Sustainment of Mental Health Supports

Sustainment of Mental Health Supports in Under-Resourced Urban Schools

Schools need sustainable systems to improve climate and address student mental health. This study compares two sustainment models for Tier 2 mental health interventions within a Positive Behavioral Interventions and Support (PBIS) framework. Using a 2-arm, cluster randomized Type-2 Hybrid trial, 12 urban public schools participated over three years each. School district intervention Implementers (e.g., school counselors) and district-level coaches participated throughout the study, while Tier 2 Team Members (e.g., social workers, behavioral health staff) were involved during the initial implementation phase only. Primary outcomes include fidelity, penetration, cost, and student outcomes (mental health and academic engagement) for evidence-based practices (Coping Power Program [CPP]; Cognitive Behavioral Therapy [CBT] for Anxiety Treatment in Schools [CATS]).

Inclusion Criteria:

• Schools: Any school in the participating urban, public school district already implementing Positive Behavioral Interventions and Supports (PBIS).
• Tier 2 Team Members: Any staff from participating schools involved in the PBIS leadership team at that school.
• Tier 2 Implementers: Any Masters-level staff assigned by their school's principal to deliver Tier 2 interventions.
• Tier 2 Coaches: Any Masters-level clinician employed by the school district to support staff implementing Tier 2 interventions
• Students: Any student at participating schools in grades 4-8 who scores above > 1 standard deviation (SD) above the mean on the Emotional Symptoms or Conduct Problems scales of the Strengths and Difficulties Questionnaire (SDQ), plus Impact Supplement scores of 1 (A medium amount) or 2 (A great deal), completed by a parent or a teacher. Then, based on the student's score (Emotional Symptoms=internalizing symptoms, Conduct Problems=externalizing symptoms), the teacher must complete the Social, Academic, and Emotional Behavioral Risk Screener (SAEBRS), which is the school district's standard screening criteria for Tier 2 services for externalizing behaviors, or the child must complete the Screen for Child Anxiety Related Disorders (SCARED) for interlaizing behaviors. Based on these scores, the student is eligible to enroll in the intervention.

Exclusion Criteria:

• Schools: Any schools not currently implementing PBIS at Tier 1.
• Tier 2 Team Members and Implementers: Any school personnel that are not involved in the leadership team or Tier 2 team.
• Students: Any student with a Special Education classification of "Intellectual Disability," or with a history of psychotic or autistic spectrum disorders, according to school records, will be excluded because they would be unlikely to benefit from our Tier 2 interventions, as they were not designed for these demographics.