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Service Delivery Innovation Profile

School-Based Transition Program Connecting High-Risk Adolescents to Mental Health and Support Services Improves Academic and Familial Functioning


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Snapshot

Summary

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.

Evidence Rating (What is this?)

Moderate: The evidence consists of a comparison of post-implementation relapse rates among participants to a sample taken from the larger community, pre- and post-implementation measures of academic functioning, and anecdotal reports of improved family functioning.
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Developing Organizations

Brookline Community Mental Health Center; Brookline High School
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Patient Population

Age > Adolescent (13-18 years); Vulnerable Populations > Mentally ill; Substance abusersend pp

Problem Addressed

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.

What They Did

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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.

Did It Work?

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Results

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.

Evidence Rating (What is this?)

Moderate: The evidence consists of a comparison of post-implementation relapse rates among participants to a sample taken from the larger community, pre- and post-implementation measures of academic functioning, and anecdotal reports of improved family functioning.

How They Did It

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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.
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Funding Sources

Robert Wood Johnson Local Initiative Funding Partners Program; Brookline High School; Brookline Community Mental Health Center; Blue Cross Blue Shield of Massachusetts Foundation; Bay State Federal Charitable Foundation; Brookline Community Foundation; Brookline Public Schools; Brookline Housing Authority; Brookline Tuberculosis & Health Society; Klarman Family Foundation; Friends of Brookline Public Health; Sidney & Esther Rabb Charitable Foundation; Sovereign Bank
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.end fs

Adoption Considerations

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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.

More Information

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Contact the Innovator

Henry White, MD
Clinical Director
Brookline Community Mental Health Center
41 Garrison Road
Brookline, MA 02445
Phone: (617) 277-8107
Fax: (617) 734-6385
E-mail: henrywhite@brooklinecenter.org

Innovator Disclosures

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.

References/Related Articles

BRYT Program. Brookline Community Mental Health Center. Available at: http://www.brooklinecenter.org/bryt

White H, Langman N, Henderson S. A school-based transition program for high-risk adolescents. Psychiatr Serv. 2006;57(8):1211. [PubMed]

Footnotes

1 White H, Langman N, Henderson S. A school-based transition program for high-risk adolescents. Psychiatr Serv. 2006;57(8):1211. [PubMed]
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Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: December 23, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: March 26, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: February 15, 2012.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.