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Baffsky R, Ivers R, Cullen P, McGillivray L, Werner-Seidler A, Calear AL, Batterham PJ, Toumbourou JW, Stokes R, Kotselas P, Prendergast T, Torok M. Co-design and Development of Implementation Strategies: Enhancing the PAX Good Behaviour Game in Australian Schools. JOURNAL OF PREVENTION (2022) 2023; 44:679-704. [PMID: 37741909 PMCID: PMC10638156 DOI: 10.1007/s10935-023-00749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/25/2023]
Abstract
Effective implementation strategies are important for take-up of programs in schools. However, to date, few implementation strategies have been co-designed with teachers and support staff (including principals) in Australia. The aim of this study was to iteratively co-design multiple implementation strategies to enhance the delivery of mental health prevention program, PAX Good Behaviour Game, in New South Wales primary schools. The secondary aim was to evaluate the acceptability of the implementation strategies from the perspective of school staff. Twenty-nine educational staff (including principals) informed the co-design of the implementation strategies across three phases. Phase 1 involved a rapid review of the literature and stakeholder meetings to agree upon potential evidence-based strategies. Phase 2 involved focus group discussions with educational staff to co-design implementation strategies. Phase 3 involved semi-structured interviews with school staff to assess strategy acceptability after implementation at 6-months post-baseline. Data were analysed using deductive, framework analysis. The final co-designed intervention included nine implementation strategies accessible through a toolkit delivered to the school's leadership team. These strategies were deemed acceptable in school settings that experienced periods of both face-to-face and remote learning due to the changing COVID-19 situation in 2021. This paper contributes to the implementation literature by transparently reporting how educational staff-informed implementation strategies were iteratively co-designed. This will provide a roadmap for other researchers to co-design implementation strategies to further support the delivery of evidence-based prevention programs in schools.
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Affiliation(s)
- Rachel Baffsky
- School of Population Health, University of New South Wales, Sydney, Samuels Building, F25, Samuel Terry Ave, Kensington, NSW, Australia.
| | - Rebecca Ivers
- School of Population Health, University of New South Wales, Sydney, Samuels Building, F25, Samuel Terry Ave, Kensington, NSW, Australia
| | - Patricia Cullen
- School of Population Health, University of New South Wales, Sydney, Samuels Building, F25, Samuel Terry Ave, Kensington, NSW, Australia
| | | | | | - Alison L Calear
- Centre for Mental Health Research, The Australian National University, Acton, ACT, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Acton, ACT, Australia
| | - John W Toumbourou
- School of Psychology and Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, VIC, Australia
| | - Rhoni Stokes
- Department of Education, New South Wales (NSW), Parramatta, NSW, Australia
| | - Pauline Kotselas
- Department of Education, New South Wales (NSW), Parramatta, NSW, Australia
| | - Traci Prendergast
- Department of Education, New South Wales (NSW), Parramatta, NSW, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, Australia
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Rungan S, Montgomery A, Smith-Merry J, Liu HM, Eastwood J. Retrospective audit of a school-based integrated health-care model in a specialised school for children with externalising behaviour. J Paediatr Child Health 2023; 59:1311-1318. [PMID: 37964701 DOI: 10.1111/jpc.16515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/17/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
AIM Problematic externalising behaviours in adolescents are associated with high individual and societal burden. A school-based multidisciplinary health clinic, Ngaramadhi Space (NS), was developed at Yudi Gunyi School, a specialised behavioural school in Sydney, Australia, to improve access to holistic health-care and behavioural support. This evaluation aimed to describe the demographics, clinic attendance, health screening, recommendations made, and changes in Strengths and Difficulties Questionnaire (SDQ) scores of students attending the clinic. METHODS Retrospective evaluation of students including changes in SDQ scores using descriptive statistics (26 July 2016 to 14 May 2019; n = 79). RESULTS Prior to the assessment, few students engaged with a paediatrician or mental health professional (22.8%; 27.8%, respectively). Child protection services were involved with 76%. NS attendance was high (failure-to-attend = 7.6%; cancellations = 8.9%). New issues found at the assessment included: parental separation (31.6%); trauma history (27.8%); substance use (19%); emotional wellbeing concerns (16.5%), learning difficulties (12.7%), domestic violence (12.7%) and medical conditions (10.1%). SDQ teacher reports showed a significant decrease in total difficulties scores (M = 6.2, SD = 6.165, P < 0.05, eta squared = 1.013 (large effect)) and all subsets. No significant differences in parent and self-reported SDQ. CONCLUSIONS Students with problematic externalising behaviour have unmet health and social needs. The NS school-based integrated health-care model offers a novel, convenient and innovative way to engage these students. This approach has high initial attendance rates with teacher-reported SDQ results showing some behavioural improvement. Further qualitative studies are required.
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Affiliation(s)
- Santuri Rungan
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
| | - Alicia Montgomery
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy (CDRP), The University of Sydney, Sydney, New South Wales, Australia
| | - Huei Ming Liu
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
| | - John Eastwood
- Croydon Community Health Centre, Sydney Local Health District, Melbourne, New South Wales, Australia
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Hotez E, Rava J, Russ S, Ware A, Halfon N. Using a life course health development framework to combat stigma-related health disparities for individuals with intellectual and/or developmental disability (I/DD). Curr Probl Pediatr Adolesc Health Care 2023; 53:101433. [PMID: 37867057 DOI: 10.1016/j.cppeds.2023.101433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
In the U.S., 1 in 6 children has an intellectual and/or developmental disability (I/DD). This population experiences a multitude of negative health outcomes across the life course, relative to the general population. Stigma-the social devaluation of individuals with certain characteristics, identities, or statuses within interpersonal, educational, healthcare, and policy contexts-is a potentially preventable contributor to health disparities. To date, existing approaches for addressing and preventing stigma are limited to discrete and siloed interventions that often fail to address the lifelong, cumulative impacts of the specific types of stigma experienced by the I/DD population. In the current paper, we describe three elements of Life Course Health Development (LCHD)-a novel translational framework that draws on evidence from biology, sociology, epidemiology, and psychology-that healthcare providers can use to prevent stigma-related health disparities and improve outcomes for individuals with I//DDs. We discuss the utility of targeting prevention to sensitive periods; prioritizing interventions for the most damaging types of stigmas; and leveraging supports from multiple service systems and sectors. By incorporating evidence from life course science into efforts to address stigma-related health disparities, providers can more effectively and strategically prevent and combat stigma-related health disparities for the I/DD population in childhood and across the life course.
