Background:Limited research has examined the effectiveness and cost-effectiveness of training strategies to sustain mental health evidence-based practices (EBPs) in urban elementary schools. Methods:We conducted a hybrid type 2 cluster-randomized trial comparing Prepare for Sustainment (PFS)-school district coach supervision of implementers supported by external consultants-to Sustainment as Usual (SAU), which relied on coach supervision alone. Two EBPs were implemented: the Coping Power Program (CPP) for externalizing problems and CBT for Anxiety Treatment in Schools (CATS) for anxiety. The study included three phases: full support (Phase 1), reduced support (Phase 2), and no support (Phase 3). Participants included 40 master's-level implementers, two district coaches, and 435 K-8 students. Outcomes included content and process fidelity, service penetration, mental health symptoms (parent and student report), and academic engagement with learning (teacher report). We also examined implementers' perceptions of training. Results:PFS implementers demonstrated stronger process fidelity: greater engagement with students in Phase 2 and warmer, clearer, and more organized treatment delivery in Phase 3. Content fidelity and service penetration did not differ between conditions in either phase. PFS showed medium and small effect-size improvement on student behavioral and emotional engagement with learning in Phase 2, and a large effect size in behavioral engagement and a medium effect-size improvement in behavioral disaffection with learning in Phase 3 compared to SAU. Students receiving CPP in Phase 2 in the PFS condition demonstrated a large improvement on self-reported externalizing behavior, and students receiving CATS in Phase 2 showed a medium-size reduction in internalizing symptoms relative to students in SAU. Qualitative data showed that implementers who did not receive support from coaches desired supervision on effective EBP delivery, and those experiencing reduced support wanted more frequent guidance. Administrators noted that ongoing collaboration with district coaches would have enhanced their ability to support implementers. Conclusion:A sustainment strategy consisting of an initial training for implementers and occasional consultation for school district coaches is effective for achieving high process fidelity and medium to large effects for engagement with learning activities and mental health outcomes compared to a sustainment as usual strategy. Trial Registration:ClinicalTrials.gov identifier NCT04869657. Registered May 3, 2021.

Teacher-delivered Tier 1 (i.e., whole class) and Tier 2 (i.e., targeted) behavioral classroom interventions are effective in improving student academic and behavioral functioning, but often not delivered as recommended. Implementation strategies, especially strategies that are both feasible and effective, could support teachers in the delivery of these interventions. This pilot randomized controlled trial evaluated the acceptability, feasibility, and preliminary evidence of effectiveness of the Positive Behavior Management Toolkit (PBMT) in supporting teacher implementation and student outcomes. The PBMT is a modular implementation resource package to support K-5 teachers in delivering Tier 1 and Tier 2 behavioral interventions. Twenty teachers were randomized to receive either the PBMT or implementation support as usual. Quantitative and qualitative results suggested that the PBMT was highly acceptable, feasible and contextually appropriate. We also collected data on teacher fidelity to behavioral interventions and student outcomes for enrolled focal students with symptoms of attention-deficit/hyperactivity disorder (ADHD) at baseline and post-intervention. Although the pilot study was underpowered to conduct significance testing, the results suggested the PMBT may be effective in supporting teacher implementation outcomes and were mixed regarding student outcomes.

Background:Schools are the primary context for mental health services for youth in the United States and a critical setting for increasing access to mental health care, especially for youth from low income and historically minoritized communities. However, numerous barriers to implementing evidence-based practices persist for chronically underserved youth in schools. Establishing strong collaborations with community partners is essential for successful implementation. Objective:This conceptual overview offers the ACCESS model as a resource for school-partnered training and consultation efforts, in contrast to previous applications that emphasized community mental health and inpatient contexts. Method:Drawing from our groups' collective decades of partnering with school and community members to deliver evidence-based practice training and consultation support in underserved schools and reflecting on our collaborations with community mental health agencies contracted to provide mental health services in schools, we outline a practical model for partners to provide training and implementation support in the school context. Specifically, we have described applications of the ACCESS model (Creed et al., 2014; Stirman et al., 2010) in training and consultation in partnership with leaders, service providers, and educators working in underserved school settings. The ACCESS model provides guidance for trainers and implementers to Assess and adapt training content, Convey the basics during initial training, provide Consultation to facilitate learning and behavior change, Evaluate work samples to assess EBP fidelity, Study outcomes, and foster Sustainment of practices over time. Conclusion:The ACCESS model offers a practical roadmap for school-partnered EBP implementation, outlining each step and providing concrete guidance for psychologists with applied examples from our work. This authorship team represents co-developers of the ACCESS model and three distinct research groups that have provided training and consultation in partnership with numerous public-school systems. Throughout, we emphasize how school-academic partnerships can support implementation in underserved schools.

