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In a previous randomized controlled trial (RCT), Virtual Interview Training for Transition Age Youth (VIT-TAY) enhanced employment for autistic youth receiving transition services. For this study, a nonrandomized hybrid effectiveness-implementation trial evaluated whether VIT-TAY maintained its core implementation and effectiveness functions when scaled out to students with disabilities in 32 schools. Also, we compared the implementation and effectiveness between VIT-TAY and Virtual Reality Job Interview Training (VR-JIT; developed for adults and previously evaluated in students with disabilities). Core implementation functions did not differ between VIT-TAY and VR-JIT. Greater engagement with either training was significantly associated with employment (both p < .05). Overall, VIT-TAY was feasibly implemented with high adherence and may be effective at enhancing employment for students with disabilities. Limitations and implications for research and practice are discussed.

Vocational outcomes among transition-age youth receiving special education services are critically poor and have only incrementally improved since the implementation of the Workforce Innovation Opportunity Act. Few studies highlight whether interviewing may be critical to obtaining vocational outcomes such as competitive employment or internships. This study evaluated vocational interviewing and outcomes among 656 transition-age youth receiving special education pre-employment transition services from 47 schools. Results suggest 20.8% of these youth were currently employed, and 88.8% of these employed youth interviewed prior to obtaining their job, which is higher than anecdotal evidence suggests and speaks to the importance of job interview skills as an intervention target for special education pre-employment transition services. We discuss the implications and directions for further study.

Despite criticisms dating back to the 1950s, and minimal progress reducing mental health burdens, the dominant training model in clinical psychology has not changed. We argue that for clinical psychologists to reduce mental health burdens, they (collectively) need to devote a much larger proportion of their professional efforts to a broader range of activities. We propose a highly flexible two-phase model for clinical psychology training. The initial Foundational Knowledge and Competency Phase focuses on foundational concepts in the science of clinical psychology and direct client care. During the Focused Competency Phase, students may continue training for traditional roles in providing direct client care or, alternatively, develop other roles for using psychological science to address mental health conditions.

Empirical engagement-promoting strategies in child and family mental health services have been identified largely within the context of clinic-based services delivered by mental health professionals. However, the magnitude of unmet youth mental health need necessitates expanding the scope of mental health services, and the associated engagement strategies, beyond traditional models and service providers. The present study aimed to extend our understanding of engagement strategies to a school-based mental health service model, using a community health worker (CHW) workforce implementing an early intervention program with parents and school-aged children (K-4) in high poverty urban communities. Qualitative semi-structured individual interviews were conducted with 16 CHWs to capture their descriptions of the engagement strategies they utilized with parents throughout program implementation. Transcripts were coded and themes were identified following procedures for thematic analysis. Thematic analyses revealed ten themes describing a range of engagement strategies falling into two overarching categories: (1) rapport building, and (2) responsive delivery. Themes within the rapport building category included non-judgmental supportive listening, increasing social proximity, praise, privacy and confidentiality, and leveraging relationships. Themes within the responsive delivery category included flexibility, consistency, advocacy, incentives, and meeting needs. Findings provide preliminary evidence regarding the ability of CHWs to identify and implement a range of engagement strategies with parents and families that parallel empirically-based engagement strategies in traditional services. These findings speak to the potential of this workforce to engage underserved families in mental health services, underscoring the important role for CHWs in reducing mental health disparities.

This study reports the results of a single-arm, noncontrolled, Type 3 hybrid effectiveness-implementation trial evaluating virtual reality job interview training (VR-JIT) delivered in five preemployment transition programs comprising 15 schools, 10 administrators, 23 teachers, and 279 youth ages 16–21 years receiving special education preemployment transition services. Fidelity, expected implementation feasibility, and teacher and student acceptance of VR-JIT were high. Youth completed virtual interviews ( M = 10.8, SD = 7.4) over 6–8 weeks. At the 6-month follow-up, teachers reported that youth using VR-JIT had employment rates higher than current national employment rates for youth with disabilities. A multinomial logistic regression revealed VR-JIT engagement was associated with greater employment rates by 6-month follow-up (odds ratio = 1.63, p = .002). This study provides promising evidence that VR-JIT may be feasibly implemented with high fidelity in special education preemployment transition services and can potentially enhance employment outcomes among transition-age youth receiving special education services.

Objective: This study examined parents’ participation in a school-and home-based prevention and early intervention service model designed to promote positive parenting and parent involvement in sch...

Validating frameworks for understanding classroom processes that contribute to student learning and development is important to advance the scientific study of teaching. This article presents one such framework, Teaching through Interactions, which posits that teacher-student interactions are a central driver for student learning and organizes teacher-student interactions into three major domains. Results provide evidence that across 4,341 preschool to elementary classrooms (1) teacher-student classroom interactions comprise distinct emotional, organizational, and instructional domains; (2) the three-domain latent structure is a better fit to observational data than alternative one- and two-domain models of teacher-student classroom interactions; and (3) the three-domain structure is the best-fitting model across multiple data sets.

