A randomized controlled trial on the interconnected systems framework for school mental health and PBIS: Focus on proximal variables and school discipline.

This study reviews findings for the first randomized controlled trial (RCT) on the Interconnected Systems Framework (ISF) for school mental health (SMH) and Positive Behavioral Interventions and Supports (PBIS). Since its development in the late 2000s, the ISF has been supported by federally funded centers for SMH and PBIS, and, guided by a national workgroup, is being implemented in >50 communities in the United States. This experimental evaluation of the ISF involved an RCT implemented in 24 schools in two southeastern states, with the ISF implemented in eight schools, PBIS alone implemented in eight schools, and typically co-located PBIS+SMH implemented in eight schools. Related to very poor implementation, documented by two sources of fidelity data, two ISF schools were dropped from major analyses; hence, the study used a treatment on the treated (ToT; Rubin, 1974) as compared to a more traditional Intent-to-Treat approach (ITT; Lachin, 2000). This is the first paper from this large study, with emphasis here on proximal variables and school discipline. Within schools' multi-tiered systems of support (MTSS), ISF schools delivered more Tier 2 (early intervention) and Tier 3 (treatment) interventions to a greater proportion of students than the other two conditions by the second year of the intervention. There was also a dramatic difference in the provision of interventions by community mental health clinicians in ISF schools (almost half of interventions delivered) as compared to PBIS+SMH schools (around 3% of interventions delivered), underscoring the critical role of the ISF in integrating clinicians into MTSS teams and core school functions in SMH. As compared to the other two conditions, ISF schools also had reduced office discipline referrals (ODRs) and in-school suspensions, as well as reduced ODRs and out-of-school suspensions for African American students. Findings are discussed in relation to future directions of education-mental health system partnerships in improving the delivery and impact of SMH programs and services, demonstrated in the ISF.