Caregiver Strain, Social Support and Mental Health Service Use Among Urban African American Mothers.

Caregiver strain and social support have been identified as both facilitators and deterrents to parental mental health service use on behalf of their children. This study focused on the relationship between caregiver strain, social support, and mental health service use among African American mothers of children at-risk or meeting criteria for a disruptive behavioral disorder and living in urban communities of concentrated poverty. Mothers (n = 89), participating in a five-year NIMH funded study of school-based community mental health services, completed measures at baseline of caregiver strain and both perceived and received social support. Service use was calculated as the sum total of services (sessions) received. Associations between caregiver strain and service use were examined, and perceived and received social support were explored as potential moderators. Baseline covariates included child's age, gender, symptom severity, and maternal employment status. Findings highlighted child symptom severity as the strongest predictor of caregiver strain and perceived social support as moderating the association between caregiver strain and service use. Mothers were more likely to utilize services when experiencing relatively high levels of perceived support or high caregiver strain but not both, highlighting the importance of their interrelationship. Received support did not moderate the association between strain and service use. In addition, mothers utilized services more often for sons than daughters and when unemployed. Implications for research and practice are discussed.

Teacher Job Stress and Satisfaction in Urban Schools: Disentangling Individual-, Classroom-, and Organizational-Level Influences.

Schools remain among the most frequent providers of children's mental health services, particularly in low-income urban settings. Several decades of research have focused on training teachers to implement evidence-based interventions for minimizing disruptive behavior. Studies consistently demonstrate robust improvements in student behavior and learning; however, the impact on teachers' work-related stress or satisfaction is not well understood. Six urban, high-poverty elementary schools were randomly assigned to a school mental health services model (Links to Learning; L2L) for referred, disruptive students or to services and professional development as usual (SAU). Teachers (n = 71, K-4 general education teachers) in L2L schools participated in professional development and consultation in two universal and two targeted interventions to reduce disruptive behaviors and promote learning. Teachers (n = 65) in SAU schools participated in professional development as usual. Multiple regression models examined teacher reports of individual-level self-efficacy, classroom-level student functioning, and school-level organizational health as predictors of stress and satisfaction. Findings revealed no significant difference between conditions on teacher work-related stress or satisfaction. Organizational health was the strongest predictor of stress and satisfaction. Training on and implementation of evidence-based classroom interventions did not appear to significantly impact teachers' work-related stress or satisfaction. Instead, findings point to organizational climate and teacher connectedness as potential levers for change, supporting prior work on teacher stress and satisfaction in schools. The significance of targeting organizational factors may be particularly significant in urban school districts.

Strengthening Positive Parenting in the Context of Intimate Partner Abuse.

Intimate partner violence has been associated with long-term negative effects on mothers' mental health status, use of positive parenting practices, and their children's externalizing behavioral difficulties. Especially strong is the association between concurrent experiences of partner violence and maternal parenting. In this case study, we examined the impact of behavioral parent training on parenting and outcomes for a 6-year-old Latino diagnosed with oppositional defiant disorder (ODD). The family was participating in a larger study examining the implementation and cultural adaptations of an evidence-based parent training program, Helping the Noncompliant Child. Mother reported a history of domestic violence and ongoing abusive behavior from her intimate partner but only wanted services focused on addressing child's behavioral difficulties and improving the quality of parent-child interactions. Adaptations included but were not limited to the translation of all intervention materials, extending the number of sessions focused on each parenting strategy, flexibility with regard to the location and time of therapy sessions, negotiating safe times for the family to participate in treatment, and case management. Parent reports of child behavior and parenting stress moved from the clinical range to the normal range from pre- to post-test. Mother also reported increased use of positive parenting practices. These data, along with closing semi-structured interviews, suggest that within the context of ongoing partner abuse, a mother's parenting and her child's behavior can be positively affected by parent training that is adapted and responsive to the context of their family's situation.

A Framework for Translating an Evidence-Based Intervention from English to Spanish.

