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Over the past decade, healthcare providers nationwide have contended with a growing boarding crisis as pediatric patients await psychiatric treatment in emergency departments (EDs). COVID-19 has exacerbated this urgent youth mental health crisis, driving EDs to act as crisis units. Journey mapping is a robust methodology with which to examine strengths and challenges in patient care workflows such as boarding and emergency psychiatric care. Psychiatric, emergency medicine, and hospitalist providers serving patients boarding at a northeastern children's hospital participated in semi-structured qualitative interviews. Investigators conducted directed content analysis with an inductive approach to identify facilitators, barriers, and persistent needs of boarding patients, which were summarized in a patient journey map. Findings were presented to participants for feedback and further refinement. Quantitative data showed a three-fold increase in the number of patients who boarded over the past three years and a 60% increase in the average time spent boarding in the ED. Emergent qualitative data indicated three stages in the boarding process: Initial Evaluation, Admitted to Board, and Discharge. Data highlighted positive and negative factors affecting patient safety, availability of beds in pediatric hospital and psychiatric inpatient settings, high patient-provider ratios that limited staffing support, and roadblocks in care coordination and disposition planning. Patient journey mapping provided insight into providers' experiences serving patients boarding for psychiatric reasons. Findings described bright points and pain points at each stage of the boarding process with implications for psychiatric care and systemic changes to reduce boarding volume and length of stay.

Efforts towards adaptation, dissemination, and implementation of culturally robust, evidence-informed mental healthcare rely on community-engaged research (CEnR). Academic-community partnerships help bring science to service for vulnerable and historically disenfranchised populations (e.g., communities of color and those characterized by poverty). A growing literature supports the development of a framework of ethics for CEnR. This article examines ethical tensions in the context of the American Psychological Association Ethics Code General Principles – Beneficence and Nonmaleficence; Fidelity and Responsibility; Integrity; Justice; and Respect for People’s Rights and Dignity – and presents the 4R action plan to support application of APA guidelines to academic-community partnership with youth-serving organizations.

Adolescents with a history of child maltreatment experience increased risk for psychopathology that sets them on a trajectory towards a range of difficulties in adulthood. Various factors influence caregivers’ decisions to seek mental health services (MHS) that could improve developmental outcomes. The present study applied a machine learning algorithm, elastic net, to a sample of 878 adolescent-caregiver dyads from the Longitudinal Studies of Child Abuse and Neglect. Analyses simultaneously examined a large number of factors to determine their ability to discriminate between caregivers who perceived a need for MHS and those who did not, as well as caregivers who utilized MHS and those who did not. Results highlight family demographics, chronic parental stressors, youth psychopathology, and exposure to recent adversities as good classifiers of caregiver perceived need for (77.6%; sensitivity = .77; specificity = .78) and utilization of (71%; sensitivity = .71; specificity = .71) adolescent MHS. Elastic net identified adolescent clinical externalizing and internalizing problems, and parental stress related to child(ren)’s behavior as high value classifiers of both outcomes. Youth living with non-kin caregivers were also significantly more likely to utilize MHS. Findings highlight the importance of assessing clinical need, stress related to child(ren)’s behavior, and caregiver kinship in understanding the likelihood that at-risk families will seek adolescent MHS.

Estimates in dissemination, implementation, and services (DIS) research continue to present a 17-year lag for implementation of only 14% of evidence-based clinical services and technologies in practice (Chambers, 2018) – especially troubling for communities characterized by disproportionately high rates of poverty, crime and mental health need (Yoshikawa, Aber, & Beardslee, 2012). Academic-community partnerships offer pathways by which to speed the transport of evidence-based innovations; however, a range of challenges can disrupt implementation and adoption (Damschroder et al., 2009). This manuscript presents Compassion-Oriented Reflection and Engagement (CORE), a framework to inform academic collaborators’ perspectives and practices towards building flexible, responsive partnerships with youth-serving community-based organizations.

