ADVANCING TAILORED IMPLEMENTATION OF EVIDENCE-BASED PRACTICE IN SCHOOL MENTAL HEALTH

Abstract

Approximately 1 in 5 youth aged 8–18 experiences a mental health problem (e.g., anxiety, depression, conduct, trauma) that requires mental health services; however, only about half receive evidence-based services, 70-80% of which are received in schools. There is an urgent need to address the implementation gap that limits youth access to quality mental health services and compromises longer term youth mental health outcomes. Improving mental health service implementation in schools requires the development and use of effective implementation strategies tailored to address context-specific barriers. Currently, implementation strategies are often selected based on a one-size-fits-all approach; however, to increase the likelihood that they will exert their desired effect, there is a need to use evidence-based knowledge and include participatory involvement of stakeholders to select and adapt strategies that are matched to site-specific barriers and deemed feasible for use in a given setting. The purpose of this development study was to engage school-based stakeholders in mixed method inquiry that facilitated the design of an implementation facilitation approach, the Facilitated Implementation Tailoring (FIT) technique. Our findings highlight the need to engage end-users at the outset of implementation strategy design. While all stakeholders welcomed the use of facilitation for school-based implementation efforts, several major and minor revisions to the FIT strategy were recommended following synthesis of stakeholder. Major revisions recommended included using a flexible yet structured “Pick-and-Choose" model that was comprehensive yet not over packaged to respond to stakeholders’ preferences and based needs. In addition, minor changes were suggested. Implications for theory and practice as well as limitations and future research are discussed.