Exploring Fidelity Elements of a Motivational Interviewing-Based Implementation Strategy to Improve Adoption of Evidence-Based Practices in Schools

Abstract

Highly prevalent mental health needs among youth necessitate the use of evidence-based practices (EBPs). However, EBPs are inconsistently implemented in their primary service delivery setting, schools. Educators’ and School-based clinicians’ motivation and beliefs often hinder their EBP adoption. Beliefs and Attitudes for Successful Intervention in Schools (BASIS) is a theory-informed, group-based, pre-implementation strategy that blends Motivational Interviewing (MI), Strategic Education, and Social Influence techniques shown to improve individual behavior change mechanisms and evidence-based practice (EBP) adoption. MI techniques (e.g. elicit change talk, build an action plan) are integrated throughout BASIS sessions (n= 2; group 3–10), including facilitator-mediated technical aspects (e.g. elicit change talk with open-ended questions, reflect on participant experiences); and individually oriented and small group workbook activities (e.g. setting an intention, problem-solving, planning). As part of a large-scale cluster-randomized control trial simultaneously examining the effectiveness of BASIS and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), BASIS was delivered via the web by a community-based facilitator to 47 school-based mental healthcare (SBMH) practitioners serving 47 schools in six states. In this paper, we describe the BASIS fidelity elements of content adherence (Aim 1); comprehensiveness, facilitation supports, facilitator competence, and participant responsiveness (Aim 2); and explore the variability and associations between fidelity elements (Aim 3). Overall fidelity elements were high, and closer analysis revealed that adherence and responsiveness were associated. These exploratory findings point to a need for future research to describe and analyze fidelity elements of BASIS other group-based MI-embedded supports, particularly for complex or comprehensive web-based MI-delivery.

For the nearly one in five youth with emotional, behavioral, and mental health needs in the US (Child and Adolescent Health Measurement Initiative, 2023), there is a demand for evidence-based practices (EBPs) in accessible settings (Hoover & Bostic, 2021). While EBPs have demonstrated effectiveness addressing such needs, their implementation in schools – the most common context for children’s mental health services – remains limited (Duong et al., 2021). Educators’ individual factors, such as their self-efficacy and attitudes, strongly predict their EBP adoption (Cook et al., 2019; Miller & Moyers, 2017; Stahmer et al., 2015), making them critical targets for implementation strategies (Baffsky et al., 2023). To address these factors, Motivational Interviewing (MI; Miller & Rollnick, 2013), a well-established approach for enhancing the motivation and intentions that drive behavior change is being increasingly incorporated into training and coaching for educators (Frey et al., 2013; Reinke et al., 2011). The translation of MI to improve EBP use requires specification of how MI can be delivered to with high levels of fidelity (Akiba et al., 2022; Small et al., 2025). We provide an example of how core fidelity elements of MI were delivered in an efficacy trial of Beliefs and Attitudes for Successful Implementation Schools (BASIS), an effective, group-based, MI-driven implementation strategy (Carroll et al., 2007; Cook et al., 2019; Larson et al., 2021; Lyon, Cook, & Duong, 2019; Merle et al., 2023).

MI as a core component of individually-focused implementation strategies

MI can be used in conjunction with other effective EBP training approaches to increase adoption and implementation quality (Bradshaw et al., 2018; Reinke et al., 2008, 2011; Sibley et al., 2021). Through dialogue with a trained facilitator, MI can influence individual-level barriers to behavior change, such as implementing a new EBP (Larson et al., 2021). Within these conversations, the facilitator addresses ambivalence, elicits change talk, and maintains a supportive, non-judgmental, and positive stance for the individual to identify and develop an intention to change behavior (Frey et al., 2021). MI strongly influences an individual’s motivation to change their behaviors (Gayes & Steele, 2014) and has emerging effects for educational and health practitioners (Bradshaw et al., 2018; Pas & Bradshaw, 2021). MI consists of technical aspects (i.e., presenting open-ended questions, affirming, evoking change talk, and identifying and building on a need to change), relational aspects (i.e., empathy, collaboration), and avoiding MI-inconsistent behaviors with potential counteractive effects (i.e., shaming, exerting excessive control; Frey et al., 2021; Miller & Moyers, 2017). These dimensions are theoretically and empirically supported moderators of MI effects (Magill et al., 2018; Romano & Peters, 2015). However, for MI in less common applications, such as via web-based technology or as an implementation strategy, fidelity remains poorly described (Akiba et al., 2022; Shingleton & Palfai, 2016; Small et al., 2025).

BASIS: a motivational interviewing-based multicomponent strategy

BASIS is an EBP agnostic implementation strategy that blends MI with multiple, theoretically grounded techniques, ultimately improving school-based implementers’ beliefs, motivation, and adoption of EBPs (Cook et al., 2019; Larson et al., 2021; Merle et al., 2023). BASIS is delivered in two brief sessions, bookending standard EBP training with a pre-session delivered shortly before training (pre-intentional motivation) and a post-training session shortly after (volitional motivation; Health Action Process Approach [HAPA]; Schwarzer, 2008). To address individual mechanisms of behavior change (attitudes, subjective norms, perceived behavioral control; Theory of Planned Behavior [TPB]; Ajzen, 1991), a facilitator delivers strategic education, social proofing, MI, problem-solving planning, and action planning. BASIS is designed to encourage educator change talk through an elicit-provide-elicit structure, open-ended questions, expressing empathy, and affirming educators’ attempt to change (Larson et al., 2021). To ensure each educator engages in MI, the facilitator models change talk, presents a prompt to engage them in eliciting a reason for change and then explains and models participation in that segment which educators then complete in small groups and independently with structured written guides (Cook et al., 2019; Larson et al., 2021). Researchers have delivered BASIS with high MI fidelity, evaluated with gold-standard measures of Motivational Interviewing Treatment Integrity (MITI), including adherence, competence, and participant responsiveness (Larson et al., 2021).

In this study, BASIS was provided to support school-based mental health (SBMH) practitioners’ adoption of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), a mental health EBP. TF-CBT addresses symptoms of post-traumatic stress, depression, and anxiety among trauma-exposed children and youth (Thielemann et al., 2022). TF-CBT is a multiphase treatment that first develops youths’ coping skills, followed by trauma-narration and processing, and ending with consolidation and closure (Cohen et al., 2012). School-based delivery of TF-CBT is relatively new, and SBMH practitioners identified several barriers to implementation, including practitioners’ outcome expectancy, ability to plan for schedule changes related to delivery, and task self-efficacy (Connors et al., 2021)) – all barriers that BASIS targets. Therefore, school-based TF-CBT is an archetype use case to examine BASIS fidelity elements across components that integrate MI techniques.

