Multi-level determinants of implementation and sustainment in the education sector

项目摘要 在学校环境中提供的循证方案（EBP）在降低儿童死亡风险方面显示出巨大的希望。 情绪和行为障碍（EBD）的发展在小学年龄的儿童。然而，努力 在学校环境中维持循证教育方案面临着一些障碍。改善学校的EBP持续性， 代表了公共卫生的优先事项，但很少有研究可以为可持续发展提供信息 战略布局为了弥补这一差距，并为制定可持续发展战略奠定基础， 需要确定预测可持续性的具体因素。为达致这个目标，建议的计划将 实现三个主要目标：（1）确定是否可塑性教师（自我效能，倦怠，归因）， 干预（可用性）和学校（气候，课堂气氛，课堂逆境）因素预测 EBP治疗保真度（依从性，能力）和对EBP的修改（依从性一致性，保真度- （2）评估EBP治疗保真度和EBP的影响 在实施过程中对儿童结果的修改（破坏性行为问题，社交技能）， （3）探讨教师、干预和学校因素的作用机制 影响可持续性成果。该项目建立在一项为期4年的联邦政府资助的随机对照试验基础上 评估最好的班级，一个有效的，教师提供的干预措施，为K-3年级的儿童在风险， EBD。样本将包括不同社区的96名教师，384名儿童和12所小学 位于弗吉尼亚州和佛罗里达州。在实施阶段，随机分配到班级最佳的教师将 接受为期一天的培训，然后每周进行14次基于实践的辅导。为了达到学习目的， 一个多层次的，间断的时间序列设计将被用来检查基线因素之间的关系， 治疗忠诚度（坚持和能力的核心最佳类的做法），修改（忠诚度- 一致、忠诚度不一致）和孩子的结果（破坏性行为、社交技能），然后是混合的 方法的方法来阐明影响可持续性成果的机制。独立观察员 将使用一个黄金标准，具有强大的心理测量特性，以评估治疗的保真度 在实施过程中的8个时间点（基线、4周、8周、治疗后）， 干预[14周]）和维持（基线、4周、8周、14周）。我们的长期目标， 与NIMH战略优先事项4一致，以加强资助研究的公共卫生影响， 从事研究，以最大限度地维持学校环境中的循证生产方式，从而改善成果， 孩子该R 01是我们实现EBP承诺的关键组成部分，将帮助我们创建 我们可以通过NIMH制定一项旨在改善学校EBP可持续性的战略蓝图 R34提案，随后使用R 01提案进行评估。

PROJECT SUMMARY Evidence-based programs (EBPs) delivered in school settings show great promise in reducing risk for the development of emotional and behavioral disorders (EBDs) among elementary-aged children. However, efforts to sustain EBPs in school settings face a number of barriers. Improving EBP sustainment in schools thus represents a public health priority, but very little research exists to inform the development of sustainment strategies. In order to address this gap, and build a foundation for sustainment strategy development, the specific factors that predict sustainment need to be identified. To achieve this goal, the proposed project will accomplish three primary aims: (1) Determine if malleable teacher (self-efficacy, burnout, attributions), intervention (usability), and school (climate, classroom atmosphere, classroom-level adversity) factors predict EBP treatment fidelity (adherence, competence) and modifications to EBPs (fidelity-consistent, fidelity- inconsistent) during implementation or sustainment; (2) Assess the impact of EBP treatment fidelity and EBP modifications on child outcomes (disruptive behavior problems, social skills) during implementation and sustainment; and (3) Explore the mechanisms through which teacher, intervention, and school factors influence sustainment outcomes. This project builds on a 4-year, federally-funded randomized controlled trial evaluating BEST in CLASS, an effective, teacher-delivered intervention for K-3rd grade children at risk for EBDs. The sample will include 96 teachers, 384 children, and 12 elementary schools in diverse communities located in VA and FL. During the implementation phase, the teachers randomized to BEST in CLASS will receive a one-day training followed by 14 weekly sessions of practice-based coaching. To achieve study aims, a multilevel, interrupted time series design will be used to examine the relation between baseline factors, treatment fidelity (adherence and competence to the core BEST in CLASS practices), modifications (fidelity- consistent, fidelity-inconsistent), and child outcomes (disruptive behavior, social skills), followed by a mixed method approach to elucidate the mechanisms that influence sustainment outcomes. Independent observers will use a gold-standard, observer-rated measure with strong psychometric properties to rate treatment fidelity and modifications to BEST in CLASS at 8 timepoints during implementation (baseline, 4 weeks, 8 weeks, post- intervention [14 weeks]) and sustainment (baseline, 4 weeks, 8 weeks, 14 weeks). Our long-term goal, consistent with NIMH Strategic Priority 4 to strengthen the public health impact of funded research, is to engage in research to maximize the sustainment of EBPs in school settings and thus improve outcomes for children. This R01 is a critical building block in our effort to realize the promise of EBPs and will help us create the blueprint for a strategy designed to improve EBP sustainment in schools that we can develop with a NIMH R34 proposal and subsequently evaluate with a R01 proposal.