Yanchen Zhang

Emerging literature has highlighted the importance of discerning general and strategic organizational context (OC) factors (e.g., leadership and climate) and their interaction effect on individual implementation behaviors (e.g., attitudes toward evidence-based practices; EBPs) in youth mental healthcare. This study aimed to examine how leadership and climate (general and strategic) are associated with implementer attitudes toward EBPs across the individual and organizational levels and their interaction effect in schools. A series of multilevel models (MLMs) were fitted on a diverse sample of schools actively implementing universal prevention programs for youth mental health (441 implementers from 52 schools). The organization-level aggregates and individual educators' perceptions of general and strategic leadership and climate, and their interaction terms, were entered as level-2 and level-1 predictors of four attitudinal dimensions (Requirement, Openness, Appeal, and Divergence) based on their level of measurement. At the organizational level, higher levels of strategic leadership and climate, but not their general counterparts, were consistently associated with more favorable attitudes in all four dimensions. At the individual/within-school level, higher levels of perceived general and strategic leadership and climate were associated with more favorable attitudes of Requirement and Openness. At the organizational/between-school level, general climate moderated the positive effect of strategic climate on implementers' perception of appeal and divergence of EBPs. Our findings indicate that leaders should make data-based decisions to allocate resources on strategic and/or general leadership and climate to foster favorable staff attitudes toward EBPs based on the level of measurement, implementation-specificity, and attitudinal dimensions.

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; n(treatment) = 22) or active control condition (administrative meeting; n(control) = 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.

Treatment integrity is critical to realizing the effects of evidence-based programs and practices (EBPPs) that aim to promote student mental and behavioral health. Across disciplines, time is consistently referenced as one of the most significant barriers to successful implementation outcomes (e.g., treatment integrity) of EBPPs. However, there is limited to no research that has examined the relationship between time allocation, treatment integrity, and student outcomes, especially at the school organizational level. This study used data from 106 elementary schools implementing Tier 1 school-wide positive behavior interventions and supports to examine the associations among two types of time allocation (collaboration/planning and professional development), school-level treatment integrity, and suspension. Results supported significant associations between two types of time allocation and both implementation and student behavioral outcomes. Moreover, the mediation analysis suggested that treatment integrity mediated the relationship between both types of time allocation (collaboration/planning and professional development) and student behavioral outcomes at the school level. Limitations and implications for research and practice are discussed.

Child and adolescent exposure to potential trauma experiences is pervasive. Given the prevalence, deleterious mental and physical effects, and economic cost of trauma exposure, child- and family-service systems are adopting trauma-informed approaches, including practices like trauma screening. Although a number of trauma-focused screening and assessment measures exist for youth, the majority are lengthy and inappropriate for universal administration. This study describes the development and preliminary validation of the Traumatic Stress Screen for Children and Adolescents (TSSCA), a six-item screening measure for trauma exposure and traumatic stress symptoms. Using two samples of youth presenting at community practice settings (n(1) = 134,n(2) = 137), reliability, discriminative validity, and criterion-related validity were calculated for the TSSCA. Results support the TSSCA as an empirically derived, reliable, and valid screening measure for exposure to trauma and symptoms of traumatic stress for youth ages 7 to 18.

Strong teacher-student relationships have long been considered a foundational aspect of a positive school experience. The aim of the current study was to evaluate the effects of the establish-maintain-restore (EMR) method for improving teacher-student relationships and students' classroom behavior while providing elementary teachers with structured professional development and follow-up support. A matched randomized design with a sample of fourth- and fifth-grade teachers and students was used to investigate whether the EMR method produced significant improvements in teacher-student relationships and student outcomes using hierarchical linear modeling to account for nesting at the classroom level. Results indicated that the EMR method was associated with significant improvements in teacher-reported teacher-student relationships as well as improvements in observed indices of students' classroom behavior (academic engaged time and disruptive behavior). Findings also revealed that teacher-reported changes in teacher-student relationships were significantly associated with moderate changes in student classroom behavior. The implications of this study for school-based universal prevention and directions for future research are discussed.