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      Evidence-Based Mental Health Programs in Schools: Barriers and Facilitators of Successful Implementation

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          Abstract

          Although schools can improve children’s access to mental health services, not all school-based providers are able to successfully deliver evidence-based practices. Indeed, even when school clinicians are trained in evidence-based practices (EBP), the training does not necessarily result in the implementation of those practices. This study explores factors that influence implementation of a particular EBP, Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Semi-structured telephone interviews with 35 site administrators and clinicians from across the United States were conducted 6–18 months after receiving CBITS training to discuss implementation experiences. The implementation experiences of participants differed, but all reported similar barriers to implementation. Sites that successfully overcame such barriers differed from their unsuccessful counterparts by having greater organizational structure for delivering school services, a social network of other clinicians implementing CBITS, and administrative support for implementation. This study suggests that EBP implementation can be facilitated by having the necessary support from school leadership and peers.

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          Most cited references11

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          The Challenge of Innovation Implementation

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            Multisystemic treatment of serious juvenile offenders: long-term prevention of criminality and violence.

            This article examined the long-term effects of multisystemic therapy (MST) vs. individual therapy (IT) on the prevention of criminal behavior and violent offending among 176 juvenile offenders at high risk for committing additional serious crimes. Results from multiagent, multimethod assessment batteries conducted before and after treatment showed that MST was more effective than IT in improving key family correlates of antisocial behavior and in ameliorating adjustment problems in individual family members. Moreover, results from a 4-year follow-up of rearrest data showed that MST was more effective than IT in preventing future criminal behavior, including violent offending. The implications of such findings for the design of violence prevention programs are discussed.
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              A mental health intervention for schoolchildren exposed to violence: a randomized controlled trial.

              No randomized controlled studies have been conducted to date on the effectiveness of psychological interventions for children with symptoms of posttraumatic stress disorder (PTSD) that has resulted from personally witnessing or being personally exposed to violence. To evaluate the effectiveness of a collaboratively designed school-based intervention for reducing children's symptoms of PTSD and depression that has resulted from exposure to violence. A randomized controlled trial conducted during the 2001-2002 academic year. Sixth-grade students at 2 large middle schools in Los Angeles who reported exposure to violence and had clinical levels of symptoms of PTSD. Students were randomly assigned to a 10-session standardized cognitive-behavioral therapy (the Cognitive-Behavioral Intervention for Trauma in Schools) early intervention group (n = 61) or to a wait-list delayed intervention comparison group (n = 65) conducted by trained school mental health clinicians. Students were assessed before the intervention and 3 months after the intervention on measures assessing child-reported symptoms of PTSD (Child PTSD Symptom Scale; range, 0-51 points) and depression (Child Depression Inventory; range, 0-52 points), parent-reported psychosocial dysfunction (Pediatric Symptom Checklist; range, 0-70 points), and teacher-reported classroom problems using the Teacher-Child Rating Scale (acting out, shyness/anxiousness, and learning problems; range of subscales, 6-30 points). Compared with the wait-list delayed intervention group (no intervention), after 3 months of intervention students who were randomly assigned to the early intervention group had significantly lower scores on symptoms of PTSD (8.9 vs 15.5, adjusted mean difference, - 7.0; 95% confidence interval [CI], - 10.8 to - 3.2), depression (9.4 vs 12.7, adjusted mean difference, - 3.4; 95% CI, - 6.5 to - 0.4), and psychosocial dysfunction (12.5 vs 16.5, adjusted mean difference, - 6.4; 95% CI, -10.4 to -2.3). Adjusted mean differences between the 2 groups at 3 months did not show significant differences for teacher-reported classroom problems in acting out (-1.0; 95% CI, -2.5 to 0.5), shyness/anxiousness (0.1; 95% CI, -1.5 to 1.7), and learning (-1.1, 95% CI, -2.9 to 0.8). At 6 months, after both groups had received the intervention, the differences between the 2 groups were not significantly different for symptoms of PTSD and depression; showed similar ratings for psychosocial function; and teachers did not report significant differences in classroom behaviors. A standardized 10-session cognitive-behavioral group intervention can significantly decrease symptoms of PTSD and depression in students who are exposed to violence and can be effectively delivered on school campuses by trained school-based mental health clinicians.

                Author and article information

                Contributors
                +1-310-8253131 , alangley@mednet.ucla.edu
                Journal
                School Ment Health
                School Mental Health
                Springer US (Boston )
                1866-2625
                1866-2633
                11 May 2010
                11 May 2010
                September 2010
                : 2
                : 3
                : 105-113
                Affiliations
                [1 ]Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 300 UCLA Medical Plaza, Suite 1315, Los Angeles, CA 90095 USA
                [2 ]Division of Mental Health Services and Policy Research, New York State Psychiatric Institute, Columbia University, New York, NY USA
                [3 ]University of Pittsburgh School of Medicine, Pittsburgh, PA USA
                [4 ]RAND Corporation, Santa Monica, CA USA
                Article
                9038
                10.1007/s12310-010-9038-1
                2906726
                20694034
                de538c04-f86b-418a-8e3b-28cec72ef422
                © The Author(s) 2010
                History
                Categories
                Original Paper
                Custom metadata
                © Springer Science + Business Media, LLC 2010

                Health & Social care
                school,child,adolescent,implementation,ebp
                Health & Social care
                school, child, adolescent, implementation, ebp

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