Background Research has identified cognitive behavioral therapy with exposures (CBT) as an effective treatment for youth anxiety. Despite implementation efforts, few anxious youth receive CBT. Direct-to-consumer marketing offers a different approach to address the unmet need for youth receiving effective treatments. Involving a local caregiver key opinion leader in direct-to-consumer initiatives may be an effective strategy to increase caregiver demand for CBT. Research indicates that key opinion leaders improve health promotion campaigns, but key opinion leaders have not been studied in the context of increasing caregiver demand for evidence-based treatments. Method Project CHAT (Caregivers Hearing about Anxiety Treatments) will test the role of key opinion leader participation in conducting outreach presentations to increase caregiver desire to seek CBT for their youth’s anxiety. Caregiver attendees (N = 180) will be cluster randomized by school to receive one of two different approaches for presentations on CBT for youth anxiety. Both approaches will involve community outreach presentations providing information on recognizing youth anxiety, strategies caregivers can use to decrease youth anxiety, and how to seek CBT for youth anxiety. The researcher-only condition will be co-facilitated by two researchers. In the key opinion leader condition, a caregiver key opinion leader from each local community will be involved in tailoring the content of the presentation to the context of the community, co-facilitating the presentation with a researcher, and endorsing strategies in the presentation that they have found to be helpful. In line with the theory of planned behavior, caregiver attendees will complete measures assessing their knowledge of, attitudes towards, perceived subjective norms about, and intention to seek CBT pre- and post-presentation; they will indicate whether they sought CBT for their youth at 3-month follow-up. Results will be analyzed using a mixed method approach to assess the effectiveness of a key opinion leader to increase caregiver demand for CBT. Discussion This study will be the first to examine the potential of key opinion leaders to increase caregiver demand for CBT. If proven effective, the use of key opinion leaders could serve as a scalable dissemination strategy to increase the reach of evidence-based treatments. Trial registration This trial was registered on clinicaltrials.gov (NCT04929262) on June 18, 2021. At the time of trial registration, pre/post-presentation data had been collected from 17 participants; thus, it was retrospectively registered.

OBJECTIVE Parents' perceived benefits and barriers to participation in cognitively stimulating activities may help explain why income-related discrepancies in early and frequent participation in such activities exist. We sought to develop an improved understanding of attitudes and beliefs surrounding play among families who live in predominantly low-income urban communities. METHODS Using qualitative methods, focus groups were conducted with parents of children 2 weeks to 24 months of age who attended a primary care clinic serving predominantly low-income urban communities. Discussions were recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS Thirty-five parents participated in 6 focus groups. Participants were 61% female and 94% nonwhite; 71% had children who received public health insurance. Analyses revealed 7 major themes that mapped onto the Health Belief Model's core domains of perceived need, barriers, and cues to action: (1) play as important for developing parent-child relationships, (2) toy- and media-focused play as important for developmental and educational benefit, (3) lack of time due to household and work demands, (4) lack of knowledge regarding the importance of play, (5) media-related barriers, (6) need for reminders, and (7) need for ideas for play. CONCLUSION Caregivers of young children describe many important benefits of play, yet they have misconceptions regarding use of toys and media in promoting development as well as notable barriers to participating in play, which may be opportunities for intervention. Public health programs may be more effectively implemented if they consider these attitudes to develop new or refine existing strategies for promoting parent-child learning activities.

This paper describes the process of a community-academic partnership to navigate implementation challenges for a school-based service model led by paraprofessionals to promote positive parenting in high poverty urban communities. We describe the process by which we (a) identified implementation challenges, (b) sustained a university-community collaboration to redesign the paraprofessional service model, and (c) assessed the feasibility of the new model involving four social service agencies in 16 schools with over 600 families. The structure and process of the collaboration and refinement are described with attention to who was best positioned to engage in the collaboration and how the partnership worked to balance scientific rigor with responsiveness to paraprofessional workforce strengths. Feasibility data indicated that the revised model was successfully implemented by paraprofessional staff; 92.2% of possible staff monthly reports were completed and discussion of key goals was incorporated into 94.2% of interactions. Continual monitoring provided critical feedback from stakeholders as we drew on and interpreted these various sources of information to build and refine the service model. We suggest that these processes are critical steps to bridge the research-to-practice gap, by promoting practices that are aligned with the needs of children and families, and the staff who serve them.

Caregiver strain and social support have been identified as both facilitators and deterrents to parental mental health service use on behalf of their children. This study focused on the relationship between caregiver strain, social support, and mental health service use among African American mothers of children at-risk or meeting criteria for a disruptive behavioral disorder and living in urban communities of concentrated poverty. Mothers (n = 89), participating in a five-year NIMH funded study of school-based community mental health services, completed measures at baseline of caregiver strain and both perceived and received social support. Service use was calculated as the sum total of services (sessions) received. Associations between caregiver strain and service use were examined, and perceived and received social support were explored as potential moderators. Baseline covariates included child’s age, gender, symptom severity, and maternal employment status. Findings highlighted child symptom severity as the strongest predictor of caregiver strain and perceived social support as moderating the association between caregiver strain and service use. Mothers were more likely to utilize services when experiencing relatively high levels of perceived support or high caregiver strain but not both, highlighting the importance of their interrelationship. Received support did not moderate the association between strain and service use. In addition, mothers utilized services more often for sons than daughters and when unemployed. Implications for research and practice are discussed.

