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Ecological Psychology: Replacing the

Medical Model Paradigm for School-Based
Psychological and Psychoeducational
Services
a
Terry B. Gutkin
a
San Francisco State University

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To cite this article: Terry B. Gutkin (2012): Ecological Psychology: Replacing the Medical Model
Paradigm for School-Based Psychological and Psychoeducational Services, Journal of Educational and
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 Journal of Educational and Psychological Consultation, 22:1–20, 2012
Copyright © Taylor & Francis Group, LLC
ISSN: 1047-4412 print/1532-768X online
DOI: 10.1080/10474412.2011.649652

INTRODUCTION

Ecological Psychology: Replacing the

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Medical Model Paradigm for School-Based

Psychological and Psychoeducational Services

TERRY B. GUTKIN
San Francisco State University

Traditional medical model service delivery systems have facilitated

the creation of nationwide mental health and education pan-
demics for children and youth. The characteristics and shortcom-
ings of medical model approaches leading to these problems are
explicated, including the focus of services on individuals rather
than populations, relying almost exclusively on remediation rather
than prevention and early intervention, unintentionally creating a
severe shortage of service providers, and providing treatments that
lack sufficient efficacy. An ecological model of human behavior
and service delivery is presented as an alternative that embodies
the potential to address these problems and successfully address
the mental health and education pandemics we currently face. It
is concluded that a paradigm shift toward an ecological model is
both essential and long overdue.

In his classic book, The Structure of Scientific Revolutions, Thomas Kuhn

(1970) argued that science typically advances in small, incremental steps,
each of which builds on those that preceded it, until one or more anomalies
are encountered. In Kuhn’s work, anomalies are conceptualized as phenom-
ena that cannot be explained adequately or addressed successfully by the
dominant theoretical paradigm being followed by scholars at the time. Sir
Isaac Newton’s theory of gravity was forced to give way to Albert Einstein’s

Correspondence should be sent to Terry B. Gutkin, San Francisco State University, Burk
Hall 524, 1600 Holloway Avenue, San Francisco, CA 94132. E-mail: tgutkin@sfsu.edu

1
 2 T. B. Gutkin

theory of relativity once it became clear that the older theory could no
longer account for the results of new research findings. Regardless of the
particular arena of scientific endeavor, once unearthed, anomalies demand
a shift from ‘‘normal science’’ to the development and exploration of a new
paradigm.
Sheridan and Gutkin (2000) suggested that we had arrived at just such a
point in the science and practice of school psychology in particular and the
delivery of school-based mental health and educational services in general.
D. J. Reschly and Ysseldyke (2002) soon came to the same conclusion. The
case that was made then is even stronger now (Gutkin, 2009). The need
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for a paradigm shift away from traditional medical model conceptualizations

and toward ecological understandings of human functioning could not be
more evident. It is for these reasons that this special issue of the Journal of
Educational and Psychological Consultation is being published.
As we move into the 2nd decade of the 21st century, our nation faces
clear and seemingly irrefutable evidence of systematic failure in our systems
of care addressing mental health services and education. Statistics from highly
credible sources abound detailing the breadth and depth of the problems
confronting us. A small handful of the many well-documented examples are
described here.
A recent national survey conducted by the National Institute of Mental
Health (NIMH) found that (a) each year more than a quarter of the American
population has a diagnosable mental disorder, with nearly 6 in 10 of these
individuals having difficulties characterized as either ‘‘moderate’’ or ‘‘serious’’
(Kessler, Chiu, Demler, & Walters, 2005), and (b) the bulk of these people
‘‘remain either untreated or poorly treated’’ (Wang et al., 2005, p. 629). These
findings were confirmed by Norcross (2006), who summarized the results
of the World Health Organization World Mental Health Survey Consortium
(2004) and reported the following:
The statistics on professionally treated mental disorders are compelling.
Approximately 85% of Americans will not receive health care treatment
for their diagnosable mental or substance-abuse disorder within a year.
In fact, more than 70% of them will never receive specialized mental
health care. (Norcross, 2006, p. 683)

Data such as these led Thomas Insel, the Director of NIMH, to describe the
quality of contemporary mental health services as an ‘‘unacceptable failure’’
(Insel & Fenton, 2005, p. 590).
Parallel data for children and youth are equally discouraging. In the
Report of the Surgeon General’s Conference on Children’s Mental Health, the
opening sentence of the conference summary states that ‘‘the nation is facing
a public crisis in mental healthcare for infants, children and adolescents’’
(U.S. Public Health Service, 2000). Broad-based national studies suggest that
(a) ‘‘approximately one in five children and adolescents experiences the
 Ecological Model 3

signs and symptoms of a DSM-IV disorder during the course of a year’’

