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At-Risk Adolescents

Community level risk factors

Family difficulties
Barriers in access to care
Substandard housing
Food insecurity
Inadequate school resources
Community violence
Environmental toxins
Neighborhood disadvantage

Chronic stressors create wear-and-tear on physiological response systems responsible for managing acute stress

Increased risk of internalizing problems
Decreased emotion regulation abilities
Interference with coping strategies

Atkins et al., 2006; Evans & Kim, 2013; Santiago et al., 2013; Slopen et al., 2010

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School-Based Interventions

Accessible and affordable

Schools are the largest provider of mental healthcare to youth
Reduce logistical barriers to services

Allow a natural context to practice psychosocial skills

Fosters learning acquisition
Targets multiple key areas of development
Reduces the stigma of seeking care

Coping techniques, building resiliency, and problem-solving
Literature gap: often do not address emotion dysregulation associated with chronic stress

Calear & Christensen, 2010; Neil & Christensen, 2009; Masia-Warner et al., 2006

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Dialectical Behavior Therapy

Cognitive-behavioral form of therapy, originally developed for individuals with chronic suicidality or BPD

Increases emotion regulation abilities
4 core skills taught as modules

Adapted for use with adolescents (DBT-A)

Demonstrated efficacy for various mental health problems
Current study is among first to examine school-based DBT

Emotion Regulation

Mindfulness

Interpersonal Effectiveness

Distress Tolerance

Linehan, 1993; Rathus & Miller, 2002; Linehan, 2006; MacPherson et al., 2013

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Project SOARing

Purpose of School-Based Opportunities for Adolescent Recovery (SOARing) is to evaluate the effectiveness of a school-based DBT-skills group intervention

Address the significant need for mental health support at Sierra High School
Determine whether DBT skills can be taught effectively within a Tier 2 intervention

Protocol Development
DBT Skills in Schools: Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A)
SOAR community intervention

Mazza et al., 2016

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Pre-Pilot Trial Aims

Collect data to determine feasibility, acceptability, and preliminary effectiveness of Project SOARing
Explore avenues for scaling and sustainability of the intervention in San Bernardino school district
Incorporate pilot data into a proposal for a larger RCT of the intervention

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Participants and Measures

Recruited from Sierra High School

Students with academic credit deficiencies

Administered a mental health survey that screens for trauma, depression, and anxiety

Eligibility: emotion regulation difficulties
Exclusion: psychosis, active suicidal ideation, developmental delays
Initial pre-pilot feasibility trial

5 participants: 100% male; 40% Latin, 20% Native American, 20% White, 20% Other

Conducted brief satisfaction questionnaire
Collected field note data to determine feasibility and acceptability

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Procedure

Protocol Development

Made preliminary adjustments to existing SOAR materials
Assessed fit of program materials to school context

Implementation

Facilitated by two clinical psychology graduate students trained in DBT foundations
Weekly supervision and consultation with study PI
Reflected on adaptations needed and discussed logistics for future pilot study

Develop plan for larger randomized intervention

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Field Note Results – Feedback

Provide more space to discuss the utilization of each skill being learned

Ability to share and hear experiences of both students and facilitators

Review the previous skill at the beginning of each week to consolidate learning
Utilize white board for open discussion
Positive response to hands-on activities involving movement/interaction with objects
Positive response to leaders integrating themselves with students

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Field Note Results - Challenges

Students felt averse to paper questionnaires
Attendance difficulties
Student disruptions

Possibility for more individualized therapy attention
Negative impact on group

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Modifications Made

Include more experiential examples and exercises and limit didactics

Allows for more interaction and participation from students

Change format from lecture-style to group discussion
Encourage students to engage (e.g., bag of affirmations)
Provide additional space for processing after discussions on heavier topics (i.e., sadness, grief)

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Discussion and Implications

Qualitative results indicate that Project SOARing demonstrates sufficient acceptability, feasibility, and appropriateness
Impact

Student satisfaction surveys revealed that the intervention was well-received
Feedback provided informs future intervention protocols

Scaling and Sustainability

Plans to conduct larger interventions
Continued partnership and expanded support at Sierra High School

Limitations

Students were non-randomly selected
Evidence from quantitative data pending

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Future Directions

Pilot study (Spring 2020 prior to pandemic-related discontinuation)

Satisfaction and Youth Outcomes Questionnaire (YOQ) data collected
Universal DBT-Skills Project
Proof-of-Concept Randomized Trial

Planning for a Fall 2021 intervention
Groups of ~9 students will meet 50 minutes weekly for 12 weeks
Compare immediate to delayed treatment group for meaningful improvements in mental health and academic outcomes

Compare pre- and post-treatment outcomes within immediate treatment group

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Acknowledgements and Contact

Thank you to Dr. Boustani, Abby Alido, and co-authors for support
Contact Information:

emazzone@students.llu.edu
mboustani@llu.edu

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References

Atkins, M. S., Frazier, S. L., Birman, D., Adil, J. A., Jackson, M., Graczyk, P. A., Talbott, E., Farmer, A. D., Bell, C. C., & McKay, M. M. (2006). School-based mental health services for children living in high poverty urban communities. Administration and Policy in Mental Health and Mental Health Services Research, 33(2), 146.

Calear, A. L., & Christensen, H. (2010). Systematic review of school-based prevention and early intervention programs for depression. Journal of adolescence, 33(3), 429-438.

Evans, G. W., & Kim, P. (2013). Childhood poverty, chronic stress, self‐regulation, and coping. Child development perspectives, 7(1), 43-48.

Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. Guilford Press.

Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., Korslund, K. E., Tutek, D. A., Reynolds, S. K., & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of general psychiatry, 63(7), 757-766.

MacPherson, H. A., Cheavens, J. S., & Fristad, M. A. (2013). Dialectical behavior therapy for adolescents: Theory, treatment adaptations, and empirical outcomes. Clinical child and family psychology review, 16(1), 59-80.

Masia-Warner, C., Nangle, D. W., & Hansen, D. J. (2006). Bringing evidence-based child mental health services to the schools: General issues and specific populations. Education and Treatment of Children, 29(2), 165-172.

Mazza, J. J., Dexter-Mazza, E. T., Miller, A. L., Rathus, J. H., & Murphy, H. E. (2016). DBT? Skills in Schools: Skills Training for Emotional Problem Solving for Adolescents Dbt Steps-a. Guilford Publications.

Neil, A. L., & Christensen, H. (2009). Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety. Clinical psychology review, 29(3), 208-215.

Rathus, J. H., & Miller, A. L. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and life-threatening behavior, 32(2), 146-157.

Santiago, C. D., Kaltman, S., & Miranda, J. (2013). Poverty and mental health: How do low‐income adults and children fare in psychotherapy? Journal of clinical psychology, 69(2), 115-126.

Slopen, N., Fitzmaurice, G., Williams, D. R., & Gilman, S. E. (2010). Poverty, food insecurity, and the behavior for childhood internalizing and externalizing disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 49(5), 444-452.