School-based Providers Research Articles

The Role of Implementation Climate in Moderating Educator Use of Evidence-Based Practices and Outcomes for Autistic Students.

Ensuring effective use of evidence-based practice (EBP) for autism in schools is imperative due to the significantly increasing number of autistic students receiving school services each year. High-quality EBP use has proven challenging in schools. Research indicates implementation climate, or how EBP are supported, rewarded, and valued, and EBP resources are related to successful implementation. However, limited understanding of system-level contextual factors that impact EBP implementation for school-based providers makes development of appropriate implementation supports challenging. Understanding these factors is crucial for selecting and tailoring implementation strategies to support EBP scale up. In this observational study, California school-based providers (n = 1084) completed surveys related to implementation climate, leadership, autism experience and EBP implementation (use, competence, knowledge). Student outcomes included state level academic and behavioral indicators. Using an implementation science framework (Aarons et al., in Administration and Policy in Mental Health and Mental Health Services Research 38:4-23, 2011) and multilevel modeling, we examined the relationship between EBP Implementation and student outcomes and the moderation effects of provider and district level factors. Higher implementation climate predicted better EBP implementation outcomes, and proved more impactful when provider hands-on autism experience was low. Greater EBP resources predicted a higher percentage of students who met math standards only when district poverty level was high. Our findings suggested moderating effects on EBP implementation from both provider and system level factors. Implementation climate and resources may be especially key in addressing equity issues related to high poverty schools in which teachers often have less autism experience.

Collaborative mental health for children: Perspectives of school and clinical psychologists.

There is a need for increased collaboration between mental health providers who work with children and youth to increase continuity of care across settings. While schools can be an optimal location for mental health support, school psychologists often have to work with clinical providers given the increases in youth mental health needs and the shortage of school-based providers. This study used an online survey with a mixed-methods approach to understand the collaboration practices of school and clinical psychologists. A sample of 57 practitioners in the United States were asked to provide their perceptions of the roles of their interagency providers, their collaboration practices, and the benefits or barriers in the collaboration process. Findings indicated differences in providers' perceptions of the quality of assessments conducted and the importance of particular psychological practices to the roles of clinical and school psychologists. Content analysis of open-ended responses found that while providers acknowledge the benefits of collaboration there was distrust among providers. Implications for training programs and future research directions are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya.

Globally, 350 million under-5s do not have adequate childcare. This may damage their health and development and undermine societal and economic development. Rapid urbanization is changing patterns of work, social structures, and gender norms. Parents, mainly mothers, work long hours for insecure daily wages. To respond to increasing demand, childcare centers have sprung up in informal settlements. However, there is currently little or no support to ensure they provide safe, nurturing care accessible to low-income families. Here, we present the process of co-designing an intervention, delivered by local government community health teams to improve the quality of childcare centers and ultimately the health and development of under-5 children in informal settlements in Kenya. This mixed methods study started with a rapid mapping of the location and basic characteristics of all childcare centers in two informal settlements in Nairobi. Qualitative interviews were conducted with parents and grandparents (n = 44), childcare providers, and community health teams (n = 44). A series of 7 co-design workshops with representatives from government and non-governmental organizations (NGOs), community health teams, and childcare providers were held to design the intervention. Questionnaires to assess the knowledge, attitudes, and practices of community health volunteers (n = 22) and childcare center providers (n = 66) were conducted. In total, 129 childcare centers were identified -55 in Korogocho and 77 in Viwandani. School-based providers dominated in Korogocho (73%) while home-based centers were prevalent in Viwandani (53%). All centers reported minimal support from any organization (19% supported) and this was particularly low among home-based (9%) and center-based (14%) providers. Home-based center providers were the least likely to be trained in early childhood development (20%), hence the co-designed intervention focused on supporting these centers. All co-design stakeholders agreed that with further training, community health volunteers were well placed to support these informal centers. Findings showed that given the context of informal settlements, support for strengthening management within the centers in addition to the core domains of WHO's Nurturing Care Framework was required as a key component of the intervention. Implementing a co-design process embedded within existing community health systems and drawing on the lived experiences of childcare providers and parents in informal settlements facilitated the development of an intervention with the potential for scalability and sustainability. Such interventions are urgently needed as the number of home-based and small center-based informal childcare centers is growing rapidly to meet the demand; yet, they receive little support to improve quality and are largely unregulated. Childcare providers, and government and community health teams were able to co-design an intervention delivered within current public community health structures to support centers in improving nurturing care. Further research on the effectiveness and sustainability of support to private and informal childcare centers in the context of low-income urban neighborhoods is needed.