Children with selective mutism (SM) experience significant challenges in a variety of social situations, leading to difficulties with academics, peers, and family functioning. Despite the extensive evidence base for cognitive-behavioral interventions for youth anxiety, the literature has seen relatively limited advancement in specialized treatment methods for SM. In addition, geographic disparities in SM treatment expertise and the roughly 6-month duration of some of the supported SM treatment protocols can further restrict the accessibility and acceptability of quality SM care. Intensive group behavioral treatment (IGBT) for SM was developed to expand the portfolio of evidence-based SM treatment options by offering brief, but high-dose, expert SM intervention in a group format for youth ages 3–10 years that can be completed in 1 week. In this article, we outline IGBT for SM program, which has already received initial support in a waitlist-controlled trial. Our presentation is organized around the five main components of the treatment model: (1) individual “lead-in” sessions, (2) camp (i.e., all-day group sessions for children held in a simulated classroom setting, with an emphasis on graduated exposures and structured reinforcement), (3) parent training, (4) school outreach, and (5) booster treatment, as needed. We conclude with a discussion of clinical considerations and future directions for further IGBT refinement and evaluation.

Anxiety disorders are collectively the most prevalent mental health problems affecting youth. To increase the reach of mental health care, recent years have seen increasing enthusiasm surrounding mobile platforms for expanding treatment delivery options. Apps developed in academia and supported in clinical trials are slow to reach the consumer marketplace. Meanwhile, proliferation of industry-developed apps on consumer marketplaces has been high. The present study analyzed content within mobile products prominently marketed toward consumers for anxiety in youth. Systematic inventory of the Google Play Store and Apple Store using keyword searches for child and adolescent anxiety yielded 121 apps, which were evaluated on the basis of their descriptive characteristics, mobile functionalities, and adherence to evidence-based treatment principles. Findings revealed that evidence-based treatment content within the sample is scant and few comprehensive anxiety self-management apps were identified. Advanced features that leverage the broader functionalities of smartphone capabilities (e.g., sensors, ecological momentary assessments) were rarely present. Findings underscore the need to increase the prominence and accessibility of quality child anxiety intervention products for consumers. Strategies for improving marketing of supported apps to better penetrate consumer markets are discussed.

Objective Given problems and disparities in the use of community-based mental health services for youth, school personnel have assumed frontline mental health service roles. To date, most research on school-based services has evaluated analog educational contexts with services implemented by highly trained study staff, and little is known about the effectiveness of school-based mental health services when implemented by school professionals. Method Random-effects meta-analytic procedures were used to synthesize effects of school-based mental health services for elementary school-age children delivered by school personnel and potential moderators of treatment response. Forty-three controlled trials evaluating 49,941 elementary school-age children met the selection criteria (mean grade 2.86, 60.3% boys). Results Overall, school-based services demonstrated a small-to-medium effect (Hedges g = 0.39) in decreasing mental health problems, with the largest effects found for targeted intervention (Hedges g = 0.76), followed by selective prevention (Hedges g = 0.67), compared with universal prevention (Hedges g = 0.29). Mental health services integrated into students’ academic instruction (Hedges g = 0.59), those targeting externalizing problems (Hedges g = 0.50), those incorporating contingency management (Hedges g = 0.57), and those implemented multiple times per week (Hedges g = 0.50) showed particularly strong effects. Conclusion Considering serious barriers precluding youth from accessing necessary mental health care, the present meta-analysis suggests child psychiatrists and other mental health professionals are wise to recognize the important role that school personnel, who are naturally in children’s lives, can play in decreasing child mental health problems.

SuperBetter is a family of interfaces including a browser-based game, an online forum, and a companion mobile application that collectively seek to “gamify” resilience, wellness, motivation, and mental health. Players register and use “gamified” components and content to address mental and physical health challenges and to pursue identified goals. The primary strength of the SuperBetter ecosystem is its innovative approach, drawing on gaming metaphors and the use of evidence-based strategies in both its design and provided content. Efforts in creating an engaging, playable system incentivizing users’ incremental steps towards larger goals are constrained by SuperBetter’s relative lack of structure and direction, limits to meaningful progress monitoring, its largely static content regardless of varied user goals, and broad concerns regarding the utility of the overall system. The program presents a potential model for the application of gaming techniques and design to the dissemination of clinically effective concepts to a larger consumer market, but presently lacks sufficient empirical support for claims of evidence-based effectiveness.

