Testing a Package of Evidence-Based Practices in School Mental Health

Abstract

This study tested an integrated package for high-quality school mental health (SMH) services involving quality assessment and improvement, family engagement and empowerment, modular evidence-based practice, and implementation support. Within a two-year randomized controlled trial, 35 clinicians, who provided services to 529 students and their families, were randomly assigned to the enhanced quality assessment and improvement intervention condition and a comparison condition focused on promoting personal and staff wellness. Significant clinician-level findings were found for increased use and fidelity of evidence-based practices and greater use of structured assessments and sessions involving family members. Results are discussed in relation to needed methodological improvements in SMH treatment outcome research and increasing use of evidence-based practices by clinicians by adding accountability and incentives to training, coaching, and implementation support.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. Aarons, G. A. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS). Mental Health Services Research,6(2), 61–74.

    PubMed  PubMed Central  Google Scholar 

  2. Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms & profiles. Burlington: University of Vermont.

    Google Scholar 

  3. Adelman, H. S., & Taylor, L. (2000). Shaping the future of mental health in schools. Psychology in the Schools,37(1), 49–60.

    Google Scholar 

  4. Adelman, H. S., Taylor, L., Weist, M. D., Adelsheim, S., Freeman, B., Kapp, L., et al. (1999). Mental health in schools: A federal initiative. Children’s Services: Social Policy, Research, and Practice,2, 95–115.

    Google Scholar 

  5. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.)., Text revision Washington, D.C.: Author.

    Google Scholar 

  6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: Author.

    Google Scholar 

  7. Anglin, T. M. (2003). Mental health in schools. In M. D. Weist, S. Evans, & N. Lever (Eds.), Handbook of school mental health: Advancing practice and research (pp. 89–106). New York: Springer.

    Google Scholar 

  8. Angold, A., Erkanli, A., Farmer, E. M., Fairbank, J. A., Burns, B. J., Keeler, G., et al. (2002). Psychiatric disorder, impairment, and service use in rural African American and white youth. Archives of General Psychiatry,59(10), 893–901.

    PubMed  Google Scholar 

  9. Atkins, M. S., Frazier, S. L., Birman, D., Adil, J. A., Jackson, M., Graczyk, P. A., et al. (2006). School-based mental health services for children living in high poverty urban communities. Administration and Policy in Mental Health and Mental Health Services Research,33(2), 146.

    PubMed  Google Scholar 

  10. Baker, T. L., Wise, J., Kelley, G., & Skiba, R. J. (2016). Identifying barriers: Creating solutions to improve family engagement. School Community Journal,26, 161–184.

    Google Scholar 

  11. Barkley, R. A. (2013). Defiant children: A clinician’s manual for assessment and parent training. New York: Guilford.

    Google Scholar 

  12. Barkley, R. A., Edwards, G. H., & Robin, A. I. (1999). Defiant teens: A clinician’s manual for assessment and family intervention. New York: Guilford.

    Google Scholar 

  13. Barrett, S., Eber, L., & Weist, M. D. (2013). Advancing education effectiveness: An interconnected systems framework for Positive Behavioral Interventions and Supports (PBIS) and school mental health. Eugene: Center for Positive Behavioral Interventions and Supports (funded by the Office of Special Education Programs, U.S. Department of Education), University of Oregon Press.

    Google Scholar 

  14. Becker, K. D., Lee, B. R., Daleiden, E. L., Lindsey, M., Brandt, N. E., & Chorpita, B. F. (2015). The common elements of engagement in children’s mental health services: Which elements for which outcomes? Journal of Clinical Child & Adolescent Psychology,44(1), 30–43.

    Google Scholar 

  15. Blasé, K. A., Fixsen, D. L., Sims, B. J., & Ward, C. S. (2015). Implementation science: Changing hearts, minds, behavior and systems to improve educational outcomes. Oakland: The Wing Institute.

    Google Scholar 

  16. Burnett-Zeigler, I., & Lyons, J. S. (2012). Youth characteristics associated with intensity of service use in a school-based mental health intervention. Journal of Child and Family Studies,21(6), 963–972.

    Google Scholar 

  17. Calhoun, K. S., Moras, K., Pilkonis, P. A., & Rehm, L. P. (1998). Empirically supported treatments: Implications for training. Journal of Consulting and Clinical Psychology,66(1), 151.

