School-Based Transition Program Connecting High-Risk Adolescents to Mental Health and Support Services Improves Academic and Familial Functioning
School-Based Transition Program Connecting High-Risk Adolescents to Mental Health and Support Services Improves Academic and Familial Functioning
Brookline High School and the Brookline Community Mental Health Center implemented the Brookline Resilient Youth Team (BRYT) to help 14- to 18-year-olds (and their families) who have recently experienced serious emotional disorders, medical issues, substance abuse, or other issues. BRYT provides clinical support, case management, and academic assistance to these vulnerable adolescents, helping to reintegrate them into school life. The cornerstone of the program is a team of two school-based clinical coordinators and a classroom aide who work closely with students and their families during the crisis period and a 12- to 18-week transitional program that is offered free of charge. Although BRYT has not yet been formally evaluated, the vast majority of those adolescents served have continued their schooling without disruption. Data suggest improvements in academic and familial functioning.
Many adolescents experience serious emotional disorders, medical issues, or other hardships that require them to be absent from school and disrupt their lives. Returning to school after such events can be very difficult, and the risk of relapse is quite high.
- A common problem: Each year, 1 in 10 adolescents has a serious emotional disorder that often results in a psychiatric hospitalization or prolonged absence from school. These disorders typically disrupt the adolescent's schooling, home life, and social supports. In Brookline, MA, an urban community with great economic and cultural diversity, approximately 6 percent of high school students were thought to be in need of an intervention due to psychiatric hospitalization, substance abuse treatment, a serious medical event, or incarceration.1
- Difficult to return to school: Returning to school after being hospitalized or otherwise dealing with these kinds of problems can be quite difficult. Faced with problems such as depression, anxiety, trouble concentrating, fear of relapse, and social rejection, these adolescents are at high risk of academic failure and social isolation. Their families also face hardships in trying to navigate the maze of medical, mental health, and substance abuse services that are needed to help the adolescent. The complex needs of these students overwhelm most public high school staff.
Description of the Innovative Activity
Brookline High School and the Brookline Community Mental Health Center implemented BRYT to help 14- to 18-year-olds (and their families) who have recently experienced serious emotional disorders, medical issues, substance abuse, or other issues. BRYT provides clinical support, case management, and academic assistance to these vulnerable adolescents, helping to reintegrate them into school life. The cornerstone of the program is a team of two school-based clinical coordinators and a classroom aide who work closely with students and their families during the crisis period and a 12- to 18-week transitional program that is offered free of charge. Key elements of the program are described below:
- Clinical support for teens and families: Two clinical coordinators who are trained social workers provide clinical support and counseling to teens and their families. The clinical coordinators do not serve as the primary therapists but rather provide emotional support with respect to managing depression and psychotic symptoms, dealing with stress, getting organized, and maintaining focus. They also provide clinical support to families, including adjusting expectations after a prolonged absence from school (and potentially from the home as well in the event of hospitalization). They meet with students and their families before reentry into school and help them decide on short-term goals and plans, such as schedule changes and tutoring. Students usually meet with clinical coordinators daily, the length of the meeting varying according to the needs of the adolescent. Family contact includes daily telephone calls or e-mails as well as family meetings on a weekly or biweekly basis.
- Care coordination: The clinical coordinators also provide case management services, helping students and their families negotiate the fragmented mental health and school system, facilitating communication with health care personnel and therapists, and serving as liaisons between students, teachers, and tutors. They organize and lead meetings of care providers and school staff directed at developing and implementing individualized plans for each student. In addition, they assist families in locating health resources in the school and community.
- Academic assistance: The classroom aide provides academic assistance and tutoring to students in a supportive in-school environment. The classroom aide serves as an advocate for the adolescent, negotiating workloads with teachers and helping students organize and complete assignments on time. BRYT staff also educate teachers on how to respond to the needs of seriously emotionally ill students.
