Student Outcomes of Integrative Mental Health Services
Purpose: There is a growing need for school-based interventions to address the behavioral and academic challenges of the growing number of students who experience mental health problems. Although many evidence-based mental health interventions are being implemented in schools, they tend to address a single mental health disorder (e.g., anxiety) and do not adequately address the complex, multiple problems facing many children in schools. One evidence-based intervention, ChildSTEPS, is a flexible, integrative, modular approach to psychotherapy that provides school clinicians with an approach that integrates multiple evidence-based practices for multiple child problems. Prior research indicated ChildSTEPS was more effective than usual treatment for improving mental health outcomes. The purpose of this study is to further explore the efficacy of ChildSTEPS by assessing its impact on mental health and academic outcomes.
Project Activities: Elementary age students referred for school-based mental health intervention will be randomly assigned to receive the ChildSTEPS intervention or to a services-as-usual condition. Student assessments will be conducted at pre-treatment, weekly throughout treatment, monthly throughout treatment, at immediate post-treatment, and at 6-months post-treatment. Researchers will use multiple measures to assess student behavioral and academic outcomes. Researchers will also examine factors that moderate or mediate the impact of the intervention on student outcomes.
Products: The products of this project will be evidence of the efficacy of the ChildSTEPS intervention program. Peer reviewed publications will also be produced.
Setting: The study will take place in eight elementary schools in a large urban district in the Boston area.
Sample: The sample will consist of approximately 200 students in grades 3-7, ages 7-13. All students have been referred for mental health services.
Intervention: The ChildSTEPS program has two components: 1) an integrative, flexible protocol which includes evidence-based interventions using treatment modules that provide guidance for treating students for multiple mental health diagnoses, and 2) an online system that provides clinicians weekly feedback on child treatment response. The program can be used for a variety of mental health disorders, and the modules can be adjusted for use in varied lengths of time and allow clinicians to choose the order in which to use them, based on student need.
Control Condition: Students in the control group will receive mental health services typically provided by the schools.
Research Design and Methods: Researchers will address three main questions: (1) What is the impact of Child STEPs, compared to usual services, on student mental health? (2) What is the impact of Child STEPs, compared to usual care, on students’ school-related outcomes (e.g., attendance, engagement, academic skills, and discipline problems)? (3) Are the effects of Child STEPs on students’ school-related outcomes mediated by changes in student mental health?
Elementary age students referred for school-based mental health intervention will be randomly assigned to receive the ChildSTEPS intervention or to a services as usual condition. Researchers will recruit approximately 70 students per year for three years to participate in the study. The study will use double block randomization, with both clinicians and students randomly assigned to the treatment or control groups. Student assessments will be conducted at pretreatment, weekly throughout treatment, monthly throughout treatment, at immediate post treatment, and at 6-months post-treatment. Researchers will also examine factors that moderate or mediate the impact of the intervention on student outcomes.
Key Measures: A variety of outcome measures will be used to assess mental health, school functioning, and academic outcomes. Mental health outcomes will be assessed using standardized checklists completed by students, clinicians, caregivers, and teachers (e.g. the Post Traumatic Stress Disorder Index). School functioning will be assessed using record reviews, attendance reports, and office referral rates. Academic outcomes will be assessed using record reviews, reports from teachers and students, and the School Engagement Measure. The researchers will collect data on fidelity of implementation of ChildSTEPS using coded observations. They will also collect data on moderators (student gender and ethnicity, initial problem severity, and clinician type) and one mediator (whether changes in school functioning are mediated by changes in mental health).
Data Analytic Strategy: The researchers will use a variety of analytic strategies including multilevel modeling with repeated measures (Level 1) nested within students (Level 2) who are nested within therapists (Level 3). Researchers will use latent variable regressions to determine the effects of ChildSTEPS on improving mental health and academic outcomes. In addition, the research team will also explore moderators and mediators of intervention effects.