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Affiliation(s)
- Emily Hotez
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States.
| | - Julianna Rava
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Shirley Russ
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Allysa Ware
- Family Voices, 110 Hartwell Avenue, Lexington, MA, 02421, United States
| | - Neal Halfon
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States; Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
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Zhang Y, Cook C, Fallon L, Corbin C, Ehrhart M, Brown E, Locke J, Lyon A. The Interaction Between General and Strategic Leadership and Climate on Their Multilevel Associations with Implementer Attitudes Toward Universal Prevention Programs for Youth Mental Health: A Cross-Sectional Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:427-449. [PMID: 36585557 DOI: 10.1007/s10488-022-01248-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
Emerging literature has highlighted the importance of discerning general and strategic organizational context (OC) factors (e.g., leadership and climate) and their interaction effect on individual implementation behaviors (e.g., attitudes toward evidence-based practices; EBPs) in youth mental healthcare. This study aimed to examine how leadership and climate (general and strategic) are associated with implementer attitudes toward EBPs across the individual and organizational levels and their interaction effect in schools. A series of multilevel models (MLMs) were fitted on a diverse sample of schools actively implementing universal prevention programs for youth mental health (441 implementers from 52 schools). The organization-level aggregates and individual educators' perceptions of general and strategic leadership and climate, and their interaction terms, were entered as level-2 and level-1 predictors of four attitudinal dimensions (Requirement, Openness, Appeal, and Divergence) based on their level of measurement. At the organizational level, higher levels of strategic leadership and climate, but not their general counterparts, were consistently associated with more favorable attitudes in all four dimensions. At the individual/within-school level, higher levels of perceived general and strategic leadership and climate were associated with more favorable attitudes of Requirement and Openness. At the organizational/between-school level, general climate moderated the positive effect of strategic climate on implementers' perception of appeal and divergence of EBPs. Our findings indicate that leaders should make data-based decisions to allocate resources on strategic and/or general leadership and climate to foster favorable staff attitudes toward EBPs based on the level of measurement, implementation-specificity, and attitudinal dimensions.
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Affiliation(s)
- Yanchen Zhang
- Department of Psychological & Quantitative Foundations, The University of Iowa, 361 Lindquist Center, Iowa City, IA, 52242, USA.
| | - Clay Cook
- Department of Educational Psychology, University of Minnesota, 341 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Lindsay Fallon
- Department of Counseling and School Psychology, University of Massachusetts-Boston, 100 William T. Morrissey Blvd., Boston, MA, 02125, USA
| | - Catherine Corbin
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Box 354920, Seattle, WA, 98115, USA
| | - Mark Ehrhart
- Department of Industrial/Organizational Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, USA
| | - Eric Brown
- Department of Public Health Sciences, University of Miami, Coral Gables, FL, 33124, USA
| | - Jill Locke
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Box 354920, Seattle, WA, 98115, USA
| | - Aaron Lyon
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Box 354920, Seattle, WA, 98115, USA
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Jenkins L, Kinney J, Kaminski S, Howell J. Innovations in University-School Partnerships to Provide Mental Health Services. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2023. [DOI: 10.1080/15377903.2023.2182859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
| | | | | | - James Howell
- Florida State University, Tallahassee, Florida, USA
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Choi SY, Rusch A, Lane A, Liebrecht C, Bilek EL, Eisenberg D, Andrews C, Perry M, Smith SN. Individual and organizational factors as predictors of early evidence-based practice adoption in Michigan high schools: Baseline data from an implementation trial. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231159429. [PMID: 37091540 PMCID: PMC10052498 DOI: 10.1177/26334895231159429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
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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Affiliation(s)
- Seo Youn Choi
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Amy Rusch
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Annalise Lane
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Celeste Liebrecht
- Department of Learning Health Sciences, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Emily L. Bilek
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Eisenberg
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Carolyn Andrews
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Morgan Perry
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Shawna N. Smith
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Seo Youn Choi, Department of Health Management and Policy, University of Michigan, SPH II, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
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Kriegshauser KD, Sexton CC, Bozsik FM, Blossom JB, Wiese AD, Adams Larsen M, Hale LR. The Feasibility of a Family-Focused CBT Skills Self-Help App. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wood BJ, Ellis F. Universal Mental Health Screening Practices in Midwestern Schools: A Window of Opportunity for School Psychologist Leadership and Role Expansion? CONTEMPORARY SCHOOL PSYCHOLOGY 2022:1-11. [PMID: 36217533 PMCID: PMC9534464 DOI: 10.1007/s40688-022-00430-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 11/20/2022]
Abstract
The conducting of universal mental health screening is one widely endorsed practice suitable for use within P-12 school settings to more proactively identify children and young people experiencing or displaying characteristics of a mental health disorder. Absent routine screening, many school-age youth with mental health concerns, especially those of an internalizing nature, may go unidentified and left without timely treatment, support, and services. The current study, which employed survey methodology with principal respondents from four Midwestern states, primarily sought to contribute to and update the literature on the universal mental health screening practice habits of P-12 schools. Most principal respondents reported that their school does not currently conduct universal mental health screening and cited barriers (e.g., money, time, lack of support system in place) to screening commonly documented in prior studies. Many principals reported at least a moderate degree of interest in their school beginning to conduct universal screening in their buildings; however, a similar majority reported little to no knowledge about this important practice. Fortunately, principal respondents were generally interested in and receptive to support from their school psychologist in exploring and eventually implementing the conducting of universal mental health screening in their building. Implications for practice and future research, along with the potential for school psychologist leadership and role expansion, are discussed.
