An Examination of Evidence-Based Practice Processes Across Service Settings: How Do Schools and Clinics Compare?

Background Much of the U.S. research on evidence-based practices (EBPs) for youth mental health care occurs in outpatient mental health clinics, but more actual youth mental health care takes place in schools. Can EBPs be delivered with fidelity in schools, given their complexity and their primary focus on education?Objective We sought to find out using treatment session data from clinics and schools where the same EBP was implemented. We examined EBP fidelity (including adherence and competence) by clinicians in both settings, to investigate possible context differences.Method We used observational coding of treatment fidelity collected from two randomized controlled trials testing the Modular Approach to Therapy for Children with Anxiety, Depression, or Conduct Problems (MATCH) in clinics and schools. The school sample included 102 elementary and middle school students randomized to MATCH or usual care and treated by 47 clinicians (M age 36.1 and SD 9.15, 91.5% female, 68.1% white, 72.3% licensed, 42.6% social workers) in five school districts. The clinic sample included 166 youths randomized to MATCH or usual care and treated by 41 clinicians (M age 42.8 and 11.15, 87.8% female, 87.8% white, 95.1% licensed, 82.9% social workers) in three large outpatient mental health clinics.Results For the sample as a whole, across settings and conditions, approximately 70% of session time involved delivery of EBP content. School-based sessions were about half the length of clinic sessions, but school-based clinicians showed significantly better EBP adherence and competence than clinic-based clinicians in the MATCH condition.Conclusions Although treatment sessions were markedly shorter in schools than clinics, school providers were more adherent and competent in implementing EBP content than clinic providers with training in MATCH. Such findings suggest that schools may be an appropriate context for implementing evidence-based intervention.