IES Blog

In honor of Mental Health Awareness Month, NCSER is featuring an IES-funded study on student behavioral supports and interventions that best address the mental health needs of students. Positive Behavioral Interventions and Supports (PBIS) and school mental health (SMH) are both evidence-based interventions that provide student mental health support independent of one another. For this blog, we interviewed Dr. Brandon Schultz, principal investigator of a current study investigating the integration of both PBIS and SMH into a comprehensive school intervention. In the interview below, he discusses the differences between PBIS and SMH, how this research contributes to equity and inclusion in the classroom, and his research journey.

Your study is comparing schools that integrate PBIS and SMH into the enhanced version of the Interconnected Systems Framework (ISF) to schools that implement these as separate, parallel systems. Can you describe PBIS and SMH, and explain the key differences between the integrated framework and parallel systems?

PBIS is a tiered prevention system that addresses student behavioral needs. It provides universal support (Tier 1) to all students, including clear schoolwide behavioral expectations and a rewards system for desired behaviors. For students who do not respond to these efforts, Tier 2 provides targeted help through classroom-level or small group interventions, such as teacher consultation or student mentoring/counseling. For students who need intensive support, Tier 3 provides specialized one-to-one behavioral services. SMH, in contrast, focuses specifically on mental illnesses (for example, anxiety, trauma, depression) and, in some cases, involves community-based therapists working contractually with schools. Typically, PBIS and SMH function separately as co-located services, but there is a growing recognition that student needs are best met when these efforts are meaningfully integrated. Integration, however, is challenging because it requires educators to rethink their teaming and progress monitoring practices and include different stakeholders in critical decision-making processes. This study tests innovations to the ISF model, designed by my co-PI, Dr. Mark Weist (University of South Carolina), to meet the challenges of integrating these systems in two diverse school districts.

How did you become interested in this area of research?

My previous research was mostly focused on school-based interventions for students with ADHD, but it became clear that without systems-level change, interventions meant to help students with ADHD are unlikely to be implemented or sustained effectively, no matter how well they are designed. So, I became interested in understanding school systems and identifying the elements, processes, and resources that are critical for student support services of all kinds. 

How does your research contribute to equity and inclusion in education?

Part of my current study is focused the degree to which innovations to the ISF model can reduce racial inequities in school disciplinary actions. Research shows that Black students receive higher rates of exclusionary punishments (for example, suspensions and expulsions) than their White counterparts, even after controlling for the type of infraction. The modified ISF model aims to reduce the overall need for exclusionary punishments, especially among students of color. By improving team functioning, ISF allows educators to identify systemic problems that lead to racial inequities in disciplinary referrals and to generate new strategies to address student needs in a fair and equitable manner. With this model, we anticipate increased support for students of color that obviates disciplinary referrals. We are working with school districts now to examine disciplinary data before, during, and after the implementation of the enhanced ISF. Our hope is to identify strategies that close race-related gaps and share the lessons learned broadly.

Have you encountered any challenges in studying this integrated framework in elementary schools?

Yes, absolutely. Systems-level change in general is difficult, as it requires change agents to overcome structural inertia rooted in local norms, routines, and expectations. Those challenges have been exacerbated by the COVID-19 pandemic and preexisting trends in childhood mental illnesses. 

During the pandemic, student progress in mathematics and reading have dramatically declined. Meeting these academic needs, a priority for teachers, can divert attention away from student mental health needs. For example, all teachers in one of our states are required to take a year-long online course in reading instruction, partly to address student learning loss. Although commendable, this requirement creates a significant burden for teachers that can leave little room for other concerns. 

Preexisting mental health trends demonstrate that mental illness was increasing sharply among school-age children; by 2018, nearly 15% of all K-12 students experienced a psychiatric condition each year. Then, with the onset of the pandemic, indicators of childhood mental illness (for example, emergency room visits for suicidal behavior) spiked. Childhood anxiety and depression doubled worldwide from pre-pandemic estimates, and it is unclear whether those rates will return to baseline.

Together, these events have created real challenges, not just for our research, but for student support services in general.

What is currently the greatest area of need in studying school-based systems that support student mental health, particularly for those students with or at risk for emotional and behavioral disorders?