- Dedicated classroom for vulnerable students: A specialized “home-base” classroom is located near the entrance of the high school, serving as a safe and manageable respite where vulnerable students can check in as needed during the day, receive tutoring, and get counseling and academic support (e.g., organizing and completing school work). The classroom accommodates 8 to 12 students at a time, and most students in the program schedule specific times to be there.
Context of the Innovation
BRYT is a collaboration between Brookline High School, which serves approximately 1,900 students in the town of Brookline, MA, and the Brookline Community Mental Health Center, a nonprofit center offering the full spectrum of outpatient care. BRYT was developed in response to several cases where Brookline High School students could not manage in school after a prolonged absence caused by hospitalization, substance abuse, or some other problem. These students ended up either relying completely on a social worker, dropping out of school, or being diverted into costly special education programs. In addition, school leaders found that they had no way of identifying at-risk teenagers or providing support services to them.
Although BRYT has not yet been formally evaluated, the vast majority of those adolescents served have continued their schooling without disruption. Standardized tests and anecdotal evidence suggest that the program has improved academic and familial functioning.
- Continued schooling, with low relapse rate: The vast majority of the 160 teenagers served between 2004 and 2007 continued their schooling without disruption. The relapse rate among those served was approximately 11 percent, well below the community average of 20 to 25 percent. (This figure was derived by reviewing a representative sample of similar adolescents from the broader community.)
- Better functioning: BRYT students demonstrate improvement on the Child and Adolescent Functional Assessment Scale, which assesses a youth's degree of impairment in day-to-day functioning due to emotional, behavioral, psychological, psychiatric, or substance use problems; mean scores among BRYT participants fell from 89 at admission to 64 at 3-month followup.1 In addition, families of participating adolescents report improved functioning, with less stress and anxiety.
- Potential for reduced costs: Although no hard data are available, the program appears to prevent the need for expensive placements in out-of-school programs, repeating of grades, and rehospitalizations.
Information provided in February 2012 indicates that a formal evaluation of the BRYT model is under way and will be completed in 2014. This evaluation will consider the effectiveness of the program in improving students' outcomes in several domains: academic performance, clinical state, family functioning, cost, and access to care. The evaluation will compare the outcomes of students in schools with transition programs to those of students in a matched set of schools that do not have this service.
Planning and Development Process
Key steps in the planning and development process include the following:
- Forming a collaborative and conducting focus groups: A collaborative, consisting of the school, the local mental health center, and parent representatives, conducted focus groups with students who had been through crises. These focus groups provided insights as to which services would and would not be helpful to them.
- Hiring and training staff: The program hired social workers with case coordination experience and provided on-the-job training that focused on understanding the school system and available resources. A tutor with experience as a classroom teacher was hired as the classroom aide and trained to understand the intricacies of the high school.
- Initial demonstration: A year-long demonstration proved successful, which allowed the program to secure 4 years of funding.
Resources Used and Skills Needed
- Staffing: Program staff consist of two clinical coordinators, a classroom aide, and a program director.
- Costs: The program costs approximately $150,000 annually.
The Blue Cross Foundation of Massachusetts provided initial funding for the 1-year demonstration project, after which time the Robert Wood Johnson Foundation provided 4 years of additional funding.
Getting Started with This Innovation
- Use an appropriate staffing model: Employing both school-based and mental health staff is crucial to addressing both academic and psychiatric needs. Schools also appreciate the involvement of a mental health center, because they typically lack the resources to deal with serious mental health issues.
- Find dedicated classroom space: Having dedicated classroom space for vulnerable students is essential to running the program.
Sustaining This Innovation
- Maintain an open door policy: It is important to recognize and welcome vulnerable students at any time.
- Track cost savings: Monitor the program's impact on out-of-school placements and the number of students repeating a grade. Demonstrating the program's ability to reduce costs can help to maintain support among school leaders.
