BRIDGING SCHOOL, HEALTH, AND FAMILY SYSTEMS: A PHENOMENOLOGICAL STUDY OF MEDICAL FAMILY THERAPISTS IN SCHOOL-BASED MENTAL HEALTH SERVICES

Abstract

School-based mental health services have expanded significantly across the United States as educators and policymakers increasingly recognize the connection between student well-being and educational success. Despite this expansion, many school-based mental health systems continue to operate within fragmented organizational structures characterized by limited interdisciplinary collaboration and inconsistent inclusion of families in care processes. These structural gaps raise important questions about how integrated behavioral health services are experienced by families and how relational processes within schools may influence the effectiveness of these services. This dissertation examines the role of relational integration and family inclusion within school-based mental health systems through a multi-part research design. The first chapters provide a historical and policy analysis of the development of school-based health services in the United States, followed by a systematic review examining levels of integrated care and family inclusion within school-based health systems. Findings from the systematic review suggest that while access to behavioral health services in schools has expanded, most programs operate at moderate levels of professional integration and low levels of family inclusion. To further explore these dynamics, the dissertation presents a phenomenological study examining caregiver experiences of Medical Family Therapy (MedFT) within school-based mental health services. Caregiver responses reveal seven themes reflecting relational processes of care, therapeutic skill development across home and school contexts, and system-level structures that shape family engagement. Participants frequently describe Medical Family Therapists as relational bridges connecting families, educators, and healthcare systems through communication, collaboration, and coordinated support. The findings suggest that relational communication, psychological safety, and interdisciplinary collaboration function as core mechanisms through which integrated care is experienced within school environments. This dissertation is the articulation of relational integration as a central organizing principle for school-based mental health systems, demonstrating how the field of Medical Family Therapy can operationalize family-inclusive, interdisciplinary models of care that extend therapeutic impact across educational, family, and community contexts. These findings offer important implications for clinical practice, school system design, and public policy aimed at strengthening integrated behavioral health systems for children and families.