Article

The Family Journal: Counseling and

Therapy for Couples and Families
The Influence of School-Based Family 2020, Vol. 28(3) 273-282
ª The Author(s) 2020
Article reuse guidelines:
Counseling on Elementary Students sagepub.com/journals-permissions
DOI: 10.1177/1066480720933537
and Their Families journals.sagepub.com/home/tfj

Viki P. Kelchner1 , Laurie O. Campbell1, Cassandra C. Howard2,

Jasmine Bensinger1, and Glenn W. Lambie1

Abstract
A family counseling intervention grounded in systemic family therapy was conducted in a Title I school-based setting with (N ¼ 48)
kindergarten through sixth-grade student-clients and their primary caregivers. Families’ perception of family communication and
satisfaction on the Family Adaptability and Cohesion Evaluation Scale-IV was investigated to determine changes in the percentile
score at three benchmarks. A repeated measure analysis of variance indicated a statistically significant difference over time in
caregivers’ perception of family communication and satisfaction after 5 and 10 weeks. There was no difference in relationship to
gender. School-based family counseling programs can contribute to improved family communication and satisfaction. School-
based counselors can partner with institutions of higher education to provide free and accessible counseling for students and
families in the greatest need.

Keywords
counseling, family counseling, school-based counseling intervention, outcome research, Title I Schools

