School-based Mental Health Treatment Services
Conditions
Keywords
measurement-based care (MBC)
Brief summary
The purpose of the study is to examine the implementation outcomes (i.e., feasibility, appropriateness, acceptability, and fidelity) of MBC in school-based mental health treatment services. The investigators plan to observe the effectiveness of MBC on student engagement and treatment outcomes as a secondary goal. This pilot implementation-effectiveness trial is designed to inform a future, large-scale trial with more participants.
Detailed description
A clustered, multiple-baseline design will be used to examine the impact of implementation support on clinicians' fidelity, use and ratings of MBC appropriateness, acceptability and fidelity. Approximately 50 school-based mental health (SMH) clinicians will be recruited to participate from up to three school districts. All clinicians will receive the same implementation supports; there is no random assignment to condition. Following an initial control period of at least 1 month, school districts will start receiving implementation supports. During the initial control period, baseline MBC use, attitudes, acceptability, feasibility and appropriateness (per clinician self-report) will be collected, as well as needs assessment data from clinician surveys to inform necessary adjustments to the implementation supports. Baseline engagement and student outcomes will be collected after initial clinician training session. MBC implementation outcomes (i.e., MBC use, attitudes, acceptability, appropriateness, and feasibility), engagement and student outcomes will be collected at 3-month and 6-month follow-up during intervention supports, plus a 9-month follow-up interval. This allows clinicians in the two school districts to be compared to each other and to their own baseline. The primary comparison is pre-post ratings of implementation outcomes for all N=50 clinicians. The secondary comparisons are pre-post ratings of engagement and student outcomes, and between-agency differences.
Interventions
BEHAVIORALMeasurement-based care (MBC)
Clinicians will receive a 3-hour interactive MBC training followed by six months of post-training consultation. Training and consultation will include how to collect, score, and use student- and parent-reported progress measures with students and families to inform collaborative progress monitoring and treatment decisions.
Sponsors
National Institute of Mental Health (NIMH)
Yale University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
To be eligible for inclusion in the study, a clinician must meet all of the following criteria: * Female, male or other gender ≥18 years of age at the time of recruitment. * Provide school-based individual and/or family mental health treatment in an elementary, middle or high school in a participating school district. * Hold a professional license or certification in their state to provide mental health treatment OR be supervised by a licensed or certified mental health professional in their state. * English-speaking. * Ability to provide informed consent.
Exclusion criteria
\- Clinicians who do not meet all inclusion criteria are excluded. There are no other
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Clinician Attitudes Toward Standardized Assessment | Baseline, 3-month follow up, 6-month follow up, 9-month follow up | Change in clinician-reported Attitudes toward Standardized Assessment-Monitoring and Feedback Scale (e.g., a score of 5 = strongly agree across is most favorable; possible scores range from 1-5) |
| Change in Clinician Feasibility of MBC | Baseline, post training, 3-month follow up, 6-month follow up, 9-month follow up | Change in clinician-reported Feasibility of Intervention Measure (e.g., a score of 5 = completely agree and is most favorable; possible scores range from 1-5) |
| Change in Clinician Fidelity to MBC | 9-month follow up (end of school year; end of study period) | Monthly fidelity monitoring of ORS measures entered in the online system as evidence of administration with student or parent respondents. A count of participants meeting the established fidelity threshold of 2 or more ORS measures will be calculated each month. Possible scores range from 0-100%. |
| Change in Clinician Use of MBC | Baseline, post training, 3-month follow up, 6-month follow up, 9-month follow up | Change in clinician-reported Current Assessment Practice Evaluation - Revised (e.g., a score of 100% across all items is most favorable). Possible scores range from 0-100%. |