Articulating fidelity of BASIS delivery to improve adoption of TF-CBT

To understand if an implementation strategy is effective at improving targeted implementation outcomes (e.g., adoption), fidelity needs to be assessed across core characteristics and delivery elements (Akiba et al., 2022; Carroll et al., 2007). Unfortunately, most studies include only a few fidelity components, predominantly adherence, with little detail on how the implementation strategy is designed, how well it is delivered, and how recipients engage with it, leaving little opportunity to explain variance in impact or translation (Akiba et al., 2022; Gearing et al., 2011). Prior BASIS trials have demonstrated high and reliable fidelity measured through observational global or “gestalt” items (i.e., overall ratings; An et al., 2020) and specific MI tools (e.g., MITI code; Larson et al., 2021; Moyers et al., 2016; Proctor et al., 2011). Nevertheless, applications of BASIS and similar implementation strategies across a range of school contexts would benefit from more robust description, measurement, and evaluation of comprehensiveness, facilitation supports, and multiple data sources for participants responsiveness (Akiba et al., 2022; Gottfredson et al., 2015).

Recently, researchers have called for implementation strategies to be specified across key dimensions to uncover variability in effects on implementation or clinical outcomes (Akiba et al., 2022) and move beyond adherence as the primary fidelity indicator. The foundational framework by Carroll et al. (2007) depicts fidelity dimensions, hypothesizes their interrelationships, theorizing that the following elements moderate content adherence: 1) comprehensiveness of intervention operationalization, 2) facilitation supports, 3) quality or competence of delivery, and 4) participant responsiveness. The authors suggest that the degree to which the intervention is operationalized may influence how impactful adherence to intervention delivery is on intervention outcomes (Carroll et al., 2007). They propose that quality, participant responsiveness, and facilitation supports also operate as moderators, suggesting that when an intervention is delivered well along each of these elements, the effect of the adherence improves. In other words, the extent to which participants receive an implementation strategy, such as BASIS, as intended may be in part related to how well the strategy is described, the facilitation methods, the competence with which it is delivered, and the degree to which participants engage.

We applied the Carroll et al. (2007) framework to the BASIS implementation strategy when delivered in this trial through a non-researcher facilitator via tele-sessions. In Figure 1, we present the definitions and operationalization of BASIS fidelity elements in alignment with this framework, including a) the interventions’ comprehensiveness, b) facilitators’ adherence to planned procedures, c) competence of delivery, d) facilitation supports used to support delivery, and e) participants’ responsiveness through those facilitation supports. For BASIS, content adherence includes the techniques of strategic education, problem-solving planning, action planning, and MI. In Figure 1, we provide an example of the MI techniques open-ended questions, reflection, elicitation, summarization, and affirmation, used to generate cognitive dissonance from the pre-session. Ultimately, BASIS delivery impacts practitioners’ individual mechanisms of behavior change (Ajzen, 1991) and implementation outcomes (Cook et al., 2019; Larson et al., 2021; Lyon, Cook, & Duong, 2019; Merle et al., 2023).

Figure 1.

Operationalization of basis fidelity elements, practitioner behavior change mechanisms, and EBP adoption.

In the case of MI embedded within BASIS, it is theorized that a facilitators’ use of specific prompts and responses guided by structured resources and participants’ engagement in those through change talk would strengthen the effect of adherence on behavior change. Altogether, these aspects may be necessary to ensuring MI is optimally effective at improving implementers’ use of an EBP and youth outcomes. For MI specifically, there is room to describe the distinctive interactional supports and responsiveness from both the facilitator and recipients, particularly when embedded for groups and delivered via the web (Shingleton & Palfai, 2016). We present BASIS delivery fidelity from an effectiveness trial as a well-defined use case of the potential influence of key elements to adherence and practitioners’ EBP implementation.

Purpose

As a tele- and group-delivered multicomponent strategy inclusive of MI, we theorize that each fidelity element (adherence, comprehensiveness, facilitation supports, and participant responsiveness), is critical to evaluating if SBMH practitioners received BASIS as intended to yield effects on behavior change. This paper aims to elucidate content adherence and potential influential elements (Carroll et al., 2007) to BASIS delivery as they relate to MI components. We will describe the BASIS content adherence across a large-scale RCT (Aim 1). Next, we describe the elements that may relate to content adherence, including comprehensiveness (facilitation guide, scripts, slides), facilitation supports (purpose, delivery mode, participant expected engagement mode, participant activity type), facilitator competence, and participant responsiveness (Aim 2). Finally, we explore variability and associations between these elements (Aim 3). We will discuss implications for future iterations of BASIS and other group-based delivery of MI to improve EBP use and youth outcomes.

Methods

Data source

Participants were drawn from the intervention group from a large-scale hybrid type 2 effectiveness-implementation stratified cluster randomized trial (Lyon et al., 2021), which evaluated the BASIS implementation strategy’s main effects, mediators, and moderators on implementation outcomes and TF-CBT on youth mental health outcomes. In this study, a practitioner from each participating school was randomized to BASIS plus TF-CBT (BASIS + TF-CBT), attention control plus TF-CBT (AC + TF-CBT), or enhanced treatment as usual Lyon et al. (2021). We recruited participants over three waves (N = 6 groups, 6–10 participants per group), one per academic year. Data for this study are from the BASIS sessions provided before and after TF-CBT training, (pre-session = 3.5 hr; post-session = 2 hr).

Participants

The larger study recruited 191 SBMH practitioners (e.g., school counselors and psychologists) through school districts and community-based organizations in eight states. Of the 191, 62 SBMH practitioners were randomized to receive BASIS during the 2020–2022 school years; the final sample of BASIS participants included 47 practitioners who completed post-training. Practitioners were eligible to participate in the study if they had 1) a minimum of a master’s degree in a subject related to counseling and mental health or Board Certified Behavior Analyst (BCBA) certification, 2) no previous formal training in TF-CBT or CBT + 3) provided SBMH services, and 4) were not actively receiving support to implement another related intervention (e.g., CBT+). Participants attended one of the six sets of pre- and post-sessions (3–10 participants in each set) immediately before and after their TF-CBT training. BASIS participants were from 47 schools (within 14 school districts) across six states. School districts in the BASIS + TF-CBT condition were predominantly White (52.1%), and Hispanic/Latinx (17.8%). A significant portion of the student population consisted of English language learners (46%), students receiving free or reduced lunch (32.5%), and students from low-income households (31%).

