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Risk factors for psychological distress among help-seeking youth are poorly understood. Addressing this gap is important for informing mental health service provision. This study aimed to identify risk factors among youth attending Jigsaw, a youth mental health service in Ireland. Routine data were collected from N = 9,673 youth who engaged with Jigsaw (Mean age = 16.9 years, SD = 3.14), including presenting issues, levels of psychological distress, age, and gender. Confirmatory Factor Analysis identified thirteen factors of clustering issues. Several factors, including Self-criticism and Negative Thoughts, were strongly associated with items clustering as psychological distress, however these factors were poorly predictive of distress as measured by the CORE (YP-CORE: R2 = 14.7%, CORE-10: R2 = 6.9%). The findings provide insight into associations between young people's identified presenting issues and self-identified distress. Implications include applying appropriate therapeutic modalities to focus on risk factors and informing routine outcome measurement in integrated youth mental health services. [ABSTRACT FROM AUTHOR]

Eating disorders (EDs) are serious, deadly disorders that emerge in adolescence and early adulthood. Further, reported incidences of EDs are increasing worldwide. As such, accessible, affordable, and effective early intervention and prevention efforts are critical. The Body Project is a well-established ED prevention program with demonstrated success at reducing ED symptom severity and the risk of onset of EDs in young females. However, it has not yet been formally evaluated in an Australian population, nor have the benefits of the treatment for young people of all genders been thoroughly investigated. This protocol paper outlines the design for a study which aims to investigate the outcomes and feasibility of the Body Project as a brief ED prevention program within an Australian youth mental health service: headspace Camperdown. This pragmatic trial will compare outcomes between a Body Project treatment group and a Treatment-as-usual control group. Primary outcomes include body image concerns, ED symptomatology and general psychological distress, measured pre- and post-treatment, and at one-month follow-up. All young people attending headspace Camperdown for care are eligible for participation in the trial. The Body Project program is comprised of four group-based 1.5 h sessions run over 4 consecutive weeks. Overall, a trial of the Body Project as an ED prevention program is warranted to investigate the outcomes of the intervention in this sample and will provide valuable information about the feasibility for widespread implementation of the treatment as part of a stepped-care approach to intervention for EDs at youth mental health service locations across Australia. ANZCTR Trial Registration Number: ACTRN12623000695606 (registered 29 June 2023). [ABSTRACT FROM AUTHOR]

We examine the association between trauma patterns, gender identity, ethnicity, foster care involvement, and mental health needs in a sample of low-income youth. Our community sample included 2,175 clients aged 6 or older (Mage = 11.9), has a closely-even gender ratio (55% female and 45% male and others) and is ethnically diverse (37% Black, 31% Multiracial, 14% Latinx, 9% White, 10% Others). 61% of youth in this sample have involvement with the foster care system. Latent class analysis was used to identify trauma patterns, explore predictors of latent class membership, and estimate the cumulative mental health needs for each trauma class. Results revealed four trauma patterns (Low Trauma, Caregiving Disruption, Community Violence, and Multiple Trauma). Girls were more likely than boys to be in the high-trauma groups. Compared to Black youth, Latinx youth were more likely to be in the Multiple Trauma class, whereas White youth were less likely to be in the high trauma classes. Youth with past or current involvement with the foster care system were more likely than those without to be in the high-trauma classes. Mental health needs for youth in Low Trauma and Caregiving Disruption were comparable, but were highest for those in Community Violence. Contrary to expectation, the Multiple Trauma group did not have the highest-level mental health needs. Interventions for low-income youth can benefit from knowing which trauma patterns are associated with various levels of mental health needs. Newer models of care focusing on building healthy communities may be the way forward. [ABSTRACT FROM AUTHOR]

Standardized assessment measures are important for accurate diagnosis of mental health problems and for treatment planning and evaluation. However, little is known about youth mental health providers' typical use of standardized measures across disciplines and outside the context of evidence-based practice initiatives. A multidisciplinary national survey examined the frequency with which 674 youth mental health providers administer standardized and unstandardized measures, and the extent to which organizational (i.e., implementation climate, rigid hierarchical organizational structure) and provider (i.e., attitudes toward standardized assessment measures, highest degree, practice setting) characteristics are associated with standardized measure use. Providers used unstandardized measures far more frequently than standardized measures. Providers' perceptions (a) that standardized measures are practical or feasible, (b) that their organization supports and values evidence-based practices, and (c) that their organization has a rigid hierarchical structure predicted greater use of standardized measures. Working in schools predicted less frequent SMU, while working in higher education and other professional settings predicted more frequent SMU. Standardized measures were not routinely used in this community-based sample. A rigid hierarchical organizational structure may be conducive to more frequent administration of standardized measures, but it is unclear whether such providers actually utilize these measures for clinical decision-making. Alternative strategies to promote standardized measure use may include promoting organizational cultures that value empirical data and encouraging use of standardized measures and training providers to use pragmatic standardized measures for clinical decision making. [ABSTRACT FROM AUTHOR]

