Using Implementation Science to Enhance Responsiveness of a Universal Prevention Curriculum to Meet Student Needs

Summary

School-based prevention interventions have demonstrated notable potential to reduce the onset and escalation of drug use and mental health problems, including among youth exposed to adversity. Effective implementation of evidence-based interventions, such as the Michigan Model for Health, is critical to improving adolescent health and well-being.^1,2 Researchers have consistently found that effective prevention yields a good societal return on investment.³ Yet, a persistent gap remains in what we know works (interventions like the Michigan Model) and how to effectively deliver these interventions in community settings and achieve their public health impact.⁴

To address these challenges, public and community health scholar Dr. Andria Eisman gathered a multidisciplinary team of researchers and community partners, including state health coordinators like MiSHCA (Michigan School Health Coordinators Association) and health department partners. Together, they set out to support teachers in implementing the Michigan Model, the state’s health curriculum, and improving the responsiveness of this Tier 1 prevention intervention for the large number of youth exposed to various forms of adversity. Universal or Tier 1 interventions are designed to support all youth regardless of their identified risk level. Tier 1 interventions provide the foundation for creating a positive environment focused on the whole school, whole community, whole child (WSCC) model,⁵ promoting health, safety, and positive developmental trajectories of youth. The project focuses on schools that serve a notable proportion of adolescents and families experiencing economic hardship, as these youths are especially at risk for poor health outcomes. The team used a set of implementation strategies, that is tools, training, and resources that teachers and schools need to successfully deliver the Michigan Model. This effort included an adapted curriculum and provide trauma-skilled training and hands-on implementation support from the health coordinators.

Significance

Preventing or tempering the onset and escalation of drug use can reduce the burden of social, emotional, and economic costs that these disorders place on youth and their families, communities, and society.⁶ Systematically designing and testing implementation strategies to improve the delivery of prevention programming, a core component of the Whole Child model, (for example, improving fit between the intervention and context/population needs) will support enhanced system responsiveness and, ultimately, reduce student drug use and related outcomes (e.g., improved mental health, academic achievement).

The proposed research can also contribute to reducing health disparities. Teachers and schools in low-resource environments often have competing demands and scarce resources. The youths who may be most likely to benefit from prevention interventions may also be those least likely to receive it with fidelity due to multiple implementation barriers. This research will support using implementation science to meet the needs of families and communities experiencing socioeconomic disadvantage who are at increased risk of exposure to stress, trauma, marginalization, and its consequences including the onset and escalation of drug use by developing implementation support suited to the setting.

Benefits

Demonstrated benefits are those that have been observed and are verifiable.

Potential benefits are those logically expected with moderate to high confidence.

Adapted the Michigan Model and provided training support to reduce the onset and escalation of drug use in students. potential.

Clinical

Therapeutic procedures

The project ensured effective implementation of an evidence-based prevention intervention in schools as students are required to take 1 semester of health in high school in Michigan, which could optimize the impact on their well-being. potential.

Community

Community health services

The project provides support for teachers in meeting the needs of students exposed to adversity as well as an opportunity for ongoing support from an implementation support practitioner (health coordinator) to engage in problem-solving, and overcoming barriers to engaging and supporting students. potential.

Community

Health education resources

Effective implementation of the Michigan Model can build protective factors that reduce the negative impacts of risk exposure including substance misuse. potential.

Community

Disease prevention & reduction

The bundle of implementation supports has the potential to improve the quality of prevention programming, which could enhance student health and well-being. potential.

Community

Life expectancy & quality of life

Specialized implementation support for teachers may result in better mental health and substance use outcomes for students. potential.

Community

Disease prevention & reduction

Designed in low-resource settings to take into consideration the competing demands and scarce resources; the potential benefits in the short and long term for students far outweigh the upfront investment in effectively delivering prevention. potential.

Economic

Cost effectiveness

Tempering the onset and escalation of drug use can reduce downstream economic costs like substance use treatment, involvement in the justice system, school failure, and unemployment. potential.

Economic

Cost savings

Decreased drug use and improved mental health outcomes can reduce the burden on communities who disproportionately experience the consequences (e.g. substance use disorders) with limited access to treatment services. potential.

Economic

Societal & financial cost of illness

The results of this pilot study inform resource allocation and implementation interventions for schools and will include a report for all partners and interested parties. potential.

Policy

Scientific research reports

This research has community, and economic implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.⁸

Community

With input from an advisory board, the team designed and tested a bundle of implementation support strategies to help teachers and schools meet the needs of youth at heightened risk of drug use and other poor outcomes. The goal is to reduce the burden on school staff to meet student needs in low-resource environments using existing implementation support infrastructure across the state (i.e., school health coordinators) to ensure the implementation is effective and sustainable. The benefit will be realized when the implementation strategies are refined and scaled up across the state. The benefit will occur across Michigan and can inform other states and systems seeking similar change.

Economic

Tier 1 prevention interventions represent a good societal return on investment. Effective prevention could save $18 for every $1 invested; in the U.S., nationwide implementation of effective school-based EBIs with fidelity could save $1.3 billion annually (3). The cost of strategies to support effective implementation and sustainment of interventions such as the Michigan Model are often unknown including to key shareholders and decision makers (7). Organizations and systems will benefit from knowing what implementation will cost them and having pragmatic information to guide how best to allocate scarce resources.

Policy

The results of the study will be shared with the state agency, school, and health coordinator partners to provide preliminary estimates of the time and resources required to deploy the implementation support strategies. This will aid in data-driven decision-making around staff time and inform potential shifts in resource allocation to optimize student outcomes.

Lessons Learned

As the team completes this pilot project and moves forward with scale-up, “going slow to go fast” has been central to the process. That is, building trust and relationships with state agencies and implementation support personnel has enabled the team to move forward with innovative approaches to improving the implementation of a state-adopted universal prevention curriculum.