Commentary: School Contextual Influences on the Dissemination of Interventions

Abstract

Kazdin (2001) has noted that the effects of empirically supported treatments in actual clinical practice are to be less robust than have been evident in the controlled clinical research trials examining those treatments. In my experience in providing training to school personnel on cognitive-behavioral interventions for at-risk children, it has been evident that some staff in some school settings respond extraordinarily well to training and ultimately implement the program with great effectiveness, but other staff and other schools seem less able to foster useful implementation of the program. When school psychologists or school counselors come from schools with very autocratic administrations, with very poor communication and little support among the school staff, and with school-wide philosophies that are antithetical to cognitive-behavioral interventions, the fact that the intervention can work well in prior controlled research may have little effect on the program's utility in these settings. Although the field of intervention research has evolved to the point where we have a relatively clear understanding of how clinical research should evolve in stages from pilot studies to controlled efficacy and effectiveness studies, the process of successful dissemination and implementation of research-based interventions is remarkably less clear. It is not apparent how we can foster clinical use of research-based interventions, and how we can ensure that interventions are conducted in ways that are faithful and true to the tested intervention (Kazdin, 2001). The article by Ringeisen, Henderson, and Hoagwood (2003) represents an important step in beginning to address and conceptualize these issues. Ringeisen et al. conclude that simply stated, context matters (p. 166) when implementing empirically supported interventions in the school setting, and they provide a state-of-the-art summary of how individual-level, organizational-level, and state/federal-level factors can affect dissemination. This focus on contextual factors is timely, and the Ringeisen et al. article can have notable policy implications for how effective mental health interventions can best be implemented in school settings. The emphasis on organizational-level factors is especially noteworthy, because factors such as school climate have generally been neglected when planning for, and researching, optimal dissemination of mental health programs in schools. The paper raises practical and essential questions to be answered about this array of contextual influences on program implementation. In this commentary, I wish to amplify and extend several topics raised by Ringeisen et al. on the organizational context in schools. Understanding the Organizational Mechanisms That Influence Program Implementation in School Settings Ringeisen et al. (2003) usefully note that the school organizational context is likely to influence the uptake, adoption, and sustainability (p. 162) of newly introduced interventions. However, it will be necessary for intervention researchers and program implementers to understand precisely the mechanisms in the school climate that complicate or facilitate program implementation. Ultimately, minimodels of the key organizational features should be hypothesized and tested, contributing to a rigorous science of dissemination. This research work will require experimental studies of how organizational factors can influence school personnel's likelihood of using new empirically supported interventions for children's problem behaviors (e.g., Dane, 2001), as well as applied research on these factors as interventions are actually implemented during field trials and dissemination studies. This research can ultimately explain how the schools' organizational climate, through certain specific mechanisms, can influence implementation. Although these exact mechanisms within school settings are currently unknown, educational psychology research on topics such as school climate (Haynes, Emmons, & Ben-Avie, 1997) and teacher-student relationships (Pianta, 1999) may be useful in identifying key school organizational mechanisms. …