Intolerance of Uncertainty (IU), defined as the dispositional interpretation of uncertain or ambiguous events as stressful and problematic, has been linked to excessive worry and other anxiety-related problems in adults and youth. IU has been conceptualized as a vulnerability factor for excessive worry and anxiety, but the historical absence of a supported measure of IU in young children has hampered longitudinal research needed to evaluate temporal relationships between IU and anxiety and the differential developmental pathways of IU leading to different anxiety disorders and depression. The present study evaluated the psychometric properties of a newly developed 17-item parent-report measure of younger children's Responses to Uncertainty and Low Environmental Structure (i.e., the RULES questionnaire). We examined the preliminary structure, reliability, and validity of the RULES within a treatment-seeking sample of children aged 3-10 (N=160) with anxiety. Findings from an exploratory factor analysis supported a one-factor model that retained all 17 items. The RULES demonstrated strong internal consistency, and predictive, convergent, and divergent validity. In this early childhood sample, the RULES also showed stronger associations with anxiety than did a previously supported measure of IU developed for older youth, and showed preliminary sensitivity to treatment-related change. Findings provide preliminary psychometric support for the RULES as a parent-report measure of children's responses to uncertainty and low environmental structure that may inform etiologic models of anxiety.

Organized after-school programs can mitigate risk and build resilience for youth in urban communities. Benefits rely on high-quality developmental experiences characterized by a supportive environment, structured youth–adult interactions, and opportunities for reflective engagement. Programs in historically disenfranchised communities are underfunded; staff are transient, underpaid, and undertrained; and youth exhibit significant mental health problems which staff are variably equipped to address. Historically, after-school research has focused on behavior management and social-emotional learning, relying on traditional evidence-based interventions designed for and tested in schools. However, after-school workforce and resource limitations interfere with adoption of empirically supported strategies and youth health promotion. We have engaged in practice-based research with urban after-school programs in economically vulnerable communities for nearly two decades, toward building a resource-efficient, empirically informed multitiered model of workforce support. In this paper, we offer first-person accounts of four academic– community partnerships to illustrate common challenges, variability across programs, and recommendations that prioritize core skills underlying risk and resilience, align with individual program goals, and leverage without overextending natural routines and resources. Reframing obstacles as opportunities has revealed the application of mental health kernels to the after-school program workforce support and inspired lessons regarding sustainability of partnerships and practice.

Explosive growth of communication technologies and increased ubiquity of Internet access in both urban and rural communities and particularly in youth have occurred. Coupled with concerns regarding limitations to traditional service provision models, researchers and practitioners are looking to affordable, acceptable technologies to expand the reach of evidence-based care and reduce barriers to intervention and unmet need in areas with few providers. This chapter describes the present literature on use of video teleconferencing, web-based programs, social media, and smartphone apps to enhance mental health intervention delivery, psychiatric assessment, and training and supervision. The strengths of the various delivery methods are discussed for providing empirically supported mental healthcare, focusing on implications related to science and practice with children and families. Outlined also are current limitations, risks, and challenges to technology-mediated services, including the significant gaps in the evidence base underlying these technologies and the legal, ethical, and safety issues that remain.

Anxiety disorders are one of the most prevalent and impairing classes of mental health difficulties affecting young children. Though the vast majority of supported programs for child anxiety focus on youth ages 7 years and up, preliminary support has emerged for exposure-based adaptations of parent-coaching interventions, i.e., the Parent Child Interaction Therapy (PCIT) CALM Program, to address anxiety disorders in early childhood. Despite these advances, low rates of community service use and accessibility persist. The increased ubiquity of Internet access has positioned videoteleconferencing (VTC) as a powerful tool to overcome traditional barriers to care. The present case study details the VTC delivery of the PCIT CALM Program in the treatment of a 6 year-old boy presenting with generalized anxiety disorder and separation anxiety disorder. This case provides qualitative support for the feasibility of delivering integrated real-time parent coaching and exposure therapy to address early childhood anxiety disorders via VTC. The remission of the patient’s anxiety across treatment sessions suggests that the telehealth format may be a useful modality for the delivery of early childhood anxiety treatment. The technical considerations for the delivery of VTC therapy as well as the implications for treatment are discussed.

