Program Goals/Target Population
This Emotional and Behavioral Health Crisis Response and Prevention (EBH–CRP) intervention is a comprehensive training, organization, and support protocol for school and community stakeholders in Baltimore County (Md.) Public Schools (BCPS) aimed at increasing school/community competence in responding to and preventing student emotional and behavioral health crises. The BCPS Urgent Crisis Intervention Committee developed the intervention after identifying gaps in the prevention and response to emotional behavioral health crises; the committee wanted to provide additional resources to address student health needs (Lewis et al. 2019).
The EBH–CRP intervention is intended for students who display intense emotional behaviors that are not quickly diffused or resolved. Specifically, the primary targets of the intervention include students who act out in class; students who threaten classmates, teachers, principals, school buildings, and themselves; and students who engage in other potentially dangerous activities and behaviors.
Services Provided
The EBH–CRP intervention uses a five-tier approach to address emotional and behavioral health concerns across the continuum of services and supports, including universal emotional and behavioral health and safety promotion as well as prevention, early intervention, and crisis response and relapse prevention. This model builds on the Multitiered System of Student Emotional and Behavioral Health Supports (MTSS) that was previously employed by BCPS (NCSMH 2018). The first three of the five EBH–CRP tiers are adopted from the MTSS model, but EBH–CRP expands the third tier to enhance the schools’ capacity to address emotional and behavioral health crises and prevent relapse, and two additional tiers were added.
Tier 1 is universal prevention, aimed at all students. The goal of universal prevention is to improve school climate by using the Safe School Ambassador (SSA) program. The SSA program introduces influential student leaders to practical, nonviolent communication and intervention skills with which they may engage their peers and prevent bullying and harassment. SSA students are trained to notice mistreatment among peers and meet regularly with school staff to discuss what they have observed and intervened with.
Tier 2 is early identification of emotional and behavioral health concerns. This is addressed through Kognito At-Risk Online Training, which provides staff with online simulations of situations related to the emotional and behavioral health of students and increases their skills in identifying, approaching, and referring students.
Tier 3 is assessment and service linkage. The goals of this tier are to map and coordinate existing school and community supports and to streamline the referral and assessment processes. School officials are interviewed regarding students’ emotional and behavioral health, what kind of assistance these students seek, and what interventions and outcomes are most frequently utilized. These interventions are documented on a School Resource Map, which aids program staff in developing a Crisis Resource List to support students when additional resources are requested.
Tier 4 is crisis response. Schools develop and implement a standardized crisis response—culturally sensitive, school-informed protocol focused on de-escalation and diversion in an emotional or behavioral health incident. Crisis response is implemented by licensed certified social workers who act as school district mobile crisis coordinators. These coordinators are contacted when a student is in crisis, which is defined by the EBH–CRP protocol as “marked and ongoing aggression, impulsivity, erratic actions, irritability, anger, anxiety, sadness, and/or bizarre actions or statements in which the student is unable and/or unwilling to respond to school routines and interventions as normally provided” (Lewis et al., 2019:, p. 5). In addition, staff are trained in Life Space Crisis Intervention (LSCI) to use in their daily interactions with students. LCSI is an intervention that focuses on cognitive behavior modification and prosocial skills training. This helps enable staff to better prevent and resolve crises on their own.
Finally, Tier 5 is postcrisis relapse prevention, which is addressed through a manualized procedure called the Process for Crisis Assessment and Relapse Prevention (P–CARP). The P–CARP helps staff identify and evaluate why a particular crisis happened and to plan what response can help prevent a similar crisis from reoccurring with the student (Lewis et al. 2019).
