Implementation of School-Based Behavioral Health Services Over Time: A Longitudinal, Multi-level Qualitative Study

Behavioral health practitioners recognize how critical the process of implementation is to the successful use of evidence-based practices. It is further recognized that implementation is a complex, time-consuming process and that successful implementation often occurs in stages. Capitalizing on a national evaluation examining the implementation of school-based behavioral health (SBBH) services, this project involved an analysis of qualitative interview data to assess the unique barriers and facilitators that arise across time and organizational levels in the implementation of SBBH services. Forty-eight semi-structured telephone interviews were analyzed across 3 years and two organizational levels in seven sites (n = 48). Qualitative analysis identified five major implementation facilitators including communication and collaboration, data utilization, leadership, planning, and training. Major barriers to implementation included systemic state/governmental barriers, workforce shortages, and funding issues. While there were small changes in the relative importance of these facilitators and barriers over time and by organizational level, the most salient barriers and facilitators remained important across all 3 years of the study. Differences across organizational levels included greater emphasis at local levels for facilitators such as training and leadership and a greater emphasis at state levels for state/governmental barriers. Results suggest that while the importance of given facilitators and barriers changes as implementation progresses, the major factors that contribute to implementation are likely to remain unchanged over time. Effective communication/collaboration among stakeholders remains a powerful facilitator across time, and systemic state/governmental barriers remain a potent barrier. Implications for increasing successful integration of behavioral health services in public school settings are discussed.