Pre-Implementation Enhancement Strategy To Improve Teachers' Intention to Implement Evidence-Based Practices
Condition: Child Behavior Disorders; Implementation Science; Adolescent Problem Behavior at School; Healthcare Providers
MeSH terms: Mental Disorders; Problem Behavior; Child Behavior Disorders
Study type: Interventional

Summary: 
      Background: As the most common setting where youth access behavioral health services, the
      education sector frequently employs training and follow-up consultation as cornerstone
      implementation strategies to promote the uptake and use of evidence-based practices (EBPs),
      which are often insufficient to produce desired implementation outcomes (e.g., intervention
      fidelity) and changes in youth behavioral health outcomes (e.g., reduced externalizing
      behaviors). There is a need for theoretically-informed pre-implementation enhancement
      strategies (PIES) that increase the yield of training and follow-up consultation.
      Specifically, social-cognitive theory explicates principles to inform the design of strategy
      content and specific mechanisms of behavior change, such as intentions to implement (ITI), to
      target via a PIES that increase provider to more active implementation strategies. Methods:
      This triple-blind randomized controlled trial preliminarily examined the efficacy of a
      pragmatic PIES (SC-PIES) to improve the implementation of universal EBPs in the education
      sector. Participants were randomly assigned to the treatment (PIES) or active control
      condition (meeting with administrators). The investigators assessed participants' ITI,
      intervention fidelity, and youth behavioral health outcome before, immediately after, and
      six-week following treatment.
    

Detailed description: 
      1. Background and study aims:

           As the most common setting where youth access behavioral health services, the education
           sector frequently employs training and follow-up consultation as cornerstone
           implementation strategies to promote the uptake and use of evidence-based practices
           (EBPs). However, these strategies alone are not sufficient to promote the desired
           implementation (e.g., intervention fidelity) and youth behavioral health outcomes (e.g.,
           externalizing behaviors). Theory-informed pragmatic pre-implementation enhancement
           strategies (PIES) are needed to increase the yield of training and consultation.
           Specifically, social-cognitive theory explicates principles to inform the design of
           strategy content and specific mechanisms of behavior change (e.g., "intentions to
           implement"; ITI) to target to increase providers' responsiveness to training and
           consultation. This triple-blind parallel randomized controlled trial preliminarily
           examined the efficacy of a pragmatic PIES based on social-cognitive theories (SC-PIES)
           to improve the implementation and youth outcomes of universal EBPs in schools. Four aims
           will be examined:

             1. As compared to control, does the pre-implementation enhancement strategy based on
                social-cognitive theories (SC-PIES) significantly improve teachers' implementation
                intentions to implement PCBM practices at posttest after adjusting baseline and
                covariates?

             2. As compared to control, is receiving SC-PIES associated with significantly improved
                teachers' intervention fidelity and class-wide youth behavioral health outcome at
                the 6-week follow-up after adjusting for baseline and covariates?

             3. Does teachers' intention to implement mediate the association between study
                condition and intervention fidelity?

             4. Does teachers' intervention fidelity mediate the association between their
                intentions to implement and class-wide youth behavioral health outcomes?

        2. Who can participate? Any teacher who has no prior training about or experience of
           implementing Proactive Classroom Behavioral Management Strategies (PCBM) targeting youth
           behaviors in a school district. No restriction on age, gender, experience, or other
           demographic variables.

        3. What does the study involve? The participating teachers will be randomly assigned to
           either the treatment (SC-PIES) or active control condition (administrative meeting). The
           SC-PIES was delivered to teachers as a one-hour professional development session
           immediately before receiving specific training about evidence-based PCBM practices and
           subsequent follow-up consultation. Teachers in the active control condition will meet
           with their administrators to talk about their work irrelevant to SC-PIES or student
           behaviors. The investigators assessed teachers' ITI, intervention fidelity, and youth
           behavioral outcome (academic engagement as an incompatible behavior to externalizing
           disorders) before treatment, immediately after training, and six weeks afterward.

        4. What are the possible benefits and risks of participating? Teachers participating in
           this study will benefit from expert training and consultation to improve their
           intentions and skills to implement a set of EBPs to help their students' behavioral
           problems. No risks to participants were expected based on relevant literature in
           education and implementation science.
    

Intervention name(s): Pre-implementation enhancement strategies (SC-PIES); Sham comparator
Intervention type(s): Behavioral; Other
Intervention description(s): The SC-PIES was delivered to teachers as a one-hour professional development session immediately before receiving specific training about evidence-based student behavioral management practices and follow-up consultation. SC-PIES content was grounded in three social-cognitive principles: (a) growth mindset, (b) saying-is-believing, and (c) commitment and consistency.; Participants in the active control condition will meet with school administrators to talk about their work irrelevant to SC-PIES or student behaviors. The meeting lasted for the same duration as the SC-PIES at the same time as those in the treatment condition.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This is a triple-blind parallel randomized controlled trial. Specifically, teachers from a diverse urban district were recruited and randomly assigned to either the treatment (SC-PIES) or active control condition (administrative meeting). Based on the condition assigned, teachers received the SC-PIES (or met with administrators) before EBP training. The investigators assessed teachers' ITI, intervention fidelity, and youth behavioral outcome (academic engagement as an incompatible behavior to externalizing disorders) before treatment, immediately after training, and six weeks afterward.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Implementation Science; School Mental Health Services; Healthcare Providers; School Teachers