Grant to Fund Behavioral Health Interventions in Philadelphia School District

The failure to address the emotional and behavioral problems of school-age children can have serious, life-changing ramifications, including poor grades, suspension and expulsion, and problems with the law later in life. Aggressive, defiant, disruptive, and antisocial behavior stems from externalizing behavior disorders, which are highly prevalent in school settings today.

Only 1 in 5 children with emotional and behavioral disorders receive mental health services, studies show, with low-income and ethnically diverse children lagging far behind their middle class, Caucasian counterparts. At the heart of this disparity is a shortage of specialized services in low-income communities, the high cost of these services, and the stigma attached to using such services for low-come minority families. Minority students in urban school districts are especially at risk due to the anxiety and deleterious effects of living in unsafe and deprived neighborhoods.

Unfortunately, evidence-based interventions are not successfully deployed in urban schools. Such interventions are all too often derailed by inadequate training and poor implementation by service providers in the school, and the lack of resources to contract with outside behavioral health providers.

The National Institute of Child Health and Human Development awarded Children’s Hospital a $3.1 million grant to study the level of support school personnel need to effectively implement an intervention program called School-Wide Positive Behavioral Interventions and Supports (SW-PBIS) for typically developing students as well as students with, or at risk for, externalizing or anxiety disorders. S

W-PBIS is a comprehensive service delivery strategy that combines universal and targeted interventions to address students’ emotional and behavioral issues can help improve overall school climate, perceived school safety, and student academic performance. The program focuses on preventing new cases of problem behaviors through school-wide discipline, classroom behavior management, and effective instructional practices.

The program emphasizes teaching all students key behavioral expectations and routines, and creating a proactive communication system for students and school staff. Children with or at risk for externalizing behavior problems or excessive anxiety will participate in group coping skills training.

Specifically, the study will examine whether school personnel can implement the components of a two-tier SW-PBIS program with the same level of fidelity, integrity and effectiveness when they receive a relatively low level of support from coaches and supervisors as they can with a high level of support.

Ricardo Eiraldi, PhD, is the principal investigator and program director of the Behavioral Health in Urban Schools Program (BHUSP). His line of research centers on addressing mental health services disparities by creating internal capacity for preventing and treating behavioral health disorders in urban schools. He and his team and the School District of Philadelphia have selected six schools in North Philadelphia for participation in the project. The schools will be randomly assigned to receive either a high level or a low level of training and consultation to implement SW-PBIS interventions over a five-year period.

Investigators will additionally study the impact of high and low levels of support on students’ mental health disparities and academic productivity, as well as the cost-effectiveness of the respective support levels.

“We know that school personnel can implement SW-PBIS with fidelity from a program development grant project we already conducted in two other schools located in the same area of the school,” Dr. Eiraldi said. “Now we would like to know how much support school personnel actually need in order to implement the program with fidelity and effectiveness.”

The School District of Philadelphia fully supports this project. Providing SW-PBIS strategies in school settings is ideal for identifying students with or at risk for externalizing and anxiety disorders, and for reducing service disparities because the program is available to all students. School-based services can be conveniently provided while children are attending school and often at little or no cost to their families. School-based services can also take advantage of existing infrastructure and behavioral health personnel. Finally, teachers and administrators in SW-PBIS schools spend less time to dealing with behavioral health problems.