(U.S. Department of Health and Human Services, 1999, p. 193); (b) ‘‘one in
ten children and adolescents suffers from mental illness severe enough to
result in significant functional impairment’’ (National Advisory Mental Health
Council Workgroup on Child and Adolescent Mental Health Intervention
Development and Employment, 2001, p. 9); but (c) as reported by Strein,
Hoagwood, and Cohn (2003), ‘‘approximately 70% of children and adoles-
cents who are in need of mental health treatment do not receive any such
services’’ (p. 24). Complementing these distressing mental health data are
those drawn from education. For example, comparisons of 15-year-olds in
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2006 showed that the United States ranked 23rd and 16th for mathematics
and science literacy, respectively, out of 29 developed nations (National
Center for Education Statistics, 2009). In The State of America’s Children
2008, the Children’s Defense Fund (2009) reports that (a) only about 30% of
America’s 4th and 8th graders are reading at grade level, (b) only about 25%
of America’s 12th graders are doing math at grade level, (c) a public school
student is suspended every second, and (d) a high school student drops out
of school every 11 s.
These data seem to be only the proverbial tip of the iceberg. Gutkin
(2009) referred to this state of affairs as ‘‘mental health and education pan-
demics’’ (p. 464). There is probably enough statistical bad news regarding
the well-being of children in the United States in 2012 to fill up all the pages
of this special issue and then some. Of course, just a simple trip to most
local school districts would reveal the same phenomena.
We cannot simply continue along with ‘‘business as usual.’’ Although
it is undoubtedly true that current service delivery models are effective for
many individual children and youth, it is also undeniable that they are failing
terribly when one considers our nation’s population of young people as a
whole. Nothing could be clearer. This then is the anomaly that must be
addressed by a paradigm shift.

THE MEDICAL MODEL: AN IMPEDIMENT TO

ADDRESSING THE PANDEMIC EFFECTIVELY

Even though the multiplicity of causes leading to the poor state of America’s
children is obviously extremely complex and not fully understood by anyone,
it seems clear that the medical model paradigm contributes in significant
ways to the problem. By attributing mental health and educational difficulties
primarily to internal states of disease and pathology, the medical model
inadvertently creates a service delivery system that results in the previously
documented crises facing children (and adults) today. A few of the most
salient factors leading to these outcomes are considered here briefly. A more
far-reaching and thorough analysis is provided by Gutkin (2009).
 4 T. B. Gutkin

Focusing on Services for Individuals Rather Than

General Populations
The sheer magnitude of the pandemics described previously suggests that
population-based change is needed if we are to achieve effective solutions
to the mental health and education dilemmas facing children (Huppert,
2009; Keyes, 2007; Strein et al., 2003). It is nearly impossible to solve these
massive problems by directing our attention toward one individual child at
a time. It is the equivalent of trying to put out a forest fire by attending
to the individual characteristics of each tree caught up in the conflagration.
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It is a strategy that is doomed to failure. By focusing almost exclusively

on individual psychopathology, however, the medical model discourages
precisely the types of systemic problem solving and intervention that are
most needed.

Focusing on Remediation Rather Than Prevention and

Early Intervention
Albee (1999) observed that no mass disorder has ever been eliminated
by treating those who have it. Prevention and early intervention are the
treatments of choice when facing pandemics. Driven by a pathology-centered
medical model, however, our current service delivery systems rely primarily
on waiting passively for full-blown dysfunction to emerge before we be-
come involved trying to provide assistance. It is like waiting for Humpty
Dumpty to fall off the wall and splatter on the ground before any action
is taken. Rather than trying ‘‘to put Humpty Dumpty back together again’’
after the fact, it would make so much more sense to intervene proactively
by (a) preventing Humpty Dumpty from falling off the wall (e.g., widen the
wall, give him balance training), (b) being ready to catch Humpty Dumpty
before he hits the ground (e.g., provide a safety net), or (c) modifying
the environment to minimize the damage to Humpty Dumpty (e.g., pro-
vide cushions on the ground to break his fall). Although remediation and
treatment services for victims must always be made available when neces-
sary, relying almost exclusively on this strategy is a no-win approach if the
goal is to diminish the impact of a pandemic or prevent one from getting
started. Pervasive reliance on curative strategies is particularly inappropriate
in light of a strong and growing body of research indicating that preven-
tion and early intervention programs are often very effective (e.g., Durlak,
2009).