Mental health challenges are problematic for youth and fami-
lies in the United States and may create obstacles to school
success. Approximately 20% of children have had a diagnosa-
ble mental health disorder at some time period in their lives and
only one in the five of those children receives the necessary and
appropriate services for treatment (Capp, 2015; Kaffenberger
& Seligman, 2007; Merikangas et al., 2010). When mental
health concerns are not addressed during childhood, they may
negatively influence future academic achievement and social–
emotional problems throughout adulthood (i.e., depression,
anxiety; Beaudoin, 2016). Children with mental health con-
cerns are more likely to be suspended and expelled for beha-
vioral problems and tend to have a higher number of absences
from school than their school counterparts without the same
challenges (Stagman & Cooper, 2010).
Environmental stressors may impact families living in low-
income communities contributing to substantial disparities in
childhood and overall well-being and mental health (Macklem,
2014; Stagman & Cooper, 2010; Williams & Greenleaf, 2012).
Children from low socioeconomic status (SES) families often
encounter multiple barriers when trying to access mental health
services (Gamble & Lambros, 2014). Barriers for low SES
families utilizing professional mental health treatment for their
children may include (a) the lack of insurance or financial
means to pay for services, (b) existing language barriers, (c)
limited transportation, and (d) stigmas and misconceptions sur-
rounding mental illness (Gambles & Lambros, 2014). Children
may react to unmet mental health needs through internalizing
(e.g., depression, anxiety, withdrawal) and externalizing beha-
viors (attention seeking, hyperactivity, aggression) within the
school and home environments (Axelrod et al., 2009; Ballard
et al., 2014). Therefore, it is imperative that families and school
communities work together to identify and treat children’s
mental health issues to promote prosocial behavior, academic
performance, and emotional well-being (Beaudoin, 2016).
Mental health services within schools can be one way to
strengthen the partnership between families and schools (Ana-
kwenze & Zuberi, 2013; DiCocco, 1986). Mental health pro-
fessionals placed in the school setting may bridge
communication and foster collaboration between administra-
tors, teachers, and guardians when implementing mental health
treatment for a child (Blount, 2012; Cooper-Haber & Haber,
2015; DiCocco, 1986; Ofordile, 2009; Terry, 2002). Addition-
ally, providing counseling within the schools may raise aware-
ness among school staff and families concerning early mental
1
University of Central Florida, Orlando, FL, USA
2
Department of Learning Sciences and Educational Research, University of
Central Florida, Orlando, FL, USA
Corresponding Author:
Viki P. Kelchner, University of Central Florida, 4000 Central Florida Blvd.,
Orlando, FL 32816, USA.
Email: viki.kelchner@ucf.edu
274 The Family Journal: Counseling and Therapy for Couples and Families 28(3)
health concerns warning signs before symptoms are exacer-
bated (Capp, 2015; Cefai & Cavioni, 2015; Salerno, 2016).
Literature Review
Family factors such as family SES and dysfunctional family
factors (e.g., lack of family cohesion, family conflict, rigid
family parenting styles, home environment instability) can con-
tribute to children’s academic performance and learning which
can be predictors of lower levels of academic success for chil-
dren (Crespi & McNamara, 2015; Oxford & Lee, 2011). The
consequences of not addressing childhood mental illness have
implications in other societal systems. There has been a rise in
juvenile offending, and youth involved with the Department of
Juvenile Justice have a higher rate of mental health issues
(Scholt & Van der Ploeg, 2015; Vincent et al., 2008). Children
in vulnerable populations, including low SES, are frequently
exposed to multiple traumatic events throughout their child-
hood, such as abuse, neglect, and secondary adversities that
derive from distress (Osofsky et al., 2015). Furthermore, chil-
dren from families living below or at the poverty line may lack
parental involvement and support for learning pursuits due to
families’ own educational background or limited resources
(Oxford & Lee, 2011). Transgenerational education patterns
are established over multiple generations within a family.
These patterns may lead to decreased school–family bonding
or may lead to a deficiency in school relationships that may
inhibit academic success as measured by achievement. In one
study of third-grade students, conducted by Dubow et al.
(2009), guardians’ level of education was found to predict
similar education levels and occupational prestige for their
children. Moreover, children’s self-efficacy and potential are
affected by these complex factors that are beyond their control
(Crespi & McNamara, 2015).
School-Based Mental Health Counseling Services
(SBMHCS)
SBMHCS are defined as any program, intervention, or strategy
applied in a school setting that was specifically designed to
influence students’ emotional, behavioral, or social functioning
(Rones & Hoagwood, 2000). SBMHCS have been shown to be
effective in benefiting children, families, and the school com-
munity in a variety of ways including engagement and atten-
dance (Anakwenze & Zuberi, 2013). In school settings,
children and their families are more engaged in counseling
services and exhibit increased cooperation with treatment inter-
ventions made by school-based mental health professionals
compared with counseling settings in outside agencies (Mince,
2000; Perfect & Morris, 2011; Solomon et al., 2016). A
research synthesis of 23 studies investigating the effectiveness
of mental health services delivered in school-based settings
found that adolescents were 21 times more likely to utilize
school-based mental health services compared to community
health centers (Bains & Diallo, 2016). SBMHCS attendance
rates are higher than outside community health centers, as they
are typically free and are offered in the school, which helps to
mitigate barriers to receiving services (Blackman et al., 2016).
Ultimately, without SBMHCS, vulnerable children may not
otherwise receive the help they need. If a healthy family–
school bond is already established, stigmas related to seeking
mental health counseling in families from low-income commu-
nities may be minimized (Anakwenze & Zuberi, 2013).
Montañez et al. (2015) examined the effectiveness of
SBMHCS to treat children living in poverty in New York City.
A comprehensive school-based mental health promotion and
prevention program indicated that students from ethnic minor-
ity backgrounds made strides in social performance, atten-
dance, and standardized test scores. Lambros and colleagues
(2016) found students with a dual diagnosis of intellectual dis-
abilities and a co-occurring mental health disorder who parti-
cipated in a school-based intensive outpatient program had a
reduction in the number of school suspensions and absences.
Students in their study also displayed positive changes in beha-
vior per caregiver report. Overall, the literature supports the
notion that SBMHCS helps improve child suspension rates,
academic performance, internalizing behavior, and externaliz-
ing behavior (Ballard et al., 2014; Bernstein et al., 2005; Kayler
& Sherman, 2009; Liber et al., 2013).
However, there are some research synthesis and meta-
analytic studies that provide conflicting evidence of SBMHCS.
A meta-analytic review of 23 studies between 1985 and 2009
investigated the impacts and outcomes of SBMHCS on low
SES urban youth and concluded the evidence for program and