Background: Recognized by public health agencies as a target to promote developmental and educational equity, the primary care setting offers an ideal opportunity to reach millions of children who live in low-income communities. However, how to more efficiently leverage the primary care setting to deliver a sustainable and effective preventive intervention to promote positive parenting behaviors that encourage early childhood development remains a challenge. We designed Sit Down …

OBJECTIVE. The current study examined associations among organizational social context, after-school program (ASP) quality, and children’s social behavior in a large urban park district. METHOD. Thirty-two park-based ASP are included in the final sample, including 141 staff and 593 children. Staff reported on organizational culture (rigidity, proficiency, resistance) and climate (engagement, functionality, stress), and children’s social skills and problem behaviors. Youth and their parents reported on program quality indicators (e.g., activities, routines, relationships). Parents also completed a children’s mental health screener. A series of Hierarchical Linear RESULTS. Models revealed that proficiency and stress were the only organizational predictors of program quality; associations between stress and program quality were moderated by program enrollment and aggregated children’s mental health need. Higher youth and parent perceived program quality related to fewer staff-reported problem behaviors, while overall higher enrollment and higher aggregated mental health need were associated with fewer staff-reported social skills. CONCLUSIONS. Data are informing ongoing efforts to improve organizational capacity of urban after-school programs to support children’s positive social and behavior trajectories.

Objective More than 200 million children younger than the age of 5 years fail to reach their full developmental potential in low- and middle-income countries (LMICs). The purpose of this study was to describe the feasibility of integrating a brief program to promote early childhood development within a health care setting serving a predominantly rural population in India. Methods We conducted a prospective, noncomparative, mixed-methods study. An adapted parent-directed program was administered to caregivers of 2- to 6-month-old children while waiting for their health care provider. Caregivers completed baseline and 4-week follow-up surveys. Thematic analyses and generalized equation estimates were used for analyses in the following feasibility indicators: acceptability, demand, implementation and practicality, and limited efficacy testing. Results Forty-seven caregivers were recruited; most were women (98%) and had equal to or less than 12 years of schooling (61%). Forty-six of 47 participants completed the follow-up at 1 month. Three administrators were trained to deliver the program over the course of 2 days. Caregivers perceived a need for the program and found the content and structure of the program useful. However, there were important suggestions for improvement, including greater visual content and dissemination to nonparental caregivers and fathers. Significant increases were seen on self-reported parenting behaviors regarding a child's caregiving environment. Conclusion Our findings support the feasibility of integrating an adapted, low-intensity program in a primary care setting in India, but important adaptations and considerations will need to be addressed before effectiveness testing on a wider scale. We discussed implications for offering sustainable population-level interventions to promote early childhood development in LMICs.

In collaboration with a large state entity, two virtual professional learning communities (VPLCs) were developed to support community mental health providers following a 12-month evidence-b...

Objectives Encouraging key parenting behaviors in early infancy may help decrease income-related developmental disparities. In this study we assessed whether a brief, primary care-based program (Sit Down and Play; SDP) could be successful in impacting key parenting behaviors that promote early childhood development. Methods An ethnically diverse group of predominantly low-income caregivers of children 2-6 months of age were enrolled, interviewed, and randomized to intervention (n = 20) or control (n = 20) groups. Intervention families received SDP at recruitment and the subsequent well-child visit. Control families were provided handouts regarding developmental milestones. One month after the second well-child visit, all families were reinterviewed (n = 34; 85% retention rate). Using open-ended questions and standardized measures (i.e., StimQ), parents were asked about parenting behaviors central to children's development: (1) participation in cognitively stimulating activities, (2) provision of learning materials, and (3) the quality of parent-child verbal interactions. Potential impact on perceived parenting confidence was also explored utilizing The Parenting Sense of Competence Scale. Analyses were conducted using chi square tests and analysis of variance. Results A significant main effect of time, and as hypothesized, an interaction between time and condition emerged that favored SDP on play behaviors (p = 0.03). Post-intervention, SDP families had significantly higher levels of interactional activities between a parent and child that promote cognitive development (p = 0.02). Conclusions for Practice Results appear promising for an accessible, low-intensity program delivered in the primary care setting. Further studies to determine the effectiveness of SDP on parenting behaviors and subsequent developmental outcomes are warranted.

Schools remain among the most frequent providers of children’s mental health services, particularly in low income urban settings. Several decades of research have focused on training teachers to implement evidence-based interventions for minimizing disruptive behavior. Studies consistently demonstrate robust improvements in student behavior and learning; however, the impact on teachers’ work-related stress or satisfaction is not well understood. Six urban, high poverty elementary schools were randomly assigned to a school mental health services model (Links to Learning; L2L) for referred, disruptive students or to services and professional development as usual (SAU). Teachers (n = 71, K-4 general education teachers) in L2L schools participated in professional development and consultation in two universal and two targeted interventions to reduce disruptive behaviors and promote learning. Teachers (n = 65) in SAU schools participated in professional development as usual. Multiple regression models examined teacher reports of individual-level self-efficacy, classroom-level student functioning, and school-level organizational health as predictors of stress and satisfaction. Findings revealed no significant difference between conditions on teacher work-related stress or satisfaction. Organizational health was the strongest predictor of stress and satisfaction. Training on and implementation of evidence-based classroom interventions did not appear to significantly impact teachers’ work-related stress or satisfaction. Instead, findings point to organizational climate and teacher connectedness as potential levers for change, supporting prior work on teacher stress and satisfaction in schools. The significance of targeting organizational factors may be particularly significant in urban school districts.

