), along with school counselors (11%).
Students in grades 10-12 also answered questions about how programming has
changed over time, since they started high school. During this interview question, many
students elaborated on the programs and strategies where they have observed positive
change during their high school careers. Eighty-eight percent of participants surveyed
indicated that they have observed much positive change since starting high school in
terms of the resources which are available to students. Participants most commonly cited
the Chill Room being on-sight as an effective strategy to help students access services.
Students reported that they liked the flexibility of this space and that it was effective in
helping them to find what worked for them. Less commonly, but still emerging as a
theme, participants also referenced SEMHA raising awareness to mental health concerns
and reducing stigma.
Students were also asked about the barriers to accessing services and support
within their school. When these student responses were analyzed 75% of students
reported that accessing services was “easy” and 25% of students reported that it was
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difficult. Students most frequently cited teachers not allowing them to access guidance/
school counselors or the Chill Room as one of the biggest barriers to accessing services.
Students also cited the Chill Room’s operating hours presented a barrier to accessibility.
(The Chill Room is currently only open to students Tuesday-Thursday). This lack of
availability creates a barrier to consistent service delivery.
Students were also asked a series of questions related to opportunities for
improvement. On these questions, students most frequently identified training for staff (to
help teachers better recognize the signs of a mental health problem) as one of the best
ways to improve district programming moving forward. Other suggestions included:
more advertisement of district programs and more consistency/ intentionality in the
schedule to help students access services.
Research Question Three: Data Analysis & Results
Research question three focused on the impact on parent perceptions regarding
the availability of mental health and social service programming, a survey instrument was
designed and used to gather data. This survey aimed to assess parent/guardian
perceptions of the overall state of adolescent mental health, the school’s role in service
delivery, the efficacy of existing programming, barriers to accessing programming,
referral processes, and other relevant information. The survey was administered at the
start and close of the study to determine if there was any change in parent perceptions of
programming before and after the implementation of new school initiatives. Descriptive
statistics were used to analyze participant responses and determine the community's
perception of the most prevalent barriers and most successful programming. Frequency
tables were created to show how often different categories of responses occurred within
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the community. Trend analysis was also employed to examine whether and how the data
changed during the six-month project period, comparing pre and post survey results.
Results: Parent Pre Surveys
During the pre-survey, parents within the Tussey Mountain Community
community overwhelmingly recognized the critical need for mental health and social
service. The first question in the survey asked parents to rate their agreement with the
statement, "mental health services are important for the overall well-being of students in
our school district.” Almost 90% of parents surveyed indicated some level of agreement
with this statement, with 77.8% selecting "Strongly Agree;” another 11.1% chose
"Agree;" and the remaining 11.1% responded "Neither agree nor disagree." This indicates
a very high consensus among parents regarding the critical importance of mental health
support for students in the district.
The second question on the parent survey asked parents to indicate their level of
agreement with the statement, "social service programs are essential in supporting
students facing challenges outside of school." A significant proportion of parents reported
that they, 66.7%, "Strongly Agree." Additionally, 11.1% selected "Agree," and 22.2%
chose "Neither agree nor disagree." This also demonstrates strong parental recognition of
the necessity of social service programs in addressing challenges students face outside the
school environment.
In response to the third question, "there is a growing need for mental health and
social service support in our rural community," parents again showed strong agreement,
with 77.8% selecting "Strongly Agreed." Another 11.1% chose "Agree," and 11.1% opted
for "Neither agree nor disagree." This consistent strong agreement across the first three
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questions underscores a widely perceived and increasing need for both mental health and
social service support within their rural community.
Despite these positive results, participating parents reported significant gaps in the
accessibility, awareness, and effectiveness of programming available during the
pre-survey, particularly those offered by or in collaboration with the school district. A
notable shift in sentiment occurred with the fourth question, "students in our school
district have easy access to mental health services when needed." A clear majority of
parents, 66.7%, "Disagreed" with this statement. Only 11.1% "Strongly Agreed," and
22.2% selected "Neither agree nor disagree." This indicated a strong perception among
parents that access to mental health services were not readily available for students in the
district, pointing to a significant accessibility barrier at the start of this project.
For the fifth question, "I am aware of the different types of social service and
mental health programs available to students and families in our community," responses
were quite varied. While 11.1% "Strongly Agreed" and 11.1% "Agreed," a combined
77.7% either chose "Neither agree nor disagree" (44.4%) or "Disagree" (33.3%). These
mixed responses indicated a discrepancy in awareness among parents regarding the
various support programs available in their community, at the start of this action research
project.
Regarding the sixth question, "the mental health services offered by the school
district are effective in addressing student needs," opinions leaned towards skepticism or
neutrality. 44.4% of parents "Disagree," and an equal 44.4% selected "Neither agree nor
disagree." Only 11.1% "Agreed," and no parents "Strongly Agreed." This indicates a
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prevailing sentiment that the school district's mental health services were either
ineffective or their efficacy was unclear to parents during the first administration of this
survey.
The seventh question, "The social service programs offered in collaboration with
the school district are helpful for students facing challenges," also presented mixed
responses. While 22.2% "Agreed," a combined 77.7% either chose "Neither agree nor
disagree" (33.3%), "Disagree" (33.3%), or "Strongly Disagree" (11.1%). Suggesting that
collaborative social service programs were not consistently perceived as beneficial or
helpful by parents during the pre-survey.
Concerning the eighth question, "School staff effectively communicate mental
health resources available to students to students and families, when needed," a
significant majority of parents expressed disagreement (55.6% "Disagree," and 11.1%
"Strongly Disagree," totaling 66.7%). Only 11.1% "Agreed," and 22.2% chose "Neither
agree nor disagree." This clearly indicates a perceived deficiency in how school staff
communicate mental health resources to families.
Finally, for the ninth question, "The school environment is supportive of students
seeking mental health help," a substantial proportion of parents expressed a lack of
support. 44.4% "Disagree," and 22.2% "Strongly Disagree," resulting in 66.6%
expressing negative perceptions. The remaining 33.3% chose "Neither agree nor
disagree," and no parents "Agreed" or "Strongly Agreed." This suggests that parents
generally do not perceive the school environment as conducive to students seeking
mental health assistance.
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Table 10 illustrates parental attitudes, toward mental health services, as well as
their perceived accessibility in a series of pie charts:
Table 10
Parent Pre-Survey Mental Health Service Perceived Importance & Accessibility
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To further explore parent concerns related to existing programming and barriers,
thematic coding was completed. The researcher’s coding notes have been included in
Appendix J, to summarize prevailing themes which emerged as a result of the coding
process.
Commonly, the biggest barriers to success from the perception of parents to
successful mental health programming were stigma and/ or confidentiality concerns, a
lack of awareness about available programs, and systemic issues within the school related
to communication, follow-through, and staff responsiveness. Parent responses also
indicated strong desire for more integrated, school-based mental health services,
improved staff training, and better communication to destigmatize and facilitate access to
care.
Concerns about school practices contributing to student stress also emerged as a
significant point. During the pre survey, parents expressed a clear desire for the school to
be more actively involved and to have more in-house resources rather than relying solely
on external referrals.
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In addition to the qualitative data obtained regarding parent reports of barriers, a
quantitative analysis was also completed for survey questions, 19-25 which asked
specific questions related to parent perception of commonly identified barriers within the
review of literature. Parents who completed this portion of the survey, reported seeking
mental health services for their child within the past calendar year from the date they
completed the pre-survey.
Regarding the cost of mental health programming or services, 20% of respondents
identified it as a "Major Barrier," while 40% found it "Somewhat of a Barrier," and
another 40% indicated it was "Not a Barrier." This suggested that while cost was a
significant impediment for a minority, it was a moderate concern for a larger group, and
not an issue for others.
Transportation to outside agency appointments was largely not a barrier, with
60% of participants reporting it as "Not a Barrier." However, 40% did experience it as
"Somewhat of a Barrier," indicating that while not a universal issue, it still posed
difficulties for a notable segment of families. Similarly, scheduling with outside agency
providers was also predominantly "Not a Barrier" for 60% of respondents, with 40%
finding it "Somewhat of a Barrier."
A more pronounced challenge emerged concerning awareness about available
mental health or social service programs in the community. Here, 20% of respondents
identified this as a "Major Barrier," and 60% as "Somewhat of a Barrier," with only 20%
reporting it as "Not a Barrier." This highlighted a significant need for improved
communication and outreach regarding existing resources within the community.
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Concerns about confidentiality or stigma proved to be a substantial deterrent.
While 40% of respondents indicated this was "Not a Barrier," 20% found it "Somewhat
of a Barrier," 20% a "Significant Barrier," and another 20% a "Major Barrier." This broad
distribution underscored the varying, but often impactful, role of stigma in preventing
families from seeking help.
Difficulties navigating the process of getting help, such as referrals and
paperwork, were also a notable obstacle. Forty percent of participants described this as a
"Significant Barrier," 20% as "Somewhat of a Barrier," and 40% as "Not a Barrier." This
suggested that administrative complexities created considerable hurdles for a notable
portion of families.
Finally, long wait times for appointments were identified as a critical barrier. A
significant 40% of respondents categorized this as a "Major Barrier," while 20% found it
"Somewhat of a Barrier," and 40% reported it as "Not a Barrier." This indicated that
delays in accessing timely appointments were a primary concern for a substantial number
of families seeking mental health support.
