Advancing Implementation Quality and Training of School Professionals: A Focus on the Arizona Anxiety Resilience Building Project

Introduction:  Implementation quality has been identified as a key factor in securing the effectiveness of group-based evidence-based treatments (EBTs). In order to successfully train individuals to use EBTs in real-world settings, careful consideration must be paid to understanding the specific features associated with implementation quality. Berkel and colleagues (2011) have proposed an empirically-based, theoretical model, that suggests the quality of facilitator behaviors, which includes clinical process skills (e.g., enthusiasm, rapport) and interactive teaching methods, predicts student responsiveness, and in turn is related to program outcomes. We build upon this empirically-based model by including facilitator competencies (clarity, knowledge, pacing) as an aspect of facilitator behaviors and examining more closely the links between group leader competencies, clinical process skills, and student responsiveness (understanding and active participation).

Methods: The current study uses data from a school-based anxiety preventive intervention pilot study which targets 4^th and 5^th grade students. Nine school staff members (3 school social workers, 6 school psychologists) from 9 schools across four school districts were selected to receive approximately 6 hours of training on the six session preventive intervention protocol.  Each leader facilitated one to two groups (approximately 5 children per group). Immediately following each session, group leaders and observers were asked to provide ratings of implementation quality (i.e., group leader competencies, clinical process skills, and student responsiveness).

 

Results: Preliminary correlation analyses assessing session-level implementation quality showed a significant relation between group leader competencies and clinical process skills (r = .48, p < .01). Student responsiveness was also significantly correlated with both leader competencies (r = .50, p < .01) and clinical process (r = .39, p < .01). Regression analyses revealed that these group leader characteristics significantly predicted student responsiveness (R² = .28; F(2, 81) = 15.83, p < .001). Interestingly, group leader competencies are a stronger predictor of student responsiveness (B = .43, p <.001) compared to clinical process skills (B = .22, p =.07).

 

Conclusions: These findings advance the conceptualization of training and implementation protocol for school-based prevention programs. Specifically, the extent to which group leaders are able to structure and deliver program content, as well as display clinician skills is significantly related to the level of student responsiveness to the intervention.  Moreover, the greater contribution of basic leader skills than clinician skill on student responsiveness has implications for the recruitment and training of effective group leaders.