Mental Health Interventions In Schools Research Articles

Measuring School Staff Confidence and Worries to Deliver Mental Health Content: An Examination of the Psychometric Properties of Two Measures in a Sample of Secondary School Staff

Secondary school staff are often tasked with delivering mental health content to students, yet there has been little research on staff confidence to do so. Given the responsibility placed on staff to support student mental health, reliable and valid measures are needed to facilitate assessment of teacher confidence in the classroom and evaluation of the impact of interventions designed to enhance teacher confidence and ultimately support the delivery of mental health interventions in schools. This study aimed to examine the psychometric properties of the Teacher Confidence Scale for Delivering Mental Health Content (TCS-MH) and the What Worries Me Scale (WWMS), both developed by Linden and Stuart (2019) and previously tested on a sample of elementary school teachers. Within this paper we examine the factor structure, reliability, and validity of these measures in a large sample (N = 644) of secondary school staff. Exploratory factor analysis suggested that each scale had a single factor structure with all original items retained. This was further supported with confirmatory factor analysis. Examination of the reliability of both scales found that they had good internal consistency. Finally, through correlation analyses, both measures demonstrated satisfactory convergent and discriminant validity from mental health knowledge, mental health stigma, general anxiety, and teacher efficacy. Both the TCS-MH and the WWMS show great promise as measures of secondary school staff confidence to deliver mental health content.

Impact on Students of the Act-Belong-Commit Mentally Healthy Schools Framework.

Schools can have a significant role in affecting the mental health and wellbeing of both students and staff, with considerable implications for society as a whole. Hence, there is a need for school-based interventions to both assist those experiencing mental health problems and to implement activities and policies that facilitate the enhancement and maintenance of good mental health. Unlike most school mental health interventions that are focussed on, and specific to, the school setting, the Act-Belong-Commit Mentally Healthy Schools Framework is based on the principles of the Act-Belong-Commit community-wide general population mental health promotion campaign, which has been adapted to the school setting via the World Health Organisation's Health Promoting Schools Framework. The Mentally Healthy Schools Framework is a whole-school approach to enhancing both student and staff mental health. This paper reports the findings of a preliminary impact survey administered to students after the adoption of the Framework in a number of primary and secondary schools in Western Australia. Students from two schools that had only recently adopted the Framework completed a "Baseline" questionnaire, and students from three schools that had been implementing the Framework for at least 17 months completed a "Follow-up" questionnaire. The results suggest that the Mentally Healthy Schools Framework, adapted from a community-wide campaign, can have a positive impact on students in terms of increasing openness about mental health, increasing awareness of behaviours conducive to good mental health, and increasing engagement in behaviours to improve their mental health. Such positive impacts have clear implications not only for prevention of mental disorders, but for academic achievement, employment, and overall contribution to society.

Implementing a Brief Evidence-Based Tier 2 School Mental Health Intervention: The Enablers and Barriers as Seen through a Clinical Team Supervisor Lens

This paper describes the implementation of BRISC, a brief evidence-based intervention within an implementation framework; specifically, we provide a 5-year retrospective on the successes and remaining gaps of the approach. Interviews were conducted with 13 clinical team leads from diverse school boards in Ontario. Seven themes emerged from our coding: BRISC being seen as an effective and efficient practice, clinicians’ attitudes and self-efficacy, promoting system readiness, high-quality training, data-informed decision-making, effective clinical supervision, and communities of practice to create ongoing learning and professional development. These themes highlight the importance of considering different levels and systems in developing an implementation plan.

Effectiveness of a school-based mental health intervention for school teachers in urban Pakistan: a randomized controlled trial

