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

摘要 抑郁症和焦虑症影响20-30%的学龄青年，导致发育不良， 学术成果。心理社会循证实践，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得。学生获得心理健康 学校的服务比其他任何地方都多，但学校专业人员（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的实施战略，解决学生，SP， 社区障碍。复制有效计划（REP），辅导和促进是三个以前 这些国家制定了执行战略，但在强度和理论基础上各不相同。REP组合 定制的干预包装、教学培训和技术支持，以提高提供者的知识。 教练通过持续的现场监督扩展教学培训，以提高提供者的能力， 验收促进导师提供战略思维，以促进自我效能，倡导使用 有效的实践和确保管理员的支持。辅导和促进可能是昂贵的， 对于早期的使用者来说，这可能是不必要的。自适应实现干预可用于提供 更深入的执行战略只提供给那些需要它们的人。本研究的主要目的是 比较两种适应性实施干预对CBT频率的有效性 由SP（主要结局）和学生抑郁和焦虑症状向学生提供 （次要结果）。学校将首先随机接受REP或REP +辅导。有需要的学校 的额外援助随后将随机继续REP或REP+辅导，或 获得更多便利。次要目标包括确定实施效果的调节因素（例如， 社会决定因素，领导支持），确定早期引入辅导的成本和/或 通过引导增强，并确定指导和引导改进的机制 在SP中使用CBT并影响学生的成绩。这项为期五年的实施试验将适用于一个新的 在所有83所学校的网络中进行连续多分配随机试验（SMART） 密歇根州的县，涉及100多所学校，200个SP和2000多名学生。网络工具将 方便学生和学生的数据收集。这将是第一项测试实施 在全州范围内，由学校工作人员为学龄青年提供跨诊断EBP-接受治疗 to populations人口with limited有限access访问.该提案涉及两个国家卫生优先事项：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 社区环境中的实施科学;以及国家精神卫生研究所战略目标4：加强公共卫生影响 通过社区伙伴关系（4.2）和实施战略（4.3）开展研究。

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).