Evidence-based practice in child and adolescent mental health最新文献

Background: Between 50-70% of youth involved in the juvenile legal system meet criteria for at least one psychiatric condition. To address this mental health crisis, juvenile diversion programs often screen youth for behavioral health conditions and refer them to providers. However, only a small proportion of youth in need of treatment initiate care during or after their involvement with the system.

Objective: The primary aim of this mixed methods study was to identify perceived barriers to treatment participation among caregiver-youth dyads involved in a court diversion program. We examined caregiver and youth demographic characteristics, behavioral health, and legal system factors associated with greater levels of treatment barriers.

Method: We conducted surveys, interviews, and reviewed administrative court records for 100 caregivers and youth in a juvenile court diversion program in a northeastern state (July 2023-May 2024). Procedures were approved by the health system-affiliated IRB.

Results: Caregivers reported an average of four barriers to treatment participation. The most common barriers included youth resistance to treatment and scheduling conflicts. Bivariate and multivariate analyses showed that caregivers from minoritized racial backgrounds, with lower income or education, and those with Hispanic/Latinè-identifying youth reported higher perceived barriers. Qualitative findings echoed these results, and additionally highlighted barriers including mistrust of court-affiliated services, long waitlists, limited provider availability, and a strong caregiver preference for culturally matched, community-based services.

Conclusions: Our results indicate that while caregivers are motivated to get their child into treatment, they face several different types of barriers to service engagement. These findings underscore the need for acceptable, accessible and family-centered behavioral health service pathways.

Objective: This study marks the first phase of the development of a reliable and valid suicide risk assessment tool for preteen youth. In this phase, authors sought to understand the lived experiences of preteens with suicidal thoughts and behaviors (STBs) and their caregivers, with the goal of informing our understanding and improving the assessment of STBs in preteens.

Method: We conducted qualitative interviews with youth in acute care settings who had onset of STBs during their preteen years (i.e., 8-12 years of age; n= 11) and caregivers of preteens with STBs (n=11). We queried about suicidal ideation, pre-suicide attempt warning signs and risk factors, ways in which suicidal risk was communicated by preteens, suicide attempt planning and intent, and early detection of risk.

Results: Youth and caregivers provided perspectives on the lived experiences of preteen STBs, identifying critical risk factors and warning signs (e.g., increasing isolation, major shifts in typical behaviors), barriers to communication of risk (e.g., fear of hospitalization, fear of punishment), importance of family-centered and individualized risk assessment that takes into consideration personal and cultural identities (e.g., minoritized identities, religious beliefs), and ways to better support preteens (e.g., asking direct questions about STBs, checking in on mood and well-being more regularly).

Conclusion: Qualitative interviews provided valuable insights regarding the lived experiences of preteens reporting STBs and their caregivers. This research highlights the need for family-centered, individualized, and culturally sensitive approaches to understanding, assessing, and mitigating preteen STBs and the development and validation of comprehensive risk assessment tools and practices explicitly designed for preteens.

Background: Suicide is a leading cause of death among youth, and rates continue to increase across the United States. Pediatric primary care providers (PCPs) are uniquely positioned to identify acute periods of increased suicidal ideation and provide timely intervention.

Objective: The present study assessed the feasibility and acceptability of training and implementation of a primary care-adapted version of Safe Alternatives for Teens and Youth-Acute (SAFETY-A), a brief, strengths-based, cognitive-behaviorally oriented, family intervention for suicidal thoughts and behaviors in youth, among pediatric PCPs.

Method: This multisite pilot study involved collaboration between eight Texas-based academic institutions who assisted with the recruitment and training of 68 PCPs. PCPs attended five SAFETY-A training sessions and completed self-report surveys for 6 months post-training.

Results: Prior to SAFETY-A training, PCPs indicated a significant training gap, with 83% indicating that they had not received sufficient prior training in suicide risk assessment and risk reduction/intervention. PCPs found SAFETY-A training acceptable, reporting significant improvements in knowledge, skills, and confidence. PCPs also found SAFETY-A implementation feasible, using the intervention a total of 288 times over the course of 6 months (M uses per PCP = 6.9). However, PCPs found the SAFETY-A training schedule less feasible, with many PCPs unable to attend all five training sessions.

Conclusions: Findings suggest that a tiered training structure allowing for more flexibility in training commitment might be more feasible for busy PCPs seeking training in SAFETY-A. Ongoing efforts to feasibly scale-up SAFETY-A training efforts across Texas incorporate these findings with the goal of making SAFETY-A training available to all PCPs across the state.

Background: Adolescent hospitalization for suicide-related thoughts and behaviors has increased over the past decade, with few interventions shown to improve outcomes post-discharge. Given the majority of adolescents return to school following a suicide-related crisis, we developed and pilot-tested Practice Experiences for School Reintegration (PrESR)^™, a virtual reality (VR) intervention designed to teach therapeutic skills to hospitalized adolescents and allowing them to practice using these skills in stressful situations set in school settings that they would be expected to experience following discharge.

