Novel Application of System Support Mapping for Sustainment of Trauma-focused Mental Health Intervention in School-Based Health Centers: A Case Study

Efforts to improve access to mental health care and the quality of available services are a central issue in advancing mental health equity for children and adolescents. This current case study represents a large-scale effort to develop and implement a sustainment plan for the Cognitive Behavioral Intervention for Trauma in Schools (CBITS), an evidence-based program to support youth with traumatic stress symptoms, in an urban community. A diverse group of stakeholders including federally qualified health centers, state and federal government representatives, researchers, and local advocacy groups worked together to identify a method for assessing the program’s assets and needs, execute the selected method, and analyze the results to formulate a concrete action plan. This case study includes a novel application of System Support Mapping, a process that guides stakeholders to consider and document a system from their own perspective by creating a “map” of the roles, responsibility, needs, and resources. This process was applied for the first time as a method used to support and enhance sustainment of promising or evidence-based practices in a real-time, real-world context. Stakeholders identified the following sustainment priorities: 1) Funding to support non-billable service components; 2) Board of Education, teacher, and principal buy-in and support; and 3) Obtaining consent from guardians for screening and CBITS services. Results are discussed with respect to their alignment with sustainment factors in the literature and the ways in which local data collection through the System Support Mapping process led to actionable steps toward program sustainment.