Efficacy trial of a school-based preventive intervention

说明(由申请人提供)：该项目满足以下需求：(1)为已经出现新的精神健康问题的幼儿提供负担得起和可持续的“指示”预防干预措施，以及(2)能够在可接近的“真实世界”环境中有效提供的干预措施。这项提案寻求RO1资金用于一项随机对照试验(RCT)，以评估促进韧性儿童倡议(PRCI)在推断城市少数族裔儿童中的心理健康问题以及预防未来的疾病和昂贵的服务方面的有效性。PRCI是初级精神卫生项目(PMHP)的第二代改编。以学校为基础的PMHP是40年前由Cowen和他的同事开发的，已经传播到美国的1500所学校。PMHP计划的优点包括对学校的生态有效性和适度的成本。PRCI大大修改了PMHP使用的干预内容和实施方法。在PRCI中，孩子们在学校导师的24次会议中学习情绪调节和应对的行为和认知技能。在10次家访中，导师教父母帮助孩子发展技能。PRCI的初步试验表明，干预在短期内减少了儿童的问题，并且在目标行为和情绪结果上比PMHP有更大的影响。需要这项试验来确定PRCI干预的长期疗效。在这项拟议的为期5年的研究中，200名儿童将被随机分配到PRCI干预组，200名儿童被分配到5所城市学校的75个教室中控制条件。(1)“我们将比较30个月内外化和内化问题的干预和控制水平、服务需求和家庭功能指数，以评估计划的有效性。(2)我们将努力确定取得积极成果所需的执行忠诚度水平。(3)我们将检验关于PRCI对儿童发展影响的机制的假设。该项目可以通过将改进的干预扩展到目前正在实施PMHP的1000多所学校和美国其他学校来产生积极的公共卫生影响。从推进预防科学的角度来看，拟议的研究可以促进改善社区干预和有效使用受过专门培训的非专业干预者所需的知识。

DESCRIPTION (provided by applicant): This project responds to the need for (1) affordable and sustainable 'indicated' preventive interventions for young children already showing emerging mental health problems, and for (2) interventions that can be delivered effectively in accessible, 'real-world' settings. This proposal seeks RO1 funding for a randomized controlled trial (RCT) to evaluate the efficacy of the Promoting Resilient Children Initiative (PRCI) in Deducing mental health problems among urban, minority children and in preventing future disorders and costly services. The PRCI is a second-generation adaptation of the Primary Mental Health Project (PMHP). The school-based PMHP was developed 40 years ago by Cowen and colleagues and has been disseminated to 1,500 schools in the U.S. The PMHP program's strengths include ecological validity for schools and moderate cost.. PRCI significantly modifies both the intervention content and method of implementation used in PMHP. In PRCI children learn behavioral and cognitive skills for emotion regulation and for coping in 24 sessions with school-based Mentors. In 10 home visits the Mentors teach parents to assist their children in developing skills. A preliminary trial of PRCI suggests that the intervention reduces children's problems in the short-term and has a larger impact than PMHP on targeted behavioral and emotional outcomes. This trial is needed to determine the longer-term efficacy of the PRCI intervention. For the proposed 5-year study, 200 children will be randomly assigned to PRCI intervention and 200 to control conditions from 75 classrooms in 5 urban schools. (1)"We will compare intervention and control levels of externalizing and internalizing problems, need for services, and indices of family functioning over 30 months to assess program efficacy. (2) We will seek to determine levels of implementation fidelity required to achieve positive outcomes. (3) We will test hypotheses about mechanisms that govern the impact of PRCI on children's development. This project can have a positive public health impact through the potential to expand an improved intervention to more than 1,000 schools currently implementing PMHP and to other schools in the U.S. From the standpoint of advancing prevention science, the proposed study can contribute to knowledge needed to improve interventions in communities and the effective use of specially trained non-professional intervenors.