Abstract
The purpose of this study was to delineate the factors that influence teachers’ support and involvement in successful implementation of an early intervention, school-based trauma program, Cognitive Behavioral Intervention for Trauma in Schools (CBITS). In schools that had already used the intervention for at least one school year, we interviewed teachers and other stakeholders to understand what factors influence teacher support and clarify the role teachers desire in the implementation process. This paper also illuminates barriers to their support and collaboration and identifies methods to improve future implementation and sustainability. We conducted 40 semi-structured qualitative telephone interviews with school staff across three geographic regions in the USA. Participants were asked about their experiences with CBITS in their schools and asked to share both facilitators and challenges to implementation. Four key themes emerged: Support for CBITS was related to teachers’ perceived need for a trauma program on campus; teachers struggled with the competing priorities of balancing students’ social-emotional needs with their missing class to attend CBITS; teachers desired more direct communication with clinicians; and teachers felt they needed more trauma education. Suggested improvements include acknowledging teacher concerns about lost instructional time for CBITS sessions and offering groups during non-core academic instruction, expanding trauma education for teachers, so they can better respond to and connect traumatized students with intervention services, including regular consultation between teacher and clinicians about participating students, and improvements in academic performance following the intervention should be shared with teachers to improve their support.
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Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4–23.
Adi, Y., Killoran, A., Janmohamed, K., & Stewart-Brown, S. (2007). Systematic review of the effectiveness of interventions to promote mental wellbeing in children in primary education: Report 1: Universal approaches non-violence related outcomes. National Institute for Health and Clinical Excellence.
Alisic, E. (2012). Teachers’ perspectives on providing support to children after trauma: A qualitative study. School Psychology Quarterly, 27(1), 51–59.
Alisic, E., Bus, M., Dulack, W., Pennings, L., & Splinter, J. (2012). Teachers’ experiences supporting children after traumatic exposure. Journal of Traumatic Stress, 25(1), 98–101.
Averill, O. H., & Rinaldi, C. (2011). Multi-tier system of supports. Essentials on Education Data and Research Analysis, 91–94.
Balas, E. A., & Boren, S. A. (2000). Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics, 2000(2000), 65–70.
Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. (2004). A multi-site, randomized controlled trial for children with abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43(4), 393–402.
Corbin, J. M., & Strauss, A. (1990). Grounded theory research: Procedures, canons, and evaluative criteria. Qualitative Sociology, 13(1), 3–21.
Delaney-Black, V., Covington, C., Ondersma, S. J., Nordstrom-Klee, B., Templin, T., Ager, J., et al. (2002). Violence exposure, trauma, and IQ and/or reading deficits among urban children. Archives of Pediatrics and Adolescent Medicine, 156(3), 280–285.
Diekstra, R. F., & Gravesteijn, C. (2008). Effectiveness of school-based social and emotional education programmes worldwide. Social and emotional education: An international analysis, 255–312.
Domitrovich, C. E., Bradshaw, C. P., Poduska, J. M., Hoagwood, K., Buckley, J. A., Olin, S., et al. (2008). Maximizing the implementation quality of evidence-based preventive interventions in schools: A conceptual framework. Advances in School Mental Health Promotion, 1(3), 6–28.
Feinstein, N. R., Fielding, K., Udvari-Solner, A., & Joshi, S. V. (2009). The supporting alliance in child and adolescent treatment: enhancing collaboration among therapists, parents, and teachers. American Journal of Psychotherapy, 63(4), 319.
Fixsen, D., Blase, K., Metz, A., & Van Dyke, M. (2013). Statewide implementation of evidence-based programs. Exceptional Children, 79(2), 213–230.
Fixsen, D. L., Naoom, S. F., Blase, K. A., & Friedman, R. M. (2005). Implementation research: A synthesis of the literature (No FMHI Publication #231). Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, National Implementation Research Network.
Flaspohler, P. D., Meehan, C., Maras, M. A., & Keller, K. E. (2012). Ready, willing, and able: Developing a support system to promote implementation of school-based prevention programs. American Journal of Community Psychology, 50(3–4), 428–444.
Forman, S. G., Olin, S. S., Hoagwood, K. E., Crowe, M., & Saka, N. (2009). Evidence-based interventions in schools: Developers’ views of implementation barriers and facilitators. School Mental Health, 1(1), 26–36.
Graham, A., Phelps, R., Maddison, C., & Fitzgerald, R. (2011). Supporting children’s mental health in schools: Teacher views. Teachers and Teaching: Theory and Practice, 17(4), 479–496.
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82(4), 581–629.
Jaycox, L. H. (2004). CBITS: Cognitive behavioral intervention for trauma in schools. Longmont, CO: Sopris West Educational Services.
Jaycox, L. H., Cohen, J. A., Mannarino, A. P., Walker, D. W., Langley, A. K., Gegenheimer, K. L., & Schonlau, M. (2010). Children’s mental health care following Hurricane Katrina: A field trial of trauma-focused psychotherapies. Journal of Traumatic Stress, 23(2), 223–231.
Jaycox, L. H., Stein, B. D., Kataoka, S. H., Wong, M., Fink, A., Escudero, P., et al. (2002). Violence exposure, posttraumatic stress disorder, and depressive symptoms among recent immigrant school children. Journal of the American Academy of Child and Adolescent Psychiatry, 41(9), 1104–1110.
Kataoka, S., Jaycox, L. H., Wong, M., Nadeem, E., Langley, A., Tang, L., et al. (2011). Effects on school outcomes in low-income minority youth: Preliminary findings from a community-partnered study of a school trauma intervention. Ethnicity and Disease, 21(3 Suppl 1), S1.
