Targeted Interventions

Aside from one-on-one mental health care from an office-based professional, clinicians have begun to develop school-based mental health interventions that leverage the environment to deliver care.

Below are two examples, one focused on aggression and the other on traumatic stress.

Second Step is an evidence-based prevention program for 4- to 14-year-olds that addresses impulsive and aggressive behavior, promotes anger management, and teaches problem-solving skills.

A study of 790 students showed that teacher and parent reports were not affected by the intervention—a common problem in school-based trials of behavioral approaches. But behavior observations by professional observers indicated significant decreases in physical aggression and increases in prosocial behavior.⁴⁶

Analysis of the program in 3,616 middle school students showed a 42% decrease in physical aggression⁴⁷ and a 20% decrease of bullying in special education environments.⁴⁸

Cognitive Behavioral Intervention for Trauma in Schools (CBITS) is an evidence-based intervention for children with symptoms of post-traumatic stress disorder (PTSD). Children are identified by experienced school personnel and treated by a trained professional working with the school.

PTSD is a significant problem in young people, particularly in the poor urban environments CBITS was developed to serve.

• Lifetime PTSD in children 14-18: 5%⁴⁹

CBITS is a novel group intervention that lasts for 12 sessions (10 group and 2 individual) and can be delivered by school-based mental health personnel. A study of 126 students with PTSD and depression symptoms showed that, compared to no intervention, 86% reported less-severe PTSD symptoms and 67% reported less-severe depression symptoms.⁵⁰

⁴⁶ Grossman, D.C., Neckerman, H.J., Koepsell, T.D., Liu, P.Y., Asher, K.N., Beland, K., Frey, K., & Rivara, F.P. (1997). Effectiveness of a violence prevention curriculum among children in elementary school. A randomized controlled trial. JAMA. 277(20): 1605-11. doi:10.1001/jama.1997.03540440039030

⁴⁷ Espelage, D.L., Low, S., Polanin, J.R., Brown, E.C. (2013). Impact of a middle school program to reduce aggression, victimization, and sexual violence. Journal of Adolescent Health. 53(2): 180-186. doi: 10.1016/j.jadohealth.2013.02.021

⁴⁸ Espelage, D.L., Polanin, J.R., & Rose, C.A. (2015). Social-emotional learning program to reduce bullying, fighting, and victimization among middle school students with disabilities. Remedial and Special Education, doi: 10.1177/0741932514564564

⁴⁹ Merikangas, K., Hep, J., Burstein, M., Swanson, S., Avenevoli, S., Cui, L., Benejet, C…Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of American Academy of Child and Adolescent Psychiatry. 49(10): 980-989. doi: 10.1016/j.jaac.2010.05.017

⁵⁰ Stein, B.D., Jaycox, L.H., Kataoka, S.H., Wong, M., Tu, W., Elliott, M.N., & Fink, A. (2003). A mental health intervention for schoolchildren exposed to violence: a randomized controlled trial. JAMA, 290(5): 603-611. doi:10.1001/jama.290.5.603.