Identifying implementation strategies to address barriers to universal mental health screening implementation: An expert panel study

Implementation of universal mental health screening (UMHS) to systematically identify and respond to students' mental health strengths and needs is a core feature of multi-tiered systems of support (MTSS). Although MTSS is increasingly adopted, a multitude of barriers preclude schools or districts from adopting and implementing UMHS. School teams can strategically use implementation strategies to support UMHS implementation, however, guidance about which implementation strategies best address prominent UMHS barriers is limited. This study used a two-round, modified Delphi survey to generate expert recommendations about implementation strategies to address 14 UMHS barriers. We aimed to build consensus across three expert panels (N = 72), including school leaders, school mental health practitioners, and researchers. Experts were asked to select from a list and rank up to five strategies to address each barrier. Participants also had the opportunity to suggest additional strategies and to comment on their rankings. Descriptive analyses demonstrated that the total sample of experts reached consensus (i.e., chosen as one of the "top five" by at least 60 % of all experts) on two to five strategies per barrier (M = 4.0), with all three expert groups reaching consensus on at least one strategy for most barriers. There was heterogeneity in the recommendations provided across the UMHS barriers and by each type of expert. Participants' comments on their strategy rankings were organized into three major themes reflecting elaboration on barriers that affect UMHS implementation, ranking process and considerations, and components of causal pathway models that can inform how implementation strategies work. The strategies this study's experts recommended offer a useful starting point for implementation teams and researchers working to strategically address the implementation gap for UMHS.