Background Little is known about the effectiveness and cost-effectiveness of train-the-trainer implementation strategies in supporting mental health evidence-based practices in schools, and about the optimal level of support needed for TT strategies. Methods The current study is part of a larger type 2 hybrid cluster randomized controlled trial. It compares two train-the-trainer strategies, Train-the-Trainer (TT) and Train-the-Trainer plus ongoing consultation for trainers (TT +) on the delivery of a group cognitive behavioral treatment protocol for anxiety disorders. Participants were 33 therapists, 29 supervisors, and 125 students who were at risk for anxiety disorders from 22 urban schools. Implementation outcomes were implementation fidelity and treatment dosage. Student outcomes were child- and parent-reported symptoms of anxiety, child-reported symptoms of depression, and teacher-reported academic engagement. We estimated the cost of implementing the intervention in each condition and examined the probability that a support strategy for supervisors (TT vs TT +) is a good value for varying values of willingness to pay. Results Therapists in the TT and TT + conditions obtained similarly high implementation fidelity and students in the conditions received similar treatment dosages. A mixed effects modeling approach for student outcomes revealed time effects for symptoms of anxiety and depression reported by students, and emotional disaffection reported by teachers. There were no condition or condition × times effects. For both conditions, the time effects indicated an improvement from pre-treatment to post-treatment in symptoms of anxiety and depression and academic emotional engagement. The average cost of therapist, supervisor, and consultant time required to implement the intervention in each condition was $1002 for TT and $1431 for TT + ( p = 0.01). There was a greater than 80% chance that TT was a good value compared to TT + for all values of willingness to pay per one-point improvement in anxiety scores. Conclusions A TT implementation approach consisting of a thorough initial training workshop for therapists and supervisors as well as ongoing supervision for therapists resulted in adequate levels of fidelity and student outcomes but at a lower cost, compared to the TT + condition that also included ongoing external expert consultation for supervisors. Trial registration ClinicalTrials.gov identifier: NCT02651402.

Public schools are a major provider of mental health services for children in the US. Mental and behavioral health services range from universal programming to individualized clinical supports to address student needs. These services in schools are delivered by various professionals including non-teaching and teaching school personnel, school-employed clinicians, and/or contracted community mental health partners. Provision of mental health services requires complex coordination of providers across disciplines, although few professionals have training in multidisciplinary collaboration strategies. Attention to team processes, such as delineating team members' roles, improving communication, and identifying collaboration strategies, may impact the effectiveness of evidence-based mental health service provision in real world settings. One intervention, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), has been used in healthcare with positive outcomes and has been adapted to educational settings. The current paper describes the community-partnered subsequent adaptation of TeamSTEPPS for schools. Needs assessment interviews identified challenges, successes, and goals for student mental health. Overarching themes extracted from interviews include limited resources at multiple levels (e.g., financial support, time, and personnel), communication challenges, and poor role clarity. A community advisory board provided guidance during the adaptation and implementation planning process. Adaptations to the intervention included tailoring the intervention to the school context and the development of flexible training plans. In addition, individualized implementation plans were developed with each school partner to mitigate foreseeable barriers to rolling-out TeamSTEPPS. Our team is currently piloting the adapted TeamSTEPPS intervention and implementation strategies in partnership with three school districts.

