Adapting a Compilation of Implementation Strategies to Advance School-Based Implementation Research and Practice

Community-based implementation strategy use and satisfaction: A mixed-methods approach to using the ERIC compilation for organizations serving children on the autism spectrum

Background

Despite efforts to use standardized taxonomy and research reporting, documenting implementation strategies utilized in community settings remains challenging. This case study demonstrates a practical approach to gather use of and satisfaction with implementation strategies utilized within community-based sites to understand community providers' perspectives of implementing an early intensive behavioral intervention (EIBI) for children on the autism spectrum across different settings.

Methods

Using a sequential explanatory mixed-methods design, survey and interview data were collected from directors/supervisors and direct providers (n = 26) across three sites (one university and two community-based replication sites). The Implementation Strategies and Satisfaction Survey (ISSS) was administered to identify staff-reported implementation strategy use and satisfaction. Informed by quantitative results, follow-up semi-structured interviews were conducted with a subsample (n = 13) to further understand staff experiences with endorsed implementation strategies and elicit recommendations for future efforts.

Results

Survey results were used to demonstrate frequencies of implementation strategies endorsed by site and role. Overall, staff felt satisfied with implementation strategies used within their agencies. Content analysis of qualitative data revealed three salient themes related to implementation strategy use-context, communication, and successes and challenges-providing in-depth detail on how strategies were utilized, and strategy effectiveness based on community providers' experiences. Recommendations were also elicited to improve strategy use within "broader" community settings.

Conclusions

The project demonstrated a practical approach to identifying and evaluating implementation strategies used within sites delivering autism services. Reporting implementation strategies using the ISSS can provide insight into community providers' perspectives and satisfaction with agency implementation strategy use that can generate more relevant and responsive strategies to address barriers in community settings. Plain language abstract Examining community providers' preferences and experiences with implementation strategies used to facilitate evidence-based practice uptake can broaden our understanding of what, how, and why implementation strategies work in community-based settings ( Chaudoir et al., 2013; Leeman et al., 2017; Proctor et al., 2013). Such efforts have great potential to tailor implementation strategies to address barriers/facilitators typically found in community-based settings.This case study demonstrates a practical approach using mixed methodology to: (a) gather self-reported use of and satisfaction with implementation strategies to understand community providers' perspectives of implementation strategy success. Using a new survey, the Implementation Strategies and Satisfaction Survey (ISSS) conjoined with interviews, the study demonstrated a practical approach using standardized language to report strategies used in one university-based site and two community-based replication sites that deliver an early intensive behavioral intervention (EIBI) for children on the autism spectrum. This paper contributes to one of the five priorities to enhance public health impact-improve tracking and reporting of implementation strategies utilized when translating research into practice ( Dingfelder & Mandell, 2011; Powell et al., 2019; Stahmer et al., 2019). This approach emphasizes the importance of understanding context (e.g., community organizations providing services to children on the autism spectrum) to develop strategies that work better for EIBI implementation and scale-up. Understanding community provider's preferences and experiences with implementation strategies can support use of implementation strategies that better fit usual care contexts, with the ultimate goal of improving implementation practice in community-based settings.

Consensus on strategies for implementing high priority mental health care practices within the US Department of Veterans Affairs

Background

Identifying feasible and effective implementation strategies remains a significant challenge. At present, there is a gap between the number of strategies prospectively included in implementation trials, typically four or fewer, and the number of strategies utilized retrospectively, often 20 or more. This gap points to the need for developing a better understanding of the range of implementation strategies that should be considered in implementation science and practice.

Methods

This study elicited expert recommendations to identify which of 73 discrete implementation strategies were considered essential for implementing three mental health care high priority practices (HPPs) in the US Department of Veterans Affairs: depression outcome monitoring in primary care mental health (n = 20), prolonged exposure therapy for treating posttraumatic stress disorder (n = 22), and metabolic safety monitoring for patients taking antipsychotic medications (n = 20). Participants had expertise in implementation science, the specific HPP, or both. A highly structured recommendation process was used to obtain recommendations for each HPP.

Results

Majority consensus was identified for 26 or more strategies as absolutely essential; 53 or more strategies were identified as either likely essential or absolutely essential across the three HPPs.