service effectiveness was limited (Farahmand et al., 2011).
Noted limitations of the studies in the review included (a) small
sample sizes, (b) lack of information to support the develop-
mental appropriateness of the SBMHCS interventions, and (c)
minimal follow-up measures to further evaluate provided inter-
ventions. Conversely, Salerno (2016) conducted a systematic
literature review of 15 studies relevant to the effectiveness of
universal mental health awareness interventions in K–12
schools and suggested that improved knowledge and attitudes
of mental health awareness can be enhanced by SBMHCS.
Nevertheless, the review cautioned that the results are not gen-
eralizable because most of the studies’ research designs were
not rigorous enough to claim cause–effect relationships.
Systemic Family Therapy (SFT)
SFT is a theoretical orientation and family systems approach
that conceptualizes human behavior and mental health chal-
lenges through the lens of the social systems in which the client
or the family is situated (Retzlaff et al., 2013). SFT is a para-
digm shift from client’s individualized perspective to a systems
perspective (Ray, 2016). Incorporating the entire family system
allows room for understanding all components of a client.
Assisting an individual with their functioning in isolation of
family connections, relationships, and intergenerational ele-
ments is a secondary pursuit in SFT (Goldenberg et al.,
2017). SFT primarily focuses on the organization of the family
system and communication patterns, reciprocal interactions,
Kelchner et al.
and connections with larger ecological systems (e.g., school,
work, cultural memberships, and community support) and any
other micro- or macrosystems (Goldenberg et al., 2017).
The SFT framework and family-based interventions address
the whole family system including all subsystems (parent–par-
ent, parent–child, sibling–sibling, and nuclear family–extended
family). Furthermore, SFT approaches may be well suited to
target changes in school-aged children’s overall mental health
outcomes (Goldenberg et al., 2017; Lorås, 2018; Riedinger
et al., 2017; Ungar, 2015). Regardless of the treatment setting,
SFT practice has shown to help reduce negative outcomes
associated with child abuse and neglect (Carr, 2009, 2014).
Many internalizing behaviors which may lead to mood disor-
ders, somatic illness, and eating disorders, and externalizing
behaviors which may lead to conducts disorders, substance
abuse, and attention deficit hyperactivity disorders are mani-
festations of childhood abuse and neglect (Carr, 2009, 2014;
Cottrell & Boston, 2002; Sydow et al., 2013).
School-based family counseling (SBFC) is family counsel-
ing that takes place in the school setting. Gerrard (2008) con-
ducted a review of the literature across mental health
professions dating back from the 1920s and reported that the
major benefits experienced by students receiving SBFC
included (a) improved academic functioning, (b) reduced pro-
blematic emotional and behavioral symptoms, (c) decreased
incidences of classroom disruption affecting other students,
(d) improved prosocial behaviors in the home, (e) strengthened
relationships between schools and families served by SBFC,
and (f) promotion of cost-effective access to counseling ser-
vices. Stormshak et al. (2011) conducted a controlled experi-
mental design with a random sample of 593 adolescents and
their families from three Title I middle schools occurring over a
span of 3 years. Stormshak et al.’s (2011) findings demon-
strated that family-centered interventions lowered students’
incidences of antisocial behaviors as well as substance abuse
throughout the middle school years. Such findings suggest the
union between the SFT approach and the school setting can
positively impact children, families, peers, school staff, and
teachers.
The majority of research done on SBMHCS has focused on
individualized treatment for youth, without incorporating the
family system (Cooper-Haber & Haber, 2015; Green, 2015). A
future direction for expanding the reach of SBMHCS would be
to incorporate a family systems approach in the counseling
process within the schools. Using a family systems approach,
while incorporating mental health professionals, teachers, and
administrators may lead to a decrease in student dropout risk
factors (e.g., poor attendance, low-grade achievement, suspen-
sion, and conduct issues; Blount, 2012; Boutelle, 2010; Ofor-
dile, 2009; Powell, 2011; Stagman & Cooper, 2010).
The effectiveness of family counseling to target child men-
tal health issues has been established in nonschool settings and
contexts (Carr, 2009). However, the lack of research regarding
SBFC may be due to a lack of training in the family systems
approach and working in a school setting (Mince, 2000). Mar-
tin (2013) surveyed a random sample of 657 members of the
275
American School Counseling Association and found (a) school
counselors did not feel adequately prepared and competent to
use a family systems perspective, (b) school counselors thought
family systems practice was less important in the school set-
ting, and (c) family systems practice was used less frequently in
the school systems. The importance of utilizing a family sys-
tems approach to mental health counseling with children in
school settings may mitigate school personnel’s misconcep-
tions of problems originating from within the child alone with-
out consideration of the family system and the notion of the
child being “bad” (Powell, 2011).
Elementary school students from low SES families experi-
ence higher rates of mental health concerns, which left
untreated may persist into adulthood (Solomon et al., 2016;
U.S. Department of Health and Human Services, 2001). Lim-
ited transportation, stigma associated with mental health, lack
of finances, and restricted number of services are some of the
possible barriers to children living at low SES levels receiving
psychological services (Gamble & Lambros, 2014). SBFC ser-
vices are a good option to help mediate some of the known
barriers of families and children accessing mental health
resources (Powers et al., 2013). Although family systems
approaches have been shown to be effective with children in
vulnerable populations, there is a lack of research and focus on
SBFC.
Thus, the purpose of this investigation is to examine the
effectiveness of SBFC intervention with children from three
Title I elementary schools on family communication and fam-
ily satisfaction and caregivers’ perspectives of the intervention.
The research questions for the investigation are as follows:
Research Question 1: When considering family commu-
nication and family satisfaction as measured by the Fam-
ily Adaptability and Cohesion Evaluation Scale
(FACES)-IV, is there a statistically significant group dif-
ference over time (i.e. pretest, after 5 and 10 visits) of
students participating in SBFC?
Research Question 2: What were caregivers’ percep-
tions of school-based family therapy as it specifically
relates to their child and family?
Method
A mixed-methods convergent designed study was conducted to
investigate an SBFC intervention with children from three Title
I elementary schools.
Context of the Study
Through an established school-based partnership between an
institution of higher education and a school district, an SBFC
program was conducted during a 30-week period. The elemen-
tary school student-clients were recruited from the current stu-
dent body of three Title I elementary schools in the
southeastern United States. The percentage of students receiv-
ing free and reduced lunch at the three elementary schools was
276 The Family Journal: Counseling and Therapy for Couples and Families 28(3)