Table 11 illustrates these figures and parental attitudes surrounding each barrier:
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Table 11
Barriers Reported in Parent Pre Surveys
Results: Parent Post Surveys
A total of eleven parents participated in the post survey, which took place
approximately six months from the date of the pre-survey. It should be noted that due to
anonymity in the survey design, there is no way of knowing if this group of participants
participated in the pre-survey or not. The terms “pre” and “post” reflect a snap-shot in
time, at the beginning and end of this project, with near-identical questions being asked.
These terms are not necessarily indicative that a change in perspective occurred over time
within the same survey participant.
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During this administration of the survey, survey participants overwhelmingly
recognized the importance of mental health and social services for students, with 91% of
respondents either agreeing or strongly agreeing that mental health services were
important for overall well-being, and 91% similarly agreeing or strongly agreeing about
the essential nature of social service programs. A strong consensus once again emerged
regarding the increasing need for these services in the rural community, as 91% of
parents agreed or strongly agreed with this statement.
Once again, a notable divergence in opinion appeared when addressing the
accessibility of mental health services. Only 27% of participants agreed that students had
easy access to mental health services, while 45% disagreed or strongly disagreed, with
27% remaining neutral. Awareness of available programs was also a point of concern,
with 45% of parents disagreeing or strongly disagreeing that they were aware of different
program types, compared to 27% who agreed or strongly agreed and 27% who were
neutral.
Regarding the effectiveness of school district-offered services, only 27% believed
mental health services were effective, while 45% disagreed or strongly disagreed and
27% remained neutral. Social service programs offered in collaboration with the school
district fared slightly better, with 36% finding them helpful, 36% disagreeing, and 27%
remaining neutral.
Communication was once again reported as a concern by survey participants
during this administration of the survey. Seventy-three percent of respondents disagreed
or strongly disagreed that school staff effectively communicated these resources, with
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only 9% agreeing and 18% reporting neutral feelings about the issue. Opinions were also
mixed on the school environment's supportiveness of students seeking mental health help.
Only 27% of parents agreed that the environment was supportive, while 36% disagreed or
strongly disagreed, and 36% were neutral, indicating a lack of consistent positive
perception in this area. Table 12 appears on the next page and to illustrate the
proportionate responses to these survey questions.
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Parent Post-Survey Mental Health Service Perceived Importance & Accessibility
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As with the first administration of this survey, parent concerns related to existing
programming and barriers were analyzed using thematic coding. The researcher’s coding
notes have been included in Appendix K to summarize prevailing themes which emerged
as a result of the coding process. Parents reported strong support with district initiatives
which support the growing need for mental health and social services for students.
However, from the parent’s perspective, the district faces significant challenges in terms
of accessibility, awareness, and perceived effectiveness. The most critical barriers
identified are stigma, coupled with perceived shortcomings in staff understanding,
communication, and accountability. Parents communicated a desire for improved
communication, comprehensive staff training with an emphasis on empathy and
accountability, and initiatives to increase awareness.
Once again, quantitative analysis was completed for survey questions, 19-25
which asked specific questions related to parent perception of commonly identified
barriers within the review of literature. This portion of the post survey was only
completed by parents who had sought mental health services for their student. Many of
these results are similar to those reported in the qualitative analysis.
In terms of financial accessibility, the cost of mental health programming or
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services was primarily perceived as either not a barrier or only somewhat of a barrier.
Specifically, 60% of parents indicated that cost was "Not a Barrier," while 40%
considered it "Somewhat of a Barrier."
Regarding logistical challenges, transportation to outside agency appointments
was largely not seen as a significant hurdle, with 80% of parents reporting it was "Not a
Barrier," and 20% perceiving it as "Somewhat of a Barrier." Similarly, scheduling
appointments with outside agency providers posed a barrier for a minority of parents,
with 60% stating it was "Not a Barrier" and 40% finding it "Somewhat of a Barrier."
However, awareness about available mental health or social service programs in
the community emerged as a more notable obstacle. While 60% of parents reported it was
"Not a Barrier," a substantial 20% identified it as a "Significant Barrier," and another
20% considered it "Somewhat of a Barrier."
Concerns about confidentiality or the stigma associated with seeking mental
health help represented the most pronounced barrier among these categories. For 60% of
parents, these concerns were "Not a Barrier." However, 20% indicated they were a
"Major Barrier," and another 20% viewed them as a "Significant Barrier."
Difficulties navigating the process of getting help, such as referrals and
paperwork, also presented a barrier for some parents. While 40% found this "Not a
Barrier," an equal 40% considered it a "Significant Barrier," and 20% identified it as
"Somewhat of a Barrier." Long wait times for appointments were also a notable concern,
with 20% of parents reporting them as a "Major Barrier," and 60% as "Somewhat of a
Barrier," while 20% found them "Not a Barrier."
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Table 13 illustrates these parent responses in proportionate pie charts:
Table 13
Barriers Reported in Parent Post Surveys
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Comparison: Pre and Post Surveys
As indicated, due to the anonymous nature of the surveys and their submissions,
there is no way of knowing if participants who completed the pre survey, at the beginning
of this action research project repeated the survey during the post administration. When
reviewing results, it is important to read the results as a snapshot of parental attitudes at
the time of the survey, rather than interpreting them as a change in perceptions over time
within the same research group. With this in mind, it is valuable to compare both the
qualitative and quantitative survey data during both administrations to gain a
comprehensive understanding of the parent perception district programming and
initiatives.
Parents in the Tussey Mountain community consistently recognized the vital
importance of mental health and social services for students, both at the start and end of
the project. In the initial pre-survey, an overwhelming 90% of parents agreed or strongly
agreed that mental health services were crucial for student well-being. This sentiment
remained strong in the post-survey, with 91% of respondents expressing similar
agreement.
Similarly, the essential nature of social service programs in supporting students
facing challenges outside of school was a point of widespread agreement. In the
pre-survey, 77.8% of parents agreed or strongly agreed that these programs were
essential. This consensus was maintained in the post-survey, with 91% of parents
agreeing or strongly agreeing. The perception of a growing need for both mental health
and social service support within the rural community was also a consistent theme, with
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77.8% of parents agreeing or strongly agreeing in the pre-survey, and 91% in the
post-survey.
Despite the strong recognition of need, both survey administrations highlighted
significant and persistent gaps in the accessibility, awareness, and effectiveness of
available programming, particularly those offered by or in collaboration with the school
district.
A notable area of continued concern was the accessibility of mental health
services. In the pre-survey, a clear majority of parents (66.7%) disagreed with the
statement that students had easy access to mental health services. This perception
remained largely unchanged in the post-survey, where only 27% of participants agreed
that students had easy access, while 45% disagreed or strongly disagreed.
Awareness of available programs also remained a significant issue. In the
pre-survey, a combined 77.7% of parents either chose "Neither agree nor disagree" or
"Disagree" when asked about their awareness of different program types. This lack of
awareness persisted in the post-survey, with 45% of parents disagreeing or strongly
disagreeing that they were aware of various program types.
Regarding the effectiveness of school-district offered mental health services,
opinions consistently leaned towards skepticism or neutrality across both surveys. In the
pre-survey, 88.8% of parents either disagreed or remained neutral about the effectiveness
of these services. The post-survey showed a similar trend, with 45% disagreeing or
strongly disagreeing, and 27% remaining neutral. Social service programs offered in
collaboration with the school district also presented mixed responses in both
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administrations, suggesting they were not consistently perceived as beneficial or helpful.
Finally, communication from school staff regarding available mental health
resources was a consistent area of concern. In the pre-survey, a significant majority of
parents (66.7%) expressed disagreement that school staff effectively communicated these
resources. This negative sentiment was even more pronounced in the post-survey, with
73% of respondents disagreeing or strongly disagree. The perception of the school
environment's supportiveness of students seeking mental health help also remained a
challenge. In the pre-survey, 66.6% of parents expressed negative perceptions in this area,
and in the post-survey, only 27% of parents agreed that the environment was supportive.
Chapter Summary
To thoroughly address each research question, a mixed-methods approach was
employed, integrating both quantitative and qualitative data collection and analysis. This
strategy ensured a comprehensive understanding of the contextual issues. The
action-research project leveraged data triangulation by utilizing multiple sources,
including student surveys, parent surveys, interviews, discipline data, and Chill Room
usage records. This approach enhanced the internal validity of the study by offering
diverse perspectives on the research questions and mitigating potential biases from any
single data source. The use of data triangulation allowed for a more nuanced and detailed
understanding of the research questions, a technique that involved examining research
questions through various data sources, methods, or perspectives.
Pre and post student survey data revealed a more protective school environment,
showing improvements in how pro-social behaviors were rewarded and in the general
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sense of safety and support. Perceptions of the school's drug environment also improved,
particularly regarding alcohol and marijuana. Furthermore, there was a noticeable
positive shift in students' perceptions of school social factors, especially concerning
teacher relationships, school connectedness, academic support, order and discipline, and
the school social environment. However, academic satisfaction showed a decline, while
the physical environment remained stable.
Discipline data revealed mixed trends, with slight increases in warnings,
detentions, and in-school suspensions, but a positive decrease in out-of-school
suspensions. Chill Room usage consistently increased, and data showed a significant
positive shift in student mood and readiness for school tasks after visits.
