Implementation strategies for multi-component school behavioral health interventions: a scoping review

Abstract

Despite the demonstrated effectiveness of school-based behavioral, social-emotional and mental health interventions, implementation in real-world settings is often disappointing. Implementation strategies are key to attaining desired outcomes. This scoping review examined the distribution of peer-reviewed research on implementation strategies for school behavioral health interventions within a multi-tiered framework, disaggregating the body of research by intervention intensity (e.g., universal/Tier 1, targeted/Tier 2, intensive/Tier 3) and content area (e.g., externalizing problems, internalizing problems, social-emotional competencies) to identify patterns and gaps that will inform directions for future research. Three academic databases were searched for empirical, peer-reviewed articles published in English between 2011 and 2024 examining implementation strategies for school interventions targeting internalizing, externalizing, or social-emotional outcomes. Only articles with at least one implementation outcome were included. The School Implementation Strategies Translating ERIC Resources (SISTER) compilation guided coding of strategies. Data were also extracted on study characteristics (location, design, sample, setting), intervention characteristics (intervention name/description, intensity/tier, and content area), implementation strategy characteristics (actor, action, action target, temporality, dose, outcome, and justification), and findings. Based on a review of 78 articles, findings indicated that 33 distinct implementation strategies were investigated, either singularly or in combination with other strategies. Most of the articles focused on support strategies for interventions that targeted externalizing behavior, with relatively few examining strategies for internalizing or social-emotional interventions. More of the research focused on universal (Tier 1) interventions than on targeted (Tier 2) or intensive (Tier 3) interventions. Recent increases in youth internalizing problems, though troubling, were not reflected in the observed distribution of implementation strategies in the research on school behavioral health interventions. Improving outcomes for all youth necessitates greater research on implementation strategies for intensive social-emotional and mental health interventions to achieve a full continuum of quality supports and services. This review was registered with Open Science Framework.