Conclusions

The large number of strategies identified as essential starkly contrasts with existing research that largely focuses on application of single strategies to support implementation. Systematic investigation and documentation of multi-strategy implementation initiatives is needed.

Plain Language Summary

Most implementation studies focus on the impact of a relatively small number of discrete implementation strategies on the uptake of a practice. However, studies that systematically survey providers find that dozens or more discrete implementation strategies can be identified in the context of the implementation initiative. This study engaged experts in implementation science and clinical practice in a structured recommendation process to identify which of the 73 Expert Recommendations for Implementing Change (ERIC) implementation strategies were considered absolutely essential, likely essential, likely inessential, and absolutely inessential for each of the three distinct mental health care practices: depression outcome monitoring in primary care, prolonged exposure therapy for posttraumatic stress disorder, and metabolic safety monitoring for patients taking antipsychotic medications. The results highlight that experts consider a large number of strategies as absolutely or likely essential for supporting the implementation of mental health care practices. For example, 26 strategies were identified as absolutely essential for all three mental health care practices. Another 27 strategies were identified as either absolutely or likely essential across all three practices. This study points to the need for future studies to document the decision-making process an initiative undergoes to identify which strategies to include and exclude in an implementation effort. In particular, a structured approach to this documentation may be necessary to identify strategies that may be endogenous to a care setting and that may not be otherwise be identified as being "deliberately" used to support a practice or intervention.

Amplification of school-based strategies resulting from the application of the dynamic adaptation process to reduce sexual and gender minority youth suicide

Background

Evidence-informed practices (EIPs) are imperative to increase school safety for lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) students and their peers. Recently, the Expert Recommendations for Implementing Change (ERIC), a taxonomy of discrete implementation strategies used in health care settings, was adapted for schools. The School Implementation Strategies, Translating the ERIC Resources (SISTER) resulted in 75 discrete implementation strategies. In this article, we examine which SISTER strategies were used to implement six EIPs to reduce suicidality among LGBTQ high school students. We applied the dynamic adaptation process (DAP), a phased, data-driven implementation planning process, that accounts for adaptation while encouraging fidelity to the core elements of EIPs.

Methods

Qualitative data derived from 36 semi-structured interviews and 16 focus groups conducted with school professionals during the first of a 3-year effort to implement EIPs in 19 high schools. We undertook iterative comparative analysis of these data, mapping codes to the relevant domains in the SISTER. We then synthesized the findings by creating a descriptive matrix of the SISTER implementation strategies employed by schools.

Results

We found that 20 SISTER strategies were encouraged under the DAP, nine of which were amplified by school personnel. Nine additional SISTER strategies not specifically built into the DAP were implemented independently by school personnel, given the freedom the DAP provided, resulting in a total of 29 SISTER strategies.

Conclusion

This study offers insight into how schools select and elaborate implementation strategies. The DAP fosters freedom to expand beyond study-supported strategies. Qualitative data illuminate motives for strategy diversification, such as improving EIP fit. Qualitative methods allow for an in-depth illustration of the strategies that school personnel enacted in their efforts to implement the EIPs. We discuss the utility of the DAP in supporting EIP implementation to reduce disparities for LGBTQ students.

Plain language abstract

Implementation science is, in part, concerned with implementation strategies, which are actions made to bridge implementation gaps between evidence-informed practices and the contexts in which practices are to be used. Implementation experts compiled a list of strategies for promoting the use of new practices in school settings. The authors of this article examine which implementation strategies in this list were promoted by the research team and which were employed independently by school personnel. Our results illustrate how school personnel applied strategies based on the conditions and needs of their individual schools. These results will contribute to knowledge about implementation strategies and improve readiness by building in strategies implementation teams will use. The authors conducted interviews and focus groups with school personnel involved in implementing six evidence-informed practices for reducing suicidality and other negative outcomes for lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) high school students. Findings are from the end of the first year of implementation and provide a glimpse into how and why certain implementation strategies were employed by school personnel to facilitate adoption of the practices. Findings describe how they applied these strategies in communities where LGBTQ people were marginalized and where anti-LGBTQ stigma influenced policies and resulted in barriers to implementation. This article contributes to efforts to identify and tailor implementation strategies that can encourage the use of evidence-informed practices to improve the well-being of LGBTQ youth and other health disparity populations.

