Efficacy of a Brief Intervention Strategy for School Mental Health Clinicians
Co-Principal Investigator: Elizabeth McCauley
Purpose: The purpose of this study is to examine the efficacy of the Brief Intervention Strategy for School Clinicians (BRISC) by assessing its impact on mental health and academic outcomes of high-school students in a large, multi-site trial. Findings from previous IES research (R305A120128, Brief Intervention for School Clinicians) show that in a sample of 66 students, the BRISC has positive effects on a variety of outcomes, including mental health impairment, emotional symptoms, and coping skills.
Project Activities: The project will begin with the research team recruiting schools, randomly assigning them to a condition (BRISC or no BRISC), and training the relevant personnel to implement the intervention. Researchers will interview participating students prior to initial treatment, weekly throughout the intervention period, at the end of the intervention period, and then twice more at bimonthly intervals. The team will collect academic outcomes through 12 months post-enrollment. They will interview parents prior to the intervention, immediately post-intervention, and then again 4 months later. Researchers will collect data on fidelity of implementation throughout the intervention period in both the treatment and the services as usual (SAU) groups. The research team will be entering and analyzing data throughout the project, with dissemination activities primarily occurring during Year 3 of the project.
Products: The results from this study will provide evidence of the BRISC's potential to improve mental health, behavioral, and academic outcomes for high-school students. The study will also provide evidence for BRISC's potential to affect the clinical practices of school mental health providers and the dynamic between clinicians and students. Researchers will also produce peer-reviewed conference presentations and journal manuscripts.
Setting: This study will take place in public high schools serving urban, suburban, and rural communities in 13 districts in Minnesota, Maryland, and Washington.
Sample: For the first 3 months of 2017, researchers will recruit up to 10 students in each of 52 high schools from students who are referred to or seek school mental health services for the first time in the 2016–2017 academic year. If a school has not had 10 students recruited for the study by April 1, 2017, then recruitment in that school will resume in the following academic year until the sample size for that school reaches 10 students.
Intervention: The BRISC is a brief, evidence-based, and flexible intervention tailored to the presenting problems of high-school students, as well as their approach to help-seeking and their patterns of service participations. Clinicians using the 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. Motivational interviewing, cognitive restructuring, relaxation, and communication skills are used to ensure the student's success. Systematic progress monitoring guides clinical decisions within the BRISC and referral to alternative services across school-wide tiers of support as needed.
Research Design and Methods: Researchers are implementing a cluster randomized trial, with schools randomly assigned to conditions. Each school has one clinician, so randomly assigning schools is tantamount to randomly assigning clinicians. Early in 2017, 52 high schools will be randomly assigned to BRISC or school-based mental health services as usual (SAU). Across two school years researchers will enroll 10 students per clinician who were referred to receive mental health services. The research team will use longitudinal data collection with students and parents, analyses of school records, implementation measures, and clinician and administrator surveys/ interviews to evaluate between-group differences on outcomes, moderators and mediators of outcome, and feasibility/acceptability/costs of the BRISC.
Control Condition: Students referred to care by clinicians in schools assigned to the control condition will receive school mental health services as usual.
Key Measures: Researchers will assess mental health outcomes using standardized checklists for students, parents, and clinicians. They will assess student academic outcomes using student self-report and school records. Researchers will collect data on service processes for both SAU and BRISC, along with fidelity of implementation data, using clinician self-report and coded recordings for a sample of sessions.
Data Analytic Strategy: The data will initially be checked for baseline equivalence of the treatment and control groups as well as any differential attrition between the groups. Researchers will address the primary research questions using multilevel growth modeling.