Creating a Severe Shortage of Service Providers

By medicalizing the mental health and educational problems facing our
nation’s children and youth, the medical model serves to drastically restrict
 Ecological Model 5

the pool of people deemed by society and its institutions to be qualified

and appropriate to provide services. Conceptualizing psychological and psy-
choeducational dysfunction to be the result of internal biological pathologies
creates a situation in which ‘‘doctors’’ (physicians, psychiatrists, doctoral-
level psychologists) are required to provide treatment. The problem with
this is twofold. First, as argued eloquently by Albee (e.g., 1968, 1990) for
over 40 years, there simply are not nearly enough ‘‘doctors’’ to meet the
needs of more than a small fraction of those requiring mental health care
in our society. Second, the evidence is compelling that doctoral degrees
are not necessary to provide effective services (Berman & Norton, 1985;
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Bratton, Ray, Rhine, & Jones, 2005; Bright, Baker, & Neimeyer, 1999; Carlson
& Christenson, 2005; Christensen & Jacobson, 1994; Guli, 2005; Michael,
Huelsman, & Crowley, 2005; Norcross, 2006; Salloum, 2010; Sheridan, Eagle,
& Doll, 2006; Weisz, Weiss, Han, Granger, & Morton, 1995).
Perhaps of even greater concern, the medical model has the potential to
unintentionally disempower the most important and accessible caregivers in
the lives of children and adolescents, namely, parents and teachers. Without
sufficient (or any) training in biology, neurology, psychiatry, or psychology,
it would not be surprising if these (and other) primary caregivers experi-
enced feelings of low self-efficacy when trying to create behavioral and/or
educational change for children labeled with medical model, Diagnostic
and Statistical Manual (DSM)- and/or Individuals with Disabilities Education
Improvement Act (IDEIA)-type diagnoses. As is well known from extensive
research (Bandura, 1977, 1986b, 2000), perceptions of low self-efficacy often
lead to ineffectual problem solving and a lack of resolve to persist with
change efforts when immediate success is not forthcoming (as is so often
the case with children’s mental health and educational problems). As argued
by Gutkin (2009), however, addressing the mental health and education
pandemics is impossible without the vigorous participation of teachers and
parents.

Any thought of systematically improving the lives of large numbers of

children, be it in the areas of mental health or education, without working
successfully with and through [teachers and parents] is, to put it bluntly,
ludicrous: : : : The key to providing children with an effective education
is teachers. The key to socializing and raising psychologically healthy
children is parents. Regardless of how insightful and expert school psy-
chologists might be, they cannot really make very much of a difference
for young people without the competent assistance and cooperation of
adults such as these: : : : The robust engagement of teachers, parents,
and other relevant adults in the delivery of [mental health and educa-
tion] services is central to achieving success: : : : Making this happen
requires an approach that empowers mental health paraprofessionals
and increases their sense of self-efficacy: : : : Couching [mental health and
educational] services in terms of internal, biological, and psychopatho-
 6 T. B. Gutkin

logical disease states, however, has the very real potential of disempow-
ering teachers [and] parents: : : : Upon hearing that a student is suffering
from neurological deficits or an ‘‘emotional disturbance,’’ for example,
it would be easy for many crucial adults in that student’s environment
to ‘‘check out,’’ assuming that they cannot possibly be of significant
assistance. (p. 481)

Providing Treatments That Lack Sufficient Efficacy

In light of the low emphasis placed on prevention and early intervention,
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it becomes particularly important that treatments, once implemented, are

powerful and highly effective. Unfortunately, that does not appear to be
the case with the majority of medical model interventions employed with
school-age children both inside and outside of school settings. For example,
meta-analyses of special education ‘‘interventions demonstrated effects that
primarily ranged from negligible to small and, at best, medium, : : : [and]
the obtained ESs [effects sizes] are not eloquent testimony to the efficacy
of practices that have almost come to define special education’’ (Kavale &
Forness, 1999, p. 1003). Weisz, McCarty, and Valeri (2006), addressing the
efficacy of psychotherapy to treat depression in children and adolescents,
reported meta-analytic results that were ‘‘significant but modest in their
strength, breadth and durability’’ (p. 132). These findings are congruent
with those reported by (a) Weisz, Doss, and Hawley (2005) in a more
broadly based review of psychotherapy outcomes for youths, and (b) Eder
and Whiston (2006), who addressed the efficacy of school-based coun-
seling. The very existence of the mental health and education pandemics
among our nation’s young people suggests strongly that once psychological
and/or psychoeducational dysfunctions become well entrenched in young
people it is very unlikely that traditional medical model treatments will lead
to a ‘‘cure.’’
Although a detailed analysis of why traditional medical model treatment
programs are less than optimally effective is beyond the scope of this article,
a few important issues appear to be particularly worthy of attention.