Irritability is often described as a common problem affecting youth referred for mental health services; however, little is known about the prevalence and nature of irritability as a focus of treatment. We examined assessment data from a diverse sample of youths (N = 206; ages 7–15; 52% male, 48% female; 33% White, 27% Black, 25% Latinx) referred for outpatient treatment of emotional and behavioral concerns. Caregivers and youths completed nomothetic (standardized checklist) and idiographic (free response) measures at intake. Irritability was identified as a top problem (TP) in 58% of cases, commonly reported by caregivers (38%), youths (42%), or both (23%)—rates that were significantly greater than those of other TP domains (depression, anxiety, ADHD, conduct, and defiance). Further analyses identified clinical correlates of irritability TPs, with results supporting the incremental utility of multiple informants and methods. Findings suggest that irritability is among the most common problems for which families seek youth treatment. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth of color experience high rates of mental health disorders, yet they experience challenges to accessing mental health services. Community health worker (CHW) models of care have potential to promote equitable mental health services among LGBTQ youth. Our aim was to understand how CHW models could be adapted to better support LGBTQ youth of color in accessing mental health services. Semi-structured qualitative interviews were conducted with LGBTQ youth of color (n = 16), caregivers of LGBTQ youth (n = 11), and CHWs (n = 15) in Massachusetts and California. Interviews were coded by 8 members of the research team. A Rapid Qualitative Analysis was conducted to identify themes. Caregivers, youth, and CHWs all endorsed the value of CHW models for this population. They also almost universally suggested multiple adaptations are needed for the model to be effective. Four main categories of themes emerged related to intervention adaptations: (1) Why adaptations are needed for LGBTQ youth, (2) Who should serve as CHWs providing care, (3) How CHWs should be trained, and (4) What content needs to be included in the intervention. Broadly, findings suggest the relevance of having CHW models for LGBTQ youth of color to address stigma and discrimination experienced, access to culturally and linguistically relevant services, and the need for caregiver support of LGBTQ youth. CHWs need increased training in these areas. [ABSTRACT FROM AUTHOR]

Transition-age youth with mental health conditions from low socio-economic backgrounds often drop out of mental health services and, as such, do not receive therapeutic doses of treatment. Cornerstone is an innovative team-based, multi-component intervention designed to address the clinical needs of this understudied population through coordination and extensive provision of services in vivo (in the community). The present study used a convergent parallel mixed-methods design. Researchers collected quantitative and qualitative data during a small developmental trial, analyzing the two data types independently and then exploring them side-by-side to evaluate feasibility, acceptability, and preliminary implementation. Semi-structured interviews and quantitative surveys were conducted with transition-age youth, clinic staff, and policy makers. Qualitative interview guides were developed using the Consolidated Framework for Implementation Research to build understanding on implementation determinants alongside feasibility and acceptability. A two-group preliminary randomized trial was conducted to assess feasibility outcomes, such as recruitment, randomization, measurement performance, and trends in pre- to post- outcomes. Using grounded theory coding techniques, transcripts were coded by multiple coders, and themes were identified on acceptability and implementation. The team recruited fifty-six transition-age youth. Randomization was used in the study and the intervention was provided without incident. Results suggest individual components with both the social worker and mentor were more acceptable to participants than group-based approaches. Thematic analyses revealed themes associated with the inner, outer, and policy contexts describing a range of critical implementation determinants. Findings suggest that Cornerstone is feasible, acceptable, and promising for transition-age youth. It represents an innovative multi-component intervention worth exploring for transition-age youth with mental health conditions in a larger efficacy trial. Trial registration: The trial was registered at ClinicalTrials.gov (NCT02696109) on 22 April 16, Protocol Record R34-MH102525-01A1, New York University, Cornerstone program for transition-age youth with serious mental illness: study protocol for a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Although youth participation is oft-acknowledged as underpinning mental health policy and service reform, little robust evidence exists about the participation of children and youth in mental health policymaking. A scoping review based on Arksey and O'Malley's framework was conducted to identify and synthesize available information on children and youth's participation in mental health policymaking. Published studies up to November 30, 2020 were searched in Medline (OVID), PsycINFO (OVID), Scopus, and Applied Social Sciences Index and Abstracts (PROQUEST). Further studies were identified through Google Scholar and a grey literature search was conducted using Google and targeted web searches from October to December, 2020. Three reviewers performed screening and data extraction relevant to the review objective, followed by an online consultation. From 2,981 records, 25 publications were included. A lack of diversity among the youth involved was found. Youth were often involved in situational analysis and policy design, but seldom in policy implementation and evaluation. Both the facilitators of and barriers to participation were multifaceted and interconnected. Despite a range of expected outcomes of participation for youth, adults, organizations, and communities, perceived and actual effects were neither substantially explored nor reported. Our recommendations for mental health policymaking highlight the inclusion of children and youth from diverse groups, and the creation of relational spaces that ensure safety, inclusiveness, and diversity. Identified future research directions are: the outcomes of youth participation in mental health policymaking, the role of adults, and more generally, how the mental health of children and youth shapes and is shaped by the policymaking process. [ABSTRACT FROM AUTHOR]

