Correction: Primary aim results of a clustered SMART for developing a school-level, adaptive implementation strategy to support CBT delivery at high schools in Michigan.
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ABSTRACT:
SUBMITTER: Smith SN
PROVIDER: S-EPMC9367019 | biostudies-literature | 2022 Aug
REPOSITORIES: biostudies-literature
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Correction: Primary aim results of a clustered SMART for developing a school-level, adaptive implementation strategy to support CBT delivery at high schools in Michigan.
Smith Shawna N SN Almirall Daniel D Choi Seo Youn SY Koschmann Elizabeth E Rusch Amy A Bilek Emily E Lane Annalise A Abelson James L JL Eisenberg Daniel D Himle Joseph A JA Fitzgerald Kate D KD Liebrecht Celeste C Kilbourne Amy M AM
Implementation science : IS 20220811 1
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Project description:BackgroundSchools increasingly provide mental health services to students, but often lack access to implementation strategies to support school-based (and school professional [SP]) delivery of evidence-based practices. Given substantial heterogeneity in implementation barriers across schools, development of adaptive implementation strategies that guide which implementation strategies to provide to which schools and when may be necessary to support scale-up.MethodsA clustered, sequential, multiple-assignment randomized trial (SMART) of high schools across Michigan was used to inform the development of a school-level adaptive implementation strategy for supporting SP-delivered cognitive behavioral therapy (CBT). All schools were first provided with implementation support informed by Replicating Effective Programs (REP) and then were randomized to add in-person Coaching or not (phase 1). After 8 weeks, schools were assessed for response based on SP-reported frequency of CBT delivered to students and/or barriers reported. Responder schools continued with phase 1 implementation strategies. Slower-responder schools (not providing ≥ 3 CBT components to ≥10 students or >2 organizational barriers identified) were re-randomized to add Facilitation to current support or not (phase 2). The primary aim hypothesis was that SPs at schools receiving the REP + Coaching + Facilitation adaptive implementation strategy would deliver more CBT sessions than SPs at schools receiving REP alone. Secondary aims compared four implementation strategies (Coaching vs no Coaching × Facilitation vs no Facilitation) on CBT sessions delivered, including by type (group, brief and full individual). Analyses used a marginal, weighted least squares approach developed for clustered SMARTs.ResultsSPs (n = 169) at 94 high schools entered the study. N = 83 schools (88%) were slower-responders after phase 1. Contrary to the primary aim hypothesis, there was no evidence of a significant difference in CBT sessions delivered between REP + Coaching + Facilitation and REP alone (111.4 vs. 121.1 average total CBT sessions; p = 0.63). In secondary analyses, the adaptive strategy that offered REP + Facilitation resulted in the highest average CBT delivery (154.1 sessions) and the non-adaptive strategy offering REP + Coaching the lowest (94.5 sessions).ConclusionsThe most effective strategy in terms of average SP-reported CBT delivery is the adaptive implementation strategy that (i) begins with REP, (ii) augments with Facilitation for slower-responder schools (schools where SPs identified organizational barriers or struggled to deliver CBT), and (iii) stays the course with REP for responder schools.Trial registrationClinicalTrials.gov, NCT03541317 , May 30, 2018.
| S-EPMC9264291 | biostudies-literature
Project description:BackgroundDepressive and anxiety disorders affect 20-30% of school-age youth, most of whom do not receive adequate services, contributing to poor developmental and academic outcomes. Evidence-based practices (EBPs) such as cognitive behavioral therapy (CBT) can improve outcomes, but numerous barriers limit access among affected youth. Many youth try to access mental health services in schools, but school professionals (SPs: counselors, psychologists, social workers) are rarely trained adequately in CBT methods. Further, SPs face organizational barriers to providing CBT, such as lack of administrative support. Three promising implementation strategies to address barriers to school-based CBT delivery include (1) Replicating Effective Programs (REP), which deploys customized CBT packaging, didactic training in CBT, and technical assistance; (2) coaching, which extends training via live supervision to improve SP competence in CBT delivery; and (3) facilitation, which employs an organizational expert who mentors SPs in strategic thinking to promote self-efficacy in garnering administrative support. REP is a relatively low-intensity/low-cost strategy, whereas coaching and facilitation require additional resources. However, not all schools will require all three strategies. The primary aim of this study is to compare the effectiveness of a school-level adaptive implementation intervention involving REP, coaching, and facilitation versus REP alone on the frequency of CBT delivered to students by SPs and student mental health outcomes. Secondary and exploratory aims examine cost-effectiveness, moderators, and mechanisms of implementation strategies.MethodsUsing a clustered, sequential multiple-assignment, randomized trial (SMART) design, ≥ 200 SPs from 100 schools across Michigan will be randomized initially to receive REP vs. REP+coaching. After 8 weeks, schools that do not meet a pre-specified implementation benchmark are re-randomized to continue with the initial strategy or to augment with facilitation.DiscussionEBPs need to be implemented successfully and efficiently in settings where individuals are most likely to seek care in order to gain large-scale impact on public health. Adaptive implementation interventions hold the promise of providing cost-effective implementation support. This is the first study to test an adaptive implementation of CBT for school-age youth, at a statewide level, delivered by school staff, taking an EBP to large populations with limited mental health care access.Trial registrationNCT03541317 -Registered on 29 May 2018 on ClinicalTrials.gov PRS.
