Discussion
MTSS
This project evaluated the potential for improving the efficiency of SMH via a school-based assessment, brief intervention, and triage approach for students with socio-emotional concerns. BRISC provides a first-line intervention using consistent assessment to inform level and type of ongoing services needed in a prevention-oriented, multi-tiered delivery model. Research questions focused on feasibility, fidelity, student report of problems, and ability of BRISC to promote efficiency within SMH. We also measured a range of mental health outcomes over 6-month follow-up to evaluate whether this emphasis on efficiency compromised these outcomes compared to SMH “as usual.”SMHPs who participated in the study were predominantly outpatient clinic providers deployed to the school setting. Their training and established practice were geared to traditional, longer term supportive therapy. The structured, measurement-based, and goal-oriented BRISC approach represented a different way of practicing aligned with data-informed, multi-tiered frameworks used by schools. Despite the learning curve required and deviation from typical practice, SMHPs rated BRISC as feasible, acceptable, and appropriate. Importantly, the majority of SMHPs rated BRISC as easy to learn, “compatible with the school mission,” and “likely to improve students’ social, emotional, and academic success.” SMHPs delivered BRISC with fidelity; however, session 3 fidelity was lower than for other sessions. This was likely due to the complexity introduced by the option to use evidence-based treatment elements as needed.A second key finding was that SMHPs in the BRISC condition were significantly more likely (53% to 15%) to report that they had completed treatment after 4 sessions than SAU. BRISC-assigned SMHPs were also more likely to refer students to alternative and/or more intensive services. Students in the BRISC condition were also significantly more likely to report receipt of SMH at 2 months and less likely to report SMH services at 6 months. These results support the hypothesis that BRISC can promote SMH that is more efficient and better aligned with MTSS and public health frameworks.Finally, we asked whether SMHPs’ use of a brief strategy to achieve greater efficiency would compromise mental health outcomes. To the contrary, students served via BRISC showed significantly greater improvement on their self-rated top mental health problems at 2 and 6 months. Symptom and functioning measures showed significant improvement, but slopes did not differ by condition. Students served by BRISC SMHPs were less likely to receive outpatient care at 6 months. This finding could indicate that BRISC more effectively addressed students’ “top problems” to an extent that reduced their need for longer-term mental health services. Or, it could be that students in the BRISC condition felt more confident in their school-based provider to help them in the future, reducing the need for clinic-based services. Such questions will need to be examined in more in-depth research with longer follow-up.