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Affiliation(s)
- Brandon J. Wood
- School of Intervention and Wellness, University of Toledo, 2801 W. Bancroft St, Toledo, OH 43606 USA
| | - Faith Ellis
- School of Intervention and Wellness, University of Toledo, 2801 W. Bancroft St, Toledo, OH 43606 USA
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Lyon AR, Corbin CM, Brown EC, Ehrhart MG, Locke J, Davis C, Picozzi E, Aarons GA, Cook CR. Leading the charge in the education sector: development and validation of the School Implementation Leadership Scale (SILS). Implement Sci 2022; 17:48. [PMID: 35854385 PMCID: PMC9295535 DOI: 10.1186/s13012-022-01222-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Strategic implementation leadership is a critical determinant of successful implementation, hypothesized to create a more supportive implementation climate conducive to the adoption and use of evidence-based practices. Implementation leadership behaviors may vary significantly across contexts, necessitating studies that examine the validity of established measurement tools in novel health service delivery sectors. The education sector is the most common site for delivering mental health services to children and adolescents in the USA, but research focused on implementation leadership in schools is in the early phases, and there is a need for adaptation and expansion of instruments in order to tailor to the school context. The current study adapted and validated the School Implementation Leadership Scale (SILS) (based on the Implementation Leadership Scale) in a sample of elementary school personnel from six school districts who were implementing one of two well-established prevention programs for supporting children’s mental health. Methods Participants were 441 public school teachers from 52 elementary schools in the Midwest and West Coast of the USA. Participants completed a survey that contained: (1) an adapted and expanded version of the SILS with additional items generated for four existing subscales as well as three new subscales (communication, vision/mission, and availability), and (2) additional tools to evaluate convergent and divergent validity (i.e., measures of general/molar leadership and teaching attitudes). Data underwent (1) examination of item characteristic curves to reduce items and ensure a pragmatic instrument, (2) confirmatory factor analyses to establish structural validity, and (3) evaluation of convergent and divergent validity. Results Item reduction analyses resulted in seven subscales of three items each. Results indicated acceptable fit for a seven-factor structural model (CFI = .995, TLI = .99, RMSEA = .07, SRMR = 0.02). Second-order factor loadings were high (λ = .89 to .96), suggesting that the SILS subscales comprise a higher-order implementation leadership factor. All subscales demonstrated good inter-item reliability (α = .91–.96). Convergent and divergent validity results were generally as hypothesized, with moderate to high correlations between SILS subscales and general leadership, moderate correlations with teaching attitudes, and low correlations with school demographics. Conclusions Overall, results provided strong structural, convergent, and divergent validity evidence for the 21-item, 7-factor SILS instrument. Implications for the measurement of implementation leadership in schools are discussed, as well as strategies to support leaders to enhance their strategic behaviors related to the implementation of mental health prevention programs (e.g., adaptation of existing leadership-focused implementation strategies). Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01222-7.
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Affiliation(s)
- Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Catherine M Corbin
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Eric C Brown
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Office, 104, Miami, FL, 33136, USA
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, P.O. Box 161390, Orlando, FL, 32816-1390, USA
| | - Jill Locke
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Chayna Davis
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Elissa Picozzi
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, USA.,UC San Diego ACTRI Dissemination and Implementation Science Center, San Diego, USA.,Child and Adolescent Services Research Center, San Diego, USA
| | - Clayton R Cook
- Department of Organizational Leadership and Policy Development, University of Minnesota, 206 Burton Hall-178 Pillsbury Drive SE, Minneapolis, MN, 55455, USA
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10
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Smith SN, Almirall D, Choi SY, Koschmann E, Rusch A, Bilek E, Lane A, Abelson JL, Eisenberg D, Himle JA, Fitzgerald KD, Liebrecht C, Kilbourne AM. Primary aim results of a clustered SMART for developing a school-level, adaptive implementation strategy to support CBT delivery at high schools in Michigan. Implement Sci 2022; 17:42. [PMID: 35804370 PMCID: PMC9264291 DOI: 10.1186/s13012-022-01211-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Schools increasingly provide mental health services to students, but often lack access to implementation strategies to support school-based (and school professional [SP]) delivery of evidence-based practices. Given substantial heterogeneity in implementation barriers across schools, development of adaptive implementation strategies that guide which implementation strategies to provide to which schools and when may be necessary to support scale-up. Methods A clustered, sequential, multiple-assignment randomized trial (SMART) of high schools across Michigan was used to inform the development of a school-level adaptive implementation strategy for supporting SP-delivered cognitive behavioral therapy (CBT). All schools were first provided with implementation support informed by Replicating Effective Programs (REP) and then were randomized to add in-person Coaching or not (phase 1). After 8 weeks, schools were assessed for response based on SP-reported frequency of CBT delivered to students and/or barriers reported. Responder schools continued with phase 1 implementation strategies. Slower-responder schools (not providing ≥ 3 CBT components to ≥10 students or >2 organizational barriers identified) were re-randomized to add Facilitation to current support or not (phase 2). The primary aim hypothesis was that SPs at schools receiving the REP + Coaching + Facilitation adaptive implementation strategy would deliver more CBT sessions than SPs at schools receiving REP alone. Secondary aims compared four implementation strategies (Coaching vs no Coaching × Facilitation vs no Facilitation) on CBT sessions delivered, including by type (group, brief and full individual). Analyses used a marginal, weighted least squares approach developed for clustered SMARTs. Results SPs (n = 169) at 94 high schools entered the study. N = 83 schools (88%) were slower-responders after phase 1. Contrary to the primary aim hypothesis, there was no evidence of a significant difference in CBT sessions delivered between REP + Coaching + Facilitation and REP alone (111.4 vs. 121.1 average total CBT sessions; p = 0.63). In secondary analyses, the adaptive strategy that offered REP + Facilitation resulted in the highest average CBT delivery (154.1 sessions) and the non-adaptive strategy offering REP + Coaching the lowest (94.5 sessions). Conclusions The most effective strategy in terms of average SP-reported CBT delivery is the adaptive implementation strategy that (i) begins with REP, (ii) augments with Facilitation for slower-responder schools (schools where SPs identified organizational barriers or struggled to deliver CBT), and (iii) stays the course with REP for responder schools. Trial registration ClinicalTrials.gov, NCT03541317, May 30, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01211-w.
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Affiliation(s)
- Shawna N Smith
- Department of Health Management and Policy, School of Public Health, University of Michigan, SPH II, 1415 Washington Heights, Ann Arbor, MI, 48109, USA. .,Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, USA.
