Implementation Strategies to Promote Measurement-Based Care in Schools: Evidence from Mental Health Experts Across the United States

Background: Despite an established, comprehensive taxonomy of implementation strategies, minimal guidance exists for how to select and adapt strategies to specific services and contexts. We employed a replicable method to identify the most feasible and important implementation strategies to increase mental health providers’ use of measurement-based care (MBC) in schools. MBC is the routine use of patient-reported progress measures throughout treatment to inform patient-centered, data-driven treatment adjustments. Methods: A national sample of 52 school mental health providers and researchers completed two rounds of modified Delphi surveys to rate the relevance, importance, and feasibility of 33 implementation strategies identified for school settings. Strategies were reduced and definitions refined using a multimethod approach. Final importance and feasibility ratings were plotted on “go-zone” graphs and compared across providers and researchers to identify top-rated strategies. Results: The initial 33 strategies were rated as “relevant” or “relevant with changes” to MBC in schools. Importance and feasibility ratings were high overall for both survey rounds; importance ratings (3.61 - 4.48) were higher than feasibility ratings (2.55 – 4.06) on average. Survey 1 responses resulted in a reduced, refined set of 21 strategies, and six were rated most important and feasible on Survey 2: 1) assess for readiness and identify barriers and facilitators; 2) identify and prepare champions; 3) develop a usable implementation plan; 4) offer a provider-informed menu of free, brief measures; 5) develop and provide access to training materials; and 6) make implementation easier by removing burdensome documentation tasks. Provider and researcher ratings were not significantly different, with a few exceptions: providers reported higher feasibility and importance of removing burdensome paperwork than researchers, and providers reported higher feasibility of train-the trainer approaches than researchers; researchers reported higher importance of monitoring fidelity than providers. Conclusions: The education sector is the most common setting for child and adolescent mental health service delivery in the United States. Effective MBC implementation in schools has the potential to elevate the quality of care received by many children, adolescents and their families. This empirically-derived, targeted list of six implementation strategies offers potential efficiencies for future testing of MBC implementation in schools.