    PubMed  Google Scholar 

  18. Campbell, D. T., & Stanley, J. C. (1963). Experimental and quasi-experimental designs for research. Boston: Houghton Mifflin.

    Google Scholar 

  19. Center for School Mental Health. (2006). School mental health quality assessment questionnaire. Baltimore: Author, University of Maryland Baltimore.

    Google Scholar 

  20. Chorpita, B. F. (2006). Modular cognitive behavioral therapy for childhood anxiety. New York: Guilford.

    Google Scholar 

  21. Chorpita, B. F., & Daleiden, E. L. (2007). Biennial report: Effective psychosocial interventions for youth with behavioral and emotional needs. Honolulu: Child and Adolescent Mental Health Division, Hawaii Department of Health.

    Google Scholar 

  22. Chorpita, B. F., & Weisz, J. R. (2009). Modular approach to therapy for children with anxiety, depression, or conduct problems (MATCH-ADC). Satellite Beach: PracticeWise, LLC.

    Google Scholar 

  23. Clarke, A. T., Marshall, S. A., Mautone, J. A., Soffer, S. L., Jones, H. A., Costigan, T. E., et al. (2015). Parent attendance and homework adherence predict response to a family–school intervention for children with ADHD. Journal of Clinical Child & Adolescent Psychology,44(1), 58–67.

    Google Scholar 

  24. Connors, E. H., Arora, P., Curtis, L., & Stephan, S. H. (2015). Evidence-based assessment in school mental health. Cognitive and Behavioral Practice,22(1), 60–73.

    Google Scholar 

  25. Cook, D. A., & Beckman, T. J. (2010). Reflections on experimental research in medical education. Advances in Health Sciences Education,15(3), 455–464.

    PubMed  Google Scholar 

  26. De Leeuw, E. D., & Van der Zouwen, J. (1988). Data quality in telephone and face-to-face surveys: A comparative meta-analysis. In R. Groves, P. Biemer, L. Lybert, J. Massey, W. Nicholls II, & J. Waksberg (Eds.), Telephone survey methodology (pp. 21–33). New York: Wiley.

    Google Scholar 

  27. Eiraldi, R., Wolk, C. B., Locke, J., & Biedas, R. (2015). Clearing hurdles: The challenges of implementation of mental health evidence-based practices in under-resourced schools. Advances in School Mental Health Promotion,8, 124–140.

    PubMed  PubMed Central  Google Scholar 

  28. Evans, S. W., Glass-Siegel, M., Frank, A., Van Treuren, R., Lever, N. A., & Weist, M. D. (2003). Overcoming the challenges of funding school mental health programs. In M. D. Weist, S. Evans, & N. Lever (Eds.), Handbook of school mental health: Advancing practice and research (pp. 73–86). New York: Springer.

    Google Scholar 

  29. Evans, S. W., Owens, J. S., Mautone, J. A., DuPaul, G. J., & Power, T. J. (2014). Toward a comprehensive life-course model of care for attention-deficit/hyperactivity disorder. In M. D. Weist, S. Evans, & N. Lever (Eds.), Handbook of school mental health: Research, training, practice, and policy (pp. 413–426). New York: Springer.

    Google Scholar 

  30. Evans, S. W., Sapia, J. L., Axelrod, J., & Glomb, N. K. (2002). Practical issues in school mental health: Referral procedures, negotiating special education, and confidentiality. In H. Ghuman, M. D. Weist, & R. Sarles (Eds.), Providing mental health services to youth where they are: School- and community-based approaches (pp. 75–94). New York: Brunner-Routledge.

    Google Scholar 

  31. Evans, S. W., & Weist, M. D. (2004). Implementing empirically supported treatments in schools: What are we asking? Clinical Child and Family Psychology Review,7, 263–267.

    PubMed  Google Scholar 

  32. Fabiano, G. A., Chafouleas, S. M., Weist, M. D., Sumi, W. C., & Humphrey, N. (2014). Methodology considerations in school mental health research. School Mental Health,6(2), 68–83.

    Google Scholar 

  33. Fazel, M., Hoagwood, K., Stephan, S., & Ford, T. (2014). Mental health interventions in schools in high income countries. Lancet Psychiatry,1(5), 377–387.

    PubMed  PubMed Central  Google Scholar 

  34. Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).

