Edward Zigler Center in Child Development & Social Policy, Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
Dev Psychopathol. 2021 May;33(2):634-646. doi: 10.1017/S0954579420001790.
Early childhood mental health consultation (ECMHC) has been promoted by the federal government as a promising model for reducing early childhood expulsions and suspensions and is now implemented by numerous states. Despite growing ECMHC proliferation, this study is only the second randomized controlled trial of ECMHC, extending the methodologies of the first to include assessment of effects on random peers. Classrooms were assigned randomly to treatment or waitlist-control condition (n = 51 classrooms, 57 preschool teachers, and 190 preschoolers). Evaluation measures were collected at both pretreatment and posttreatment, following approximately six consultation visits. Classroom and teacher outcomes were evaluated with ordinary least squares regressions, while hierarchical linear modeling was used to evaluate child-level outcomes, accounting for the nested study design. Treatment children (both the target children who prompted the referral for ECMHC and random peers) evidenced significant improvements in social and emotional skills. Promising trend findings were noted for child behavior problem reduction and teacher pedagogical approach and locus of control. No significant effects were found on likelihood of expulsion and classroom mental health climate. This is the first ECMHC to demonstrate effects on nontarget peers in a rigorous randomized controlled trial. Programmatic and methodologic limitations and implications are discussed.
儿童心理健康早期咨询 (ECMHC) 已被联邦政府推广为减少儿童早期开除和停学的有前途的模式，现在许多州都在实施。尽管 ECMHC 的普及程度不断提高，但这项研究仅是第二项 ECMHC 的随机对照试验，将第一项研究的方法扩展到包括对随机同伴的影响评估。教室被随机分配到治疗组或候补控制组（n = 51 个教室，57 名学前教师和 190 名学龄前儿童）。在大约六次咨询访问后，在治疗前和治疗后都收集了评估措施。使用普通最小二乘法回归评估教室和教师的结果，而使用分层线性模型评估儿童层面的结果，以考虑到嵌套的研究设计。接受治疗的儿童（包括促使进行 ECMHC 转诊的目标儿童和随机同伴）在社交和情感技能方面都有显著提高。在减少儿童行为问题以及教师的教学方法和控制源方面也观察到了有希望的趋势发现。在开除的可能性和课堂心理健康氛围方面没有发现显著影响。这是第一项在严格的随机对照试验中证明对非目标同伴有效的 ECMHC。讨论了项目和方法学的局限性和影响。
