This proposal seeks to improve the effectiveness of mental health services for children with Conduct Problems (CP) and their families by evaluating the hypothesis that delivery), of services in the community settings that support and maintain CP will enhance treatment outcome, service satisfaction/use, and cost-effectiveness. Multimodal services targeting three domains: (family, school, neighborhood) that are conducted either in the Community or an outpatient Clinic will be compared in a randomized clinical trial for 140 clinically referred children (ages 6-11) with a diagnosis of Oppositional/Defiant Disorder or Conduct Disorder. Treatment will last approximately four months and will be monitored via video/audio tapes and supervision to ensure adherence. Cases will be evaluated at pretreatment, posttreatment, and at both six-month and 12-month follow-up. End-point and intent-to-treat analyses will incorporate multivariate models. After intervention and at both follow-ups cases receiving Community-based services are expected to show greater improvements than those receiving Clinic-based services on specific measures in the five assessment domains recommended for evaluation of program effectiveness (see Hoagwood et al., 1996): 1) Severity of CP symptoms (e.g., fewer CD symptoms), 2) functional status/impairment (e.g., enhanced home and school adjustment), 3) environmental context (e.g., less family coercion/violence), 4) client consumer satisfaction (e.g., higher child and parent ratings of service acceptability and usefulness), and 5) service use/system involvement (e.g., higher rates of participation). Predictive models will be tested to determine child (e.g., ADHD, social competence), parent (e.g., depression, harsh punishment) and family variables (e.g., support, conflict) associated with heightened service participation and clinical improvement, and to determine how these predictors differ by treatment setting. A final exploratory aim is designed to estimate the direct cost of providing community-based services and evaluate the cost-effectiveness of community-based services relative to clinic-based services with respect to key effectiveness variables (e.g., Conduct Disorder, family violence). The findings promise to lead to more responsive, cost-effective interventions for these high-risk youth and their families. Such research is especially timely given the controversy surrounding the willingness of third-party payers to cover these services.
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