Academic Enhancement site

This off-reservation boarding school serves over 600 students in grades 4-12; approximately 85% of the students reside in campus dormitories. After having documented significant improvement on a number of outcomes during a previous High Risk Youth Prevention demonstration grant, the site submitted a Therapeutic Residential Model proposal, requesting funding to continue successful elements developed under the demonstration grant and to expand mental health services. The site received Therapeutic Residential Model funding for school year 2001-2002. Once funds were received, the site chose to shift Therapeutic Residential Model funds to an intensive academic enhancement effort. While not in compliance with the Therapeutic Residential Model initiative and therefore not funded in subsequent years, this site created the opportunity to enhance the research design by providing a naturally occurring placebo condition at a site with extensive cross-sectional data baselines that addressed issues related to current federal educational policies.     

L3 Therapeutic Model site

L3 is an intertribal residential school enrolling approximately 200 students in grades 5-8 from tribes in the northern Midwest. As a result of successful grant-writing which espoused Circle of Courage and Asset-Building, the school built up an impressive configuration of programs funded by a variety of sources, including a cadre of mental health professionals, and began increasingly to rely on their assessments and services. First funded by the Therapeutic Residential Model program in the 2002-2003 school year, L3 used the funding that year primarily to increase professional-level services of a psychiatrist and psychologist, and to maintain or expand programs which would otherwise have been terminated as funding from short-term sources was running out. Evaluation of this project began in January 2003, when the site was assessed and determined to be strongly oriented toward provision of Level Three, or professional-level, psychiatric and medical mental health services. The initial evaluation report identified a low retention rate and raised concerns that the presence of more than 200 staff on campus had resulted in a diffusion of responsibility, lack of consistency, and duplication or redundancy of services; that elements of the environment appeared to be detrimental to social development and emotional stability; and that an unusually high proportion of students were receiving psychiatric diagnoses and medication. The site was asked to address these issues, and additional funding was provided to bolster lower levels of triage by adding paraprofessional case managers to advocate or students and coordinate provision of services for them. Retention remained low at this site throughout the course of funding, and there were a high number of assaults and psychiatric hospitalizations compared with other sites.     

Level 1 Therapeutic Model site

This site is an intertribal residential grant school annually enrolling over 250 students in grades 1-8 from tribes located in three states on the Northern Great Plains. From its inception in 1890, the boarding school's mission has been to provide services for young children in need of a safe and supportive living and learning environment. For over a decade, this site has used strategies centered on respecting children, structuring students' time, and providing the therapeutic benefits of a well-maintained campus. This site also has a long history of believing in each child's inherent value and potential. When Therapeutic Residential Model funding commenced at the midpoint of the 2002-2003 school year, L1 focused these new resources on strengthening and refining its program. The number of personnel positions increased from 98 to 135, with new positions principally going to dormitory staff and four Masters-level counselor positions. This increase in staff allowed L1 to proactively address the children's developmental needs. The site also adopted and implemented the Applied Humanism caregiving model. In accordance with Applied Humanism, an interview was utilized that allowed the site to identify and hire applicants possessing the attitudes and skills necessary to be good caregivers, existing staff were trained so that they understood the kind of caregiving that would be expected of them, supervision procedures and practices were implemented that supported and encouraged good caregivers and provided time-limited assistance to those who were not, and relevant agency policies and procedures were revised as needed to align with the Applied Humanism philosophy. In addition, the Morningside program was brought in to systematically address the students' academic lags in reading. The results of implementing the Therapeutic Residential Model were a reduction in behavioral incidents, a decrease in the amount of money spent on external mental health services, an increase in the retention rate, an increase in academic skills in selected areas, and higher scores on pre-post measures of adjustment, interpersonal relationships, and adaptability.     

