Schools are the most common venue for youth mental health services, but school 
mental health (SMH) typically does not use evidence-based strategies. Moreover, SMH is often delivered inefficiently, with few students receiving needed care and triage decisions not based on measurement of symptoms or progress. To respond to these concerns, a multidisciplinary team developed and established the efficacy of the Brief Intervention for School Clinicians (BRISC), a four-session engagement, brief intervention, and triage strategy targeting a range of mental health (e.g., anxiety, depression, past trauma) and other problems (academic, peer, family). Like other evidence-based SMH strategies, however, integration of BRISC into authentic education settings could be improved via collaborative redesign that tailors implementation strategies (IS) to the “real-world” education. Moreover, stakeholders have observed that the reach of BRISC would be improved by adapting its implementation support strategies to school-employed practitioners such as school counselors, school social workers, and paraprofessionals. To address serious MH workforce shortages and meet the need for accessible, contextually-appropriate, and engaging interventions for youth with emerging MH problems, the current project will iteratively adapt BRISC ISs for use by school-based providers (e.g., school counselors, school social workers) via the University of Washington ALACRITY Center’s (UWAC) Discover, Design/Build, Test (DDBT) approach and methods drawn from the field of human-centered design.  
 

The first aim of the BRISC Redesigned In Districts to Grow Evidence (BRIDGE) study is to iteratively redesign ISs to maximize BRISC usability, engagement, and contextual appropriateness with a sample of school counselors (n = 10) and administrators (n = 5). Adaptation will be led by a collaborative study redesign team composed of researchers, UWAC Methods Core support staff, and school MH practitioners (SMHPs) from diverse (2 suburban/high-resource, 2 rural/low-resource) school districts. Aim 2 will then consist of a pilot effectiveness-implementation hybrid type-3 trial, during which we will compare DDBT mechanisms (usability, engagement, appropriateness) and implementation outcomes (adoption, fidelity, adaptation, reach) for the original package of BRISC ISs (BR-O) versus adapted BRISC ISs (BRA). Finally, we will evaluate the potential for positive impact of original and adapted BRISC for students referred to or seeking SMH treatment on mental health outcomes (student top problems, anxiety, depression, MH functioning) (Aim 3). Participants in Aims 2 and 3 will include n = 12 school clinicians and n = 60 students. Data will be combined with other UWAC projects to inform overarching evaluation of the DDBT framework and the impact of redesign on implementation and clinical outcomes. 

The accessibility of school-based mental health services provides substantial opportunity to increase youths’ access to mental health care. BRISC provides a research-based strategy for improving structure, efficiency, and effectiveness of school-based mental health services. Cornerstone implementation strategies have been used to support BRISC; however, achieving success in different districts and communities requires systematic redesign of implementation strategies. Developing tailored implementation strategies will support expanded use of BRISC in varied school contexts.