Implementation climate and readiness for the THRIVE intervention in school settings: a mixed methods study.

Abstract

Background: Schools are increasingly recognized as critical settings for delivering mental health interventions. The successful implementation of school-based programs like THRIVE, a parent-child intervention, is likely influenced by the organizational context and the school's readiness for change. This mixed methods study, part of a Type 2 hybrid implementation-effectiveness RCT, aimed to explore baseline contextual factors that may influence the implementation of THRIVE in school settings.

Methods: Using a convergent mixed methods design, we investigated the climate of schools implementing THRIVE. Twenty-five interventionists were recruited from six school districts. Quantitative data were collected using the School Implementation Climate Scale (SICS) and Organizational Readiness for Change (ORC). Individual qualitative interviews guided by the Consolidated Framework for Implementation Research (CFIR) were also conducted. Schools were classified as resource-rich or resource-constrained using the Social Vulnerability Index. Descriptive and bivariate statistics were performed. Deductive thematic analysis was conducted. Results were integrated through a joint display table to identify convergences and divergences.

Results: The overall SICS score averaged 3.27 (SD = 0.66) and the overall ORC score averaged 3.79 (SD = 0.42), suggesting moderately positive school implementation climate and readiness. On average, participating schools demonstrated a strong focus on evidence-based practice (EBP) and high availability of training and resources for EBP, while providing limited incentives for EBP use (M = 2.09, SD = 0.93). They also presented a collaborative and supportive working environment with shared values but insufficient communication (M = 3.36, SD = 0.73). Qualitative findings are mostly consistent with quantitative results. Most interventionists (n = 24) believed THRIVE aligns with school values and family needs and remained optimistic despite barriers such as time commitment and negative perceptions. Compared to resource-rich schools (n = 11), resource-constrained schools (n = 14) placed less emphasis on EBP (t(23) = 2.37, p < .05) and had fewer facilitators (n = 5), but perceived greater benefits in implementing THRIVE (n = 14).

Conclusions: This study found a moderately positive implementation climate and organizational readiness for change in schools adopting the THRIVE intervention. However, limited incentives, communication challenges, and resource constraints may hinder successful implementation. The divergence between strong support for EBPs and the lack of resources suggests that implementation strategies must be tailored and flexible to promote buy-in and address structural barriers.

Trial registration: ClinicalTrials.gov NCT06139874. Registered on November 27, 2023.