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How Do School Mental Health Services Vary Across Contexts? Lessons Learned from Two Efforts to Implement a Research-Based Strategy

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Abstract

Although the education sector has been referred to as the “de facto” mental health system for children and adolescents, such statements obscure the tremendous heterogeneity of school-based mental health (SMH) initiatives. This study asked how different school contexts and SMH provider types may influence different aspects of SMH service delivery. Data are derived from results of evaluations of implementation and outcomes of a research-based practice model (the Brief Intervention for School Clinicians [BRISC]) tested in two common but quite different SMH contexts. In one context, BRISC was implemented in a large urban school district by externally employed practitioners working in schools (n = 5); in the second context, BRISC was implemented across a large Canadian province by school-employed mental health practitioners (n = 24). Results suggest that certain variables showed small differences across contexts, including intervention adherence, and perceived relevance, acceptability, and feasibility of BRISC. Other variables varied much more substantively, such as baseline seriousness of mental health needs, rate of out referral of students to alternative community-based services, and student mental health outcomes. Although exploratory, the current study focuses a useful lens on practice patterns across SMH contexts in secondary schools and underscores the importance of considering contextual factors early in an implementation process.

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Funding

This work was funded by the Institute for Educational Sciences (Grant Number R305A120128).

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Authors and Affiliations

  1. University of Washington School of Medicine, 6200 74th Street NE, Seattle, WA, 98115, USA

    Kelly Whitaker, Eric J. Bruns, Semret Nicodimos, Kristy Ludwig, Aaron R. Lyon, Michael D. Pullmann & Elizabeth McCauley

  2. Ontario School Mental Health ASSIST, 33 Belleville Street, Toronto, ON, M4E3X9, Canada

    Alexandra Fortier & Kathy Short

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  1. Kelly Whitaker
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  2. Alexandra Fortier
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Correspondence to Kelly Whitaker.

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Authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board (IRB) of the University of Washington and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent for the Washington cohort was obtained for all participants, given these data were collected under the auspice of a federal research study. Data collection for the Ontario cohort was not deemed subject of formal IRB review because it was a quality improvement evaluation of the BRISC intervention in which (1) data were recorded by the investigator in such a manner that participants could not be identified, directly or through identifiers linked to the subjects, and (2) data were collected primarily for the purpose of evaluating public benefit and identifying possible changes in or alternatives to the program.

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Whitaker, K., Fortier, A., Bruns, E.J. et al. How Do School Mental Health Services Vary Across Contexts? Lessons Learned from Two Efforts to Implement a Research-Based Strategy. School Mental Health 10, 134–146 (2018). https://doi.org/10.1007/s12310-017-9243-2

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