Examining the Effects of a Brief, Group-Based Motivational Implementation Strategy on Mechanisms of Teacher Behavior Change

Training and consultation are core implementation strategies used to support the adoption and delivery of evidence-based prevention programs (EBPPs), but are often insufficient alone to effect teacher behavior change. Motivational interviewing (MI) and related behavior change techniques (e.g., strategic education, social influence, implementation planning) delivered in a group format offer promising supplements to training and consultation to improve EBPP implementation. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a theoretically informed, motivational implementation strategy delivered in a group format prior to and immediately after EBPP training. The purpose of this study was to examine the proximal effects of BASIS-T on hypothesized mechanisms of behavior change (e.g., attitudes, subjective norms, intentions to implement) in the context of teachers receiving training and consultation to implement the Good Behavior Game. As part of a pilot trial, 83 elementary school teachers from 9 public elementary schools were randomly assigned (at the school-level to reduce contamination across participants) to a BASIS-T (n = 44) or active comparison control (n = 39) condition, with both conditions receiving Good Behavior Game (GBG) training and consultation. A series of mixed effects models revealed meaningful effects favoring BASIS-T on a number of hypothesized mechanisms of behavior change leading to increased motivation to implement GBG. The implications, limitations, and directions for future research on the use of MI with groups of individuals and other behavior change techniques to increase the yield of training and consultation are discussed.

Partnering with School Providers to Co-Design Mental Health Interventions: An Open Trial of Act & Adapt in Urban Public Middle Schools

Schools are well positioned to provide access to youth mental health services, but implementing effective programs that promote emotional and behavioral functioning in school settings is complicated by the poor fit of interventions developed in research settings to complex school contexts. The current study formed a research-practice partnership with two urban public schools and mental health providers employed by those schools (N = 6, 100% female, 50% Black/African American, 50% White/Caucasian) in the adaptation of a depression prevention intervention, Act & Adapt. The intervention was modified by decreasing meeting time and streamlining session content, increasing flexibility, making intervention materials more similar to academic curriculum, and increasing the focus on managing disruptive behavior within group sessions. In an open trial, 6^th grade students (N = 22; 59% boys, 31% Hispanic, 22% Black/African American, 4% Asian, 30% White/Caucasian) at both schools who were identified as clinically "at risk" reported improvements from baseline to post-intervention and at one-year follow-up on measures of emotional and behavioral difficulties and coping strategies, with parallel results by caregiver report. The providers reported satisfaction with the intervention, and qualitative analyses of provider focus groups suggested both barriers and facilitators to research-practice collaborations to implement mental health interventions in schools.

Scaling evidence-based treatments through digital mental health

A large number of Internet websites, mobile apps, wearable devices, and video games that are hoped to improve behavioral, cognitive, and affective targets associated with mental health have been developed. Although technology provides the promising potential to help spread evidence-based mental health treatments, that potential is still largely unrealized. The vast majority of technology-based mental health products, deemed digital mental health interventions (DMHIs), have not been tested and show little fidelity to evidence-based treatments. Furthermore, best practices around the use of technologies in clinical services are underdeveloped and few clinicians have been trained to integrate these tools in their practice. We present an overview of DMHIs and discuss key aspects related to their implementation. We organize these aspects according to the Consolidating Framework for Implementation Research, a framework that identifies constructs related to effective implementation. These constructs are categorized into 5 domains including characteristics of DMHIs, the individuals involved, associated processes, the inner setting, and the outer setting. Our goal is to highlight key areas of consideration for leveraging technology to support the implementation of evidence-based treatments and to emphasize challenges and opportunities that come from using technology to scale evidence-based mental health treatments. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

School Staff's Perspectives on the Adoption of Elementary-School Physical Activity Approaches: A Qualitative Study

Background

There is a need to understand how schools adopt physical activity approaches (curricula, programs and practices), but few studies report on this process.

Purpose

To obtain elementary school staff's perspectives regarding how their schools are currently adopting physical activity approaches.

Methods

We recruited 15 participants from four job types in an urban Texas school district to participate in semi-structured interviews. We coded and analyzed interviews using directed content analysis and iterative categorization.

Results

We identified four themes pertaining to how the district, schools, and teachers contribute to the adoption of approaches. Themes included: (1) Staff identify new approaches through numerous channels; (2) Adoption occurs at multiple organizational levels; (3) District staff fulfilled a supporting role in the adoption process; and (4) School staff's perceptions of approach characteristics influence adoption.