Objective: This pilot optimization trial examined the feasibility, acceptability, and safety of PrESR for augmenting standard inpatient care with adolescents hospitalized for suicide-related crises.

Method: Using a Multiphase Optimization Strategy (MOST) framework, we recruited adolescents hospitalized for suicide-related thoughts and behaviors (n=42) to be randomized into one of eight conditions testing three different VR-enhanced skill lessons and practice sessions: affect regulation, cognitive restructuring, and problem-solving.

Results: Research clinicians delivered individual sessions of PrESR with a high degree of fidelity (93-100%), but patients were often discharged before completing more than one skill. Of the participants who participated in the intervention, the majority agreed or strongly agreed with statements endorsing PrESR and its components as important, appropriate, and easy to use, largely supporting acceptability. Participants also provided feedback for improvement, informing slight changes to the next version of the intervention. More generally, PrESR did not appear to result in significant safety concerns based self-reported ratings of subjective distress and pre/post measures of physical symptoms related to cybersickness.

Conclusion: Findings support the feasibility of delivering a brief version of PrESR and preliminary acceptability for the intervention. VR technology and content show promising potential for adolescent suicide prevention and mental health support. Future research should examine PrESR for improving patient outcomes and preventing suicide.

Outpatient medical settings are a critical source of mental health care for adolescents and young adults. This is due to the familiarity and accessibility of those settings and challenges accessing mental health care elsewhere. Adolescents and young adults who die by suicide are more likely to have seen a medical provider in the prior month than a mental health specialist, but few suicide care interventions have been developed to specifically address the challenges of working in these outpatient medical settings. This paper provides the perspective of the University of Washington Suicide Care Research Center on the importance of incorporating evidence into public policy decisions regarding workforce development and standards of care for adolescents and young adults experiencing suicidal thoughts and behaviors, their families, and their outpatient medical setting providers; and the equal importance of integrating policy and funding perspectives in clinical services and implementation science. The paper will review the trends in suicide care policy and funding structures as relevant to adolescents and young adults in outpatient medical settings, provide recommendations to advance the translation of research into evidence-based policy decisions for adolescents and young adults at risk of suicide, and recommendations for researchers on incorporating policy perspectives in the development and evaluation of evidence-based interventions. We will share how the University of Washington Suicide Care Research Center is operationalizing these recommendations.

Background: Consistent evidence finds supportive, affirming parents have a significant positive impact on LGBTQ + youth mental health. Yet few studies have examined the experiences of parents of LGBTQ + youth with mental health service needs, a notable gap in the literature given the considerable proportion of LGBTQ + youth with mental health difficulties.

Objectives: The current study aimed to characterize the experiences of parents of LGBTQ + youth in navigating services for their child to inform future parent-focused resource and intervention development.

Methods: A sample of N = 12 parents of LGBTQ + children (ages 9-17) with a history of mental health service use residing in the Southeastern U.S. were recruited to participate in one of three semi-structured focus group interviews. Focus group interviews were audio recorded and transcribed; data were coded using flexible and reflexive six-step thematic analysis approach.

Results: Three key themes emerged: (1) parents' challenges related to accessing and navigating mental health services for their LGBTQ + children, (2) parents' need for their own resources and support as they navigate these challenges, and (3) parent-identified recommendations to improve LGBTQ + youth and family support. Subthemes highlighted the complexities parents face given their dual role in both affirming their child's identities as well as supporting their child's mental health needs, particularly within the sociopolitical context of the Southeastern U.S.

Conclusion: Findings demonstrate the need for affirming and accessible mental health resources for LGBTQ + youth and families in Southeastern U.S. as well as the need for parent-focused resources to better support parents of LGBTQ + youth experiencing mental health problems. Based on parents' perspectives, we offer a set of recommendations for child and adolescent mental healthcare providers and organizations for supporting LGBTQ + youth and families.

Background: Schools are the primary context for mental health services for youth in the United States and a critical setting for increasing access to mental health care, especially for youth from low income and historically minoritized communities. However, numerous barriers to implementing evidence-based practices persist for chronically underserved youth in schools. Establishing strong collaborations with community partners is essential for successful implementation.

Objective: This conceptual overview offers the ACCESS model as a resource for school-partnered training and consultation efforts, in contrast to previous applications that emphasized community mental health and inpatient contexts.

Method: Drawing from our groups' collective decades of partnering with school and community members to deliver evidence-based practice training and consultation support in underserved schools and reflecting on our collaborations with community mental health agencies contracted to provide mental health services in schools, we outline a practical model for partners to provide training and implementation support in the school context. Specifically, we have described applications of the ACCESS model (Creed et al., 2014; Stirman et al., 2010) in training and consultation in partnership with leaders, service providers, and educators working in underserved school settings. The ACCESS model provides guidance for trainers and implementers to Assess and adapt training content, Convey the basics during initial training, provide Consultation to facilitate learning and behavior change, Evaluate work samples to assess EBP fidelity, Study outcomes, and foster Sustainment of practices over time.

