SMART Center Research Projects

This planning grant is designed to develop a school-specific adaptation of the Collaborative Care model and associated training materials in order to: (1) Enhance capacity to provide SBMH services by increasing the number of healthcare providers (including primary care providers and indigenous school-based personnel) who can participate in the delivery of mental health services to youth experiencing mood and anxiety problems; (2) Improve SBMH accessibility by reducing stigma via the utilization of primary care providers and indigenous school personnel as points of entry for services; and (3) Increase the extent to which SBMH services reflect high quality evidence-based practices.

This project will use machine learning algorithms to evaluate the extent to which high school students’ social media posts provide the information needed to accurately predict and manage suicide risk in real time.

The ACT SMARTER project will redesign an evidence-based implementation toolkit called, “Autism Community Toolkit: Systems to Measure and Adopt Research-Based Treatments (ACT SMART). The ACT SMART toolkit was developed and shown to be effective in targeting autism EBP decision-making in community settings and has immense potential to improve autism EBP adoption and implementation. The goal of the current project is to conduct an educational redesign of ACT SMART for use in public schools with input from stakeholders so that the implementation toolkit can be useful and usable in middle and high schools. Learn more here.

The purpose of this multi-site study is to develop and evaluate a multi-phase implementation and sustainment strategy to support evidence-based practice use across different interventions for individuals with autism, settings, and ages. Click here for more information.

We have developed and are currently testing the Beliefs and Attitudes for Successful Implementation in Schools (BASIS) implementation strategy. BASIS is a theoretically-drive, intervention-agnostic, and individually-focused implementation strategy designed to increase motivation and engagement prior to – and immediately following – initial training in evidence-based practices. Access the BASIS R01 study protocol here.

Check out related projects: BASIS-Optimization and BASIS-T

The goal of this study is to make the theory driven pre-implementation – Beliefs and Attitudes for Successful Implementation in Schools (BASIS) – to be most impactful and optimized for effectiveness and delivered in a digitized, resource-sensitive, scalable, and potentially sustainable way to improve school-based mental health providers’ implementation of evidence-based practices (EBP). The BASIS optimization project is funded as a component of the NIMH-funded IMPACT Center at the University of Washington.

We have developed – and are currently conducting a large-scale randomized trial of – at teacher-focused version of the Beliefs and Attitudes for Successful Implementation in Schools (BASIS) implementation strategy. BASIS-T is being tested in context of Positive Greetings at the Door (PGD) implementation. Details are available in a study protocol published in Implementation Science.

This project is designed to deliver and evaluate an early warning system and Tier 2 intervention (Student Engagement and Empowerment) to improve student attendance, behavior, and achievement. In doing so, this project investigates the effects of building capacity within schools to make data-driven decisions surrounding the selection and delivery of evidence-based, brief, relatively low-cost interventions proven to improve students’ mindsets and school belonging, two constructs linked to increased school engagement and safety.

BOLT is focused on designing and texting an online training platform and post-training consultation procedures to support measurement-based care / routine outcome monitoring among school-based mental health providers. Both the platform and the training will be iteratively developed using best practices from the field of user-centered design.

The purpose of this project is to develop and test a Tier-3 team-based Wraparound (T3W) intervention package for schools. Researchers will carry out their study in three phases. In the first phase, they will iteratively adapt the existing Wraparound model for use in elementary schools. In the second phase, they will test the feasibility of the revised intervention in elementary settings. In the third phase, they will complete a pilot test to evaluate the promise of the intervention, and with gather cost information. The project will yield a complete T3W intervention package, including training and coaching curricula, guidelines for districts and schools, supervisor supports, fidelity measures, and data systems, as well as preliminary evidence of the promise of positive outcomes.

The Brief Intervention Strategy for School Clinicians (BRISC) is a 4-session, evidence-based, and flexible “Tier 2” intervention tailored to high school students and designed to fit the school context. This cluster randomized efficacy trial (52 public high schools in three states) will use longitudinal data collection with students and parents; analyses of school records; implementation measures; and clinician and administrator surveys and interviews to evaluate outcomes of BRISC compared to services as usual, as well as moderators and mediators of outcomes and feasibility, acceptability, and costs of BRISC. For more information, click here.