Student interviews revealed key strategies and challenges in accessing mental and
behavioral health services at Tussey Mountain Middle/High School. All interviewed
students reported experiencing stress, anxiety, or depression at school, with most (87.5%)
aware of available resources like the Chill Room (67%), the school-based therapist
(33%), and the counseling office (33%). Most students (75%) felt resources were
adequate, primarily learning about them from teachers (55.5%).
The most effective strategy reported was an adult explaining and guiding students
through options (75%), often by Allegheny Health Network staff and teachers. Students
noted significant positive changes since starting high school, especially praising the Chill
Room's onsite availability and flexibility.
However, barriers persisted, with 25% finding access difficult, largely due to
teachers not allowing access to resources and the Chill Room's limited operating hours.
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Students suggested staff training to better recognize mental health needs, increased
program advertisement, and greater scheduling consistency as crucial improvements.
Parents also completed surveys at two points during this action research project.
Parents overwhelmingly recognized the critical need for mental health and social services
for students, with over 90% consistently agreeing that these services were important for
well-being and that there was a growing community need. Despite this consensus,
significant and persistent gaps in accessibility, awareness, and effectiveness were
reported across both surveys. A majority of parents (66.7% pre, 45% post) disagreed that
students had easy access to mental health services. Awareness of available programs
remained a concern, with 77.7% of parents pre-survey and 45% post-survey indicating
mixed awareness or disagreement about program knowledge. The effectiveness of
school-district mental health services was consistently met with skepticism or neutrality
(88.8% pre, 72% post).
Communication from school staff about resources and the school environment
was also reported as a common concern among parents in both qualitative and
quantitative responses. Qualitative data also identified stigma, lack of awareness, and
systemic issues as major barriers.
While cost, transportation, and scheduling were less frequently major barriers,
they remained "somewhat of a barrier" for many. Parents expressed a strong desire for
more integrated, school-based services, improved staff training, and better
communication to destigmatize and facilitate access.
While this chapter focused on detailing these results, the subsequent chapter will
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transition to a deeper analytical discussion, interpreting these findings in relation to the
existing literature and addressing the overarching research questions.
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CHAPTER V
Conclusions & Recommendations
This action research project undertook a comprehensive investigation into the
effectiveness of interventions designed to enhance mental and behavioral health services
at Tussey Mountain Middle/High School. Using a robust mixed-methods approach, this
study triangulated quantitative data from student and parent surveys, discipline records,
and Chill Room usage logs with rich qualitative insights gleaned from student interviews
to obtain a comprehensive understanding into district programming.
This multifaceted strategy allowed for a nuanced understanding of the prevailing
contextual issues. The findings revealed significant positive shifts in student perceptions,
particularly concerning school safety, the supportive environment, and the school's
approach to drug-related concerns. Furthermore, improvements in social factors, such as
teacher relationships and a greater sense of school connectedness, were evident,
alongside the demonstrable value of the Chill Room, marked by its increased utilization
and positive impact on student well-being.
Despite these encouraging developments, the investigation also brought to light
persistent challenges. While a decrease in out-of-school suspensions was observed, an
increase in warnings, detentions, and in-school suspensions suggests areas warranting
further attention. Crucially, student perspectives highlighted barriers to accessing mental
and behavioral health resources, including limited operating hours for the Chill Room
and instances where access was restricted by staff. Parents, in parallel, consistently
reported significant gaps in the accessibility, awareness, and perceived effectiveness of
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existing services, coupled with concerns about communication from school personnel.
Qualitative data from parents further emphasized the role of stigma, lack of awareness,
and systemic issues as major impediments.
Moving forward, it is important to explore these results further to draw
meaningful connections to the established research questions. It is also important to
explore the limitations of this action research study, exploring how the research design,
methodology, or external factors may have influenced the interpretation of the findings.
Exploration in these areas will provide a context to provide recommendations for
future research, to identify areas that warrant closer examination to potentially. This
discussion will also facilitate actionable steps for further improvements to the
programming within the Tussey Mountain School District.
Research Question One: Conclusions
When studying the research question, “what was the impact on self-reported risk
factors and protective factors before and after the implementation of mental and social
service programming initiatives” many tangible improvements to district programming,
services and culture were realized. The action research project demonstrated several
tangible improvements. First and foremost, there were increased student perceptions of a
protective school environment. Students reported feeling a greater sense of overall safety,
support, and recognition for prosocial behaviors. Students also perceived a less prevalent
and risky drug environment within the school, particularly concerning alcohol and
marijuana.
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There is also much evidence of an enhanced school social climate. There was a
clear and measurable improvement in students' perceptions of teacher relationships, their
sense of school connectedness, the level of academic support, the effectiveness of order
and discipline, and the overall school social environment. Students also increasingly felt
they were being treated equally and fairly within the school.This was coupled with a
notable decrease in serious discipline infractions.
The Chill Room proved to be a highly effective and increasingly utilized resource
for students to manage their emotions and improve their readiness for learning. The
consistent and significant reduction in students' self-reported distress levels after using
the Chill Room is another clear and tangible outcome of this project.
Impact on Risk Factors
A reduction in self-reported risk factors was realized during this study. Data from
the PhenX School Drug Environment ToolKit reveals a generally positive shift in
students' perceptions of the school's drug environment, indicating a reduction in
perceived risk. Improvements were noted in these areas:
● General School Drug Environment: This overall summary scale decreased from 2.97
pre-intervention to 2.79 post-intervention (with scores closer to 5 indicating more
prevalent use or risk behaviors). This is a positive indicator that students perceive a
less prevalent or risky drug environment.
● School Alcohol Environment: A significant perceived reduction in alcohol
prevalence or risk behaviors was observed, with scores decreasing from 2.81 to 2.38.
● School Marijuana Environment: This saw the most substantial decrease, dropping
from 3.04 to 2.52, suggesting a significant improvement in students' perceptions of
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marijuana prevalence or associated risks.
● School Tobacco Environment: While overall positive, there was a minor uptick in
perceived tobacco risk (from 2.15 to 2.23), suggesting that tobacco use or risk
perceptions may not have responded as favorably to the interventions as alcohol and
marijuana.
School discipline data also provided some insight into the impact of district
initiated programming on student risk factors. Discipline data presents mixed trends,
indicating that while some severe risk behaviors decreased, others saw an increase.
Out-of-School Suspensions (OSS) saw a significant decrease from last school year to this
school year. This is a clear positive trend, suggesting that the most severe disciplinary
actions were less frequently necessary.
While there was a decrease in more severe disciplinary actions, low and mid-level
disciplinary actions remained relatively stable or increased, with warnings increasing
slightly, detentions increasing significantly, and in-school suspensions rising sharply.
Additionally, referrals to SAP, Counseling, or Other Agencies decreased.
When considered in context, these could indicate more minor behavioral issues
but also a shift in how less severe behaviors are being managed by the principal's office.
Coupled with fewer principal-initiated external referrals, there is some evidence that
proactive approaches such as use of district-initiated mental health programs are being
used to address behaviors before they escalate to more serious disciplinary infractions,
such as those which require out-of-school suspension.
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Impact on Protective Factors
Based on the quantitative data collected from the PhenX School & Protective
Factors ToolKit, the PhenX School Drug Environment surveys, the PhenX School Social
Factors ToolKit, disciplinary data, and Chill Room usage records, the implementation of
mental and social service programming initiatives at Tussey Mountain Middle/High
School demonstrated a mixed but generally positive impact on self-reported risk and
protective factors among students.
The aggregate data from the PhenX School & Protective Factors ToolKit indicates
an overall positive movement towards a more protective school environment for the eight
participating students. Specifically, improvements were noted in these areas:
● General School Protective Environment: This key summary scale showed a positive
upward trend, increasing from an average of 2.79 pre-intervention to 2.97
post-intervention (with scores closer to 4 indicating a more protective environment).
This suggests that students perceived a greater sense of overall safety and support
within the school following the initiatives.
● School Rewards for ProSocial Involvement: Perceptions significantly improved,
moving from 2.64 pre-intervention to 2.86 post-intervention. This indicates that
students felt their positive behaviors were better recognized and acknowledged after
the programming initiatives.
● Academic Performance: This subdomain also showed a positive shift, improving
from 3.08 pre-intervention to 2.56 post-intervention (where lower scores indicated a
more protective environment). This suggests a more supportive academic
environment was perceived.
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● School Opportunities for ProSocial Involvement: While the overall trend was
positive, there was a minor, albeit slight, decrease in perceived opportunities for
prosocial involvement (from 2.91 to 2.86). This suggests that while other protective
aspects improved, the perceived avenues for pro-social engagement may require
further attention.
Analysis of student responses reported using the PhenX School Social Factors
ToolKit also demonstrates a noticeable positive shift in students' perceptions of school
social factors, indicating an increase in protective elements related to their sense of
connectedness and pride. The combined percentage of responses indicating overall
positive sentiments increased from 47.11% at the start of the study to 59.22% at the end
of the study. Similarly, negative sentiments decreased from 23.97% to 14.59%. This
indicates a general improvement in students' perceptions of the school's social
environment.
The most notable improvements were observed in Teacher Relationships (which
improved from 44.1% reporting positive responses to 75.0% reporting positive
responses). Improvement was also noted in other sub domains. School Connectedness
(increased from 23.7% to 43.9%), Academic Support (further solidified from 81.0% to
86.5%), Order and Discipline (increased from 52.4% to 64.2%). Furthermore, School
Social Environment (combined positive sentiment surged from 15.4% to 46.7%).
