University of Washington School of Medicine, Seattle, USA.
Midwest Center for School Mental Health, St. Paul, USA.
Prev Sci. 2023 May;24(4):701-714. doi: 10.1007/s11121-022-01463-4. Epub 2023 Mar 17.
Schools offer an advantageous setting for the prevention, early identification, and treatment of mental health problems for youth. However, school mental health (SMH) services are typically not based on evidence for effectiveness, nor are they efficiently delivered, with SMH practitioners (SMHPs) able to only treat a small number of students in need. The current study evaluated the feasibility, acceptability, efficiency, and outcomes of a four-session assessment, engagement, problem-solving, and triage strategy for SMHPs that aimed to improve efficiency while being based on elements of evidence-based care. The study, conducted in 15 US school districts in three states, used stratified random assignment to assign 49 high schools and their participating SMHP(s) to either the Brief Intervention for School Clinicians (BRISC; N = 259 students) or services as usual (SAU; N = 198 students). SMHPs implemented BRISC elements with adequate to excellent fidelity and reported the strategy was feasible and well-aligned with presenting problems. Students assigned to BRISC reported significantly greater engagement in SMH at 2 months and completion of SMH treatment by 6 months. BRISC-assigned SMHPs reported significantly greater treatment completion after four sessions (53.4%) compared to SAU (15.4%). Students in the BRISC condition also reported significantly greater reduction in problem severity as evaluated by the Youth Top Problems Assessment. No differences were found for anxiety or depression symptoms or overall functioning. Results indicate that BRISC is a feasible early intervention and triage strategy that may aid in more efficient provision of SMH services with no compromise to SMH effectiveness.
学校为预防、早期发现和治疗青少年的心理健康问题提供了有利的环境。然而，学校心理健康（SMH）服务通常不是基于有效性的证据，也没有得到有效提供，SMH 从业者（SMHPs）只能治疗少数有需要的学生。本研究评估了四节评估、参与、解决问题和分诊策略对 SMHPs 的可行性、可接受性、效率和结果，该策略旨在提高效率，同时基于循证护理的要素。这项研究在美国三个州的 15 个学区进行，采用分层随机分配将 49 所高中及其参与的 SMHP(s)分配到简短干预学校临床医生（BRISC；N=259 名学生）或常规服务（SAU；N=198 名学生）。SMHPs 以足够到优秀的保真度实施了 BRISC 要素，并报告该策略是可行的，并且与呈现的问题非常一致。被分配到 BRISC 的学生在 2 个月时报告了更大的 SMH 参与度，并在 6 个月时完成了 SMH 治疗。与 SAU（15.4%）相比，BRISC 分配的 SMHPs 在四节课后报告的治疗完成率显著更高（53.4%）。BRISC 条件下的学生在青年最关心问题评估中也报告了问题严重程度的显著降低。在焦虑或抑郁症状或总体功能方面没有发现差异。结果表明，BRISC 是一种可行的早期干预和分诊策略，它可以在不影响 SMH 效果的情况下，更有效地提供 SMH 服务。
