Alex Lloyd, Tom (Chin-Han) Wu, Laura Lucas, Adeola Agunbiade, Romana Saleh, Pasco Fearon, Essi Viding
Involving young people with lived experience in youth mental health research is important. In recognition of the value of collaborating with experts by experience, international funders are increasingly mandating that mental health research is developed by teams that include individuals from the population of study. Yet, research into how Patient Public Involvement, specifically co-production and co-design, is implemented in youth mental health research is limited to date. The current review examined this question and identified common practices for collaborating with experts by experience in young people's mental health research. Academic databases were systematically searched for studies that had involved young people in mental health research, had described these activities, and had reported some demographic information about the experts by experience. From a total of 2130 studies that were screened, 37 studies were eligible for inclusion. The use of co-production and co-design spanned a wide range of topics, including interventions, digital support tools and psychometric studies. Interactive workshops were the primary method of engaging experts by experience, although some studies utilised interviews or focus groups. From the reviewed studies we identified common methodological practices including: Scene setting, utilising a cyclical process, ensuring appropriate engagement and recognition of the cultural context. We draw on these findings to suggest common methods for conducting co-production and co-design activities, and emphasise the importance of ensuring experts by experience are respected and safeguarded throughout their collaboration in research. We also outline areas that deserve future attention and development, and include a response from two young people aged 16–18 and their suggestions for improving and extending co-production methods.
{"title":"No decision about me, without me: Collaborating with young people in mental health research","authors":"Alex Lloyd, Tom (Chin-Han) Wu, Laura Lucas, Adeola Agunbiade, Romana Saleh, Pasco Fearon, Essi Viding","doi":"10.1002/jcv2.12291","DOIUrl":"10.1002/jcv2.12291","url":null,"abstract":"<p>Involving young people with lived experience in youth mental health research is important. In recognition of the value of collaborating with experts by experience, international funders are increasingly mandating that mental health research is developed by teams that include individuals from the population of study. Yet, research into how Patient Public Involvement, specifically co-production and co-design, is implemented in youth mental health research is limited to date. The current review examined this question and identified common practices for collaborating with experts by experience in young people's mental health research. Academic databases were systematically searched for studies that had involved young people in mental health research, had described these activities, and had reported some demographic information about the experts by experience. From a total of 2130 studies that were screened, 37 studies were eligible for inclusion. The use of co-production and co-design spanned a wide range of topics, including interventions, digital support tools and psychometric studies. Interactive workshops were the primary method of engaging experts by experience, although some studies utilised interviews or focus groups. From the reviewed studies we identified common methodological practices including: Scene setting, utilising a cyclical process, ensuring appropriate engagement and recognition of the cultural context. We draw on these findings to suggest common methods for conducting co-production and co-design activities, and emphasise the importance of ensuring experts by experience are respected and safeguarded throughout their collaboration in research. We also outline areas that deserve future attention and development, and include a response from two young people aged 16–18 and their suggestions for improving and extending co-production methods.</p>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":"4 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Myrofora Kakoulidou, Georgia Pavlopoulou, Susie Chandler, Steve Lukito, Maciej Matejko, Isabel Jackson, Beta Balwani, Tiegan Boyens, Dorian Poulton, Luke Harvey-Nguyen, Zoe Glen, Archie Wilson, Elisa Ly, Elizabeth Macauley, Sylvan Baker, Georgina Bullen, Edmund J. S. Sonuga-Barke, RE-STAR team
Background
There is a growing expectation that neurodivergent young people, such as those with diagnoses of attention-deficit/hyperactivity disorder (ADHD) and/or autism, should play a central role in shaping research on neurodevelopmental conditions. However, currently, their involvement is typically limited to arms-length advice. To address this, the Regulating Emotions-Strengthening Adolescent Resilience (RE-STAR) programme has co-developed a framework for deepening the involvement of neurodivergent participants in translational research. Here we apply this to build, implement and evaluate a new approach to participatory qualitative research.
Methods
Development – Building on the track record of successful collaboration between RE-STAR academic researchers (ARs) and its Youth Researcher Panel (Y-RP), a cycle of meetings was convened to co-develop a collaborative protocol for the participatory approach. Implementation – ARs and Y-RPers applied the general protocol to study a specific topic. This involved co-designing and co-delivering an interview schedule to study the emotional experiences of 12 adolescents with diagnoses of ADHD and/or autism and then co-analysing the interviews. Evaluation – ARs, Y-RPers and interviewees shared their reflections on the participatory approach and its implementation, during interviews (N = 36) and short open-ended surveys (N = 22).
Results
Development - The protocol for the participatory approach gave detailed advice on how to engage Y-RP members (or equivalent) in the co-design, co-delivery and co-analysis of interviews. Implementation - The approach was successfully implemented by ARs and Y-RPers working together to co-design an interview to study the emotional lives of adolescents with diagnoses of ADHD and/or autism, co-deliver it and then co-analyse the interview scripts. Evaluation - The implementation experience of the Y-RP, ARs and interviewees was characterised by common themes relating to (a) adapting research methods and making practical adjustments; (b) taking on new roles, adding value to research and (c) valuing neurodivergent characteristics.
