The mental health needs of children and youth are well-documented as an underaddressed and significant public health need in the United States. A number of barriers prevent children, youth, and families from accessing behavioral health services in standard clinic settings, including lack of sufficient transportation, cost, and stigma related to receiving services. School behavioral health (SBH) programs—in which community mental health providers join school teams to better address the social, emotional/behavioral, and academic needs of students—are growing in the United States because of their ability to reach youth who need, but may not otherwise receive, services. However, these efforts are limited by a lack of patient and stakeholder engagement. This has commonly resulted in SBH programs being not implemented, implemented inconsistently, or underutilized. The study will compare an evidence-based Patient-Centered Enhancements (PCE) intervention added to an evidence-based framework termed Clinical Services Supports (CSS) in a three-year intervention for students in middle schools. We predict the addition of the PCE intervention will improve school climate and enhance SBH services, resulting in significantly improved social, emotional/behavioral, and academic outcomes in students. The proposed study is highly responsive to PCORI’s call for comparative effectiveness research on alternative features of healthcare systems, including building effective behavioral health care in schools in ways that are actively guided by patients and diverse stakeholders; involving and coordinating services across youth-serving systems; and connecting progress across school building, district, state, regional, and national levels of scale.
This study has three aims:
1. We will evaluate the extent to which PCE increases the number of students and families receiving school behavioral health services and expressing satisfaction with services received.
2. We will evaluate the impact of PCE on students’ social, emotional/behavioral, and academic outcomes throughout the course of the intervention period (sixth through eighth grade).
3. We will evaluate the follow-up effects of PCE on social, emotional/behavioral, and academic outcomes and risk behaviors in a sample of students followed into high school.
This study will represent a randomized controlled trial, with three years of intervention versus comparison and conducted in 20 middle schools in rural, suburban, and urban areas, with 10 schools randomly assigned to implement the CSS intervention and 10 schools randomly assigned to implement the PCE intervention. The CSS condition was evaluated in two prior studies and found to be effective for engaging families in services and increasing use of evidence-based practices. The PCE condition includes the CSS intervention components and evidence-based PCEs that target (1) mental health literacy and stigma reduction and (2) enhancing family–school–mental health partnerships. The inclusion of these enhancements is based on feedback given by patients and stakeholders in a series of research forums focused on improving the quality of school behavioral health services through the support of a recently completed PCORI Eugene Washington Engagement award.
Throughout the course of the study, a diverse patient stakeholder advisory board (PSAB) will guide the research team in ensuring patient and stakeholder engagement, and will guide study planning, implementation, analyses, and sharing of findings. The project will also increase engagement between patients and stakeholders and the research team by utilizing a cutting-edge information-sharing and continuing-education approach, Extension for Community Healthcare Outcomes, which will involve a learning and feedback loop between the research team and the PSAB, the study schools, and the stakeholders and systems leaders. The PSAB will guide dissemination efforts that will capitalize on regional and national conferences that include more than 1,500 participants annually, with listservs that will approach or exceed 100,000 diverse stakeholders by study end. See the Southeastern School Behavioral Health Community website and the Center for School Mental Health website for professional communities that will support the study and its dissemination.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.