School District Partner: North Clackamas School District, Portland, Oregon

Co-Principal Investigator: Connell, Arin M.

Purpose: The purpose of this project is to conduct an efficacy trial of the Family Check-Up (FCU) Online to address emotional and behavioral challenges among middle school students with or at risk for disability during their transition back to school after the pandemic-related school closures. Mental health and behavior problems are at epidemic proportions as a result of the pandemic. These adverse effects have been more pronounced for students with or at risk for disabilities who were already behind academically or struggling with behavioral problems before COVID-19. To address this need, the research team will evaluate the efficacy of the FCU Online, a school-based, ecological approach to family intervention and risk reduction on the behavior, academic performance, and absenteeism of middle school students with or at risk for disability. The team will also examine whether home–school communication, positive parenting, and behavioral routines will mediate intervention efficacy. Although the FCU Online was previously pilot tested in a small randomized trial, this study will be the first test of the model as a large-scale, school-based intervention. In addition to testing efficacy, an implementation study will be conducted. The researchers will train school providers in the FCU model to understand factors related to successful uptake of the model, with the goal of informing future large-scale dissemination efforts.

Project Activities: Using a randomized controlled trial, the research team will examine whether the FCU Online improves student attendance, behavior, and academic achievement, as well as home–school communication, positive parenting, and use of behavioral routines over a 2-year period. During this trial, the team will also examine the cost-effectiveness of the intervention. They will then conduct an implementation study with school-based staff to assess usability, feasibility, and acceptability, as well as to examine facilitators and barriers to adoption and implementation, to better understand how this intervention would be applied in real-world settings.

Products: This project will result in evidence of the efficacy of the FCU Online on outcomes for middle school students with or at risk for disability and their families, as well as cost-effectiveness and implementation. The project will also result in peer-reviewed publications and presentations as well as products that support use of evidence from this project for education stakeholders such as practitioners and policymakers.

Structured Abstract

Setting: The research will take place at an urban middle school in Oregon.

Sample: The participants for the randomized controlled trial (RCT) include a diverse group of 300 middle school students and their families. Equal numbers of boys and girls will be recruited for participation. Students will be screened for risk of disability or will have an IEP for emotional and behavioral disorders or related disability. Ten key school-based stakeholders (educators, administrators, behavior specialists) will participate in structured interviews for the implementation study.

Intervention: The Family Check-Up (FCU) Online is a modified version of a previously developed in-person, year-long intervention focused on fostering skills that lead to success in home and school environments. The current version is delivered using a telehealth model through a smartphone web-based app, is supported through a trained coach, and has additional enhancements. The FCU Online engages caregivers and targets areas of strength and risk by using an assessment-based procedure and motivational interviewing to improve parenting skills, parent involvement, and ultimately youth emotional problems, behavior, and educational outcomes. It incorporates a motivational interview; assessments of child behavior, parent well-being, and parenting skills; and data-driven feedback based on norms. It also provides content to help parents improve their behavioral parenting skills and their child's behavior and emotional well-being. After parents complete a brief online assessment, computer-generated feedback provides them with results and directs them to specific parenting modules based on the Everyday Parenting Curriculum (including positive parenting, limit setting, monitoring, and family communication/problem solving). The curriculum is supplemented by a tailored module focused on school routines and a new module created for the COVID-19 pandemic focused on such skills as coping, health routines, and screen time for healthy development. The telehealth coaching integrates live coaching (via phone calls or video conferencing) and is designed to promote behavioral change. Participants receive at least three telehealth support sessions, with additional support sessions scheduled as needed, with all the FCU Online components generally completed by parents within 3 months.

Research Design and Methods: For the RCT, students will be randomly assigned to either the intervention or business-as-usual condition. The students and their families will be followed in a longitudinal design for 2 years, with data collected at five time points (pretest, 3 months, 6 months, 12 months, and 2 years) from teachers, families, and youth. Data will also be collected on implementation and fidelity from school providers. At the end of the RCT, school-based personnel will be trained to implement the FCU Online model. For this implementation study, the research team will assess uptake and usage through interviews with key stakeholders as well as through FCU Online usage data.

Control Condition:  Students and their families assigned to the control condition will attend school and receive all the usual services available to support learning within the district.

Key Measures:  Students will be screened for eligibility using school-identified risk indicators such as attendance, behavior, and class performance, as well as an annual school-administered mental health screener. Key measures will assess (a) family sociocultural contexts and resources, such as parent and student ratings of stress, family conflict and relationships, parenting self-competence, and family impacts from COVID-19; (b) student mental health/behavioral regulation, including parent, student, and/or teacher ratings of attention and self-regulation; (c) family management and parent–school involvement, such as parent reports of home-to-school communication and positive parenting skills; and (d) school records reviews of academic achievement and attendance. The research team will measure constructs in each domain with assessments from multiple informants (parents, youth, teachers). Researchers will also collect implementation data such as fidelity, usage, dosage, feasibility, acceptability of the model, and barriers to implementation. Implementation data will be collected via interviews, rating scales, and online usage data.

Data Analytic Strategy: Analyses of intervention effects will follow an Intention-to-Treat framework. Mixed-model analysis of covariance will be used to test time-specific effects of the intervention at each follow-up data collection point after intervention, while latent growth models will be used to analyze trajectories of change over time. These models will be used to conduct tests of (a) the main effects of intervention, (b) mediation of intervention effects on primary outcomes, and (c) moderation of intervention effects by such characteristics as child gender, race/ethnicity, and level of risk (such as extent of behavior problems).

Cost Analysis: The cost study will use the ingredients method for estimating costs. The cost-effectiveness analysis will assess incremental FCU Online costs in relation to incremental impacts on the study's primary outcomes of reduced emotional and problem behavior, improved achievement, and improved attendance. Incremental cost-effectiveness ratios (difference between intervention and control group costs per youth divided by the difference between intervention impacts) will be calculated separately for each of the study's primary outcomes.

Related Projects: Testing the Efficacy of an Ecological Approach to Family Intervention and Treatment During Early Elementary School to Prevent Problem Behavior and Improve Academic Outcomes (R305A140189); Family-Centered Intervention in Schools to Reduce Social and Behavioral Problems From Early Elementary School to Adolescence (R324A180037)