Proposal Presentation Doctor of Public Health Date of Presentation

1. The Relationship Between Academic Performance and Mental Health among Head Start Children Proposal Presentation Doctor of Public HealthDate of Presentation DrPH Candidate Morgan State University School of Community Health and Policy

2. Presentation Outline • Introduction • Purpose of the Study • Background • Significance/Rationale • Literature Review • Methods • Research Questions and Hypotheses • Study Design • Analytical Framework • Study Implications, Strengths and Weaknesses • Questions

3. Purpose of the Study To examine the relationship between academic performance and mental health among young children using a national Head Start sample

4. Background Mental Health – is a state of successful performance or mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity (Health People, 2010)

5. Background • 22 -23% of the U.S. adult population or 44 million people have diagnosable mental disorders (Surgeon General, 2010) • Among the adult U.S. population, 19% have mutually exclusive mental health disorders, 3% have mental health disorders in conjunction with addictive behaviors (Surgeon General, 2010)

6. Background cont. • 20% of children had mental health disorders which can account for functional impairment (Surgeon General’s Report on Mental Health, 1999) • 21% of children 9 to 17 had diagnosable mental or addictive disorder associated with at least minimum impairment (Surgeon General’s Report on Mental Health, 1999) • Mental and behavioral disorders can lead to school failure, alcohol or illicit drug use, violence, or suicide (Healthy People, 2010)

7. Background cont. • Two very important aspects of mental health development • Social Development • Emotional Development

8. Background cont. • Social development • Children who have a positive trust relationship and feel connected to their parents are often able to formulate better adaptive practices as they grow and mature in adolescence (Konaska, Aksan, Knaack & Rhines, 2004; Stolz, Barber, & Olsen, 2005) • Positive parenting relationship also leads to adolescents developing prosocial behaviors of being empathetic to the needs of others in various situations that may arise (Carlo, McGinley, Hayes, Batenhorst, & Wilkinson, 2007).

9. Background cont. • Emotional development • Children who feel emotionally their parents are not concerned about them often are more likely to fall prey to peer victimization, which often leads to a decline in their overall mental health (Rigby, Slee & Martin, 2007) • Children who feel that their parents are very dominant and try to maintain psychological control over them can lead to depression and antisocial behavior (Stolz, Barber & Olsen, 2005)

10. Theoretical Framework • Life Course Theory • Explores the notion that changing lives evolve along developmental trajectories (Elder, 1998) • Seeks to understand proximal experiences within the individual, the environment, and the individual environment interaction that contribute to the nonrandom distribution of mental health outcomes (Kellam, 1997)

11. Life Course Framework Neighborhood Community Community Work Work School Family Social Network Family Social Network School Family Multi-generations Family Peers Childhood Adolescence Young Adulthood Middle Ad.

12. Review of the Literature

13. Conceptual Model PRE-K KINDERGARTEN Family Context Child Mental Health Parent Mental Health Academic Performance Child Mental Health Academic Performance

14. Life Course • Usefulness of life course model • In looking at patterns of life pathways over time • The life course helps to predict future outcomes based upon present factors • The major focus of the life course model is on the various social fields that one passes through in each stages of life (Kellam, 1997) • Social tasks are expected to be performed with specific criteria for success or failure • Natural rater who defines and evaluates the adequacy with which the tasks were completed • Natural rater changes based upon the social field in which one finds themselves

15. Mental Health over the Life Course • 40 year longitudinal study of third grade students from ages 8 to 48 to examine the long term consequences of aggressive and antisocial behavior in childhood, adolescence, and young adulthood (Huesmann, Dubow & Boxer, 2009)

16. Mental Health over the Life Course cont. • Parent as natural rater • Examined the association between parental major depressive and generalized anxiety disorders and child behavior problems (Meadows, McLanahan, & Brooks-Gunn, 2007) • Did an assessment of parenting and home environments (Leventhal, Selner-O’Hagan, Brooks-Gunn, Bingenheimer, and Earls , 2004)

17. Mental Health over the Life Course cont. • Parent/teacher/peer as natural raters • A study that looks at the teacher and parent as natural raters examined the implications for choosing certain instruments to establish eligibility for emotional and behavioral disorders among preschoolers (Feil, Small, Forness, Serna, Kaiser, Brooks-Gunn, et al., 2005) • Sought to get a better understanding of the associations between specific maltreatment types and aggression using a gender-informed approach. (Cullerton-Sen, Cassidy, Murray-Close, Cicchetti, Crick, and Rogosch, 2008)

18. Mental Health over the Life Course cont. • Parent/teacher/peer/child as natural raters • Determine whether mother and peers’ responses to direct and indirect aggression would contribute to children’s use of direct and indirect aggression (Valles & Knuston, 2008) • In this study, there was an investigation of the longitudinal relationships between self-system processes and depressive symptoms among maltreated and nonmaltreated children (Kim & Cicchetti, 2006).

