1 - (SYM 103) Social Determinants of Implementation: Poverty as a Barrier to New Trends in Mental Health

Background

The successful implementation of evidence-based practices (EBP) in mental health is widely dependent on determinants such as institutional climate, supportive leadership, and individual characteristics to support new techniques or interventions. While much research has focused on more direct and proximal factors, little attention has been paid to how outer setting characteristics may be barriers to successful implementation. These ‘social determinants of implementation’ (i.e., how the social environmental factors may influence implementation of new or active EBPs) were investigated using data from a large type-2 hybrid randomized effectiveness-implementation trial that measured implementation climate and leadership, and individual subjective norms among implementers to examine differences in the capacity of schools to implement an EBP in the face of district wealth, specifically in those districts with high wealth variability.

Methods

Analyses used data from 116 school mental health providers across 9 states. Organizational and individual factors were assessed using the Implementation Climate Scale (ICS), Implementation Leadership Scale (ILS), and a Modified Subjective Implementation Norms Questionnaire. The participant results were examined in a multivariate linear regression with the school-level income-to-poverty ratio (IPR), a ratio of the average income of households attending a school to the regional poverty level, free-and-reduced lunches (FRL), and the Locality designation and student-to-teach ratio (STR) data of the individual school included as independent variables of interest.

Results

Results indicated that the IPR was negatively correlated with the ILS and ICS (β=-0.26, p=0.001; β=-0.27, p=0.001). Results also demonstrated that school size and student teacher ratio were both highly correlated with the IPR of the school in relationship to the ILS and ICS (β=-0.26, p=.001; β=0.22, p=.001). Finally, there was no significant association between any independent variables and Subjective Norms.

Discussion

Districts with high levels of variability within poverty at the school-level may hinder the implementation of evidence-based practices within schools, potentially through in-school environments, and implementation-focused leadership practices. Future research should aim to increase the sample size of providers assessed using these instruments, with greater power to examine potential moderating and mediating factors that have contributed to these strong correlational findings.