Author: bharriso

Enhancing Quality in
School Mental Health

Why We Need Evidence-based Treatments

The literature on traditional psychotherapy compels clinicians to improve the quality of services provided in expanded school mental health. A study published in the Journal of Consulting and Clinical Psychology revealed little support for the effectiveness of traditional child psychotherapy when compared to an academic tutoring control group. Weiss, Catron, Harris, and Phung (1999) used a multiinformant assessment approach and conducted assessments at five different times during the course of the study. Outcomes were grouped according to five domains: psychopathology; adaptive functioning; environments; systems-level outcomes; and consumer perspectives. Analyses revealed no significant difference in treatment effects across treatment and control groups in any of the five domains. This is in sharp contrast to the consistently positive effects of using evidence-based therapies and techniques, even when used in community settings.
This finding shows how imperative it is to use evidence-based practices in our everyday treatment. Many practitioners, though, worry that adopting manualized treatments will hinder their ability to conduct therapy n a meaningful manner. Some mental health care professionals argue that manuals limit creativity and ignore the complexity of individual cases.
Instead of dismissing environmental variables as a nuisance, Kazdin and Weisz (2003) urge researchers to consider the impetus behind studies designed to measure effective therapeutic techniques in real world conditions. Establishing a direct connection between research and practice requires an organized effort on the part of academic and clinical leaders. you at the intersection of research and practice.
Kazdin, A.E., & Weisz, J.R. (2003). Evidence-based psychotherapies for children and adolescents. New York: Guilford Press.
Weiss, B., Catron, T., Harris, V., & Phung, T.M. (1999). The effectiveness of traditional child psychotherapy. Journal of Consulting and Clinical Psychology, 67 (1), 82-94.

Factors that influence early termination of treatment

Among children receiving mental health services, a very large proportion terminates services after only one or two contacts with a mental health provider. Some research suggests that the youth that drop out of treatment are the ones who need it the most: dropouts displayed more severe externalizing problems, more antisocial behavior and poor peer relations. Dropouts also came from markedly more disadvantaged backgrounds: parents often had a history of antisocial behavior and typically used adverse child-rearing practices.
What factors lead to dropout, according to the families?
Waiting time before and between appointments
Inconvenience of the appointments in relation to work and school
Perceived inappropriateness of the services
Disconnect between the services that were offered and what the families believed they needed
Baruch, G. (1998). Adolescents who dropout of psychotherapy at a community-based psychotherapy center: A preliminary investigation of the characteristics of early dropouts, late dropouts, and those who continue treatment. British Journal of Medical Psychology, 71(3), 233-245.
Kazdin, A.E. & Mazurick, J.L. (1994). Dropping out of child psychotherapy: Distinguishing early and late dropouts over the course of treatment. Journal of Consulting and Clinical Psychology, 62 (5), 1069-1074.
Massey, O.T., Kershaw, M.A., Falk, K.K. & Hannah, S.K. (2000). Children who drop out of treatment: Final report. Agency for Health Care Administration

Engaging Families in
School Mental Health

As most school mental health clinicians know, engaging students and families in the therapeutic process requires a great deal of tact and timing. While incentives may entice some to answer a questionnaire, money offers no substitute for effective communication.
In a recent article, McKay and Bannon (2004) mention the importance of first face-to-face encounters between clinicians and clients as it relates to treatment outcomes. Clinicians should describe treatment goals in a way that empowers parents and encourages students to actively participate in the improvement process. Parents and students should be very involved in identifying treatment goals and developing treatment plans.
Clinicians must establish rapport to effectively engage families. Especially in under-served communities, building therapeutic alliance necessitates sensitivity to differences within and between cultures. By couching mental health in culturally relevant terms, clinicians give parents greater reason to participate in their child’s therapy.
Clinicians trained in cultural awareness exhibit a broader understanding of client socialization. This can lead to improved understanding of the client and family and may result in more appropriate treatment recommendations (Harrison, McKay, and Bannon, 2004). If parents feel like they can make a difference, research shows that they are more likely to do so!
Harrison, M.E., McKay, M.M., & Bannon, W.M. (2004). Inner-city mental health service use: The real question is why youth and families do not use services. Community Mental Health Journal, 40(2), 199-131.
McKay, M.M. & Bannon, W.M. (2004a). Engaging families in child mental health services. Child & Adolescent Psychiatric Clinics of North America, 3(4), 905-921.