Development and Testing of a Brief Engagement, Triage, and Intervention Strategy for School Mental Health Clinicians - The BRISC Model

Emotional and behavioral well-being is critical to school success and currently upwards of 70% of all mental health treatment for children is delivered in schools. School-based services effectively reduce access disparities for ethnic minority and low-socioeconomic status youth.  Unfortunately, utilization of evidence-based practices by providers in the education sector has been low. To maximize impact across the broad spectrum of mental health needs exhibited by youth in school settings, school-based strategies and interventions must be designed to be effective, efficient, and demonstrate good fit with the educational context. 

The Brief Intervention Strategy for School Clinicians (BRISC) is a brief, stepped-care, evidence-based, and flexible “Tier 2” strategy tailored to high school students and designed specifically for delivery in the school setting. Based on treatment elements shared across effective interventions for internalizing and externalizing problems in adolescents, BRISC provides a flexible structure with up to four sessions (lasting between 30 and 60 minutes) to assess, engage, identify, and address difficulties that cause distress and impact academic performance, behavioral/social, and overall functioning. Empirically-supported engagement, skill-building strategies, and outcome monitoring are delivered within a psychoeducation and problem solving framework to address the student’s identified problem(s). BRISC activates student engagement in the treatment process by helping them to effectively address a specific concern, with a focus on one thing they can impact in 3-4 sessions, while assessing if additional treatment, services, or referrals are needed. Pathways for what occurs following BRISC are modeled after the “response to intervention” (RTI) framework typical in schools. 

In this presentation, we will present the rationale for BRISC; the iterative steps used to develop and test the BRISC protocol (expert and stakeholder input, feasibility and acceptability testing in schools, pilot testing with existing school-based practitioners, and a small matched comparison study); and the basics of the protocol itself. We will also present results of the small (n = 66) comparison study, which indicated positive, small to large sized effects (ES = .30 to 1.33) in favor of BRISC compared to school-based mental health services as usual for impairment, emotional symptoms, therapeutic alliance, coping skills, and client satisfaction. Lessons for the prevention and education fields will be summarized as will next steps for BRISC, which include additional feasibility trials, testing with novel types of school-based helpers (e.g., school nurses, social workers, and counselors), and a proposal for a larger, multi-site efficacy trial now under review.