Bridging K-12 Student Mental Health Policy to Practice Gaps with a Multi-Component Framework.

K-12 schools are a major sector for efforts to prevent and treat student mental health problems. In the United States, these efforts have led to the emergence of the MultiTiered System of Supports (MTSS) universal prevention, early intervention, and treatment policy framework. With a major focus on behavioral and mental health, MTSS has been adopted by all fifty state education departments. However, multi-level complexities of addressing student mental health within and across organizational structures complicate MTSS and broader policy development, implementation, and evaluation; disconnects between policy writers and practitioners obstruct progress, limiting positive outcomes. To bridge these policy-to-practice gaps, a multi-component solution is needed. The authors propose integrating the following elements: the Massachusetts School Mental Health Consortium's Five Guiding Principles for Building a Coordinated School Mental Health System, the comprehensive school improvement methodology Evolutionary Systems Improvement (ESI); and the ontological framework of BioPsychoSocioTechnical Systems Theory (BPST). Individual application of these components has already yielded systems-level improvements outperforming compliance-driven procedures. Used together, these components offer a multi-level solution for establishing conceptually-guided, measurement-based loops that transcend the restrictions of uninformed policy, supporting stakeholders as they work to systematically eliminate barriers and improve student mental health.

A randomized controlled trial of a trauma-informed school prevention program for urban youth: Rationale, design, and methods.

INTRODUCTION: Youth in disadvantaged urban areas are frequently exposed to chronic stress and trauma, including housing instability, neighborhood violence, and other poverty-related adversities. These exposures increase risk for emotional, behavioral, and academic problems and ultimately, school dropout. Schools are a promising setting in which to address these issues; however, there are few universal, trauma-informed school-based interventions for urban youth. METHODS/DESIGN: Project POWER (Promoting Options for Wellness and Emotion Regulation) is a randomized controlled trial testing the impact of RAP Club, a trauma-informed intervention for eighth graders that includes mindfulness as a core component. Students in 32 urban public schools (n = 800) are randomly assigned to either RAP Club or a health education active control group. We assess student emotional, behavioral, and academic outcomes using self-report surveys and teacher ratings at baseline, post-intervention, and 4-month follow up. Focus groups and interviews with students, teachers, and principals address program feasibility, acceptability, and fidelity, as well as perceived program impacts. Students complete an additional self-report survey in ninth grade. Schools provide students' academic and disciplinary data for their seventh, eighth, and ninth grade years. In addition, data on program costs are collected to conduct an economic analysis of the intervention and active control programs. DISCUSSION: Notable study features include program co-leadership by young adults from the community and building capacity of school personnel for continued program delivery. In addition to testing program impact, we will identify factors related to successful program implementation to inform future program use and dissemination.

The conjoint influence of home enriched environment and lead exposure on children's cognition and behaviour in a Mexican lead smelter community.

A range of studies has been conducted on the detrimental effects of lead in mining and smelting communities. The neurocognitive and behavioural health effects of lead on children are well known. This research characterized the conjoint influence of lead exposure and home enriched environment on neurocognitive function and behaviour for first-grade children living in a Mexican lead smelter community. Structural equation models were used for this analysis with latent outcome variables, Cognition and Behaviour, constructed based on a battery of assessments administered to the first-grade children, their parents, and teachers. Structural equation modelling was used to describe complex relationships of exposure and health outcomes in a manner that permitted partition of both direct and indirect effects of the factors being measured. Home Environment (a latent variable constructed from information on mother's education and support of school work and extracurricular activities), and child blood lead concentration each had a main significant effect on cognition and behaviour. However, there were no statistically significant moderation relationships between lead and Home Environment on these latent outcomes. Home Environment had a significant indirect mediation effect between lead and both Cognition and Behaviour (p-value<0.001). The mediation model had a good fit with Root Mean Square Error of Approximation <0.0001 and a Weighted Root Mean Square Residual of 0.895. These results were highly significant and suggest that Home Environment has a moderate mediation effect with respect to lead effects on Behaviour (ß=0.305) and a lower mediation effect on Cognition (ß=0.184). The extent of home enrichment in this study was most highly related to the mother's support of schoolwork and slightly less by the mother's support of extracurricular activities or mother's education. Further research may be able to develop approaches to support families to make changes within their home and child rearing practices, or advocate for different approaches to support their child's behaviour to reduce the impact of lead exposure on children's cognitive and behavioural outcomes.

School attendance problems and youth psychopathology: structural cross-lagged regression models in three longitudinal data sets.

This study tests a model of reciprocal influences between absenteeism and youth psychopathology using 3 longitudinal datasets (Ns = 20,745, 2,311, and 671). Participants in 1st through 12th grades were interviewed annually or biannually. Measures of psychopathology include self-, parent-, and teacher-report questionnaires. Structural cross-lagged regression models were tested. In a nationally representative data set (Add Health), middle school students with relatively greater absenteeism at Study Year 1 tended toward increased depression and conduct problems in Study Year 2, over and above the effects of autoregressive associations and demographic covariates. The opposite direction of effects was found for both middle and high school students. Analyses with 2 regionally representative data sets were also partially supportive. Longitudinal links were more evident in adolescence than in childhood.

The developmental impact of two first grade preventive interventions on aggressive/disruptive behavior in childhood and adolescence: an application of latent transition growth mixture modeling.

