This is a request for an ADAMHA Research Scientist Award. The overall objective of the research program is to strengthen the base of knowledge about mental health services for children and adolescents (herein referred to collectively as """"""""children""""""""). Research bearing on child services is often bifurcated into two insular streams: (a) Controlled, experimental research of modest ecological validity, and (b) Ecologically valid research of more modest experimental rigor. The research program described here is an attempt to bridge the gap, maximizing information by drawing from the strengths of both experimental and clinic-based research. The program is designed to generate a body of knowledge addressing the following questions: (l) What kinds of child problems and referral processes lead children into mental health services? (2) What factors are associated with children's persistence in, and attrition from, mental health care? (3) What are the effects of child mental health interventions? The program also explores whether answers to these questions differ as a function of child ethnicity and (where relevant) national culture. The questions are addressed through an array of methods: (a) A multi-site, longitudinal study of clinic-based child mental health care; (b) focused comparisons of mental health care data on Caucasian, Latino, and African- American youngsters; (c) complementary comparisons of data from Thailand and the U.S.; (d) multiple applications of a recently developed statistical procedure to referral problem data; and (e) multiple applications of meta-analysis to data on treatment attrition and treatment outcome. An overarching aim is to promote a conceptual synthesis, an integrated picture of how children gain access to mental health care, why they persist or drop out, and what impact services have on their functioning and adaptation. A longer-term goal is to find ways of improving children's access to mental health care, their persistence in it once they have access, and the benefits of the interventions they receive.
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