School-based mental health practitioners

Of the 47 BASIS participants, the ethnic composition included 95.7% (n = 45) identified as not Hispanic or Latinx and 4.3% (n = 2) identified as Hispanic/Latinx. Most participants identified as White (91.3%, n = 42), 2.2% (n = 1) identified as Black/African American, 4.3% (n = 2) identified as more than one race, and 2.2% (n = 1) identified as Asian. All participants held a master’s degree (17%, higher degrees).

Study design

Implementation strategy: BASIS

BASIS training was delivered synchronously via Zoom to groups of 6–10 participants (year 1 cohort n = 13, year 2 cohort n = 17, year 3 cohort n = 18) maintaining the same cohort grouping for pre- and post-sessions. Aligned with Figure 1 and the fidelity framework, we will operationalize BASIS along Carroll and colleagues’ fidelity framework (2007). First, describing its comprehensiveness, next the facilitation supports, and finally, the measures used for participant responsiveness, competence, and adherence.

BASIS comprehensiveness

BASIS is comprehensive given its complexity and detailed delivery (Carroll et al., 2007). BASIS sessions consist of a trained non-researcher facilitator (described below) who delivers MI-based techniques to elicit change talk, reflect on participant experiences, focus on the rationale for adopting the new practice, and build an action plan in a large group format (Cook et al., 2015; Larson et al., 2021; Lyon et al., 2021; Merle et al., 2023). As a pre-implementation strategy targeting individual-level mechanisms at both the motivational and volitional stages before adoption (Ajzen, 1991; Schwarzer, 2008), BASIS was delivered prior to training in TF-CBT (pre-session; 3 hr) and then in a session immediately following the training (post-session; 2 hr). Although prior iterations of BASIS were delivered in person, due to the COVID-19 pandemic, BASIS was delivered leveraging accessible and familiar technology: Zoom for synchronous video conferencing and Zoom tools (e.g., breakout rooms, polls, and chat function), pre-made Microsoft PowerPoint slide presentation for screen sharing, and Google Docs for individual and small group workbook activities. BASIS training included individual, small group, and large group activities with facilitation via MI techniques across the full pre- and post-sessions. The facilitator delivered strategic education on all primary dimensions of BASIS. Co-facilitators provided support by ensuring participants joined their small groups, oriented to the correct workbook sections, and stayed on task by answering logistical questions and occasionally using open-ended prompts to remind them of the original prompt for the activity.

Strategic education.

BASIS uses strategic education to improve participant attitudes toward adopting a new EBP. The strategic education explicitly walks participants through MI dimensions of engaging, focusing, evoking, and planning (see “Purpose” in Table 1). During this, the facilitator encouraged participants to reflect on the benefits of TF-CBT use and to question engrained negative beliefs about adopting TF-CBT. For example, participants explored the prevalence of trauma and how school settings are key in providing mental health services. They explored common challenges encountered when adopting an EBP (e.g., lack of support from leadership, competing demands for time, feeling alone or isolated, and logistical barriers). Participants were also prompted to consider ethical aspects (e.g., qualifications for delivery, effective therapy, and diverse youth) of delivering TF-CBT and encouraged to share perspectives.

Table 1.

Heat map of fidelity elements within sections aligned with MI-Purpose, organized by highest to lowest scores across elements.

		Participant Responsiveness
		Adherence	Workbook Responsiveness	Group Engagement	Competence
Section	MI Purpose	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
PRE: Fact/Fiction EBP (2)	–	4(0)	–	4(0)	4(0)
PRE: Wrap-up (6)b	–	3.83(0.41)	–	–	3.83(0.41)
POST: Conclusion (6)e	–	3.78(0.17)	–	4(0)	3.67(0.52)
PRE: Ethics (4) 1	Summarize & Evoke ethics & new practice	3.56(0.37)	1.46(0.89)	2.75(0.5)	3(0)
PRE: Problem-Solve (6)	Elicit & Affirm solutions overcome barrier	3.48(0.27)	1.97(0.9)	3.67(0.52)	3.17(0.98)
POST: Mental Health (5) 1	Elicit Motivational Statements	3.42(0.40)	–	3.2(0.45)	3.2(0.45)
PRE: Introduction (4) 1,4	–	3.38(0.48)	1.68(0.44)	3.75(0.5)	4(0)
PRE: Clarify Values (5)1,4	Evoke mind-set of prioritizing new practices	3.33(0.33)	1.66(0.6)	3.6(0.55)	3.4(0.55)
POST: Introduction (6)c 2	–	3.25(0.69)	–	4(0)	3.67(0.52)
PRE: Set Intentions (2)	Evoke & Affirm intention & TF- CBT goals	3.17(0.24)	–	2.5(0.71)	3(0)
PRE: EBP (1) 1	–	3(0)	–	3(0)	4(0)
POST: Goal Setting (6)	Elicit & Affirm TF-CBT implementation goals	2.94(1.02)	1.38(0.81)	3(0.89)	3.5(0.55)
PRE: Fidelity (6)*	Elicit reflection based on the notion of fidelity	2.90(1.07)	–	3.4(0.55)	3.33(0.82)
POST: First Steps (6)d	Elicit & Affirm benefits of implementing	2.67(0.52)	1.78(0.39)	4(0)	3(0)
POST: Imp. Plan (6)	Elicit & Affirm solutions to	2.67(0.20)	1.94(0.25)	3.67(0.52)	2.67(0.52)
POST: Opp. Change (6)	Evoke cognitive dissonance & Affirm need	2.08(0.20)	1.788(0.36)	3.83(0.41)	3.5(0.55)
PRE: Values & Goals (4)a*	Focus on radical acceptance to shift and persist	1.83(1.00)	1.58(0.61)	4(0)	2.75(0.96)

No te. Sections organized by highest adherence, workbook responsiveness (where applicable), group engagement, and then competence. Imp. = Implementation, Opp. = Opportunity, PWB = participant workbook;

^an for participant responsiveness = 1;

^bn for participant responsiveness = 0;

^cn for participant responsiveness = 4;

^dn for participant responsiveness = 3;

^en for participant responsiveness = 2;

¹= section not coded due to recording error for group 1,

²= section not coded due to recording error for group 2;

⁴= section not coded due to recording error for group 4.

Motivational interviewing techniques.

The MI elicit-provide-elicit format was used, where the facilitator elicits reflections through questions or workbook activities, provides information to promote critical thinking, and elicits discussion to change mind-set and promote flexibility and solution-generation (Ingersoll & Wagner, 2012). When participants engage in reflection or discussion, the facilitator’s role includes active listening and providing one or several of the five MI techniques including; (a) providing open-ended questions to evoke the need for change; (b) reflection on participant contributions and reinforcement of solutions; (c) summarizing main ideas; (d) affirming and validating shared ideas, strengths, and feelings; and (e) eliciting self-motivational statements to promote intrinsic disposition and increase participant trust (see Figure 1).