An extensive literature documents the numerous interrelated stressors families in poverty face, and associated risks for children's wellbeing. Positive parenting holds tremendous promise as a counterbalance to these risks; thus, evidence-based parenting programs represent one of the most important approaches in the arsenal of services for children and youth in poverty. However, logistic and perceptual barriers with particular relevance for low-income families contending with multiple stressors prevent many parents from engaging in supportive services. Applying an ecological public health model, we present evidence for innovative service models from within and outside of the parenting literature that provide support to individuals and families in communities of poverty, highlighting aspects of service models that align with the needs of high poverty families. Specifically, we review evidence that parenting programs may reach and engage more families if services are 1) led by fellow community members to align with cultural norms and multiply opportunities for service provision; 2) embedded in key settings such as homes and schools with flexibility to bridge settings; 3) aligned with the goals and needs of those settings, and bundled with other services to address families' pressing needs, thereby taking a “family-centered” form; and 4) offered through multiple formats, from traditionally formatted sequenced curricula to informal conversations infused with core parenting principles. Expanding the workforces, settings, intervention foci, and formats that can support parents' adoption of positive parenting practices may reduce the research to practice gap for some of our nation's most vulnerable children and families.

Children stand to lose if the federal government follows through on threats to cut funding for critical safety-net programs that have long supported families and communities. Although cuts directly targeting children's mental health are a great concern, cuts to policies that support health, housing, education, and family income are equally disturbing. These less publicized proposed cuts affect children indirectly, but they have direct effects on their families and communities. The importance of these services is supported by an extensive body of social learning research that promotes collective efficacy-neighbors positively influencing each other-shown to have positive long-term effects on children's development and adult outcomes. In this article, the authors describe two federal programs that by virtue of their impact on families and communities are likely to promote collective efficacy and positively affect children's mental health; both programs are facing severe cutbacks. They suggest that states adopt a cross-system approach to promote policies and programs in general medical health, mental health, housing, education, welfare and social services, and juvenile justice systems as a viable strategy to strengthen families and communities and promote collective efficacy. The overall goal is to advance a comprehensive national mental health policy for children that enhances collaboration across systems and strengthens families and communities, which is especially critical for children living in marginalized communities.

Paraprofessional workforces are becoming more common and can serve the otherwise unmet needs of diverse children and families. Compared to other workforces, limited research to date has explored factors such as stress and burnout that influence the sustainability of this workforce. Mindfulness-based interventions have been studied as stress-reduction programs for other workforces, but it is currently unknown whether mindfulness is acceptable to paraprofessionals, particularly those of a diverse ethnicity living in low-income, urban environments. The current investigation is a pilot study examining whether six weeks of mindfulness-based skills training can reduce stress, burnout, and improve sleep quality among a diverse paraprofessional workforce. Twenty six paraprofessionals (ages 24–58, M = 37.04, SD = 9.65) completed measures pre-training, post-training, and at a four week follow-up. Results indicated that this paraprofessional workforce found mindfulness practices acceptable and experienced significant reductions in perceived stress and emotional exhaustion, as well as improved sleep quality (p

Objective: This article describes the demographic distribution of, and association between, neighborhood disorganization and mental health diagnosis by race in a large cohort of urban children with chronic medical conditions. Methods: Data for this study were from Coordinated Healthcare for Complex Kids (CHECK), a health care demonstration project funded by the Center for Medicare and Medicaid Innovation. We conducted regression analyses to examine the relationship between neighborhood disorganization and mental health diagnosis among 6,458 children enrolled in CHECK. Results: The most common mental health diagnoses were mood disorders (8.6%), Attention-Deficit/Hyperactivity Disorder (7.4%), conduct disorders (6.1%), and anxiety disorders (4.8%). Black children had the highest neighborhood disorganization scores compared with other racial/ethnic categories. However, Black children had the lowest proportion of mental health diagnoses. Lower neighborhood disorganization was associated with having a mental health diagnosis; however, when adding race/ethnicity to the model, neighborhood disorganization no longer was significant. Conclusions: Level of neighborhood disorganization was highly correlated with racial/ethnic composition of the neighborhoods, and Black children disproportionately resided in highly disorganized neighborhoods compared with other groups. Neighborhood disorganization may not have sufficient variability within the racial/ethnic categories, which may explain the absence of an interaction between race/ethnicity and mental health diagnosis.

The primary care office offers an ideal setting to encourage parenting behaviors that promote early childhood development. We conducted a pilot study to establish feasibility and acceptability of Sit Down and Play (SDP), a brief primary care-based program to facilitate positive parenting behaviors through take-home play activities. A prospective 1-month study was conducted in an urban primary care clinic. SDP was administered to 30 caregivers of 6–12 month old children while they waited for their well-child appointment. Caregivers completed baseline and 4-week follow-up surveys. Open-ended interview questions regarding acceptability and usefulness of SDP were administered and analyzed using content analysis. Parenting practices related to child development were measured with standardized measures and changes analyzed using paired t-test and linear mixed effects models. Most caregivers were mothers (90%) and non-white (97%); the majority of children received Medicaid (87%). There were significant increases in parental reports of practices related to child development (p

School psychologists have training and expertise in consultation and evidence-based interventions that position them well to support early career teachers (ECTs). The current study involved iterative development and pilot testing of an intervention to help ECTs become more effective in classroom management and engaging learners, as well as more connected to colleagues. The intervention included group seminars, professional learning communities, and coaching. The sample included 15 ECTs and 57 school personnel in three high-poverty, urban schools. Feasibility and initial promise of the intervention were examined using a mixed-method design, which yielded promising trends in ECTs' effectiveness and connectedness. ECTs described facilitators to effectiveness and connectedness associated with the intervention and barriers associated with the structural realities of schools and gaps in their training. ECTs described effectiveness as neither static nor global and perceived meaningful progress, leveragi...