There was also a positive shift in students' perceptions of fairness, with the
percentage of students disagreeing or strongly disagreeing with statements of
exclusion/privilege increasing from 28.57% to 47.62%. This indicates a stronger belief
among students that they are being treated equally and fairly. These shifts suggest that the
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programming initiatives fostered stronger relationships, a greater sense of belonging, and
a more positive and secure social atmosphere within the school.
While many areas improved, School Physical Environment remained relatively
stable with no significant increase in positive perception. More notably, Academic
Satisfaction indicated a decline in positive feelings (from 64.2% to 33.3%), suggesting
students felt less satisfied with their academic experiences as the project progressed. This
could be a critical area for future attention.
Additionally, data from the Chill Room strongly supports its role as a valuable
protective factor. This was evident through continued, increased utilization. "Drop-ins"
consistently and significantly increased from December to April, indicating growing
student awareness and willingness to utilize this resource for emotional regulation.
Additionally, the "Average Rating Out" was consistently and significantly lower than the
"Average Rating In" across all months (e.g., in February, the average reduction was 1.9
points from 3 to 1.2). This consistently demonstrates a substantial positive shift in student
mood and readiness for school tasks after visits, highlighting the Chill Room's
effectiveness in de-escalation and promoting well-being.
Recommendations for Future Research
While study of this research question yielded very positive results for the students
and school at large, during this action research project, several areas of further inquiry
have emerged which may assist in continuing to improve programming within the Tussey
Mountain School District and other schools.
Further study may be beneficial to determine why survey participants reported a
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decline in academic satisfaction during the course of this study and how this could be
addressed through targeted interventions. This could be achieved through conducting
qualitative interviews with students to delve deeper into their perceptions of curriculum,
workload, grading, instructional methods, and relevance of learning. Supplementing this
with teacher and parent focus groups could help gain a more comprehensive
understanding of this issue. This was identified as an important area for study, as a
limited number of parent respondents (in research question three) reported homework
stressors as a concern for their student.
Additionally, as indicated it is currently unclear why warnings, detentions, and
in-school suspensions increased and the number of external referrals decreased. As
discussed this could be evidence that addition of programming available within the
school has led to a more proactive approach but more research is needed at this time to
better describe and understand the relationship between mental health initiatives and
student discipline. Interviewing teachers and administrators to understand their
perceptions of behavioral trends and changes in disciplinary practices could help school
leaders better understand this relationship. Within the Tussey Mountain School District,
this data could also provide greater context to parent concerns reported in research
question three regarding staff misunderstandings of mental health disorders.
Research Question Two: Conclusions
Research question two sought to determine what strategies, as reported by
students, were effective for helping students access mental and behavioral health services
at Tussey Mountain Middle/High School and determine what barriers existed. Based on
the self-reported data from student interviews, the most effective strategy for helping
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students access mental and behavioral health services at Tussey Mountain Middle/High
School was direct, personalized guidance from a trusted adult, particularly teachers and
Allegheny Health Network staff, combined with the readily available and flexible Chill
Room. The tangible benefits of this and other district initiatives was evident in student
interview responses as well as the specific identification of successful strategies which
improved access and awareness of mental health resources in the school district.
Student Reports of Awareness
The overwhelming consensus among interviewed students (100%) that they have
experienced stress, anxiety, or depression at school underscores the critical need for
accessible mental and behavioral health services. A significant majority of students
(87.5%) are aware of available mental health resources. The high level of student
awareness of available resources indicates that initial efforts to inform students have been
largely successful.
The most frequently reported effective strategy (75% of students) was having an
adult explain and walk them through options. This highlights the crucial role of human
connection and personalized support over passive information dissemination. Students
benefit significantly when an adult not only informs them but actively assists them in
navigating the process of accessing help.
Teachers (33% of responses) and Allegheny Health Network staff (33% of
responses) were equally identified as particularly helpful in this "walking through"
process. This suggests that these groups are perceived by students as approachable and
instrumental in facilitating access. The role of paraprofessionals (22%) and school
counselors (11%) also indicates a multi-faceted network of support.
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Furthermore, the finding that 55.5% of students learned about services from
teachers reinforces their critical role not just as facilitators of access, but also as primary
disseminators of information. This underscores their direct and consistent contact with
students. Additionally, when triangulated with findings from research question one which
indicated marked improvement in the area of teacher relationships, there is strong
evidence to suggest that levering teacher relationships as part of the referral process and
providing additional systems of support for both teachers and students can continue to be
an impactful practice.
Student Reports of Access
The provision of the Chill Room and the on-sight therapist through Allegheny
Health Network proved to be an effective strategy at increasing student access to mental
health services. Throughout student interviews, students consistently identified the Chill
Room as a highly valued and effective resource. Students praised its flexibility and
effectiveness in helping them "find what worked for them," indicating it serves as a
low-barrier, self-directed support mechanism.
During the student interviews, nearly ninety percent of participants noted positive
change in available resources since starting high school, most commonly citing the Chill
Room being on-site as an effective strategy. The Chill Room was highly recognized (67%
of aware students) and appreciated by students for its flexibility and effectiveness in
supporting their well-being. One-third of students recognized the school-based therapist
(Allegheny Health Network) as a helpful resource.
As indicated, an overwhelming percentage of older participants (88%) noted
much positive change in available resources since they started high school. These
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students mentioned the Chill Room and SEMHA's efforts to reduce stigma, This a
successful cultural shift within the school regarding mental health openness and support
among the student body. While 75% of students felt resources were adequate, the
qualitative response indicating "things were moving in the right direction, but that more
students needed to take it up" suggests that perceived adequacy is tied to actual utilization
and awareness among the broader student body, not just those interviewed.
Student-Reported Barriers
Two barriers to accessing services emerged among students who stated they found
accessing services difficult, making them the most salient and actionable findings from
the student perspective, with regard to service access. While teachers were reported as a
valuable resource to helping initially connect students with resources, teachers not
allowing students access to the Chill Room was perceived as a barrier. A small number of
students who reported that accessing services was “difficult,” specifically mentioned
teachers preventing them from going to the guidance/school counselors or the Chill
Room. This barrier raises legitimate concerns regarding the balance between student well
being and the daily realities of classroom management, the school’s instructional purpose
and established procedures for accessing the Chill Room.
Students also explicitly cited that the Chill Room's operating hours (currently
Tuesday-Thursday) created a barrier to accessibility and consistent service delivery. Due
to staffing issues, similar to those noted in other settings in the review of literature, the
Chill Room is currently only staffed part time (Tuesday, Wednesday, and Thursday).
While the Chill Room is highly valued, its restricted availability means students
experiencing distress on Mondays or Fridays, or outside of those specific hours, do not
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have immediate access to this preferred resource. This inconsistency can make it
challenging for students to rely on the Chill Room.
Recommendations for Future Research
Investigation into this research question, further solidifies the benefits of schools
serving as access points for student mental health services, as also identified in the
literature review. As schools adapt to this changing role, more research may be needed to
determine the needs of teaching professionals. Further study may help school leaders and
researchers better understand teachers' perspectives on student mental health needs,
service access, and the challenges of allowing students to leave class. Additionally, as
more schools implement point-of-access models, similar to the one in this study, future
research may be needed to determine the long-term educational impact of programs such
as this.
Research Question Three: Conclusions
Research question three investigated the impact on community perceptions of
district-initiated mental health and social service programming. Two surveys (a pre and
post survey), with near-identical questions provided via district social media. Due to the
anonymous nature of the surveys and the online means of submission, there is no way to
determine if the same or different participants completed these surveys. Results should be
interpreted as collective parent perceptions at a particular point in time, rather than a
change in perception within the same group of research participants.
Both pre- and post-surveys demonstrated an overwhelming consensus among
parents regarding the critical importance of mental health and social services for student
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well-being, with approximately 90% of parents supporting or identifying a need for
mental health and social service programming within the school system. Survey results
indicated a disconnect between parents who had sought mental health services for their
students since the implementation of studied programming and those who did not.
Parents who had sought mental health treatment for their student, reported modest
improvements in logistical barriers. When the survey results were also compared to
student survey and interview results, there was also discrepancy between student and
parent perceptions of program efficacy, communication and the supportiveness of staff
and the school environment.
Among parents who reported that their child has received mental health services
during the study period, the cost of services appears to be perceived as less of a barrier.
Prior to the survey, 20% of parents considered cost a major barrier, 40% a somewhat
barrier, and 40% not a barrier. Post-survey, the perception of cost as a major barrier
dropped to 0%, with 40% still seeing it as somewhat of a barrier and 60% reporting it as
not a barrier. This suggests that while cost remains a concern for some, it is no longer
considered a major obstacle by any surveyed parents. The provision of free-access to the
Chill classroom educator may have helped improve parent perceptions in this area. The
provision of on-sight programming also seems to have impacted parent perception with
regard to transportation to and from appointments. In this area, there was a positive shift,
with 80% of parents reporting that transportation was "Not a Barrier" in the post-survey,
compared to 60% pre-survey. When viewed in the context of other parent responses,
citing the lack of resources in the rural area, there is further evidence to suggest that the
school as an access point for services offers other positive benefits for parents.
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Among the parent survey group as a whole, significant and persistent gaps in
perceived accessibility, awareness, effectiveness, communication from school staff, and
the supportive nature of the school environment remained largely unchanged and
revealed some areas for continued improvement and engagement within the parent
stakeholder group moving forward.