Reliability and Validity of Diagnoses

A foundational step in the provision of treatment under the medical model
is the assessment of referred students for the purposes of determining an
IDEIA- and/or DSM-type diagnosis. Unfortunately, the reliability and validity
of such diagnoses is often highly questionable. This flaw in our current
service delivery model is one that has both a long history and considerable
contemporary evidence (e.g., Davidow & Levinson, 1993; Macmann & Bar-
nett, 1999; McDermott, 1980; Meehl, 1954; Sarbin, 1997; Tharinger, Laurent
& Best, 1986; Watkins, 2009). According to Widiger and Trull (2007),
 Ecological Model 7

There are many failures of the existing DSM-IV-TR diagnostic categories,

including excessive diagnostic comorbidity, inadequate coverage, arbi-
trary and unstable boundaries with normal psychological functioning,
heterogeneity among persons sharing the same diagnosis, and [an] inad-
equate scientific base. (p. 72)

With weak reliability and validity, it should come as no surprise that medical
model diagnoses often fail to lead to strong treatments.
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Treatment Validity of Diagnoses

The primary function of diagnosis is to direct clinicians toward appropriate
and effective treatments for clients; that is, first and foremost diagnoses must
possess treatment validity if they are to serve any significant purpose for
practitioners. In medicine, a diagnosis of diabetes tells physicians to admin-
ister insulin whereas a diagnosis of a blocked coronary artery directs doctors
to perform procedures such as an angioplasty. To be useful, diagnoses must
be linked with empirically validated differential treatments (EVDTs). Medical
model diagnoses in psychology and education, however, generally do not
meet this essential criterion. After reviewing the research pertaining to the
Diagnostic and Statistical Manual, 4th edition, text revision (DSM-IV-TR), for
instance, Widiger and Trull (2007) concluded that this diagnostic taxonomy
‘‘routinely fails in this goal’’ (p. 72). Similar conclusions have been reached
in regard to interventions for school children in school settings (e.g., Good,
Vollmer, Creek, Katz, & Chowdhri, 1993; Gresham & Gansle, 1992; Gresham
& Witt, 1997; Pashler, McDaniel, Rohrer, & Bjork, 2009; D. J. Reschly &
Ysseldyke, 2002). In point of fact, diagnoses cannot possibly be closely
connected to EVDTs if they lack adequate reliability and validity and as
such knowing a child’s formal diagnosis tells clinicians precious little about
how to proceed with treatment. Given that traditional medical model services
have historically led school psychology and related practitioners to spend the
majority or a vary large proportion of their time developing client diagnoses
(D. J. Reschly & Ysseldyke, 2002) and that these diagnoses fail to provide
EVDTs, it should come as no surprise that treatment programs emerging
from the medical model are often less effective than we would hope and are
insufficient to fully meet the needs of our clients.

Disconnect Between Information Gathered for Diagnosis

and the Information Needed for Effective Treatment
The medical model directs practitioners to gather detailed information re-
garding the psychopathologies and internal disease states of children. Un-
fortunately, information of this nature is frequently not what is needed
 8 T. B. Gutkin

to produce effective intervention programs in school settings. When one

stops to consider the range of treatments typically provided for students
it quickly becomes clear that the great bulk of them are, at heart, en-
vironmental manipulations (e.g., changes in curriculum, instructional ap-
proaches, behavior management strategies, classroom settings, classroom
rules). Rather than learning about internal pathologies, clinicians ‘‘require de-
tailed information about teachers and the classroom environments in which
they work, parents and the nature of the home environments in which
they live, and community leaders and the array of community programs
they offer’’ (Gutkin, 2009, p. 475). By systematically deemphasizing the
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environment, however, the medical model leads practitioners away from

the very information that is most needed for the purposes of treatment
planning.

