Improving Student Mental Health: Adaptive School-based Implementation of CBT
Condition: Depression; Anxiety
MeSH terms: Depression
Study type: Interventional

Summary: 
      The overarching goal of this study is to improve the delivery of an established,
      evidence-based intervention (cognitive-behavioral therapy-CBT) in Michigan schools through
      different implementation strategies designed to better educate school professionals.
      Specifically, the study will assist the ongoing Transforming Research into Action to Improve
      the Lives of Students (TRAILS) Program by evaluating different ways to educate school
      professionals (SPs) to improve their delivery of CBT to high school students and ultimately
      improve student mental health outcomes in the state of Michigan. The three educational
      approaches are Replicating Effective Programs (REP), Coaching, and Facilitation.
    

Detailed description: 
      This study seeks to develop an effective and efficient sequence of implementation strategies
      for encouraging delivery of Cognitive Behavioral Therapy (CBT) by school professionals in
      high schools across Michigan. In the run-in phase, all schools will receive support and
      training from REP for three months. After three months, schools will be randomized to either
      (1) continue with REP; or (1) augment REP with a minimum of 12 weeks of coaching. Eight weeks
      after this first randomization, schools will be evaluated to determine whether they might
      also benefit from an augmentation of their current strategy with Facilitation. Schools that
      could benefit from Facilitation (defined as delivering 3 or more CBT modules to less than 10
      students or reporting 3 or more organizational barriers to delivering CBT) will be
      re-randomized to either (1) continue with their current strategy (REP or REP + Coaching); or
      (2) have their current strategy augmented with Facilitation. All implementation support will
      be discontinued 12 months after first randomization; outcomes will be assessed through 18
      months after study start.

      This results in four sequences of implementation strategies: REP only; REP + Facilitation for
      those who did not adequately respond initially to REP alone; REP + Coaching; and REP +
      Coaching + Facilitation for those who did not adequately respond initially to REP + Coaching.
    

Intervention name(s): Stage 1 Strategy: REP; Stage 1 Strategy: REP + Coaching; Stage 2 Strategy: Augment with Facilitation; Stage 2 Strategy: No augmentation
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): Schools will receive a daylong didactic training covering core elements of CBT and proper screening and identification of students; training to help SPs identify eligible students; a package that includes tools to deploy CBT; and ongoing technical assistance in CBT implementation.; Schools will receive a daylong didactic training covering core elements of CBT and proper screening and identification of students; training to help SPs identify eligible students; a package that includes tools to deploy CBT; ongoing technical assistance in CBT implementation; and weekly visits from a CBT expert or "Coach", for a minimum of 12 weeks.; In addition to first-line treatment (REP or REP + Coaching), schools will also receive support from a Facilitator who is a member of the study team and has expertise in CBT, implementation methods, and use of EBPs in schools will support SPs in strategic thinking and leadership skills to address organizational barriers.; Schools will continue to receive their first-line treatment (REP or REP + Coaching); no additional support will be offered.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Adaptive implementation; Coaching; Facilitation; School mental health; Implementation intervention