Schools are often the primary setting for entry to care,3 with 70-80% of all youth mental health services delivered in schools.4 Yet, school-based EBPs are rarely adopted, delivered with fidelity, or sustained over time.5 There is an urgent need to address the implementation gap that limits youth access to quality school- based EBPs and compromises youth mental health outcomes.6 Improving implementation of school-based EBPs requires effective implementation strategies that are tailored to locally prioritized barriers.7 Facilitation has become an increasingly popular and potentially effective approach for tailoring strategies; however, there is limited empirical guidance regarding replicable methods facilitators use to engage stakeholders in (a) identifying and prioritizing implementation barriers, (b) matching and modifying implementation strategies to address barriers, and (c) co-developing implementation plans to improve implementation and client outcomes. This project aims to iteratively develop, refine and demonstrate the promise of a theory-informed facilitation intervention, the Facilitated Implementation Tailoring (FIT) strategy, to address gaps that limit the consistent effectiveness of facilitation for the purposes of tailoring implementation strategies to address local barriers to implementation. FIT builds off of the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and will include adaptations of the Program Planning Model, which provides theory-informed methods of facilitating solution-oriented prioritization and planning processes in innovation implementation projects. To develop and refine FIT, this proposal will leverage an ongoing implementation effort between the Institute of Translational Research, the Minnesota Department of Health Services, and Hennepin County schools focused on the delivery of the Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) for trauma-exposed youth.33-35 The proposed research will address two aims:
Aim 1 will involve a development study including four focus groups, two with internal and external facilitators and two with school-based stakeholders (n=24-32) to inform refinements to FIT content and delivery and develop a fidelity tool.
Aim 2 will involve a feasibility demonstration study including application of the revised FIT with internal facilitators and school-based stakeholder in partnering schools (n=18-24) to inform refinements to FIT content and delivery as well as process variables (i.e., consensus, collective efficacy, collaboration) hypothesized as potential causal mechanisms by which FIT exerts an effect that in future evaluation of FIT. Fidelity to FIT will also be assessed. To accomplish the aims, the applicant will receive training in: 1) implementation strategy design and tailoring, 2) participatory research, and 3) mixed methods research under the direction of Drs. Clayton Cook, Aaron Lyon, Cara Lewis, Byron Powell, Amy Kilbourne, and Andrew Van de Ven. Training will support the PIs long-term goal to become a leader in implementation science and pursue an independently funded research career dedicated to improving mental health service quality in non-specialty settings.
This project aims to iteratively develop, refine and demonstrate the promise of a theory-informed facilitation intervention, the Facilitated Implementation Tailoring (FIT) strategy, to address gaps that limit the consistent effectiveness of facilitation for the purposes of tailoring implementation strategies to address context-specific barriers to evidence-based practice implementation. FIT builds off of the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and will include adaptations of the Program Planning Model, which provides theory-informed methods of facilitating solution-oriented prioritization and planning processes in innovation implementation projects. To develop and refine FIT, this proposal will leverage an ongoing implementation effort between the Institute of Translational Research, the Minnesota Department of Health Services, and school districts in the greater Twin Cities metropolitan area focused on the delivery of the Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) for trauma-exposed youth.33-35
