Paul Flaspohler

As youth behavioral health needs in the United States continue to grow, schools are increasingly important settings for prevention and service delivery. Yet evidence-based practices (EBPs) are not consistently implemented or sustained at scale. In this article, we present a critical narrative review of dissemination and implementation efforts in school behavioral health (SBH) through the lens of the Interactive Systems Framework for Dissemination and Implementation 2.0 (ISF 2.0). We reviewed and synthesized relevant SBH and implementation science literature to identify promising practices, persistent challenges, and gaps in the field, and then applied the ISF 2.0 as an analytic lens to examine how these issues operate across the systems involved in SBH implementation. Findings suggest that misalignment in goals, strategies, roles, and communication across systems can impede the delivery of EBPs to schools in ways that are feasible, responsive to local needs, and sustainable. Drawing on these findings, we developed ISF 2.0–guided questions and applied them to three prominent SBH implementation initiatives: the National Center for School Mental Health (NCSMH), the Center on Positive Behavioral Interventions and Supports (Center on PBIS), and the South Carolina School Behavioral Health Academy (SBHA). Selected based on their national or regional prominence, accessibility of information, and implementation activities, these illustrative cases demonstrate how the ISF 2.0 can be used to identify cross-system strengths, gaps, and opportunities for improvement. Although this review is narrative rather than systematic and the cases are illustrative rather than exhaustive, the analysis highlights the importance of stronger bidirectional communication and greater attention to how knowledge is generated, translated, adapted, and used in partnership with stakeholders. The ISF 2.0 provides a promising framework for understanding the complex systemic factors shaping SBH implementation and for strengthening alignment among the systems that generate knowledge, support implementation, and deliver services. Greater cross-system alignment should help schools implement and sustain effective behavioral health practices that are responsive to community needs and improve youth well-being.

Teachers are critically involved in the delivery of school-based mental health promotion (SMHP) interventions in school, though pre-service teacher education often leaves teachers feeling underprepared in this area. Thus, understanding how best to build teachers’ capacity for delivery through effective professional development (PD) is essential for teachers to fulfill their role as delivery agents to achieve SMHP outcomes. This systematized review focuses on identifying components of high-quality teacher PD for SMHP and examining the empirical support for these components. In a two-phase analysis, we examined the descriptive literature regarding teacher PD for SMHP to identify common elements. This resulted in the identification of components relevant to training (interactive, guided by staff input) and technical assistance (TA), including the goals (skill development, motivation, generalization/adaptation), approach (collaborative, individualized, data-driven, strengths-based), and activities (modeling, performance feedback, reflection, problem solving) involved. A second phase focused on the examination of empirical evidence for these PD components. While the empirical evidence for these components was limited, the identified components represent a current standard of practice in teacher PD for SMHP, based on the existing research. These components may provide a framework for practical use in planning teacher PD related to SMHP and for designing future research into effective capacity building in this area.

School mental health (SMH) teams have been widely recommended to support multi-tiered mental health program implementation in schools. Available research suggests emerging best practices that promote effective SMH teaming and indicates the importance of having team members who are highly engaged (e.g., actively involved, retained on the team). Despite evidence that these factors improve team functioning, there is limited knowledge of SMH team prevalence, best practice use, and factors impacting member engagement among a diverse sample of elementary schools. This study surveyed a cross-sectional sample of elementary principals (n = 314) across the United States whose schools implement multi-tiered SMH programs. Most principals (89%, n = 280) reported using teams to organize these programs. Schools in urban/suburban communities, with 300 or more students, or with specific school funding for SMH activities were more likely to have SMH teams. Only one-third of principals reported that their team members participated in related training. Other SMH team best practices were commonly reported (by two-thirds or more teams). Results of a linear regression model indicate that larger teams (six or more members) and teams with access to resources had significantly higher member engagement scores. The study’s findings provide recommendations for practice and future research directions.

The key objectives of this chapter are for readers to do the following: To frame discussion of future directions, we return to our rationale for ...

In this article, we compare and contrast the Multilevel Implementation Quality Framework (Domitrovich et al, 2008, this issue) with other emerging frameworks, theories, and models emerging in health services literature. We describe application of the Interactive Systems Framework for Dissemination and Implementation (ISF) to support strengthening implementation of Expanded School Mental Health Services (ESMH) in Ohio. We argue that participatory framework development presents promise as a means to overcome disciplinary and structural impediments to promoting implementation of ESMH. We describe the process of engaging key stakeholders to explore, understand, and improve implementation of ESMH services, and provide examples of how the process led to improved understanding of dissemination and implementation, and fomented commitment and support for strategies to strengthen implementation of ESMH services across the state.