Perhaps the greatest area of need for supporting students with emotional and behavioral disorders is understaffing in critical school mental health positions. There is a significant shortage of school psychologists, counselors, social workers, and nurses nationwide. In North Carolina, the current ratio of school psychologists to students is 1:2,527, five times higher than recommended. This understaffing hinders schools’ ability to provide high-quality services and complicates efforts to test and refine innovative practices because field-based practitioners are unable to collaborate on research efforts. Researchers have had to hire individuals to fulfill critical roles, such as behavioral consultants, that might otherwise have been assigned to district-employed staff. Trained personnel then exit the school district when the research project ends and that skillset is lost. We hope that states prioritize the hiring of school mental health practitioners in the coming years to ensure optimal student support services and that university-school research collaborations can reliably lead to sustainable innovations.

NCSER looks forward to seeing the results of this efficacy trial and will continue to fund research aimed at supporting the mental health and social-emotional-behavioral needs of students with or at risk for disabilities.

This blog was authored by Isabelle Saillard, student volunteer for NCSER and undergraduate at the University of Virginia.

In May 2021, we launched a new blog series called Spotlight on School-based Mental Health to unpack the why, what, when, who, and where of providing mental health services in schools. This first post in the series focuses on the why by discussing three IES-funded projects that highlight the importance of these services.

Increasing access to needed services. A primary benefit of school-based mental health is that it can increase access to much-needed services. A 2019 report from the Substance Abuse and Mental Health Services Administration (SAMSHA) indicates that 60% of the nearly 4 million 12- to 17-year-olds who reported a major depressive episode in the past year did not receive any treatment whatsoever. What can be done to address this need? One idea being tested in this 2019 efficacy replication study is whether school counselors with clinician support can provide high school students a telehealth version of a tier-2 depression prevention program with prior evidence of efficacy, Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST). Through individual and group sessions, the IPT-AST program provides direct instruction in communication and interpersonal problem-solving strategies to decrease conflict, increase support, and improve social functioning.   

Improving access to services for Black youth. Social anxiety (SA) is a debilitating fear of negative evaluation in performance and social situations that can make school a particularly challenging environment. The connection between SA and impaired school functioning is likely exacerbated in Black youth who often contend with negative racial stereotypes. In this 2020 development and innovation project, the research team aims to expand Black youth’s access to mental health services by improving the contextual and cultural relevance of a promising school-based social anxiety intervention, the Skills for Academic and Social Success (SASS). Through community partnerships, focus groups, and interviews, the team will make cultural and structural changes to SASS and add strategies to engage Black students in urban high schools who experience social anxiety.

Reducing stigma by promoting well-being. The second leading barrier cited by adolescents for not seeking mental health treatment include social factors such as perceived stigma and embarrassment. One way to counteract these barriers is to frame intervention in more positive terms with a focus on subjective well-being, a central construct in positive psychology. In this 2020 initial efficacy study, the research team is testing the Well-Being Promotion Program in middle schools in Florida and Massachusetts. In 10 core sessions, students low in subjective well-being take part in group activities and complete homework assignments designed to increase gratitude, acts of kindness, use of signature character strengths, savoring of positive experiences, optimism, and hopeful or goal-directed thinking.

These three projects illustrate why we need to carefully consider school-based mental health as a logical and critical part of success in school, particularly as we navigate the road to helping students recover from disengagement and learning loss during the coronavirus pandemic.  

Next in the series, we will look at the what of school-based mental health and highlight several projects that are developing innovative ways to support the mental health of students and staff in school settings.

Written by Emily Doolittle (Emily.Doolittle@ed.gov), NCER Team Lead for Social Behavioral Research at IES

The ED Games Expo is an annual showcase of game-changing innovations in education technology developed through programs at ED and across the federal government. Since 2013, the Expo has been an in-person event at venues across Washington, D.C. Because of COVID-19, the 2021 Expo will be an entirely virtual experience from June 1 to 5.

This year, the Expo will showcase more than 160 learning games and technologies and feature 35 different virtual EdTech events of interest to a broad audience of viewers. See the Agenda for the lineup for the Ed Games Expo.

ED Games Expo: Featuring INSIGHTS into Children’s Temperament

INSIGHTS into Children’s Temperament, an IES-supported intervention, is being featured at the Expo this year. INSIGHTS supports children’s social-emotional development and academic learning by helping teachers and parents see how differences in children’s behavior might reflect temperament/personality. Children work with the INSIGHTS puppets and learn that other children and adults react differently to the same situation due to their temperaments. IES has supported two randomized controlled trials (RCTs, the “gold standard” for claims of impact) of INSIGHTS – one in New York City and the other (ongoing) in rural Nebraska. Evidence from the NYC RCT and a longitudinal follow up indicate that children who participate in the INSIGHTS program during early elementary school experience better academic and social behavioral outcomes immediately following participation in the program, and these positive impacts persist into middle school. 

