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Johnsen DB, Lomholt JJ, Heyne D, Jensen MB, Jeppesen P, Silverman WK, Thastum M. The Effectiveness of Modular Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual for Youths Displaying School Attendance Problems: A Randomized Controlled Trial. Res Child Adolesc Psychopathol 2024; 52:1397-1412. [PMID: 38739306 PMCID: PMC11420258 DOI: 10.1007/s10802-024-01196-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/14/2024]
Abstract
School attendance problems (SAPs) are associated with negative short- and long-term outcomes. Despite high prevalence of SAPs, there is a shortage of evidence-based interventions. Existing approaches often target either school refusal or truancy, leaving a gap in effective interventions addressing both types of SAPs. This randomized controlled trial (RCT) assessed the effectiveness of Back2School (B2S), a modular transdiagnostic cognitive behavioral therapy (CBT) for SAPs, compared to treatment as usual (TAU). Outcomes included youths' school attendance and mental health. A group (B2S, TAU) × time (Pre, Post, 3-Month Follow-Up) design involving 152 youths (B2S; n = 74, TAU; n = 78) with SAPs (i.e., ≥ 10% absence in the past three months), aged 6-16 years (M = 12.2, SD = 2.2, males = 60%) were used. B2S comprised three months of CBT with youths, parents, and school involvement, while TAU comprised public and/or private intervention services. On average, youths in B2S received 15.0, (SD = 3.9) hours of intervention, while those in TAU received 13.4, (SD = 21.6). Intervention effects were investigated using mixed linear models. Both B2S and TAU exhibited significant within-group improvements in school attendance, with no significant differences between them. However, the B2S group significantly outperformed TAU in reducing youths' emotional problems, conduct problems, problems with peers, the overall impact of problems, and increasing youths self-efficacy for attending school and parent self-efficacy for dealing with a SAP. This RCT represents the first evaluation of a modular transdiagnostic CBT for youths displaying SAPs, showing significant mental health and self-efficacy benefits. (Clinical trial registration: ClinicalTrials.gov: NCT03459677).
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Affiliation(s)
- Daniel B Johnsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Johanne J Lomholt
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
- TrygFonden's Centre for Child Research, Aarhus University, Aarhus, Denmark
| | - David Heyne
- School of Psychology, Deakin University, Melbourne, Australia
| | - Morten B Jensen
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Wendy K Silverman
- Child Study Center, Yale University School of Medicine, New Haven, USA
| | - Mikael Thastum
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
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McKay EA, Mattheus D, Fontenot HB. Mental Health Interventions in Middle Schools: A 10-Year Review of Research. J Sch Nurs 2024:10598405241265904. [PMID: 39090789 DOI: 10.1177/10598405241265904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Schools can play an important role in addressing growing concerns about adolescent mental health. Mental health of high school students has predominantly been the focus in literature with less emphasis on younger adolescents. This review identified articles published in the last decade that described evaluations of middle school-based mental health interventions and randomized participants to an intervention or control condition. Fourteen interventions met the inclusion criteria. About two-thirds of interventions were based on mindfulness or cognitive behavioral therapy. Many trials utilized racially diverse, low-income samples. All interventions were delivered to groups, and three contained a parent component. Five trials increased rigor by using an active control condition. Almost two-thirds of the interventions were effective (p < .10) in reducing at least one depression, anxiety, affect, or internalizing symptom outcome compared to a control group. This article provides information about intervention characteristics, efficacy, theoretical framework, and acceptability/feasibility.
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Affiliation(s)
- Elizabeth Anne McKay
- University of Massachusetts, Lowell, Solomont School of Nursing, Lowell, MA, USA
| | - Deborah Mattheus
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, School of Nursing, Honolulu, HI, USA
| | - Holly B Fontenot
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, School of Nursing, Honolulu, HI, USA
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Hoover SA. Investing in School Mental Health: Strategies to Wisely Spend Federal and State Funding. Psychiatr Serv 2024; 75:801-806. [PMID: 38566559 DOI: 10.1176/appi.ps.20230553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
In the context of the current youth mental health crisis, it is prudent to reconsider how resources are allocated to facilitate the delivery of effective and comprehensive supports and services to children and adolescents. Schools are the main delivery sites for youth mental health services. Many districts have adopted comprehensive school mental health systems (CSMHS) to provide a multitiered approach comprising mental health promotion, prevention, and intervention to students via partnerships between school and community health and behavioral health providers. COVID-19 relief funding and other new federal and state investments in school mental health have led to expansions of school mental health programming in most states. An impending federal funding cliff necessitates an examination of how to wisely invest now to achieve the greatest positive future impact on youth mental health. To capitalize on opportunities to sustain effective school mental health and maximize return on investment, states may consider four strategies: leverage cross-sector partnerships to advance school mental health policies and funding, strengthen and expand Medicaid coverage of CSMHS, establish and enhance data systems, and create state technical assistance and professional development support for CSMHS implementation through local education agencies.
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Affiliation(s)
- Sharon A Hoover
- Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore
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Gray K, Marlotte L, Aralis H, Kaufman J, Kataoka S, Venegas-Murillo A, Lester P, Escudero P, Ijadi-Maghsoodi R. Understanding and Addressing the Needs of Students in Special Education Through a Trauma-Informed Resilience Curriculum. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:405-421. [PMID: 38722275 DOI: 10.1080/19371918.2024.2316866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
This school program evaluation aims to highlight the mental health needs of students in special education with behavioral and emotional challenges and describe the implementation of a resilience curriculum with this population. We evaluated district mental health data from a convenience sample of 814 students in grades 5-12 special education to identify risk for mental health symptoms, violence exposure, and substance use. School social workers provided feedback on the implementation of the resilience curriculum to inform program evaluation. Students reported significant risk for traumatic stress, anxiety, and depressive symptoms, and high rates of violence exposure and substance use. School social workers described adaptations to the resilience curriculum and gave recommendations for future implementation. Students receiving special education services for behavioral and emotional challenges had high mental health need, including high rates of violence exposure, and may benefit from a trauma-informed school-based resilience curriculum adapted for their needs.
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Affiliation(s)
- Kristin Gray
- Nathanson Family Resilience Center, Jane and Terry Semel Institute for Neuroscience & Human Behavior at UCLA, Los Angeles, California, USA
| | - Lauren Marlotte
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior at UCLA, Los Angeles, California, USA
| | - Hilary Aralis
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Joshua Kaufman
- Public School Student Health and Human Services and Psychiatric Social Worker, USA
| | - Sheryl Kataoka
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior at UCLA, Los Angeles, California, USA
- Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, California, USA
| | - Angela Venegas-Murillo
- Department of Pediatrics, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Patricia Lester
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior at UCLA, Los Angeles, California, USA
| | - Pia Escudero
- Public School Student Health and Human Services and Psychiatric Social Worker, USA
| | - Roya Ijadi-Maghsoodi
- Division of Population Behavioral Health, Jane and Terry Semel Institute for Neuroscience & Human Behavior at UCLA, Los Angeles, California, USA
- VA Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Brinley SK, Tully LA, Carl T, McLean RK, Cowan CSM, Hawes DJ, Dadds MR, Northam JC. Universal Child Mental Health Screening for Parents: a Systematic Review of the Evidence. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:798-812. [PMID: 38879722 PMCID: PMC11322249 DOI: 10.1007/s11121-024-01693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 08/15/2024]
Abstract
Childhood represents a critical window for the emergence and treatment of mental health disorders, yet many are not being identified, or are identified too late to receive adequate intervention. This systematic review (Prospero registration: CRD42022299560) aimed to determine the effectiveness and acceptability of parent reported universal mental health screening (UMHS) to improve the early identification of children at-risk of mental health difficulties, and to identify barriers and enablers that may influence parental engagement. Six databases were searched in February 2022 for peer-reviewed, primary research. Studies conducted in targeted populations, evaluating psychometric properties, or focused on screening non-psychological problems were excluded. Ten studies examined parent reported (n = 3,464 parents) UMHS for children from birth to 18 years, suggesting an overall scarcity of research. Findings are presented in a table of study characteristics and a narrative summary of acceptability, effectiveness, barriers, and enablers. Quantitative findings indicated that parents generally support and accept UMHS. Research assessing effectiveness was limited, although two studies indicated increased referrals and referral adherence following positive screens. Confidentiality and stigma were commonly identified barriers. Quality assessment using the Mixed Methods Appraisal Tool indicated that studies varied in quality, meeting four to seven of the seven quality criteria. Understanding and addressing parent attitudes to UMHS across settings is necessary for the successful implementation of screening and improvement of child mental health outcomes. More high-quality research studies, including randomized controlled trials are therefore needed to examine the acceptability and effectiveness of UMHS for parents and their children.
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Affiliation(s)
- Shona K Brinley
- The School of Psychology, The Faculty of Science, The University of Sydney, Sydney, NSW, Australia.
| | - Lucy A Tully
- The School of Psychology, The Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Talia Carl
- The School of Psychology, The Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Rebecca K McLean
- The School of Psychology, The Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Caitlin S M Cowan
- The School of Psychology, The Faculty of Science, The University of New South Wales, Sydney, NSW, Australia
| | - David J Hawes
- The School of Psychology, The Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Mark R Dadds
- The School of Psychology, The Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Jaimie C Northam
- The School of Psychology, The Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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Mautone JA, Holdaway A, Chan W, Michel JJ, Guevara JP, Davis A, Desrochers C, Evans E, Gajary Z, Leavy S, Rios D, Tremont KL, Cacia J, Schwartz BS, Jawad AF, Power TJ. Reducing disparities in behavioral health treatment in pediatric primary care: a randomized controlled trial comparing Partnering to Achieve School Success (PASS) to usual ADHD care for children ages 5 to 11 - study protocol. BMC PRIMARY CARE 2024; 25:225. [PMID: 38909215 PMCID: PMC11193903 DOI: 10.1186/s12875-024-02473-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Integrating behavioral health services into pediatric primary care can improve access to care, especially for children marginalized by poverty and racial/ethnic minority status. In primary care, a common presenting concern is attention-deficit/hyperactivity disorder (ADHD). Services in primary care for marginalized children with ADHD typically include medication alone; therapy to improve skills and build relationships is less available. This study evaluates the effectiveness of a behavioral intervention offered through primary care for marginalized families coping with ADHD (Partnering to Achieve School Success, PASS) compared to treatment as usual (TAU). METHOD Three hundred participants will be randomly assigned to PASS or TAU. Participants include children ages 5 to 11 who have ADHD and are from economically marginalized families. PASS is a personalized, enhanced behavioral intervention that includes evidence-based behavior therapy strategies and enhancements to promote family engagement, increase caregiver distress tolerance, and provide team-based care to improve academic and behavioral functioning. TAU includes services offered by primary care providers and referral for integrated behavioral health or community mental health services. Outcomes will be assessed at mid-treatment (8 weeks after baseline), post-treatment (16 weeks), and follow-up (32 weeks) using parent- and teacher-report measures of service use, child academic, behavioral, and social functioning, parenting practices, family empowerment, and team-based care. Mixed effects models will examine between-group differences at post-treatment and follow-up. Analyses will examine the mediating role of parenting practices, family empowerment, and team-based care. Subgroup analyses will examine differential effects of intervention by child clinical characteristics and socioeconomic factors. DISCUSSION This study is unique in targeting a population of children with ADHD marginalized by low socioeconomic resources and examining an intervention designed to address the challenges of families coping with chronic stress related to poverty. TRIAL REGISTRATION This study was registered on clinicaltrials.gov (NCT04082234) on September 5, 2019, prior to enrollment of the first participant. The current version of the protocol and IRB approval date is October 4, 2023. Results will be submitted to ClinicalTrials.gov no later than 30 days prior to the due date for the submission of the draft of the final research report to the Patient-Centered Outcomes Research Institute.
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Affiliation(s)
- Jennifer A Mautone
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA.