Regarding stigma and confidentiality, the results suggest a polarization in parents'
views. Pre-survey, 20% saw it as a major barrier, 20% as significant, 20% as somewhat,
and 40% as not a barrier. Post-survey, while the "somewhat" category disappeared (0%),
the percentage of parents identifying it as a major barrier (20%) and significant (20%)
remained the same. This means 40% of parents still viewed stigma/confidentiality as a
significant or major hurdle, while 60% considered it not a barrier. This shift implies that
for a subset of parents, stigma and confidentiality continue to be substantial concerns,
even as others no longer perceive it as an issue.
Awareness of services also continued to be a significant issue. Before the survey,
20% of parents viewed awareness as a major barrier, 60% as somewhat of a barrier, and
20% as not a barrier. The post-survey data for awareness is less clear and presents some
inconsistencies. While 0% of parents considered awareness a major barrier post-survey,
20% reported it as somewhat and 20% as significant, totaling 40% who still saw it as a
barrier to some degree. The remaining 60% considered it not a barrier. The noted
discrepancy where 45% disagreed about awareness in another survey question further
highlights that, despite some improvements in the "major barrier" category, overall
awareness still remained a problem for a substantial portion of parents.
Qualitative analysis of parent responses indicates consistent concerns about a lack
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of easy access to mental health services and ability of school staff to communicate
opportunities. This finding would suggest that some parents remain unaware of on-sight
district programming. Within the pre-survey, a combined 77.7% of parents expressed
mixed awareness or disagreement about program knowledge. This persisted in the post,
with 45% disagreeing or strongly disagreeing that they were aware of different program
types. This would imply that the initiatives did not effectively bridge the awareness gap
for parents. While students reported learning about services from teachers, this
information did not consistently reach the parent community, indicating a disconnect in
communication strategies. Communication concerns also emerged as primary parent
concern in qualitative responses.
Recommendations for Future Research
These results are very similar to those noted by Longhurst et al. (2021) who found
that parents and caregivers generally supported mental health services in the school
system, as they are convenient to access and provide a familiar environment for their
child. Similarly, in this study, many parents said that they wished for better
communication from the school regarding the program and their child’s progress. Abrams
(2023) also communicates concerns about ineffective parent communication. Based on
each of these findings, it is recommended that more specific research be conducted on
how parents wish to receive information about programming.
Within the Tussey Mountain School District, it would also be beneficial to
explore the divergence in perceptions among parents who have sought treatment for their
student and those who have not, as well as the divergence from the perceptions noted in
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student surveys and interviews. Future research should also explore if differing
perceptions occur in other settings among these stakeholder groups and the potential root
causes for such divergence.
Limitations
When considering the limitations of this study, it is important to acknowledge that
a change in research methodology (PAYS data used to establish the context vs identified
data sources in the research methodology) limits the researcher’s ability to make direct
comparisons from the baseline data to the data collected. The shift away from relying
solely on PAYS data means that direct comparisons to broader state trends or historical
PAYS data within the district will be limited. This could affect the study's external
validity, or generalizability, as it may be harder to place the findings within a larger
context. While broader comparisons to PAYS data are limited, the researcher has chosen
methods to allow for a more focused evaluation of the specific district-initiated programs,
through use of both quantitative and qualitative data.
Another limitation of qualitative research identified by Mertler (2022) is that this
form of research, historically, has less participants. This was noted in the present study, as
limited sample sizes were noted for stakeholder surveys and interviews. A total of eight
students participated in the student surveys and interviews. In total, twenty parents
submitted survey data for analysis.
While thematic saturation might have been achieved for key themes, the small
number of participants potentially limits the generalizability of the findings to the entire
student population at Tussey Mountain Middle/High School. Perceptions might differ
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among a larger, more diverse group of students or parents
Additionally, much of the data in this survey relies on student and parent reports,
which can be subject to recall bias, social desirability bias, or a limited understanding of
all available services.
Recommendations for Future Initiatives at the Tussey Mountain School District
The positive shifts in student connection to the school, indicate that the current
mental and social service programming initiatives are having a beneficial impact,
particularly, the Chill Room. The increased Chill Room usage and its demonstrated
effectiveness in mood regulation are highly encouraging. Future improvements should
focus on ensuring consistent and optimal operating hours for the Chill Room, addressing
any barriers to access (e.g., teacher permission and staffing) and continuing to effectively
advertise its availability and benefits to all students and staff.
The slight increase in perceived tobacco risk and the decline in Academic
Satisfaction, reported on the student surveys highlight areas needing targeted
interventions. This could involve revised prevention programs for tobacco or a review of
academic support structures, curriculum, or instructional practices to enhance student
engagement and satisfaction. The district can use existing infrastructure within the
contracted programming through Allegheny Health Network to implement targeted
intervention and prevention programs in these areas.
Additionally, the positive impact on teacher relationships, reported by students
and parents, suggests that professional development focused on further building positive
student-teacher interactions and recognizing mental health needs is valuable and should
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be continued or expanded.
Furthermore, the increase in warnings, detentions, and ISS, while OSS decreased,
warrants a deeper dive. This could lead to a review of disciplinary policies to understand
if this reflects increased vigilance, a lower threshold for intervention, or if students are
needing more low-level support. Professional development for staff on de-escalation and
positive behavior interventions could be beneficial.
The continued parent concerns regarding accessibility, awareness, and
effectiveness, as well as communication from school staff, suggest a need for more
proactive and clear communication strategies regarding available mental health and social
services. This includes consistent outreach to parents and ensuring all staff are
well-informed and able to guide students and families to appropriate resources.
Conducting dedicated parent focus groups and surveys could help identify specific
communication preferences and barriers, as well as piloting new communication
strategies and assess their impact on parent awareness and engagement, based on these
results.
Financial Implications
This project, itself, was inexpensive to conduct, but the programs it evaluated
carried significant costs. These new initiatives for the current school year were entirely
funded by grants and philanthropic donations. This influx of external funding, combined
with the proposed capstone research project, gave the district a valuable chance to
understand how different groups viewed the effectiveness and challenges of these
programs. This capstone project has enabled the district to make data-driven decisions
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about the future of programs like the Chill Project, basing their choices on proven impact.
The Chill Project was consistently reported as one of the most impactful initiatives by
students. Furthermore, significant positive changes to reported risk and protective factors
indicate a significant, positive impact on the student body.
During this project, the researcher also evaluated options to sustain programming
for future years, in the absence of grant funding. These efforts have yielded an additional
year of services for the district for the upcoming school year (2025-2026), as the district
continues to seek means through which this program can be financially sustainable and
fiscally-responsible. This was achieved through a variety of means. First and foremost,
additional philanthropic funding has been obtained through the partnership with
Allegheny Health Network. The district’s rural setting and unique challenges provides an
environment where program efficacy of the Chill Project can be evaluated in a new
setting. Organizational interest and the potential to meet needs in a rural, rather than
suburban or urban setting helped facilitate the provision of continued philanthropic
donations, as educators and mental health providers, alike, seek to respond to the
adolescent mental health crisis in rural America.
Additionally, although staffing concerns created barriers to program access, as a
Chill classroom educator was only available part time, this reduction in cost did enable
the programing to continue for a longer period of time, due to grant funds not being
exhausted in one year. In addition to the Chill classroom educator, the current cost of
services from Allegheny Health Network also includes an on-sight school-based
counselor. The on-sight counselor for Allegheny Health Network currently carries a
caseload that is currently 64% funded through insurance billing. As the program grows
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and more students receive this service, the cost of services billed to the district through
Allegheny Health Network will decrease, making the program more sustainable.
Finally, school leaders, including the researcher, discussed additional available
funding streams. Through these discussions, it was discovered that, in some
circumstances, some of the services offered to students receiving special education
services from the Chill Room can be paid using funding from the Individuals with
Disabilities Education Act (IDEA) in very specific situations. Use of this additional
funding stream was instrumental in funding the programming for one additional year. The
provision of an additional year of program funding provides more opportunities for the
school district to pursue additional funding streams which could lead to improved
financial sustainability.
Closing
Amidst these very important fiscal conversations, it is essential not to overlook a
critical dimension, the profound human impact. Budgets for those in the public sector,
such as schools are not merely a ledger of expenses and revenues; they are a declaration
of values and a blueprint for the future of a community's children. Future school years
will provide the Tussey Mountain School District time to build on the successes and
tangible improvements realized within this action research project, as well as build
financial sustainability of programming to meet the challenging and evolving set of needs
which necessitated the need for this project and programming.
Ultimately, this project demonstrated significant strides in fostering a more
supportive and protective environment for students' mental and behavioral well-being
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within the Tussey Mountain School District. The consistent and enthusiastic utilization of
the Chill Room, paired with a notable positive shift in student mood and readiness for
learning, underscores the direct and beneficial impact of accessible in-school resources.
Furthermore, the overall improvement in student perceptions of school safety, prosocial
behavior recognition, and critical social factors like teacher relationships and school
connectedness, paint a compelling picture of a school community better equipped to meet
the holistic needs of its students. These positive outcomes reported by the student
stakeholder group, as well as the strong support for mental health programming reported
by parents, lay a strong foundation for continued growth and refinement of mental and
behavioral health initiatives within the district. The findings of this action research
project helped identify a path forward to better meeting student needs and the challenges
reported within the parent stakeholder group.
