Selecting and Testing Implementation Strategies to Advance Measurement-based Care in School Mental Health

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Selecting and Testing Implementation Strategies to Advance Measurement-based Care in School Mental Health PROJECT SUMMARY: Annually, between 14-20% of children and adolescents are diagnosed with a mental illness, and only about half receive treatment. Although a large proportion of services received are school-based, the delivery of evidence-based practices in school mental health (SMH) is highly inconsistent. A vital opportunity to improve SMH quality is the successful implementation of measurement-based care (MBC). MBC involves clinicians’ routine use of brief, reliable and valid student- or parent-reported symptom and functioning data to monitor progress and inform treatment decisions. MBC is an evidence-based practice associated with greater and faster reduction of symptoms, improvements in functioning, patient engagement and shared decision-making. Despite evidence of effectiveness and good fit with school settings, MBC use in SMH practice is limited. The goal of this K08 is to select and pilot test a set of school context-specific implementation strategies to facilitate MBC among SMH clinicians. With training and advanced mentorship from outstanding scientists in mental health services research, measurement-based care, and implementation science such as Drs. Melanie Bennett, Mark Weist, Sharon Hoover, John Landsverk, Clayton Brown, Richard Goldberg and Aaron Lyon, and as a faculty member at the only national Center for School Mental Health, I am ideally positioned to lead school-based implementation research with additional training in four areas: (1) training clinicians in MBC tools and processes; (2) implementation strategies, frameworks, research design; (3) multilevel modeling and mixed methods and (4) scientific writing and research-to-practice partnership skills. The research plan will involve purposively sampling 25 SMH Stakeholder Expert Panelists (i.e., SMH clinicians, services administrators, education leaders, clinical researchers, implementation intermediaries and implementation scientists) from the National SMH Census to identify and achieve consensus on implementation strategies specific to MBC in SMH via a modified Delphi process. Next, Panelists will engage in an established Concept Mapping method to organize and rate strategies to inform strategy selection. Finally, we will pilot test selected strategies with 30 SMH clinicians in two districts using a multiple-baseline implementation trial to test the effect of implementation strategies on MBC implementation (i.e., fidelity, acceptability, appropriateness, feasibility) and observe the effect of MBC use on student outcomes and patient engagement. By partnering closely with SMH clinicians and stakeholders, this project offers the opportunity to identify and adapt or develop implementation strategies that are feasible, scalable and ecologically-valid to promote the uptake of MBC among front line SMH clinicians. The mentored training and research experiences afforded by this K08 will provide the foundation for a future R01 submission to conduct a fully-powered Hybrid design testing the implementation and effectiveness of MBC strategies in SMH. The skills I obtain will equip me to develop an independent program of research as an implementation scientist focused on improving the quality of mental health care in schools.