| S-EPMC6126013 | biostudies-literature
Project description:Schools are key environments in which physical activity (PA) can be promoted. Various strategies and opportunities should be used to engage children in PA within schools. The aim of this study was to evaluate the effectiveness of the multi-component Active Schools: Skelmersdale (AS:Sk) pilot intervention on children's PA and sedentary time (ST). The AS:Sk intervention was implemented for eight weeks in four schools with three control schools continuing normal practice. It consisted of eight components: active breaks, bounce at the bell, 'Born To Move' videos, Daily Mile or 100 Mile Club, playground activity challenge cards, physical education teacher training, newsletters, and activity homework. Child-level measures were collected at baseline and follow-up, including objectively measured PA. After accounting for confounding variables, the intervention had a significant effect on school day ST which was significantly less for the intervention children by 9 min per day compared to the control group. The AS:Sk pilot intervention was effective in reducing school day ST but significant changes in PA were negligible. To increase the efficacy of the current and future school-based interventions, authors should focus on implementation and process evaluations to better understand how schools are implementing intervention components.
| S-EPMC5982050 | biostudies-literature
Project description:IntroductionPrimary school-based physical activity interventions, such as The Daily Mile initiative, have the potential to increase children's physical activity levels over time, which is associated with a variety of health benefits. Comparing interventions or combining results of several studies of a single intervention is challenging because previous studies have examined different outcomes or used different measures that are not feasible or relevant for researchers in school settings. The development and implementation of a core outcome set (COS) for primary school-based physical activity interventions would ensure outcomes important to those involved in implementing and evaluating interventions are standardised.Methods and analysisOur aim is to develop a COS for studies of school-based physical activity interventions. We will achieve this by undertaking a four-stage process:(1) identify a list of outcomes assessed in studies through a systematic review of international literature; (2) establish domains from these outcomes to produce questionnaire items; (3) prioritise outcomes through a two-stage Delphi survey with four key stakeholder groups (researchers, public health professionals, educators and parents), where stakeholders rate the importance of each outcome on a 9-point Likert scale (consensus that the outcomes should be included in the COS will be determined as 70% or more of all stakeholders scoring the outcome 7%-9% and 15% or less scoring 1 to 3); (4) achieve consensus on a final COS in face-to-face meetings with a sample of stakeholders and primary school children.Ethics and disseminationWe have received ethical approval from Imperial College London (ref: 19IC5428). The results of this study will be disseminated via conference presentations/public health meetings, peer-reviewed publications and through appropriate media channels.Trial registration numberCore Outcome Measures in Effectiveness Trials Initiative (COMET) number: 1322.
| S-EPMC6937029 | biostudies-literature
Project description:The purpose of this research is to look at how primary schools in England have adapted their outdoor spaces in the context of COVID-19 rules and guidelines to meet the needs of students returning from school closures and national lockdown of Spring/Summer 2020, how that impacted play and learning value of their grounds, and to consider how these findings might inform future school grounds design. Thus, we used a mixed-method approach that included qualitative interviews with representatives from six primary schools (three in rural and three in urban areas), quantitative desk research, and in-person site surveys. We used literature-based scoring criteria to quantify changes in the playground before and after the implementation of COVID-19 measures. The research reveals that the zoning of play areas and other aspects of the school grounds may negatively affected the value of play and learning. We also found a substantial disparity in the amount of outside space per pupil (OSPP) available across schools. Those with the lowest OSPP also had the lowest outdoor and environmental learning provision, lacking the flexibility to accommodate this alongside other requirements of staggered play breaks and PE. The amount of outdoor space that a school has available per pupil averaged at 32 m2 for urban schools and 43 m2 for rural schools. Finally, we have explored how spatial layout and design elements may have supported or inhibited schools' abilities to respond to children's needs, and how this might inform adaptive school grounds design considerations for the future.
