This project responds to the need for (1) affordable and sustainable 'indicated' preventive interventions for young children already showing emerging mental health problems, and for (2) interventions that can be delivered effectively in accessible, 'real-world' settings. This proposal seeks RO1 funding for a randomized controlled trial (RCT) to evaluate the efficacy of the Promoting Resilient Children Initiative (PRCI) in Deducing mental health problems among urban, minority children and in preventing future disorders and costly services. The PRCI is a second-generation adaptation of the Primary Mental Health Project (PMHP). The school-based PMHP was developed 40 years ago by Cowen and colleagues and has been disseminated to 1,500 schools in the U.S. The PMHP program's strengths include ecological validity for schools and moderate cost.. PRCI significantly modifies both the intervention content and method of implementation used in PMHP. In PRCI children learn behavioral and cognitive skills for emotion regulation and for coping in 24 sessions with school-based Mentors. In 10 home visits the Mentors teach parents to assist their children in developing skills. A preliminary trial of PRCI suggests that the intervention reduces children's problems in the short-term and has a larger impact than PMHP on targeted behavioral and emotional outcomes. This trial is needed to determine the longer-term efficacy of the PRCI intervention. For the proposed 5-year study, 200 children will be randomly assigned to PRCI intervention and 200 to control conditions from 75 classrooms in 5 urban schools. (1)""""""""We will compare intervention and control levels of externalizing and internalizing problems, need for services, and indices of family functioning over 30 months to assess program efficacy. (2) We will seek to determine levels of implementation fidelity required to achieve positive outcomes. (3) We will test hypotheses about mechanisms that govern the impact of PRCI on children's development. This project can have a positive public health impact through the potential to expand an improved intervention to more than 1,000 schools currently implementing PMHP and to other schools in the U.S. From the standpoint of advancing prevention science, the proposed study can contribute to knowledge needed to improve interventions in communities and the effective use of specially trained non-professional intervenors.
