Promoting Evidence-Based Mental Health Practices: One Road to Achieving Excellence

Schools represent a major option to promote evidence-based mental health services to children and families. The need for these services is extraordinary as reflected in some of these alarming statistics: Ten to 22% of children and youth in the U.S. (approximately 15 million) are in need of mental health services. Of those 15 million children and youth, approximately 21% receive mental health services. Close to 75% these children are eligible to receive these services in our nation’s schools. Children growing up in communities of concentrated poverty are especially vulnerable given that they may not have access to mental health services. In the latter case, the U. S. Census Bureau has noted that about 1 in 4 children in the U. S. spend some or all of their childhood living in an environment of poverty. And poverty represents a major risk factor for developing both health and mental health problems.

Schools across our nation have done much to help children and families living in poverty and those initiatives will be critical in the future. Such programs involve, for example, Head Start, Supplemental Nutrition Program, National School Lunch Program, School Breakfast Program, among others. Fortunately, there are also a number of mental health initiatives that schools can also embrace and those are the focus of this article.1 Among a large number of possibilities that might be addressed in schools I have chosen to focus on three that in my view represent king pin factors that can help schools move forward toward excellence. These initiatives include resource mapping, adopting evidence-based practices, and empowering problem solving teams to address student mental health challenges in schools. School professionals can embrace the best mental health interventions that research has supported (evidence-based practices) to address the overwhelming mental health needs of children and youth (see Kratochwill, 2007). These services can typically be implemented by individual professionals or teams working together in schools.

Resource Mapping: Finding Out What We Have

One of the first things that school professionals can do to embrace evidence-based practices is to engage in resource mapping. The resource mapping (sometimes called asset mapping) of mental health resources in a school or district involves a systematic examination of the programs, procedures, and personnel involved in the delivery of these services. There are several reasons why a school should conduct a resource mapping exercise. First, school budgets are tight and resources to serve mental health needs can be expensive. Priorities must be established for what resources will be directed toward mental health services. Second, some schools may not have the best and most recent programs and procedures in place. There are a growing number of good programs that researchers are developing and these programs should be targeted for selection (see below). Third, some schools may actually be implementing programs and practices that are known to be discredited or not supported by research.

The latter rationale for resource mapping deserves some further commentary. Discredited programs and practices are actually more common than once thought and they represent a major drain on school resources including professional time. Some programs and practices are adopted because someone, for example, may have read or heard in a workshop of a new program that promises to eliminate bullying in the middle school or stop drug and alcohol abuse among secondary school students. However, close examination of these programs may show that there is actually no support for positive outcomes and even worse, they may increase the problem they are trying to address. School professionals should examine credible web sites that feature reviews of programs (see the next section) and consult an article by Koocher, McMann, and Stout (2015) that provides an overview of numerous discredited assessment and intervention practices.

Resource mapping typically involves the following stages: pre-mapping (e.g., establish a coordinator, establish work procedures), mapping (e.g., identify resources, examine funding options, map community resources), strategic implementation (e.g., collect and analyze resources, facilitate access to community resources), evaluate and recycle (e.g., evaluate the resource mapping effectiveness and plan, sustain efforts). Each of these stages can be completed by a specially formed team or an existing team such as a building or problem solving team. Although it is beyond the scope of this article to outline the resource mapping process in detail, a guide has been created that can help in this process (see Sanetti, Kratochwill, Ring, & Volpiansky,  2005; and see resources by Adelman & Taylor, 2006). These resources can provide a step-by-step guide to moving through the four stages noted above.

Adopting Evidence-Based Practices: Increasing the Chance of Success

School professionals should strongly consider adopting programs and practices that have strong empirical support. Evidence-based programs are those that have been found to be effective in research in a particular area and these studies have involved investigations vetted in literature reviews by national organizations or federal clearinghouses (e.g., the U.S. Department of Education What Works Clearinghouse). Some examples of these programs are featured below. The movement in education toward adopting response-to-intervention or multi-tiered systems of support has been premised on schools using evidence-based academic and behavioral programs that have been found to be effective in promoting student academic skills and positive behavioral outcomes. Essentially, adopting an evidence-based program or practice increases the likelihood/probability that the program will be effective in the school.

There are several major advantages in adopting evidence-based programs in schools. First, research reviews of programs and practices will provide an important lead as to what a school may expect to see as an outcome from a particular application. For example, research reviews in the area of bullying will provide some important information on what reduction in bullying should be expected once the program is applied at a particular grade level or with certain school diversity characteristics. Second, most reviews of programs will provide information on the resources needed to actually implement the program and under what conditions it was effective. For example, some programs such as positive behavior support will require that a team of professionals be formed and that these professionals work together to restructure some policies and procedures for how discipline procedures are handled in the school. Third, most reviews of programs will feature what is lacking in evidence for implementation thereby providing school professionals with information on additional issues and/or accommodations that will be necessary for the program to have a high chance of success. Fourth, reviews of research in an area will provide some options for how programs should be evaluated when implemented in the school. Outcome evaluation will be critical in making decisions on the effectiveness of the program or modifications that may be necessary.