A primary barrier to translation of clinical research discoveries into care delivery and population health is the lack of sustainable infrastructure bringing researchers, policymakers, practitioners, and communities together to reduce silos in knowledge and action. As National Institutes of Health's (NIH) mechanism to advance translational research, Clinical and Translational Science Award (CTSA) awardees are uniquely positioned to bridge this gap. Delivering on this promise requires sustained collaboration and alignment between research institutions and public health and healthcare programs and services. We describe the collaboration of seven CTSA hubs with city, county, and state healthcare and public health organizations striving to realize this vision together. Partnership representatives convened monthly to identify key components, common and unique themes, and barriers in academic-public collaborations. All partnerships aligned the activities of the CTSA programs with the needs of the city/county/state partners, by sharing resources, responding to real-time policy questions and training needs, promoting best practices, and advancing community-engaged research, and dissemination and implementation science to narrow the knowledge-to-practice gap. Barriers included competing priorities, differing timelines, bureaucratic hurdles, and unstable funding. Academic-public health/health system partnerships represent a unique and underutilized model with potential to enhance community and population health.

Community health workers (CHWs) offer many advantages for effective dissemination of mental health interventions, and thus a potential means through which to mitigate the many barriers to treatment faced by minority youth and their families. However, studies using CHWs have mainly focused on whether interventions implemented by this workforce are effective, while leaving much unknown about the nature of CHWs’ role and the key elements that make them effective. The primary aim of the present study was to better understand one of the central components defining the CHW role: their shared community membership with the population served. We used the term social proximity to refer to this closeness to the population served, and to encapsulate the shared characteristics, background, and experiences that could comprise defining features of community membership. In order to better characterize and understand social proximity, we interviewed 16 CHWs (called Student-Family Liaisons, or SFLs) implementing a school-based early intervention program (Partners Achieving Student Success, or PASS) in Latino and African American communities of urban poverty. The program targeted promoting child and parent engagement in schooling as a protective factor for children’s mental health. SFLs were interviewed about the strategies, characteristics, and elements of their role that they leveraged in connecting with and engaging families. Thematic analyses of semi-structured interviews revealed four main themes defining social proximity for this CHW workforce: (1) experiences of parenthood or caring for children, (2) knowledge and understanding of practices or experiences related to ethnicity/race, (3) familiarity with and understanding of the neighborhood community, and (4) experiences of life hardships and struggles. These elements of social proximity were featured most prominently in the engagement strategy of relating. SFLs’ accounts illustrated how their experience of social proximity was informed by specific typologies of similarities (experiential and deep-level), contextually relevant similarities, and program-based similarities. Additionally, these accounts highlight the need for supporting, promoting, and celebrating the natural traits and lived experiences of CHWs, for these are the defining features that make this workforce unique and also what CHWs consistently draw upon when connecting with community members during service delivery.

This study explored the role of paraprofessionals within a school-based prevention and early intervention program to promote children's engagement in learning and positive parenting practices. Study aims were designed to understand how paraprofessionals perceive their role in high-need communities and how they define their work within schools. Two focus groups were conducted with school family liaisons (SFLs) during the 2015-2016 school year. Transcribed audio recordings were coded using thematic analysis wherein 2 authors coded independently, followed by audited discussion and final consensus codes. SFLs acknowledged the importance of serving high-need communities and relationship building was central to their role. They leveraged contextual knowledge (culture, language, and neighborhood) to engage parents, allowing them to serve as effective advocates for parents/families in the school setting. Findings support the importance of paraprofessionals in prevention-focused services and highlight how leveraging shared experiences and prioritizing relationship building facilitates their work as advocates within schools.

Children's service systems are faced with a critical need to disseminate evidence-based mental health interventions. Despite the proliferation of comprehensive implementation models, little is known about the key active processes in effective implementation strategies. This proof of concept study focused on the effect of change agent interactions as conceptualized by Rogers' diffusion of innovation theory on providers' (N = 57) use of a behavioral intervention in a child welfare agency. An experimental design compared use for providers randomized to training as usual or training as usual supplemented by change agent interactions after the training. Results indicate that the enhanced condition increased use of the intervention, supporting the positive effect of change agent interactions on use of new practices. Change agent types of interaction may be a key active process in implementation strategies following training.

Recent health care legislation and shifting health care financing strategies are transforming health and behavioral health (a broad term referring to mental health, substance use, and health behavior) care in the United States. Advances in knowledge regarding effective treatment and services coupled with incentives for innovation in health and behavioral health care delivery systems make this a unique time for mobilizing our science to enhance the success of health and behavioral health care redesign. To optimize the potential of our current health care environment, a team was formed composed of leaders from the Societies of Clinical Child & Adolescent Psychology, Pediatric Psychology, and Child and Family Policy and Practice (Divisions 53, 54, and 37 of the American Psychological Association). This team was charged with reviewing the scientific and policy literature with a focus on five major issues: (a) improving access to care and reducing health disparities, (b) integrating behavioral health care within primary care, (c) preventive services, (d) enhancing quality and outcomes of care, and (e) training and workforce development. The products of that work are summarized here, including recommendations for future research, clinical, training, and policy directions. We conclude that the current emphasis on accountable care and evaluation of the outcomes of care offer numerous opportunities for psychologists to integrate science and practice for the benefit of our children, families, and nation. The dramatic changes that are occurring in psychological and behavioral health care services and payment systems also require evolution in our practice and training models.

