A National Growth Plan Rooted in One State’s Success

Ten years ago, the Brookline Community Mental Health Center in Massachusetts launched a new program to aid students returning to Brookline High School after a prolonged absence due to mental health or medical conditions. The program’s success raised tough questions about how to manage future growth—a familiar conundrum in the nonprofit world.

At first, however, the mental health center focused on meeting a pressing local need, not creating a replicable model. The program—called Bridge to Resilient Youth in Transition (BRYT, pronounced “bright”)—has four elements:

1. Transition planning and continued engagement with the student, family, school staff, and outside providers from the time of school reentry until the student’s return to a normal class schedule (typically 8–12 weeks)
2. Several types of integrated services, including clinical counseling, care coordination, academic support, and family support
3. A dedicated school room, open and staffed throughout the school day
4. At least two full-time staff in the room—one a clinician and the other an academic support professional.

Results from BRYT’s first few years showed real promise. Most of the 160 students the program served continued their schooling without disruption, and the relapse rate was approximately 11 percent—half the expected rates. Word of the Brookline Center program spread to neighboring school districts, and several requested help in establishing their own. The center team responded by offering one-to-one assistance, a monthly meeting for program staff from other schools, and an annual symposium.

The Brookline Center model grew from two schools in 2008 to more than 25 schools in the 2014-15 school year. Today, approximately 12 percent of public high school students in Massachusetts have access to a program modeled on BRYT, and more than 1,400 students have been served by such programs.

While BRYT has spread across Massachusetts, the program clearly addresses a national one. Each year, hundreds of thousands of students experience long school absences due to medical or mental health conditions, creating serious academic and emotional difficulties for students and their families. Kids Count reports that 7 percent of students ages 12–17 (1.8 million students) missed 11 or more days of school during the 2011-12 school year due to illness or injury. As the US Agency for Healthcare Quality and Research noted, “Many adolescents experience serious emotional disorders, medical issues, or other hardships that require them to be absent from school and disrupt their lives. Returning to school after such events can be very difficult, and the risk of relapse is quite high.” The Brookline Center’s program is one of the few nationwide that address this problem, according to national school-based mental health experts.

In 2014, with support from the Robert Wood Johnson Foundation and in partnership with the Bridgespan Group, the Brookline Center began developing a growth plan. It knew it had a model that could work in high schools across the nation, but what was the best way to scale it?

“So far, we’re only in Massachusetts,” said Dr. Henry White, the Brookline Center’s clinical director, who created the original model back in 2004. “And even in Massachusetts, only a small percentage of the state’s public high school students have access to a BRYT program. There is so much need and so much untapped potential.”

In its growth plan, the Brookline Center decided that it needed to take the first steps to national scale in Massachusetts. Accordingly, over the next several years the center aims to bring BRYT to districts serving at least a quarter of the state’s high school students. The goal is to make BRYT the norm in Massachusetts’ high schools so that the question changes from “What is BRYT?” to “Why doesn’t our school have a BRYT program?”

But if the model can work anywhere, why limit the focus to one state? The Brookline Center has three reasons:

• Statewide growth capitalizes on momentum that already exists within Massachusetts. BRYT has some local media awareness, a strong and growing funding base, and a growing number of local “champions” for the program—principals, school board members, public officials, parents, and students who have directly benefitted from BRYT.
• Fidelity to the model is vital. While the Brookline  Center does not implement the program in other school districts, its hands-on technical assistance methods and support for program staff have helped keep most BRYT programs remarkably close to the original model. The Brookline Center wants to learn how to adapt this technical assistance approach statewide before trying to work with programs across the nation.
• Statewide expansion will be a powerful argument for national adoption. Making BRYT the norm in Massachusetts high schools—small or large, urban or suburban—will do more to change the conversation about how to handle reentry than scattershot programs across the country will. Demonstrating that the program is so critical that it can spread across an entire state also gives BRYT time to further develop a more rigorous evidence base for the program. A formal evaluation, supported by the Robert Wood Johnson Foundation and the Klarman Family Foundation, is currently underway, and results should be available within 18 months.

Too many promising programs have tried to go national too quickly—without the assets to support national growth, a plan for ensuring fidelity to the model, or evidence that the program can succeed anywhere. The Brookline Center aims to avoid these pitfalls by focusing its near-term growth in Massachusetts and building its case for national scale on the basis of statewide success, and provides a growth model from which other nonprofits can learn.

Read more stories by Taz Hussein & Sridhar Prasad.