From leadership research to district action: Leveraging the dynamic adaptation process to address LGBTQ+ health equity in New Mexico high schools

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Abstract Background Reducing adolescent suicide in the United States is a public health priority, and lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth are at elevated risk. The Centers for Disease Control and Prevention has identified six evidence-informed school-based practices (EIPs) that enhance health equity and potentially reduce suicide-related behavior for LGBTQ+ students. Guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, we conducted a five-year, community-engaged cluster randomized controlled trial in 42 New Mexican high schools to study the implementation of these six EIPs. This paper assesses the effectiveness, utility, and benefits of the study's implementation strategy—the Dynamic Adaptation Process (DAP), a participatory and multifaceted implementation approach. Methods Our convergent parallel mixed-method analysis focused on 22 New Mexico high schools randomized into an implementation condition. Data sources included annual structured assessments of EIP implementation, individual and small-group qualitative interviews with school professionals, periodic debriefs and interviews with implementation coaches, and coach activity logs. We analyzed quantitative data using linear regressions and qualitative data using deductive coding techniques, integrating the results through a joint display. Results The schools experienced statistically significant changes compared to their baseline in adopting safe spaces, prohibitions on bullying and harassment based on LGBTQ+ identity, inclusive health education materials, staff professional development, and facilitation of students' access to LGBTQ+ affirming healthcare. We attribute these changes to the impact of the DAP. The DAP facilitated collaboration among school professionals and community organizations to shift knowledge and attitudes and execute contextually responsive implementation strategies. It also fostered relationship-building and leadership, encouraging school leaders to legitimate implementation efforts and champion health equity for LGBTQ+ students. Discussion Participatory implementation science models like the DAP can help prioritize health equity for marginalized populations by enabling the uptake of practices likely to contribute to well-being. This mixed-methods study provides a rich example for future research tackling health disparities for LGBTQ+ people in schools and other complex systems. Keywords: adoption, dynamic adaptation process, health disparities, implementation strategy, LGBTQ+, mixed- methods, schools

Study methods

Our study took place in high schools in New Mexico, a culturally and geographically diverse state ranking 50th in education, 48th in economic well-being, and 50th in overall child well-being (45). The state education department oversees schools organized into 89 districts governed by local school boards. Schools have some flexibility over school management and curriculum implementation. Despite allocating almost half its annual budget to public education (Kindergarten-12th grade), the state has historically struggled to provide sufficient resources, especially for students from low-income families and communities of color (46, 47).

Limitations

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A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Select one recurring district decision. Publish the decision owner, evidence requirements, consultation process and appeal route; test the process on a bounded low-risk decision. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Track decision time, unresolved objections, documented reasons, appeals and access differences. Review whether the process changes who can participate and who carries the burden. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Cathleen Elizabeth Willging; Daniel Shattuck; Mary M Ramos; Bonnie O Richard; Adrien Lawyer; Elizabeth Dickson; Gregory A Aarons. Leveraging the dynamic adaptation process to address LGBTQ+ health equity in New Mexico high schools. Frontiers in Health Services (2025-06-03). https://doi.org/10.3389/frhs.2025.1499508

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.