Classrooms are unique and complex work settings in which teachers and students both participate in and contribute to classroom processes. This article describes the measurement phase of a study that examined the social ecology of urban classrooms. Informed by the dimensions and items of an established measure of organizational climate, we designed the Student Climate Survey ( n = 53 items) to assess student psychological climate in third through eighth grades. We administered the survey to 621 students at three time points within one school year in 69 classrooms within eight urban schools. A multidimensional item response theory (IRT) analysis based on a full-information item bifactor model revealed 18 items that loaded on a primary factor and demonstrated good criterion and predictive validity. Opportunities for the Student Climate Survey to advance our contextual understanding of urban classrooms and inform intervention are discussed.

Schools have long been the primary setting for children's mental health services but have neither the resources nor the expertise to manage these services independently. The critical importance of school success for children's adjustment provides a strong rationale for schooling as an essential component of children's mental health services. In this article, we review evidence for how schooling and mental health coalesce, suggesting an alignment of school and community mental health resources that prioritizes successful schooling as a key mental health outcome. We describe collaborative principles and ecological practices that advance a public health focus on children's mental health while also reducing the burden on schools to maintain mental health services. We close with a model of mental health services illustrating these principles and practices in high-poverty urban schools and propose future directions for research and practice to promote positive mental health for all children and youth.

This study explored the effects of family, peer, and school risk and supportive factors on internalizing problems (i.e., depressive and anxiety symptoms). Risk factors included peer (i.e., relational and overt victimization) and family risk factors (i.e., mother/father alienation and family conflict). Protective factors included peer (i.e., peer trust and communication), family (i.e., parent trust and communication), and school supportive factors (i.e., bonding with a teacher and school interest). Based on a sample of low-income, Chinese immigrant, high school students (N 286), structural equation modeling was used to investigate main effects of family, peer, and school risk and supportive factors on internalizing problems as well as the moderating effects of supportive factors on the link between risk factors and internalizing problems. Peer and family risk factors as well as family and school supportive factors significantly predicted anxiety and depressive symptoms in the expected directions. However, peer supportive factors did not predict internalizing problems. The moderation analyses revealed that only school supportive factors moderate the effects of family risk factors on internalizing problems. Implications for research and counseling with Asian immigrants are discussed.

As changes in health-care delivery impel us to refine clinical science training, the opportunity arises to reconceptualize internship training to align more closely with clinical science values and outcomes. We present observations on the evolution of internship training with a focus on the following issues. First, we highlight the significance of a public-health perspective for clinical science as a basis for refining training goals and practices. Second, we briefly review how internship training evolved (where it has come from) to set the context for continuing evolution (where it might go). Third, we discuss the need for an expanded definition of clinical competence for clinical science training to better align with innovations in health care and to prepare graduates for new career opportunities. Finally, we present examples of new models for internship training that might accommodate the continuing redefinition of internship training in clinical science.

In 2005, the Illinois State Mental Health Authority embarked on an initiative to close the gap between research and practice in the children's mental health system. A stakeholder advisory council developed a plan to advance evidence informed practice through policy and program initiatives. A multilevel approach was developed to achieve this objective, which included policy change, stakeholder education, and clinician training. This article focuses on the evidence-informed training process designed following review of implementation research. The training involved in-person didactic sessions and twice-monthly telephone supervision across 6 cohorts of community based clinicians, each receiving 12 months of training. Training content initially included cognitive behavioral therapy and behavioral parent training and was adapted over the years to a practice model based on common element concepts. Evaluation based on provider and parent report indicated children treated by training clinicians generally showed superior outcomes versus both a treatment-as-usual comparison group for Cohorts 1 to 4 and the statewide child population as a whole after 90 days of care for Cohorts 5 to 6. The results indicated primarily moderate to strong effects for the evidence-based training groups. Moving a large public statewide child mental health system toward more effective services is a complex and lengthy process. These results indicate training of community mental health providers in Illinois in evidence-informed practice was moderately successful in positively impacting child-level functional outcomes. These findings also influenced state policy in committing resources to continuing the initiative, even in difficult economic times.

The benefits of evidence-based practice (EBP) and the utilization of evidence-based treatments (EBTs) is well documented in the professional practice and training literature. However, the literature explaining methods by which to train and supervise professionals in these areas is less clear. To facilitate the highest level of clinical care, mental health trainee, professionals, and those who educate and supervise clinicians will benefit from identifying and evaluating effective and efficient methods for implementing EBP and EBTs. This manuscript reports on three programs across the training and professional continuum that provide training and supervision/consultation on EBT. Commonalities among the program include an individualized training approach, the use of active learning strategies, and measuring individuals’ progress in learning and/or outcomes. Data regarding student response to EBP and EBT training in graduate study is provided. Additionally, a model for internship training in clinical research and clinical practice is described. Finally, pilot data is provided regarding training methods for preparing professional clinicians to provide an EBT. The development of models addressing EBP and EBT in academic, training and professional practice areas is instrumental in developing skilled clinicians and researchers able to address the clinical needs of their clients

This study examined the factor structure of the Organizational Health Inventory-Elementary version (OHI-E; Hoy et al. in Open schools/healthy schools: measuring organizational climate. Sage, Beverly Hills, CA, 1991) in a sample of 203 teachers working in 19 high-poverty, urban schools and the association of organizational school health with teacher efficacy, teacher stress, and job satisfaction. Results indicated a similar factor structure of the OHI-E as compared with the population of schools in the original sample (Hoy et al. in Open schools/healthy schools: measuring organizational climate. Sage, Beverly Hills, CA, 1991), and that specific components of organizational health, such as a positive learning environment, are associated with teacher efficacy, stress, and satisfaction. Overall, teachers’ relations with their peers, their school leadership, and their students appear especially critical in high-poverty, urban schools. Recommendations for research and practice related to improving high-poverty, urban schools are presented.