(a) School 1, 95%; (b) School 2, 87%; and (c) School 3, 92%. Table 1. Participant Demographics.
The gender of the students at the three elementary schools (N ¼
Demographic Category n %
2,247) is equally divided (females ¼ 1,101 [49%] and males ¼
1,146 [51%]). The students at the three elementary school iden- Gender
tified with the following ethnic/racial groups: Black/African Female 25 52.1
American (n ¼ 1,057, 47%), Hispanic (n ¼ 639, 28%), White Male 23 47.9
(n ¼ 491, 22%), Multiracial (n ¼ 110, 5%), Asian (n ¼ 22, Race
Black/African American 17 35.4
<1%), Indian (n ¼ 5, <1%), and Hawaiian or Other Pacific
Hispanic 15 31.3
Islander (n ¼ 5, <1%). Geographically, all three schools were Multiracial 2 4.2
located in suburban areas within 5 miles of each other. Pacific Islander 1 2.1
White 12 25
Individualized education plan
Procedures Yes 18 37.5
Recruitment of the elementary school student-clients was No 30 62.5
Free and reduced lunch
facilitated through school personnel (e.g., administrators,
Yes 39 81.3
teachers, family liaisons, and school counselors) using conve- No 9 18.8
nience sampling. Specifically, school counselors contacted the Grade
clinical coordinator with the names of potential student-clients. Kindergarten 10 20.8
The clinical coordinator then contacted the parents or guardians First grade 6 12.5
to inform them about the no cost, SBFC services, and confirm Second grade 6 12.5
interest. A clinical coordinator recruited student-clients by Third grade 8 16.7
Fourth grade 12 25
attending parent events at the schools and passing out recruit-
Fifth grade 4 8.3
ment brochures to interested families. Finally, parents or guar- Sixth grade 2 4.2
dians contacted a research team member if they were interested School
in having their child and family receive mental health services School A 16 33.3
and participate in the research investigation. School B 14 29.2
Parents or guardians and their children participated in a School C 18 37.5
prescreening interview that provided details about the counsel-
ing services and assisted in completing initial paperwork (e.g.,
Parent/Guardian Informed Consent for Research, Client Infor- age of the student-client was 7.64 years old (SD ¼ 1.905, range
mation, and Consent for Counseling Services). In addition, ¼ 4–11). Participants were almost evenly split on gender, with
sample screening was employed to ensure that the SBFCI pro- 52.1% identifying as female (n ¼ 25) and 47.9% identifying as
vided was appropriate to meet the needs of the elementary male (n ¼ 23). The majority of participants belonged to an
school students and their families. For instance, research team ethnic/racial minority, with only 25% (n ¼ 12) identifying as
members confirmed that (a) the student-clients/families were White, 35.4% identifying as African American (n ¼ 17), and
willing to participate in the counseling services provided after 31.3% identifying as Hispanic (n ¼ 15). Almost 38% of parti-
school hours, (b) transportation would be provided from school cipants had an individualized education plan (n ¼ 18), and
after each scheduled session, and (c) scheduled sessions would 81.3% qualify for free or reduced lunch (n ¼ 39).
be attended on a regular basis. The SBFCI was available after
school hours for 3 hr 1 day per week at each school. The SBFCI
Systemic Theory as the School-Based Family Counseling
was provided for 30 weeks of the academic school year. Addi-
tionally, efforts were made to ensure that student-clients’ pre-
Intervention
senting concerns would be appropriately addressed by novice All student-clients received treatment from counselors who
counselors under the direct supervision of experienced clinical were trained in systemic theory. Rather than applying a theo-
supervisors. retical orientation and techniques typically focused on indivi-
Participants’ data were collected at three time points—base- dualized treatment, counselors used SFT to guide the SBFCI
line, after five sessions, and after 10 sessions—to investigate that sought to benefit the student participants and their families.
change. Prior to the recruitment of participants, approval was Counselors collaborated with family members toward creating
granted from the university’s institutional review board and the healthier emotional relationships, effective communication
participating school district to conduct the study. patterns, clear boundaries, and problem-solving as the primary
objective of treatment, in addition to ameliorating the present-
ing problem of the child and their accompanying symptoms
Participants (Kaslow et al., 2012). The counselor initiated treatment by
A total of 48 kindergarten through sixth-grade student-clients assessing the child, family members, and teachers, essentially
completed more than five counseling sessions within the mapping the ecosystem of the child and family before design-
SBFCI with complete data collection (see Table 1). The mean ing steps of the treatment plan with the family (Goldenberg
Kelchner et al.
et al., 2017). For example, each counselor used a genogram as
an initial assessment technique to obtain a graphic representa-
tion of the nuclear and extended family on both sides over three
generations, which allowed counselors to investigate the origin
of the family’s and child’s presenting problem.
Counselors used SFT traditions to hypothesize the question
of which dysfunctional mechanisms kept families from chang-
ing (homeostasis) when it was necessary (Cottrell & Boston,
2002). The counselors assisted the family in gaining insight
into the origins of their problems through establishing circular
causality. Instead of attributing certain problems to an identi-
fied family member, or a linear chain of events with a cause-
and-effect relationship to problems, families were able to
recognize the multiple relational transactions and environmen-
tal conditions that modulate and perpetuate members’ charac-
teristics and behaviors (Flaskas, 2010). The counselors were
advised to take a nonpathologizing approach and view of the
family while structuring the therapeutic process in such a way
in which blaming is minimized, transparency is encouraged,
and appreciation is expressed among members in and out of
session (Lorås, 2018). Furthermore, counselors taught parents
and guardians cognitive and behavioral skills, such as manag-
ing negative interactions and affecting regulation strategies
applicable to themselves and their children (Kaslow et al.,
2012). Families were able to learn a balance of establishing
both firmness and flexibility around rules and family roles in
order to reach a better level of family functioning (Goldenberg
et al., 2017).
Supervision. Clinical supervision was provided to counselors to
ensure the welfare of the clients and to promote treatment
fidelity to SFT counseling. Each supervisor was trained in SFT
and family counseling. Clinical supervision included live
supervision, group supervision, and triadic supervision. Prior
to each counseling session, counselors participated in group
supervision at one of the school sites. This supervision pro-
vided counselors the opportunity to discuss their clients, learn
SFT techniques, and receive feedback on their approach from
their peers and supervisor. Additionally, supervisors provided
live supervision through bud-in-ear technology while counse-
lors were providing services to ensure client safety with imme-
diate feedback. Finally, counselors received triadic supervision
off-site where they were able to process their clinical work and
discuss treatment goals related to SFT. Through supervision,
counselors received formative and summative feedback to
facilitate their clinical growth working with families that
aligned with SFT.
Instrument
FACES-IV is a self-report assessment to measure family cohe-
sion and family flexibility. The 42-item assessment is meant to
measure the effectiveness of family therapy (Olson, 2011).
There are six subscales within the instrument, two of which
were considered in this investigation, the Family Communica-
tion and Family Satisfaction. Scoring is completed using an
277
Excel spreadsheet. Parents’ responses are recorded, and scores
are automatically calculated for subscales. For this study, the
percentile scores for each of the subscales under review were
considered at three time points: precounseling and after 5 and
10 counseling sessions.
Feedback Form
A feedback form was deployed after Sessions 5 and 10 asking
caregivers to share any other thoughts about their child and the
SBFC sessions. The form consisted of one question: Please
indicate anything else that you would like to share or clarify
about your child and the SBFC sessions that were not addressed
in the FACES-IV instrument that you just completed. It was
determined from prior years of conducting school-based family
interventions that some caregivers preferred to provide more
information than a scale allowed.
Data Analysis
To analyze the percentile scores obtained from the FACES-IV
data (e.g., Family Satisfaction and Family Communication), a
repeated measure analysis of variance (ANOVA) was con-
ducted to determine the mean change in scores from preinter-
vention to two time points during therapy (5 and 10 sessions).
Data were cleaned and limited to those who had participated in
family therapy sessions and had three scores on both subscales.
Next, data were screened for outliers and one participant was
removed as they had more scores than session visits. Other
statistical analyses included a paired sample t test of the Family
Satisfaction and Communication after the Session 5 and Ses-
sion 10 benchmarks.
To analyze the open-ended questions on the feedback form,
all results were read by two of the authors. Potential codes were
jointly determined based on the initial readings and the mean-
ing patterns observed. Two overarching themes emerged: (a)
student behavior development and (b) family dynamics differ-
ences. These themes were further categorized into positive/
advantages, strengths/negative, and challenges/limitations.
Next, the researchers coded all comments into these themes
and subcategories. To eliminate researcher bias, the comments
were coded independently and then converged to establish con-
sensus. In the rare instance where there was divergence, the
coders discussed the rationale for their coding and consensus
was met.
Results
Research Question 1: When considering family commu-
nication and family satisfaction as measured by the
FACES-IV, is there a statistically significant group dif-
ference over time (i.e. pretest, after 5 and 10 visits) of
students participating in SBFC? There were 48 families
who responded after 5 visits and 30 families after 10 visits
(see Table 2).
278 The Family Journal: Counseling and Therapy for Couples and Families 28(3)