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA.
| | - Alex Holdaway
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
| | - Wendy Chan
- Graduate School of Education at University of Pennsylvania, Philadelphia, PA, USA
| | - Jeremy J Michel
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | - James P Guevara
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Colette Desrochers
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Zia Gajary
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | - Siobhan Leavy
- Chester County Intermediate Unit, Downingtown Philadelphia, PA, USA
| | - Danah Rios
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | - Katie L Tremont
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
| | - Jaclyn Cacia
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
| | - Billie S Schwartz
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | - Abbas F Jawad
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas J Power
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, USA
- Perelman School of Medicine at, University of Pennsylvania, Philadelphia, PA, USA
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7
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Soleimanpour S, Simmons C, Saphir M, Ng S, Jenks K, Geierstanger S. Equity in Mental Health Care Receipt among Youth Who Use School-Based Health Centers. Am J Prev Med 2024:S0749-3797(24)00195-8. [PMID: 38876296 DOI: 10.1016/j.amepre.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Youth experience significant mental health (MH) needs, and gender- and racially/ethnically-diverse youth are less likely than peers to receive care. School-based health centers (SBHCs) are a healthcare delivery model that may decrease disparities. This study examined the role of SBHCs in reducing disparities in MH care receipt among SBHC clients. METHODS Data from electronic health records of 5,396 youth ages 12 to 21 years who visited 14 SBHCs in one California county from 2021 to 2023 were analyzed in 2023-2024 using multiple logistic regression to assess disparities in MH care receipt and depression screenings. RESULTS Receipt of MH care from SBHCs varied significantly by gender but not age, sexual orientation, or race/ethnicity. Compared to female clients, males had reduced odds (AOR: 0.50) and gender-diverse clients had higher odds (AOR: 2.70) of receiving MH care. For receipt of depression screenings, male clients had reduced odds (AOR: 0.86); Latino clients had higher odds than white clients (AOR: 1.80); and older adolescents and young adults had higher odds than younger adolescents (AORs: 1.44 and 1.45, respectively). Receipt of follow-up MH care after a positive depression result varied only by gender, with male clients having reduced odds (AOR: 0.63). DISCUSSION SBHCs may reach youth who are traditionally less likely to seek care in other settings, including racially/ethnically- and gender-diverse youth. As in other settings, engaging males in healthcare is an area for improvement. These findings help to demonstrate the potential of SBHCs for decreasing disparities in mental health care.
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Affiliation(s)
- Samira Soleimanpour
- Philip R. Lee Institute for Health Policy Studies & Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
| | - Cailey Simmons
- Public Health and Preventive Medicine Residency Program, California Department of Public Health, Berkeley, California
| | - Melissa Saphir
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
| | - Sandy Ng
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
| | - Kale Jenks
- Center for Healthy Schools and Communities, Alameda County Health Care Services Agency, San Leandro, California
| | - Sara Geierstanger
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
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Yang Y(S, Law M, Vaghri Z. New Brunswick's mental health action plan: A quantitative exploration of program efficacy in children and youth using the Canadian Community Health Survey. PLoS One 2024; 19:e0301008. [PMID: 38848408 PMCID: PMC11161078 DOI: 10.1371/journal.pone.0301008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/09/2024] [Indexed: 06/09/2024] Open
Abstract
In 2011, the New Brunswick government released the New Brunswick Mental Health Action Plan 2011-2018 (Action Plan). Following the release of the Action Plan in 2011, two progress reports were released in 2013 and 2015, highlighting the implementation status of the Action Plan. While vague in their language, these reports indicated considerable progress in implementing the Action Plan, as various initiatives were undertaken to raise awareness and provide additional resources to facilitate early prevention and intervention in children and youth. However, whether these initiatives have yielded measurable improvements in population-level mental health outcomes in children and youth remains unclear. The current study explored the impact of the Action Plan by visualizing the trend in psychosocial outcomes and service utilization of vulnerable populations in New Brunswick before and after the implementation of the Action Plan using multiple datasets from the Canadian Community Health Survey. Survey-weighted ordinary least square regression analyses were performed to investigate measurable improvements in available mental health outcomes. The result revealed a declining trend in the mental wellness of vulnerable youth despite them consistently reporting higher frequencies of mental health service use. This study highlights the need for a concerted effort in providing effective mental health services to New Brunswick youth and, more broadly, Canadian youth, as well as ensuring rigorous routine outcome monitoring and evaluation plans are consistently implemented for future mental health strategies at the time of their initiation.
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Affiliation(s)
- Yuzhi (Stanford) Yang
- Department of Psychology, Faculty of Science, Applied Science, and Engineering, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Moira Law
- Department of Psychology, Faculty of Science, St. Mary’s University, Halifax, Nova Scotia, Canada
| | - Ziba Vaghri
- Global Child Program, Integrated Health Initiative, Faculty of Business, University of New Brunswick, Saint John, New Brunswick, Canada
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Lawson GM, Azad G. School-Based Mental Health Interventions: Recommendations for Selecting and Reporting Implementation Strategies . THE JOURNAL OF SCHOOL HEALTH 2024; 94:581-585. [PMID: 38627895 DOI: 10.1111/josh.13458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Gwendolyn M Lawson
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gazi Azad
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
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Poirier M, Lemelin JP, Déry M, Crescenzi O, Temcheff CE. An examination of the relationship between conduct problems and depressive symptoms comorbidity and temperament among elementary school children. Child Psychiatry Hum Dev 2024; 55:655-666. [PMID: 36138302 DOI: 10.1007/s10578-022-01421-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/06/2022] [Accepted: 08/09/2022] [Indexed: 11/03/2022]
Abstract
Although the comorbidity between conduct problems (CP) and depressive symptoms (DS) is associated with a host of negative outcomes, the factors, such as temperament, that might explain this comorbidity in school-aged boys and girls are poorly understood. This study compared elementary school children presenting co-occurring CP and DS to children with DS only, CP only, and those with low-level symptoms on temperament dimensions, and explored the moderating role of child sex in the associations. Participants are 487 children (M = 8.38 years, SD = 0.92, 52.2% girls) divided into four groups (CP + DS, DS only, CP only, control). Findings suggest that boys with CP and DS presented a lower level of fear than boys with DS and boys from the control group. They also presented higher levels of activity than boys with DS. Girls with CP and DS presented lower levels of fear than girls with DS, lower levels of approach and activity than girls with CP, and higher levels of shyness than girls from the control group. These findings suggest that temperament may discriminate children with comorbid CP and DS from those presenting only CP or DS.
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Affiliation(s)
- Martine Poirier
- Département des sciences de l'éducation, Université du Québec à Rimouski, 300, allée des Ursulines, C. P. 3300, succ. A Rimouski, G5L 3A1, Québec, Canada.
| | - Jean-Pascal Lemelin
- Département de psychoéducation, Université de Sherbrooke Sherbrooke, Québec, Canada
| | - Michèle Déry
- Département de psychoéducation, Université de Sherbrooke Sherbrooke, Québec, Canada
| | - Olivia Crescenzi
- Educational & Counselling Psychology, McGill University, Montréal, Québec, Canada
| | - Caroline E Temcheff
- Educational & Counselling Psychology, McGill University, Montréal, Québec, Canada
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Kuriyan AB, Albright J, Rushworth S, Duresso B, Testa S, Eiraldi RB, Marshaleck EW, Wolk CB. Partnering with Schools to Adapt a Team Science Intervention: Processes and Challenges. SCHOOL MENTAL HEALTH 2024; 16:695-709. [PMID: 39372095 PMCID: PMC11452467 DOI: 10.1007/s12310-024-09665-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 10/08/2024]
Abstract
Public schools are a major provider of mental health services for children in the US. Mental and behavioral health services range from universal programming to individualized clinical supports to address student needs. These services in schools are delivered by various professionals including non-teaching and teaching school personnel, school-employed clinicians, and/or contracted community mental health partners. Provision of mental health services requires complex coordination of providers across disciplines, although few professionals have training in multidisciplinary collaboration strategies. Attention to team processes, such as delineating team members' roles, improving communication, and identifying collaboration strategies, may impact the effectiveness of evidence-based mental health service provision in real world settings. One intervention, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), has been used in healthcare with positive outcomes and has been adapted to educational settings. The current paper describes the community-partnered subsequent adaptation of TeamSTEPPS for schools. Needs assessment interviews identified challenges, successes, and goals for student mental health. Overarching themes extracted from interviews include limited resources at multiple levels (e.g., financial support, time, and personnel), communication challenges, and poor role clarity. A community advisory board provided guidance during the adaptation and implementation planning process. Adaptations to the intervention included tailoring the intervention to the school context and the development of flexible training plans. In addition, individualized implementation plans were developed with each school partner to mitigate foreseeable barriers to rolling-out TeamSTEPPS. Our team is currently piloting the adapted TeamSTEPPS intervention and implementation strategies in partnership with three school districts. Supplementary Information The online version contains supplementary material available at 10.1007/s12310-024-09665-7.
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Affiliation(s)
- Aparajita Biswas Kuriyan
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Fl., Philadelphia, PA 19104 USA
| | | | - Samantha Rushworth
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Fl., Philadelphia, PA 19104 USA
| | - Biiftu Duresso
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Fl., Philadelphia, PA 19104 USA
| | - Shannon Testa
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Fl., Philadelphia, PA 19104 USA
| | - Ricardo B. Eiraldi
- Pediatrics and Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
- Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | | | - Courtney Benjamin Wolk
- Center for Mental Health, University of Pennsylvania Perelman School of Medicine, 3535 Market St. 3rd Fl., Philadelphia, PA 19104 USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA
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Speck JS, Frick PJ, Vaughan EP, Walker TM, Robertson EL, Ray JV, Myers TDW, Thornton LC, Steinberg L, Cauffman E. Health Service Utilization in Adolescents Following a First Arrest: The Role of Antisocial Behavior, Callous-Unemotional Traits, and Juvenile Justice System Processing. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:393-405. [PMID: 38427148 PMCID: PMC11076348 DOI: 10.1007/s10488-024-01341-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 03/02/2024]
Abstract
Previous research indicates that youth exhibiting antisocial behavior are at risk for utilizing a disproportionate amount of health services compared to youth without these problems. The present study investigates whether being processed by the juvenile justice system and showing callous-unemotional (CU) traits independently predict health service utilization (medical and mental health service use and out-of-home placement) over and above the severity of antisocial behavior across adolescence. A total of 766 participants who had been arrested for the first time in adolescence provided data at ten appointments over a period of seven years. Results showed that self-reported antisocial behavior at the time of arrest predicted increased use of most health service use types over the next seven years (i.e. medicine prescriptions, tests for sexually transmitted infections, mental health service appointments, and out-of-home placements). All except prescription medication use remained significant when controlling for justice system processing and CU traits. Further, justice system processing added significantly to the prediction of medical service appointments. Whereas CU traits were associated with mental health service appointments and out-of-home placements, these did not remain significant when controlling for severity of antisocial behavior. These findings are consistent with prior research documenting the health care costs of antisocial behavior.
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Affiliation(s)
- Julianne S Speck
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA.
| | - Paul J Frick
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Erin P Vaughan
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Toni M Walker
- Harris County Juvenile Probation Department, Houston, USA
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Walton CC, Purcell R, Henderson JL, Kim J, Kerr G, Frost J, Gwyther K, Pilkington V, Rice S, Tamminen KA. Mental Health Among Elite Youth Athletes: A Narrative Overview to Advance Research and Practice. Sports Health 2024; 16:166-176. [PMID: 38173251 PMCID: PMC10916785 DOI: 10.1177/19417381231219230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
CONTEXT Participation in sports during youth is typically beneficial for mental health. However, it is unclear whether elite sport contexts contribute to greater risk of psychological distress or disorder. The aims of this paper are to highlight conceptual issues that require resolution in future research and practice, and to examine the key factors that may contribute to the mental health of elite youth athletes (EYAs). EVIDENCE ACQUISITION A narrative overview of the literature combined with the clinical and research expertise of the authors. STUDY DESIGN Narrative overview. LEVEL OF EVIDENCE Level 5. RESULTS EYAs experience a range of biopsychosocial developmental changes that interact with mental health in a multitude of ways. In addition, there are various sport-specific factors that contribute to the mental health of EYAs that may become more prominent in elite contexts. These include - but are not limited to - patterns relating to athlete coping and self-relating styles, the nature of peer, parental, and coach relationships, organizational culture and performance pressures, and mental health service provision and accessibility. CONCLUSION A range of critical factors across individual, interpersonal, organizational, and societal domains have been shown to contribute to mental health among EYAs. However, this evidence is limited by heterogeneous samples and varied or imprecise terminology regarding what constitutes "youth" and "elite" in sport. Nevertheless, it is clear that EYAs face a range of risks that warrant careful consideration to progress to best practice principles and recommendations for mental health promotion and intervention in elite youth sport. SORT Level C.