Purpose: Treatment focus diffusion (TFD), dividing focus across multiple concerns during treatment, is common in public mental health care and differs from the more narrowly focused empirically supported treatments for youth reported in the literature. The present study examined whether and to what extent TFD is associated with youth functional improvement over the course of therapy. Method: This study utilized multi-level modeling techniques to analyze 12 consecutive years of standardized routine clinical service data from youth receiving treatment in one of two intensive in-home service settings: (a) Multisystemic Therapy (MST; n = 776 youths, 99 therapists), an implemented evidence-based treatment based on ecological theories of behavior in which therapists work with the multiple systems a youth interacts with (school, community, family), and (b) a standards-based service (n = 1854 youth, 413 therapists). Both service settings operate in the context of a publicly funded mental health care system which serves youth and families who are typically from underserved and low-income backgrounds. Majority of youth in this sample identified as multi-ethnic and male, and they, on average, were approximately 13 years old with three co-occurring diagnoses. Results: A significant TFD by service format interaction on youth functional improvement (alone and in the overall model) and follow up simple effects indicated that higher TFD was associated with significantly poorer outcomes in MST. The parameter estimate for TFD on functional improvement in the standards-based service format was in the same direction, but not statistically significant. Conclusion: Our findings suggest that maintaining a narrower treatment focus might be beneficial to clients, particularly in implemented evidence-based treatments. Likewise, TFD could be a helpful case monitoring tool for clinicians, supervisors, and systems leaders when reviewing intensive-in-home cases. [ABSTRACT FROM AUTHOR]

Purpose: Treatment engagement poses challenges for youth mental health providers. With the expansion of evidence-based treatments (EBTs), providers face complex decisions regarding how to engage youth and families using available information sources. This study investigated how EBT protocols are associated with the selection and delivery of engagement practices. Method: Twenty engagement practices were coded in a sample of digital recordings of early treatment sessions (N = 193) from the Child STEPs in California study, a randomized trial testing modular treatment and community-implemented treatment for youth mental health problems. Data were collected on which protocols mental health providers reportedly used to guide their sessions and the protocols in which they had received training. We examined which information sources (i.e., the guiding protocol, other protocols in training history, unspecified source) were associated with observed engagement practices. Results: In sessions guided by a protocol, most observed engagement practices were accounted for by the guiding protocol (p <.001), rather than protocols in training history or unspecified sources (p <.001). In sessions not guided by a protocol, most observed practices were accounted for by training history (p <.001). Practice frequency and extensiveness was generally greater when a protocol guided the session. Conclusions: Inclusion in protocols is associated with the selection and delivery of engagement practices, but this strategy might be insufficient for supporting the use of the full range of engagement practices supported by evidence. Supports are needed that leverage the engagement evidence base to ensure that selected practices empirically fit the engagement needs of youth and families. [ABSTRACT FROM AUTHOR]

Publicly funded initiatives are underway to improve implementation of evidence-based practices (EBP) in youth mental health services. However, we know little about the success of these initiatives or about EBP implementation independent of such initiatives. We examined EBP implementation in a treatment as usual (TAU) state and in six states with publicly funded EBP initiatives (EBPIs). In Study 1, we examined providers' use of practices derived from the evidence base (PDEB) and their predictors among 780 providers in a TAU state. In Study 2, we conducted a systematic review of implementation strategies, outcomes, and predictors of EBP use in six state funded EBPIs. Study 1 suggests TAU providers use PDEB alongside practices without consistent research support; provider racial/ethnic minority status, learning theory orientation, and manual use predict greater PDEB use. Study 2 indicates EBPIs employ multiple recommended implementation strategies with variable outcomes across studies and measurement approaches. Predictors of EBP use in EBPIs also varied, though training, setting, and youth age were consistent predictors across studies. While sample differences and inconsistent measurement across studies made direct comparisons somewhat tenuous, rates of PDEB use in the TAU sample appeared similar to those in publicly funded EBPIs. However, two states reported comparisons with TAU samples and found higher EBP implementation under EBPI. Different predictors impacted EBP use in TAU versus EBPIs. Our findings highlight the need for improved evaluation of EBPIs including clear reporting standards for outcomes and more consistent, standardized measurement of EBP use in order to better understand and improve EBPIs. [ABSTRACT FROM AUTHOR]

Delayed access to mental health services for children and adolescents has been linked to an increased risk of harm and nonattendance to scheduled appointments. While studies suggest that the lack of standardized assessments for prioritizing individuals has contributed to long wait times, the inconsistent use of assessments across service sectors in Ontario continues to persist. This has contributed to a paucity of information surrounding which children and adolescents may require urgent mental health services. Using a large secondary data set, this study examined whether service sector (e.g., school), and other individual client characteristics (e.g., age, sex, legal guardianship, interpersonal and school conflict) predicted greater mental health service urgency in 61,448 children and adolescents assessed using the interRAI Child and Youth Mental Health Screener. Binary logistic regression revealed that all predictors, except for sector, showed a significant effect on service urgency. Findings are instrumental in prioritization, reducing the likelihood that children with acute needs remain on waitlists. [ABSTRACT FROM AUTHOR]

Stay-at-home orders and public health safety concerns precipitated by the COVID-19 pandemic facilitated rapid changes in policy and reimbursement regulations and resulted in the sudden uptake of telehealth in mental health practices across the United States. This study explored how mental health service providers experienced the use of telehealth in serving their rural clients who are youth and older adults. A purposive sampling strategy was employed to identify and recruit mental health service providers and insurance agency representatives for this study. By means of online focus groups, this statewide study explored the experiences of 147 mental health and public insurance providers using telehealth to serve rural youth and elderly in Pennsylvania amid the pandemic in 2020. NVivo 12 qualitative analysis software was used in data analysis. The findings suggest that telehealth is perceived as both: silver linings during the pandemic (service continuation during the pandemic, improved parental involvement and responsiveness, easing the transportation challenges, and decrease in no-show rates) and some roadblocks to success (Not for every youth!, Technology challenges among the older adults, and "Dead zones" without internet and cellphone reception). Policy and practice recommendations are suggested including incentives for proactive telehealth uptake, telehealth parity laws and reimbursement policies, and incentivizing innovative use of technology for specific populations and therapeutic modalities. Continuous policy support and organizational efforts to provide customized telemental health are called for to remediate rural disparities in access to mental health services beyond the pandemic period. [ABSTRACT FROM AUTHOR]