Basis facilitation supports

While BASIS is relatively complex, given its multi-strategy implementation, we leveraged several facilitation supports to simplify delivery: 1) tech support, 2) clear facilitator guides with scripted prompts 3) cloud-based participant workbooks, clear guides to build its comprehensiveness, and convey the details.

The scripted delivery of BASIS was presented on the “notes” on PowerPoint, which included each sections’ thematic information, specific timepoints for activities, and prompts for MI techniques (i.e., the script prompted the facilitator to provide examples and elicit reflection throughout the session). In addition, the facilitator suggested developing a facilitation guide (see Supplemental File A), which we implemented in years two and three. The facilitation guide was a structured document consisting of an extensive table presented by a slide with facilitator notes, directions, abbreviated scripts, a visual slide preview, and technology instructions (i.e., screen share). The PowerPoint slides included icons to cue the facilitator and participants to the corresponding activities and facilitation supports (i.e., individual workbooks, small group workbooks, small group breakout groups, whole group sharing, Zoom chat box participation, and unmute and talk). Each delivery element had a corresponding icon in the slides to cue participants for the upcoming activities and engagement mode. The technology assistant provided individual and group workbooks via Google Doc links and used “breakout rooms” for small groups assigned and maintained throughout the session.

Participant workbooks.

We provided participants with individual and group online Google Doc workbooks for pre- and post-session activities (n = 5–8, n = 5–6, respectively). Pre-session individual workbooks consisted of two activities with open-ended questions to prompt reflective answers on professional values, professional learning, and the impact of TF-CBT on student outcomes and set intentions and goals for the TF-CBT training. The pre-session group workbooks include prompting participants to work together to develop several solutions they could use to address common implementation barriers (e.g., lack of leadership support, competing time demands, logistics, or feeling alone; n = 3–6 activities). The post-session individual workbooks prompt participants to reflect on their efforts to implement TF-CBT and its potential impact on students, create an action plan, and create a problem-solving plan to avoid getting stuck (n = 3–4 activities). The post-session group workbook prompted participants to outline the initial steps of TF-CBT implementation (n = 2 activities), which their small group then rated on the extent to which they were realistic and doable, detailed, and likely to lead to successful initiation. A tech person (research assistant, [Author six]) also supported participant access to technology (i.e., troubleshooting audio and sending links to Google-based workbooks).

BASIS facilitator

The BASIS facilitator (author 13), who was not involved in BASIS development, was a licensed social worker (MSW) with 17 years of experience providing direct services to youth in community contexts, supervising other practitioners delivering youth mental health services, and trained in MI (9-hr training). [Author 13] is a nationally certified TF-CBT practitioner trained in CBT+ (Rivera Nales et al., 2024), which includes motivational enhancement-style interventions to increase client engagement. The facilitator was selected due to their training, relatability, and credibility having shared professional experiences in schools, which they described to participants at the beginning of the pre-session to establish credibility and rapport, consistent with the spirit of MI (Miller & Moyers, 2017). The facilitator had previously completed a nine-hour MI training, completed a “train-the-supervisor” cohort with the developers of TF-CBT, has participated in multiple studies, including CBT+, which included motivational enhancement style interventions to increase client engagement.

Facilitator training in BASIS.

The facilitator was trained by the BASIS sub-team which consisted of one of the original developers of BASIS, a trained school psychologist and MI practitioner; a doctoral student in school psychology trained in MI; a postdoctoral scholar with school-based implementation and coaching experience; and a bachelor’s level research assistant. The facilitator attended 5–10 hr annually of BASIS sub-team meetings before delivering to each cohort (year 1:10 hr, year 2:5 hr, year 3:10 hr). Each study year consisted of the following facilitator training: 1) sharing the content of training, including the slides with notes that indicated the purpose of each slide and activity, the workbook, and the videos; 2) a one to two-hour meeting with the sub-team walking through the purpose of the slides and articulating main ideas while the facilitator could ask questions for clarification or changes; 3) at least one independent rehearsal annotating script; 4) another one to two-hour meeting with the facilitator to share feedback and changes, or practice sections for feedback; and 5) a final rehearsal of all the BASIS components for pre- and post-sessions (4 hours). Additionally, the facilitator was well-versed in utilization of Zoom format for delivery of coaching and consultation to school personnel, caregiver support sessions, student-delivered therapy, and facilitation of graduate-level coursework and district trainings.

Co-facilitators.

One to two co-facilitators were assigned to each session to work with one to two small groups. BASIS co-facilitators included Master’s (n = 4) or Ph.D. (n = 2) research team members, who had experience working and researching in schools. They participated in the BASIS sub-team to design the strategies and practiced facilitating the small groups during rehearsals with the facilitator and lead researchers.

Technology assistant.

One research assistant was assigned to each session to provide the facilitator with appropriate workbook links through the Zoom Chat box.

EBP targeted for adoption by SBMH practitioners: TF-CBT

TF-CBT is an established EBP selected to address participating districts’ need related to students’ trauma as well as increasing concerns about student safety. TF-CBT is a 12–16 session intervention for students aged 3 to 18 years with trauma exposure and related mental health sequelae. It includes individual sessions for the youth, individual sessions for caregivers, and conjoint sessions (Cohen et al., 2017). TF-CBT training consisted of a self-paced online training called “TF-CBT Web” and a 3-day live TF-CBT training delivered by nationally certified TF-CBT trained therapists. Participants were asked to screen students who a) were new to their caseload, b) had a new issue, or c) needed more intensive support. Participants referred students to participate in the study if they endorsed at least one traumatic event and had a 21 or higher on the Child Post-Traumatic Symptom Scale for DSM-V (CPSS-V) assessment (Foa et al., 2018).

Measures

BASIS fidelity

BASIS fidelity was reviewed on video recordings of the Zoom sessions and rated on one form across content adherence, competence, and group engagement using a fidelity measure revised from prior BASIS iterations (Cook et al., 2015; Larson et al., 2021; Lyon et al., 2021; Merle et al., 2023) to align with education-based modifications, tele-delivery, and a new facilitator. Fidelity was operationalized based on the facilitator script and training, which aligned with the facilitator guide (see Supplemental file A) that included specific facilitator content and behaviors designed to be delivered in sequence and in conjunction with specific visual supports (i.e., slideshow, visual icons as cues for opportunities to respond) and activities (i.e., individual and small group workbooks). As such, fidelity was measured within each section of the BASIS session (i.e., Introduction, Plate), which comprised a topic that included strategic education, an elicit-provide-elicit framework, and facilitation supports (Larson et al., 2021; Lyon et al., 2021). Fidelity to BASIS delivery was measured across three dimensions: content adherence, competence of delivery, and participant responsiveness (scale of 0 to 4; Table 2), in the three recordings that started after session initiation (2 pre and 1 post). We did not impute any missing data, and calculated percentages based on the number of BASIS sections recorded.