Garland et al.’s comprehensive review of the state of clinic-based community-based mental health care for U.S. children highlights many recent advances in usual care (UC) while also describing the continued gap between need and service provision, the limited effectiveness of services provided, and a number of other obstructions and dilemmas ranging from perceived stigma on the part of families to limited fiscal resources on the part of service providers. Based on these long-standing concerns, the review summarizes research on three foci for change and offers future directions for each: Enhanced engagement strategies to retain families in services, improved training and support to increase the use of evidenced based practices, and expanded measurement and feedback systems to monitor services in real time. Unaddressed, however, is whether these changes are sufficient to reform children’s mental health care. Even if enacted extensively and outstandingly – a feat we imagine that nobody familiar with UC would realistically expect – will unmet need for care improve and effective services be available to the large number of children in need of mental health services?

The objective of this study is to test the feasibility and impact of a 10-wk after-school exercise program for children with attention deficit hyperactivity disorder and/or disruptive behavior disorders living in an urban poor community.Children were randomized to an exercise program (n = 19) or a comparable but sedentary attention control program (n = 16). Cognitive and behavioral outcomes were collected pre-/posttest. Intent-to-treat mixed models tested group-time and group-time-attendance interactions. Effect sizes were calculated within and between groups.Feasibility was evidenced by 86% retention, 60% attendance, and average 75% maximum HR. Group-time results were null on the primary outcome, parent-reported executive function. Among secondary outcomes, between-group effect sizes favored exercise on hyperactive symptoms (d = 0.47) and verbal working memory (d = 0.26), and controls on visuospatial working memory (d = -0.21) and oppositional defiant symptoms (d = -0.37). In each group, within-group effect sizes were moderate to large on most outcomes (d = 0.67 to 1.60). A group-time-attendance interaction emerged on visuospatial working memory (F[1,33] = 7.42, P0.05), such that attendance to the control program was related to greater improvements (r = 0.72, P0.01), whereas attendance to the exercise program was not (r = 0.25, P = 0.34).Although between-group findings on the primary outcome, parent-reported executive function, were null, between-group effect sizes on hyperactivity and visuospatial working memory may reflect adaptations to the specific challenges presented by distinct formats. Both groups demonstrated substantial within-group improvements on clinically relevant outcomes. Findings underscore the importance of programmatic features, such as routines, engaging activities, behavior management strategies, and adult attention, and highlight the potential for after-school programs to benefit children with attention deficit hyperactivity disorder and disruptive behavior disorder living in urban poverty where health needs are high and services resources few.

This study examined a model for mental health consultation, training and support designed to enhance the benefits of publicly-funded recreational after-school programs in communities of concentrated urban poverty for children's academic, social, and behavioral functioning. We assessed children's mental health needs and examined the feasibility and impact of intervention on program quality and children's psychosocial outcomes in three after-school sites (n = 15 staff, 89 children), compared to three demographically-matched sites that received no intervention (n = 12 staff, 38 children). Findings revealed high staff satisfaction and feasibility of intervention, and modest improvements in observed program quality and staff-reported children's outcomes. Data are considered with a public health lens of mental health promotion for children in urban poverty.

Children in high poverty urban schools experience mental health difficulties and academic underachievement at elevated rates (Atkins, Hoagwood, Kutash, & Seidman, 2010; Whipple, Evans, Barry, & Maxwell, 2010). Underfunded schools struggle to meet student needs and teachers report difficulties motivating and managing students (Reinke, Stormont, Herman, Puri, & Goel, 2011). Observations in elementary classrooms reveal inconsistent access to effective classrooms in schools with high proportions of economically disadvantaged students (Pianta, Belsky, Houts, Morrison, & NICHD Early Child Care Research Network, 2007). Effective classrooms are defined by the presence of supportive teacher-student interactions (instructional, emotional, and behavioral) which together create a classroom environment conducive to academic and social-emotional development (Hamre & Pianta, 2010). When children with adjustment problems are in effective classrooms, their achievement has been shown to match that of their typically developing peers (Hamre & Pianta, 2005). Promoting effective teaching practices in elementary classrooms in low-income schools may thus benefit the adaptation of all students – those with and without behavioral difficulties. Recent efforts to promote effective teaching through teacher consultation and classroom coaching have been promising. Preschool teachers in high poverty schools who received training, coaching, and consultation improved in their management of behavior and provision of emotional support; and, children increased their self-regulation skills and academic performance beyond the skills and performance of comparison children (Raver et al., 2008; Raver et al., 2011). Similarly, in elementary schools assigned to receive training and coaching as a part of a social-emotional and academic learning program (4Rs; Brown, Jones, LaRusso, & Aber, 2010), intervention teachers demonstrated greater instructional and emotional support compared to control group teachers. The promise of these models is tempered by concerns about sustainability. Across studies, researchers employ external coaches and consultants as primary interventionists (e.g., Jones, Brown, & Aber, 2011; Raver et al., 2008). These interventionists are unfamiliar to teachers at the start of the study and depart when the study ends. Recent scholarship suggests the importance of considering issues of intervention feasibility and sustainability from the start (Aarons, Hurlburt, & Horwitz, 2011; Wandersman et al., 2008). Employing individuals already working in the school to deliver novel interventions may increase their sustainability (Atkins et al., 2008). In addition, to advance the learning and development of children with behavioral difficulties and their classmates, school mental health services may need to be re-conceptualized to include a focus on universal prevention (Nastasi, 2004) and effective classrooms (Cappella, Frazier, Atkins, Schoenwald, & Glisson, 2008). Accordingly, we designed and evaluated a teacher consultation and coaching program – Bridging Mental Health and Education in Urban Schools (BRIDGE; Cappella, Jackson, Wagner, Hamre, & Soule, 2011) – to increase effective classroom interactions and improve the functioning of children with behavioral challenges and their classmates. Embedded within the regular activities of school mental health professionals, BRIDGE represents a step toward the broader goal of enabling school and community mental health resources to support effective classrooms. Rather than focus only on the whole classroom or students with behavioral problems, BRIDGE applies a two-tiered approach to improving classroom interactions for all children (universal) and children with behavioral difficulties (targeted). A randomized trial of the initial effects of this program illuminates the extent to which school mental health staff can support teachers to increase effective teaching and promote the academic, behavioral, and social adaptation of children in urban poor schools.