Table 2. Paired Sample t Test for Family Satisfaction and Communication.

Subscales over Time M SD t df p

Family satisfaction pretest after five visits 19.479 26.493 5.094 47 <.001
Family satisfaction pretest after 10 visits 14.967 22.789 3.597 29 <.001
Family communication pretest after 5 visits 14.958 26.357 3.932 47 <.001
Family communication pretest after 10 visits 11.20 21.018 2.919 29 .007

Table 3. Representative Comments of Caregivers’ Perceptions About Participating in School-Based Family Counseling.

Student Behavior Development Family Dynamics Differences

Positive I noticed that my child identified with the story, was more willing Our family is more than beyond vocal about our feelings and
to discuss emotional states, and had increased knowledge of describing what and how certain events or words (good or
coping mechanisms. bad) has affected us.
My son would not be where he is today if it were not for this Before starting this program, I did not know how to express my
program. Our family has grown so much and we cannot put emotions to my daughters. I didn’t even know how to hug
into words how thankful we are. them. All of this changed. I still have a lot of work to do but
my family is stronger and I am a better dad now.
We started the program just for our daughter but we had no We look forward to sessions each week since these family
idea. My daughter is very complex and in the past counselors sessions help all of us.
have not wanted to work with her because of her medical
complexity. This program welcomed her and my family. I have
begun to see a light come on for her when it used to be very
dim. She, her sister, and me are able to speak about our
feelings and even have weekly family time. Thank-you from
the bottom of our hearts for an often thankless job
The teachers call home now with good things to say instead of This program has helped me to understand how to advocate for
bad things to say. My heart doesn’t stop when I see it is the my son and to work with the school system. I am a better
school calling now. parent for being a part of this program.
My child has been in less trouble in school since we started the
program. He has not had one discipline referral since the first
week we began.
My son has made improvements in the way he and I
communicate but also in his reading and other classes. This
program saved his life. I only wish this program was offered in
middle school.
Negative or We wish we could have counseling twice a week. We need a This program has helped us but the problem is it does not go
neutral Monday session and a Thursday to get us through the rest of over the summer, so we are left without help.
the week.

