Author: Deloach, Kendra P
Date published: March 1, 2012
Interdisciplinary collaboration (IC) is a critically important theme generally, and of particular significance in school mental health (SMH), given the range of people from different disciplines who work in schools and the various systems in place (see Bronstein, 2003; Mellin, 2009). Reflecting the move to a true shared school-family-community system agenda, the collaborative context in schools includes school-employed mental health professionals (e.g., school psychologists, school counselors, school social workers), health professionals (e.g., school nurses, speech pathologists), special and general educators, collaborating mental health professionals from the community, school administrators, families and family advocates, resource staff, and others. Notably, as SMH is becoming an increasing force in the United States (President's New Freedom Commission, 2003) and in other countries (Rowling & Weist, 2004), an expanded approach is being emphasized with community professionals joining those in schools to augment the work that is occurring, increasing the likelihood that community mental health will actually reach youth and families and that typically underresourced schools receive enhanced resources and support to offer the full intervention continuum of mental health promotion (see Weist, 1997). To truly embody a collaborative approach, this work should demonstrate respect for individual professions, incorporate effective communication, share information across professionals and systems, and engage in reflection of the collaborative process (Bronstein, 2003; Weiner, 1990; Reich & Reich, 2006).
The importance of IC has been well identified in many of the disciplines involved in school mental health - social work, psychology, and related healthcare and educational fields (Allen, 1998; Bronstein, 2003; Maidenberg & Golick, 2001; Reich & Reich, 2006; Rossen, Bartlett, & Herrick, 2008; Weiner, 1990; Wittenberg-Lyles, Oliver, Demiris, Baldwin, 8c Regehr, 2008). These respective professions recognize the need for ICs in addressing complex multisystemic societal problems that are inadequately addressed by a single profession (Reich 8c Reich, 2006). The need for IC is especially evident now that funding sources and community resources have continued to dwindle. With fewer resources available, helping professionals must use effective strategies to address multifaceted problems. In this context, IC helps to capture diverse knowledge, skills, resources, and practices of each discipline proffering comprehensive, acceptable, and feasible solutions (Bronstein, 2003; Reich 8c Reich, 2006).
Because collaboration is an interpersonal process taking place to varying degrees within and/or across disciplines (Weiner, 1990), professional organizations (e.g., the National Association of School Psychologists, American Psychological Association [APA], National Association of Social Workers, Council for Exceptional Children) have begun providing guidelines for such collaboration and are seeking to identify advantages, barriers, and models for successful collaboration. Increased IC directly affects the training of researchers, educators, practitioners, and the development of programs within universities, schools, and communities (Allen, 1998; Bronstein, 2003; Maidenberg & Golick, 2001; Reich 8c Reich, 2006; Rossen, Bartlett, 8c Herrick, 2008). Although IC is promoted within disciplines, the degree to which these professions provide guidance on this process varies, but further examination, including practical advice for implementation, is still needed.
In this article, a diverse team of professionals (early career psychologists, a social worker, a special educator, and faculty in psychology and special education) working on implementing a large-scale study will present study background and themes related to IC as the study plays out. First, we will describe our interdisciplinary team's collaborative approach toward implementing a multicomponent mental health and classroom intervention package for high school youth with social, emotional, and behavioral disabilities (EBD) and their families. We then discuss obstacles in sustaining interdisciplinary collaborations with schools and present strategies for overcoming them.
In schools, students with EBD require significant mental health and educational services by school mental health professionals and educators. Students with EBD have the poorest proximal and distal educational and behavioral outcomes of any disability group (Bradley, Doolittle, 8c Bartoletta, 2008; Wagner et al, 2006). As for their educational outcomes, they have lower grades, fail more courses, are retained more frequently, and get suspended and expelled more times than students in any other disability group (Knitzer, Steinberg, 8c Fleisch, 1999). Furthermore, students with EBD often experience many unfavorable postschool behavioral outcomes - high rates of school drop-out, unemployment, substance abuse, criminality, incarceration, and premature death (Bullis 8c Cheney, 1999).
