Nancy Lever

Research Findings: One in 5 preschool-aged children (under age 5) have a serious mental health difficulty that can have lasting negative effects. Most children under age 5 (63%) attended preschool, day care centers, Head Start, or another prekindergarten program. This leaves early childhood programs well-positioned to support the wellbeing of our earliest learners if they could offer gold standard multi-tiered systems of support for mental health care. However, there is not currently a measure for preschool teams to self-assess and improve their school mental health quality. To address this gap, we adapted an existing measure of school mental health quality for K-12 schools to preschools. Measure development included initial modifications by a preschool quality workgroup, a modified Delphi procedure including 3 rounds of data collection, and a Principal Component Analysis. The resulting measure, the School Mental Health Quality Assessment – Preschool (SMHQA-PS) consists of 46 Likert-style items covering 6 domains of preschool mental health system. Practice and Policy: This measure provides an evidence-informed tool to assist preschool mental health teams in advancing the quality of mental health supports in preschools while creating consistent language for families, school teams, researchers, and policymakers to use across school mental health programs in Pre-K-12 schools.

Educators play a critical role in promoting mental health and well-being with their students. Educators also recognize that they lack knowledge and relevant learning opportunities that would allow them to feel competent in supporting student mental health. As such, educators require resources and training to allow them to develop skills in this area. The Mental Health Technology Transfer Center (MHTTC) Network partnered with the National Center for School Mental Health at the University of Maryland School of Medicine to develop Classroom Well-Being and Information for Educators (WISE), a free, three-part mental health literacy training package for educators and school staff that includes an online course, video library, and resource collection. The Classroom WISE curriculum focuses on promoting positive mental health in the classroom, as well as strategies for recognizing and responding to students experiencing mental health related distress. This paper describes the curriculum development process, including results of focus groups and key informant interviews with educators and school mental health experts. Adoption of Classroom WISE can help educators support student mental health and assist in ameliorating the youth mental health crisis.

Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based intervention to treat post-traumatic stress disorder among youth ages 3–18 years old. In this pilot study, 31 clinicians in 13 urban public schools received TF-CBT training to improve access to high-quality trauma treatment for youth in need. A mixed methods design was used to assess implementation barriers, facilitators, and outcomes to examine initial feasibility, acceptability, and appropriateness of TF-CBT delivered in school settings. Although 70% of clinicians reported confidence in the evidence-base of TF-CBT and its potential to support their students who have a very high prevalence of lifetime trauma exposure, implementation practice outcomes suggest a wide range of TF-CBT use (range = 0–11 students enrolled per clinician, mean = 1.4 students) with 23 clinicians implementing the TF-CBT model with at least one case. Results point to the potential value of training school mental health clinicians in TF-CBT based on its compatibility with student needs. Yet, by connecting focus group results to top-rated barriers and facilitators, we identify several adjustments that should be made to improve intervention-setting fit in future studies. Specifically, school setting-specific intervention adaptations, school-tailored implementation support, and thoughtful consideration of school-based clinicians’ roles and responsibilities are needed to enhance future implementation success.

Learning collaboratives (LCs) have often been used to improve somatic health care quality in hospitals and other medical settings, and to some extent to improve social services and behavioral health care. This initiative is the first demonstration of a national, systematic LC to advance comprehensive school mental health system quality among school district teams. Twenty-four districts representing urban, rural, and suburban communities in 14 states participated in one of two 15-month LCs. Call attendance (M = 73%) and monthly data submission (M = 98% for PDSA cycles and M = 65% for progress measures) indicated active engagement in and feasibility of this approach. Participants reported that LC methods, particularly data submission, helped them identify, monitor and improve school mental health quality in their district. Qualitative feedback expands quantitative findings by detailing specific benefits and challenges reported by participants and informs recommendations for future research on school mental health LCs. Rapid-cycle tests of improvement allowed teams to pursue challenging and meaningful school mental health quality efforts, including mental health screening in schools, tracking the number of students receiving early intervention (Tier 2) and treatment (Tier 3) services, and monitoring psychosocial and academic improvement for students served.