Background Shifting organizational priorities can negatively affect the sustainment of innovations in community settings. Shifting priorities can present barriers to conducting clinical research in schools if a misalignment occurs between school district priorities and the aims of the study. Often this misalignment occurs due to a shift during the period between when the study is submitted for funding and when research activities begin. Participatory research approaches can be employed to restore alignment between study processes and school district priorities. The purpose of the study is to describe data from a shared process with district partners. The shared process resulted in modifications to the main study's implementation processes and strategies in order to restore alignment with evolving school priorities while remaining faithful to the aims of the study. Method Data originated from qualitative interviews conducted with 20 school district and school personnel in a large urban school district. Qualitative themes were organized into categories based on a social-ecological school implementation framework. Data from team meetings, meetings with school district administrators, and emails served to supplement and verify findings from interview analyses. Results Themes included barriers and facilitators at the macro-, school-, individual-, team-, and implementation quality levels. Adaptations were made to address barriers and facilitators and restore alignment with school district priorities. Most adaptations to study processes and implementation strategies focused on re-training and providing more information to school district coaches and school-based staff. New procedures were created, and resources were re-allocated for the larger study. Conclusions Findings were discussed in relation to the implementation literature in schools. Recommendations for sustaining strong collaboration among researchers and school partners are provided.

Background:Train-the-trainer (TT) implementation strategies (in which designated clinicians are trained to then train others in an intervention) are promising approaches to support mental health clinician use of evidence-based interventions in school contexts. However, there is little evidence to date examining clinicians' perceptions of the acceptability and feasibility of TT strategies, or comparing clinicians' perceptions of different types of TT strategies. Methods:The current study was conducted as part of a larger hybrid effectiveness-implementation trial, in which school-based therapists and supervisors received one of two different types of implementation support to implement cognitive behavioral therapy (CBT) groups for anxiety: TT (i.e., initial training for therapists and supervisors) or enhanced TT (TT+; i.e., initial training for therapists and supervisors, and ongoing external consultation for supervisors). We used applied thematic analysis to compare qualitative interview transcripts from 28 therapist interviews and 33 supervisor interviews from therapists and supervisors who received TT or TT+ support and report themes that were similar and different across the two groups. Results:Most themes were similar across the TT and TT+ conditions: therapists and supervisors in both conditions perceived the group anxiety intervention as acceptable and viewed supervision as acceptable, helpful, and feasible. Therapists and supervisors in both conditions had mixed impressions of the contextual appropriateness of the group anxiety intervention, and some reported logistical challenges with weekly supervision. Some unique themes were identified among the TT+ condition, including supervisors experiencing professional growth, and therapists and supervisors perceiving supervision as critically important and enjoyable. Conclusions:These results suggest that TT implementation support, using a model in which an internal supervisor receives initial training and then provides ongoing supervision, is acceptable and feasible to support a group CBT intervention in schools. The results also highlight additional benefits that therapists and supervisors perceived when supervisors received ongoing consultation. Clinical Trial Registration Information:The clinical trial from which these data were derived was registered at ClinicalTrials.gov (https://clinicaltrials.gov/) prior to the time of first patient enrollment. The registration number is: NCT02651402.

Schools face an unprecedent demand for mental health services. Student mental health problems can be addressed via a continuum of mental health evidence-based practices (EBPs) integrated within school-wide Positive Behavioral Interventions and Supports (PBIS). However, integrating mental health interventions with PBIS can be challenging. The purpose of this study is to examine the integration of mental health interventions with PBIS in a group of schools in Pennsylvania. We describe the extent to which schools implementing PBIS with fidelity were using mental health EBPs at tiers 2 and 3, examine recommendations about how to achieve further integration, and identify school professional needs for training and support. The study is based on a statewide sample of 48 K-8 schools. Members of the leadership team completed questionnaires and participated in qualitative interviews. Most schools had established advanced tiers of support and offered EBPs for externalizing behavior problems at tier 2. However, few schools reported offering mental health EBPs at tier 3, or interventions for internalizing problems. Qualitative analyses of interview transcripts revealed key recommendations regarding characteristics of interventions students should receive, who should provide the extra supports to students and the type of training that should be made available to school personnel and providers of tier 2 and tier 3 interventions. Participants indicated school mental health personnel did not receive adequate technical assistance to implement EBPs.

