Implementation of Targeted Mental Health Interventions in Urban Schools: Preliminary Findings on the Impact of Training Strategy on Program Fidelity

Eiraldi, Ricardo; Khanna, Muniya; Jawad, Abbas F.; Power, Thomas J.; Cacia, Jaclyn; Cabello, Beatriz; Schwartz, Billie S.; Swift, Lauren E.; Kanine, Rebecca M.; Orapallo, Andrew; McCurdy, Barry L.; Mautone, Jennifer A.

doi:10.1080/23794925.2020.1784056

Cited by 6 publications

(18 citation statements)

References 33 publications

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“…The effect size refers to the differences in implementation fidelity between PS and SAU (ES = (|µ 1 − µ 2 |/σ)) in Phase 2 and Phase 3. Using the empirical results from our prior study on the effects of PBIS with mental health supports [ 7 ], the intra-cluster correlation coefficient (ICC) was set to 0.05. A group sample of 6 clusters (schools) per PS and SAU with 5 implementers per cluster, (i.e., 30 implementers in PS and 30 implementers in SAU; 60 total) achieve 85% power to reject the null hypothesis of equal implementation fidelity means when the population mean difference between PS and SAU is assumed to be 9.0%, standard deviations of 9.5, and with a significance level (alpha) of 0.05 using a two-sided two-sample t-test.…”

Section: Methodsmentioning

confidence: 99%

“…The three EBPs that will be used in this study have been found to be effective in multiple studies. Also, our group has found the interventions to be effective specifically with students in the School District of Philadelphia (SDP) [ 7 , 8 , 28 ]. Our training and consultation approach has been used in two prior randomized trials in the SDP and shown to be feasible, clinically-effective and acceptable by therapists and supervisors [ 7 , 8 , 28 ].…”

Section: Sustainment Of Ebps In Schoolsmentioning

confidence: 99%

“…Also, our group has found the interventions to be effective specifically with students in the School District of Philadelphia (SDP) [ 7 , 8 , 28 ]. Our training and consultation approach has been used in two prior randomized trials in the SDP and shown to be feasible, clinically-effective and acceptable by therapists and supervisors [ 7 , 8 , 28 ]. We contacted administrators and school counselors from schools participating in a study using mental health EBPs embedded within PBIS to determine whether schools continued to implement the EBPs after the end of the study.…”

Section: Sustainment Of Ebps In Schoolsmentioning

confidence: 99%

“…School-wide positive behavioral interventions and supports (PBIS) [3] is a service delivery framework based on the public health model used in schools to improve school climate and safety. This framework is a useful vehicle for implementing targeted (Tier 2) mental health EBPs for children with or at risk for mental health disorders [4][5][6][7][8]. PBIS is effective in reducing office discipline referrals (ODR) and improving children's behavior [9] and overall school climate [10].…”

Section: Introductionmentioning

confidence: 99%

“…certainly true) questionnaire used to assess the psychological adjustment of children and youth, ages 4-17 Pre-treatment Rating scale Parents/teachers Adherence to training strategies Consultation adherence Internal Consultation Adherence Measure (ICAM) The ICAM is an 8-item rating scale measuring adherence to Coaching (e.g., The Internal Trainer encouraged the counselor to deliver content using active learning strategies such as role play) and Didactics (e.g., The internal Trainer reviewed the specifics of the activities of the upcoming session and helped counselor prepare) rated on a 4-point scale (1 = minimal, Team coaching fidelity Tier 2 Coaching Fidelity Checklist (Tier 2 CFC) The Tier 2 CFC is a 7-item checklist assessing coaching fidelity (e.g., Coach attends meeting on time and observes entire Tier 2 team meeting) rated on a yes/no scale Ongoing Quan Research staff Compare sustainment conditions Implementation measures Content fidelity of group CBT Coping Power and CATS Content Fidelity Checklist (CFC) [7] The CFC reflects each activity component of the session agenda of the treatment protocols. Raters use a yes/no response scale to indicate whether or not the implementer covered a particular component Ongoing Coding Research staff Content fidelity of CI/CO Check-In/Check-Out Fidelity Checklist [56]The Check-In/Check-Out Fidelity Checklist is a 9-10-item checklist used to observe the Tier 2 implementer during morning check-in and afternoon check-out rated as either occurring or Fidelity Checklist (PFC)[7] The PFC is a 10-item checklist rated on a scale of 1 to 5, with 1 being Not at all and 5 being Very Often.Ratings are given on the extent to which school staff members delivered the intervention in an orderly fashion, using active learning strategies and examples that are relevant to the students to Tier 2 structures and processes Tiered Fidelity Inventory (TFI) for Tier 2[57] The Tier 2 section of the TFI has 13 items organized into three subscales: (a) teams, (b) interventions, and (c) evaluation. School teams use a 3-point scale with supporting data sources and a detailed rubric to determine whether the core feature addressed in each item is not implemented, partially implemented, or fully implemented a 2-item questionnaire assessing EBP penetration at the school provider level (behavioral health staff involved in the implementation of EBPs at Tier 2 of PBIS), and EBP penetration at the student service level (students receiving EBPs at…”

