Aaron R Lyon

University of Washington Seattle | UW · Department of Psychiatry and Behavioral Sciences

Successful implementation of school-wide interventions (i.e., delivered to all students by a wide array of school personnel) is key to promoting students' academic achievement and psychosocial development. Yet, the implementation of school-wide interventions is complex and can be psychologically taxing for implementing personnel. If evidence-based...

Background Youth with ADHD are at risk of academic impairments, dropping out of high school, and dysfunction in young adulthood. Interventions delivered early in high school could prevent these harmful outcomes, yet few high school students with ADHD receive treatment due to limited access to intervention providers. This study will test a peer-deli...

Background Teacher-delivered behavioral classroom management interventions are effective for students with or at-risk for attention-deficit/hyperactivity disorder (ADHD) or other disruptive behavior challenges, but they can be difficult for teachers to use in the classroom. In this study, we will pilot test a package of implementation strategies to...

Background High-quality implementation is crucial for students to reap the benefits of school-based evidence-based practices (EBP). Despite data being routinely used to support EBP delivery to students, there is a dearth of data-driven decision-making related to school-wide implementation of universal EBPs like Multi-Tiered Systems of Support (MTSS...

Existing literature has established the effectiveness of school-wide positive behavioral interventions and supports (SWPBIS) for improving school-level student behavioral and academic outcomes. But the real-world implementation of SWPBIS is often inadequate, which leads to lackluster outcomes. Researchers have identified amendable implementer-level...

Existing literature has established the effectiveness of school-wide positive behavioral interventions and supports (SWPBIS) for improving school-level student behavioral and academic outcomes. But the real-world implementation of SWPBIS is often inadequate, which leads to lackluster outcomes. Researchers have identified amendable implementer-level...

Background The Evidence-Based Practice Attitudes Scale (EBPAS) is widely used in implementation research, but it has not been adapted and validated for use among general education teachers, who are most likely to deliver evidence-based prevention programs in schools, the most common setting where youth access social, emotional, and behavioral healt...

Emerging literature has highlighted the importance of discerning general and strategic organizational context (OC) factors (e.g., leadership and climate) and their interaction effect on individual implementation behaviors (e.g., attitudes toward evidence-based practices; EBPs) in youth mental healthcare. This study aimed to examine how leadership a...

As the most common setting where youth access behavioral healthcare, the education sector frequently employs training and follow-up consultation as cornerstone implementation strategies to promote the implementation of evidence-based practices (EBPs). However, these strategies alone are not sufficient to promote desirable implementation (e.g., inte...

Background There is a fundamental gap in understanding the causal mechanisms by which strategies for implementing evidence-based practices address local barriers to effective, appropriate service delivery. Until this gap is addressed, scientific knowledge and practical guidance about which implementation strategies to use in which contexts will rem...

Background The public health impact of behavioral and biobehavioral interventions to prevent and treat mental health and substance use problems hinges on developing methods to strategically maximize their effectiveness, affordability, scalability, and efficiency. Methods The multiphase optimization strategy (MOST) is an innovative, principled fram...

In-service training is a critical and frequently utilized implementation strategy to support the adoption and delivery of evidence-based practice (EBP) across service settings, but is characteristically ineffective in producing provider behavior changes, particularly when delivered in single exposure didactic events. EBP trainers are in a strategic...

Background Strategies to implement evidence-based interventions (EBIs) in children’s mental health services have complex direct and indirect causal impacts on multiple outcomes. Ripple effects are outcomes caused by EBI implementation efforts that are unplanned, unanticipated, and/or more salient to stakeholders other than researchers and implement...

Background Implementation science is at a sufficiently advanced stage that it is appropriate for the field to reflect on progress thus far in achieving its vision, with a goal of charting a path forward. In this debate, we offer such reflections and report on potential threats that might stymie progress, as well as opportunities to enhance the succ...

Group-based didactic training is a cornerstone implementation strategy used to support the adoption and delivery of evidence-based prevention programs (EBPP) by teachers in schools, but it is often insufficient to drive successful implementation. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a theory-based...

Background Implementation climate is an organizational construct theorized to facilitate the adoption and delivery of evidence-based practices. Within schools, teachers often are tasked with implementing universal prevention programs. Therefore, they are ideal informants when assessing school implementation climate for initial and continuous implem...

