ABSTRACT
This article reviews the progression of a research program designed to develop, implement, and study the implementation of "achievable" evidence-based practices (EBPs) in schools. We review challenges encountered and ideas to overcome them to enhance this avenue of research. The article presents two federally funded randomized controlled trials involving comparison of a four-component targeted intervention (Quality Assessment and Improvement, Family Engagement and Empowerment, Modular Evidence-Based Practice, Implementation Support) versus a comparison intervention focused on personal wellness. In both studies, primary aims focused on changes in clinician attitudes and behavior, including the delivery of high-quality EBPs and secondary aims focused on student-level impacts. A number of challenges, many not reported in the literature, are reviewed, and ideas for overcoming them are presented. Given the reality that the majority of youth mental health services are delivered in schools and the potential of school mental health services to provide a continuum of mental health care from promotion to intervention, it is critical that the field consider and address the logistical and methodological challenges associated with implementing and studying EBP implementation by clinicians.
Subject(s)
Evidence-Based Practice , Health Services Research , Mental Health Services/organization & administration , School Health Services/organization & administration , Students/psychology , Adolescent , Continuity of Patient Care/organization & administration , Delivery of Health Care/organization & administration , Humans , Male , Mental Health , Randomized Controlled Trials as Topic , SchoolsABSTRACT
Therapeutic Assessment (TA) with children is a hybrid of psychological assessment and short-term intervention. It uses the ongoing process and results of psychological assessment to enhance parents' understanding of their child and to facilitate change. Clinical reports and single case studies suggest that TA with children is an acceptable and effective brief intervention. However, no aggregate data have been published to support this claim. This pilot study investigated the acceptability and preoutcome-postoutcome of TA with 14 clinically referred children with emotional and behavior problems and their parents. Results indicated high treatment acceptability as well as significantly decreased child symptomatology and enhanced family functioning as reported by children and mothers. In addition, mothers demonstrated a significant increase in positive emotion and a significant decrease in negative emotion pertaining to their children's challenges and future. The findings, although limited due to the design and small sample size, support assertions from published single case studies that TA is possibly an efficacious child and family intervention for children with emotional and behavioral problems and should be studied in a larger, comparison design.
Subject(s)
Affect , Patient Acceptance of Health Care , Personality Disorders/diagnosis , Personality Disorders/therapy , Adult , Aged , Caregivers , Child , Humans , Maternal Age , Middle Aged , Motivation , Parent-Child Relations , Pilot Projects , Severity of Illness Index , Social Facilitation , Treatment OutcomeABSTRACT
We present a case study of a child's psychological assessment using the methods of Therapeutic Assessment (TA). The case illustrates how TA can help assessors understand the process and structure of a family by highlighting how maladaptive family processes and interactions impact a child's development. It also illustrates how TA with a child can serve as a family intervention. In this case, it became apparent that the child's social difficulties were significant, not minor as initially reported by the parents, and were rooted in an insecure attachment, underlying depression, an idiosyncratic view of the world, and longing for attention, all of which were hidden or expressed in grandiose, expansive, and off-putting behaviors. In addition, the familial hierarchy was inverted; the parents felt ineffective and the child felt too powerful, leading to enhanced anxiety for the child. Intervention throughout, punctuated by the family session and feedback sessions, allowed the parents to develop a new "story" about their child and for the child to experience a new sense of safety. Following the TA, the parents and child indicated high satisfaction, enhanced family functioning, and decreased child symptomatology. Subsequent family therapy sessions allowed the family to further implement the interventions introduced in the TA.
Subject(s)
Behavior Therapy/methods , Child Behavior/psychology , Depression/therapy , Parent-Child Relations , Parents/psychology , Child , Child Development , Communication Barriers , Depression/diagnosis , Female , Humans , Personality Assessment , Self Concept , Treatment OutcomeABSTRACT
School mental health (SMH) programs are gaining momentum and, when done well, are associated with improved academic and social-emotional outcomes. Professionals from several education and mental health disciplines have sound training and experiences needed to play a critical role in delivering quality SMH services. School psychologists, specifically, are in a key position to advance SMH programs and services. Studies have documented that school psychologists desire more prominent roles in the growth and improvement of SMH, and current practice models from national organizations encourage such enhanced involvement. This article identifies the roles of school psychologists across a three-tiered continuum of SMH practice and offers an analysis of current training and professional development opportunities aimed at such role enhancement. We provide a justification for the role of school psychologists in SMH, describe a framework for school psychologists in the SMH delivery system, discuss barriers to and enablers of this role for school psychologists, and conclude with recommendations for training and policy.