| Change in Clinician Acceptability of the PCOMS | 3-month follow up, 6-month follow up, 9-month follow up | Change in clinician-reported Usage Rating Profile - Assessment (e.g., a score of 6 = strongly agree and is most favorable; possible scores range from 1-6. ) |
| Change in Clinician Acceptability of MBC | Baseline, 3-month follow up, 6-month follow up, 9-month follow up | Change in clinician-reported Acceptability of Intervention Measure (e.g., a score of 5 = completely agree and is most favorable; possible scores range from 1-5) |
| Change in Clinician Appropriateness of MBC | Baseline, 3-month follow up, 6-month follow up, 9-month follow up | Change in clinician-reported Intervention Appropriateness Measure (e.g., a score of 5 = completely agree and is most favorable; possible scores range from 1-5) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Parent Engagement | Baseline, 3-month follow up, 6-month follow up, 9-month follow up | Data were not collected due to study design changes during the pandemic, which were approved by the Yale IRB and NIMH. |
| Change in Child Engagement | 3-month follow up, 9-month follow up | Data were not collected due to study design changes during the pandemic, which were approved by the Yale IRB and NIMH. |
| Change in Child Functioning | 3-month follow up, 9-month follow up | Data were not collected due to study design changes during the pandemic, which were approved by the Yale IRB and NIMH. |
| Change in Child Emotional and Behavioral Symptoms | Baseline, 3-month follow up, 6-month follow up, 9-month follow up | Data were not collected due to study design changes during the pandemic, which were approved by the Yale IRB and NIMH. |
Countries
United States
Participant flow
Recruitment details
Only clinicians were enrolled. Parents were not enrolled in the study. Clinicians were considered completed if they completed at least one baseline, 3-month follow up, 6-month follow up, or 9-month follow up survey.
Participants by arm
| Arm | Count |
|---|---|
| Measurement-based Care Year 1 Clinicians will receive a 3-hour interactive MBC training followed by six months of post-training consultation. Training and consultation will include how to collect, score, and use student- and parent-reported progress measures with students and families to inform collaborative progress monitoring and treatment decisions.
Measurement-based care (MBC): Clinicians will receive a 3-hour interactive MBC training followed by six months of post-training consultation. Training and consultation will include how to collect, score, and use student- and parent-reported progress measures with students and families to inform collaborative progress monitoring and treatment decisions.
Year 1 is for academic school year 2021-2022 | 12 |
| Measurement-based Care Year 2 Clinicians will receive a 3-hour interactive MBC training followed by six months of post-training consultation. Training and consultation will include how to collect, score, and use student- and parent-reported progress measures with students and families to inform collaborative progress monitoring and treatment decisions.
Measurement-based care (MBC): Clinicians will receive a 3-hour interactive MBC training followed by six months of post-training consultation. Training and consultation will include how to collect, score, and use student- and parent-reported progress measures with students and families to inform collaborative progress monitoring and treatment decisions.
Year 2 is for academic school year 2022-2023. | 57 |
| Total | 69 |
Baseline characteristics
| Characteristic | Measurement-based Care Year 2 | Measurement-based Care Year 1 | Total |
|---|---|---|---|
| Age, Customized Age 21-30 | 8 Participants | 2 Participants | 10 Participants |
| Age, Customized Age 31-40 | 16 Participants | 5 Participants | 21 Participants |
| Age, Customized Age 41-50 | 16 Participants | 3 Participants | 19 Participants |
| Age, Customized Age 51-60 | 12 Participants | 2 Participants | 14 Participants |
| Age, Customized Age 61 and over | 5 Participants | 0 Participants | 5 Participants |
| Highest Degree Earned Bachelors | 1 Participants | 0 Participants | 1 Participants |
| Highest Degree Earned Doctorate | 1 Participants | 0 Participants | 1 Participants |
| Highest Degree Earned Masters | 55 Participants | 12 Participants | 67 Participants |
| Professional Discipline Multiple | 5 Participants | 0 Participants | 5 Participants |
| Professional Discipline Other | 1 Participants | 0 Participants | 1 Participants |
| Professional Discipline Professional Counseling | 1 Participants | 2 Participants | 3 Participants |
| Professional Discipline School Psychology | 6 Participants | 3 Participants | 9 Participants |
