Sustainment of Mental Health Supports in Under-Resourced Urban Schools

项目摘要/摘要 这所学校是向儿童提供心理健康服务的关键场所。全校范围内的积极行为 干预和支持(PBIS)是一种基于公共卫生模式的服务提供战略，是一种有用的 实施心理健康EBPS的工具。在PBIS中，学校实施通用(Tier 1)干预以 改善学校氛围和安全，并可对患有或以下疾病的儿童采用有针对性的(第二级)团体干预 精神健康障碍的风险。关于在Tier使用心理健康EBPS的研究很少 2.充分和持续的培训机会经常被认为是实现以下目标所需的“基本做法” 成功地维持干预措施的好处。学校工作人员，无论是否接受过心理健康培训， 在提供足够支持的情况下，能够以保真度和临床有效性实施第二级干预。 成功实施有针对性的团体干预的学校心理健康项目通常使用正在进行的 来自内部监督人员的监督。多项研究表明，更有经验的学校 可以成功地对人员进行培训，使其成为实施EBPS的人员的教练和主管。在……里面 为了让这些学校获得有针对性的心理健康的潜在公共心理健康益处 学校干预，一种高效、可扩展、成本效益高和可持续的培训和咨询模式 这需要从专家转移到学校教练，从教练转移到EBP实施者。 关于哪些维持支助模式是有效的、可行的和具有成本效益的，人们知之甚少。 这项研究的目的是(A)比较第二层心理的忠诚度、成本效益和学生结果 2个维持条件下的卫生干预措施；(B)评估协商调解人和主持人 支持执行忠诚度；(C)评估协商的可行性和可接受性 支持。 这项研究建议使用双臂随机对照试验，类型2混合整群随机设计。 来自12所学校的60名学校工作人员将获得为期1年的全面初步执行支助，然后将 随机分配接受2种维持条件之一：(A)由学校提供的远程会诊 地区教练，他们自己将从专家外部顾问那里获得远程支持 (维持1[S1])；及。(B)由地区旅游巴士照常提供的会诊，没有外部支援。 (维持2[S2])。S1将经历一段支持率下降的时期，然后是一段没有支持率的时期。这个 由学校人员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(ISF) 传播和实施研究。拟议研究的结果将提供一个可扩展和成本- 在资源不足的学校维持PBIS心理健康支持的有效策略。

PROJECT SUMMARY / ABSTRACT The school is a key setting for the delivery of mental health services to children. School-wide positive behavior interventions and supports (PBIS), a service delivery strategy based on the public health model, is a useful vehicle for implementing mental health EBPs. In PBIS, schools implement universal (Tier 1) interventions to improve school climate and safety, and can employ targeted (Tier 2) group interventions for children with or at risk for mental health disorders. Very little research has been conducted on using mental health EBPs at Tier 2. Adequate and ongoing training opportunities are frequently identified as “essential practices” needed to successfully sustain the benefits of interventions. School personnel, with or without prior mental health training, can implement Tier 2 interventions with fidelity and clinical effectiveness when provided adequate support. School mental health programs that successfully implement targeted group interventions often use ongoing supervision from internal supervisors. A number of studies have shown that more experienced school personnel can successfully be trained to serve as coaches and supervisors for those implementing EBPs. In order for these schools to receive the potential public mental health benefits of targeted mental health interventions in schools, an efficient, scalable, cost-effective and sustainable model of training and consultation that can be transferred from experts to school coaches and from coaches to EBP implementers is needed. Little is known about which models of support for sustainment are effective, feasible, and cost-effective. The aims of the study are (a) to compare fidelity, cost-effectiveness, and student outcomes of Tier 2 mental health interventions across 2 sustainment conditions, (b) assess mediators and moderators of consultation support on implementation fidelity, and (c) assess perceived feasibility and acceptability of consultation support. The study proposes to use a 2-arm, randomized controlled trial, Type 2 Hybrid cluster randomized design. Sixty school personnel from 12 schools will receive full initial implementation support for 1 year and then will be randomly assigned to receive one of 2 sustainment conditions: (a) remote consultation provided by school district coaches who themselves will be receiving remote support from expert external consultants (Sustainment 1 [S1]); and (b) consultation as usual provided by district coaches with no external support (Sustainment 2 [S2]). S1 will have a period of diminished support followed by a period of no support. 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 (ISF) for dissemination and implementation research. The results of the proposed study will provide a scalable and cost- effective strategy for the sustainment of PBIS mental health supports in under-resourced schools.