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Affiliation(s)
- Courtney C Walton
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Elite Sports and Mental Health, Orygen, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Rosemary Purcell
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Elite Sports and Mental Health, Orygen, Melbourne, Australia
| | - Jo L Henderson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Jeemin Kim
- Faculty of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
- Department of Kinesiology, Michigan State University, East Lansing, Michigan
| | - Gretchen Kerr
- Faculty of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
| | - Joshua Frost
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Elite Sports and Mental Health, Orygen, Melbourne, Australia
| | - Kate Gwyther
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Elite Sports and Mental Health, Orygen, Melbourne, Australia
| | - Vita Pilkington
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Elite Sports and Mental Health, Orygen, Melbourne, Australia
| | - Simon Rice
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Elite Sports and Mental Health, Orygen, Melbourne, Australia
| | - Katherine A Tamminen
- Faculty of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
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Bayne M, Chirico I, Wei L, Galanter C. Impact of Illness Severity Tools on Adolescent Psychiatric Managed Care in California. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:162-171. [PMID: 38051430 DOI: 10.1007/s10488-023-01323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/07/2023]
Abstract
Youth with mental illness struggle to receive essential behavioral health care. One obstacle is denial of coverage by insurance. In California, managed care consumers may apply for independent medical review (IMR) which potentially overturns an insurance denial through the California Department of Managed Healthcare (CDMHC). The authors aim to analyze IMR appeals for psychiatric treatment among adolescents and elucidate factors associated with obtaining coverage of care. We performed an analysis to identify factors that are associated with depression and substance use disorder (SUD) treatment claim denials in 11-20-year-olds from 2001 to 2022 using CDMHC data. Logistic regression modeling was used to identify specific factors related to claim characteristics and medical society instruments that are significantly associated with overturning a denial by IMR. Behavioral health IMRs are overturned at a higher rate than non-behavioral health claims. 54.5% of those with depression and 36.3% of those with SUD initially denied care coverage were overturned by IMR. For those seeking depression treatment, we found a significantly greater odds of overturn by IMR if there was a reference of CALOCUS [1.64, 95%CI (1.06-2.5)]. The odds of a SUD treatment denial being overturned was significantly greater if referencing CALOCUS [3.85 (1.54-9.62)] or ASAM [2.47, [4.3 (1.77-10.47)]. After the standardized implementation of illness severity tools in IMRs, the odds of a medically necessary claim being overturned was 2.5 times higher than before the standards. With a high percentage of claims being overturned after IMR, the findings suggest that health plans inappropriately deny medically necessary behavioral health treatment. The use of medical society instruments was associated with higher odds of overturning a denial. The recent decision of CDMHC to implement standard use of CALOCUS and similar illness severity criteria is supported by our findings and may facilitate more equitable care.
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Affiliation(s)
- Mitchell Bayne
- State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
| | - Isabella Chirico
- Mount Sinai Morningside West, 1090 Amsterdam Ave, New York, NY, 10025, USA
| | - Lulu Wei
- State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Cathryn Galanter
- State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
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Moore SA, Cooper JM, Malloy J, Lyon AR. Core Components and Implementation Determinants of Multilevel Service Delivery Frameworks Across Child Mental Health Service Settings. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:172-195. [PMID: 38117431 PMCID: PMC10850020 DOI: 10.1007/s10488-023-01320-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/21/2023]
Abstract
Multilevel service delivery frameworks are approaches to structuring and organizing a spectrum of evidence-based services and supports, focused on assessment, prevention, and intervention designed for the local context. Exemplar frameworks in child mental health include positive behavioral interventions and supports in education, collaborative care in primary care, and systems of care in community mental health settings. Yet, their high-quality implementation has lagged. This work proposes a conceptual foundation for multilevel service delivery frameworks spanning diverse mental health service settings that can inform development of strategic implementation supports. We draw upon the existing literature for three exemplar multilevel service delivery frameworks in different child mental health service settings to (1) identify core components common to each framework, and (2) to highlight prominent implementation determinants that interface with each core component. Six interrelated components of multilevel service delivery frameworks were identified, including, (1) a systems-level approach, (2) data-driven problem solving and decision-making, (3) multiple levels of service intensity using evidence-based practices, (4) cross-linking service sectors, (5) multiple providers working together, including in teams, and (6) built-in implementation strategies that facilitate delivery of the overall model. Implementation determinants that interface with core components were identified at each contextual level. The conceptual foundation provided in this paper has the potential to facilitate cross-sector knowledge sharing, promote generalization across service settings, and provide direction for researchers, system leaders, and implementation intermediaries/practitioners working to strategically support the high-quality implementation of these frameworks.
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Affiliation(s)
- Stephanie A Moore
- School of Education, University of California Riverside, Riverside, CA, 92521, USA.
| | | | - JoAnne Malloy
- Institute on Disability, College of Health and Human Services, University of New Hampshire, Durham, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
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Patte KA, Battista K, Ferro MA, Bélanger RE, Wade TJ, Faulkner G, Pickett W, Riazi NA, Michaelson V, Carsley S, Leatherdale ST. School learning modes during the COVID-19 response and pre- to during pandemic mental health changes in a prospective cohort of Canadian adolescents. Soc Psychiatry Psychiatr Epidemiol 2024; 59:137-150. [PMID: 37668673 PMCID: PMC10799804 DOI: 10.1007/s00127-023-02557-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/15/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Considerable debate centered on the impact of school closures and shifts to virtual learning on adolescent mental health during the COVID-19 pandemic. We evaluated whether mental health changes differed by school learning modes during the pandemic response among Canadian adolescents and whether associations varied by gender and perceived home life. METHODS We used prospective survey data from 7270 adolescents attending 41 Canadian secondary schools. Conditional change linear mixed effects models were used to examine learning mode (virtual optional, virtual mandated, in-person, and blended) as a predictor of change in mental health scores (depression [Centre for Epidemiologic Studies - Depression], anxiety [Generalized Anxiety Disorder-7], and psychosocial well-being [Flourishing scale]), adjusting for baseline mental health and covariates. Gender and home life happiness were tested as moderators. Least square means were calculated across interaction groups. RESULTS Students learning in a blended learning mode had greater anxiety increases relative to their peers in other learning modes. Females learning fully in-person and males learning virtually when optional reported less of an increase in depression scores relative to their gender counterparts in other learning modes. Learning virtually when optional was associated with greater declines in psychosocial well-being in students without happy home lives relative to other learning modes. CONCLUSION Findings demonstrate the importance of considering gender and home environments as determinants of mental health over the pandemic response and when considering alternative learning modes. Further research is advised before implementing virtual and blended learning modes. Potential risks and benefits must be weighed in the context of a pandemic.
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Affiliation(s)
- Karen A Patte
- Faculty of Applied Health Sciences, Department of Health Sciences, Brock University, Niagara Region, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada.
| | - Katelyn Battista
- School of Public Health Sciences, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada
| | - Richard E Bélanger
- Projet COMPASS-Québec, VITAM-Centre de recherche en santé durable de l'Université Laval, 2480 Chemin de La Canardière, Quebec City, QC, G1J 2G1, Canada
- Faculty of Medecine, Departement of Pediatrics, Université Laval, Ferdinand Vandry Pavillon, 1050 Avenue de La Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Terrance J Wade
- Faculty of Applied Health Sciences, Department of Health Sciences, Brock University, Niagara Region, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, Lower Mall Research Station Room 337, 2259 Lower Mall, Vancouver, BC, V6T 1Z3, Canada
| | - William Pickett
- Faculty of Applied Health Sciences, Department of Health Sciences, Brock University, Niagara Region, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Negin A Riazi
- Faculty of Applied Health Sciences, Department of Health Sciences, Brock University, Niagara Region, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Valerie Michaelson
- Faculty of Applied Health Sciences, Department of Health Sciences, Brock University, Niagara Region, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Sarah Carsley
- Public Health Ontario, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada
| | - Scott T Leatherdale
- School of Public Health Sciences, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada
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17
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Brattfjell ML, Jozefiak T, Lydersen S, Wichstrøm L. Service Use as a Predictor of Change in Mental Health Problems Among Children: A Prospective Cohort Study. Psychiatr Serv 2023; 74:1256-1262. [PMID: 37254505 DOI: 10.1176/appi.ps.20220079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Psychosocial interventions for children's mental health problems typically differ in several characteristics, such as therapist training, content, motivation for treatment, and extent of comorbid conditions among patients, depending on whether the interventions take place in clinical research studies or in real-life settings. Accordingly, the effects found in research studies may not be generalizable to typical service provision. The authors sought to examine the potential associations between receiving usual care and later psychiatric symptoms, impairment, and potential improvements in social skills. METHODS Participants (N=996) drawn from the 2003-2004 birth cohorts in Trondheim, Norway, included children who received usual care and those who did not receive any services (as a control group). The children were assessed with biennial clinical interviews from ages 4 to 14 years. Random intercept, cross-lagged panel models were combined with propensity scoring to adjust for measured time-varying and all unmeasured time-invariant confounders. RESULTS Usual care was not associated with alterations in social skills or impairment due to mental health problems. Similarly, usual care provided to 7- to 12-year-olds did not predict changes in the number of symptoms of psychiatric disorders. However, usual care received at ages 0-4 and 5-6 predicted a slight increase in the number of psychiatric symptoms 2 years later. No significant associations between usual care and improved outcomes were detected. CONCLUSIONS These observational findings reveal the need to implement existing evidence-based approaches in usual care and to develop evidence-based approaches to the complex cases often seen in specialty and community care systems.
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Affiliation(s)
- Maria Larsen Brattfjell
- Department of Psychology (Brattfjell, Wichstrøm), Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health (Jozefiak, Lydersen), Norwegian University of Science and Technology, Trondheim, Norway; Department of Child and Adolescent Psychiatry, St. Olav's Hospital, Trondheim, Norway (Wichstrøm)
| | - Thomas Jozefiak
- Department of Psychology (Brattfjell, Wichstrøm), Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health (Jozefiak, Lydersen), Norwegian University of Science and Technology, Trondheim, Norway; Department of Child and Adolescent Psychiatry, St. Olav's Hospital, Trondheim, Norway (Wichstrøm)
| | - Stian Lydersen
- Department of Psychology (Brattfjell, Wichstrøm), Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health (Jozefiak, Lydersen), Norwegian University of Science and Technology, Trondheim, Norway; Department of Child and Adolescent Psychiatry, St. Olav's Hospital, Trondheim, Norway (Wichstrøm)
| | - Lars Wichstrøm
- Department of Psychology (Brattfjell, Wichstrøm), Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health (Jozefiak, Lydersen), Norwegian University of Science and Technology, Trondheim, Norway; Department of Child and Adolescent Psychiatry, St. Olav's Hospital, Trondheim, Norway (Wichstrøm)
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Hecht CA, Gosling SD, Bryan CJ, Jamieson JP, Murray JS, Yeager DS. When do the effects of single-session interventions persist? Testing the mindset + supportive context hypothesis in a longitudinal randomized trial. JCPP ADVANCES 2023; 3:e12191. [PMID: 38054060 PMCID: PMC10694537 DOI: 10.1002/jcv2.12191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/15/2023] [Indexed: 12/07/2023] Open
Abstract
Background Single-session interventions have the potential to address young people's mental health needs at scale, but their effects are heterogeneous. We tested whether the mindset + supportive context hypothesis could help explain when intervention effects persist or fade over time. The hypothesis posits that interventions are more effective in environments that support the intervention message. We tested this hypothesis using the synergistic mindsets intervention, a preventative treatment for stress-related mental health symptoms that helps students appraise stress as a potential asset in the classroom (e.g., increasing oxygenated blood flow) rather than debilitating. In an introductory college course, we examined whether intervention-consistent messages from instructors sustained changes in appraisals over time, as well as impacts on students' predisposition to try demanding academic tasks that could enhance learning. Methods We randomly assigned 1675 students in the course to receive the synergistic mindsets intervention (or a control activity) at the beginning of the semester, and subsequently, to receive intervention-supportive messages from their instructor (or neutral messages) four times throughout the term. We collected weekly measures of students' appraisals of stress in the course and their predisposition to take on academic challenges. Trial-registration: OSF.io; DOI: 10.17605/osf.io/fchyn. Results A conservative Bayesian analysis indicated that receiving both the intervention and supportive messages led to the greatest increases in positive stress appraisals (0.35 SD; 1.00 posterior probability) and challenge-seeking predisposition (2.33 percentage points; 0.94 posterior probability), averaged over the course of the semester. In addition, intervention effects grew larger throughout the semester when complemented by supportive instructor messages, whereas without these messages, intervention effects shrank somewhat over time. Conclusions This study shows, for the first time, that supportive cues in local contexts can be the difference in whether a single-session intervention's effects fade over time or persist and even amplify.