399 The development of a digital game to prevent suicide in youth who misuse substances

OBJECTIVES/GOALS: Suicide is the second leading cause of death in teens. Substance misuse, including opioids, is a risk factor for suicidal thoughts and behaviors among teens. School-based approaches are promising, yet they lack evidence on their effectiveness. To fill this gap, we created supportED, a digital game to prevent suicide in youth who misuse substances. METHODS/STUDY POPULATION: We conducted focus groups and interviews to inform the development of the digital game and discuss approaches to enhance user experiences, acceptability, and feasibility of the intervention. A semi-structured focus group/interview guide was developed, pilot tested, and used in focus groups/interviews. The guides aligned with constructs from a safety planning intervention, a well-recognized, evidence-based suicide prevention intervention, to identify potential warning signs of emotional distress, coping strategies, and resources for seeking help to prevent suicidal thoughts and behaviors. Focus groups/interviews were led by a facilitator, who is also a certified school counselor and licensed professional counselor, and a co-facilitator who took field notes and provided debrief summaries. RESULTS/ANTICIPATED RESULTS: A total of 35 participants, including 10 high-school-aged teens [aged 16-19], 10 college-aged youth [aged 18-22], 10 school-based providers, and five interviews with adults who had experience with opioids in their youth informed the development stage. Of the focus group participants, 25.7% identify as female (n=23), 71.4% identify as male (n=6), and 2.9% do not identify as male or female (n=1); 60% identify as White (n=18), 20% identify as multi-racial (n=6), 10% identify as Black (n=3), 3.3% identify as Asian (n=1), and 6.7% identify as race unknown (n=2); and, 37.1% (n=13) identify as Hispanic/Latinx. Salient themes that emerged focused on opioids, substance misuse, mental health, bullying, grief, family, identity, and stigma to create six distinct narratives in the digital game. DISCUSSION/SIGNIFICANCE: Findings informed the development of a digital game to prevent suicide among adolescents who misuse substances. The digital game is currently being evaluated in a pilot RCT to assess the preliminary efficacy of the intervention, user experience, usability, and feasibility of delivering the intervention and protocols among 60 youth.

Predictors of expert providers' familiarity with intervention practices for school- and transition-age youth with autism spectrum disorder.

School-age children, adolescents, and young adults with autism spectrum disorder encounter many different types of providers in their pursuit of treatment for anxiety, behavior problems, and social difficulties. These providers may all be familiar with different types of intervention practices. However, research has not yet investigated patterns in expert providers' familiarity with different practices nor how these patterns are related to the characteristics of providers (years in practice, academic discipline, setting) and the youth (age and intellectual disability) they typically support. A panel of 53 expert transdisciplinary providers rated their familiarity with 55 intervention practices (derived from research and expert nominations) via an online Delphi poll. Advanced statistical methods were used to identify types of intervention practices with which providers were familiar, which included two approaches (cognitive and behavioral) and two strategies (engagement and accessibility). Providers who practiced outside a school setting or treated clients without intellectual disability were more familiar with cognitive approaches. Clinical psychologists, behavior analysts, and school-based providers were more familiar with behavioral approaches. Providers practicing outside school settings were also more familiar with engagement strategies, and providers with more years in practice were more familiar with accessibility strategies. These results may help families and researchers to better anticipate how services may vary depending on the types of autism spectrum disorder providers seen and work to reduce disparities in care that may result.

