The primary goal of the proposed study is to examine a multiple family group (MFG) service delivery strategy on service use and outcome for urban, low-income children of color. The study will involve school-age, inner-city children (7 to 11 years) meeting diagnostic criteria for ODD or CD, and their families, in a 16-week series of group meetings with 6 to 8 families in each group. The MFG service delivery strategy has been designed in collaboration with urban parents to strengthen specific aspects of parenting skills and family relationship processes (child management skills, family communication, within family support and parent/child interaction). Sessions also have been designed to target factors (e.g. parental stress, use of emotional and parenting support, family involvement with the child in context and stigma associated with mental health care) which potentially affect inner-city service use and outcomes. The study will include 372 youth and their families (including adult caregivers and siblings between the age of 6 and 18 years) nested within 10 child outpatient clinics. Youth and their families will be randomly assigned to one of 2 conditions: 1) MFG or;2) standard of care (traditionally offered outpatient services). A 5-wave experimental research design with assessments at baseline, 8 weeks (midway through MFG), posttest (16 weeks), 6, and 18 month follow-up will be used to test the following hypotheses: 1) youth in a MFG will evidence significantly reduced externalizing behavioral difficulties and increased functional capacities relative to youth receiving standard services over time;2) youth and their family members involved in a MFG will display significantly higher levels of attendance and will report significantly enhanced relationships with providers and motivation to address mental health goals in comparison to those receiving standard outpatient care longitudinally;3) involvement in a MFG will be associated with significant improvements in parenting skills, family communication, within family support and parent/child interaction relative to participation in standard outpatient care over time and;4) participation in a MFG will be associated with significant decreases in parenting stress and stigma associated with service use and increases in use of parenting/emotional support resources, parental involvement at school, supervision of youth and with enhanced youth and family-level outcomes relative to participation in standard services. The proposed study responds to calls for effectiveness studies that examine """"""""engaging"""""""" service delivery models set within urban child mental health centers that struggle with serious services capacity issues.
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