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APPENDICES
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Appendix A
Institutional Review Board Documentation
144
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Appendix B
Survey Informed Consent Letter
Dear Parent/Guardian,
A research study, Bridging the Gap: Implementing a Multi-Stakeholder Approach to
Enhance Mental Health and Social Service Initiatives in a Rural School District, an
Action-Research Project, is being conducted at our school to better understand students’
experiences and factors that contribute to their well-being and success in school. This
project has received approval from PennWest University Institutional Review Board
effective from 10/18/2024 through 10/17/2025.
This research will help us develop programs and supports to improve the school
environment for all students.
Your child is being invited to participate in a survey about student risk factor and school
connectedness among students in the Tussey Mountain School District. The purpose of
this survey is to gather information about students’ perspectives on the importance,
accessibility, and effectiveness of school services, as well as their potential impact on
student behaviors.
Your student is also being invited to participate in an interview about access to mental
health services. The purpose of this survey is to gather information about students’
perspectives on the importance, accessibility, and effectiveness of school services, as well
as their potential impact on student behaviors.
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Your student’s input will help inform the district’s programming to better meet the needs
of our student body, as a whole.
Participation- Surveys
Students in grades 9-12 are eligible to participate in this survey with parental consent.
Participation in this survey is entirely voluntary. The decision to participate or decline to
participate will not affect your or your child’s relationship with the school district in any
way.
If you consent to your child’s participation in this survey, your child will meet with the
researcher at the time of your choosing. During this time, your student will be provided
with two surveys to complete.
Your child will repeat these surveys again in the spring. Each administration of the survey
will take approximately 30 minutes. You or your child may choose to stop participating in
this study at any time without penalty. Just because your child has started the survey does
not mean he or she has to complete it.
Confidentiality
Your child’s responses to this survey will be completely anonymous. No identifying
information will be collected during the actual survey or interview. After your student has
completed the survey or interview, their responses will be stored in a locked file. There
will be no way of identifying your child’s survey once it has been completed and stored
with the remainder of the surveys.
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Potential Risks
While the risks associated with participation in this survey are minimal, some questions
may ask about sensitive topics such as their relationships with school staff members,
thoughts on discipline practices, and alcohol/ drug usage among teens in the community
which may cause emotional discomfort. If your child feels uncomfortable answering any
question, he or she may skip it or stop the survey altogether. We advise you to
thoughtfully consider these potential risks before consenting to your child’s participation
in this research study. Contact information for mental health agencies in our area is also
available for any participant or family who would like information on these resources.
Benefits
Select participants will be awarded a nominal gift card. Outside of this benefit, there is no
direct benefit to research participants. However, information collected will help the
school district better understand the needs of students when designing future programs.
The information collected will help our school district better understand risk factors
impacting our students and assess their overall connectedness to our school.
Questions
If you have any questions about the research, or a research-related injury, please contact
Denelle Diehl at die33397@pennwest.edu. If you have questions about your child’s rights
as a research participant that you need to discuss with someone, you can contact the
PennWest University Institutional Review Board at InstReviewBoard@Pennwest.edu.
Consent
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By completing this form, you are providing consent for your student to participate in the
surveys or interviews.
Student Name:__________________________________________________________
Parent Signature:________________________________________________________
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Appendix C
Student Assent Statement (Surveys)
You are being asked to participate in a research study. Your participation is voluntary and
you may stop at any time.
This research study is taking a look at how our students feel about our school and student
risk factors. We want to use this information to better meet the needs of our students.
Your part in this study will be to complete two surveys. These will take approximately
fifteen minutes each to complete. You will be provided with a private space to complete
the survey. Once you are finished you will place the surveys in the locked box you have
been shown. Because your name is not on either survey, no one will know how you have
responded.
The survey responses will only be seen by the researcher, Ms. Diehl. Your parents,
teachers and other school staff will not be shown the surveys.
Your parents or guardians have consented for you to participate in this interview,
however, you do not have to do this, and you can stop at any time and nothing bad will
happen to you. If you choose to not answer a question or stop the interview, no one will
be upset with you.
If you want to stop taking part in the study, you just need to tell Ms. Diehl that you want
to stop. If you have any questions about the study, you may ask now or at any point
during the survey.
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After the study if something is upsetting to you, you should speak with your parent(s) or
guardian(s).
I agree to be in this study, have had all my questions answered, and know I can stop at
any time.
____________________________
_________________
Student Participant Signature
Date
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Appendix D
Informed Consent (Interviews & Surveys)
Dear Parent/Guardian,
A research study, Bridging the Gap: Implementing a Multi-Stakeholder Approach to Enhance
Mental Health and Social Service Initiatives in a Rural School District, an Action-Research
Project, is being conducted at our school to better understand students’ experiences and factors
that contribute to their well-being and success in school. This project has received approval from
PennWest University Institutional Review Board effective from 10/18/2024 through 10/17/2025.
This research will help us develop programs and supports to improve the school environment for
all students.
Your child is being invited to participate in a survey about student risk factor and school
connectedness among students in the Tussey Mountain School District. The purpose of this
survey is to gather information about students’ perspectives on the importance, accessibility, and
effectiveness of school services, as well as their potential impact on student behaviors.
Your student’s input will help inform the district’s programming to better meet the needs of our
student body, as a whole.
Participation- Surveys
Students in grades 9-12 are eligible to participate in this survey with parental consent.
Participation in this survey is entirely voluntary. The decision to participate or decline to
participate will not affect your or your child’s relationship with the school district in any way.
If you consent to your child’s participation in this survey, your child will meet with the researcher
at the time of your choosing. During this time, your student will be provided with two surveys to
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complete.
Your child will repeat these surveys again in the spring. Each administration of the survey will
take approximately 30 minutes. You or your child may choose to stop participating in this study at
any time without penalty. Just because your child has started the survey does not mean he or she
has to complete it.
Participation- Interviews
Students in grades 9-12 are eligible to participate in this survey with parental consent.
Participation in this survey is entirely voluntary. The decision to participate or decline to
participate will not affect your or your child’s relationship with the school district in any way.
If you consent to your child’s participation in this survey, your child will meet with the researcher
at the time of your choosing. During this time, your student will meet with the researcher
individually, and complete an oral interview. You or your child may choose to stop participating
in this study at any time without penalty. Just because your child has started the interview does
not mean he or she has to complete it.
Confidentiality
Your child’s responses to this survey will be completely anonymous. No identifying information
will be collected during the actual survey or interview. After your student has completed the
survey or interview, their responses will be stored in a locked file. There will be no way of
identifying your child’s survey once it has been completed and stored with the remainder of the
surveys.
Potential Risks
While the risks associated with participation in this survey are minimal, some questions may ask
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about sensitive topics such as their relationships with school staff members, thoughts on
discipline practices, and alcohol/ drug usage among teens in the community which may cause
emotional discomfort. If your child feels uncomfortable answering any question, he or she may
skip it or stop the survey altogether. We advise you to thoughtfully consider these potential risks
before consenting to your child’s participation in this research study. Contact information for
mental health agencies in our area is also available for any participant or family who would like
information on these resources.
Benefits
There is no direct benefit to your child for participating in this survey. However, information
collected will help the school district better understand the needs of students when designing
future programs. The information collected will help our school district better understand risk
factors impacting our students and assess their overall connectedness to our school.
Questions
If you have any questions about the research, or a research-related injury, please contact Denelle
Diehl at die33397@pennwest.edu. If you have questions about your child’s rights as a research
participant that you need to discuss with someone, you can contact the PennWest University
Institutional Review Board at InstReviewBoard@Pennwest.edu.
Consent
By completing this form online, you are providing consent for your student to participate in the
surveys or interviews. Your consent will be verified via phone. You may also sign below:
Parent Signature:
Date:
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Appendix E
Student Assent Form (Interviews)
You are being asked to participate in a research study. Your participation is voluntary and you
may stop at any time.
This research study is taking a look at mental health services available in our school and what our
students’ needs are. Your part in this study will be to answer some interview questions about
your experiences at our school. This interview will take approximately 30 minutes.
During the interview, the researcher, Miss Diehl will be recording written notes about your
responses. Your name will not be placed on this note sheet. After you have finished, this note
sheet will be stored in a locked drawer with other interview note sheets. This will help protect
your privacy, as no one will know which note sheet records your answers. These note sheets will
not be seen by anyone but the researcher, Miss Diehl.
Additionally, your answers will not be shared with anyone else.
Your parents or guardians have consented for you to participate in this interview, however, you do
not have to do this, and you can stop at any time and nothing bad will happen to you. If you
choose to not answer a question or stop the interview, no one will be upset with you.
If you want to stop taking part in the study, you just need to tell Ms. Diehl that you want to stop.
If you have any questions about the study, you may ask now or at any point during the interview.
After the study if something is upsetting to you, you should speak with your parent(s) or guardian
(s).
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I agree to be in this study, have had all my questions answered, and know I can stop at any time.
____________________________
_________________
Student Participant Signature
Date
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Appendix F
Student Interview Script
Access to Mental Health Services
● Have you ever felt stressed, anxious, or depressed while at school? If so, what did you do
about it?
● Do you know of resources at our school that help students when they are experiencing
these feelings?
● How did you find out about the mental health resources available at our school?
● Was it easy or difficult to access these services? Why?
● (FOR STUDENTS IN GRADES 10, 11, 12) What grade are you in? _____ Think about
the services that were offered at the time you started high school in grade 9. Have the
services changed? How? If yes, how do you feel about these changes?