Level 2 Therapeutic Model site

L2, one of the original sites first funded under the Therapeutic Residential Model Initiative in 2001-2002, is operated as a peripheral dormitory. This dormitory cares for 185 boys and girls in grades 1-12 who attend local public schools. L2 presented an outstanding proposal which identified gaps in services and presented a reasonable budget to address those gaps by adding additional mental health services and increasing the number of residential and recreation staff. With only minor modifications to this budget, the site efficiently and effectively implemented the strategies it had proposed and utilized evaluation feedback to fine-tune systems and maximize positive outcomes. The Therapeutic Residential Model funds enabled the site to move from a functional dormitory to a therapeutic residential situation where the needs of students are assessed and addressed. Outcome indicators in spring 2002, 2003, 2004, and 2005 showed impacts in a number of areas when compared with the baseline year of 2000-2001: Retention of students steadily increased going from 40.7% in 2000-2001 to 68.4% in 2004-2005; 75 students graduated from high school during the four Therapeutic Residential Model years, compared with 41 in the preceding four years; Academic Proficiency and ACT scores improved significantly; Thirty-day cigarette use dropped from 62% in spring 2001 to 38% in spring 2005 among 7th and 8th graders, from 58% to 33% among 9th and 10th graders, and from 72% to 29% among 11th and 12th graders; Alienation indices showed an increase in feelings of inclusion and a decrease in lack of meaning. This site is an outstanding example of what can be done with a well-designed and responsibly implemented Therapeutic Model Program, and the measurable impacts which can result from such strategic use of resources.     

From Model to Case: Implementation,Follow-Up,and Evaluation of a Permanent School Prevention Program

This article describes the prevention model Creciendo Juntos [Growing up Together], its theoretical framework, characteristics and methodological approach, and the population groups in which it has been implemented and results obtained. It then focuses on the implementation, beginning in 2013, of a school prevention program based upon this model that covered a whole school community. After 4 years, the process, results, and impact were evaluated, and the data are presented here. Process evaluation was developed through observations of the development of the program on the premises and in school groups. Interviews of school authorities, teachers, and facilitators were also conducted. The impact evaluation was conducted by means of a trend study, developed using two samples. In the 2014 baseline, randomly selected students participated as the experimental group. The data obtained in a Mexico City survey were considered part of the control group. In 2017, a second application was performed, which used the validated data from epidemiological research on students in the same geographical area as the control group. The process evaluation showed that the program guidelines had been incorporated as part of the school identity, and the guidelines provided were followed. The impact evaluation evidenced favorable modification of drug use: a decrease of more than 30% in tobacco use in the past year and problems associated with alcohol use in all age groups, and a decrease of 25% in marijuana use in the past year. The evaluation process developed supports the implementation of the Creciendo Juntos model and underlines the importance of its flexibility and the possibility for adaptation of guidelines and procedures to the specific situation of each community.

     

Preliminary Evaluation of a School-Based Youth Leadership and Prevention Program in Rural Alaska Native Communities

Youth Leaders Program (YLP) is a health intervention implemented in a rural Alaskan school district, which utilizes natural helpers and peer leaders to increase protective factors such as school engagement and personal/cultural identities, and to reduce risks associated with drug/alcohol abuse, violence, and bullying. Through these means, the program aims to ultimately decrease the disproportionately high rates of indigenous youth suicide in the region. This paper describes process and outcome evaluation findings from the program during the 2013–2014 school year. Data collected include a survey for program participants done at the beginning and end of the study year (n = 61, complete pairs); pre- and post-intervention school data (attendance, GPA, and disciplinary actions) (n = 86); an all-school survey asking students at the participating schools about their experience with YLP and participating youth (n = 764); interviews with program advisors (n = 11) and school principals (n = 2); and focus groups with participating students at all eleven participating schools at the end of the year. Outcomes included increased school attendance (mean attendance increased from 146 to 155 days) and improved academic performance (mean GPA of 8th, 9th, and 10th graders increased from 3.01 to 3.14) of program participants; positive peer reviews of participating student interventions in cases of bullying, depression, and suicidality; and a reported increase in the sense of agency, responsibility, and confidence among participating youth. The YLP appears to improve school climate and increase school and other protective factors for participating students. Recommendations for program implementation in the future and implications for school health will be discussed.     

Implementing a consultation-liaison service in a psychiatrically underserved area.

