Challenges and Solutions in the Implementation of the School-Based Pathway to Care Model: The Lessons From Nova Scotia and Beyond

TY - JOUR

T1 - Challenges and Solutions in the Implementation of the School-Based Pathway to Care Model

T2 - The Lessons From Nova Scotia and Beyond

AU - Kutcher, Stan

AU - Wei, Yifeng

N1 - Funding Information: Experiences in the application and ongoing development of the School-Based Pathway to Care Model indicate that it is possible to implement the model as a whole or to apply individual components that serve the goals of each component within the wider framework of enhancing system capacity for addressing mental health care needs of secondary school students. This dialectic or praxis process has provided rich program evaluation data that have been used to improve the components of the model and to inform approaches to its application. Following are key lessons learned. First, it is necessary to identify local champions within education and health sectors (primary care and mental health) that can help apply the model and mould it to fit local realities. These champions also serve to help overcome obstacles within and across systems. These champions ideally could be brought together as an action committee to develop, apply, and evaluate the model as well as engaging key players from the different sectors involved. The “go-to” educator training sessions provide an ideal opportunity for these champions to engage their representative communities and to begin to establish or enhance linkages between schools and health providers: both formal and informal. These linkages require both personal and system-level participation to help establish and reinforce their application. The combination of formal (system administrative structures) with informal (combined training) approaches to integration seem to be a key component for success. Second, there is no “best” application of the model. Its flexibility allows locations to choose the components that they wish to or have the ability to apply. Additional components can be applied as local opportunities permit. For example, although primary care capacity in diagnosis and treatment of adolescent mental disorders is part of the model, two of the jurisdictions were not at the point to develop this component of their health care delivery system. In another setting, this was able to proceed because a commitment had been made to address this issue. This feature differentiates the model from programs that demand a high degree of fidelity for application. The flexible nature of the model and its ability to show good outcomes without demanding fidelity are particular strengths, as this allows the model to meet the needs of people and settings rather than the other way around. Third, supplementary mental health resources available at a single point of contact are useful to teachers applying for the Mental Health Curriculum. As a result of these lessons, the Team has established a wealth of such resources, both on its own website ( www.teenmentalhealth.org ) and in collaboration with Taking It Global ( www.tig.com ), an international educational resource. Embedded in the (teenmentalhealth.org) website is the ongoing development of a repository hosting mental health resources screened and validated to meet criteria for quality and classroom utility for teachers. An online discussion forum for teachers is also soon being added to this online resources repository. Fourth, train-the-trainer and online learning approaches will be necessary for the broader dissemination of the model and its various components. The Team is now responding to this need by building e-learning modules on their website ( www.teenmentalhealth.org ) and creating train-the-trainer programs. Fifth, at the systems level, it is important that both Components 1 and 2 of the model be addressed concurrently. Putting the Mental Health Curriculum into place without implementing the in-school capacity to recognize and respond to students with mental disorders is unfair to students, schools, and providers alike. School boards are thus encouraged to simultaneously address both components. As an example of this understanding, the new educational strategy for the Province of Nova Scotia, Kids and Learning First ( Nova Scotia Department of Education, 2012 ), has incorporated this lesson into its approach in addressing school mental health in the Province. Meanwhile, we note that there are some challenges that need to be further addressed so that there can be improvement in the model’s application. For instance, it remains challenging to link primary care with the school system, although this component has shown early promise in British Columbia. To change current primary care practice and to better integrate mental health care into primary care will require substantial support from policy makers and related stakeholders. Perhaps the approach currently being applied in parts of British Columbia will inform responsible parties as to the value of and need for this approach once the program evaluation has been completed and can be disseminated. Another major issue is that of measurement of mental health literacy for each group of the participants—students, teachers, student services providers, health providers, and so on—needs to be refined. The development of this part of the school mental health field is in its infancy and members of the Team have identified this as an upcoming priority. Lastly, although work to date has demonstrated encouraging results, more rigorous research has yet to be conducted to provide stronger evidence for both short- and long-term outcomes of the model application. Nonetheless, and with the above caveats considered, we feel that there is reasonable comfort in the data currently available to support the implementation of the School-Based Pathway to Care Model, especially its tested components, such as the Mental Health Curriculum , its companion teachers training program, and the “Go-to Educator” training program. To our knowledge, the Mental Health Curriculum is the only evidence-based high-school mental health curriculum available globally, and the approach that is applied within the School-Based Pathway to Care Model is consistent with national mental health policy considerations such as they have been articulated in both Evergreen ( Kutcher & McLuckie, 2010 ) and the Mental Health Strategy for Canada: Changing Directions, Changing Lives ( http://strategy.mentalhealthcommission.ca/ ). Further independent research directed towards various components of the model, especially with regard to linkage to and interaction within primary care, would be very useful. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Sun Life Financial; The T. R. Meighan Family Foundation; The IWK Health Center; The Dalhousie Medical Research Foundation; The Katheryn H. Weldon Charitable Foundation and the Department of Psychaitry, Dalhousie University; the IWK Foundation.

PY - 2013/3

Y1 - 2013/3

UR - http://www.scopus.com/inward/record.url?scp=84875433466&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875433466&partnerID=8YFLogxK

U2 - 10.1177/0829573512468859

DO - 10.1177/0829573512468859

M3 - Article

AN - SCOPUS:84875433466

SN - 0829-5735

VL - 28

SP - 90

EP - 102

JO - Canadian Journal of School Psychology

JF - Canadian Journal of School Psychology

IS - 1

ER -