Background Teacher-delivered behavioral classroom management interventions are effective for students with or at-risk for attention-deficit/hyperactivity disorder (ADHD) or other disruptive behavior challenges, but they can be difficult for teachers to use in the classroom. In this study, we will pilot test a package of implementation strategies to support teachers in using behavioral classroom interventions for students with ADHD symptoms. Methods We will use a 2-group, randomized controlled trial to compare outcomes for teachers who receive Positive Behavior Management Implementation Resources (PBMIR), a theory and data-driven implementation resource package designed to increase teacher implementation of behavioral classroom management interventions, with those who do not receive this additional implementation support. We will measure teacher implementation outcomes (e.g., observed fidelity to behavioral classroom interventions) and student clinical outcomes (e.g., ADHD-related impairment, ADHD symptoms, student–teacher relationship, academic performance) before and after an 8-week intervention period for both groups; we will also measure teacher-reported acceptability, appropriateness, and feasibility for the PBMIR group following the intervention period. Discussion If there is preliminary evidence of feasibility and effectiveness, this pilot study will provide the foundation for evaluation the PBMIR at a larger scale and the potential to improve outcomes for students with or at risk for ADHD. Trial registration This clinical trial was registered at ClinicalTrials.gov. ( https://clinicaltrials.gov/ ) on 8/5/2022 which was prior to the time of first participant enrollment. The registration number is: NCT05489081.

BackgroundCognitive behavioral therapy (CBT) for pediatric anxiety is efficacious for reducing anxiety symptoms and improving functioning, but many children are unable to access CBT for anxiety in community settings. Schools are an important setting in which children access mental health care, including therapy for anxiety. In this setting, therapy is usually delivered by Masters-level therapists. ObjectivesFriends for Life (FRIENDS), a 12-session, manualized, group CBT program for anxiety has demonstrated effectiveness when implemented in schools. However, prior research has also found challenges regarding feasibility and cultural fit when delivering FRIENDS in the urban school context. To address these challenges, we adapted FRIENDS for implementation in the school setting so that it might be more feasible and culturally appropriate for low-income, urban schools in the United States, while maintaining the core components of treatment. The current study uses a mixed-method approach to compare the effectiveness, cost-effectiveness, and perceived appropriateness of FRIENDS and CATS when delivered by Masters-level therapists with train-the-trainer support. Materials and methodsFirst, we compared change scores for student outcomes (i.e., child-report MASC-2 total score, parent-report MASC-2 total score, teacher-report Engagement and Disaffection subscale scores) from pre- to post- treatment between students receiving FRIENDS and students receiving CATS to assess whether the two conditions resulted in equivalent outcomes. Second, we compared the cost and cost-effectiveness between the groups. Finally, we used an applied thematic analysis to compare appropriateness of the interventions as perceived by therapists and supervisors. ResultsThe mean change score for the child-reported MASC-2 was 1.9 (SE = 1.72) points in the FRIENDS condition and 2.9 (SE = 1.73) points in the CATS condition; results indicated that the conditions were similar in their treatment effects, and symptom reductions were small in both groups. The modified protocol, CATS, was shown to cost significantly less to implement compared to FRIENDS and showed greater cost-effectiveness. Finally, compared to therapists and supervisors in the CATS condition, therapists and supervisors in the FRIENDS condition more strongly described aspects of the intervention that were not appropriate for their context and in need of more extensive adaptations. ConclusionRelatively brief, group CBT for anxiety, with adaptations to improve cultural fit, is a promising approach to treat youth anxiety symptom when delivered by school-based therapists with train-the-trainer implementation support.

