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Australia has undergone significant youth mental health reform over the past 10 years, leading to numerous studies examining the effects of community-based mental health care programs for Australian youth. However, no synthesis of this literature currently exists. Therefore, this systematic review aimed to: (1) describe the types of community-based mental health programs that have been delivered to Australian youth in the past 10 years; and (2) examine their impact in improving young people's mental health symptomology and psychosocial functioning. A systematic search of the peer-reviewed literature was conducted. Studies were included if they evaluated the extent to which such programs improved mental health symptomology (e.g., depression, anxiety, substance use) and/or psychosocial outcomes (e.g., social functioning, school engagement, employment) for Australian youth aged 10-25 years. Thirty-seven studies were included. Four types of community-based youth mental health care programs were identified: therapy (n = 16), case management (n = 9), integrated 'one-stop-shop' (n = 6) and lifestyle (n = 6) programs. The majority of therapeutic programs were effective in reducing mental health symptomology. Case management and integrated approaches consistently yielded significant improvements in both symptomology and psychosocial outcomes. Lifestyle programs were effective in alleviating depressive symptoms, but inconclusive for other outcomes. This review provides support for youth-friendly, systemic, multidisciplinary and integrated assertive outreach models of community mental health care to improve outcomes for young Australians experiencing mental health concerns. Several recommendations for future research are provided to strengthen the local evidence-base supporting community mental health programs to ultimately enhance young people's life trajectory., (© 2022. The Author(s).)

AbstractBackgroundMethodsResultsConclusionThis study aimed to determine factors influencing help-seeking, accessing treatment and sustaining recovery among Filipino PWUDs during the country’s war against drugs.Purposive sampling was used with respondents recommended by program managers or community facilitators of community-based drug rehabilitation programs. In-depth interviews with clients and their families were conducted in 17 local government units across 8 regions in the Philippines. Transcripts were analyzed using Nvivo 12.The results highlight barriers to help-seeking, including the PWUDs’ belief that they don’t need help, fear of police and incarceration, stigma and discrimination. Enablers to help seeking and treatment adherence were motivation to change, accessible treatment options and family support. Community acceptance, quality of care of service providers, and support of community leaders enabled both help-seeking and recovery.The findings suggest the impact of a punitive approach and the need to reframe drug use as a health issue. Results also suggest the need to reduce stigma and discrimination and promote positive messaging to enable help-seeking, adherence, and recovery. [ABSTRACT FROM AUTHOR]

Children living in regional and rural areas report poorer mental health than metropolitan children, however, there are few, if any, evidence-based school well-being programs tailored for this group. This study aimed to elicit the views of stakeholders about what should be included in well-being programs for these young people and how they should be delivered. Nine online focus groups were conducted with 29 participants including children, teachers, parents/caregivers, school leaders, and school well-being staff. Thematic analysis was conducted, and findings revealed several unique aspects of rural life that should be included in school well-being programs for these communities. These included the losses and isolation experienced in these communities, the cumulative risk and impact of disasters in rural areas, and inadequate access to mental health and support services. The results can be used to justify further investment and delivery of targeted well-being programs for students living in regional and rural locations. [ABSTRACT FROM AUTHOR]

Objective: We (a) describe the development of a hospital–school–community telepartnership (HSCT) program targeting suicidality crisis response implemented in the immediate aftermath of the COVID-19 pandemic, (b) report on service utilization outcomes from the first year and half of program implementation, and (c) share early lessons learned and implications for future directions. Method: Using program evaluation data collected from September 2020 to December 2021, demographic, usage outcomes, care coordination, and support outcomes are reported. Representative case vignettes are also illustrated. Results: Students (N = 258) were referred to the HSCT program for suicidality from partnering school districts in the large metropolitan area of Austin, Texas. Students referred were adolescents, 12 years of age and older (n = 196, 76%). Sixty-two (24%) of the students referred for suicidal ideation entered the HSCT program through urgent same-day assessment. Medication evaluations were offered for 125 (48%) of the students. The most frequently prescribed medications included antidepressants (e.g., SSRIs; n = 29, 64%). Program clinicians referred 12 (5%) students identified as high risk for suicide for hospitalization. Of the 258 total students, 212 (82%) were referred to community providers for therapy. Conclusions: By providing rapid access to crisis response with mental health specialists and care coordinators, at-risk students received timely evidence-based care and referral to mental health resources in their communities. Public Significance Statement: A hospital–school–community telepartnership program targeting suicidality crisis response was developed in Austin, Texas at the outset of the COVID-19 pandemic to increase rapid response and inter-agency care coordination for students in kindergarten through high school. The telepartnership program helped facilitate timely access to mental health support and referral care coordination to community mental health intervention services. [ABSTRACT FROM AUTHOR]

