While it is estimated that 12% of the general population in the United States under 18 suffers from a mental disorder, estimates for socio- economically disadvantaged children are 20% or higher. Unfortunately, these at-risk children often do not receive needed mental health services because of a lack of accessible services, or because their families lack the resources to obtain services. Thus, increased access for this population is critical. However, increased access to services will not alone be sufficient to meet this population's mental health needs: Effective services must be provided. The purpose of the proposed study is to: (1) increase the accessibility of children's mental health services by providing them in the children's schools; and (2) determine whether teachers can serve as an effective therapeutic proxy for parents, given that in many instances environmental conditions (e.g., living in high- stress neighborhoods) make it difficult or impossible for parents to be involved in their children's services. To achieve these objectives, children in need of but not currently receiving mental health services will be selected from 3 schools in the Metro Nashville School System serving high-risk neighborhoods. These children will be chosen based on severity and breadth of psychopathology (i.e., they will be comorbid for internalizing and-externalizing problems), and randomly assigned to receive: (1) research-based, time-limited, structured mental health services containing a parent-training component; (2) research-based, time- limited, structured mental health services containing a teacher-training component; or (3) a no-services control group. All subjects, as well as their peers, will receive five assessments of their behavioral, emotional and social functioning using a multi-domain, multi-informant assessment procedure. Analyses of these data will determine whether teacher-training programs are as effective as parent-training programs in reducing children's mental health problems. The long term goals of this research program are to develop and evaluate a series of empirically-derived children's mental health services that are appropriate for use and effective in a variety of clinical settings, including outpatient clinics and the public school system.
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