Children in rural settings are less likely to receive mental health services than their urban and suburban counterparts and even less likely to receive evidence-based care. Rural schools could address the need for mental health interventions by using evidence-based practices within a tiered system of supports such as positive behavioral interventions and supports. However, very few school professionals, with or without mental health training, have received training on evidence-based practices. Rural schools need implementation strategies focused on training to prepare school personnel for the implementation of interventions with fidelity. Little is known about training strategies that are feasible and appropriate for the rural school context. User-centered design is an appropriate framework for the development of training strategies for professionals in rural schools because of its participatory approach and the development of products that fit the context where they are going to be used. The purpose of the study was to develop and assess components of an online training platform and implementation strategy based on the user-centered design. Quantitative and qualitative data from 25 participants from an equal number of schools in rural areas of Pennsylvania were used in the study. A mixed-methods design utilizing complementary descriptive statistics and theme analyses indicated that the training platform and implementation strategy were perceived as highly acceptable, appropriate, feasible and usable by school professionals. The resulting training platform and implementation strategy will fill a void in the training literature in rural schools.

BACKGROUND:An increasing number of schools in rural settings are implementing multi-tier positive behavioral interventions and supports (PBIS) to address school-climate problems. PBIS can be used to provide the framework for the implementation of evidence-based practices (EBPs) to address children's mental health concerns. Given the large service disparities for children in rural areas, offering EBPs through PBIS can improve access and lead to better long-term outcomes. A key challenge is that school personnel need technical assistance in order to implement EBPs with fidelity and clinical effectiveness. Providing ongoing on-site support is not feasible or sustainable in the majority of rural schools, due to their remote physical location. For this reason, remote training technology has been recommended for providing technical assistance to behavioral health staff (BHS) in under-served rural communities.OBJECTIVES:The purpose of this study is to use the user-centered design, guided by an iterative process (rapid prototyping), to develop and evaluate the appropriateness, feasibility, acceptability, usability, and preliminary student outcomes of two online training strategies for the implementation of EBPs at PBIS Tier 2.METHODS:The study will employ a pragmatic design comprised of a mixed-methods approach for the development of the training platform, and a hybrid type 2, pilot randomized controlled trial to examine the implementation and student outcomes of two training strategies: Remote Video vs. Remote Video plus Coaching.DISCUSSION:There is a clear need for well-designed remote training studies focused on training in non-traditional settings. Given the lack of well-trained mental health professionals in rural settings and the stark disparities in access to services, the development and pilot-testing of a remote training strategy for BHS in under-served rural schools could have a significant public health impact.ETHICS AND DISSEMINATION:The project was reviewed and approved by the institutional review board. Results will be submitted to ClinicalTrials.gov and disseminated to community partners and participants, peer-reviewed journals, and academic conferences.TRIAL REGISTRATION:ClinicialTrials.gov, NCT05034198 and NCT05039164.

Positive school climates are associated with numerous benefits for students and school staff. Although there is some evidence that the implementation of school-wide positive behavioral interventions and supports (SWPBIS) impacts features of school climate, such as organizational health, the specific aspects of SWPBIS that contribute to climate have yet to be investigated. In this study, we examined how different components of SWPBIS predicted 490 school staff members’ perceptions of school climate. After controlling for race and time in the profession, aspects of staff members’ school climate perceptions were positively predicted by the teaching of behavioral expectations and having well-defined corrective consequence systems, and they were negatively predicted by district support for the SWPBIS initiative and having strong school-wide reward systems. These results have implications for which components of SWPBIS schools should prioritize for training and development to have the strongest impact on their staff members’ perceptions of school climate.

PURPOSE Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder affecting over 9% of children in the United States. Family caregivers are often responsible for the management of their child's ADHD. Contextual influences, such as healthcare providers, systems, and resources, are factors contributing to the ease or difficulty of family management. The purpose of this article is to qualitatively describe the major contextual influences that impact family management for ethnically diverse children with ADHD. DESIGN AND METHODS This analysis is part of a mixed methods study using a concurrent nested design (QUAL + quant) to understand the phenomenon of family management from a contextual and socioecological perspective. In this analysis, cross-sectional data from caregivers of children with ADHD (N = 50) within a large northeastern city in the United States were collected, analyzed, and interpreted in the qualitative descriptive tradition. Semistructured interviews were conducted with participants to understand the contextual influences within family management. Conventional content analysis resulted in the emergence of barrier and facilitator domains and subdomains. RESULTS Caregivers were predominantly female (98%) and between 24 and 61 years with a mean age of 37.54 (SD = 1.18). Caregivers identified their children as Black or African American (56%), White (26%), Multi-Racial (16%), Hispanic or Latinx (8%), and Asian (2%). Contextual influences within family management emerged as barrier or facilitator domains. Barrier domains included: (1) family, (2) healthcare systems, (3) educational systems, (4) stigma, and (5) financial, insurance, and policy issues. Facilitator domains included: (1) family and community, (2) healthcare providers, and (3) educational providers. Subdomains within each domain are expanded in the article. PRACTICE IMPLICATIONS Specialists in pediatric nursing should consider contextual influences within family management for ethnically diverse children with ADHD. As healthcare providers, it is important to recognize system-level barriers or facilitators for caregivers and their children and find creative ways to overcome obstacles and leverage strengths within families, communities, and care systems. Another important area for pediatric specialists to consider is understanding how stigma impacts children with ADHD. Policy-level engagement and advocacy should maximize the political will of nurses, families, and educators to create change within communities.