Mentoring programs are popular mechanisms for promoting positive youth development due to developmental research suggesting that youth with strong relationships with a special adult have a lower likelihood of a range of negative outcomes. Community-based mentoring programs are mechanisms for promoting access to mental health support and positive youth outcomes. Youth mentorship programs reveal mixed and modest outcomes, yet youth outcomes are more robust for high-quality relationships. Ethnic-racial identity is hypothesized to affect the relationship quality because shared identities are thought to facilitate trust and empower youth to succeed. However, studies have found that ethnic-racial match does not affect the strength of the dyadic relationship. This study attempts to address these disparate findings by explicitly examining ethnic-racial matching and relationship quality at two-time points. We conducted a two-step hierarchical regression to determine whether ethnic-racial match affected mentee reports of the relationship at follow-up. The results show ethnic-racial match did not significantly predict positive dimensions of the relationship at follow-up. Moreover, same-ethnic-racial matches reported a lower rate of change and slightly less relationship dissatisfaction at time 2 compared to cross-ethnic-racial matches. Results contribute to existing literature showing mixed results in ethnic-racial matching in youth mentorship programs. [ABSTRACT FROM AUTHOR]

Introduction: A high prevalence of depression in rural areas has led to increases in suicidality. Our study aim is to investigate the role of psychological inflexibility as a mediator in the relationship between socioeconomic risk factors and depression in a rural population in Borneo. Methods: 115 participants were enlisted in this cross-sectional study that utilized convenience sampling of all participants in a community healthcare program. Three questionnaires were used: the sociodemographic risk factor questionnaire, the PHQ-9 questionnaire to measure depression, and the AAQ-II questionnaire to measure psychological inflexibility. The sociodemographic data was analyzed and described using descriptive statistics using IBM SPSS version 28.0. The statistical analysis of the mediating model was carried out using PLS-SEM and SmartPLS 4.0 (Henseler et al., 2016). An indirect effects analysis was performed on the structural model to explain the mediating effect of psychological inflexibility between socioeconomic factors and depression. Results: The analysis showed that psychological inflexibility acts as a mediator in the relationship between both being married and native, and depression. Other socioeconomic risk factors such as gender, employment, and education level did not mediate between psychological inflexibility and depression. Conclusion: Marriage and native ethnicity are identified as a buffer and protective factor from psychological inflexibility and depression. Future research should focus on establishing a clearer picture of how marital status and native ethnicity of Sabah affects psychological flexibility and mental health. [ABSTRACT FROM AUTHOR]

The prevalence of mental health difficulties among children and adolescents is rising. This study aimed to explore early adolescents' lived experiences of a school- and community-based prevention program, including what helps, why, and when. Seventy-eight semi-structured interviews were conducted with early adolescents (aged 10 to 13) as part of the evaluation of HeadStart, a UK-based program. A reflexive thematic analysis was conducted and a typology was developed to facilitate comparisons between participants' experiences. The typology consisted of five groups, including early adolescents who described positive or helpful experiences of HeadStart support, those who wanted more support, those who described more mixed or unhelpful experiences of support, and those who did not report receiving much or any support. Cross-group themes highlighted the 'bridges' that interventions can build to promote mental health and wellbeing, e.g. learning new coping or problem-solving skills. There was more variation between the groups in terms of the 'walls' (e.g. issues with intervention content, timing, or location) that may limit intervention effectiveness. There were also some group differences in terms of the other sources of social support that participants had access to and the level of difficulties that they were facing in their lives. The findings suggest that intervention developers should tailor design and delivery according to different profiles of early adolescents who may be more or less able or willing to accept help, and who may experience different formats, structures, and content of support as either more or less useful. [ABSTRACT FROM AUTHOR]

