School-Based Mental Health Services for Urban Children

Study Description

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

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.

Condition or disease	Intervention/treatment	Phase
Conduct Disorder; Oppositional Defiant Disorder; Attention Deficit Disorder With Hyperactivity	Behavioral: Community mental health consultation model program; Behavioral: Treatment as usual (TAU)	Not Applicable

Detailed Description:

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 evaluated 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 involved parent, child, and teacher participants. During Year 1, teacher participants attended a professional development series that focused on strategies that classroom teachers can use to help children with learning and behavior problems at school. The series involved weekly 30-minute sessions, which were held before and after school hours, for a total of 6 months. Teachers completed a brief survey about the content and structure of sessions at the end of each session and gave a monthly review on how they applied their new strategies in the classroom setting. Teachers continued to attend booster sessions of up to 1 hour each month during Year 2. Teachers also participated in periodic case consultation meetings with parents and mental health providers to further develop ways to improve student participants' learning and behavior.

Child participants received either the community mental health program associated with their school or received general clinic-based services (Treatment as usual). The school component of the mental health program consisted of a classroom environment in which the teachers implemented their newly learned strategies to enhance the academic and behavioral performance of the child participants. Parents of child participants in the community mental health program were invited to attend a series of parent/teacher meetings and home visits where mental health service providers discussed strategies that parents and teachers can use to help improve their children's learning and behavior. Parents completed a brief questionnaire at the end of each meeting and gave a monthly review of how they implemented their new strategies in the home setting. Parents continued to communicate with research staff regarding services provided throughout the study.

Assessments for all participants occurred five times over 3 years. Assessments for parent participants included 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 included 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 also conducted a 2-hour classroom observation five times over 3 years. Individual child participants were also observed in the classroom by research staff for three 15-minute intervals five times over the study period.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	482 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Single (Outcomes Assessor)
Primary Purpose:	Health Services Research
Official Title:	Mental Health Services & Predictors of Learning in Urban Schools
Study Start Date :	June 2005
Actual Primary Completion Date :	May 2010
Actual Study Completion Date :	May 2010

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
Experimental: Links to Learning; Participants received the community mental health consultation model program.	Behavioral: Community mental health consultation model program; The community mental health consultation model program included 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 focused on the strongest teacher and parent predictors of student learning.; Other Name: Links to Learning (L2L)
Active Comparator: Services as Usual; Participants received treatment as usual and referrals.	Behavioral: Treatment as usual (TAU); TAU included referral to community mental health clinic-based services, where participants received standard care for mental health-related problems.

Outcome Measures

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Primary Outcome Measures :

1. Social Skills Rating System (Parent Report) [ Time Frame: Measured at pre- and post-school year for 3 years ]
   This rating scale was completed by parents to assess how frequently their child engaged in a range of disruptive, prosocial, and academic behaviors (0 = Never to 2 = Very Often). Normative data are provided by age and sex and the measure was standardized on a heterogeneous population of which one third were urban and 28% were minorities. The scale score, Social Skills, was the primary outcome measure. Scores are rated on a scale of 0 (Never) to 2 (Very Often). The scale score, Social Skills, containing 38 items, was the primary outcome measure. Scores range from 0 to 76 with higher scores indicating improved social skills.

Secondary Outcome Measures :

1. The Academic Competence Evaluation Scale (ACES) [ Time Frame: Measured at pre- and post-school year for 3 years ]
   The ACES is a teacher rating scale that describes a set of behaviors and attitudes measuring teachers' perceptions of student's academic competence and performance. The scale consists of 30 items rated on a 5-point scale (1 = Never, 2 = Seldom, 3 = Sometimes, 4 = Often, 5 = Almost Always). The total score was reported as a mean per item with higher scores indicating better academic competence. Scores could range from 1 to 30.

Eligibility Criteria

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Ages Eligible for Study:	5 Years to 12 Years (Child)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

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
• Parents and teachers of these students were also eligible to participate

Exclusion Criteria:

• Severe developmental or medical disability

Note: Teachers, parents, and mental health providers of the children enrolled in the study were also consented as per directions from our Institutional Review Board (IRB) because we were asking about sensitive information. Therefore, the ages listed below are for the children enrolled in the study as this was the determining criteria for study participation. Ages of participating adults (i.e., parents and teachers) were included in Baseline Characteristics to provide a complete description of the study participants. However, although adults participated in the study, the eligibility criteria were based on child characteristics as noted above.

Contacts and Locations

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Locations

United States, Illinois
University of Illinois at Chicago, Institute for Juvenile Research
Chicago, Illinois, United States, 60608

Sponsors and Collaborators

University of Illinois at Chicago

National Institute of Mental Health (NIMH)

Investigators

Principal Investigator:	Marc S. Atkins, PhD	University of Illinois at Chicago

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Publications:

Mehta TG, Atkins MS, Frazier SL. The Organizational Health of Urban Elementary Schools: School Health and Teacher Functioning. School Ment Health. 2013 Sep 1;5(3):144-154.

Neal JW, Neal ZP, Atkins MS, Henry DB, Frazier SL. Channels of change: contrasting network mechanisms in the use of interventions. Am J Community Psychol. 2011 Jun;47(3-4):277-86. doi: 10.1007/s10464-010-9403-0.

Neal, JW, Shernoff, ES, Frazier, S.L, Stachowicz, E, Frangos, U, & Atkins, MS (2008). Change from within: Engaging teacher key opinion leaders in the diffusion of interventions in urban schools. The Community Psychologist, 41:2, 53-57

Atkins MS, Frazier SL. Expanding the Toolkit or Changing the Paradigm: Are We Ready for a Public Health Approach to Mental Health? Perspect Psychol Sci. 2011 Sep;6(5):483-7. doi: 10.1177/1745691611416996.

Atkins MS, Hoagwood KE, Kutash K, Seidman E. Toward the integration of education and mental health in schools. Adm Policy Ment Health. 2010 Mar;37(1-2):40-7. doi: 10.1007/s10488-010-0299-7.

Responsible Party:	Marc Atkins, Professor, University of Illinois at Chicago
ClinicalTrials.gov Identifier:	NCT00612690 History of Changes
Other Study ID Numbers:	R01MH073749 ( U.S. NIH Grant/Contract ); DSIR 82-SECHC ( Other Grant/Funding Number: NIH )
First Posted:	February 12, 2008
Results First Posted:	June 4, 2014
Last Update Posted:	June 4, 2014
Last Verified:	May 2014

Keywords provided by Marc Atkins, University of Illinois at Chicago:

Children; School-Based Mental Health Services; Urban Poverty

Additional relevant MeSH terms:

Disease; Attention Deficit Disorder with Hyperactivity; Conduct Disorder; Attention Deficit and Disruptive Behavior Disorders	Pathologic Processes; Neurodevelopmental Disorders; Mental Disorders