Response to Intervention as a Vehicle for Powerful Mental Health Interventions in the Schools

Article excerpt

School psychologists can work within a Response to Intervention (RtI) framework to increasingly promote the mental health of students. This article shares the unfolding of two composite case studies that exemplify how a practicing school psychologist can use a problem-solving framework to deliver effective mental health interventions to individual students. The first case involved an elementary school student who markedly improved in terms of on-task behavior, and the second case concerned a high school student who overcame school refusal and negative affect. The advantages of providing brief counseling and psychological consultation prior to a possible full evaluation or special education placement are discussed.

KEYWORDS: mental health, intervention, problem-solving, elementary school students, high school students

The reauthorization of the Individuals with Disabilities Education Act (IDEA) emphasizes Response to Intervention (RtI) as an alternative to IQ-achievement discrepancies in the identification of learning disabilities (U.S. Department of Education, 2004). This is likely the reason that the RtI literature has emphasized academic skills. As an example of the emphasis on academics, consider that the software for keeping track of Tier I, Tier II, and Tier III curriculum-based measurement (CBM) data (e.g., AIMSWEB) have been around for quite some time, whereas behavioral progress monitoring systems and related software (e.g., the Behavior Intervention Monitoring and Assessment System; Bardos, McDougal, & Meier, 2010) are still being developed. As Gresham (2004) noted, the use of RtI logic to measure intervention response is better established in the academic domain than it is in the mental health domain, but RtI is well suited for addressing behavioral problems. Despite its potential usefulness, relatively few articles have discussed the application of RtI to behavioral problems (Hawken, Vincent, & Schumann, 2008), and RtI has been underutilized by school systems for addressing social and emotional challenges (Cheney, Flower, & Templeton, 2008).

One may view RtI as a promising framework within which school psychologists can prevent children from being unnecessarily labeled, placed, or medicated for attention and emotional disorders. In fact, in a recent study of RtI and behavior, the majority of students at risk for emotional disturbance across nine elementary schools responded well to a thorough intervention (Cheney et al., 2008). Because approximately 20% of children in the U.S. have significant emotional and behavioral difficulties, and most of these children do not receive mental health services, utilizing RtI to better serve children at risk for emotional and behavioral disorders presents an extremely important option for school psychologists (Cheney et al., 2008; Gresham, 2005; U.S. Surgeon General, 1999).

At Tier III, or the tertiary intervention level, in RtI, there is the expectation of the delivery and formative assessment of brief (i.e., 10 weeks), individualized and intense interventions prior to a full evaluation or special education placement (VanDerHeyden, Witt, & Gilbertson, 2007). This article presents two powerful case studies (composites to protect confidentiality) to educate school psychologists about how Tier III intensive interventions can meaningfully improve the mental health of children and youth in the schools. Both cases occurred in districts that were accustomed to the traditional role of the psychologist, but, in these cases, the psychologist gradually increased the implementation of a problem-solving model of RtI. Problem solving involves the application of the scientific method through clear problem identification, in-depth problem analysis, intervention development, ongoing measurement of students' intervention response, and refinement of the intervention based on data (Marston, 2005).

Although advanced single-subject designs for treating significant behavior problems are found frequently in school psychology journals (e. …

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