Fostering SMART partnerships to develop an effective continuum of behavioral health services and supports in schools.

Abstract

The education sector offers compelling opportunities to address the shortcomings of traditional mental health delivery systems and to prevent and treat youth mental, emotional, and behavioral (MEB) problems. Recognizing that social and emotional wellness is intrinsically related to academic success, schools are moving to adopt multi-tier frameworks based on the public health model that provide a continuum of services to all children, including services to address both academic and MEB problems. In this paper, we review the potential value of multi-tier frameworks in facilitating access to, and increasing the effectiveness of, mental health services in schools and review the empirical support for school-based mental health interventions by tier. We go on to describe a community-academic partnership between the Seattle Public Schools and the University of Washington School Mental Health Assessment, Research, and Training (SMART) Center that exemplifies how multi-tier educational frameworks, research and evidence, and purposeful collaboration can combine to improve development and implementation of a range of school-based strategies focused on MEB needs of students. Finally, we present a set of 10 recommendations that may help guide other research and practice improvement efforts to address MEB problems in youth through effective school mental health programming.

Collaborative care in schools: enhancing integration and impact in youth mental health

“…A growing number of schools offer population-based services through Multi-Tiered Systems of Support (MTSS), an integrative framework for organizing school-based approaches to preventing and addressing emotional and behavioral as well as academic problems (Bruns et al, 2016; Fazel, Hoagwood, et al, 2014). MTSS is intended to provide a continuum of care that emphasizes evidence-based services, progress monitoring, and data-driven decision making based on student needs.…”

“…In MTSS, Tier 1 interventions are delivered to all students and students who are identified as needing additional help receive targeted support at Tier 2. Those who continue to struggle after receiving secondary-level supports are provided with intensive, individualized, Tier 3 interventions (Bruns et al, 2016). CC begins its stepped care approach with a caseload of service recipients who receive brief, relatively inexpensive interventions (that approximate the focus of Tier 2) before advancing to more intensive services reminiscent of Tier 3.…”

“…Furthermore, far fewer studies and less guidance is available to inform Tier 2 and 3 services (Bruns et al, 2016) and a significant gap between “what works” and what actually gets implemented, particularly in relation to school-based mental health, remains (Forman et al, 2013; Owens et al, 2014). Integration of components of the CC approach, such as navigating entry into appropriate services, delivering a continuum of selective and indicated behavioral health supports, and systematizing effective behavioral health progress monitoring, could facilitate achievement of MTSS objectives.…”

“…Redefining professional roles by shifting some tasks to other (less expensive or more accessible) service providers is an implementation strategy with growing enthusiasm and empirical support (Murray et al, 2014; Patel, 2009; Powell et al, 2012, 2015). Although there may be variability in the extent to which different service providers are interested in adopting new roles, authors have begun to point out the promise of this approach for SBMH (Bruns et al, 2016; Fazel, Patel, Thomas, & Tol, 2014; Owens et al, 2014). Mapping indigenous service providers’ roles to determine who may be situated to deliver components of the CC model in schools represents an important future step for continued research.…”

“…Barriers include continued stigma surrounding mental health treatment (Bowers, Manion, Papadopoulos, & Gauvreau, 2013), an insufficiently sized SBMH workforce to address the service needs of school populations (Lyon, Maras, Pate, Igusa, & VanderStoep, 2015), and low use of high-quality, evidence-based practices (EBP) among existing school practitioners (Owens et al, 2014). Greater use of integrated approaches for providing mental health care in schools could substantially improve mental, emotional, behavioral, and academic outcomes for youth by improving the effectiveness, efficiency, and contextual appropriateness of education sector services (Atkins, Hoagwood, Kutash, & Seidman, 2010; Bruns et al, 2016; Stephan, Mulloy, & Brey, 2011). …”