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

项目摘要/摘要 与非农村地区相比，农村地区的卫生保健提供者更少，也更缺乏训练有素的人员。学校有 更多地参与精神卫生服务的提供，并拥有增加机会的巨大潜力 对儿童和青少年来说。需要在培训和服务提供方面进行创新，以改善心理健康 农村学校的护理质量和可获得性。循证实践(EBP)可以融入学校-- 宽阔的多层系统，目前用于改善学校环境和安全。全校积极进取 行为干预和支持(PBIS)，一种基于公共卫生模式的服务提供战略是 一个例子。农村地区越来越多的学校正在使用PBIS。我们的研究团队已经使用了 PBIS将为患有或有精神健康障碍风险的儿童纳入第二级EBPS。考虑到大的 农村地区儿童的服务差距，通过PBIS提供EBPS可以改善获得机会并导致 更好的长期结果。 学校工作人员，无论是否接受过心理健康培训，都可以忠实地实施第二级干预 和临床效果，如果得到足够的咨询支持。在城市和郊区的学校，这项支持 可提供给现场的学校工作人员。但是，提供持续的现场支持是不可行的，或者 由于偏远的地理位置，农村学校可持续发展。出于这个原因，远程医疗技术已经 建议在服务不足的农村社区培训行为卫生工作人员(BHS)。 本研究的目的是使用迭代过程(快速原型)来开发和评估 远程培训战略的适当性、可行性、可接受性和初步效果 支持使用第二级EBPS的资源，并有效支持农村学校的护理协调做法。 参与者将是经过和没有接受过心理健康培训的学校工作人员和农村地区的K-8学生 宾夕法尼亚州的学校，被认为有外在化和内在化精神健康障碍的风险。 这项研究的目的是(1)从学校利益相关者那里获得意见，这些利益相关者以社区为基础 参与式研究，(2)使用迭代快速原型方法开发异步和 基于初步研究和目标1数据的同步远程训练策略，以及(3)进行试点试验 远程训练策略与控制条件的对比。 这项研究将采用务实的设计，包括目标1-2的混合方法和试点 AIM 3的随机临床试验。参与者将是68名行为卫生工作人员和156名K- 8.学校工作人员将实施的干预措施是针对最常见的外部化和 将精神健康障碍内在化。我们的指导框架是交互系统框架 传播和实施研究。我们将使用这项研究的数据提交R01拨款提案 与大量农村学校一起测试独立在线培训平台的效果。

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.