Improving Student Mental Health: Adaptive Implementation of School-based CBT

This study seeks to develop an effective and efficient sequence of implementation strategies
for encouraging delivery of Cognitive Behavioral Therapy (CBT) by school professionals in
high schools across Michigan. In the run-in phase, all schools will receive support and
training from REP for three months. After three months, schools will be randomized to either
(1) continue with REP; or (1) augment REP with a minimum of 12 weeks of coaching. Eight weeks
after this first randomization, schools will be evaluated to determine whether they might
also benefit from an augmentation of their current strategy with Facilitation. Schools that
could benefit from facilitation (defined as delivering 3 or more CBT modules to less than 10
students or reporting 3 or more organizational barriers to delivering CBT) will be
re-randomized to either (1) continue with their current strategy (REP or REP + Coaching); or
(2) have their current strategy augmented with facilitation. All implementation support will
be discontinued 12 months after first randomization; outcomes will be assessed through 18
months after study start.

School Administrators

Inclusion Criteria:

- Working at a school that is located within a 2-hour drive of a TRAILS coach

- Employed at a Michigan high school full or part time

- Able to read and understand English

Exclusion Criteria:

- Unable to provide informed consent for participation in the study activities

School Professional

Inclusion Criteria:

- Working at a school that is located within a 2-hour drive of a TRAILS coach

- Employed at a Michigan high school full or part time

- Have a background in clinical school social work, counseling, psychology, or similar
area

- Able to read and understand English

Exclusion Criteria:

- Has previously received coaching in CBT through the TRAILS or similar programs

- Has a significant illness or condition that precludes their participation in the
implementation strategies, including the REP training and student identification
process, Coaching, or Facilitation

- Unable to provide informed consent for participation in the study activities

Student

Inclusion Criteria:

- Age 14-21 years

- Currently enrolled in the 9th, 10th, or 11th grade at time of first assessment at one
of the participating schools

- Have at least one symptom of depression or anxiety that impacts their daily well-being
or functioning, as determined by the SP

- Able to read and understand English and comprehend assessments

Exclusion Criteria:

- Evidence of psychosis, as identified by any standardized measure; reported by the
student, parent, or referral source; or noted by the SP during the recruitment and
screening process

- Evidence of a severe pervasive developmental disability, mental retardation or other
cognitive impairment that would interfere with the potential for benefit from skills
groups, as identified by the student, parent, or referral source.

- Unable to attend CBT group sessions