For sustained uptake to occur in this setting, accessing patients’ app data must be simple and streamlined. However, there is concern that the addition of coaching components will hurt app scalability. Some work has suggested beneficial effects of personalized coaching via text messages or phone calls in increasing app use and decreasing anxiety and depression symptoms (Mohr et al. 2019). The CBT version was no more effective; it was hypothesized that this version may have been less visually appealing and that the CBT principles were too complex to be communicated effectively via an app. It has been argued that many app functions can be achieved through simple text messaging that does not require smartphone ownership, data availability, or the frequent updates inherent to app use (Willcox et al. 2019). Further research regarding this potential digital placebo effect is needed to isolate the active ingredients contributing to MH app effectiveness (Firth et al. 2017a).
Measurement Properties of Implementation Outcomes
- More specific to school mental health, Giordano and colleagues (2020) found that among 15 Head Start teachers receiving coaching for social–emotional classroom practices, those with internal peer coaches demonstrated better intervention fidelity and student social skills as compared to those with external coaches.
- Background Implementation science comprises a large set of theories suggesting interacting factors at different organisational levels.
- Specifically, there is a need to better understand the types of implementation determinants that are most salient at each stage, how these determinants can be measured and assessed in a pragmatic way, and whether some implementation strategies are more appropriate or have differential effects depending upon the phase of implementation.
- As a beginning step, researchers should report the referent for all implementation outcomes measured.
Aside from a few notable examples of recently completed school-based Type 2 trials in the https://www.nationalacademies.org/read/26809/chapter/5 domains of computer-assisted interventions for autism (Pellecchia et al., 2020) and cognitive behavioral therapy (Eiraldi et al., 2024), nearly all hybrid trial examples we identified are study protocols for ongoing work. Increasingly, hybrid Type 1 trials are not considered “true” implementation research studies since implementation strategies and outcomes are observed, not empirically evaluated. A case study of the de-implementation of a school-based trauma program over a two-year period highlighted the role of severe budget and staffing cuts and a district-level decision to refocus staff on providing mandated services (Nadeem & Ringle, 2016).
The Department of Global Health Implementation Science Program
Aarons and colleagues (this issue) show how mixed methods can be used to determine how quantitative and qualitative results converge as well as how qualitative findings can expand upon quantitative findings (Palinkas et al., 2011). We urge researchers to use theories and frameworks to guide the planning, conduct, and reporting of their research in order to work toward more generalizable knowledge in the field of implementation. The EPIS framework provides a manageable scope for the special issue, grounds the work in the extant literature, and provides a common language to use across studies. The use of implementation frameworks such as the EPIS framework (Aarons et al., 2011) and the policy ecology framework (Raghavan et al., 2008) is tremendously helpful when considering system-level implementation. Each of these stakeholder groups have important perspectives that need to be brought to bear in system-level implementation (Chambers & Azrin, 2013).
While these models do not directly address implementation, they underscore that active ingredients of strategy must be specified and linked to multiple types of outcomes, as discussed below. Complexity science (Fraser and Greenhalgh 2001; Liyaker et al. 2006) aims to capture the practice landscape, while quality improvement approaches such as the IHI and QUERI models further inform implementation at the organizational level. Moreover, agency organizational culture may wield the greatest influence on acceptance of empirically supported treatments and the willingness and capacity of a provider organization to implement such treatments in actual care. Conrad and Christianson (2004) offer a well-specified graphic model of the interactions between local health care market and social environments (health plans, provider organizations, and decisions of organizations, physicians, and patients) with mathematically derived statements. Also relevant to the organizational level are provider financial incentives to improve patient health outcomes and consumer satisfaction.
Review: Methods and tools to assess implementation of mental health policies and plans: A systematic review — R0/PR2
As these efforts continue to advance, it will be important that implementation research in school mental health—and education more generally—does not simply adopt the health-oriented conceptualization of implementation wholesale and uncritically. As school mental health implementation research continues to evolve over the next decade, we hope to see expanded emphasis on ways to promote equitable implementation. For instance, Renshaw and Phan (2023) recently proposed an expansion of implementation reporting recommendations for school-based mindfulness interventions to center equity (e.g., through explicit attention to principles that research teams might employ to center diversity, equity, and inclusion during intervention adaptation). This includes the development of multiple equity-oriented implementation frameworks (e.g., Eslava-Schmalbach et al., 2019; Woodward et al., 2019), processes to surface and address equity concerns in implementation strategies (Gaias et al., 2022), and guidance about how to incorporate equity into the evaluation of context and measurement of implementation outcomes (Brownson et al., 2021). Throughout this paper, we have attempted to underscore opportunities to advance equitable implementation in school mental health.
There are countless theories, frameworks, taxonomies, and models that can guide, describe, or evaluate intervention implementation and address the contextual factors that impact the intervention planning and implementation process . This process of translating an intervention from one setting to another can be facilitated by using implementation science methods. Not only does context determine what we deem a problem and the interventions we choose to address it, but context is the linchpin of successful implementation. Implementation science has grown considerably in school mental health over the past decade, driven by the persistent gaps between knowledge about “what works” to promote student well-being and what is typically delivered in schools.