The Impact of Socio-Economic Status and Implementation Factors on School Mental Health Implementation Outcomes

Abstract

Up to one-fifth of students have social, emotional, or behavioral difficulties that warrant support. Additionally, schools are the primary location in which students receive this support. Numerous evidence-based practices (EBPs) addressing student mental health have been developed for implementation in school settings; however, the uptake of EBPs in schools for students with mental health difficulties remains low. The field of implementation science focuses on the mechanisms that connect research and practice. A key component of implementation science is the link between implementation factors and implementation outcomes. This study investigates the relationship among three inner-organizational implementation factors (strategic implementation leadership, implementation climate, implementation citizenship behavior), school socio-economic status (SES), and three intervention outcomes (adherence, competence, and penetration). Strategic implementation leadership constitutes specific behaviors that leaders enact in order to influence implementers in support of successful implementation. Implementation climate embodies employee perceptions of the utility and value of EBP use in an organization. Implementation citizenship behavior is defined as discretionary behavior exhibited by school staff that supports EBP implementation. In order to investigate this topic, secondary analysis of data collected from an online survey was conducted. The 125-item survey was distributed to all 212 members of a large network of California educators who provide consultative and behavioral health intervention services to students and staff members in public schools representing rural, urban, and suburban settings. A subset of items from the original survey was analyzed in the present study; 196 of the 212 people solicited responded to the survey. The three inner-organizational factors (strategic implementation leadership, implementation climate, implementation citizenship behavior) showed moderately strong correlations with each other; however, SES was not correlated with any of these factors. Additionally, three multiple linear regression models were used to determine whether strategic implementation leadership, implementation climate, implementation citizenship behavior, and SES were associated with penetration, adherence, and competence. Finally the interaction between SES and each predictor variable was investigated to see if they were associated with outcomes. For each outcome (penetration, adherence, and competence), the three inner-organizational implementation factors combined accounted for significant variance in the model, and strategic implementation leadership was associated with adherence, competence, and penetration. There were no significant interactions between SES and the three implementation factors under study. The findings in this study highlight the importance of developing inner-organizational factors to support implementation outcomes. Of the three factors under study, strategic implementation leadership was significantly associated with each implementation outcome lending support for the importance of developing strong implementation leadership within schools. Additionally, the combined salience and strong relationships among the three inner-organizational factors studied herein, lend support for the development of these factors to promote implementation outcomes.