Conclusions
This new RE-STAR protocol proved feasible to implement in a way that was generally perceived, from multiple perspectives, to add depth and authenticity to research into the experiences of neurodivergent young people.
{"title":"Deepening the participation of neurodivergent youth in qualitative mental health research: Co-development of a general approach and the evaluation of its implementation in a study on emotion","authors":"Myrofora Kakoulidou, Georgia Pavlopoulou, Susie Chandler, Steve Lukito, Maciej Matejko, Isabel Jackson, Beta Balwani, Tiegan Boyens, Dorian Poulton, Luke Harvey-Nguyen, Zoe Glen, Archie Wilson, Elisa Ly, Elizabeth Macauley, Sylvan Baker, Georgina Bullen, Edmund J. S. Sonuga-Barke, RE-STAR team","doi":"10.1002/jcv2.12287","DOIUrl":"10.1002/jcv2.12287","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is a growing expectation that neurodivergent young people, such as those with diagnoses of attention-deficit/hyperactivity disorder (ADHD) and/or autism, should play a central role in shaping research on neurodevelopmental conditions. However, currently, their involvement is typically limited to arms-length advice. To address this, the <i>Regulating Emotions-Strengthening Adolescent Resilience</i> (RE-STAR) programme has co-developed a framework for deepening the involvement of neurodivergent participants in translational research. Here we apply this to build, implement and evaluate a new approach to participatory qualitative research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Development – Building on the track record of successful collaboration between RE-STAR academic researchers (ARs) and its Youth Researcher Panel (Y-RP), a cycle of meetings was convened to co-develop a collaborative protocol for the participatory approach. Implementation – ARs and Y-RPers applied the general protocol to study a specific topic. This involved co-designing and co-delivering an interview schedule to study the emotional experiences of 12 adolescents with diagnoses of ADHD and/or autism and then co-analysing the interviews. Evaluation – ARs, Y-RPers and interviewees shared their reflections on the participatory approach and its implementation, during interviews (<i>N</i> = 36) and short open-ended surveys (<i>N</i> = 22).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Development - The protocol for the participatory approach gave detailed advice on how to engage Y-RP members (or equivalent) in the co-design, co-delivery and co-analysis of interviews. Implementation - The approach was successfully implemented by ARs and Y-RPers working together to co-design an interview to study the emotional lives of adolescents with diagnoses of ADHD and/or autism, co-deliver it and then co-analyse the interview scripts. Evaluation - The implementation experience of the Y-RP, ARs and interviewees was characterised by common themes relating to (a) adapting research methods and making practical adjustments; (b) taking on new roles, adding value to research and (c) valuing neurodivergent characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This new RE-STAR protocol proved feasible to implement in a way that was generally perceived, from multiple perspectives, to add depth and authenticity to research into the experiences of neurodivergent young people.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":"4 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrea MacLeod, Ifigeneia Manitsa, Stephane De Brito
We are pleased to present our Special Issue on Participatory Research. In this editorial, we outline how the disability rights movement has been instrumental to the development of participatory approaches, before giving consideration to some of the debates and criticisms associated with participatory research in practice. We summarise the contributions offered by the studies within this issue and propose four areas of consideration, drawn from the body of included research, to inform future developments.
{"title":"Participatory research in child psychology & psychiatry: Embracing untidiness to break new ground","authors":"Andrea MacLeod, Ifigeneia Manitsa, Stephane De Brito","doi":"10.1002/jcv2.12284","DOIUrl":"10.1002/jcv2.12284","url":null,"abstract":"<p>We are pleased to present our Special Issue on Participatory Research. In this editorial, we outline how the disability rights movement has been instrumental to the development of participatory approaches, before giving consideration to some of the debates and criticisms associated with participatory research in practice. We summarise the contributions offered by the studies within this issue and propose four areas of consideration, drawn from the body of included research, to inform future developments.</p>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":"4 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evelyn Mary-Ann Antony, Nadin Beckmann, Steve Higgins
Background
Recent research has suggested that emotion dysregulation (ED) is a key mechanism which explains the associations between mental health illnesses, including attention deficit hyperactivity disorder and internalising problems, among youth. However, literature reviews have led to mixed and inconclusive findings on the conceptualisations of ED. Specifically, understanding ED in the context of middle childhood, otherwise known as ‘the forgotten years’, may be crucial, as it serves as a significant developmental stage, where children develop a sense of self and rationalise their emotions. This scoping review aims to address the present challenge of conceptualising ED during middle childhood.
Methods
ProQuest, PsycINFO, Scopus and Web of Science were searched in October 2024. Articles were included if ED and emotional dysregulation (including positive emotions) were conceptualised, if the paper was a review (i.e., scoping, literature, meta-analysis etc), participants of the target age range (6–12-year) were in the sample, and papers were in English. Studies were excluded if the sample included other age groups, such as infants and pre-schoolers, alongside focussing on other phenomena, such as self-regulation.
