Investigating the Longitudinal Association between Fidelity to a Large-Scale Comprehensive School Mental Health Prevention and Intervention Model and Student Outcomes

Many youth experience mental health problems resulting in internalizing and externalizing behaviors. Interrelated variables can influence these experiences, including socio-economic status, race, gender and age impacting disproportionately. With mental health of U.S. students reportedly worsening, significantly hindering academic growth, it is crucial to meet the emotional, behavioral and mental health needs of youth.

Much of youth time is spent in the environment, making schools an ideal setting to identify, prevent and intervene. However, there are challenges that impede this goal. Many schools fail to use screening and assessment methods to identify the 15% of students presenting with additional social, emotional and behavioral needs. Teacher and office discipline referrals to identify students can be reactive, often catching issues after having time to develop.

A Coalition of six school districts and a parochial school, in collaboration with researchers, was established. Utilizing a universal screening within a comprehensive model, youth in need were identified and provided accommodations, supports and resources quickly in efforts to prevent social, emotional and behavioral problems. Evidence-based interventions were identified that directly connected to the problem areas identified through the Early Identification system (EIS).

Various measures were utilized including the (EIS) a universal social, emotional, and behavioral screener administered throughout the year. Both student and teacher reported electronically, measuring seven domains: internalizing behavior, externalizing behavior, emotion dysregulation, peer relationship problems, attention and academic issues, school disengagement, and relational aggression. The data populates in dashboard reports timely for schools to review, indicated as green, yellow, red (needs attention) format for individual, grade and building level. A measure to evaluate fidelity to the Coalition model was developed regarding specific activities that each school should be doing to implement at high fidelity (I.e.) data collection and assessment of universal screening data; intervention planning and implementation across levels; and progress monitoring/evaluation of the intervention effectiveness.

The study purpose was to investigate patterns of student social, emotional, and behavioral risk over time among a community sample of students (3rd-12th grade) and the association of these risk patterns with fidelity to a school-based mental health model. Overall growth of social, emotional, and behavioral problems declined over a 3-year period. Four student categories were identified using growth mixture modeling. These growth trajectories were associated with fidelity to the model. Results showed that trajectories where students have higher or increasing problems were more likely to be from schools with lower fidelity.

Contrary to national data, this study noted an overall decline in student-reported social, emotional, and behavioral problems over time. This may support the need for schools to engage in systematic universal screening so they may act upon early indicators of risk factors instead of allowing these issues to manifest info office referrals, absenteeism, suspensions, and poor academic performance.

This study represents an advanced translational study to bring effective practices to scale across multiple school districts to impact the population health of students. These promising findings suggest that the implementation of the prevention-based Coalition model, is one potential explanation for the declining rates of mental health concerns.