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Déry M, Temcheff CE, Poirier M, Boutin S, Lapalme M, Lemieux A. Developmental Trajectory of Conduct Problems Among Boys and Girls Receiving Psychoeducational Services at Elementary Schools. CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2023; 38:287-301. [PMID: 37869732 PMCID: PMC10584659 DOI: 10.1177/08295735231198747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/22/2023] [Accepted: 08/15/2023] [Indexed: 10/24/2023]
Abstract
Elementary public schools remain the most common venues for addressing children's severe conduct problems. Nevertheless, very few longitudinal studies have examined association between receiving psychoeducational services for conduct problems in school and subsequent conduct problem severity. This study explored if psychoeducational service reception contributed to reduce conduct problems in a sample of 434 elementary school-aged boys and girls presenting a high level of conduct problems. The study used a repeated measures design at 12-month intervals, for 4 years. Information regarding the severity of children's conduct problems and services was provided by parents and teachers. Latent Growth Modeling was used to identify a mean trajectory of conduct problems. Results revealed that psychoeducational services were associated with a decrease in conduct problems over time, but this association was only observed in boys. There was no association between service reception at study inception and the trajectory of conduct problems among girls. These results suggests that psychoeducational services are well suited to the difficulties of boys with conduct problems; however, they may call for a review of the services offered to girls in schools, both in terms of the detection of conduct problems in young girls, and in terms of their treatment options.
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20
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Tuaf H, Orkibi H. Community-based programs for youth with mental health conditions: a scoping review and practical implications. Front Public Health 2023; 11:1241469. [PMID: 38026340 PMCID: PMC10651729 DOI: 10.3389/fpubh.2023.1241469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Approximately 14% of all adolescents globally cope with mental health conditions. However, community-based psychosocial services for adolescents with mental health conditions are scarce and under-researched. Scant scholarly attention has been paid to leisure and/or social activities in community-based rehabilitation services for adolescents with mental health conditions. Objectives To begin to fill this gap, we chose a bottom-up framework to probe the following questions: Which community-based programs for adolescents with mental health conditions exist worldwide? What common characteristics do they present? What is their range of services? Method We systematically searched three leading academic databases, reference lists, and worldwide websites in English. Eligibility criteria Programs with information in English that provide services in a community setting, service content that includes leisure and/or social activities, cater to users aged 10-18, and content explicitly targets adolescents with mental health conditions. Results Twenty-seven psychosocial programs that provide leisure and/or social activities and encourage the promotion of adolescent mental health in the community were identified. We mapped and categorized the programs into three groups: integrated recovery, leisure recovery, and advocacy recovery. Conclusion Practical implications for implementation are suggested based on the findings. Specifically, service providers should attend to the psychological needs of adolescents by prioritizing peer interaction and offering suitable social and leisure activities. These activities can also boost adolescent participation in community-based rehabilitation programs and address the treatment gap. Comprehensive studies and uniform terminology in the field are needed.
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Affiliation(s)
- Hila Tuaf
- Drama & Health Science Lab, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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21
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Stuenkel M, Koob C, Richardson E, Griffin SF, Sease KK. School-Based Mental Health Service Utilization Through the COVID-19 Pandemic and Beyond. THE JOURNAL OF SCHOOL HEALTH 2023; 93:1000-1005. [PMID: 37525409 DOI: 10.1111/josh.13384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND We examined trends in mental health service utilization before, during, and in the immediate return to in-person learning throughout the COVID-19 pandemic. METHODS Retrospective chart review was assessed for changes in odds of any visit being a mental health encounter from five school-based health centers from the 2018-2019 to the 2021-2022 school years. Data are limited to the in-person school year from mid-August to early June. RESULTS Data were assessed from 1239 students seen through 2256 visits over the 4 school years (Mage = 12.93). The odds of any visit being related to a mental health encounter increased each school year, with the 2020 to 2021 and 2021 to 2022 school years having significant increases in odds (both compared to the first and to the antecedent school year). In addition, during the 2019 to 2020 and 2020 to 2021 school years, the odds of a repeated mental health encounter significantly increased from year to year. CONCLUSIONS Findings indicate a steadily increasing number of mental health service utilization needs among adolescent students that was significantly exponentiated throughout the COVID-19 pandemic.
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Affiliation(s)
- Mackenzie Stuenkel
- Bradshaw Insititute for Community Child Health & Advocacy, Prisma Health Children's Hospital, Greenville, SC
| | - Caitlin Koob
- Department of Public Health Sciences, Clemson University, Clemson, SC
| | - Emily Richardson
- Bradshaw Insititute for Community Child Health & Advocacy, Prisma Health Children's Hospital, Greenville, SC
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, Clemson, SC
| | - Kerry K Sease
- Bradshaw Insititute for Community Child Health & Advocacy, Prisma Health Children's Hospital, Greenville, SC
- Pediatrics, University of South Carolina School of Medicine, Greenville, SC
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Xu Y, Yang H, Jin Z, Xiang J, Xu H, Pokay YH, Mao H, Cai X, Wu Y, Wang DB. Application of a Digital Mental Health Clinic in Secondary Schools: Functionality and Effectiveness Evaluation. JMIR Form Res 2023; 7:e46494. [PMID: 37883144 PMCID: PMC10636614 DOI: 10.2196/46494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Adolescents experience relatively more stress than other populations as they are facing rapid physical changes and adapting to complex social environments. However, access for this population to professional service providers is limited. Therefore, there is an increasing need for access to mental health services and new mental health care resources tailored to adolescents. OBJECTIVE The aim of this study was to evaluate the functionality and effectiveness of a school digital mental health clinic (DMHC) created by a Chinese psychiatric hospital and provided to secondary school students for a trial. METHODS The trial period of the DMHC was from January to July 2021 at three secondary schools in Taizhou City, China. Under a collaborative agreement between the local educational bureau and provider, use of the DMHC was free to all students, teachers, and staff of the schools. The functionality of the DMHC was compared with existing digital health interventions introduced in the literature and its effectiveness was quantitatively analyzed in terms of the volume of received counseling calls, number of calls per 100 students, length and time of calls, and reasons for the calls. The mini course video views were analyzed by topics and viewing time. RESULTS The design functions of the DMHC are well aligned with required factors defined in the literature. The first advantage of this DMHC is its high accessibility to students in the three schools. All functions of the DMHC are free to use by students, thereby eliminating the economic barriers to seeking and receiving care. Students can receive virtual counseling during or after regular working hours. Acceptability of the DHMC was further ensured by the full support from a national top-tier mental health facility. Any audio or video call from a student user would connect them to a live, qualified professional (ie, a psychiatrist or psychologist). Options are provided to view and listen to resources for stress relief or tips to help address mental health needs. The major reasons for the counseling calls included difficulties in learning, interpersonal relationships, and emotional distress. The three topics with the highest level of interest for the mini course videos were emotional assistance, personal growth, and family member relationships. The DMHC served as an effective tool for crisis prevention and intervention during nonworking hours as most of the live calls and mini video viewing occurred after school or over the weekend. Furthermore, the DMHC helped three students at high risk for suicide and self-injury through live-call intervention. CONCLUSIONS The DMHC is an effective complementary solution to improve access to professional mental health care facilities, especially during nonworking hours, thereby helping adolescents meet their mental health needs. Extension of the DMHC into more schools and other settings is recommended.
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Affiliation(s)
- Yi Xu
- Zhejiang Jerinte Health Technology Co, Ltd., Wenzhou, China
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
| | - Hongshen Yang
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zhou Jin
- Key Laboratory of Alzheimer's Disease of Zhejiang Province, School of Mental Health and The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jian Xiang
- Zhejiang Jerinte Health Technology Co, Ltd., Wenzhou, China
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
| | - Haiyun Xu
- Zhejiang Jerinte Health Technology Co, Ltd., Wenzhou, China
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
| | | | - Haibo Mao
- Zhejiang Jerinte Health Technology Co, Ltd., Wenzhou, China
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xugong Cai
- Zhejiang Jerinte Health Technology Co, Ltd., Wenzhou, China
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yili Wu
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Alzheimer's Disease of Zhejiang Province, School of Mental Health and The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
| | - Deborah Baofeng Wang
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
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Moore KL, Munson MR, Jaccard J. Ethnic Identity and Mechanisms of Mental Health Service Engagement Among Young Adults with Serious Mental Illnesses. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01842-9. [PMID: 37870731 PMCID: PMC11035489 DOI: 10.1007/s40615-023-01842-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE Young adults from minoritized racial and ethnic groups have lower rates of engagement in treatment for serious mental illnesses (SMI). Previous research suggests a relationship between ethnic identity development and engagement in mental health services, but it remains unclear how a sense of belonging and attachment to one's racial and ethnic group influences participation in treatment among young adults with SMI. METHODS Bivariate analyses and structural equation modeling (SEM) were used to examine whether ethnic identity was associated with treatment engagement (attendance and investment in treatment) and how ethnic identity might influence engagement through theoretical proximal mediators. Eighty-three young adults with SMI (95% from minoritized racial and ethnic groups) were recruited from four outpatient psychiatric rehabilitation programs and assessed at least 3 months after initiating services. RESULTS Stronger ethnic identity was associated with greater investment in treatment but not with treatment attendance. The SEM analysis indicated that stronger ethnic identity may improve investment in treatment by enhancing hope (0.53, p < .05) and beliefs that mental health providers are credible (0.32, p < .05), and by increasing self-efficacy (-0.09, p < .05). Proximal mediators of engagement were associated with investment in treatment (hope and credibility, p < .05, and self-efficacy p = 0.055). CONCLUSIONS Findings provide preliminary evidence of an empirical and theoretical relationship between ethnic identity development and engagement in treatment among young adults with SMI. Assessment and strengthening of a young person's ethnic identity may be a promising approach for improving their engagement in services and reducing inequities in their care.
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Affiliation(s)
- Kiara L Moore
- New York University, Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA.
| | - Michelle R Munson
- New York University, Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - James Jaccard
- New York University, Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
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Alaie I, Svedberg P, Ropponen A, Narusyte J. Longitudinal trajectories of sickness absence among young adults with a history of depression and anxiety symptoms in Sweden. J Affect Disord 2023; 339:271-279. [PMID: 37437735 DOI: 10.1016/j.jad.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/05/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Depression and anxiety are associated with increased risk of sickness absence (SA), yet the developmental patterns of SA remain unclear. We aimed to identify trajectories of SA in young adults with depression and/or anxiety, accounting for sociodemographic and occupational factors. METHODS Longitudinal study of 1445 twin individuals with elevated depressive/anxiety symptoms in late adolescence or young adulthood (age range: 19-30), assessed in Swedish surveys completed in 2005. Through linkage to nationwide registries, individuals were prospectively followed from 2006 to 2018. The outcome included consecutive annual days of SA, which were analyzed using group-based trajectory modeling. Multinomial logistic regression estimating odds ratios (OR) with 95 % confidence intervals (CI) was used to examine associations of age, sex, and educational level with the resulting SA trajectories. RESULTS Four distinct SA trajectories were identified in the total sample: 'high-increasing' (6 %), 'low-increasing' (12 %), 'high-decreasing' (13 %), and 'low-constant' (69 %). Increasing age was associated with higher odds of belonging to the low-increasing trajectory (OR = 1.07, 95 % CI = 1.02-1.12). Women had higher odds of belonging to the low-increasing trajectory (OR = 1.67, 95 % CI = 1.10-2.53), compared with men. Higher education was associated with lower odds of belonging to high-increasing (OR = 0.34, 95 % CI = 0.22-0.54) and high-decreasing (OR = 0.59, 95 % CI = 0.43-0.81) trajectories, compared with lower education. Few differences were observed in analyses stratified by occupational sector. LIMITATIONS Information on potential confounders (e.g., psychiatric comorbidity, work-environment factors) was not available. CONCLUSIONS Among young adults with prior depression/anxiety, close to every fifth showed rising SA trajectories over time. This calls for targeted strategies to improve public mental health already at young ages.
