Erin Girio-Herrera

Perceived barriers to help-seeking among parents of at-risk kindergarteners in rural communities.

This study examined help-seeking and perceived barriers to childrens mental health service utilization in a large sample of parents living in rural communities who are at various stages in the help-seeking process. The goals were to (a) obtain a demographic profile of at-risk kindergarteners and their parents, (b) examine parent-reported help-seeking behaviors, and (c) assess barriers to mental health service use. Parent and teacher report of the Behavior Assessment System for Children, Second Edition, were used to screen children (N = 597) at kindergarten entry and to identify their risk status. Parents also completed the Barriers to Participation Scale and reported the frequency of help-seeking behaviors related to their childs problems. Using a cutoff score of 1.5 standard deviations above the mean, nearly half (51%) of children were identified as at-risk (76% low risk, 24% high risk) for emotional, behavioral, social, and adaptive problems. Barriers and help-seeking did not differ across parents of low and high risk children. Among parents of at-risk children, only 33% believed their child had a problem. Parents sought informal help more often than professional help; however, medical doctors and school staff were sought most among professionals. The majority of parents (61%) endorsed at least one barrier that would interfere with mental health service use. Results highlight the importance of early school mental health screening and the need for interventions to increase parent problem recognition and engagement in mental health service utilization.

Incremental benefits of a daily report card intervention over time for youth with disruptive behavior.

This study examined the percentage of children who respond positively to a daily report card (DRC) intervention and the extent to which students achieve incremental benefits with each month of intervention in a general education classroom. Participants were 66 children (87% male) with attention-deficit hyperactivity disorder or disruptive behavior problems who were enrolled in a school-based intervention program in rural, low-income school districts in a Midwest state. The DRC was implemented by each childs teacher, who received consultation from a graduate student clinician, school district counselor, or school district social worker. A latent class analysis using growth-mixture modeling identified two classes of response patterns (i.e., significant improvement and significant decline). Results indicated that 72% of the sample had all of their target behaviors classified as improved, 8% had all of their targets classified as declining, and 20% had one target behavior in each class. To examine the monthly incremental benefit of the DRC, individual effect sizes were calculated. Results for the overall sample indicated that most children experience a benefit of large magnitude (.78) within the first month, with continued incremental benefits through Month 4. The differential pattern of effect sizes for the group of improvers and the group of decliners offer data to determine when and if the DRC should be discontinued and an alternative strategy attempted. Evidence-based guidelines for practical implementation of the DRC are discussed.

Predictors of Response and Mechanisms of Change in an Organizational Skills Intervention for Students with ADHD.

The purpose of the study was to evaluate predictors of response and mechanisms of change for the Homework, Organization, and Planning Skills (HOPS) intervention for middle school students with Attention-Deficit/Hyperactivity Disorder (ADHD). Twenty-three middle school students with ADHD (grades 6–8) received the HOPS intervention implemented by school mental health providers and made significant improvements in parent-rated materials organization and planning skills, impairment due to organizational skills problems, and homework problems. Predictors of response examined included demographic and child characteristics, such as gender, ethnicity, intelligence, ADHD and ODD symptom severity, and ADHD medication use. Mechanisms of change examined included the therapeutic alliance and adoption of the organization and planning skills taught during the HOPS intervention. Participant implementation of the HOPS binder materials organization system and the therapeutic alliance as rated by the student significantly predicted post-intervention outcomes after controlling for pre-intervention severity. Adoption of the binder materials organization system predicted parent-rated improvements in organization, planning, and homework problems above and beyond the impact of the therapeutic alliance. These findings demonstrate the importance of teaching students with ADHD to use a structured binder organization system for organizing and filing homework and classwork materials and for transferring work to and from school.

Trajectories and Predictors of Response to the Challenging Horizons Program for Adolescents With ADHD

The Challenging Horizons After School Program is one of the only psychosocial interventions developed specifically for adolescents with attention-deficit/hyperactivity disorder (ADHD) that has demonstrated efficacy in multiple randomized controlled trials. To date, however, all research with the intervention has evaluated outcomes at the group level, and it is unclear whether all adolescents respond similarly, or if the intervention is particularly well suited for certain adolescents with ADHD. This type of information is needed to guide stakeholders in making informed choices as part of dissemination and implementation efforts. The purpose of this study was to evaluate trajectories of response to intervention for a large sample of middle-school age adolescents with ADHD (grades 6-8) who received the after-school intervention (N=112). An additional goal of the study was to evaluate potential predictors of response trajectories, focusing on determining what factors best distinguished between intervention responders and nonresponders. Latent trajectory analyses consistently revealed four or five distinct classes. Depending on the outcome, between 16% and 46% of participants made large improvements, moving into the normal range of functioning, and between 26% and 65% of participants made small or negligible improvements. Multivariate predictor analyses revealed that a strong counselor/adolescent working alliance rated from the adolescent perspective and lower levels of parenting stress and parent-adolescent conflict consistently predicted an increased likelihood of intervention response. Implications of these findings for disseminating the after school intervention and for further intervention development are discussed.

