Table 1 Summary of implementation strategies across REP, REP+coaching (REP+C), REP+facilitation (REP+F), and REP+coaching+facilitation (REP+C/F)
Implementation component | REP | REP+C | REP+F | REP+C/F |
|---|---|---|---|---|
Replicating Effective Programs (REP) | All sites | All sites randomized | All REP sites that might benefit from facilitation randomized | All REP+C sites that might benefit from facilitation randomized |
Step 1: market CBT and disseminate CBT package: a. Recruit schools, disseminate information on CBT program (TRAILS), and R01 study b. Recruit SPs and require they identify 10 students for CBT c. Orient and train SPs to use web tool to track all CBT encounters c. Schedule SP CBT training and program CBT web tool d. Disseminate CBT package (manual + implementation guide) to school professionals (SPs). Implementation guide includes overview of CBT core components (e.g., cognitive restructuring, exposure), session agendas, sample screening forms, talking points, and additional resources. | ♦ | ♦ | ♦ | ♦ |
Step 2: train SPs in CBT 1-day training on the evidence behind CBT and a step-by-step walk-through of core components. Cover common signs of depression and anxiety in students and utilization of public domain screens (e.g., PHQ9T, GAD7). | ♦ | ♦ | ♦ | ♦ |
Step 3: as-needed program assistance and CBT uptake monitoring: bi-weekly conference calls held by REP specialists with an interactive website that provides additional resources (video, case simulations) and Q&A forum led by a REP/CBT expert to address questions regarding clinical content, use of the web tool, manualized materials, and school-based implementation. | ♦ | ♦ | ♦ | ♦ |
Coaching (C) | ||||
 CBT expert (coach) attends with SP the CBT sessions delivered to identified students. Coaches will meet with SPs before and/or after each session to address any concerns, questions, or challenges to delivery.  a. Weekly pre-session planning by phone or email, direction to appropriate materials and resources, and role-play practice of specific treatment elements  b. In vivo modeling of treatment skills during CBT group treatment sessions, observation of SPs’ treatment delivery, post-session discussion of strengths and areas for improvement, and practice of skills with feedback  c. Didactic instruction/guided practice of specific skills as needed. |  | ♦ |  | ♦ |
Facilitation (F) | ||||
 Step 1: initiation and benchmarking: facilitator with expertise in CBT, implementation methods, education system, and use of EBPs in schools contacts each SP and holds a call with SP to review potential barriers and facilitators to CBT uptake, and set measurable goals for CBT uptake |  |  | ♦ | ♦ |
 Step 2: mentoring: facilitator and SP hold regular calls to develop rapport; provides guidance to SP on overcoming specific barriers to CBT uptake by aligning SP strengths with available influence at the school and needs of administrators. If needed, facilitator refers SP to REP TA. |  |  | ♦ | ♦ |
 Step 3: leveraging: Facilitator continues calls with SP and with SP reaches out to school administrators, identifies school/community priorities per administration input, and helps SP align CBT use/goals with these existing priorities. Facilitator helps SP summarize and describe added value of CBT to administrators and other school employees (e.g., consistency with other initiatives). |  |  | ♦ | ♦ |
 Step 4: ongoing marketing: facilitator, leadership, and SP summarize progress and develop sustainability plans. |  |  | ♦ | ♦ |