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Affiliation(s)
- Iman Alaie
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Division of Child and Adolescent Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Annina Ropponen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jurgita Narusyte
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Giovanelli A, Sanchez Karver T, Roundfield KD, Woodruff S, Wierzba C, Wolny J, Kaufman MR. The Appa Health App for Youth Mental Health: Development and Usability Study. JMIR Form Res 2023; 7:e49998. [PMID: 37792468 PMCID: PMC10585433 DOI: 10.2196/49998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/24/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. OBJECTIVE The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appa's 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. METHODS The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers' characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. RESULTS Participants reported finding Appa helpful, with 100% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. CONCLUSIONS Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program.
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Affiliation(s)
- Alison Giovanelli
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
- Appa Health, Oakland, CA, United States
| | - Tahilin Sanchez Karver
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Katrina D Roundfield
- Appa Health, Oakland, CA, United States
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | | | | | - J Wolny
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Michelle R Kaufman
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Pederson CA, Dir AL, Schwartz K, Ouyang F, Monahan PO, Tu W, Wiehe SE, Aalsma MC. Associations between outpatient treatment and the use of intensive psychiatric healthcare services. Clin Child Psychol Psychiatry 2023; 28:1380-1392. [PMID: 36737059 DOI: 10.1177/13591045231154106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The current manuscript examines concurrent and longitudinal associations between the utilization of outpatient and intensive psychiatric services among Medicaid-enrolled youth. Using an administrative dataset of Medicaid claims from 2007 to 2017, youth were included if they were between the ages of 10-18 (M = 13.4, SD = 2.6) and had a psychiatric Medicaid claim (N = 33,590). Psychiatric services were coded as outpatient, emergency department (ED), inpatient, or residential based on Medicaid codes. Logistic regression analyses indicated that the receipt of even one outpatient visit significantly reduced the odds of having an ED, inpatient, and residential visit within 60-, 90-, and 120-day windows. Survival analyses indicated most youth did not have any ED, inpatient, or residential visit following their first outpatient visit. For remaining youth, having an outpatient visit significantly increased the risk of having an ED, inpatient, and residential visit following their initial appointment, which may suggest these youth are being triaged to a more appropriate level of care. Classification accuracy analyses indicated a cutoff of 2 outpatient visits yielded maximum accuracy in determining youth with ED, inpatient, and residential visits. Findings highlight use of outpatient-level services in reducing risk of more intensive service utilization.
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Affiliation(s)
- Casey A Pederson
- Indiana University School of Medicine, Department of Psychiatry, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
| | - Allyson L Dir
- Indiana University School of Medicine, Department of Psychiatry, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
| | - Katherine Schwartz
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Indiana University School of Medicine, Department of Biostatistics & Health Data Sciences, Indianapolis, IN, USA
| | - Patrick O Monahan
- Indiana University School of Medicine, Department of Biostatistics & Health Data Sciences, Indianapolis, IN, USA
| | - Wanzhu Tu
- Indiana University School of Medicine, Department of Biostatistics & Health Data Sciences, Indianapolis, IN, USA
| | - Sarah E Wiehe
- Indiana University School of Medicine, Department of Pediatrics, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA
| | - Matthew C Aalsma
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
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Casseus M. Racial and ethnic disparities in unmet need for mental health care among children: A nationally representative study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01801-4. [PMID: 37737936 DOI: 10.1007/s40615-023-01801-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/10/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND There is a dearth of large, nationally representative studies that examine racial/ethnic disparities in self-reported unmet need for mental health care among children and youth. OBJECTIVE This study assessed racial/ethnic disparities in unmet need for mental health care, use of psychotropic medication, and reasons for forgone care among children and youth. METHODS This nationally representative cross-sectional study analyzed data from the combined 2016-2020 National Survey of Children's Health (n = 151,876). Bivariate statistics and multivariable logistic regression models assessed the association between race/ethnicity, unmet need for mental health care, and use of psychotropic medication. Reasons for forgone care were also examined. RESULTS Black non-Hispanic children and youth had approximately twice the odds of unmet mental health care needs (AOR, 1.97; 95% CI 1.53-2.55) as White non-Hispanic children and youth. The likelihood of reporting that it was not possible to see a mental health professional was higher for Black non-Hispanic (AOR, 3.39; 95% CI 1.64-7.01) and Multi-racial/Other non-Hispanic children and youth (AOR, 2.96; 95% CI 1.40-6.25) compared with White non-Hispanic peers. Black non-Hispanic, Hispanic, and Multi-racial/Other non-Hispanic children and youth were also less likely to use psychotropic medication (p < 0.001). Common reasons for forgoing care included cost, problems getting an appointment, and lack of transportation or childcare. CONCLUSIONS This study found significant racial/ethnic disparities in unmet mental health care, psychotropic medication use, and barriers in accessing mental health care. Data from this study suggest that eliminating these disparities requires policy interventions that address medical and societal barriers to health care access and quality.
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Affiliation(s)
- Myriam Casseus
- Division of Population Health, Quality, and Implementation Science, Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
- Child Health Institute of New Jersey, New Brunswick, NJ, USA.
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Bogdan T, Xie W, Talaat H, Mir H, Venkataraman B, Banfield LE, Georgiades K, Duncan L. Longitudinal studies of child mental disorders in the general population: A systematic review of study characteristics. JCPP ADVANCES 2023; 3:e12186. [PMID: 37720586 PMCID: PMC10501698 DOI: 10.1002/jcv2.12186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/01/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Longitudinal studies of child mental disorders in the general population (herein study) investigate trends in prevalence, incidence, risk/protective factors, and sequelae for disorders. They are time and resource intensive but offer life-course perspectives and examination of causal mechanisms. Comprehensive syntheses of the methods of existing studies will provide an understanding of studies conducted to date, inventory studies, and inform the planning of new longitudinal studies. Methods A systematic review of the research literature in MEDLINE, EMBASE, and PsycINFO was conducted in December 2022 for longitudinal studies of child mental disorders in the general population. Records were grouped by study and assessed for eligibility. Data were extracted from one of four sources: a record reporting study methodology, a record documenting child mental disorder prevalence, study websites, or user guides. Narrative and tabular syntheses of the scope and design features of studies were generated. Results There were 18,133 unique records for 487 studies-159 of these were eligible for inclusion. Studies occurred from 1934 to 2019 worldwide, with data collection across 1 to 68 time points, with 70% of studies ongoing. Baseline sample sizes ranged from n = 151 to 64,136. Studies were most frequently conducted in the United States and at the city/town level. Internalizing disorders and disruptive, impulse control, and conduct disorders were the most frequently assessed mental disorders. Of studies reporting methods of disorder assessment, almost all used measurement scales. Individual, familial and environmental risk and protective factors and sequelae were examined. Conclusions These results summarize characteristics of existing longitudinal studies of child mental disorders in the general population, provide an understanding of studies conducted to date, encourage comprehensive and consistent reporting of study methodology to facilitate meta-analytic syntheses of longitudinal evidence, and offer recommendations and suggestions for the design of future studies. Registration DOI: 10.17605/OSF.IO/73HSW.
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Affiliation(s)
- Theodora Bogdan
- Department of Psychiatry and Behavioural NeurosciencesOfford Centre for Child StudiesMcMaster UniversityHamiltonOntarioCanada
| | - Weiyi Xie
- Department of Psychiatry and Behavioural NeurosciencesOfford Centre for Child StudiesMcMaster UniversityHamiltonOntarioCanada
| | - Habeba Talaat
- Department of Psychiatry and Behavioural NeurosciencesOfford Centre for Child StudiesMcMaster UniversityHamiltonOntarioCanada
| | - Hafsa Mir
- Department of Psychiatry and Behavioural NeurosciencesOfford Centre for Child StudiesMcMaster UniversityHamiltonOntarioCanada
| | - Bhargavi Venkataraman
- Department of Psychiatry and Behavioural NeurosciencesOfford Centre for Child StudiesMcMaster UniversityHamiltonOntarioCanada
| | | | - Katholiki Georgiades
- Department of Psychiatry and Behavioural NeurosciencesOfford Centre for Child StudiesMcMaster UniversityHamiltonOntarioCanada
| | - Laura Duncan
- Department of Psychiatry and Behavioural NeurosciencesOfford Centre for Child StudiesMcMaster UniversityHamiltonOntarioCanada
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29
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Butler W, Kim H, Keuroghlian AS. Psychiatric Boarding of Transgender and Gender Diverse Youth Awaiting Treatment. LGBT Health 2023; 10:412-415. [PMID: 36971585 DOI: 10.1089/lgbt.2022.0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
With increased prevalence and duration of pediatric mental health boarding that disparately impacts transgender and gender diverse (TGD) youth, it is critical to consider disparities that TGD youth experience in accessing mental health care. Although mental health care for TGD youth has long been considered specialty care, frontline, primary medical, and mental health clinicians must be equipped to serve TGD patients' psychiatric needs. Inequities that TGD youth face require examination and intervention at multiple levels, including societal discrimination, lack of culturally responsive primary mental health care, and barriers to gender-affirming care in emergency departments and psychiatric inpatient units.
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Affiliation(s)
| | - Heather Kim
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- National LGBTQIA+ Health Education Center, The Fenway Institute, Boston, Massachusetts, USA
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30
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Kamali M, Edwards J, Anderson LN, Duku E, Georgiades K. Social Disparities in Mental Health Service Use Among Children and Youth in Ontario: Evidence From a General, Population-Based Survey. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:596-604. [PMID: 36503305 PMCID: PMC10411367 DOI: 10.1177/07067437221144630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine differences in mental health-related service contacts between immigrant, refugee, racial and ethnic minoritized children and youth, and the extent to which social, and economic characteristics account for group differences. METHODS The sample for analyses includes 10,441 children and youth aged 4-17 years participating in the 2014 Ontario Child Health Study. The primary caregiver completed assessments of their child's mental health symptoms, perceptions of need for professional help, mental health-related service contacts, experiences of discrimination and sociodemographic and economic characteristics. RESULTS Adjusting for mental health symptoms and perceptions of need for professional help, children and youth from immigrant, refugee and racial and ethnic minoritized backgrounds were less likely to have mental health-related service contacts (adjusted odds ratios ranged from 0.54 to 0.79), compared to their non-immigrant peers and those who identified as White. Group differences generally remained the same or widened after adjusting for social and economic characteristics. Large differences in levels of perceived need were evident across non-migrant and migrant children and youth. CONCLUSION Lower estimates of mental health-related service contacts among immigrant, refugee and racial and ethnic minoritized children and youth underscore the importance and urgency of addressing barriers to recognition and treatment of mental ill-health among children and youth from minoritized backgrounds.
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Affiliation(s)
- Mahdis Kamali
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, Ron Joyce Children's Health Centre, Hamilton, ON, Canada
| | - Jordan Edwards
- Offord Centre for Child Studies, Ron Joyce Children's Health Centre, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Ron Joyce Children's Health Centre, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Katholiki Georgiades
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, Ron Joyce Children's Health Centre, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Chandrasekhar JL, Bowen AE, Heberlein E, Pyle E, Studts CR, Simon SL, Shomaker L, Kaar JL. Universal, School-Based Mental Health Program Implemented Among Racially and Ethnically Diverse Youth Yields Equitable Outcomes: Building Resilience for Healthy Kids. Community Ment Health J 2023; 59:1109-1117. [PMID: 36757609 PMCID: PMC10289906 DOI: 10.1007/s10597-023-01090-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
Although suicide is a leading cause of mortality among racial and ethnic minority youth, limited data exists regarding the impact of school-based mental health interventions on these populations, specifically. A single-arm pragmatic trial design was utilized to evaluate the equity of outcomes of the universal, school-based mental health coaching intervention, Building Resilience for Healthy Kids. All sixth-grade students at an urban middle school were invited to participate. Students attended six weekly sessions with a health coach discussing goal setting and other resilience strategies. 285 students (86%) participated with 252 (88%) completing both pre- and post-intervention surveys. Students were a mean age of 11.4 years with 55% identifying as girls, 69% as White, 13% as a racial minority, and 18% as Hispanic. Racial minority students exhibited greater improvements in personal and total resilience compared to White students, controlling for baseline scores.