BackgroundSchools have a major role in promoting children’s physical and psychological health and well-being and the mental health literacy of all key stakeholders, especially teachers, is critical to achieving this goal. Teachers’ knowledge and beliefs about psychological problems influence the way they deal with their students’ mental health issues. This study is a preliminary investigation evaluating the effectiveness and feasibility of a School Mental Health Programme (SMHP) developed by the World Health Organization’s Eastern Mediterranean Regional Office (WHO-EMRO) in improving mental health literacy and self-efficacy among school teachers in an inner-city area of urban Lahore.MethodsTeachers were randomly assigned to 3 days standardized WHO-EMRO School Mental Health Manual based Intervention (n = 118) or to a wait list delayed intervention control group (n = 113). Teachers were assessed pre and post training and at 3 months follow up using measures for mental health literacy (Primary outcome) and self-efficacy. School Heads completed the WHO School Psychosocial Profile and students reported socioemotional skills and psychological problems using Strengths and Difficulties questionnaire at baseline and 3 months post intervention.ResultsCompared with waitlist group, teachers in intervention group presented a significant increase in mental health literacy (F2,181 = 8.92; P < 0.001), as well as better teacher’s self-efficacy in classroom management and student engagement (F2,181 = 16.45; P ≤ 0.000 and F2,181 = 4.65; P ≤ 0.011, respectively). Increase confidence in helping students with mental health problems was also noted in the intervention arm (F2,181 = 15.96 P ≤ 0.000). Improvement in overall school environment was also found. No statistical difference in the emotional and behavioural difficulties in students was noticed at 3 months.ConclusionThis study is one of the first preliminary investigation of WHO-EMRO school mental health intervention in Pakistan. The study showed that intervention led to significant improvement in mental health literacy and self-efficacy among teachers, which was largely sustained over time. Despite a major limitation of lack of clustering and likely contamination affecting follow up outcomes, the study showed promising results in the context of mental health promotion, prevention and early intervention in schools in Lahore, Pakistan. A larger cluster randomised trial is justified, given the level of participant engagement and acceptability by schools.Trail Registration: ClinicalTrials.gov registry (NCT02937714) Registered 13th October 2016, https://register.clinicaltrials.gov.

Want to improve school mental health interventions? Ask young people what they actually think

Abstract As part of the recent ‘therapeutic turn’ in education, schools are now commonly seen as a place for mental health guidance and support. This often involves interventions—special curricula of lessons or activities (e.g. counselling sessions), which aim to either prevent mental health problems or manage those that have already started. Running these interventions in schools makes good sense: rates of mental health problems in young people are rising, and large numbers can be reached in this setting. However, evidence for the effectiveness of such interventions has been mixed. One way to improve how helpful and useful they are, we argue here, would be to ask young people themselves what they think about these programmes. This involves collecting qualitative data: gathering in-depth information about young people's experiences and opinions, rather than relying solely on numerical data, such as rating scales. The small number of existing published qualitative studies in this area show that many young people do find these interventions helpful, but there are issues that warrant careful attention. For example, some young people can feel worried or vulnerable during classroom-based exercises, and others don't see how the interventions are relevant for their own lives. Here, we explore this literature and recommend two avenues for future work: ask more young people what they think of existing interventions, and get them involved in the design of new ones. Together, this will put young people's voices at the heart of school-based mental health interventions.

Engaging peers to promote well‐being and inclusion of newcomer students: A call for equity‐informed peer interventions

AbstractAlthough newcomer youth demonstrate high levels of resiliency, many experience challenges in emotional, linguistic, academic, and social functioning. Over the past decade, some promising school‐based psychosocial interventions for newcomer youth have been developed. These interventions are necessary, but not sufficient to promote well‐being. Without attention to the larger context, focusing solely on the skills and adjustment of newcomer youth could potentially stigmatize students further. There is a need to engage non‐newcomer peers for two reasons. First, peer relationships and inclusion are important predictors of well‐being. Second, from an equity lens, there is a need to create environments that promote youth well‐being; at the very least, these environments must engage non‐newcomer youth in recognizing and combatting discrimination. This study outlines the need for peer‐focused programming to support newcomers and describes existing research on interventions developed to promote peer relationships (e.g., mentoring) or reduce discrimination (e.g., teacher‐led discrimination reduction approaches). We identify other intervention models that could inform how to add an equity lens to school mental health intervention, including how a gender‐sexuality alliance model could be adapted, and how equity considerations could be integrated into bystander approaches. We conclude with specific implications and recommendations for embedding equity into school mental health.

