# Hybrid Effectiveness-Implementation Trial of a School Clinician Training and Psychosocial ADHD/ODD Intervention Program Adapted for Schools across Mexico (CLS-A-FUERTE)

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2024 · $790,962

## Abstract

Neurodevelopmental disorders of Attention-Deficit/ Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) are extremely common but underserved with Evidence-Based Treatments (EBT) worldwide. Thus, our team developed, implemented and evaluated a school clinician training and ADHD/ODD intervention (i.e., the Collaborative Life Skills [CLS] program) for Mexico: a setting with high unmet need. We integrated technology into our in-person program (CLS-FUERTE) to create a digitally-enahnced version (CLS-R-FUERTE). Given findings demonstrating feasibility, acceptability, and efficacy of both program versions, we propose a Type 2 Hybrid Effectiveness-Implementation Design to evaluate the program effectiveness, mechanisms of intervention change, and maintenance barriers/facilitators in a scaled-up cluster randomized controlled trial with n = 40 schools across two Mexican -while also- exploring the impact of an implementation strategy in which we adapt the program to fit each school’s needs/resources during the maintenance period to encourage sustainability (i.e., CLS-A-FUERTE). Our implementation process is guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) model with evaluation following the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework. 
Aim 1) Test the effectiveness and implementation of the CLS-A-FUERTE school clinician training and ADHD/ODD intervention program adapted for schools across Mexico. We expect:
H1) School clinicians will engage in training and implement chosen intervention components with fidelity
H2) Teachers and/or families will engage in chosen intervention components and adhere to the strategies
H3) Students receiving CLS-A-FUERTE will show greater improvement in ADHD/ODD symptom and impairment severity (rated by parents/teachers) compared to students receiving school services as usual 
Aim 2) Evaluate mechanisms of sustained intervention change. We expect:
H4) Improvements in parenting behaviors will mediate sustained intervention effects 
H5) Improvements in teacher and/or school clinician competency will mediate intervention effects
Aim 3) Identify CLS-A-FUERTE maintenance barriers and facilitators. We expect across adaptations that sustained intervention effects and continuation of program activities at follow-up will relate to: 
H6) Program feasibility (i.e., cost estimates) and acceptability (i.e., participant satisfaction)
H7) Characteristics of participating schools and school context factors
Aim 4) Expand research capacity to a novel university setting. We expect emerging investigators will:
H8) Complete clinical research coursework and produce deliverables (i.e., presentations, papers, grants)
H9) Show improved EBT skills, research capacity and culture ratings, and competency as program trainers

## Key facts

- **NIH application ID:** 10986915
- **Project number:** 1R01MH134368-01A1
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Lauren Marie Haack
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $790,962
- **Award type:** 1
- **Project period:** 2024-08-15 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10986915

## Citation

> US National Institutes of Health, RePORTER application 10986915, Hybrid Effectiveness-Implementation Trial of a School Clinician Training and Psychosocial ADHD/ODD Intervention Program Adapted for Schools across Mexico (CLS-A-FUERTE) (1R01MH134368-01A1). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10986915. Licensed CC0.

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