Results
The current scoping review explored the conceptualisations drawn from research studies conducted in the United States, Germany, Austria, France, and Australia. 11 studies were included in this review and two key themes were extrapolated (a) issues with processing emotions (i.e., emotion generation/reactivity) and (b) issues with adopting appropriate emotion regulation strategies and the failure in doing so, leading to issues in attaining goal-directed behaviours.
Conclusions
The findings support the importance of considering how ED should be measured, based on holistic perspectives of the mechanism, alongside clinical screening for emotional deficits at earlier stages of life.
最近的研究表明，情绪失调（ED）是解释青少年心理健康疾病（包括注意力缺陷多动障碍和内化问题）之间关联的关键机制。然而，文献综述导致了对ED概念化的混合和不确定的发现。具体来说，在童年中期（也被称为“被遗忘的岁月”）的背景下理解ED可能是至关重要的，因为它是一个重要的发展阶段，在这个阶段孩子们发展了自我意识并使他们的情绪合理化。这一范围审查的目的是解决目前的挑战，概念化ED在儿童中期。方法于2024年10月检索ProQuest、PsycINFO、Scopus和Web of Science。如果文章是概念化ED和情绪失调（包括积极情绪），如果论文是一篇综述（即，范围界定，文献，元分析等），在样本中有目标年龄范围（6 - 12岁）的参与者，并且论文是英文的。如果样本包括其他年龄组，如婴儿和学龄前儿童，同时关注其他现象，如自我调节，则研究被排除在外。结果当前的范围审查探讨了从美国、德国、奥地利、法国和澳大利亚进行的研究中得出的概念。本审查包括11项研究，并推断了两个关键主题(a)处理情绪的问题（即情绪产生/反应）和(b)采用适当的情绪调节策略及其失败的问题。导致实现目标导向行为的问题。结论：研究结果支持了考虑如何测量ED的重要性，基于机制的整体观点，以及在生命早期阶段对情绪缺陷的临床筛查。
{"title":"Reconceptualising emotion dysregulation in the context of middle childhood: A scoping review of reviews","authors":"Evelyn Mary-Ann Antony, Nadin Beckmann, Steve Higgins","doi":"10.1002/jcv2.12296","DOIUrl":"10.1002/jcv2.12296","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recent research has suggested that emotion dysregulation (ED) is a key mechanism which explains the associations between mental health illnesses, including attention deficit hyperactivity disorder and internalising problems, among youth. However, literature reviews have led to mixed and inconclusive findings on the conceptualisations of ED. Specifically, understanding ED in the context of middle childhood, otherwise known as ‘the forgotten years’, may be crucial, as it serves as a significant developmental stage, where children develop a sense of self and rationalise their emotions. This scoping review aims to address the present challenge of conceptualising ED during middle childhood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>ProQuest, PsycINFO, Scopus and Web of Science were searched in October 2024. Articles were included if ED and emotional dysregulation (including positive emotions) were conceptualised, if the paper was a review (i.e., scoping, literature, meta-analysis etc), participants of the target age range (6–12-year) were in the sample, and papers were in English. Studies were excluded if the sample included other age groups, such as infants and pre-schoolers, alongside focussing on other phenomena, such as self-regulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The current scoping review explored the conceptualisations drawn from research studies conducted in the United States, Germany, Austria, France, and Australia. 11 studies were included in this review and two key themes were extrapolated (a) issues with processing emotions (i.e., emotion generation/reactivity) and (b) issues with adopting appropriate emotion regulation strategies and the failure in doing so, leading to issues in attaining goal-directed behaviours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings support the importance of considering how ED should be measured, based on holistic perspectives of the mechanism, alongside clinical screening for emotional deficits at earlier stages of life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":"5 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcv2.12296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Beth T. Bell, Laura Fox, Louisa Salhi, Daniel Fitton
Background
Adolescents' engagement with online mental health support (e.g., apps, social media) may affect their engagement with traditional support, including in schools. However, research has typically considered engagement with online- and school-based mental health support separately meaning the mesosystemic interaction between the two is overlooked. Using co-produced exploratory qualitative methods, the present study explored adolescents' and adult stakeholders' perceptions of how and why adolescents engage with school-based and online mental health support, the interaction between these two modalities, and the associated risks and opportunities.
Methods
A youth advisory board (n = 4; Age = 18–25) co-created data collection methods, ethics procedures, and data analysis. For the main phase of data collection, 27 adolescents (Age M = 15.42, SD = 1.58, Range = 12–18, Girls = 73.1%, White = 84.6%) with mental health difficulties who had engaged with online support while at school were recruited from across England. Participants chose to participate in an interview (n = 10) or focus group (n = 17, 5 groups). In addition, interviews were conducted with 12 adult stakeholders who worked in fields related youth mental health.
Results
Data was analysed using template analysis resulting in four themes; (a) Support is abundant, but accessing what you need when you need it is tough, (b) Human connection is vital and can be achieved in diverse ways, (c) Striving for autonomy and control, (d) Navigating credibility and trust across contexts.
Conclusions
Different types of support met adolescents' needs in different ways, and each offered relative strengths and weaknesses. Findings highlight how adolescents value autonomy and choice when engaging with support, using multiple different sources of support in complementary and self-directed ways to meet their needs. Several challenges were identified across settings, which could be overcome through increased collaboration. This improved collaboration has potential to improve the quality of support available to adolescents.
