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On-the-Ground Perspectives of the Barriers and Facilitators to Implementing a Multi-Tiered Mental Health Supports Model

Sun, April 14, 9:35 to 11:05am, Philadelphia Marriott Downtown, Floor: Level 4, Franklin 11

Abstract

Objectives:
There is a significant gap between youth who need mental health treatment and youth who actually receive support; recent estimates reveal that 7.7 million U.S. children with a treatable mental health condition did not receive services (Whitney & Peterson, 2019). Schools often serve as the “gateway” to mental health services, minimizing barriers to access and stigma, especially in low income communities and for racial/ethnic minority families (Ali et al., 2019). Therefore, it is critical not only to understand the efficacy of such services, but also the challenges and best practices in implementation - especially from the perspectives of those delivering and overseeing these services. To shed light on this, we conducted and analyzed interviews with four stakeholder groups (i.e., school-based clinicians, principals, county education leaders, and county health leaders) to understand: “What barriers and facilitators arose during the first two years of implementation of the Schools as Centers of Wellness initiative”?


Guiding frameworks, data sources, and method:
This study and data are guided by key tenets and frameworks of effective research-practice partnerships (RPP), such as building relational trust, capacity, and rigorous and practice-driven evidence (Henrick et al., 2017), generated in the context of a broader project. Members of the RPP engaged in purposive sampling, collectively generating a list of key stakeholders with deep knowledge about the initiatives’ implementation. Nineteen individual interviews and two small group interviews were conducted by the research team in Summer 2022; in total, 23 people representing all four stakeholder groups participated in semi-structured interviews. Content related to barriers and facilitators in the first two years of implementation and specific examples of successful implementation were coded in an iterative fashion through a process of consensual qualitative research (CQR; Hill et al., 2005). Main themes were then presented in RPP meetings to engage in co-interpretation.


Results:
We identified four main themes related to implementation that were reflective of the practice and policy experiences among the RPP members. The two themes related to barriers were: (1) systems-level challenges between the education and health systems that restricted the sharing of critical information among professionals; and (2) school demands exceeded clinician capacity as clinicians struggled to juggle competing responsibilities, meet student need, while also acquiring new skills related to working in schools. Two themes related to facilitators were: (3) responsive collaboration and strong communication among leadership gave rise to “workarounds” to the aforementioned systems-level barriers; and (4) relationships and support, both top-down from leadership and horizontal among colleagues, provided critical instrumental and emotional guidance to navigate this innovative work.

Significance:
School-wide, systems-change mental health initiatives hold the promise of being an effective and efficient way to respond to student well-being. This paper leverages the voices of on-the-ground experts to share insights with other districts and jurisdictions engaging in similar school-based mental health initiatives. Additional research insights about variation by school site, how these implementation findings have influenced ongoing program delivery, and other policy considerations will be discussed.

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