School Principals’ Perceived Barriers and Facilitators to the Normalization of School-Based Mental Health Services: A Multimethod Investigation

Schools have become primary providers of mental health services for children and adolescents (Kern et al. in School Mental Health 9:205–217, 2017). Within schools, school principals play a significant role in the implementation of school-based mental health (SBMH; Langley et al. in School Mental Health 2:105–113, 2010). This multimethod study aimed to investigate school principals’ perceptions of SBMH, specifically in how they view SBMH and what barriers and facilitators they identify to successful implementation. School principals from 244 public schools in the United States completed a survey, and 19 principals also participated in semi-structured interviews. Data from a quantitative measure based on Normalization Process Theory (NPT; Finch et al. in BMC Med Res Methodol 18(1):1–13, 2018) indicated that while principals strongly believe SBMH will become a normal part of their work in the future, their responses to whether they are familiar with SBMH and see it as a normal part of the current work were less robust. Results from a framework analysis of the qualitative results identified barriers and facilitators to the implementation of SBMH within and outside of schools, thus aligning with implementation science frameworks such as the Exploration, Preparation, Implementation, and Sustainment (EPIS; Moullin et al. in Implement Sci 14:1–1, 10.1186/s13012-018-0842-6, 2019) framework. The findings may inform SBMH policy in light of the increasing number of children and adolescents with mental health needs (Hoover and Bostic in Psychiatr Serv 72(1):37–48, 2021).