Spreading This Innovation
The program has now been replicated in high schools in 10 school districts in Massachusetts and Ohio. Funding for these replications came from the school budgets. School administrators (principals, guidance counselors, special education staff) strongly supported establishing these programs for teens with serious emotional illness. Before the initiation of the programs, these students were dropping out of school or being diverted into very costly special education programs.
Contact the Innovator
Note: Innovator contact information is no longer being updated and may not be current.
Henry White, MD
Brookline Community Mental Health Center
41 Garrison Road
Brookline, MA 02445
Phone: (617) 277-8107
Fax: (617) 734-6385
Dr. White has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.
White H, Langman N, Henderson S. A school-based transition program for high-risk adolescents. Psychiatr Serv. 2006;57(8):1211. [PubMed]
Jen's Cup of Tea<br>Written by Katherine Porter, Brookline Resilient Youth Team Program Coordinator
It took several moments for Suzanne Donnellan, a school psychologist at Brookline High School, to recognize the poised, excited young woman who ran up to her in the hallway. “Dr. Donnellan, how are you!” she exclaimed, without waiting for an answer. “School is fantastic. I just was accepted into the orchestra. And believe it or not, I love my classes. Well, almost all my classes!” she said, as she turned to greet some friends who had just left their classroom. “See you later!” By now, Suzanne realized that the cheerful student was Jennifer, whom she had come to know the previous year, when Jen was in the BRYT (Brookline Resilient Youth Team) Program. Jen had moved to Brookline in the summer before her freshman year. She had registered for school and attended the orientation for new students. But then, she had refused to return when her regular classes began. For about 2 weeks, Jen's guidance counselor tried to convince Jen to return, even making two home visits. The counselor consulted with Suzanne, who set up a meeting with the family. Jen's mother told Suzanne that Jen was not only refusing to go school but had also insisted on stopping her music lessons, saying she didn't feel like playing violin anymore—she just wanted to stay at home. The only places Jen seemed to feel comfortable were at her mother's place of work and at her weekly session with her therapist. “Can you tell me what makes it hard for you to come to school?” Suzanne asked Jen. In a small, barely audible voice, her eyes glued to the floor, Jen replied, “I don't know. School just makes me feel bad.” She began to cry.
Suzanne referred Jennifer to the BRYT Program. Meeting with the BRYT Clinical Coordinator, Katherine Porter, Jen agreed to come to school, but only to stay in the BRYT classroom, located near the front door of the school. At first, she insisted her mother accompany her to the room. After a week or so, she came into the room alone. Jen adopted the couch as her regular spot. She would make a cup of tea from the BRYT water dispenser, arrange her books on the couch around her, and only then, tentatively begin to talk to some of the other students. She seemed particularly comfortable with the classroom aide, Justin Kasarsky, who began working with Jen on some of her overdue schoolwork.
Katherine learned from Jen's therapist that the teen had been assaulted while walking home from school the previous year but was not yet ready to talk about it. When she came to school, Jen began seeing disturbing images and experiencing flashbacks that made her feel as though she was out of control or “going crazy.” Katherine talked with Jen and her mother about some strategies to help her manage her anxiety. In coordination with the therapist, Katherine arranged for Jen to see a child psychiatrist at the local mental health center.
After 3 weeks in the program, Jen said she felt ready to start classes again. She began with her history class, after meeting with the teacher a few times in the BRYT classroom. By the time school began again in January after the Christmas vacation, Jen was ready to spend most of her time in class, though she returned to BRYT room during lunch and when she had unscheduled time.
With Justin's help, she was able to finish her overdue work and got credit for the first semester. During the winter, Jennifer would check in at the BRYT classroom only once or twice a week when she was having a particularly rough day. In April, Katherine realized that 2 weeks had gone by without Jen's visit. Then the next day, Jen stopped in, made a cup of tea, and found her customary spot on the couch. “Just visiting!” she said. But the visit was cut short when one of her friends appeared at the door. Jen jumped up, ran out, saying, “See you later!”