| S-EPMC8881889 | biostudies-literature
Project description:BackgroundAsthma control in adolescents is low with half of the young people in a London study identified as having suboptimal control when measured using the Asthma Control Test. Control of asthma symptoms can be improved by addressing barriers to good self-management, such as poor understanding of asthma and adherence to medication. The aim of this study was therefore to develop the My Asthma in School (MAIS) intervention for the improvement of asthma control and self-management in adolescents and to test its initial feasibility. The intervention intended to combine a strong focus on theory with a design specifically aimed to engage adolescents.MethodsThe intervention development was based on previous qualitative and quantitative findings, and on guidelines from the Medical Research Council for the development of complex interventions. The COM-B (Capability, Opportunity, Motivation-Behaviour) model was applied to inform the design of intervention elements. Behavioural targets were identified from existing barriers to good asthma self-management and were then used to guide the development of engaging intervention elements, which were described using the Behavioural Change Technique (BCT) Taxonomy version 1. Adolescents were involved throughout this process. The MAIS intervention was tested in a feasibility phase in London secondary schools with adolescents aged between 11 and 13.ResultsThe complex school-based MAIS intervention comprised a first school visit from a theatre group, who conducted a workshop with all year 7-8 students and addressed peer understanding and attitudes to asthma. The second visit included four self-management workshops for adolescents with asthma, including games, short-films and role play activities. Forty different types of techniques to change behaviour were applied, totalling 163 instances of BCT use across intervention elements, addressing all areas of capability, opportunity and motivation. In this initial feasibility study, 1814 adolescents with and without asthma from nine schools received the theatre intervention visit; 23 adolescents with asthma from one of the schools attended the workshop visit. The intervention was found acceptable and engaging, and 91.4% of participants agreed that the workshops changed how they think or feel about asthma.ConclusionThis study demonstrates development and initial feasibility of a complex theory-based intervention, and how it can combine engaging media and interactive elements, to achieve a multi-directional approach to behavioural change. However more work is needed to assess the feasibility of trial processes, including recruitment and delivery format of the workshops.
| S-EPMC7465390 | biostudies-literature
Project description:Large spatial datasets with many spatial covariates have become ubiquitous in many fields in recent years. A question of interest is to identify which covariates are likely to influence a spatial response, and whether and how the effects of these covariates vary across space, including potential abrupt changes from region to region. To solve this question, a new efficient regularized spatially clustered coefficient (RSCC) regression approach is proposed, which could achieve variable selection and identify latent spatially heterogeneous covariate effects with clustered patterns simultaneously. By carefully designing the regularization term of RSCC as a chain graph guided fusion penalty plus a group lasso penalty, the RSCC model is computationally efficient for large spatial datasets while still achieving the theoretical guarantees for estimation. RSCC also adopts the idea of adaptive learning to allow for adaptive weights and adaptive graphs in its regularization terms and further improves the estimation performance. RSCC is applied to study the acceptance of COVID-19 vaccines using county-level data in the United States and discover the determinants of vaccination acceptance with varying effects across counties, revealing important within-state and across-state spatially clustered patterns of covariates effects.
