Rachel is a PhD Candidate at the University of New South Wales, Australia. Her PhD is focused on the co-design and trial of strategies to improve the implementation of evidence-based mental health prevention program, the PAX Good Behaviour Game, in New South Wales primary schools. It is funded by a scholarship from the Wellbeing Health & Youth Centre of Research Excellence in Adolescent Health funded by the NHMRC (APP1134894).
Since 2018, she has worked as a Research Assistant applying implementation science and mixed methods research to optimise school-based programs targeting the health and wellbeing of young people who experience disadvantage.
Rachel is also involved in a number of research projects on interpersonal violence. She worked with practitioners and survivors in the domestic and family violence (DFV) sector to co-design a trauma-informed, long-term recovery service for women with lived experience of DFV, recently funded by the Australian government.
The United Nations has issued a call to action for schools to deliver evidence-based prevention programs to address the growing burden of mental health, but implementation has failed in real-world settings. There is a need for implementation scientists to develop and trial strategies to address this translational problem.
In this qualitative study, we used realist interviews and focus group discussions with educational staff (N=29) and performed a realist evaluation of a multicomponent implementation strategy called PAX Plus, designed to enhance the adoption of international evidence-based mental health prevention program, PAX Good Behaviour Game, in New South Wales primary schools.
The PAX Plus strategies consistently reported to improve implementation outcomes were having a recognition system for positive reinforcement, leadership support through monthly meetings, training, and distributing support resources. Strategies that did not appear to work but could potentially be reformatted were monitoring progress using self-report methods, distributing e-newsletters with practical tips and having an online peer learning network.
Internationally, school-based practitioners can use findings from this study to develop/adapt their own strategies to improve the implementation outcomes of mental health prevention programs which will improve effectiveness outcomes. Improving the effectiveness of mental health prevention programs is a priority to address Sustainable Development Goal 3.4, to reduce premature death from non-communicable diseases by one third by 2030. This study also highlights to other implementation scientists how realist evaluations can be pragmatically used to improve knowledge translation of evidence-based programs in schools.
Learning outcome: We recommend school-based practitioners use recognition systems, training, leadership support and streamlined resources to increase the likelihood a mental health prevention program will be adopted and sustained in schools.