Implementation strategies to promote measurement-based care in schools: evidence from mental health experts across the USA

Abstract

Background Despite an established taxonomy of implementation strategies, minimal guidance exists for how to select and tailor strategies to specific practices and contexts. We employed a replicable method to obtain stakeholder perceptions of the most feasible and important implementation strategies to increase mental health providers’ use of measurement-based care (MBC) in schools. MBC is the routine use of patient-reported progress measures throughout treatment to inform patient-centered, data-driven treatment adjustments. Methods A national sample of 52 school mental health providers and researchers completed two rounds of modified Delphi surveys to rate the relevance, importance, and feasibility of 33 implementation strategies identified for school settings. Strategies were reduced and definitions refined using a multimethod approach. Final importance and feasibility ratings were plotted on “go-zone” graphs and compared across providers and researchers to identify top-rated strategies. Results The initial 33 strategies were rated as “relevant” or “relevant with changes” to MBC in schools. Importance and feasibility ratings were high overall for both survey rounds; on a scale of 1 to 5, importance ratings (3.61–4.48) were higher than feasibility ratings (2.55–4.06) on average. Survey 1 responses resulted in a reduced, refined set of 21 strategies, and six were rated most important and feasible on Survey 2: (1) assess for readiness and identify barriers and facilitators; (2) identify and prepare champions; (3) develop a usable implementation plan; (4) offer a provider-informed menu of free, brief measures; (5) develop and provide access to training materials; and (6) make implementation easier by removing burdensome documentation tasks. Provider and researcher ratings were not significantly different, with a few exceptions: providers reported higher feasibility and importance of removing burdensome paperwork than researchers, providers reported higher feasibility of train-the trainer approaches than researchers, and researchers reported higher importance of monitoring fidelity than providers. Conclusions The education sector is the most common setting for child and adolescent mental health service delivery in the USA. Effective MBC implementation in schools has the potential to elevate the quality of care received by many children, adolescents, and their families. This empirically derived, targeted list of six implementation strategies offers potential efficiencies for future testing of MBC implementation in schools.

Enhancing school capacity to adopt school behavioural health best practices: A multiple‐case study evaluation

“…Following the selection of schools, the project team utilized numerous strategies to support adoption of school behavioural health best practices across recommended conceptual phases of engagement with school partners (Connors et al, 2022; Dunst et al, 2019; Katz & Wandersman, 2016; Le et al, 2016). Throughout the course of the project, schools actively participated in consecutive phases of capacity‐building, including Phase 1 collaborative needs assessment and decision‐making processes; Phase 2 planning and implementation of capacity‐building strategies (individualized TA, a monthly 2.5‐h CoP meeting and professional development/training); and Phase 3 reflection, evaluation and sustainability.…”

“…Finally, this study did not address the role that funding or an incentive to participate might have had on the school's engagement and level of commitment. Compensation for staff time to create and pursue stated objectives has been included as part of other capacity-building frameworks, but funding levels and stipulations around the use of monetary incentives have not been well-researched (Connors et al, 2022).…”

“…Strengthening the adoption of school behavioural health best practices within schools and LEAs presents unique challenges that may be best addressed by community and social psychology given its emphasis on understanding the effect of social and organizational factors on health outcomes along with its ability to examine the ways in which individuals, organizations and communities are interconnected. As studies of effective implementation strategies related to school behavioural health treatment suggest (Connors et al, 2022), more research is needed to illuminate the impact of distinct strategies to strengthen schools' capacity to incorporate best practices associated with the spectrum of prevention, early intervention and treatment services comprising CSBHSs.…”

Study protocol: Novel Methods for Implementing Measurement-Based Care with youth in Low-Resource Environments (NIMBLE)

“…Step 1 : The research team and practice partners will collaboratively select at least one promising strategy from existing compilations [ 35 , 36 ] and our experience, per prioritized barrier. Strategy selection will be guided by an assessment of the evidence, plausibility, and feasibility of each strategy.…”

Measurement feedback system implementation in public youth mental health treatment services: a mixed methods analysis

“…We were blind to clinician class membership during coding; class membership was an added variable after coding was completed. We both received doctoral-level training and supervision in qualitative methods, with experience conducting and publishing qualitative and mixed methods research [67][68][69][70][71][72][73][74].…”