Mood and anxiety disorders impact 30-40% of school-age children, affecting individuals and communities socially and economically. These mood and anxiety disorders are often treatable, yet fewer than 20% of impacted youth have access to evidence-based practices such as cognitive behavioral therapy (CBT). Schools and their associated staff professionals, such as guidance counselors and social workers, offer a promising means of improving access to effective mental health care. The school setting allows for service provision regardless of insurance coverage, socioeconomic status, or transportation. Additionally, students report more willingness to use mental health services at school than in other settings. Regrettably, many school professionals don’t receive sufficient training to enable them to deliver CBT and other evidence-based practices.
The University of Michigan TRAILS Program (Transforming Research into Action to Improve the Lives of Students) seeks to fill this need among staff and increase treatment access for school-aged children. TRAILS provides CBT training and resources for school staff and then pairs each school with a TRAILS Coach–doctorate and masters-level clinicians with established CBT expertise who have received TRAILS training. Coaches and school staff then co-facilitate skill-building groups where students learn techniques shown to reduce symptoms of depression and anxiety. TRAILS launched in 2013 in three Ann Arbor Public Schools and is currently leading several state-wide initiatives reaching nearly 3,000 students.
Despite the growth and popularity of various strategies for implementing evidence-based practices like TRAILS, few studies have assessed the efficacy of coaching as an implementation strategy. Therefore, TRAILS launched a pilot cohort to understand the effects of coaching in nine public schools in Central and Southeast Michigan. Participating school professionals received training on CBT techniques for depression and anxiety and using standardized assessment tools to inform service delivery. Training was followed by implementation support from TRAILS Coaches. Coaching included one-on-one communication, session planning, and in-person support during staff-led student CBT skill-building groups. Student groups met weekly for 10-12 sessions (11 students per group). Each week features different CBT skills and, by the end of the sessions, students have a toolbox of coping mechanisms they can apply to help them deal with anxiety and depression in their daily lives.
This pilot feasibility study provides an early indication that didactic training followed by in-person coaching may be an effective model for enhancing EBP use in school settings.
A two-part evaluation was done to assess school professionals’ confidence in, utilization of, and positive attitudes toward CBT. The first round analyzed data captured immediately after the training. The second round analyzed data captured after the professionals facilitated student skill-building groups. After the initial training, they demonstrated improvement in all three measures. These improvements were sustained or increased when the training was coupled with support from TRAILS coaches who co-facilitated the student groups. Without such post-training support, improvements attributed to training were more likely disappear after a short duration.
TRAILS program effectiveness was also demonstrated among students who participated in skills groups, with students experiencing significant reductions in depression and anxiety symptoms. Students with higher baseline trauma exposure saw substantial improvement in some, but not all, anxiety and depression measures. These results suggest that a successfully implemented and accessible, effective teaching and coaching program may be especially important to promote resource equity and, ultimately, student health for students impacted by traumatic life events.
This pilot feasibility study provides an early indication that didactic training followed by in-person coaching may be an effective model for enhancing EBP use in school settings. Though this was not an efficacy trial, findings among students demonstrated that CBT delivered by school professionals may significantly reduce symptoms of depression and anxiety. TRAILS is now engaged in a large-scale randomized controlled study funded by the National Institutes of Health designed to measure program impact for both students and school staff.