Development and Evaluation of a University-Based External Coaching Program for School Behavioral Health

School behavioral health (SBH) systems coaching is a developing approach to implementation support for the delivery of high-quality behavioral health support in schools through a multi-tiered prevention and intervention framework. Articulating coaching components and understanding how, when, and why external coaching supports systems change and implementation are essential, but research on the nature, scope, mechanisms, and effectiveness of external coaching for school behavioral health is limited. In the current study, we describe the development and implementation of the School Behavioral Health Academy (SBHA) Coaching program in South Carolina and present findings from a qualitative formative evaluation study. Thematic analysis of key informant interviews with district and school program implementation leaders (N = 8) provides evidence of perceived improvements in systems practices and positive staff and student outcomes related to participation in SBHA Coaching. Articulated barriers and facilitators point to potential mechanisms of change and implementation determinants. Participants described perceived changes and needs related to SBH understanding, infrastructure, norms, and mindsets, as well as the coaching skills and methods they found influential. Results are interpreted in relation to behavior change theory, systems change theory, and the Implementation Drivers Framework. Future directions for program development, research, and practice are discussed.