Perceived parent needs in engaging with therapeutic supports for children with disabilities in school settings: An exploratory study

BackgroundParent engagement in therapeutic services for children with disabilities could optimize service delivery while addressing service disparities. However, service providers must first understand parents’ needs to effectively involve parents. AimsThis study examines what needs parents identify as important when engaging with school-based therapies and how well these needs are being met. Methods and proceduresParents of children with Individualized Education Plans rated statements related to their needs for trust, information, support and guidance, and personal needs when engaging with their child’s therapies. Parents also provided demographic information on them and their child[ren] with a disability. Outcomes and resultsParents endorsed an average of 83 % of needs as important but 51 % of needs as unmet. On average, 65 % of needs related to feeling trusted by service providers were met. In contrast, needs related to receivings upport and guidance (M = 58 %), information (M = 55 %), and addressing parent's own needs (M = 53 %) were frequently unmet. Parents indicated that needs related to feeling trusted by service providers were most frequently met. In contrast, needs related to receiving information were most frequently unmet. Race/ethnicity and number of children with a disability influenced the number of needs endorsed as important and unmet. ConclusionThis feasibility study suggests that parents find a variety of needs regarding their interactions with school-based providers as important to them. However, given the high proportion of needs indicated being unmet, significant gaps likely exist in effectively engaging parents, especially for Parents of Color and parents with multiple children with disabilities. ImplicationsThis study provides a list of tangible needs school-based providers can use to improve parent engagement with school-based therapies. School-based providers and administrators can use the needs identified as important and unmet in this study to create actionable steps that aim to improve parent engagement in school-based services.

Which Children Use School-Based Health Services as a Primary Source of Care?

School-based health centers (SBHCs) offer primary and preventive health care for children and adolescents. Using nationally representative data, we aimed to examine which child and family characteristics are associated with using school-based health care providers as the primary source of health care, and whether care received from these providers met the criteria for a medical home. Using data from the 2016-2018 National Survey of Children's Health (NSCH), we analyzed children's usual source of care (school-based provider, doctor's office or clinic, other location, or none), and whether they received care meeting medical home criteria. Based on a sample of 64,710 children, 0.5% identified school-based providers as their primary source of health care. Children who were older, uninsured, or living in the Northeast were significantly more likely to report school-based providers as their usual source of care. Children whose usual source of care was a school-based provider were less likely to receive care meeting medical home criteria than children who usually received care at a doctor's office. While SBHCs improve access to care, our findings indicate potential challenges with establishing a medical home for children who usually receive health care from a school-based provider.

Gauging Perceptions and Attitudes About Student Anxiety and Supports Among School-Based Providers

Gauging Perceptions and Attitudes About Student Anxiety and Supports Among School-Based Providers

Implementing Trauma Informed Suicide Prevention Care in Schools: Responding to Acute Suicide Risk

ABSTRACT Suicide is the second leading cause of death of school-aged youth, and youth with histories of trauma are at increased risk of suicidal thoughts and actions. Given the impact of trauma on youth development, there has been an increased emphasis on trauma-informed practices in schools. However, while school-based providers encounter, assess, and intervene with youth at risk of suicide, the extent to which trauma-informed practices are incorporated in these procedures is unclear. Available evidence suggests that schools are sometimes over-reliant on emergency services rather than collaborating with students and families in a trauma-informed manner to develop plans for stabilization and linkage to care that are alternatives to referral to higher levels of care. This paper outlines key considerations for school-based suicide risk assessment and crisis intervention, including safety planning, and offers recommendations for improving intervention procedures in school settings that are trauma-informed and support care linkage. An enhanced school-based risk assessment and intervention care process model is offered with special considerations for collaborating with families, developing safe alternatives to emergency service referral (as appropriate), and connecting students to appropriate care proportionate to identified risk. SAFETY-A, an intervention model intended to complement school-based risk assessment procedures, is described to demonstrate a trauma-informed approach in working with students and families at-risk of suicide or self-harm following the enhanced care process model.

Implementation of school-based services for students with autism: Barriers and facilitators across urban and rural districts and phases of implementation.