| | - Daniel Almirall
- Survey Research Center, Institute of Social Research, University of Michigan, Ann Arbor, USA.,Department of Statistics, University of Michigan, Ann Arbor, USA
| | - Seo Youn Choi
- Department of Health Management and Policy, School of Public Health, University of Michigan, SPH II, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Elizabeth Koschmann
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Amy Rusch
- Department of Health Management and Policy, School of Public Health, University of Michigan, SPH II, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Emily Bilek
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Annalise Lane
- Department of Health Management and Policy, School of Public Health, University of Michigan, SPH II, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - James L Abelson
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Daniel Eisenberg
- Department of Health Policy and Management, UCLA, Los Angeles, USA
| | - Joseph A Himle
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, USA.,School of Social Work, University of Michigan, Ann Arbor, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York City, USA
| | - Celeste Liebrecht
- Department of Learning Health Sciences, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Amy M Kilbourne
- Department of Learning Health Sciences, Michigan Medicine, University of Michigan, Ann Arbor, USA.,Quality Enhancement Research Initiative (QUERI), US Department of Veterans Affairs, Washington, D.C., USA
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Larson M, Cook CR, Sullivan MM, Lyon AR, Lewis CC. Validation and Use of the Measure of Effective Attributes of Trainers in School-Based Implementation of Proactive Classroom Management Strategies. SCHOOL MENTAL HEALTH 2022; 14:724-737. [PMID: 35035589 PMCID: PMC8753011 DOI: 10.1007/s12310-022-09499-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 11/30/2022]
Abstract
In-service training is a critical and frequently utilized implementation strategy to support the adoption and delivery of evidence-based practice (EBP) across service settings, but is characteristically ineffective in producing provider behavior changes, particularly when delivered in single exposure didactic events. EBP trainers are in a strategic position to leverage their trainee-perceived characteristics to influence trainees' attitudes, motivation, and intentions to implement, and ultimately increase the likelihood of successful uptake of skills. The purpose of this study was to extend research on the measure of effective attributes of trainers (MEAT) by examining its underlying factor structure and reliability in the context of in-service EBP training for teachers (i.e., structural validity). This study also examined the predictive validity of the MEAT by examining relationships with a measure of teacher intentions to implement EBPs following a standardized training experience (i.e., predictive validity). An exploratory factor analysis (EFA) was employed to determine the latent factors (i.e., subscales of characteristics) that underlie the data. Additionally, a forward selection, stepwise regression was conducted to determine the extent to which trainer attributes could explain variance in intentions to implement. Results indicated that the MEAT was a valid and reliable measure to examine trainer attributes in school settings. Moreover, findings suggested that trainer attributes, particularly those related to trainee perceptions of the trainers' welcoming disposition (i.e., related to trainers' warm, positive temperament and internal character traits), were significantly associated with trainees' intentions to implement the trained upon EBP.
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Affiliation(s)
- Madeline Larson
- Department of Educational Psychology, University of Minnesota, Twin Cities, 56 East River Road, Minneapolis, MN 55455 USA
| | - Clayton R Cook
- Department of Educational Psychology, University of Minnesota, Twin Cities, 56 East River Road, Minneapolis, MN 55455 USA
| | - Margaret M Sullivan
- Department of Educational Psychology, University of Minnesota, Twin Cities, 56 East River Road, Minneapolis, MN 55455 USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, 2815 Eastlake Ave E #200, Seattle, WA 98102 USA
| | - Cara C Lewis
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St, Bloomington, IN 47405 USA.,MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101 USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, 2815 Eastlake Ave E #200, SeattleSeattle, WA 98102 USA
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12
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L’efficacité de la thérapie est-elle modulée par la relation thérapeutique en fonction du motif de consultation ? EVOLUTION PSYCHIATRIQUE 2021. [DOI: 10.1016/j.evopsy.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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A Theory-Informed Approach to Locally Managed Learning School Systems: Integrating Treatment Integrity and Youth Mental Health Outcome Data to Promote Youth Mental Health. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09413-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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DiGirolamo AM, Desai D, Farmer D, McLaren S, Whitmore A, McKay D, Fitzgerald L, Pearson S, McGiboney G. Results From a Statewide School-Based Mental Health Program: Effects on School Climate. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2020.1837607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
| | | | | | | | | | - Danté McKay
- Georgia Department of Behavioral Health and Developmental Disabilities
| | - Layla Fitzgerald
- Georgia Department of Behavioral Health and Developmental Disabilities
| | - Stephanie Pearson
- Georgia Department of Behavioral Health and Developmental Disabilities
| | - Garry McGiboney
- Georgia Department of Education; currently at Sharecare, Inc
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Reinke WM, Herman KC, Thompson A, Copeland C, McCall CS, Holmes S, Owens SA. Investigating the Longitudinal Association Between Fidelity to a Large-Scale Comprehensive School Mental Health Prevention and Intervention Model and Student Outcomes. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2020.1870869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Duong MT, Bruns EJ, Lee K, Cox S, Coifman J, Mayworm A, Lyon AR. Rates of Mental Health Service Utilization by Children and Adolescents in Schools and Other Common Service Settings: A Systematic Review and Meta-Analysis. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:420-439. [PMID: 32940884 DOI: 10.1007/s10488-020-01080-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 01/21/2023]
Abstract
A meta-analysis was conducted to examine the relative rates of youth mental health service utilization across settings among the general population and among those with elevated mental health symptoms or clinical diagnoses. Rates of school-based mental health were compared to outpatient, primary care, child welfare, juvenile justice, and inpatient. Nine studies presented rates of mental health service use for general-population youth in the U.S., and 14 studies presented rates for youth with elevated symptoms or clinical diagnoses. Random effects meta-analysis was used to calculate mean proportions of youth receiving care in each sector. Of general population youth, 7.28% received school mental health services. Rates for other sectors are as follows: 7.26% in outpatient settings, 1.76% in primary care, 1.80% in inpatient, 1.35% in child welfare, and 0.90% juvenile justice. For youth with elevated mental health symptoms or diagnoses, 22.10% of youth were served by school-based mental health services, 20.56% outpatient settings, 9.93% primary care, 9.05% inpatient, 7.90% child welfare, and 4.50% juvenile justice. Schools and outpatient settings are the most common loci of mental health care for both the general population and samples of youth with elevated symptoms or clinical diagnoses, although substantial amounts of care are also provided in a range of other settings. Results hold potential for informing resource allocation, legislation and policy, intervention development, and research. Given that mental health services are delivered across many settings, findings also point to the need for interconnection across child-serving sectors, particularly schools and outpatient clinics.
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Affiliation(s)
- Mylien T Duong
- Education, Research, and Impact, Committee for Children, Seattle, USA.
| | - Eric J Bruns
- University of Washington School of Medicine, Seattle, USA
| | - Kristine Lee
- University of Washington School of Medicine, Seattle, USA
| | - Shanon Cox
- University of Washington School of Medicine, Seattle, USA
| | | | | | - Aaron R Lyon
- University of Washington School of Medicine, Seattle, USA
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Cook CR, Lyon AR, Locke J, Waltz T, Powell BJ. Adapting a Compilation of Implementation Strategies to Advance School-Based Implementation Research and Practice. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:914-935. [PMID: 31152328 DOI: 10.1007/s11121-019-01017-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Schools, like other service sectors, are confronted with an implementation gap, with the slow adoption and uneven implementation of evidence-based practices (EBP) as part of routine service delivery, undermining efforts to promote better youth behavioral health outcomes. Implementation researchers have undertaken systematic efforts to publish taxonomies of implementation strategies (i.e., methods or techniques that are used to facilitate the uptake, use, and sustainment of EBP), such as the Expert Recommendations for Implementing Change (ERIC) Project. The 73-strategy ERIC compilation was developed in the context of healthcare and largely informed by research and practice experts who operate in that service sector. Thus, the comprehensibility, contextual appropriateness, and utility of the existing compilation to other service sectors, such as the educational setting, remain unknown. The purpose of this study was to initiate the School Implementation Strategies, Translating ERIC Resources (SISTER) Project to iteratively adapt the ERIC compilation to the educational sector. The results of a seven-step adaptation process resulted in 75 school-adapted strategies. Surface-level changes were made to the majority of the original ERIC strategies (52 out of 73), while five of the strategies required deeper modifications for adaptation to the school context. Six strategies were deleted and seven new strategies were added based on existing school-based research. The implications of this study's findings for prevention scientists engaged in implementation research (e.g., creating a common nomenclature for implementation strategies) and limitations are discussed.
