As discovered through this partnership, implementation of school mental health interventions can be challenging, given that this is a non-mental health system [29]. Screening for PTSD symptoms on campus has been recognized by school partners as a key component of CBITS implementation, because many students otherwise go undetected. School clinicians would hear from students who had experienced violence yet had no adult in their lives who was aware of the trauma or its impact on the student. Obtaining parental consent for a school screening can present major challenges, however, including misperceptions and fears about the intent of the questions or views of violence exposure as “normal in our community.” Broad educational outreach about the impact of trauma on youth and the effects of trauma on school success has been a major effort of our school community-research partnership. As a result, several innovative solutions to “getting the word out” were created: a jointly made video of students and school community members talking about the effects of trauma on youth (now also available in Spanish), partnering with faith organizations and lay health promoters to outreach to the faith community [30], and students themselves developing poetry readings to share with their school community how they have moved forward toward a path to wellness.

Another major barrier to implementing treatments in schools is the lack of infrastructure that frequently exists in a specialty mental health center to support training and delivery of evidence-based treatments. Frequently school mental health clinicians have few clinical colleagues on campus with whom to consult when cases present challenges. As our school partners and sites across the country were faced with these challenges, we partnered with our school colleagues in developing online resources that can be readily accessed. At CBITSprogram.org, school-based clinicians can access and post adaptations and tools that have been developed in the field to facilitate implementation. An online training and “quick tips” and “ask the expert” resources have been co-developed between research clinicians and school partners to make tools relevant for school communities and to support dissemination efforts [31]. From development, to evaluation, to implementation and dissemination, this CBITS school community-research partnership has guided program development and research efforts that respond to the real needs of communities.

This school community-research partnership has resulted in the CBITS intervention and others being developed and disseminated nationally and internationally. The research evidence has led to CBITS being listed in local and national registries of evidence-based practices, allowing for billing and sustainment of the intervention delivery. The partnership itself has sustained through multiple grants to support the community efforts, mainly through funding from the Substance Abuse and Mental Health Services Administration and National Institute of Health support for research. Finally, the responsiveness of our partnered team to the real needs of “on the ground” clinicians has resulted in implementation tools to improve dissemination. From this work, one direction that our partnership has been taking is a broader “Trauma-Informed School” approach, with attention to a school climate that supports students who have experienced trauma, resources for teachers and school staff who have experienced primary and secondary traumatic stress, and primary prevention in classrooms that teach students better communication and coping skills in addition to early and intensive interventions for those students with PTSD.

Another lesson learned through these school community-academic partnerships with LAUSD has been the generative role of continuing to train clinicians and researchers in community partnerships. Having clinicians-in-training learn experientially how academic institutions can effectively partner with school communities will prepare our future workforce to better understand this model of a two-way shared knowledge exchange. Creating an environment in which postdoctoral fellows and junior researchers can become involved in established partnership projects is critical for a research agenda that includes the encouragement of community partnered research to decrease disparities and improve access to mental health care for all students. RIM, a trainee who conducted focus groups with students to understand the barriers to seeking mental health care and ways to improve engagement in mental health services through school-based health centers, summarizes her experiences in this way:

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  In my training as a child psychiatrist, I constantly strive to give something to my patients in the therapy sessions. A validation of their experience, an insight to take with them, sometimes just a calm place to play and be heard, even if they do not want to speak in words. Yet in the focus groups, the students gave us much more than we could offer them. The groups were not a question-and-answer session, nor a therapy group. They were an invitation into the students’ world, a place where they answered honestly and openly. They spoke about stress, not just stress from grades or tests, but from their daily lives, “relationships…abuse…family abuse…family problems.” They spoke about how students kept things inside, due to embarrassment, fear of being judged, or secrets being exposed. They described a need for connection, trust, and, most of all, for someone to understand their experiences. What they told us not only informed our research, and ultimately the district’s services, but also impacted my clinical work. I found myself listening differently with my patients and inquiring more about their environments and about the quality of their relationships with teachers and staff at school.
  
  
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  We all felt the need to give something back to the students who had so poignantly affected us. Without the barrier of the white coat or the formality of a clinic evaluation, we took on a different role with the students, distinct from our role of researcher or clinician. At the end of the focus groups, we turned off the recorders and opened up time for questions they had for us. Many eagerly asked about different colleges, if they could handle the workload, and what our experiences had been. At that moment, we became mentors and gave encouragement and support to these LAUSD students.
  
  
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  The students transformed our way of thinking about their struggles, about the schools, and about their lives. In the space of the group, when the students spoke to each other, and validated one another, the hope is that they also gained something. Group dialogue about one’s community has the potential to facilitate self-reflection, understanding of barriers, and, I hope, plant seeds of empowerment for change. This power of reflective knowledge has been described as the “power of competence, connection, and confidence” [32].

Community-academic partnerships provide essential two-way learning, not only by supporting the community partner but also by informing and transforming the academic researcher. As demonstrated by the two examples in this narrative, school-academic partnerships can build on the strengths of communities and together create unique solutions to urgent needs. In this era of health care reform, identifying how social determinants of mental health such as education and needs of the community can be addressed, while at the same time bolstering the strength of the community and partnering with community members to improve health in a mutual process, will grow ever more important.