Project SUMS (scaling up of mental health in schools): design and methods for a pragmatic, cluster randomised waitlist-controlled trial on integrated school mental health intervention for adolescents

BackgroundThere is an increasing need for Mental Health Promotion (MHP) among adolescents, especially in developing countries with limited resources and rapid socio-demographic transition. With the growing burden of mental health problems among adolescents (suicide, depression) and their preferences to seek help from their peers, improving Mental Health Literacy (MHL) and behaviours for First Aid in Mental Health (MH-FA) becomes crucial to promote their mental health.MethodsSchools are ideal settings for reaching the vulnerable adolescents. The proposed study evaluates the effectiveness of a classroom-based teacher-led integrated school mental health intervention called SUMS (MHP + MHL + MH-FA). The study will involve a pragmatic, cluster-randomised waitlist-controlled design to evaluate the effectiveness of SUMS intervention using schools as unit-of-randomisation. The study will be conducted in Srinivaspura taluka (Sub-district) of Kolar district (administrative unit of health) of Karnataka in collaboration with a multi-disciplinary expert team from NIMHANS (National Institute of Mental Health And Neuro Sciences), Bangalore-India and Department of Education, Government of Karnataka, India. A total of 8 schools (400 students studying in 6–8 grade) from Srinivaspura taluka will be randomised into intervention and waitlist control group. The intervention group will receive SUMS intervention through 10–15 h of classroom sessions. The primary outcome is the improvement in positive mental health literacy, as measured by the Mental Health-Promoting Knowledge (MHPK-10) scale. Changes in MH-FA knowledge and intentions, Mental health stigma, help-seeking and resilience are assessed as secondary outcomes. Data will be collected at baseline, 6-weeks, 6-months and 12-months post-intervention. The waitlist-control schools will receive the interventions at the end of the 12-month follow-up assessment in intervention-schools.DiscussionThis is the first study to integrate Mental Health Literacy with Mental Health Promotion and behaviours for First Aid in Mental Health to promote mental health well-being among adolescent school children in India. With a need to build a more substantial evidence base on School Mental Health Promotion approaches in developing countries, the study findings will have implications for implementing and operationalising Health and Wellness Ambassador initiative in India.Trial registrationClinical Trials Registry - India, CTRI/2019/07/020394. Registered prospectively on 29 July 2019. (ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=35724&EncHid=&userName=sums).

School mental health best practices institute; capacity building of teachers in mental health literacy in Pakistan

AimsMental health disorders in children are largely unrecognized in low- and middle-income countries like Pakistan. Teachers, due to their interactions and time spent with children, are important elements in promoting child mental health. Despite this, little importance is given to school mental health (SMH) in the country, and teachers’ training in SMH is almost non-existent. With less than ten child and adolescent psychiatrists, recruiting teachers is vital to provide mental health care to children and adolescents, the majority of the country's population. This study aims to evaluate the effectiveness of a SMH training intervention for teachers in Pakistan.MethodA 3-day training intervention was planned for school teachers in collaboration with International Association of Child and Adolescent Psychiatry and Allied Professions. The School Mental Health curriculum by the World Health Organization and Stan Kutcher's Mental Health Literature were adapted after literature review and discussions with experts, and administered as Blended Learning. The intervention was evaluated using pre-workshop, post-workshop and overall feedback surveys. SPSS 25.0 (IBM Corp., Armonk, N.Y., USA) software was used for descriptive analysis. For open ended questions, central themes were identified, tabulated, and analyzed descriptively.ResultA total of 63 participants registered for the workshop. The participants’ mean age was 36.0 years, with 86% women and 14% men. Participants were mostly teachers, however, principals, administrators and counsellors also attended. Participants’ reasons for attending were that they wanted to ‘increase their knowledge’ and learn ‘practical management’ of mental health issues. When asked about student wellbeing, 43% participants said it was a neglected area. Overall, 86.9% of participants felt the objectives were met well or very well and 87.61% stated there was adequate time for discussion. In addition, 90.47% participants responded that facilitators explained concepts well and 94.39% said facilitators answered questions well. Half of all Blended Learning activities were viewed by more than 50% of participants. Activity views decreased by 63.41% from the pre-workshop activities to day 3 activities. Improvements suggested by participants included taking a more problem-solving approach and focusing on the local context.ConclusionEvidence-based SMH interventions that train teachers are much-needed in the local resource-constrained settings. This intervention met its objectives effectively, however, Blended Learning was not well-received. We have studied learning analytics and identified the potential learner's profile of teachers as students. Adult learning principles should be implemented in future endeavours. This is a flagship project for future international collaborations between mental health professionals for cross-cultural knowledge exchange.