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Affiliation(s)
- Jessica L Chandrasekhar
- Division of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Erin Heberlein
- Children's Hospital Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Emily Pyle
- Children's Hospital Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Christina R Studts
- Division of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stacey L Simon
- Division of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lauren Shomaker
- Division of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Jill L Kaar
- Division of Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
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Graaf G, Palmer AN. Parent Ratings of Health Insurance Adequacy for Children with Emotional, Behavioral, or Developmental Problems. Acad Pediatr 2023; 23:1204-1212. [PMID: 36336328 PMCID: PMC10578061 DOI: 10.1016/j.acap.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Parents of children with special health care needs (CSHCN) report that private insurance is less adequate than public health coverage. Parents of CSHCN with emotional, behavioral, or developmental problems (EBDPs) may perceive private insurance to be especially inadequate due to higher need for a wider array of non-medical services and supports. This study's objective is to assess differences in parent ratings of insurance adequacy for public versus private health coverage between non-CSHCN, CSHCN, and CSHCN with EBDPs. METHODS This study pooled publicly available data from the 2016 through 2019 National Survey of Children's Health. Multivariable fixed effects logistic regression models estimated the association between insurance type, CSCHN and EBDP status, and parent ratings of their child's insurance adequacy. Marginal effects were calculated for insurance type, CSHCN and EBDP status, and their interactions to estimate the size of the association. RESULTS Among all subgroups, consistently more parents with publicly insured children rated their insurance as adequate compared to those with private insurance. Parents of privately insured CSHCN with EBDPs rated their insurance as adequate at significantly lower rates than any other group of parents (55%)-including those with privately insured children without EBDPs (non-CSHCN= 67%; CSHCN = 63%) and all other parents with publicly insured children (non-CSHCN = 87%; CSHCN = 83%; CSHCN with EBDPs = 84%). CONCLUSIONS Future research should investigate if perceptions of insurance adequacy among families whose CSHCN has an EBDP aligns with reports of service access and unmet health care needs.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work (G Graaf), The University of Texas at Arlington, Arlington, Tex.
| | - Ashley N Palmer
- Department of Social Work (AN Palmer), Texas Christian University, Fort Worth, Tex
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Marraccini ME, Griffard MKR, Whitcomb CE, Wood C, Griffin DC, Pittleman C, Sartain L. School-based Mental Health Supports During COVID-19: School Professional Perspectives. PSYCHOLOGY IN THE SCHOOLS 2023; 60:2460-2482. [PMID: 37692888 PMCID: PMC10488322 DOI: 10.1002/pits.22869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/15/2023] [Indexed: 01/28/2023]
Abstract
Objective The present study explored the ways school professionals adapted school-based mental health supports and services for remote delivery during the COVID-19 pandemic. Method We surveyed 81 school professionals (e.g., counselors, psychologists, social workers) and conducted in-depth interviews with a subsample of professionals (n=14) to explore their perceptions and experiences of supporting youth with mental health concerns and suicide-related risk during the fall and winter of the 2020-2021 school year. Results Commonly endorsed school-based mental health interventions (e.g., counseling services, checking in), ways of communicating (phone, email), and individuals delivering supports and services to students with suicide-related risk (e.g., counselors, teachers) were identified based on school professional survey responses. Qualitative findings point to facilitators (e.g., specific platforms for connecting with students and families) and barriers (e.g., limited communication) to successful service delivery during COVID-19. Conclusion Findings highlight the creative ways school support professionals adapted to provide school-based mental health supports. Implications for remote school-based mental health services during and following the pandemic are discussed.
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Affiliation(s)
| | | | - Cason E Whitcomb
- Gillings School of Public Health, University of North Carolina at Chapel Hill
| | - Caitlin Wood
- School of Education, University of North Carolina at Chapel Hill
| | - Dana C Griffin
- School of Education, University of North Carolina at Chapel Hill
| | - Cari Pittleman
- School of Education, University of North Carolina at Chapel Hill
| | - Lauren Sartain
- School of Education, University of North Carolina at Chapel Hill
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Skarphedinsson G, Karlsson GK. The Feasibility and Efficacy of a Group-Based, Brief Transdiagnostic Cognitive-Behavioral Treatment for Adolescents with Internalizing Problems. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01552-7. [PMID: 37294420 DOI: 10.1007/s10578-023-01552-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
The present study aimed to assess the efficacy of a group-based, brief transdiagnostic cognitive-behavioral therapy (CBT) program for adolescents with internalizing problems, such as anxiety and depressive disorders, seeking help in a primary health care clinic in Iceland. The group-based CBT program consisted of eight weekly 110-min sessions covering psychoeducation, cognitive restructuring, behavioral activation, exposure, problem-solving, social skills, and mindfulness. The study recruited 53 participants, who were randomly assigned to either receive the group treatment or be placed on a wait-list for monitoring purposes. Measures were taken at baseline, during treatment (week 4), at posttreatment (week 8), and at 2-, 4-month, and 1-year follow-ups. The primary outcome measures were the self-reported total scores of total anxiety and depression using the Revised Children's Anxiety and Depression Scale (RCADS). The study found a significant effect of time and time * treatment interaction on the depression and anxiety total scores. The secondary outcome measures, RCADS parent-rated depression and anxiety total scores, did not show significant effects of time * treatment interaction. However, during naturalistic follow-up, a significant reduction in parent-reported depression and anxiety total scores was observed. The study also observed good treatment adherence, as well as high satisfaction among parents and youth. The results suggest that this group-based, brief transdiagnostic CBT group treatment is feasible and effective in reducing depressive and anxiety symptoms in adolescents with internalizing problems and highlights the importance of addressing comorbidity in treatment.
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Heatly MC, Nichols-Hadeed C, Stiles AA, Alpert-Gillis L. Implementation of a School Mental Health Learning Collaborative Model to Support Cross-Sector Collaboration. SCHOOL MENTAL HEALTH 2023; 15:1-18. [PMID: 37359161 PMCID: PMC10102686 DOI: 10.1007/s12310-023-09578-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 06/28/2023]
Abstract
Facilitating success for students with behavioral health challenges requires effective collaboration among professionals from traditionally disparate systems (e.g., education, health, and mental health). The current investigation describes a case-study implementation of a school-based learning collaborative model and explores its effectiveness in promoting knowledge, skill, efficacy, and systems-related improvements in cross-sector collaboration. The learning collaborative (LC) was offered to school teams over the course of a year and consisted of a combination of didactic and experiential learning opportunities, guest speakers, district-specific improvement goals, peer learning and support, and individualized consultation support. Evaluation efforts included evidence demonstrating the efficacy of the LC, improvement in person-centered knowledge skills and competencies, and generation of concrete changes in school systems. Respondents consistently shared that the quality of the LC was high that the topics were highly useful for their day-to-day practice, and that they would recommend the LC to their colleagues and peers. In turn, this process fostered improvement in educators' knowledge, skills, and confidence, and generated systemic improvement in districts to support children with behavioral health needs and their families. Specific components of this model that best account for changes are discussed, along with implications for application and next steps.
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Affiliation(s)
- Melissa C. Heatly
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - Corey Nichols-Hadeed
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - Allison A. Stiles
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
| | - Linda Alpert-Gillis
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY USA
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Gorfinkel LR, Snell G, Long D, Del Casal M, Wu J, Schonert-Reichl K, Guhn M, Samji H. Access to mental health support, unmet need and preferences among adolescents during the first year of the COVID-19 pandemic. Health Promot Chronic Dis Prev Can 2023; 43:182-190. [PMID: 36651881 PMCID: PMC10111570 DOI: 10.24095/hpcdp.43.4.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has had widespread effects on adolescent mental health. However, little is known about support-seeking, unmet need and preferences for mental health care among adolescents. METHODS The Youth Development Instrument (YDI) is a school-administered survey of adolescents (N = 1928, mean age = 17.1, SD = 0.3) across British Columbia, Canada. In this cohort, we assessed the characteristics of accessed mental health supports, prevalence of unmet need and preferences for in-person versus internet-based services. RESULTS Overall, 40% of adolescents obtained support for mental health, while 41% experienced unmet need. The most commonly accessed supports were family doctors or pediatricians (23.1%) and adults at school (20.6%). The most preferred mode of mental health care was in-person counselling (72.4%), followed by chat-based services (15.0%), phone call (8.1%) and video call (4.4%). The adjusted prevalence of accessing support was elevated among adolescents with anxiety (adjusted prevalence ratio [aPR] = 1.29, 95% CI: 1.10-1.51), those who used alcohol (1.14, 1.01-1.29), gender minorities (1.28, 1.03-1.58) and sexual minorities (1.28, 1.03-1.45). The adjusted prevalence of unmet need was elevated among adolescents with depression (1.90, 1.67-2.18), those with anxiety (1.78, 1.56-2.03), females (1.43, 1.31-1.58), gender minorities (1.45, 1.23-1.70) and sexual minorities (1.15, 1.07-1.23). CONCLUSION Adolescents of gender or sexual minority status and those with anxiety were more likely than others to have discussed mental health concerns and also to have reported unmet need. The most common sources of support were primary health care providers and adults at school, while the most and least preferred modes of support were in-person and video call services, respectively.
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Affiliation(s)
- Lauren R Gorfinkel
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gaelen Snell
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Applied Research in Mental Health and Addictions, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - David Long
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Applied Research in Mental Health and Addictions, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Mari Del Casal
- Centre for Applied Research in Mental Health and Addictions, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Judy Wu
- Centre for Applied Research in Mental Health and Addictions, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kimberly Schonert-Reichl
- Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Guhn
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Hasina Samji
- Centre for Applied Research in Mental Health and Addictions, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- The British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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Henke RM. Knowing Well, Being Well: well-being born of understanding: The COVID-19 Pandemic and Children: Implications for Future Health. Am J Health Promot 2023; 37:263-288. [PMID: 36646664 DOI: 10.1177/08901171221140641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Pinkerton LM, Kisiel CL, Risser HJ. Treatment Engagement Among Children Exposed to Violence: A Systems Perspective. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4215-4239. [PMID: 35968728 DOI: 10.1177/08862605221114306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Childhood exposure to violence is a major public health issue. Effective treatment can reduce the impact of violence exposure on child outcomes. However, disparities in treatment engagement can interfere with effective treatment. This study reviews data collected from 2,546 children referred to community-based mental health services from 2001 to 2015 after exposure to violence. Children were categorized into three groups: those who attended intake but never started treatment, referred to as the Nonengager group; those who started but discontinued treatment prior to meeting treatment goals, referred to as the Attriter group; and those who completed treatment as rated by the treating therapist, referred to as the Completer group. The three groups were analyzed for differences in behavioral and emotional problems, racial identity, child social support, household income, number of people living in the home, parent stress, parent social support, community violence exposure, and neighborhood-level child opportunity. Analyses demonstrated that the Completer group were more likely to: live in neighborhoods with higher levels of childhood opportunity, identify as White, have an annual household income of $40,000 or greater, have significantly fewer people living in the home, report lower levels of parental stress, report higher levels of parental social support, report higher levels of child social support, and have significantly lower scores of emotional and behavioral problems after treatment. Overall, our study supports the importance of considering multiple ecological levels when targeting treatment engagement for children after exposure to violence. Results indicate that children from more advantaged environments are more likely to complete treatment, which leads to better outcomes. This can exacerbate existing disparities. Findings highlight the need for systems change and advocacy for children in less advantaged environments and meeting families in their specific context, to combat treatment disparities.
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Affiliation(s)
- Linzy M Pinkerton
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Heather J Risser
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Nadeem E, R Van Meter A. The Impact of the COVID-19 Pandemic on Adolescents: An Opportunity to Build Resilient Systems. Am J Health Promot 2023; 37:274-281. [PMID: 36646661 DOI: 10.1177/08901171221140641d] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The impact of the COVID-19 pandemic on adolescents is significant. Educational progress and mental health, in particular, have been negatively affected. Among youth from vulnerable communities, pre-existing academic and health disparities have been exacerbated. Youth outcomes are often attributed to individual resilience - or lack thereof; in this paper, we describe how failure to adapt and effectively cope at the system level (ie, lack of system resilience) is implicated in the current dual educational and mental crisis. We describe opportunities to make our systems more nimble and better-equipped to support youth moving forward.
