Symposium 103 - Considering Multilevel Determinants of Implementation to Maximize the Uptake and Impact of Evidence-Based Interventions in Schools

Saturday, November 18, 2023

4:30 PM – 6:00 PM PST

Location: Quinault, Level 5

CE: 1.5

Keywords: Implementation, School, Evidence-Based Practice
Level of Familiarity: Basic to Moderate
Recommended Readings: Lyon, A.R., Bruns, E.J. From Evidence to Impact: Joining Our Best School Mental Health Practices with Our Best Implementation Strategies. School Mental Health 11, 106–114 (2019). https://doi.org/10.1007/s12310-018-09306-w, Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation science, 4(1), 1-15., Liu, F. F., Coifman, J., McRee, E., Stone, J., Law, A., Gaias, L., ... & Lyon, A. R. (2022). A brief online implicit bias intervention for school mental health clinicians. International Journal of Environmental Research and Public Health, 19(2), 679., Zhang, Y., Cook, C., Fallon, L. et al. The Interaction Between General and Strategic Leadership and Climate on Their Multilevel Associations with Implementer Attitudes Toward Universal Prevention Programs for Youth Mental Health: A Cross-Sectional Study. Adm Policy Ment Health (2022). https://doi.org/10.1007/s10488-022-01248-5,

Chair(s)

Freda Liu, Ph.D. (she/her/hers)

Assistant Professor
University of Washington School of Medicine
Seattle, Washington

Discussant(s)

AL

Aaron Lyon, Ph.D. (he/him/his)

Professor
University of Washington
Seattle, Washington

Presenter(s)

IM

Ian Muse, B.A. (he/him/his)

Research Coordinator
University of Washington, Seattle
Seattle, Washington
RG

Roger Goosey, B.S. (he/him/his)

Research Manager
University of Washington School of Medicine
Seattle, Washington
YL

Yasmin Landa, B.A. (she/her/hers)

Research Assistant
University of Washington School of Medicine
Seattle, Washington
RR

Rosemary Reyes, B.A. (she/her/they/them)

Research Study Coordinator
University of Washington, Seattle
SEATTLE, Washington

School is the most common setting in which youth receive mental health services (Duong et al., 2021), but the use of evidence-based practices (EBPs) continues to lag. School-based mental health encompasses a wide range of supports, from universal prevention (e.g., social emotional learning; SEL) programs to indicated interventions for specific clinical presentations (e.g., Trauma-Focused CBT). Although many of these EBP packages are now available, implementation barriers often prevent adequate uptake to fully benefit students in need, particularly those from minoritized or marginalized groups. Understanding and addressing multilevel implementation barriers and facilitator (i.e., determinants) would greatly improve the uptake and impact of EBPs. This symposium showcases four studies that examine implementation determinants in multiple domains per the Consolidated Framework of Implementation Research (CFIR, Damschroder et al., 2009). This symposium aims to demonstrate the importance of a clear multilevel understanding of the most critical implementation determinants to optimize implementation outcomes. This is especially pertinent when recognizing that the implementation of any new EBP comes with the risk of worsening existing inequities if there is disparate uptake or effectiveness of the EBP. Consistent with this year’s conference theme, this symposium will also highlight methodologies for applying an equity lens to implementation to attend to potential downstream disparities.

We will begin from a broad, system-level vantage point when considering implementation determinants and then zoom in. Specifically, the first paper will examine how Outer Setting factors like community level poverty and indicators of school resourcefulness (e.g., student-teacher ratio) affect implementation climate and leadership—important organizational level facilitators of implementation.

The second paper will directly examine the effects of implementation leadership and climate (Inner Setting factors) by experimentally manipulating school principal’s involvement in implementation of an evidence-based SEL. Preliminary pilot results will be presented from this on-going randomized implementation trial.

The third paper focuses on individual level factors of implementation. Specifically, this paper will describe a randomized pilot hybrid type-3 effectiveness-implementation trial of an equity-explicit implementation strategy designed to address implicit bias in school-based mental health clinicians and improve experiences of minoritized youth receiving services.

The last paper will examine the role of intervention characteristic in implementation success. Specifically, this paper will evaluate intervention usability of two EBPs implemented in the school setting as part of a large, randomized controlled hybrid type-2 effectiveness-implementation trial.

Finally, our discussant—a senior scholar with extensive experience designing and testing implementation strategies for use in schools and other accessible community settings who has published over 150 peer-reviewed publications on these topics—will identify and extend themes across presentations.

Learning Objectives:

At the end of the session, the learner will be able to:

Describe the importance of taking a multilevel approach to considering and addressing implementation determinants.
Identify at least 3 different levels (domains) on which to consider implementation determinants per the CFIR.
Give at least one example of how a multilevel approach to implementation can promote health equity.
Goal 1: demonstrate the importance of a clear multilevel understanding of critical implementation determinants for implementation success.
Goal 2: highlight opportunities for centering equity in considering multilevel implementation approaches.