mentioning

confidence: 99%

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Study protocol: cluster randomized trial of consultation strategies for the sustainment of mental health interventions in under-resourced urban schools: rationale, design, and methods

et al. 2022

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Background The school is a key setting for the provision of mental health services to children, particularly those underserved through traditional service delivery systems. School-wide Positive Behavioral Interventions and Supports (PBIS) is a tiered approach to service delivery based on the public health model that schools use to implement universal (Tier 1) supports to improve school climate and safety. As our prior research has demonstrated, PBIS is a useful vehicle for implementing mental and behavioral health evidence-based practices (EBPs) at Tier 2 for children with, or at risk for, mental health disorders. Very little research has been conducted regarding the use of mental health EBPs at Tier 2 or how to sustain implementation in schools. Methods/design The main aim of the study is to compare fidelity, penetration, cost-effectiveness, and student outcomes of Tier 2 mental health interventions across 2 sustainment approaches for school implementers in 12 K-8 schools. The study uses a 2-arm, cluster randomized controlled trial design. The two arms are: (a) Preparing for Sustainment (PS)—a consultation strategy implemented by school district coaches who receive support from external consultants, and (b) Sustainment as Usual (SAU)—a consultation strategy implemented by school district coaches alone. Participants will be 60 implementers and 360 students at risk for externalizing and anxiety disorders. The interventions implemented by school personnel are: Coping Power Program (CPP) for externalizing disorders, CBT for Anxiety Treatment in Schools (CATS) for anxiety disorders, and Check-in/Check-out (CICO) for externalizing and internalizing disorders. The Interactive Systems Framework (ISF) for Dissemination and Implementation guides the training and support procedures for implementers. Discussion We expect that this study will result in a feasible, effective, and cost-effective strategy for sustaining mental health EBPs that is embedded within a multi-tiered system of support. Results from this study conducted in a large urban school district would likely generalize to other large, urban districts and have an impact on population-level child mental health. Trial registration ClinicalTrials.gov identifier number NCT04869657. Registered May 3, 2021.

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Section: Methodsmentioning

confidence: 99%

Section: Sustainment Of Ebps In Schoolsmentioning

confidence: 99%

Section: Sustainment Of Ebps In Schoolsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Study protocol: cluster randomized trial of consultation strategies for the sustainment of mental health interventions in under-resourced urban schools: rationale, design, and methods

et al. 2022

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Development of an Online Training Platform and Implementation Strategy for School-Based Mental Health Professionals in Rural Elementary Schools: A Mixed-Methods Study

Eiraldi

Comly

Goldstein

et al. 2023

School Mental Health

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Children in rural settings are less likely to receive mental health services than their urban and suburban counterparts and even less likely to receive evidence-based care. Rural schools could address the need for mental health interventions by using evidence-based practices within a tiered system of supports such as positive behavioral interventions and supports. However, very few school professionals, with or without mental health training, have received training on evidence-based practices. Rural schools need implementation strategies focused on training to prepare school personnel for the implementation of interventions with fidelity. Little is known about training strategies that are feasible and appropriate for the rural school context. User-centered design is an appropriate framework for the development of training strategies for professionals in rural schools because of its participatory approach and the development of products that fit the context where they are going to be used. The purpose of the study was to develop and assess components of an online training platform and implementation strategy based on the user-centered design. Quantitative and qualitative data from 25 participants from an equal number of schools in rural areas of Pennsylvania were used in the study. A mixed-methods design utilizing complementary descriptive statistics and theme analyses indicated that the training platform and implementation strategy were perceived as highly acceptable, appropriate, feasible and usable by school professionals. The resulting training platform and implementation strategy will fill a void in the training literature in rural schools.

