Sustainment of Mental Health Supports

Primary outcomes

1. Content Fidelity of Cognitive Behavioral Therapy (CBT) for Anxiety Treatment in Schools (CATS) Implementation

   Time frame: Across the 8-session CATS intervention period (approximately 8 weeks)

   The Cognitive Behavioral Therapy (CBT) for Anxiety Treatment in Schools (CATS) Content Fidelity Checklist (CFC) measures implementer adherence to required components of each CATS group session based on audio-recorded sessions. A separate 4-item checklist is completed for each of the eight CATS sessions, with session-specific items scored using a yes/no format to indicate whether required content was delivered. Fidelity is calculated as the percentage of items scored "Yes" out of the total items on the checklist/expected, with scores ranging from 0% to 100%. Higher scores indicate greater fidelity of implementation.

2. Content Fidelity of Coping Power Program (CPP) Implementation

   Time frame: Across the 12-session CPP intervention period (approximately 12 weeks)

   The Coping Power Program (CPP) Content Fidelity Checklist (CFC) measures implementer adherence to required components of each CPP group session based on audio-recorded sessions. A separate checklist is completed for each of the 12 CPP sessions, with session-specific items (ranging from 4 to 8 items depending on the session) scored using a yes/no format to indicate whether required content was delivered. Fidelity is calculated as the percentage of items scored "Yes" out of the total items on the checklist, with scores ranging from 0% to 100%. Higher scores indicate greater fidelity of implementation.

3. Process Fidelity of Cognitive Behavioral Therapy (CBT) for Anxiety Treatment in Schools (CATS) and Coping Power Program (CPP) Implementation

   Time frame: Across intervention session periods (approximately 8 to 12 weeks of intervention delivery)

   The Process Fidelity Checklist (PFC) measures the quality of intervention delivery during the Cognitive Behavioral Therapy (CBT) for Anxiety Treatment in Schools (CATS) and Coping Power Program (CPP) group sessions, including organization, use of active learning strategies, clarity of presentation, engagement of students, and relevance of examples. The checklist includes 10 items rated on a 0 to 5 scale (0=Not at all to 5=Very Often). Scores are calculated as the mean rating across items and sessions, with possible scores ranging from 0 to 5. Higher scores indicate greater fidelity of implementation.

4. Penetration of Cognitive Behavioral Therapy (CBT) for Anxiety Treatment in Schools (CATS) and Coping Power Program (CPP) Implementation

   Time frame: Throughout the intervention implementation period (up to approximately 4 years from study start)

   The Penetration Inventory (PI) is an Excel tracking tool used to document teacher referrals for Cognitive Behavioral Therapy (CBT) for Anxiety Treatment in Schools (CATS) and Coping Power Program (CPP) interventions among students in grades 4-8 and the number of students who received one of the evidence-based practices (EBPs). Penetration is calculated as the proportion of referred students who received an EBP, expressed as a percentage, with higher scores indicating greater penetration of Tier 2 services.

5. Personnel Cost of Sustainment Strategies for Cognitive Behavioral Therapy (CBT) for Anxiety Treatment in Schools (CATS) and Coping Power Program (CPP) Interventions

   Time frame: Throughout the implementation period (timesheets completed approximately 3-4 times per year, up to approximately 4 years)

   Total personnel cost associated with intervention implementation, based on staff-reported time spent on intervention- and study-related activities (including training, consultation, intervention preparation and delivery, assessment/documentation, and travel). Personnel time was collected using timesheets completed approximately 3-4 times per year, and costs were estimated using salary and benefit information from school district administrative data. Higher costs indicate greater personnel resources required to implement the sustainment strategy.

6. Change in Behavioral and Emotional Functioning (The Behavior Assessment System for Children, Third Edition [BASC-3])

   Time frame: From pre-intervention to post-intervention (approximately 8-12 weeks)

   The Behavior Assessment System for Children, Third Edition (BASC-3) parent report measures children's and adolescents' behavioral and emotional functioning. Scores are reported as standardized T-scores, with higher scores indicating greater behavioral or emotional problems. Parents/caregivers completed the BASC-3 at pre-intervention and post-intervention to assess change over time.

7. Change in Behavioral and Emotional Symptoms (Behavior and Feelings Scale - Youth Self-Report [BFS])

   Time frame: From pre-intervention to post-intervention (approximately 8-12 weeks)

   The Behavior and Feelings Survey (BFS) - Youth Self-Report measures youths' behavioral and emotional symptoms. Possible scores range from 0 to 48 on the total score, with higher scores indicating greater symptom severity. Students completed the BFS at pre-intervention and post-intervention to assess change over time.

8. Change in Student Academic Engagement (Engagement Versus Disaffection with Learning - Teacher and Student Report [EvsD-TR/SR])

   Time frame: From pre-intervention to post-intervention (approximately 8-12 weeks)

   The Engagement Versus Disaffection with Learning - Teacher Report (EvsD-TR) and Student Report (EvsD-SR) measure students' academic engagement and disaffection in the classroom. The instrument includes four subscales: Behavioral Engagement, Emotional Engagement, Behavioral Disaffection, and Emotional Disaffection. Each subscale score ranges from 5 to 20, with higher scores indicating greater levels of the respective construct (engagement or disaffection). Teachers completed the EvsD-TR, and students completed the EvsD-SR at pre-intervention and post-intervention to assess change in academic engagement over time.