Table 2.

Descriptives and relations between fidelity elements across sessions.

	Adherence	Participant Responsiveness			Group Engagement	Competence
	Mean	Mean	SD	p value	Mean	Mean
Pre-Session Overall	3.34	1.72	0.31	0.007*	3.38	3.61
Pre-Session A	3.36	1.59D	0.44		3.63	3.67
Pre-Session B	3.48	1.85	0.20		3.33	4.00
Pre-Session C	3.42	1.70	0.37		3.67	3.00
Pre-Session D	2.84	1.42A,E,F	0.33		3.25	4.00
Pre-Session E	3.44	1.83D	0.13		3.57	3.50
Pre-Session F	3.47	1.92D	0.10		2.86	3.50
Post-Session Overall	2.86	1.86	0.13	< 0.01*	3.66	3.33
Post-Session A	2.81	1.74D	0.15		4.00	3.50
Post-Session B	2.86	1.83D	0.07		3.40	3.33
Post-Session C	2.86	1.95F	0.13		3.50	3.17
Post-Session D	2.91	1.99A,B,F	0.04		3.75	3.33
Post-Session E	3.05	1.89F	0.08		3.50	3.33
Post-Session F	2.68	1.76C,D,E	0.07		3.80	3.33

Note. *Subscripts in Participant Responsiveness Mean scores, indicate that a session’s responsiveness scores differs significantly ( < .05) from the session with the superscripted letter. For example, pre-session A significantly differs from pre-session D.

Video fidelity coding (for adherence, competence, and participant responsiveness) was conducted by a post-doctoral researcher (third author) and a research project coordinator (author six); 90% of agreement was reached by the 2^nd coded video. Coders received structured training (2 hr) specific to the study’s fidelity protocol, including guided practice and review of sample sessions from a BASIS trainer who was not a facilitator in this trial. Following this, they independently coded two randomly selected sets (pre and post) sessions achieving point-by-point reliability >85% for independence (range of 86–94% with no components lower than 85%). For independent coding, both coders coded two videos, then met to consensus code with the non-facilitator BASIS Trainer graduate research assistant (second author) to resolve discrepancies to prevent coder drift over time. Disagreements were spurious (range of 67–93%, 86%) and resolved via consensus.

Content adherence.

Adherence to intervention refers to the training delivered as planned and measured at the topic level within each section. In this dimension, fidelity coders reviewed adherence to the protocol, including six components. The components were sharing the correct slides, providing all activities, respecting timeliness and estimated duration, aligning with the script, minimal deviation within training sections, and using MI techniques. Fidelity coders (Author three, Author six) reviewed each training video. They coded for no adherence (0 = no components in the section), a small amount (1 = one to two components), partial (2 = three components), most (3 = four to five of the components), or full (4 = all six components).

Competence.

Competence of BASIS delivery represents maintaining responsiveness, upbeat tone and affect, topical relevance and focus, and sufficient explanations (Larson et al., 2021) and was measured at the topic level within each section (i.e., see Table 1). Fidelity coders (Lyon et al., 2021) reviewed each training video. They coded for no components (0 = no components in the section), small amount (1 = one component), partial (2 = delivered two components), most (3 = three components), and full (4 = four components).

Participant responsiveness.

Participant responsiveness was measured via multiple data sources (Akiba et al., 2022) at the session (group engagement) and individual levels (participant workbook responsiveness). For group engagement, coders viewed the video recorded whole group activities and recorded the number of participants demonstrating active participation (e.g., unmuting to respond, sharing thoughts, using the chat box when prompted), on-task behavior (e.g., completing workbook activities), and responsiveness to others (e.g., commenting on peer contributions, engaging in discussions) from video. Raters coded the degree to which participants were responsive, engaged, and on task, with 0= not engaged, 1 = few engaged, 2 = some engaged, 3 = most engaged, and 4 = all engaged. A rating of NA (not applicable) indicated no planned opportunity to respond in that section.

Individual participant responsiveness was coded through analysis of written workbook responses (individual and small group responses). Individual responsiveness was coded by written prompt component (e.g., describe your wish and what for engaging in the TF-CBT training was scored for both the “wish” and the “what”) using a three-point scale designed to capture the degree to which each response addressed the intended prompt. The scale included not responsive (0 = relevant response is missing/not provided), somewhat responsive (1 = response is either incomplete, vague, or lacks sufficient detail to fully address the prompt), and responsive (2 = response is accurate, relevant, and addresses the prompt completely). Coder 1 (second Author) and Coder 2 (first Author), both trained BASIS facilitators for other trials, developed the scale and applied it on three randomly selected pre/post sessions with >90% accuracy. Coder 1 coded 100% of all files, and Coder 2 coded >33% (35% to 39%) of workbooks for each cohort year, and pre/post group ongoing. Point-by-point agreement was calculated across all double-coded workbooks and averaged 92%, indicating high interrater reliability. Discrepancies were discussed and resolved through consensus.

Data analyses

Descriptive statistics were computed using R studio SPSS version 30 (IBM Corp [IBM], 2020; R Core Team, 2022)

Aim 1. Content adherence.

Means, ranges, and standard deviations were calculated as an average within and across each pre- and post-session sections (pre: Introduction, Clarifying Values, Mental Health, Professional Ethics, Evidence-based Practice, Fact or Fiction EBP, Fidelity of Implementation, Problem-Solving Barriers, Values and Goal Setting, Setting Training Intentions, and Wrap-up; post- Introduction, Opportunity for Change, Initial Steps toward TF-CBT, Goal Setting, Implementation Planning, and Reminders and Conclusion)

Aim 2. Potentially influential fidelity elements.

Descriptives (i.e., means, standard deviations, ranges) for facilitator competence, group engagement, and individual participant workbook responsiveness scores were calculated within and across sections and sessions. In addition, participants’ percentage of workbook activities attempted.

Aim 3. Analyses.

Kruskal Wallis tests were run to identify whether individual participant workbook responsiveness differed by session. This allowed us to examine whether participant responsiveness differed in sessions with descriptively higher or lower levels of adherence. Kruskal–Wallis tests are non-parametric tests, like an ANOVA, for small sample sizes.

