Effectiveness of School- and Home-Based Mental Health Services in Improving Learning and Behavior in Children in Urban Schools

This study will evaluate the effectiveness of school- and home-based mental health services and training modules in supporting learning and behavior in financially disadvantaged children who live in urban areas.

There are an estimated 4.5 to 6.3 million children with mental disorders in the United States. Emotional and behavioral problems associated with childhood mental disorders have a significant impact, with affected children at an increased risk of reduced quality of life and school dropout. If left untreated, childhood mental disorders may continue into adulthood, often impairing ability to function as an adult. It is believed that, compared to clinic-based services, school- and home-based mental health services may lead to greater improvements in children's learning and behavior at school and home. Especially important to this type of approach is a collaborative effort among parents, teachers, and children to encourage and maintain positive behaviors and academic performance both at home and in the classroom. This study will evaluate the effectiveness of school- and home-based mental health services and training modules in supporting learning and behavior in financially disadvantaged children who live in urban areas.

This 3-year study will involve parent, child, and teacher participants. During Year 1, teacher participants will attend a professional development series that will focus on strategies that classroom teachers can use to help children with learning and behavior problems at school. The series will involve weekly 30-minute sessions, which will be held before and after school hours, for a total of 6 months. Teachers will fill out a brief survey about the content and structure of sessions at the end of each session and will give a monthly review on how they are applying their new strategies in the classroom setting. Teachers will continue to attend booster sessions of up to 1 hour each month during Year 2. Teachers will also participate in periodic case consultation meetings with parents and mental health providers to further develop ways to improve student participants' learning and behavior.

Child participants will either undergo the community mental health program associated with their school or receive general clinic-based services. The school component of the mental health program will consist of a classroom environment in which the teachers implement their newly learned strategies. The teachers will aim to enhance the academic and behavioral performance of the child participants. Parents of child participants in the community mental health program will be invited to attend a series of parent/teacher meetings and home visits where mental health service providers will discuss strategies that parents and teachers can use to help improve their children's learning and behavior. Parents will fill out a brief questionnaire at the end of each meeting and will give a monthly review of how they are implementing their new strategies in the home setting. Parents will continue to communicate with research staff regarding services provided throughout the study.

Assessments for all participants will occur five times over 3 years. Assessments for parent participants will include questions about their child's behavior at school and home, their child's use of mental health services, involvement in their child's schooling, and possible stresses in life. Assessments for teachers will include questions about the behavior and academic performances of the child participants, parent involvement with the children's schooling, and stresses in their work environment. A research staff member will also conduct a 2-hour classroom observation five times over 3 years. Individual child participants will also be observed in the classroom by research staff for three 15-minute intervals five times over the study period.

• Conduct Disorder
• Oppositional Defiant Disorder
• Attention Deficit Disorder With Hyperactivity

• Behavioral: Community mental health consultation model program
  The community mental health consultation model program includes collaboration among community mental health providers and (1) parent advocates to effectively maintain families in a school-based mental health program, (2) classroom teachers to enhance children's academic performance, and (3) peer-identified influential teachers to influence classroom teachers' use of behavior management strategies. This model further focuses on the strongest teacher and parent predictors of student learning.
  Other Name: Links to Learning (L2L)
• Behavioral: Treatment as usual (TAU)
  TAU includes referral to community mental health clinic-based services, where participants will receive standard care for mental health-related problems.

• Experimental: 1
  Participants will undergo the community mental health consultation model program.
  Intervention: Behavioral: Community mental health consultation model program
• Active Comparator: 2
  Participants will receive treatment as usual and referrals.
  Intervention: Behavioral: Treatment as usual (TAU)

Inclusion Criteria:

• Student in kindergarten through 4th grade in a participating school
• Diagnosis of conduct disorder, oppositional defiant disorder, or attention deficit hyperactivity disorder as confirmed by parent and/or teacher report

Exclusion Criteria:

• Severe developmental or medical disability