Advancing our understanding of evidence-based practice implementation in school mental health setting

Abstract

School mental health programs critically deliver substantial mental health services to youth and adolescents, positioning school-based mental health providers as valuable agents for supporting the delivery of high-quality, evidence-based treatment approaches. Toward the goal of improving school-based mental health student outcomes, some systems have focused on providing school-based providers with intensive training and ongoing support in implementing evidence-based practice (EBP). While a burgeoning body of EBP implementation research exists for public sector mental healthcare institutions, less has been done to understand the specific implementation processes and outcomes in school mental health settings. This series of research helps to address this gap in knowledge about EBP implementation in school mental health by evaluating different components of a local system-wide education sector EBP training initiative. Empirical questions across this three-study series are organized to roughly reflect Aaron and colleagues (2011) Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, a conceptual model for conducting and describing EBP implementation initiatives in public sector service systems. Study 1 sought to further our understanding of community care practices in school mental health settings during exploration and preparation phases of implementation. Descriptive examination of school-based providers’ reported characteristics, intentions to use different therapeutic techniques, and previous clinical training prior to implementation revealed diverse provider profiles characterized by breadth, rather than depth of previous training experiences and treatment intentions. Study 2 focused on evaluating initial provider training in EBP occurring at the outset of the implementation phase, and found that following training, providers were more selective in their treatment approaches and endorsed significantly less techniques with minimal support from the evidence-base. There was also a differential effect between problem areas, such that providers more accurately selected anxiety-, but not disruptive behavior-related treatment techniques post training. Study 2 additionally examined factors that may contribute to changes in providers’ intentions to use techniques with regard to the evidence-base. Results indicated that while organizational implementation characteristics did not predict changes in treatment intentions, factors such as climate and citizenship behavior were associated with treatment approaches with less evidence-based support. Study 3 lastly examined predictors of providers’ participation in ongoing consultation sessions, a strategy meant to promote long-term EBP fidelity in the sustainment phase of implementation. Organizational and individual adopter characteristics explored in this study did not predict consultation completion; however, more positive perceptions of EBP behavior among organizational staff and being in rural areas were associated with more training and consultation disengagement.