Background: Adolescents lack access to mental health evidence-based practices (EBPs), leading to poor public health outcomes for youth. Schools provide promising venues for increasing mental health EBP access as school professionals (SPs, e.g., counselors, social workers) can offer EBPs to students in an environment unfettered by common barriers (e.g., insurance, stigma). Just as in clinical settings, supportive implementation climate and leadership are organizational characteristics that may promote EBP uptake in schools and are potentially modifiable through implementation interventions; however, little is known about the role of implementation climate and implementation leadership in encouraging EBP delivery in schools.

Methods: We collected data from SPs at 114 Michigan high schools enrolled in a statewide trial aimed at implementing Cognitive Behavioral Therapy (CBT) in schools. In the trial run-in phase, all SPs received access to web-based CBT resources and minimal implementation support. SPs were asked to report CBT delivery weekly, barriers to CBT adoption, CBT knowledge (via 22 objective questions), and demographics. SPs also completed the Implementation Climate Scale (ICS) and Implementation Leadership Scale (ILS) to assess early CBT adoption and reported barriers and, among early adopters, CBT knowledge scores, and components delivered.

Results: Overall, 198/221 SPs (90%) completed run-in phase measures. Average ILS/ICS scores were 1.57 and 1.78, on a scale 0 (low) - 4 (high), lower than typically found in clinical settings. A total of 66 SPs (33%) reported delivering CBT at least once during the run-in phase. Higher ILS/ICS scores were associated with fewer reported barriers (p=0.04, 0.03) to CBT delivery; however, ILS/ICS composite scores did not predict early adoption (p=0.99, 0.58, respectively). Among the 66 early adopters, controlling for experience and prior CBT training, ILS/ICS were not associated with more CBT knowledge (B=-0.003, -0.006; p>0.05) nor diverse component delivery (B=-0.03, -0.06; p>0.05).

Conclusions: Schools have potential to improve adolescent mental health by increasing access to EBPs, but unmeasured school organizational characteristics may serve as barriers to implementation. While existing measures of implementation leadership and climate offer value in predicting barriers to early mental health EBP adoption, they may fail to capture organizational characteristics that stymie downstream EBP implementation in schools.

background: Evidence-based practices for students with autism rarely are implemented in community settings the way they were designed. Traditional implementation strategies have met with mixed success in increasing implementation fidelity. It is likely that more conceptual work is needed to identify specific targets for implementation strategies to increase their effectiveness and efficiency.

objective: to examine the utility of combining constructs from well-tested psychological theories of behavior prediction with those from organizational theory in predicting implementation of evidence-based practices, with the goal of identifying specific targets for implementation strategies

methods: At the beginning of the school year, we surveyed 71 autism support teachers in one urban school district regarding their intentions to use and attitudes, norms and self-efficacy towards the use of three evidence-based classroom practices. We also measured the organizational culture and climate, as well as implementation leadership and climate. We then measured teachers’ use of three evidence-based practices over the course of the school year. Structural equation modeling was used to examine associations among organizational variables, psychological variables, and use of these practices.

results: The conceptual model accounted for between 50 and 75% of the variance in implementation, depending on the specific practice. Intentions were associated with use of each practice; attitudes was generally the best predictor of intentions, followed by self-efficacy. Organizational variables both predicted attitudes, norms and self-efficacy, and moderated the association between intentions and implementation.

discussion: combined constructs from different theories accounted for a substantial variation in the use of evidence-based practices, and identified specific targets to increase implementation. Next steps are to test this model experimentally, by fielding strategies designed to target the specific predictors of implementation.

Background/Context: Evidence-based collaborative care interventions (CCIs) can improve public health by mitigating the access gap in mental health care treatment. However, CCIs can be difficult to implement and efforts to scale up CCIs are often stymied by a lack of practitioner knowledge for identifying and addressing barriers to community-based CCI implementation. Implementation roadmaps provide ‘scripts’ outlining critical steps practitioners should follow in scaling up CCIs to new settings, including guidance for identifying and addressing implementation barriers, developing metrics for evaluating success, and laying groundwork for long-term intervention sustainability. The Michigan Mental Health Integration Partnership (MIP) supports the scale up and spread of CCIs that enhance access to care for Medicaid-eligible consumers with behavioral healthcare needs, while also providing an in situ implementation laboratory for informing sustained uptake of CCIs across a variety of community-based settings. This study leverages MIP project experiences to inform an empirically-based Implementation Roadmap that practitioners can use to guide community-based CCI implementation.

Description: Semi-structured interviews were carried out with stakeholders from seven successfully-adopted MIP CCI projects to define common barriers, challenges, and implementation strategies deployed by the project teams. Interviews were then used to identify a series of common, critical steps scaffolding the CCI implementation process, and accompanying metrics for evaluating implementation progress.

Lessons Learned: Interviews were conducted with 25 stakeholders across seven MIP project teams: 14 with Principal Investigators and Project Managers, and 11 with key personnel at implementation sites. Stakeholders commonly identified a number of barriers to and strategies for success, including success of web-based tools for facilitating program implementation, importance of upper level administration buy-in, and the need for flexibility in tailoring implementation strategy deployment to specific site needs. These findings informed our resulting Implementation Roadmap, which identifies eleven critical implementation steps and evaluative metrics for investigators implementing CCIs to consider across pre-implementation, implementation, and sustainability phases.

Recommendations/Implications: Maximal CCI public health impact requires improved reach. Our Implementation Roadmap provides a clear guide for early stage community CCI implementation efforts, and ensures practitioners collect key metrics and systematically address barriers in ways that are foundational for larger scale, sustainable implementation efforts.

Background: Mental health disorders are a critical public health issue among youth. Youth in socioeconomically challenged communities are especially at risk of poor mental health outcomes due to heightened violence, stress and trauma exposure. School climate plays a prominent role in shaping youths’ mental well-being. Evidence-based interventions (EBIs) that create positive school environments are key to reducing risk of poor mental health. Yet, EBIs are rarely delivered with fidelity in community settings. Low resource communities, in particular, face competing demands and scarce resources that undermine program implementation and effectiveness. Consequently, implementation strategies, theory based methods to enhance EBI delivery, are needed to achieve desired public health outcomes.

Description: This study is a hybrid type II cluster randomized trial (9 schools, n=1728) that incorporates implementation facilitation to deliver a comprehensive school safety program in Genesee County, Michigan. The comprehensive program includes three EBIs: 1. Restorative justice, 2. Mental health first aid (MHFA), and 3. Crime prevention through environmental design. Multiple EBIs have notable potential to achieve positive outcomes but are challenging to implement. Consequently, we incorporate Facilitation to support delivery. Facilitation is from the integrating Promoting Action on Research Implementation in Health Services framework that provides flexible, ongoing, individualized assistance for implementation through addressing contextual, innovation, recipient, and provider barriers.

Lessons Learned: School climate specialists (CSs) served as implementation facilitators. We conducted semi-structured interviews with the CSs during Year 1. The CSs reported that, of the 3 interventions, teachers described challenges with MHFA implementation frequently. They identified barriers related to the innovation (poor understanding and integration of MHFA and challenges to teacher training), context (policies regarding student referrals for services), recipients (students exhibiting symptoms) and providers (teacher discomfort with addressing behavioral health issues).

Implications: Based on CS feedback, development of an implementation guide to aid in the effective integration of MHFA as part of comprehensive school safety initiatives is necessary. This will include recommendations for addressing identified barriers associated with training and delivery, such as articulating how the three programs complement each other, training alternatives, and approaches to incorporating other school professionals (e.g., the school counselor) to support program adoption.