Discussion

We found that schools adopt physical activity approaches at both the district- and school-level. Additionally, multiple stakeholders played a role in the adoption process and those roles varied across approaches.

Translation to Health Education Practice

Time, money, space, staff, competing priorities, limited information, the school's mission, and the benefits an approach provides to children are factors that researches and practitioners should consider when starting a new physical activity approach.

Designing the Future of Children's Mental Health Services

Advancements in evidence-based psychosocial interventions, digital technologies, and implementation strategies (i.e., health services research products) for youth mental health services have yet to yield significant improvement in public health outcomes. Achieving such impact will require that these research products are easy to use, useful, and contextually appropriate. This paper describes how human-centered design (HCD), an approach that aligns product development with the needs of the people and settings that use those products, can be leveraged to improve youth mental health services. We articulate how HCD can advance accessibility, effectiveness, and equity, with specific consideration of unique aspects of youth mental health services.

Partners in School: An Implementation Strategy to Promote Alignment of Evidence-Based Practices Across Home and School for Children with Autism Spectrum Disorder

When parents and teachers align their practices across home and school, it may optimize services for children with autism spectrum disorder (ASD). Partners in School is a multi-faceted implementation strategy designed to improve ASD services in schools. The goal is to increase parents' and teachers' use of evidence-based practices (EBPs) and to align those EBPs across settings. We piloted Partners in School with 49 parent-teacher dyads to assess administration and the factors associated with reported fidelity to the model. Specifically, we measured the number of intervention steps both parents and teachers completed (reported alignment) and the characteristics associated with intervention alignment. Partners in School involves parent-teacher participation in a pre-consultation interview, an in-person consultation meeting, active implementation of the same EBPs in their respective settings, and a post-consultation interview. Parents and teachers also completed surveys pre- and post-consultation. On average, parents and teachers completed approximately five EBP steps on their own in their respective settings (i.e., at home or at school). Of these five steps, parents and teachers both completed three of the same EBPs steps, on average. Different factors were related to reported alignment for parents versus teachers; however, a similarity noted for both parents and teachers was that communication variables were associated with reported alignment. Our findings indicate the important role of communication in aligning stakeholders for ASD service delivery models.

Aligning implementation and user-centered design strategies to enhance the impact of health services: results from a concept mapping study

BACKGROUND

Innovative approaches are needed to maximize fit between the characteristics of evidence-based practices (EBPs), implementation strategies that support EBP use, and contexts in which EBPs are implemented. Standard approaches to implementation offer few ways to address such issues of fit. We characterized the potential for collaboration with experts from a relevant complementary approach, user-centered design (UCD), to increase successful implementation.

METHOD

Using purposive and snowball sampling, we recruited 56 experts in implementation (n = 34) or UCD (n = 22). Participants had 5+ years of professional experience (M = 10.31), worked across many settings (e.g., healthcare, education, human services), and were mostly female (59%) and white (73%). Each participant completed a web-based concept mapping structured conceptualization task. They sorted strategies from established compilations for implementation (36 strategies) and UCD (30 strategies) into distinct clusters, then rated the importance and feasibility of each strategy.

RESULTS

We used multidimensional scaling techniques to examine patterns in the sorting of strategies. Based on conceptual clarity and fit with established implementation frameworks, we selected a final set of 10 clusters (i.e., groups of strategies), with five implementation-only clusters, two UCD-only clusters, and three trans-discipline clusters. The highest-priority activities (i.e., above-average importance and feasibility) were the trans-discipline clusters plus facilitate change and monitor change. Implementation and UCD experts sorted strategies into similar clusters, but each gave higher importance and feasibility ratings to strategies/clusters from their own discipline.

CONCLUSIONS

In this concept mapping study, experts in implementation and UCD had perspectives that both converged (e.g., trans-discipline clusters, which were all rated as high-priority) and diverged (e.g., in importance/feasibility ratings). The results provide a shared understanding of the alignment between implementation science and UCD, which can increase the impact and sustainability of EBP implementation efforts. Implications for improved collaboration among implementation and UCD experts are discussed.

