Rural School Counselors’ Experiences Responding to the Rural Youth Mental Health Crisis
DOI:
https://doi.org/10.3776/tpre.2025.v15n1p28-65Keywords:
Rural Schools, Mental health, school counselingAbstract
In response to a gap in the literature and the growing mental health needs of rural youth, the authors conducted a phenomenological investigation comprised of fifteen rural school counselors nationwide exploring the rural youth mental health crisis’s impact on their students, schools, and roles. The following themes emerged: rising youth mental health needs, protective and risk factors, pandemic impacts, and school counselors’ changing roles. Implications for rural school counselors, school districts, and counselor preparation are discussed, along with limitations and future research.
References
Alexander, E. R., Savitz-Romer, M., Nicola, T. P., Rowan-Kenyon, H. T., & Carroll, S. (2022). “We are the heartbeat of the school”: How school counselors supported student mental health during the COVID-19 Pandemic. Professional School Counseling, 26(1b), 1-10. https://doi.org/10.1177/2156759X221105557
American Academy of Pediatrics. (2021). AAP-AACAP-CHA declaration of a national emergency in child and adolescent mental health. https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/
American Medical Association. (2023). AMA adopts new public health policies to improve health of nation. https://www.ama-assn.org/press-center/press-releases/ama-adopts-new-public-health-policies-improve-health-nation-6
American School Counselor Association. (2019). The ASCA National Model: A framework for school counseling programs (4th ed.).
American School Counselor Association. (2020). The school counselor and student mental health [position statement]. https://www.schoolcounselor.org/Standards-Positions/Position-Statements/ASCA-Position-Statements/The-School-Counselor-and-Student-Mental-Health
American School Counselor Association. (2022). ASCA Ethical Standards for School Counselors. https://www.schoolcounselor.org/getmedia/44f30280-ffe8-4b41-9ad8-f15909c3d164/EthicalStandards.pdf
Arakelyan, M., Jennifer A. E., & Leyenaar, J. K. (2022). Suicide and self-harm in youth presenting to a U.S. rural hospital during COVID-19. Hospital Pediatrics, 12(10): 336–342. https://doi.org/10.1542/hpeds.2022-006635
Anderson, J. R., Mayes, T. L., Fuller, A., Hughes, J. L., Minhajuddin, A., & Trivedi, M. H. (2022). Experiencing bullying's impact on adolescent depression and anxiety: Mediating role of adolescent resilience. Journal of Affective Disorders, 1(310), 477–483. https://doi.org/10.1016/j.jad.2022.04.003
Appling, B. M., Tuttle, M., & May, V. S. (2019). The experiences of school counselors who collaborate with clinical mental health counselors. Professional School Counseling, 23(1), 1-10. https://doi.org/10.1177/2156759X19882660
Bhatnagar, R., & Many, J. (2022). Teachers using social emotional learning: Meeting student needs during COVID-19. International Journal of Technology in Education (IJTE), 5(3), 518-534. https://doi.org/10.46328/ijte.310
Bitsko, R. H., Claussen, A. H, Lichstein. J., Black, L. I., Jones, S. E., Danielson, M. L., Hoenig, J. M., Davis, J. S. P., Brody, D. J., Gyawali, S., Maenner, M. J., Warner, M., Holland, K. M., Perou, R., Crosby, A. E., Blumberg, S. J., Avenevoli, S., Kaminski, J. W., & Ghandour, R. M (2022). Mental health surveillance among children–United States, 2013–2019. MMWR Suppl, 71(2):1–42. doi: 10.15585/mmwr.su7102a1.
Bleasdale, J. E., Peterson, M. C., & Nidich, S. (2019). Effect of meditation on social/emotional well-being in a high-performing high school. Professional School Counseling, 23(1), 1-8. https://doi.org/10.1177/2156759X20940639
Bomysoad, R. N., & Francis, L. A. (2020). Adverse Childhood Experiences and mental health conditions among adolescents. The Journal of Adolescent Health, 67(6), 868–870. https://doi.org/10.1016/j.jadohealth.2020.04.013
Boulden, R. & Brown, C. (2022). “We’re kind of forgotten”: An initial investigation of Appalachian school counselors’ lived experiences responding to the opioid crisis. School Community Journal, 32(2), 113-138.
Boulden, R., Brown, C., & Coffield, E. (2022). “The single fish in the sea”: Exploring the lived experiences of rural school counselors earning RAMP. Professional School Counseling, 26(1), 1-12. https://doi.org/10.1177/2156759X211044145
Boulden, R., & Henry, S. (2023). A phenomenological investigation of rural school counselors’ experiences providing career development. Professional School Counseling, 27(1), 1-12. https://doi.org/10.1177/2156759X231213324
Boulden, R., & Schimmel, C. J. (2022). Factors that affect school counselor retention in rural settings: An exploratory study. The Rural Educator, 43(4), 1-14.
