Skip to main content

Advertisement

SpringerLink
Log in

Can We Move the Needle on School Mental Health Quality Through Systematic Quality Improvement Collaboratives?

  • Original Paper
  • Published:
School Mental Health Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Notes

  1. 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Charmaz, K., & Bryant, A. (2007). The SAGE Handbook of Grounded Theory. https://doi.org/10.4135/9781848607941.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Parke, C. S. (2012). Making use of district and school data. Practical Assessment, Research, and Evaluation, 17(1), 10.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

Download references

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

  1. Department of Psychiatry, Yale University, 389 Whitney Avenue, Office 106, New Haven, CT, 06511, USA

    Elizabeth H. Connors

  2. National Center for School Mental Health, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, 4th Floor, Baltimore, MD, 21201, USA

    Elizabeth H. Connors, Mills Smith-Millman, Jill H. Bohnenkamp, Taneisha Carter, Nancy Lever & Sharon A. Hoover

  3. McLean Hospital, 799 Concord Avenue, Cambridge, MA, 02138, USA

    Mills Smith-Millman

Authors
  1. Elizabeth H. Connors
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mills Smith-Millman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jill H. Bohnenkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Taneisha Carter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nancy Lever
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sharon A. Hoover
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elizabeth H. Connors.

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

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12310-020-09374-x

Keywords

Search

Navigation