Increased availability of research-supported, school-based prevention programs, coupled with the growing national policy emphasis on use of evidence-based practices, has contributed to a shift in research priorities from efficacy to implementation and dissemination. A critical issue in moving research to practice is ensuring high-quality implementation of both the intervention model and the support system for sustaining it. The paper describes a three-level framework for considering the implementation quality of school-based interventions. Future directions for research on implementation are discussed.

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Statewide learning collaboratives have the potential to improve access to evidence-based psychotherapies for children and adolescents with disruptive behavior disorders (DBD) by improving knowledge and skills among mental health clinicians practicing in rural communities. We describe the effectiveness of using the CATIE learning collaborative to train Idaho-based mental health clinicians to treat DBD. Ninety-one clinicians completed a 6-month Coping Power Program (CPP) training course over a 2-year period. Improvement in clinician-reported self-efficacy and reported DBD patient-outcomes were observed. Ongoing benefit of learning collaboratives seems contingent on sustained engagement from local stakeholders. Recruitment and training clinicians beyond the grant-funded period were challenging. Public Health Significance StatementLimited access to evidence-based children's mental health services is disproportionately felt in rural parts of the U.S. Learning collaboratives are increasingly utilized to address this gap by training existing healthcare professionals to become more comfortable providing evidence-based mental health care. This study adds to existing literature by describing our experience with implementing a 2-year statewide learning collaborative in a large rural state and observed initial impact on patient care.

Objective: To understand the benefits of an intensive 6-months-long training program (with or without assistance of an embedded care manager) on primary care providers’ (PCPs’) adoption of evidence-based practices for diagnosing and managing Attention-Deficit/Hyperactivity Disorder (ADHD). Methods: Following an intensive weekend training in primary care pediatric mental health service delivery, 47 PCPs were randomly assigned to 6 months of ongoing educational support via twice-monthly conference calls, either with or without additional assistance of a care manager. In addition to the impact of a care manager, basic science-derived predictors of behavior change were examined to explore impact on PCPs’ initial and subsequent intentions/decisions to adopt 11 specific changes in ADHD practices. Effects of practice obstacles on PCPs’ practice decisions, both initially and over 6 months, were also examined. Results: PCPs’ initial and subsequent decisions to employ program-targeted ADHD evidence-based practices increased over time and were significantly predicted by underlying hypothesized predictors. Additional support of a care manager had minimal effects on PCPs’ initial and subsequent decisions to apply specific evidence-based ADHD practices. Of note, PCPs’ initial worries/perceptions concerning practice obstacles decreased significantly over time, likely due to twice-monthly support calls. Conclusions: With intensive and sustained support, PCPs will adopt most evidence-based practices for ADHD diagnosis and treatment. Many initially anticipated obstacles dissipated over time. Additional support of care managers had little impact on PCPs’ longitudinal decisions to adhere to ADHD practice guidelines. Basic science predictors of behavior change are robust correlates of PCPs’ practice changes and should be more routinely applied to understand and improve training outcomes in multiple areas of health service delivery.