● Do you think there are enough mental health resources available at our school?
● Is there anything else you would suggest to improve student programs?
Effective Strategies
● If you or a friend did seek help, what was that experience like? What worked well?
● Were there any school programs or activities that helped you or a friend with mental
health?
● Who at the school has been helpful to you when you were struggling?
● What kind of support would have been most helpful to you?
Barriers to Access
● What prevented you or your friends from seeking help when you needed it?
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● Were there any stereotypes or stigmas about mental health that made it hard to ask for
help?
● What would make it easier for students to seek help?
● What would you change about the way mental health services are offered at our school?
Follow-up Questions
● Can you tell me more about that?
● How did that make you feel?
● What do you mean by [specific answer]?
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Appendix G
Informed Consent (Parent Surveys)
Welcome!
You are invited to participate in a research study about mental health and social services
for students in the Tussey Mountain School District.
The purpose of this survey is to gather information about parents’ perspectives on the
importance, accessibility, and effectiveness of these services. Your input will help inform
the district’s programming to better meet the needs of our students.
This study is being conducted by Denelle Diehl, who currently serves as the Director of
Education for the school district, in conjunction with coursework at PennWest University.
The title of this study is: Bridging the Gap: Implementing a Multi-Stakeholder Approach
to Enhance Mental Health and Social Service Initiatives in a Rural School District, an
Action-Research Project.
This study has received approval from the Institutional Review Board at PennWest
University. The effective date of approval is 10/18/2024. This approval expires
10/17/2025.
Participation & Withdrawal From The Study
All parents and guardians eighteen years of age and older with at least one student
enrolled in Tussey Mountain Middle or High School are eligible to participate in this
survey. Participation in this survey is entirely voluntary. You may choose to stop
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participating at any time without penalty. Your decision to participate or not will not
affect your or your child’s relationship with the school district. This survey will take
approximately forty minutes to complete.
Potential Risks
The risks anticipated with participating in this survey have been deemed to be minimal.
However, some questions may ask about sensitive topics such as mental health, which
may cause emotional discomfort. If you feel uncomfortable answering any question, you
may skip it or stop the survey altogether.
Benefits
There is no direct benefit to you for participating in this survey. However, your input will
help the researcher and the school district better understand the needs of students and
families regarding mental health and social services. This information will be used to
improve programs and support systems for students.
Confidentiality & Data Security
Your responses to this survey will be completely anonymous. You will not be asked to
provide any information that could be identify you (eg. name). The survey is NOT linked
to IP addresses. Individual responses will not be reported, just the aggregated data.
All information reported in this survey will be confidential within local, state, and federal
laws. The PennWest University Institutional Review Board (IRB) may review the
research records. The study's results may be shared in aggregate form at meeting or in a
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journal but your individual responses will not be revealed. Records from this study will
be kept by Denelle Diehl for at least (3) years after the study is complete.
Non-identifiable information collected as part of this research could be used for future
studies or distributed to another investigator with informed consent.
Questions
If you have any questions about the research, or a research-related injury, please contact
Denelle Diehl at die33397@pennwest.edu. If you have questions about your rights as a
research participant that you need to discuss with someone, you can contact the PennWest
University Institutional Review Board at InstReviewBoard@Pennwest.edu.
By clicking on the "I agree" box and continuing with the survey, you have acknowledged
that you have read the entire informed consent and are at least 18 years of age. You also
acknowledge that you agree to participate in the survey and have the right to not to
answer any or all of the questions in the survey. Finally, you understand that your
participation is completely voluntary and you may quit the study at any time without
penalty.
Thank you for your consideration!
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Appendix H
Parent Survey Questions
Part 1: Importance of Mental Health & Social Services
Instructions: Please rate your level of agreement with the following statements using the
scale provided.
● Strongly Disagree (1) Disagree Somewhat (2) Agree Somewhat (3) Strongly
Agree (4)
1. Mental health services are important for the overall well-being of students in our
school district.
2. Social service programs are essential in supporting students facing challenges
outside of school.
3. There is a growing need for mental health and social service support in our rural
community.
Part 2: Accessibility and Effectiveness
Instructions: Please rate your level of agreement with the following statements about the
current mental health and social service programs in the school district.
1. Students in our school district have easy access to mental health services when
needed.
2. I am aware of the different types of social service and mental health programs
available to students and families in our community.
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3. The mental health services offered by the school district are effective in
addressing student needs.
4. The social service programs offered in collaboration with the school district are
helpful for students facing challenges.
Part 3: Barriers and Suggestions
1. (Open Ended) In your opinion, what are the biggest barriers preventing students
from accessing mental health and social service programs in our school district?
2. (Open Ended) What suggestions do you have for improving the accessibility and
effectiveness of mental health and social service programs in our schools?
Part 4: Additional Information
(Open Ended) Please share any additional comments or suggestions you have regarding
mental health and social service support for students in our school district.
1. In the past year, has your student sought any mental health treatment or
services? (Yes/No)
○ If yes, please continue to question 2.
○ If no, please skip to question 5.
2. How did your student access mental health support? (Please select all that
apply)
○ Private therapist or counselor
○ School counselor
○ School psychologist
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○ School social worker
○ Telehealth services
○ Hospital emergency room/inpatient program
○ Other (Please specify)
3. During your search for mental health services, did the school provide any of
the following resources or assistance? (Please select all that apply)
○ Information on available mental health providers in the community
○ Support navigating the referral process
○ School-based mental health screening or assessment
○ Collaboration with outside providers
○ Assistance with scheduling (if needed)
○ Use of school facilities and technology to participate in teletherapy
programs
○ Other (Please specify)
4. (Open ended) How helpful was the school in assisting you in finding mental
health services for your student? Please elaborate on your experience.
5. (Strongly Disagree - Somewhat Disagree - Somewhat Agree - Strongly Agree)
The School staff effectively communicate mental health resources available to
students to students and families.
6. (Strongly Disagree - Somewhat Disagree - Somewhat Agree - Strongly Agree)
The school environment is supportive of students seeking mental health help.
7. (Open ended) What improvements could the school make to better support
students and families seeking mental health services?
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Part 2: Barriers to Access
Instructions: Please rate the extent to which the following factors would prevent you
from seeking mental health or social services for your child.
Scale: (Not a Barrier / Somewhat of a Barrier / Significant Barrier / Major Barrier)
1. Cost of mental health services or programs.
2. Availability of mental health services or programs after school hours or on
weekends.
3. Transportation difficulties in getting to appointments.
4. Lack of awareness about available mental health or social service programs
in the community.
5. Concerns about confidentiality or stigma associated with seeking mental
health help.
6. School not adequately informing parents about available resources.
7. Difficulties navigating the process of getting help (e.g., referrals, paperwork).
8. Long wait times for appointments.
9. Other (Please specify)
(Open Ended) Please share any additional thoughts or experiences you have had
regarding barriers to accessing mental health and social services for your student.
(Open Ended) If you found the efforts of the school helpful in coordinating care for your
student, please share what strategies or programs were successful and why:
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Appendix I
Thematic Coding, Research Question Two
Theme 1: Prevalence of Mental Health Challenges
● Universal Experience of Stress/Anxiety/Depression: 100% of students reported
feeling "stressed, anxious, or depressed while at school."
Theme 2: Awareness and Utilization of Resources
● High Awareness of Resources: 87.5% of respondents were aware of resources.
● Most Frequently Utilized/Noted Resources:
○ Chill Room (67% of aware students)
○ School-based therapist through Allegheny Health Network (33% of aware
students)
○ School counseling/guidance office (33% of aware students)
Theme 3: Perceptions of Resource Sufficiency
● General Adequacy of Resources: 75% of students felt there were adequate
mental health resources
● Perceived Insufficiency: 12.5% of respondents felt there were not enough
resources
● Engagement Gap: One respondent noted things were "moving in the right
direction," but emphasized the need for more students to "take it (the
opportunities) up."/ Also advertisement & awareness
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Theme 4: Channels of Information about Services
● Primary Information Source: Teachers: 55.5% of students learned about
services from talking with their teachers.
● Other Information Sources (less common):
○ Conversations with school/guidance counseling office
○ SEMHA Team publications
○ School announcements
○ Word of mouth (other classmates)
Theme 5: Effective Strategies for Accessing Mental Health Services
● Adult Guidance: 75% of students found it helpful to have an adult explain and
walk them through options.
○ Key Personnel Facilitating Access:
■ Allegheny Health Network staff (33% of responses)
■ Teachers (33% of responses)
■ District paraprofessionals (22% of responses)
■ School counselors (11% of responses)
Theme 6: Perceived Changes in Programming Over Time (Grades 10-12)
● Significant Positive Change: 88% of participants observed "much positive
change" in available resources since starting high school
● Most Common Positive Change: Chill Room: Participants most commonly
cited the Chill Room's on-site presence, flexibility, and effectiveness
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● Other Positive Changes: SEMHA raising awareness and reducing stigma
Theme 7: Barriers to Accessing Services
● Perceived Ease of Access: 75% of students reported accessing services was
"easy"
● Perceived Difficulty of Access: 25% of students reported accessing services was
"difficult"
● Primary Barrier: Teacher Discretion/Denial: Most frequently cited barrier was
teachers not allowing access to guidance/school counselors or the Chill Room
● Operational Barrier/ Limited Operating Hours: The Chill Room's limited
operating hours (Tuesday-Thursday) presented a barrier to consistent service
delivery
Theme 8: Opportunities for Improvement
● Top Suggestion/ Staff Training: Most frequent suggestion was training for staff
to help teachers better recognize signs of mental health problems.
