Consider two facts:

1) American children spend a large percentage of their days at school.

2) The number of kids in the United States diagnosed with mental illness is on the rise.

Because he understands these two realities, Clayton Cook believes that school is the best place to address children’s mental health needs.

“School is the environment where kids naturally exist, the place where they spend the biggest chunk of their waking time,” said Cook, associate professor of educational psychology at the University of Minnesota’s College of Education and Human Development. “If kids can get their mental health needs met where they are, rather than having to travel to receive those services, they are more likely to get the help they need.”

To make sure that kids get their mental health needs met at school, Cook and his colleagues at the University and around the country have identified key intervention programs that have been proven to reduce the rate of mental illness among schoolchildren. They have also developed ways that schools can easily implement those programs for their students.

Cook’s research has shown that when schools employ these intervention strategies, the rate of mental illness among their students is significantly reduced.

Sounds good, right? The only problem that Cook, a John W. and Nancy E. Peyton Faculty Fellow in Child and Adolescent Wellbeing, has discovered is that it can be hard to get schools to make the cultural changes required to fully implement these programs.

“If you have inadequate leadership in a school,” he said, “they aren’t always skilled enough to support their staff in adapting to change and implementing these programs.” Change is hard, Cook explained. And in tradition-driven institutions like schools, changing staff behaviors can feel like pulling teeth: “We understand that it can be hard to change established systems. Our work is focused on supporting leaders who are in the process of acquiring new behaviors in the interest of children’s mental health. Leadership support makes or breaks an implementation effort.” 

Programs that work

Cook’s intervention programs have several components, but two programs he likes to teach educators are Social and Emotional Learning, or SEL, and Positive Behavioral Intervention and Support, or PBIS.

When Cook and his team of graduate students work with a school, they train staff and administrators in the programs and work with them for a number of weeks to make sure that the programs are embedded in culture of the institution.

Cook explained that SEL “focuses on emotion management and interpersonal skills like empathy and conflict resolution — non-academic skills that enable better academic functioning and life success.” 

A positive approach to discipline using community systems of support, PBIS is, Cook explained, “a school-wide approach where you teach models and use positive expectations to get the desired results. In this approach, staff all get on the same page and adopt similar practices for students in and outside of the classroom. This promotes a more positive and emotionally healthy environment.”

Schools that have successfully adopted Cook’s intervention plan have found significant reductions in rates of mental illness among their students.

“We’ve worked with schools that, prior to implementing these programs, have as many as 30 percent of their kids identified by a screener as having mental health issues,” Cook said. “After these programs have time to establish themselves in the culture of the school, that number can get down to as low as 10 percent of students with mental health concerns. That’s a big shift.”

Though fully establishing these interventions takes time and commitment, Cook said that he has found that it is far less costly and time consuming to implement these programs than it is to intervene with troubled kids on a case-by-case basis.

“It’s a much more costly approach to wait until mental health problems arise and then have to organize individual treatments for the 30 percent of kids in the school with mental health needs,” he said. “If you can improve the overall environment to address all of your students’ needs, fewer are going to need individual treatment in the first place.” 

The mental health gap

Cook knows from personal experience that school can be a lifeline.

“I grew up in a household that put me at risk for a number of problems,” he said. “My dad was a high school dropout. He is part Native American. That explains the historical issues he went through and why our family was in poverty. I was a latchkey kid who was making poor choices, getting involved in drugs, getting into trouble. Sports kept me involved in school and also allowed me a little luck in the form of coaches who kept me in school because they had an interest in keeping me on the team. That was a safety net that got me engaged, and got me into junior college. Ultimately I had an opportunity to get my BA and then eventually my Ph.D.”

From his own growing-up years, Cook understood that kids who lacked support and guidance at home can and do benefit from the structure of the school environment. When at-risk kids also struggle with mental illness, he said, the odds that they will be able to get help for those issues outside of school are low. 

“Parents in poverty encounter significant barriers that prevent accessing needed care,” he said.

Cook sees this issue as a “mental health gap.” Because of this gap, he said he wants to make mental health care available to kids who aren’t getting the support they need at home to grow up mentally healthy and strong.

“Most of my research is going to try to address the giant access gap that exists for kids that are not receiving mental health services,” said Cook, who has worked with schools around the country and is now narrowing his focus a bit to look at more Minnesota schools. “The vast majority of kids with mental health problems don’t receive needed services.” 

Center of influence

No matter how far he’s come as an adult, Cook never forgets his own childhood.

“My childhood experiences gave me an interest in the discipline and structure of school and how we harness those benefits to help kids by promoting their mental health while they are at school,” Cook said.

He doesn’t blame poor parents for their children’s mental health problems: He understands firsthand about the struggles they are facing just to keep their heads above water. “Some of our work also focuses on mental health and dropout prevention,” he added, “on making sure that kids who are at risk like I was don’t fall through the cracks.”

In many communities, schools play a central role, Cook said. He tries to explain that key position to the teachers and administrators he works with when he talks about these evidence-based school-wide mental health programs.

“Too many kids aren’t getting the help they need from home supports alone,” Cook said. “Our focus is to try to harness the influence of the school, to improve the quality of mental health services that kids are able to access there. Broadly speaking, that is where my research and collaborative projects rest: in trying to close the mental health access gap. When we can address kids’ mental health needs in school, we create a much more level playing field.”