Examining frequency and modality of parent engagement in an elementary school mental health intervention

ABSTRACT School psychologists are encouraged to empower parents to be active partners in their child’s education, including providing social-emotional supports. Typical parent engagement efforts involve trying to get parents to attend school meetings, which may overlook other ways parents can meaningfully support students. The current study examined engagement in a racially/ethnically diverse, predominantly low-income sample of parents of early elementary students participating in school-based group therapy. Most parents engaged in parent meetings, but approximately 20% engaged in other ways, including home activities. Lower income was associated with less frequent meeting attendance, while child racial/ethnic minority status predicted greater skill support at home. Therapist-parent relationship predicted meeting attendance. Results suggest that schools may enhance engagement by providing varied opportunities for parents.

Multilevel Barriers and Facilitators to Sustainability of a Universal Trauma-Informed School-Based Mental Health Intervention Following an Efficacy Trial: A Qualitative Study

Limited research exists about factors that influence the sustainability of preventive school mental health interventions when research support ends. This study assessed barriers and facilitators to sustaining RAP (Relax, be Aware, do a Personal rating) Club, a trauma-informed universal mental health intervention, in urban schools following efficacy trial implementation. Between 2016-2018, 13 Baltimore City schools implemented RAP Club. We evaluated RAP Club sustainability using semi-structured interviews with administrators (n=10) and school staff trained to deliver the intervention (n=11), as well as review of intervention fidelity logs (n=137) and notes from supervision calls (n=10) with school staff and research team members who implemented the program. Although most school staff described RAP Club as acceptable and beneficial, none of the 13 schools sustained the intervention. Barriers to sustainability included low self-efficacy among school staff trained to deliver the intervention, school staff turnover, logistical challenges with space and time in the regular school calendar to deliver the program, insufficient funding to sustain the program outside of the research context, and limited planning and ongoing communication between school personnel and researchers about sustainability. Recommendations for increasing post-trial program sustainability include developing sustainability plans with schools during the pre-implementation phase, enhancing ongoing support for school staff during the implementation phase, and using academic-community partnerships to facilitate sustainability and intervention scale-up during the post-implementation phase. Increasing sustainability of beneficial school-based mental health programs has the potential to reduce mental health disparities and promote health equity.

Student, teacher, and caregiver perceptions on implementing mental health interventions in Ugandan schools.

The vast majority of children and adolescents in low and middle-income countries (LMICs) lack access to interventions for mental health problems. Schools provide a critical platform for evidence-based intervention delivery for young people. However, a significant need exists to understand the implementation context and strategies for delivering school mental health interventions in LMICs. We conducted a focused ethnography to explore students', teachers', and caregivers' perspectives on implementing evidence-based mental health interventions (EBIs) within a widespread violence prevention program in Uganda. Data collection occurred in Kampala, Uganda, using two schools that have previously implemented an evidence-based violence prevention program widely used in Ugandan schools schools, the Good School Toolkit (GST). Trained, local researchers facilitated four focus group discussions (FGDs) with caregivers (n = 22), four FGDs with teachers (n = 25), and in-depth interviews with primary school students (n = 12). Verbatim transcripts were analyzed using a framework analysis approach. Participants revealed a school culture that promotes schools' responsibility to students beyond academics, including positive teacher-student relationships. Participants recommended an implementation process that trains teachers and students in screening and referral, peer group delivery, and is accompanied by a school-wide approach to stigma reduction and mental health literacy. Participants fundamentally agreed that teachers could be trained as intervention facilitators. This study highlights the potential advantage of leveraging an existing intervention that already addresses implementation factors, such as school culture, as a fertile platform for implementing interventions for child and adolescent mental health in LMICs. Despite the growth of implementation research for child and adolescent mental health, the study of implementation science for child and adolescent mental health in low and middle-income countries (LMICs) remains scarce. Schools provide a critical platform for evidence-based intervention delivery for young people. However, a significant need exists to understand the implementation context and strategies for delivering school mental health interventions in LMICs. This study provides rich qualitative data describing the context and influences for the successful implementation of mental health interventions in LMIC schools. We conducted interviews and focus groups with teachers, students, and caregivers to determine their perspectives on implementing evidence-based mental health interventions (EBIs) within a widespread violence prevention program in Uganda. Participants revealed a school culture promoted by the existing program that promotes schools' responsibility to students beyond academics, including positive teacher-student relationships. Findings suggest the existing program provides fertile ground for the successful implementation of evidence-based mental health interventions in schools.

