Using readiness to understand implementation challenges in school mental health research

Abstract

Schools and research partners are increasingly implementing complex, multicomponent interventions and school‐wide frameworks to better meet students' social, emotional, behavioral, and academic needs; however, in the research and real‐world contexts, implementation is often fraught with many challenges and barriers to success. This study explores implementation barriers encountered during a randomized controlled trial testing effects of one complex intervention strategy—the Interconnected Systems Framework—from the lens of a practical model for conceptualizing organizational readiness—the Interactive Systems Framework for Dissemination and Implementation. Implementation of the Interconnected Systems Framework was explored via focus group and key informant interviews with school and mental health professionals, and research team members responsible for implementing the intervention in randomly assigned study schools. Results from inductive thematic analysis of verbatim transcripts identified three primary implementation challenges: staff turnover, inadequate leadership buy‐in, and insufficient time for training/planning. Each challenge is explored from interview participants' perspectives and the extant literature, then connected to recommendations from implementation science to help others avoid similar challenges in their well‐intentioned efforts to address the mounting concern for students' wellbeing.

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

“…Capacity‐building strategies were deemed helpful to school partners when they “fit” the context, resources and expertise available at each of the participating schools, which was only achieved after the project team demonstrated that they deeply understood the recipients’ “norms, values, and languages” (Leeman et al, 2017). This study extends previous work by focusing on the need for a tailored capacity‐building strategy that integrates foundational improvements in general capacity at both the organizational and individual levels as well as the innovation‐specific capacity to implement incremental improvements in school‐based behavioural health best practices with clear links to student, staff and family wellbeing (Splett et al, 2022). The combination of general and innovation‐specific capacity change targets and the collaborative use of the School Behavioural Health Best Practice Guide and Scoring Tool aligned this intervention's capacity‐building aims with continuous quality improvement approaches.…”

“…Building the capacity of important actors and institutions central to improving practice and sustaining change has been a focus of many research and practice‐based school interventions with mixed results (Katz & Wandersman, 2016). Some researchers have warned that the more typical assistance provided to schools to improve their innovation‐specific capacity is not likely to help schools overcome the significant implementation barriers associated with contextual variables and general capacity (Splett et al, 2022). Leeman et al (2017) used the evidence‐based system for innovation support (EBSIS) framework in their systematic review of interventions seeking to build non‐clinical practitioners' capacity to implement evidence‐based interventions (EBI) (Leeman et al, 2017).…”

“…-based behavioural health best practices with clear links to student, staff and family wellbeing(Splett et al, 2022). The combination of general and innovation-specific capacity change targets and the collaborative use of the School Behavioural Health Best Practice Guide and Scoring Tool aligned this intervention's capacity-building aims with continuous quality improvement approaches.…”

Collaborative mental health for children: Perspectives of school and clinical psychologists.

“…The Interconnected Systems Framework is one existing approach that provides clear guidance for what such a roadmap for collaboration might involve in connecting mental health support within tiered school systems and practices (Eber et al, 2020). Implementation determinants often identified by school psychologists, clinical psychologists, and other mental health professionals, include staff turnover, leadership buy-in, and time for training and planning (Splett et al, 2022). Thus, it would also be helpful for programs or frameworks to target implementation strategies to address those barriers, such as training for leadership teams, train-the-training approaches, or strategies to audit beliefs about collaboration with tailored approaches to address those beliefs (Lewis et al, 2021).…”

Educator-Informed Development of a Mental Health Literacy Course for School Staff: Classroom Well-Being Information and Strategies for Educators (Classroom WISE)

“…Participants' satisfaction with the course, videos, and resources, as well as changes in knowledge, attitudes, and impact on strategies used in the classroom are being evaluated. Additionally, dissemination and implementation science is increasingly being used in school settings to understand how to overcome challenges to uptake of effective practices [46], including those just discussed. Through research in education and health care settings, it's clear that one course or workshop does not necessarily lead to change in practice or use of a new program [47,48]; therefore, several studies are underway to identify best practices for implementation of Classroom WISE that would assist technical assistance purveyors, including the MHTTC Network, to help school districts and schools adopt this training package and better serve children and adolescents in the location where the majority of mental health services are provided to them, schools.…”