Failing to Focus Treatment on Relevant Environments

By locating the source of dysfunction internally in the students we hope
to serve, the medical model encourages practitioners to treat children and
youth without attending sufficiently to the environments in which they func-
tion. Doing this, however, fails to recognize the essential role that envi-
ronments often play in creating and maintaining psychological and psy-
choeducational dysfunction. Although, as noted earlier, providing therapy
to school children and youth may be effective, it does very little (if any-
thing) to modify the environments in which young people live out their
lives (i.e., school, home, community). ‘‘ ‘Curing’ internal pathologies and
then returning children to unchanged environments that either created or
supported the creation of these pathologies in the first place would seem to
be an act of futility that invites recidivism and poor generalization’’ (Gutkin,
2009, p. 482). Providing personal counseling or psychotherapy to a student
who is acting out in class as a result of a teacher’s ineffective classroom
management strategies without making meaningful changes to that teacher’s
behavior would be an example of falling into this trap. Even if we ‘‘heal’’
this student in our therapy office it seems unlikely that the progress that has
been made will be maintained once the student returns to the dysfunctional
classroom.
This line of reasoning led Gutkin and Conoley (1990) to propose the
‘‘Paradox of School Psychology,’’ in which they argued that ‘‘to serve children
effectively school psychologists must, first and foremost, concentrate their
attention and professional expertise on adults’’ (p. 212). The medical model,
which so clearly directs attention almost exclusively toward the internal
lives of troubled children and away from school, home, and community
environments, thus diminishes the potential impact of treatment programs
by encouraging practitioners to ignore vital environmental variables. Gutkin
and Conoley are suggesting that focusing exclusively on victims is probably
 Ecological Model 9

not the most impactful way to provide services for them, particularly when
those needing assistance are children and adolescents in school settings.

The Big Picture

What happens when a service delivery system is characterized by (a) an
extremely high incidence rate, (b) far too few trained professionals to provide
service to all those needing help, (c) excessive reliance on the treatment of
fully formed ‘‘diseases’’ rather than the employment of prevention and early
intervention strategies, (d) a lack of powerful interventions, (e) low rates of
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‘‘cure,’’ and (f ) the disempowerment of vast numbers of potentially effective

service providers? Almost inevitably, with the sufficient passage of time, the
result is systemic failure. Summing it up with a simple metaphor, when
water pours into a boat faster than it can be bailed out, the ultimate and
easily predictable outcome is that the boat will sink. To the extent that the
medical model contributes significantly to the creation of the flawed service
delivery model described earlier, it leads both directly and indirectly to the
mental health and education pandemics that so deeply and adversely affect
our nation and its children.

WHERE DO WE GO FROM HERE? SHIFTING TO AN

ECOLOGICAL PARADIGM

Although there are numerous theoretical and applied writings that detail the
ecological model and its application to practice (e.g., Bandura, 1978, 1986a;
Barker, 1965, 1968; Chess & Thomas, 1999; Cicchetti & Toth, 1997; Conyne
& Cook, 2004; Conyne & Mazza, 2007; Greenleaf & Williams, 2009; Gutkin,
2009; Lewin, 1951; Moos, 1973, 2002; Morse, 1993; Pianta, 1999; Reynolds,
Gutkin, Elliott, & Witt, 1984; Stormshak & Dishion, 2002; Swartz & Martin,
1997), the work of Urie Bronfenbrenner (e.g., 1979) is generally credited with
developing the most far-reaching and widely accepted expression of this
perspective. The centerpiece of his formulation was the proposal of four in-
terlocking levels of the environment, each of which continuously affects and
is impacted by all of the others. The first of these are microsystems, reflecting
local environments in which people live and function on a daily basis (e.g.,
home, school, and community settings). Ongoing interrelationships among
microsystems were conceptualized by Bronfenbrenner as mesosystems (e.g.,
home-school interactions). Exosystems are viewed as those that influence
people in a reasonably direct manner even though one does not typically
interact directly with these systems (e.g., decisions made by a school board).
Finally, Bronfenbrenner identified macrosystems, which also exert powerful
influences on people’s lives even though the great majority of people will
never have direct contact with these systems (e.g., passage of the No Child
 10 T. B. Gutkin
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FIGURE 1 Typical Student Ecosystem.

