Engaging youth and families in school mental health services.

In this article, an overview is provided of strategies to engage youth and their families in school mental health (SMH) services throughout the course of treatment. Resources are outlined to help SMH providers determine which strategies are most suitable for youth and their families, based on outcomes desired, barriers to engagement, and stage of treatment. Four case vignettes are presented to describe implementation of these strategies.

Attention-deficit/hyperactivity disorder symptoms mediate the association between deficits in executive functioning and social impairment in children.

We investigated whether symptoms of attention-deficit/hyperactivity disorder (ADHD) are pathways through which deficits in inhibition and working memory are associated with teacher- and parent-rated social impairment in children. Participants were 64 children (55% males; 53% with ADHD) in grades 3-6. Consistent with our hypotheses, the association between inhibition and social impairment was mediated by hyperactivity/impulsivity and the association between working memory and social impairment was mediated by inattention. Support was not obtained for alternative models wherein the association between inhibition and social impairment was mediated by inattention, and the association between working memory and social impairment was mediated by hyperactivity/impulsivity. Further, tests of hierarchical models suggest that neither inhibition nor working memory is primary but, rather, that these cognitive processes are related to one another and that they collectively (but not uniquely) contribute to hyperactivity/impulsivity and inattention. These findings have implications for conceptual models of ADHD, for understanding factors that influence and sustain social impairment among youth with symptoms of the disorder, and for interventions aimed to addressing such impairment.

Program and practice elements for placement prevention: a review of interventions and their effectiveness in promoting home-based care.

Preventing unnecessary out-of-home placement for youth with behavioral and emotional needs is a goal of several public child-serving services, including child welfare, juvenile justice, and child mental health. Although a small number of manualized interventions have been created to promote family driven and community-based services and have empirical support, other less established programs have been initiated by local jurisdictions to prevent out-of-home placement. To synthesize what is known about efforts to prevent placement, this article describes the common program and practice elements of interventions described in 37 studies (published in 51 articles) that measured placement prevention outcomes for youth at risk for out-of-home care because of behavioral or mental health needs. The most common program elements across published interventions were program monitoring, case management, and accessibility promotion. The most common clinical practice elements for working with youth were assessment and individual therapy; for caregivers, problem solving skills were most frequently included; and family therapy was most common for the family unit. Effect size estimates for placement-related outcomes (decreased out-of-home placement, decreased hospitalization, decreased incarceration, and decreased costs) were calculated to estimate the treatment effectiveness of the interventions in which the program components and clinical practices are embedded.

Implementation Science in School Mental Health: Key Constructs in a Developing Research Agenda.

In this paper, we propose an implementation science research agenda as it applies to school mental health (SMH). First, we provide an overview of important contextual issues to be considered when addressing research questions pertinent to the implementation of mental health interventions in schools. Next, we critically review three core implementation components: (a) professional development and coaching for school professionals regarding evidence-based practices (EBPs); (b) the integrity of EBPs implemented in schools; and (c) EBP sustainment under typical school conditions. We articulate research questions central to the next generation of research in each of these areas as well as methods to address such questions. Our intent in doing so is to contribute to a developing blueprint to guide community-research partnerships as well as funding agencies in their efforts to advance implementation science in SMH.

The relationship between sluggish cognitive tempo and impairment in children with and without ADHD.

This study examined impairment in multiple domains of functioning in children with and without ADHD who present with high or low levels of sluggish cognitive tempo (SCT) while taking into account the total symptom ratings of ADHD. Participants were 584 children in kindergarten through eighth grade (55.7 % male, 91.7 % Caucasian), drawn from five archival datasets. Two, 2 (SCT groups: high and low) x 3 (ADHD Status: ADHD-I, ADHD-C, and non-ADHD) MANCOVAs were conducted with the total ADHD symptom ratings and child age as covariates. One MANCOVA was conducted on scores on the teacher Impairment Rating Scale (IRS; Fabiano et al. Journal of Clinical Child and Adolescent Psychology 35:369-385, 2006) and the other on the 6 scores on the parent IRS. The results indicated that the presence of SCT symptoms was associated with greater functional impairment at home according to parent report while it was associated with less functional impairment at school according to teacher report. Thus, the relationship between SCT symptoms and impairment differs depending on the informant and the context in which impairment is evaluated.