The sustainability of public health interventions in schools: a systematic review

BACKGROUND

The sustainability of school-based health interventions after external funds and/or other resources end has been relatively unexplored in comparison to health care. If effective interventions discontinue, new practices cannot reach wider student populations and investment in implementation is wasted. This review asked: What evidence exists about the sustainability of school-based public health interventions? Do schools sustain public health interventions once start-up funds end? What are the barriers and facilitators affecting the sustainability of public health interventions in schools in high-income countries?

METHODS

Seven bibliographic databases and 15 websites were searched. References and citations of included studies were searched, and experts and authors were contacted to identify relevant studies. We included reports published from 1996 onwards. References were screened on title/abstract, and those included were screened on full report. We conducted data extraction and appraisal using an existing tool. Extracted data were qualitatively synthesised for common themes, using May's General Theory of Implementation (2013) as a conceptual framework.

RESULTS

Of the 9677 unique references identified through database searching and other search strategies, 24 studies of 18 interventions were included in the review. No interventions were sustained in their entirety; all had some components that were sustained by some schools or staff, bar one that was completely discontinued. No discernible relationship was found between evidence of effectiveness and sustainability. Key facilitators included commitment/support from senior leaders, staff observing a positive impact on students' engagement and wellbeing, and staff confidence in delivering health promotion and belief in its value. Important contextual barriers emerged: the norm of prioritising educational outcomes under time and resource constraints, insufficient funding/resources, staff turnover and a lack of ongoing training. Adaptation of the intervention to existing routines and changing contexts appeared to be part of the sustainability process.

CONCLUSIONS

Existing evidence suggests that sustainability depends upon schools developing and retaining senior leaders and staff that are knowledgeable, skilled and motivated to continue delivering health promotion through ever-changing circumstances. Evidence of effectiveness did not appear to be an influential factor. However, methodologically stronger primary research, informed by theory, is needed.

TRIAL REGISTRATION

The review was registered on PROSPERO: CRD42017076320, Sep. 2017.

Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 2)

As noted in Part 1 of this two-part review, school attendance is an important foundational competency for children and adolescents, and school absenteeism has been linked to myriad short- and long-term negative consequences, even into adulthood. Categorical and dimensional approaches for this population have been developed. This article (Part 2 of a two-part review) discusses compatibilities of categorical and dimensional approaches for school attendance and school absenteeism and how these approaches can inform one another. The article also poses a multidimensional multi-tiered system of supports pyramid model as a mechanism for reconciling these approaches, promoting school attendance (and/or prevention of school absenteeism), establishing early warning systems for nimble response to school attendance problems, assisting with global policy review and dissemination and implementation, and adapting to future changes in education and technology.

Use of Human-Centered Design to Improve Implementation of Evidence-Based Psychotherapies in Low-Resource Communities: Protocol for Studies Applying a Framework to Assess Usability

BACKGROUND

This paper presents the protocol for the National Institute of Mental Health (NIMH)-funded University of Washington's ALACRITY (Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness) Center (UWAC), which uses human-centered design (HCD) methods to improve the implementation of evidence-based psychosocial interventions (EBPIs). We propose that usability-the degree to which interventions and implementation strategies can be used with ease, efficiency, effectiveness, and satisfaction-is a fundamental, yet poorly understood determinant of implementation.

OBJECTIVE

We present a novel Discover, Design/Build, and Test (DDBT) framework to study usability as an implementation determinant. DDBT will be applied across Center projects to develop scalable and efficient implementation strategies (eg, training tools), modify existing EBPIs to enhance usability, and create usable and nonburdensome decision support tools for quality delivery of EBPIs.

METHODS

Stakeholder participants will be implementation practitioners/intermediaries, mental health clinicians, and patients with mental illness in nonspecialty mental health settings in underresourced communities. Three preplanned projects and 12 pilot studies will employ the DDBT model to (1) identify usability challenges in implementing EBPIs in underresourced settings; (2) iteratively design solutions to overcome these challenges; and (3) compare the solution to the original version of the EPBI or implementation strategy on usability, quality of care, and patient-reported outcomes. The final products from the center will be a streamlined modification and redesign model that will improve the usability of EBPIs and implementation strategies (eg, tools to support EBPI education and decision making); a matrix of modification targets (ie, usability issues) that are both common and unique to EBPIs, strategies, settings, and patient populations; and a compilation of redesign strategies and the relative effectiveness of the redesigned solution compared to the original EBPI or strategy.