Debate: Implementation Science can help bridge the gap between evidence and policy - a case study from the Eastern Mediterranean Region.

The burden from mental disorder in the Eastern Mediterranean Region (EMR) has risen steadily over the last three decades. The unmet need for interventions puts pressure on policymakers for urgent action, often leading to the introduction of programmes developed in high-income countries, with very little attention to how well these meet local needs. Till well-designed local research including randomised controlled trials become common practice in low- and middle-income countries, implementation science could provide relatively cheaper and quicker ways of ensuring that these interventions do indeed lead to patient benefit. We present a case study of a teacher-delivered school mental health intervention developed by international experts, and implemented in the EMR under the auspices of the World Health Organization. We used an implementation research framework to adapt the programme to local needs, obtain stakeholder buy-in, and design an online-training programme for rapid dissemination in local schools in Egypt, Iran, Jordan and Pakistan. Within the official roll-out of the programme in one EMR country (Pakistan), we embedded a hybrid effectiveness-implementation cluster randomised control trial to evaluate both clinical and implementation outcomes of the adapted intervention. The approach allows for rapid adaptation and evidence building within real-world implementation settings. Capacity in low- and middle-income countries for such research needs to be developed.

A qualitative exploration of 14 to 17-year old adolescents' views of early and preventative mental health support in schools.

Preventative interventions may be effective in reducing and preventing symptoms of mental ill health in children and young people. However, there is a paucity of research in this area that explores the views of young people. This paper reports on a qualitative study to inform the future development of attractive and appropriate early and preventative school-based mental health interventions. Semi-structured interviews were conducted with a purposive sample of 12 young people aged 14-17 in North East England. Interviews were audio-recorded, transcribed, anonymised and analysed following a thematic approach. Four key themes were identified, relevant to those providing, designing and commissioning early and preventative mental health interventions in schools: 'mental health literacy', 'risk factors for wellbeing decline', 'experience of school-based support' and 'recommendations for future support'. Young people have varying levels of mental health literacy, but are able to identify academic stress, bullying and the transition from primary to secondary school as leading causes of worry. Young people want more regular and in-depth mental health education, tailored levels of support in school and improved training for teachers.

Understanding Barriers to Teacher Use of a Daily Report Card Intervention Aided by Online Implementation Support

There is limited use of empirically supported mental health interventions in schools. Leveraging technology may reduce some barriers, however, use may still be limited. To further understand variable intervention use, this study investigated the challenges experienced by teachers invited to implement a daily report card (DRC) intervention aided by an interactive website called the DRC.Online (DRC.O). The DRC is a structured approach to the delivery of a tailored positive reinforcement intervention to support individual students struggling with attention and/or behavior difficulties delivered by teachers with daily feedback to the student themselves and their caregivers. The study was embedded within a pilot rollout of the DRC.O in elementary schools in two school districts in Canada. Data for this qualitative inquiry were derived from 21 semi-structured interviews and two focus groups conducted with teachers and other school personnel who had varying levels of DRC.O use. A descriptive qualitative approach was used. Five constructs were identified: (1) Intervention Demands for the Teacher, (2) Finding and Creating a Fit for the Intervention, (3) Perceived Focus on the Negatives, (4) Managing Technological Components, and (5) Influencing Contextual Factors. Each construct contains aspects of challenges that may have influenced the extent of use of the DRC.O. Some of the identified factors overlap with challenges identified in previous studies of intervention implementation; however, details within the above constructs identify additional nuances that may inform specific adjustments that may improve uptake and implementation.