| Professional Discipline Social Work | 44 Participants | 7 Participants | 51 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Asian or Asian American | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Black or African American | 3 Participants | 1 Participants | 4 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Hispanic or Latino | 9 Participants | 1 Participants | 10 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Missing (Did not respond) | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Multiple Races | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Prefer not to answer | 2 Participants | 1 Participants | 3 Participants |
| Race/Ethnicity, Customized Race/Ethnicity White or Caucasian | 40 Participants | 9 Participants | 49 Participants |
| Sex/Gender, Customized Gender Female | 51 Participants | 12 Participants | 63 Participants |
| Sex/Gender, Customized Gender Male | 5 Participants | 0 Participants | 5 Participants |
| Sex/Gender, Customized Gender Other | 1 Participants | 0 Participants | 1 Participants |
| Years in Mental Health | 16.43 years | 11.12 years | 13.78 years |
| Years in School | 13.45 years | 10.21 years | 11.83 years |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 13 | 0 / 79 |
| other Total, other adverse events | 0 / 13 | 0 / 79 |
| serious Total, serious adverse events | 0 / 13 | 0 / 79 |
Outcome results
Primary
Change in Clinician Acceptability of MBC
Change in clinician-reported Acceptability of Intervention Measure (e.g., a score of 5 = completely agree and is most favorable; possible scores range from 1-5)
Time frame: Baseline, 3-month follow up, 6-month follow up, 9-month follow up
Population: Not all participants were asked to complete each survey that was administered across the study time period. However, the number analyzed varies based on actual survey completion results, which varies by time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Measurement-based Care Year 1 | Change in Clinician Acceptability of MBC | 6-month | 4.64 score on a scale | Standard Deviation 0.63 |
| Measurement-based Care Year 1 | Change in Clinician Acceptability of MBC | 9-month | 4.56 score on a scale | Standard Deviation 0.51 |
| Measurement-based Care Year 1 | Change in Clinician Acceptability of MBC | 3-month | 4.54 score on a scale | Standard Deviation 0.51 |
| Measurement-based Care Year 1 | Change in Clinician Acceptability of MBC | Baseline | 3.96 score on a scale | Standard Deviation 0.65 |
| Measurement-based Care Year 2 | Change in Clinician Acceptability of MBC | 3-month | 3.58 score on a scale | Standard Deviation 0.87 |
| Measurement-based Care Year 2 | Change in Clinician Acceptability of MBC | Baseline | 3.52 score on a scale | Standard Deviation 0.95 |
| Measurement-based Care Year 2 | Change in Clinician Acceptability of MBC | 9-month | 3.76 score on a scale | Standard Deviation 0.75 |
Primary
Change in Clinician Acceptability of the PCOMS
Change in clinician-reported Usage Rating Profile - Assessment (e.g., a score of 6 = strongly agree and is most favorable; possible scores range from 1-6. )
Time frame: 3-month follow up, 6-month follow up, 9-month follow up
Population: Not all participants were asked to complete each survey that was administered across the study time period. However, the number analyzed varies based on actual survey completion results, which varies by time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Measurement-based Care Year 1 | Change in Clinician Acceptability of the PCOMS | 3-Month | 4.62 score on a scale | Standard Deviation 0.51 |
| Measurement-based Care Year 1 | Change in Clinician Acceptability of the PCOMS | 6-Month | 4.70 score on a scale | Standard Deviation 0.54 |
| Measurement-based Care Year 1 | Change in Clinician Acceptability of the PCOMS | 9-Month | 4.38 score on a scale | Standard Deviation 0.59 |
| Measurement-based Care Year 2 | Change in Clinician Acceptability of the PCOMS | 3-Month | 3.69 score on a scale | Standard Deviation 0.78 |
| Measurement-based Care Year 2 | Change in Clinician Acceptability of the PCOMS | 9-Month | 3.95 score on a scale | Standard Deviation 0.7 |
Primary
Change in Clinician Appropriateness of MBC
Change in clinician-reported Intervention Appropriateness Measure (e.g., a score of 5 = completely agree and is most favorable; possible scores range from 1-5)
Time frame: Baseline, 3-month follow up, 6-month follow up, 9-month follow up