Boulden, R., & Schimmel, C. (2024). Addressing the rural youth mental health crisis through Youth Mental Health First Aid. The Rural Educator, 45(2). 61-67. https://doi.org/10.55533/2643-9662.1413
Centers for Disease Control and Prevention. (n.d.). Youth Risk Behavior Survey: Data summary and trends report. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf
Creswell, J. W., & Poth, C. N. (2016). Qualitative inquiry and research design: Choosing among five approaches. Sage.
Crumb, L., Mingo, T. M., & Crowe, A. (2019). “Get over it and move on”: The impact of mental illness stigma in rural, low-income United States populations. Mental Health and Prevention, 13, 143–148. https://doi.org/10.1016/j.mhp.2019.01.010
Curtin, S. C., & Garnett, M. F. (2023). Suicide and homicide death rates among youth and young adults aged 10–24: United States, 2001–2021. https://stacks.cdc.gov/view/cdc/128423
Figas, K., Giannouchos, T., & Crouch, E. (2022). Rural-Urban differences in child and adolescent mental health prior to and during the COVID-19 pandemic: Results from the National Survey of Children’s Health. Rural & Minority Health Research Center. https://sc.edu/study/colleges_schools/public_health/research/research_centers/sc_rural_health_research_center/documents/youthmhbriefnov2022final.pdf
Gay, Lesbian & Straight Education Network. (2019). The 2021 National School Climate Survey. https://www.glsen.org/sites/default/files/2022-10/NSCS-2021-Full-Report.pdf
Geulayov G., Borschmann R., Mansfield K.L., Hawton K., Moran P., Fazel M. (2022). Utilization and acceptability of formal and informal support for adolescents following self-harm before and during the first COVID-19 lockdown: Results from a large-scale English schools survey. Frontiers in Psychiatry, 13(881248), 1-14. doi: 10.3389/fpsyt.2022.881248.
Goodman-Scott, E., & Cholewa, B. (2023). Research design: Qualitative approaches. In B. Zyromski & Dimmitt (Eds.), School Counseling Research: Advancing the Professional Evidence Base. Oxford.
Grimes, T. O. (2020). Exploring the phenomenon of rural school counselors’ professional
identity construction. Professional School Counseling, 24(1), 1-13. https://doi.org/10.1177/2156759X20965180
Hays, D. G., & Singh, A. A. (2023). Qualitative research in education and social sciences (2nd ed.). Cognella.
Health Resources and Services Administration. (2023). Designated Health Professional Shortage Areas statistics, second quarter summary. https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport
Hoffmann J. A., Hall, M., Lorenz, D., & Berry, J. G. (2021). Emergency department visits for suicidal ideation and self-harm in rural and urban youths. Journal of Pediatrics, 238, 282–289. doi: 10.1016/j.jpeds.2021.07.013
Holme, J. J., Jabbar, H., Germain, E., & Dinning, J. (2017). Rethinking teacher turnover: Longitudinal measures of instability in schools.
Educational Researcher, 47(1), 62–75. https://doi.org/10.3102/0013189X17735813.
Hughes, J. E., Ulmer, J. D., Clark, J., Disberger, B., Hock, G., & Ellis, J. (2023). In their own words: Student mental health in rural, low socioeconomic high schools. The Rural Educator, 44(2), 14-29. https://doi.org/10.55533/2643-9662.1380
Kelleher, K. J., & Gardner, W. (2017). Out of sight, out of mind – Behavioral and developmental care for rural children. New England Journal of Medicine, 376(14), 1301–1303. doi: 10.1056/NEJMp1700713
Koita, K., Long, D., Hessler, D., Benson, M., Daley, K., Bucci, M., Thakur, N., & Harris, N. B. (2018). Development and implementation of a pediatric Adverse Childhood Experiences (ACEs) and other determinants of health questionnaire in the pediatric medical home: A pilot study. PLoS One, 13(12), 1–16. https://doi.org/10. 1371/journal.pone.0208088.
Kush, J. M., Badillo-Goicoechea, E., Musci, R. J., & Stuart, E. A. (2022). Teachers’ mental health during the COVID-19 Pandemic. Educational Researcher, 51(9), 593-597. https://doi.org/10.3102/0013189X221134281
Mariani, M., Bayani, J., & Kneidel, L. F. (2022). Addressing the social/emotional needs of students during the pandemic. Professional School Counseling, 26(1), 1-10. https://doi.org/10.1177/2156759X221090529
Martin, I., Cunningham, P. D., Zyromski, B., Nuñez, M., Romero, S. D., & Choi, J. (2022). Small-group investigation of the True Goals curriculum with high school students: A randomized control study. Professional School Counseling, 26(1), 1-11. https://doi.org/10.1177/2156759X221137312
McCance-Katz, E., & Lynch, C (2019). Guidance to states and school systems on addressing mental health and substance use issues in schools. https://store.samhsa.gov/sites/default/files/d7/priv/pep19-school-guide.pdf
Meany-Walen, K. K., Teeling, S., Davis, A., Artley, G., & Vignovich, A. (2016). Effectiveness of a play therapy intervention on children’s externalizing and off-task behaviors. Professional School Counseling, 20(1), 89-101. https://doi.org/10.5330/1096-2409-20.1.89
Mental Health America. (2020). Addressing the youth mental health crisis: The urgent need for more education, services, and supports. https://mhanational.org/sites/default/files/FINAL%20MHA%20Report%20-%20Addressing%20Youth%20Mental%20Health%20Crisis%20-%20July%202021.pdf
Merriam-Webster (2024). Crisis. In Merriam-Webster.com dictionary. https://www.merriam-webster.com/dictionary/crisis
Morales, D. A., Barksdale, C. L., & Beckel-Mitchener, A. C. (2020). A call to action to address rural mental health disparities. Journal of Clinical and Translational Science, 4(5), 463-467. https://doi.org/10.1017/cts.2020.42
Moustakas, C. (1994). Phenomenological research methods. Sage.