Bridging the Gap: Comparing School Personnel and Student Perspectives on the Mental Health Needs of Students

Background, aims and objectives: Teachers and other school personnel are often the first point of contact for a student who is experiencing mental distress. They are therefore particularly well-placed to provide ongoing social and emotional support to students. Nevertheless, most school personnel are not trained to recognize and respond to mental health problems. Methods: In order to better understand the needs and challenges around student mental health and improve school mental health interventions and resources, we used quantitative and qualitative survey items to compare the perspectives of both school staff and students. To obtain personnel feedback, a 14-item online survey was distributed at the primary and secondary school levels. To obtain student feedback, 7 survey items were added to an existing school-based program survey that was distributed at participating high schools. Results: Out of 32 schools surveyed, 254 personnel responded, including 60 high school personnel. In addition, 756 students responded from 10 high schools. Though there is agreement between personnel and students on the need to address student mental health issues, there is an apparent disconnect between reports on what is being done and what needs to go into supporting student mental health. Conclusion: Along with teachers and other school personnel, students should be part of the needs assessment and priority setting processes around school mental health. Strategies to improve student mental health programs and practices are addressed.

Partnering with School Providers to Co-Design Mental Health Interventions: An Open Trial of Act & Adapt in Urban Public Middle Schools.

Schools are well positioned to provide access to youth mental health services, but implementing effective programs that promote emotional and behavioral functioning in school settings is complicated by the poor fit of interventions developed in research settings to complex school contexts. The current study formed a research-practice partnership with two urban public schools and mental health providers employed by those schools (N = 6, 100% female, 50% Black/African American, 50% White/Caucasian) in the adaptation of a depression prevention intervention, Act & Adapt. The intervention was modified by decreasing meeting time and streamlining session content, increasing flexibility, making intervention materials more similar to academic curriculum, and increasing the focus on managing disruptive behavior within group sessions. In an open trial, 6th grade students (N = 22; 59% boys, 31% Hispanic, 22% Black/African American, 4% Asian, 30% White/Caucasian) at both schools who were identified as clinically "at risk" reported improvements from baseline to post-intervention and at one-year follow-up on measures of emotional and behavioral difficulties and coping strategies, with parallel results by caregiver report. The providers reported satisfaction with the intervention, and qualitative analyses of provider focus groups suggested both barriers and facilitators to research-practice collaborations to implement mental health interventions in schools.

‘Push on through’: Children’s perspectives on the narratives of resilience in schools identified for intensive mental health promotion

Child mental health is a growing concern for policymakers across the global north. Schools have become a key site for mental health interventions, with new programmes aimed at promoting ‘resilience’, through which children may maintain or regain mental health during adversity. As one of the first studies to explore the early impact of intensive mental health promotion in schools from children’s perspectives, we adopt a governmentality approach to consider the logic and techniques of such programmes with a specific focus on England. An innovative visual methodology was used to focus on student perspectives of mental health interventions in school. Young peoples’ photo representations of mental health were collected and used to stimulate focus group discussions with 65 students aged 12–14, across seven schools. ‘Resilience’ was seen to be the key organising concept for mental health interventions in schools. The concept was viewed as narrowly focused on attitude towards—and performance in—school work, with individuals being encouraged to ‘push on through’ difficulties to achieve success. Young people were critical of this approach, suggesting several alternatives. These included increased access to independent mental health professionals, safe spaces within schools and mental health education that addressed the social and affective dimensions of mental health difficulties.

A Cross-Site Partnership to Examine Implementation and Sustainability of a School-Based Trauma Program.

