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

学校心理健康测量关怀实施策略的选择与检验 健康 项目概要： 每年有14-20%的儿童和青少年被诊断患有精神疾病， 一半接受治疗。虽然所接受的服务大部分是以学校为基础的， 学校心理健康（SMH）的循证实践是高度不一致的。一个重要的改善机会 SMH质量是成功实施基于测量的护理（MBC）。MBC涉及临床医生的 常规使用简短、可靠和有效的学生或家长报告的症状和功能数据来监测 并为治疗决策提供信息。MBC是一种循证实践， 更快地减轻症状，改善功能，患者参与和共同决策。 尽管有证据表明，MBC在SMH实践中的有效性和与学校环境的良好配合是有限的。 本K 08的目标是选择和试点测试一套学校特定的实施策略， 促进SMH临床医生之间的MBC。通过杰出科学家的培训和高级指导， 心理健康服务研究，基于测量的护理和实施科学，如Melanie博士 班尼特、马克·韦斯特、莎伦·胡佛、约翰·兰兹沃克、克莱顿·布朗、理查德·戈德堡和亚伦·里昂，以及 作为唯一的国家学校心理健康中心的一名教员，我非常适合领导 以学校为基础的实施研究，并在四个方面进行额外的培训：（1）培训临床医生使用MBC工具 （2）实施策略、框架、研究设计;（3）多层次建模和混合建模;（4）多层次建模和混合建模。 方法和（4）科学写作和研究实践的伙伴关系技能。研究计划将涉及 有目的地抽样25个SMH利益相关者专家小组成员（即，SMH临床医生，服务管理员， 教育领导者、临床研究人员、实施中介机构和实施科学家）， 全国SMH普查，以确定SMH中具体的MBC实施战略并达成共识 通过修改后的德尔菲过程。接下来，小组成员将参与一个既定的概念图方法， 组织和评价战略，以告知战略选择。最后，我们将对选定的30项战略进行试点测试， 两个地区的SMH临床医生使用多基线实施试验来测试实施效果 关于实施《禁雷公约》的战略（即，忠实性、可接受性、适当性、可行性），并遵守 MBC使用对学生结果和患者参与度的影响。通过与SMH临床医生密切合作， 该项目为确定和调整或制定实施战略提供了机会， 可行、可扩展和生态有效，以促进一线SMH采用MBC 临床医生K 08提供的指导培训和研究经验将为以下方面奠定基础： 未来的R 01提交，以进行全功率混合设计测试的实施， MBC策略在SMH中的有效性。我获得的技能将使我能够开发一个独立的程序 作为一名实施科学家，他专注于提高学校心理健康护理的质量。

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.