Modification and Evaluation of an Evidence-based, Universal, Mental Health Promotion Program in Title I schools in rural Alabama: Advocates for All Youth (ALLY)
Type of DegreePhD Dissertation
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In the US, the presence of a lifetime diagnosis of either depression or anxiety rose from 5.4% in 2003 to 8.4% in 2012 in children aged 6-17 years (Bitsko et al., 2018) and by 2016, 16.5% had at least one mental health disorder including depression or anxiety (Whitney & Peterson, 2019). Children and adolescents exposed to adverse childhood experiences (ACE, e.g., parental divorce, maltreatment, trauma, bullying, and family conflict) are more likely to experience chronic stressor states which predispose them to mental health disorders (e.g., anxiety and depression). Suicide is the second most common cause of death among youth with the incidence of suicide increasing with the occurrence of every ACE. Individuals from low socioeconomic status (SES) backgrounds are more likely to experience ACEs. Indeed, many youths from low-SES backgrounds are disproportionately more likely to have higher mental health burdens and are less likely to access mental health care due to poor access (i.e., cost, transportation, and availability of clinicians). Therefore, there is a need for interventions focused on mental health promotion to reduce the incidence and severity of mental disorders in youth, particularly those from low-SES backgrounds. The school is an ideal environment to implement such interventions because students spend most of their time in school, there are reduced barriers to access, and many students can be reached simultaneously. One such intervention, the Advocates for All Youth (ALLY), is a 6-week universal program aimed at reducing anxiety and depression via individualized health coaching targeting 5th and 6th grade students. The aim of this dissertation was to describe the modification and efficacy of this program for use in Title I elementary schools in Alabama with children from rural, low-income, and predominantly Black community. Study 1 demonstrated the feasibility and described the modifications of the ALLY program aimed at increasing mental and physical health of 5th and 6th grade students in a rural Title I school. Study 2 described the outcomes and efficacy of the modified ALLY program on mental and physical health in 6th graders in three Title I schools using a randomized control design (intervention and waitlist control). Overall, the ALLY program was not associated with improvements in mental and physical health in this population. Future directions and limitations of the ALLY program are discussed. This program of research represents an important first step in determining further modifications that would be necessary to improve mental and physical health in ethnically minoritized middle school students from low SES backgrounds.