Most multidisciplinary consultation-liaison services are developed in settings where there are both psychiatric residents and an adequate psychiatric liaison faculty. In this paper, the authors report some of the obstacles and attempts at overcoming them in the implementation of such services in an underserved area in which there is a scarcity of both residents in training and psychiatric liaison faculty. The process of collaboration between a primary-care-oriented medical school and a community general hospital is described, and roles of program participants are defined. Special attention is paid to funding problems.     

Overview of the ACCESS Program. Access to Community Care and Effective Services and Supports

The authors provide an overview of the ACCESS program (Access to Community Care and Effective Services and Supports), which evaluated the integration of service systems and its impact on outcomes for homeless persons with severe mental illness. The ACCESS program provided funds and technical assistance to nine community sites to implement strategies for system change that would promote systems integration. These experimental sites, along with nine comparison sites, also received funds to support outreach and assertive community treatment for 100 clients a year for four years at each site. Data on the implementation of system change strategies were collected from 1994 to 1998 during annual visits to the sites. Data on changes in systems integration were obtained from interviews with key informants from relevant organizations in each community. Client outcome data were obtained at program entry and three and 12 months later from 7,055 program participants across the four annual client cohorts at all sites. Detailed findings from the ACCESS evaluation are presented in two accompanying articles, and overall conclusions are offered in a fourth article.     

Universal Emotional Health Screening at the Middle School Transition

This article describes the implementation of the Developmental Pathways Screening Program (DPSP) and an evaluation of program feasibility, acceptability, and yield. Using the Mood and Feelings Questionnaire (MFQ) and externalizing questions from the Youth Self Report (YSR; Achenbach, 2001), universal classroom-based emotional health screening was implemented with students as they began middle school. Of all sixth graders enrolled in four participating Seattle schools, 861 (83%) were screened. Students who screened positive for emotional distress (15% of students screened) received onsite structured clinical evaluations with children's mental health professionals. Seventy-one percent of students who were evaluated were found to be experiencing significant emotional distress, with 59% warranting referral to academic tutoring, school counselor, and/or community mental health services. Successful implementation of in-class screening was facilitated by strong collaboration between DPSP and school staff. Limitations of emotional health screening and the DPSP are discussed, and future steps are outlined.     

Consulting to implement nontraditional community programs for the long-term mentally disabled

Research studies have documented the success of several models of community-based care for the long-term mentally disabled. Yet despite their success, these models have not been widely implemented. In the present case study, consultation, technical assistance and increased funding were provided to a community mental health agency to facilitate implementing an assertive community treatment program as an alternative to hospitalization. Numerous barriers to implementation were encountered, and an analysis of the community agency's response, based on principles from the planned change literature, is presented. Recommendations for future program change efforts on behalf of the long-term mentally disabled are included.From the state of Michigan Department of Mental Health, Lansing.     

Randomized controlled trial of REbeL: A peer education program to promote positive body image,healthy eating behavior,and empowerment in teens

Short-term outcomes associated with participation in REbeL, a peer-led dissonance-based eating disorder prevention program for high school students, were evaluated. Seventy-one students across the three high schools were enrolled in the study (REbeL N = 48; Control N = 23) and were assessed on measures of eating attitudes and behaviors, body image, weight bias, self-esteem, empowerment, and mood at the beginning of the school year; 37 REbeL students and 20 control students completed assessments at the end of the school year. Mixed effects GLM compared groups on outcomes at the end of the academic year. When controlling for baseline scores, students in both REbeL schools, compared to control school students, demonstrated statistically significantly lower scores at post-test on the EDE-Q Global score, the EDE-Q Restraint, Eating Concern, Shape Concern and Weight Concern subscales, and the Body Checking Questionnaire (all ps < .05). This study provides preliminary empirical support for the REbeL program.     

