Mechanisms for change: A theoretical pathway for a school-wide social-emotional learning initiative in an urban middle school.

Introduction: Investment in academic instruction without complementary attention to the social-emotional environment of students may lead to a failure of both. The current study evaluates a proposed mechanism for change, whereby academic achievement occurs as a result of the social-emotional learning environment impacting behavioral (discipline) outcomes. Methods: We tested the hypothesized model during each year of a 3-year intervention to determine whether the relations among these constructs held potential as a pathway for targeted improvement. Results: Path analysis for each year demonstrated excellent fit [Year 1: χ2 (19) = 76.16, CFI = 0.99, RMSEA = 0.05,TLI = 0.98; Year 2: χ2 (19) = 70.68, CFI = 0.99, RMSEA = 0.048, TLI = 0.98; Year 3: χ2 (19) = 66.59, CFI = 0.99, RMSEA = 0.05, TLI = 0.98] supporting the theoretical model for change. For each year the effect of the SEL Environment construct on discipline was significant, as was the effect of discipline on Academic Performance. Further, the indirect effect of SEL Environment on Academic Performance was significant across all years. Discussion: The consistency of these relationships supports the proposed logic model as a potential mechanism for change and has the potential to guide interventions for whole school improvement.

The impact of school climate in social-normative expectations in low and high SES schools.

This study examined the associations among race/ethnicity, school climate, and social-normative expectations (expectations about peers' future achievement) in high and low socioeconomic status (SES) schools, with a particular focus on school climate as a process that might influence social-normative expectations. Results showed that more positive perceptions of school climate were significantly associated with higher levels of social-normative expectations in both low and high SES settings. Additionally, identifying as Black was negatively associated with social-normative expectations in both high and low SES schools. School climate significantly moderated the negative relationship between race and social-normative expectations in high SES schools; however, there was no moderation in low SES schools. In both high and low SES schools, school climate was a robust predictor of social-normative expectations, highlighting the importance of social-normative expectations as a metric of school climate improvement in both high and low SES schools. In conclusion, policies related to school culture and climate, school improvement, and turnaround should explicitly focus on the connection of racial and ethnic equity, specifically for Black and Latinx students, to reflect the range and reality of students' social-normative expectations.

The increasing impact of socioeconomics and race on standardized academic test scores across elementary, middle, and high school.

For students and schools, the current policy is to measure success via standardized testing. Yet the immutable factors of socioeconomic status (SES) and race have, consistently, been implicated in fostering an achievement gap. The current study explores, at the school-level, the impact of these factors on test scores. Percentage of students proficient for Language and Math was analyzed from 452 schools across the state of New Jersey. By high school, 52% of the variance in Language and 59% in Math test scores can be accounted for by SES and racial factors. At this level, a 1% increase in school minority population corresponds to a 0.19 decrease in percent Language proficient and 0.33 decrease for Math. These results have significant implications as they suggest that school-level interventions to improve academic achievement scores will be stymied by socioeconomic and racial factors and efforts to improve the achievement gap via testing have largely measured it.

Test performance characteristics of a case-finding psychosocial questionnaire for children with burn injuries and their families.

BACKGROUND: The Long-Form Psychosocial Questionnaire (LFPQ) includes full versions of the Child Stress Reaction Checklist, the Family Environment Scale, and the Parenting Stress Index. Condensed versions of these measures were used to create a Short-Form Psychosocial Questionnaire (SFPQ) that could be used as an indicator of child well-being and specific areas of child, parent, and family functioning in children aged 0 years to 18 years with burn injury. METHODS: Parents of 830 children aged 0 years to 18 years with acute burn injury from the Shriners Hospitals for Children Multi-Center Benchmarking Study completed the LFPQ at baseline and follow-up visits up to 48 months at four major burn centers. The internal consistency reliability and variability of the LFPQ explained by the SFPQ for each of the measures were calculated. The construct validity of the SFPQ measures was determined by factor analysis. The magnitude of the change for the SFPQ measures during 48 months of follow-up was examined. RESULTS: The internal consistency reliability of the short-form measures ranged from 0.62 to 0.90. The variability of the long-form measures explained by the short-form measures was 61% for the Child Stress Reaction Checklist (average of six long-form scales), 60% for the Family Environment Scale (conflict), and 90% for the Parenting Stress Index (average of 13 scales). Factor analysis supported the construct validity of the model for the short-form measures. The magnitude of change for the short-form measures showed clinical improvement for 48 months. CONCLUSION: The SFPQ is both a reliable and valid assessment for evaluating the psychosocial functioning of children following burn injuries.

Patterns of medication administration from 2001 to 2009 in the treatment of children with acute burn injuries: a multicenter study.

