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Reach for success: an initial evaluation of implementation quality in school settings

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Anxiety is one of the most common psychiatric disorders among children yet characterized by lower use of mental health services. Preventive efforts have demonstrated promise in the ability to reduce

Anxiety is one of the most common psychiatric disorders among children yet characterized by lower use of mental health services. Preventive efforts have demonstrated promise in the ability to reduce anxiety symptoms. However, as evidence-based interventions move into real-world settings, there is a need to systematically examine potential implementation factors that may affect program outcomes. The current study investigates the relations between different aspects of implementation and their effect on outcomes of a school-based preventive intervention targeting anxiety symptoms. Specifically, the study examines: (1) the measurement of quality of delivery, (2) specific relations among implementation components, (3) relations between these facets and anxiety program outcomes. Implementation data were collected from nine school-based mental health staff and observer ratings. Program outcomes (pretest and immediate posttest) were measured from 59 participants and their parents (mostly mothers) in the intervention condition. Implementation components included adherence, quality of delivery, time spent, participant responsiveness, and perceived usefulness of program materials. Program outcomes included child-reported emotional expressivity, physiological hyperarousal, negative cognitions, social skills, self-efficacy, and child and parent reported levels of child anxiety. Study findings indicated that quality of delivery was best captured as two facets: skillful presentation and positive engagement. Adherence and quality of delivery were associated with greater participant responsiveness, although time spent was not. Significant relations were found between some implementation components and some program outcomes. Further efforts can be used to optimize the translation of evidence-based programs into real-world settings.

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  • 2017

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Developmental changes in anxiety and social competence in early childhood: exploring growth and the roles of child temperament and gender

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This dissertation examined how anxiety levels and social competence change across the course of early elementary school, as well as how individual differences at the transition to kindergarten may influence

This dissertation examined how anxiety levels and social competence change across the course of early elementary school, as well as how individual differences at the transition to kindergarten may influence these trajectories. Previous research has supported unidirectional relations among anxiety and social competence, but few studies explore how inter- and intra-individual changes in social competence and anxiety may be related across time. From a developmental perspective, studying these trajectories following the transition to kindergarten is important, as cognitive and emotion regulation capacities increase markedly across kindergarten, and the relative success with which children navigate this transition can have a bearing on future social and emotional functioning across elementary school. In addition, given gender differences in anxiety manifestation and social competence development broadly, gender differences were also examined in an exploratory manner. Data from parent and teacher reports of a community sample of 291 children across kindergarten, 1st, and 2nd grades were analyzed. Results from bivariate growth models revealed steeper increases in anxiety, relative to peers in the sample, were associated with steeper decreases in social competence across time. This finding held after controlling for externalizing behavior problems at each time point, which suggests that relations among anxiety and social competence may be independent of other behavior problems commonly associated with poor social adjustment. Temperament variables were associated with changes in social competence, such that purportedly "risky" temperament traits of higher negative emotionality and lower attention control were associated with concurrently lower social competence in kindergarten, but with relatively steeper increases in social competence across time. Temperament variables in kindergarten were unrelated with changes in anxiety across time. Gender differences in relations among anxiety in kindergarten and growth in social competence also were revealed. Findings for teacher and parent reports of child behavior varied. Results are discussed with respect to contexts that may drive differences between parent and teacher reports of child behavior, as well as key developmental considerations that may help to explain why kindergarten temperament variables examined herein appear to predict changes in social competence but not changes in anxiety levels.

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  • 2016