    Google Scholar 

  35. Flaherty, L. T., & Osher, D. (2003). History of school-based mental health services. In M. D. Weist, S. Evans, & N. Lever (Eds.), Handbook of school mental health: Advancing practice and research (pp. 11–22). New York: Springer.

    Google Scholar 

  36. 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.

    Google Scholar 

  37. Garbacz, S. A., Herman, K. C., Thompson, A. M., & Reinke, W. M. (2017). Family engagement in education and intervention: Implementation and evaluation to maximize family, school, and student outcomes. Journal of School Psychology,62, 1–10.

    PubMed  Google Scholar 

  38. Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry,38(5), 581–586.

    PubMed  PubMed Central  Google Scholar 

  39. Graczyk, P. A., Domitrovich, C. E., & Zins, J. E. (2003). Facilitating the implementation of evidence-based prevention and mental health promotion efforts in schools. In M. D. Weist, S. Evans, & N. Lever (Eds.), Handbook of school mental health: Advancing practice and research (pp. 301–318). New York: Springer.

    Google Scholar 

  40. Hansen, N. B., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice,9(3), 329–343.

    Google Scholar 

  41. Harden, J., & Hilbe, J. (2012). Generalized estimating equations. Boca Raton: CRC Press.

    Google Scholar 

  42. Hicks, T. B., Shahidullah, J. D., Carlson, J. S., & Palejwala, M. H. (2014). Nationally certified school psychologists’ use and reported barriers to using evidence-based interventions in schools: The influence of graduate program training and education. School Psychology Quarterly,29(4), 469.

    PubMed  Google Scholar 

  43. Hoagwood, K. E. (2005). Family-based services in children’s mental health: A research review and synthesis. Journal of Child Psychology and Psychiatry,46(7), 690–713.

    PubMed  Google Scholar 

  44. Hoagwood, K. E., Olin, S. S., Kerker, B. D., Kratochwill, T. R., Crowe, M., & Saka, N. (2007). Empirically based school interventions targeted at academic and mental health functioning. Journal of Emotional and Behavioral Disorders,15(2), 66–92.

    Google Scholar 

  45. Jensen, P. S., & Hoagwood, K. E. (2008). Improving children’s mental health through parent empowerment: A guide to assisting families. New York: Oxford University Press.

    Google Scholar 

  46. 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.

    PubMed  Google Scholar 

  47. Koren, P. E., DeChillo, N., & Friesen, B. J. (1992). Measuring empowerment in families whose children have emotional disabilities: A brief questionnaire. Rehabilitation Psychology,37(4), 305.

    Google Scholar 

  48. Kratochwill, T. R., Albers, C. A., & Shernoff, E. S. (2004). School-based interventions. Child and Adolescent Psychiatric Clinics of North America,13(4), 885–903.

    PubMed  Google Scholar 

  49. Lane, K. L., Menzies, H., Bruhn, A., & Crnobori, M. (2011). Managing challenging behaviors in schools: Research-based strategies that work. New York: Guilford Press.

    Google Scholar 

  50. 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.

    PubMed  PubMed Central  Google Scholar 

  51. Leaf, P. J., Alegria, M., Cohen, P., Goodman, S. H., Horwitz, S. M., Hoven, C. W., et al. (1996). Mental health service use in the community and schools: Results from the four-community MECA study. Journal of the American Academy of Child and Adolescent Psychiatry,35(7), 889–897.

    PubMed  Google Scholar 

  52. Leatherman, S. T., & McCarthy, D. (2004). Quality of health care for children and adolescents: A chartbook. New York: Commonwealth Fund.

    Google Scholar 

  53. Lever, N., Mathis, E., & Mayworm, A. (2017). School mental health is not just for students: Why teacher and staff wellness matter. Report on Emotional & Behavioral Disorders in Youth,17(1), 6–12.

    Google Scholar 

  54. Lindsey, M. A., Brandt, N. E., Becker, K. D., Lee, B. R., Barth, R. P., Daleiden, E. L., et al. (2014). Identifying the common elements of treatment engagement interventions in children’s mental health services. Clinical Child and Family Psychology Review,17(3), 283–298.

    PubMed  Google Scholar 

  55. Loades, M. E., & Mastroyannopoulou, K. (2010). Teachers’ recognition of children’s mental health problems. Child and Adolescent Mental Health,15(3), 150–156.

