TY - JOUR
T1 - Multilevel Barriers and Facilitators to Sustainability of a Universal Trauma-Informed School-Based Mental Health Intervention Following an Efficacy Trial
T2 - A Qualitative Study
AU - Arnold, Kimberly T.
AU - Pollack Porter, Keshia M.
AU - Frattaroli, Shannon
AU - Durham, Rachel E.
AU - Clary, Laura K.
AU - Mendelson, Tamar
N1 - Funding Information:
This study was funded by the National Institute of Mental Health (Grant Number T32 MH109436 02, Barry; Grant Number T32 MH109433, Mandell), the National Institute of Child Health and Human Development (Grant Number 1R01HD090022, Mendelson), and the Institute of Education Sciences (Grant Number R305A160082, Mendelson).
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.
PY - 2021/3
Y1 - 2021/3
N2 - Limited research exists about factors that influence the sustainability of preventive school mental health interventions when research support ends. This study assessed barriers and facilitators to sustaining RAP (Relax, be Aware, do a Personal rating) Club, a trauma-informed universal mental health intervention, in urban schools following efficacy trial implementation. Between 2016 and 2018, 13 Baltimore City schools implemented RAP Club. We evaluated RAP Club sustainability using semi-structured interviews with administrators (n = 10) and school staff trained to deliver the intervention (n = 11), as well as review of intervention fidelity logs (n = 137) and notes from supervision calls (n = 10) with school staff and research team members who implemented the program. Although most school staff described RAP Club as acceptable and beneficial, none of the 13 schools sustained the intervention. Barriers to sustainability included low self-efficacy among school staff trained to deliver the intervention, school staff turnover, logistical challenges with space and time in the regular school calendar to deliver the program, insufficient funding to sustain the program outside of the research context, and limited planning and ongoing communication between school personnel and researchers about sustainability. Recommendations for increasing post-trial program sustainability include developing sustainability plans with schools during the pre-implementation phase, enhancing ongoing support for school staff during the implementation phase, and using academic–community partnerships to facilitate sustainability and intervention scale-up during the post-implementation phase. Increasing sustainability of beneficial school-based mental health programs has the potential to reduce mental health disparities and promote health equity.
AB - Limited research exists about factors that influence the sustainability of preventive school mental health interventions when research support ends. This study assessed barriers and facilitators to sustaining RAP (Relax, be Aware, do a Personal rating) Club, a trauma-informed universal mental health intervention, in urban schools following efficacy trial implementation. Between 2016 and 2018, 13 Baltimore City schools implemented RAP Club. We evaluated RAP Club sustainability using semi-structured interviews with administrators (n = 10) and school staff trained to deliver the intervention (n = 11), as well as review of intervention fidelity logs (n = 137) and notes from supervision calls (n = 10) with school staff and research team members who implemented the program. Although most school staff described RAP Club as acceptable and beneficial, none of the 13 schools sustained the intervention. Barriers to sustainability included low self-efficacy among school staff trained to deliver the intervention, school staff turnover, logistical challenges with space and time in the regular school calendar to deliver the program, insufficient funding to sustain the program outside of the research context, and limited planning and ongoing communication between school personnel and researchers about sustainability. Recommendations for increasing post-trial program sustainability include developing sustainability plans with schools during the pre-implementation phase, enhancing ongoing support for school staff during the implementation phase, and using academic–community partnerships to facilitate sustainability and intervention scale-up during the post-implementation phase. Increasing sustainability of beneficial school-based mental health programs has the potential to reduce mental health disparities and promote health equity.
KW - Adolescents
KW - School-based mental health intervention
KW - Sustainability
KW - Trauma
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U2 - 10.1007/s12310-020-09402-w
DO - 10.1007/s12310-020-09402-w
M3 - Article
C2 - 33628336
AN - SCOPUS:85098769622
SN - 1866-2625
VL - 13
SP - 174
EP - 185
JO - School Mental Health
JF - School Mental Health
IS - 1
ER -