A Brief Engagement, Triage, and Intervention Strategy for School Mental Health Practitioners – The BRISC Model

• In Event: 2-210 - Mental Health in Schools: Providing Strategies to Students Across the K-12 Grade Span

Integrative Statement

Introduction: Emotional and behavioral well-being is critical to school success, and research shows that upwards of 70% of all mental health treatment for children is delivered in schools. Unfortunately, school mental health (SMH) providers rarely use evidence-based approaches, are often poorly integrated into the school context, and struggle to meet the emotional and behavioral needs of all students. To maximize impact across the broad spectrum of mental health needs exhibited by youth in school settings, school-based strategies and interventions must be designed to be effective, efficient, and demonstrate good fit with the educational context, including feasibility for use by “indigenous” school-based helpers, such as school counselors and social workers.

The Brief Intervention Strategy for School Clinicians (BRISC) is a brief, stepped-care, evidence-based, and flexible strategy tailored to high school students. Based on treatment elements shared across effective interventions for internalizing and externalizing problems in adolescents, BRISC provides a flexible structure with up to four sessions to assess, engage, identify, and address difficulties that cause emotional/behavioral distress and subsequent academic performance. Empirically-supported engagement and skill-building strategies, as well as outcome monitoring are delivered within a psychoeducation and problem solving framework to address the student’s identified problem(s), while assessing if additional treatment, services, or referrals are needed. Pathways for what occurs following BRISC are modeled after the “response to intervention” (RTI) framework typical in schools, contributing to its “fit” to real-world education settings.

This presentation will present the rationale for and development of BRISC, the basics of the protocol itself, and results of a matched comparison study of its implementation and effectiveness.

Study Population: The study included n = 29 students served by five clinicians trained on BRISC, compared to n = 37 students served by 10 similar clinicians providing services as usual (SAU).

Methods: Clinicians implemented BRISC elements with good fidelity and reported the strategy was feasible and aligned with student needs. BRISC students reported greater satisfaction and therapeutic alliance than SAU. BRISC students also showed greater reduction in depression and anxiety symptoms. Academic outcomes were not associated with condition. After four sessions, the majority of BRISC students were discharged without need for continued services, suggesting BRISC could promote efficiency and “reach.”

Results and Discussion: We will conclude the presentation with a summary of relevant lessons for the developmental psychopathology, mental health treatment, and education fields, as well as a description of current and future directions for BRISC. One such direction is feasibility and outcome trials in new environments and with novel types of school-based helpers. For example, evaluation of BRISC as a province-wide strategy in Canada found near-equal fidelity when used by bachelor’s level school resource personnel, larger within-student effects on emotional and behavioral symptoms, and higher ratings of feasibility and usefulness. We will also present initial results from a larger (N=52 schools; 520 students), multi-site efficacy trial now being completed in three states.

Authors

• Eric J Bruns, University of Washington School of Medicine
  Presenting Author

• Elizabeth McCauley, University of Washington School of Medicine
  Non-Presenting Author