    Google Scholar 

  56. Lyon, A. R., & Bruns, E. J. (2019). From evidence to impact: Joining our best school mental health practices with our best implementation strategies. School Mental Health,11(1), 106–114.

    PubMed  Google Scholar 

  57. McKay, M. M., & Bannon, W. M., Jr. (2004). Engaging families in child mental health services. Child and Adolescent Psychiatric Clinics,13(4), 905–921.

    Google Scholar 

  58. Merikangas, K. R., He, J. P., Brody, D., Fisher, P. W., Bourdon, K., & Koretz, D. S. (2010). Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics,125, 75–81.

    PubMed  Google Scholar 

  59. Meyer, O. L., & Zane, N. (2013). The influence of race and ethnicity in clients’ experience of mental health treatment. Journal of Community Psychology,41(7), 884–901.

    PubMed  PubMed Central  Google Scholar 

  60. Moher, D., Schulz, K. F., & Altman, D. G. (2001). The CONSORT statement: Revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Medical Research Methodology,1, 2.

    PubMed  PubMed Central  Google Scholar 

  61. Murphy, J. M., Abel, M. R., Hoover, S., Jellinek, M., & Fazel, M. (2017). Scope, scale, and dose of the world’s largest school-based mental health programs. Harvard Review of Psychiatry,25(5), 218–228.

    PubMed  Google Scholar 

  62. Nabors, L. A., Lehmkuhl, H. D., & Weist, M. D. (2003). Continuous quality improvement and evaluation of expanded school mental health programs. In M. D. Weist, S. W. Evans, & N. A. Lever (Eds.), Handbook of school mental health: Advancing practice and research (pp. 275–284). New York: Springer.

    Google Scholar 

  63. National Institute of Mental Health. (2001). Blueprint for change: Research on child and adolescent mental health, a report of the National Advisory Mental Health Council’s Workgroup on Child and Adolescent Mental Health Intervention and Deployment. Rockville: National Institute of Mental Health.

    Google Scholar 

  64. New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America, final report (Pub. No. SMA-03-3832). Rockville: Author.

    Google Scholar 

  65. 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.

    Google Scholar 

  66. Rones, M., & Hoagwood, K. (2000). School-based mental health services: A research review. Clinical Child and Family Psychology Review,3(4), 223–241.

    PubMed  Google Scholar 

  67. Sburlati, E. S., Schniering, C. A., Lyneham, H. J., & Rapee, R. M. (2011). A model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders. Clinical Child and Family Psychology Review,14, 89–109.

    PubMed  Google Scholar 

  68. Schaeffer, C. M., Bruns, E., Weist, M. D., Stephan, S. H., Goldstein, J., & Simpson, Y. (2005). Overcoming challenges to using evidence-based interventions in schools. Journal of Youth and Adolescence,34(1), 15–22.

    Google Scholar 

  69. Silverman, W. K., & Hinshaw, S. P. (2008). The second special issue on evidence-based psychosocial treatments for children and adolescents: A 10-year update. Journal of Clinical Child & Adolescent Psychology,37(1), 1–7.

    Google Scholar 

  70. Splett, J. W., Perales, K., Halliday-Boykins, C. A., Gilchrest, C., Gibson, N., & Weist, M. D. (2017). Best practices for teaming and collaboration in the interconnected systems framework. Journal of Applied School Psychology,33(4), 347–368.

    Google Scholar 

  71. Stephan, S. H., Sugai, G., Lever, N., & Connors, E. (2015). Strategies for integrating mental health into schools via a multitiered system of support. Child and Adolescent Psychiatric Clinics of North America,24(2), 211–231.

    PubMed  Google Scholar 

  72. Stephan, S. H., Weist, M., Kataoka, S., Adelsheim, S., & Mills, C. (2007). Transformation of children’s mental health services: The role of school mental health. Psychiatric Services,58(10), 1330–1338.

    PubMed  Google Scholar 

  73. Sugai, G., & Horner, R. H. (2009). Responsiveness-to-intervention and school-wide positive behavior supports: Integration of multi-tiered system approaches. Exceptionality: A Special Education Journal,17(4), 223–237.