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Affiliation(s)
- Clayton R Cook
- University of Minnesota, Twin Cities, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA.
| | - Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Jill Locke
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Thomas Waltz
- Eastern Michigan University, 301D Science Complex, Ypsilanti, MI, 48197, USA
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
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A Multidimensional, Multi-tiered System of Supports Model to Promote School Attendance and Address School Absenteeism. Clin Child Fam Psychol Rev 2020; 23:316-337. [DOI: 10.1007/s10567-020-00317-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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19
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NeMoyer A, Nakash O, Fukuda M, Rosenthal J, Mention N, Chambers VA, Delman D, Perez G, Green JG, Trickett E, Alegría M. Gathering Diverse Perspectives to Tackle "Wicked Problems": Racial/Ethnic Disproportionality in Educational Placement. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 65:44-62. [PMID: 31273819 PMCID: PMC7059762 DOI: 10.1002/ajcp.12349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Among students receiving behavioral health and special education services, racial/ethnic minority students are consistently overrepresented in settings separate from general classrooms. Once separated, many young people struggle to improve academically and face significant difficulty upon trying to return to a general education setting. Given the complex, ongoing, and multifaceted nature of this challenge, racial/ethnic disproportionality can be identified as a "wicked problem," for which solutions are not easily identified. Here, we describe our community-engaged research efforts, eliciting perspectives from relevant partners in an ongoing dialogue, to better integrate diverse stakeholders' perspectives when attempting to address such disparities. We conducted focus groups and qualitative interviews with members of three stakeholder groups: community-serving organizations, individuals with lived experience of behavioral health conditions, and state-level policymakers, with a shared interest in addressing racial and ethnic disparities. Participant responses illustrated the "wickedness" of this problem and highlighted the need for additional supports for students, families, and school personnel, increased collaboration across relevant systems and agencies, and reduced barriers related to funding. Overall, this methodology bridged differing perspectives to develop, in concert with our partners, a shared language of the problem and a core set of issues to consider when seeking to effect change.
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Affiliation(s)
- Amanda NeMoyer
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ora Nakash
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya, Herzliya, Israel
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jill Rosenthal
- National Academy for State Health Policy, Portland, ME, USA
| | - Najeia Mention
- National Academy for State Health Policy, Portland, ME, USA
| | | | | | | | - Jennifer G Green
- Wheelock College of Education and Human Development, Boston University, Boston, MA, USA
| | - Edison Trickett
- School of Education and Human Development, University of Miami, Coral Gables, FL, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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20
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Gini G, Holt M, Pozzoli T, Marino C. Victimization and Somatic Problems: The Role of Class Victimization Levels. THE JOURNAL OF SCHOOL HEALTH 2020; 90:39-46. [PMID: 31707741 DOI: 10.1111/josh.12844] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/24/2018] [Accepted: 03/12/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND The link between peer victimization and somatic problems is well-established. What is currently understudied is under what contextual conditions victims' health might be most likely to be compromised. Studies demonstrate that victims suffer from poorer adjustment when they belong to a group in which victimization is less normative (social misfit hypothesis). We examined whether the association between individual victimization and somatic problems was stronger in classrooms with lower class victimization. METHODS A sample of 1906 adolescents (65% girls; Mage = 14.4, SD = 1.2) completed a survey about school life quality, peer victimization, and health problems. RESULTS Multilevel modeling with Bayes estimator indicated modest variation in somatic problems between classrooms. At the individual level, peer victimization was associated with higher reports of somatic problems. This association varied across classroom as a function of class victimization level. Simple slope computation confirmed that the association between peer victimization and somatic complaints became stronger as class victimization levels decreased. CONCLUSIONS Victims in classrooms with lower levels of victimization are more likely to report somatic problems. Anti-bullying programs should consider the effects of class norms on victims' adjustment and address the possible risks for those who continue to be victimized.
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Herrenkohl TI, Hong S, Verbrugge B. Trauma-Informed Programs Based in Schools: Linking Concepts to Practices and Assessing the Evidence. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:373-388. [PMID: 31355976 DOI: 10.1002/ajcp.12362] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
When children experience stress and adversity in their homes and communities, schools become a critically important setting in which to intervene and foster their resilience. Changing practices within schools so that vulnerable and traumatized children are better understood and more compassionately served is a goal shared by many school professionals, yet schools remain poorly equipped to address the needs of these children. Any number of school-based programs have the potential to benefit children with an elevated risk for academic difficulties and mental health disorders, although questions remain as to which programs are most promising, effective, and sustainable. Questions also remain about which programs best serve diverse populations and which have potential to reach the largest number of children, including those who do not outwardly manifest behaviors consistent with an underlying disorder but nonetheless require support. In this review, we take stock of existing programs used in schools to address the social, emotional, and academic needs of children with trauma histories. We summarize components of a various trauma-focused programs, categorized as: (a) individual and group-based approaches, (b) classroom-based approaches, and (c) school-wide approaches. For each category, we review and comment on the state and quality of research findings and provide illustrative examples from the literature to show how programs address trauma in the school context. Findings of the review suggest that empirical evidence currently favors individual and group-based approaches, although classroom-based and school-wide programs may be better positioned for integration, access to services, and sustainability. Implications and recommendations center on future research, practice, and policy.
