DESCRIPTION (provided by applicant): The proposed study examines a two-level strategy for overcoming barriers to the implementation of effective mental health treatments for youth in very rural, deeply impoverished communities. The two-level strategy includes (1) the implementation of an evidence-based practice (EBP) delivered in the homes of referred youth by therapists organized to provide treatment over large, rural, geographical areas and (2) an organizational-community intervention (entitled ARC) that changes the social context in which the service is provided and supports therapists' efforts to serve children in widely-dispersed, isolated communities. The study will be conducted in eight of the poorest, least populated counties in the rural Appalachian Mountains of East Tennessee. The sample will include 720 children referred to juvenile courts in those counties as a result of antisocial behavior. Half of the children selected in each county will receive an EBP, Multisystemic Therapy (MST), and half will receive the usual care provided to children referred to juvenile courts in the eight counties. In addition, an organizational-community intervention (ARC) will be administered in half (four) of the counties by change agents (Ph.D. industrial-organizational psychologists trained in organizational and community development). The change agents will work with treatment teams, judges, school administrators, and other community opinion leaders to address the barriers to mental health care in rural Appalachia and develop community and organizational support for the implementation of the EBP. Multisystemic Therapy (MST) will be provided by Youth Villages, the state's largest private children's mental health service organization. MST services will be funded by the Bureau of TennCare, the state's Medicaid-waiver health insurance program that covers children eligible for Medicaid as well as the children of the working poor who are ineligible for Medicaid. The services are being structured and funded in a way that will ensure they can be sustained in each county, if successful, after the completion of the study.