Abstract
Learning collaboratives (LCs) have often been used to improve somatic health care quality in hospitals and other medical settings, and to some extent to improve social services and behavioral health care. This initiative is the first demonstration of a national, systematic LC to advance comprehensive school mental health system quality among school district teams. Twenty-four districts representing urban, rural, and suburban communities in 14 states participated in one of two 15-month LCs. Call attendance (M = 73%) and monthly data submission (M = 98% for PDSA cycles and M = 65% for progress measures) indicated active engagement in and feasibility of this approach. Participants reported that LC methods, particularly data submission, helped them identify, monitor and improve school mental health quality in their district. Qualitative feedback expands quantitative findings by detailing specific benefits and challenges reported by participants and informs recommendations for future research on school mental health LCs. Rapid-cycle tests of improvement allowed teams to pursue challenging and meaningful school mental health quality efforts, including mental health screening in schools, tracking the number of students receiving early intervention (Tier 2) and treatment (Tier 3) services, and monitoring psychosocial and academic improvement for students served.
Similar content being viewed by others
Notes
1This total is driven in part by two teams who produced a large proportion (N = 26) mental health screening PDSAs.
References
Algozzine, B., Barrett, S., Eber, L., George, H., Horner, R., Lewis, T., et al. (2017). School-wide PBIS Tiered Fidelity Inventory. Retrieved May 4, 2020 from https://www.pbis.org/resource/tfi.
American Diabetes Association. (2004). The breakthrough series: IHI’s collaborative model for achieving breakthrough improvement. Diabetes Spectrum, 17(2), 97–101.
Bruns, E. J., Walwrath, C., Glass Siegal, M., & Weist, M. D. (2004). School-based mental health services in Baltimore: Association with school climate and special education referrals. Behavior Modification, 28(4), 491–512. https://doi.org/10.1177/0145445503259524.
Charmaz, K., & Bryant, A. (2007). The SAGE Handbook of Grounded Theory. https://doi.org/10.4135/9781848607941.
Chung, H., Klein, M. C., Silverman, D., Corson-Rikert, J., Davidson, E., Ellis, P., et al. (2011). A pilot for improving depression care on college campuses: Results of the college breakthrough series-depression (CBS-D) project. Journal of American College Health, 59(7), 628–639. https://doi.org/10.1080/07448481.2010.528097.
Connors, E. H., Stephan, S. H., Lever, N., Ereshefsky, S., Mosby, A., & Bohnenkamp, J. (2016). A national initiative to advance school mental health performance measurement in the US. Advances in School Mental Health Promotion, 9(1), 50–69.
Conradi, L., Wilson, C., Agosti, J., Tullberg, E., Richardson, L., Langan, H., et al. (2011). Promising practices and strategies for using trauma-informed child welfare practice to improve foster care placement stability: A breakthrough series collaborative. Child Welfare, 90(6), 207–225.
Dix, K. L., Slee, P. T., Lawson, M. J., & Keeves, J. P. (2012). Implementation quality of whole-school mental health promotion and students’ academic performance. Child and Adolescent Mental Health, 17(1), 45–51. https://doi.org/10.1111/j.1475-3588.2011.00608.x.
Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. (2011). The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions. Child Development, 82(1), 405–432.
Flannery, K. B., Fenning, P., Kato, M. M., & McIntosh, K. (2014). Effects of school-wide positive behavioral interventions and supports and fidelity of implementation on problem behavior in high schools. School Psychology Quarterly, 29(2), 111.
Ghandour, R. M., Flaherty, K., Hirai, A., Lee, V., Walker, D. K., & Lu, M. C. (2017). Applying collaborative learning and quality improvement to public health: Lessons from the collaborative improvement and innovation network (CoIIN) to reduce infant mortality. Maternal and Child Health Journal, 21(6), 1318–1326. https://doi.org/10.1007/s10995-016-2235-2.
Greenberg, M. T., Weissberg, R. P., Obrien, M. U., Zins, J. E., Fredericks, L., Resnik, H., et al. (2003). Enhancing school-based prevention and youth development through coordinated social, emotional, and academic learning. American Psychologist, 58(6/7), 466–474. https://doi.org/10.1037/0003-066x.58.6-7.466.