Youths' experiences in seeking and accessing help for mental health problems can have pervasive and lasting effects on personal and interpersonal functioning. In particular, youth who experience validating experiences presumably persevere in seeking help and generally have positive treatment outcomes, whereas youth who experience invalidation are also likely to experience, at least in the short term, ruptures in therapeutic relationships, shame, and reluctance to seek services. The goal of the current study was to expand on previous research assessing youths' interactions with mental health providers, allied professionals, family members, and peers, with a focus on subjective experiences of validation and invalidation. The current study investigated both validating and invalidating experiences in seeking, accessing, and maintaining professional services among 31 Canadian youth (n = 20 girls, n = 11 boys; 12 to 21 years old [M = 16.97, SD = 2.01]) who were diagnosed or self-identified with at least one of five conditions: depression (n = 26), anxiety (n = 22), eating disorders (n = 9), autism spectrum disorder (n = 2), or conduct disorder or oppositional defiant disorder (n = 2). Youth were recruited using convenience (e.g., posted advertisements in mental health clinics) and snowball sampling methods. Journey mapping methodology (i.e., participants created visual representations of milestones of their mental health journeys) was employed accompanied by semi-structured interviews to prompt youth to expand on their experiences (e.g., "Could you describe what was happening in your life when you first felt you would need support for your mental health?"). Four themes emerged using inductive thematic analysis, marked by the presence (validation) or lack (invalidation) of: feeling heard, feeling seen, feeling understood, and receiving helpful actions. Participants also reported key consequences of validation and invalidation. Findings broaden a conceptualization of validation across supportive relationships and an understanding of factors that enhance or impede the formation or maintenance of therapeutic relationships with youth. Clinical implications and limitations are discussed. [ABSTRACT FROM AUTHOR]

This exploratory study described the distribution of mental health service costs in youth with mental disorder and determined if costs differed for youth with comorbid internalizing and externalizing disorder compared to those with comorbid internalizing disorders. Data come from youth (8–17 years; n=75) receiving mental health services at a children's hospital in Canada. Billing amounts specified in the Health Insurance Act of Ontario were used to estimate costs. Overall, past-year service use costs were $7436.63. Hospitalizations represented the largest cost. Youth with comorbid internalizing and externalizing disorders had higher total (β=0.81 [0.17, 1.45]), hospital (β=0.93 [0.03, 1.84]), and professional (β=0.87 [0.04, 1.69]) costs. These preliminary findings suggest that comorbidity type is associated with the costs of past-year mental health services used by youth. Research is needed to understand the reasons for elevated costs and whether the increased services used by youth with comorbid internalizing and externalizing disorders are effective. [ABSTRACT FROM AUTHOR]

Youth with autism spectrum disorder (ASD) have high rates of co-occurring mental health needs that necessitate mental health interventions. Given the unique clinical characteristics of youth with ASD, there have been significant efforts to adapt and test mental health interventions for this population. Yet, characterization of the nature and types of interventions adaptations is limited, especially across the wide range of interventions tested for youth with ASD with a focus on implementation factors. Additionally, understanding how these interventions may be implemented in community services is limited. The aims of this systematic review are to characterize the (1) types of interventions tested for co-occurring mental health conditions for youth with ASD; (2) adaptations to mental health interventions for use with youth with ASD; and (3) implementation strategies, outcomes, and determinants of mental health interventions to inform their translation to community service settings. Eighty-three articles testing interventions targeting mental health symptoms in youth with ASD that included implementation factors in analyses were reviewed. The Stirman et al. (2013; 2019) FRAME adaptation, Powell et al. (2012;2015) implementation strategies, and Proctor et al. (2011) implementation outcomes taxonomies were applied to characterize the nature and types of adaptations for use with youth with ASD and types of implementation strategies, outcomes, and determinants used, when available, respectively. Of the interventions examined, the majority (64.1%) were originally designed to target youth mental health concerns and were then adapted to be used with ASD. The most common adaptations included those to the intervention content, particularly adding elements with tailoring or refining aspects of the intervention while maintaining core functions. Half of the articles described at least one implementation strategy used during intervention testing. Fidelity and acceptability were the most frequently examined implementation outcomes, with some examination of appropriateness and feasibility. Nineteen percent of articles described implementation determinants (i.e. barriers/facilitators) of these implementation outcomes. The common adaptations for ASD provide direction for future intervention development and for training community therapists. Further examination, specification, and reporting of implementation strategies and outcomes within ongoing efforts to adapt and interventions to meet the co-occurring mental health needs of youth ASD are needed to facilitate their translation to community settings. Areas for future research as well as clinical implications are discussed. [ABSTRACT FROM AUTHOR]