Over the past several years numerous options to access information on evidence-based programs have emerged. Some of the more frequently accessed sites include the following:

Institute of Education Sciences What Works Clearinghouse; Available at: http://ies.ed.gov/ncee/wwc/

The Evidence-Based Intervention Network at the University of Missouri; available at:

http://ebi.missouri.edu/

Supporting and Responding to Behavior: Evidence-Based Classroom Strategies for Teachers; Available at: https://www.osepideasthatwork.org/evidencebasedclassroomstrategies/

For schools that would like to provide staff with training in evidence-based practices some options are also available. The IRIS Center at Vanderbilt University has also developed resources that provide an overview of evidence-based practices relevant to school professionals and can be used in training. These resources include the following:

Evidence-Based Practices (Part 1): Identifying and Selecting a Practice or Program (Audios: p. 3): http://iris.peabody.vanderbilt.edu/module/ebp_01/

Evidence-Based Practices (Part 2): Implementing a Practice or Program with Fidelity (Audios: pp. 2, 4): http://iris.peabody.vanderbilt.edu/module/ebp_02/#content

Evidence-Based Practices (Part 3): Evaluating Learner Outcomes and Fidelity (Audios: pp. 2, 6, 7, 8): http://iris.peabody.vanderbilt.edu/module/ebp_03/#content

Problem Solving Teams: Getting By With the Help of Our Friends

One of the first things that a school must consider is if there is a problem solving team and does it address mental health issues of students in the school. Most of what is presented in this section is premised on the assumption that the school has an active problem solving team. A problem solving team functions to address the behavioral and emotional challenges of students in the school. These teams are sometimes referred to as building level teams, consultation teams, or problems solving teams. These teams are typically made up of a building principal, school psychologist or social worker, special education, and regular education teacher. Other school professionals may be on the team as needed depending on the nature of the issues being addressed and nature of the referrals to the team.

In our work we have adopted the Decision Observation, Recording, and Analysis tool (DORA-II) (Algozzine, Newton, Horner, Todd, & Algozzine, 2012) to assist teams to perform good problem solving. The team must have good foundations to problem solve [i.e., meeting started on time, at least 75% of members present at start, previous meeting minutes available, agenda available, roles assigned (facilitator, minute taker, data analyst), next meeting scheduled, meeting ends on time, and at least 75% of members present at the end]. We have found that most teams have good-to-excellent foundations for their team meetings. However, teams seem to struggle more with the thoroughness with which they function in the problem solving process (i.e., problem precision, identified goals, solution implementation plan, solution implementation integrity, status of old problems compared against goals, and summative evaluation decisions).

We have developed resources for assisting problem solving teams in a recent research project, Learning to Improve School Teams (Project LIST, Thomas Kratochwill and Jennifer Asmus). Modules have been developed to assist a team through the problem solving process and improve the thoroughness of problem solving with referrals for mental health issues including the adoption of evidence-based mental health interventions.

Schools and school professionals face serious challenges in the education of our nation’s school systems. Increasingly there are resources and programs available to assist in addressing the mental health needs of students. In this brief article I have outlined some initial steps that school can take to form better mental health services. Engaging in resource mapping, adopting evidence-based programs, and having a well-functioning problem solving team can assist in moving toward excellence in addressing the mental health needs of students.

Suggested Resources

Adelman, H. S., & Taylor, L. (2006). The school leader’s guide to student learning supports: New directions for addressing barriers to learning. Thousand Oaks, CA: Corwin. 

Algozzine, B., Newton, S., Horner, R., Todd, A., & Algozzine, K. (2012). Development and technical characteristics of a team decision-making assessment tool: Decision, observation, recording, and analysis (DORA). Journal of Psychoeducational Assessment, 30(3), 237–249.

Koocher, G. P., McMann, M. R., & Stout, A. O. (2015) Discredited Assessment and Treatment Methods Used with Children and Adolescents: A Delphi Poll. Journal of Clinical Child & Adolescent Psychology, 44, 722-729.

Kratochwill, T. R. (2007). Preparing psychologists for evidence-based practice: Lessons learned and challenges ahead. American Psychologist, 62, 826-843. 

Sanetti, L. H., Kratochwill, T. R., Ring, M., & Volpiansky, P.  (2005). Resource mapping: A toolkit.  Madison, WI: Wisconsin Department of Public Instruction.

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