Background Public schools in the United States are the main providers of mental health services to children but are often ill equipped to provide quality mental health care, especially in low-income urban communities. Schools often rely on partnerships with community organizations to provide mental health services to students. However, collaboration and communication challenges often hinder implementation of evidence-based mental health strategies. Interventions informed by team science, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), have the potential to improve treatment implementation and collaboration within schools. Objective The objective of this study is to improve communication and collaboration strategies among mental health and school staff by adapting an evidence-based team science intervention for school settings. We present a protocol for a hybrid effectiveness-implementation study to adapt TeamSTEPPS using stakeholder feedback, develop a tailored implementation plan, and pilot the adapted content in eight schools. Methods Study participants will be recruited from public and charter schools and agencies overseeing school mental health services in the local metro area. We will characterize current services by conducting a needs assessment including stakeholder interviews, observations, and review of administrative data. Thereafter, we will establish an advisory board to understand challenges and develop possible solutions to guide additional TeamSTEPPS adaptations along with a complementary implementation plan. In aim 3, we will implement the adapted TeamSTEPPS plus tailored implementation strategies in eight schools using a pre-post design. The primary outcome measures include the feasibility and acceptability of the adapted TeamSTEPPS. In addition, self-report measures of interprofessional collaboration and teamwork will be collected from 80 participating mental health and school personnel. School observations will be conducted prior to and at three time points following the intervention along with stakeholder interviews. The analysis plan includes qualitative, quantitative, and mixed methods analysis of feasibility and acceptability, school observations, stakeholder interviews, and administrative data of behavioral health and school outcomes for students receiving mental health services. Results Recruitment for the study has begun. Goals for aim 1 are expected to be completed in Spring 2021. Conclusions This study utilizes team science to improve interprofessional collaboration among school and mental health staff and contributes broadly to the team science literature by developing and specifying implementation strategies to promote sustainability. Results from this study will provide knowledge about whether interventions to improve school culture and climate can ready both mental health and school systems for implementation of evidence-based mental health practices. Trial Registration ClinicalTrials.gov NCT04440228; https://clinicaltrials.gov/ct2/show/NCT04440228 International Registered Report Identifier (IRRID) DERR1-10.2196/26567

Objective:To identify factors associated with discrepancy in parent-teacher reporting of symptoms of ADHD.Method:Parents and teachers rated 1,364 children using an ADHD rating scale. Data were analyzed using multiple regressions and ANOVA.Results:Demographic variables predicted greater parent-teacher discrepancy for ethnic minority families than for Caucasian families. Comorbidity variables predicted greater discrepancy for children who had a comorbid externalizing disorder. Academic performance variables predicted discrepancy for children who showed more homework problems. When all significant predictors were entered together, externalizing disorders and homework problems emerged as significant predictors. Participants whose parents reported higher levels of symptoms were of significantly higher socioeconomic status. Participants whose teachers reported higher levels of symptoms were significantly less likely to have a comorbid externalizing disorder and parent-reported homework problems.Conclusion:Parent-teacher discrepancies are likely to occur when the child has significant homework and externalizing behavior problems.

