A Systematic Review of the Facilitators and Barriers to the Sustained Implementation of School-Wide Positive Behavioral Interventions and Supports

Usability and social consequences of the early identification system as a universal screener for social, emotional, and behavioral risks.

“…On a positive note we did not find evidence that fidelity of implementation varied based on school-level student characteristics including the proportion of students who qualified for FRPL or who identified as White. Though future studies will need to replicate this finding with more fine-tuned analyses, these findings counter trends in implementation science suggesting that schools with higher percentage of students on FRPL implement less well (Fox et al, 2021; Schaper et al, 2016). It may be that the EIS design and implementation features mitigate the challenges that high FRPL schools encounter when attempting to implement full-school initiatives.…”

“…One way to frame equitable use of a tool or framework is to examine how consistently and properly it is applied across different school contexts where known inequities occur. For instance, some research has shown that schools with lower resources and higher levels of student need are less able or likely to implement evidence-based interventions (Fox et al, 2021). Several studies examining implementation fidelity of school-wide positive behavior interventions and supports (SW-PBIS) found that schools with higher percentages of students who qualified for free- or reduced-price lunch (FRPL; a commonly used proxy for socioeconomic status) implemented less well over time (Gottfredson et al, 2002; Molloy et al, 2013; Payne & Eckert, 2010; Schaper et al, 2016).…”

“…It is not known whether schools could use and sustain implementation without technical assistance. Like MTSS or any other implementation skill, technical assistance or coaching is needed for schools to successfully initiate and sustain initiatives (Fixsen et al, 2005). Here, the EIS development team has simply applied that logic to the use of screeners.…”

Core Components and Implementation Determinants of Multilevel Service Delivery Frameworks Across Child Mental Health Service Settings

“…Supportive policies that provide funding or facilitate reimbursement for component interventions may counter financial barriers to implementation (e.g., insufficient funding following grant award periods; Stroul, 2013 ; Vinson et al, 2001 ). Within the inner setting, strong organizational leadership (i.e., leadership engagement ) can guide implementation of the multilevel service delivery framework across the system—whether that is a primary care practice, local school or school district, or community behavioral health agency (Fox et al, 2022 ; Stroul, 2013 ; Whitebird et al, 2014 ). Developing a shared vision and goals for implementation across implementers within the organization is also a prominent determinant of this component (i.e., relative priority ; Heflinger, 1996 ; Mendenhall & Frauenholtz, 2014 ).…”

“…For example, a systematic review of CoCM for depression conducted by Wood et al ( 2017 ) identified barriers and facilitators to the implementation of specific components of CoCM (e.g., barriers to multi-professional teamwork included organization culture and negative staff attitudes to change, whereas facilitators included staff champions and peer learning and support). Scholars have also identified and investigated core components (e.g., Molloy et al, 2013 ; Center on PBIS, 2015 ) and salient implementation determinants (e.g., Fox et al, 2022 ) for PBIS. However, to our knowledge, research has yet to link implementation determinants to core features of exemplar frameworks in school or community care settings nor to the core components shared by multilevel service delivery frameworks.…”