Is the metabolic syndrome associated to childhood obesity and lifestyle

Longitudinal studies of inner city mental health centers indicate that the -no-show rate for appointments is at least 50% (Sanchez-Hucles, 1999; Zahner, Pawelkiewicz, DeFrancesco, et al., 1992). The stigma attached to receiving mental health services may prevent many children from low-income, minority families from receiving treatment (U.S. Public Health Service, 2000). Moreover, African American children and families residing in urban areas have reported that mental health providers need to deliver more culturally appropriate treatment (Fong and Futuro, 2001; Matt and Navarro, 1997; Wills, 1998). As our society moves toward multiculturalism, research aimed at recording what types of mental health services are most beneficial for individuals from different ethnic groups will be important (Illovsky, 2003).Due to the lack of services for urban children from low-income families (e.g., community-based clinics often have long waiting lists), we recommend providing mental health services in schools (Nabors and Rofey, 2003). As the United States moves toward a multicultural society, more information about how interventions work for children from ethnic minority groups will be needed (Illovsky, 2003). Implementation studies are one method for examining whether successful clinic-based interventions can be effectively deployed in community settings, like school-based mental health (SBMH) clinics (Chorpita, Yim Donkervoet, et al., 2002; Connor-Smith and Weisz, 2003; Nabors and Rofey, 2003). Thus, this chapter presents information about how implementation studies can be used to examine whether interventions can be successfully transported to SBMH clinics. This chapter also will review examples of interventions that could be implemented in schools serving African American children from low-income families.IMPLEMENTATION STUDIESImplementation studies or fidelity checks involve assessing whether treatment was provided or delivered as planned (Moncher and Prinz, 1991). If treatment was delivered as planned and is related to enhanced outcomes, then one can assume it was successfully transported. Interventions may need to be changed or delivered differently when treatment is provided in schools (Chorpita, Yim Donkervoet, et al., 2002). Consequently, implementation studies may provide information about whether interventions need to be fine-tuned to result in optimal outcomes for children (Connor-Smith and Weisz, 2003; Schoenwald and Hoagwood, 2001).METHODS FOR CONDUCTING IMPLEMENTATION STUDIESMany different research techniques can be used to conduct fidelity studies (Bond, Evans, Salyers, et al., 2000; Moncher and Prinz, 1991). Videotaping sessions and then having experts code the videotapes to see what techniques were used and whether they were implemented as planned, is one way to gather information about the type of intervention that is being delivered. When the therapy treatment process implemented is associated with outcomes, research and practice can intersect, increasing knowledge about what interventions are related to successful outcomes (Bickman, 1992). Another method, that is less costly and also may provide information about the type of interventions, is using fidelity checklists to document the content of sessions (Everhard and Wandersman, 2000; Schoenwalkd, Henggeler, Bondino, et al., 2000). The fidelity checklist provides an opportunity for clinicians to record whether they implemented the interventions according to the procedures described in a manual or according to programmatic guidelines (Weersing, Weisz, Donenberg, et al., 2002). Additionally, supervisors can review the process of treatment implementation with the clinician during supervision sessions, and then rate their perceptions of how well the clinician followed methods or adhered to the steps required for implementing interventions (Henggeler, Schoenwalkd, Liao, et al., 2002; Holloway and Neufeldt, 1995).Unfortunately, there are drawbacks to conducting research, including implementation studies, which may challenge the utility of this strategy for deploying information in SBMH clinics. …