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Community and School-Based Behavioral Health Service (CSBBH) was developed through a collaborative process that included schools, behavioral health providers, counties, and a payor. The clinical model within CSBBH relies on a common factors approach. To evaluate the effectiveness of CSBBH to meet the needs of students across a diverse state, clinical model performance and outcomes were examined for 2,584 Medicaid-eligible children aged 4.5 to 11 years in urban and rural communities. First, propensity score matching was used to compare CSBBH to Treatment as Usual (TAU). CSBBH was associated with greater improvement in child functioning and slightly lower therapeutic alliance compared to TAU. Next, the utility of the model for urban vs. rural students was compared. As expected, there were many differences at baseline between children in urban and rural settings. Compared to children from rural settings, children from urban settings were more culturally diverse and had higher rates of utilization of prior mental health services but had lower rates of complex diagnoses. Despite these differences, the service was consistently applied across schools and caregiver-reported outcomes were comparable and positive across groups. Teachers in urban and rural schools reported improvements in hyperactivity, but other outcomes (e.g., prosocial behavior, emotional symptoms) varied. This study highlights the importance of a scalable and sustainable payor–provider collaborative approach to address the needs of children across a diverse state.

To explore the relationship between plasma concentrations of caffeine and subjective and polysomnographic measures of sleep in both good sleeper controls (GSC) and individuals with primary insomnia (PI), following the consumption of low-moderate quantities of caffeine in the home environment.65 PI and 29 GSC, each consuming4 four coffee cup equivalents of caffeine daily, were recruited. Subjects completed a diary detailing sleep habits and caffeine consumption, one night of polysomnography, and a blood sample for measurement of plasma caffeine and its metabolites at bedtime. Plasma concentrations of caffeine, its primary metabolite, paraxanthine, and other metabolites were determined for each subject and correlated with self-report and polysomnographic measures.No statistically significant differences were found between GSC and PI with respect to number of caffeinated beverages consumed (p = 0.91), estimated absolute caffeine ingestion (p = 0.48), time of caffeine consumption (p = 0.22), or plasma concentrations of caffeine (p = 0.92) or paraxanthine (p = 0.88). Significant correlations were found between plasma concentrations of caffeine/paraxanthine and endorsed caffeine intake (r = 0.58, p0.05) and estimated absolute caffeine ingestion (r = 0.57, p0.05). Plasma caffeine/paraxanthine was significantly correlated with percent stage 1 sleep (r = 0.32, p0.05). However, plasma concentrations of caffeine/paraxanthine were not significantly correlated with other subjective or polysomnographic measures of sleep disturbance in either GSC or PI.These data suggest that low-moderate amounts of caffeine consumed in the home environment, and mostly during morning hours, have little effect on subjective or polysomnographic measures of sleep in GSC or PI.