A meta-analysis was conducted to examine the relative rates of youth mental health service utilization across settings among the general population and among those with elevated mental health symptoms or clinical diagnoses. Rates of school-based mental health were compared to outpatient, primary care, child welfare, juvenile justice, and inpatient. Nine studies presented rates of mental health service use for general-population youth in the U.S., and 14 studies presented rates for youth with elevated symptoms or clinical diagnoses. Random effects meta-analysis was used to calculate mean proportions of youth receiving care in each sector. Of general population youth, 7.28% received school mental health services. Rates for other sectors are as follows: 7.26% in outpatient settings, 1.76% in primary care, 1.80% in inpatient, 1.35% in child welfare, and 0.90% juvenile justice. For youth with elevated mental health symptoms or diagnoses, 22.10% of youth were served by school-based mental health services, 20.56% outpatient settings, 9.93% primary care, 9.05% inpatient, 7.90% child welfare, and 4.50% juvenile justice. Schools and outpatient settings are the most common loci of mental health care for both the general population and samples of youth with elevated symptoms or clinical diagnoses, although substantial amounts of care are also provided in a range of other settings. Results hold potential for informing resource allocation, legislation and policy, intervention development, and research. Given that mental health services are delivered across many settings, findings also point to the need for interconnection across child-serving sectors, particularly schools and outpatient clinics. [ABSTRACT FROM AUTHOR]

Background: Homework, or between-session practice of skills learned during therapy, is integral to effective youth mental health TREATMENTS. However, homework is often under-utilized by providers and patients due to many barriers, which might be mitigated via mHealth solutions. Methods: Semi-structured qualitative interviews were conducted with nationally certified trainers in Trauma Focused Cognitive Behavioral Therapy (TF-CBT; n = 21) and youth TF-CBT patients ages 8–17 (n = 15) and their caregivers (n = 12) to examine barriers to the successful implementation of homework in youth mental health treatment and potential mHealth solutions to those barriers. Results: The results indicated that many providers struggle to consistently develop, assign, and assess homework exercises with their patients. Patients are often difficult to engage and either avoid or have difficulty remembering to practice exercises, especially given their busy/chaotic home lives. Trainers and families had positive views and useful suggestions for mHealth solutions to these barriers in terms of functionality (e.g., reminders, tracking, pre-made homework exercises, rewards) and user interface (e.g., easy navigation, clear instructions, engaging activities). Conclusions: This study adds to the literature on homework barriers and potential mHealth solutions to those barriers, which is largely based on recommendations from experts in the field. The results aligned well with this literature, providing additional support for existing recommendations, particularly as they relate to treatment with youth and caregivers. [ABSTRACT FROM AUTHOR]

For youth with disabilities within the juvenile justice system, transition is multifaceted and can constitute movement from facility to facility or education placement to placement. However, within a juvenile justice context, transition is also a legal term of art that derives from a set of interrelated laws, policies, and procedures that guide juvenile justice system professionals' transition practices and serves as a foundation for service delivery and associated youth outcomes. For youth with emotional disturbance (ED) or related conditions, transition also incorporates the process of migrating mental or behavioral health treatment or supports upon reentry. However, youth support during all facets of transition (e.g., compliance with legal transition mandates, placement, service continuity) is often insufficient to help youth transition successfully. Related to this, juvenile justice system professionals often struggle to use law and policy to guide their pre- and postrelease transition planning across education, mental and behavioral health, employment, and mentoring supports. Using a legal compliance focal point theoretical perspective, this article first explores the relevant legal provisions that address prerelease transition supports for youth with disabilities within the juvenile justice system. It then offers suggestions for building a framework to bridge the gap between legal compliance and transition support across the pre- and postrelease transition spectrum. [ABSTRACT FROM AUTHOR]

Measurement feedback systems (MFSs) that routinely collect and report client progress to mental health therapists have demonstrated beneficial impact on outcomes in numerous studies, with evidence that there is a dose–response relationship related to the implementation of the MFS. The current study examined the impact of MFS implementation (Implementation Index) on youth symptom outcomes separately by caregiver and youth self-report. Additionally, we tested the extent to which Implementation Index rates varied by individual therapists and clients, and whether therapist and client characteristics predicted MFS implementation. Methods: Administrative data (client charts, youth- and caregiver-reported Youth Outcome Questionnaires) for 229 youth (52.83% Latinx, 42.79% girls, M age = 10.33) treated during a 1-year period at a community mental health organization in Central Texas were analyzed using multi-level modeling. Caregiver-reported symptoms decreased faster for those with a higher MFS Implementation Index. Between-group differences among therapists accounted for a significant proportion of variance in the Implementation Index for caregiver report, whereas client differences accounted for most of the variance in the Implementation Index for youth self-report. Therapist trainee status predicted a significant increase in the Implementation Index for caregiver-report data. Youth symptom improvement as reported by caregivers varied with the extent of MFS implementation fidelity, and MFS implementation fidelity was higher for clients treated by trainees relative to staff therapists for caregiver report of symptoms. [ABSTRACT FROM AUTHOR]

