This application extends a program of research that examines the capacity of publicly-funded after-school programs to promote children's mental health in urban, poor communities, where the risks for mental health difficulties are extremely high and the resources available to meet those needs are severely limited. The proposed study will be conducted at the Chicago Park District's Park Kids program, one of the largest providers of publicly-funded after school programs for children and youth in Chicago. We recently completed the first study in this program of research (NIMH R34-MH070637; PI: Frazier; see Preliminary Studies Project NAFASI) examining the feasibility of mental health consultation to after school program staff around academic enrichment, coaching behaviors, activity engagement and behavior management. Those findings reveal strong evidence for the feasibility of intervention, high staff satisfaction, and encouraging though modest improvements in children's adaptive functioning. The current application will expand the NAFASI intervention to reflect a growing literature in children's mental health services linking organizational social context with service quality and outcomes which suggests that effective and sustainable change at a program level will require more concentrated intervention at an organizational level. Hence, we propose to examine in Years 1-3 via mixed-effects regression models how social context (by direct observation and staff perceptions) operates in after school programs in relation to child and parent reported program quality and children's mental health outcomes (staff and self report) for 12 randomly selected children ages 8 to 16 in each of the 84 Park Kids programs throughout Chicago (n=357 staff, 1,008 children). These data will be used to (1) provide norms for after school programs on a measure of organizational social context, (2) estimate the variance component structures associated with site that will be used to power a subsequent clinical trial, and (3) inform the expansion in Year 4 of organizational-level intervention components for the NAFASI intervention. The proposed study will contribute to the overall goal of this research to develop new models of community mental health practice focused on supporting the mission, improving the quality, and enhancing the capacity of after- school programs to promote mental health and adaptive functioning for children living in urban poverty.

R01MH081049

2009-02-05

2014-11-30