Mark D. Weist - US grants

DESCRIPTION: (Provided by the Applicant) In response to PA-00-111, this application seeks to systematically enhance the quality, appropriateness and effectiveness of mental health services in schools. The last two decades in the United States have witnessed the progressive development of expanded school mental health (ESMH) programs, which provide comprehensive mental health care to youth in general and special education through partnerships between schools and community agencies. The Center for School Mental Health Assistance (CSMHA) is one of two federally funded centers to advance school-based mental health programs. Since its inception in 1995, the center has had a major focus on school mental health quality and for the past two years has been working to develop a set of 10 principles and corresponding quality indicators reflecting the vision of best practice for the ESMH field. Through a survey and interactive forums with school health, mental health and education staff nationwide the principles and quality indicators have been refined, and a quality assessment and improvement (QAI) intervention based on them has been developed. The study will involve ESMH programs in three locations: Delaware, Maryland and Texas. Within each program, through stratified random assignment we will assign ESMH clinicians in schools to either receive a systematic Quality Assessment and Improvement (QAI) intervention (targeted group: 35 clinicians in 40 schools) or receive an intervention on Staff Wellness Plus Information on the ESMH Principles (comparison group: 35 clinicians in 40 schools). In the proposed three-year study, clinicians in targeted and comparison schools will participate in the respective interventions in Years 1 and 2. Between groups (targeted versus comparison) analyses will be conducted on dependent variables of the quality of services provided by clinicians, clinician attitudes and behavior, satisfaction ratings provided by students, parents and schools staff, and student grades, attendance, lateness and discipline problems. Year 3 will focus on analyses, writing and broad dissemination of findings and lessons learned through the CSMHA's networks.

DESCRIPTION (provided by applicant): This application seeks to extend findings from a previous randomized controlled trial, funded by NIMH (Enhancing Quality in Expanded School Mental Health;1R01MH71015-01A1;2003 -2007), which resulted in the development and refinement of a systematic and achievable strategy for promoting high quality, evidence- based services by clinicians working in school mental health (SMH) programs in Delaware, Maryland, and Texas. In the prior study, clinicians assigned to systematic Quality Assessment and Improvement (QAI) as compared to a condition focused on personal wellness were more likely to engage in evidence-based practices and to demonstrate quality indicators associated with best practice in SMH. However in this study, involving a formative evaluation, distal impacts on emotional/behavioral functioning by students being treated by clinicians were not shown. The failure to achieve student-level impacts was likely related to the formative evaluation, with study procedures enhanced but evolving from Year 1 to Year 2, and to the multi-site study, which contributed error variance. In addition, the prior study did not involve implementation support to assure that clinicians were applying learned skills in their schools. In this follow-up study, we proposed to evaluate an enhanced quality assessment and improvement (EQAI) intervention involving four components: 1) Implementation support (IS), involving on-site coaching including rehearsal, feedback, emotional support, and administrative support based on research and a theoretical model developed by the National Implementation Research Network (with leaders Dean Fixsen and Karen Blase helping to develop IS and on the study's Advisory Panel), 2) systematic QAI to ensure that clinicians are most effectively implementing learned skills in the environment of schools, 3) family engagement and empowerment (FEE) based on recent research through an NIMH Developing Center to study co-investigator, Kimberly Hoagwood and colleagues, and 4) evidence- based practice (EBP) focusing on disruptive behavioral problems through an expanded modular intervention, developed in consultation with study Advisory Panel member, Bruce Chorpita. The study will be implemented in the largest and most successful SMH program in South Carolina (SC), operating in Horry County, with 36-40 full-time clinicians randomly assigned to either EQAI or PW, with both conditions well-developed through the prior R01. The study will measure impacts on proximal outcomes of clinician demonstration of skills in EBP, quality of SMH services, and FEE, and measure distal impacts including student emotional/behavioral functioning, school behavior and performance, and parenting stress. Moderating and/or mediating influences such as clinician experience, attitudes toward evidence-based practice, working alliance with families, and clinician stress will also be explored. With expected positive findings, the study is positioned to have a transformative impact since SC is a leading state for SMH, with almost half of the schools including comprehensive services, and strong local/state support for the study and generalizing findings from it. PUBLIC HEALTH RELEVANCE: In a well established school mental health program operating in a South Carolina school district of 44 schools, will study the impact of an Enhanced Quality Assessment and Improvement (EQAI) intervention designed to improve the effectiveness of services. The EQAI intervention is based on theory and prior research and extends important research on implementing high quality mental health prevention and intervention in the real world setting of schools.

ABSTRACT African American (AA) and Hispanic/Latinx (HL) adolescents disproportionately engage in interpersonal violence/aggression. Even after exposure to evidence- and school-based violence prevention programs, racial/ethnic (R/E) disparities in aggression persist for these populations. One factor accounting for the disparities is R/E discrimination. Three major forms of R/E discrimination-related processes occur in schools: 1) peer R/E discrimination, 2) teachers' unintentional R/E biases, and 3) R/E disproportionality in harsh discipline, all of which have been linked to R/E minority students' poor educational and behavioral outcomes. Thus, effectively preventing aggression/violence among AA and HL youth requires a comprehensive approach that addresses R/E discrimination on multiple levels in schools. Yet, research levering empirically supported ways of addressing discrimination to enhance school-based violence prevention is sorely lacking. Drawing on compelling evidence for the efficacy of diverse approaches to addressing R/E discrimination from members of the research team, an integrated multilevel discrimination intervention is proposed to target four areas.1) Reduce unintentional bias in school personnel using the prejudice-habit breaking intervention, the only intervention that has been shown experimentally to produce long-term changes in bias. 2) Reduce peer R/E discrimination using an adaption of the prejudice-habit breaking intervention for adolescents. 3) Reduce R/E disproportionality in discipline by identifying the settings and practices in the school that are the greatest drivers of the disparities and problem-solving to address these drivers. 4) Reduce teacher stress using occupational stress management. The purpose of this study is to examine the effects of integrating these R/E discrimination interventions (RED) into mental health-enhanced Positive Behavioral and Interventions Supports (PBIS-MH), an evidence-based approach to reducing aggression and other problem behavior in schools..8 middle schools will be randomly assigned to 2 years of PBIS-MH or PBIS-MH augmented to address R/E discrimination (PBIS-MH+ RED). Data will be collected from students, teachers, and parents and school records over the course of 2 years, with a subset of youth participants assessed again at 1-year follow up while they are in high school. The study will address the following novel aims: 1) Examine the effects PBIS-MH +RED on discrimination targets. 2) Examine the effects of PBIS-MH +RED on student aggressive behavior and aggression risk factors. We will also explore the extent to which R/E group and gender moderate these effects. 3) Examine the extent that discrimination targets mediate the effects of PBIS-MH +RED on aggression and aggression risk. This study addresses critical questions needed to move the field forward in the development of comprehensive evidence-based approaches to reducing aggression in AA and HL youth.