The law requires that schools use evidence-based practices to educate students with autism spectrum disorder. However, these practices are often not used, or are not used correctly in school programs. Understanding barriers and facilitators of use of evidence-based practices in schools will help improve the implementation process. This study uses focus groups to characterize how school-based providers representing urban or rural school districts perceive barriers and facilitators for implementing new practices for students with autism spectrum disorder. Guiding questions include the following: (1) Are contextual factors perceived as barriers or facilitators and how do these vary by district location? and (2) What are the key factors impacting implementation across the Exploration, Preparation, Implementation, and Sustainment phases? Focus group participants (n = 33) were service providers to children with autism spectrum disorder from urban- and rural-located school districts. Several personnel-related themes (attitudes and buy-in, knowledge and skills, staffing, and burnout) were shared by participants representing both urban and rural districts. However, some personnel-related themes and organizational factors were unique to rural or urban districts. For example, themes related to system and organizational factors (leadership approval, support and expectations, district structure, competing priorities, time for effective professional development, litigation and due process, and materials and resources) differed between the district locations. This project serves as an initial step in identifying implementation strategies that may improve the use of evidence-based practices in schools.

Understanding Demographics Characteristics of E-Cigarette Users in California and the Need for Tailored Interventions

ABSTRACT Background: E-cigarette use has increased rapidly in the past decade despite studies showing their negative health outcomes. There is limited knowledge on the characteristics of users and possible interventions. Purpose: This study presents the demographic characteristics of e-cigarette users in California, propose tailored interventions, and advocate for policies changes. Methods: We used secondary data from the California Health Interview Survey 2018 with 925 participants ages 18–84. Descriptive statistics and Pearson’s chi-square cross-tabulations were conducted to determine if associations existed between demographics and other covariates. Results: Among participants, the majority were male (67.6%) and the largest age group was 18–25-year-olds (38.9%). Many participants had some college, vocational training, or an associate degree (56.4%), never married (59.4%), and earned below 300% the federal poverty level. Reasons identified for engaging in e-cigarette consumption were to quit tobacco cigarette smoking, the perception that e-cigarettes were healthier, to reduce tobacco cigarette smoking, for social enjoyment, and to satisfy curiosity. Discussion: These findings demonstrate is a difference in e-cigarette consumption depending on users’ demographic characteristics. Translation to Health Education Practice: Results support the need for tailored interventions that include school-based interventions, public education, community, provider interventions, advocacy, and policy restrictions to reduce e-cigarettes consumption. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars

Interagency Collaboration for Pediatric Autism Spectrum Disorder: Perspectives of Community-Based Providers.

Interagency collaboration between community and school settings is one mechanism to serve the complex needs of pediatric patients with autism spectrum disorder (ASD). We surveyed a national sample of community-based providers to examine their perspectives on interagency collaboration with school-based providers when serving pediatric patients with ASD. Medical and behavioral/mental health professionals practicing in community settings were recruited. Participants (N = 116) completed an online survey about their interagency collaboration experiences with schools. The majority of the sample reported engaging in interagency collaboration with school-based providers; however, the frequency was limited and was associated with the number of years working in the field. Community-based providers wanted more didactic and hands-on experiences in collaboration. Barriers and facilitators were related to schools' administration, school personnels' training in ASD, information exchange, and delineating between identification systems. Our findings highlight the importance of leadership support and the need for innovative training experiences to support school-community interagency collaboration.

Randomized Trial of Show Me FIRST: A Brief School-Based Intervention for Internalizing Concerns

ABSTRACT Better integration of evidence-based practices (EBPs) in schools can improve access to effective youth mental health care. However, EBPs typically developed and tested within clinics may not be feasible for school-based implementation. We conducted a small randomized trial comparing Show Me FIRST, a brief intervention designed for efficient uptake in diverse clinical settings, against usual care (UC) in a school-based sample of 34 youth (70.59% female, 79.41% White; 11.76% Latinx; M = 12.21 years old; 41.18% received free or reduced lunch) with significantly elevated depression and anxiety. Using a mixed methods approach to gauge feasibility and efficacy, we found that school-based providers were able to deliver most content with fidelity and within six sessions. Youth and providers reported significant symptom improvements, but comparisons against UC were nonsignificant. Providers reported several challenges to implementing Show Me FIRST with the high-risk sample that may help explain these findings and suggest future adaptations.

