School-Based Interventions for Children with Behavioral Difficulties: Inconsistent Implementation of Evidence-Based Practices

Background: Children with behavioral difficulties, including those with attention-deficit/hyperactivity disorder (ADHD), and their teachers frequently experience challenges at school, leading to school-based interventions. Objective: This exploratory study evaluated the utilization and evidence-base of school-based interventions for behavioral difficulties among school mental health professionals in Dutch schools. Method: A survey was conducted among 102 school mental health professionals to assess their utilization of school-based interventions, attitudes toward evidence-based practice, knowledge about behavioral problems, and educational background. The evidence-base of reported interventions was evaluated, and associations of professionals’ attitudes, knowledge, and educational background with the use of evidence-based interventions were analyzed. Interventions were identified based on a previous study of regularly used interventions in Dutch schools. Results: Large heterogeneity in evidence-based practice was found: 18.6% of school mental health professionals only used evidence-based interventions, while 38.2% used at least one evidence-based intervention alongside non-evidence-based ones. However, 26.5% used interventions without sufficient empirical support, and 16.7% indicated to not use any intervention for children with behavioral difficulties at all. About half of the currently used lack empirical support and evidence-based interventions specifically developed for behavioral difficulties were rarely used. No predictors were significantly associated with the use of evidence-based interventions. Conclusions: These findings underscore the need for a better implementation of effective school-based interventions for children with behavioral difficulties. A multifaceted approach is required, including research into promising interventions, deimplementation of interventions that lack sufficient evidence, and enhanced support for implementing evidence-based interventions in schools.