The CLS-R-FUERTE project in Mexico. Neurodevelopmental disorders of inattention and disruptive behavior, such as Attention-Deficit/ Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), are among the most common youth mental health conditions across cultures. An efficacious and feasible solution to improving affected youth’s ADHD/ODD is training existing school clinicians to deliver evidence-based intervention with fidelity. Converting interventions and school clinician training programs for fully-remote delivery allows for more flexibility, accessibility, affordability, scalability, and promise for ongoing consultation than in-person options. Thus, our project funded by the National Institute of Mental Health (NIMH) and National Institute of Health Fogarty International Center (NIH-FIC) sought to:
Aim 1) Conduct an open-trial of the fully-remote CLS-R-FUERTE program and make iterative changes
Aim 2) Build research capacity in Mexico for scalable intervention and training programs
Aim 3) Compare the fully-remote CLS-R-FUERTE program vs. care-as-usual in an 8-school clustered Randomized Controlled Trial
For more information on the CLS-R-FUERTE project, visit: https://reporter.nih.gov/project-details/10297427
Publications from this project:
Haack, L. M., Pfiffner, L. J., Darrow, S., Lai, J. Alcaraz Beltrán, K., Martinez Beltran, J. U., Candil, E. M., García, K. D., Arriaga Guerrero, F., Saldaña, D. M. L., Valdez , M. E., & Araujo, E. J. (in press). Implementation of a Multi-Site Digitally-Enhanced School Clinician Training andADHD/ODD Intervention Program in Mexico: Randomized Controlled Trial of CLS-R-FUERTE. Journal of Technology in Behavioral Science (epub ahead of print). DOI: 10.1007/s41347-023-00367-6
Haack, L. M., Pfiffner, L. J., Darrow, S. M., Lai, J., Alcaraz Beltrán, D. K., Beltrán, J. U. M., Moreno Candil, E., Delgado García, K., Arriaga Guerrero, M. F., Ledesma Saldaña, D. M., Urquídez Valdez, M. E., & Araujo, E. A. (2023). Enhancing accessibility and scalability of school-based programs to improve youth attention and behavior: Open feasibility trial of the remote CLS-R-FUERTE program in Mexico. School Psychology (epub ahead of print). DOI: 10.1037/spq0000580
https://www.growkudos.com/publications/10.1037%252
The CLS-FUERTE program in Mexico. Despite well-established Evidence-Based Treatments (EBTs) for Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), many low-resource settings lack EBT access. We conducted a school-clustered randomized controlled pilot of CLS-FUERTE (a multicomponent behavioral EBT adapted for children in Mexico) with 58 students in efforts funded by the National Intitute of Health Fogarty International Center (NIH-FIC; 5R25TW009343; Fellow = Haack) and Health Initiative of The Americas- Berkeley School of Public Health Research Program on Migration and Health (PIMSA; Co-PIs = Haack & Araujo). We randomly assigned four schools to receive CLS-FUERTE and four to receive school services as usual. We compared groups post-treatment on parent- and teacher-rated ADHD/ODD symptoms and impairment. CLS-FUERTE fidelity, attendance, engagement, and acceptability was high and students receiving CLS-FUERTE showed greater improvement in teacher-rated ADHD, ODD, and impairment, as well as parent-rated ADHD and impairment, compared to students receiving usual services. Pilot results suggest that psychosocial EBTs can be successfully implemented by School Mental Health Providers in Mexico. This project represented the first known effort to implement and evaluate a behavioral school-based program to improve youth attention and behavior in Latin America.
Haack, L. M., Araujo, E. A., Meza, J., Friedman, L. M., Spiess, M., Alcaraz, K., Delucchi, K., Mojardin, A., & Pfiffner, L. J. (in press). Can school mental health providers deliver psychosocial treatment improving youth attention and behavior in Mexico? a Pilot randomized controlled trial of CLS-FUERTE. Journal of Attention Disorders (online ahead of print); https://doi.org/10.1177/1087054720959698; PMID: 32996347
The CLS-Spanish program in the United States (U.S.) Behavioral intervention trials for ADHD consistently document
favorable fidelity and outcome results. However, less is known about the generalizability of these findings to non-English-speaking groups. Thus, we adapted the Collaborative Life Skills (CLS) Program for Spanish-speaking families (i.e., CLS-S) and implemented/evaluated the adapted program in a pilot study funded by the National Institute of Mental Health (NIMH). Participants included 24 Latinx children in grades second-fifth across four elementary schools; two of these schools (n = 12) were assigned to receive CLS-S and two schools (n = 12) were assigned to usual school services followed by CLS-S after completion of the trial. Results suggest CLS can be successfully implemented in Spanish, as evidenced by high levels of CLS-S fidelity to intervention, as well as high levels of participant attendance and adherence to treatment strategies. Results also suggest promising outcomes from CLS-S, as evidenced by significant post-treatment improvement in ADHD and ODD symptoms reported by parents/caregivers and teachers, social skills reported by parents/caregivers, and organizational problems reported by teachers for treated families compared to families receiving school services as usual. Parent/caregiver reports of ADHD and ODD symptom improvement also are significant at follow-up during the next school year. Qualitative themes emerged supporting CLS-S process and outcome results, including parent/caregiver appreciation of the collaborative design, rapport with staff, and ease of CLS-S employment. Taken together, mixed-method findings support translating evidence-based interventions for theoretically-guided implementation/evaluation in our increasingly diverse communities.
Haack, L. M., Araujo, E. A., Delucchi, K. Beaulieu, A., & Pfiffner, L. J. (2019). The Collaborative Life Skills Program implemented in Spanish (CLS-S): Investigation of intervention process, outcomes, and qualitative feedback. Evidence-Based Practice in Child & Adolescent Mental Health, 4(1), 18-41. https://doi.org/10.1080/23794925.2018.1560236; PMID: 31938725
Haack, L. M., Meza, J.,Jiang, Y., Araujo, E., & Pfiffner, L. J. (2018). Influences to ADHD problem recognition: Mixed-method investigation and recommendations to reduce disparities for Latino youth. Administration and Policy in Mental Health and Mental Health Services Research, 45(6), 958-977. doi.org/10.1007/s10488-018-0877-7.
Araujo, E. A., Haack, L. M., & Pffifner, L. J. (2017). Emotional, social and cultural experiences of Latino children with ADHD symptoms and their families. Journal of Child and Family Studies, 26, 3512–3524. 10.1007/s10826-017-0842-1
To read more about the CLS-FUERTE and CLS-S programs, please see our Policy Brief available in English and Spanish.