During the 2020 ED Games Expo, Sandee McClowry and her team performed an INSIGHTS lesson at the Kennedy Center to hundreds of attendees, including children, students, and families. INSIGHTS will be featured in this year’s ED Games Expo in three ways.

• Tuesday, June 1 at 8PM Eastern: There will be an “ED Games Expo Kick Off Show” hosted by the puppets from the INSIGHTS intervention and the characters from the Between the Lions children’s television program. All of the characters will share information about the ED Games Expo while having a lot of fun and hijinks on a road trip to Washington, DC.  The Show will be introduced by the Secretary of Education, Miguel Cardona, and will also feature cameo appearances by IES, ED, and government team members.
• Wednesday, June 2 from 9PM to 9:45PM Eastern: Sandee McClowry will be hosting a Master Class for Educators. The event will introduce all of the INSIGHTS friends, including Coretta the Cautious, Gregory the Grumpy, Fredrico the Friendly, and Hilary the Hard Worker. The video will provide practical guidance to educators on how to deliver the intervention in a classroom. The event will conclude with a rich and engaging discussion with expert practitioners about how INSIGHTS addresses the social and emotional learning of children, educators, and parents. Click Here to access the YouTube broadcast of the Master Class and set a reminder to watch on June 1.
• Materials from INSIGHTS, including puppets that can be printed out and professional development resources for educators, will be available to try out during the Expo and in the month of June.

For URL links to watch the ED Games Expo Kick Off Show and Master Class for Educators, See the Agenda. For more information and on how to access the resources INSIGHTS intervention, see the website.

Written by Emily Doolittle (Emily.Doolittle@ed.gov), NCER Team Lead for Social Behavioral Research at IES

This May as we recognize National Mental Health Awareness Month, schools around the country are welcoming students and educators back for in-person instruction after more than a year of remote or hybrid teaching and learning. One issue schools must consider during this transition back is the increase in mental health concerns among adults, young adults, and adolescents this past year. Here at IES, we support research that explores, develops, and tests innovative, field-initiated approaches to support mental health in schools and classrooms. This new IES blog series will explore school-based mental health by looking at IES-funded research that helps answer the five Ws:

• Why school-based mental health? The first blog in the series will consider the benefits of school-based mental health such as providing increased access to services, especially for children of color, and potentially counteracting the stigma some associate with mental health treatment.

• What can schools do to support the mental health of their students and staff? The second blog in the series will highlight several projects that are developing innovative new ways to provide mental health services in school settings.

• When during the school day can schools implement these mental health practices so that they do not compete with the academic/instructional goals of school? The third blog in the series will highlight a variety of projects that delve into the implementation challenges inherent to providing school-based mental health services and support.

• Who in the school should implement these mental health practices? The fourth blog in the series will explore the critical scale up challenge for schools of having staff with adequate time who can be appropriately trained to provide mental health supports to students.

• Where can these mental health practices be implemented? The final blog in the series will investigate the implementation challenges of different education settings (PreK, elementary, middle, high school, postsecondary) for school-based mental health programs and practices.  

See these blogs for more information about some of the school-based mental health research supported through the two IES research centers, the National Center for Education Research (NCER) and the National Center for Special Education Research (NCSER).  

Written by Emily Doolittle (Emily.Doolittle@ed.gov), NCER Team Lead for Social Behavioral Research at IES

Many elementary school students experience anxiety that interferes with learning and achievement, but few receive services. To expand the network of support for these young students, IES-funded researchers have turned to school nurses as a potential front-line resource. The Child Anxiety Learning Modules (CALM) intervention incorporates cognitive-behavioral therapy (CBT) and other evidence-based strategies for school nurses to use when a child has vague somatic complaints that often signal underlying anxiety.

In 2014, IES funded a Development and Innovation grant to support the development of CALM to enhance the capacity of elementary school nurses to help children with anxiety. Based on promising findings of feasibility and reduced anxiety and fewer school absences, the development team is launching an initial efficacy trial this fall to investigate the scale up potential of the CALM intervention.