Results

See Table 1 for the detailed descriptive data on content adherence (Aim 1), competence, and participant responsiveness (Aim 2), which is depicted within sections across sessions. Table 1 depicts the MI-specific interactions and purpose for sections and heat-map for a visual demonstration of patterns of higher scores (green tones) and lower scores (red tones) across the fidelity elements (Aim 3).

Aim 1. Content adherence

BASIS content adherence and MI techniques across pre-sessions (rating scale of 0–4) was, on average, 3.27 (SD = 0.30, Range = 2.73 – 3.47). Content adherence to the 11 pre-session sections varied – for example, Values and goal setting had the lowest average content adherence (M = 1.83, SD = 1.00, Range = 0.67 – 2.67), while the section on Fact or Fiction EBP had the highest average content adherence (M = 4.00, SD = 0.00, Range = 4.00). Overall, post-session content adherence was, on average, 2.90 (SD = 0.17, Range = 2.69 – 3.11) and varied, such that the section on Opportunity for Change had the lowest average content adherence (M = 2.08, SD = 0.20, Range = 2.00 – 2.50), while content adherence to the Introduction had the highest average content adherence (M = 3.25, SD = 0.69, Range = 2.00 – 4.00).

Aim 2. Potential influential elements

Competence

Facilitator competence with delivering the dimensions of BASIS and MI techniques during the pre-session was, on average, 3.42 (SD = 0.43, Range 2.73 – 3.47). Average delivery competence for the 11 pre-session sections ranged from 2.00 to 4.00, depending on the section. Of note, three sections (i.e., Introduction, Evidence-based Practice, and Fact or Fiction EBP) had average competence scores of 4.00 (SD = 0.00). Like content adherence, delivering the section on Values and goal setting also had the lowest competence average (M = 2.75, SD = 0.96, Range = 2.00 – 4.00). Facilitator competence during the post-session was, on average, 3.33 (SD = 0.11, Range = 3.17 – 3.50). Average competence in the six post-session sections varied—Implementation Planning had the lowest average score (M = 2.67, SD = 0.52, Range = 2.00 – 3.00), while the highest was for delivering both the section on Introduction and Wrap-Up (M = 3.67, SD = 0.52, Range = 3.00 – 4.00).

Participant responsiveness

On average, group engagement during the pre-session was 3.35 (SD = 0.34, Range = 2.75 – 3.67). Engagement was lowest on average for the pre-session section on Setting Training Intentions (M = 2.50, SD = 0.71, Range = 2.00 – 3.00) and highest for the sections on Fact or Fiction EBP and Values and goal setting (M = 4.00, SD = 0.00). Average group engagement was high across the post-session sections (M = 3.66(SD = 0.23, Range = 3.40 – 4.00). Individual workbook responsiveness was measured through attempts at workbook activities and responsiveness to prompts. Most participants attempted most activities across pre- and post-sessions with all participants attempting all activities across most sessions (pre-session; M = 94%, Range = 67–100%, post-session; M = 95% Range = 75% to 100%). While 100% of groups attempted most group activities, only one individual activity, Reflecting on opportunity for “change” had 100% of participants attempting. For all other sections, over 90% of participants attempted the activity, except for Evidence-Based Practice (73%).

A closer examination of participant responsiveness to workbook prompts revealed a high average score during the pre-session (M = 1.64on a 0–2 scale, Range = 0–2, SD = 0.51), which increased in the post-session (M = 1.88) with less variability among participants (Range = 1.5–2, SD = 0.14). Across pre- and post, average scores of participant responsiveness was high (M = 1.80) with little variability (Range = 1.33–2.00, SD = 0.17) between participants.

Aim 3. Exploring variability and associations between adherence and other elements

Using the means identified in Aims 1 and 2, we identified the lowest and highest content adherence mean scores for sections across sessions and reviewed the scores for variability and any associations with potentially influential elements (facilitator competence, facilitation supports, BASIS, and MI comprehensiveness, and participant responsiveness) within that section. The variability is represented in the SDs in Table 1, which the heat map visually depicts the Fact or Fiction EBP, a highly scripted section with no MI specific content and no workbook activity, had the highest average content adherence score with the least variability across sessions (M = 4.0, SD = 0.0), one of the highest competence scores (M = 4.0, SD = 0.0), and the highest group engagement (M = 4.0, SD = 0.0). A less scripted, more interactive section that required MI delivery, Values & Goals had the lowest adherence (M = 1.83, SD = 1.00), and competence (M = 2.75, SD = 0.96), low workbook responsiveness, but high group engagement (M = 4.0, SD = 0.0). Taken together, sections with higher complexity as part of the element of comprehensiveness, such as Values & Goals had the lowest content adherence, which is more complex and cannot be fully scripted because the facilitator uses MI to be responsive to any range of readiness shared by participants.

The visual display depicts the highest scores for sections without any MI components, and decreasing average scores starting with group engagement for MI-embedded sections (Problem-Solving, Mental Health, Introduction, Clarifying Values, Setting Intentions), generally to more varied and overall lower scores for post-session elements that included MI (Goal Setting, First Steps, Implementation Planning) and some pre-session (Fidelity, and Values & Goals). Participants demonstrated high levels of workbook responsiveness across both pre- and post-sessions. On a 3-point scale of 0–2, the average responsiveness score during pre-sessions was 1.64 (SD = 0.51), indicating most participants engaged meaningfully with workbook content. Responsiveness was higher during post-sessions, with an average score of 1.88 (SD = 0.15). The sections on Fact or Fiction EBP and Wrap-up had the highest average responsiveness scores (M = 4.0), indicating full engagement across all participants. The post-session Conclusion also showed strong responsiveness (M = 3.78, SD = 0.17). In contrast, sections requiring more MI-driven responses had lower responsiveness scores and showed more variability. For example, Ethics (M = 1.46, SD = 0.89), Problem-Solving (M = 1.79, SD = 0.90), and Mental Health (M = 1.68, SD = 0.44). Findings suggest that while participants were generally responsive to workbook activities, responsiveness appeared lower for more complex MI-based interactions.

Given participants were grouped by session, we evaluated differences and relations between sessions (n = 6 pre, n = 6 post; See Table 2). Pre-session Facilitator adherence was significantly higher for Session B (M = 3.48, SD = 1.85) as compared to the lowest, Session D (M = 2.84, SD = 1.42). For post-session facilitator adherence, Session E (M = 3.05, SD = 1.89) was compared to the lowest (post-session F, M = 2.68, SD = 1.76). Participant workbook responsiveness at pre-session was significantly higher for Session B (M = 1.85, SD = 0.20) than for Session A (M = 1.59, SD = 0.44). For the post-session, participant workbook responsiveness in Session D (M = 1.99, SD = 0.04) was significantly higher as compared to Session A (M = 1.74, SD = 0.15). Group engagement in pre-sessions was significantly higher for Session C (M = 3.67, SD = 0) compared to Session F (M = 2.86, SD = 0). Group engagement in post-sessions was significantly higher for Session A (M = 4.00, SD = 0) compared to Session B (M = 3.40, SD = 0). Competence in pre-sessions was higher for Sessions B and D (M = 4.00, SD = 0) compared to Session C (M = 3.00, SD = 0). Competence in post-sessions was higher for Session A (M = 3.50, SD = 0) compared to Session C (M = 3.17, SD = 0).

