Table 2.

Summary of Challenges and Potential Approaches

Challenge	What we did	Advantages	Limitations	Recommendations
Scheduling group or individual meetings	Scheduled sessions during school day (based on feedback from schools and students)	• More inclusive and accessible • No transportation barriers • Does not conflict with after-school commitments • Does not require supervision from school staff after hours	• Missing class is major barrier for students and teachers • May conflict with exams and state-mandated testing • May be more difficult to find an available room	• Schedule during elective classes • Consider scheduling during lunch (and providing food) • May need to schedule on different days of the week accommodate testing or minimize specific classes missed • Limit the number of sessions missed for a particular class
Limited space available	Scouted rooms on weekly basis	• Makes it possible to meet during school day, even when a consistent room is not available	• Causes confusion about location for students • Clinicians may have to track down students individually	• Use a sign in an agreed-upon location to designate the meeting room • For schools where space is barrier, consider scheduling after school instead
Communication with parents	Sent detailed information to parents about the study; sent information on assessment results	• Informs parents of the study procedures • Alerts parents that child reported elevated levels of distress • Provides referrals for additional intervention • Meets ethical standards	• Some parents may be upset to learn that their child may be distressed • Some parents may be dismissive of concerns or suspicious of intervention	• Use multiple communications to prepare parents for receiving feedback about their child • Use neutral and nonstigmatizing language when referring to child’s distress • Use a liaison to address cultural barriers and improve communication
Balancing confidentiality and safety concerns	Prepared staff for issues of confidentiality; did not share information about child’s functioning with school, unless a safety concern arose	• Protects child’s privacy • Meets ethical and legal requirements • Allows child/family to be more comfortable with sharing personal information with clinicians	• School staff may not understand why such information cannot be shared • School staff may feel ill prepared to handle issues that arise unexpectedly	• Periodically discuss and reinforce with school staff ethical/legal issues of confidentiality • Develop a clear policy about confidentiality/student safety issues and share with all staff