Challenges and Ideas from a Research Program on High-Quality, Evidence-Based Practice in School Mental Health

Abstract

Objective Reviews the progression of a research program designed to develop, implement and study the implementation of “achievable” evidence-based practices (EBPs) in schools. Reviews challenges encountered and ideas to overcome them to enhance this avenue of research. Method Presents two federally funded randomized controlled trials involving comparison of a four-component targeted intervention (Quality Assessment and Improvement, Family Engagement and Empowerment, Modular Evidence-Based Practice, Implementation Support) versus a comparison intervention focused on Personal Wellness. In both studies primary aims focused on changes in clinician attitudes and behavior, including the delivery of high quality, evidence-based practices and secondary aims focused on student level impacts. Results A number of challenges, many not reported in the literature are reviewed, and ideas for overcoming them are presented. Conclusions Given the reality that the majority of youth mental health services are delivered in schools and the potential of school mental health (SMH) services to provide a continuum of mental health care from promotion to intervention, it is critical that the field consider and address the logistical and methodological challenges associated with implementing and studying EBP implementation by clinicians.

The Family Check-Up Online Program for Parents of Middle School Students: Protocol for a Randomized Controlled Trial

“…Programs such as the FCU Online represent an important next-generation direction in delivering behavioral health programs to parents and caretakers of school-aged children. Previous researchers and clinicians have been working to integrate evidence-based behavioral health prevention and intervention programs (also termed mental health programs) into schools for more than three decades (eg, [ 86 , 87 ]). Nearly all these attempts identified a consistent set of barriers when moving from “hothouse” efficacy demonstrations to the real-life frontiers of community educational settings and service providers.…”

“…These barriers primarily include lack of resources (particularly in rural settings); stigma and parental resistance associated with behavioral health screening and diagnostic methods [ 88 ]; competing responsibilities of intervention staff; lack of support from school administrators and teachers, who often have no exposure to or training in behavioral health practices that are evidence based; difficulty in engaging families; and administrative and staff turnover, which creates a tremendous and ongoing staff training problem. The fact that many evidence-based practices are not flexible in terms of allowing shorter sessions and briefer interventions, and that most are developed for single issues (eg, anxiety, depression, or oppositional defiant disorder), makes it difficult to integrate various behavioral health programs [ 57 , 87 , 89 ], which creates additional barriers to uptake in real-life community settings.…”

Who’s in the Child’s Corner: Bringing Family, Community, and Child Protective Services Together for the Protection of Children

“…Broadening further, there are clear failures of the child protection-related system of carers to provide meaningful support to families preventively, before making a hotline call for suspected child maltreatment. For example, school-based mental health services, when they exist at all, tend to underemphasize parental engagement (Weist et al 2014) and rarely offer family-based or individual adult interventions (e.g., family therapy, parental substance misuse treatment). Even outside formal mental health services, school professionals who may care deeply about the stressors a child is experiencing are discouraged from forming supportive relationships with students' family members (e.g., structural barriers, time constraints) and are not given the skills for doing so.…”

Toward Dynamic Adaptation of Psychological Interventions for Child and Adolescent Development and Mental Health

“…Here, we focus on the school environment because many child and youth mental health services are delivered in school and after-school settings. At the same time, various conceptual, methodological, and logistical challenges exist that threaten high-quality implementation and dissemination (see Weist et al, 2014). To give one example, the leadership team must deal with the district's (or other local or governmental agency's) choice of educational programs in a typical school.…”