Left Behind Act (2002) by Congress). Like all ecologies, changes in any part
of the overall system reverberate throughout the entire system, impacting
people and events at all systemic levels (see Figure 1).
Complementing Bronfenbrenner’s (1979) conceptual understanding of
interlocking environmental systems was his idea that individual human be-
havior was the result of complex interactions between (a) the attributes of
people on the one hand and (b) the characteristics of micro-, meso-, exo-,
and macroenvironments on the other. Gutkin (2009) attempted to summarize
these ideas and relate them to the dominant medical model paradigm as
follows:

Human behavior is a function of complex interactions between the char-

acteristics of individuals and the environments in which they function.
Neither the former nor the latter provide adequate explanatory power
in isolation from each other. Unlike the medical model, which focuses
on context-independent disease states : : : , the ecological approach is
premised on the idea that ‘‘context counts.’’ From an ecological perspec-
tive, the point is not that internal, biological states and characteristics
are unimportant. Clearly : : : they play a significant role in all human
experience: : : : Rather, the defining conceptual issue of ecological theory
is that knowing about internal, biological states is not sufficient in and of
itself, as these phenomena always find expression as they interact with
external environments. It is this interaction, between internal states and
external environments, which must be the fundamental unit of analysis
for psychologists. (p. 478)

Recent research, in fact, points more strongly than ever toward a bidirectional
and reciprocal interaction between the biological characteristics of people
and the nature of those environments that surround them (e.g., Ambady
& Bharucha, 2009; Breedlove, Rosenzweig, & Watson, 2007; Rusk & Rusk,
2007). A fictitious case study developed by Gutkin (2009) and intended to
show an ecosystem in action is presented in the Appendix.
 Ecological Model 11

Potential Advantages of the Ecological Model

Although shifting away from the medical model and toward an ecological
paradigm will by no means instantaneously resolve all of the problems noted
earlier with contemporary psychological and educational service delivery
systems, it would nonetheless be a substantive step in the right direction.
Space limitations preclude responding thoroughly to each of the criticisms
raised previously regarding the medical model. A brief analysis, however, is
possible. The interested reader is again referred to Gutkin (2009) for a more
complete discussion of these and related issues.
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Creating Opportunities to Focus Services on Populations

Rather Than Just Individuals
Bronfenbrenner’s (1979) conceptualization of micro-, meso-, exo-, and
macroenvironments is clearly consistent with increased opportunities to
focus on populations rather than just individuals. Even at just the level of
microenvironments, directing our attention to classrooms, schools, homes,
communities, and so on opens up a wealth of possibilities to impact large
numbers of students all at once. By moving away from an exclusive focus on
individuals and toward a meaningful consideration of environmental systems,
service providers can develop interventions that address universal (e.g., all
first graders, all high school students), selective (e.g., children undergoing
school transitions), and indicated (e.g., students who have developed mild
reading problems) populations (Durlak, 2009). The opportunities for reach-
ing larger groups becomes even more obvious once our work is directed to
meso-, exo-, and (when possible) macrosystems. The adoption of ecological
approaches is highly congruent with the development and use of public
health strategies (Nastasi, 2004; Strein et al., 2003; Ysseldyke et al., 2006).

Creating Opportunities to Provide Prevention and Early

Intervention Services Rather Than Just Remediation
The ability of ecologically based services to address prevention and early
intervention is rather straightforward (Durlak, 2009; J. Meyers, Meyers, &
Grogg, 2004). If human behavior is strongly influenced by micro-, meso-,
exo-, and macroenvironments, then changing the characteristics of one or
more of these environments should lead to meaningful psychological and
psychoeducational change in those who populate these environments. For
example, rather than serving students only after they have failed one or
more academic subjects, prevention and early intervention can be achieved
by adopting empirically validated teaching methods in schools, classrooms,
and homes before problems arise or when early signs of academic distress
are present. Rather than waiting for aggression and violence to erupt among
 12 T. B. Gutkin

high-risk students, the school curriculum can be modified proactively to

include instruction in problem solving, anger management, cognitive refram-
ing, and so on.

Empowering a Broad Array of Service Providers

Once modifying the environment, at any level, is added to the conceptual
equation for how meaningful change is brought about in human behav-
ior, virtually everybody becomes empowered to provide prevention, early
intervention, and remediation services. It does not take advanced graduate
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degrees to change the environment. Everybody changes their environment in

one manner or another virtually every day of their lives. As noted previously,
the research literature is reasonably clear that mental health paraprofessionals
can be effective (often just as effective as mental health professionals) even
when employing sophisticated interventions such as psychotherapy (e.g.,
Christensen & Jacobson, 1994). There can be little doubt that teachers, peers,
parents, and so on can intervene successfully in the lives of children and
adolescents if (a) interventions are framed as environmental manipulations,
and (b) paraprofessionals are given the permission and knowledge to make
necessary environmental changes. Without being intimidated by DSM- and
IDEIA-type diagnoses and with the assistance of consultation services from
psychologists and so on, the recruitment and use of extremely large numbers
of service providers becomes a very real possibility (see Miller’s 1969 classic
analysis of ‘‘giving psychology away’’ [p. 1071]).