We examine whether the availability of peer support reduces disparities in service use among minority youth ages 16–24 with serious mental illness in Los Angeles and San Diego Counties. Administrative data from 2015–2018 was used to summarize service use among 13,363 transition age youth age 16–24 with serious mental illness who received services from 183 outpatient public mental health programs; 17.2% were Black, 67.4% were Latinx, and 15.4% were non-Latinx white. The availability of peer support was assessed via a program survey. Generalized linear models were used to assess the relationship between availability of peer support, defined as having a peer specialist on staff, and the annual number of outpatient mental health visits. We also examined the relationship between racial/ethnic concordance of youth and peer specialists and use of outpatient services. Forty-six percent of youth received services from programs that employed peer specialists. Among youth in both counties, the availability of peer support was associated with an increase in annual outpatient visits (P ≤.05 each). Peer support was associated with reductions in service use disparities among Black and Latinx youth in Los Angeles County (P <.001 each). Peer concordance was associated with an increase in outpatient service use among Latinx youth in both counties (P <.05 each). Peer support was associated with increases in use of outpatient mental health services. Detailed examination of the context for youth peer support implementation is merited to identify the specific pathways that improve outcomes. [ABSTRACT FROM AUTHOR]

Most mental health professionals encounter challenges to helping youth and families enroll and participate in mental health services. The empirical literature suggests that most engagement strategies are well-suited for certain types of engagement challenges. In this mixed-methods study, we examined whether mental health professionals reported using any solutions from the evidence base and, if so, the extent to which these procedures fit the engagement challenges they encountered. We surveyed all 244 mental health professionals working in a large urban school district about their experiences engaging youth and families in services. We coded professionals' written responses to open-ended questions about the challenges they encountered engaging youth and families in services, along with solutions they used to address these challenges. Most reported engagement challenges (83.3%) had a corresponding solution in the evidence base. Most reported solutions (86.5%) were practices found in the evidence base, yet most practices from the evidence base were infrequently nominated by professionals. Moreover, only 38.5% of professionals reported at least one solution that fit at least one of their challenges. In general, professionals reported using a narrow subset of engagement strategies from the literature, which often did not fit the engagement problems encountered. These results highlight opportunities for developing and disseminating a framework that explicitly coordinates evidence-based solutions matched to specific engagement challenges to support provider selection and application of engagement procedures and ultimately enhance youth and family engagement in services. [ABSTRACT FROM AUTHOR]

Linking mental health services to organised sport offers an avenue to identify and improve mental health among adolescents. In this study, we investigated the efficacy, acceptability and feasibility of an integrated mental health system embedded within a junior sports development program. A three-step integrated mental health program for 12- to 15-year-old rugby league players (N = 74) was delivered in urban (n = 44) and rural (n = 33) areas. Specifically, this system (a) assessed participant mental health on primary outcome measures of anxiety, depression, and anger/conduct problems (and secondary outcome measures of personal attributes and relationships), (b) provided feedback to participants, parents and program coordinators, and (c) connected participants and parents to a multi-component intervention including online resources, a group-based workshop program (4 × 30-min sessions), and tailored individual-level follow-up and referral to further care for participants at high risk of mental health problems. From pre- to post-program, boys' anxiety symptoms declined significantly (with only a trend-level reduction in depression), and there were significant improvements in grit (for urban boys only), efficacy to manage negative emotions, and prosocial behaviour. In addition, when boys reported symptoms associated with high risk for mental health problems, providing parents with feedback enhanced boys' access to care and was associated with significant declines in anxiety symptoms. The program was generally acceptable and feasible, with very high retention in the youth sports development program. Overall, early findings support further deployment and evaluation of integrated mental health systems embedded within sporting contexts to address mental health problems among adolescent boys. [ABSTRACT FROM AUTHOR]

This article presents a commentary on the interactive associations of demographic factors on youth's psychopathology and mental health service utilization. Intersectionality allows for a more comprehensive understanding of how intersecting non-dominant identities play a role in health outcomes and mental health treatment use. However, these studies can consider conceptualizing intersectionality beyond the methods/statistics, as well as attend to the broader context around what the scientific data is informing. Further, it is imperative that researchers conducting this type of work consider multiple possible interpretations and acknowledge the researcher(s) positionality. Research implications that incorporate intersecting non-dominant demographic identities and its role with other broader systems of position, privilege, and power are therefore discussed. In doing so, these implications may further contribute to the discussion of youth's mental health- and mental healthcare-disparities. [ABSTRACT FROM AUTHOR]

Advancements in evidence-based psychosocial interventions, digital technologies, and implementation strategies (i.e., health services research products) for youth mental health services have yet to yield significant improvement in public health outcomes. Achieving such impact will require that these research products are easy to use, useful, and contextually appropriate. This paper describes how human-centered design (HCD), an approach that aligns product development with the needs of the people and settings that use those products, can be leveraged to improve youth mental health services. We articulate how HCD can advance accessibility, effectiveness, and equity, with specific consideration of unique aspects of youth mental health services. [ABSTRACT FROM AUTHOR]

There is limited empirical evidence documenting the magnitude and correlates of area-level variability in unmet need for children's mental health services. Research is needed that identifies area-level characteristics that can inform strategies for reducing unmet need in the population. The study purpose is to: (1) estimate area-level variation in children's unmet need for mental health services (using Service Areas as defined by the Ontario Ministry of Children and Youth Services), and (2) identify area-level service arrangements, and geographic and population characteristics associated with unmet need. Using individual-level general population data, area-level government administrative data and Census data from Ontario, Canada, we use multilevel regression models to analyze unmet need for mental health services among children (level 1) nested within Service Areas (level 2). The study finds that 1.64% of the reliable variance in unmet need for mental health services is attributable to between-area differences. Across areas, we find that Service Areas with more agencies had a lower likelihood of unmet need for mental health services. Compared to other Service Areas, Toronto had much lower likelihood of unmet need compared to the rest of Ontario. Rural areas, areas with unsatisfactory public transport, and areas with higher levels of socio-economic disadvantage had a higher likelihood of unmet need for mental health services. These findings identify challenges in service provision that researchers, policymakers and administrators in children's mental health services need to better understand. Policy implications and potential Service Area strategies that could address equitable access to mental health services are discussed. [ABSTRACT FROM AUTHOR]