Background Initial training and ongoing post-training consultation (i.e., ongoing support following training, provided by an expert) are among the most common implementation strategies used to change clinician practice. However, extant research has not experimentally investigated the optimal dosages of consultation necessary to produce desired outc...

Clinician bias is a contributor to health care inequities, but research on racial-ethnic bias among mental health professionals, especially toward minoritized youths, is limited. This column describes two studies involving mental health clinicians in schools, where most youths access mental health services. Study 1 used a mixed-methods approach to...

Background Strategic implementation leadership is a critical determinant of successful implementation, hypothesized to create a more supportive implementation climate conducive to the adoption and use of evidence-based practices. Implementation leadership behaviors may vary significantly across contexts, necessitating studies that examine the valid...

Background: Strategic implementation leadership is a critical determinant of successful implementation, hypothesized to create a more supportive implementation climate conducive to the adoption and use of evidence-based practices. Implementation leadership behaviors may vary significantly across contexts, necessitating studies that examine the vali...

For Schoolwide Positive Behavior Interventions and Supports (SWPBIS) to be effective, educators must use the practices as intended. Whether a teacher uses a practice as intended can depend, in part, on how feasible the practice is perceived to be. Identifying malleable factors associated with teachers’ perceptions of SWPBIS feasibility can help sch...

Background Despite an established taxonomy of implementation strategies, minimal guidance exists for how to select and tailor strategies to specific practices and contexts. We employed a replicable method to obtain stakeholder perceptions of the most feasible and important implementation strategies to increase mental health providers’ use of measur...

Background: Training and follow-up consultation alone are proven insufficient to facilitate successful implementation of evidence-based practices and programs (EBPPs) and often lead to languishing outcomes. Theory-informed Pre-Implementation Enhancement Strategies (PIES) bear the potential to amplify the effect of training and consultation on impr...

Schools play a critical role in students' diabetes management and ensure their safety and well-being. We conducted key informant interviews with 11 school nurses in Missouri to assess determinants for diabetes care implementation. Five themes and 29 subthemes were identified concerning school nurses, schools, external stakeholders, government, and...

Objectives: We conducted a mixed-method focus group study to (a) assess the appropriateness and likely effectiveness of strategies that target individual behavior change mechanisms associated with perceived barriers of lack of time and unsupportive leadership and (b) identify recommendations regarding strategies for overcoming the barriers. Metho...

Background: As the most common setting where youth access behavioral healthcare, the education sector frequently employs training and follow-up consultation as cornerstone implementation strategies to promote the implementation of evidence-based practices (EBPs). However, these strategies alone are not sufficient to promote desired implementation (...

Emerging literature highlighted the importance to discern the general and strategic types of organizational context (OC) factors (e.g., leadership and climate) and explore their interaction effect on individual implementation behaviors (e.g., attitudes toward evidence-based practices; EBPs) in youth mental healthcare. This study aimed to examine th...

Evidence-based programs (EBPs) delivered in elementary schools show great promise in reducing risk for emotional and behavioral disorders (EBDs). However, efforts to sustain EBPs in school face barriers. Improving EBP sustainment thus represents a priority, but little research exists to inform the development of sustainment strategies. To address t...

Background The education sector is one of the most common and accessible settings for universal prevention programs for youth mental health. But it suffers from suboptimal implementation of evidence-based practices (EBPs). Although the organizational context (OC) contains crucial implementation factors, successful implementation ultimately resides...

There is a well-documented gap between research and practice in the treatment of mental health problems. One promising approach to bridging this gap is training community-based providers in evidence-based practices (EBPs). However, a paucity of valid, reliable measures to assess a range of outcomes of such trainings impedes our ability to evaluate...

Mental health organizations that serve youth are under pressure to adopt measurement-based care (MBC), defined as the continuous collection of client-report data used to support clinical decision-making as part of standard care. However, few frameworks exist to help leadership ascertain how to select an MBC approach for a clinical setting. This pap...

(Reprint link: https://rdcu.be/ceBiH) Treatment integrity is critical to realizing the effects of evidence-based programs and practices (EBPPs) that aim to promote student mental and behavioral health. Across disciplines, time is consistently referenced as one of the most significant barriers to successful implementation outcomes (e.g., treatment...