Providing Efficacious Treatments

Moving to a service delivery model based on ecological theory should lead
to more efficacious treatments because, at the simplest level, it expands the
range of treatment targets to include micro-, meso-, exo-, and macroenviron-
ments in addition to focusing directly on the internal workings of individual
students. Fundamentally, the medical model is too reductive in nature and
the ecological approaches provide a more accurate picture of why people
behave as they do (Gutkin, 2009). Although internal biological and psychic
factors unquestionably exert significant influence on human functioning, the
profound impact of environmental factors is also undeniable. As suggested
earlier, ecological approaches are superior because ‘‘context counts.’’ Chil-
dren who are exposed to effective versus ineffective teaching, parenting,
behavior management strategies, and so on, respond differentially. Because
Figure 1 is, in fact, an accurate representation of some of the multiple causal
variables that interact in determining the behavior of children and adoles-
cents (and adults), ecological interventions have an inherent advantage over
those driven by medical model thinking that focuses almost exclusively on
internal student pathologies.
 Ecological Model 13

Reliability and validity of diagnoses. The problems noted previously

regarding the questionable reliability and validity of DSM- and IDEIA-type
diagnoses are greatly diminished because medical model diagnoses play a
much less central role in ecologically based service delivery models. Rather
than attempting to diagnose student pathologies, the ecological model seeks
to determine how to optimize the fit between student needs and environ-
mental characteristics. Response to intervention (RTI) models are among
the innovations that have emerged from this point of view (A. L. Reschly,
Coolong-Chaffin, Christenson, & Gutkin, 2007).
Treatment validity of diagnoses. Given the significantly reduced role of
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DSM- and IDEIA-type diagnoses in ecological approaches, concerns regard-

ing treatment validity of these diagnoses are reduced dramatically. Despite
this, treatment validity of interventions remains a variable of major impor-
tance. Given the focus on person-environment interactions and the obvious
complexity of these phenomena, treatment validity under the ecological
model is approached more from a process perspective rather than attempt-
ing to find the correct treatment based on client diagnosis. Methodologies
such as progress monitoring, data-based decision making, RTI, and ongoing
consultation are employed to assess the efficacy of interventions, allowing
them to be monitored and revised as necessary until satisfactory outcomes
are achieved (Ysseldyke et al., 2006).
Gathering diagnostic data that are closely connected to treatment im-
plementation. Unlike the medical model that focuses so heavily on intra-
personal data gathering during assessment and diagnosis but then relies
on environmental interventions for treatment, the ecological model would
appear to be more internally consistent. By conceptualizing prevention,
early intervention, and remediation in terms of person-environment interac-
tions, the ecological model encourages practitioners conducting assessments
and diagnoses to concentrate heavily on both the environments that will
ultimately be modified in the provision of treatment and the behavior of
adults who control those environments (e.g., teachers, parents). Treatment
recommendations are less tied to the internal characteristics of students
and more attuned to assessing what interventions will most likely work
for students in light of the specific caregivers (e.g., teachers, parents) who
would be implementing those treatments and the environmental settings
(e.g., classrooms, homes) in which these plans would be carried out (Gutkin
& Curtis, 2009).
Focusing treatment on relevant environments. Unlike the medical
model, the very nature of the ecological paradigm demands that clinicians
pay significant attention to relevant environments surrounding children.
Rather than relying on ‘‘curing’’ individuals, ecologically focused services
target the alteration of school, home, and community environments to
alleviate presenting student problems and prevent future dysfunctions from
developing.
 14 T. B. Gutkin

Reconsidering the Big Picture With the

Ecological Paradigm
Given that the ecological model has not yet replaced traditional medical
model service delivery systems, it is not possible to state with certainty
that the hypothesized benefits detailed in this article would materialize as
predicted should it emerge as the dominant paradigm. Although preliminary
evidence is quite supportive (e.g., Durlak, 2009; Gutkin, 2009; Gutkin &
Curtis, 2009; Ysseldyke et al., 2006), substantial additional research is needed.
On a conceptual level, however, it seems clear that ecological approaches
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are responsive to the substantive shortcomings of the medical model that

have led (and continue to lead) our nation’s children and adolescents (and
adults) inexorably into a mental health and education pandemic. It is my
strong opinion that the time for change has long since passed and that further
delay simply exacerbates the severity of extant problems.

