In the US, roughly one in five children experiences a mental health problem severe enough to warrant diagnosis and intervention. The education sector offers compelling opportunities to improve service access, but school mental health (SMH) providers are unlikely to deliver high-quality evidence-based practices (EBP), dramatically reducing the public health impact of these services. Multiple barriers interfere with SMH providers receiving adequate training and support in EBP, including limited time and scarce training resources. The goal of this project is to improve school-based care by developing and testing an online training and consultation system to facilitate use of routine outcome monitoring (ROM), an EBP with extensive empirical support and a feasible and cost-effective minimal intervention necessary for change. Although ROM is not routinely used by SMH providers, our preliminary work has found that targeted training can improve ROM uptake. Unfortunately, due to issues such as time, training resources, and practitioner geographic dispersion, especially in rural areas (<1 practitioner per school), ROM training is inaccessible to many SMH providers. Online training (OLT) addresses these barriers. In addition, because OLT is self-paced and flexible, it is associated with lower levels of provider burnout. OLT is also cost effective and scalable because its only requirements are internet access and server support. Regardless of the training modality, post-training consultation is essential for practitioner behavior change. To be optimally effective, consultation needs to be collaborative and responsive to learner needs. Using user-centered design methodology, which emphasizes iterative development of parsimonious and compelling products, the current R34 proposal will maximize the feasibility, usability, and efficiency of an innovative approach to OLT and follow-up consultation for SMH clinicians ? Brief Online Training (BOLT) for ROM.
In Aim 1, we will develop the OLT platform via iterative prototyping and continuous user testing to optimize system usability and training's impact on provider knowledge and attitudes about ROM.
In Aim 2, we will iteratively develop BOLT post-training consultation procedures to optimize putative mechanisms of effective consultation: consultant collaboration & responsiveness.
In Aim 3, we will conduct a pilot randomized controlled trial of the full BOLT training/consultation package to test (1) BOLT effects on ROM knowledge, attitudes, and weekly assessments of ROM use; (2) the incremental impact of consultation dosage on ROM use; and (3) mechanisms of BOLT impact, including (a) platform usability, (b) clinician knowledge and attitude gains, (c) collaboration, and (d) responsiveness of consultation. This project will yield feasibility data to inform a subsequent effectiveness-implementation hybrid trial that will experimentally test BOLT mechanisms of change and its impact on youth outcomes.

Public Health Relevance

In the US, roughly one in five children experiences a mental health problem severe enough to warrant diagnosis and intervention, and 70-80% of youth mental health interventions are delivered in schools, yet school mental health providers are unlikely to deliver high-quality evidence-based practices. This project will develop and test an efficient and scalable online training for a feasible, minimal intervention necessary for change: routine outcome monitoring, or the systematic, repeated collection of outcome data to evaluate patient progress and inform intervention decisions. By developing an effective and accessible training for providers in this evidence-based practice, the current project aims to enhance the public health impact of school-based mental health services.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Special Emphasis Panel (ZMH1)
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Pintello, Denise
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University of Washington
Schools of Medicine
United States
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