Enhanced Support for Behavioral Barriers to Learning: An Evaluation of the SCHOOL STARS Program

Study Overview
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Brief Summary
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This small pilot study will enroll children ages 5-12 years of age with disruptive behavior problems at school. These children and their families will be offered an enhanced model of primary care, which includes pre-visit record review, standardized content of primary care visits, post-visit care coordination by the primary care team, and coordination of services between the primary care team and the school. We hypothesize that children receiving this enhanced model of care will achieve better behavioral outcomes at both school and home.

Official Title
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Enhanced Support for Behavioral Barriers to Learning: An Evaluation of the SCHOOL STARS (Supporting Child Health Outcomes, Optimizing Learning, Striving to Achieve Real Solutions) Program

Conditions
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Disruptive Behavior Disorder, Childhood Onset, Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder in Children, Disruptive Mood Dysregulation Disorder

Intervention / Treatment
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* Other: enhanced model of primary care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Student at a local public school Primary care patient at the Pediatric Primary Care Center (PPC) at CCHMC, or a CCHMC-affiliated school-based health center School disciplinary problems defined as: (1) any suspension from school within the last 2 school months and/or (2) frequent calls to the parent from school (1+ times per week x 1 month) Parent is in the contemplative, preparation, or action stage of readiness for starting medication or therapy if recommended by a healthcare provider for their child's behavior problems Student may or may not have an existing diagnosis of an externalizing behavioral health disorder, such as ADHD, Oppositional Defiant Disorder, or Disruptive Mood Dysregulation Disorder. Exclusion Criteria: Non-English-speaking parent Enrolled in another ADHD study Severe developmental delay or autism Potential cardiac contraindications to starting stimulant medications without an EKG (personal or family history of heart disease in a child, family history of sudden death before age 50, family history of death due to heart disease before age 50, personal history of seizures, personal history of unexplained syncopal episodes) Patients who have an established relationship with a PPC Care Manager Patients who have seen the same primary care provider for the last two well child or behavior-related visits (unless approved/referred by that primary care provider)

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Interventional Model Description: Pre-post within-subject design
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Enhanced model of primary care<br> | Other: enhanced model of primary care<br>* The SCHOOL STARS model of care includes pre-visit planning, standardized visit content, post-visit care coordination, and coordination between primary care and school.<br>* Other names: SCHOOL STARS care model;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Child Behavior Checklist scores (externalizing subscale) | parent-completed assessment of child behavior; T scores for the externalizing subscale range 0-100 with higher scores being worse | at enrollment and 3 months post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in disciplinary referrals at school | number of times per week child was referred for disciplinary action at school | 3 months pre-intervention to 3 months post-intervention | 
| Change in calls to parent from school | number of calls per week to the parent from school about the child's behavior | 3 months pre-intervention to 3 months post-intervention | 
| Change in days of suspension from school | number of days child was suspended from school | 3 months pre-intervention and 3 months post-intervention | 
| Change in Vanderbilt Attention Deficit Hyperactivity Disorder Rating Scale scores | (for participants with ADHD); Total Symptoms Score for items 1-18 (inattentive and hyperactive symptoms); Range 0-54; Higher scores represent a worse outcome | all historical data and all data up to 3 months post-intervention |