THE SPECIAL ISSUE: ECOLOGICAL APPROACHES TO

MENTAL HEALTH AND EDUCATIONAL SERVICES FOR
CHILDREN AND ADOLESCENTS

This special issue is intended to help move us closer to the changes we

need to cope with the mental health and education pandemics we currently
face. It is designed to speed up our progress toward transitioning away
from the medical model and toward the ecological paradigm. In this special
issue leading scholars address their attention to the ecological aspects of
assessment (Ysseldyke, Lekwa, Klingbeil, & Cormier, this issue); classroom
teaching (Doll, Spies, & Champion, this issue); home-school interactions (A.
L. Reschly & Christenson, this issue); RTI services (Greenwood & Kim, this
issue); organization development and systems change (A. B. Meyers, Meyers,
Graybill, Proctor, & Huddleston, this issue); community-based prevention,
health promotion, and public health (Trickett & Rowe, this issue); and so-
cial justice and advocacy for children (Williams & Greenleaf, this issue).
Collectively, these articles provide a potential road map for a long overdue
and essential paradigm shift toward ecological approaches to the conceptu-
alization and delivery of psychological and psychoeducational services for
children and adolescents in school settings.

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Terry B. Gutkin, PhD, received his doctorate in educational psychology in 1975 from the
University of Texas, Austin. Subsequently, he served on the faculty of the Department of
Educational Psychology at the University of Nebraska-Lincoln for 26 years. For most of that
time he was the Director of the School Psychology Program. In 2001, Dr. Gutkin moved to
San Francisco State University, where he served as Department Chair for three years. Currently
he teaches courses there in school-based consultation and research design.

Note: The author reports that to the best of his knowledge neither he nor his affiliated
institution has financial or personal relationships or affiliations that could influence or bias
the opinions, decisions, or work presented in this manuscript.
 20 T. B. Gutkin

APPENDIX
FICTITIOUS CASE STUDY SHOWING
AN ECOSYSTEM IN ACTION

A national economic recession (macrosystem) results in a local school board

deciding to cut costs by increasing its student-teacher ratio (exosystem).
Bobby is a fourth-grade student in this school district. Since entering school
he has had to struggle somewhat with academics and a variety of mild be-
havior problems, but he has been able to progress successfully despite these
challenges. Bobby’s fourth-grade teacher, Ms. Smith, who cares deeply about
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him (microsystem) has a number of additional difficult students transferred

into to her class from a school in the district that was closed due to budget
cuts (mesosystem). Ms. Smith’s professional life is further complicated by
the school district (exosystem) listing her school as one that is not making
adequate yearly progress (AYP) according to the guidelines stipulated by
No Child Left Behind (macrosystem). The principal of the school begins to
place considerable pressure on all of the teachers to bring up the school’s
test scores (mesosystem). Ms. Smith is no longer able to devote as much
personal time to Bobby and he begins to fall progressively further behind
academically (microsystem). Bobby’s harried teacher eventually refers him
for special education services (microsystem). He is diagnosed as learning
disabled and placed part-time in a resource program with a teacher who has
little patience for his ‘‘needy’’ behaviors (microsystem). For Bobby, failure
experiences in school become increasingly prevalent and by the end of the
fourth grade he ‘‘turns off’’ to learning and begins to escalate his acting out
in a variety of ways at home (microsystem) and school (microsystem). As
the next academic year begins, the district budget crisis worsens (exosystem)
resulting in progressively higher student-teacher ratios throughout the school
district (mesosystem) and at Bobby’s school (microsystem). The resource
teacher informs Bobby’s fifth-grade teacher that he is a difficult student who
needs stern discipline (mesosystem). The fifth-grade teacher puts Bobby’s
parents on notice that she will not tolerate his ‘‘disruptive and disrespectful’’
behaviors (mesosystem). This leads to increasing pressure at home from his
parents to ‘‘straighten up and fly right’’ (microsystem) and ultimately a change
in his relationship patterns at school resulting in a new, less academically
oriented circle of friends (microsystem). As the fifth grade ends, Bobby is
moving on to middle school with poor basic academic skills, a ‘‘bad attitude,’’
and a preference for peers who see little value in education.

Reprinted with permission from Gutkin (2009).