Despite alarming rates and negative consequences associated with urban teacher attrition, mentoring programs often fail to target the strongest predictors of attrition: effectiveness around classroom management and engaging learners; and connectedness to colleagues. Using a mixed-method iterative development framework, we highlight the process of developing and evaluating the feasibility of a multi-component professional development model for urban early career teachers. The model includes linking novices with peer-nominated key opinion leader teachers and an external coach who work together to (1) provide intensive support in evidence-based practices for classroom management and engaging learners, and (2) connect new teachers with their larger network of colleagues. Fidelity measures and focus group data illustrated varying attendance rates throughout the school year and that although seminars and professional learning communities were delivered as intended, adaptations to enhance the relevance, authenticity, level, and type of instrumental support were needed. Implications for science and practice are discussed.

Kazdin and Blase aptly describe the enormous mental health burden facing our nation and suggest several ways to reform the workforce, setting, and content of services to address this long-standing unmet need. We propose that current health care reform legislation and associated advances in service delivery provide a unique and timely opportunity for a paradigm shift in mental health research, practice, and training to support services that are comprehensive, readily accessible, and relevant to a broad range of mental health needs and capacities. Using the recent public health initiative to contain the H1N1 virus for comparison, and informed by a long-standing and extensive literature documenting the need for a public health model for mental health, we describe the rationale for a three-tiered public mental health model, illustrated with examples from ongoing research, to minimize universal risk for mental health difficulties via capacity building in natural settings; reduce onset and severity of symptoms by prioritizing high-risk groups via screening and services for targeted populations; and reduce psychiatric impairment among individuals with more intensive needs via individual, family, and group interventions. New priorities for clinical science to support a public health approach are proposed.

This study examines the association between classroom characteristics and teacher–student agreement in perceptions of students' classroom peer networks. Social network, peer nomination, and observational data were collected from a sample of second through fourth grade teachers (N = 33) and students (N = 669) in 33 classrooms across five high-poverty urban schools. Results demonstrate that variation in teacher–student agreement on the structure of students' peer networks can be explained, in part, by developmental factors and classroom characteristics. Developmental increases in network density partially mediated the positive relationship between grade level and teacher–student agreement. Larger class sizes and higher levels of normative aggressive behavior resulted in lower levels of teacher–student agreement. Teachers' levels of classroom organization had mixed influences, with behavior management negatively predicting agreement, and productivity positively predicting agreement. These results underscore the importance of the classroom context in shaping teacher and student perceptions of peer networks.

Although urban teachers are at-risk of experiencing significant work-related stress, urban teacher stress has been neglected in the research literature to date. Through semi-structured interviews conducted with a sample of K-4 urban teachers (N = 14) from three high-poverty schools in a large, Midwestern city, we examined teachers’ perceptions regarding sources and impact of stress and the resources needed to address identified stressors. Results from consensual qualitative research (CQR; Hill et al. in Couns Psychol, 25:517–572, 1997; Hill et al. in Consensual qualitative research: an update, 2005) suggest that at least one-half of the cases identified lack of resources, excessive workload, school-level disorganization, managing behavior problems, and accountability policies as significant sources of stress. The majority of teachers reported that occupational stress significantly impacted their personal relationships and physical health, and teachers identified human and material resources as most important to reducing work-related stress. Implications for organizationally based interventions and school policies to address urban teacher stress are discussed.

This study informs community science, and seeks to narrow the research-to-practice gap, by examining how the interpersonal networks within a setting influence individuals’ use of interventions. More specifically, it explores the role of two network mechanisms—cohesion and structural similarity—in urban elementary school teachers’ use of interventions designed to improve academic and behavioral outcomes for students. Lagged regression models examine how position in advice giving networks influenced weekly use of the daily report card and peer assisted learning by kindergarten through fourth grade teachers in three schools. Results indicate that intervention use spreads among teachers with similar patterns of advice-giving relationships (i.e., via structural similarity), rather than from teachers who are sources of advice (i.e., via cohesion). These results are consistent with findings in other settings, and suggest that researchers wishing to increase the use of an intervention should select change agents based on their patterns of their relationships, rather than on their direct connections.