Development and evaluation of a remote training strategy for the implementation of mental health evidence-based practices in rural schools: pilot study protocol

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Abstract

Background

An increasing number of schools in rural settings are implementing multi-tier positive behavioral interventions and supports (PBIS) to address school-climate problems. PBIS can be used to provide the framework for the implementation of evidence-based practices (EBPs) to address children’s mental health concerns. Given the large service disparities for children in rural areas, offering EBPs through PBIS can improve access and lead to better long-term outcomes. A key challenge is that school personnel need technical assistance in order to implement EBPs with fidelity and clinical effectiveness. Providing ongoing on-site support is not feasible or sustainable in the majority of rural schools, due to their remote physical location. For this reason, remote training technology has been recommended for providing technical assistance to behavioral health staff (BHS) in under-served rural communities.

Objectives

The purpose of this study is to use the user-centered design, guided by an iterative process ( rapid prototyping), to develop and evaluate the appropriateness, feasibility, acceptability, usability, and preliminary student outcomes of two online training strategies for the implementation of EBPs at PBIS Tier 2.

Methods

The study will employ a pragmatic design comprised of a mixed-methods approach for the development of the training platform, and a hybrid type 2, pilot randomized controlled trial to examine the implementation and student outcomes of two training strategies: Remote Video vs. Remote Video plus Coaching.

Discussion

There is a clear need for well-designed remote training studies focused on training in non-traditional settings. Given the lack of well-trained mental health professionals in rural settings and the stark disparities in access to services, the development and pilot-testing of a remote training strategy for BHS in under-served rural schools could have a significant public health impact.

Ethics and dissemination

The project was reviewed and approved by the institutional review board. Results will be submitted to ClinicalTrials.gov and disseminated to community partners and participants, peer-reviewed journals, and academic conferences.

Trial registration

ClinicialTrials.gov, NCT05034198 and NCT05039164

Related collections

Most cited references 83

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Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Laura Damschroder, David Aron, Rosalind E Keith … (2009)

Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.

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Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda

Enola Proctor, Hiie Silmere, Ramesh Raghavan … (2010)

An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of “implementation outcomes” distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working “taxonomy” of eight conceptually distinct implementation outcomes—acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability—along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.

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Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.

Geoffrey M Curran, Mark Bauer, Brian Mittman … (2012)

This study proposes methods for blending design components of clinical effectiveness and implementation research. Such blending can provide benefits over pursuing these lines of research independently; for example, more rapid translational gains, more effective implementation strategies, and more useful information for decision makers. This study proposes a "hybrid effectiveness-implementation" typology, describes a rationale for their use, outlines the design decisions that must be faced, and provides several real-world examples. An effectiveness-implementation hybrid design is one that takes a dual focus a priori in assessing clinical effectiveness and implementation. We propose 3 hybrid types: (1) testing effects of a clinical intervention on relevant outcomes while observing and gathering information on implementation; (2) dual testing of clinical and implementation interventions/strategies; and (3) testing of an implementation strategy while observing and gathering information on the clinical intervention's impact on relevant outcomes. The hybrid typology proposed herein must be considered a construct still in evolution. Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice.

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Author and article information

Contributors

Ricardo Eiraldi:

ORCID: http://orcid.org/0000-0003-3997-696X

eiraldi@upenn.edu

Barry L. McCurdy: barrymc@pcom.edu

Muniya S. Khanna: muniya@muniyakhannaphd.com

Jessica Goldstein: golsteij1@chop.edu

Rachel Comly: comlyr@chop.edu

Jennifer Francisco: Jennifer.francisco@devereux.org

Laura E. Rutherford: laura.rutherford@devereux.org

Tara Wilson: wilsont8@chop.edu

Kathryn Henson: hensonk@chop.edu

Thomas Farmer: tfarmer@pitt.edu

Abbas F. Jawad: jawad@chop.edu

Journal

Journal ID (nlm-ta): Pilot Feasibility Stud

Journal ID (iso-abbrev): Pilot Feasibility Stud

Title: Pilot and Feasibility Studies

Publisher: BioMed Central (London )

ISSN (Electronic): 2055-5784

Publication date (Electronic): 17 June 2022

Publication date PMC-release: 17 June 2022

Publication date Collection: 2022

Volume: 8

Electronic Location Identifier: 128

Affiliations

[1 ]GRID grid.239552.a, ISNI 0000 0001 0680 8770, Roberts Center for Pediatric Research, , Children’s Hospital of Philadelphia, ; 2716 South Street, Room 8293, Philadelphia, PA 19146-2305 USA

[2 ]GRID grid.25879.31, ISNI 0000 0004 1936 8972, Department of Pediatrics, , University of Pennsylvania Perelman School of Medicine, ; Philadelphia, PA USA

[3 ]GRID grid.282356.8, ISNI 0000 0001 0090 6847, School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine, ; Philadelphia, USA

[4 ]OCD and Anxiety Institute, Plymouth Meeting, PA USA

[5 ]GRID grid.454404.5, Devereux Center for Effective Schools, ; King of Prussia, PA USA

[6 ]GRID grid.21925.3d, ISNI 0000 0004 1936 9000, School of Education, , University of Pittsburgh, ; Pittsburgh, PA USA

Author information

Ricardo Eiraldi http://orcid.org/0000-0003-3997-696X

Article

Publisher ID: 1082

DOI: 10.1186/s40814-022-01082-4

PMC ID: 9205032

PubMed ID: 35710520

SO-VID: 078b7820-f1c5-4860-b746-9060979e8a9c

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 16 September 2021

Date accepted : 1 June 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000133, Agency for Healthcare Research and Quality;

Award ID: 1R18HS027755

Award Recipient : Ricardo Eiraldi

Custom metadata

Keywords: rural schools,user-centered design,positive behavioral interventions and supports,mental health evidence-based practices,tier 2

Data availability:

Keywords: rural schools, user-centered design, positive behavioral interventions and supports, mental health evidence-based practices, tier 2

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Development and evaluation of a remote training strategy for the implementation of mental health evidence-based practices in rural schools: pilot study protocol

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Abstract

Background

Objectives

Methods

Discussion

Ethics and dissemination

Trial registration

Related collections

The Behavioral Economics of Music: A Framework for the Study of Music Listening, Evaluation, and Choice Behavior

Most cited references 83

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda

Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.

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Cited by 1

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