    Google Scholar 

  74. Suldo, S. M., Gormley, M. J., DuPaul, G. J., & Anderson-Butcher, D. (2014). The impact of school mental health on student and school-level academic outcomes: Current status of the research and future directions. School Mental Health,6(2), 84–98.

    Google Scholar 

  75. Teasley, M. L. (2018). School shootings and the need for more school-based mental health services. Children & Schools,410(3), 131–137.

    Google Scholar 

  76. Treasure, T., & MacRae, K. (1998). Minimisation: The platinum standard for trials? British Medical Journal,317(7155), 362–364.

    PubMed  Google Scholar 

  77. United States Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General. Rockville: Author.

    Google Scholar 

  78. U.S. Public Health Service. (2000). Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda (Publication No. 017-024-01659-4). Washington, D.C.: Department of Health and Human Services.

    Google Scholar 

  79. Weist, M. D. (1997). Expanded school mental health services: A national movement in progress. In T. H. Ollendick & R. J. Prinz (Eds.), Advances in clinical child psychology (Vol. 19, pp. 319–352). New York: Springer.

    Google Scholar 

  80. Weist, M. D., Eber, L., Horner, R., Splett, J., Putnam, R., Barrett, S., et al. (2018). Improving multi-tiered systems of support for students with “internalizing” emotional/behavioral problems. Journal of Positive Behavior Interventions,20(3), 172–184.

    Google Scholar 

  81. Weist, M. D., Garbacz, A., Lane, K. E., & Kincaid, D. (2017). Aligning and integrating family engagement in Positive Behavioral Interventions and Supports (PBIS): Concepts and strategies for families and schools in key contexts. Eugene: Center for Positive Behavioral Interventions and Supports (funded by the Office of Special Education Programs, U.S. Department of Education), University of Oregon Press.

    Google Scholar 

  82. Weist, M. D., Lever, N., Stephan, S., Youngstrom, E., Moore, E., Harrison, B., et al. (2009). Formative evaluation of a framework for high quality, evidence-based services in school mental health. School Mental Health,1(3), 196–211.

    Google Scholar 

  83. Weist, M. D., Sander, M. A., Lowie, J. A., & Christodulu, K. V. (2002). The expanded school mental health framework. Childhood Education,78(5), 269–273.

    Google Scholar 

  84. Weist, M. D., Sander, M. A., Walrath, C., Link, B., Nabors, L., Adelsheim, S., et al. (2005). Developing principles for best practice in expanded school mental health. Journal of Youth and Adolescence,34, 7–13.

    Google Scholar 

  85. Weisz, J. R. (2004). Psychotherapy for children and adolescents: Evidence-based treatments and case examples. New York: Cambridge University Press.

    Google Scholar 

  86. Weisz, J. R., Bearman, S. K., Santucci, L. C., & Jensen-Doss, A. (2017). Initial test of a principle-guided approach to transdiagnostic psychotherapy with children and adolescents. Journal of Clinical Child and Adolescent Psychology,46(1), 59–73.

    Google Scholar 

  87. Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Miranda, J., Bearman, S. K., et al. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial. Archives of General Psychiatry,69(3), 274–282.

    PubMed  Google Scholar 

Download references

Acknowledgements

We express our deep appreciation to the National Institute of Mental Health (NIMH) for the research grant supporting this study—Strengthening the Quality of School Mental Health Services (#R01MH0819141; 2010–2015, M. Weist, PI)—and NIMH project officers Beverly Pringle, and Denise Pintello for their guidance on this study. This publication also was made possible in part by Grant Number T32-GM081740 from NIH-NIGMS. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIGMS or NIH. Thanks are extended to Samantha Paggeot and Eryn Bergeron for their significant work as senior clinicians on the study, to the Waccamaw Center for Mental Health of the South Carolina Department of Mental Health, to the Horry County School District, and to Elaine Miller.

Funding

This study was funded by the National Institute of Mental Health (#R01MH0819141).

Author information

Affiliations

Authors

Corresponding author

Correspondence to Mark D. Weist.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Weist, M.D., Hoover, S., Lever, N. et al. Testing a Package of Evidence-Based Practices in School Mental Health. School Mental Health 11, 692–706 (2019). https://doi.org/10.1007/s12310-019-09322-4

Download citation

Keywords

  • School mental health
  • Evidence-based practice
  • Family engagement and empowerment
  • Quality assessment and improvement