We asked the developers of CALM—Golda Ginsburg (University of Connecticut School of Medicine) and Kelly Drake (Founder/Director of the Anxiety Treatment Center of Maryland; Johns Hopkins University School of Medicine)—to answer a few questions for our blog. Here’s what they answered.

Can you describe how the CALM intervention was developed? What led you to develop an intervention for school nurses to implement?

We have been developing and evaluating psychosocial interventions for youth with anxiety for the last two decades, and we’ve learned a lot about effective, evidence-based strategies. We know that CBT, which consists of coping strategies that target the physical, cognitive, and behavioral manifestations of anxiety, is effective in helping youth manage and reduce anxiety. Unfortunately, we’ve also learned that most youth do not receive these—or any—services to help them. To address this gap in service utilization, our efforts have focused on ways of improving access to these therapeutic strategies by broadening the pool of potential providers. Given that early interventions can reduce the long-term consequences of untreated anxiety AND that youth with anxiety often complain of troublesome physical symptoms at school, we naturally thought of school nurses as a key provider with enormous potential. However, although nurses reported spending a lot of time addressing mental health issues, they received minimal training in doing so. That’s when the idea of the CALM intervention was born. We developed the initial CALM intervention using an iterative process in which versions of the intervention and its implementation procedures were sequentially refined in response to feedback from expert consultants, school nurses, children, parents, and school personnel until it was usable in the school environment by school nurses.

Was it part of the original plan to develop an intervention that could one day be used at scale in schools?

Yes—absolutely! Members of the National Association of School Nurses have been on our advisory team throughout to help us plan for how to scale up the intervention if we find it helps students.

What was critical to consider during the research to practice process?

A central focus was to minimize burden on school staff and to integrate the intervention within the goals and mission of schools’ interdisciplinary teams. Therefore, using a multidisciplinary support team was critical in taking the intervention from a research idea to an intervention that school nurses could delivered in their real-world practice setting—schools! As clinical psychologists, we also relied on our multidisciplinary team to ensure the intervention was usable by school nurses in terms of content and flexible and feasible for their busy school day. Indeed, school nurses and school nurse organizations provided critical support for the development of CALM with a focus on feasible strategies and methods for nurses to implement. They also provided invaluable feedback regarding perceived barriers to successful implementation of the intervention and adoption by nurses and school systems, and solutions to potential barriers and options for scaling up the intervention. We also relied on experts in school-based mental health programs and those with expertise in designing, evaluating, and implementing evidence-based prevention programs in schools. We also leveraged state-level expertise by consulting with school health experts in the Connecticut State Department of Education and the Connecticut Nurses Association regarding mental health education for nurses.

What model are you using for dissemination and sustainability?

A wide variety of methods will be used to disseminate findings from the current study to reach different stakeholders. We will present and publish findings at 1) national scientific and practitioner-oriented conferences, 2) Maryland and Connecticut State Departments of Education and participating school districts, and 3) in relevant peer-reviewed journals. In addition, should the findings reveal a beneficial impact of the intervention, we will have the final empirically supported training and intervention materials available for broad scale implementation. The CALM intervention will be packaged to include a training seminar, training videos, nurse intervention manual, child intervention handouts, consultation/coaching plan, and assessment materials. The research team will offer training seminars with all supporting materials to school nurse organizations at the national, state, and local levels. We will also engage nurse supervisors to identify nurses—or volunteer themselves—to become trainers for newly hired nurses in the future. Finally, our current Advisory Board, which consists of members of the National Association of School Nurses (NASN), school nurses, and researchers with expertise in large scale school-based mental health program implementation and evaluation, will assist in broad dissemination and sustainability efforts.

Golda S. Ginsburg, Ph.D., Professor of Psychiatry, University of Connecticut School of Medicine and Adjunct Professor at The Johns Hopkins University School of Medicine, has over 25 years of experience developing and evaluating school-based interventions including school-based interventions for anxiety delivered by school clinicians, teachers, and nurses.

Kelly Drake, Ph.D., Founder/Director of the Anxiety Treatment Center of Maryland, Research Consultant with UConn, and Assistant Professor of Psychiatry in the JHU School of Medicine has extensive training and experience in clinical research with anxious youth and training clinicians in delivering CBT for children.

This interview was produced by Emily Doolittle (Emily.doolittle@ed.gov) of the Institute of Education Sciences. This is part of an ongoing interview series with education researchers, developers, and partners who have successfully advanced IES-funded education research from the university laboratory to practice at scale.