{"title":"Exploring adolescents' and stakeholders' perceptions of online and school-based mental health provision","authors":"Beth T. Bell, Laura Fox, Louisa Salhi, Daniel Fitton","doi":"10.1002/jcv2.12288","DOIUrl":"10.1002/jcv2.12288","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Adolescents' engagement with online mental health support (e.g., apps, social media) may affect their engagement with traditional support, including in schools. However, research has typically considered engagement with online- and school-based mental health support separately meaning the mesosystemic interaction between the two is overlooked. Using co-produced exploratory qualitative methods, the present study explored adolescents' and adult stakeholders' perceptions of how and why adolescents engage with school-based and online mental health support, the interaction between these two modalities, and the associated risks and opportunities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A youth advisory board (<i>n</i> = 4; Age = 18–25) co-created data collection methods, ethics procedures, and data analysis. For the main phase of data collection, 27 adolescents (Age <i>M</i> = 15.42, <i>SD</i> = 1.58, <i>Range</i> = 12–18, <i>Girls</i> = 73.1%, White = 84.6%) with mental health difficulties who had engaged with online support while at school were recruited from across England. Participants chose to participate in an interview (<i>n</i> = 10) or focus group (<i>n</i> = 17, 5 groups). In addition, interviews were conducted with 12 adult stakeholders who worked in fields related youth mental health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data was analysed using template analysis resulting in four themes; (a) <i>Support is abundant, but accessing what you need when you need it is tough</i>, (b) <i>Human connection is vital and can be achieved in diverse ways</i>, (c) <i>Striving for autonomy and control</i>, (d) <i>Navigating credibility and trust across contexts</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Different types of support met adolescents' needs in different ways, and each offered relative strengths and weaknesses. Findings highlight how adolescents value autonomy and choice when engaging with support, using multiple different sources of support in complementary and self-directed ways to meet their needs. Several challenges were identified across settings, which could be overcome through increased collaboration. This improved collaboration has potential to improve the quality of support available to adolescents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":"4 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>As part of a broader exploration into the transition to adolescence among neurodivergent girls, McKinney et al. (<span>in press</span>) examined the phenomenon of camouflaging—efforts to adapt one's behaviour to appear more neurotypical—and its relationship to mental health. Collecting data from 70 neurodivergent girls with diagnoses of autism, attention deficit hyperactivity disorder (ADHD) and/or developmental coordination disorder (DCD), McKinney et al. confirmed predictions that not only is camouflaging present in this group of girls, but it was also a strong predictor of both anxiety and depression. Setting aside the importance of the findings, this research showcases two important developments in the field of neurodevelopmental research, which I will explore further in this commentary: (a) the move towards a transdiagnostic approach, and (b) the growing commitment to participatory approaches.</p><p>Traditionally, research into neurodevelopmental conditions has focussed on children and young people (CYP) grouped according to diagnostic categories (e.g., autism, ADHD, DCD). These CYP have tended to be compared with one another (in cross-syndrome comparison studies) or have been compared against the performance of their typically developing peers. Such approaches have their roots in both clinical and academic best practice. From a clinical perspective, it was only in DSM-5 (American Psychiatric Association [APA], <span>2013</span>) that neurodevelopmental diagnoses were able to co-occur. Prior to this change, an autism