Evidence based practice in a school based setting opportunities issues and possible directions
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Evidence-Based Practice in a School-Based Setting: Opportunities, issues, and possible directions.

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Opportunities in a School Setting

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Evidence based practice in a school based setting opportunities issues and possible directions

Evidence-Based Practice in a School-Based Setting: Opportunities, issues, and possible directions

Julia Graham Lear, PhD, Director, Center for Health & Health Care in Schools, The George Washington University, Washington, DC. The MacArthur Foundation Mental Health Network. Chicago, IL. July 17, 2002.


Opportunities in a school setting

Opportunities in a School Setting

  • A school “base” enables providers to overcome access barriers for most children. 50 million American children and youth between ages 5 and 17 attend school; 90% attend public schools.

  • Perversely, economic and racial segregation in schools enables targeting on those populations with greatest need.

  • Many school districts, especially the largest, have established mental health-service arrangements -- including school system-organized care, school-based extensions of community-based mental health programs, & school-based health centers.


Challenges difficulties and just plain problems

Challenges, difficulties and just plain problems

  • Strengthening mental health interventions is low on school principals’ priority list and principals rule.

  • Participating in a mental health study may not be a priority for mental health professionals because they may have less time for student interventions than is indicated on paper.

  • Shortage of mental health providers may lead to IEPs under-identifying the mental health needs of students & thus students may not be eligible for service.

  • The strength and quality of the school system’s supervisory structure for mental health professionals in school are highly variable.


Recurring issues in school based mental health

Recurring issues in school-based mental health

  • Who to serve? Population-targeted practice v. individual targeted practice? Disadvantaged populations?

  • What services to offer? Prevention? Screening? Diagnosis? Short-term or long-term interventions?

  • How to serve? Are tools & interventions validated with target populations?

  • Whose goals? Does mental health care in schools support education objectives or health objectives?


Who to serve what problems to address

Who to serve, what problems to address?

  • The issues that mental health professionals in school-based health centers identify as needing greater attention and more effective interventions:

    Depression and ADD/ADHD

    Anxiety disorders.

  • Depression and ADD/ADHD have been identified as sentinel conditions on the CQI tool for school-based health centers.


Increasing likelihood of study success in a school setting

Increasing Likelihood of Study Success in a School Setting

  • Hold a competition for study participation

  • Precede the study with researcher-observations of the school setting. Identify disparities between the paper description and actual workday of the mental health staff.

  • Beware of school systems that may be transferring funding for school-based mental health providers from the superintendent to the discretion of principals.

  • Consider involving school-based health centers. There are more than 1500 around the country; they offer mental health care in a multi-disciplinary environment.


Increasing study impact

Increasing Study Impact

  • Invite larger group to review study design; solicit input from parents, teachers, school policymakers, and school-based professionals

  • Lay the groundwork for a demand-driven strategy for strengthening mental health services in schools


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