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FINAL Full Dissertation_T.Middleton_Examining the Role of Organizational and Societal Factors on School Counselors’ SDoH Competency2.02 MB
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Dissertation
Examining the role of organizational and contextual factors on school counselors’ perceived social determinants of health competency
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2026
DOI: 10.25820/etd.008365
Abstract
Adverse social determinants of health, such as poverty, racism, trauma, and other systemic inequities, negatively impact K-12 students' mental health and educational success. In alignment with other helping professions, there is an explicit call to integrate the social determinants of health across the practice, identity, training, and research aspects of the counseling profession. While schools have long been established as a place to mitigate these social barriers, among school personnel, school counselors describe addressing social determinants and unfamiliarity with the social determinants of health framework, as school counselor training lacks an explicit introduction to the framework, and counselor educators describe difficulties integrating social determinants of health into their teaching. Given school counselors' ethical obligation to remove barriers to student development and well-being, unfamiliarity may inadvertently lead to unethical practices and negative K-12 student mental health and educational outcomes. In response, the related growing sub-body of social determinants of health related school counseling literature explicitly call for a more contextualized understand of school counselors' perceived social determinants of health competency and viewing this sub-body of literature through the lens of Bandura's triadic reciprocal causation suggests that lesser is known about the contextual factors influence school counselors' social determinants of health informed efforts in comparison to personal and behavioral factors.
Therefore, the purpose of this study was to examine the influence of organizational and contextual factors on school counselors' perceived social determinants of health competency. Relying on the three concentric ring nomological network of organizational empowerment theory, perceived organizational support, interorganizational collaboration, and community actions, along with individual factors (e.g., sociodemographic attributes, CACREP-accredited training) and contextual factors (e.g., student enrollment characteristics, student-to-counselor caseload, school Title 1 designation) were examined as predictors and covariates of perceived SDoH competency in school counselors.
Using an exploratory, non-experimental, cross-sectional design with survey methodology, the study invited participants who (1) held an active license/certification in school from a U.S. State or territory, (2) currently serve as a school counselor in a K-12 educational setting in a U.S. State or territory, and (3) have at least six months of professional school counseling experience beyond their master's degree program, to complete an online Qualtrics survey. The survey instrument included sociodemographic questions alongside several established measures, such as the Survey of Perceived Organizational Support, the Interorganizational Collaboration Scale, and the Collaborating with Community Scale. A total of 267 completed and submitted the survey. Results from missing-data analyses and preliminary assumption checks reduced the sample to 235 complete cases, which were analyzed using bivariate correlations and hierarchical linear regression in SPSS 31.
Results of the bivariate correlation showed that school counselors' perceived social determinants of health competency positively related to coordinating current work aspect of interorganizational collaboration, collaborating in the community, perceived school-based health center access, student enrollment characteristics (i.e., racial/ethnic minority, free-and-reduced lunch, English as a Second Language, experiencing housing instability, foster care-involved, judicial system-involved), racial/ethnic status, sexual and gender minority status, and graduating from a CACREP-accredited training. In contrast, perceived social determinants of health competency negatively relate to student-to-counselor caseload, age, gender, and years of experience. As a result of organizational empowerment theory guiding the entry of all variables across four steps, the hierarchical linear regression analyses showed that, collectively, the individual, organizational, and contextual factors examined in this study accounted for 24.2% of the variance in school counselors' perceived social determinants of health competency—the study also presents the unique and additive effects each predictor and covariate at each hierarchical step.
Interpretations of these results through the lens of organizational empowerment theory, along with relevant implications for school counselors, counselor educators, policy, and research, are discussed.
Details
- Title: Subtitle
- Examining the role of organizational and contextual factors on school counselors’ perceived social determinants of health competency
- Creators
- Tevin Middleton
- Contributors
- Gerta Bardhoshi (Advisor)David Duys (Committee Member)Martin, III Kivlighan (Committee Member)Yung-Wei (Dennis) Lin (Committee Member)Duhita Mahatmya (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Counselor Education (Counselor Education & Supervision)
- Date degree season
- Spring 2026
- DOI
- 10.25820/etd.008365
- Publisher
- University of Iowa
- Number of pages
- xv, 189 pages
- Copyright
- Copyright 2026 Tevin Middleton
- Language
- English
- Date submitted
- 04/27/2026
- Description illustrations
- illustrations, tables
- Description bibliographic
- Includes bibliographical references (pages 150-188).
- Public Abstract (ETD)
Adverse social determinants of health (SDoH), such as poverty, racism, trauma, and other systemic inequities, can negatively impact K-12 students' mental health and educational success. While schools can be an opportune time for school personnel to mitigate these barriers, school counselors—who are ethically required to remove barriers impeding student development and success—simultaneously describe addressing adverse SDoH while not fully understanding them and while facing organizational and structural barriers in the workplace. Broadly, the counseling profession is working to integrate SDoH into practice; however, when examining the growing sub-body of SDoH-related school counseling literature, understanding of the contextual influences on school counselors' SDoH-related knowledge and action is lacking compared to that of personal and behavioral factors. Thus, this study examines the influence of organizational and contextual factors—such as perceived organizational support, interorganizational collaboration, and the collaborating in community aspect of the school-family-community partnership framework—as well as individual factors (e.g., sociodemographic attributes, CACREP-training) and contextual factors (e.g., student enrollment characteristics, student-to-counselor caseload) to predict school counselors' perceived SDoH competency.
Recruitment efforts resulted in 267 school counselors participating in the study. The organizational empowerment theory-driven hierarchical linear regression analyses revealed that individual, organizational, and contextual factors examined in this study collectively predict a meaningful amount of school counselors' perceived SDoH competency, as the theory suggests. Organizational empowerment theory informs reported interpretations of these results, and a discussion of relevant implications for school counselors, counselor educators, policy, and research follows.
- Academic Unit
- Counselor Education
- Record Identifier
- 9985177271902771
Metrics
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