This large scale efficacy study, conducted in 12 high schools in four states (VT, NH, IL, MD), tests whether the RENEW (Rehabilitation, Empowerment, Natural supports, Education and Work) program can improve social-emotional functioning and academic performance for the estimated 5-10% of high school students at risk for school failure due to mental, emotional, and behavioral (MEB) challenges.

This study will test the effectiveness of the newly-redesigned paraeducator-delivered RUBI for use in Educational Settings (RUBIES) intervention compared to usual care training in reducing disruptive behavior in 80 elementary-school children with ASD. This study also will examine paraeducator- and child-level mechanistic pathways of the RUBIES intervention.

The HELM project will adapt and test an existing leadership-focused implementation strategy (Leadership and Organizational Change for Implementation; https://link.springer.com/article/10.1186/s13012-014-0192-y) for use with elementary school principals in buildings where universal social, emotional, and behavioral program are being implemented. For more information about this project, click here.

This project aims to assess the unique and combined influences of community-based health organization and school contexts on school-based mental health practitioners’ use of evidence-based practices.

The aims of this project are to use an iterative design to: (1) develop materials that assist schools in the implementation of a web-based technology tool to assist teachers in the use of individual support plans in the classroom (iBESTT), and (2) evaluate the effectiveness of the training materials in producing school teams and teachers that implement iBESTT with high fidelity for students at-risk for or with chronic behavior problems.

This project will redesign an evidence-base psychosocial intervention, Collaborative Assessment and Management of Suicidality (CAMS), for use in the school context, using mixed qualitative and quantitative methods.

The Kids FACE FEARS (Kids Face-to-face And Computer-Enhanced Formats Effectiveness study for Anxiety and Related Symptoms) trial is a large multi-site pragmatic comparative effectiveness study evaluating face-to-face vs. online cognitive-behavioral therapy (CBT) for the treatment of child and adolescent anxiety.

This project is evaluating the impact of art-based mindfulness on the learning experiences of chronically stressed children in schools. The team is exploring art-based mindfulness as a culturally responsive practice for socio-emotional learning for diverse youth in schools. The study is built on the premise that all children can benefit from mindful practices through visual, physical, and tactile sensory experiences. Using an iPad app called L.A.U.G.H. ® (Let Art Unleash Great Happiness) and AmbientArt® technology, students in a racially diverse school are engaged in art-based mindfulness in the classroom. Through participating in L.A.U.G.H. time, we are learning that chronically stressed students are better able to regulate their emotions, have increased compassion for themselves and others, feel more connected to school and have greater joy in the process of learning. These benefits occur not only for individual students but also the classroom environment and overall school culture.

This mixed methods study contributes to the science of intervention adaptation by 1) using an expert consensus Delphi method to create a decision support tool for making EBP adaptations in routine practice settings and 2) examining which modifications were made to school-based EBPs during three recent implementation efforts.

(Training & Technical Assistance) In addition to regular training activities and special areas of focus, the Northwest Mental Health Technology Transfer Center (Northwest) has received funding to support increased training and technical assistance for school mental health in Alaska, Idaho, Oregon, and Washington. To operationalize this support Northwest has partnered with the University of Washington School Mental Health Assessment, Research, and Training (SMART) Center, a national leader in developing and supporting implementation of evidence-based practices (EBPs) in schools, including prevention, early intervention, and intensive supports. The Northwest School Mental Health (SMH) and Multi-tiered System of Supports (MTSS) Training and Technical Assistance (TA) Center, within the UW SMART Center, supports school mental health efforts with the goal to support states, districts, schools and community partners to build an equitable single system of delivery in which education and mental health systems are integrated across the tiers.

The purpose of this study is to identify which evidence-based practices (EBPs) teachers and paraeducators use to more meaningfully include and retain autistic children in general education settings; and the malleable individual and organizational characteristics that increase EBP use. Click here for more information.

This project will iteratively develop and pilot a brief professional development training to enhance teachers’ skills in establishing, maintaining, and restoring relationships with high school students, particularly those from marginalized racial/ethnic groups.

The first year of this project will develop a taxonomy, or list with definitions and examples, of possible ripple effects that might result from common strategies used to implement children’s mental health services. This taxonomy could be used by researchers, implementers, and others in implementation planning and monitoring efforts. The second year of this project will test the feasibility of developing a pragmatic measure of one ripple effect.

