Bridging Mental Health and Education in Urban Elementary Schools: Participatory Research to Inform Intervention Development
Cappella, Elise, Jackson, Daisy R., Bilal, Caroline, Hamre, Bridget K., Soule, Charles, School Psychology Review
Increasing numbers of elementary schools have mental health professionals on site to prevent and alleviate the behavioral difficulties that interfere with learning (Brener, Weist, Adelman, Taylor, & Vernon-Smiley, 2007, Kutash, Duchnowski, & Lynn, 2006). Behavioral problems, such as inattention, impulsivity, and defiance, are common in urban high-poverty schools. Teachers express concerns about disruptive behavior (Reinke, Stormont, Herman, Puri, & Goel, 2011), and children with behavioral problems are at risk for maladjustment (Tolan & Henry, 1996). School mental health services offer the promise of support--yet this promise is inconsistently realized. Studies reveal minimal effects on children's behavioral and academic functioning (Hoagwood et al., 2007), and mental health remains isolated from the mission and structure of schools (Weist & Paternite, 2006). Recent calls have been made to align school mental health with educational goals as a means toward increasing its relevance and effect (Atkins, Hoagwood, Kutash, & Seidman, 2010; Cappella, Frazier, Atkins, Schoenwald, & Glisson, 2008).
School mental health professionals are trained in assessment, individual and group therapy, crisis and case management, and family outreach (Brener et al., 2007), all of which facilitates their direct work with children and families (Kaufman, Hughes, & Riccio, 2010). It is less common for these professionals to have the language and tools to support classroom teachers (Schaeffer et al., 2005). Yet teachers arguably have the most effect on children's adaptation in school (Heck, 2007; Nye, Konstantopoulos, & Hedges, 2004). Effective teacher-student interactions are critical to academic and social-emotional development, particularly among children experiencing multiple problems (Hamre & Pianta, 2005; Mashburn et al., 2008). Effective interactions communicate warmth and respect, positive and clear expectations, and engaging and rich opportunities for learning (Hamre & Pianta, 2010). More adequately preparing mental health professionals to help teachers interact effectively with students with behavioral difficulties--and all students--may increase the effect these professionals can have on children's development.
Toward this goal, and guided by community-based participatory methods (Gittelsohn et al., 2006; Lantz, Israel, Schulz, & Reyes, 2006), a teacher consultation and coaching program was developed for school mental health professionals to deliver as a part of their ongoing activities in urban low-income schools. The program--Bridging Education and Mental Health in Urban Schools (BRIDGE)--fits within the broader framework of education and mental health interventions (e.g., Nastasi, 2004), and draws specifically from two existing models: MyTeachingPartner (MTP; Pianta, Mashburn, Downer, Hamre, & Justice, 2008) and Links to Learning (L2L; Atkins et al., 2006; Cappella et al., 2008). Goals are to increase effective teacher-student interactions across the classroom and with children with behavioral difficulties as a means toward children's academic, social, and behavioral adjustment in underfunded schools (Cappella, Hamre, Jackson, Wagner, & Soule, 2011).
One element of the intervention development process is contextualizing the program for its settings in order to increase its relevance and feasibility. Although it is not new to engage in participatory processes to "naturalize" interventions (e.g., Gittelsohn et al., 2006; National Research Council and Institute of Medicine, 2002), it is uncommon for these processes to be the focus of published scholarship in school psychology or prevention science. Toward this end, this article documents findings from a collaborative study to inform the adaptation of BRIDGE (Phase I) and a pilot experimental trial to assess the implementation of the adapted BRIDGE program by indigenous staff in urban schools (Phase II). Aims are to increase the specificity with which we describe approaches to intervention development (Cates, 1995; Wandersman, 2003) and enhance the likelihood of building sustainable programs to support children in schools. …