Sustainment of Mental Health Supports in Under-Resourced Urban Schools

PROJECT SUMMARY / ABSTRACT The school is a key setting for the delivery of mental health services to children. School-wide positive behavior interventions and supports (PBIS), a service delivery strategy based on the public health model, is a useful vehicle for implementing mental health EBPs. In PBIS, schools implement universal (Tier 1) interventions to improve school climate and safety, and can employ targeted (Tier 2) group interventions for children with or at risk for mental health disorders. Very little research has been conducted on using mental health EBPs at Tier 2. Adequate and ongoing training opportunities are frequently identified as “essential practices” needed to successfully sustain the benefits of interventions. School personnel, with or without prior mental health training, can implement Tier 2 interventions with fidelity and clinical effectiveness when provided adequate support. School mental health programs that successfully implement targeted group interventions often use ongoing supervision from internal supervisors. A number of studies have shown that more experienced school personnel can successfully be trained to serve as coaches and supervisors for those implementing EBPs. In order for these schools to receive the potential public mental health benefits of targeted mental health interventions in schools, an efficient, scalable, cost-effective and sustainable model of training and consultation that can be transferred from experts to school coaches and from coaches to EBP implementers is needed. Little is known about which models of support for sustainment are effective, feasible, and cost-effective. The aims of the study are (a) to compare fidelity, cost-effectiveness, and student outcomes of Tier 2 mental health interventions across 2 sustainment conditions, (b) assess mediators and moderators of consultation support on implementation fidelity, and (c) assess perceived feasibility and acceptability of consultation support. The study proposes to use a 2-arm, randomized controlled trial, Type 2 Hybrid cluster randomized design. Sixty school personnel from 12 schools will receive full initial implementation support for 1 year and then will be randomly assigned to receive one of 2 sustainment conditions: (a) remote consultation provided by school district coaches who themselves will be receiving remote support from expert external consultants (Sustainment 1 [S1]); and (b) consultation as usual provided by district coaches with no external support (Sustainment 2 [S2]). S1 will have a period of diminished support followed by a period of no support. The interventions to be implemented by school personnel are EBPs for the most common externalizing and internalizing mental health disorders. Our guiding framework is the Interactive Systems Framework (ISF) for dissemination and implementation research. The results of the proposed study will provide a scalable and cost- effective strategy for the sustainment of PBIS mental health supports in under-resourced schools.