RESULTS

The UWAC received institutional review board approval for the three separate studies in March 2018 and was funded in May 2018.

CONCLUSIONS

The outcomes from this center will inform the implementation of EBPIs by identifying cross-cutting features of EBPIs and implementation strategies that influence the use and acceptability of these interventions, actively involving stakeholder clinicians and implementation practitioners in the design of the EBPI modification or implementation strategy solution and identifying the impact of HCD-informed modifications and solutions on intervention effectiveness and quality.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03515226 (https://clinicaltrials.gov/ct2/show/NCT03515226), NCT03514394 (https://clinicaltrials.gov/ct2/show/NCT03514394), and NCT03516513 (https://clinicaltrials.gov/ct2/show/NCT03516513).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/14990.

Importance and feasibility of an adapted set of implementation strategies in schools

Implementation strategies are methods or techniques used to enhance the adoption, implementation, and sustainment of a new program or practice. Recent studies have facilitated implementation strategy prioritization by mapping strategies based on their feasibility and importance, but these efforts have not been replicated across distinct service delivery contexts. The aim of the current project was to evaluate the feasibility and importance of an education-adapted taxonomy of implementation strategies and to directly compare feasibility and importance ratings to the original Expert Recommendations for Implementing Change (ERIC) taxonomy, the leading compilation of implementation strategies in healthcare. A sample of 200 school-based consultants who support social, emotional, and mental health services provided ratings of feasibility and importance for each of the 75 strategies included in the adapted School Implementation Strategies, Translating ERIC Resources (SISTER) compilation. Results identified strategies rated as: (a) both feasible and important, (b) important but not feasible, (c) feasible but not important, and (d) neither feasible nor important. When mapped onto scatterplots using feasibility and importance ratings, comparison of ERIC and SISTER ratings indicated that approximately one third of the strategies shifted from one quadrant of the feasibility and importance axis to another. Findings demonstrate the value of efforts to adapt and generalize existing implementation products to novel service settings, such as schools. Additionally, findings assist implementation researchers and practitioners in prioritizing the selection of actionable and practically relevant implementation strategies to advance the quality of school mental health services.

Understanding the Organizational Implementation Context of Schools: A Qualitative Study of School District Administrators, Principals, and Teachers

Key features of the school environment can have a significant impact on teachers' effective use of evidence-based practices (EBP), yet implementation-specific organizational constructs have rarely been studied in the education sector. This study examined three aspects of the organizational implementation context (implementation leadership, climate, and citizenship behavior), which have been conceptualized and validated in other service settings. Focus groups with central office administrators, principals, and teachers were conducted to understand the applicability and conceptual boundaries of these organizational constructs in schools. Focus group transcripts were coded, and the results indicated both similarities and differences in their conceptualizations of implementation leadership, climate, and citizenship behavior in school. The data indicated that: (1) implementation leadership was largely present in schools with the addition of Distributed Leadership; (2) two implementation climate constructs were most clearly present (i.e., Focus on EBP and Educational Support for EBP) and two additional constructs (i.e., Existing Support to Deliver EBP and Prioritization of EBP) emerged as part of this construct; and (3) implementation citizenship behavior (Helping Others and Keeping Informed) was consistently acknowledged across schools and two new components emerged (i.e., Information Sharing and Observation/Feedback). Recommendations to researchers and community stakeholders are discussed.

From evidence to impact: Joining our best school mental health practices with our best implementation strategies

There is substantial research evidence for the effectiveness of school mental health strategies across problem areas, developmental levels, and the prevention-intervention spectrum. At the same time, it is clear that the education and mental health fields continue to struggle to apply this evidence at any level of scale. This commentary reflects on ways in which education-specific applications of implementation science principles - and explicit consideration of determinants of implementation success - may guide more consistent use of evidence in school mental health. After reviewing implementation determinants and strategies across multiple levels of effect (i.e., the outer setting, inner setting, individual, and intervention levels), the commentary goes on to recommend specific areas of needed attention in school mental health implementation efforts and research. These include a need to adapt interventions to better fit the context of schools, streamlining school mental health programs and practices to make them more implementable, and recognizing the critical role of assessment and selection of evidence-based interventions by school leaders. The commentary concludes by reflecting on the substantial opportunity provided by the education sector to both apply and advance implementation science.