This application will study a model for school-based mental health services for urban low-income children and families that is guided by empirical evidence for schooling as critical for children's social and emotional adjustment, and by evidence for the direct and indirect benefits of academic achievement for children's mental health. A primary hypothesis of this proposal is that aligning mental health resources to support children's learning will lead to stronger mental health outcomes for children, relative to mental health services as usual. The model builds on cumulative evidence from a program of NIMH-funded research based in inner city Chicago Public Schools in which community mental health providers collaborated with (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 (key opinion leaders) to influence classroom teacher's use of behavior management strategies. This proposal replicates and extends these collaborative models to focus on the most robust teacher and parent predictors of student learning. The proposal also builds on an ongoing collaboration between the research team with the Illinois State Division of Mental Health and the Chicago Public Schools, to inform public policy on the development of effective models for community mental health collaboration with urban schools. The key research questions will be examined by a 2 conditions (Experimental vs. Comparison) X 5 time points (baseline, time 2, time 3, time 4, follow-up) longitudinal design with random assignment of 15 schools to conditions from a pool of 43 eligible schools of similar size, ethnic representation, poverty level, and achievement in adjacent high poverty neighborhoods. Children (n = 473) with one or more Disruptive Behavior Disorder in Kindergarten through 4th grades will be identified by teacher screening and follow-up standardized parent and teacher ratings. Fifteen schools will be randomly selected and assigned to either a comparison mental health services-as-usual condition, or to the experimental intervention condition, in which mental health providers (MHPs) will work in collaboration with key opinion leader (KOL) teachers, and parent advocates (PAs) to provide consultation to children's classroom teachers and parents on evidence-based strategies for targeted predictors of children's learning. It is hypothesized that, relative to comparison sites, the experimental school mental health intervention will lead to improvement in children's academic performance, behavior at home, and behavior at school relative to the treatment-as-usual comparison. Mediational effects of teacher and parent performance on predictors of learning will be examined along with possible moderating effects of child, family, and teacher characteristics. The experimental model is consistent with recent calls for a contextually-relevant understanding of children's mental health needs and capacities, and responds to the need for alternative models for mental health service delivery in impoverished, vulnerable, and under-served communities. -
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