Background In DSM-5, the agoraphobia core symptom criterion has been revised to require fear about multiple situations from across at least two distinct domains in which escape might be difficult or panic-like symptoms might develop. The present study examined patterns and correlates of the recent change in a sample of anxious youth with symptom presentations consistent with the DSM-IV agoraphobia definition and/or specific phobia (SP) to consider how the recent diagnostic change impacts the prevalence and composition of agoraphobia in children and adolescents. Method Analyses (N = 151) evaluated impairment and correlates of agoraphobic youth who no longer meet the DSM-5 agoraphobia criteria relative to agoraphobic youth who do meet the new DSM-5 criteria. Secondary analyses compared agoraphobic youth not meeting DSM-5 criteria to SP youth. Results One-quarter of youth with symptom presentations consistent with the DSM-IV agoraphobia definition no longer met criteria for DSM-5 agoraphobia, but showed comparable severity and impairment across most domains to youth who do meet criteria for DSM-5 agoraphobia. Further, these youth showed higher levels of anxiety sensitivity and internalizing psychopathology relative to youth with SP. Conclusions A substantial proportion of impaired youth with considerable agoraphobic symptom presentations have been left without a specified anxiety diagnosis by the DSM-5, which may affect their ability to receive and/or get coverage for services and their representation in treatment evaluations. Future DSM iterations may do well to include a “circumscribed” agoraphobia specifier that would characterize presentations of fear or anxiety about multiple situations, but that do not span across at least two distinct situational domains.

Having passed the one-year anniversary of the initial DSM-5 publication, this paper presents a guiding summary of key areas of change—and lack thereof—across DSM definitions of disorders affecting anxious youth, and offers data-informed evaluations and commentaries clarifying the areas in which DSM-5 should be celebrated as a meaningful advancement in the assessment of child anxiety, diagnostic dilemmas in child anxiety assessment from previous DSM editions that remain unresolved in DSM-5, and areas in which DSM-5 may have actually introduced new problems into the assessment of child anxiety. We organize our review and commentary around five of the meaningful changes in DSM-5 with implications for the assessment of anxious youth: (1) the new classification of selective mutism as an anxiety disorder; (2) the removal of the social anxiety disorder “generalized” specifier and the new addition of a “performance-only” specifier; (3) the revised operationalization of agoraphobia and the decoupling of agoraphobia from panic disorder; (4) the creation of a new category—disruptive mood dysregulation disorder—for diagnosing youth presenting with chronic irritability and severe temper outbursts; and (5) the revised classification of anxiety disorders not otherwise specified in the DSM. We then turn our attention to discuss four areas of noted diagnostic dilemmas in the assessment of child anxiety from DSM-IV that remain unresolved in the new DSM-5: (1) the phenomenological overlap between the OCD and generalized anxiety disorder (GAD) definitions; (2) the phenomenological overlap between GAD and major depressive disorder (MDD) definitions; (3) differential diagnostic utility across the separation anxiety disorder symptoms; and (4) the extent to which youth presenting with multiple marked and persistent fears should be assigned multiple distinct diagnoses of specific phobia.

