From Evidence to Impact: Joining Our Best School Mental Health Practices with Our Best Implementation Strategies
There is substantial research evidence for the effectiveness of school mental health strategies across problem areas, developmental levels, and the prevention-intervention spectrum. At the same time, it is clear that the education and mental health fields continue to struggle to apply this evidence at any level of scale. This commentary reflects on ways in which education-specific applications of implementation science principles—and explicit consideration of determinants of implementation success—may guide more consistent use of evidence in school mental health. After reviewing implementation determinants and strategies across multiple levels of effect (i.e., the outer setting, inner setting, individual, and intervention levels), the commentary goes on to recommend specific areas of needed attention in school mental health implementation efforts and research. These include a need to adapt interventions to better fit the context of schools, streamlining school mental health programs and practices to make them more implementable, and recognizing the critical role of assessment and selection of evidence-based interventions by school leaders. The commentary concludes by reflecting on the substantial opportunity provided by the education sector to both apply and advance implementation science.
KeywordsSchool mental health Implementation science Children Adolescents Education Evidence-based practice
The authors received no funding to support this article.
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Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants performed by either of the authors.
- Aarons, G. A., Ehrhart, M. G., Farahnak, L. R., & Hurlburt, M. S. (2015). Leadership and organizational change for implementation (LOCI): A randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation. Implementation Science, 10(1), 11.Google Scholar
- Aarons, G. A., Ehrhart, M. G., Moullin, J. C., Torres, E. M., & Green, A. E. (2017). Testing the leadership and organizational change for implementation (LOCI) intervention in substance abuse treatment: A cluster randomized trial study protocol. Implementation Science, 12(1), 29.Google Scholar
- Balas, E. A., & Boren, S. A. (2000). Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics 2000: Patient-Centered Systems. Retrieved from https://augusta.openrepository.com/augusta/handle/10675.2/617990.
- Beidas, R. S., Marcus, S., Aarons, G. A., Hoagwood, K. E., Schoenwald, S., Evans, A. C., et al. (2015). Predictors of community therapists’ use of therapy techniques in a large public mental health system. JAMA Pediatrics, 169(4), 374–382. https://doi.org/10.1001/jamapediatrics.2014.3736.Google Scholar
- Bradshaw, C. P., Mitchell, M. M., & Leaf, P. J. (2010). Examining the effects of school wide positive behavioral interventions and supports on student outcomes: Results from a randomized controlled effectiveness trial in elementary schools. Journal of Positive Behavior Interventions, 12(3), 133–148. https://doi.org/10.1177/1098300709334798.Google Scholar
- Bruns, E. B., Pullmann, M. D., Nicodimos, S., Lyon, A. R., Ludwig, K., Namkung, N., & McCauley, E. (in press). Pilot test of an engagement, triage, and brief intervention strategy for school mental health. School Mental Health. Google Scholar
- Cook, C. R., Lyon, A. R., Kubergovic, D., Browning Wright, D., & Zhang, Y. (2015). A supportive beliefs intervention to facilitate the implementation of evidence-based practices within a multi-tiered system of supports. School Mental Health, 7(1), 49–60. https://doi.org/10.1007/s12310-014-9139-3.Google Scholar
- Cook, C. R., Lyon, A. R., Locke, J., Waltz, T., & Powell, B. (in press). Adapting a compilation of implementation strategies to advance school-based implementation research and practice. Prevention Science. Google Scholar
- Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 50. https://doi.org/10.1186/1748-5908-4-50.Google Scholar
- Dopp, A. R., Parisi, K. E., Munson, S. A., & Lyon, A. R. (in press). A glossary of user-centered design strategies for implementation experts. Translational Behavioral Medicine. Google Scholar
- Freeman, R., Miller, D., & Newcomer, L. (2015). Integration of academic and behavioral MTSS at the district level using implementation science. Learning Disabilities—A Contemporary Journal, 13(1), 59–72.Google Scholar
- Glisson, C. (2002). The organizational context of children’s mental health services. Clinical Child and Family Psychology Review, 5(4), 233–253.Google Scholar
- Gottfredson, D. C., & Gottfredson, G. D. (2002). Quality of school-based prevention programs: Results from a national survey. Journal of Research in Crime and Delinquency, 39(1), 3–35.Google Scholar
- Henggeler, S. W., Chapman, J. E., Rowland, M. D., Halliday-Boykins, C. A., Randall, J., Shackelford, J., et al. (2008). Statewide adoption and initial implementation of contingency management for substance-abusing adolescents. Journal of Consulting and Clinical Psychology, 76(4), 556–567. https://doi.org/10.1037/0022-006X.76.4.556.Google Scholar
- Houtrow, A. J., Larson, K., Olson, L. M., Newacheck, P. W., & Halfon, N. (2014). Changing trends of childhood disability, 2001–2011. Pediatrics, 134(3), 530–538.Google Scholar
- Joyce, B. R., & Showers, B. (2002). Student achievement through staff development, 3rd edn. Alexandria, VA: Association for Supervision and Curriculum Development.Google Scholar
- Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27.Google Scholar
- Lane, K. L., Menzies, H. M., Ennis, R. P., & Bezdek, J. (2013). School-wide systems to promote positive behaviors and facilitate instruction. Journal of Curriculum and Instruction, 7(1), 6–31.Google Scholar