Understand the mental health status of residents aged 15 and above in a sports tourism town, the research aimed was to check the influence of the construction of sports tourism towns on the psychological status of local residents. For this purpose, a multistage random sampling method was used to conduct a questionnaire survey on the mental health status of 3295 local residents, and the data were processed and analysed using SPSS 19.0 software. Of the 3295 residents surveyed, 410 had poor mental health, accounting for 12.44% of the total number of people surveyed. The total score of SCL-90 of residents in local provinces is lower than the national norm (t=14.647, P=0.000), and the scores of various factors of SCL90 of residents in local provinces are significantly higher than the national norm (P=0.000). The correlation analysis results showed that the total score of happiness was negatively correlated with the total score of SCL-90 (r= 1.883, P<0.01 ), and the psychological awareness and hygiene score was also negatively correlated with the total score of SCL-90 (r=0.598, P<0.01). The results of multiple linear regression analysis showed that the factors that entered the regression equation included total happiness score, marital status, family life, satisfaction with the environment, whether life was monotonous, personality, participation in gatherings, and whether the three generations of the family had mental illness, according to the size of the standard regression coefficient, the most influential factor is the total score of happiness(~= 0.426), followed by marital status(~= 0.097).The mental health status of residents in the local province is not optimistic, the total score of happiness, marital status, family life, satisfaction with the environment, whether life is monotonous, and personality have varying degrees of impact on residents' mental health. Necessary intervention measures should be taken to improve their mental health based on their influencing factors. The research could help to application of targeted interventions and community-based programs to enhance the mental well-being of local residents in sports tourism towns, fostering sustainable development and social harmony. The research limitations and future directions were also discussed. [ABSTRACT FROM AUTHOR]

Background: Little is known about the cost-effectiveness of parent training programs when offered universally in U.S. elementary schools in disadvantaged urban communities. Objective: To estimate the cost-effectiveness of a universal school-based implementation study of the Chicago Parent Program (CPP). Methods: CPP was offered universally from 2014 to 2017 to parents of PreK students in 12 Baltimore City Title 1 schools (n = 380; 61.1% Black/African American, 24.1% Hispanic). CPP program implementation and operating costs were estimated using microcosting methods and data drawn from study records. A Complier Average Causal Effects (CACE) framework was used to estimate an Incremental Cost Effectiveness Ratio (ICER) for CPP's average cost per child per 1% decrease in conduct problem prevalence at follow-up. This ICER was then compared with comparable ICERs for four parenting interventions that have been implemented and evaluated in Europe: Connect, Incredible Years, COPE, and Comet. Results: CPP cost $937.51 per child (95% CI: $902.09 to $971.92). Adjusted CACE estimates indicated that CPP resulted in a 31.4% reduction (95% CI: -39.7% to -23.9%) in conduct problem prevalence at follow-up among children whose parents attended CPP. The mean ICER for CPP was $29.86 per each 1% reduction in prevalence (95% CI: $21.05 to $50.71). CPP's ICER was similar to ICERs for Connect ($25.50) and COPE ($29.72), and less than ICERs for Incredible Years ($50.36) and Comet ($59.69). Conclusion: School-based CPP offered universally to parents of children transitioning to Kindergarten in extremely disadvantaged U.S. urban communities was found to offer relatively good value compared with similar parenting programs that are widely used in Europe. [ABSTRACT FROM AUTHOR]

