Implementing evidence-based mental health practices in schools: Feasibility of a coaching strategy

Pages212-231
DOIhttps://doi.org/10.1108/JMHTEP-05-2018-0028
Published date27 June 2019
Date27 June 2019
AuthorElizabeth Koschmann,James L. Abelson,Amy M. Kilbourne,Shawna N. Smith,Kate Fitzgerald,Anna Pasternak
Subject MatterHealth & social care
Implementing evidence-based mental
health practices in schools: Feasibility of
a coaching strategy
Elizabeth Koschmann, James L. Abelson, Amy M. Kilbourne, Shawna N. Smith,
Kate Fitzgerald and Anna Pasternak
Abstract
Purpose Mood and anxiety disorders affect 2030 percent of school-age children, contributing to
academic failure, substance abuse, and adult psychopathology, with immense social and economic impact.
These disorders are treatable, but only a fraction of students in need have access to evidence-based
treatment practices (EBPs). Access could be substantially increased if school professionals were trained to
identify students at risk and deliver EBPs in the context of school-based support services. However, current
training for school professionals is largely ineffective because it lacks follow-up supported practice, an
essential element for producing lasting behavioral change. The paper aims to discuss these issues.
Design/methodology/approach In this pilot feasibility study, the authors explored whether a coaching-based
implementation strategy could be used to integrate common elements of evidence-based cognitive behavioral
therapy (CBT) into schools. The strategy incorporated didactic training in CBT for school professionals followed by
coaching from an expert during co-facilitation of CBT groups offered to students.
Findings In total, 17 school professionals in nine high schools with significant cultural and socioe-conomic
diversity participated, serving 105 students. School professionals were assessed for changes in confidence
in CBT delivery, frequency of generalized use of CBT skills and attitudes about the utility of CBT for the school
setting. Students were assessed for symptom improvement. The school professionals showed increased
confidence in, utilization of, and attitudes toward CBT. Student participants showed significant reductions in
depression and anxiety symptoms pre- to post-group.
Originality/value These findings support the feasibility and potential impact of a coaching-based
implementation strategy for school settings, as well as student symptom improvement associated with
receipt of school-delivered CBT.
Keywords Implementation, Dissemination, Evidence-based practice, CBT, School
Paper type Research paper
Introduction
Mood and anxiety disorders affect 2030 percent of school-age youth and contribute to
poor developmental and academic outcomes, substance abuse, and adult psychopathology,
as well as immense social and economic costs (Asarnow et al., 2005; Charvat, 2012; Costello
et al.,2005;Jaycoxet al., 2009; Kessler et al., 2003; Merikangas et al., 2010; Merikangas
et al., 2009; Mychailyszyn et al., 2011; National Institutes of Health, 2013). Evidence-based
practices (EBPs), such as cognitive behavioral therapy (CBT), can improve clinical as well as
social and academic outcomes (Compton et al., 2004; David-Ferdon and Kaslow, 2008;
Greenberg et al.,2003;Marchet al., 2004; Smyth and Arigo, 2009; Walkup et al., 2008; Weisz
et al., 2009; Zins et al., 2004). Clinically meaningful benefit from CBT can be observed in as
few as six-to-eight sessions (Nieuwsma et al., 2012) and across a variety of settings and
populations (Ginsburg et al., 2012; Gottfredson and Gottfredson, 2002; Huey and Polo, 2008;
Kataoka et al., 2002; Rossello and Bernal, 1999; Silverman et al.,1999).CBTbenefitsarealso
evident when it is delivered in individual and group formats (Manassis et al., 2002), using
Received 1 May 2018
Revised 27 February 2019
Accepted 16 April 2019
Ethical approval: all procedures
performed in this study were in
accordance with the ethical
standards of the institutional and/
or national research committee
and with the 1964 Helsinki
declaration and its later
amendments or comparable
ethical standards. The research
reported in this paper was
supported by funds from the
Center of Medicare and Medicaid
Services through the Michigan
Department of Health and Human
Services (F048524) and The
Michigan Health Endowment Fund
(NO2202), and through generous
foundation and private gifts to the
University of Michigan
Comprehensive Depression
Center. The funding sources had
no involvement in study design; in
the collection, analysis and
interpretation of data; in the writing
of the report; and in the decision
to submit the paper for publication.
The views expressed in this paper
are those of the authors and do
not necessarily represent the views
of any public or not for profit
institution. The authors would like
to thank the schools and school
professionals without whose
collaboration this research could
not have been accomplished.
(Information about the authors
can be found at the end of
this article.)
PAGE212
j
THE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE
j
VOL. 14 NO. 4 2019, pp.212-231, © Emerald Publishing Limited, ISSN 1755-6228 DOI 10.1108/JMHTEP-05-2018-0028
modular or components-based programs (Chiu et al., 2013; Galla et al., 2012; Lyon et al.,
2011) and across racial or ethnic groups (Ferrell et al., 2004; Ginsburg and Drake, 2002;
Kataoka et al., 2003; Rossello and Bernal, 1999; Silverman et al., 1999; Southam-Gerow
et al., 2001).
