Promoting Teachers' Implementation of Classroom-Based Prevention Programming Through Coaching: The Mediating Role of the Coach-Teacher Relationship

Supervisory Alliance as a Moderator of the Effects of Behavioral Rehearsal on TF-CBT Fidelity: Results from a Randomized Trial of Supervision Strategies

Exposure is an important element of treatment for many evidence-based treatments but can be challenging to implement. Supervision strategies to support exposure delivery may be an important tool to facilitate the use of exposure techniques; however, they must be considered and used in the context of the supervisory alliance. The present study examined relations between supervisory alliance and fidelity to the trauma narrative (TN; i.e., imaginal exposure) component of Trauma-Focused Cognitive Behavioral Therapy. We also examined how supervisory alliance moderated the effect of behavioral rehearsal use in supervision on TN fidelity. We analyzed data from a randomized controlled trial, in which forty-two supervisors and their clinicians (N = 124) from 28 Washington State community-based mental health offices participated. Clinicians were randomized to receive one of two supervision conditions-symptom and fidelity monitoring (SFM) or SFM with behavioral rehearsal (SFM + BR). Supervisory alliance alone did not predict delivery (i.e., occurrence) or extensiveness of delivery of the trauma narrative. Client-focused supervisory alliance moderated the effectiveness of behavioral rehearsal-as client-focused alliance increased, the odds of delivering the TN also increased significantly. Future research should further investigate how to appropriately match supervision techniques with supervisory dyads and explore the interplay of alliance with supervision techniques a supervisor might employ.

Strategies for Enhancing the Implementation of Universal Mental Health Prevention Programs in Schools: A Systematic Review

A number of school-based mental health prevention programs have been found to be effective in research trials, but little is known about how to support implementation in real-life settings. To address this translational problem, this systematic review aims to identify effective strategies for enhancing the implementation of mental health prevention programs for children in schools. Four electronic databases were searched for empirical, peer-reviewed articles in English from January 2000 to October 2021 reporting the effects of implementation strategies for school-based universal mental health programs. Twenty-one articles were included in the narrative synthesis and assessed for quality using the Mixed Methods Appraisal Tool. Twenty-two strategies were found to be effective at improving program fidelity or adoption. The strategies with the strongest positive evidence base were those that involved monitoring and provision of feedback, engaging principals as program leaders, improving teachers' buy-in and organising school personnel implementation meetings. We recommend school-based practitioners trial strategies with positive findings from this review as part of their continuous quality improvement. This review highlights the pressing need for large-scale, randomised controlled trials to develop and trial more robust strategies to enhance adoption, as the five implementation studies found to measure adoption used qualitative methods limited by small samples sizes and case study designs.

Adolescent Substance Use Behavior Change Through School Intervention Is Improved by Teacher and School Implementation Support Together, Especially for Girls

An earlier trial of a school-based, preventative intervention, HealthWise South Africa, demonstrated some efficacy in preventing adolescent drinking and smoking in the Western Cape, South Africa. This was followed by the current implementation trial, which examined how implementation support conditions influenced adolescent drinking and smoking behavior change in the HealthWise intervention. The hybridized implementation-effectiveness trial included 34 schools (n = 2175 students) that provided student data at four waves through Grades 8 to 10. Implementation support conditions included a combination of two components (enhanced school environment and teacher consultation), resulting in four conditions: enhanced school environment, teacher consultation, both components, and standard delivery. Using configural frequency analysis, we examined how drinking and smoking behavior change differed across four configurations of intervention support longitudinally and by gender. For baseline non-smokers, results indicated sustained differences in abstention from smoking and smoking initiation between schools that received both support components and schools in the standard delivery condition. These results were primarily driven by girls. For baseline drinkers and smokers in the both components condition, changes in drinking were delayed until Grade 9 and smoking decayed by Grade 10. Results suggest that providing both school and teacher implementation support synergistically facilitates improved intervention outcomes both immediately following intervention and 2 years later across schools with diverse resource levels. Future iterations of HealthWise, and other interventions, may benefit from a multilevel implementation support strategy to improve student outcomes. More research is needed to understand how to improve HealthWise effectiveness among boys.