We examine the impact of two universal preventive interventions in first grade on the growth of aggressive/disruptive behavior in grades 1-3 and 6-12 through the application of a latent transition growth mixture model (LT-GMM). Both the classroom-centered and family-centered interventions were designed to reduce the risk for later conduct problems by enhancing the child behavior management practices of teachers and parents, respectively. We first modeled growth trajectories in each of the two time periods with separate GMMs. We then associated latent trajectory classes of aggressive/disruptive behavior across the two time periods using a transition model for the corresponding latent class variables. Subsequently, we tested whether the interventions had direct effects on trajectory class membership in grades 1-3 and 6-12. For males, both the classroom-centered and family-centered interventions had significant direct effects on trajectory class membership in grades 6-12, whereas only the classroom-centered intervention had a significant effect on class membership in grades 1-3. Significant direct effects for females were confined to grades 1-3 for the classroom-centered intervention. Further analyses revealed that both the classroom-centered and family-centered intervention males were significantly more likely than control males to transition from the high trajectory class in grades 1-3 to a low class in grades 6-12. Effects for females in classroom-centered interventions went in the hypothesized direction but did not reach significance.

Psychosocial outcomes of anxious first graders: a seven-year follow-up.

This study examined the concurrent and long-term psychosocial outcomes associated with anxiety symptoms among a community sample of predominately low-income African Americans (N=149; 72 females). We classified first graders as high or low anxious using child, parent, and teacher reports. Academic, social, and psychological outcomes were assessed in the first and eighth grades. Logistic regressions with concurrent data revealed that highly anxious children were significantly more likely to score lower on measures of academic achievement and peer acceptance, but higher on measures of depression and aggression compared to their low-anxious peers. Longitudinal analyses revealed that high-anxious first graders, compared to their low-anxious peers, scored significantly lower on measures of academic achievement, aggression, and peer acceptance; and higher on measures of anxiety and depression in the eighth grade. Importantly, outcomes varied depending on informant. Findings suggest that, similar to European American youth, early-onset anxious symptoms in African American children are associated with both concurrent and long-term academic, social, and psychological difficulties.

Observational measures of parenting in anxious and nonanxious mothers: does type of task matter?

This study examined the relation between type of parent-child interaction task and parenting behaviors among a predominantly African American community-based sample. Twenty-five anxious and matched nonanxious (N = 50) mothers were videotaped with their children (M age = 5.8 years) engaging in both a structured and unstructured task. Blind raters coded 3 parent behaviors hypothesized to play a role in the development of child anxiety: overcontrol, anxious behavior, and criticism. Results indicated that higher levels of overcontrol, anxious behavior, and criticism were found in the structured compared to unstructured task. Levels of criticism, among anxious mothers only, were significantly correlated across tasks. Results suggest that situation specific aspects of parent-child interaction tasks may influence parenting behaviors. These findings help explain variations in observational research in the anxiety literature and highlight the need for careful selection of parent-child tasks in future research.

Neurocognitive skills moderate urban male adolescents' responses to preventive intervention materials.

The present experiment was designed to determine whether individual variation in neurobiological mechanisms associated with substance abuse risk moderated effects of a brief preventive intervention on social competency skills. This study was conducted in collaboration with the ongoing preventive intervention study at Johns Hopkins University Prevention Intervention Research Center (JHU PIRC) within the Baltimore City Public Schools. A subsample (N = 120) of male 9th grade students was recruited from the larger JHU study population. Approximately half of the participants had a current or lifetime diagnosis of CD while the other half had no diagnosis of CD or other reported problem behaviors. Measures of executive cognitive function (ECF), emotional perception and intelligence were administered. In a later session, participants were randomly assigned to either an experimental or control group. The experimental group underwent a facilitated session using excerpted materials from a model preventive intervention, Positive Adolescent Choices Training (PACT), and controls received no intervention. Outcomes (i.e., social competency skills) were assessed using virtual reality vignettes involving behavioral choices as well as three social cognition questionnaires. Poor cognitive and emotional performance and a diagnosis of CD predicted less favorable change in social competency skills in response to the prevention curriculum. This study provides evidence for the moderating effects of neurocognitive and emotional regulatory functions on ability of urban male youth to respond to preventive intervention materials.

Childhood predictors of anxiety symptoms: a longitudinal study.

The present study examined the concurrent and prospective relation between a select number of potential predictors and symptoms of anxiety among a high-risk community sample of 149 predominately African American children. Parent and child reports of anxiety were assessed in the first and seventh grade. Six domains of childhood risk factors (i.e., Loss-Death, Loss-Separation, Social Adversity, Negative Family Environment, Academic Difficulties, and Peer Rejection) were assessed using multiple informants in the first grade. Results indicated that children who experienced a more negative family environment, had a greater number of losses and deaths, and experienced academic failures in the first grade exhibited higher levels of anxiety (concurrently and/or at the six year follow-up). Findings provide empirical support to etiological models that posit both parental/familial and environmental factors contribute to the development of heightened anxiety in children.

Experience Corps: design of an intergenerational program to boost social capital and promote the health of an aging society.

Population aging portends a crisis of resources and values. Desired solutions could include intergenerational strategies to harness the untapped potential of older adults to address societal needs and to generate health improvements for older adults. Despite the desire of many older adults to remain socially engaged and productive, the creation of productive roles has lagged. This report describes the conceptual framework and major design features of a new model of health promotion for older adults called Experience Corps. Experience Corps operates at, and leads to benefits across, multiple levels, including individuals, schools, and the larger community. At the individual level, we propose a model based on Erikson's concept of generativity to explain how and why Experience Corps works. At the level of schools, we propose a parallel model based on social capital. Experience Corps is a volunteer service program designed to improve the lives of urban children and to yield health improvement for older persons. It illustrates how population aging creates new opportunities to address difficult social problems. This article explores how the linkage of concepts at multiple levels motivates a potentially cost-effective, feasible, and high-impact program.