Group CBT for Externalizing Disorders in Urban Schools: Effect of Training Strategy on Treatment Fidelity and Child Outcomes.
Public schools are an ideal setting for the delivery of mental health services to children. Unfortunately, services provided in schools, and more so in urban schools, have been found to lead to little or no significant clinical improvements. Studies with urban school children seldom report on the effects of clinician training on treatment fidelity and child outcomes. This study examines the differential effects of two levels of school-based counselor training: training workshop with basic consultation (C) vs. training workshop plus enhanced consultation (C+) on treatment fidelity and child outcomes. Fourteen school staff members (counselors) were randomly assigned to C or C+. Counselors implemented a group cognitive behavioral therapy protocol (Coping Power Program, CPP) for children with or at risk for externalizing behavior disorders. Independent coders coded each CPP session for content and process fidelity. Changes in outcomes from pre to post were assessed via a parent psychiatric interview and interviewer-rated severity of illness and global impairment. Counselors in C+ delivered CPP with significantly higher levels of content and process fidelity compared to counselors in C. Both C and C+ resulted in significant improvement in interviewer-rated impairment; the conditions did not differ from each other with regard to impairment. Groups did not differ with regard to pre- to- posttreatment changes in diagnostic severity level. School-based behavioral health staff in urban schools are able to implement interventions with fidelity and clinical effectiveness when provided with ongoing consultation. Enhanced consultation resulted in higher fidelity. Enhanced consultation did not result in better student outcomes compared to basic consultation. Implications for resource allocation decisions with staff training in EBP are discussed.
['Eiraldi|Ricardo|R|', 'Mautone|Jennifer A|JA|', 'Khanna|Muniya S|MS|', 'Power|Thomas J|TJ|', 'Orapallo|Andrew|A|', 'Cacia|Jaclyn|J|', 'Schwartz|Billie S|BS|', 'McCurdy|Barry|B|', 'Keiffer|Jacqueline|J|', 'Paidipati|Cynthia|C|', 'Kanine|Rebecca|R|', 'Abraham|Manju|M|', 'Tulio|Shelby|S|', 'Swift|Lauren|L|', 'Bressler|Shannon N|SN|', 'Cabello|Beatriz|B|', 'Jawad|Abbas F|AF|']
D000223:Adaptation, Psychological D000293:Adolescent D002648:Child D002675:Child, Preschool D016000:Cluster Analysis D015928:Cognitive Behavioral Therapy D005260:Female D006801:Humans D008297:Male D008605:Mental Health Services D065886:Neurodevelopmental Disorders D012017:Referral and Consultation D012572:School Health Services D012574:Schools D013334:Students D016896:Treatment Outcome D014505:Urban Population
urban schools training fidelity dissemination and implementation evidence-based practice