A repeated measure ANOVA was conducted to evaluate the
mean increase of the construct family satisfaction over time.
There was a main effect for time, Wilks’s l ¼ .49, F(2, 28) ¼
28.96, p < .001, Z2p ¼ .51, a large effect size. We further tested
the construct of family satisfaction by gender. The difference
was not statistically significant by the child client’s gender,
F(2, 28) ¼ .106, p ¼ .899, Z2p ¼ .004, a medium effect size.
To evaluate family communication, a repeated measure
ANOVA indicated a main effect for time, Wilks’s l ¼ .592,
F(2, 28) ¼ 9.66, p ¼ .001, Z2p ¼ .40, a large effect size. We also
further tested family communication by gender. The difference
was not statistically significant by the child client’s gender,
F(2, 28) ¼ .992, p ¼ .898, Z2p ¼ .008, a medium effect size.
To answer Research Question 2 about caregivers’ percep-
tions of school-based family therapy as it specifically relates to
their child and family, caregivers’ comments from an open-
ended question were coded and categorized. Of the possible
48 families represented, the program received 22 responses to
the open-ended question. Eighty-six percent of the comments
were rated as positive. The other 14% were neutral comments
or negative. Sixty-eight percent of the comments related to
student behavior development and the other 32% were related
to family dynamic differences. These unsolicited comments
were coded into two themes: student behavior development
and family dynamic differences (Table 3).
Discussion
Limited research has investigated the effectiveness of SBFCI
with children and families. In this mixed-methods convergent
study, an SBFC intervention was conducted with children from
three Title I elementary schools. Participants were asked to rate
aspects of family communication and satisfaction utilizing the
Kelchner et al.
FACES-IV. To contextualize the quantitative results, caregiver
perceptions were collected at the same time.
The findings indicated a statistically significant difference
in caregivers’ ratings on the FACES-IV of family satisfaction
and family communication, indicating that their family com-
munication as well as their satisfaction with each other
improved over time. These results are similar to other studies
conducted in schools (Cooper-Haber & Sanchez, 2013). When
family counseling occurs and is continual and all parties are
committed, there can be improved communication and family
satisfaction. Gerrard and Soriano (2013) noted school-based
family counseling was a culturally responsive modality for
family counseling. Similarly, in this study, at three Title I
schools inclusive of underserved and underrepresented popula-
tions, school-based counseling correlated with improved fam-
ily communication and satisfaction. Caregivers in this study
confirmed that family counseling was a needed support for
their families (Gerrard & Soriano, 2018) and that students’
school and home behavior improved as the families partici-
pated in counseling. Further, our results indicate school-based
counseling was an important contributor to family cohesion,
parental involvement, and school engagement for diverse
youth and played a key role in academic success (Stormshak
et al., 2010).
The school environment can be an important context for
family counseling as counselors in this study were viewed as
an extension of the school system. By virtue of the counseling
taking place at school, families felt supported by the school
because the family therapist established a safe space in a famil-
iar setting. Furthermore, when families feel supported by the
school, the school–family bond is strengthened, which may
lead to better academic gains for children (Cooper-Haber &
Sanchez, 2013). School-based family therapists can provide
needed support for their clients since navigating family, school,
and community systems is a crucial component of family and
school success.
Caregivers’ perceptions of school-based family therapy pro-
vided evidence of student’s behavior development and family
dynamic differences. Caregivers attributed the student’s aca-
demic and personal behavioral improvements to participating
in SBFC partnership. The way a family system functions influ-
ences the child’s well-being including their internalizing and
externalizing behaviors (Scholte & Van der Ploeg, 2015).
When family discord decreases and positive functioning
increases, the likelihood of the child’s success in and out of
school becomes greater. Caregivers and students attributed
improvements to having tools for communication and
problem-solving. Other researchers have noted the importance
of the partnership between school-based family therapists,
caregivers, the family system, and academic performance (Sor-
iano et al., 2013).
Limitations and Implications
The limitations of this study included the limited number of
participants for all data points collected. The number of
279
participants between the pretest and 10 visits decreased, per-
haps due to attrition, survey fatigue, or caregivers not complet-
ing or returning forms as intended. The limited number of
respondents limits the generalizability of the findings.
Implications for schools include seeking a partnership with a
local university and their counselors-in-training programs to
provide school-based family therapy at the school (Gerrard &
Soriano, 2013; Soriano et al., 2013). Providing a program for
youth in schools can reach students who may not otherwise
access mental health services (Gamble & Lambros, 2014) and
reduce social stigmatization (Solomon et al., 2016). District
and school administrators can further support school-based,
family counseling interventions by providing resources such
as time and space for counseling sessions and supporting the
inclusion of family-based counseling. With increased funding
for mental health services in school districts and with a greater
demand for mental health concerns in family systems (e.g.,
COVID-19, bullying, and school shootings), more trained
school-based family counselors are needed. Counselor educa-
tion programs should train their marriage and family students
to work within the school context because these counselors
would have the training and skill sets to understand and support
multiple levels of individual, family, group, and community
systems (Laundy, 2015). With the rise in the need for mental
health services for children and the increase in juvenile offend-
ing, policies have focused on the functioning of the child and
pretermitted to include the influence of the family system func-
tioning on the child’s well-being (Scholte & Vander Ploeg,
2015). Furthermore, children’s social, emotional, and academic
achievement could increase by creating policy changes that
incorporate the family system. At the district and school level,
administrators can support school-based, family counseling
interventions by providing resources such as time and space
for counseling sessions and incorporating family-based coun-
seling into their response to intervention
In summary, the findings supported school-based family
therapy for these students at Title I schools. School-based
family counselors are well positioned to understand the com-
plexities of school systems while connecting and supporting