Objective Remote technologies are increasingly being leveraged to expand the reach of supported care, but applications to early child-behavior problems have been limited. This is the first controlled trial examining video-teleconferencing to remotely deliver behavioral parent training to the home setting with a live therapist. Method Racially/ethnically diverse children ages 3-5 years with disruptive behavior disorders, and their caregiver(s), using webcams and parent-worn Bluetooth earpieces, participated in a randomized trial comparing Internet-delivered parent-child interaction therapy (I-PCIT) versus standard clinic-based PCIT (N = 40). Major assessments were conducted at baseline, midtreatment, posttreatment, and 6-month follow-up. Linear regressions and hierarchical linear modeling using maximum-likelihood estimation were used to analyze treatment satisfaction, diagnoses, symptoms, functioning, and burden to parents across conditions. Results Intent-to-treat analyses found 70% and 55% of children treated with I-PCIT and clinic-based PCIT, respectively, showed "treatment response" after treatment, and 55% and 40% of children treated with I-PCIT and clinic-based PCIT, respectively, continued to show "treatment response" at 6-month follow-up. Both treatments had significant effects on children's symptoms and burden to parents, and many effects were very large in magnitude. Most outcomes were comparable across conditions, except that the rate of posttreatment "excellent response" was significantly higher in I-PCIT than in clinic-based PCIT, and I-PCIT was associated with significantly fewer parent-perceived barriers to treatment than clinic-based PCIT. Both treatments were associated with positive engagement, treatment retention, and very high treatment satisfaction. Conclusion Findings build on the small but growing literature supporting the promising role of new technologies for expanding the delivery of behavioral parent training. (PsycINFO Database Record

Children’s mental health problems are highly prevalent and impose enormous burdens at the individual, family, and societal level. Fortunately, the past few decades have witnessed tremendous advances in the development and evaluation of developmentally sensitive cognitive behavioral procedures with demonstrated success in treating a considerable share of mental health problems presenting in youth. In this chapter, we provide a brief overview of the cognitive behavioral treatment (CBT) model for youth mental health problems, followed by a discussion of key developmental considerations and distinguishing attributes of CBT when targeting mental health problems in youth. We then turn attention to how CBT differentially addresses specific domains of child mental health problems and review major advances and innovations in recent years that hold great promise for meaningfully expanding the reach and quality of CBT for an even a larger proportion of affected children and adolescents. These innovations include the development of transdiagnostic, modular, and intensive CBT formats, as well as the promising role of technology for improving the accessibility of CBT for traditionally underserved child populations. We conclude by highlighting areas in need of continued empirical attention and lay out an agenda for future research seeking to optimize the public health impact of CBT procedures for redressing children’s mental health problems.

BACKGROUND: The majority of research on terrorism-exposed youth has examined large-scale terrorism with mass casualties. Limited research has examined children’s reactions to terrorism of the scope of the Boston Marathon bombing. Furthermore, the extraordinary postattack interagency manhunt and shelter-in-place warning made for a truly unprecedented experience in its own right for families. Understanding the psychological adjustment of Boston-area youth in the aftermath of these events is critical for informing clinical efforts. METHODS: Survey of Boston-area parents/caretakers (N = 460) reporting on their child’s experiences during the attack week, as well as psychosocial functioning in the first 6 attack months. RESULTS: There was heterogeneity across youth in attack- and manhunt-related experiences and clinical outcomes. The proportion of youth with likely attack/manhunt-related posttraumatic stress disorder (PTSD) was roughly 6 times higher among Boston Marathon–attending youth than nonattending youth. Attack and manhunt experiences each uniquely predicted 9% of PTSD symptom variance, with manhunt exposures more robustly associated than attack-related exposures with a range of psychosocial outcomes, including emotional symptoms, conduct problems, hyperactivity/inattention, and peer problems. One-fifth of youth watched >3 hours of televised coverage on the attack day, which was linked to PTSD symptoms, conduct problems, and total difficulties. Prosocial behavior and positive peer functioning buffered the impact of exposure. CONCLUSIONS: Clinical efforts must maintain a broadened focus beyond simply youth present at the blasts and must also include youth highly exposed to the intense interagency pursuit and manhunt. Continued research is needed to understand the adjustment of youth after mass traumas and large-scale manhunts in residential communities.