We tested associations between adherence and participant responsiveness and found adherence was significantly and positively associated with participant responsiveness for pre-sessions (t = 3.7475, df = 46, p = .0005,) and post-sessions (t = 3.27, df = 46, p = .002).

Discussion

For youth with mental health needs, school-based delivery of EBPs is a critical mechanism for improved clinical outcomes (Duong et al., 2021), yet practitioners struggle to adopt these EBPs (Lyon et al., 2024). MI-based implementation strategies can enhance educators’ EBP implementation (Frey et al., 2013, Lee et al., 2014; Reinke et al., 2011), although clear and specific implementation strategy fidelity measurement and reporting is needed to realize their potential (Akiba et al., 2022). We described web-based delivery and facilitation supports of BASIS by a non-researcher facilitator and the theorized influential fidelity elements (comprehensiveness, facilitation supports, facilitator competence, and participant responsiveness; Carroll et al., 2007). Our results suggest that each fidelity element may explain key pieces of implementation delivery and receipt (Small et al., 2025). Future research can use similar facilitation supports to operationalize delivery and collect fidelity from multiple data sources across multiple elements to detect potential active components (Akiba et al., 2022), particularly if we find BASIS improves adoption, consistent with prior studies (Larson et al., 2021; Lyon, Cook, & Duong, 2019). Moreover, a critical next step of this work is to understand how these EBP implementation gains are associated with student clinical outcomes.

In this effectiveness study, BASIS comprehensiveness addressed challenges seen in prior MI studies (Sibley et al., 2021) and may have contributed to the non-researcher facilitators’ high fidelity (Akiba et al., 2022; Carroll et al., 2007). We were able to operationalize the implementation strategy with greater detail than typical MI-based implementation strategy studies (Small et al., 2025), using scripting, facilitation guides, and clear visual icons to support the facilitator in competently delivering BASIS and MI strategies with high adherence, despite the strategy’s complexity. Although the MI components can be captured and evaluated through a more refined measure, this contribution is worthy of exploring for other multicomponent strategies that embed MI, particularly in group-based delivery in which a facilitator is managing and responding potentially to the motivational states of multiple recipients (Frey et al., 2021; Pas & Bradshaw, 2021).

In the future, implementation strategy guides and manuals that embed MI prompts can be used by school-based professionals with MI training, like our facilitator, extending their clinical MI skills to support implementation via feasible delivery through groups and the web (Rangachari et al., 2022). Moreover, as more school-based mental health practitioners are trained in MI for therapeutic delivery to students (Small et al., 2025), leveraging their MI expertise as an implementation strategy component holds great promise for enhancing EBP use among other school-based professionals. Given the consistent financial constraints facing schools (Farrie & Kim, 2025), capitalizing on existing MI resources may be a way to feasibly integrate MI to support the mental and behavioral health of children and youth (Lyon, Cook, & Locke, 2019).

Importantly, the variability observed reinforces a need to measure, report, and analyze fidelity across each element (Carroll et al., 2007), particularly for MI-based implementation strategies (Akiba et al., 2022; Small et al., 2025). BASIS fidelity varied between sessions, within sessions between topics, and between fidelity elements (i.e., content adherence, competence). Combined with our observation that adherence was lower for sections with more MI techniques and complexity, special attention to ensuring high dosage of high-quality delivery of MI-techniques may ensure that MI is fully received by practitioners and feasible for the facilitator (Williams et al., 2022). The varying degrees of competence, content adherence, and participant responsiveness indicate that measuring adherence alone may not explain the impacts of MI or any implementation strategy (Akiba et al., 2022). Specifically, as MI requires relational, conversational, and responsive communication to elicit change talk and, ultimately, behavior change, individual participant responsiveness may be a necessary element to measure (Apodaca & Longabaugh, 2009; Small et al., 2025). Additionally, multiple data sources revealed sometimes contrasting representation of individual and group responsiveness. Thus, for MI-based delivery, it remains important to provide multiple opportunities to respond via multiple response modes (e.g., chat, breakout rooms, “reactions,” polls) to individuals and groups to ensure engagement within necessary MI interactions, which may take multiple forms in group and web-based delivery (Romig & Alves, 2021).

Limitations

Important limitations to this study should be considered when interpreting quantitative findings. First, consistent with the population of SBMH practitioners (American School Counselor Association, 2023), our sample was predominantly White and female and not representative of the diversity of students and communities in the United States. Second, this study began with the onset of the COVID-19 pandemic, while we quickly shifted to virtual delivery, we had occasional technical errors (e.g., some recordings were abbreviated, and participants occasionally struggled to access features and audio/video). Third, each participant cohort had slight variations given contemporary issues (i.e., more content on culturally responsive practice). In addition, the facilitator was trained to deliver a primarily scripted intervention with a clear facilitation guide but was not given the fidelity instrument as a component of their delivery preparation or ongoing feedback. Finally, although we used a fidelity tool aligned with prior BASIS trials and the MITI (Larson et al., 2021), this study did not use MITI. doing so in the future can provide a more comprehensive assessment and enable testing of key relationships (Carroll et al., 2007).

Conclusion

To address the persistent need for generalizable, scalable, and effective implementation strategies to support youth mental health (Gottfredson et al., 2015; Lyon, Cook, & Locke, 2019), this paper offers a blueprint of the necessary fidelity elements of a MI-embedded multicomponent implementation strategy delivered by a non-researcher facilitator (Cook et al., 2019; Larson et al., 2021; Lyon, Cook, & Duong, 2019; Merle et al., 2023). This blueprint draws from frameworks to demonstrate the high-fidelity web and group-based delivery across key elements (adherence, facilitation supports, comprehensiveness, and participant responsiveness (Akiba et al., 2022; Carroll et al., 2007). The high-fidelity, and sometimes varying, delivery suggests that, like client-facing interventions, translating implementation strategies to authentic facilitators and contexts can benefit from planful and clearly articulated fidelity across these elements (Akiba et al., 2022). This approach shows promise for helping more educators access MI-based implementation strategies to empower them to use EBPs effectively and, ultimately, improve student mental health outcomes.