diagnosis would commonly ‘trump’ other neurodevelopmental diagnoses such as ADHD, as well as other co-occurring diagnoses such as anxiety (see Happé & Frith, <span>2020</span>, for an historical overview). From an academic perspective, neurodevelopmental research has long emphasised the importance of experimental control. For instance, in autism research, there has traditionally been a focus on recruiting autistic CYP with ‘pure’ autism, whose data would not be confounded by the presence of co-occurring diagnoses (see Happé & Frith, <span>2020</span>). Indeed, there are ongoing calls for research to move back towards the use of carefully selected samples of autistic CYP who display a more prototypical presentation of autism, advocating that such approaches may yield more consistent research findings and therefore further advance the field (Mottron, <span>2021</span>).</p><p>In contrast, transdiagnostic research studies ‘focus on characteristics and mechanisms that may not align with any conventional diagnostic category’ (Astle et al., <span>2022</span>, p. 398). In their review on the transdiagnostic revolution in neurodevelopmental research, Astle et al. (<span>2022</span>) provide several reasons why we need to move away from the longstanding focus on individual neurodevelopmental categories and towards a more inclusive, dimensional approach. These reasons include the high degree of heterogeneity <i>within</i> diagn
作为对神经分化女孩向青春期过渡的更广泛探索的一部分，McKinney等人（出版中）研究了伪装现象——努力使自己的行为看起来更神经化——及其与心理健康的关系。McKinney等人收集了70名被诊断为自闭症、注意缺陷多动障碍（ADHD）和/或发育协调障碍（DCD）的神经发散性女孩的数据，证实了他们的预测，即伪装不仅存在于这组女孩中，而且它也是焦虑和抑郁的一个强有力的预测因素。抛开这些发现的重要性不谈，这项研究展示了神经发育研究领域的两个重要发展，我将在本评论中进一步探讨：(a)向跨诊断方法的转变，以及(b)对参与性方法的日益承诺。传统上，对神经发育状况的研究主要集中在根据诊断类别（如自闭症、多动症、DCD）分组的儿童和年轻人（CYP）身上。这些CYP倾向于相互比较（在交叉综合征比较研究中），或者与发育正常的同龄人的表现进行比较。这些方法在临床和学术最佳实践中都有其根源。从临床角度来看，只有在DSM-5（美国精神病学协会[APA]， 2013）中，神经发育诊断才能同时发生。在此变化之前，自闭症诊断通常会“胜过”其他神经发育诊断，如多动症，以及其他共同发生的诊断，如焦虑(见happe&；弗里思，2020年，历史概述)。从学术角度来看，神经发育研究一直强调实验控制的重要性。例如，在自闭症研究中，传统上关注的是招募患有“纯粹”自闭症的自闭症CYP，他们的数据不会被同时发生的诊断所混淆(见happe&；弗里斯,2020)。事实上，不断有人呼吁研究转向使用精心挑选的自闭症CYP样本，这些样本显示出更典型的自闭症表现，主张这种方法可能会产生更一致的研究结果，从而进一步推进该领域（Mottron, 2021）。相比之下，跨诊断研究“关注的是可能与任何传统诊断类别不一致的特征和机制”（Astle et al., 2022，第398页）。Astle等人（2022）在对神经发育研究的跨诊断革命的回顾中，提供了几个原因，说明为什么我们需要从长期以来对个体神经发育类别的关注转向更包容、更维度的方法。这些原因包括诊断类别内部的高度异质性，以及诊断类别之间的高度重叠（Astle等人，2022）。这些观察结果与神经发育诊断标准的扩大相一致，DSM-5 （APA, 2013）首次允许“说明者”（例如，患有语言延迟的自闭症）。Fletcher-Watson（2022，第418页）警告说，在缺乏跨诊断研究的情况下，我们限制了“真正发现的潜力，以及对实践和人们生活的实际影响”。麦金尼等人通过招募神经分化样本，包括被诊断为自闭症、多动症和/或DCD的女孩，他们的工作（已出版）肯定与最近的跨诊断研究相一致。此外，将女孩列入等待评估的名单是减少与获得诊断相关的不平等现象的重要途径（参见Astle等人，2022年）。值得注意的是，在McKinney等人的神经典型对照组中，所有的女孩都使用父母报告的自闭症、ADHD和DCD的测量方法进行筛选。有趣的是，最初被招募到这一组的13名参与者，由于他们的父母报告他们是神经典型的，随后由于达到/超过筛选措施的截止分数而被从数据集中删除。如果研究人员根据神经类型（即神经分化或神经典型）对参与者进行分类，这一结果可以说强调了使用筛选措施与自我报告的重要性，但它也提出了我们在区分神经分化和神经典型方面划清界限的问题。happ<s:1>和Frith（2020）提出了一种有争议的可能性，即研究人员可能会避免在对照组中筛查常见的心理健康状况；类似于不再寻求招募“纯”自闭症的CYP群体。因此，值得注意的是，麦金尼等人的一个“神经典型”参与者报告了强迫症（OCD）的诊断。 由于对所有潜在的神经分化指标进行筛查是不实际的，McKinney等人对焦点的神经发育诊断（即自闭症、多动症和DCD）进行筛查的方法，同时清楚地记录了任何其他已报道的诊断，似乎是一个明智的中间立场。这种方法也承认区分神经分化和神经典型性的内在复杂性，这与一个人的需求最好通过维度而不是类别来理解的观点是一致的(参见Cuthbert &；因塞尔,2013)。McKinney等人（出版中）承认，他们的跨诊断样本研究的一个关键限制是使用了针对特定神经分化群体（即自闭症患者）设计的研究结果测量，以测量可能针对自闭症患者的结构（即自闭症特征的伪装）。因此，使用青少年版的伪装自闭症特征问卷（CAT-Q）可能无法捕捉到与ADHD或DCD诊断更相关的伪装方面。Hull et al., 2019)，这将是未来研究中需要解决的一个重要领域。事实上，如果我们开始在神经发育研究中使用跨诊断样本，关键的下一步是努力开发可靠和有效的结果测量，包括广泛的神经分化群体。McKinney等人（在媒体上）工作的优势在于其对参与式方法的承诺。近年来，人们越来越意识到，对神经分化的研究并不总是映射到它寻求服务的社区的需求和优先事项（Pellicano et al., 2014）。此外，研究参与者报告了参与研究的负面经历，注意到他们的参与经常被低估，他们与研究人员的互动是消极的，他们几乎没有收到关于研究或其结果的反馈（见Ashworth等人，2021）。参与式方法——神经分化者及其盟友的观点决定了“研究做什么，如何做，以及如何实施”（Fletcher-Watson, 2022, p. 943）——已被提议作为这个问题的潜在解决方案。然而，尽管有“参与性时代精神”的报道（Palmer等人，2019），以及鼓励更明确地报告社区参与神经发育研究的倡议（例如，Tan等人，2024），参与性方法仍然是例外，而不是规则；特别是在研究方面，社区成员与研究人员平等分享决策权和/或控制研究过程（Tan et al., 2024）。McKinney等人（已出版）的研究集中在符合社区优先事项的主题上，在一系列层面上嵌入社区参与，并补偿贡献者的时间和专业知识。尤其令人鼓舞的是，看到关于社区参与的方法和影响的明确报告，因为通常缺乏关于社区参与的报告的性质和程度（Tan et al., 2024）。由于没有一种“正确”的参与式研究实践方式，McKinney等人（已出版）为其他研究人员提供了一个反思和学习的范例，以支持他们自己的参与式实践（参见Pickard等人，2022）。使用参与式报告模板，例如GRIPP-2（患者和公众参与报告指南）；Staniszewska et al., 2017)，正如Tan et al.（2024）所倡导的那样，未来可能进一步有助于提高参与性实践报告的一致性和透明度。第一作者是一名博士研究员，论文中报告的工作构成了博士论文的一部分，这一点尤其值得称赞，因为博士研究员和其他早期职业学者在将参与性实践纳入他们的工作时经常面临系统性障碍。例如，皮卡德等人（2022）采访的早期职业研究人员谈到，支持他们的资深学者对参与性实践缺乏热情，同时也缺乏参与参与性实践的时间。这将是naïve暗示McKinney等人报道的参与性实践（已出版）不需要领导这项工作的博士研究员以及支持这项研究的整个团队投入大量的时间、精力和承诺。然而，在博士学位的背景下鼓励和开展这样的项目是令人鼓舞的。同样值得承认的是，近年来，还有一些其他优秀的参与项目由博士研究人员进行。这些项目(例如
