A Pre-Implementation Enhancement Strategy to Increase the Yield of Training and Consultation for School-Based Behavioral Preventive Practices: a Triple-Blind Randomized Controlled Trial

Abstract

Background : As the most common setting where youth access behavioral healthcare, the education sector frequently employs training and follow-up consultation as cornerstone implementation strategies to promote the implementation of evidencebased practices (EBPs). However, these strategies alone are not sufficient to promote desirable implementation (e.g., intervention fidelity) and youth behavioral outcomes (e.g., mitigated externalizing behaviors). Theory-informed pragmatic preimplementation enhancement strategies (PIES) are needed to prevent the lackluster outcomes of training and consultation. Specifically, social-cognitive theory explicates principles that inform the design of PIES content and specify mechanisms of behavior change (e.g., " intentions to implement "; ITI) to target increasing providers' responsiveness to training and consultation. Methods: This triple-blind parallel randomized controlled trial preliminarily examined the efficacy of a pragmatic PIES based on social-cognitive theories (SC-PIES) to improve implementation and youth behavioral outcomes from universal preventive EBPs in the education sector. Teachers from a diverse urban district were recruited and randomly assigned to the treatment (SC-PIES; n treatment = 22) or active control condition (administrative meeting; n control = 21). Based on the condition assigned, teachers received the SC-PIES or met with administrators before their EBP training. We assessed teachers' ITI, intervention fidelity, and youth behavioral outcome (academic engagement as an incompatible Powered by Editorial Manager® and ProduXion Manager® from Aries Systems CorporationNote. This paper has been accepted by Prevention Science behavior to externalizing disorders) at baseline, immediately after training, and six weeks afterward. Results : A series of ANCOVAs detected sizeable effects of SC-PIES, where teachers who received SC-PIES demonstrated significantly larger improvement in their ITI, intervention fidelity, and youth behaviors as compared to the control. Conditional analyses indicated that teachers' ITI partially mediated the effect of SC-PIES on intervention fidelity, which in turn led to improved youth behaviors. Conclusions : Findings suggest that theory-informed pragmatic PIES targeting providers' ITI can boost their responsiveness to implementation strategies, as reflected in improved implementation behaviors and youth behavioral outcomes. The results have implications for targeting motivational mechanisms of behavior change and situating preventive implementation strategies at the intersection between the preparation and active implementation stages of an implementation process. Limitations and implications for research and practice are discussed. Trial registration: Clinicaltrials.gov: NCT05240222. Registered on: 2/14/2022. Retrospectively registered. https://clinicaltrials.gov/show/NCT05240222

Associations among educators’ beliefs, intervention fidelity, and student outcomes in school-wide positive behavior interventions, and supports: A school-level moderated mediation analysis.

“…For instance, school consultants can designate influential members in the building as "implementation champions" to share publicly with colleagues the importance and benefits of SWPBIS for their work and student outcomes. School leaders can prioritize their implementation-specific leadership behaviors (e.g., effective and proactive communication and support for SWPBIS) while adopting policies and practices that foster an implementation-specific climate that explicitly encourages and rewards the delivery of SWPBIS (Zhang et al, 2022). More research is needed to develop more school-level theory-informed implementation strategies to promote staff's shared supportive beliefs about EBPs that entail school-level implementation, although emerging research exists on such implementation strategies at the individual level.…”

“…These implementation strategies were based on social–cognitive principles of saying is believing, commitment and consistency, and social proofing (Cialdini, 2001). School-based research has indicated that, when teachers participated in activities designed to improve their behavioral and normative beliefs about implementing an EBP before attending training about the EBP, they exhibited improved intentions and intervention fidelity in their subsequent delivery of the EBP (e.g., Zhang et al, 2022). Regarding behavioral beliefs and attitudes, saying is believing indicates that, when individuals publicly advocate for a behavior, they often modify their own beliefs and attitudes toward that behavior to align with their commitment, even if their initial views were different (Aronson et al, 2002).…”

“…Moreover, for universal EBPs like SWPBIS, it is common for educators to receive implementation support such as intensive training and coaching (e.g., Scaletta & Tejero Hughes, 2021). However, educators may be ambivalent or resistant to implementing new EBPs after receiving these implementation supports, resulting in suboptimal implementation and student outcomes (Zhang et al, 2022). Hence, implementation strategies for promoting educators’ beliefs supportive of SWPBIS (e.g., SBI) are better positioned at the initial stage of an implementation process when educators start receiving implementation support.…”

“…Hence, implementation strategies for promoting educators’ beliefs supportive of SWPBIS (e.g., SBI) are better positioned at the initial stage of an implementation process when educators start receiving implementation support. This way, educators will come to the training with positive beliefs, which can enhance their receptiveness to and benefit from the implementation support (Zhang et al, 2022).…”

School‐Based Mental Health Interventions: Recommendations for Selecting and Reporting Implementation Strategies*

“…Additionally, pre-implementation enhancement strategies 20,21 are particularly relevant for the Preparation phase. Pre-implementation enhancement strategies are delivered prior to the active implementation phase, with the goal of enhancing the impact of implementation-phase strategies.…”