Piloting a Learning Collaborative for School-Based Bilingual Providers Delivering Evidence-Based Interventions

Bilingual providers play a critical role in increasing access to mental health care, yet there is a dearth of literature on bilingual provider training needs when delivering evidence-based interventions, especially to youth, and even less research on school-based interventions delivered in Spanish. One group with high mental health needs that relies on bilingual providers is newcomer youth, who have migrated to the U.S. within the past 5 years. Despite this high need, very few interventions have been developed for newcomers. One exception is Supporting Transition Resilience of Newcomer Groups (STRONG), a group-based, school-delivered behavioral intervention targeting stress, anxiety, depressive symptoms, and externalizing behaviors among newcomer youth. To date, however, interventions like STRONG remain underutilized in schools due to barriers like low leader support and poor provider fit. To maximize the public health impact of interventions delivered to Spanish-speaking youth, strategies that enhance bilingual provider training are needed.

Learning Collaboratives (LC) are a promising implementation strategy that can strengthen intervention fit with schools and foster collective learning for bilingual providers. LCs involve recurring sessions with faculty experts, organization leaders, and providers who engage in Plan-Do-Study-Act (PDSA) cycles to overcome implementation challenges, and extant studies show LCs can positively influence provider fidelity and intervention sustainment. The LC in this study will aim to enhance the implementation of STRONG in schools for newcomer youth facilitated by bilingual providers. This study will be guided by the Exploration, Preparation, Implementation and Sustainment (EPIS) and Consolidated Framework for Implementation Research (CFIR) frameworks and builds upon a completed Exploration phase with school district partners, where STRONG was chosen as the intervention to be adopted.

This study will recruit approximately 72 newcomer youth (ages 10-18) and their caregivers, 18 school mental health providers, and 9 school leaders, across four school districts and one county-level program. All youth will be receiving the STRONG intervention in their respective schools, delivered by school mental health providers and school staff familiar with the newcomer student experience, and all school provider/school leaders will take part in the LC.

STRONG is a 10-week intervention, consisting of 10 small group sessions, one individual session, and teacher and parent education sessions. STRONG is strengths based, teaches newcomers coping skills, draws from cognitive behavioral therapy, and helps foster positive identity and facilitate social connectedness among newcomers. School providers will participate in a 2-day in-person STRONG training led by a national expert and will have access to up to 4 hours of consultation with a STRONG national expert during their first time implementing STRONG. Providers will implement STRONG in two cycles, and data will be collected for each STRONG implementation cycle. Providers and school leaders will be asked to complete pre- \& post- surveys and an interview. Providers will also be asked to audio record the STRONG sessions so the research team can measure their fidelity to the STRONG model. To assess clinical outcomes, youth and their caregivers will be completing measures of mental health symptoms, coping and resilience, and social connectedness, at pre- \& post-STRONG.

School staff will participate in the LC over the span of 12 months (anticipated February 2026-February 2027). LC activities include in-person Peer Learning Workshops (formally "Learning Sessions;" anticipated in February 2026, September 2026, \& February 2027), and Team Support Calls (formally"Collaboration Calls;" frequency contingent on school leader and provider recommendations). The Peer Learning Workshops will focus on shared learning, collaboration, and implementation problem-solving related to STRONG delivery. Ongoing LC supports will include structured team support calls, PDSA cycles, and written feedback forms during STRONG implementation cycles. These activities are designed to support continuous quality improvement, address barriers to implementation, and strengthen teamwork and leadership engagement. Quantitative and qualitative data will be integrated to evaluate implementation processes and outcomes and to inform future scaling of STRONG in school settings serving newcomer youth. At least one provider from each STRONG facilitation team will be asked to complete weekly feedback forms during each STRONG cycle (i.e., 10 feedback forms per STRONG implementation cycle). To prevent additional burden on school staff to provide evaluation data, the Peer Learning Workshops and Team Support Calls will be recorded in order to track implementation challenges, proposed solutions and the outcomes of attempting the proposed solutions. Providers will receive compensation for submitting the STRONG audio recording and the weekly feedback forms

For the Primary Aim, this study will use a simultaneous mixed method QUAL+quant design using post-surveys and interviews to assess provider and leader perspectives on acceptability, feasibility and appropriateness of LC activities. Learning sessions will be audio recorded, and meeting minutes will be reviewed. Providers will complete various scales to assess leadership support of the LC, school commitment to the LC, and their level of agreement with recommending the LC to others. When the LC concludes, providers and leaders' semi-structured individual interviews will ask about barriers and facilitators to participating in LC activities and delivering STRONG. For qualitative analyses, we will apply Rapid Qualitative Analysis (RQA) to characterize feasibility including barriers and facilitators to LC engagement and implementation. RQA was created for implementation research to quickly leverage findings to tailor implementation strategies and inform practice.

For the secondary aim, we will use pre-post surveys with school leaders, school providers, parents and newcomers to evaluate the effectiveness of LC and STRONG. Feasibility is operationalized as attendance in LC learning sessions, number of PDSA cycles, completion of monthly PDSA reports, progress on PDSA goals, and barriers/facilitators to participating in the LC. Providers will complete monthly reports via Qualtrics to collect STRONG implementation metrics (e.g., student attendance), and PDSA data. We hypothesize that higher engagement in LC activities will be positively related to stronger fidelity and greater improvement in clinical outcomes. Fidelity will be measured with an observational coding system developed by the research team to measure STRONG adherence and competence. We will also have self-adherence checklists completed by a STRONG facilitator at each session. To assess clinical outcomes, Youth and caregivers will complete standardized clinical symptom measures for both internalizing and externalizing disorders at pre- and post- surveys.

Purposeful sampling strategies will be used to recruit school staff and caregivers from an established network of school district partners, including school district leaders and providers. Our network of school district partners will help identify potential school staff participants - specifically, leaders, and providers to participate in the interviews. School district partners will not be engaged in research activities. Specifically, they will not obtain informed consent, discuss the research study, or collect any data related to the study. Their sole role will be to identify potential school staff and parent/caregivers and obtain their permission to provide the research team with their contact information. Any questions from potential participants will be redirected to the research team. Research team members will follow up directly with the potential participants to explain the study, review informed consent, and screen for eligibility. For parents/caregivers of newcomer students, school staff will be asked to identify parents of newcomers (aged 10-17) and gain their permission for the research team to contact them regarding the research study. When parents/caregivers provide permission to be contacted by research personnel, school staff will message caregiver contact information to the research team. For newcomer students, the research team will complete an informed assent process with students who are eligible and invited to participate in the STRONG intervention.