{"title":"Developments and future directions in neurodevelopmental research: A commentary on ‘camouflaging in neurodivergent and neurotypical girls at the transition to adolescence and its relationship to mental health: A participatory methods research study’","authors":"Laura Crane","doi":"10.1002/jcv2.12289","DOIUrl":"10.1002/jcv2.12289","url":null,"abstract":"<p>As part of a broader exploration into the transition to adolescence among neurodivergent girls, McKinney et al. (<span>in press</span>) examined the phenomenon of camouflaging—efforts to adapt one's behaviour to appear more neurotypical—and its relationship to mental health. Collecting data from 70 neurodivergent girls with diagnoses of autism, attention deficit hyperactivity disorder (ADHD) and/or developmental coordination disorder (DCD), McKinney et al. confirmed predictions that not only is camouflaging present in this group of girls, but it was also a strong predictor of both anxiety and depression. Setting aside the importance of the findings, this research showcases two important developments in the field of neurodevelopmental research, which I will explore further in this commentary: (a) the move towards a transdiagnostic approach, and (b) the growing commitment to participatory approaches.</p><p>Traditionally, research into neurodevelopmental conditions has focussed on children and young people (CYP) grouped according to diagnostic categories (e.g., autism, ADHD, DCD). These CYP have tended to be compared with one another (in cross-syndrome comparison studies) or have been compared against the performance of their typically developing peers. Such approaches have their roots in both clinical and academic best practice. From a clinical perspective, it was only in DSM-5 (American Psychiatric Association [APA], <span>2013</span>) that neurodevelopmental diagnoses were able to co-occur. Prior to this change, an autism diagnosis would commonly ‘trump’ other neurodevelopmental diagnoses such as ADHD, as well as other co-occurring diagnoses such as anxiety (see Happé & Frith, <span>2020</span>, for an historical overview). From an academic perspective, neurodevelopmental research has long emphasised the importance of experimental control. For instance, in autism research, there has traditionally been a focus on recruiting autistic CYP with ‘pure’ autism, whose data would not be confounded by the presence of co-occurring diagnoses (see Happé & Frith, <span>2020</span>). Indeed, there are ongoing calls for research to move back towards the use of carefully selected samples of autistic CYP who display a more prototypical presentation of autism, advocating that such approaches may yield more consistent research findings and therefore further advance the field (Mottron, <span>2021</span>).</p><p>In contrast, transdiagnostic research studies ‘focus on characteristics and mechanisms that may not align with any conventional diagnostic category’ (Astle et al., <span>2022</span>, p. 398). In their review on the transdiagnostic revolution in neurodevelopmental research, Astle et al. (<span>2022</span>) provide several reasons why we need to move away from the longstanding focus on individual neurodevelopmental categories and towards a more inclusive, dimensional approach. These reasons include the high degree of heterogeneity <i>within</i> diagn","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":"4 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christina Bartnick, Hanna Christiansen, Silvia Schneider
Background
As summarized by the Lancet Psychiatry Commission on youth mental health (McGorry et al., 2024), the statistics on mental disorders in children are alarming and highlight the need to expand and optimize research on childhood mental health. Although patient and public involvement (PPI) of those affected has the potential to boost both the acceptance and outcomes of research studies, the active involvement of young children, that is, primary school children, in mental health research has been neglected.
