A Community Engaged Approach to Implementing Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents (STEPS-A) in Rural West Virginia Schools: Phase One

Background and Purpose: Youth are experiencing an unprecedented mental health crisis. Rural youth are at heightened risk with limited access to behavioral health services. Universal social-emotional learning (SEL) curricula are a promising approach to increase access to mental health supports to all students. Yet, there is a critical gap in implementation research of SELs in rural settings. One promising universal SEL is Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents (STEPS-A) because there is evidence of it showing academic and mental health outcomes improvement. However, STEPS-A has not been studied in vulnerable rural settings. The first step (Phase 1) of our multi-year community-engaged implementation study was to determine whether STEPS-A was 1) appropriate, acceptable, and feasible in a rural context and 2) identify barriers and facilitators to rural implementation. We hypothesized that that school stakeholders in rural West Virginia would rate STEPS-A as highly appropriate, acceptable, and feasible. We also expected that participants would identify the need for adaptations to STEPS-A use in rural settings.

Methods: The Enhanced Replicating Effective Programs (E-REP) implementation framework provides guidance for all study phases. E-REP consists of five stages (preconditions, pre-implementation, implementation, evaluation, and maintenance). Our Phase 1 efforts involve the preconditions and pre-implementation stages. In the pre-conditions stage, we collaborated with existing state partnerships to identify and engage a rural West Virginia County with known concerns about youth mental health. Once engaged, we established a local Community Advisory Board (CAB) for Phase 1. Collectively, we identified 1) STEPS-A as a promising intervention to fit local needs, 2) a site to implement the intervention, 3) study participants, 4) appropriate training methods, and 5) study measures. In the pre-implementation stage, six school staff went to a three-day STEPS-A training. Participants completed a cross sectional survey with follow up qualitative interviews to examine appropriateness, acceptability, and feasibility of STEPS-A, and to identify barriers and facilitators to rural implementation. The survey consisted of the reliable and validated Acceptability of Intervention Measure, Intervention Appropriateness Measure and Feasibility of Intervention Measure. We conducted subsequent qualitative interviews and analyzed data using thematic analysis.

Results: Quantitative analysis shows that participants found STEPS-A to be highly acceptable (M=4.4/5, SD=0.53), appropriate (M=4.3/5, SD=0.51), and feasible (M=4/5, SD=0.60). Qualitative analysis indicated the need for additional administrative and technical support, culturally relevant materials, and integration into existing school curriculum and structure.

Conclusions and Implications:

Results show STEPS-A has promise for use in rural settings, if specific contextually-relevant implementation adaptations are incorporated. Findings from this research will inform development, adoption, and sustainability of contextually relevant prevention and early intervention programs in rural low-resourced school-based settings using community-engaged, mixed-methods approaches.