Enhancing collaborative relationships and mental health literacy to improve school behavioral health for middle school students: a randomized controlled trial

Escalating youth mental health challenges have challenged schools and providers to effectively support student well-being. School behavioral health (SBH) programs are evolving rapidly to meet this need, and this study pursued implementation of community-partner recommended enhancements to improve SBH programming and outcomes for students. This study aimed to evaluate the effectiveness of stakeholder-recommended enhancements to SBH on increasing the number of students and families engaged in therapy; and to evaluate the impact of the intervention on social, emotional, behavioral and academic outcomes. This comparative effectiveness trial tested two approaches to effective SBH, both involving core evidence-based strategies, and one including four community partner-recommended enhancements: mental health literacy, family-school-clinician partnerships, therapeutic alliance, and cultural responsiveness and equity. The enhanced condition was associated with an increased use of telehealth services and improvements in behavioral functioning of students at a 6-month post assessment. Treatment effect heterogeneity analyses indicated a potential amplifying effect of stigma reduction on improvement in students’ behavioral functioning. Emphasizing mental health literacy (MHL) and enhanced relationships (including collaboration with families, focus on therapeutic alliance, understanding cultural responsiveness and equity) shows promise for enhancing SBH programming to improve practice and points to a range of important future research directions grounded in implementation science. ClinicalTrials.gov ID NCT03901274. First submitted March 29, 2019.