Population: Not all participants were asked to complete each survey that was administered across the study time period. However, the number analyzed varies based on actual survey completion results, which varies by time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Measurement-based Care Year 1 | Change in Clinician Appropriateness of MBC | 6-month | 4.68 score on a scale | Standard Deviation 0.55 |
| Measurement-based Care Year 1 | Change in Clinician Appropriateness of MBC | 9-month | 4.47 score on a scale | Standard Deviation 0.54 |
| Measurement-based Care Year 1 | Change in Clinician Appropriateness of MBC | 3-month | 4.50 score on a scale | Standard Deviation 0.55 |
| Measurement-based Care Year 1 | Change in Clinician Appropriateness of MBC | Baseline | 4.13 score on a scale | Standard Deviation 0.79 |
| Measurement-based Care Year 2 | Change in Clinician Appropriateness of MBC | 3-month | 3.52 score on a scale | Standard Deviation 0.99 |
| Measurement-based Care Year 2 | Change in Clinician Appropriateness of MBC | Baseline | 3.64 score on a scale | Standard Deviation 0.87 |
| Measurement-based Care Year 2 | Change in Clinician Appropriateness of MBC | 9-month | 3.93 score on a scale | Standard Deviation 0.8 |
Primary
Change in Clinician Attitudes Toward Standardized Assessment
Change in clinician-reported Attitudes toward Standardized Assessment-Monitoring and Feedback Scale (e.g., a score of 5 = strongly agree across is most favorable; possible scores range from 1-5)
Time frame: Baseline, 3-month follow up, 6-month follow up, 9-month follow up
Population: Not all participants were asked to complete each survey that was administered across the study time period. However, the number analyzed varies based on actual survey completion results, which varies by time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Measurement-based Care Year 1 | Change in Clinician Attitudes Toward Standardized Assessment | 6-Month | 4.21 score on a scale | Standard Deviation 0.48 |
| Measurement-based Care Year 1 | Change in Clinician Attitudes Toward Standardized Assessment | 9-Month | 3.98 score on a scale | Standard Deviation 0.57 |
| Measurement-based Care Year 1 | Change in Clinician Attitudes Toward Standardized Assessment | 3-Month | 4.31 score on a scale | Standard Deviation 0.38 |
| Measurement-based Care Year 1 | Change in Clinician Attitudes Toward Standardized Assessment | Baseline | 3.65 score on a scale | Standard Deviation 0.63 |
| Measurement-based Care Year 2 | Change in Clinician Attitudes Toward Standardized Assessment | 3-Month | 3.36 score on a scale | Standard Deviation 0.7 |
| Measurement-based Care Year 2 | Change in Clinician Attitudes Toward Standardized Assessment | Baseline | 3.33 score on a scale | Standard Deviation 0.59 |
| Measurement-based Care Year 2 | Change in Clinician Attitudes Toward Standardized Assessment | 9-Month | 3.49 score on a scale | Standard Deviation 0.65 |
Primary
Change in Clinician Feasibility of MBC
Change in clinician-reported Feasibility of Intervention Measure (e.g., a score of 5 = completely agree and is most favorable; possible scores range from 1-5)
Time frame: Baseline, post training, 3-month follow up, 6-month follow up, 9-month follow up
Population: Not all participants were asked to complete each survey that was administered across the study time period. However, the number analyzed varies based on actual survey completion results, which varies by time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Measurement-based Care Year 1 | Change in Clinician Feasibility of MBC | 6-Month | 4.07 score on a scale | Standard Deviation 1.16 |
| Measurement-based Care Year 1 | Change in Clinician Feasibility of MBC | 9-Month | 4.08 score on a scale | Standard Deviation 0.64 |
| Measurement-based Care Year 1 | Change in Clinician Feasibility of MBC | 3-Month | 4.29 score on a scale | Standard Deviation 0.66 |
| Measurement-based Care Year 1 | Change in Clinician Feasibility of MBC | Baseline | 3.92 score on a scale | Standard Deviation 0.48 |
| Measurement-based Care Year 2 | Change in Clinician Feasibility of MBC | 3-Month | 3.45 score on a scale | Standard Deviation 0.85 |
| Measurement-based Care Year 2 | Change in Clinician Feasibility of MBC | Baseline | 3.47 score on a scale | Standard Deviation 0.86 |
| Measurement-based Care Year 2 | Change in Clinician Feasibility of MBC | 9-Month | 3.74 score on a scale | Standard Deviation 0.68 |
Primary
Change in Clinician Fidelity to MBC
Monthly fidelity monitoring of ORS measures entered in the online system as evidence of administration with student or parent respondents. A count of participants meeting the established fidelity threshold of 2 or more ORS measures will be calculated each month. Possible scores range from 0-100%.