school counselors, teachers, administrators, social workers,
and families to ensure school and family successes. The union
of school-based mental health services and family therapy
results in success for schools, children, and families. Future
research could consider a larger sample size and include other
student outcomes related to achievement, teacher ratings, and
students’ perceptions of their counseling experiences.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
280 The Family Journal: Counseling and Therapy for Couples and Families 28(3)
ORCID iD
Viki P. Kelchner https://orcid.org/0000-0002-9852-5758
References
Anakwenze, U., & Zuberi, D. (2013). Mental health and poverty in the
inner city. Health & Social Work, 38(3), 147–157. https://doi.org/
10.1093/hsw/hlt013
Axelrod, M. I., Elizabeth, J. Z., Haugen, K. A., & Klein, J. A. (2009).
Self-management of on-task homework behavior: A promising
strategy for adolescents with attention and behavior problems.
School Psychology Review, 38(3), 325.
Bains, R. M., & Diallo, A. F. (2016). Mental health services in school-
based health centers: Systematic review. The Journal of School
Nursing, 32(1), 8–19. https://doi.org/10.1177/1059840515590607
Ballard, K., Sander, M., & Klimes-Dougan, B. (2014). School-related
and social-emotional outcomes of providing mental health services
in schools. Community Mental Health Journal, 50(2), 145–149.
https://doi.org/10.1007/s10597-013-9670-y
Beaudoin, A. L. (2016). Childhood mental illness: Impact and recom-
mended interventions. Dissertation Abstracts International: Sec-
tion B: The Sciences and Engineering, 76, 1–99.
Bernstein, G., Layne, A., Egan, E., & Tennison, D. (2005). School-
based interventions for anxious children. Journal of American
Academic Child Adolescent Psychiatry, 44(11), 1118–1127.
https://doi.org/10.1097/01.chi.0000177323.40005.a1
Blackman, K. F., Powers, J. D., Edwards, J. D., Wegmann, K. M.,
Lechner, E., & Swick, D. C. (2016). Closing the gap: Principal
perspectives on an innovative school-based mental health interven-
tion. The Urban Review, 48(2), 245–263. https://doi.org/10.1007/
s11256-016-0353-1
Blount, T. (2012). Dropout prevention: Recommendations for school
counselors. Journal of School Counseling, 10(16), 1–33.
Boutelle, M. (2010). Pooling resources reduces number of dropouts.
Education Digest: Essential Readings Condensed for Quick
Review, 75(5), 50–55.
Capp, G. (2015). Our community, our schools: A case study of pro-
gram design for school-based mental health services. Children &
Schools, 37(4), 241–248. https://doi.org/10.1093/cs/cdv030
Carr, A. (2009). The effectiveness of family therapy and systemic
interventions for child-focused problems. Journal of Family
Therapy, 31(1), 3–45. https://doi.org/10.1111/j.1467-6427.2008.
00451.x
Carr, A. (2014). The evidence base for family therapy and systemic
interventions for child-focused problems. Journal of Family Ther-
apy, 36(2), 107–157. https://doi.org/10.1111/1467-6427.12032
Cefai, C., & Cavioni, V. (2015). Beyond PISA: Schools as contexts for
the promotion of children’s mental health and well-being. Contem-
porary School Psychology, 19(4), 233–242. https://doi.org/10.
1007/s40688-015-0065-7
Cooper-Haber, K., & Haber, R. (2015). Training family therapists for
working in the schools. Contemporary Family Therapy: An Inter-
national Journal, 37(4), 341–350. https://doi.org/10.1007/s10591-
015-9361-7
Cooper-Haber, K., & Sanchez, S. (2013). A multi-systemic approach
to reducing suspensions and expulsions in schools in the United
States. International Journal for School Based Family Counseling,
4, 113.
Cottrell, D., & Boston, P. (2002). Practitioner review: The effective-
ness of systemic family therapy for children and adolescents.
Journal of Child Psychology and Psychiatry, 43(5), 573–586.
https://doi.org/10.1111/1469-7610.00047
Crespi, T. D., & McNamara, M. L. (2015). The family dynamic in
children’s mental health: Considerations for counseling and
psychotherapy within schools. Online Journal of Counseling &
Education, 4(1), 13–24.
DiCocco, B. E. (1986). A guide to family/school interventions for the
family therapist. Contemporary Family Therapy, 8(1), 50–61.
https://doi.org/10.1007/BF00891833
Dubow, E. F., Boxer, P., & Rowell, L. (2009). Long-term effects of
parents’ education on children’s educational and occupational suc-
cess. Merrill-Palmer Quarterly, 55(3), 224–249.
Farahmand, F. K., Grant, K. E., Polo, A. J., & Duffy, S. N. (2011).
School-based mental health and behavioral programs for low-
income, urban youth: A systematic and meta-analytic review.
Clinical Psychology: Science and Practice, 18(4), 372–390.
https://eric.ed.gov/?id¼ED567195
Flaskas, C. (2010). Frameworks for practice in the systemic field: Part
1—Continuities and transitions in family therapy knowledge. Aus-
tralian and New Zealand Journal of Family Therapy, 31(3),
232–247. https://doi.org/10.1375/anft.31.3.232
Gamble, B. E., & Lambros, K. M. (2014). Provider perspectives on
school-based mental health for urban minority youth: Access and
services. Journal of Urban Learning, Teaching, and Research, 10,
25–38.
Gerrard, B. A. (2008). School-based family counseling: Overview,
trends, and recommendations for future research. International
Journal for School-Based Family Counseling, 1(1), 6–24.
Gerrard, B. A., & Soriano, M. (2013). School-based family counsel-
ing: Transforming family-school relationships. Institute for
School-Based Family Counseling.
Gerrard, B. A., & Soriano, M. (2018). The role of community inter-
vention in school-based family counseling. International Journal
for School-Based Family Counseling, 10, 1–11.
Goldenberg, I., Stanton, M., & Goldenberg, H. (2017). Family ther-
apy: An overview (9th ed.). Cengage Learning.
Green, A. L. (2015). Theoretically guided examination of caregiver
strain and its relationship with school-based mental health services
utilization and parent engagement in services. Dissertation
Abstracts International: Section B: The Sciences and Engineering,
77, 1–53.
Kaffenberger, C., & Seligman, L. (2007). Helping students with men-
tal and emotional disorders. In B. Erford (Ed.), Transforming the
school counseling profession (Vol. 2, pp. 351–383). Pearson.
Kaslow, N. J., Broth, M. R., Smith, C. O., & Collins, M. H. (2012).
Family-based interventions for child and adolescent disorders.
Journal of Marital and Family Therapy, 38(1), 82–100. https://
doi.org/10.1111/j.1752-0606.2011.00257.x
Kayler, H., & Sherman, J. (2009). At-risk ninth-grade students: A
psychoeducational group approach to increase study skills and
grade point averages. Professional School Counseling, 12(6),
434–439.
Kelchner et al.
Lambros, K., Kraemer, B., Wager, J. D., Culver, S., Angulo, A., &
Saragosa, M. (2016). Students with dual diagnosis: Can school-
based mental health services play a role? Journal of Mental Health
Research in Intellectual Disabilities, 9(1–2), 3–23. https://doi.org/
10.1080/19315864.2015.1091055
Laundy, K. C. (2015). Family therapy in schools. Family Therapy
Magazine, 14(1), 52–57.
Liber, J. M., De Boo, G. M., Huizenga, H., & Prins, P. J. M. (2013).
School-based intervention for childhood disruptive behavior in
