title: A cluster randomized trial to evaluate external support for the implementation of positive behavioral interventions and supports by school personnel.
abstract: BACKGROUND
  Urban schools lag behind non-urban schools in attending to the behavioral health needs of their students. This is especially evident with regard to the level of use of evidence-based interventions with school children. Increased used of evidence-based interventions in urban schools would contribute to reducing mental health services disparities in low-income communities. School-wide positive behavioral interventions and supports (SWPBIS) is a service delivery framework that can be used to deliver universal preventive interventions and evidence-based behavioral health treatments, such as group cognitive behavioral therapy. In this article, we describe our ongoing research on creating internal capacity for program implementation. We also examine the cost-effectiveness and resulting school climate when two different levels of external support are provided to personnel as they implement a two-tier SWPBIS program.
  
  
  METHODS
  The study follows six K - 8 schools in the School District of Philadelphia randomly assigned to consultation support or consultation-plus-coaching support. Participants are: approximately 48 leadership team members, 180 school staff and 3,900 students in Tier 1, and 12 counselors, and 306 child participants in Tier 2. Children who meet inclusion criteria for Tier 2 will participate in group cognitive behavioral therapy for externalizing or anxiety disorders. The study has three phases, baseline/training, implementation, and sustainability. We will measure implementation outcomes, service outcomes, child outcomes, and cost.
  
  
  CONCLUSIONS
  Findings from this study will provide evidence as to the appropriateness of school-wide prevention and treatment service delivery models for addressing services disparities in schools. The effectiveness and cost-effectiveness analyses of the two levels of training and consultation should help urban school districts and policymakers with the planning and deployment of cost-effective strategies for the implementation of evidence-based interventions for some of the most common behavioral health problems in school children.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01941069.
authors.affiliation: Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, 3440 Market St, Philadelphia, PA 19104-3306, USA. eiraldi@mail.med.upenn.edu.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Eiraldi
authors.forename: Barry
authors.initials: B
authors.lastname: McCurdy
authors.forename: Muniya
authors.initials: M
authors.lastname: Khanna
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mautone
authors.forename: Abbas F
authors.initials: AF
authors.lastname: Jawad
authors.forename: Thomas
authors.initials: T
authors.lastname: Power
authors.forename: Zuleyha
authors.initials: Z
authors.lastname: Cidav
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Cacia
authors.forename: George
authors.initials: G
authors.lastname: Sugai
mesh_terms: D001008:Anxiety Disorders / Q000628:therapy; D001521:Behavior Therapy / Q000458:organization & administration*; D002648:Child; D002653:Child Behavior Disorders / Q000628:therapy*; D004777:Environment; D019317:Evidence-Based Medicine; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D012107:Research Design; D012572:School Health Services / Q000458:organization & administration*; D012959:Socioeconomic Factors; D014505:Urban Population