Stacy L. Frazier

Toward the Effective and Efficient Measurement of Implementation Fidelity

Implementation science in mental health is informed by other academic disciplines and industries. Conceptual and methodological territory charted in psychotherapy research is pertinent to two elements of the conceptual model of implementation posited by Aarons and colleagues (2010)—implementation fidelity and innovation feedback systems. Key characteristics of scientifically validated fidelity instruments, and of the feasibility of their use in routine care, are presented. The challenges of ensuring fidelity measurement methods are both effective (scientifically validated) and efficient (feasible and useful in routine care) are identified as are examples of implementation research attempting to balance these attributes of fidelity measurement.

Common Elements of Adolescent Prevention Programs: Minimizing Burden While Maximizing Reach

A growing number of evidence-based youth prevention programs are available, but challenges related to dissemination and implementation limit their reach and impact. The current review identifies common elements across evidence-based prevention programs focused on the promotion of health-related outcomes in adolescents. We reviewed and coded descriptions of the programs for common practice and instructional elements. Problem-solving emerged as the most common practice element, followed by communication skills, and insight building. Psychoeducation, modeling, and role play emerged as the most common instructional elements. In light of significant comorbidity in poor outcomes for youth, and corresponding overlap in their underlying skills deficits, we propose that synthesizing the prevention literature using a common elements approach has the potential to yield novel information and inform prevention programming to minimize burden and maximize reach and impact for youth.

Building Capacity Within Community-Based Organizations: New Directions for Mental Health Promotion for Latino Immigrant Families in Urban Poverty

By 2050, Latino school-aged youth are projected to outnumber their non-Latino white peers (Fry & Gonzales, 2008). One in every four youth below 18 has at least one foreign-born parent, with 37 % of 40 million foreign-born in the US of Latin American descent (Grieco et al., 2012). Despite the fact that immigrant mental health has been an urgent national priority for over a decade (Flores et al., 2002; Pumariega & Rothe, 2010), it appears clear that the community mental health system cannot address this alone (Bringewatt & Gershoff, 2010; Huang et al., 2005) and falls short of strengthening natural supports within communities (Alegrı́a et al., 2010). Barriers to medical care thwart specialty referrals (Flores et al., 2005; Beniflah et al., 2013), and a dearth of bilingual, culturally competent providers exacerbates slow dissemination of empirically supported treatments into community mental health settings (Stagman & Cooper, 2010). We propose that high rates of mental health need and low service utilization among Latino immigrant families (DeRose et al., 2007; Kataoka et al., 2002; RAND, 2001) call for service models within non-specialty settings that build upon natural resources toward reducing risk factors and improving outcomes. Mental Health Risk Factors for Immigrant Families

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 childrens 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.

Children’s Responses to Hypothetical Provocation by Peers: Coordination of Assertive and Aggressive Strategies

Children often respond to aggression by peers with assertive bids or aggressive retaliation. Little is known, however, about whether and how children coordinate these strategies across different types of provocation. The present study examined endorsement of aggressive and assertive responses to hypothetical physical, relational, and verbal provocation in a sample of lower-income children (N = 402, M age = 10.21, SD = 1.46). Latent-profile analysis revealed 3-class models for both aggression and assertion, each reflecting low, moderate, and high levels of endorsement. There was no association between children’s reported use of aggression and assertion. For example, children who endorsed high levels of aggression were equally likely to be classified as low, moderate, or high on assertive responding. For both assertion and aggression, parental ratings of children’s externalizing behavior and social skills differed across the low and high groups. No such differences were found between the low and moderate groups, despite the latter groups endorsing markedly higher levels of assertive and aggressive responses. This pattern of findings may be due, in part, to the situation specificity of children’s responding. Our findings hint at the complexity of children’s behavioral repertoires and contribute to a growing literature that suggests the need for intervention models that consider both social skills and social situations.

Randomized Controlled Trial of Exercise for ADHD and Disruptive Behavior Disorders.