| S-EPMC9335734 | biostudies-literature
Project description:BackgroundPhysical inactivity in adolescents is a major public health issue. Schools are important settings for physical activity interventions. The WISH Study was a peer-led, school-based walking intervention that aimed to increase physical activity levels of adolescent girls. This study uses the RE-AIM Framework to present the process evaluation of the WISH Study with a focus on factors that affected participation, motivation, and enjoyment of the intervention.MethodsPupils (n589 12-14 years) were recruited from 18 schools in the border region of Ireland and Northern Ireland. In intervention schools (n9), older pupils (15-18 years) were trained as walk leaders and led pupils (12-14 years) in brisk walks (10-15 min) during the school day, across the school year (2021-22). Questionnaires to measure self-efficacy for walking and physical activity, health-related quality of life and reasons for engaging in physical activity were administered throughout the intervention. At the end of the intervention focus groups were held with pupils, and interviews conducted with teachers and walk leaders. Attendance at walks was monitored by walk leaders. Quantitative data were analysed descriptively, and qualitative analysis was undertaken using thematic analysis. Themes were reported under RE-AIM indicators (reach, effectiveness, adoption, implementation, and maintenance).ResultsPupils in the intervention schools (n286) were representative of adolescent girls in Northern Ireland and Ireland, in terms of their activity level. At baseline, 15% of these pupils met the recommended physical activity guidelines of 60 min moderate-vigorous physical activity per day, as measured by accelerometers. The total number of walks reported per school ranged from 2 to 104 across intervention schools. One quarter of pupils (n74, 26%) never attended a walk and 15% (n23) of walk leaders did not lead a walk. Pupils and walk leaders self-reported improvements in their physical health, mental well-being, and social relationships, and walk leaders reported gaining transferrable skills. Implementation was aided by school support in some schools, although barriers such as COVID-19, lack of time, harsh weather, inadequate facilities for indoor walks, and walk leader availability, were identified. Staff engagement was a key driver for the maintenance of walks.ConclusionsDespite a promising feasibility study and a comprehensive walk leader training programme, the extent to which the intervention was adopted and implemented varied, suggesting future school-based physical activity interventions need to consider individual school contexts to ensure intervention fidelity.Trial registrationISRCTN 12847782.
| S-EPMC11877823 | biostudies-literature
Project description:BackgroundParents play a critical role in their children's health. We explored the association of children's perception of their parents' health behaviors and education level with the health behaviors of middle-school students participating in a school-based wellness program.MethodsStudents completed a baseline survey on their dietary, physical activity, and sedentary behaviors, and their parents' health behaviors and education. Descriptive statistics and generalized linear regression with random intercept analyzed which child-reported parent behaviors, parent education levels, and demographic factors were associated with healthy child behaviors.ResultsAmong 4607 students, for all behaviors assessed, children who perceived their parent exhibiting a healthy behavior were more likely to display the same healthy behavior. Healthier diet, more physical activity, and less sedentary habits were reported by students who reported their parents had college or higher education, compared to students who reported their parents had some college or less education.ConclusionsThese results encourage increased parental involvement in childhood wellness programs. Additionally, these data suggest interventions which target parents with lower educational attainment may also benefit their children's health behaviors. As we continue to understand how adolescent behavior is shaped, we can increase the effectiveness of targeted health education for parents and children.
| S-EPMC11562258 | biostudies-literature
Project description:IntroductionSmartphone and social media use is prevalent during adolescence, with high levels of use associated with lower levels of mental well-being. Secondary schools in the UK have introduced policies that restrict daytime use of smartphones and social media, but there is no evaluation on the impact of these policies on adolescent mental well-being. The SMART Schools Study aims to determine the impact of daytime restrictions of smartphone and social media use on indicators of adolescent mental well-being, anxiety, depression, physical activity, sleep, classroom behaviour, attainment and addictive social media use.Methods and analysisThis is a natural experimental observational study using mixed methods. Secondary schools within a 100 mile radius of the recruiting centre in the West Midlands (UK) have been categorised into two groups: Schools that restrict (intervention) and permit (comparator) daytime use of smartphones. We aim to recruit 30 schools (20 restrictive, 10 permissive) and 1170 pupils aged 12-13 and 14-15 years. We will collect data on mental well-being, anxiety and depressive symptoms, phone and social media use, sleep and physical activity from pupil surveys, and accelerometers. Policy implementation measures and data on individual pupil factors will be collected through school staff surveys, and website/policy analysis. Six case study schools will explore individual, school and family/home factors that influence relationships between school smartphone policies, smartphone/social media use, and mental well-being. Economic evaluation will be completed through a cost-consequence analysis from an education sector perspective.Ethics and disseminationEthical approval was obtained from the University of Birmingham's Research Ethics Committee (ERN_22-0723). Parents/carers of pupil participants can complete a form to opt their child out of the study. Pupil, school staff and parent/carer participants are asked to complete online/written consent (or assent). Findings will be disseminated through policy briefings, resources for schools, social media, reports, and open access publications.Trial registration numberISRCTN77948572.
| S-EPMC10335462 | biostudies-literature