Determinants of Implementing the Mental Health Action Plan (MHAP) Pilot Program With Fidelity

• Published in: Psychology in the schools Vol. 62; no. 9; pp. 3498 - 3511
• Main Authors: Nygaard, Malena A., Ormiston, Heather E.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc 01.09.2025
• Subjects: Academic achievement; Care plans; Caregivers; Check Lists; Checklists; Clinical outcomes; Fidelity; Health insurance; Health status; Implementation; implementation fidelity; implementation science; Intervention; Mental health; mental health action plan; Mental health care; Mental Health Programs; Mental health services; Program Implementation; Qualitative research; School Health Services; school mental health; Students; Teachers; Triads
• ISSN: 0033-3085; 1520-6807
• DOI: 10.1002/pits.23556

ABSTRACT To promote improved student outcomes, school mental health providers (SMHPs) monitor implementation fidelity when implementing evidence‐based interventions. Current approaches for implementation fidelity monitoring (e.g., intervention checklists) do not account for other relevant implementation indicators best captured through qualitative data. Therefore, this study employed a multi‐faceted approach to monitoring implementation fidelity of the Mental Health Action Plan (MHAP) Program, a school‐based person‐centered care planning program developed to coordinate mental health care at school. The purpose of this mixed methods study was to explore the extent to which the MHAP Program was implemented as intended by describing determinants (i.e., barriers and facilitators) to adherent implementation. Three participant triads (student, caregiver, teacher) and three SMHPs were included in the study. Implementation fidelity checklists and field note data was collected and analyzed using reflexive thematic analysis and descriptive statistics. Qualitative results provided greater context for the quantitative results and elucidated potential adaptations to enhance youth‐intervention fit. Themes related to the caregiver‐child relationship, logistical barriers, student factors, SMHP competing responsibilities, and team dynamics impacted implementation fidelity. Implications for monitoring implementation fidelity of school mental health interventions via qualitative methods as well as study limitations are discussed. Summary Logistical barriers, such as competing responsibilities, difficulty scheduling MHAP Meetings, provider shortages, and school schedule constraints, impacted implementation fidelity in this study. Student behavior problems and the caregiver‐child relationship were additional barriers to implementation fidelity because caregivers did not inherently adopt a strengths‐based approach during MHAP Meetings. Ultimately, study findings suggest field note data can be used to monitor the implementation fidelity of school‐based mental health interventions, and in turn, can be used formatively to guide treatment recommendations.