Schools have been identified as an ideal setting for increasing access to mental health services particularly for underserved minority youth. The emerging field of implementation science has begun to systematically investigate strategies for more efficiently integrating evidence-based practices into community settings. Significantly less translational research has focused specifically on the school setting. To address this need, we examined the implementation of a school-based trauma intervention across three distinct regions. We conducted key informant interviews guided by Mendel's Framework of Dissemination in Health Services Intervention Research with multiple school stakeholders to examine what school organizational characteristics influence the adoption and implementation process and sustainability of Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Participants were selected from schools in three geographic regions in the United States: Western, Midwestern, and Southern. Our findings reveal that while sites had some common organizational factors that appeared to facilitate implementation, regions differed in how they compensated for less robust implementation domains. Across all regions, school stakeholders recognized the need for services to support students impacted by trauma. In the Western region, there was no centralized district policy for implementation; therefore, implementation was facilitated by school-level change agents and supervision support from the district mental health unit. In the Midwestern region, centralized district policies drove implementation. In both the Midwestern and Southern regions, implementation was facilitated by collaboration with a local mental health agency. This study contributes to the paucity of empirical information on the organizational factors that influence the implementation of evidence-based mental health interventions in schools. Our findings reveal that different implementation strategies across policies, structures, and resources can result in implementation of a school-based intervention. Frameworks such as Mendel's can be helpful in identifying areas of strength and improvement of implementation within a school organization.

Adaptive School-based Implementation of CBT (ASIC): clustered-SMART for building an optimized adaptive implementation intervention to improve uptake of mental health interventions in schools

BackgroundDepressive and anxiety disorders affect 20–30% of school-age youth, most of whom do not receive adequate services, contributing to poor developmental and academic outcomes. Evidence-based practices (EBPs) such as cognitive behavioral therapy (CBT) can improve outcomes, but numerous barriers limit access among affected youth. Many youth try to access mental health services in schools, but school professionals (SPs: counselors, psychologists, social workers) are rarely trained adequately in CBT methods. Further, SPs face organizational barriers to providing CBT, such as lack of administrative support. Three promising implementation strategies to address barriers to school-based CBT delivery include (1) Replicating Effective Programs (REP), which deploys customized CBT packaging, didactic training in CBT, and technical assistance; (2) coaching, which extends training via live supervision to improve SP competence in CBT delivery; and (3) facilitation, which employs an organizational expert who mentors SPs in strategic thinking to promote self-efficacy in garnering administrative support. REP is a relatively low-intensity/low-cost strategy, whereas coaching and facilitation require additional resources. However, not all schools will require all three strategies. The primary aim of this study is to compare the effectiveness of a school-level adaptive implementation intervention involving REP, coaching, and facilitation versus REP alone on the frequency of CBT delivered to students by SPs and student mental health outcomes. Secondary and exploratory aims examine cost-effectiveness, moderators, and mechanisms of implementation strategies.MethodsUsing a clustered, sequential multiple-assignment, randomized trial (SMART) design, ≥ 200 SPs from 100 schools across Michigan will be randomized initially to receive REP vs. REP+coaching. After 8 weeks, schools that do not meet a pre-specified implementation benchmark are re-randomized to continue with the initial strategy or to augment with facilitation.DiscussionEBPs need to be implemented successfully and efficiently in settings where individuals are most likely to seek care in order to gain large-scale impact on public health. Adaptive implementation interventions hold the promise of providing cost-effective implementation support. This is the first study to test an adaptive implementation of CBT for school-age youth, at a statewide level, delivered by school staff, taking an EBP to large populations with limited mental health care access.Trial registrationNCT03541317—Registered on 29 May 2018 on ClinicalTrials.gov PRS

Best Practices in School Mental Health for Attention-Deficit/Hyperactivity Disorder: A Framework for Intervention

Children with ADHD comprise one of the most common groups requiring supports from school mental health providers, yet current school structures and special education policies are not optimally situated to support and adapt to the inconsistent behaviors that are the hallmark of children with ADHD. The present paper reviews and synthesizes contemporary evidence-based reviews for school mental health interventions for children with ADHD across the preschool, elementary, and middle/high school levels to provide an overview of recommendations for best practice for school mental health practitioners. The preponderance of evidence across meta-analyses, systematic reviews, and practice guidelines support classroom contingency management strategies, with emerging evidence supporting training in organizational skills and homework supports. Behavioral parent training is also a supported intervention, but relatively few attempts have been made to evaluate it when integrated into school environments. A comprehensive, integrated approach for treating ADHD in school settings across universal, targeted, and indicated tiers is presented, providing an initial outline of a framework for school mental health treatment that could be utilized by school mental health practitioners.