Interest in the applications of mindfulness practice in education is growing in the scientific community. Recent research has shown that mindfulness practice in schools may be beneficial for executive functions (EFs) which are abilities crucial for healthy development. The study of the effects of mindfulness practices on children's neural correlates of EFs, particularly inhibitory control, may provide relevant information about the impact and mechanisms of mindfulness‐based interventions (MBIs) in children. The aim of the present study was to investigate the effects of a MBI in elementary school children on the neural correlates of inhibitory control via a randomized controlled trial. Children from two 4th grade classrooms and two 5th grade classrooms located in a school identified as having low socioeconomic status in Santiago de Chile were randomly assigned to either receive a MBI or serve as active controls and receive a social skills program. Both before and after the interventions, electroencephalographic activity was recorded during a modified version of the Go/Nogo task in a subsample of children in each group. Additionally, teachers completed questionnaires of students' EFs and students completed self‐report measures. Results revealed increases in EFs assessed by questionnaires together with improved P3 amplitude associated with successful response inhibition in children who received the MBI compared to active controls. These results contribute to the understanding of the ways in which mindfulness practices can promote the development of inhibitory control together with EF improvement, factors identified as critical for children's social and emotional development and positive mental health. Research Highlights: This study investigated the effects of a mindfulness‐based intervention in children from a low socioeconomic status school on neural correlates of EFs.Children performed a Go/Nogo task while electroencephalographic activity was recorded and completed questionnaires before and after a MBI or an active control program.Improvements in EFs assessed by questionnaires together with an increased Nogo‐P3 activity associated with successful inhibition in children who received the MBI were found.The results could contribute to understand how mindfulness practice can promote the development of inhibitory control in children from vulnerable populations. [ABSTRACT FROM AUTHOR]

Background: The mental health impacts of climate change-related disasters are significant. However, access to mental health services is often limited by the availability of trained clinicians. Although building local community capability for the mental health response is often prioritised in policy settings, the lack of evidence-based programs is problematic. The aim of this study was to test the efficacy of the Skills for Life Adjustment and Resilience programme (SOLAR) delivered by trained local community members following compound disasters (drought, wildfires, pandemic-related lockdowns) in Australia. Method: Thirty-six community members were trained to deliver the SOLAR programme, a skills-based, trauma informed, psychosocial programme. Sixty-six people with anxiety, depression and/or posttraumatic stress symptoms, and impairment were randomised into the SOLAR programme or a Self-Help condition. They were assessed pre, post and two months following the interventions. The SOLAR programme was delivered across five 1-hourly sessions (either face to face or virtually). Those in the Self-Help condition received weekly emails with self-help information including links to online educational videos. Results: Multigroup analyses indicated that participants in the SOLAR condition experienced significantly lower levels of anxiety and depression, and PTSD symptom severity between pre – and post-intervention (T1 to T2), relative to the Self-Help condition, while controlling for scores at intake. These differences were not statistically different at follow-up. The SOLAR programme was associated with large effect size improvements in posttraumatic stress symptoms over time. Conclusion: The SOLAR programme was effective in improving anxiety, depression and posttraumatic stress symptoms over time. However, by follow-up the size of the effect was similar to an active self-help condition. Given the ongoing stressors in the community associated with compounding disasters it may be that booster sessions would have been useful to sustain programme impact. Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12621000283875.. We tested the efficacy of a brief, skills-based psychosocial programme under randomised controlled conditions following compound disasters. The SOLAR programme was associated with improvements in anxiety, depression and posttraumatic stress symptoms across time. The SOLAR programme may benefit from booster sessions especially where there are ongoing impacts of disaster. [ABSTRACT FROM AUTHOR]

By age 18, 22-27% of adolescents have experienced depressive symptoms increasing their risk of peripheral mental health and social issues. Despite the development of effective depression prevention programs, issues related to dissemination persist. This study aims to identify ways of increasing the likelihood of dissemination by a) investigating how prevention effects differ based on the professional background of the prevention program group leader and b) evaluating adolescent depression prevention in terms of comprehensive prevention – prevention with the breadth to reduce peripheral mental health and social issues. This cluster-randomized trial included 646 eighth-grade students recruited from German secondary schools. Adolescents were randomized into three conditions: teacher-led prevention, psychologist-led prevention, or school-as-usual. Results from hierarchical linear models reveal differences in effects based on implementation type and adolescent gender and provide preliminary evidence for a wider reach of depression prevention such that, regardless of implementation type or gender, the tested program was effective in reducing hyperactivity over time. Taken together, our findings warrant further research and suggest that depression prevention programs may have an effect on some peripheral outcomes, but not others, and that these effects may differ based on the profession of the group leader and adolescent gender. With continued empirical research investigating the efficaciousness of comprehensive prevention, this type of prevention has the potential to impact a larger proportion of the population and improve the cost-benefit ratio of prevention, thus increasing the likelihood of dissemination. [ABSTRACT FROM AUTHOR]