Study protocol for a cluster-randomized trial of a bundle of implementation support strategies to improve the fidelity of implementation of schoolwide Positive Behavioral Interventions and Supports in rural schools

Background

Improving the implementation of evidence-based interventions is important for population-level impacts. Positive Behavioral Interventions and Supports (PBIS) is effective for improving school climate and students’ behavioral outcomes, but rural schools often lag behind urban and suburban schools in implementing such initiatives.

Methods/Design

This paper describes a Type 3 hybrid implementation-effectiveness trial of Rural School Support Strategies (RS3), a bundle of implementation support strategies selected to improve implementation outcomes in rural schools. In this two-arm parallel group trial, 40 rural public schools are randomized to receive: 1) a series of trainings about PBIS; or 2) an enhanced condition with training plus RS3. The trial was planned for two years, but due to the pandemic has been extended another year. RS3 draws from the Interactive Systems Framework, with a university-based team (support system) that works with a team at each school (school-based delivery system), increasing engagement through strategies such as: providing technical assistance, facilitating school team functioning, and educating implementers. The primary organizational-level outcome is fidelity of implementation, with additional implementation outcomes of feasibility, acceptability, appropriateness, and cost. Staff-level outcomes include perceived climate and self-reported adoption of PBIS core components. Student-level outcomes include disciplinary referrals, academic achievement, and perceived climate. Mediators being evaluated include organizational readiness, school team functioning, and psychological safety.

Discussion

The study tests implementation strategies, with strengths including a theory-based design, mixed methods data collection, and consideration of mediational mechanisms. Results will yield knowledge about how to improve implementation of universal prevention initiatives in rural schools.

Analysis of the correlation between occupational stress and mental health of primary and secondary school teachers

BACKGROUND

With the rapid advancement of the educational reform, the requirements for primary and secondary school teachers are increasing, which makes the work pressure of teachers become greater, which can lead to a variety of mental health problems. It is the primary task to promote the psychological health of primary and secondary school teachers by analyzing the stress of teachers and putting forward reasonable countermeasures.

OBJECTIVE

The study aimed to analyze the direct and indirect effects of occupational stress on the mental health level of primary and secondary school teachers.

METHODS

317 teachers from 6 rural primary and secondary schools in Zhejiang province were selected as research subjects. A questionnaire was designed to collect information of occupational stress, mental health, and social support scores. The teachers were compared for differences in gender, marriage status, class teacher, occupational stress, and mental health. The correlation among occupational stress, mental health, and social support was analyzed by structural equation model.

RESULTS

The occupational stress of male teachers was higher than that of female teachers in self-development, work load, and career expectation, and the mental health was lower than that of female teachers in work (P < 0.05). The occupational stress of married teachers was significantly higher than that of unmarried teachers, and their mental health was significantly higher than that of unmarried teachers (P < 0.05). The occupational stress of teachers with senior professional titles was lower than that of teachers with primary and intermediate titles in the dimensions of self-development, work load, and career expectation (P < 0.05). The occupational stress of class teachers was higher than that of non-class teachers in terms of student factors, work load, and career expectation (P < 0.05). The direct path coefficient between occupational stress and mental health was -0.421, and the indirect path coefficient between occupational stress and mental health was -0.172.

CONCLUSIONS

The occupational stress of male, married, class teacher, and teacher with the primary and intermediate titles was significantly greater than that of female, unmarried, non-class teacher, and senior title teacher. In conclusion, the occupational stress of primary and secondary school teachers can not only directly predict the mental health level, but also indirectly affect the mental health level through social support.

Leveraging Motivational Interviewing to Coach Teachers in the Implementation of Preventive Evidence-Based Practices: A Sequential Analysis of the Motivational Interviewing Process

Though emerging research supports the effectiveness of school-based coaching models utilizing motivational interviewing (MI), an examination of the specific drivers behind these effects is notably lacking in the prevention field. This study leveraged sequential analysis to examine how teachers' verbalization of change talk (i.e., language in support of change) and sustain talk (i.e., language in support of maintaining the status quo) was influenced by coaches' use of MI-consistent (i.e., collaborative language supportive of change) and MI-inconsistent (e.g., confrontational, directive) language, respectively. We also examined whether teacher and coach factors were related to coach-teacher language dynamics. Data were collected from 87 teachers in 16 elementary and middle schools randomized in a trial to the Double Check preventive intervention (see Bradshaw et al., 2018). Audio-recorded coaching feedback sessions were coded using an adapted version of the Motivational Interviewing Sequential Code for Observing Process Exchanges (MI-SCOPE). Sequential analyses indicated that MI-consistent and change talk were significantly more likely than chance to occur consecutively. Teachers' sustain talk was also more likely to occur sequentially with coach use of MI-consistent language and teacher change talk; the latter suggests teacher ambivalence. Coaches rarely used MI-inconsistent language, and its occurrence was only associated with more MI-inconsistent language. Regression analyses indicated that teacher age, efficacy, burnout, classroom organization, and some design features (i.e., cohort, coach, coach-teacher racial match) were associated with different coach-teacher language dynamics. This novel school-based study illustrates how coaching MI evoked teacher change talk related to use of evidence-based programs.

