Using modular psychotherapy in school mental health: provider perspectives on intervention-setting fit

The "fit" or appropriateness of well-researched interventions within usual care contexts is among the most commonly cited, but infrequently researched, factors in the successful implementation of new practices. The current study was initiated to address two exploratory research questions: How do clinicians describe their current school mental health service delivery context? and How do clinicians describe the fit between modular psychotherapy and multiple levels of the school mental health service delivery context? Following a year-long training and consultation program in an evidence-based, modular approach to psychotherapy, semistructured qualitative interviews were conducted with 17 school-based mental health providers to evaluate their perspectives on the appropriateness of implementing the approach within a system of school-based health centers. Interviews were transcribed and coded for themes using conventional and directed content analysis. Findings identified key elements of the school mental health context including characteristics of the clinicians, their practices, the school context, and the service recipients. Specific evaluation of intervention-setting appropriateness elicited many comments about both practical and value-based (e.g., cultural considerations) aspects at the clinician and client levels but fewer comments at the school or organizational levels. Results suggest that a modular approach may fit well with the school mental health service context, especially along practical aspects of appropriateness. Future research focused on the development of methods for routinely assessing appropriateness at different stages of the implementation process is recommended.