A Sequential Explanatory Mixed Methods Evaluation of Implementation of Secondary and Tertiary School-Based Prevention Programs

Introduction

Real-world implementation of evidence-based secondary and tertiary prevention in schools can prove difficult, with limitations including time and school personnel, a lack of ongoing support for evidence-based implementation, and competition with established programs and priorities in the school system, resulting in a divide between recommendations and actual implementation (Cammack et al., 2014; Langley et al., 2010). We tested implementation of two evidence-based mental health interventions in Charlotte Mecklenburg Schools as prevention methods for school violence and safety problems.

Methods

We used a sequential explanatory mixed-methods design (Clark & Creswell, 2011) including quantitative and qualitative data collection to explore why some clinicians use the enhanced therapies regularly and others did not. As part of a larger randomized controlled trial, mental health providers (n = 43), including social workers, counselors, psychologists, and community therapists, in 8 middle and K-8 schools were trained to implement Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) and dialectical behavior therapy (DBT) as secondary and tertiary prevention programs, respectively.

Quantitative implementation data were used to identify program providers who delivered SPARCS and DBTs at the highest rates and with the most fidelity in contrast to those with lower rates of implementation and/or lower fidelity. Following intensive training and one year of implementation, all providers were recruited to complete interviews about the barriers and supports for using the evidence-based programs, and implementing them to fidelity. Interviews continue to be completed and full qualitative results will be prepared for the presentation.

Results

Providers in 3 of the 8 schools trained in the SPARCS program, implemented 1 cycle of the SPARCS program, while 5 of 8 schools implemented 2 cycles of the program. For the DBT skills training group component, providers had no implementation in 2 schools, partial implementation in 2 schools, and full implementation in 4 schools. Overall, DBT was implemented with less frequency and fidelity than SPARCS.

Initial qualitative results suggest that high implementers report being encouraged by student enjoyment of the program and skills being relevant to students. Barriers identified by low implementers include difficulty in obtaining parent consent, the complexity and length of the DBT skills training groups, and scarcity of time to devote to implement the DBT skills training groups.

Conclusions

Results suggest that a significant portion of school-based providers struggle with implementation following training in evidence-based practices for many reasons. Some complex programs may face prohibitive barriers in real-world school settings.