Pre-implementation Perceptions of Urban School-Based Mental Health Providers

Abstract

Schools are a critical setting to connect youth to mental health services. Recent policies aim to increase access to evidence-based practices (EBPs) in schools, especially in underserved communities, by integrating community providers into school-based settings to ensure access and quality of behavioral healthcare services. However, little is known about the unique contextual factors prior to school-based implementation of EBPs including providers’ characteristics and attitudes toward EBP adoption. The present study aims to fill this gap by completing an evaluation of community provider characteristics and implementation factors at their community agencies before they began a state-mandated adoption and implementation of EBPs in schools. Analyses included a sample of 719 therapists located within 27 agencies and a subsample of 117 therapists located within 21 agencies. We assessed pre-training perceptions of EBPs, cognitive behavioral therapy (CBT) knowledge (the EBP of primary focus on the policy), acceptability, feasibility, appropriateness with the larger sample of 719 therapists. Only a subset of participants from the larger sample (n = 117) completed the implementation climate and leadership measures. We also examined the role of provider race/ethnicity in the process of EBP implementation. Between 65.9 and 78.0% of the sample identified as an ethnic minority. Consistent with past work, we found that provider perceptions of implementation climate and leadership were associated with EBP attitudes and CBT knowledge. In relation to our exploratory question, we found that White participants reported significantly lower rewards for EBP and higher selection for openness as compared to racial/ethnic minority participants. These findings extend the literature by providing context of co-located community therapists’ attitudes and add to the growing literature on how provider race/ethnicity may lead to differences in implementation factors as a result of systemic issues.