Implementation strategies for school-based universal prevention: A qualitative pilot study of Enhanced and standard Replicating Effective Programs

Background School-based universal prevention programs, like the Michigan Model for Health™ (MMH), hold promise for enhancing youth behavioral health but often face implementation challenges due to insufficiently addressing priority student issues. Previous research identified trauma-sensitive content as a student need in the MMH. Enhanced Replicating Effective Programs (REP), a multicomponent implementation strategy, is well suited to support program providers in addressing priority health issues among youth. Method This pilot cluster-randomized controlled trial compared Enhanced REP (tailored curriculum, training, and implementation facilitation with trauma-sensitive content) to standard REP (standard curriculum, initial training, as-needed technical assistance) across eight high schools serving low-income students. Through semistructured interviews at three time points, we assessed teacher perceptions of feasibility, acceptability, and appropriateness related to REP core and enhanced components. Results Teachers generally found Enhanced REP to deliver MMH satisfactory and suitable. However, the school environment, notably administrative support, influenced feasibility compared to standard REP. Enhanced REP teachers reported benefits in meeting student needs that were not seen in the standard REP group. The standard REP data helped to understand the comparative value of the enhanced strategy during a time of notable upheaval and mental health challenges due to the COVID-19 pandemic. Conclusions While some schools may succeed with less intensive strategies (REP), many may require more intensive approaches for effective implementation. Enhanced REP shows promise in tailoring curriculum delivery and providing additional support to meet student needs, but its success may hinge on organizational support, especially from leadership. Future research should investigate the addition of organizational-level strategies, such as leadership training, to optimize implementation and explore the comparative effectiveness of Enhanced versus standard REP.