Background and Goals:

The Wraparound service model (WSM) is the most common care coordination strategy for youth with serious emotional disorders(SEO), with programs in nearly every U.S. state serving more than 100,000 youth. A recent meta-analysis of 17 controlled studies found significant positive effects of WSM on mental health (MH) symptoms, out of home placement rates, and health care expenditures, confirming its critical role in behavioral healthcare for children and adolescents. As is the case for other evidence-based practices, the degree to which data are consistently measured and used to inform care, i.e., “measurement-based care” or MBC, accounts for a large proportion of the variance in outcomes for Wraparound. For example, collection and use of data assessing client satisfaction, therapeutic alliance, and progress substantially increase likelihood of achieving target outcomes as a function of treatment. However, research on WSM shows that measurement and use of data, such as via Routine Outcome Monitoring, is inconsistent at best.

The goal of this SBIR is to develop and test a mobile ROM (mROM) system tailored to WSM. The proposed SMART-Wrap (Short Message Assisted Responsive Treatment for Wraparound) product will provide a feasible and acceptable mROM approach for WSM-enrolled parents/caregivers and youth based on evidence-based principles and past research for effective mROM. SMS (“short message system”) is supported by every mobile device and network with no software download needed. More than 98% of SMS messages are opened, compared to just 20% of emails, and on average, 90% of SMS messages are opened within the first 3 seconds of receipt.l161 SMART-Wrap will periodically administer brief, straightforward (1-2 items) SMS-based assessments of intermediate outcomes that have been found to predict clinical outcomes of WSM (e.g., harm to self and others, hospitalization, out of home placement)). Data will be used to:

1. Populate tabular and graphical displays (based on user permissions) to inform decision-making by WSM care providers, supervisors, and program managers (i.e., the WSM care team);
2. Trigger alerts to WSM care team members, such as escalation in caregiver stress or youth symptoms; and
3. Generate automated SMS outreach messages for families.

This 18-month Phase I project will accomplish the following specific aims: 

Aim 1: Design SMS system. Leveraging our team’s unparalleled access to WSM-implementing organizations, we will work with 50 WSM expert advisors, including experienced youth and caregivers, to determine an initial set of SMS assessment items and define the algorithm for generating data-driven alerts and outreach messages for each end user type (youth, parents/caregivers, WSM care team members). The Phase I proof of concept prototype will focus on four intermediate outcomes associated with positive clinical outcomes for WSM, specifically: therapeutic alliance, treatment satisfaction, youth symptoms, and parent stress/optimism.

Aim 2: Test SMS system. We will evaluate item psychometrics and messaging system feasibility with 30 families with a youth with SEO currently enrolled in WSM. Parents/caregivers and youth will independently interact with the prototype messaging system over a two-week period and then participate in follow-up focus groups and complete a prototype evaluation survey. We expect target end users to report high feasibility, usability, and acceptability for the prototype messaging system. We also expect items to show acceptable psychometric properties for youth and caregivers. Findings will be used to inform iterative modifications to items and enhancements to the text messaging platform prior to Phase I pilot testing.

Aim 3: Develop care team report features. Building on recommendations from our WSM expert advisors in Aim 1 as well as input from our expert consultants, we will create an online dashboard for WSM teams including tabular and graphical data displays, message and alert tracking logs, and reports to support team­ based decision-making. The online dashboard will be fully functioning to support the Phase I pilot test.

Aim 4: Conduct pilot test. We will work with established WSM provider organizations (WPO) to recruit 10 WSM care teams (approx . 30 WSM providers, 10 program managers, and 10 supervisors across 10 WPOs). Teams will use the SMART-Wrap prototype with 1 family over a 2-month pilot period (n=30 families). Software usage metrics will be collected and participants will complete follow-up online surveys. We hypothesize high usability (e.g., expected completion times, few help requests) and positive views of the prototype’s feasibility, acceptability, and added value across participant types (youth, caregivers, care team members). Positive results will set the stage for a Phase II SBIR to fully examine efficacy for service and clinical outcomes.

Commercial Application. SMART-Wrap will offer a feasible, cost-efficient, and scalable software system to meet the documented public health need for mROM and MBC in care coordination for youth behavioral health. Our end product will provide a novel solution to over 1,000 WPOs and WSM initiatives, many of which already license other technologies from this team, with future expansion to programs that serve youth and adults via other coordinated care models. 3C’s expertise in iterative software development and UW’s extensive ongoing research and commercial channels into WSM will provide a solid foundation for these efforts.

