Stacy L. Frazier, Ph.D. - US grants

[unreadable] DESCRIPTION (provided by applicant): This application proposes to adapt and pilot test an efficacy-based, manualized intervention to enhance the mental health benefits for children attending publicly funded, inner city, after-school programs. The proposed study is consistent with objectives of the R34 mechanism (1. Development and Pilot Testing of New or Adapted Interventions, and 2. Adaptation and Pilot Testing for Effectiveness) towards a planned program of research to study how mental health consultation and support can strengthen the benefits of after-school programs for inner city children's academic, social, and behavioral functioning. Despite extensive problems facing urban communities during after-school hours, few empirical studies have examined children's use of time, quantity and quality of programs available, participation rates, and the potential mental health benefits of programs. We propose to collaborate with a large, publicly funded provider of after-school programs - Chicago Park District's Park Kids program - toward three research goals. Children (n=318) in grades 1 to 8 who attend one of the participating programs will be enrolled in the study. First, we will collaborate with after-school program staff toward the adaptation and application of a manualized, efficacy-based intervention [unreadable] (Pelham, 1985) to meet the needs, capabilities, and constraints of their program, and we will provide training and ongoing support. Second, we will develop and implement a fidelity measure of staff adherence to the intervention. Third, we will use random-effects regression models to pilot test the impact of the intervention at three (experimental) after-school sites compared to three (comparison) after-school-as-usual sites on four domains of children's outcomes (Hoagwood et al., 1996): symptoms (children's externalizing and internalizing problems), functioning (children's academic, social, and behavioral outcomes), environmental outcomes (staff psychological climate), and satisfaction (parent and staff). This proposal responds to recent national concerns about after-school care, and the need for alternative venues for mental health service delivery in inner cities (Stephenson, 2000; Surgeon General's report). [unreadable] [unreadable]

DESCRIPTION (provided by applicant): This application extends a program of research that examines the capacity of publicly-funded after-school programs to promote children's mental health in urban, poor communities, where the risks for mental health difficulties are extremely high and the resources available to meet those needs are severely limited. The proposed study will be conducted at the Chicago Park District's Park Kids program, one of the largest providers of publicly-funded after school programs for children and youth in Chicago. We recently completed the first study in this program of research (NIMH R34-MH070637;PI: Frazier;see Preliminary Studies Project NAFASI) examining the feasibility of mental health consultation to after school program staff around academic enrichment, coaching behaviors, activity engagement and behavior management. Those findings reveal strong evidence for the feasibility of intervention, high staff satisfaction, and encouraging though modest improvements in children's adaptive functioning. The current application will expand the NAFASI intervention to reflect a growing literature in children's mental health services linking organizational social context with service quality and outcomes, which suggests that effective and sustainable change at a program level will require more concentrated intervention at an organizational level. Hence, we propose to examine in Years 1-3 via mixed-effects regression models how social context (by direct observation and staff perceptions) operates in after school programs in relation to child and parent reported program quality and children's mental health outcomes (staff and self report) for 12 randomly selected children ages 8 to 16 in each of the 84 Park Kids programs throughout Chicago (n=357 staff, 1,008 children). These data will be used to (1) provide norms for after school programs on a measure of organizational social context, (2) estimate the variance component structures associated with site that will be used to power a subsequent clinical trial, and (3) inform the expansion in Year 4 of organizational-level intervention components for the NAFASI intervention. The proposed study will contribute to the overall goal of this research to develop new models of community mental health practice focused on supporting the mission, improving the quality, and enhancing the capacity of after- school programs to promote mental health and adaptive functioning for children living in urban poverty. PUBLIC HEALTH RELEVANCE: The proposed study will examine relationships among organizational features of after school programs, child and parent reports of program experiences, and children's behavior toward the further development of an intervention to impact on the ability of after school programs to promote children's adaptive functioning. The study will be conducted at 84 organized after school programs directed by the Chicago Park District. This application is the next step in a program of research that examines the capacity of publicly-funded after-school programs to promote children's mental health in urban, poor communities.

Project Summary/Abstract This R34 resubmission proposes to develop and examine a mental health service model for families of infants/toddlers with developmental delay that reduces risk for mental health problems, and in turn, enhances readiness for preschool. Infants/toddlers with developmental delay exhibit significantly higher rates of disruptive behaviors, peer problems, impulsivity, and academic failure. Their parents also are at elevated risk for mental health problems and child maltreatment. Families of infants/toddlers with developmental delay are more likely to live in poverty with limited access to services, and most receive government-funded, home- based Early Intervention (EI) services (i.e., Part C of the Individuals with Disabilities Education Act). We propose to leverage the unique position of Infant-Toddler Developmental Specialists (ITDS), front-line providers of EI services, to support parent-infant/toddler interactions and reduce family risks for mental health problems. Based on a rich empirical literature, we selected Child-Directed Interaction (CDI), the first phase of Parent-Child Interaction Therapy, as an evidence-based intervention to increase positive parent-infant/toddler interactions and reduce negative interactions. CDI aligns with the training, role, and function of ITDS, and responds to the needs of referred families. We will collaborate with EI provider agencies toward a service model that emphasizes initial training, ongoing supervision, and quality assurance to facilitate infant/toddler mental health (social, emotional, behavioral competence) and parent mental health (anxiety/depression, parenting stress, caregiver strain). We will examine feasibility, fidelity, and acceptability of the proposed model to identify facilitators and barriers to service delivery, and we will examine its promise compared to services as usual (n = 4 agencies, 16 ITDS, 112 families). In light of the extensive needs and depleting resources faced by families of infants/toddlers with developmental delay, the proposed work provides a unique opportunity to enhance the natural role and capacity of a skilled EI workforce to provide high quality services that minimize mental health problems and facilitate healthy child and family trajectories.

Abstract Increasing enrollment and greater reliance on after-school programs (ASPs) for social emotional learning (SEL) coincides with research demonstrating that participation in high quality ASPs contribute meaningfully to positive youth development and mental health, especially for youth living in communities of concentrated urban poverty. These benefits rely on high quality experiences in a supportive environment with structured youth- adult interactions and well-organized opportunities for engagement. However, organizational and workforce variability across ASPs underscores the myriad challenges associated with consistent, high quality, and sustained SEL programming in ASPs. The traditional model for professional development (PD) and implementation of SEL curriculum in schools does not transfer to the after-school setting. Hence, we propose a technology-based innovation for ASP provider training in SEL programming that harnesses strengths, acknowledges limitations, and leverages opportunities inherent to diverse and complex ASPs. To our knowledge, the proposed product will be the first technology product that provides self-paced interactive instruction and practice to build workforce skills necessary for after-school providers to create and capitalize on teachable moments during after-school routines and recreation to meet the social, emotional, and behavioral needs of enrolled youth. This 12-month SBIR Phase I project will accomplish three specific aims: (1) develop a fully functioning software prototype; (2) conduct prototype usability and feasibility testing with frontline ASP youth care workers; and (3) conduct prototype testing with organizational stakeholders. The proposed SBIR project will directly address the need for innovative cost- and time-efficient solutions to engage after-school frontline providers in PD. The online curriculum will extend our team's public health approach to professionalizing ASP youth care workers to improve program quality and, ultimately, improve social, emotional, and behavioral outcomes for youth. Iterative development and testing will enhance and document the benefits of our proposed online PD curriculum to elevate the role of ASP youth care workers to ASP professionals. Our goal is to support broad scale dissemination and use of our online SEL training suite for ASP providers. We will market the final product as a cost and time efficient means to address the PD training needs of the more than 625,000 frontline youth care workers in the U.S. after-school market.