Randomized Trial of Show Me FIRST: A Brief School-Based Intervention for Internalizing Concerns

ABSTRACT

Better integration of evidence-based practices (EBPs) in schools can improve access to effective youth mental health care. However, EBPs typically developed and tested within clinics may not be feasible for school-based implementation. We conducted a small randomized trial comparing Show Me FIRST, a brief intervention designed for efficient uptake in diverse clinical settings, against usual care (UC) in a school-based sample of 34 youth (70.59% female, 79.41% White; 11.76% Latinx; M = 12.21 years old; 41.18% received free or reduced lunch) with significantly elevated depression and anxiety. Using a mixed methods approach to gauge feasibility and efficacy, we found that school-based providers were able to deliver most content with fidelity and within six sessions. Youth and providers reported significant symptom improvements, but comparisons against UC were nonsignificant. Providers reported several challenges to implementing Show Me FIRST with the high-risk sample that may help explain these findings and suggest future adaptations.

Keywords:

• school mental health
• feasibility
• evidence-based practice
• implementation

ASSOCIATE EDITOR:

• Keith Herman

DISCLOSURE

The authors have no conflicts of interest to report.

Notes

1 One coauthor is a school psychologist who had learned and implemented Show Me FIRST during her graduate training and shared it with several school-based colleagues.

2 Analyses were run using 100 imputations. The pattern of results was the same when using multiple imputation and listwise deletion.

3 We also ran group comparisons on the PHQ-8 controlling for baseline scores given that the UC condition PHQ-8 scores were higher at baseline, and the results remained nonsignificant.

Additional information

Notes on contributors

Evelyn Cho

Evelyn Cho, MA, is a graduate student in the Department of Psychological Sciences at the University of Missouri. Her research focuses on the dissemination and implementation of evidence-based practices for youth mental health problems in community-based clinical care contexts.

Jenna Strawhun

Jenna Strawhun, PhD, NCSP, is a licensed psychologist and clinical assistant professor in the Department of Psychological Sciences at the University of Missouri. She is also a regional coordinator for the Boone County Schools Mental Health Coalition focused on evidence-based assessment and intervention services in schools. Her clinical and research activities primarily relate to evidence-based service delivery for children and adolescents with internalizing issues.

Sarah A Owens

Sarah A. Owens, PhD, NCSP, is an assistant teaching professor in the Department of Education, School, & Counseling Psychology at the University of Missouri. She is the associate director of the Boone County Schools Mental Health Coalition partnership with local school districts. Her areas of interest include supporting teacher implementation of evidence-based practices, effective adoption and translation of interventions to schools, measurement and support for fidelity of implementation, prevention of mental health concerns.

Siena K Tugendrajch

Siena Tugendrajch, MA, is a doctoral candidate in the Department of Psychological Sciences at the University of Missouri. Her primary research and clinical interests are in the dissemination and implementation of evidence-based practices for youth and families and in the science of high-quality clinical supervision. She is currently a practicum student in the Boone County Mental Health Coalition. She also provides therapy through the MU Psychological Services Clinic for a range of presenting concerns for youth and adults.

Kristin M. Hawley

Kristin M. Hawley, PhD, is a clinical psychologist, codirector of the Center for Evidence-Based Youth Mental Health, and associate professor in the Department of Psychological Sciences at the University of Missouri. She has an active research program focused on improving mental health services for children, adolescents, and families. She continues to provide clinical training, consultation, and supervision to graduate students and professionals.