Despite the growing number of evidence-based mental health treatments for youth being developed, few are effectively practiced routinely in community settings. One reason may be the lack of attention paid to how these treatments are implemented in the context of the organization providing the services to youth, whether it is in a clinic, social service agency, or school. This application proposes to take a conceptual framework from the management literature and modify it for evaluating implementation effectiveness of a mental health intervention in the school system. These concepts will be applied to the development of an implementation strategy for a school-based trauma intervention, the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program. CBITS has been found to be effective in decreasing trauma-related symptoms and now has been delivered in a number of U.S. sites. However, continued use of the intervention has varied. One implementation strategy that has been used in the health care sector to improve medical care quality and was recently piloted with CBITS is the Learning Collaborative (LC) approach. The LC encourages stakeholders across organizations to share how they have resolved barriers to implementation.
The specific aims of this application are: 1) to further refine a CBITS implementation strategy, based on the Learning Collaborative approach, that addresses the key constructs for implementation effectiveness, 2) to adapt and pilot organizational management measures of implementation factors and implementation effectiveness for use in assessing the implementation of CBITS in schools, and 3) to compare a CBITS Learning Collaborative implementation strategy to a CBITS Implementation as Usual strategy for feasibility and acceptability.
For Aim 1, the modifications of the CBITS LC strategy will be informed by semi-structured interviews with a sample of clinicians who have participated in a CBITS LC from sites across the country.
In Aim 2, we plan to adapt measures from the management literature and then pilot them with 80 CBITS clinicians from U.S. sites. Finally Aim 3 will be achieved by randomly assigning three schools in Los Angeles to receive the CBITS LC implementation strategy and three schools to receive implementation as usual. The evaluation will consist of survey data that will inform semi-structured interviews with key stakeholders in each participating school at two time points: Time 1 (Month 12) and Time 2 (Month 21). Findings from this exploratory pilot will provide the necessary data to conduct a larger evaluation of CBITS implementation in schools. The long-term objectives of this work are to identify key strategies to improve the implementation of school-based mental health treatments generally and to determine how implementation can best be accomplished within the school system and structure.
This application is relevant to public health in that it will provide preliminary evidence for improving the way in which evidence-based treatments are delivered in schools. This is highly relevant to addressing the substantial unmet need for mental health services in children given that it has been documented that the school system is the most common place that children and adolescents gain access mental health services.
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|Nadeem, Erum; Jaycox, Lisa H; Kataoka, Sheryl H et al. (2011) Going to Scale: Experiences Implementing a School-Based Trauma Intervention. School Psych Rev 40:549-568|
|Kataoka, Sheryl; Novins, Douglas K; DeCarlo Santiago, Catherine (2010) The practice of evidence-based treatments in ethnic minority youth. Child Adolesc Psychiatr Clin N Am 19:775-89|