Implementing the teen marijuana check-up in schools-a study protocol

Implement Sci. 2017 Aug 10;12(1):103. doi: 10.1186/s13012-017-0633-5.


Background: Substance misuse is now encountered in settings beyond addiction specialty care, with schools a point-of-contact for student access to behavioral health services. Marijuana is a leading impetus for adolescent treatment admissions despite declining risk perception, for which the Teen Marijuana Check-Up (TMCU)-a tailored adaptation of motivational enhancement therapy-offers an efficacious service option. To bridge the knowledge gap concerning effective and affordable technical assistance strategies for implementing empirically supported services, the described trial will test such a strategy to facilitate school-based TMCU implementation.

Methods: A type II effectiveness/implementation hybrid trial will test a novel strategy for a TMCU purveyor to provide technical assistance on an 'as-needed' basis when triggered by a fidelity drift alarm bell, compared to resource-intensive 'gold-standard' technical assistance procedures of prior efficacy trials. Trial procedures adhere to the EPIS framework as follows: (1) initial mixed-method exploration of the involved school contexts and identification of TMCU interventionist candidates in elicitation interviews; (2) interventionist preparation via a formally evaluated training process involving a two-day workshop and sequence of three training cases; (3) post-training implementation for 24 months for which trained interventionists are randomized to 'as-needed' or 'gold-standard' technical assistance and self-referring students randomized (in 2:1 ratio) to TMCU or waitlist/control; and (4) examination of TMCU sustainment via interventionist completion of biannual outcome assessments, cost analyses, and exit interviews. Hypothesized effects include non-differential influence of the competing technical assistance methods on both TMCU fidelity and intervention effectiveness, with lesser school costs for the 'as-needed' than 'gold-standard' technical assistance and greater reduction in the frequency of marijuana use expected among TMCU-exposed students relative to those assigned to waitlist/control.

Discussion: This trial-occurring in Washington state as legislative, fiscal, and sociocultural forces converge to heighten exposure of American adolescents to marijuana-related harms-is set to advance understanding of best implementation practices for this and other efficacious, school-based interventions through examination of a data-driven technical assistance method. If shown to be clinically useful and affordable, the concept of a fidelity drift alarm could be readily translated to other empirically supported services and in other health settings.

Trial registration: NCT03111667 registered 7 April 2017.

Keywords: Adolescent marijuana use; EBP implementation; Fidelity; Motivational enhancement therapy; Technical assistance; Therapy training.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Female
  • Health Promotion / methods*
  • Humans
  • Male
  • Marijuana Abuse / prevention & control*
  • Marijuana Abuse / psychology*
  • Motivational Interviewing*
  • School Health Services / organization & administration*
  • Students / psychology*
  • Washington

Associated data