School-Based Mental Health Practitioners: A Resource Guide for Educational Leaders.

School-based mental health practitioners can offer enhanced support to schools and students; yet their training, roles, and expertise vary. The roles of these professionals are often conflated, misunderstood, or marginalized in their utility throughout the school system. The purpose of this manuscript is to enhance the capacity of educational leaders to make informed hiring, contracting, and role assignment decisions that best fit school and student needs regarding school mental health services. We clarify the landscape of two distinct groups of qualified school mental health professionals-those who are education certified and those who are independently licensed; each group represents professionals from multiple disciplines. We illuminate similarities and differences of these professionals and juxtapose the utility of traditional mental health versus school-based mental health. We then discuss the similarities and differences of qualified school mental health professionals described within the context of traditional and school-based mental health preparation and service delivery. We conclude by contributing three resources for educational leaders to support the process of engaging school-based mental health practitioners. First, we offer a planning guide to understand state variations in certification requirements across professionals. Second, we provide a hiring guide primer that summarizes education requirements and delineates role orientations for school mental health practitioners. Third, we provide an interview guide to help clarify a candidate's experience and skills useful to contemporary school needs. We conclude by offering recommendations for educational leaders to become more effective consumers of school-based mental health services. Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-022-09530-5.

Mechanisms of Motivational Interviewing: a Conceptual Framework to Guide Practice and Research.

Reviews of the motivational interviewing (MI) training literature demonstrate MI is a nuanced skill set that takes carefully planned didactic training, application of skills in context-specific practice settings, and ongoing support to promote reflective practice and sustained proficiency. Despite the robust knowledge base related to training and how MI works to achieve favorable outcomes, these two literature bases are not well integrated. In an effort to inform and guide future research, we propose the mechanisms of motivational interviewing (MMI) conceptual framework, which expands upon previous work. Specifically, the framework adds training as an ongoing process consistent with Bennett-Levy's (Behav Cogn Psychother 34:57-78, 2006) model of skill development and acquisition to the existing two-path framework that helps us to understand how MI works to achieve its desired effects (Magill et al., J Consult Clin Psychol 82:973-983, 2014). Herein, we describe measures used to evaluate the mechanisms within the four MMI framework links: initial training to competency, competency to proficiency, proficiency to talk about change, and talk about change to behavior change. Next, we synthesize the literature associated with each of the mechanisms of the MMI. We conclude by discussing implications for practice and research. This framework offers a more complete path structure to understand the mechanisms of change associated with MI that could improve our understanding of inconsistent effect sizes observed across prior trials evaluating MI effectiveness.

Comprehensive Cost Analysis of First Step Next for Preschoolers with Disruptive Behavior Disorder: Using Real-World Intervention Data to Estimate Costs at Scale.

While the long-term societal costs for youth with disruptive behavior disorders are well documented, there is a dearth of information about the comprehensive costs of implementing even the most well-regarded early intervention programs, and the costs of scaling effective interventions are even less well understood. This study estimated the costs of delivering and disseminating First Step Next (FSN), an established tier two school-based early intervention, in preschool and kindergarten settings, including the training and ongoing technical assistance that support sustained, high-quality implementation. Using the Ingredients Method, we estimated (a) the per student costs of implementation, (b) the incremental cost of offering FSN to an additional student, and (c) the cost to disseminate FSN to 40 preschool and kindergarten students, including a sensitivity analysis to examine potential areas of cost savings. The per child cost to implement the FSN intervention with 29 triads in two cohorts was $4330. The incremental cost per additional student was only $2970, highlighting efficiencies gained once intervention infrastructure had been established. The cost of disseminating the intervention to a single cohort of 40 students was $170,106, or $4253 per student. The range in sensitivity analysis was $3141-$7829 per student, with variability in personnel wages having the greatest impact on cost estimates. This research expands on existing literature by providing a more comprehensive understanding of the cost of effective disruptive behavior interventions based on real-world implementation data, using these data to estimate dissemination costs, and showing how dissemination costs are particularly sensitive to personnel wages.

Effects of the First Step to Success Intervention on Preschoolers with Disruptive Behavior and Comorbid Anxiety Problems.

Preschoolers with elevated anxiety symptoms are at high risk not only for developing more severe mental health disorders in later life but are also apt to respond more poorly to intervention if they present with comorbid disruptive behavior. Because early signs of anxiety disorders may not be recognized as such in preschool settings, many children selected for Tier 2 interventions that target externalizing problem behaviors may also have co-occurring anxiety symptoms and disorders. The First Step to Success intervention has recently been adapted for preschoolers with externalizing behaviors and was found to be efficacious in a randomized controlled trial. The current report examines effects of the First Step intervention on a subsample of 38 preschoolers with comorbid anxiety symptoms. Compared to usual-care controls, preschoolers who were assigned to the First Step intervention demonstrated medium to large effects in reducing externalizing behavior and improving social functioning outcomes, but had small effects for reductions in internalizing behaviors. Implications for intervening with preschoolers at risk for comorbid disruptive and anxiety behaviors are discussed.

First Step to Success: Applications to Preschoolers at Risk of Developing Autism Spectrum Disorders.

Preschool children with Autism Spectrum Disorder (ASD) may not always be recognized as such during their early years, but some of their behavioral problems may nonetheless prompt a referral for behavioral intervention. Whether such an intervention brings any benefit has not been well studied. We identified a subsample of 34 preschool children at risk for autism spectrum disorder from a large randomized controlled trial (N = 126) of the First Step to Success program. Children at risk of developing ASD demonstrated significant improvements on seven of 11 outcome measures and on a responder analyses based on symptom severity. Process and fidelity measures also suggested that First Step was both feasible and socially acceptable. Implications for early intervention for children at risk of developing ASD are discussed.

The Feasibility of First Step to Success with Preschoolers.

The primary purpose of this study was to examine feasibility of the preschool version of the First Step to Success (FSS) intervention. Toward this end, the following four research questions were addressed: (1) To what extent was the intervention implemented with integrity? (2) To what extent do teachers and parents perceive the intervention to be socially valid? (3) To what extent were teachers and parents satisfied with the intervention? and (4) To what extent was the intervention effective in reducing problem behavior and improving social skills? Twelve students participated in the study. Treatment integrity, social validity, and satisfaction results were analyzed at the aggregate level, and a reliable change index was calculated at the case level for primary outcome measures to assess the potential efficacy of the intervention. Fidelity data suggest the preschool version of the intervention can be implemented with acceptable integrity by coaches and teachers in preschool settings. Social validity outcomes suggest parents' perceptions of the program's goals, procedures, and outcomes were extremely favorable, and social validity from the teacher perspective was acceptable. The results provide initial evidence that participating in the preschool version of the FSS intervention improves children's social skills and decreases problem behavior.