Development and Pilot Testing of a Remote Training Strategy for the Implementation of Mental Health Evidence-Based Practices in Rural K-8 Schools

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PROJECT SUMMARY / ABSTRACT Rural areas have fewer, and less well trained, health care providers than non-rural areas. Schools have become more involved in the delivery of mental health services and hold great potential for increasing access to children and adolescents. Innovations in training and service delivery are needed to improve mental health care quality and availability in rural schools. Evidence-based practices (EBPs) can be incorporated into school- wide multi-tiered systems that are currently used to improve school climate and safety. School-wide Positive Behavioral Interventions and Supports (PBIS), a service-delivery strategy based on the public health model is one example. A growing number of schools in rural areas are employing PBIS. Our research team has used PBIS to incorporate EBPs at Tier 2 for children with, or at risk for, mental health disorders. Given the large service disparities for children in rural areas, offering EBPs through PBIS can improve access and lead to better long-term outcomes. School personnel, with or without prior mental health training, can implement Tier 2 interventions with fidelity and clinical effectiveness if given adequate consultation support. In urban and suburban schools, this support can be provided to school staff on site. However, providing ongoing on-site support is not feasible or sustainable in rural schools, due to their remote physical location. For this reason, telehealth technology has been recommended for the training of behavioral health staff (BHS) in under-served rural communities. The purpose of this study is to use an iterative process (Rapid Prototyping) to develop and evaluate the appropriateness, feasibility, acceptability, and preliminary efficacy of a remote training strategy that provides resources to support use of Tier 2 EBPs and effective support for care coordination practices in rural schools. Participants will be school personnel with and without prior mental health training and K-8 students in rural schools in Pennsylvania who are deemed at risk for externalizing and internalizing mental health disorders. The Aims of the study are to (1) obtain input from school stakeholders employing community-based participatory research, (2) use the iterative rapid prototyping approach to develop an asynchronous and synchronous remote training strategy based on preliminary studies and Aim 1 data, and (3) conduct a pilot trial of a remote training strategy vs. a control condition. The study will employ a pragmatic design comprised of a mixed-method approach for Aims 1-2, and a pilot randomized clinical trial for Aim 3. Participants will be 68 behavioral health staff and 156 children in grades K- 8. 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 for dissemination and implementation research. We will use data from this study to submit an R01 grant proposal to test the effectiveness of a free-standing online training platform with a large number of rural schools.