Project Activities
In this 3-year project, the researchers first convened national and local experts to review and provide feedback on preliminary BRISC protocols. Based on this input, they conducted an initial implementation study to evaluate feasibility and inform the development of fidelity measures. In the second year, the researchers conducted 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 (RCT) was used to test BRISC's potential for positive impact on student social, behavioral, mental health, and academic outcomes.
Structured Abstract
Setting
The study took place in a large urban center in Washington State.
Sample
Participants were 21 school-based health center clinicians and 96 high school students seeking mental health services. Students were 14-19 years of age and the majority were female. Parents/guardians and teachers also provided data.
Intervention
The Brief Intervention for School Clinicians (BRISC) is 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 convened national and local experts to review and provide feedback on preliminary BRISC protocols. This input was used to create a "beta" version of the BRISC protocol that was implemented by doctoral-level clinicians on the research team with high school students. The goals of this initial implementation were to evaluate the BRISC protocol for feasibility and inform the development of fidelity measures. In Year 2, the researchers tested the validity of the BRISC protocol in public high schools with school-based mental health clinicians randomly assigned to implement BRISC or continue with delivery of services as usual. In Year 3, the researchers conducted a randomized controlled trial (RCT) to test BRISC's potential for positive impact on student mental health and academic outcomes. Students and clinicians were interviewed throughout to obtain feedback to inform the iterative development of the intervention.
Control condition
Students in the control conditions in the validation study and in the RCT received mental health services as 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 were 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 were 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 was assessed with the Youth Client Satisfaction Questionnaire (YCSQ). Process measures included the Therapy Process Observational Coding System-Strategies Scale and the Therapeutic Alliance Scale for Children (TASC).
Data analytic strategy
The researchers used descriptive analyses to determine intervention feasibility and basic psychometric analyses to validate fidelity measures. To determine BRISC's promise for improving student outcomes, the effects of BRISC versus services as usual at post-intervention were 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 were 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 were included in the model including baseline youth symptom severity, therapeutic alliance (TASC), and BRISC fidelity. For all analyses, the researchers checked for potential selection bias due to attrition. Data missing at random was modeled using maximum likelihood estimation; the researchers used all student data including students providing partial data.
People and institutions involved
IES program contact(s)
Products and publications
Journal article, monograph, or newsletter
Bruns, E.J., Duong, M., Lyon, A.R., Pullman, M.D., Cook, C., and McCauley, E. (2016). Fostering SMART Partnerships to Develop Integrated Behavioral Health Services in Schools. American Journal of Orthopsychiatry, 86 (2): 156–170.
Bruns, E.J., Pullmann, M.D., Nicodimos, S., Lyon, A. R., Ludwig, K., Namkung, N., and McCauley, E. (2019). Pilot Test of an Engagement, Triage, and Brief Intervention Strategy for School Mental Health. School Mental Health 11, 148–162. https://doi.org/10.1007/s12310-018-9277-0
Lyon, A.R., Bruns, E.J., Ludwig, K., Vander Stoep, A., Pullmann, M.D., Dorsey, S., Eaton, J., Hendrix, E., and McCauley, E. (2015). The Brief Intervention for School Clinicians (BRISC): A Mixed-Methods Evaluation of Feasibility, Acceptability, and Contextual Appropriateness. School Mental Health, 7 (4): 273–286.
Lyon, A.R., Bruns, E.J., Weathers, E.S., Canavas, N., Ludwig, K., Vander Stoep, A., Cheney, D., and McCauley, E. (2014). Taking EBPs to school: Developing and Testing a Framework for Applying Common Elements of Evidence Based Practice to School Mental Health. Advances in School Mental Health Promotion, 7 (1): 42–61.
Lyon, A.R., Lau, A., McCauley, E., Vander Stoep, A., and Chorpita, B.F. (2014). A Case for Modular Design: Implications for Implementing Evidence-Based Interventions With Culturally-Diverse Youth. Professional Psychology: Research and Practice, 45 (1): 57–66.
Lyon, A.R., Ludwig, K., Romano, E., Koltracht, J., Vander Stoep, A., and McCauley, E. (2014). Using Modular Psychotherapy in School Mental Health: Provider Perspectives on Intervention-Setting fit. Journal of Clinical Child and Adolescent Psychology, 43 (6): 890–901.
Whitaker, K., Fortier, A., Bruns, E. J., Nicodimos, S., Ludwig, K., Lyon, A. R., ... & McCauley, E. (2018). How do School Mental Health Services Vary Across Contexts? Lessons Learned From Two Efforts to Implement a Research-Based Strategy. School Mental Health, 1–13.
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Supplemental information
Co-Principal Investigators: Bruns, Eric; Berliner, Lucy; Dorsey, Shannon; Cheney, Doug; and Vander Stoep, Ann
- The project team developed BRISC, a 4-session assessment, engagement, triage, and initial intervention strategy for mental health clinicians working in high schools.
- BRISC is feasible, acceptable, and appropriate to the high school context.
- In the pilot RCT, BRISC was implemented with fidelity and was feasible and acceptable to both clinicians and students. BRISC students showed greater reduction in depression and anxiety symptoms, but similar academic outcomes, to students receiving services as usual. After four sessions, the majority of BRISC students were discharged without need for continued services, suggesting it could promote efficiency.
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