Using a social determinants of health framework, we argue that the majority of evidence-based interventions focused on child and adolescent mental health are limited by their focus on individual youth (and sometimes families). While necessary, these interventions are insufficient for addressing the midstream- and upstream/macro-level determinants of mental health in society. We illustrate our perspective through four examples from youth mental health and related services, in which midstream and upstream interventions—i.e., at the community and public policy levels—need to be prioritized along with downstream treatments to improve population mental health and reduce social inequalities in mental health outcomes. [ABSTRACT FROM AUTHOR]

Drawing upon the National Survey of Children with Special Healthcare Needs (2009/2010), multilevel logistic regression analysis assessed the relationship between parent report of a youth having an emotional, behavioral, or developmental problem (EBDP), their level of reported functional limitations, and parents' report of unmet mental health care needs and experience with cost-barriers to accessing needed healthcare services. Results indicate that, compared to all privately insured youth with special health care needs, parents of privately insured youth with EBDP are much more likely to report their child having unmet mental health care needs (OR 12.16; p < 0.001) and experiencing cost barriers to care (OR 2.37; p < 0.001). Parents of privately insured youth with EBDP with functional limitations are even more likely to report these concerns (Unmet Mental Health Needs: OR 17.09; p < 0.001; Cost Barriers: OR 5.77; p < 0.001). However, findings suggest that having public insurance is associated with reductions in the odds of having unmet needs for youth with SED by 50%. Public insurance and dual coverage is associated with reductions in the odds of encountering cost barriers to care by almost 50% for children with EBDP, and by more 50% for youth with EBDP and functional impairments. [ABSTRACT FROM AUTHOR]

In order to improve the youth mental health system, there is an international movement toward developing community-based service hubs that provide integrated, collaborative care to youth. However, the implementation of multisystem collaboration is complex and can be hampered by barriers. This paper presents a formative evaluation of the YouthCan IMPACT integrated youth services project based on the Consolidated Framework for Implementation Research (CFIR), to identify facilitators and barriers to successful implementation. Results highlight that previous positive working relationships along with collaborative investment of resources from partnering organizations are essential to implement an integrated youth service model. In addition, it is important that representative members of all key stakeholder groups, including staff, youth, and caregivers, be involved in the development and execution of the project to ensure effective implementation. Attention to the facilitators and barriers to implementation may help teams seeking to implement highly collaborative, integrated models of service delivery for youth in the community. [ABSTRACT FROM AUTHOR]

Despite progress in research on evidence-based treatments (EBTs) for youth psychopathology, many youths with mental health needs do not receive services, and EBTs are not always effective for those who access them. Wise interventions (WIs) may help address needs for more disseminable, potent youth mental health interventions. WIs are single-component, social-psychological interventions designed to foster adaptive meaning-making. They have improved health-related and interpersonal youth outcomes, yet their potential to reduce youth psychopathology has not been systematically explored. Accordingly, we conducted a systematic, descriptive review characterizing WIs' potential to reduce youth mental health problems. Across 25 RCTs (N = 9219 youths, ages 11-19) testing 13 intervention types, 7 WIs qualified as "Well-Established," "Probably Efficacious," or "Possibly Efficacious" for reducing one or more types of youth psychopathology, relative to controls. Among these, 5 WIs significantly reduced youth depressive symptoms; 3, general psychological distress; and 1 each, eating problems, anxiety, and substance use. Three of these 7 WIs were self-administered by youths, and four by trained interventionists; collectively, they were 30-168 min in length and targeted clinic-referred and non-referred samples in clinical, school, and laboratory settings. Overall, certain WIs show promise in reducing mild-to-severe youth psychopathology. Given their brevity and low cost relative to traditional (i.e., therapist-delivered, 12- to 16-week, clinic-based) EBTs, WIs may represent beneficial additions to the youth mental healthcare ecosystem. Priorities for future research are proposed, including testing WIs for parents, younger children, and externalizing problems; as EBT adjuncts; and in schools and primary care clinics to increase access to brief, effective supports. [ABSTRACT FROM AUTHOR]

This study examined providers' reflections on delivering managing and adapting practice (MAP), an evidence-informed framework that guides decision-making from scientific and client data. Consensual qualitative research methods were used to analyze the reflections of 201 youth mental health providers. Results indicated that providers approached MAP according to their own preferences and particular cases. While most appeared to approach MAP from a practice management standpoint, when faced with challenging cases, providers used coordination and outcomes management resources. Regardless of approach, most providers came to appreciate the full framework through reflective practice. Their diverse approaches offer lessons for evidence-based practice implementation and sustainment. [ABSTRACT FROM AUTHOR]

