Project Summary/Abstract 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. Despite initial promising results of training school clinicians to treat ADHD/ODD in settings suffering from high unmet need, such as Mexico, scalability is limited by a lack of researchers with capacity to train, monitor, and evaluate school clinicians in such efforts on a large scale. Thus, we need to develop more feasible interventions and training programs for school clinicians, as well as create a system with capacity for scalable training and evaluation, to combat the widespread impact of ADHD/ODD worldwide. Converting interventions and school clinician professional development programs for fully-remote delivery allows for more flexibility, accessibility, affordability, scalability, and promise for ongoing consultation than in-person options. Supporting scalable training for school clinicians could address a significant public health concern in Mexico, as only 14% of Mexican youth with mental health disorders receive treatment and less than half of those treated receive more than minimally adequate care. Our team is uniquely suited for this effort, given that we developed the only known school-home ADHD/ODD evidence-based intervention in Latin America -and- have developed a web-based training for U.S. school clinicians with promising preliminary results. Our prior studies and high levels of unmet need make Mexico an ideal location for this proposal; however, lessons learned could be used to expand scalable school clinician training for evidence-based intervention in other settings and/or for other disorders. Thus, we will: Aim 1) Conduct an open-trial of the fully-remote program and make iterative changes. We predict: H1) school clinicians trained remotely will be satisfied and show improved evidence-based practice skills H2) families and teachers participating remotely will be satisfied and youth will show improved ADHD/ODD H3) observation/feedback from a 3-school open-trial will guide iterative changes to the remote program Aim 2) Build research capacity in Mexico for scalable intervention and training programs. We predict: H4) the university (UAS) will host a course on clinical research, remote intervention and training programs H5) students will show improved evidence-based practice skills and demonstrate competency as trainers Aim 3) Compare the fully-remote program vs. care-as-usual in an 8-school clustered RCT. We predict: H6) school clinicians trained in the remote program will be satisfied and show improved skills H7) parents, youth, and teachers treated by school clinicians in the remote program will engage/adhere H8) youth in the remote program will show more ADHD/ODD improvements compared to care-as-usual

Project Narrative 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. We need to develop more feasible intervention and training programs for school clinicians, as well as create a system with clinical research capacity for scalable school clinician training and evaluation, to combat the widespread impact of ADHD and ODD worldwide. This could not only address a significant public health concern in Mexico (as only 14% of Mexican youth with mental health disorders receive treatment and less than half of those treated receive more than minimally adequate care), but also could be used to expand scalable school clinician training for evidence-based intervention delivered remotely in other settings and/or for other disorders.