Schools are the most common site to implement evidence-based prevention programs and practices (EBPs) to improve behavioral and mental health outcomes among children and adolescents. Research has highlighted the critical role of school administrators in the adoption, implementation, and evaluation of such EBPs, focusing on the factors they should consider during the adoption decision and the behaviors needed for successful implementation. However, scholars have only recently begun to focus on the de-adoption or de-implementation of low-value programs and practices to make room for evidence-based alternatives. This study introduces escalation of commitment as a theoretical framework for understanding why school administrators may stick with ineffective programs and practices. Escalation of commitment is a robust decision-making bias in which people feel compelled to continue with a course of action even when performance indicators suggest it is not going well. Using grounded theory methodology, we conducted semi-structured interviews with 24 building- and district-level school administrators in the Midwestern United States. Results suggested that escalation of commitment occurs when administrators attribute the underlying causes of poor program performance not to the program itself but instead to issues related to implementation, leadership, or the limitations of the performance indicators themselves. We also identified a variety of psychological, organizational, and external determinants that accentuate administrators' continuance of ineffective prevention programs. Based on our findings, we highlight several contributions to theory and practice. [ABSTRACT FROM AUTHOR]

A number of school-based mental health prevention programs have been found to be effective in research trials, but little is known about how to support implementation in real-life settings. To address this translational problem, this systematic review aims to identify effective strategies for enhancing the implementation of mental health prevention programs for children in schools. Four electronic databases were searched for empirical, peer-reviewed articles in English from January 2000 to October 2021 reporting the effects of implementation strategies for school-based universal mental health programs. Twenty-one articles were included in the narrative synthesis and assessed for quality using the Mixed Methods Appraisal Tool. Twenty-two strategies were found to be effective at improving program fidelity or adoption. The strategies with the strongest positive evidence base were those that involved monitoring and provision of feedback, engaging principals as program leaders, improving teachers' buy-in and organising school personnel implementation meetings. We recommend school-based practitioners trial strategies with positive findings from this review as part of their continuous quality improvement. This review highlights the pressing need for large-scale, randomised controlled trials to develop and trial more robust strategies to enhance adoption, as the five implementation studies found to measure adoption used qualitative methods limited by small samples sizes and case study designs. [ABSTRACT FROM AUTHOR]

Background: Worldwide, mental health issues constitute a substantial threat to people's social, economic, and mental well-being and contribute significantly to many fatalities each year. In Bangladesh, people with mental health issues typically delay contacting health professionals because they prefer traditional or religious healers. Moreover, the situation is exacerbated by a lack of awareness, social stigma, and negative perception of sufferers of mental health issues on the part of families and the community. Therefore, this paper investigates the social perception and stigmatization of individuals living with mental health problems and their caregivers in Khulna, Bangladesh. Methods: Data were collected from university students with concurring mental health issues as well as their closest caregivers, who had in-depth knowledge of the problem and a willingness to take care of the individuals with mental health issues. Following the criteria for data collection, eight individuals living with mental health problems and five caregivers were purposively selected for this research. A semi-structured in-depth interview guide was used for the confidential data collection process, which took place in November and December 2021, and each interview lasted 40–50 min on average. Results: This study used thematic analysis to present the results; the findings showed that: individuals afflicted with mental health problems sought both medical and spiritual support to recover. Those with mental health issues who received positive family support recovered relatively faster than those who did not. However, negative social perception and stigmatization were the key impediments for individuals suffering from mental health problems and their families, as they found it difficult to discuss their issues with relatives and communities when attempting to access support or seek remedies. Moreover, the commonality of social stigmas, such as labeling mental health problems as equal to 'madness,' hindered disclosure to family members, peers, and the community. Conclusion and recommendations: In Bangladesh, the majority of individuals living with mental health problems are stigmatized and do not receive emotional support. Hence, we suggest nationwide community-based awareness-building programs to promote more positive perceptions of the fight against mental health disorders. Furthermore, counseling and awareness-building programs for effective discouragement of non-scientific remedies such as spiritual healing, as well as diagnosis and medication at the primary stage of sickness, are recommended for early detection and better medical assistance. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "A microcosting approach for planning and implementing community-based mental health prevention programs: what does it cost?" The authors of the article identified errors in the affiliations listed. Affiliation 1 and affiliation 2 were found to be the same, so affiliation 1 was deleted. Additionally, Sharmily Roy's affiliations should be listed as affiliations 1 and 4 instead of 1 and 2. The original article has been corrected. The publisher, Springer Nature, remains neutral regarding jurisdictional claims and institutional affiliations. The authors of the article are Sharmily Roy, Henry Shelton Brown III, Lisa Sanger Blinn, Sarah Carter Narendorf, and Jane E. Hamilton. [Extracted from the article]