School-Based Screening for Mental Health in Early Childhood

Epidemiological data indicate that mental health problems affect approximately 15-25% of school-aged children in the United States (e.g., Roberts, Attkisson, & Rosenblatt, 1998); yet only 20% of youth in need receive mental health services (e.g., Mills, Stephan, Moore, Weist, Daly, & Edwards, 2006). Universal screening, when paired with effective early intervention, can decrease the propensity for future academic difficulties and related problems (Albers et al., 2007; Dowdy, Ritchey, & Kamphaus, 2010; Lane, Oakes, & Menzies, 2010). The current evidence and practice associated with universal screening for mental health problems in schools are discussed in this chapter to serve as a guide for the key processes of planning, implementation and follow up services. This chapter focuses on screening for mental health problems in early childhood (i.e., prior to middle school) using an evidence-based framework for responding to national recommendations for screening, highlighting critical issues at each phase in the process. Emerging areas of research in universal school-based mental health screening and critical implications for future inquiry are also discussed.

Pediatricians May Address Barriers Inadequately When Referring Low-Income Preschool-Aged Children to Behavioral Health Services

Background. Low-income parents often seek help from pediatricians for early childhood social-emotional problems but seldom follow through with referrals to behavioral health services. Objective. We sought to understand low-income parents’ experiences seeking help from pediatricians for social-emotional problems and how those experiences influenced decisions about accessing behavioral health services. Methods. We conducted 20 semi-structured interviews with low-income parents with concerns about their children’s behavior or emotions. Participants were asked about experiences seeking help from pediatricians and decision-making about accessing behavioral health services. Results. Three themes emerged: (1) Participants described reluctance to recognize social-emotional problems, which was often reinforced by doctors’ reassurance. (2) Participants reported pediatricians did not meet their expectations about testing, providing explanations/advice, or addressing behavior on-site. (3) Participants had unclear expectations of behavioral health services. Conclusions. Primary care mechanisms that reliably educate parents about behavioral trajectories and the role of behavioral health providers may improve follow-up rates.

Rates of Common Classroom Behavior Management Strategies and Their Associations With Challenging Student Behavior in Elementary School

In this study, we (a) describe patterns of challenging student behaviors (classwide and for a target student with attention deficit hyperactivity disorder [ADHD]) and teacher behaviors (i.e., praise, commands, and responses to challenging behavior) in kindergarten through Grade 5 classrooms, (b) examine the relations between these behaviors, and (c) describe a threshold of teacher behaviors most associated with low levels of challenging student behavior. Participants were 55 teachers observed using a modified version of the Student Behavior Teacher Response (SBTR) system. Across grades, there was variability in rates of classwide challenging behavior per hour (M = 35.81 to 102.62) and rates of praise per hour (M = 10.90 to 37.70). The percentage of challenging behaviors to which teachers responded appropriately was generally low (M = 27% to 47%) and stable across grades. For classwide challenging behavior, higher percentages of appropriate teacher response were significantly associated with lower rates of challenging behavior (b = −.43; p < .01), but effective commands and labeled praise were not. Classwide challenging behaviors dropped to 30 per hour once teachers reach a threshold of 51% appropriate response, with little incremental benefit at higher levels. Implications for professional development and future study of behavior management practices are discussed.

Screening for Social, Emotional, and Behavioral Problems at Kindergarten Entry: Utility and Incremental Validity of Parent Report

Abstract. The current study examined the utility and incremental validity of parent ratings on the Strengths and Difficulties Questionnaire and Disruptive Behavior Disorders rating scale completed at kindergarten registration in identifying risk status as defined by important criterion variables (teacher ratings, daily behavioral performance, and quarterly grades). The participants were 252 kindergarten students from one school district. Receiver operating characteristic analyses and area-under-the-curve values indicated that most subscales had low to moderate utility in identifying children showing at-risk academic performance and social, emotional, and behavioral problems. However, forward linear regression analyses indicated that parent ratings provided incremental validity relative to the academic screening tool used by the school district, accounting for an additional 3.69% to 22.37% of the variance in kindergarten outcomes. Implications for the use of parent ratings in universal screening for social, emotional, and behavioral problems at kindergarten entry are discussed.

Using Flexible Clinical Processes in the Unified Protocol for the Treatment of Emotional Disorders in Adolescence

The purpose of this manuscript is to highlight the Unified Protocol for the Treatment of Emotional Disorders in Adolescents (UP-A) as an exemplar model of a principle-based, flexible treatment for adolescents with either depressive or anxiety disorders. The theoretical basis, mechanism of change, and research support for three of the UP-As guiding treatment principles are presented. Verbal exchanges between UP-A therapists and adolescent clients are shared to demonstrate clinical processes related to UP-A techniques that follow such guiding principles. The benefits of this approach to treatment are discussed, including reduction in the number of evidence-based treatment manuals to be learned, administered, and supervised. The UP-A has demonstrated positive outcomes, yet further examination of clinical process variables is warranted. These clinical process variables and additional future directions for the UP-A are addressed.