- Lewis, C. C. (2017). What are implementation mechanisms and why do they matter? In Plenary presentation at the 2017 conference of the Society for Implementation Research Collaboration (SIRC), Seattle, WA.Google Scholar
- Lewis, C. C., Fischer, S., Weiner, B. J., Stanick, C., Kim, M., & Martinez, R. G. (2015). Outcomes for implementation science: an enhanced systematic review of instruments using evidence-based rating criteria. Implementation Science, 10(1), 155. https://doi.org/10.1186/s13012-015-0342-x.Google Scholar
- Locke, J., Lee, K., Cook, C. R., Frederick, L., Vazquez-Colon, C., Ehrhart, M. G., et al. (in press). Understanding the organizational implementation context of schools: A qualitative study of multiple stakeholders. School Mental Health. Google Scholar
- Locke, J., Olsen, A., Wideman, R., Downey, M. M., Kretzmann, M., Kasari, C., et al. (2015). A tangled web: The challenges of implementing an evidence-based social engagement intervention for children with autism in urban public school settings. Behavior Therapy, 46(1), 54–67. https://doi.org/10.1016/j.beth.2014.05.001.Google Scholar
- Lyon, A. R., & Bruns, E. J. (in press). User-centered redesign of evidence-based psychosocial interventions to enhance implementation—hospitable soil or better seeds? JAMA Psychiatry. Google Scholar
- Lyon, A. R., Cook, C. R., Brown, E. C., Locke, J., Davis, C., Ehrhart, M., et al. (2018a). Assessing organizational implementation context in the education sector: Confirmatory factor analysis of measures of implementation leadership, climate, and citizenship. Implementation Science, 13(1), 5. https://doi.org/10.1186/s13012-017-0705-6.Google Scholar
- Lyon, A. R., Cook, C. R., Locke, J., Davis, C., Powell, B. J., & Waltz, T. J. (under review). Importance and feasibility of an adapted set of strategies for implementing evidence-based mental health practices in schools.Google Scholar
- Lyon, A. R., Koerner, K., & Chung, J. (2018). How implementable is that evidence-based practice? A methodology for assessing complex innovation usability. In Paper presented at the 11th annual conference on the science of dissemination and implementation. Washington, DC.Google Scholar
- Lyon, A. R., Lau, A. S., McCauley, E., Vander Stoep, A., & Chorpita, B. F. (2014a). A case for modular design: Implications for implementing evidence-based interventions with culturally diverse youth. Professional Psychology: Research and Practice, 45(1), 57–66. https://doi.org/10.1037/a0035301.Google Scholar
- Lyon, A. R., Ludwig, K., Romano, E., Koltracht, J., Vander Stoep, A., & McCauley, E. (2014b). Using modular psychotherapy in school mental health: Provider perspectives on intervention-setting fit. Journal of Clinical Child & Adolescent Psychology, 43, 890–901.Google Scholar
- Lyon, A. R., Whitaker, K., Locke, J., Cook, C. R., King, K. M., Duong, M., et al. (2018b). The impact of inter-organizational alignment (IOA) on implementation outcomes: Evaluating unique and shared organizational influences in education sector mental health. Implementation Science: IS, 13. https://doi.org/10.1186/s13012-018-0721-1.
- Maynard, B., Farina, A., & Dell, N. (2017). Effects of trauma-informed approaches in schools. Downloaded October 6, 2018 from https://www.campbellcollaboration.org/library/effects-of-trauma-informed-approaches-in-schools.html.
- McIntosh, K., Mercer, S. H., Nese, R. N. T., Strickland-Cohen, M. K., & Hoselton, R. (2016). Predictors of sustained implementation of school-wide positive behavioral interventions and supports. Journal of Positive Behavior Interventions, 18(4), 209–218. https://doi.org/10.1177/1098300715599737.Google Scholar
- Metz, A., & Louison, L. (2018). The Hexagon Tool: Exploring Context. Chapel Hill, NC: National Implementation Research Network, Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill.Google Scholar
- New Jersey School Boards Association. (2016). Unfunded and underfunded state and federal mandates: A burden on local school districts. Retrived October 1, 2018 from https://www.njsba.org/wpcontent/uploads/2016/05/Unfunded-Underfunded-Mandates-may2016.pdf.
- Powell, B. J., Beidas, R. S., Rubin, R. M., Stewart, R. E., Wolk, C. B., Matlin, S. L., et al. (2016). Applying the policy ecology framework to Philadelphia’s behavioral health transformation efforts. Administration and Policy In Mental Health, 43(6), 909–926. https://doi.org/10.1007/s10488-016-0733-6.Google Scholar
- Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., et al. (2015). A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10(1), 21. https://doi.org/10.1186/s13012-015-0209-1.Google Scholar
- Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., et al. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65–76. https://doi.org/10.1007/s10488-010-0319-7.Google Scholar
- Purtle, J., Brownson, R. C., & Proctor, E. K. (2017). Infusing science into politics and policy: The importance of legislators as an audience in mental health policy dissemination research. Administration and Policy in Mental Health and Mental Health Services Research, 44(2), 160–163.Google Scholar
- Purtle, J., Lê-Scherban, F., Wang, X., Shattuck, P. T., Proctor, E. K., & Brownson, R. C. (2018). Audience segmentation to disseminate behavioral health evidence to legislators: An empirical clustering analysis. Implementation Science, 13(1), 121.Google Scholar
- Williams, E. C., Achtmeyer, C. E., Young, J. P., Rittmueller, S. E., Ludman, E. J., Lapham, G. T., et al. (2016). Local implementation of alcohol screening and brief intervention at five veterans health administration primary care clinics: Perspectives of clinical and administrative staff. Journal of Substance Abuse Treatment, 60, 27–35. https://doi.org/10.1016/j.jsat.2015.07.011.Google Scholar