Regrettably, fewer than 20 percent of youth in need access EBPs such as CBT (Chorpita et al.,
2002; Fixsen et al., 2005; Kessler et al., 2003; March, 2011; Merikangas et al., 2011).
Widespread access is hindered by both consumer- and provider-based obstacles. For child
and family consume rs, there may be stigm a associated with clinic-based treatment (Garrison
et al., 1999; Langley, Nadee m et al., 2010; Merry et al., 2004), high costs coupled with
inadequate insurance coverage, or a lack of affordable or convenient transportation to clinics
where EBPs are most available. These barriers have particular impact on low-income youth,
children of color, and those living in rural or under-resourced areas where effective services are
particularly scarce (Burns et al., 1995; Huey et al., 2014; Weist et al., 2007; Zins et al., 2004).
For providers, dis illusionment with best prac tices has resulted from a profus ion of EBP manuals
(Chorpita et al., 2005; Chorpita and Regan, 2009; Chorpita and Viesselman, 2005; NIMH,
2001; Hogan, 2003; Lembke et al., 2010) and obstacles to accessing EBP training that is both
affordable and effective (Beidas and Kendall, 2010a; Fixsen et al., 2005; Funderburk et al.,
2015; Herschell et al., 2010; Owens et al., 2014). As a result, dissemination and high-fidelity
implementation of proven practices are difficult, severely limiting their impact (Beidas and
Kendall, 2014; Zatzick et al., 2009).
Delivery of EBPs with in schools, by schoo l professionals, ma y offer a compelling w ay to
increase access. The school setting offers unique advantages for enhancing access to health
and social services (Garrison et al., 1999; Langley et al., 2010; Merry et al., 2004). Students are
more willing to use me ntal health servic es at schools than in ot her community sett ings (Burns
et al., 1995; Farmer et al., 2003); and the majority of youth who access mental health care dos o
exclusively in school (Green et al., 2013; Rones and Hoagwood, 2000; Weist et al., 2007).
School mental health professionals (SPs), such as school counselors or social workers, who
observe and intera ct with students da ily, can offer servic es regardless of st udentsinsurance
coverage, socio-economic status, parental involvement, access to transportation, or comfort
seeking clinic-based care. Comparative effectiveness research on school-delivered CBT is
limited and has yield ed inconsistent r esults, but studies s uggest a benefit for a v ariety of
diagnoses, including anxiety, depression, post-traumatic stress disorder (PTSD) and behavioral
difficulties (David-Ferdon and Kaslow, 2008; Ghafoori and Tracz, 2001; Herzig-Anderson et al.,
2012; Jaycox et al., 2009; Kataoka et al., 2002; Kavanagh et al., 2009; Lewinsohn et al., 1990;
Lochman, 1992; Lochman et al., 2013; Macklem, 2010; Masia-Warner et al., 2005; Masia
Warner et al., 2007; Mychailyszyn et al., 2011; Reynolds and Coats, 1986; Ruffolo and Fischer,
2009; Weist, 1997; Weisz et al., 2009).
Despite demonstrated effectiveness, successful implementation of CBT in schools remains rare
(Atkins, Frazier et al., 2003; Beidas, Edmunds, Marcus and Kendall, 2012; Beidas, Mychailyszyn,
Edmunds, Khanna, Downey and Kendall., 2012; Forman et al., 2008; Hallfors and Godette,
2002; Mychailyszyn et al., 2011; Rones and Hoagwood, 2000; Zins et al., 2004).
One implementation barrier is difficulty identifying students with mental illnesses, particularly
those students with internalizing disorders such as anxiety and depression who often dont pose
disciplinary problems (Masia Warner and Fox, 2012). Another significant obstacle is lack of
adequate training in EBPs for school professionals, especially training and post-training support
that accommodate these professionalsbusy schedules, despite the clear evidence that delivery
of EBPs promotes academic, social, and developmental success among recipients (Zins et al.,
2007). Though SPs do provide individual and group counseling, their graduate preparation rarely
prepares them to deliver EBPs (Shernoff et al., 2003). Moreover, professional development
offered to this workforce tends to rely on one-time workshops or brief seminars, which are
insufficient to result in good treatment fidelity or sustainability (Allen et al., 2012; Beidas and
Kendall, 2010b; Jensen-Doss et al., 2008; Sholomskas et al., 2005; Weissman et al., 2006).
Without post-training support, SPs fail to develop the necessary competence and confidence to
sustain EBP use long term and attitudinal resistance remains common (Bearman et al., 2013;
Beidas, Edmunds, Marcus and Kendall, 2012; Beidas, Mychailyszyn, Edmunds, Khanna,
VOL. 14 NO. 4 2019
j
THE JOURNAL OF MENTAL HEALTH TRAINING, EDUCATION AND PRACTICE
j
PAGE213

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT