Improving Efficiency and Effectiveness of School Mental Health Care
MH, MTSS, depressed
FRANKLIN
School-based services are characterized by large caseloads and clinician time constraints; they also tend to be crisis-driven (Langley et al., Education frameworks taking a broader public health approach, such as Multi-Tiered Systems of Supports (MTSS; National Center on Response to Intervention, While there is substantial support for the effectiveness of “Tier 1” universal strategies such as school-wide social-emotional learning programs (Durlak et al., Examples of efforts to tailor EBPs for use in school settings include adaptations of solution-focused brief therapy (SFBT). Early SFBT studies showed promise as a practical and efficient approach for students with internalizing and externalizing problems (Kim & Franklin, A second relevant example is provided by “modular” approaches to therapy that use “common elements” of EBP tailored to the needs of a specific student. “Show Me FIRST” is a brief (6 session) school-based modular approach for depressed and anxious youth that incorporates strategies such as relaxation training, cognitive restructuring, problem solving, and behavioral activation. A pilot trial found support for feasibility but no differences on mental health outcomes compared to school-based usual care. A review concluded that modular approaches are potentially useful to SMHPs, but that more research is needed to determine if school-based providers, given the demands of their settings, can deliver these approaches effectively (Kininger et al., In sum, whole-school frameworks such as applications of MTSS hold substantial promise for improving school-wide student MH outcomes. Such frameworks, however, also require targeted and intensive individual- and group-based SMH strategies for identified students that align with MTSS principles such as being research-based, data-informed, and provided within a tiered framework. Few models have been developed and rigorously tested for delivering SMH services that are both based on evidence for effectiveness as well as responsive to the vast and growing demands on SMHPs.