# Improving Student Mental Health: Adaptive Implementation of School-based CBT

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2020 · $690,865

## Abstract

ABSTRACT
Depressive and anxiety disorders affect 20-30% of school age youth, contributing to poor developmental and
academic outcomes. Psychosocial evidence-based practices such as cognitive behavioral therapy (CBT), can
improve outcomes in these disorders, but numerous barriers limit access. Students access mental health
services at schools more than anywhere else, but school professionals (SPs, e.g., counselors, social workers)
are generally not trained to deliver CBT. Efficient and successful implementation of CBT in schools requires
scientific study of implementation strategies designed to optimize uptake, addressing student, SP, and
community barriers. Replicating Effective Programs (REP), Coaching, and Facilitation are three previously
established implementation strategies, but vary in intensity and theoretical foundation. REP combines
customized intervention packaging, didactic training, and technical support to improve provider knowledge.
Coaching extends didactic training via ongoing, live supervision to improve provider competence and
acceptance. Facilitation mentors providers in strategic thinking to promote self-efficacy in championing the use
of effective practices and securing administrator support. Coaching and Facilitation can be expensive and
may be unnecessary for early adopters. An adaptive implementation intervention can be used to provide the
more intensive implementation strategies only to those who need them. The primary aim of this study is to
compare the effectiveness of two adaptive implementation interventions on the frequency of CBT
delivered to students by SPs (primary outcome) and on student depressive and anxiety symptoms
(secondary outcomes). Schools will first be randomized to receive REP or REP + Coaching. Schools in need
of additional assistance will subsequently be randomized to continue with REP or REP+Coaching or to
receive added Facilitation. Secondary aims include determining moderators of implementation effects (e.g.,
social determinants, leadership support), determining the cost of early introduction of Coaching and/or
augmentation with Facilitation, and identifying the mechanisms by which Coaching and Facilitation improve
CBT use among SPs and impact student outcomes. This five-year implementation trial will apply a novel
sequential multiple assignment randomized trial (SMART) design across a network of schools in all 83
counties in Michigan, involving over 100 schools, 200 SPs, and over 2000 students. Web-based tools will
facilitate data collection from SPs and students. This will be the first study to test implementation of a
transdiagnostic EBP for school-age youth, at a statewide level, delivered by school staff – taking the treatment
to populations with limited access. The proposal addresses two national health priorities: 1) reducing mental
health care and provider capacity gaps affecting youth, and 2) enhancing the knowledge base of
implementation science in community settings; and NIMH strategic ...

## Key facts

- **NIH application ID:** 9974596
- **Project number:** 5R01MH114203-04
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** AMY M KILBOURNE
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $690,865
- **Award type:** 5
- **Project period:** 2017-08-25 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9974596

## Citation

> US National Institutes of Health, RePORTER application 9974596, Improving Student Mental Health: Adaptive Implementation of School-based CBT (5R01MH114203-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9974596. Licensed CC0.

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