Addressing Mental Health Services Disparities for Ethnically Diverse Children

描述（由申请人提供）： 这项拟议的研究是为了响应一项名为“通过翻译研究消除健康差异”（R18）的计划公告。这项研究的目的是适应基于证据的干预措施，用于城市学校大量的低收入拉丁美洲学生。这些干预措施将在以家庭为中心的系统内提供，以便为儿童提供有可能随着时间的推移自我维持的心理健康服务。干预措施，这是基于SW-PBS的方法，将解决一系列的行为障碍和伴随的同伴困难的儿童在学校和家里经历的。这项研究将在两所公立学校（K至第五和K至第八）在城市地区的低收入拉丁美洲家庭高度集中。将同时收集该项目三个方面的数据：（a）开发数据收集系统;（B）改进主要学校系统;（c）议定书的修改和执行。拟议的研究旨在覆盖所有参加学校的儿童。研究的目的是：（1）开发一个有用、有效和可接受的SW-PBS数据收集系统;（2）建立学校系统的能力，以支持SW-PBS的实施;（3）确定SW-PBS小学和中学干预措施中需要调整的组成部分;（4）确定在两所资源不足的学校实施SW-PBS干预措施的可行性;（5）评估第1层和第2层干预措施的可接受性（采用）;以及（6）估计与实施SW-PBS一揽子计划相关的健康结果。将根据重点小组、后续访谈和对93名家长和60名教师的简短调查，确定和修改以证据为基础的干预措施。第一级干预措施将首先在1 027名学生身上实施。对第1层干预措施没有反应的儿童将被分配到一个或多个第2层干预措施，或者他们将被评估并转介到社区接受治疗。预计将有154名儿童在学校接受第二层干预，63名第二层儿童的父母将在社区中心接受父母技能培训。这项拟议的研究是研究人员、全校积极行为支持专家（SW-PBS）、教职员工、学校管理人员、家长/照顾者和社区心理健康工作者之间合作的结果。这项研究涉及到2010年健康人的一个具体目标-减少或消除不同种族儿童之间的心理健康服务差距。这项研究可能有助于建立一个有效的系统，为低收入，市中心的儿童和家庭提供心理健康服务。本研究获得的数据可能有助于更好地了解促进资源不足的城市学校适应和实施循证干预措施的因素。本提案中描述的适应性循证干预措施可能有助于减少城市种族多样性儿童之间的心理健康服务差异。该提案还可能增加对资源不足的城市学校的全校积极行为支持（SW-PBS）干预措施的有效性的研究兴趣。

DESCRIPTION (provided by applicant): The proposed study is in response to a Program Announcement entitled, Elimination of Health Disparities through Translation Research (R18). The purpose of the study is to adapt evidence-based interventions for use in urban schools with large numbers of low-income Latino students. The interventions will be delivered within a family-centered system for the delivery of mental health services for children that has the potential to be self- sustaining over time. The interventions, which are based on SW-PBS methodology, would address a range of behavioral disorders and concomitant peer difficulties experienced by children at school and at home. The study will take place in two public schools (K through 5th and K through 8th) in an urban area with high concentrations of low-income Latino families. Data will be collected simultaneously on three ongoing aspects of the project: (a) Development of a data collection system; (b) Improvement of key school systems; (c) Protocol modification and implementation. The proposed study is designed to reach all children attending the participating schools. Aims of the study are: (1) To develop a data collection system for SW-PBS that is useful, efficient, and acceptable; (2) To build the capacity of the school system to support the implementation of SW-PBS; (3) To identify components of SW-PBS primary and secondary tier interventions that need adaptation; (4) To determine the feasibility of implementing SW-PBS interventions in two under-resourced schools; (5) To assess acceptability of Tier 1 and Tier 2 interventions (uptake); and (6) To estimate the health outcome associated with the implementation of the SW-PBS package. Evidence-based intervention packages will be identified and modified based on focus groups, follow-up interviews and brief surveys with 93 parents and 60 teachers. Tier 1 interventions will be implemented first on 1,027 students. Children who do not respond to Tier 1 interventions will be assigned to one or more interventions for Tier 2 or they will be assessed and referred for treatment in the community. It is expected that 154 children will receive Tier 2 interventions in the school and that 63 parents of children in Tier 2 will receive parental skills training at a community center. The proposed study is the result of a partnership between researchers, experts in school-wide positive behavior support (SW-PBS), teaching staff, school administrators, parents/caregivers and community mental health workers. The study addresses a specific goal of Healthy People 2010--reducing or eliminating mental health services disparities among ethnically diverse children. The study may contribute to the development of an efficient and effective system for the delivery of mental health services to low-income, inner-city children and families. Data obtained for this study may contribute to a better understanding of factors that facilitate the adaptation and implementation of evidence-based interventions in under-resourced urban schools. The adapted evidence-based interventions described in this proposal are likely to contribute to a reduction in mental health services disparities among urban ethnically-diverse children. The proposal may also increase research interest in the effectiveness of school-wide positive behavior support (SW-PBS) interventions in under-resourced urban schools.