Targeting School Climate and Children?s Behavioral Health in Urban Schools

描述(由申请人提供)：在不同种族/民族背景的城市儿童中，对心理健康服务的需求未得到满足的情况非常高。随着总体需求持续上升，学校正迅速成为儿童心理健康服务的主要来源。外化行为障碍和焦虑症在低收入城市儿童中非常普遍。不幸的是，针对这些障碍的循证干预(EBI)很少在城市学校使用。全校积极行为支持(SWPBS)是一种多层次的服务提供策略，结合了普遍性和针对性的干预措施，已被发现在改善学校氛围、学校安全感和学生阅读成绩方面有效。作为SWPBS系统的一部分，可以为高危和高危学生提供有针对性的群体认知行为治疗(GCBT)。不幸的是，SWPBS和GCBT很少被资源不足的城市学校聘用，部分原因是学区没有足够的资源与拥有EBI专业知识的外部提供者签约，以解决行为健康问题。此外，由于对服务提供者培训不足和实施保真度低等问题，在“现实世界”环境中广泛部署EBI受到了阻碍。建立培训和支持辅导员和其他学校工作人员的机制，重点是保持高度的执行忠诚度和完整性，可以促进城市学校显着增加EBI的使用，并有助于降低行为健康差距。本项目的总体目的是确定实施两级SWPBS计划的学校工作人员，当他们从教练和主管那里获得的支持水平(LLS)低于他们的支持水平(HLS)时，是否能够以相同水平的保真度、完整性和临床有效性来实施该计划的组成部分，该计划针对典型的发育儿童和患有外在性或焦虑症的儿童。我们还想确定接受HLS两年的学校人员是否可以在接下来的两年里接受LLS的同时，继续以类似水平的保真度、完整性和临床有效性来实施计划的组成部分。我们将计算与开发和实施SWPBS计划相关的总成本和净成本。这项研究采用队列序贯设计，跟踪了费城学区6所独立的K-8学校，产生了大约48名领导团队成员、180名学校工作人员和3900名学生，以及12名辅导员，即84组4-5岁的儿童，在每个CBT小组中患有对立违抗性障碍或品行障碍，或面临这些障碍的风险。 每个CBT组有3-4名患有广泛性焦虑症、分离性焦虑症或社交恐惧症或有患广泛性焦虑症、分离性焦虑症或有风险的儿童，总共有306名可评估的儿童参与者。学校将被随机分配，从项目工作人员那里获得HLS或LLS。拟议的研究符合国家儿童健康与人类发展研究所(儿童健康与人类发展研究所)目前的战略计划，特别是承诺支持旨在解决少数群体和低收入儿童入学准备和学业成功障碍的研究。

DESCRIPTION (provided by applicant): Unmet need for mental health services is extraordinarily high among urban children of diverse racial/ethnic backgrounds. As overall need continues to rise, schools are fast becoming the main source of mental health services for children. Externalizing behavior disorders and anxiety disorders are highly prevalent in low-income urban children. Unfortunately, evidence-based interventions (EBI) for those disorders are seldom employed in urban schools. School-Wide Positive Behavior Support (SWPBS), a multi-level services delivery strategy that combines universal and targeted interventions, has been found to be effective in improving school climate, perceived school safety, and student reading scores. Targeted group cognitive behavioral therapy (GCBT) can be provided to at-risk and high-risk students as part of the SWPBS system. Unfortunately, SWPBS and GCBT are seldom employed in under-resourced urban schools, in part, because school districts do not have enough resources to contract outside providers with expertise in EBIs for behavioral health problems. Also, widespread deployment of EBIs to "real world" settings has been hampered by problems such as inadequate training of service providers and poor implementation fidelity. The creation of mechanisms for the training and support of counselors and other school personnel that focus on maintaining high implementation fidelity and integrity can facilitate a significant increase in the use of EBIs in urban schools and contribute to lowering behavioral health disparities. The overall purpose of this project is to determine whether school personnel implementing a two-tier SWPBS program for typically developing children and children with, or at risk for, externalizing or anxiety disorders, can implement the components of the program with the same level of fidelity and integrity and clinical effectiveness when they receive a Low Level of Support (LLS) from their coaches and supervisors as compared to a High Level of Support (HLS). We also want to determine whether school personnel who receive HLS for two years could continue to implement the components of the program with a similar level of fidelity and integrity and clinical effectiveness while receiving LLS during the following two years. We will calculate the total costs and net costs associated with the development and implementation of the SWPBS program. The study uses a cohort-sequential design and follows 6 separate K-8 schools in the Philadelphia School District, yielding approximately 48 leadership team members, 180 school personnel, and 3,900 students in Tier 1, and 12 counselors, 84 groups of 4-5 children with, or at risk for, oppositional defiant disorder or conduct disorder in each CBT group, and 3-4 children with, or at risk for, generalized anxiety disorder, separation anxiety disorder, o social phobia in each CBT group, for a total of 306 evaluable child participants. Schools will be randomly assigned to receive either HLS or LLS from project staff. The proposed study is consistent with the current strategic plan of the National Institute of Child Health and Human Development (NICHD), particularly the commitment to support research that addresses barriers to school readiness and academic success for minority and low-income children.