Project 3: Organizational implementation strategies to integrate a new mental health workforce in schools

PROJECT 3 SUMMARY Innovative workforce solutions to increase youth mental health care access are a national priority. The University of Oregon’s Ballmer Institute is training the nation’s first undergraduate workforce to increase youths’ access to mental health evidence-based practices (EBPs) in schools. The Institute trains child behavioral health specialists (CBHS) to deliver evidence-based prevention, promotion, and intervention for common youth mental health concerns. Workforce training alone, however, does not produce increased access. A positive implementation climate that supports integration of this new workforce into routine school mental health services is needed to increase youths’ access to care. One promising approach to foster a positive implementation climate is to strategically target key change agents such as mid-level managers. The purpose of this project is to co-design and test an implementation strategy to support school mid-level managers in creating a positive implementation climate to integrate CBHS-delivered EBPs in schools. In line with the ACCESS center’s goals, optimal CBHS integration will accelerate youths’ access to quality school- based mental health care, and ultimately, improve youth mental health. This study is grounded in an established academic-community partnership between the Ballmer Institute and Oregon’s Portland Public Schools District. Guided by the Discover, Design, Build, and Test framework, we apply pragmatic implementation science methods and human-centered design (HCD) principles to achieve the following aims: Aim 1: Identify mutable determinants to inform strategy design by conducting a rapid ethnographic assessment with school partners. Aim 2: Employ HCD with key stakeholders to co-design and iteratively refine the implementation strategy, followed by iterative prototyping in one school. Aim 3: Test the impact of the implementation strategy vs. implementation-as-usual in a pilot hybrid type 3 implementation-effectiveness trial (N=10 schools, 10 Ballmer supervisors, 30 Ballmer CBHS, 35 school personnel, serving 120 youth). In both conditions, CBHS will deliver brief relaxation and problem-solving skills groups with middle school students referred for Tier 2 services. In schools randomized to the implementation strategy, mid-level managers will participate in 4-6 coaching calls and develop tailored workplans to support CBHS delivery of skills groups. Primary outcomes are perceptual (acceptability, feasibility, appropriateness) and behavioral (reach, penetration, fidelity) implementation outcomes and mechanisms (implementation climate, staff attitudes, perceptions about CBHS). Secondary outcomes are youth mental health mechanisms (emotion regulation, self-efficacy) and outcomes (internalizing, externalizing symptoms; academic functioning). Study completion will result in an implementation strategy to integrate a novel undergraduate workforce in schools, and methods and data to support a fully powered R01 hybrid type 3 trial. Fostering positive implementation climate to integrate a new workforce can increase reach of youth mental health care and advance mental health equity.