Methods
Based on the results of our systematic literature analysis of PPI of children in mental health research, the concept development of the Children's Council ‘Mental Health’ was administered in cooperation with several stakeholders and focus groups (practitioners and researchers in the field of clinical psychology and psychotherapy across the lifespan, representatives from three self-help organizations for mental disorders, children's focus group). The concept was further optimized in collaboration with the German Children's Fund (Deutsches Kinderhilfswerk e. V.).
Results
The Children's Council was successfully founded with five children aged between 6 and 9 years. Participation is positively received, and each meeting is evaluated using visual measurements. The results from the meetings are presented and discussed. They serve as basis for concrete recommendations for involving young children in mental health research.
Conclusions
To the best of our knowledge, this is the first structured approach involving young children in mental health research studies. The main goal of our study is the direct and immediate empowerment of children, in this case primary school children at the age of 6–12 years. This is associated with a child-friendly exchange on topics related to mental health, as well as the enhancement of the education process on mental disorders and prevention.
背景：正如《柳叶刀》青少年精神卫生精神病学委员会（McGorry et al., 2024）所总结的那样，儿童精神障碍的统计数据令人震惊，并强调需要扩大和优化儿童精神卫生研究。尽管患者和公众参与（PPI）有可能提高研究的接受度和结果，但幼儿（即小学生）积极参与心理健康研究一直被忽视。方法：基于我们对儿童心理健康研究中PPI的系统文献分析结果，儿童理事会“心理健康”概念的发展是与几个利益相关者和焦点小组（临床心理学和心理治疗领域的从业者和研究人员，三个精神障碍自助组织的代表，儿童焦点小组）合作进行的。与德国儿童基金会（Deutsches Kinderhilfswerk e. V.）合作，进一步优化了这一概念。结果：5名6 - 9岁的儿童成功成立了儿童理事会。积极接受参与，每次会议都使用视觉测量进行评估。会议的结果被展示和讨论。它们是让幼儿参与心理健康研究的具体建议的基础。结论：据我们所知，这是第一个涉及幼儿心理健康研究的结构化方法。我们研究的主要目标是直接和立即赋予儿童权力，在这种情况下，6-12岁的小学生。与此同时，还就与心理健康有关的主题开展了一次对儿童友好的交流，并加强了关于精神障碍和预防的教育进程。
{"title":"Giving children a voice: Concept development and foundation of the first Children's council “mental health” in Germany","authors":"Christina Bartnick, Hanna Christiansen, Silvia Schneider","doi":"10.1002/jcv2.12293","DOIUrl":"10.1002/jcv2.12293","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As summarized by the Lancet Psychiatry Commission on youth mental health (McGorry et al., 2024), the statistics on mental disorders in children are alarming and highlight the need to expand and optimize research on childhood mental health. Although patient and public involvement (PPI) of those affected has the potential to boost both the acceptance and outcomes of research studies, the active involvement of young children, that is, primary school children, in mental health research has been neglected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Based on the results of our systematic literature analysis of PPI of children in mental health research, the concept development of the Children's Council ‘Mental Health’ was administered in cooperation with several stakeholders and focus groups (practitioners and researchers in the field of clinical psychology and psychotherapy across the lifespan, representatives from three self-help organizations for mental disorders, children's focus group). The concept was further optimized in collaboration with the German Children's Fund (Deutsches Kinderhilfswerk e. V.).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The Children's Council was successfully founded with five children aged between 6 and 9 years. Participation is positively received, and each meeting is evaluated using visual measurements. The results from the meetings are presented and discussed. They serve as basis for concrete recommendations for involving young children in mental health research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>To the best of our knowledge, this is the first structured approach involving young children in mental health research studies. The main goal of our study is the direct and immediate empowerment of children, in this case primary school children at the age of 6–12 years. This is associated with a child-friendly exchange on topics related to mental health, as well as the enhancement of the education process on mental disorders and prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":"4 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The importance of embedding participatory methods within youth mental health research is well accepted and often a funding prerequisite. However, we argue that there is a need to revisit the core values of the approach in order to ensure that participatory methods remain meaningful, effective and authentic. This should entail rigorously examining ‘why’ and ‘how’ to approach participatory methods - not merely outlining the ‘what’ and ‘when’. We need to prioritise the naturalistic epistemic advantage youth can bring to our research, assigning them a unique collaborative role to reflect this rather than seeking to professionalise our participants. Similarly, we should explore innovative methods to empower youth to apply their lived experience and knowledge alongside the researcher. Equally, we must continue to reflect on our roles as researcher, ensuring we develop the skills necessary for participatory research with children and young people.