For patients with fibromyalgia it is important to seek strategies from science that enable them to have a better quality of life. In the present article, the evaluation of the quality of life of patients with fibromyalgia, during a physical exercise program in the community, is expressed. For this purpose, research methods and techniques were used, which allowed its logical development. Within the use of theoretical methods, historical-logical, analytical-synthetic and inductive-deductive methods were used. Among the empirical methods and techniques, observation, interview, survey and documentary review were used. Descriptive statistics were also used; mean percentage calculation and standard deviation; as well as inferential statistics; used for the comparison of related samples by means of the Wilcoxon test. As a result of the research process, significant differences are expressed in the sample studied with a significance level of p<0.005. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of a school-based creative expression program on mental health and classroom social relationships in elementary school children with refugee and nonrefugee migration backgrounds. It was hypothesized that children receiving the intervention would report less externalizing and internalizing problem behaviors, less posttraumatic functioning, and more positive classroom social relationships at posttest than children receiving education as usual, particularly for refugee children. Classes in three multiethnic Belgian elementary schools were randomly assigned to a creative intervention (7 classes, 68 students) or control condition (6 classes, 52 students). All participants (8–12 years old) had a migration background. Almost half (47%) were refugees, 53% were first- to third-generation nonrefugee immigrants. Data collection included pre- and posttest assessment with children, parents, and teachers. Multilevel analysis was used to assess outcomes. Children in the intervention condition rated the classroom climate at posttest more positive than their control peers (d =.33). Children who received the intervention did not show less symptomatic functioning than children in the education-as-usual condition. However, post hoc analysis by baseline severity showed that students with high baseline levels of posttraumatic stress reported less trauma symptoms at posttest in the intervention group than in the control group (d = −.97). This effect was moderated by children's refugee background, indicating a differential effect in which refugee children show more reduction of trauma symptoms as compared to nonrefugee immigrant children. The intervention supported classroom climate and alleviated posttraumatic stress in children with increased posttraumatic symptomatology. Public Policy Relevance Statement: The school and the relationships that develop within the school context are central to refugee and immigrant children's mental health. This study indicates that a school-based creative expression program can support classroom climate and alleviate traumatic symptoms in refugee and immigrant elementary school children. Policy makers should consider incorporating a focus on fostering classroom safety and positive peer interactions as central points of concern in their efforts to increase refugee and immigrant students' well-being. [ABSTRACT FROM AUTHOR]