● Other Suggestions:
○ More advertisements of district programs
○ More consistency/intentionality in scheduling to help students access
services
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Appendix J
Thematic Coding, Pre Parent Surveys
Theme 1: Perceived Importance vs. Actual Accessibility & Effectiveness of Services
● Strong Agreement on Importance: There was a near-universal consensus that
mental health services and social service programs are important and essential for
student well-being, especially in a rural community with a growing need. This was
evident in the repeated "Strongly Agree" responses to the opening survey questions.
● Disagreement/Neutrality on Accessibility and Effectiveness: In stark contrast to
the perceived importance, there was significant disagreement or neutrality regarding
the ease of access, awareness of programs, and effectiveness of existing mental
health and social service provisions.
○ Many parents "Disagree" that students have easy access to services.
○ Several parents "Disagree" or "Neither agree nor disagree" with being aware of
available programs.
○ Similarly, effectiveness of school district-offered mental health and social
service programs receives mixed to negative responses ("Disagree," "Neither
agree nor disagree," "Strongly Disagree").
○ Communication of resources by school staff and the supportive nature of the
school environment for seeking help also lean towards disagreement or
neutrality.
Theme 2: Key Barriers to Accessing Services
This theme emerges strongly from the open-ended questions and the scaled barrier
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questions.
● Stigma and Confidentiality Concerns:
○ "It is not confidential for where or when you’re going somewhere and therefore
they are further embarrassed and not seeking help."
○ "Concerns about confidentiality or stigma associated with seeking mental health
help" is frequently rated as a "Significant Barrier" or "Major Barrier."
○ One parent mentioned: "It's embarrassing and makes them not want to go to
their mental health appointments."
● Lack of Awareness and Communication:
○ Parents explicitly state "Lack of resources," "Lack of diversity," and "Lack of
support due to rural community."
○ "Awareness about available mental health or social service programs in the
community" is often cited as a "Somewhat of a Barrier" or "Major Barrier."
○ Repeated calls for "More awareness of services and availability with
confidential meetings" and "Better communication."
○ "School staff effectively communicate mental health resources available to
students to students and families, when needed" received significant
disagreement.
● Systemic and School-Specific Issues:
○ Lack of School Support/Trust: Several parents relayed negative experiences
they have had in the past
○ Follow-through and Effectiveness: Repeated responses regarding follow
through and communication were noted
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○ Cost/Financial Barriers: "Their ability to pay / with or without insurance" is
mentioned, and "cost of mental health programming or services" is rated as a
"Major Barrier" by some.
○ Navigation Difficulties: "Difficulties navigating the process of getting help
(e.g., referrals, paperwork)" is a recurring barrier.
○ Long Wait Times: "Long wait times for appointments" is also noted as a
barrier.
○ Attendance Policies: "For those who go to counseling once a week and to a
psychiatrist on a regular basis it is a pain to have to have student attendance
improvement meetings, especially when they have only had an absence or two
otherwise due to illness. It's embarrassing and makes them not want to go to
their mental health appointments."
Theme 3: Suggestions for Improvement
This theme synthesizes parents' recommendations for enhancing mental health and social
service support.
● Increased Communication and Awareness:
○ "More awareness of services and availability with confidential meetings."
○ "Talk about opportunities by making students aware and flyers/notifications to
parents."
○ "Provide more resources and education to parents in the rural community."
○ "Better communication."
● School-Based and Integrated Services:
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○ "School-based program incorporated," "incorporate more mental health
awareness into the school district," "incorporate more mental health lessons in
the school district for students."
○ "Have more mental health services available in the district, not just from outside
agencies."
○ Suggestions for hiring dedicated staff: "Social worker for elementary, middle
and high school. If funds are available, possibly look into hiring a mental health
worker as well for each school or work with contracting a school-based
program..."
● Improved School Staff Training and Responsiveness:
○ "More mental health training for staff members."
○ "Listen to what parents are saying. Parents know the children and what they hear
better."
○ "Re-educating staff on mental health. (Parents relayed negative experiences with
certain staff members)
● Addressing Systemic Issues (Stigma, Cost, Policy):
○ "I think students should have the ability to get services no matter if they can pay
for it or not."
○ Addressing the attendance policy for mental health appointments.
○ "Rule out mental health needs vs behavioral."
● Community Involvement:
○ "Involvement in more mental health community activities such as Out of
Darkness Walk (suicide)."
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Theme 4: School's Role in Supporting Students Seeking Help (Mixed Experiences)
● Limited Direct Assistance: When students did seek help, the school's direct
assistance in finding services was often "Not at all" or "Somewhat helpful not fully."
● Common School Resources Provided (When Available): "Information on
available mental health providers in the community" and "School counselor" were
the most common ways the school provided access or support.
● Desire for More Proactive and Integrated Support: Parents expressed a clear
desire for the school to be more actively involved and to have more in-house
resources rather than relying solely on external referrals.
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Appendix K
Thematic Coding, Parent Post Surveys
Theme 1: Perceived Importance and Growing Need for Services
● High Agreement on Importance: The vast majority of respondents strongly agreed
or agreed that "Mental health services are important for the overall well-being of
students" and "Social service programs are essential in supporting students facing
challenges outside of school." There was near-unanimous agreement that "There is a
growing need for mental health and social service support in our rural community."
This indicates a strong consensus among stakeholders about the critical role of these
services.
Theme 2: Gaps in Accessibility, Awareness, and Effectiveness
● Mixed Perceptions of Easy Access: Agreement was highly divided on the statement
"Students in our school district have easy access to mental health services when
needed." Many respondents disagreed or neither agreed nor disagreed, suggesting
that easy access is not consistently perceived across the district.
● Varying Awareness of Programs: Awareness of "different types of social service and
mental health programs" was also mixed, with responses ranging from "Strongly
Agree" to "Strongly Disagree," indicating inconsistent knowledge among the
community.
● Concerns about Effectiveness: A significant number of respondents disagreed with
the statement that "The mental health services offered by the school district are
effective in addressing student needs" and "The social service programs offered in
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collaboration with the school district are helpful for students facing challenges."
This points to a perceived lack of efficacy in current offerings.
● Communication Deficiencies: There was a strong tendency to disagree with the
statement that "School staff effectively communicate mental health resources
available to students and families, when needed," highlighting a critical
communication gap.
● Supportive Environment Doubts: The perception of the "school environment as
supportive of students seeking mental health help" also garnered mixed to negative
responses, with several disagreements and "neither agree nor disagree," suggesting a
less than fully supportive atmosphere.
Theme 3: Identified Barriers to Accessing Services
● Stigma and Bullying (Major Barrier): This emerged as a paramount concern.
Respondents explicitly mentioned "being bullied for seeking services," "fear of
being judged," and "being found out and bullied or harassed." The data on specific
barriers also showed that "concerns about confidentiality or stigma" were identified
as a "Major Barrier" by 20% of those who answered this question, and a "Significant
Barrier" by another 20%.
● Communication and Awareness (Significant Barrier): A lack of knowledge about
services ("knowledge of the services," "communication," "awareness of services")
was frequently cited. Specific barrier data revealed that "awareness about available
mental health or social service programs in the community" was a "Significant
Barrier" for 20% of respondents and "Somewhat of a Barrier" for 60%.
● Teacher/Staff Understanding and Support (Significant Barrier): Several comments
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highlighted concerns with a lack of staff awareness.
● Systemic and Practical Barriers:
○ Transportation and School Absences: Explicitly mentioned by some.
○ Cost: While not always a primary barrier, it was noted as "Somewhat of a
Barrier" (60%) or "Not a Barrier" (40%) among those who responded to this
specific question in this dataset.
○ Navigating the Process: "Difficulties navigating the process of getting help (e.g.,
referrals, paperwork)" was a "Significant Barrier" for 40% and "Somewhat of a
Barrier" for 20%.
○ Long Wait Times: This was identified as a "Major Barrier" by 20% and
"Somewhat of a Barrier" by 20%.
Theme 4: Suggestions for Improvement
● Increased Communication and Awareness: Suggestions repeatedly emphasized
"more knowledge and support from the school to let students know it is ok to seek
help," "electronic newsletter," and "agency fairs."
● Enhanced Staff Training:
● Better Follow Through: Many parents stressed the importance of consistent
follow-through to ensure every student receives the necessary assistance. Parents
expressed a strong desire for the school to take student needs seriously and prevent
any student from feeling overlooked, ensuring they receive the focused help they
deserve.
Theme 5: Experiences Seeking Help (Parents' Perspective)
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● Varied Access Points: For children who sought help in the past six months, access
primarily occurred via "Private therapist or counselor" and "Telehealth services."
One instance involved "onsite counseling through an outside facility" offered by the
school.
● Mixed School Helpfulness: The school's assistance in finding mental health services
was rated from "Not helpful" to "Very helpful." One positive experience highlighted
the university's free school-based counseling.
● Lack of School Resources Provided: Most parents indicated that the school provided
"None" of the listed resources during their search, though one mentioned "onsite
counseling through an outside facility" and another "information on available mental
health providers." This aligns with the perceived communication gap, as these
resources are available.