BACKGROUND People often prefer evidence-based psychosocial interventions (EBPIs) for mental health care, but these interventions often remain unavailable to people in non specialty or integrated settings, such as primary care and schools. Previous research has suggested that usability–a concept from human centered design–could support an understand...

Background: People often prefer evidence-based psychosocial interventions (EBPIs) for mental health care; however, these interventions frequently remain unavailable to people in nonspecialty or integrated settings, such as primary care and schools. Previous research has suggested that usability, a concept from human-centered design, could support...

Background As the most common setting where youth access behavioral health services, the education sector frequently employs training and follow-up consultation as cornerstone implementation strategies to promote the implementation of evidence-based practices (EBPs). However, these strategies alone are not sufficient to promote desired implementati...

Clinician bias has been identified as a potential contributor to persistent healthcare disparities across many medical specialties and service settings. Few studies have examined strategies to reduce clinician bias, especially in mental healthcare, despite decades of research evidencing service and outcome disparities in adult and pediatric populat...

Lay abstract: Teachers often report concerns about behavior challenges in their students with autism spectrum disorder (ASD) in the school setting. Furthermore, teachers often report that they do not have adequate training in how to manage these challenging behaviors effectively. The RUBI program is an intervention initially developed for parents...

Background The delivery of evidence-supported treatments (EST) in children’s mental health could be a valuable measure for monitoring mental healthcare quality; however, efforts to monitor the use of EST in real world systems are hindered by the lack of pragmatic methods. This mixed methods study examined the implementation and agency response rate...

There has been an increase in school mental health research aimed at producing generalizable knowledge to address longstanding science-to-practice gaps to increase children's access to evidence-based mental health services. Successful dissemination and implementation are both important pieces to address science-to-practice gaps, but there is concep...

Background Strategic implementation leadership is a critical determinant of successful implementation, hypothesized to create a more supportive implementation climate conducive to the adoption and use of evidence-based practices. Implementation leadership behaviors may vary significantly across contexts, necessitating studies that examine the valid...

Background: Despite an established, comprehensive taxonomy of implementation strategies, minimal guidance exists for how to select and adapt strategies to specific services and contexts. We employed a replicable method to identify the most feasible and important implementation strategies to increase mental health providers’ use of measurement-based...

Background: Despite an established, comprehensive taxonomy of implementation strategies, minimal guidance exists for how to select and adapt strategies to specific services and contexts. We employed a replicable method to identify the most feasible and important implementation strategies to increase mental health providers’ use of measurement-based...

Objective: In this study, we examined the influence of multi-level barriers on school diabetes care quality. Methods: We administered an online survey to nurses in Missouri K-12 schools (N = 245). We assessed 57 potential barriers in 5 domains (at individual, school, community, social/ cultural, and political/economic levels). We developed 38 crite...

Introduction Mechanisms explain how implementation strategies work. Implementation research requires careful operationalisation and empirical study of the causal pathway(s) by which strategies effect change, and factors that may amplify or weaken their effects. Understanding mechanisms is critically important to replicate findings, learn from negat...

Proctor et al.'s (2021) comment "Division 21 Has Been Devoted to Human-Centered Design Since the 1950s" on our article (Lyon et al., 2020) is a welcome addition and useful touchpoint surrounding the historical and current relationship between human-centered design and psychological science. "Siloing" in psychology inhibits the progress of the disci...

Background Whereas the value of an evidence-based intervention (EBI) is often determined by its effect on clinical outcomes, the value of implementing and using EBIs in practice is broader, reflecting qualities such as appropriateness, equity, costs, and impact. Reconciling these value conflicts involves a complicated decision process that has rece...

Introduction High schoolers with attention-deficit/hyperactivity disorder (ADHD) experience substantial impairments, particularly in the school setting. However, very few high school students with ADHD receive evidence-based interventions for their difficulties. We aim to improve access to care by adapting evidence-based psychosocial intervention c...

Background Implementation strategies have flourished in an effort to increase integration of research evidence into clinical practice. Most strategies are complex, socially mediated processes. Many are complicated, expensive, and ultimately impractical to deliver in real-world settings. The field lacks methods to assess the extent to which strategi...

Diabetes management at school demands close collaboration of multiple stakeholders, including students with diabetes and parents, school nurses, teachers/staff, and local health care providers. This scoping review identified and synthesized evidence concerning factors that contributed to the quality and effectiveness of diabetes care implementation...