Biographies

Maria L. Hugh is an Assistant Professor of Special Education at the University of Kansas. Her research examines educators’ decision-making and adoption of feasible evidence-based practices that improve children’s outcomes. As an early childhood special educator, she leads child and practitioner-informed research at the intersection of developmental differences and individualized intervention delivery. Dr. Hugh partners with schools, communities, and pre- and in-service educators using implementation science and mixed-methods approaches to advance equitable and effective practices.

Ana Paula Martínez Cueto is a Graduate Research Assistant and third year PhD student in Special Education at the University of Kansas. She holds an M.Ed. in Early Childhood and ABA therapy and founded the first ECI+ABA center in Monterrey, Mexico. Her research focuses on caregiver behavior training, culturally adapting interventions for Latino families, and developing professional training for caregivers. Ana Paula integrates implementation science and elevates stakeholder voices to ensure interventions are relevant, meaningful, and sustainable in real-world contexts.

Kathryn E. Bruzios is a Postdoctoral Scholar in Psychiatry & Behavioral Sciences at the University of Washington, affiliated with the SMART and ALACRITY Centers. She earned her PhD in Prevention Science from Washington State University. Her research centers on designing and evaluating implementation strategies to improve youth behavioral and mental health outcomes in schools and community settings.

Catherine M. Corbin, PhD, is an Assistant Research Professor at the University of Florida’s Prevention and Intervention Network (PIN) within the College of Education and affiliate faculty within the University of Washington’s School Mental Health Assessment, Research, and Training (SMART) Center. Dr. Corbin’s work focuses on students’ and teachers’ social-emotional well-being and the implementation of Tier 1 programs to support each. They specifically focus on student-teacher relationships, educator well-being, and development of implementation strategies to maximize the effectiveness of school-based social, emotional, and behavioral programs. Dr. Corbin is also interested in the potential of school-based de-implementation (i.e., the discontinuation or reduced use of low-value and harmful practices) to make resources available for educators’ to successfully implement and sustain evidence-based/informed practices. These interrelated lines of inquiry are progressed using advanced quantitative methodology, with a particular emphasis on developing and/or refining measures for research and practice. Dr. Corbin’s work is motivated by a future in which all students and educators have access to the skills, opportunities, and services needed to succeed in school and life.

Larissa M. Gaias is an Acting Assistant Professor in Psychiatry & Behavioral Sciences at the University of Washington and faculty at the SMART Center. She engages in partnership-driven research and evaluation to support schools, districts, community organizations, state agencies, and other partners in building accessible, effective, and equitable mental health services and systems for youth.

Yasmín Landa is a first-year doctoral student in the Clinical Science program at the University of California, Berkeley, where she is supported by the Chancellor’s Fellowship for Graduate Study and mentored by Dr. Giovanni Ramos. She earned her B.A. in Psychology and Sociology from the University of Washington. As an undergraduate, she was funded through the Ronald E. McNair Scholars and the Mary Gates Research programs to conduct an independent project examining how social and physical in-patient experiences shape post-hospitalization treatment engagement. Following graduation, she served as a Research Study Coordinator at the School Mental Health Assessment, Research, and Training (SMART) Center, working with Drs. Aaron Lyon and Freda Liu. Her current work focuses on closing the research-to-practice gap to improve access to evidence-based mental health services (i.e., practices, interventions, treatments) for racially and ethnically minoritized communities, particularly Latinx, immigrant, and Spanish-speaking groups. She uses implementation science, community-engaged partnerships, data-driven cultural adaptations, and digital tools to advance this goal.

Mahima Joshi is a Research Scientist at the University of Washington’s SMART Center. She holds a BA in Public Health from the University of Rochester and an MPH from UW. Her interests include preventive mental health care and implementation science, and she works on projects such as BASIS and BASIS-Optimization to enhance school-based mental health interventions.

Rose Reyes earned her B.A. in Psychology from the University of Washington and currently works as a research coordinator at the UW SMART Center. She has contributed to multiple NIH- and IES-funded research projects, including BASIS (Beliefs and Attitudes Toward Successful Implementation in Schools) and VIBRANT (Virtual Implicit Bias Reduction and Neutralization Training). Her research interests focus on developing equity-centered implementation strategies that support low-burden clinical decision-making and enhance the delivery of evidence-based interventions (EBIs) in resource-constrained settings.

Roger Goosey is a Research Manager at the University of Washington’s SMART Center. He holds a degree in Biology with minors in Education, Learning & Society, and Global Health from UW. His interests include educational equity and implementation science. He supports research focused on developing and testing implementation strategies to bolster implementation of school-based mental health services. URL: https://smartcenter.uw.edu/profiles/roger-goosey/

Michael Pullmann was a Research Professor in Psychiatry & Behavioral Sciences at the University of Washington and co-director of the SMART Center Methods Core when the work for this manuscript was completed. His research focuses on school mental health, juvenile justice, wraparound services, and implementation methods for mental health delivery in community settings. URL: https://scholar.google.com/citations?user=Dkh-qNUAAAAJ&hl=en

Clayton R. Cook, PhD is an implementation scientist and psychologist. A former paraprofessional and middle school math teacher, Dr. Cook has spent over 15 years partnering with school systems nationwide to implement practices that promote equitable outcomes for students. Previously a professor and researcher, he has studied youth mental health, educator well-being, social-emotional learning, and evidence-based implementation. Dr. Cook has secured over $20 million in research funding, published 100+ peer-reviewed articles, and delivered numerous keynotes. His work has been featured in major outlets, influencing policy and practice in schools. URL: https://experts.umn.edu/en/persons/clayton-r-cook/

Dr. Madeline Larson is researcher and psychologist who co-develops and evaluates the effectiveness of programs and implementation strategies. She has over a decade of experience as a mental health practitioner specializing in child and adolescent trauma, Dr. Larson has led federally funded research focused on optimizing implementation strategies to increase educator readiness for evidence-based practices. She is a former chair of the Society for Implementation Research Collaboration and partners nationally to scale and sustain effective solutions.

Rachel Barrett is a lecturer at the University of Washington School of Social Work. Her interests include improving access to quality mental health services in schools and supporting the next generation of mental health practitioners. She is a researcher contributing to implementation science projects such as BASIS-T and school-based mental health interventions, collaborating with colleagues at UW and UMN.

Aaron R. Lyon is a Professor at the University of Washington whose research focuses on developing and testing implementation strategies to enhance social, emotional, and behavioral services in schools. He leverages human-centered design to improve the scalability of psychosocial interventions and implementation strategies.