BackgroundDespite consistent recognition of their influence, empirical study of how outer setting factors (e.g., policies, financing, stakeholder relationships) influence public systems’ investment in and adoption of evidence-based treatment (EBT) is limited. This study examined associations among unmodifiable (e.g., demographic, economic, political, structural factors) and modifiable (e.g., allocation of resources, social processes, policies, and regulations) outer setting factors and adoption of behavioral health EBT by US states.MethodsMultilevel models examined relationships between state characteristics, an array of funding and policy variables, and state adoption of behavioral health EBTs for adults and children across years 2002–2012, using data from the National Association for State Mental Health Program Directors Research Institute and other sources.ResultsSeveral unmodifiable state factors, including per capita income, controlling political party, and Medicaid expansion, predicted level of state fiscal investments in EBT. By contrast, modifiable factors, such as interagency collaboration and investment in research centers, were more predictive of state policies supportive of EBT. Interestingly, level of adult EBT adoption was associated with state fiscal supports for EBT, while child EBT adoption was predicted more by supportive policies. State per capita debt and direct state operation of services (versus contracting for services) predicted both child and adult EBT adoption.ConclusionsState-level EBT adoption and associated implementation support is associated with an interpretable array of policy, financing, and oversight factors. Such information expands our knowledge base of the role of the outer setting in implementation and may provide insight into how best to focus efforts to promote EBT for behavioral health disorders.

Despite research demonstrating the importance of student–teacher relationships for student functioning, little is known about strategies to enhance such relationships, particularly in secondary school. The current study examined effects of a professional development for middle school teachers on the Establish-Maintain-Restore (EMR) approach. EMR aims to enhance teachers’ skills in cultivating relationships with students and involves brief training (3 hr) and ongoing implementation supports. In a randomized controlled trial, 20 teachers and 190 students were assigned to EMR or control. Observers rated academically engaged time and disruptive behavior, and teachers reported on relationship quality. Multilevel models showed that EMR resulted in significant improvements in student–teacher relationships (Hedge’s g = .61, 95% CI [0.21, 1.02]), academically engaged time (g = .81, 95% CI [0.01, 1.63]), and disruptive behavior (g = 1.07, 95% CI [0.01, 2.16]). Results indicate potential promise for EMR.

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Quantitative methods remain the fundamental approach for hypothesis testing, but in approaches to data analysis there is substantial evidence of a gap between what is optimal and what is typical. It is clear that diffusion and dissemination alone are not maximally effective at improving data analytic practices in clinical psychological science. Amid declines in quantitative psychology training, and growing demand for advanced quantitative methods, applied researchers are increasingly called upon to conduct and evaluate research using methods in which they lack expertise. This "research-to-practice" gap in which rigorously developed and empirically supported quantitative methods are not applied in practice has received little attention. In this article, we describe how implementation science, which aims to reduce the research-to-practice gap in health care, offers a promising set of methods for closing the gap for quantitative methods. By identifying determinants of practice (i.e., barriers and facilitators of change), implementation strategies can be selected to increase adoption and high-fidelity application of new quantitative methods to improve scientific inferences and policy and practice decisions in clinical psychological science. General scientific summary: Making studies more replicable will require more effective use of statistics in research, but there is a large gap between how statistics are applied in psychological research and how they should be applied. The current article describes how the lessons of clinical implementation science, which has focused on getting evidence based treatments into community practice settings, may be applied to improve research in clinical psychology.

Despite evidence that school mental health can enhance access to care for students from marginalized racial/ethnic groups, disparities remain in the appropriateness, quality, effectiveness, and outcomes of school mental health services. Implementation strategies hold some promise for addressing the disparities that emerge as result of inequitable implementation of mental health services. However, without explicitly examining implementation strategies through an equity lens, it is unclear the extent to which they will promote equitable implementation or student outcomes. Thus, the goal of the current paper is to describe the Adapting Strategies to Promote Implementation Reach and Equity framework, a generalizable process for adapting implementation strategies to explicitly center the goal of reducing disparities in implementation and service recipient outcomes. We outline a three‐step process for incorporating an equity lens into implementation strategies and provide examples of how this framework can be applied to implementation strategies in school mental health. We also discuss examples of projects where implementation strategies were intentionally paired with school mental health programs to enhance racial equity. Implications and recommendations for school mental health and implementation research and practice are discussed.

The psychotherapy field has focused on evidence‐based intervention (EBIs) packages as the primary vehicle for implementing evidence‐based practices. EBIs tend to employ a replacement paradigm that is both inconsistent with the skill augmentation approach service providers prefer and relatively ineffective for changing clinician behavior. EBIs comprise both intervention content (i.e., specific clinical techniques) and intervention structures (i.e., supports that organize content). Although usual care typically includes delivery of some EBI content elements, insufficient attention has been paid to the contextually‐appropriate improvement opportunities provided by evidence‐based intervention structures. Two candidate structures—measurement‐based care and structured supervision—are reviewed surrounding their ability to support “high‐fidelity treatment as usual,” or the explicit planning and deployment of practices already present in experienced providers’ clinical repertoires.

Background Individual-level implementation determinants, such as clinician attitudes, commonly influence the successful adoption of evidence-based practices, but few explicit strategies have been tested with regard to their ability to impact these key mechanisms of change. This paper reports on an initial test of a blended, theoretically informed pre-implementation strategy designed to target malleable individual-level determinants of behavior change. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a brief and pragmatic pre-implementation strategy that uses strategic education, social influence techniques, and group-based motivational interviewing to target implementation attitudes, perceived social norms, perceived behavioral control, and behavioral intentions to implement among mental health clinicians working in the education sector. Methods As part of a pilot trial, 25 school mental health clinicians were randomized to BASIS ( n = 12) or an attention control placebo ( n = 13), with both conditions receiving training and consultation in an evidence-based intervention for youth experiencing trauma (the Cognitive Behavioral Intervention for Trauma in Schools). Theorized mechanisms of change (attitudes, perceived social norms, perceived behavioral control, and behavioral intentions) were assessed at baseline, post-training, and 4-month follow-up. Clinician participation in post-training consultation and intervention adoption were also tracked. Results A series of regression models and independent sample t tests indicated that BASIS had significant, medium to large effects on the majority of its proximal mechanisms from baseline to post-training. BASIS was also associated with a greater latency between initial training in the intervention and discontinuation of participation in post-training consultation, with clinicians in the BASIS condition persisting in consultation for an average of 134 days versus 32 days for controls, but this difference was not statistically significant. At 4-month follow-up, most differences in the theorized mechanisms had attenuated, and approximately the same small number of BASIS clinicians adopted the trauma intervention as controls. Conclusion Findings suggest that the brief BASIS pre-implementation strategy had a significant influence on its proximal mechanisms of change, but that these changes did not persist over time or translate into adoption of the trauma intervention. Implications for theory refinement, revisions to the BASIS protocol, and next steps for research surrounding individual-level implementation strategies are discussed. Trial registration ClinicalTrials.gov Identifier: NCT03791281 . Registered 31 December 2018—Retrospectively registered Electronic supplementary material The o...