Sustained Effects of a School-Based Psychiatry Program

To provide access to timely youth psychiatric care, the Bridge Program: School-Based Psychiatry provides interim, school-based psychiatric services by child psychiatrists and psychiatric nurse case managers at no cost to families. In its first year, Bridge served 394 youths, mostly from economically disadvantaged backgrounds, within 10 days of referral. Parents and teachers reported significant reductions in symptoms and high ratings of satisfaction and social validity. In the present study, we examine these same indicators during Bridge’s third year of implementation to examine Bridge’s sustained effects. During its third year (January to June 2018), Bridge served 210 youths (the majority were from economically disadvantaged families) within 4 weeks of referral. Outcomes for youth symptoms, treatment adherence, and parent and school personnel satisfaction remained as strong or stronger compared to the first year. These findings demonstrate promise for Bridge’s sustainability and provide implications for school-based providers.

Social Services Cooperating with Schools to Enable Community: The Case of two Territories of Southern Italy

ABSTRACT The Program of Intervention for Prevention of Institutionalization (P.I.P.P.I.) is a programme that integrates research, training, and intervention in working with families living in vulnerable situations. It is funded by the Italian Ministry of Welfare and, since 2011, has cumulatively involved roughly 8000 professionals from Social and Health Services and Schools, as well as 4000 children and their families in more than 200 territories across Italy. P.I.P.P.I. focuses on supporting children and families through multi-professional, holistic, and resilience-based interventions, in order to reduce child neglect. Bronfenbrenner’s ecology of human development and its definition of neglect are the rationale for the programme, and discussing the theories on community and community capacity linked with resilience theory, this paper reflects on enabling community as an approach to alleviating social disadvantage and promoting child, family, and community wellbeing and resilience. The cases of two territories in Southern Italy will be presented and reviewed in order to illustrate how the service-school-family relationship was promoted within a resilience community approach. Using information from meetings, focus-groups with professionals, and document reviews, programme implementation will be presented and discussed to explore how the governance of social services and school-based service providers make decisions and organize activities to facilitate participation by children, parents, teachers, and social professionals, enabling more community development. Implications for practice, policy and research are highlighted.

Abstract B048: HPV vaccination in Hmong-American adolescents: A multilevel and assets-based qualitative study

Abstract Background: Rates of human papillomavirus (HPV) vaccine uptake in Hmong-Americans, an Asian American and Pacific Islander (AAPI) minority group, are substantially lower than the majority of Americans. In 2015, a community health center (CHC) in Minnesota found that HPV vaccine rates for Hmong children ages 9-17 were 32% in girls and 20% in boys, much lower than nationally published HPV coverage rates in 2017 (47% and 53%, respectively). This qualitative study identified barriers, facilitators, and decision-making processes about HPV vaccinations among Hmong adolescents and parents. Methods: Hmong adolescents (14-17 years old) and their parents were recruited from a local CHC to participate in focus group sessions. Using a community-based participatory action research approach, bilingual community researchers conducted eight focus groups with adolescents and parents. Prior to focus groups, participants provided demographic information and completed a survey about HPV and HPV vaccination. Focus group transcripts were analyzed using participatory thematic analysis. Themes were codified using a socioecological model (multilevel) framework combined with an assets lens. Results: A total of 12 adolescents and 13 parents participated in the focus groups (N = 25). Both survey and focus group results showed that Hmong adolescents and parents had low levels of awareness regarding HPV or the HPV vaccine. At the individual-level, both adolescents and parents reported concerns about side effects and costs as potential reasons for not getting vaccinated. Whereas, an individual-level facilitator for both adolescents and parents included personal agency (i.e., individual desire to want to learn more about HPV and the HPV vaccine). At the community-level, barriers included community narratives around traumatic experiences with vaccine, and facilitators included strong community connections and communications. At the institutional-level, barriers included lack of a school policy requiring HPV vaccinations and structural constraints in health care settings, while facilitators included ease of obtaining vaccines at school-based clinics and provider authoritative decision making. Finally, there was a range of decision-making processes between parents and adolescents and parents and providers. Conclusion: A culturally-appropriate HPV educational program for Hmong adolescents and parents could address barriers and build on facilitators and assets to promote HPV vaccine uptake. These findings have been used in the development of an eHealth application to increase HPV vaccinations in Hmong adolescents. Future research studies that test the feasibility, acceptability, and efficacy of culturally-tailored, multilevel HPV vaccination interventions may provide evidence about the efficacy of culturally-appropriate education in comprehensive vaccine strategies. Citation Format: Serena Xiong, Maiyia Y Kashouaher, Bai Vue, Kathleen A Culhane-Pera, Shannon L Pergament, Jay Desai, Hee Yun Lee. HPV vaccination in Hmong-American adolescents: A multilevel and assets-based qualitative study [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B048.