In recognizing the significant need to improve services for students with EBD, the Institute for Education Sciences (IES), the major research arm of the U.S. Department of Education, funded the Center for Adolescent Research in the Schools (CARS) in 2008. The CARS project is a large-scale study that embraces IC between and across professionals in the mental health and special education fields with IC undergirding the development of a multicomponent intervention package for high school students with EBD. Experiences from the CARS study will serve as an example to demonstrate the process, advantages, and challenges associated with ICs.
INTERDISCIPLINARY COLLABORATION IN SCHOOL MENTAL HEALTH: ADVANTAGES AND CHALLENGES
Mental health professionals and educators have widely recognized that the scope and depth of their collaborations need to be expanded in order to provide optimal education, support, and care for the nation's youth (President's New Freedom Commission on Mental Health, 2003). As the field of SMH continues expanding, a greater need for collaboration exists among the disciplines - the intermixing of psychologists, counselors, social workers, educators, and school administrators, with staff from school and community agencies working together; however, this remains an underdeveloped agenda (see PaternitÚ, Weist, Axelrod, Weston, 8c Anderson-Butcher, 2006).
Despite the advantages of interdisciplinary work, collaborating within and across numerous boundaries, disciplines, and professions can be challenging. The National Research Council identified key obstacles focusing on different perspectives inherent among team members from different disciplines (National Research Council of the National Academies, 2008). Within-discipline differences may exist as individuals practice and communicate differently, and across-discipline differences may exist as individuals assume ambiguous roles and undesignated leadership, especially true in collaborations that adopt a nonhierarchical, egalitarian organizational structure. Based on this structure, several questions maybe raised: Who is the leader? How will accountability be attained? What will be the process for communicating and sharing information? Dilemmas related to ethical standards, practices, and procedures may conflict among different professions, disciplines, and institutions. Funding priorities and university and workplace contingencies may not value ICs because of the history of working in isolation from other disciplines and institutionalized bureaucratic barriers. Increasingly, prominent national organizations, such as APA (2009) and the National Science Foundation (2008), have recognized the value of IC by launching agendas promoting it.
Recently, at the University of South Carolina, the psychology department held a series of brown bag lunch discussions on identifying and overcoming challenges relatedto limited collaboration among school and clinical/community graduate students in the program. A number of recommendations were developed that are applicable to other disciplines, including: (a) significantly enhancing purposeful planning for integrated training (e.g., identifying areas for integrated coursework, analyzing missed opportunities and the occurrence of parallel play); (b) eliminating arbitrary narrowness in training (e.g., excessive emphasis on testing for school psychology students, no experience in schools for clinical/community students); (c) emphasizing the building of complementary skills (e.g., clinical/community and school psychology faculty and students assisting each other in working with youth presenting challenging diagnoses and expanding opportunities and skills in assessment) ; (d) moving to common training strategies wherever possible both within the department of psychology, and with other related departments and colleges (e.g., public health, social work, special education); (e) developing a theme of intolerance for "discipline-related arrogance and rigidity" (see Weist et al., 2010) and instead cultivating a mutually respectful and supportive nonhierarchical approach in all aspects of training and research; (f) providing training to purposefully address interdisciplinary skill deficits (e.g., lacking knowledge about the key roles of another discipline) and increase opportunities for IC in teaching, service, and research; and (g) developing new models for supervision that move beyond passive, expert, single-discipline approaches, to active, collaborative multidiscipline approaches. Of note,the dialogue that was heldforthis seminar ledto the development of a paper published in The Community Psychologist (Weist, Mills, Huebner, Smith, 8c Wandersman, 2010), and plans for a series of papers (including this one and another one under review that emphasizes connections with counseling psychology) seeking to promote IC in school mental health.