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Affiliation(s)
| | - Sunghyun Hong
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
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Lyon AR, Whitaker K, Richardson LP, French WP, McCauley E. Collaborative Care to Improve Access and Quality in School-Based Behavioral Health. THE JOURNAL OF SCHOOL HEALTH 2019; 89:1013-1023. [PMID: 31612501 DOI: 10.1111/josh.12843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/27/2018] [Accepted: 08/12/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Collaborative care (CC) is a well-established approach for the delivery of accessible behavioral health services in integrated health care settings. Substantial evidence supports its effectiveness in improving the quality and outcomes of adult services, and growing research indicates utility with child and adolescent populations. METHODS To date, studies examining CC models for youth have focused exclusively on primary-care settings. Nevertheless, as the most common integrated service delivery setting for youth, the education sector is an equally important context for improving access to behavioral health services for children and adolescents. RESULTS We provide a narrative review of the literature on CC, describes the relevance of CC to schools, and details its alignment with contemporary movements in education and school-based behavioral health. CONCLUSIONS Potential adaptations of the CC model for use in schools are detailed to improve: (1) behavioral health service accessibility, (2) the capacity of schools to provide behavioral health services, and (3) school service effectiveness through use of evidence-based practices. Although little research has explored the applicability of CC in the education sector, the model holds potential promise to improve the quality and efficiency of school-based behavioral health services.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
| | - Kelly Whitaker
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
| | - Laura P Richardson
- University of Washington/Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, M/S CW8-6, Seattle, WA, 98121
| | - William P French
- University of Washington, 4800 Sand Point Way NE, M/S OA.5.154, PO Box 5371, Seattle, WA, 98145
| | - Elizabeth McCauley
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
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Lyon AR, Cook CR, Locke J, Davis C, Powell BJ, Waltz TJ. Importance and feasibility of an adapted set of implementation strategies in schools. J Sch Psychol 2019; 76:66-77. [PMID: 31759470 PMCID: PMC6876555 DOI: 10.1016/j.jsp.2019.07.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 03/03/2019] [Accepted: 07/25/2019] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, United States of America.
| | - Clayton R Cook
- University of Minnesota, 250 Education Sciences Bldg, 56 East River Road, Minneapolis, MN 55455, United States of America.
| | - Jill Locke
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, United States of America.
| | - Chayna Davis
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, United States of America.
| | - Byron J Powell
- University of North Carolina at Chapel Hill, 1105C McGavran-Greenberg Hall, Campus Box 7411, 135 Dauer Drive, Chapel Hill, NC 27599, United States of America.
| | - Thomas J Waltz
- Eastern Michigan University, 900 Oakwood St., Ypsilanti, MI 48197, United States of America.
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Locke J, Lee K, Cook CR, Frederick L, Vázquez-Colón C, Ehrhart MG, Aarons GA, Davis C, Lyon AR. Understanding the Organizational Implementation Context of Schools: A Qualitative Study of School District Administrators, Principals, and Teachers. SCHOOL MENTAL HEALTH 2019; 11:379-399. [PMID: 31681447 PMCID: PMC6824712 DOI: 10.1007/s12310-018-9292-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
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.
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Taylor LK, Goldberg MG, Tran MHD. Promoting Student Success: How Do We Best Support Child and Youth Survivors of Catastrophic Events? Curr Psychiatry Rep 2019; 21:82. [PMID: 31410584 DOI: 10.1007/s11920-019-1067-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW School mental health services have achieved recognition for increased access to care and intervention completion rates. While best practice recommendations include connection of school mental health programming to multi-tiered systems of support that promote early identification and intervention, many schools struggle to operationalize student screening for trauma exposure, trauma symptoms, and service identification. Relatedly, progress monitoring for trauma symptoms, and the effect of trauma on school functioning in the context of catastrophic events, can also be difficult to systematically collect. RECENT FINDINGS Research regarding the effects of catastrophic events, such as exposure to natural disasters, terrorist attacks, war, or the journey to refugee status on children and youths school functioning, indicates salient age and gender differences among student responses. In addition, school professionals have been identified as sources of social support for students and as potential brokers to school linked intervention resources for children, youth, and their families. Based on our review, we outline recommendations for school professionals, including potential changes to school policies and procedures, and delineate future research questions.
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Affiliation(s)
- Leslie K Taylor
- Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, 1941 East Rd, Houston, TX, 77054, USA.
| | - Melissa G Goldberg
- Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, 1941 East Rd, Houston, TX, 77054, USA
| | - Minh-Hao D Tran
- Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, 1941 East Rd, Houston, TX, 77054, USA
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Gaias LM, Lindstrom Johnson S, White RMB, Pettigrew J, Dumka L. Positive School Climate as a Moderator of Violence Exposure for Colombian Adolescents. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 63:17-31. [PMID: 30609076 DOI: 10.1002/ajcp.12300] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In Colombia, many adolescents have experienced violence related to the decades-long armed conflict in the country and have witnessed or been directly victimized by violence in their communities, often related to gang activity or drug trafficking. Exposure to violence, both political and community violence, has detrimental implications for adolescent development. This study used data from 1857 Colombian adolescents in an urban setting. We aim to understand the relations between exposure to violence and adolescent outcomes, both externalizing behaviors and developmental competence, and then to understand whether school climate (i.e., safety, connectedness, services) moderates these relations. Results demonstrate that armed conflict, community violence victimization, and witnessing community violence are positively associated with externalizing behaviors, but only armed conflict is negatively associated with developmental competence. School safety, connectedness, and services moderate the relation between community violence witnessing and externalizing behaviors. School services moderates the relation between community violence victimization and developmental competence. As students perceived more positive school climate, the effects of community violence exposure on outcomes were weakened. This study identifies potential levers for intervention regarding how schools can better support violence-affected youth through enhancements to school safety, connectedness, and services.
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Affiliation(s)
| | - Sarah Lindstrom Johnson
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
| | - Rebecca M B White
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
| | - Jonathan Pettigrew
- Hugh Downs School of Human Communication, Arizona State University, Tempe, AZ, USA
| | - Larry Dumka
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
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27
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Atoum M, Alhussami M, Rayan A. Emotional and behavioral problems among Jordanian adolescents: Prevalence and associations with academic achievement. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2018; 31:70-78. [PMID: 30298603 DOI: 10.1111/jcap.12211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 09/08/2018] [Accepted: 09/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mental health concerns are important for adolescent's general wellbeing and they can be associated with their ability to function effectively in various aspects of their daily life. AIM The purpose of this study was to identify emotional and behavioral disorders (EBD) among Jordanian adolescents and their association with academic outcomes. METHODS A descriptive correlational design was used. A total of 810 adolescents participated in the study and completed the demographic survey and the Strengths and Difficulties Questionnaire (SDQ). The grade point average (GPA) was used as an indicator of the academic achievement. The GPA was correlated with the SDQ scores to identify the relationship between the EBD and academic achievement. RESULTS About 11.7% of the participants had psychological and behavioral problems. The most commonly reported problems were emotional symptoms (14.2%), conduct problems (12.5%), and hyperactivity (7.5%). There was a significant difference in psychological and behavioral problems according to the participants' gender. There was a significant negative relationship between the SDQ scores and the GPA. CONCLUSION There is a need to identify adolescents at risk of emotional and behavioral difficulties and refer them to appropriate care and support, which in turn would improve their academic achievement.