There are numerous tools available to assess coping strategies used by children and adolescents. Many of the existing measures are widely used within diverse settings, often outside of the populations within which the measures were developed. Given the varying use of coping strategies among different populations, there is a need to ascertain the validity and reliability of measurement tools used within particular settings. The current study examines the initial psychometrics of the Self-Report Coping Measure (SRCM), originally developed by Causey and Dubow (J Clin Child Adolesc Psychol 21(1): 47–59, 1992), and investigates the psychometric properties of the SRCM in a school-based, low-income, minority urban sample within six elementary schools. Students in 3rd through 8th grade (N = 298) completed the SRCM as part of a larger implementation trial. Confirmatory factor analysis was utilized to assess for fit with four previously validated models of coping factor structure. None provided adequate fit. Consequently, we conducted exploratory analyses, which suggested a three-factor solution with 28 items. Evaluation of convergent validity via correlations with subscales on the Teacher Report Form provided initial support for the validity of the scale. We then examined coping strategy use descriptively in this low-income, school-based population. No differences were found by race/ethnicity or gender; however, children in higher grade levels were less likely to use coping strategies across all factors, including both adaptive and maladaptive strategies. Implications and limitations for use of the SRCM in a low-income, minority school-based population are discussed.

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS™) is a tested strategy for improving communication and climate in hospitals. It is a promising but untested tool among school-based mental health teams. We examined the psychometric properties of the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) and Teamwork Attitudes Questionnaire (T-TAQ) among 167 school mental health team members. Team members worked for one of five agencies in 33 K-8 urban public schools. Exploratory factor analyses and descriptive data are presented. For both the T-TPQ and T-TAQ, a unitary factor structure best fit the data for this sample. The T-TPQ and T-TAQ were not significantly correlated with one another and total scores did not significantly differ by staff role. Agencies differed in T-TAQ results, and one agency had lower T-TAQ total scores relative to other agencies. Results suggest that the factor structures are different among school mental health teams than among other healthcare providers.

School-based mental health programs are increasingly recognized as methods by which to improve children's access to evidence-based practices (EBPs), particularly in urban under resourced communities. School-wide positive behavior interventions and supports (PBIS) is one approach to integrating mental health services into school-based programming; however, school providers require training and support to implement programs as intended. We have conducted a randomized controlled trial to compare two models for training school-based personnel to deliver group EBPs to children at high risk of developing internalizing or externalizing problems. School personnel (N = 24) from 6 schools in a large urban school district were trained with either a basic training and consultation strategy, or an enhanced training and consultation strategy. Preliminary findings show that the enhanced strategy resulted in 9% higher content fidelity than the basic strategy. School personnel who were switched to the basic strategy had slightly lower content fidelity for the last two years of the trial and school personnel who continued to receive basic consultation during the step-down phase saw their fidelity decline. The two conditions did not differ with regard to process fidelity.

PURPOSE:The purpose of this study was to better understand how caregivers and families manage childhood Attention Deficit Hyperactivity Disorder (ADHD) in their everyday lives and explore family management factors most relevant to child outcomes, including the child's daily life, condition management effort, condition management ability, and view of condition impact. DESIGN AND METHODS:Cross-sectional data from caregivers (N = 50) of children with ADHD (ages 5-12 years) within a large northeastern city were collected, analyzed, and interpreted using directed content analysis and qualitative methods. This inquiry was part of a larger mixed method study which examined the impact of family management on childhood ADHD and how family management factors were related to children's level of impairment across a spectrum of child functioning. RESULTS:Thematic summaries based on qualitative descriptive methods highlighted four aspects of family management including: 1) how caregivers contextualized their child's condition in everyday family life, 2) the significant effort required by caregivers to manage their child's ADHD, 3) how caregivers perceived their ability to manage their child's condition, and 4) the impact of ADHD on their child and family's future. CONCLUSIONS:Family management is an important concept within pediatric literature and may be extended to further research and practice changes for children with ADHD and their caregivers. PRACTICE IMPLICATIONS:Pediatric nurses are at the forefront of working with children and families. Understanding caregiver perspectives in regard to family management is important for strengthening collaborative partnerships with families and improving the care of children with ADHD.