LARGE-SCALE RESEARCH STUDY
CARS is a 5-year national research center and a collaborative effort between professionals in the fields of special education and mental health. The intent is to develop and manualize a comprehensive intervention package for high school students with EBD, using resources in the school, home, and community. The conceptual framework centers around the student, focusing on three intervention components involving classroom-based and mental health-based interventions: (a) enhancing school and teacher capacity, designed primarily to enhance supports provided in the school and classroom; (b) building child competence, focusing on enhancing student social and emotional development and academic performance; and (c) increasingfamily and community supports, focusing on improving parenting skills and family interactions, while facilitating their selection of quality community resources and services.
A SUCCESSFUL MODEL OF INTERDISCIPLINARY COLLABORATION
This study has two major areas of emphasis: (a) developing evidence-based strategies for promoting positive emotional/behavioral functioning and school success for youth with EBD and (b) establishing effective collaboration among research staff, mental health professionals, and educators in addressing the diverse needs of these youth. According to the recommendations by the National Research Council of the National Academies (2008), research collaborations can be successful if four component areas are focused upon: participants and personnel, the conduct of the research, practical issues, and dissemination. In the following, we use this framework to discuss challenges and successes related to IC in the CARS study.
Participants and personnel. A component of IC is engaging participants and personnel so that their skills, resources, and knowledge can be fully actualized and maximized. At one site, the school psychologist and a special educator who was also a licensed social worker led a social skills group with high-school-age students with EBD. The group was held in the school psychologist's office, a neutral environment that differed from the students'classrooms. The group exposed the students to the school psychologist, whom many of them had never met (related to work contingencies on the psychologist that got in the way of him meeting a number of students in the EBD program). Introductions from the group helped in positive relationship development helpful to the students, the school psychologist, the CARS team (including social work and special education professionals), and research specialists (recent graduates of psychology undergraduate programs).
Another example is IC that has increased through a program called Check and Connect. Each high school student participating in the CARS study has a mentor who monitors indicators of dropout (e.g., absences, suspensions, missing assignments, failing grades) and checks in with the student at least once weekly to provide support and identify interventions, when needed. Mentors are identified through a voluntary process and, across participating schools, include general educators, case managers, administrators, school psychologists, and counselors. Through the Check and Connect process, mentors develop an understanding of a wide range of student needs (e.g., academic, behavioral, social, emotional, family) and resources available to address these needs. Mentors interact with diverse disciplines regarding their mentee's intervention needs, enhancing communication and understanding of services and supports.
Conduct of the research. Collaborations usually consist of various disciplines that embrace specific procedures and methodologies; thus, this component emphasizes using multiple procedural andmethodological approaches. When collaborators engage in regular, forthright communication and collaborate on the development of instruments, methods, and procedures, the likelihood of reaching consensus on the use of multiple methodological approaches increases. For this to happen, collaborators must be flexible in negotiating measures and procedures, in generating common definitions, andin developing a sharedagenda. Collaborators should share a clear focus, participate in extensive piloting of measures, and continuously monitor progress.
In the CARS study, the classroom and mental health interventions had varying degrees of research supporting their effectiveness. Some interventions were empirically supported while others had more limited empirical support. Some interventions have support with younger students, but limited evidence with secondary age students. Finally, the interventions as an entire package and the consultation process had to be fully developed and tested with high school youth. Therefore, during the study's first 3 years, each intervention component was refined based on an iterative process involving extensive and ongoing feedback from a variety of sources - a development team (i.e., consisting of the principal investigators and site leaders), the study's site staff, school personnel, and participating youth and parents. The interventions underwent numerous iterations based on ongoing discussion and feedback from all sources. Ultimately, the grant staffs special educators and mental health professionals collaboratively decided upon the final procedures. This collaborative revision process was essential for identifying interventions that would be effective and feasible to implement and measures that would capture important and mutually agreed upon process and outcome variables.
Practical issues. Another component of collaboration is establishing strategies for handling practical issues as they occur. Creating a mechanism for regular communication is one strategy. Collaborators should maintain constant and clear communication and involvement at all levels through meetings, conferences, or electronic media (e.g., Listservs, websites, e-mail, etc).