Scaling up Evidence-Based Interventions in US Public Systems to Prevent Behavioral Health Problems: Challenges and Opportunities

A number of programs, policies, and practices have been tested using rigorous scientific methods and shown to prevent behavioral health problems (Catalano et al., Lancet 379:1653-1664, 2012; National Research Council and Institute of Medicine, 2009). Yet these evidence-based interventions (EBIs) are not widely used in public systems, and they have limited reach (Glasgow et al., American Journal of Public Health 102:1274-1281, 2012; National Research Council and Institute of Medicine 2009; Prinz and Sanders, Clinical Psychology Review 27:739-749, 2007). To address this challenge and improve public health and well-being at a population level, the Society for Prevention Research (SPR) formed the Mapping Advances in Prevention Science (MAPS) IV Translation Research Task Force, which considered ways to scale up EBIs in five public systems: behavioral health, child welfare, education, juvenile justice, and public health. After reviewing other efforts to scale up EBIs in public systems, a common set of factors were identified as affecting scale-up in all five systems. The most important factor was the degree to which these systems enacted public policies (i.e., statutes, regulations, and guidance) requiring or recommending EBIs and provided public funds for EBIs. Across systems, other facilitators of scale-up were creating EBIs that are ready for scale-up, public awareness of and support for EBIs, community engagement and capacity to implement EBIs, leadership support for EBIs, a skilled workforce capable of delivering EBIs, and data monitoring and evaluation capacity. It was concluded that the following actions are needed to significantly increase EBI scale-up in public systems: (1) provide more public policies and funding to support the creation, testing, and scaling up of EBIs; (2) develop and evaluate specific frameworks that address systems level barriers impeding EBI scale-up; and (3) promote public support for EBIs, community capacity to implement EBIs at scale, and partnerships between community stakeholders, policy makers, practitioners, and scientists within and across systems.

Self-Regulation Approach to Training Child and Family Practitioners

Evidence-based psychotherapies or programs (EBPs) exist for most mental health disorders that occur in childhood; however, the majority of children with a mental health disorder do not receive such treatments. This research-practice gap has been attributed to a range of factors that complicate the delivery of EBPs in everyday practice. While most suggestions to bridge this gap have focused on how to develop EBPs that will have a better fit for the clinical settings in which they will ultimately be deployed, a useful adjunct is to enhance practitioners' capacity to flexibly deliver EBPs to manage these factors. We propose that the extent to which a practitioner is able to change their own behaviour in response to cues and information about the current needs of their clients, and do so while maintaining the integrity of an EBP, may be a function of practitioners' self-regulatory capacity. In this conceptual paper, we describe a model of self-regulation that can be applied to child and family practitioners. We argue that practitioners with greater self-regulatory capacity are more likely to take up EBPs, sustain their use of them and have superior outcomes with clients. We draw on our experience in disseminating a system of parenting support to illustrate how practitioners' self-regulatory capacity can be enhanced while simultaneously receiving training in an EBP. Advantages and disadvantages of a self-regulatory approach to training are discussed and directions for future research are offered.

Proposing a Mechanistic Model of Clinician Training and Consultation

To make evidence-based treatments deliverable, effective, and scalable in community settings, it is critical to develop a workforce that can deliver evidence-based treatments as designed with skill. However, the science and practice of clinician training and consultation lags behind other areas of implementation science. In this paper, we present the Longitudinal Education for Advancing Practice (LEAP) model designed to help span this gap. The LEAP model is a mechanistic model of clinician training and consultation that details how training inputs, training and consultation strategies, and mechanisms of learning influence training outcomes. We first describe the LEAP model and then discuss how key implications of the model can be used to develop effective training and consultation strategies.