Implementation support: improving transportability of evidence-based treatments from laboratories to schools

Despite the proven benefits of evidence- based practices (EBTs) demonstrated in outcome research trials, their effectiveness decreases when transported to usual care (UC) settings. Researchers posit that implementation support strategies may provide a mechanism to improve EBT treatment delivery and improve their fit within complex settings such as schools. Knowledge of specific implementation modalities leading to successful EBT delivery in UC remains in early stages of research. The majority of youth with mental health disorders receive services in schools, yet these settings often have fewer specialty clinicians who can provide effective mental health care. Therefore, understanding implementation support in educational contexts is crucial to meet the emotional, behavioral, and academic needs of youth. This study examines differential implementation support for a group-based CBT intervention focused on adolescents at-risk for depression. School-based clinicians will be assigned to 1 of 2 conditions: didactic training and manual only, or didactic training, manual, weekly consultation, and weekly fidelity monitoring feedback. The primary outcomes include treatment fidelity, depressive symptoms, and academic performance. It is hypothesized that additional implementation support will increase fidelity and subsequently client outcomes. Finally, it is expected that fidelity will correlate with client outcomes. These results suggest that implementation support strategies may be both beneficial throughout treatment, and they may also help improve effectiveness of EBTs when they are transferred from research settings to UC. More empirical research is needed to understand implementation support process in relation to client outcomes to reduce the EBT research practice gap.