Haine-Schlagel, R., Brookman-Frazee, L., Janis, B., & Gordon, J. (2013). Evaluating a learning collaborative to implement evidence-informed engagement strategies in community-based services for young children. Child & Youth Care Forum, 42(5), 457–473. https://doi.org/10.1007/s10566-013-9210-5.
Hanson, R. F., Self-Brown, S., Rostad, W. L., & Jackson, M. C. (2016). The what, when, and why of implementation frameworks for evidence-based practices in child welfare and child mental health service systems. Child Abuse and Neglect, 53, 51–63. https://doi.org/10.1016/j.chiabu.2015.09.014.
Health Resources and Services Administration Maternal and Child Health Bureau. (2019). Collaborative improvement & innovation networks (CoIINs). Retrieved August 28, 2019 from https://mchb.hrsa.gov/maternal-child-health-initiatives/collaborative-improvement-innovation-networks-coiins.
Hirai, A. H., Sappenfield, W. M., Ghandour, R. M., Donahue, S., Lee, V., & Lu, M. C. (2018). The collaborative improvement and innovation network (CoIIN) to reduce infant mortality: An outcome evaluation from the US South, 2011 to 2014. American Journal of Public Health. https://doi.org/10.2105/AJPH.2018.304371.
Hoagwood, K., Burns, B. J., Kiser, L., Ringeisen, H., & Schoenwald, S. K. (2001). Evidence-based practice in child and adolescent mental health services. Psychiatric Services, 52(9), 1179–1189. https://doi.org/10.1176/appi.ps.52.9.1179.
Hoover, S., Lever, N., Sachdev, N., Bravo, N., Schlitt, J., Acosta Price, O., et al. (2019). Advancing comprehensive school mental health: Guidance from the field. Baltimore, MD: National Center for School Mental Health. University of Maryland School of Medicine.
Hoover, S., Sapere, H., Lang, J. M., Nadeem, E., Dean, K., & Vona, P. (2018). Statewide implementation of an evidence-based trauma intervention in schools. School Psychology Quaterly, 33, 44.
Kase, C., Hoover, S., Boyd, G., West, K. D., Dubenitz, J., Trivedi, P. A., et al. (2017). Educational outcomes associated with school behavioral health interventions: A review of the literature. Journal of School Health, 87(7), 554–562.
Kataoka, S. H., Rowan, B., & Hoagwood, K. E. (2009). Bridging the divide: In search of common ground in mental health and education research and policy. Psychiatric Services, 60, 1510–1515. https://doi.org/10.1176/ps.2009.60.11.1510.
Kessler, R. C., Amminger, G. P., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Üstün, T. B. (2007). Age of onset of mental disorders: A review of recent literature. Current Opinion in Psychiatry, 20(4), 359–364. https://doi.org/10.1097/YCO.0b013e32816ebc8c.
Kieling, C., Rohde, L. A., Baker-Henningham, H., Belfer, M., Conti, G., Ertem, I., et al. (2011). Child and adolescent mental health worldwide: Evidence for action. The Lancet, 378(9801), 1515–1525. https://doi.org/10.1016/S0140-6736(11)60827-1.
Langley, A. K., Nadeem, E., Kataoka, S. H., Stein, B. D., & Jaycox, L. H. (2010). Evidence-based mental health programs in schools: Barriers and facilitators of successful implementation. School Mental Health, 2(3), 105–113.
Lendrum, A., Humphrey, N., & Wigelsworth, M. (2013). Social and emotional aspects of learning (SEAL) for secondary schools: Implementation difficulties and their implications for school-based mental health promotion. Child and Adolescent Mental Health, 18(3), 158–164. https://doi.org/10.1111/camh.12006.
Lyon, A. R., Borntrager, C., Nakamura, B., & Higa-McMillan, C. (2013). From distal to proximal: Routine educational data monitoring in school-based mental health. Advances in School Mental Health Promotion, 6(4), 263–279.
McIntosh, K., Kelm, J. L., & Canizal Delabra, A. (2016). In search of how principals change: A qualitative study of events that help and hinder administrator support for school-wide PBIS. Journal of Positive Behavior Interventions, 18(2), 100–110. https://doi.org/10.1177/1098300715599960.
Mental Health Technology Transfer Center Network. (2020). School mental health. Retrieved December 21, 2019 from https://mhttcnetwork.org/schoolmentalhealth.