In the study, a variety of mental health professionals (e.g., clinical-community and school psychologists, social workers, and school counselors) and educators (general and special education teachers) collaborated to deliver the multicomponent intervention package. Each professional relied upon an array of theoretical perspectives that at times made collaborating across disciplines challenging. Differently and narrowly focused educational training limits opportunities for collaboration within and across helping professions and disciplines. Within the psychology field, unacknowledged arrogance and rigidity" perpetuates a hierarchical approach within the discipline and across disciplines (see Weist et al., 2010), upending ICs. Within schools, general educators may be unfamiliar with the needs of students with disabilities or philosophically opposed to making accommodations, regardless of legal mandates. These barriers impede the effectiveness of collaboration and get in the way of the positive influence of programs on student outcomes.
Presently within higher education, there is a movement toward offering interdisciplinary educational training to increase opportunities for an integrative educational experience. Some mental health professionals and educators may be slow to adopt an interdisciplinary approach that embodies fluidity, democracy, and respect for the merit of other theoretical frameworks, key components for advancing IC. Mental health professionals, particularly psychologists, social workers, and counselors whose previous professional training endorsed a hierarchical or expert model of consultation may devalue a more collaborative approach (see PaternitÚ, 2006; Waxman, Weist, 8c Benson, 1999), consequently undermining the success of ICs. CARS found it helpful for all project staff to attend trainings on intervention, assessment, and consultation, supportive of an interdisciplinary understanding of each staff member's efforts. Furthermore, making the student the focus of intervention has necessitated working together to assure interventions that are indicated based on a comprehensive individualized assessment are implemented, regardless of discipline.
Establishing effective collaborations. Collaborations can effect sustainable change in school mental health programs with a key mechanism being the integration of knowledge bases, supportive resources, and effective strategies from relevant disciplines. Osterloh and Koorland (1998) have asserted that collaborations in schools are strong when everyone knows the school policies and procedures; when there has been a fair process of deciding roles and responsibilities; when there is consistent, ongoing, and reciprocal communication among educators and mental health professionals; when collaborators endorse a shared agenda and openness toward using innovative approaches; and when the primary aim is on improving the benefits of existing services. Rones and Hoagwood (2000) recommended process strategies for collaborations to implement school mental health services, increasing the likelihood that such services would be sustained and maintained - consistent implementation of the program; adoption of an expanded school mental health approach (see Weist, 1997), including parents, teachers, and/or peers; use of multiple modalities; integration of mental health content into general education curricula; and implementation of developmentally appropriate interventions.
This study has adopted many of these recommendations. For instance, intervention and study procedures have been shared with district- and school-level administrators and the entire school staff. Prior to and throughout the study, responsibilities and roles continue to be clarified. CARS staff meet regularly one to three times each week with school personnel to mutually discuss items on the shared agenda. Because the study employs a consultation model, consultants observe and collect data on intervention integrity to assure interventions are consistently implemented and feedback is provided regularly. After intervention implementation, school personnel inform the consultants on how well the intervention met the needs of the youth, parents, and school personnel. School personnel have an opportunity to disclose their likelihood of integrating the interventions into their existing workload, demonstrating whether the interventions can be sustained beyond the study's life cycle.
Dissemination. In the beginning stages, collaborators should agree upon the procedures for dissemination and publication, which includes guidelines about authorship and the process for deciding order of authorship on publications. Before writing begins, collaborators should discuss what roles and responsibilities constitute the order of authorship, particularly important for university faculty who have tenure and promotion requirements demanding that they publish. Once agreed upon, obstacles pertaining to the role, extent, and mechanisms used for dissemination could either be avoided or resolved early.
Collaborators should explicitly discuss and agree upon publication and dissemination standards to control the messaging of the study. Controlling the message collectively assures that the agenda remains shared. If done, collaborators avoid being blindsided by publications that makes erroneous or controversial assertions.
