Primary aim results of a clustered SMART for developing a school-level, adaptive implementation strategy to support CBT delivery at high schools in Michigan.
Primary aim results of a clustered SMART for developing a school-level, adaptive implementation strategy to support CBT delivery at high schools in Michigan.
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DOI：
10.1186/s13012-022-01211-w
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发表时间：
2022-07-08
影响因子：
7.2
通讯作者：
Kilbourne, Amy M.
中科院分区：
文献类型：
--
作者：
Smith, Shawna N.;Almirall, Daniel;Choi, Seo Youn;Koschmann, Elizabeth;Rusch, Amy;Bilek, Emily;Lane, Annalise;Abelson, James L.;Eisenberg, Daniel;Himle, Joseph A.;Fitzgerald, Kate D.;Liebrecht, Celeste;Kilbourne, Amy M.
关键词：
学校越来越多地向学生提供心理健康服务，但往往缺乏实施战略，以支持以学校为基础（和学校专业人员[SP]）提供基于证据的做法。鉴于各学校在实施方面的障碍差异很大，制定适应性实施战略，指导向哪些学校提供哪些实施战略，以及何时可能需要支持扩大规模。一个集群，顺序，多任务随机试验（SMART）的高中在密歇根州被用来通知发展的学校层面的自适应实施策略，以支持SP提供的认知行为疗法（CBT）。所有学校都首先提供了实施支持，通过复制有效的计划（REP），然后随机添加或不添加面对面的教练（第1阶段）。8周后，根据SP报告的向学生提供CBT的频率和/或报告的障碍评估学校的反应。响应学校继续实施第一阶段实施战略。反应较慢的学校（未向≥10名学生提供≥ 3个CBT组件或确定>2个组织障碍）被重新随机分配，以在当前支持中添加促进或不添加（第2阶段）。主要目标假设是，SP在学校接受REP +辅导+促进适应性实施策略将提供更多的CBT会议比SP在学校接受REP单独。次要目标比较了四种实施策略（辅导与无辅导×促进与无促进）对CBT课程的影响，包括按类型（小组，简短和完整的个人）。分析使用了一个边缘，加权最小二乘法开发的集群SMART。SP（n = 169）在94所高中进入研究。N = 83所学校（88%）在第1阶段后反应较慢。与主要目标假设相反，没有证据表明REP +辅导+促进和REP单独之间提供的CBT会话有显著差异（平均总CBT会话数为111.4 vs. 121.1; p = 0.63）。在二次分析中，提供REP +引导的适应性策略导致最高的平均CBT交付（154.1次），而提供REP +辅导的非适应性策略最低（94.5次）。就SP报告的平均CBT交付而言，最有效的策略是自适应实施策略，该策略（i）从REP开始，（ii）为反应较慢的学校（SP发现组织障碍或努力交付CBT的学校）增加促进，以及（iii）为响应学校保留REP课程。ClinicalTrials.gov，NCT 03541317，2018年5月30日。在线版本包含补充材料，可通过10.1186/s13012-022-01211-w获取。
Schools increasingly provide mental health services to students, but often lack access to implementation strategies to support school-based (and school professional [SP]) delivery of evidence-based practices. Given substantial heterogeneity in implementation barriers across schools, development of adaptive implementation strategies that guide which implementation strategies to provide to which schools and when may be necessary to support scale-up. A clustered, sequential, multiple-assignment randomized trial (SMART) of high schools across Michigan was used to inform the development of a school-level adaptive implementation strategy for supporting SP-delivered cognitive behavioral therapy (CBT). All schools were first provided with implementation support informed by Replicating Effective Programs (REP) and then were randomized to add in-person Coaching or not (phase 1). After 8 weeks, schools were assessed for response based on SP-reported frequency of CBT delivered to students and/or barriers reported. Responder schools continued with phase 1 implementation strategies. Slower-responder schools (not providing ≥ 3 CBT components to ≥10 students or >2 organizational barriers identified) were re-randomized to add Facilitation to current support or not (phase 2). The primary aim hypothesis was that SPs at schools receiving the REP + Coaching + Facilitation adaptive implementation strategy would deliver more CBT sessions than SPs at schools receiving REP alone. Secondary aims compared four implementation strategies (Coaching vs no Coaching × Facilitation vs no Facilitation) on CBT sessions delivered, including by type (group, brief and full individual). Analyses used a marginal, weighted least squares approach developed for clustered SMARTs. SPs (n = 169) at 94 high schools entered the study. N = 83 schools (88%) were slower-responders after phase 1. Contrary to the primary aim hypothesis, there was no evidence of a significant difference in CBT sessions delivered between REP + Coaching + Facilitation and REP alone (111.4 vs. 121.1 average total CBT sessions; p = 0.63). In secondary analyses, the adaptive strategy that offered REP + Facilitation resulted in the highest average CBT delivery (154.1 sessions) and the non-adaptive strategy offering REP + Coaching the lowest (94.5 sessions). The most effective strategy in terms of average SP-reported CBT delivery is the adaptive implementation strategy that (i) begins with REP, (ii) augments with Facilitation for slower-responder schools (schools where SPs identified organizational barriers or struggled to deliver CBT), and (iii) stays the course with REP for responder schools. ClinicalTrials.gov, NCT03541317, May 30, 2018. The online version contains supplementary material available at 10.1186/s13012-022-01211-w.
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DOI：
10.1080/1754730x.2015.1037848
发表时间：
2015
期刊：
Advances in school mental health promotion
影响因子：
--
作者：
Eiraldi R;Wolk CB;Locke J;Beidas R
通讯作者：
Beidas R
DOI：
10.1037/spq0000017
发表时间：
2013-06
期刊：
School psychology quarterly : the official journal of the Division of School Psychology, American Psychological Association
影响因子：
--
作者：
Chiu AW;Langer DA;McLeod BD;Har K;Drahota A;Galla BM;Jacobs J;Ifekwunigwe M;Wood JJ
通讯作者：
Wood JJ
影响因子：
7.6
作者：
Asarnow, JR;Jaycox, LH;Wells, KB
通讯作者：
Wells, KB
影响因子：
9.7
作者：
BURNS, BJ;COSTELLO, EJ;ERKANLI, A
通讯作者：
ERKANLI, A
影响因子：
2.8
作者：
Connolly, Samantha L.;Sullivan, Jennifer L.;Bauer, Mark S.
通讯作者：
Bauer, Mark S.