{"title":"Realising the potential of participatory research in youth mental health: Time to go back to basics","authors":"Lucy Biddle, Zoë Haime","doi":"10.1002/jcv2.12292","DOIUrl":"10.1002/jcv2.12292","url":null,"abstract":"<p>The importance of embedding participatory methods within youth mental health research is well accepted and often a funding prerequisite. However, we argue that there is a need to revisit the core values of the approach in order to ensure that participatory methods remain meaningful, effective and authentic. This should entail rigorously examining ‘why’ and ‘how’ to approach participatory methods - not merely outlining the ‘what’ and ‘when’. We need to prioritise the naturalistic epistemic advantage youth can bring to our research, assigning them a unique collaborative role to reflect this rather than seeking to professionalise our participants. Similarly, we should explore innovative methods to empower youth to apply their lived experience and knowledge alongside the researcher. Equally, we must continue to reflect on our roles as researcher, ensuring we develop the skills necessary for participatory research with children and young people.</p>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":"4 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite progress in youth involvement in mental health research, considerable gaps remain in our understanding, conceptualisation, and implementation of involving children and young people in this field. This Editorial Perspective reflects on how these gaps present challenges to our research practices and often serve as barriers to meaningfully involving youth voices and experiences into the research process. We take a critical perspective to recent advances in the field of youth involvement in mental health research, reflected by the studies included in this special issue, and highlight examples of good practice paving the way for more equitable and inclusive approaches. Meaningful progress in mental health research relies on the active involvement of young people. Researchers, practitioners and policymakers have an ethical and moral responsibility to create a safe and inclusive environment that empowers young people to participate in research that impacts their lives, care, and overall quality of life.
{"title":"Shining a spotlight on youth involvement in mental health research: Challenges and innovations","authors":"Maria Michail","doi":"10.1002/jcv2.12285","DOIUrl":"10.1002/jcv2.12285","url":null,"abstract":"<p>Despite progress in youth involvement in mental health research, considerable gaps remain in our understanding, conceptualisation, and implementation of involving children and young people in this field. This Editorial Perspective reflects on how these gaps present challenges to our research practices and often serve as barriers to meaningfully involving youth voices and experiences into the research process. We take a critical perspective to recent advances in the field of youth involvement in mental health research, reflected by the studies included in this special issue, and highlight examples of good practice paving the way for more equitable and inclusive approaches. Meaningful progress in mental health research relies on the active involvement of young people. Researchers, practitioners and policymakers have an ethical and moral responsibility to create a safe and inclusive environment that empowers young people to participate in research that impacts their lives, care, and overall quality of life.</p>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":"4 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper aims to inform practice for educational psychologists and other professionals who seek to facilitate youth participatory action research (YPAR) in schools. Youth participatory action research is founded on the assumption that young people are capable of being researchers who can co-create knowledge and act to change the world. It is a worldview as well as a research approach and can be initiated to co-produce knowledge, facilitate critical thinking, promote the evaluation of social systems and/or act against social oppression.
Methods
We (a) outline the origins of YPAR and review crucial methodological elements of YPAR found in the literature, (b) support practitioners to use a YPAR approach in UK schools using a real-world example to apply theory to practice and (c) critically discuss outcomes and challenges of facilitating YPAR. An ongoing YPAR project, Breaking the Silence (BtS), facilitated by social enterprise States of Mind and IOE, UCL's Faculty of Education and Society will be outlined within the paper.
Results
BtS demonstrates the power of YPAR to promote the voices of young people, and to allow them to democratically develop action plans that challenge existing education structures. Youth researchers have presented their findings at several conferences and through a national newspaper. They continue to work alongside trade unions and other organisations to push for educational reform. However, the project has demonstrated several challenges and risks of facilitating YPAR. For example, facilitators were not always aware when youth researchers felt they had less meaningful involvement. Facilitators also found it challenging to collaboratively analyse data.
Conclusions
The project indicates that YPAR has the potential to be a democratic, empowering approach that can be brought more widely into the field of education. However, careful considerations are needed by facilitators to mitigate the challenges of the process.
{"title":"Breaking the Silence: Critical discussion of a youth participatory action research project","authors":"Jaspar Khawaja, Christopher Bagley, Becky Taylor","doi":"10.1002/jcv2.12283","DOIUrl":"10.1002/jcv2.12283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This paper aims to inform practice for educational psychologists and other professionals who seek to facilitate youth participatory action research (YPAR) in schools. Youth participatory action research is founded on the assumption that young people are capable of being researchers who can co-create knowledge and act to change the world. It is a worldview as well as a research approach and can be initiated to co-produce knowledge, facilitate critical thinking, promote the evaluation of social systems and/or act against social oppression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We (a) outline the origins of YPAR and review crucial methodological elements of YPAR found in the literature, (b) support practitioners to use a YPAR approach in UK schools using a real-world example to apply theory to practice and (c) critically discuss outcomes and challenges of facilitating YPAR. An ongoing YPAR project, Breaking the Silence (BtS), facilitated by social enterprise States of Mind and IOE, UCL's Faculty of Education and Society will be outlined within the paper.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>BtS demonstrates the power of YPAR to promote the voices of young people, and to allow them to democratically develop action plans that challenge existing education structures. Youth researchers have presented their findings at several conferences and through a national newspaper. They continue to work alongside trade unions and other organisations to push for educational reform. However, the project has demonstrated several challenges and risks of facilitating YPAR. For example, facilitators were not always aware when youth researchers felt they had less meaningful involvement. Facilitators also found it challenging to collaboratively analyse data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The project indicates that YPAR has the potential to be a democratic, empowering approach that can be brought more widely into the field of education. However, careful considerations are needed by facilitators to mitigate the challenges of the process.</p>\u0000 </section>\u0000 </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":"4 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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