disadvantaged settings: A randomized controlled trial with and
without active teacher support. Journal of Consulting & Clinical
Psychology, 81(6), 975–987. https://doi.org/10.1037/a0033577
Lorås, L. (2018). Systemic family therapy competences in child and
adolescent mental health care. Contemporary Family Therapy,
40(1), 1–9. https://doi.org/10.1007/s10591-017-9440-z
Macklem, G. L. (2014). Preventive mental health at school [electronic
resource]: Evidence-based services for students. Springer.
Martin, D. M. (2013). Factors associated with school counselors’ use
of a family systems perspective [Doctoral dissertation, University
of New Orleans]. http://scholarworks.uno.edu/td/1650/
Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S.,
Cui, L., Benjet, C, Georgiades, K, & Swendsen, J (2010). Life-
time prevalence of mental disorders in US adolescents: Results
from the National Comorbidity Study Adolescent Supplement
(NCS-A). Journal of the American Academy of Child and
Adolescent Psychiatry, 49, 980–989. https://doi.org/10.1016/
j.jaac.2010.05.017
Mince, J. (2000). Integration of the family therapy specialist into
public school pupil personnel services. Journal of Prevention &
Intervention in the Community, 21(1), 139–157. https://doi.org/10.
1300/J005v21n01_10
Montañez, E., Berger-Jenkins, E., Rodriguez, J., McCord, M., &
Meyer, D. (2015). Turn 2 Us: Outcomes of an urban elementary
school-based mental health promotion and prevention program
serving ethnic minority youths. Children & Schools, 37(2),
100–107. https://doi.org/10.1093/cs/cdv004
Ofordile, C. (2009). School-based family counseling: A new para-
digm. Sustainable Human Development Review, 1(1), 61–73.
Olson, D. (2011). FACES IV and the circumplex model: Validation
study. Journal of Marital and Family Therapy, 3(1), 64–80.
Osofsky, J., Kronenberg, M., Bocknek, E., & Hansel, T. (2015).
Longitudinal impact of attachment-related risk and exposure to
trauma among young children after hurricane Katrina. Child &
Youth Care Forum, 44(4), 493–510. https://doi.org/10.1007/
s10566-015-9300-7
Oxford, M. L., & Lee, J. O. (2011). The effect of family processes on
school achievement as moderated by socioeconomic context. Jour-
nal of School Psychology, 49(5), 597–612. https://doi.org/10.1016/
j.jsp.2011.06.001
Perfect, M. M., & Morris, R. J. (2011). Delivering school-based men-
tal health services by school psychologists: Education, training,
and ethical issues. Psychology in the Schools, 48(10),
1049–1063. https://doi.org/10.1002/pits.20612
Powell, K. (2011). What does the literature say about family therapy in
the school setting? A content analysis. Dissertation Abstracts
281
International: Section A: Humanities and Social Sciences, 72,
1–99.
Powers, J. D., Edwards, J. D., Blackman, K. F., & Wegmann, K. M.
(2013). Key elements of a successful multi-system collaboration
for school-based mental health: In-depth interviews with district
and agency administrators. The Urban Review, 45(5), 651–670.
Ray, W. A. (2016). Theory and practice of systemic therapy: A re-
introduction to Jackson and Weakland’s “conjoin family therapy”
(1961). Journal of Systemic Therapies, 34(4), 29–32.
Retzlaff, R., Sydow, K. V., Beher, S., Haun, M. W., & Schweitzer, J.
(2013). The efficacy of systemic therapy for internalizing and other
disorders of childhood and adolescence: A systematic review of 38
randomized trials. Family Process, 52(4), 619–652. https://doi.org/
10.1111/famp.12041
Riedinger, V., Pinquart, M., & Teubert, D. (2017). Effects of systemic
therapy on mental health of children and adolescents: A meta-
analysis. Journal of Clinical Child & Adolescent Psychology,
46(6), 880–894. https://doi.org/10.1080/15374416.2015.1063427
Rones, M., & Hoagwood, K. (2000). School-based mental health ser-
vices: A research review. Clinical Child & Family Psychology
Review, 3(4), 223–241.
Salerno, J. P. (2016). Effectiveness of universal school-based mental
health awareness programs among youth in the United States: A
systematic review. Journal of School Health, 86(12), 922–931.
https://doi.org/10.1111/josh.12461
Scholte, E., & Van der Ploeg, J. (2015). The family questionnaire: A
measure to assess the quality of family functioning. Journal of
Family Issues, 36(13), 1810–1828. https://doi.org/10.1177/
0192513X13506707
Solomon, C., Bierbrauer, S. L., Harris, S., Belser, C. T., Wheeler, N. J.
, Crunk, A. E., & Lambie, G. W. (2016). Experiences of caregivers
and students in an elementary school-based mental health counsel-
ing practicum program. Journal of Child and Adolescent Counsel-
ing, 2(2), 125–142. https://doi.org/10.1080/23727810.2016.
1228771
Soriano, M., Gerrard, B., & Adler, A. (2013). School-based family
counseling: An overview. In B. Gerrard & M. Soriano (Eds.),
School-based family counseling: Transforming family-school rela-
tionships (pp. 2–15). Institute for School-Based Family
Counseling.
Stagman, S., & Cooper, J. L. (2010). Children’s mental health: What
every policymaker should know. Columbia University: National
Center for Children in Poverty. http://www.lacdcfs.org/katiea/prac
tices/docs/Childrens_MH.pdf
Stormshak, E. A., Connell, A. M., Véronneau, M.-H., Myers, M. W.,
Dishion, T. J., Kavanagh, K., & Caruthers, A. S. (2011). An eco-
logical approach to promoting early adolescent mental health and
social adaptation: Family-centered intervention in public middle
schools. Child Development, 82(1), 209–225. https://doi.org/10.
1111/j.1467-8624.2010.01551.x
Stormshak, E. A., Fosco, G. M., & Dishion, T. J. (2010). Implement-
ing interventions with families in schools to increase youth school
engagement: The Family Check-Up model. School Mental Health,
2(2), 82–92.
Sydow, K. V., Retzlaff, R., Beher, S., Haun, M. W., & Schweitzer, J.
(2013). The efficacy of systemic therapy for childhood and
282 The Family Journal: Counseling and Therapy for Couples and Families 28(3)
adolescent externalizing disorders: A systematic review of 47
RCT. Family Process, 52(4), 576–618. https://doi.org/10.1111/
famp.12047
Terry, L. L. (2002). Family counseling in the schools: A graduate
course. The Family Journal, 10(4), 419–428. https://doi.org/10.
1177/106648002236762
Ungar, M. (2015). Practitioner review: Diagnosing childhood resi-
lience—A systemic approach to the diagnosis of adaptation in
adverse social and physical ecologies. Journal of Child Psy-
chology and Psychiatry, 56(1), 4–17. https://doi.org/10.1111/
jcpp.12306
U.S. Department of Health and Human Services. (2001). Mental
health: Culture, race, and ethnicity—A supplement to mental
health: A report of the surgeon general. U.S. Department of Health
and Human Services, Substance Abuse and Mental Health Services
Administration, Center for Mental Health Services.
Vincent, G. M., Grisso, T., Terry, A., & Banks, S. M. (2008). Sex
and race differences in mental health symptoms in juvenile
justice: The MAYSI-2 national meta-analysis. Journal of the
American Academy of Child and Adolescent Psychiatry,
47(3), 282–290.
Williams, J. M., & Greenleaf, A. T. (2012). Ecological psychol-
ogy: Potential contributions to social justice and advocacy in
school settings. Journal of Educational and Psychological Con-
sultation, 22(1–2), 141–157. https://doi.org/10.1080/10474412.
2011.649653