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Implementation of School-Based Behavioral Health Services Over Time: A Longitudinal, Multi-level Qualitative Study


Behavioral health practitioners recognize how critical the process of implementation is to the successful use of evidence-based practices. It is further recognized that implementation is a complex, time-consuming process and that successful implementation often occurs in stages. Capitalizing on a national evaluation examining the implementation of school-based behavioral health (SBBH) services, this project involved an analysis of qualitative interview data to assess the unique barriers and facilitators that arise across time and organizational levels in the implementation of SBBH services. Forty-eight semi-structured telephone interviews were analyzed across 3 years and two organizational levels in seven sites (n = 48). Qualitative analysis identified five major implementation facilitators including communication and collaboration, data utilization, leadership, planning, and training. Major barriers to implementation included systemic state/governmental barriers, workforce shortages, and funding issues. While there were small changes in the relative importance of these facilitators and barriers over time and by organizational level, the most salient barriers and facilitators remained important across all 3 years of the study. Differences across organizational levels included greater emphasis at local levels for facilitators such as training and leadership and a greater emphasis at state levels for state/governmental barriers. Results suggest that while the importance of given facilitators and barriers changes as implementation progresses, the major factors that contribute to implementation are likely to remain unchanged over time. Effective communication/collaboration among stakeholders remains a powerful facilitator across time, and systemic state/governmental barriers remain a potent barrier. Implications for increasing successful integration of behavioral health services in public school settings are discussed.

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Correspondence to Oliver T. Massey.

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All procedures were in accordance with the ethical standards of the institutional review boards and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, verbal consent at the time of the interview, in lieu of documented written consent, was considered an adequate safeguard to participants’ rights.

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Informed consent was obtained from all individual participants included in the study.

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Interview Guide

  1. 1.

    Can you briefly provide an overview of the Safe Schools Initiative at your site and how it works?

    1. (a)

      What are the main things you have accomplished, or are perhaps still hoping to accomplish?

  2. 2.

    What do you see as the major facilitators in implementing your plan and achieving the objectives of your state’s program?

  3. 3.

    What do you see as the major barriers or difficulties in implementing your plan and achieving the objectives of your state’s program?

  4. 4.

    Given these opportunities and barriers, what impact do you think they have had on the operations and success of the SSHS program?

  5. 5.

    What policies at the state and/or the community level facilitate and/or hinder your implementation efforts?

  6. 6.

    What can you tell me about the improvements that have been made to the services you offer and accessing those services?

    1. (a)

      Can you tell me how you ensure the quality of services you provide?

  7. 7.

    What have you learned about what makes a program successful?

  8. 8.

    What factors related to the workforce have helped to facilitate the implementation and ongoing operation of your program?

    1. (a)

      What factors related to the workforce have hindered the implementation and ongoing operation of your program?

  9. 9.

    What training programs for the mental health workforce have been initiated?

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Massey, O.T., Vroom, E.B. & Weston, A.N. Implementation of School-Based Behavioral Health Services Over Time: A Longitudinal, Multi-level Qualitative Study. School Mental Health 13, 201–212 (2021).

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  • Implementation science
  • Evidence-based practice
  • Program evaluation
  • Barriers
  • Facilitators
  • School-based services
  • Behavioral health