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

选择和测试实施策略以推进学校心理测量为基础的护理 健康状况 项目总结： 每年，14%-20%的儿童和青少年被诊断出患有精神疾病，只有大约 一半的人接受治疗。虽然很大一部分服务是以学校为基础的，但提供 基于证据的做法在学校心理健康(SMH)是高度不一致的。一个改善的重要机会 SMH质量是基于测量的护理(MBC)的成功实施。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进行监测 取得进展并通知治疗决定。MBC是一种以证据为基础的实践，与更大的 更快地减轻症状、改善功能、患者参与度和共同决策。 尽管有证据表明MBC的有效性和与学校环境的良好契合性，但在SMH实践中使用MBC是有限的。 此K08的目标是选择和试点测试一套针对学校具体情况的实施策略，以 在SMH临床医生中促进MBC。在杰出科学家的培训和高级指导下， 心理健康服务研究、基于测量的护理和实施科学，如Melanie博士 贝内特、马克·韦斯特、莎伦·胡佛、约翰·兰德弗克、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教职员工，我处于领导地位的理想位置 校本实施研究，在四个方面进行额外培训：(1)对临床医生进行MBC工具培训 和流程；(2)实施战略、框架、研究设计；(3)多层次建模和混合 方法和(4)科学写作和从研究到实践的伙伴关系技能。这项研究计划将涉及 有目的地抽样25名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、临床研究人员、实施中介和实施科学家) 全国卫生保健普查，以确定和达成关于卫生保健中针对母婴保健的具体实施战略的共识 通过改进的德尔福流程。接下来，小组成员将使用已建立的概念图方法来 组织和评估战略，为战略选择提供信息。最后，我们将对选定的30种策略进行试点测试 两个地区的SMH临床医生使用多基线实施试验来测试实施的效果 关于MBC实施的策略(即保真度、可接受性、适当性、可行性)，并遵守 使用MBC对学生成绩和患者参与度的影响。通过与SMH临床医生密切合作 和利益攸关方，该项目提供了确定和调整或制定实施战略的机会 这是可行的、可扩展的和生态有效的，以促进一线SMH对MBC的吸收 临床医生。K08提供的指导培训和研究经验将为 未来的R01提交，以进行全功率混合设计测试实施和 MBC战略在SMH中的有效性。我获得的技能将使我有能力开发一个独立的程序 作为一名实施科学家，他的研究重点是提高学校精神卫生保健的质量。

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.