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Affiliation(s)
- Maysoun Atoum
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarga, Jordan
| | - Mahmoud Alhussami
- Department of Community Health Nursing, School of Nursing, The University of Jordan, Amman, Jordan
| | - Ahmad Rayan
- Department of Nursing, Faculty of Nursing, Zarqa University, Zarqa, Jordan
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Kilbourne AM, Smith SN, Choi SY, Koschmann E, Liebrecht C, Rusch A, Abelson JL, Eisenberg D, Himle JA, Fitzgerald K, Almirall D. Adaptive School-based Implementation of CBT (ASIC): clustered-SMART for building an optimized adaptive implementation intervention to improve uptake of mental health interventions in schools. Implement Sci 2018; 13:119. [PMID: 30185192 PMCID: PMC6126013 DOI: 10.1186/s13012-018-0808-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022] Open
Abstract
Background Depressive and anxiety disorders affect 20–30% of school-age youth, most of whom do not receive adequate services, contributing to poor developmental and academic outcomes. Evidence-based practices (EBPs) such as cognitive behavioral therapy (CBT) can improve outcomes, but numerous barriers limit access among affected youth. Many youth try to access mental health services in schools, but school professionals (SPs: counselors, psychologists, social workers) are rarely trained adequately in CBT methods. Further, SPs face organizational barriers to providing CBT, such as lack of administrative support. Three promising implementation strategies to address barriers to school-based CBT delivery include (1) Replicating Effective Programs (REP), which deploys customized CBT packaging, didactic training in CBT, and technical assistance; (2) coaching, which extends training via live supervision to improve SP competence in CBT delivery; and (3) facilitation, which employs an organizational expert who mentors SPs in strategic thinking to promote self-efficacy in garnering administrative support. REP is a relatively low-intensity/low-cost strategy, whereas coaching and facilitation require additional resources. However, not all schools will require all three strategies. The primary aim of this study is to compare the effectiveness of a school-level adaptive implementation intervention involving REP, coaching, and facilitation versus REP alone on the frequency of CBT delivered to students by SPs and student mental health outcomes. Secondary and exploratory aims examine cost-effectiveness, moderators, and mechanisms of implementation strategies. Methods Using a clustered, sequential multiple-assignment, randomized trial (SMART) design, ≥ 200 SPs from 100 schools across Michigan will be randomized initially to receive REP vs. REP+coaching. After 8 weeks, schools that do not meet a pre-specified implementation benchmark are re-randomized to continue with the initial strategy or to augment with facilitation. Discussion EBPs need to be implemented successfully and efficiently in settings where individuals are most likely to seek care in order to gain large-scale impact on public health. Adaptive implementation interventions hold the promise of providing cost-effective implementation support. This is the first study to test an adaptive implementation of CBT for school-age youth, at a statewide level, delivered by school staff, taking an EBP to large populations with limited mental health care access. Trial registration NCT03541317—Registered on 29 May 2018 on ClinicalTrials.gov PRS Electronic supplementary material The online version of this article (10.1186/s13012-018-0808-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy M Kilbourne
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA. .,U.S. Department of Veterans Affairs, Quality Enhancement Research Initiative, Washington D.C., USA.
| | - Shawna N Smith
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Seo Youn Choi
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Elizabeth Koschmann
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Celeste Liebrecht
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Amy Rusch
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James L Abelson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel Eisenberg
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joseph A Himle
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Kate Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Cook CR, Davis C, Brown EC, Locke J, Ehrhart MG, Aarons GA, Larson M, Lyon AR. Confirmatory factor analysis of the Evidence-Based Practice Attitudes Scale with school-based behavioral health consultants. Implement Sci 2018; 13:116. [PMID: 30134943 PMCID: PMC6106841 DOI: 10.1186/s13012-018-0804-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/03/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Evidence-Based Practice Attitude Scale (EBPAS) is a widely used tool, but it has not been adapted and validated for use in schools, the most common setting where youth access behavioral health services. This study examined the factor structure, psychometric properties, and criterion-related validity of the school-adapted EBPAS in a sample of school-based behavioral health consultants. METHOD A research team comprised of experts in implementation of evidence-based practices in schools along with the original developer adapted the EBPAS for the school setting. The adapted instrument was administered to a representative sample (n = 196) of school-based behavioral health consultants to assess the reliability and structural validity via a series of confirmatory factor analyses. RESULTS The original EBPAS factor structure was confirmed, with the final model supporting four first-order factors that load onto a second-order factor capturing general attitudes toward evidence-based practice. Correlations among the subscales indicated both unique and shared variance. Correlations between EBPAS scores and consultant variables demonstrated differential criterion-related validity, with the total score and the Requirements and Openness subscales demonstrating the strongest correlations. CONCLUSIONS The adapted EBPAS performed well when administered to behavioral health consultants operating in the educator sector, supporting the relevance of assessing attitudes in school settings. Potential directions for future research and applications of the EBPAS in schools and other service sectors are discussed.
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Affiliation(s)
- Clayton R Cook
- University of Minnesota, 341 Education Sciences Bldg, 56 East River Road, Minneapolis, MN, 55455, USA.