Existing measures of attitudes toward evidence-based practices (EBPs) assess attitudes toward manualized or research-based treatments. Providers of youth behavioral health (N = 282) completed the Valued Practices Inventory (VPI), a new measure of provider attitudes toward specific practices for youth that avoids mention of EBPs by listing specific therapies-some of which are drawn from EBPs (e.g., problem solving) and some of which are not included in EBPs (e.g., dream interpretation). Exploratory factor analysis revealed two factors: practices derived from the evidence base (PDEB) and alternative techniques (AT). The PDEB scale was significantly correlated with scales on the Evidence-Based Practice Attitude Scale-50 (Aarons et al. in Administration and Policy in Mental Health and Mental Health Services Research, 39(5): 331-340, 2012), whereas the AT scale was not. Attitudes toward PDEB and AT were also related to provider characteristics such as years of experience and work setting. The VPI offers a complementary approach to existing measures of attitudes because it avoids mention of EBPs, which may help prevent biases in responses. [ABSTRACT FROM AUTHOR]

Deficits regulating emotions are a core process underlying both substance use and mental health disorders. Research has focused on identifying one-to-one associations between individual emotion regulation (ER) strategies and mental health symptoms. Consequently, little is known about how patterns of ER relate to a broad range of psychopathology, in treatment seeking young people. Latent class analysis was used to examine patterns of ER strategies and their relationship with symptoms of depression, anxiety, eating disorders, substance use and borderline personality disorder, in a sample of young treatment seekers. Participants were young people (N = 306, M = 20.8 years) accessing youth advocacy and support or mental health services in Australia. Participants recalled an emotionally-arousing event experienced when on their own and indicated their use of 14 possible ER responses in an online questionnaire. Symptoms of mental health and substance use were measured. The LCA identified three distinct classes of ER responses: Ruminators/avoiders (n = 76), active regulators (n = 81), and low regulators (n = 129). The ruminators/avoiders endorsed the most severe symptom picture across all disorders except alcohol use. Within this cohort, distinct patterns of ER responding had unique relationships with symptoms of psychopathology. The deleterious impact of heightened maladaptive ER strategies (rumination and avoidance) in the absence of adaptive strategies was highlighted. [ABSTRACT FROM AUTHOR]

The youth health indicator (YHI) program was developed to improve health and reduce risk behaviors for youth treated in clinic and day treatment psychiatric settings. This study examined implementation of the YHI program and factors associated with BMI % change for youth participating in the program. Outpatient facilities which implemented the YHI program were surveyed (N = 10) and lessons learned were summarized. Mixed random effects repeated measures analysis was used to examine BMI % trajectory for youth admitted during 2010-2014 with BMI % measured (N = 6403). Treatment settings indicated a variety of strategies to undertake and sustain the YHI program. Factors associated with BMI % change over time were identified. The YHI program resulted in the development of a wide variety of programmatic innovations targeted at improving youth health. Continued work needs to be done to improve the health outcomes for youth in these treatment settings. [ABSTRACT FROM AUTHOR]

We investigated the extent to which clinician-assigned diagnoses of emotional and behavioral disorders and clinicians’ perceptions of client change are consistent with structured measures of youth clinical functioning and parent/family characteristics within the context of usual care or “real world” psychotherapy. A total of 54 therapists from two publicly-funded youth outpatient mental health clinics and 128 youths and parents from the therapists’ combined caseloads were included in the study. Clinician-assigned diagnosis and youth and family demographics were collected at the initial visit, clinician-reported perceived client change was collected at 6-month follow-up, and structured measures of youth clinical functioning and parent/family characteristics were collected at both time points. Results indicate some overlap between clinician-assigned diagnosis, clinician-reported perceived client change, and structured measures of youth clinical functioning and parent/family characteristics after controlling for demographic factors. Results are discussed in terms of implications for the implementation of evidence-based practices in real world community settings. [ABSTRACT FROM AUTHOR]

Examine the impact of Colorado's Medicaid mental health carve-out program on children in child welfare and juvenile justice systems. Medicaid claims and encounter data for two experimental managed care sites and one comparison fee-for-service site are used to estimate a two-part model of inpatient, outpatient, and residential treatment center utilization, controlling for patient characteristics. The study finds that juvenile justice and child welfare populations were more strongly affected by managed care than the general youth population, regarding reduced utilization of inpatient and outpatient services. Increases in Residential Treatment Centers use were greater for juvenile justice than either the child welfare sample or the total sample. Youth in child welfare increase utilization of outpatient services. Most utilization effects are stronger for not-for-profit than for-profit managed care organizations. The experience of Colorado implies that a mental health carve-out affects patterns of care for youth and differentially so for youth in juvenile justice and child welfare systems. Controlling for population characteristics, the effects are stronger for not-for-profit than for-profit managed care organizations. [ABSTRACT FROM AUTHOR]

This study examined the “treated” prevalence, incidence, and pharmacotherapy of child and adolescent mood disorders in a managed care setting. General prevalence patterns across age and sex were similar to those reported in community epidemiology studies, although, not unexpectedly, the overall rates were somewhat lower. Primary care providers identified a substantial proportion of the youth with a mood disorder. Antidepressant medication was used more often by youth identified with a mood disorder in medical care settings than by those youth identified in specialty mental health care settings. These results are valuable in determining if youth with mood disorders receiving medication prescriptions across settings are treated according to current best practice guidelines (such as the adult depression guidelines [U.S. Department of Health and Human Services, 1993]), that is, primarily with SSRI medications. [ABSTRACT FROM AUTHOR]