Implementation of Evidence-Based Mental Health Interventions in Middle Schools to Promote School Safety

Introduction

School safety problems in the middle grades are often perpetrated by a small number of students who need selective and indicated interventions. Our study aims to prevent school violence and promote a positive school climate using several approaches to school-based mental health (SBMH) services to meet the needs of these students, including providing training for school counselors, school social workers, school psychologists, and community therapists in evidence-based therapies.

Methods

We used stratified random assignment to assign 25 middle schools in a large, metropolitan school district in the southern United States to one of three conditions of SBMH – treatment as usual (TAU), expanded treatment (EX), and enhanced treatment (EH). Our expanded treatment protocol provides services to students who would not otherwise be able to receive them due to funding. The enhanced treatment protocol trained providers in two rigorous evidence-based therapies with Dialectical Behavior Therapy (DBT) being used by therapists and psychologists for students with Tier 3 behaviors, including aggression and suicidal or self-injurious behaviors. Counselors and social workers were trained in trauma-informed Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) group program for students with less serious disruptive behaviors (Tier 2). A total of 59 providers have responded to a web-based provider survey to date, though more are expected prior to presentation of the results. Most respondents were female (88.1%) and had earned a Master’s degree or higher (98.3%).

Results

Using mixed methods data analysis, we analyzed qualitative provider responses indicating that the demands of the school environment and regular job requirements, particularly on school counselors, served as barriers to training in and implementation of evidence-based therapies. Despite these barriers, dosage data indicated that SPARCS providers were able to begin implementation of therapies, while DBT providers were slower to begin. Quantitative survey data revealed that providers working in SBMH programs had an overall positive response to using evidence-based programs based on their responses to 4 scales of the Evidence-Based Practices Attitudes Scale (Aarons et al., 2002). Providers reported the highest likelihood that they would use an evidence-based practice if they felt they “had enough training to use it correctly” (M = 4.60, sd = .535).

Conclusions 

Initial findings suggest that barriers to school-based implementation of evidence-based programs can be overcome with intensive training and support from school leadership, which may improve student outcomes. Future work will continue to follow these providers and measure prevention outcomes in students.