Middle and High School Student Perspectives on Digitally-Delivered Mental Health Assessments and Measurement Feedback Systems.

Implementation of measurement-based care (MBC) by child-serving community mental health providers, particularly school-based providers, is low. To inform user-centered design of measurement feedback systems (MFSs) and MBC implementation more broadly, semi-structured interviews were conducted with 61 middle and high school students. Interviews explored student preferences for and perceived helpfulness of different assessment methods and use of MFS in counseling. Results indicate that student preference for digitally-administered assessment is equivocal, with preferences being influenced by student perceptions of the ease of use, impersonalization, and confidentiality. Students with exposure to the MFS found it helpful when used by their provider to share assessment feedback.

How to Use Colleague Education to Help Your Caseload

How to Use Colleague Education to Help Your Caseload

Influence of commissioned provider type and deprivation score on uptake of the childhood flu immunization.

Since 2015/16 the UK seasonal influenza immunization programme has included children aged 5 and 6 years. In the South West of England school-based providers, GPs or community pharmacies were commissioned to deliver the vaccine depending on the locality. We aimed to assess variation in vaccine uptake in relation to the type of commissioned provider, and levels of socioeconomic deprivation. Data from the South West of England (2015-16 season) were analysed using multilevel logistic regression to assess variation in vaccine uptake by type of commissioned provider, allowing for clustering of children within delivery sites. Overall uptake in 5 and 6 year olds was 34.3% (37 555/109 404). Vaccine uptake was highest when commissioned through school-based programmes 50.2% (9983/19 867) and lowest when commissioned through pharmacies, 23.1% (4269/18 479). Delivery through schools resulted in less variation by site and equal uptake across age groups, in contrast to GP and pharmacy delivery for which uptake was lower among 6 year olds. Vaccine uptake decreased with increasing levels of deprivation across all types of commissioned provider. School-based programmes achieve the highest and most consistent rates of childhood influenza vaccination. Interventions are still needed to promote more equitable uptake of the childhood influenza vaccine.

“We Have to Educate Every Single Student, Not Just the Ones That Look Like Us”: Support Service Providers’ Beliefs About the Root Causes of the School-to-Prison Pipeline for Youth of Color

This study adds to the extant research on the school-to-prison pipeline by investigating how school-based service providers and administrators conceptualize the causal mechanisms constraining and enabling the school-to-prison pipeline in a large urban district. Thirty-three schools were selected for the study based on their suspension rates. Support staff and district partners (n = 36) participated in focus groups guided by semi-structured protocols. Most participants emphasized structural and systemic causes of the school-to-prison pipeline, such as institutional racism and poverty. To minimize the school-to-prison pipeline, participants highlighted the importance of relationship building and non-punitive practices in response to misbehavior, although solutions offered limited evidence of promising interventions. Given strong research indicating that racial disparities cannot be explained by differential behavior, scholarship in this area emphasizes the need to increase school-level practices that promote positive school climate. The persistence of exclusionary and punitive attitudes among a subset of the sample suggests a need for differentiated professional development to address competing frameworks for understanding the root causes of, and solutions to, the school-to-prison pipeline.