Sustainment of Mental Health Supports in Under-Resourced Urban Schools

项目总结/摘要 学校是向儿童提供心理健康服务的关键场所。全校积极行为 干预和支持（PBIS）是一种基于公共卫生模式的服务提供战略， 是实施心理健康EBP的工具。在PBIS中，学校实施普遍（第1级）干预措施， 改善学校环境和安全，并可对患有或患有以下疾病的儿童采取有针对性的（第2层）团体干预措施： 精神健康障碍的风险。很少有研究已经进行了心理健康EBP在Tier 2.充分和持续的培训机会经常被确定为“基本做法”， 成功地维持干预措施的好处。学校工作人员，无论是否接受过心理健康培训， 在提供充分支持的情况下，能够以保真度和临床有效性实施第2层干预。 成功实施有针对性的群体干预的学校心理健康计划通常使用持续的 内部监督者的监督。许多研究表明，更有经验的学校 可以成功地培训人员，使其成为实施EBP的人员的教练和监督员。在 为了让这些学校获得有针对性的心理健康的潜在公共心理健康福利， 学校干预措施，一种高效、可扩展、具有成本效益和可持续的培训和咨询模式 可以从专家转移到学校教练，从教练到EBP实施者是必要的。 人们对哪些维持支助模式是有效、可行和具有成本效益的知之甚少。 本研究的目的是：（a）比较第2层心理健康教育的保真度、成本效益和学生成绩。 在2种维持条件下采取卫生干预措施，（B）评估协商的调解人和调解人 对执行忠实性的支持，以及（c）评估人们认为协商的可行性和可接受性 支持. 本研究拟采用2组随机对照试验，2型混合整群随机设计。 来自12所学校的60名学校工作人员将获得为期1年的全面初步实施支持， 随机分配接受以下两种维持条件之一：（a）学校提供远程咨询 地区教练自己将接受外部专家顾问的远程支持 （维持1 [S1]）;及（B）由地区教练照常提供咨询服务，不需要外来支援 （维持2 [S2]）。S1将有一段时间的支持减弱，然后是一段时间的无支持。的 学校工作人员实施的干预措施是最常见的外部化和 内化心理健康障碍我们的指导框架是交互式系统框架（ISF）， 传播和实施研究。该研究的结果将提供一个可扩展的和成本- 在资源不足的学校维持基于项目的支助的心理健康支助的有效战略。

PROJECT SUMMARY / ABSTRACT The school is a key setting for the delivery of mental health services to children. School-wide positive behavior interventions and supports (PBIS), a service delivery strategy based on the public health model, is a useful vehicle for implementing mental health EBPs. In PBIS, schools implement universal (Tier 1) interventions to improve school climate and safety, and can employ targeted (Tier 2) group interventions for children with or at risk for mental health disorders. Very little research has been conducted on using mental health EBPs at Tier 2. Adequate and ongoing training opportunities are frequently identified as “essential practices” needed to successfully sustain the benefits of interventions. School personnel, with or without prior mental health training, can implement Tier 2 interventions with fidelity and clinical effectiveness when provided adequate support. School mental health programs that successfully implement targeted group interventions often use ongoing supervision from internal supervisors. A number of studies have shown that more experienced school personnel can successfully be trained to serve as coaches and supervisors for those implementing EBPs. In order for these schools to receive the potential public mental health benefits of targeted mental health interventions in schools, an efficient, scalable, cost-effective and sustainable model of training and consultation that can be transferred from experts to school coaches and from coaches to EBP implementers is needed. Little is known about which models of support for sustainment are effective, feasible, and cost-effective. The aims of the study are (a) to compare fidelity, cost-effectiveness, and student outcomes of Tier 2 mental health interventions across 2 sustainment conditions, (b) assess mediators and moderators of consultation support on implementation fidelity, and (c) assess perceived feasibility and acceptability of consultation support. The study proposes to use a 2-arm, randomized controlled trial, Type 2 Hybrid cluster randomized design. Sixty school personnel from 12 schools will receive full initial implementation support for 1 year and then will be randomly assigned to receive one of 2 sustainment conditions: (a) remote consultation provided by school district coaches who themselves will be receiving remote support from expert external consultants (Sustainment 1 [S1]); and (b) consultation as usual provided by district coaches with no external support (Sustainment 2 [S2]). S1 will have a period of diminished support followed by a period of no support. The interventions to be implemented by school personnel are EBPs for the most common externalizing and internalizing mental health disorders. Our guiding framework is the Interactive Systems Framework (ISF) for dissemination and implementation research. The results of the proposed study will provide a scalable and cost- effective strategy for the sustainment of PBIS mental health supports in under-resourced schools.