Who Gets Care? Mental Health Service Use Following a School-Based Suicide Prevention Program

OBJECTIVE: To examine symptomatology and mental health service use following students' contact with a large urban school district's suicide prevention program. METHOD: In 2001 school district staff conducted telephone interviews with 95 randomly selected parents approximately 5 months following their child's contact with the district's suicide prevention program, a School Gatekeeper Training model. Parents provided information regarding service use, their child's depressive symptoms (using the Diagnostic Interview Schedule for Children Predictive Scale, Depression module), and their perceptions of their child's need for services. Information about the crisis intervention was abstracted from a standardized assessment form. RESULTS: More than two thirds of students received school or community mental health services following contact with the suicide prevention program. Depressive symptoms, but not past year suicide attempt, predicted community mental health service use. Latino students had lower rates of community mental health service use than non-Latinos. School-based service use did not differ by student characteristics including race/ethnicity. CONCLUSIONS: Most students identified by a school-based suicide prevention program received follow-up care, although Latinos were less likely to access services outside the school. School-based mental health services may be an important way in which underserved populations at risk of suicide can receive care.     

Clinical needs assessment of middle and high school students following the 1995 Oklahoma City bombing.

OBJECTIVE: This clinical assessment was designed to identify middle and high school students in need of formal evaluation for posttraumatic response symptoms following the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City. METHOD: A clinical needs assessment instrument was developed and administered to grade 6 through 12 students 7 weeks after the bombing (N = 3,218). RESULTS: More than 40% of the students reported knowing someone injured, and more than one-third reported knowing someone killed in the blast. Posttraumatic stress symptoms at 7 weeks significantly correlated with gender, exposure through knowing someone injured or killed, and bomb-related television viewing. CONCLUSIONS: This study documents the intensity of community exposure to the bombing and the lingering symptoms of stress. The assessment was used in planning for clinical service delivery, training professional responders, and supporting funding requests.     

Non-Public Special Education Programs: Evaluating the Costs of Within School Alternatives for Students with Emotional Disturbance

Evaluation of the costs and associated budgetary savings of schoolbased mental health program alternatives to non-public education program placements is a task made increasingly necessary by external pressures on school districts' budgets. The purpose of this article is to present information from an assessment of costs and related savings associated with an innovative school mental health program that provides intensive mental health and case management services in a regular public school setting. The program is designed to avert non-public placements of students in special education identified as emotionally disturbed. We estimated a program total cost of 7,212 per student per year, or 30 per student per day. This cost was associated with a total savings of 31,826 per student per year, or 133 per student per day averted. These estimates suggest that intensive school mental health programs could in many instances offer a financially viable alternative to non-public placement.     

Alcohol and marijuana use among adolescents: Long-term outcomes of the class of 1989 study

The Minnesota Heart Health Program (MHHP) is a population-wide research and demonstration project designed to reduce cardiovascular disease in three educated communities (1980–1993) compared to three matched reference communities. The Class of 1989 Study, a substudy of the MHHP, collected self-reported data in one educated and one matched reference community. All sixth graders enrolled in both communities were invited to participate in a baseline survey in 1983, and that grade cohort was surveyed annually throughout junior high and high school until 1989. Students received interventions designed to favorably influence their smoking, physical activity levels, and eating behavior each year from 1983 to 1987. As part of this five-year intervention, a program addressing smoking, alcohol use, drinking and driving behavior, and marijuana use was implemented during the school year of 1985–1986, when students were in ninth grade. Using the school as the unit of analysis, we found that students in the intervention community in 1986 reported fewer occasions on which they had been drinking alcohol in the past 30 days than did students in the reference community. Furthermore, students in the intervention community reported less problem drinking in the previous two weeks and less driving after drinking than did students in the reference community. These positive intervention effects were not maintained through twelfth grade.     

School-based sleep education program improves sleep and academic performance of school-age children

Study objectiveThe objective of this study was to develop and evaluate the effectiveness of a school-based sleep education program aimed at improving the sleep and academic performance of school-age children.MethodsUsing a community-based participatory research approach, we created a school-based sleep education program, “Sleep for Success”™ (SFS), composed of four distinct modules that addressed the children, their family and community, the school staff, and decision makers within the school setting. Implementation was carried out in three elementary schools. Seventy-one students participated in the evaluation of the program. The effectiveness of the SFS program was evaluated using non-randomized controlled before-and-after study groups (intervention and control) assessed over two time points (pre- and post-program implementation). Before (baseline) and after implementation, sleep and academic performance were measured using actigraphy and report card marks, respectively.ResultsIn the intervention group, true sleep was extended by 18.2 min per night, sleep efficiency improved by 2.3%, and sleep latency was shortened by 2.3 min, and report card grades in mathematics and English improved significantly. No changes were noted in the control group.ConclusionParticipation in the sleep education program was associated with significant improvements in children's sleep and academic performance.     