Conclusion: The ACCESS model offers a practical roadmap for school-partnered EBP implementation, outlining each step and providing concrete guidance for psychologists with applied examples from our work. This authorship team represents co-developers of the ACCESS model and three distinct research groups that have provided training and consultation in partnership with numerous public-school systems. Throughout, we emphasize how school-academic partnerships can support implementation in underserved schools.

Background: Globally, one in seven 10-19-year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group. In low- and middle-income countries (LMICs), many children and adolescents face serious mental health disorders, including disruptive behavioral disorders (DBDs), which often begin in childhood and adolescence. Between 2016 and 2021, a large cluster randomized controlled trial was conducted in Uganda under the SMART Africa initiative to examine the impact and implementation of the Multiple Family Group (MFG) intervention for children with behavioral problems and their families. The intervention proved efficacious in reducing impaired functioning and had the potential to improve family dynamics, whether delivered by community members or parents. With limited mental health experts in Uganda, understanding the fidelity of this mental health intervention with task shifting will be critical.

Objective: This study systematically assesses the fidelity of the MFG intervention, focusing on the dose dimension, which includes the frequency and duration of intervention sessions and adherence to the intervention manual.

Methods: The fidelity assessment was embedded within the SMART Africa trial and conducted after every MFG session for facilitators and caregivers and at 25% of the sessions (sessions 4, 8, 12, and 16) by research staff. Facilitators and participants completed a 5-minute fidelity assessment checklist at the end of each session, while independent fidelity observations were conducted for 25% of the sessions by trained research assistants. Data were analyzed to assess the relationship between planned and actual implementation.

Results: In this study, the MFG intervention included 1,290 participants and caregivers, with children having an average age of 12 years and most caregivers being female with a primary education. Each session had an average attendance of over 70%, with 33% of participants attending all 15 sessions and 77.4% attending at least 11 sessions, indicating good adherence. Participants completed 16,470 fidelity assessment surveys, showing excellent coverage of intervention content (95%-100%), which improved over time. Research assistants reported high fidelity, with 567 assessments showing 93%-98% coverage. Facilitators filled out 2,189 surveys, with a mean session component coverage of 98.6%.

Conclusion: The fidelity assessment indicates that the MFG intervention was well-delivered in Uganda. High adherence and positive feedback affirm the intervention's successful implementation and support for task shifting mental health interventions while maintaining high fidelity in countries with limited mental health experts.

Background: Parent-Child Interaction Therapy (PCIT), an evidence-based treatment for children with disruptive behavior, has limited research investigating its efficacy for children with attention-deficit/hyperactivity disorder (ADHD).

Objective: This study compared group and individual PCIT for young children with ADHD with and without co-occurring disruptive behavior disorders (DBDs).

Method: This open randomized controlled trial examined group and individual PCIT for 4-6-year-old children (n = 128) with ADHD with and without co-occurring DBDs at pre-treatment, post-treatment, one- and two-year follow-up.

Results: Parent-reported disruptive behavior and ADHD symptomatology decreased following treatment, regardless of diagnosis or format, with improvements maintained at follow-up. For children with ADHD only, individual PCIT resulted in higher rates of reliable change in disruptive behavior compared to group PCIT. Individual and group PCIT appear to be effective treatments for children with ADHD with or without DBDs. Most children experienced clinically significant ADHD symptom improvement following PCIT, though rates of reliable improvement in disruptive behavior appear greater in children with ADHD only.

Conclusions: These findings highlight the potential utility of PCIT in both individual and group formats for treating childhood ADHD symptoms and co-occurring disruptive behavior. While this study suggests PCIT may be beneficial as a treatment option for children with ADHD, potentially reducing reliance on medication-based treatments, further research is needed to confirm these results and their generalizability to non-parental contexts.

Background: Young children with attention-deficit/hyperactivity disorder (ADHD) and comorbid disruptive behavior disorders (DBD) exhibit significant impairments across functional domains, which are compounded by co-occurring callous-unemotional (CU) behaviors.

Objective: This study examined the impact of the Summer Treatment Program for pre-kindergarteners (STP-PreK) on reducing callous-unemotional (CU) behaviors in children with and without ADHD and DBD.

Method: This study utilized a multi-informant approach to examine the change in CU behaviors in response to the STP-PreK via parent and teacher report across three time points. The current sample included three groups based on diagnostic status (68.7% boys; mean age = 5.47, SD = 0.77, 81.4% Latinx): ADHD Only (n = 46), ADHD+DBD (n = 129), and typically developing (TD; n = 148).

Results: Linear mixed models revealed significant initial differences in CU scores, with ADHD+DBD displaying higher CU scores, followed by ADHD Only, and then TD. Per teacher report, both ADHD groups experienced substantial decrease in CU behaviors over time, with moderate effect sizes (Cohen's d = .67-.76). At the 1-year follow-up, children in the ADHD Only group no longer significantly differed from TD peers, while the ADHD+DBD group continued to exhibit significantly higher CU scores.

Conclusion: The findings suggest that the STP-PreK has a positive impact on reducing CU behaviors in children with ADHD during the transition to kindergarten or first grade. Understanding and addressing CU traits in early childhood may contribute to improved treatment outcomes and long-term social-emotional development.