| | - Chayna Davis
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Eric C Brown
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Office 104, Miami, FL, 33136, USA
| | - Jill Locke
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Mark G Ehrhart
- University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816-1390, USA
| | - Gregory A Aarons
- University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093, USA.,Child and Adolescent Services Research Center, La Jolla, USA
| | - Madeline Larson
- University of Minnesota, 341 Education Sciences Bldg, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
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Pilot Test of an Engagement, Triage, and Brief Intervention Strategy for School Mental Health. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9277-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Fan CH, Zhang Y, Cook CR, Yang NJ. Exploring the Factor Structure of the RTI Readiness and Implementation Survey. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2018. [DOI: 10.1080/15377903.2018.1458673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Chung-Hau Fan
- Department of School Psychology and Educational Leadership, Idaho State University, Pocatello, Idaho, USA
| | - Yanchen Zhang
- Department of Educational Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Clayton R. Cook
- Department of Educational Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nai-Jiin Yang
- Department of School Psychology and Educational Leadership, Idaho State University, Pocatello, Idaho, USA
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How Do School Mental Health Services Vary Across Contexts? Lessons Learned from Two Efforts to Implement a Research-Based Strategy. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-017-9243-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lyon AR, Cook CR, Brown EC, Locke J, Davis C, Ehrhart M, Aarons GA. Assessing organizational implementation context in the education sector: confirmatory factor analysis of measures of implementation leadership, climate, and citizenship. Implement Sci 2018; 13:5. [PMID: 29310673 PMCID: PMC5759223 DOI: 10.1186/s13012-017-0705-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/27/2017] [Indexed: 12/03/2022] Open
Abstract
Background A substantial literature has established the role of the inner organizational setting on the implementation of evidence-based practices in community contexts, but very little of this research has been extended to the education sector, one of the most common settings for the delivery of mental and behavioral health services to children and adolescents. The current study examined the factor structure, psychometric properties, and interrelations of an adapted set of pragmatic organizational instruments measuring key aspects of the organizational implementation context in schools: (1) strategic implementation leadership, (2) strategic implementation climate, and (3) implementation citizenship behavior. Method The Implementation Leadership Scale (ILS), Implementation Climate Scale (ICS), and Implementation Citizenship Behavior Scale (ICBS) were adapted by a research team that included the original scale authors and experts in the implementation of evidence-based practices in schools. These instruments were then administered to a geographically representative sample (n = 196) of school-based mental/behavioral health consultants to assess the reliability and structural validity via a series of confirmatory factor analyses. Results Overall, the original factor structures for the ILS, ICS, and ICBS were confirmed in the current sample. The one exception was poor functioning of the Rewards subscale of the ICS, which was removed in the final ICS model. Correlations among the revised measures, evaluated as part of an overarching model of the organizational implementation context, indicated both unique and shared variance. Conclusions The current analyses suggest strong applicability of the revised instruments to implementation of evidence-based mental and behavioral practices in the education sector. The one poorly functioning subscale (Rewards on the ICS) was attributed to typical educational policies that do not allow for individual financial incentives to personnel. Potential directions for future expansion, revision, and application of the instruments in schools are discussed.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Clayton R Cook
- University of Minnesota, 250 Education Sciences Bldg, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Eric C Brown
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Office 104, Miami, FL, 33136, USA
| | - Jill Locke
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Chayna Davis
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Mark Ehrhart
- University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816-1390, USA
| | - Gregory A Aarons
- University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093, USA.,Child and Adolescent Services Research Center, 9500 Gilman Drive (0812), La Jolla, CA, 92093, USA
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Factors Associated with Developmental Behavioral Pediatricians Prescribing Psychotropic Medication to Children with Autism Spectrum Disorder: A Study of Three DBPNet Sites. J Dev Behav Pediatr 2017; 38:584-592. [PMID: 28816917 DOI: 10.1097/dbp.0000000000000488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Psychotropic medications are frequently prescribed to children with autism spectrum disorder (ASD), but little is known about the prescribing practices of developmental-behavioral pediatricians (DBPs). Our objective was to determine whether clinical site, age, insurance, or comorbidities influenced DBPs prescribing psychotropic medication for children with ASD. METHODS A retrospective analysis was performed using electronic health record data of all patients with ASD seen at 3 academic developmental-behavioral pediatrics (DBP) clinical programs from January 2010 to December 2011. Data included age, diagnoses, primary insurance, and medications prescribed. Factors associated with prescribing psychotropic medication were examined using generalized estimating equations. RESULTS Sites varied in the frequency with which they prescribed psychotropic medication for children with ASD (site 1: 33.1%, site 2: 49.3%, site 3: 4.0%; p < .001). We found that the following factors predicted prescribing of psychotropic medications: comorbidities (odds ratio [OR]: 2.87; 95% confidence interval [CI], 2.58-3.18), age, and primary insurance. However, the impact of insurance depended on age. For 3- to 5-year-old children, those on Medicaid were more likely to be prescribed psychotropic medications than those with private insurance (OR: 1.65; 95% CI, 1.29-2.12). This was particularly true for alpha-2-adrenergic agonists (OR: 2.48; 95% CI, 1.56-3.92) and atypical antipsychotics (OR: 2.57; 95% CI, 1.46-4.55). CONCLUSION There are large variations in prescribing psychotropic medication to children with ASD at 3 academic DBP programs. Further research is needed to understand factors that contribute to higher use of psychotropic medication in young children with Medicaid.
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Weist MD, Bruns EJ, Whitaker K, Wei Y, Kutcher S, Larsen T, Holsen I, Cooper JL, Geroski A, Short KH. School mental health promotion and intervention: Experiences from four nations. SCHOOL PSYCHOLOGY INTERNATIONAL 2017. [DOI: 10.1177/0143034317695379] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
All around the world, partnerships among schools and other youth-serving systems are promoting more comprehensive school-based mental health services. This article describes the development of international networks for school mental health (SMH) including the International Alliance for Child and Adolescent Mental Health and Schools (INTERCAMHS) and the more recent School Mental Health International Leadership Exchange (SMHILE). In conjunction with World Conferences on Mental Health Promotion, SMHILE has held pre-conference and planning meetings and has identified five critical themes for the advancement of global SMH: 1) Cross-sector collaboration in building systems of care; 2) meaningful youth and family engagement; 3) workforce development and mental health literacy; 4) implementation of evidence-based practices; and 5) ongoing monitoring and quality assurance. In this article we provide general background on SMH in four nations, two showing strong progress (the United States and Canada), one showing moderate progress (Norway), and one beginning the work (Liberia). Following general background for each country, actions in relation to the SMHILE themes are reviewed. The article concludes with plans and ideas for future global collaboration towards advancement of the SMH field.
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Lyon AR, Whitaker K, French WP, Richardson LP, Wasse JK, McCauley E. Collaborative Care in Schools: Enhancing Integration and Impact in Youth Mental Health. ADVANCES IN SCHOOL MENTAL HEALTH PROMOTION 2016; 9:148-168. [PMID: 28392832 PMCID: PMC5383210 DOI: 10.1080/1754730x.2016.1215928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Collaborative Care is an innovative approach to integrated mental health service delivery that focuses on reducing access barriers, improving service quality, and lowering healthcare expenditures. A large body of evidence supports the effectiveness of Collaborative Care models with adults and, increasingly, for youth. Although existing studies examining these models for youth have focused exclusively on primary care, the education sector is also an appropriate analog for the accessibility that primary care offers to adults. Collaborative Care aligns closely with the practical realities of the education sector and may represent a strategy to achieve some of the objectives of increasingly popular multi-tiered systems of supports frameworks. Unfortunately, no resources exist to guide the application of Collaborative Care models in schools. Based on the existing evidence for Collaborative Care models, the current paper (1) provides a rationale for the adaptation of Collaborative Care models to improve mental health service accessibility and effectiveness in the education sector; (2) presents a preliminary Collaborative Care model for use in schools; and (3) describes avenues for research surrounding school-based Collaborative Care, including the currently funded Accessible, Collaborative Care for Effective School-based Services (ACCESS) project.
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