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Affiliation(s)
- Erum Nadeem
- Graduate School of Applied and Professional Psychology, Rutgers University, USA
| | - Anna R Van Meter
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, USA
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Lawson GM, Comly R, Beidas RS, Khanna MS, Goldstein J, Brizzolara-Dove S, Wilson T, Rabenau-McDonnell Q, Eiraldi R. Therapist and supervisor perspectives about two train-the-trainer implementation strategies in schools: A qualitative study. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231190854. [PMID: 37790186 PMCID: PMC10403977 DOI: 10.1177/26334895231190854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background Train-the-trainer (TT) implementation strategies (in which designated clinicians are trained to then train others in an intervention) are promising approaches to support mental health clinician use of evidence-based interventions in school contexts. However, there is little evidence to date examining clinicians' perceptions of the acceptability and feasibility of TT strategies, or comparing clinicians' perceptions of different types of TT strategies. Methods The current study was conducted as part of a larger hybrid effectiveness-implementation trial, in which school-based therapists and supervisors received one of two different types of implementation support to implement cognitive behavioral therapy (CBT) groups for anxiety: TT (i.e., initial training for therapists and supervisors) or enhanced TT (TT+; i.e., initial training for therapists and supervisors, and ongoing external consultation for supervisors). We used applied thematic analysis to compare qualitative interview transcripts from 28 therapist interviews and 33 supervisor interviews from therapists and supervisors who received TT or TT+ support and report themes that were similar and different across the two groups. Results Most themes were similar across the TT and TT+ conditions: therapists and supervisors in both conditions perceived the group anxiety intervention as acceptable and viewed supervision as acceptable, helpful, and feasible. Therapists and supervisors in both conditions had mixed impressions of the contextual appropriateness of the group anxiety intervention, and some reported logistical challenges with weekly supervision. Some unique themes were identified among the TT+ condition, including supervisors experiencing professional growth, and therapists and supervisors perceiving supervision as critically important and enjoyable. Conclusions These results suggest that TT implementation support, using a model in which an internal supervisor receives initial training and then provides ongoing supervision, is acceptable and feasible to support a group CBT intervention in schools. The results also highlight additional benefits that therapists and supervisors perceived when supervisors received ongoing consultation. Clinical Trial Registration Information The clinical trial from which these data were derived was registered at ClinicalTrials.gov (https://clinicaltrials.gov/) prior to the time of first patient enrollment. The registration number is: NCT02651402.
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Affiliation(s)
- Gwendolyn M. Lawson
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rachel Comly
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rinad S. Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Tara Wilson
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Ricardo Eiraldi
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Pettit JW, Rey Y, Marin CE, Bechor M, Lebowitz ER, Vasey MW, Jaccard J, Abend R, Pine DS, Bar-Haim Y, Silverman WK. Attention Training as a Low-Intensity Treatment for Concerning Anxiety in Clinic-Referred Youth. Behav Ther 2023; 54:77-90. [PMID: 36608979 PMCID: PMC9825787 DOI: 10.1016/j.beth.2022.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 06/27/2022] [Accepted: 07/10/2022] [Indexed: 01/11/2023]
Abstract
Although youth anxiety treatment research has focused largely on severe and impairing anxiety levels, even milder anxiety levels, including levels that do not meet full criteria for a diagnosis, can be impairing and cause for concern. There is a need to develop and test viable treatments for these concerning anxiety levels to improve functioning and reduce distress. We present findings from a randomized controlled efficacy trial of attention bias modification treatment (ABMT) and attention control training (ACT) for youths with concerning anxiety levels. Fifty-three clinic-referred youths (29 boys, M age = 9.3 years, SD age = 2.6) were randomized to either ABMT or ACT. ABMT and ACT consisted of attention-training trials in a dot-probe task presenting angry and neutral faces; probes appeared in the location of neutral faces in 100% of ABMT trials and 50% of ACT trials. Independent evaluators provided youth anxiety severity ratings; youths and parents provided youth anxiety severity and global impairment ratings; and youths completed measures of attention bias to threat and attention control at pretreatment, posttreatment, and 2-month follow-up. In both arms, anxiety severity and global impairment were significantly reduced at posttreatment and follow-up. At follow-up, anxiety severity and global impairment were significantly lower in ACT compared with ABMT. Attention control, but not attention bias to threat, was significantly improved at follow-up in both arms. Changes in attention control and attention focusing were significantly associated with changes in anxiety severity. Findings support the viability of attention training as a low-intensity treatment for youths with concerning anxiety levels, including levels that do not meet full criteria for a diagnosis. Superior anxiety reduction effects in ACT highlight the critical need for mechanistic research on attention training in this population.
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Affiliation(s)
| | | | - Carla E Marin
- Yale Child Study Center, Yale University School of Medicine
| | | | - Eli R Lebowitz
- Yale Child Study Center, Yale University School of Medicine
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Choi SY, Rusch A, Lane A, Liebrecht C, Bilek EL, Eisenberg D, Andrews C, Perry M, Smith SN. Individual and organizational factors as predictors of early evidence-based practice adoption in Michigan high schools: Baseline data from an implementation trial. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231159429. [PMID: 37091540 PMCID: PMC10052498 DOI: 10.1177/26334895231159429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background Adolescents increasingly access mental health services in schools. School mental health professionals (SPs; school counselors, social workers, etc.) can offer evidence-based mental health practices (EBPs) in schools, which may address access gaps and improve clinical outcomes. Although some studies have assessed factors associated with EBP adoption in schools, additional research focusing on SP- and school-level factors is warranted to support EBP implementation as SPs' mental health delivery grows. Methods Baseline data were collected from SPs at Michigan high schools participating in a statewide trial to implement SP-delivered cognitive behavioral therapy (CBT) to students. Models examined factors associated with attitudes about EBPs, implementation climate, and implementation leadership, and their associations with CBT knowledge, training attendance, and pre-training CBT delivery. Results One hundred ninety-eight SPs at 107 schools (87%) completed a baseline survey. The mean Evidence-Based Practice Attitude Scale (EBPAS) total score was 2.9, and school-aggregated mean scores of the Implementation Climate Scale (ICS) and Implementation Leadership Scale (ILS) were 1.83 and 1.77, respectively, all on a scale ranging from 0 (low) to 4 (high). ICS and ILS scores were lower than typically reported in clinical settings, while EBPAS scores were higher. School characteristics were not significantly associated with EBPAS, ICS, or ILS scores, but scores did differ by SP role. Higher EBPAS scores were associated with more CBT knowledge (average marginal effect for 1 SD change [AME] = 0.15 points) and a higher probability of training completion (AME = 8 percentage points). Higher ICS scores were associated with a higher probability of pre-training CBT delivery (AME = 6 percentage points), and higher ILS scores were associated with higher probability of training completion (AME = 10 percentage points). Conclusions Our findings suggest that SPs' attitudes toward EBPs and organizational support were positively associated with early signs of implementation success. As schools increasingly fill the adolescent mental healthcare access gap, efforts to strengthen both provider attitudes toward EBP and strategic organizational factors supporting EBP delivery will be key to encouraging EBP uptake in schools. Plain Language Summary Schools are an important setting in which adolescents receive mental healthcare. We need to better understand how to implement evidence-based practices (EBPs) in this setting to improve student mental health. This study examined the attitudes and perceptions of school professionals (SPs) as key contributors to the implementation of a particular EBP, the delivery of cognitive behavioral therapy (CBT) in schools. The study found that implementation climate and leadership scores in participating schools were lower than scores typically reported in clinical settings, while scores for SP attitudes about EBP adoption were higher than typical scores in clinical settings. Results further suggest that SPs with more positive attitudes toward EBPs are more knowledgeable of CBT and more likely to complete a 1-day CBT training. We also found that higher implementation climate scores were associated with SPs reporting pre-training CBT delivery (although this association was not statistically significant), and more implementation leadership was associated with SPs completing the CBT training. These findings suggest that SP attitudes toward EBPs and organizational support in schools are positively associated with early signs of implementation success. Early, low-intensity efforts to (1) improve SP attitudes about mental health EBPs, and (2) increase schools' support for implementation may scaffold more intensive implementation efforts in schools down the road.
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Affiliation(s)
- Seo Youn Choi
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Amy Rusch
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Annalise Lane
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Celeste Liebrecht
- Department of Learning Health Sciences, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Emily L. Bilek
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Eisenberg
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Carolyn Andrews
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Morgan Perry
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Shawna N. Smith
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Nygaard MA, Ormiston HE, Heck OC, Apgar S, Wood M. Educator Perspectives on Mental Health Supports at the Primary Level. EARLY CHILDHOOD EDUCATION JOURNAL 2023; 51:851-861. [PMID: 35528139 PMCID: PMC9062637 DOI: 10.1007/s10643-022-01346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 05/03/2023]
Abstract
During the early years of formal education, young students develop a number of formative academic, motor, behavioral, and socioemotional skills that lay the foundation for future learning. Since student mental health in the early grades predicts academic achievement in later grades, mental health interventions are essential at the primary school level. Not only are teachers expected to provide academic instruction, they are now involved in providing students with mental health services, despite a lack of training to do so. The current study sought to gather the perspectives of 38 primary-level educators to gain understanding about mental health knowledge, current approaches to mitigating mental health challenges, and barriers that prevent them from successfully addressing student mental health issues. Using thematic analysis, three themes developed: (1) Educators indicate supporting primary students' mental health is within their role; (2) Systems-level constraints prevent effective mental health supports; and (3) Staff desire increased mental health resources. Implications for educators and practice are discussed.
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Affiliation(s)
- Malena A. Nygaard
- Department of Counseling and Educational Psychology, Indiana University School of Education, 201 N Rose Ave, Bloomington, IN 47405 USA
| | - Heather E. Ormiston
- Department of Counseling and Educational Psychology, Indiana University School of Education, 201 N Rose Ave, Bloomington, IN 47405 USA
| | - Olivia C. Heck
- Department of Counseling and Educational Psychology, Indiana University School of Education, 201 N Rose Ave, Bloomington, IN 47405 USA
| | - Sophia Apgar
- Department of Counseling and Educational Psychology, Indiana University School of Education, 201 N Rose Ave, Bloomington, IN 47405 USA
| | - Maureen Wood
- Department of Counseling and Educational Psychology, Indiana University School of Education, 201 N Rose Ave, Bloomington, IN 47405 USA
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Bettencourt AF, Coble K, Reinblatt SP, Jadhav S, Khan KN, Riddle MA. Characteristics of Patients Served by a Statewide Child Psychiatry Access Program. Psychiatr Serv 2022:appips20220323. [PMID: 36475823 DOI: 10.1176/appi.ps.20220323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Maryland's Behavioral Health Integration in Pediatric Primary Care (BHIPP) is a child psychiatry access program offering child-adolescent psychiatry consultation, resource and referral networking, and direct-to-patient mental health intervention. This study investigated characteristics of patients for whom primary care providers sought BHIPP services. METHODS Data from 6,939 unique patient contacts between October 2012 and March 2020 were collected on service type, demographic characteristics, presenting concerns, clinical severity, clinicians' diagnostic impressions, current treatments, and BHIPP recommendations. Descriptive statistics and latent class analysis were used. RESULTS Of the 6,939 patient contacts, 38.6% were for direct-to-patient mental health intervention, 27.3% for child-adolescent psychiatry consultation, and 34.2% for resource and referral networking. In total, 50.3% of patients were female, 58.7% were White, and 32.7% were already receiving mental health services. Latent class analysis identified four classes of presenting concerns: anxiety only (44.2%); behavior problems only (30.7%); mood and anxiety (17.1%); and attention, behavior, and learning problems (8.0%). Compared with patients in the anxiety-only class, those in the attention, behavior, and learning problems class were more likely to receive direct-to-patient mental health intervention (OR=3.59), and BHIPP clinicians were more likely to recommend in-office behavioral interventions for those in the mood and anxiety class (OR=1.62) and behavior problems-only class (OR=1.55). CONCLUSIONS Patients supported through BHIPP varied in presenting concerns, condition severity and complexity, current receipt of services, and BHIPP utilization. Latent class analysis yielded more clinically useful information about the nature and complexity of patients' concerns than did consideration of individual presenting concerns.
