Understanding usual care in schools: a mixed methods approach

Approximately 75% of youth who receive mental health services are receiving those services in schools, and yet a scarcity of research exists on the types, intensities, quality, and effectiveness of school-based interventions, creating a serious public health concern (Rones & Hoagwood, 2000). The few studies examining usual care (UC) services suggest that significant variability exists in the therapeutic process and effectiveness of those services (Weisz, Jensen-Doss, & Hawley, 2006). While over four decades of research have spurred the development of a number of evidence-based prevention and treatment interventions for youth and families (Weisz & Kazdin, 2010), transporting these protocols to real-world, community settings has been wrought with challenges (Southam-Gerow, Rodriquez, Chorpita, & Daleiden, 2012). The present study seeks to obtain a better understanding of the specific factors that impact intervention outcomes in schools by using a mixed methods approach. Systematic case studies of two school counselor-led groups focused on the prevention of depression symptoms in youth—specifically a positive outcome group and a negative outcome group—were examined. Qualitative data from video recordings and observational coding data of the interventions were used to examine the therapeutic processes of the selected groups during the intervention, and quantitative data from self-report measures were used to examine the outcomes through 6-month follow-up. Case study findings suggest that therapeutic strategies, including use of evidence-based strategies, adherence to identified goals, and repeated application of the group material, contributed to improvements in depression symptoms and functioning. Results also underscore the importance of establishing group cohesion and alliance as well as understanding logistical barriers that may interrupt important therapeutic processes. The implications of these variables are discussed for future research and training initiatives.Psy.D.Includes bibliographical referencesby Katie Moor