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

Neurodevelopmental disorders of inattention and disruptive behavior, such as attention-deficit/hyperactivity disorder and oppositional defiant disorder, are among the most common youth mental health conditions across cultures. There is a need to develop more accessible school-based intervention and training programs, as well as create a system with clinical research capacity for scalable school clinician training and evaluation, to support students with attention and behavior concerns worldwide. We adapted the collaborative life skills program for Mexico (i.e., CLS-FUERTE) for remote delivery (i.e., CLS-R-FUERTE) and conducted a three-school open trial with N = 67 participants (n = 7-8 students per school [ages 6-12] and their parents, teachers, and school clinicians). We examined fidelity to program content, attendance and adherence records, in vivo observations of program delivery, and postmeeting feedback informing iterative program changes between each school cohort. We also examined improvements in youth attention and behavior rated by parents and teachers to evaluate the remote program effectiveness. CLS-R-FUERTE feasibility, acceptability, and usability findings were promising. Iterative program changes between each school cohort were minor and included adapted curriculum order, enhanced engagement strategies, and technology adjustments. Many students demonstrated reliable change, and the pre-post program improvements were comparable to outcomes from the in-person CLS-FUERTE trial, indicating preliminary effectiveness. Our pilot CLS-R-FUERTE effort supports the process of iteratively adapting, implementing, and evaluating remote school-based intervention and training programs to enhance potential flexibility, accessibility, and scalability. Challenges emerging from technological problems and in context of the COVID-19 pandemic, as well as solutions, are discussed. Impact and Implications The widespread prevalence and impact of ADHD and ODD worldwide warrant global efforts to develop feasible and accessible school clinician training and intervention programs aimed at improving student attention and behavior. Our findings support harnessing technology and creating a system with clinical research capacity to tackle this need. These efforts could not only address a significant public health concern in Mexico but also could be used to inform scalable school clinician training for treatments that work more broadly.