From Choose and Hope to Evidence and Impact: Rethinking School-Based Behavioral Health Decisions

A challenge in school-based behavioral health is how evidence-based practices are selected and implemented. Decision-making within schools often prioritizes feasibility instead of research evidence. The purpose of this study was to examine the experiences of school decision-makers in selecting and implementing evidence-based behavioral health programs. The study employed an interpretivist methodology, conducting interviews with 18 school decision-makers across K-12 school and district settings in Florida (n = 8), Kansas (n = 7), and Pennsylvania (n = 3). The study also included observations of 14 school meetings across Florida (n = 2), and Kansas (n = 12). The participants in Florida and Kansas were a part of the interviews and observations. The data collected were analyzed using an iterative diagrammatical analysis, which created the STAR (Select, Trial, Assess, Revise) Model of Behavioral Health Implementation in Schools. This model is a non-linear framework that captures the phases of behavioral health support implementation in schools. The model components are discussed, including examples from school decision-makers. The findings of this study have implications such as (a) a novel methodology for examining school-based decision-making, (b) a new model to conceptualize and enact evidence-based practices, and (c) future studies to amplify the study’s findings.