BACKGROUND: Following the Boston Marathon attack, the extraordinary interagency manhunt and shelter-in-place made for a truly unprecedented experience for area families. Although research on Boston youth has found robust associations between manhunt-related experiences and post-attack functioning, such work does little to identify the specific needs of a particularly vulnerable population-i.e., children with a relative who participated in the manhunt. Understanding the adjustment of these youth is critical for informing clinical efforts. METHODS: Survey of Boston-area parents/caretakers (N = 460) reporting on their child's attack/manhunt-related experiences, as well as psychosocial functioning in the first six post-attack months; analyses compared youth with and without a relative in law enforcement or the armed services who participated in the manhunt. RESULTS: The proportion of youth with likely PTSD was 5.7 times higher among youth with relatives in the manhunt than among youth without. After accounting for child demographics, blast exposure, and children's own exposure to manhunt events (e.g., hearing/seeing gunfire/explosions, having officers enter/search home), having a relative in the manhunt significantly predicted child PTSD symptoms, emotional symptoms, and hyperactivity/inattention. Fear during the manhunt that a loved one could be hurt mediated relationships between having a relative in the manhunt and clinical outcomes; living within the zone of greatest manhunt activity did not moderate observed relationships. CONCLUSIONS: Children with relatives called upon to participate in the unprecedented interagency manhunt following the Boston Marathon attack carried a particularly heavy mental health burden. Continued research is needed to clarify the clinical needs of youth with relatives in high-risk occupations. Language: en

Background Social networking services (SNS) have rapidly become a central platform for adolescents’ social interactions and media consumption patterns. The present study examined a representative sample of publicly accessible content related to deliberate self-injurious cutting across three SNS platforms: Twitter, Tumblr, and Instagram. Methods Data collection simulated searches for publicly available deliberate self-injury content on Twitter, Tumblr, and Instagram. Over a six-month period at randomly generated time points, data were obtained by searching “#cutting” on each SNS platform and collecting the first 10 posts generated. Independent evaluators coded posts for presence of the following: (a) graphic content, (b) negative self-evaluations, (c) references to mental health terms, (d) discouragement of deliberate self-injury, and (e) recovery-oriented resources. Differences across platforms were examined. Results Data collection yielded a sample of 1,155 public posts (770 of which were related to mental health). Roughly 60% of sampled posts depicted graphic content, almost half included negative self-evaluations, only 9.5% discouraged self-injury, and

Objective Despite advances in supported treatments for early onset obsessive-compulsive disorder (OCD), progress has been constrained by regionally limited expertise in pediatric OCD. Videoteleconferencing (VTC) methods have proved useful for extending the reach of services for older individuals, but no randomized clinical trials (RCTs) have evaluated VTC for treating early onset OCD. Method RCT comparing VTC-delivered family based cognitive-behavioral therapy (FB-CBT) versus clinic-based FB-CBT in the treatment of children ages 4-8 with OCD (N = 22). Pretreatment, posttreatment, and 6-month follow-up assessments included mother-/therapist-reports and independent evaluations masked to treatment condition. Primary analyses focused on treatment retention, engagement and satisfaction. Hierarchical linear modeling preliminarily evaluated the effects of time, treatment condition, and their interactions. "Excellent response" was defined as a 1 or 2 on the Clinical Global Impressions-Improvement Scale. Results Treatment retention, engagement, alliance and satisfaction were high across conditions. Symptom trajectories and family accommodation across both conditions showed outcomes improving from baseline to posttreatment, and continuing through follow-up. At posttreatment, 72.7% of Internet cases and 60% of Clinic cases showed "excellent response," and at follow-up 80% of Internet cases and 66.7% of Clinic cases showed "excellent response." Significant condition differences were not found across outcomes. Conclusions VTC methods may offer solutions to overcoming traditional barriers to care for early onset OCD by extending the reach of real-time expert services regardless of children's geographic proximity to quality care. (PsycINFO Database Record

Disorders of negative affect include mental health difficulties characterized by depressive mood and/or anxious distress. These diagnoses collectively constitute one of the most prevalent and impairing classes of mental health diagnoses affecting individuals across the life span. The optimal system for classifying disorders of negative affect and their underlying mechanisms remains the subject of continued debate. We first review the DSM model of classifying disorders of negative affect, before turning our attention to dimensional models and emerging theories on common factors across these disorders. We conclude with a review of supported interventions for effectively treating disorders of negative affect.

