Brief Intervention for School Clinicians
Co-Principal Investigators: Eric Bruns, Lucy Berliner, Shannon Dorsey, Doug Cheney, and Ann Vander Stoep
Purpose: Research indicates that youth who experience mental health problems, especially those who do not receive appropriate, timely intervention, are at risk for academic failure. School-based services can improve access to help for students in need and improve their emotional and behavioral functioning. Furthermore, school-based mental health services also seem to have the potential to enhance academic achievement. However, high school settings pose many challenges for the successful implementation of evidence-based mental health interventions. In this project researchers will develop, document the feasibility of, establish fidelity measures for, and pilot test a school-based mental health intervention designed for high schools, the Brief Intervention for School Clinicians (BRISC).
Project Activities: In this 3-year project, the researchers will first convene national and local experts to review and provide feedback on preliminary BRISC protocols. Based on this input, they will then conduct an initial implementation study to evaluate feasibility and inform the development of fidelity measures. In the second year, the researchers will conduct a validation study in public high schools with school-based health centers using a multiple case study design. In the final year, a small-scale randomized control trial will be used to test BRISC's potential for positive impact on student social, behavioral, mental health and academic outcomes.
Products: Products include the Brief Intervention for School Clinicians (BRISC), a school-based mental health intervention designed to reflect the unique characteristics of high schools. Description of the intervention and evidence of its promise to enhance student social, behavioral, mental health, and academic outcomes will be shared in peer reviewed publications.
Setting: The study will take place in a large urban center in Washington State.
Sample: Participants in all phases of the study will be school-based health center clinicians (approximately 16) and roughly 120 high school students seeking mental health services. Data will also be collected from a parent/guardian and teachers. Students will likely be 14-19 years of age and 60 percent female.
Intervention: The Brief Intervention for School Clinicians (BRISC) will be tailored to the school environment and characterized by five primary elements: (1) a systematic problem-solving approach to assist mental-health providers with identifying key intervention targets, testing solutions, and supporting positive student development; (2) a modularized approach to delivering specific mental health intervention components common to evidence-based practices (e.g., coping strategies, mood changing skills, cognitive restructuring, communication analysis, and problem solving); (3) a stepped care/tiered structure in which a brief empirically based intervention (BRISC) is implemented prior to more intensive, extended, or expensive treatments; (4) culturally informed treatment engagement and motivation strategies; and (5) systematic assessment and monitoring of student behaviors and emotional states including checks of symptoms, mood, academic success, completion of practice activities, and satisfaction with the treatment process.
Research Design and Methods: In Year 1 of the project, the research team will convene national and local experts to review and provide feedback on preliminary BRISC protocols. This input will be used to create a "beta" version of the BRISC protocol that will be implemented by 2 doctoral-level clinicians on the research team with 12 high school students. The goals of this initial implementation are to evaluate the BRISC protocol for feasibility and inform the development of fidelity measures. In Year 2, a validation study will be conducted in public high schools with 8 mental health clinicians who have experience working in school settings. These clinicians will be randomly assigned to either implement BRISC or to continue with delivery of services as usual. Outcomes for 24 students working with the 4 BRISC clinicians will be compared to outcomes for another 24 students who receive services as usual from the other 4 clinicians. In Year 3, a small-scale randomized control trial (RCT) with 60 students randomly assigned to BRISC or services as usual will be conducted to test BRISC's potential for positive impact on student mental health and academic outcomes. Students and clinicians will be interviewed throughout to obtain feedback that will inform the iterative development of the intervention.
Control Condition: Students in the control conditions in the validation study and in the RCT will receive mental health services that are typically provided through the school-based health centers in the high schools (i.e., services as usual).
Key Measures: Student social, behavioral and mental health outcomes will be assessed through the use of the Behavior Assessment System for Children-2 (BASC-2), the Columbia Impairment Scale (CIS), the Clinical Global Impressions Scale (CGI), and the Revised Ways of Coping Checklist (RWCC). Academic outcomes will be assessed through the Engagement in School-Teacher Rating Scale (EIS) and the participating school district's online resource for students, families, and teachers to access student attendance, discipline and academic achievement data. Treatment satisfaction will be assessed with the Youth Client Satisfaction Questionnaire (YCSQ). Process measures include the Therapy Process Observational Coding System-Strategies Scale and the Therapeutic Alliance Scale for Children (TASC).
Data Analytic Strategy: Descriptive analyses will be used to determine intervention feasibility and basic psychometric analyses will be used to validate fidelity measures. To determine BRISC's promise for improving student outcomes, the effects of BRISC versus services as usual at post-intervention will also be assessed using analysis of covariance for behaviors/emotions (BASC-2), therapeutic alliance (TASC) satisfaction (YCSQ), symptom severity (CGI), school engagement (EIS), functioning (CIS), and coping (RWCC). Mixed effects regression models will be used to examine attendance, homework, class participation, and disciplinary actions (level 1) clustered within students (level 2), and students clustered within clinicians (level 3). Additional covariates will be included in the model including baseline youth symptom severity, therapeutic alliance (TASC), and BRISC fidelity. For all analyses, the researchers will explore whether potential selection bias exists due to attrition. Data missing at random will be modeled using maximum likelihood estimation; data will be used from all students recruited, including students providing partial data.