This article describes the development of a framework for the Spanish language adaptation of an evidence-based intervention. A systematic literature search of language adaptation of interventions highlighted most published research focuses on the translation of assessment tools rather than interventions. In response, we developed the Participatory and Iterative Process Framework for Language Adaptation (PIPFLA), a descriptive step-by-step example of how to conduct the language adaptation of an intervention that is grounded in principles of good practice and facilitates transparency of the process. A bilingual team composed of project staff, translators, and two small panels of local community experts-composed of Latino community-based clinicians and Latino immigrant parents-participated in the language adaptation of the intervention. The panels reviewed the translated materials and offered their independent emic perspectives; the intervention represented the etic perspective. Both perspectives informed and were integrated into the 11-step iterative process that comprises the PIPFLA framework.

Redesigning community mental health services for urban children: Supporting schooling to promote mental health.

OBJECTIVE: This study examined a school- and home-based mental health service model, Links to Learning, focused on empirical predictors of learning as primary goals for services in high-poverty urban communities. METHOD: Teacher key opinion leaders were identified through sociometric surveys and trained, with mental health providers and parent advocates, on evidence-based practices to enhance children's learning. Teacher key opinion leaders and mental health providers cofacilitated professional development sessions for classroom teachers to disseminate 2 universal (Good Behavior Game, peer-assisted learning) and 2 targeted (Good News Notes, Daily Report Card) interventions. Group-based and home-based family education and support were delivered by mental health providers and parent advocates for children in kindergarten through 4th grade diagnosed with 1 or more disruptive behavior disorders. Services were Medicaid-funded through 4 social service agencies (N = 17 providers) in 7 schools (N = 136 teachers, 171 children) in a 2 (Links to Learning vs. services as usual) × 6 (pre- and posttests for 3 years) longitudinal design with random assignment of schools to conditions. Services as usual consisted of supported referral to a nearby social service agency. RESULTS: Mixed effects regression models indicated significant positive effects of Links to Learning on mental health service use, classroom observations of academic engagement, teacher report of academic competence and social skills, and parent report of social skills. Nonsignificant between-groups effects were found on teacher and parent report of problem behaviors, daily hassles, and curriculum-based measures. Effects were strongest for young children, girls, and children with fewer symptoms. CONCLUSION: Community mental health services targeting empirical predictors of learning can improve school and home behavior for children living in high-poverty urban communities.

Teachers Supporting Teachers in Urban Schools: What Iterative Research Designs Can Teach Us.

Despite alarming rates and negative consequences associated with urban teacher attrition, mentoring programs often fail to target the strongest predictors of attrition: effectiveness around classroom management and engaging learners; and connectedness to colleagues. Using a mixed-method iterative development framework, we highlight the process of developing and evaluating the feasibility of a multi-component professional development model for urban early career teachers. The model includes linking novices with peer-nominated key opinion leader teachers and an external coach who work together to (1) provide intensive support in evidence-based practices for classroom management and engaging learners, and (2) connect new teachers with their larger network of colleagues. Fidelity measures and focus group data illustrated varying attendance rates throughout the school year and that although seminars and professional learning communities were delivered as intended, adaptations to enhance the relevance, authenticity, level, and type of instrumental support were needed. Implications for science and practice are discussed.

Teacher key opinion leaders and mental health consultation in low-income urban schools.

Diffusion theory posits that information is disseminated throughout a social network by the persuasion of key opinion leaders (KOLs). This study examined the relative and combined influence of peer-identified KOL teachers (n = 12) and mental health providers (n = 21) on classroom teachers' (n = 61) self-reported use of commonly recommended classroom practices for children with attention-deficit/hyperactivity disorder in 6 low-income urban African American communities, relative to teachers (n = 54) at 4 matched schools who received mental health provider consultation only. Mixed-effects regression models showed that KOLs in collaboration with mental health providers promoted higher rates of teachers' self-reported use of recommended strategies than mental health providers alone, and that these effects were mediated by KOL support but not by mental health provider support. The results suggest an expanded role for KOL teachers as indigenous and natural supports for the dissemination and implementation of school-based mental health programs.