Table 4 Final list of 21 implementation strategies and definitions for MBC in school mental health

1. Assess for readiness and identify barriers and facilitators^d

Assess readiness for MBC at provider, administration, and school setting levels. Identify strengths or facilitators that can support the implementation effort and barriers that might get in the way. This could occur before, during, and/or after implementation with providers, primarily, as well as other stakeholder groups.

2. Identify and prepare champions^d

Identify individuals who are passionate about MBC in schools and are influencers or informal leaders among fellow providers. Prepare and support them to facilitate implementation, support their peers, and overcome or address indifference or resistance that MBC may provoke in a school or district. There may be more than one champion per school site. Sites may have the option to adjust this title to local language (e.g., MBC key opinion leader, lead provider, coach, intervention specialist).

3. Develop a usable implementation plan^d

Develop a usable plan for implementation built around student outcomes as the ultimate goal of MBC implementation effort. The implementation plan will detail processes and strategies that will be used to achieve those goals. The plan should also include timeframe and milestones, roles and responsibilities of all stakeholders, and appropriate performance/progress measures. Use and update this plan to guide the implementation effort over time. It will be used to promote excitement and buy-in, collaborative planning, clear communication and training and adaptive implementation over time.

4. Alter and provide individual- and system-level incentives^d

Work to provide individual-level (e.g., provider recognition, acknowledgement, gift card) and system-level (e.g., grant money, free training and consultative support) incentives to districts or schools to participate and engage in an MBC implementation effort.

5. Develop local policy that supports implementation^b

Develop local school system policy that establishes rules, expectations, and guidelines for MBC implementation.

6. Offer a provider-informed menu of free, brief measures^c

Engage providers in a discussion about measure selection to select and distribute a small number of progress monitoring tools. Emphasize tools that are free, brief, and easy to score.

7. Develop and provide access to training materials^d

Training materials (i.e., a curriculum, toolkit, or guide) for MH professionals would include what MBC is, why MBC is important, goals of MBC, clear steps to follow, examples and non-examples of proper MBC, implementation scripts, practice profiles, timelines, and rating scales for use. The study team would develop these materials with school provider stakeholder input and would work with schools and mental health agencies to distribute materials to school providers electronically. Materials would be made available to providers following the training.

8. Make training dynamic^a

Ensure the initial training is interactive, experiential and relevant to providers (e.g., to include role plays, MBC practice examples and non-examples, MBC research base, planning ahead for MBC implementation with students served, and discussion). Make information available in multiple formats. Vary how information is delivered for various professional development schedules and structures.

9. Conduct ongoing training^a

Plan for and conduct one or more “booster” or follow-up trainings after the initial training. (Note: This is different from ongoing clinical consultation/coaching, or supervision.)

10. Support workflow adjustments^c

Provide protected time for individualized implementation planning about how the provider can integrate MBC into their existing workflow and problem solve anticipated barriers. This is intended to acknowledge providers’ limited time and provide support for self-reflection and personalized action planning. May involve engaging providers’ supervisor or building administrator for support. This could occur at the initial training, booster training, or during ongoing consultation.

11. Use train the trainer strategies^a

Train designated, local school providers to train other school mental health providers in MBC using a systematic process to support ongoing implementation and sustainability.

12. Identify early adopters^a

Identify early adopters (i.e., individuals who are particularly open to change) of MBC within the school, district or community agency to learn from their experiences and demonstrate the benefit of MBC to other providers. Early adopters could share their experiences of success with others and be involved in ongoing training and consultation efforts if they are willing. This strategy is used after implementation has started for everyone; it is different than piloting with a small group of enthusiastic providers first before implementing.

13. Facilitation^d

A process of interactive implementation support that is provided by an internal or external facilitator to the whole school or district system. Facilitation should be non-evaluative, informative and part of a supportive interpersonal relationship. Usually provided by someone who works with school leaders, providers, and all other stakeholders to problem solve and tailor the types of support provided based on specific barriers or challenges with MBC implementation. For example, a facilitator could help address systemic barriers to implementation based on what stakeholders report and recommend. This is different from ongoing clinical coaching or consultation to providers to help them implement MBC with their students directly.

14. Provide ongoing clinical consultation/ coaching^a

Provide ongoing clinical consultation and coaching by one or more experts or trained clinical peers. Consultation and coaching would be non-evaluative, flexible, individualized, and focused on helping providers improve their MBC implementation. This includes problem solving and performance feedback throughout implementation. (NOTE: Clinical consultation / coaching is typically differentiated from the next strategy, supervision, which is usually provided by an internal individual who has supervisory authority over the implementer.)

15. Provide practice-specific supervision^b

Provide school providers with supervision focusing on MBC. Supervisors are in a position of authority and support school providers who deliver new practices with evaluative feedback via performance assessment. (Note: Supervision is typically differentiated from consultation/ coaching, which may be provided by an internal or external individual who may or may not have authority over the implementer.)

16. Monitor implementation progress and provide feedback^d

Collect and summarize data regarding MBC implementation outcomes (fidelity, acceptability, how many providers are using it) over a specified time period and give it to administrators, school personnel and/or providers to monitor, evaluate, and support providers’ MBC practices. The purpose of this strategy is to continuously improve the quality of implementation and inform data-driven, real-time decisions about what supports providers need most. To do this, a quality monitoring system and procedures would first need to be developed. Also referred to as “audit and provide feedback”. (Note: This is included in strategies 13. Facilitation and 14. Ongoing clinical consultation/coaching.)

17. Involve students, family members, and other staff^a

Ask students, family members, and providers, as those receiving and providing MBC, to provide input and recommendations about implementation to improve practice and quality. Topics may include how school providers can most effectively implement MBC (to collect, share, and act on student progress data), how to ensure students and families can be actively involved in MBC, ways to make MBC purpose clear to everyone, ensuring an equal student-parent-provider partnership, addressing concerns or barriers, and/or what implementation supports are needed.

18. Create a professional learning collaborative^a

Facilitate the formation of school provider groups within or between school systems or mental health agencies to foster a collaborative learning environment to improve MBC implementation. Providers could network with others in their district or beyond who are also implementing MBC to share resources, lessons learned, and support with the help of a learning collaborative facilitator. The learning community would be organized, developed and coordinated by a research team or implementation consultant (not the providers).

19. Monitor fidelity to MBC core components^d

Integrate measurement strategies to assess the degree to which MBC core components (i.e., collecting, sharing, and acting on the student progress data) is occurring during implementation. For example, study team or clinical supervisors could review IEPs, 504 plans or treatment plans for documentation of MBC. The purpose is to inform ongoing quality improvement and implementation supports.

20. Promote adaptability^a

Identify ways MBC can be tailored or adapted to best fit with the school/classroom context, meet local needs (e.g., selecting measures most appropriate for student characteristics, cultural and linguistic competencies) and clarify which elements of MBC must be maintained to preserve fidelity. The MBC implementation study team and school personnel (mental health providers, administrators) would work together on adaptations or tailoring needed to improve feasibility, acceptability, and appropriateness of MBC. Adaptations should be documented and based on provider, student and/or family feedback after initial implementation with fidelity.

21. Make implementation easier by removing burdensome documentation tasks^a

Remove or alleviate burdensome tasks or documentation that could come with implementing MBC (e.g., removing unnecessary or unused data forms, streamlining duplicative paperwork, require only minimal necessary documentation, and make sure all data collected are used). This should apply to measures collected (i.e., improve efficiency with user-friendly forms and auto scoring) and progress note documentation (i.e., templates to document MBC data results and how they were used in session with the student and family).