Implementation Outcomes from an RCT of TRAILS-Early Intervention to Support Youth Mental Health

• In Event: Implementing School-Based Mental Health Services to Support Students

Abstract

Background: Lack of access to effective adolescent mental health treatment presents a significant public health concern. Evidence-based practices (EBPs) can improve clinical symptoms of common mental illnesses, yet the majority of adolescents with a diagnosable disorder never access any treatment, much less an EBP. Barriers to effective care include an insufficient number of community-based providers, minimal EBP penetration in community settings, limited knowledge among families about where to find effective treatments, and a pervasive social stigma associated with help-seeking. TRAILS Early Intervention (TRAILS-EI) is a school-based program developed to improve student mental health and academic outcomes.

Purpose: This paper presents implementation results from a cluster randomized trial designed to evaluate the efficacy of the TRAILS-EI in a large, urban, predominantly Black school district 

Methods: The primary sample for this study included 84 of 94 schools serving students in grades 6-12, and 130 eligible School Mental Health Professionals (SMHPs) serving in those schools during the intervention year (2024-2025). Randomization was conducted at the school level, after stratifying schools based on geographic location within the school district, and baseline rates of depression/anxiety in the school. Outcome data for this analysis are all drawn from a survey administered to all SMHPs, including counselors and social workers, in the spring of 2024. The survey covered a wide range of constructs, including: SMHPs’ background information, prior exposure to CBT training, information about their perceptions, knowledge, and use of CBT. For SMHPs working in treatment group schools, the survey collected information specifically about TRAILS implementation fidelity. 

Preliminary Findings: TRAILS-EI successfully increased the number of teachers with professional development in cognitive behavioral therapy by 20 percentage points, a 53% increase over the control schools’ base rate of 42%. While the average CBT competency scores were similar across groups, treatment group SMHPs were also 10 percentage points more likely to reach the CBT competency threshold than control group SMHPs. Despite having similar numbers of students referred for mental health services (3378 in treatment schools and 3376 in control schools), SMHPs in treatment schools report serving approximately twice as many students (1921 vs 1055) as SMHPs in control schools. The TRAILS-EI intervention also increased the reported use of TRAILS’ evidence-based practice materials; these materials reached 728 students in treatment schools compared to only 226 students in control schools. At the same time, SMHPs in the treatment group reported frequent barriers to their successful implementation of TRAILS-EI. More than 50% of treatment group SMHPs reported not having time to run groups, and an additional 20% reported difficulties in obtaining parental permission to serve students.

Authors

• Robin T Jacob, University of Michigan Ann Arbor
  Non-Presenting Co-Author

• Katja Robinson, University of Michigan Ann Arbor
  Presenting Author

• Catherine Armstrong Asher, University of Michigan
  Non-Presenting Co-Author