National Alliance on Mental Health. (n.d.). Mental health in schools. https://www.nami.org/Advocacy/Policy-Priorities/Improving-Health/Mental-Health-in-Schools
National Center for Education Statistics. (n.d.). Locale lookup. https://nces.ed.gov/programs/maped/LocaleLookup/
National Rural Health Association. (n.d.). National rural health snapshot.
https://www.ruralhealthweb.org/about-nrha/about-rural-healthcare
Ohrt, J., Webster, L., & De La Garza, M. (2014). The effects of a Success Skills group on adolescents’ self-regulation, self-esteem, and perceived learning competence. Professional School Counseling, 18(1), 169–178. doi:10.5330/2156-759X-18.1.169
Panchal, N., Kamal, R., Cox, C., Garfield, R., & Chidambaram, P. (2021). Mental health and substance use considerations among children during the COVID-19 pandemic. KFF. https://www.kff.org/coronavirus-covid-19/issue-brief/mental-health-and-substance-use-considerations-among-children-during-the-covid-19-pandemic/
Polaha, J., Williams, S. L., Heflinger, C. A., & Studts, C. R. (2015). The perceived stigma of mental health services among rural parents of children with psychosocial concerns. Journal of Pediatric Psychology, 40(10), 1095–1104. https://doi.org/10.1093/jpepsy/jsv054
Prosek, E. A., & Gibson, D. M. (2021). Promoting rigorous research by examining lived experiences: A review of four qualitative traditions. Journal of Counseling & Development, 99(2), 167-178. https://www.doi.org/10.1002/jcad.12364
Rogers, A. A., Ha, T., & Ockey, S. (2021). Adolescents' perceived socio-emotional impact of COVID-19 and implications for mental health: Results from a U.S.-based mixed-methods study. The Journal of Adolescent Health, 68(1), 43–52. https://doi.org/10.1016/j.jadohealth.2020.09.039
Rural Health Information Hub. (2017). Healthcare access in rural communities.
https://www.ruralhealthinfo.org/topics/healthcare-access
Schroeder, S., Tan, C. M., Urlacher, B., & Heitkamp, T. (2021). The role of rural and urban
geography and gender in community stigma around mental illness. Health Education & Behavior, 48(1), 63-73. https://doi.org/10.1177/1090198120974963
Showalter, D., Hartman, S. L., Eppley, K., Johnson, J., & Klein, R. (2023). Why rural matters 2023: Centering equity and opportunity. National Rural Education Association.
Stickley, A., Koyanagi, A., Koposov, R., Blatny, M., Hrdlicka, M., Schwab-Stone, M., & Ruchkin, V. (2016). Loneliness and its association with psychological and somatic health problems among Czech, Russian and U.S. adolescents. BMC Psychiatry, 16(128), 1-11. doi: 10.1186/s12888-016-0829-2
Substance Abuse and Mental Health Services Administration. (2021). Racial/ethnic differences in mental health service use among adults and adolescents (2015-2019). https://www.samhsa.gov/data/report/racialethnic-differences-mental-health-service-use
The Trevor Project. (2022). 2022 National Survey on LGBTQ Youth Mental Health. https://www.thetrevorproject.org/survey-2022/assets/static/trevor01_2022survey_final.pdf
U.S. Department of Health and Human Services. (2021). Protecting youth mental health: The U.S. Surgeon General’s advisory. https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf
U.S. Department of Health and Human Services. (2023). Biden-Harris Administration announces more than $200 million to support youth mental health. https://www.hhs.gov/about/news/2023/09/25/biden-harris-administration-announces-more-than-200-million-support-youth-mental-health.html#:~:text=media%40hhs.gov-,Biden%2DHarris%20Administration%20Announces%20More%20Than%20%24200%20Million%20To%20Support,behavioral%20health%20care%20and%20treatment.
The White House. (2023). Fact sheet: Biden-Harris Administration announces new actions to tackle nation’s mental health crisis. https://www.whitehouse.gov/briefing-room/statements-releases/2023/05/18/fact-sheet-biden-harris-administration-announces-new-actions-to-tackle-nations-mental-health-crisis/#:~:text=The%20Biden%2DHarris%20Administration%20is,out%20of%20health%20care%20settings.
Williams, S. L., & Polaha, J. (2014). Rural parents’ perceived stigma of seeking mental health services for their children: Development and evaluation of a new instrument. Psychological Assessment, 26(3), 763–773. https://doi.org/10.1037/a0036571
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