97 McManama O’Brien et al. / School Social Work with Students with Mental Health Problems CCC Code: 1532-8759/11 $3.00 ©2011 National Association of Social Workers School Social Work with Students with Mental Health Problems: Examining Different Practice Approaches Kimberly H. McManama O’Brien, Stephanie C. Berzin, Michael S. Kelly, Andy J. Frey, Michelle E. Alvarez, and Gary L. Shaffer ฀ School social workers frequently serve as the primary mental health providers to youths with mental health problems. Although school social workers play a primary role in care, many students also receive outside counseling services. Previous research has not examined whether practice approaches differ when considering mental health practice with students for whom school social workers are the primary providers versus those who receive outside counseling. This article uses respondents from the 2008 National School Social Work Survey who worked primarily with students with either emotional or behavioral problems to examine whether practice approaches differed between groups of school social workers for whom all or most of their students received outside counseling and those for whom few of their students received these services. Results demonstrate that the groups were different with respect to practice choices, as school social workers who worked with students receiving outside counseling reported greater engagement at all levels of the ecological system except for the school domain and the practice approach of group counseling. Both groups cited work with teachers as the least used aspect of school social work practice. Implications for the future of school social work research, practice, and policy are discussed. KEY WORDS: mental health; practice; school social work M ental health problems frequently af- fect the child and adolescent popula- tion, as approximately 18 percent to 22 percent of U.S. youths have mental health issues significant enough to cause functional impairment (Dore, 2005). Child and adoles- cent mental health concerns commonly arise in the classroom setting, often forcing schools to become the primary place of treatment for affected youths (Hennessy & Green-Hennessy, 2000; Hoagwood et al., 2005). School social workers frequently serve as the main mental health providers for these students (Early & Vonk, 2001; Hennessy & Green-Hennessy, 2000; Kelly, Berzin, et al., 2010). In the most recent national study on school social workers, from which the data for the present study are taken, Kelly, Berzin, et al. (2010) found that only 11 percent of respondents reported that all or most of their students receive outside counseling or therapeutic services. The role of the school social worker is more complex than that of the outpatient provider, because school social work- ers are frequently asked to intervene at multiple system levels to serve children in need and to serve in host settings that have their own norms and expectations regarding who the “client” is (Kelly, 2008; Massat, Ornstein, & Moses, 2006). Practice at multiple levels of the ecological system emphasizes that school social workers engage in tasks and interventions with the child, family, teacher, school, and community in their daily work with students. CHILD-CENTERED PRACTICE Previous research has demonstrated that school social workers are primarily oriented to child-centered practice approaches within the ecological system (Allen-Meares, 1994; Astor, Behre, Wallace, & Fravil, 1998; Hoagwood & Erwin, 1997; Kelly, 2008; Kelly, Berzin, et al. 2010; Staudt, 1991). In the most recent national