Measures
Survey questions were developed by members of the MHAC using an iterative, consensus-based process. Each year, the set of questions was revised to reflect evolving challenges in implementation, such as development of newly developed, condition-specific interventions for depression and anxiety, use of telehealth, and sustainability of the mental health program as the 3-year funding cycle was ending. Items that had 100% endorsement in Year 1 (e.g., use of recommended screening tools, ability to score them) were removed from subsequent surveys to make room for questions related to more advanced implementation. In Year 1, the survey had 50 items, in Year 2 this was expanded to 80 items, and in Year 3, a total of 71 items were included.
To quantify implementation success, points were assigned to survey answers (0-1, 0-3, 0-4) based on the level of difficulty in achieving them. Discussions among study co-authors were held to reach consensus on level of implementation difficulty. For example, success in counseling individuals with moderate to severe symptomatology was assigned more points than counseling those reporting mild symptoms. See Table 1 for example items and scoring.