Commentary: New Models for School-Based Mental Health Services

Abstract

The potential of school-based delivery systems to dramatically improve access to and positive impact of mental health prevention and intervention services cannot be underestimated (Hoagwood & Erwin, 1997). Particularly when they involve coordinated collaboration with community-based agencies and stakeholders, school-based delivery systems can provide the backbone for accessible services that are integrated across the developmental spectrum from preschool through adolescence, and that span the continuum of service need, from mental health promotion and risk reduction to intensive intervention (Weissberg & Greenberg, 1998). As noted by Atkins and his colleagues (Atkins, Graczyk, Frazier, & Abdul-Adil, 2003), however, this potential cannot be realized without innovative models for school-based delivery system design and programmatic evaluation research. Three critical challenges for the design of effective school-based mental health delivery systems include: (a) supporting the high-fidelity implementation of empirically based practices, (b) sustaining effective programming over time, and (c) fostering local adaptations that enhance cultural and community fit and ownership (Biglan, Mrazek, Carnine, & Flay, 2003; Wandersman & Florin, 2003; Weissberg, Kumpfer & Seligman, 2003). Atkins et al. (2003) provide illustrative examples of how these challenges can be addressed in ways that can significantly increase children's access to empirically supported interventions (the PALS program), integrate programming into existing school leadership structures to support long-term sustainability (the use of Key Opinion Leaders), and foster close coordination and collaboration between school-based and community-based mental health services (the SOC-C mechanism). These models are best termed promising at this time, as empirical data on theft outcome effectiveness is not yet available, but the work of Atkins et al. (2003) suggests that they are each feasible and attractive models for schools and community partners. This commentary will focus on three complementary issues: (a) school-community adaptations of empirically based programs, (b) providing a continuum of care, and (c) researching sustainability. School-Community Adaptations of Empirically Based Programs One particular strength of the new models of Atkins et al. (2003) is the innovative use of indigenous resources and school-community partnerships to expand the responsiveness of programs to community values and priorities, thus enhancing parent engagement and community support. Debate exists concerning the optimal role for community members in prevention and intervention program design. For example, in the context of prevention design, Weissberg and Greenberg (1998) contrast the assumptions underlying the Prevention Science model and the Collaborative Community Action Research model. In the former model, program designs are based primarily upon research documenting the risk and protective factors associated with targeted mental health problems, combined with randomized-controlled efficacy trials that document the positive impact of specific intervention strategies on those outcomes. In this model, the dissemination challenge is to move the empirically validated procedures into the field. In contrast, the Collaborative Community Action Research model is based on an ecological perspective that emphasizes the critical involvement of community members in partnership with researchers in all phases of program development and design, assuming that effective program design requires local wisdom and engagement for success. Weissberg and Greenberg (1998) argue compellingly for the need to combine the strengths of these two approaches, developing program design and delivery strategies that involve community leaders and participants in all phases of decision making but that also make maximal use of available research regarding developmental patterns, risk and protective factors, and empirically proven intervention strategies (see also the Conduct Problems Prevention Research Group [CPPRG], 2002). …