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Affiliation(s)
- Amie F Bettencourt
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Kelly Coble
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Shauna P Reinblatt
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Sneha Jadhav
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Kainat N Khan
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
| | - Mark A Riddle
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore (Bettencourt, Reinblatt, Khan, Riddle); Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore (Coble, Reinblatt); Kennedy Krieger Institute, Baltimore (Jadhav)
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French A, Jones KA, Bush C, Greiner MA, Copeland JN, Davis NO, Franklin MS, Heilbron N, Maslow GR. Racial and Ethnic Differences in Psychotropic Prescription Receipt Among Pediatric Patients Enrolled in North Carolina Medicaid. Psychiatr Serv 2022; 73:1401-1404. [PMID: 36039550 DOI: 10.1176/appi.ps.202100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors aimed to examine racial-ethnic differences in filled psychotropic prescriptions among a pediatric Medicaid population. METHODS This retrospective cohort study included patients ages 0-21 with at least one North Carolina Medicaid claim from October 1, 2017, through September 30, 2018 (N=983,886). The primary outcome was a filled psychotropic prescription. Separate multivariable modified Poisson regression models generated adjusted risk ratios (ARRs) and 95% confidence intervals (CIs), adjusted for patient demographic characteristics. RESULTS Black and Hispanic patients were significantly less likely to receive any filled psychotropic prescription (ARR=0.61, 95% CI=0.60-0.62; ARR=0.29, 95% CI=0.28-0.29, respectively) compared with White and non-Hispanic patients. Furthermore, Black and Hispanic patients were less likely to receive filled prescriptions in the four included drug classes compared with White and non-Hispanic patients. CONCLUSIONS Future studies should focus on understanding the factors contributing to racial and ethnic differences among pediatric patients receiving filled psychotropic prescriptions.
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Affiliation(s)
- Alexis French
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Kelley A Jones
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Christopher Bush
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Melissa A Greiner
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - J Nathan Copeland
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Naomi O Davis
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Michelle S Franklin
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Nicole Heilbron
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
| | - Gary R Maslow
- Department of Psychiatry and Behavioral Sciences (French, Copeland, Davis, Heilbron, Maslow), Department of Population Health Sciences (Jones, Greiner), and Department of Pediatrics (Maslow), Duke University School of Medicine, Durham, North Carolina; Aetion, New York City (Bush); Duke-Margolis Center for Health Policy, Durham, North Carolina (Franklin); Carolina Institute for Developmental Disabilities, University of North Carolina School of Medicine, Chapel Hill (Franklin)
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Munson MR, Jaccard J, Moore KL, Rodwin AH, Shimizu R, Cole AR, Scott LD, Narendorf SC, Davis M, Gilmer T, Stanhope V. Impact of a brief intervention to improve engagement in a recovery program for young adults with serious mental illness. Schizophr Res 2022; 250:104-111. [PMID: 36399899 PMCID: PMC9742319 DOI: 10.1016/j.schres.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 10/03/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Serious mental illnesses (SMI) commonly emerge during young adulthood. Effective treatments for this population exist; however, engagement in treatment is a persistent challenge. This study examines the impact of Just Do You (JDY), an innovative intake-focused intervention designed to improve engagement in treatment and enhance personal recovery. METHODS The study used a parallel group randomized trial to examine if and how JDY improved recovery among 121 young adults with SMI from low-resourced communities referred to personalized recovery-oriented services (PROS). Measures of engagement (buy-in and attendance) and personal recovery in this pilot study were assessed at baseline and 3-month follow-up. RESULTS Participants in JDY reported more positive engagement outcomes; that is, relative to the control group they reported higher past two week attendance (b = 0.72, p < 0.05, Cohen's d = 0.56) and higher levels of buy-in to treatment (b = 2.42, p < 0.05, Cohen's d = 0.50). JDY also impacted young adults' personal recovery (b = 0.99, p < 0.05, Cohen's d = 1.15) and did so largely by increasing their level of buy-in to the treatment program. CONCLUSION This study suggests that an engagement intervention for young adults that orients, prepares, and empowers them to be active and involved in the larger treatment program makes a difference by improving engagement and enhancing recovery. Data also support conceptualizing and examining engagement beyond treatment attendance; in this study what mattered most for recovery was the level of buy-in to treatment among young adults.
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Affiliation(s)
- Michelle R Munson
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA.
| | - James Jaccard
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA
| | - Kiara L Moore
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA
| | - Aaron H Rodwin
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA
| | - Rei Shimizu
- University of Alaska, School of Social Work, 3211 Providence Drive, Anchorage, AK 99508, USA
| | - Andrea R Cole
- Fairleigh Dickinson University, 1000 River Rd, Teaneck, NJ 07666, USA
| | - Lionel D Scott
- Georgia State University, School of Social Work, 55 Park Pl, Atlanta, GA 3030, USA
| | - Sarah C Narendorf
- University of Houston, Graduate College of Social Work, 3511 Cullen Blvd, Houston, TX 77204, USA
| | - Maryann Davis
- University of Massachusetts, Chan Medical School, 55 Lake Avenue North, Worcester, MA, USA
| | - Todd Gilmer
- University of California San Diego, Department of Family Medicine and Public Health, 9500 Gilman Drive, San Diego, CA, USA
| | - Victoria Stanhope
- New York University, Silver School of Social Work, 1 Washington Sq. N, 10003 New York, NY, USA
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Ali F, Russell C, Nafeh F, Chaufan C, Imtiaz S, Rehm J, Spafford A, Elton-Marshall T. Youth substance use service provider’s perspectives on use and service access in ontario: time to reframe the discourse. Subst Abuse Treat Prev Policy 2022; 17:9. [PMID: 35123527 PMCID: PMC8818169 DOI: 10.1186/s13011-022-00435-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/14/2022] Open
Abstract
Background Age is a critical factor in substance use and related outcomes, with adolescence being a particularly sensitive period. Early initiation of substance use has been linked with higher risk for developing substance use disorders. In Ontario, Canada, substance use is common among youth, yet treatment is underutilized, suggesting the potential for an unmet need in terms of substance use care. Despite these challenges, there is limited research examining factors that contribute to youth substance use and youth-specific barriers to substance use care. To fill this knowledge gap, this study sought to include the unique perspectives of service providers who work directly with youth to examine these issues. Methods We used a cross-sectional mixed-methods design to examine factors that contribute to substance use among youth and identify youth-specific barriers to substance use among a sample of 54 Ontario-based youth service providers. Data collection included an online survey completed by all study participants followed by qualitative interviews of a subsample of 16 participants. Data analysis included basic frequency tabulations for survey results and thematic qualitative analyses to identify common themes. Results Licit substances were identified as the most commonly used among youth, where 94% of respondents identified cannabis use and 81% identified alcohol use. Thematic analyses identified the role of dominant substance use discourses in normalizing certain substances (i.e., cannabis and alcohol) while also endorsing stigmatizing beliefs and sentiments. According to youth service providers, the intersection of these two discourses simultaneously lead to an increase in substance use while deterring youth from seeking substance use care. Conclusions Normalization and stigmatization are two dominant discourses around youth substance use, with important implications for public health interventions. Key public health strategies, as identified by participants, to reduce the overall negative effect of these factors include the need to reframe substance use discourse, from a moral failing to a public health issue and to educate youth about the impacts of use. To accomplish this goal educational campaigns to raise awareness around the health effects of use and address stigmatization are needed. Educational reforms are also needed to ensure that these programs are integrated into the school system.
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Rodwin AH, Shimizu R, Travis R, James KJ, Banya M, Munson MR. A Systematic Review of Music-Based Interventions to Improve Treatment Engagement and Mental Health Outcomes for Adolescents and Young Adults. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2022; 40:1-30. [PMID: 36407676 PMCID: PMC9666939 DOI: 10.1007/s10560-022-00893-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Mental health disorders and suicidality are rising among adolescents and young adults (A-YA) while rates of treatment engagement remain notoriously low. Emerging research supports the potential of music-based interventions to improve mental health, but their efficacy remains unclear for A-YA. This systematic review evaluates the evidence on music-based psychosocial interventions to improve engagement in treatment and/or mental health outcomes among A-YA. This review was prospectively registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-six studies were extracted. There was heterogeneity of designs, populations, measures, and outcomes. A typology of music-based interventions emerged, which is characterized by combinations of three broad categories: 1) Somatosensory, 2) Social-Emotional, and 3) Cognitive-Reflective. Most interventions are Socio-Cognitive and Holistically Integrated (combines all three) followed by Socio-Somatic. All interventions involved Social-Emotional processes. Results indicate that most studies report significant effects for mental health outcomes related to social and emotional improvements and reductions of internalizing symptoms for adolescents. Few studies targeted young adults and effects on engagement were rarely measured. There is a need for more studies that use rigorous methods. This review illuminated a need for interventions that are developmentally and culturally tailored to subgroups. Finally, the field is ripe from more studies that apply experimental therapeutics to conceptualize, operationalize, and test mechanisms of change to improve the understanding of how and for whom music-based interventions work. Recommendations for embedding these innovative strategies into research and practice for A-YA are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s10560-022-00893-x.
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Affiliation(s)
- Aaron H. Rodwin
- Silver School of Social Work, New York University, New York, NY USA
| | - Rei Shimizu
- School of Social Work, University of Alaska, Anchorage, AK USA
| | - Raphael Travis
- School of Social Work, Texas State University, San Marcos, TX USA
| | - Kirk Jae James
- Silver School of Social Work, New York University, New York, NY USA
| | - Moiyattu Banya
- Silver School of Social Work, New York University, New York, NY USA
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Felsman P, Seifert CM, Sinco B, Himle JA. Reducing Social Anxiety and Intolerance of Uncertainty in Adolescents with Improvisational Theater. ARTS IN PSYCHOTHERAPY 2022. [DOI: 10.1016/j.aip.2022.101985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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50
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Ibrahim K, Kalvin C, Morand-Beaulieu S, He G, Pelphrey KA, McCarthy G, Sukhodolsky DG. Amygdala-prefrontal connectivity in children with maladaptive aggression is modulated by social impairment. Cereb Cortex 2022; 32:4371-4385. [PMID: 35059702 PMCID: PMC9574236 DOI: 10.1093/cercor/bhab489] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 01/22/2023] Open
Abstract
Aggressive behavior is common across childhood-onset psychiatric disorders and is associated with impairments in social cognition and communication. The present study examined whether amygdala connectivity and reactivity during face emotion processing in children with maladaptive aggression are moderated by social impairment. This cross-sectional study included a well-characterized transdiagnostic sample of 101 children of age 8-16 years old with clinically significant levels of aggressive behavior and 32 typically developing children without aggressive behavior. Children completed a face emotion perception task of fearful and calm faces during functional magnetic resonance imaging. Aggressive behavior and social functioning were measured by standardized parent ratings. Relative to controls, children with aggressive behavior showed reduced connectivity between the amygdala and the dorsolateral prefrontal cortex (PFC) during implicit emotion processing. In children with aggressive behavior, the association between reduced amygdala-ventrolateral PFC connectivity and greater severity of aggression was moderated by greater social impairment. Amygdala reactivity to fearful faces was also associated with severity of aggressive behavior for children without social deficits but not for children with social deficits. Social impairments entail difficulties in interpreting social cues and enacting socially appropriate responses to frustration or provocation, which increase the propensity for an aggressive response via diminished connectivity between the amygdala and the ventral PFC.
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Affiliation(s)
- Karim Ibrahim
- Address correspondence to Karim Ibrahim, PsyD, Yale University School of Medicine, Child Study Center, 230 South Frontage Road, New Haven, CT 06520, USA. ; Denis G. Sukhodolsky, PhD, Yale University School of Medicine, Child Study Center, 230 South Frontage Road, New Haven, CT 06520, USA.
| | - Carla Kalvin
- Child Study Center, Yale University School of Medicine, New Haven, CT 06520, USA
| | | | - George He
- Department of Psychology, Yale University, New Haven, CT 06520, USA
| | - Kevin A Pelphrey
- Department of Neurology, University of Virginia, Charlottesville, VA 22903, USA
| | - Gregory McCarthy
- Department of Psychology, Yale University, New Haven, CT 06520, USA
| | - Denis G Sukhodolsky
- Address correspondence to Karim Ibrahim, PsyD, Yale University School of Medicine, Child Study Center, 230 South Frontage Road, New Haven, CT 06520, USA. ; Denis G. Sukhodolsky, PhD, Yale University School of Medicine, Child Study Center, 230 South Frontage Road, New Haven, CT 06520, USA.
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