A randomized controlled trial on the interconnected systems framework for school mental health and PBIS: Focus on proximal variables and school discipline.

This study reviews findings for the first randomized controlled trial (RCT) on the Interconnected Systems Framework (ISF) for school mental health (SMH) and Positive Behavioral Interventions and Supports (PBIS). Since its development in the late 2000s, the ISF has been supported by federally funded centers for SMH and PBIS, and, guided by a national workgroup, is being implemented in >50 communities in the United States. This experimental evaluation of the ISF involved an RCT implemented in 24 schools in two southeastern states, with the ISF implemented in eight schools, PBIS alone implemented in eight schools, and typically co-located PBIS+SMH implemented in eight schools. Related to very poor implementation, documented by two sources of fidelity data, two ISF schools were dropped from major analyses; hence, the study used a treatment on the treated (ToT; Rubin, 1974) as compared to a more traditional Intent-to-Treat approach (ITT; Lachin, 2000). This is the first paper from this large study, with emphasis here on proximal variables and school discipline. Within schools' multi-tiered systems of support (MTSS), ISF schools delivered more Tier 2 (early intervention) and Tier 3 (treatment) interventions to a greater proportion of students than the other two conditions by the second year of the intervention. There was also a dramatic difference in the provision of interventions by community mental health clinicians in ISF schools (almost half of interventions delivered) as compared to PBIS+SMH schools (around 3% of interventions delivered), underscoring the critical role of the ISF in integrating clinicians into MTSS teams and core school functions in SMH. As compared to the other two conditions, ISF schools also had reduced office discipline referrals (ODRs) and in-school suspensions, as well as reduced ODRs and out-of-school suspensions for African American students. Findings are discussed in relation to future directions of education-mental health system partnerships in improving the delivery and impact of SMH programs and services, demonstrated in the ISF.

The Role of Ethnic-Specific Gender Schemas in Ethnic Disparities in Adolescent Girls' Disruptive Behavior: A Preliminary Examination.

African American adolescent girls have evidenced higher levels of disruptive behavior than girls from other ethnic groups. However, most research focused on understanding disparities in these outcomes has been conducted without consideration of gender or has focused exclusively on boys. Yet, prior research suggests that anger and aggression are less gender-typed in African American youth than they are among youth from other ethnic backgrounds. The purpose of this preliminary investigation was to examine the extent to which ethnic-specific gender schemas about anger mediated the relationship between ethnicity and girls' disruptive behavior. Participants were 66 middle school girls (24.1 % African American, 46.3 % European American; Mage= 12.06). They completed measures of ethnic-specific gender schemas about anger, reactive and instrumental aggression, and classroom disruptive behavior. Results indicated that relative to girls from other ethnic groups, African American girls had higher levels of reactive aggression and classroom disruptive behavior, both of which are rooted in anger. In contrast, no ethnic difference was found for instrumental aggression, which is not connected to anger. Ethnic-specific gender schemas about anger at least partially accounted for ethnic differences in reactive aggression and classroom disruptive behavior. Findings highlight the importance of examining gender schemas specific to ethnicity as factors in ethnic disparities in behavioral outcomes among adolescent girls.

The DietCompLyf study: a prospective cohort study of breast cancer survival and phytoestrogen consumption.

DietCompLyf is a multi-centre prospective study designed to investigate associations between phytoestrogens - naturally occurring plant compounds with oestrogenic properties - and other diet and lifestyle factors with breast cancer recurrence and survival. 3159 women with grades I-III breast cancer were recruited 9-15 months post-diagnosis from 56 UK hospitals. Detailed information on clinico-pathological, diet, lifestyle and quality of life is collected annually up to 5 years. Biological samples have also been collected as a resource for subsequent evaluation. The characteristics of the patients and associations between pre-diagnosis intake of phytoestrogens (isoflavones and lignans; assessed using the EPIC-Norfolk UK 130 question food frequency questionnaire) and breast cancer (i) risk factors and (ii) prognostic factors are described for 1797 women who had complete data for all covariates and phytoestrogens of interest. Isoflavone intakes were higher in the patients who were younger at diagnosis, in the non-smokers, those who had breast-fed and those who took supplements. Lignan intakes were higher in patients with a higher age at diagnosis, in ex-smokers, those who had breast-fed, who took supplements, had a lower BMI at diagnosis, lower age at menarche and were nulliparous. No significant associations between pre-diagnosis phytoestrogen intake and factors associated with improved breast cancer prognosis were observed. The potential for further exploration of the relationship between phytoestrogens and breast cancer recurrence and survival, and for the establishment of evidence to improve dietary and lifestyle advice offered to patients following breast cancer diagnosis using DietCompLyf data is discussed.