Despite research documenting the scope of disaster-related posttraumatic stress (PTS) in youth, less is known about how family processes immediately postdisaster might associate with child outcomes. The 2013 Boston Marathon bombing affords a unique opportunity to assess links between immediate family discussions about community trauma and child mental health outcomes. The present study examined associations between attack-related household discussions and child PTS among Boston-area youth ages 4 to 19 following the Marathon bombing (N = 460). Caregivers completed surveys 2 to 6 months postattack about immediate household discussions about the events, child exposure to potentially traumatic attack-related experiences, and child PTS. During the Marathon bombing and manhunt, there was considerable heterogeneity in household discussions across area families, and several discussion items were differentially predictive of variability in children's PTS. Specifically, after controlling for children's direct exposure to the potentially traumatic attack/manhunt events, children showed lower PTS when it was their caregivers who informed them about the attack and manhunt, and when their caregivers expressed confidence in their safety and discussed their own feelings about the manhunt with their child. Children showed higher PTS when their caregivers did not discuss the events in front of them, asked others to avoid discussing the events in front of them, and expressed concern at the time that their child might not be safe. Child age and traumatic attack/manhunt exposure moderated several links between household discussions and child PTS. Findings underscore the importance of family communication and caregiver modeling during times of community threat and uncertainty.

In recent years, rapid advances in the sophistication and accessibility of new technologies for consumer use have been leveraged to meaningfully expand the scope of mental health services for youth. However, despite many potential benefits inherent in applying new technologies to improve the accessibility and quality of care, organizations and private providers looking to expand their services with telemental health (TMH) service options may find the broad range of software packages and hardware options daunting.We summarize key considerations for adopting a videoteleconferencing (VTC) system, and provide recommendations for institutions and providers planning to launch TMH services at varying levels.Although there is currently no single combination of VTC software and equipment that works best for every provider, certain factors such as cost, ease of use, and system functionality contribute to the setup that may serve as the "best fit" for practitioners' and clients' needs.Careful consideration of these system characteristics and their bearing on institutional functioning, quality of services, and client satisfaction and privacy prior to VTC installation can proactively reduce difficulties after TMH implementation.

Background Disasters are associated with myriad negative outcomes in youth, including posttraumatic stress disorder and related psychopathology. Prior work suggests links between caregiver distress and child mental health outcomes following community traumas, but the extent to which caregiver distress is directly linked to post-disaster child functioning, or whether such associations may simply be due to shared traumatic exposure, remains unclear. Methods The current study examined relationships among caregiver distress, caregiver-child shared traumatic exposure, and child outcomes in Boston-area families (N=460) during the six months following the 2013 Boston Marathon bombing. Parents completed surveys about their and their child׳s potentially traumatic experiences during the bombing and subsequent manhunt. Post-attack caregiver distress and child psychological functioning were also assessed. Results After accounting for caregiver-child shared traumatic exposure, significant associations were retained between caregiver distress and child functioning across several domains. Furthermore, after accounting for caregiver traumatic exposure, caregiver distress moderated relationships between child traumatic exposure and child posttraumatic stress and conduct problems, such that associations between child traumatic exposure and child posttraumatic stress and conduct problems were particularly strong among children of highly distressed caregivers. Limitations The cross-sectional design did not permit evaluations across time, and population-based methods were not applied. Conclusions Findings clarify links between caregiver distress and child psychopathology in the aftermath of disaster and can inform optimal allocation of clinical resources targeting disaster-affected youth and their families.

Many books for young children present animals in fantastical and unrealistic ways, such as wearing clothes, talking and engaging in human-like activities. This research examined whether anthropomorphism in children's books affects children's learning and conceptions of animals, by specifically assessing the impact of depictions (a bird wearing clothes and reading a book) and language (bird described as talking and as having human intentions). In Study 1, 3-, 4-, and 5-year-old children saw picture books featuring realistic drawings of a novel animal. Half of the children also heard factual, realistic language, while the other half heard anthropomorphized language. In Study 2, we replicated the first study using anthropomorphic illustrations of real animals. The results show that the language used to describe animals in books has an effect on children's tendency to attribute human-like traits to animals, and that anthropomorphic storybooks affect younger children's learning of novel facts about animals. These results indicate that anthropomorphized animals in books may not only lead to less learning but also influence children's conceptual knowledge of animals.