Implementation and student outcomes of an implementation strategy for the sustainability of group evidence-based practices in schools.

Background: Limited research has examined the effectiveness and cost-effectiveness of training strategies to sustain mental health evidence-based practices (EBPs) in urban elementary schools. Methods: We conducted a hybrid type 2 cluster-randomized trial comparing Prepare for Sustainment (PFS)-school district coach supervision of implementers supported by external consultants-to Sustainment as Usual (SAU), which relied on coach supervision alone. Two EBPs were implemented: the Coping Power Program (CPP) for externalizing problems and CBT for Anxiety Treatment in Schools (CATS) for anxiety. The study included three phases: full support (Phase 1), reduced support (Phase 2), and no support (Phase 3). Participants included 40 master's-level implementers, two district coaches, and 435 K-8 students. Outcomes included content and process fidelity, service penetration, mental health symptoms (parent and student report), and academic engagement with learning (teacher report). We also examined implementers' perceptions of training. Results: PFS implementers demonstrated stronger process fidelity: greater engagement with students in Phase 2 and warmer, clearer, and more organized treatment delivery in Phase 3. Content fidelity and service penetration did not differ between conditions in either phase. PFS showed medium and small effect-size improvement on student behavioral and emotional engagement with learning in Phase 2, and a large effect size in behavioral engagement and a medium effect-size improvement in behavioral disaffection with learning in Phase 3 compared to SAU. Students receiving CPP in Phase 2 in the PFS condition demonstrated a large improvement on self-reported externalizing behavior, and students receiving CATS in Phase 2 showed a medium-size reduction in internalizing symptoms relative to students in SAU. Qualitative data showed that implementers who did not receive support from coaches desired supervision on effective EBP delivery, and those experiencing reduced support wanted more frequent guidance. Administrators noted that ongoing collaboration with district coaches would have enhanced their ability to support implementers. Conclusion: A sustainment strategy consisting of an initial training for implementers and occasional consultation for school district coaches is effective for achieving high process fidelity and medium to large effects for engagement with learning activities and mental health outcomes compared to a sustainment as usual strategy. Trial Registration: ClinicalTrials.gov identifier NCT04869657. Registered May 3, 2021.