1 - (IOP 13) Adherence to a Multi-component School-based Intervention for ADHD as a Function of School and Family-level Socioeconomic Status

Background: The Collaborative Life Skills Program (CLS) is a school-based intervention for children in the 2nd - 5th grades with attention and behavior concerns. In CLS, school mental health providers (SMHPs) are trained to concurrently implement evidence-based classroom behavioral management, behavioral parent training, and child skills training. CLS has been shown to be effective across diverse populations, but prior CLS trials have found that low parent and teacher adherence and strategy use can reduce efficacy. Implementation challenges may be impacted by social determinants of health (Chako et al., 2016). The present study examined the effects of school and family-level socioeconomic status (SES) on parent and teacher adherence and strategy use in CLS, as well as SMHPs’ implementation of CLS.

Method: Participants were 14 SMHPs and 84 children (M age = 8.24, 75% males) in the 2nd - 5th-grade, their parents, and their teachers. This study includes data from 14 elementary schools in an urban school district in northern California randomly assigned to receive training in CLS as part of a cluster randomized trial. Children in the sample were ethnically/racially diverse (26.2% White); 37% qualified for free or reduced price school lunch based on family income. Schools ranged in size from 253 to 699 students and the proportion of children who qualified for free or reduced price lunch at each school ranged from 24% to 96%. Observers rated the quality of parents’ participation following the intervention. Teacher Daily Report Card (DRC) completion and parent group attendance rates were collected throughout the intervention.

Results: Two-level models accounted for clustering of children, parents, and teachers within schools. Parents of children who qualified for free or reduced price lunch had lower observed participation, b = -3.33, p = .002, and number of parent groups attended, b = -1.17, p = .047, than parents of children who did not qualify. However, a cross-level interaction revealed that the difference in parent participation between students who did and did not qualify for free or reduced price lunch was greater in schools with a lower proportion of students who qualified for free or reduced lunch, b = .09, p < .001. In three-level growth models, a higher proportion of children who qualified for free or reduced price lunch at the school level was associated with a lower percentage of DRCs completed by teachers initially, intercept = -.03, p < .001, and this difference remained stable across the intervention, b = .02, p = .062. On the other hand, children who qualified for free or reduced lunch did not have a significantly lower percentage of DRCs completed by teachers initially, intercept = .31, p = .256, but their percentage of completed DRCs decreased more across the intervention than that of students who did not qualify for free or reduced lunch, slope = -.53, p < .001.

Discussion: The present study highlights that low SES families and the schools that serve them face substantial barriers to intervention adherence. These finding supports the need for future research to implement targeted strategies aimed at improving adherence among low SES families.