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Individual and organizational factors as predictors of early evidence-based practice adoption in Michigan high schools: Baseline data from an implementation trial

Choi

Rusch

Lane

et al. 2023

Implementation Research and Practice

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Background Adolescents increasingly access mental health services in schools. School mental health professionals (SPs; school counselors, social workers, etc.) can offer evidence-based mental health practices (EBPs) in schools, which may address access gaps and improve clinical outcomes. Although some studies have assessed factors associated with EBP adoption in schools, additional research focusing on SP- and school-level factors is warranted to support EBP implementation as SPs’ mental health delivery grows. Methods Baseline data were collected from SPs at Michigan high schools participating in a statewide trial to implement SP-delivered cognitive behavioral therapy (CBT) to students. Models examined factors associated with attitudes about EBPs, implementation climate, and implementation leadership, and their associations with CBT knowledge, training attendance, and pre-training CBT delivery. Results One hundred ninety-eight SPs at 107 schools (87%) completed a baseline survey. The mean Evidence-Based Practice Attitude Scale (EBPAS) total score was 2.9, and school-aggregated mean scores of the Implementation Climate Scale (ICS) and Implementation Leadership Scale (ILS) were 1.83 and 1.77, respectively, all on a scale ranging from 0 ( low) to 4 ( high). ICS and ILS scores were lower than typically reported in clinical settings, while EBPAS scores were higher. School characteristics were not significantly associated with EBPAS, ICS, or ILS scores, but scores did differ by SP role. Higher EBPAS scores were associated with more CBT knowledge (average marginal effect for 1 SD change [AME] = 0.15 points) and a higher probability of training completion (AME = 8 percentage points). Higher ICS scores were associated with a higher probability of pre-training CBT delivery (AME = 6 percentage points), and higher ILS scores were associated with higher probability of training completion (AME = 10 percentage points). Conclusions Our findings suggest that SPs’ attitudes toward EBPs and organizational support were positively associated with early signs of implementation success. As schools increasingly fill the adolescent mental healthcare access gap, efforts to strengthen both provider attitudes toward EBP and strategic organizational factors supporting EBP delivery will be key to encouraging EBP uptake in schools. Plain Language Summary Schools are an important setting in which adolescents receive mental healthcare. We need to better understand how to implement evidence-based practices (EBPs) in this setting to improve student mental health. This study examined the attitudes and perceptions of school professionals (SPs) as key contributors to the implementation of a particular EBP, the delivery of cognitive behavioral therapy (CBT) in schools. The study found that implementation climate and leadership scores in participating schools were lower than scores typically reported in clinical settings, while scores for SP attitudes about EBP adoption were higher than typical scores in clinical settings. Results further suggest that SPs with more positive attitudes toward EBPs are more knowledgeable of CBT and more likely to complete a 1-day CBT training. We also found that higher implementation climate scores were associated with SPs reporting pre-training CBT delivery (although this association was not statistically significant), and more implementation leadership was associated with SPs completing the CBT training. These findings suggest that SP attitudes toward EBPs and organizational support in schools are positively associated with early signs of implementation success. Early, low-intensity efforts to (1) improve SP attitudes about mental health EBPs, and (2) increase schools’ support for implementation may scaffold more intensive implementation efforts in schools down the road.

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Implementation of Targeted Mental Health Interventions in Urban Schools: Preliminary Findings on the Impact of Training Strategy on Program Fidelity

Cited by 6 publications

References 33 publications

Study protocol: cluster randomized trial of consultation strategies for the sustainment of mental health interventions in under-resourced urban schools: rationale, design, and methods

Study protocol: cluster randomized trial of consultation strategies for the sustainment of mental health interventions in under-resourced urban schools: rationale, design, and methods

Development of an Online Training Platform and Implementation Strategy for School-Based Mental Health Professionals in Rural Elementary Schools: A Mixed-Methods Study

Individual and organizational factors as predictors of early evidence-based practice adoption in Michigan high schools: Baseline data from an implementation trial

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