Redesigning community mental health services for urban children: Supporting schooling to promote mental health.

Abstract

Objective This study examined a school- and home-based mental health service model, Links to Learning (L2L), focused on empirical predictors of learning as primary goals for services in high poverty urban communities. Method Teacher key opinion leaders (KOLs) were identified through sociometric surveys and trained, with mental health providers (MHPs) and parent advocates (PAs), on evidence-based practices to enhance children’s learning. KOLs and MHPs co-facilitated professional development sessions for classroom teachers to disseminate two universal (Good Behavior Game, Peer Assisted Learning) and two targeted (Good News Notes, Daily Report Card) interventions. Group-based and home-based family education and support were delivered by MHPs and PAs for K-4th grade children diagnosed with one or more disruptive behavior disorder. Services were Medicaid-funded through four social service agencies (N = 17 providers) in seven schools (N = 136 teachers, 171 children) in a two (L2L vs. services-as-usual SAU]) by six (pre- and post-tests for three years) longitudinal design with random assignment of schools to conditions. SAU consisted of supported referral to a nearby social service agency. Results Mixed effects regression models indicated significant positive effects of L2L on mental health service use, classroom observations of academic engagement, teacher report of academic competence and social skills, and parent report of social skills. Nonsignificant between-group effects were found on teacher and parent report of problem behaviors, daily hassles, and curriculum based measures. Effects were strongest for young children, girls, and children with fewer symptoms. Conclusions Community mental health services targeting empirical predictors of learning can improve school and home behavior for children living in high poverty urban communities.

Three‐Year Outcomes of a School‐Hospital Partnership Providing Multitiered Mental Health Services in Urban Schools

“…The therapy outcomes are consistent with those reported from the partner hospital's outpatient psychiatry service, which serves similarly complex populations of children and adolescents, while the targeted group intervention findings are consistent with outcomes of community‐based health promotion programs in general, where improvements have historically ranged from 1% to 15% . The student outcomes of the current study are also consistent with those observed in other recent comprehensive school‐based MH programs targeting demographically similar students . Even relatively modest improvements such as demonstrated in these studies, when extrapolated to large populations, have the potential for a significant public health and educational impact …”

Future Directions for Dissemination and Implementation Science: Aligning Ecological Theory and Public Health to Close the Research to Practice Gap

“…We examined the effectiveness of the service model in a three-year study in six schools with kindergarten-to-third grade children and results were promising. L2L, as compared to community-based mental health services as usual, produced significant positive effects on mental health service use, classroom observations of academic engagement, teacher report of academic competence and social skills, and parent report of social skills (Atkins et al, 2015). Though other goals, such as improved reading, were not realized, suggesting the need for further refinement of the service model, the study reinforced the value of coordination across schools and mental health agencies, and the feasibility of implementation of prevention-to-intervention strategies with goals common to both service sectors.…”

Implementation of Teacher Consultation and Coaching in Urban Schools: A Mixed Method Study

“…BRIDGE is based on two models: (a) MyTeachingPartner (MTP: Pianta, Mashburn, Downer, Hamre, & Justice, 2008; Allen, Pianta, Gregory, Mikami, & Lun, 2011), a teacher professional development program, and (b) Links to Learning (L2L: Atkins et al, 2008; 2015; Cappella et al, 2008), a mental health services model. Like MTP, BRIDGE is rooted in the CLASS, a standardized and validated observational tool for understanding and assessing effective classroom practices (Pianta, LaParo, & Hamre, 2008).…”

“…However, significant heterogeneity in implementation was observed. This is not unusual in intervention trials in which the intervention is delivered by school-based personnel rather than paid consultants, university personnel, or research staff (e.g., Aber et al, 1997; Atkins et al, 2015). Moreover, BRIDGE was designed to match classroom and student need, increasing the likelihood of variation in implementation.…”