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，未满足的心理健康服务需求非常高。随着整体需求的持续上升，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障碍在低收入城市儿童中非常普遍。不幸的是，这些疾病的循证干预（EBI）很少在城市学校。全校积极行为支持是一种多层次的服务提供战略，结合了普遍和有针对性的干预措施，已被发现在改善学校气氛、学校安全感和学生阅读成绩方面是有效的。作为SWPBS系统的一部分，可以向有风险和高风险的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很少在资源不足的城市学校使用，部分原因是学区没有足够的资源与具有行为健康问题EBI专业知识的外部提供者签订合同。此外，由于对服务提供者的培训不足和执行保真度差等问题，EBI在“真实的世界”环境中的广泛部署受到阻碍。建立机制，培训和支持辅导员和其他学校工作人员，重点是保持高度的实施保真度和完整性，可以促进在城市学校使用EBI显着增加，并有助于降低行为健康的差距。 本项目的总体目的是确定学校工作人员是否为典型发育中的儿童和患有或有可能患有外化或焦虑症的儿童实施双层SWPBS计划，在获得低水平支持（LLS）时，能够以相同的保真度和完整性以及临床有效性水平实施计划的组成部分从他们的教练和主管相比，高水平的支持（HLS）。我们还希望确定，在接下来的两年中接受LLS的学校人员是否可以继续实施该计划的组成部分，同时保持类似的忠诚度和完整性以及临床有效性。我们将计算与SWPBS计划的开发和实施相关的总成本和净成本。该研究采用队列顺序设计，并遵循费城学区的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3，900名一级学生，12名辅导员，84组4-5名儿童，或有风险，每个CBT组中的对立违抗障碍或行为障碍， 每个CBT组中有3-4名患有广泛性焦虑症、分离焦虑症、社交恐惧症或有患广泛性焦虑症、分离焦虑症、社交恐惧症风险的儿童，总共有306名可评估的儿童参与者。学校将被随机分配接受由项目工作人员提供的HLS或LLS。这项拟议的研究符合国家儿童健康和人类发展研究所（NICHD）目前的战略计划，特别是承诺支持研究，解决少数民族和低收入儿童入学准备和学业成功的障碍。

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.