|Title:||Efficacy of a Brief Intervention Strategy for School Mental Health Clinicians|
|Principal Investigator:||Bruns, Eric||Awardee:||University of Washington|
|Program:||Social and Behavioral Context for Academic Learning [Program Details]|
|Award Period:||3 years (7/1/16-6/30/19)||Award Amount:||$3,295,972|
|Type:||Efficacy and Replication||Award Number:||R305A160111|
Co-Principal Investigator: McCauley, Elizabeth
Purpose: The purpose of this study was to evaluate the efficacy of a four-session engagement, assessment, triage, and brief intervention strategy for high school students seeking or referred to school mental health (SMH) services. Findings from an IES development and innovation project (R305A120128) with a sample of 66 students showed that the Brief Intervention Strategy for School Clinicians (BRISC) promoted positive effects on a variety of outcomes, including mental health impairment, emotional symptoms, and coping skills. This study aimed to expand this research by examining effects of BRISC on mental health (MH) and academic outcomes in a large, multi-site trial. In addition, the study sought to evaluate BRISC's feasibility and acceptability as well as efficiency.
Project Activities: The research team recruited 48 high schools in three states (Washington, Maryland, and Minnesota) and randomly assigned them to BRISC (n=23) or school-based services as usual (SAU; n=25) using stratified blocked random assignment. They trained mental health clinicians and school counselors working in the experimental schools in how to implement the four-session BRISC model while practitioners in SAU schools continued to provide services as usual. Students were referred to school practitioners in both groups via typical referral pathways, received BRISC (n=259) or SAU (n=198) depending on their school's assignment, and were assessed at baseline and two and six months post-baseline by the research team. Practitioners and parents also completed measures over time. The researchers ran mixed effects regression models to assess within- and between-group differences on outcomes. The research team entered and analyzed data throughout the project and began disseminating findings to the field in November 2019. Given the positive findings and receipt of multiple requests for training, in 2020 the research team also began work on a web-based e-learning platform for BRISC to be made available to schools, districts, and SMH providers in late 2020 or early 2021.
Pre-registration site: https://clinicaltrials.gov ID: NCT03939208.
Key Outcomes: Additional information about key outcomes and study findings will be reported as peer reviewed publications are available.
Products: The results from this study provide evidence of BRISC's potential to improve mental health and behavioral outcomes for high school students. The study also provides evidence for BRISC's acceptability and feasibility, and its potential to affect the clinical practices of school mental health providers and improve the efficiency of SMH services. The research team is developing a BRISC e-learning platform that will be free and made widely available.
Setting: The study took place in 48 high schools located in urban, suburban, and rural locales within 13 districts in three states (Washington, Maryland, and Minnesota).
Sample: Within the 48 participating schools, high school students (grades 9-12) were referred to participating practitioners via typical referral pathways. Ultimately, 457 students participated, and either received BRISC (n=259) or SAU (n=198) depending on their school's assignment.
Intervention: BRISC is a four-session engagement, assessment, triage, and brief intervention strategy for high school students seeking or referred to school mental health (SMH) services. BRISC was designed to be responsive to the typical presenting problems of high school students, as well as their approach to help-seeking and their patterns of service participation. Clinicians using BRISC quickly assess the student's needs using a structured process and then engage the youth in problem solving around data-informed identified treatment goals. BRISC includes several evidence-based strategies (examples include communication skills, relaxation techniques, and cognitive restructuring) that can be used when problem solving alone is not successful. Systematic progress monitoring guides clinical decisions within BRISC, as well as "post-BRISC" decision support. Referral pathways after four sessions include: complete treatment, continue with periodic check-ins, continue SMH treatment, refer to school-based supports, or refer to more intensive or specialized MH services.
Research Design and Methods: Forty-eight high schools from three states (WA, MD, MN) were recruited and assigned to BRISC (n=23) or school-based services as usual (SAU; n=25) using stratified blocked random assignment. Mental health clinicians and school counselors working in schools in the experimental condition received training and consultation to implement the four-session BRISC model while practitioners in SAU schools provided services as usual. Typical referral pathways were used in all schools with 259 students receiving BRISC and 198 receiving SAU depending on their school's assignment. The research team assessed students at baseline and at two- and six-months post baseline. Practitioners and parents also completed measures over time.
Control Condition: Students referred to care by clinicians in schools assigned to the control condition received school mental health services as usual.
Key Measures: Researchers assessed mental health outcomes using standardized checklists for students, parents, and clinicians. They assessed student academic outcomes using student self-report and school records. Researchers collected data on service processes for both SAU and BRISC from clinicians and students and assessed fidelity of implementation via clinician self-report and coded recordings for a sample of sessions. Researchers also collected data from clinicians about feasibility and acceptability of BRISC as well as post-BRISC referrals.
Data Analytic Strategy: The researchers checked the data for baseline equivalence of the treatment and control groups as well as differential attrition between the groups. They used mixed effects regression modeling to assess within- and between-group differences on outcomes over time. They used qualitative coding and descriptive analyses to categorize self-reported top problems.
Related IES Projects: Brief Intervention for School Clinicians (R305A120128)
Project website: http://depts.washington.edu/uwsmart/programs-services/brisc/
Publications and Products
Publicly available data
The BRISC website will provide a description of available data, including an abbreviated data dictionary, and a data request portal. BRISC project data is available to interested researchers following the submission of a data request to the Principal Investigators. The formal protocol for data requests is designed to support high quality queries with sufficient safeguards and means of progress monitoring to avoid duplicating planned analyses by the study team or other researchers who have requested data.