Implementation strategies for caregiver and teacher use of behavioral interventions with ADHD: A pilot study

PROJECT SUMMARY Well-established psychosocial interventions for children with or at-risk for ADHD include behavioral parent training at home and behavioral classroom management interventions at school, both of which show strong meta-analytic evidence of effectiveness. These approaches involve adults using antecedent- and

consequence-based interventions to create contexts in which children are more likely to succeed. Moreover, the home-school relationship is critical for children's success in school and home, and interventions aiming to promote family-school collaboration are effective at improving outcomes of children with ADHD. However,

caregivers need implementation supports to implement evidence-based antecedent- and consequence-based interventions with fidelity, and caregivers often have difficulty accessing behavior therapy in community settings. Preliminary data from our ongoing work developing and pilot testing implementation strategies for

teachers in partnership with the School District of Philadelphia suggests an additional need for caregiver-facing implementation strategies to support behavioral intervention and home-school communication. Schools are a promising setting in which to provide early intervention for mental health challenges and to increase access to

mental health care. Furthermore, stronger integration between home- and school- based interventions has the potential to meaningfully improve child outcomes. Therefore, we propose to develop implementation strategies for caregivers (Supporting School Success [SSS-C]), disseminated through schools and designed to address

the specific needs of caregivers, to support caregivers of children with or at-risk for ADHD in implementing evidence-based behavioral interventions and home-school communication approaches. These caregiver-facing implementation strategies will be designed in coordination with the teacher-facing implementation strategies

(SSS-T). To prepare for a large-scale R01 Hybrid Trial, we will address two specific aims: (1) Develop and field-test caregiver-facing implementation strategies (SSS-C); (2) Pilot test SSS-C, together with the existing SSS-T implementation strategies to prepare for a large-scale Hybrid Trial. During Aim 1, we will use an

iterative, community-partnered approach to develop SSS-C, refine it in partnership with a Stakeholder Advisory Board based on feedback from try-outs with caregivers, and make final adjustments based on a field pre-test. During Aim 2, we will conduct a small-scale randomized pilot trial with 40 children and their caregivers and

teachers, and will collect implementation outcomes (i.e., acceptability, appropriateness, feasibility, caregiver and teacher fidelity) and child outcomes (i.e., ADHD symptoms, functional impairment, academics, student- teacher relationship). We will also mixed methods to examine the hypothesized mechanisms, based on the

Theory of Planned Behavior, of the caregiver- and teacher-facing implementation strategies.