PURPOSE The objective of this study is to test the feasibility and impact of a 10-wk after-school exercise program for children with attention deficit hyperactivity disorder and/or disruptive behavior disorders living in an urban poor community. METHODS Children were randomized to an exercise program (n = 19) or a comparable but sedentary attention control program (n = 16). Cognitive and behavioral outcomes were collected pre-/posttest. Intent-to-treat mixed models tested group-time and group-time-attendance interactions. Effect sizes were calculated within and between groups. RESULTS Feasibility was evidenced by 86% retention, 60% attendance, and average 75% maximum HR. Group-time results were null on the primary outcome, parent-reported executive function. Among secondary outcomes, between-group effect sizes favored exercise on hyperactive symptoms (d = 0.47) and verbal working memory (d = 0.26), and controls on visuospatial working memory (d = -0.21) and oppositional defiant symptoms (d = -0.37). In each group, within-group effect sizes were moderate to large on most outcomes (d = 0.67 to 1.60). A group-time-attendance interaction emerged on visuospatial working memory (F[1,33] = 7.42, P < 0.05), such that attendance to the control program was related to greater improvements (r = 0.72, P < 0.01), whereas attendance to the exercise program was not (r = 0.25, P = 0.34). CONCLUSIONS Although between-group findings on the primary outcome, parent-reported executive function, were null, between-group effect sizes on hyperactivity and visuospatial working memory may reflect adaptations to the specific challenges presented by distinct formats. Both groups demonstrated substantial within-group improvements on clinically relevant outcomes. Findings underscore the importance of programmatic features, such as routines, engaging activities, behavior management strategies, and adult attention, and highlight the potential for after-school programs to benefit children with attention deficit hyperactivity disorder and disruptive behavior disorder living in urban poverty where health needs are high and services resources few.

The Social Context of Urban Classrooms Measuring Student Psychological Climate

Classrooms are unique and complex work settings in which teachers and students both participate in and contribute to classroom processes. This article describes the measurement phase of a study that examined the social ecology of urban classrooms. Informed by the dimensions and items of an established measure of organizational climate, we designed the Student Climate Survey (n = 53 items) to assess student psychological climate in third through eighth grades. We administered the survey to 621 students at three time points within one school year in 69 classrooms within eight urban schools. A multidimensional item response theory (IRT) analysis based on a full-information item bifactor model revealed 18 items that loaded on a primary factor and demonstrated good criterion and predictive validity. Opportunities for the Student Climate Survey to advance our contextual understanding of urban classrooms and inform intervention are discussed.

Getting Ready for Preschool: Linking Early Intervention and Family Mental Health for Infants and Toddlers with Developmental Delay

We propose that EI presents a unique opportunity to strengthen family interactions, minimize mental health problems, and prepare infants and toddlers with DD for preschool. Accordingly, we are collaborating with EI agencies and providers to examine usability, feasibility, acceptability, and outcome of infusing empirically-supported mental health treatment components within the state-funded EI service model. These efforts align with current national priorities, reflected by early intervention components of the Affordable Care Act, and are proposed to reduce mental health disparities and improve outcomes for families at highest risk.

Disordered Society: Women in Eating Disorder Recovery Advise Policymakers on Change

This qualitative study draws on a photo-elicitation method (“PhotoVoice”) and semi-structured interviews to examine the key areas stakeholders (30 young women between the ages of 18 and 35 in eating disorder recovery) identify as meaningful venues of policy-based change. Photography and the accompanying narratives capturing personally-meaningful social, cultural, and systemic influences on recovery were shared with the research team. Photographs and interviews were examined for policy implications using thematic analysis, and six areas of improvement emerged: media, healthcare practice and access, health insurance reform, education, objectification of the female body, and mental health stigma. Implications for reform are discussed.

Peer-Assisted Social Learning for Diverse and Low-Income Youth: Infusing Mental Health Promotion Into Urban After-School Programs

Community-based after-school programs (ASPs) can promote social competence by infusing evidence-based practice into recreation. Through collaborative partnership, we developed and implemented a peer-assisted social learning (PASL) model to leverage natural opportunities for peer-mediated problem-solving. ASP-Staff (n = 5) led elementary-school youth (n = 30) through 21 activities that partnered socially-skilled and less-skilled children; outcomes were compared to children (n = 31) at another site, via quasi-experimental design. Findings were mixed, including strong evidence for fidelity (adherence) and feasibility (attendance, participation, enthusiasm) of implementation. Relative to Comparison children, PASL children demonstrated improved social skills and behavior, but no changes in problem-solving, peer likability, or social network status.