Residential change and school adjustment

Residential change, resulting in a change of schools, influences the lives of a majority of school age children. Moves often take place under difficult family conditions, and may be associated with the precipitation, or the exacerbation of emotional disturbances. Some studies have shown a correlation between moving and the prevalence of disturbance in children. Schools do not offer special help to mobile children; and under some conditions, mobility may be associated with poor academic performance. While an attitude of mental mobility may ameliorate problems associated with moving, detailed information about the adaptation to moving does not exist. The rate of moving has implications for neighborhood, or school-based community mental health programs.     

Filling the implementation gap: a community-academic partnership approach to early intervention in psychosis

Aim: The aim of this study was to describe the development of a sustainable community early psychosis programme created through an academic–community partnership in the United States to other parties interested in implementing early psychosis services founded upon evidence‐based practices within community settings. Methods: The service was developed around a sustainable core of key components, founded upon evidence‐based practice, with additional flexible elements that could be adapted to the needs of the individual commissioning county. This paper describes the ways in which funding was sourced and secured as well as the partnerships developed through this process. Results: Successful development of the Prevention and Recovery from Early Psychosis (PREP) programme in San Francisco County, California. PREP clinicians have received extensive training in the evidence‐based approaches that are available through the programme and treated 30 clients and their families in the first year of operation. Conclusions: Development of a sustainable community programme of this type in a non‐universal health‐care setting, which is historically seen as non‐integrated, required extensive partnering with agencies familiar with local resources. Implementation of the community–academic partnership bridged the gap between research and practice with successful integration of fidelity practice at the community level. The community partners were effective in sourcing funding and allocating resources, while the academic side of the partnership provided training in evidence‐based models and oversight of clinical implementation of the model. Stringent evaluation of the impact of the service is our next focus.     

Democratic Development of Standards: The Community of Communities—A Quality Network of Therapeutic Communities

As the inevitability of regulation and accountability dawned on the British Therapeutic Community movement at the end of the 1990s, a polarised debate took place. The product of that debate is now an action research based system of audit, with its principles and methods based on therapeutic community practice. This paper is written four years after the discussions started, and describes how the "Community of Communities" was conceived, what its methods are, some of the results from it first year of operation, and reflection about the nature of the process itself     

Healthy Environments and Response to Trauma in Schools (HEARTS): A Whole-School,Multi-level,Prevention and Intervention Program for Creating Trauma-Informed,Safe and Supportive Schools

The University of California, San Francisco’s Healthy Environments and Response to Trauma in Schools (HEARTS) Program promotes school success for trauma-impacted students through a whole-school approach utilizing the response to intervention multi-tiered framework. Tier 1 involves school-wide universal supports to change school cultures into learning environments that are more safe, supportive and trauma-informed. Tier 2 involves capacity building with school staff to facilitate the incorporation of a trauma-informed lens into the development of supports for at-risk students, school-wide concerns and disciplinary procedures. Tier 3 involves intensive interventions for students suffering from the impact of trauma. Program evaluation questions were: (1) Was there an increase in school personnel’s knowledge about addressing trauma and in their use of trauma-sensitive practices? (2) Was there an improvement in students’ school engagement? (3) Was there a decrease in behavioral problems associated with loss of students’ instructional time due to disciplinary measures taken? (4) Was there a decrease in trauma-related symptoms in students who received HEARTS therapy? Results indicate preliminary support for the effectiveness of the HEARTS program for each of the evaluation questions examined, suggesting that a whole-school, multi-tiered approach providing support at the student, school personnel and system levels can help mitigate the effects of trauma and chronic stress. Key areas for further studies include (a) an examination of data across more HEARTS schools that includes comparison control schools and (b) disaggregating disciplinary data by race and ethnicity to determine whether disproportionality in the meting out of disciplinary actions is reduced.