This application is being submitted in response to RFA MH-00-011 entitled """"""""Implementation of Intervention Strategies for Children with Disruptive Behaviors"""""""". Children's psychosocial problems, such as oppositional behaviors or conduct problems, are often underidentified and underserved in healthcare settings. This application seeks to evaluate the application of a specialized psychosocial treatment protocol for children with disruptive behavior problems (DBP) in pediatric primary care. The treatment procedures are derived from the investigator's existing multimodal treatment protocol whose effectiveness is being examined in the community (MH 57727; """"""""Effectiveness of Community Services for Conduct Problems""""""""). A total of 150 patients will be recruited from five pediatric primary care practices affiliated with the Children's Community Care health network. Children exhibiting DBP would be randomly assigned to the specialty treatment protocol (STP) or treatment-as-usual (TAU) in each practice. Cases assigned to STP would receive services from trained nurse-clinicians who would administer selected treatment modules in the pediatric office with designated participants (children, parents/families, teacher calls). Planned analyses will examine differences in treatment participants/process, procedures, outcomes, and cost-effectiveness as a function of treatment condition. Relative to TAU, the investigator predicts that STP will be associated with higher treatment participation rates, greater improvements in multiple clinical outcomes related to child and family functioning, and greater cost-effectiveness. Such real-world information is timely in light of changes in the types of treatments being provided to this population in pediatric primary care, the evolution of an integrated pediatric mental health care service system, and developments in clinical practice and technique based on evidence from recent empirical outcome studies. These outcomes would empirically support decisions to integrate cost-effective, specialty treatment methods in pediatric health care settings.