Merikangas, K. R., He, J. P., Brody, D., Fisher, P. W., Bourdon, K., & Koretz, D. S. (2010). Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics, 125(1), 75–81. https://doi.org/10.1542/peds.2008-2598.
Mold, J. W., Fox, C., Wisniewski, A., Lipman, P. D., Krauss, M. R., Robert Harris, D., et al. (2014). Implementing asthma guidelines using practice facilitation and local learning collaboratives: A randomized controlled trial. Annals of Family Medicine, 12(3), 233–240. https://doi.org/10.1370/afm.1624.
Nadeem, E., Olin, S. S., Hill, L. C., Hoagwood, K. E., & Horwitz, S. M. (2014). A literature review of learning collaboratives in mental health care: Used but untested. Psychiatric Services, 65(9), 1088–1099. https://doi.org/10.1176/appi.ps.201300229.
National Center for Healthy Safe Children. (2020). Retrieved June, 06, 2019 from https://healthysafechildren.org/.
National Center for School Mental Health. (2020). School health assessment and performance evaluation system (SHAPE). Retrieved January, 13, 2020 from http://theshapesystem.com/.
Nix, M., McNamara, P., Genevro, J., Vargas, N., Mistry, K., Fournier, A., et al. (2018). Learning collaboratives: Insights and a new taxonomy from AHRQ’s two decades of experience. Health Affairs, 37(2), 205–212. https://doi.org/10.1377/hlthaff.2017.1144.
Oyeku, S. O., Wang, C. J., Scoville, R., Vanderkruik, R., Clermont, E., McPherson, M. E., et al. (2012). Hemoglobinopathy learning collaborative: Using quality improvement (QI) to achieve equity in health care quality, coordination, and outcomes for sickle cell disease. Journal of Health Care for the Poor and Underserved, 23(3A), 34–48. https://doi.org/10.1353/hpu.2012.0127.
Palinkas, L. A., Aarons, G. A., Horwitz, S., Chamberlain, P., Hurlburt, M., & Landsverk, J. (2011). Mixed method designs in implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 44–53. https://doi.org/10.1007/s10488-010-0314-z.
Parke, C. S. (2012). Making use of district and school data. Practical Assessment, Research, and Evaluation, 17(1), 10.
Pinkelman, S. E., Mcintosh, K., Rasplica, C. K., Berg, T., & Strickland-Cohen, M. K. (2016). Perceived enablers and barriers related to sustainability of school-wide positive behavioral interventions and supports. Behavioral Disorders, 40(3), 171–183. https://doi.org/10.17988/0198-7429-40.3.171.
Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., et al. (2015). A refined compilation of implementation strategies: Results from the expert recommendations for implementing change (ERIC) project. Implementation Science, 10(1), 1. https://doi.org/10.1186/s13012-015-0209-1.
Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health and Mental Health Services Research, 36(1), 24–34.
Rones, M., & Hoagwood, K. E. (2000). School-based mental health services: A research review. Clinical Child and Family Psychology Review, 3(4), 223–241. https://doi.org/10.1023/A:1026425104386.
Sanchez, A., Cornacchio, D., Poznanski, B., Golik, A., & Comer, J. (2018). The effectiveness of school-based mental health services for elementary-aged children: A meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 57(3), 153–165.
School-Based Health Alliance. (2020). Quality counts: About the national quality initiative (NQI). Retrieved October 20, 2019 from https://www.sbh4all.org/current_initiatives/nqi/.
Splett, J., Owell, A., Perales, K., Eber, L., Barrett, S., Putnam, R., et al. (2016). Interconnected systems framework—Implementation Inventory (ISF-II). Columbia: University of South Florida, University of South Carolina.
Stephan, S., Brandt, N., Lever, N., Acosta-Price, O., & Connorsa, E. (2012). Key priorities, challenges and opportunities to advance an integrated mental health and education research agenda. Advances in School Mental Health Promotion, 5(2), 125–138. https://doi.org/10.1080/1754730X.2012.694719.
Stephan, S. H., Connors, E. H., Arora, P., & Brey, L. (2013). A learning collaborative approach to training school-based health providers in evidence-based mental health treatment. Children and Youth Services Review, 35(12), 1970–1978. https://doi.org/10.1016/j.childyouth.2013.09.008.
