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A Pre-Implementation Enhancement Strategy to Increase the Yield of Training and Consultation for School-Based Behavioral Preventive Practices: a Triple-Blind Randomized Controlled Trial

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Abstract

As the most common setting where youth access behavioral healthcare, the education sector frequently employs training and follow-up consultation as cornerstone implementation strategies to promote the implementation of evidence-based practices (EBPs). However, these strategies alone are not sufficient to promote desirable implementation (e.g., intervention fidelity) and youth behavioral outcomes (e.g., mitigated externalizing behaviors). Theory-informed pragmatic pre-implementation enhancement strategies (PIES) are needed to prevent the lackluster outcomes of training and consultation. Specifically, social cognitive theory explicates principles that inform the design of PIES content and specify mechanisms of behavior change (e.g., “intentions to implement” (ITI)) to target increasing providers’ responsiveness to training and consultation. This triple-blind parallel randomized controlled trial preliminarily examined the efficacy of a pragmatic PIES based on social cognitive theories (SC-PIES) to improve implementation and youth behavioral outcomes from universal preventive EBPs in the education sector. Teachers from a diverse urban district were recruited and randomly assigned to the treatment (SC-PIES; ntreatment = 22) or active control condition (administrative meeting; ncontrol = 21). Based on the condition assigned, teachers received the SC-PIES or met with administrators before their EBP training. We assessed teachers’ ITI, intervention fidelity, and youth behavioral outcome (academic engagement as an incompatible behavior to externalizing disorders) at baseline, immediately after training, and 6 weeks afterward. A series of ANCOVAs detected sizeable effects of SC-PIES, where teachers who received SC-PIES demonstrated significantly larger improvement in their ITI, intervention fidelity, and youth behaviors as compared to the control. Conditional analyses indicated that teachers’ ITI partially mediated the effect of SC-PIES on intervention fidelity, which in turn led to improved youth behaviors. Findings suggest that theory-informed pragmatic PIES targeting providers’ ITI can boost their responsiveness to implementation strategies, as reflected in improved implementation behaviors and youth behavioral outcomes. The results have implications for targeting motivational mechanisms of behavior change and situating preventive implementation strategies at the intersection between the preparation and active implementation stages of an implementation process. Limitations and implications for research and practice are discussed. 

Clinicaltrials.gov: NCT05240222. Registered on: 2/14/2022. Retrospectively registered. https://clinicaltrials.gov/show/NCT05240222

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Availability of Data and Material

The de-identified datasets are available in the Open Science Framework repository, (osf.io/d5t4m/).

Abbreviations

PIES:

Pre-implementation enhancement strategies

SC-PIES:

Social cognitive theory-informed pre-implementation enhancement strategies

EBP:

Evidence-based practice

TPB:

Theory of planned behavior

ITI:

Intentions to implement

AET:

Academic engaged time

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Authors and Affiliations

  1. Department of Psychological & Quantitative Foundations, University of Iowa, 361 Lindquist Center, Iowa City, IA, 52242, USA

    Yanchen Zhang & Alex Pauls

  2. Department of Educational Psychology, University of Minnesota, 341 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA

    Clayton R. Cook & Jordan Thayer

  3. Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA

    Gazi F. Azad

  4. Center for Applied Research and Educational Improvement, University of Minnesota, 1954 Buford Ave, Suite 425, St. Paul, MN, 55108, USA

    Madeline Larson

  5. Department of Population Health Sciences, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA

    James L. Merle

  6. Department of Psychiatry & Behavioral Sciences, University of Washington, Box 354920, 6200 NE 74Th Street, Suite 110, Seattle, WA, 98115, USA

    Aaron R. Lyon

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  1. Yanchen Zhang
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Correspondence to Yanchen Zhang.

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Zhang, Y., Cook, C.R., Azad, G.F. et al. A Pre-Implementation Enhancement Strategy to Increase the Yield of Training and Consultation for School-Based Behavioral Preventive Practices: a Triple-Blind Randomized Controlled Trial. Prev Sci 24, 552–566 (2023). https://doi.org/10.1007/s11121-022-01464-3

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