Background: Strategies to implement evidence-based interventions (EBIs) in children’s mental health services have complex direct and indirect causal impacts on multiple outcomes. Ripple effects as outcomes that are caused by EBI implementation efforts and are indirect, unplanned, unanticipated, and/or more salient to stakeholders other than to rese...

Background: Strategies to implement evidence-based interventions (EBIs) in children’s mental health services have complex direct and indirect causal impacts on multiple outcomes. Ripple effects are outcomes that are caused by EBI implementation efforts and are unplanned, unanticipated, and/or more salient to stakeholders other than to researchers a...

Background: Initial training and ongoing post-training consultation are among the most common implementation strategies used to change clinician practice. However, extant research has not experimentally investigated the optimal dosages of consultation necessary to produce desired outcomes. Moreover, the degree to which training and consultation eng...

A meta-analysis was conducted to examine the relative rates of youth mental health service utilization across settings among the general population and among those with elevated mental health symptoms or clinical diagnoses. Rates of school-based mental health were compared to outpatient, primary care, child welfare, juvenile justice, and inpatient....

Background Tailoring implementation strategies and adapting treatments to better fit the local context may improve their effectiveness. However, there is a dearth of valid, reliable, pragmatic measures that allow for the prospective tracking of strategies and adaptations according to reporting recommendations. This study describes the development a...

Background Attempting to implement evidence-based practices in contexts for which they are not well suited may compromise their fidelity and effectiveness or burden users (e.g., patients, providers, healthcare organizations) with elaborate strategies intended to force implementation. To improve the fit between evidence-based practices and contexts,...

Despite evidence that school mental health can enhance access to care for students from marginalized racial/ethnic groups, disparities remain in the appropriateness, quality, effectiveness, and outcomes of school mental health services. Implementation strategies hold some promise for addressing the disparities that emerge as result of inequitable i...

The increased prevalence of autism in the United States (1 in 54 youth) requires educators to implement evidence-based practices (EBPs). However, it is unclear which EBPs, if any, general and special education teachers and paraeducators are commonly trained to use or whether they consistently use those EBPs to support the inclusion of students with...

Background: Evidence-based interventions (EBIs) could reduce cervical cancer deaths by 90%, colorectal cancer deaths by 70%, and lung cancer deaths by 95% if widely and effectively implemented in the USA. Yet, EBI implementation, when it occurs, is often suboptimal. This manuscript outlines the protocol for Optimizing Implementation in Cancer Cont...

Mental health clinicians and administrators are increasingly asked to collect and report treatment outcome data despite numerous challenges to select and use instruments in routine practice. Measurement-based care (MBC) is an evidence-based practice for improving patient care. We propose that data collected from MBC processes with patients can be s...

Background: Despite their inclusion in Rogers' seminal diffusion of innovations theory, few implementation studies empirically evaluate the role of intervention characteristics. Now, with growing evidence on the role of adaptation in implementation, high-quality measures of characteristics such as adaptability, trialability, and complexity are nee...

Numerous evidence-based programs (EBPs) exist for delivery in schools to promote youth mental health outcomes. However, school systems often lack the internal infrastructure to support the effective implementation and sustainment of EBPs when external supports are withdrawn, resulting in notable attenuation in the benefits in youth clinical outcome...

Background: Usability - the extent to which an intervention can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction - may be a key determinant of implementation success. However, few instruments have been developed to measure the design quality of complex health interventions (i.e., those with sev...

(Note: this study has been published here: https://doi.org/10.1007/s12310-021-09412-2) Treatment integrity is critical to realizing the effects of evidence-based programs and practices (EBPPs) that aim to promote student mental and behavioral health. Across disciplines, time is consistently referenced as one of the most significant barriers to suc...

Background More than two-thirds of youth experience trauma during childhood, and up to 1 in 5 of these youth develops posttraumatic stress symptoms that significantly impair their functioning. Although trauma-focused cognitive behavior therapy (TF-CBT) has a strong evidence base, it is rarely adopted, delivered with adequate fidelity, or evaluated...

Background. Implementation strategies have flourished over the last decade in an effort to increase integration of research evidence into clinical practice. Most strategies are complex, socially-mediated processes. Many are complicated, expensive, and ultimately impractical to deliver in real-world settings. The field lacks methods to assess the ex...