Advancing School Behavioral Health Implementation: A Critical Review Using ISF 2.0

As youth behavioral health needs in the United States continue to grow, schools are increasingly important settings for prevention and service delivery. Yet evidence-based practices (EBPs) are not consistently implemented or sustained at scale. In this article, we present a critical narrative review of dissemination and implementation efforts in school behavioral health (SBH) through the lens of the Interactive Systems Framework for Dissemination and Implementation 2.0 (ISF 2.0). We reviewed and synthesized relevant SBH and implementation science literature to identify promising practices, persistent challenges, and gaps in the field, and then applied the ISF 2.0 as an analytic lens to examine how these issues operate across the systems involved in SBH implementation. Findings suggest that misalignment in goals, strategies, roles, and communication across systems can impede the delivery of EBPs to schools in ways that are feasible, responsive to local needs, and sustainable. Drawing on these findings, we developed ISF 2.0-guided questions and applied them to three prominent SBH implementation initiatives: the National Center for School Mental Health (NCSMH), the Center on Positive Behavioral Interventions and Supports (Center on PBIS), and the South Carolina School Behavioral Health Academy (SBHA). Selected based on their national or regional prominence, accessibility of information, and implementation activities, these illustrative cases demonstrate how the ISF 2.0 can be used to identify cross-system strengths, gaps, and opportunities for improvement. Although this review is narrative rather than systematic and the cases are illustrative rather than exhaustive, the analysis highlights the importance of stronger bidirectional communication and greater attention to how knowledge is generated, translated, adapted, and used in partnership with stakeholders. The ISF 2.0 provides a promising framework for understanding the complex systemic factors shaping SBH implementation and for strengthening alignment among the systems that generate knowledge, support implementation, and deliver services. Greater cross-system alignment should help schools implement and sustain effective behavioral health practices that are responsive to community needs and improve youth well-being.