Improving Student Mental Health: Adaptive Implementation of School-based CBT

摘要 抑郁症和焦虑症影响20%-30%的学龄儿童，导致发育不良和 学术成果。基于心理社会证据的实践，如认知行为疗法(CBT)，可以 改善这些疾病的结果，但许多障碍限制了获取。学生获得心理健康 学校的服务比其他地方更多，但学校的专业人员(SP，例如辅导员、社会工作者) 通常没有接受过提供CBT的培训。在学校有效和成功地实施CBT需要 科学研究旨在优化吸收、满足学生、SP和 社区障碍。复制有效计划(REP)、指导和促进是之前的三个 制定了实施战略，但力度和理论基础各不相同。代表联合收割机 定制干预包装、授课培训和技术支持，以提高提供者的知识。 教练通过持续的现场监督来扩展教学培训，以提高提供商的能力和 接受。促进指导提供者的战略思维，以促进自我效能感的使用 有效实践和确保管理员支持的能力。辅导和促进可能会很昂贵，而且 对于早期采用者来说可能没有必要。自适应实现干预可用于提供 只向有需要的人提供更密集的实施战略。这项研究的主要目的是 比较两种适应性实施干预措施对CBT频率的影响 通过SPS提供给学生(主要结果)和学生抑郁和焦虑症状 (次要结果)。学校将首先随机接受代表或代表+教练。有需要的学校 随后将随机选择继续接受销售代表或销售代表+培训或 接受额外的帮助。次要目标包括确定实施效果的调节器(例如， 社会决定因素、领导支持)，决定早期引入教练和/或的成本 通过促进来加强，并确定指导和促进改善的机制 在SP中使用CBT并影响学生成绩。这项为期五年的实施试验将应用一种新的 在所有83所学校的网络中进行顺序多任务随机试验(SMART)设计 密歇根州的县，涉及100多所学校、200个SP和2000多名学生。基于Web的工具将 促进从SP和学生那里收集数据。这将是第一个测试 在全州范围内，由接受治疗的学校工作人员提供针对学龄儿童的跨诊断EBP 提供给接触有限的人群。该提案涉及两个国家健康优先事项：1)减少精神疾病 影响青年的保健和提供者能力差距，以及2)加强以下方面的知识库 社区环境中的实施科学；以及国家卫生和医疗保健战略目标4：加强对公共卫生的影响 通过社区伙伴关系进行研究(4.2)和实施战略(4.3)。

ABSTRACT Depressive and anxiety disorders affect 20-30% of school age youth, contributing to poor developmental and academic outcomes. Psychosocial evidence-based practices such as cognitive behavioral therapy (CBT), can improve outcomes in these disorders, but numerous barriers limit access. Students access mental health services at schools more than anywhere else, but school professionals (SPs, e.g., counselors, social workers) are generally not trained to deliver CBT. Efficient and successful implementation of CBT in schools requires scientific study of implementation strategies designed to optimize uptake, addressing student, SP, and community barriers. Replicating Effective Programs (REP), Coaching, and Facilitation are three previously established implementation strategies, but vary in intensity and theoretical foundation. REP combines customized intervention packaging, didactic training, and technical support to improve provider knowledge. Coaching extends didactic training via ongoing, live supervision to improve provider competence and acceptance. Facilitation mentors providers in strategic thinking to promote self-efficacy in championing the use of effective practices and securing administrator support. Coaching and Facilitation can be expensive and may be unnecessary for early adopters. An adaptive implementation intervention can be used to provide the more intensive implementation strategies only to those who need them. The primary aim of this study is to compare the effectiveness of two adaptive implementation interventions on the frequency of CBT delivered to students by SPs (primary outcome) and on student depressive and anxiety symptoms (secondary outcomes). Schools will first be randomized to receive REP or REP + Coaching. Schools in need of additional assistance will subsequently be randomized to continue with REP or REP+Coaching or to receive added Facilitation. Secondary aims include determining moderators of implementation effects (e.g., social determinants, leadership support), determining the cost of early introduction of Coaching and/or augmentation with Facilitation, and identifying the mechanisms by which Coaching and Facilitation improve CBT use among SPs and impact student outcomes. This five-year implementation trial will apply a novel sequential multiple assignment randomized trial (SMART) design across a network of schools in all 83 counties in Michigan, involving over 100 schools, 200 SPs, and over 2000 students. Web-based tools will facilitate data collection from SPs and students. This will be the first study to test implementation of a transdiagnostic EBP for school-age youth, at a statewide level, delivered by school staff – taking the treatment to populations with limited access. The proposal addresses two national health priorities: 1) reducing mental health care and provider capacity gaps affecting youth, and 2) enhancing the knowledge base of implementation science in community settings; and NIMH strategic goal 4: strengthening public health impact of research through community partnerships (4.2) and implementation strategies (4.3).