(non-research) The SMART Center Postdoctoral Research Training Program in School Mental Health is funded by the U.S. Department of Education’s Institute for Education Sciences (IES).The fellowship’s areas of focus align with those of the SMART Center and include research-based school behavioral health strategies and policies, implementation science, educational equity, clinical research methodology, and understanding and reducing ethnic and racial disparities.

This Career Development Award uses mixed methods to examine staff- and school-level factors as predictors of implementation and sustainment of an evidence-based intervention for children with autism spectrum disorder in public schools.

The main purpose of this Goal 5 Measurement Development and Refinement Project is to develop a suite of valid, practical, and usable measures to assess characteristics of the organizational implementation context in authentic educational settings in order to support the adoption and sustainment of evidence-based practices that improve student outcomes.

The University of Washington Research Institute for Implementation Science in Education (RIISE) is the first of its kind and reflects a collaborative, innovative effort to develop the implementation research workforce in education and improve educational and related outcomes. Led by a group of Core Faculty with extensive experience conducting implementation research in schools, RIISE provides training and mentorship to established education scholars (Fellows) to increase their expertise in conceptualizing, designing, and executing implementation research studies. Specifically, the RIISE training program will support Fellows in acquiring, building fluency with, and applying implementation research knowledge and skills in their education research to develop high-quality implementation studies that bridge the “last mile” in which education research fails to reach the individuals for whom it was intended. Learn more about RIISE here.

The goal of the Minority Engagement and Disproportionality Reduction project (MENDR) is to develop an authentic research partnership between Seattle Public Schools (SPS) and the University of Washington School Mental Health Research, Assessment, and Training (UW SMART) Center, focused on the problem of practice of racial and ethnic disproportionality in discipline. Through MENDR, we will improve SPS’s capacity to use research – to identify schools with disproportionality and causes of disproportionality – and engage in a joint effort to develop, implement, and test an approach for disproportionality prevention and reduction.

The aims of this project are to: (1) evaluate the usability of leading, evidence-based Tier 1 social-emotional and behavioral interventions (SEBI) and identify unique and common usability problems, (2) explore the links between SEBI usability and implementation and student outcomes, and (3) refine the USABILITY theory of change, develop a matrix of usability problems and redesign solutions, and articulate guidance to the field for designing usable Tier 1 SEBIs.

(Training & Technical Assistance) As a key component of this mission, UW SMART has developed strategies and related infrastructure for providing training and technical assistance to state and local education agencies as well as individual school districts. The SMART Center’s “TACore” provides: 1) Training and consultation/coaching focused on developing workforce capacity (among school staff and community partners) to deliver research-based strategies, policies, and practice models relevant to the education context, 2) Technical assistance focused on building evidence-based, multi-tiered systems of school-based behavioral health, using collaborative decision-making processes guided by local data as well as research evidence, and 3) Program evaluation focused on collecting and analyzing existing (e.g., administrative datasets) and novel (e.g., surveys, focus groups) quantitative and qualitative data to determine the impact of new or existing programs, practices, and policies.

Black and Latinx youth continue to receive lower quantity and quality mental healthcare compared to Non-Hispanic White youth, despite similar rates of unmet need. Clinician implicit bias has been implicated as a major contributor to inequitable mental health treatment and outcomes for youth. This study, addressing the third aim of the supplemental BOLT parent grant (NIMH 3R34MH109605-02S1), aims to pilot test a Virtual Implicit Bias Reduction and Neutralization Training (VIBRANT) for school mental health clinicians as an innovative strategy for reducing clinician implicit bias, improving the equitable delivery of high quality, evidence-based mental healthcare, and ultimately improving mental health outcomes for Black and Latinx youth.

In response, Washington state was recently awarded $6 million from the U.S. Department of Education to create a pipeline from Washington state’s five accredited Masters in Social Work training programs to Washington state’s K-12 schools. Called the Workforce for Student Well-being Initiative or WSW, 100 aspiring school social workers will receive conditional scholarships based on their financial need so the cost of getting an education is not a barrier to their getting an advanced degree and then committing to working in a high-need public or tribal school.