Effective, scalable mental health programs are greatly needed for older adults. In this study, Mood Lifters—a peer-led, community-based program promoting mental well-being—was adapted to more specifically address the needs of older adults. Two groups completed the 14-week program via Zoom. A total of 24 participants enrolled (M age = 72 years), with 20 (83%) completing the program. Compared to baseline, program completers showed significant improvements in depression symptoms (p <.01), perceived stress (p =.04), sleep quality (p <.01), physical activity (p <.01), and brain health behaviors (p =.01), with improvements maintained at 1-month follow-up. No significant changes were reported in participants' anxiety, loneliness, or resilience. Participant ratings of program satisfaction were very high (M = 4.75/5). Results suggest Mood Lifters for Seniors is feasible to disseminate and acceptable to older adults, with preliminary evidence of benefits in several mental health domains. Future randomized trials with larger, more diverse samples are needed to confirm program benefits. [ABSTRACT FROM AUTHOR]

As children and young people today face ever increasing social, emotional and mental health challenges, schools, as one of the primary systems in children's lives, are called to broaden their agenda and help to address these challenges. This paper discusses the evaluation of a school-based, universal mental health promotion programme developed recently for the European context. The programme provides a universal curriculum from early years to high school, aiming to promote social and emotional learning and resilience and prevent social, emotional, and behavioural problems in children and adolescents. A total of 7,789 students (and their teachers and parents) from kindergarten to high school across 6 countries in Europe were recruited from 434 classrooms in 124 schools, making use of cluster sampling. A quasiexperimental longitudinal design was used to evaluate the effectiveness of the programme on students' outcomes by comparing the groups' outcomes within times (pre-test vs. post-test) and between groups (experimental vs. control group). A total of 779 classroom teachers completed pre-and-post scales measuring students' social and emotional learning, mental health and academic achievement. Results indicate that the experimental group had significantly larger increase in social and emotional competence and prosocial behaviour, and a decrease in mental health issues (externalising and internalising problems). No significant impact was found for academic outcomes. The findings are discussed in view of the limitations of the study and areas for further research. [ABSTRACT FROM AUTHOR]

Investing in school mental health programs has the potential to improve youths' access to mental health services. Barriers to the implementation of school mental health programs include limited workforce capacity, competing priorities, and lack of coordinated care. The current paper describes the history, development, and key components of the Behavioral Health Team (BHT) model that was established to promote implementation of school mental health programming. The BHT is a multi‐disciplinary team designed to maximize resources and collaboration, provide early identification of students with behavioral health needs, and match and connect students to the indicated interventions using data‐informed decision making. BHTs are tasked with selecting appropriate interventions, assuring fidelity of implementation, monitoring student progress and making adjustments based on data to enhance the sustainability and dissemination of evidence‐based prevention and intervention in schools. The paper reviews two case examples to illustrate how this model has been applied both within a large urban school district and a medium‐sized suburban school district. Results demonstrate that district support facilitates sustainability and expansion of the BHT model over time. Schools implementing this model demonstrate improvement in implementation of the BHT key components. Highlights: (1)Multi‐disciplinary school‐community teams can improve implementation of comprehensive school mental health programs and increase student access to services, yet many schools lack guidance on how to establish and sustain them.(2)The Behavioral Health Team (BHT) Model provides guidance on the implementation and key components of effective school‐community mental health teaming structures and is a promising approach to enhance the sustainability and dissemination of evidence‐based prevention and intervention in schools.(3)District support and school leadership can facilitate continuous quality improvement, sustainability, and dissemination of the BHT model. [ABSTRACT FROM AUTHOR]

The number of adolescents with mental disorders is becoming a worldwide problem, since it has an influence not only on the health of this generation while they are still in this age group but also on their health as adults. The objective of this review aimed to focus on mental health problem and health promotion program among adolescents. The significance of mental health promotion and intervention programs in enhancing adolescents' well-being and reducing mental health problems is highlighted in this study. There is an opportunity to apply a whole-school strategy with online curriculums. In the digital era, smartphone applications, social networking sites, and the Internet play an important role in daily life, there is an opportunity to develop a mental health promotion program. In addition, through the implementation of evidence-based programs, schools have been placed at the frontline of promoting positive mental health and well-being. The recommended intervention programs can be implemented in a variety of settings, including schools and communities, as well as through digital platforms. Therefore, adolescents' mental health problems can be mitigated by using effective mental health promotion programs. [ABSTRACT FROM AUTHOR]