ADDITIONAL ISSUES AND SOLUTIONS
As the study progresses, obstacles such as busy schedules, extremely busy and overcommitted school personnel, and lack of supports have been identified. To overcome these obstacles, CARS staff have trained, consulted, and evaluated the interventions within a brief, ongoing, and consistent time frame. For example, finding that teachers had little time for a lengthy training session, we scheduled brief intervention training sessions (10-15 minutes) and followed up with coaching. To increase connections to university staff working on the project, and to maximize use of resources and increase relevant training for students, CARS sites have included more graduate students in roles supportive of the study.
The CARS study has piloted a comprehensive set of interventions, some particular to special education (e.g., focused on classroom accommodations, opportunities to respond, classroom structure), and some aligned with the mental health field (e.g., focused on interpersonal skills training, depression, and anxiety) . Prior to evaluating the interventions, collaborators agreed upon criteria to evaluate intervention effectiveness. Criteria included measuring improvements in student behavior, evaluating acceptability of interventions from the perspectives of consumers (e.g., teachers, mental health personnel, students, and parents), and determining feasibility of implementation in typical settings. CARS staff used these criteria to eliminate and refine intervention components in the process of developing a final intervention package. By developing criteria for judging intervention success, the study was able to maintain a focus on effectiveness, avoiding the tendency to retain interventions in a planned research program related to history or professional allegiance.
Another concern was maintaining a special education-mental health balance within and across sites. Because the leadinvestigator at each site had expertise in either special education or mental health, CARS created a within-site balance by assuring that grant staff were hired at each site with expertise in each of the respective areas. To further assure that interventions were implemented as designed, with adequate attention to both the academic/behavioral and mental health needs of students, the principal investigators teamed to regularly visit participating sites and evaluate intervention implementation. Teams included at least one investigator with mental health expertise and one with special education expertise.
The CARS project also developed concerns that schools may neglect one area of student need in favor of another (e.g., focus only on academics without addressing mental health needs). Similarly, study investigators and staff did not want to waste valuable school time with an intervention that was not indicated. Therefore, CARS developed a comprehensive and individualized assessment plan prior to implementing interventions to determine interventions that were indicated for each student. This allowed the study to focus on student need, regardless of discipline, as well as to streamline and prioritize intervention delivery based on these student's needs.
This article presents a sample of obstacles to interdisciplinary collaboration (IC) and ideas for overcoming them in research in school mental health through examples and illustrations from the large, federally funded Center for Adolescent Research in Schools (CARS) study. While there is literature on IC, in general, applications to school mental health and research on school mental health are limited. The CARS study, representing active collaboration among special Úducation; school, clinical, and counseling psychology; special and general education; families and youth; and other stakeholders, represents fertile ground for increasing our understanding of IC in school mental health research, obstacles to it, and ideas for overcoming these obstacles. As the study moves to the major experimental arm (in Years 4 and 5; 2011-2012, 2012-2013), we will continue to track obstacles and successes to IC, and use observations to promote dialogue, collaboration, and research specifically focused on improving IC and its impacts in the delivery of learning and mental health supports for students with EBD.*
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KENDRA P. DELOACH, PhD, LMSW, is a postdoctoral fellow, team leader, and mental health facilitator of the Center for Adolescent Research in Schools (CARS) Project in the psychology department and adjunct faculty in the College of Social Work at the University of South Carolina. MELISSA DVORSKY is a research specialist and data coordinator of the CARS Project in the psychology department at the University of South Carolina. MELISSA R. W. GEORGE, PhD, is a postdoctoral fellow and team member of the CARS Project in the psychology department at the University of South Carolina. Elaine Miller is a research coordinator and classroom facilitator of the CARS Project in the psychology department at the University of South Carolina. MARK D. WEIST, PhD, is a professor in the psychology department at the University of South Carolina. LEE KERN, PhD, is Iacocca Professor of Special Education at Lehigh University.