Only about half of the youth in the United States who experience mental health problems receive indicated treatment, resulting in high societal cost. Evidence-based practices (EBP) for mental health conditions yield significant benefits to children when they are actually implemented with fidelity. Although 70 to 80% mental health services for youth are currently provided in schools, few students receive EBP. Barriers to EBP implementation in schools include both those at the organizational level (lack of funding, poor administrative support, high personnel turnover, inadequate training) as well as those at the individual level (perception of intervention acceptability and appropriateness, time demands, social norms, conflicting theoretical perspectives). Although significant attention has been devoted to categorizing implementation barriers and potential strategies, there have been few efforts to develop and test innovative interventions to enhance implementation. In schools, implementation initiatives often occur as top-down mandates without attention to the individual factors found to impact provider behavior, such as provider attitudes about, or intentions to implement EBP, following training. Failing to address these individual-level barriers is especially costly, as individual behavior change is ultimately required for successful EBP implementation, even when organizational factors (e.g., evidence-informed policy, supportive leadership, effective training) are in place. Consistent with the aims of the R21 mechanism, the goal of this study is to adapt and test the feasibility and potential efficacy of a theory-driven pre-implementation intervention to address individual-level barriers to EBP implementation ? Beliefs and Attitudes for Successful Implementation in Schools (BASIS) ? designed to improve school-based mental health providers' implementation of EBP. BASIS is intended to be a feasible and scalable first-line or adjunctive implementation enhancement intervention that is facilitative of other efforts (e.g., organizational interventions) that target high quality EBP implementation.
Aims of this study are to: (1) Adapt an existing, theory-driven implementation intervention (BASIS), previously used with educators, to improve the EBP implementation behaviors of SBMH providers; and (2) Assess the viability of a later clinical trial by: (a) establishing the feasibility, acceptability, and appropriateness of the BASIS intervention among school-based mental health providers, and (b) pilot testing BASIS, as compared to an Attention Control, delivered as pre-implementation intervention prior to training in a specific, existing EBP. Key organizational factors (e.g., implementation climate) will also be evaluated and included as covariates and we will explore trends in the data to inform the design of a larger trial. Ultimately, BASIS offers an innovative and scalable approach to improving SBMH providers' uptake and use of EBP in order to increase the number of youth with mental health problems who receive high quality services.

Public Health Relevance

Over 18 million U.S. children experience mental health problems, and only about half receive indicated treatment, resulting in negative consequences for individual health throughout life as well as increased societal cost. Evidence-based practices for mental health conditions exist, and between 70 to 80% mental health services for youth are currently provided in schools but these services are often not evidence-based. The current project aims to develop an intervention to increase school-based mental health providers' use of evidence-based practices, thereby narrowing the science-to-practice gap and ensuring that society benefits from decades of scientific research costing billions of dollars that has been invested in developing evidence- based practices.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
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Dissemination and Implementation Research in Health Study Section (DIRH)
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Pintello, Denise
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University of Washington
Schools of Medicine
United States
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