19. Mental Health over the Life Course cont. • Child/Adult as natural raters • Healthy Passages was a comprehensive assessment of adolescent health and behavior using child, parent, and school reported data. (Wiesner, Chen, Winle, Elliott, Grunbaum, Kanouse, & Schuster 2010) • African American adults between the ages of 18 and 43 to examine psychological distress, stressful events, and religiosity (Lesniak, Rudmann, Rector & Elkin, 2006)

20. Family Context and Academic Performance • The home environment is a major influence (positive/negative) on how children perform academically (Buckner, Bassuk & Beardslee, 2004; Kochanska, Aksan, Knaack, & Rhines, 2004; Carlo, McGinley, Hayes, Batenhorst, & Wilkinson, 2007 )

21. Family Context and Academic Performance • Positive parental involvement was positively related to academic performance (Niemeyer, Wong & Westerhaus, 2009) • Increased levels of consistent parental involvement in the school settings and reinforcement of concepts at home, there is an increase in the academic performance of the child (Hill, Castellino, Lansford, Nowlin, Dodge, Bates & Pettit, 2004)

22. Family Context and Academic Performance • Increase in the cognitive abilities of children in the areas of math and reading when parents had achievement related beliefs that they shared with their children on a regular basis (Neunenschwander, Vida, Garrett & Eccles, 2007) • Children who read books and sound out letters at home have better language and comprehension skill once they start school (Senechal & LeFevre, 2002; Raikes, Pan, Luze, Tamis-LeMonda, Brooks-Gunn, Constantine, et al, 2006)

23. Family Context and Academic Performance • Spillover occurred between family stressors and school problems across the high school years and was a predictor of poor academic performance in 12 grade (Flook & Fuligini, 2008) • Home environments where there are high levels of conflict and sporadic discipline paradigms often foster depressive symptoms among children exhibit conduct problems in school (Hill, Bush & Rosa, 2003)

24. School, Mental Health, and Academic Performance • Children who experience mental health issues are at increased risk of having issues with cognitive functioning (Reynolds, Girling, Coker & Eastwood, 2006) • Mental health issues often cause declines in attention and increases in hyperactivity which hinders children’s ability to take in information within the classroom setting (King, McDougall, DeWit, Hong, Miller, Offord, et al. 2005; Flannery, Wester & Singer, 2004)

25. Research Gap There is little understanding among young children how academic performance is affected by changes in mental health as they move from one grade to another.

26. Head Start as Setting for Child Development Research • Study indicated differences social and emotional development processes among children in the enriched classrooms (Bierman, Domitrovich, Nix, Gest, Welsh, Greenberg, M.T., et al., 2008) • In the findings of the study, prosocial behavior with peers was high correlated with measures of academic performance, which included classroom participation, academic knowledge, and executive functioning (Bierman, Torres, Domitrovich, Welsh, & Gest, 2009)

27. FACES Research • Significant direct effect found from neighborhood factors on Head Start children’s cognitive and behavioral outcomes. More specifically, primary caregiver education, household size, primary language spoken in the home, child’s gender and ethnicity were all significantly associated to multiple cognitive outcomes (Vaden, D’Elio, O’Brien, Tarullo, Zill, & Hubbell-McKey, 2010) • Children who spent two years in Head Start had better knowledge of letter and high frequency sight words than those children who spent one year or less. The letter word knowledge that the children received in Head Start were strong predictors of their abilities in kindergarten (Hammer, Farkas, and Maczuga, 2010)

28. METHODS

29. Research Questions and Research Hypotheses • RQ1: What is the relationship between child mental health and academic performance? • H1: Better mental health will be associated with better academic performance for children in Head Start • RQ2: What effect does children’s academic performance have on their mental health when they move into kindergarten? • H2: Higher academic performing children will have better mental health after the transition from Head Start into kindergarten

30. Study Design • Observational longitudinal cohort study • Secondary data analysis from a study known as Head Start Family and Child Experiences Survey (FACES). • FACES is a study that examines areas such as cognitive, social, emotional, and physical development of Head Start children

31. Description of the Survey Instrument • The dataset includes information • Family characteristics - well-being and accomplishments of the families • School characteristics - quality of the Head Start classroom and characteristics, needs, and opinions of Head Start teachers and program staff