Kataoka, S. H., Santiago, C. D., Jaycox, L. H., Langley, A. K., Stein, B. D., & Vona, P. (2014). Cognitive behavioral intervention for trauma in schools: Implementation and dissemination of a school-based intervention. In R. S. Beidas, P. Kendall (Eds.), Dissemination and implementation of evidence-based practices in child and adolescent mental health (p. 294).
Kataoka, S. H., Stein, B. D., Jaycox, L. H., Wong, M., Escudero, P., Tu, W., et al. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(3), 311–318.
Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among US children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548–1555.
Klem, A. M., & Connell, J. P. (2004). Relationships matter: Linking teacher support to student engagement and achievement. Journal of School Health, 74(7), 262–273.
Kos, J. M., Richdale, A. L., & Hay, D. A. (2006). Children with attention deficit hyperactivity disorder and their teachers: A review of the literature. International Journal of Disability, Development and Education, 53(2), 147–160.
Langley, A. K., Nadeem, E., Kataoka, S. H., Stein, B. D., & Jaycox, L. H. (2010). Evidence-based mental health programs in schools: Barriers and facilitators of successful implementation. School Mental Health, 2(3), 105–113.
Langley, A., Santiago, C. D., Rodriguez, A., & Zelaya, J. (2013). Improving implementation of mental health services for trauma in multicultural elementary schools: Stakeholder perspectives on parent and educator engagement. The Journal of Behavioral Health Services & Research, 40(3), 247–262.
Lynn, C. J., McKay, M. M., & Atkins, M. S. (2003). School social work: Meeting the mental health needs of students through collaboration with teachers. Children & Schools, 25(4), 197–209.
McKay, M. M., Lynn, C. J., & Bannon, W. M. (2005). Understanding inner city child mental health need and trauma exposure: Implications for preparing urban service providers. American Journal of Orthopsychiatry, 75(2), 201–210.
Mendel, P., Meredith, L. S., Schoenbaum, M., Sherbourne, C. D., & Wells, K. B. (2008). Interventions in organizational and community context: A framework for building evidence on dissemination and implementation in health services research. Administration and Policy in Mental Health and Mental Health Services Research, 35(1–2), 21–37.
Muhr, T. (2010). Atlas.ti GmbH v 6.2 [Computer software]. Berlin, Germany: Atlas.ti.
Reddy, R., Rhodes, J. E., & Mulhall, P. (2003). The influence of teacher support on student adjustment in the middle school years: A latent growth curve study. Development and Psychopathology, 15(1), 119–138.
Reinke, W. M., Stormont, M., Herman, K. C., Puri, R., & Goel, N. (2011). Supporting children’s mental health in schools: Teacher perceptions of needs, roles, and barriers. School Psychology Quarterly, 26(1), 1.
Rogers, E. M. (1995). Diffusion of innovation. New York: Free Press.
Schreiber, M., Gurwitch, R., & Wong, M. (2006). Listen, protect, connect–model & teach: Psychological first aid (PFA) for students and teachers. Washington, D.C.: US Department of Homeland Security.
Schwab-Stone, M. E., Ayers, T. S., Kasprow, W., Voyce, C., Barone, C., Shriver, T., et al. (1995). No safe haven: A study of violence exposure in an urban community. Journal of the American Academy of Child and Adolescent Psychiatry, 34(10), 1343–1352.
Stein, B. D., Jaycox, L. H., Kataoka, S. H., Wong, M., Tu, W., Elliott, M. N., et al. (2003). A mental health intervention for schoolchildren exposed to violence. JAMA, 290(5), 603–611.
U.S. Public Health Service. (2000). Report of the surgeon general’s conference on children’s mental health: A national action agenda. Washington, DC: U.S. Department of Health and Human Services.
Walter, H. J., Gouze, K., & Lim, K. G. (2006). Teachers’ beliefs about mental health needs in inner city elementary schools. Journal of the American Academy of Child and Adolescent Psychiatry, 45(1), 61–68.
Weist, M. D., Mellin, E. A., Chambers, K. L., Lever, N. A., Haber, D., & Blaber, C. (2012). Challenges to collaboration in school mental health and strategies for overcoming them. Journal of School Health, 82(2), 97–105.
Wells, K., & Jones, L. (2009). “Research” in community-partnered, participatory research. JAMA, 302(3), 320–321.
Williams, J. H., Horvath, V. E., Wei, H.-S., Van Dorn, R. A., & Jonson-Reid, M. (2007). Teachers’ perspectives of children’s mental health service needs in urban elementary schools. Children & Schools, 29(2), 95–107.
Wong, M. (2006). Commentary: Building partnerships between schools and academic partners to achieve a health-related research agenda. Ethnicity and Disease, 16(1), S149–S153.
Acknowledgments
This work was supported by the UCLA Center for Health Services and Society (NIH1P30MH082760) and Substance Abuse and Mental Health Services Administration (SAMHSA) (SM59285, SM57283). The authors would like to thank Pia Escudero, Douglas Walker, and Mary Sue Roberts for their partnership, guidance, and support.
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Baweja, S., Santiago, C.D., Vona, P. et al. Improving Implementation of a School-Based Program for Traumatized Students: Identifying Factors that Promote Teacher Support and Collaboration. School Mental Health 8, 120–131 (2016). https://doi.org/10.1007/s12310-015-9170-z
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DOI: https://doi.org/10.1007/s12310-015-9170-z