Limitations
Although the current study used rigorous methods, attrition from follow-up data collection was not trivial (15% at 2 months and 22% at 6 months) and significantly higher for students assigned to BRISC. Debriefs with interviewers suggested that SAU students were easier to schedule for follow-up interviews due to their continued mental health treatment, whereas more BRISC students had completed treatment by 3–6 months, making follow-up data collection more difficult. It is possible those lost to follow-up were actually more likely to have improved, reducing the effects found for BRISC.Second, SMHPs in the BRISC condition were explicitly trained to take stock of next steps after four sessions, meaning that the greater rate of treatment completion (53% to 15%) could be viewed as a demand characteristic in effect for just the BRISC condition. However, SMHPs in the BRISC condition were trained only to evaluate progress and triage as appropriate after four sessions, ending treatment only if progress data suggested it was warranted. As such, we do not believe this is an artifact of study design.Third, because treatment logs maintained by SMHPs were found to have been inconsistently maintained, the core outcome of treatment pathway after 4 sessions was only available via SMHP report after the third year of the study, limiting this outcome to only 22 of the 53 enrolled SMHPs. Finally, despite the multiplicity of analyses, we did not adjust for familywise error. Doing so over dozens of tests would have resulted in an unacceptable Type II error rate and presented an incomplete picture of results.