32. Description of the Sample: 2003 Cohort • Primary Sampling Units were created using information in the Head Start Information Report File • Broad profile on each program’s operations • Number of children • 1,669 programs were stratified into 30 strata with same number of enrolled children in each stratum • 30 strata were created using variables for (region, urban/rural, school based/other, percentage of non-English speaking children in program)

33. Description of the Sample: 2003 Cohort • There were 60 program groups from 68 Head Start centers • 5 programs identified as not being in operation and became ineligible

34. Description of the Sample: 2003 Cohort • A nationally representative sample of 2,400 newly entering 3 and 4 year old children and families in 63 Head Start programs • Four phases of data collection • Fall 2003 • Spring 2004 • Spring 2005 • Spring 2006

35. Description of the Sample: 2003 Cohort Head Start Kindergarten Fall 2003Spring 2004Spring 2005Spring 2005/06 3 yr cohort 3 yr cohort 3 yr cohort 3 yr cohort 4 yr cohort 4 yr cohort 4 yr cohort

36. Mental Health • Aggression - Summary score of 4 items: disobeys rules, disrupts activities, hits others, and temper tantrums (Likert scale 0-2; range 0-8) • Hyperactivity - Summary score of 3 items: can’t concentrate, nervous, and restless (Likert scale 0-2; range 0-6) • Withdrawal - Summary score of 6 items: acts young, keeps to their self, lacks confidence, often sleepy, often unhappy, and worries (Likert scale 0-2; range 0-12) • Social Adaptation - Summary score of 12 items: follows direction, makes friends, not upset, joins activities, invites others, waits turn, puts away, gives compliments, says nice things, follows rules, -uses free time, and accepts ideas (Likert scale 0-2; range 0-24)

37. Mental Health • Please describe this child according to how true each of these statements has been during the past month… • Aggression • Has temper tantrums or hot temper • Hyperactivity • Is very restless, fidgets all the time, can’t sit still • Withdrawal • Often seems unhappy, sad, or depressed • Social Adaptation • Accepts classmates’ ideas for sharing and playing

38. Academic Performance • Reading - Summary score of a test that examines receptive vocabulary skills to recognize the meaning of words, but not necessarily use it correctly in a spoken or written expression. • Math - Summary score of a cognitive development test that measures children’s skills in analyzing and solving practical problems in mathematics

39. Study Covariables

40. Study Covariables

41. Analytical Model H1 H2 Child Mental Health (HS) (A,H,W,SA) Child Mental Health (K) (A,H,W,SA) Academic Performance (HS) (math, reading) Age Race Sex Parent education Parent beliefs Parent mental health

42. Analytical Plan • Frequencies and percentages for each of the variables (both qualitative and quantitative) • Means and standard deviations for all quantitative variables • Quartiles will be generated for quantitative variables with more than 10 unique values

43. Analytical Plan • Univariable analysis • Frequencies and percentages for each of the variables (both qualitative and quantitative) • Means and standard deviations for all quantitative variables • Quartiles will be generated for quantitative variables with more than 10 unique values

44. Analytical Plan cont. • Bivariable analysis • To examine the association between the covariables (child mental health, parent interaction, parent mental health, parent beliefs, and academic performance) a correlation coefficient matrix was created. • Each of the variables was compared and the level of significance was determined.

45. Analytical Plan cont. • Multivariable analysis • Linear regression when academic performance is outcome • Logistic regression will be used to examine the relationship when mental health outcomes are dichotomized • Adjustments will be done for potential confounders or mediators, and interactions will be tested by adding interaction terms to the models

46. Analytical Plan cont. • In all analyses, study sampling design and weights were considered • Specifically, in STATA the SVY Module to handle the weights was used

47. Strengths • Fills a very important gap area within the research on young children • Very large sample size from which the population was drawn • Longitudinal study, this study alone cannot establish causality

48. Limitations • Use of secondary data • May not be generalizable outside of Head Start because the exposure may be unique to Head Start • This is one of various models that can be used. There may be other factors that are important • Imperfections that come in measuring mental health of children at such as young age

49. Implications The proposed work has the potential to: • Provide foundation for additional studies to look at the relationship between mental health and academic performance relationship among young children • Increase the knowledge of the effects of Head Start in the academic development of a child • There was good evidence for understanding the relationships that takes place in the developmental process and also to make predictions on these effects over the life course

50. Implications The proposed work has the potential to: • Further exploration of the relationship of these measures over time may be a validation to the fact that as development happens over the life course • More comprehensive, descriptive looks would need to be observed in order to really determine significance that the classroom environment plays on the mental health and academic performance of a child • Future research on other factors in the home environment that could be examined to see what influence they have on mental health and academic performance.