Children with burn injuries receive a broad range of medications, from analgesics to antipsychotics, but how utilization of these drugs differs from one pediatric burn center to another is unclear. This study examined utilization patterns of six categories of medication administered acutely to burned children as a first step in creating evidence-based practice guidelines. Six medications administered to pediatric patients enrolled in a multicenter study were recorded from patient charts using a standardized chart review template. The medication categories included opiates, benzodiazepines, antidepressants, beta-blockers, two different anesthetics, and antipsychotics. Data were analyzed by χ and logistical regression analysis. Analysis of data from three sites and 470 patients revealed significant differences in prescription patterns across hospitals for all medication groups except opiates. Differences were significant for benzodiazepines and antidepressants (χ = 7.3; P < .01 for both) controlling for age, gender, race, language, burn size, and length of stay. Differences in prescribing patterns for beta-blockers and the anesthetics ketamine and propofol failed to reach statistical significance; however, the results did trend in that direction (χ = 3.8 and 3.4, respectively; P < .10 for both). The pharmacotherapeutic agents described in this study are an integral part of acute pediatric burn care, and yet there is variation in use of these medications among the centers. The differences in prescribing indicate that, for certain drugs, a range of approaches to pharmacotherapeutics is being used and suggest that evidence-based guidelines for administration of these agents need to be developed.

Mental health matters in elementary school: first-grade screening predicts fourth grade achievement test scores.

The objective of the study was to evaluate whether mental health problems identified through screens administered in first grade are related to poorer academic achievement test scores in the fourth grade. The government of Chile uses brief teacher- and parent-completed measures [Teacher Observation of Classroom Adaptation-Revised (TOCA-RR) and Pediatric Symptom Checklist (PSC-Cl)] to screen for mental health problems in about one-fifth of the country's elementary schools. In fourth grade, students take the national achievement tests (SIMCE) of language, mathematics and science. This study examined whether mental health problems identified through either or both screens predicted achievement test scores after controlling for student and family risk factors. A total of 17,252 students had complete first grade teacher forms and these were matched with fourth grade SIMCE data for 11,185 students, 7,903 of whom also had complete parent form data from the first grade. Students at risk on either the TOCA-RR or the PSC-Cl or both performed significantly worse on all SIMCE subtests. Even after controlling for covariates and adjusting for missing data, students with mental health problems on one screen in first grade had fourth grade achievement scores that were 14-18 points (~1/3 SD) lower than students screened as not at risk. Students at risk on both screens had scores that were on average 33 points lower than students at risk on either screen. Mental health problems in first grade were one of the strongest predictors of lower achievement test scores 3 years later, supporting the premise that for children mental health matters in the real world.

Increases in behavioral health screening in pediatric care for Massachusetts Medicaid patients.

OBJECTIVE: To explore rates of screening and identification and treatment for behavioral problems using billing data from Massachusetts Medicaid immediately following the start of the state's new court-ordered screening and intervention program. DESIGN: Retrospective review of the number of pediatric well-child visits, number of screens, and number of screens that identify risk for psychosocial problems from January 2008 (the month pediatric screening started) to March 2009. During the surrounding 1-year period, we also examined the number of claims with a behavioral health evaluation code. SETTING: Massachusetts. PARTICIPANTS: Massachusetts Medicaid-enrolled children. INTERVENTION: Funded court-ordered mandate to screen for mental health during Medicaid well-child visits. OUTCOME MEASURES: Percentage of visits with a screen, percentage of screens identified at risk, and number of children seen for behavioral health evaluations. RESULTS: Major increase from 16.6% of all Medicaid well-child visits coded for behavioral screens in the first quarter of 2008 to 53.6% in the first quarter of 2009. Additionally, the children identified as at risk increased substantially from about 1600 in the first quarter of 2008 to nearly 5000 in quarter 1 of 2009. The children with mental health evaluations increased from an average of 4543 to 5715 per month over a 1-year period. CONCLUSIONS: The data suggest payment and a supported mandate for use of a formal screening tool can substantially increase the identification of children at behavioral health risk. Findings suggest that increased screening may have the desired effect of increasing referrals for mental health services.

Preliminary evidence for the effects of morphine on posttraumatic stress disorder symptoms in one- to four-year-olds with burns.

This study tested the hypothesis that very young children who received more morphine for acute burns would have larger decreases in posttraumatic symptoms 3 to 6 months later. This has never before been studied in very young children, despite the high frequency of burns and trauma in this age group. Seventy 12- to 48-month-old nonvented children with acute burns admitted to a major pediatric burn center and their parents participated. Parents were interviewed at three time points: during their child's hospitalization, 1 month, and 3 to 6 months after discharge. Measures included the Child Stress Disorders Checklist - Burn Version (CSDC-B). Chart reviews were conducted to obtain children's morphine dosages during hospitalization. Mean equivalency dosages of morphine (mg/kg/d) were calculated to combine oral and intravenous administrations. Eleven participants had complete 3 to 6-month data on the CSDC. The correlation between average morphine dose and amount of decrease in posttraumatic stress disorder symptoms on the CSDC (r = -0.32) was similar to that found in studies with older children. The correlation between morphine dose and amount of decrease in symptoms on the arousal cluster of the CSDC was significant (r = -0.63, P < .05). Findings from the current study suggest that, for young children, management of pain with higher doses of morphine may be associated with a decreasing number of posttraumatic stress disorder symptoms, especially those of arousal, in the months after major trauma. This extends, with very young children, the previous findings with 6- to 16-year olds.