Time frame: 9-month follow up (end of school year; end of study period)
Population: Some participants attrited or opted out before the end of the school year.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Measurement-based Care Year 1 | Change in Clinician Fidelity to MBC | 9 Participants |
| Measurement-based Care Year 2 | Change in Clinician Fidelity to MBC | 12 Participants |
Primary
Change in Clinician Use of MBC
Change in clinician-reported Current Assessment Practice Evaluation - Revised (e.g., a score of 100% across all items is most favorable). Possible scores range from 0-100%.
Time frame: Baseline, post training, 3-month follow up, 6-month follow up, 9-month follow up
Population: Not all participants were asked to complete each survey that was administered across the study time period. However, the number analyzed varies based on actual survey completion results, which varies by time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Measurement-based Care Year 1 | Change in Clinician Use of MBC | 6-Month | 31.59 score on a scale | Standard Deviation 37.55 |
| Measurement-based Care Year 1 | Change in Clinician Use of MBC | 9-Month | 21.29 score on a scale | Standard Deviation 23.21 |
| Measurement-based Care Year 1 | Change in Clinician Use of MBC | 3-Month | 24.33 score on a scale | Standard Deviation 24.63 |
| Measurement-based Care Year 1 | Change in Clinician Use of MBC | Baseline | 2.23 score on a scale | Standard Deviation 4.52 |
| Measurement-based Care Year 2 | Change in Clinician Use of MBC | 3-Month | 9.81 score on a scale | Standard Deviation 15.37 |
| Measurement-based Care Year 2 | Change in Clinician Use of MBC | Baseline | 19.60 score on a scale | Standard Deviation 17.15 |
| Measurement-based Care Year 2 | Change in Clinician Use of MBC | 9-Month | 11.82 score on a scale | Standard Deviation 18.38 |
Secondary
Change in Child Emotional and Behavioral Symptoms
Data were not collected due to study design changes during the pandemic, which were approved by the Yale IRB and NIMH.
Time frame: Baseline, 3-month follow up, 6-month follow up, 9-month follow up
Population: Data were not collected due to study design changes during the pandemic, which were approved by the Yale IRB and NIMH.
Secondary
Change in Child Engagement
Data were not collected due to study design changes during the pandemic, which were approved by the Yale IRB and NIMH.
Time frame: 3-month follow up, 9-month follow up
Population: Data were not collected due to study design changes during the pandemic, approved by the IRB and funder (NIMH).
Secondary
Change in Child Functioning
Data were not collected due to study design changes during the pandemic, which were approved by the Yale IRB and NIMH.
Time frame: 3-month follow up, 9-month follow up
Population: Data were not collected due to study design changes during the pandemic, which were approved by the Yale IRB and NIMH.
Secondary
Change in Parent Engagement
Data were not collected due to study design changes during the pandemic, which were approved by the Yale IRB and NIMH.
Time frame: Baseline, 3-month follow up, 6-month follow up, 9-month follow up
Population: Data were not collected due to study design changes during the pandemic, which were approved by the Yale IRB and NIMH.