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

项目总结 在学校环境中提供的循证计划(EBP)在降低风险方面显示出巨大的希望 情绪和行为障碍(EBD)在小学儿童中的发展。然而，努力 要在学校环境中维持循证医学计划，面临许多障碍。从而改善学校的EBP支持 代表着公共卫生的优先事项，但很少有研究为可持续发展提供信息 战略。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发展的具体因素。为实现这一目标，拟议的项目将 完成三个主要目标：(1)确定可塑性教师(自我效能感、职业倦怠、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治疗的保真度(坚持、能力)和对EBPS的修改(保真度-一致性、保真度- 不一致)在实施或维持期间；(2)评估EBP治疗保真度和EBP的影响 在实施和实施期间对儿童结果(破坏性行为问题、社交技能)进行修改 以及(3)探讨教师、干预和学校因素 影响可持续发展结果。该项目建立在一项为期4年、由联邦政府资助的随机对照试验的基础上。 在课堂上进行最好的评估，这是一种有效的、由教师提供的干预措施，适用于K-3年级儿童 EBDS。样本将包括96名教师、384名儿童和12所不同社区的小学 位于弗吉尼亚州和佛罗里达州。在实施阶段，随机选择班上表现最好的教师 接受为期一天的培训，然后每周接受14次以实践为基础的指导。为了实现研究目标， 将使用多水平、中断的时间序列设计来检查基线因素之间的关系， 治疗保真度(对核心最佳实践的坚持和能力)、修改(保真度- 一致、忠诚-不一致)和儿童结果(破坏性行为、社交技能)，然后是喜忧参半 方法阐明影响持续治疗效果的机制。独立观察员 将使用具有强大心理测量学特性的黄金标准、观察者评级标准来评估治疗保真度 并在实施期间的8个时间点修改为同类最佳(基准、4周、8周、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，以加强资助研究对公共健康的影响，是 参与研究，以最大限度地维持学校环境中的循证医学计划，从而改善 孩子们。R01是我们努力实现EBPS承诺的关键构建块，并将帮助我们创建 旨在改善学校EBP持续支持的战略蓝图，我们可以用NIMH来开发 R34提案，然后用R01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.