Stephan, S., Hurwitz, L., Paternite, C., & Weist, M. (2010). Critical factors and strategies for advancing statewide school mental health policy and practice. Advances in School Mental Health Promotion, 3(3), 48–58.
Stephan, S., Mulloy, M., & Brey, L. (2011). Improving collaborative mental health care by school-based primary care and mental health providers. School Mental Health, 3(2), 70–80. https://doi.org/10.1007/s12310-010-9047-0.
Stephan, S., Paternite, C., Grimm, L., & Hurwitz, L. (2014). School mental health: The impact of state and local capacity-building training. International Journal of Education Policy and Leadership, 9(7), n7.
Stoll, L., Bolam, R., McMahon, A., Wallace, M., & Thomas, S. (2006). Professional learning communities: A review of the literature. Journal of Educational Change, 7(4), 221–258. https://doi.org/10.1007/s10833-006-0001-8.
Suldo, S. M., Gormley, M. J., DuPaul, G. J., & Anderson-Butcher, D. (2014). The impact of school mental health on student and school-level academic outcomes: Current status of the research and future directions. School Mental Health, 6(2), 84–98.
Taylor, R. D., Oberle, E., Durlak, J. A., & Weissberg, R. P. (2017). Promoting positive youth development through school-based social and emotional learning interventions: A meta-analysis of follow-up effects. Child Development, 88(4), 1156–1171.
U.S. Department of Education, Office of Planning, Evaluation and Policy Development, Policy and Program Studies Service. (2018). Collaboration for safe and healthy schools: Study of coordination between school climate transformation grants and project AWARE. Retrieved from https://www2.ed.gov/rschstat/eval/school-safety/school-climate-transformation-grants-aware-full-report.pdf.
Waxman, R., & Weist, M. (1999). Toward collaboration in the growing education–mental health interface. Clinical Psychology Review, 19(2), 239–253.
Weist, M. D., & Evans, S. W. (2005). Expanded school mental health: Challenges and opportunities in an emerging field. Journal of Youth and Adolescence, 34, 3–6. https://doi.org/10.1007/s10964-005-1330-2.
Weist, M. D., Hoover, S., Lever, N., Youngstrom, E. A., George, M., McDaniel, H. L., et al. (2019). Testing a package of evidence-based practices in school mental health. School Mental Health, 11(4), 692–706. https://doi.org/10.1007/s12310-019-09322-4.
Weist, M., Lever, N., Stephan, S., Youngstrom, E., Moore, E., Harrison, B., et al. (2009a). Formative evaluation of a framework for high quality, evidence-based services in school mental health. School Mental Health, 1(4), 196–211. https://doi.org/10.1007/s12310-009-9018-5.
Weist, M. D., Mellin, E. A., Chambers, K. L., Lever, N. A., Haber, D., & Blaber, C. (2012). Challenges to collaboration in school mental health and strategies for overcoming them. Journal of School Health, 82(2), 97–105. https://doi.org/10.1111/j.1746-1561.2011.00672.x.
Weist, M. D., Paternite, C. E., Wheatley-Rowe, D., & Gall, G. (2009b). From thought to action in school mental health promotion. International Journal of Mental Health Promotion, 11(3), 32–41.
Acknowledgements
We are deeply grateful to the twenty-four school districts who participated in the quality improvement collaborative and contributed evaluation data to this project.
Funding
This study was funded by the Health Resources and Services Administration, Maternal Child Health Bureau, in partnership with the School-Based Health Alliance (Grant No. U45MC27804) and also by National Institute of Mental Health (Grant No. K08 MH116119).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Availability of Data and Material
Not applicable.
Code Availability
Not applicable.
Ethical Approval
This study was reviewed and approved by the University of Maryland Human Research Protections Office as exempt from Institutional Review Board review due to being considered Not Human Subjects Research. Participants were informed that their survey responses are confidential. This article does not contain any studies with animals performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Connors, E.H., Smith-Millman, M., Bohnenkamp, J.H. et al. Can We Move the Needle on School Mental Health Quality Through Systematic Quality Improvement Collaboratives?. School Mental Health 12, 478–492 (2020). https://doi.org/10.1007/s12310-020-09374-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12310-020-09374-x