Despite many improvements in childhood health outcomes, many children experience chronic health conditions and engage in unhealthy behaviors that can negatively affect the rest of their lives. School-based health education is one strategy to promote healthier lifestyles among children. Although health education is very prevalent in the United States, the methods used for this education are not well studied. Health education events such as voluntary tabling events (booths) were held by peer student educators and adult allies from the LA Trust for Children’s Health. This program evaluation studied the effects of voluntary peer-to-peer health education tabling events and a more traditional mandatory school-based health presentation. We analyzed survey responses from 343 high school students who attended 19 health education events at 8 public high schools in Los Angeles County. The results showed that health education tabling events at schools were viewed positively by students, allowing the vast majority to report learning useful information. The impact of the tabling events varied somewhat between grade levels and health topics. These findings can assist schools, health organizations, and health care providers in tailoring their programming to better disseminate health education materials and information, as well as understanding which health topics are interesting to students. [ABSTRACT FROM AUTHOR]

Background: Growing evidence supports the effectiveness of Internet-based prevention programs for eating disorders, but the adjunctive benefit of synchronous peer support has yet to be investigated. In the current study, a randomised controlled trial was conducted to evaluate the effectiveness of an indicated Internet-based prevention program (ProYouth OZ) with and without peer-to-peer support in reducing disordered eating behaviours and attitudes. Method: Fifty young adults (18–25 years) with eating disorder symptoms were randomised to one of three study conditions: (1) ProYouth OZ (without peer-to-peer support), (2) ProYouth OZ Peers (with peer-to-peer support), and (3) a waitlist control group. Outcomes were assessed at three different time points. Eating disorder symptoms (primary outcome) were measured with the Eating Disorder Examination Questionnaire. Results: Of 415 screened participants, 73 (17.6%) were eligible and 213 (51.3%) excluded due to severe eating disorder symptoms. Fifteen participants (30%) completed the post-intervention survey. Of the two intervention groups, 20.6% failed to access any component of the program. Of 17 ProYouth OZ Peers participants, 58.8% attended at least one chat session, 20% attended 2–5 sessions, and 11.8% attended all six sessions. Due to limited outcome data, it was not possible to statistically examine between-group differences in outcomes. Visual inspection of individual profiles revealed that both ProYouth OZ Peers participants who completed the post-intervention survey showed a decrease in disordered eating compared with only one of the six completers in ProYouth OZ. Conclusion: Findings highlight the challenges of trialling Internet-based eating disorder prevention programs in the community. The study identified a large group of emerging adults with eating disorders who were interested in an Internet-based program, suggesting a high level of unmet need. Future research on synchronous peer-to-peer support in Internet-based prevention for eating disorders is warranted. Further studies are required to identify optimal strategies for reaching this population (e.g., online vs. offline) and evaluating the effectiveness of a range of strategies for promoting engagement. Finally, there is an urgent need to develop innovative widely accessible interventions for individuals who experience clinically relevant eating disorder symptomatology but may not be ready or able to seek professional face-to-face treatment. Trial registration: ACTRN12615001250527, Registered 16 November 2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615001250527 Plain English summary: Internet-based prevention programs for eating disorders are effective, but a variety of challenges have been found when offering them in real-world settings. The current study aimed to test ProYouth OZ, an Internet-based eating disorder prevention program consisting of multiple components including peer support. In total, 50 young adults (18–25 years) with eating disorder symptoms were allocated to one of three versions of the program. In total, 21% did not access the program. From 17 participants in the peer support group, 60% attended at least one chat session and 12% attended all six sessions. Given that only fifteen participants (30%) completed the questionnaire after the intervention, it is not possible to draw reliable conclusions about the effectiveness of the program. Findings demonstrate the difficulty of recruiting emerging adults, engaging them with the program and collecting data after participation. The majority of interested participants experienced an eating disorder, suggesting they may be searching for help online. Future studies should investigate the use of peer support, identify strategies for reaching eligible participants and develop approaches to increase engagement. Finally, it is important to develop innovative programs that provide self-help strategies and facilitate help-seeking for those who are experiencing an eating disorder. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to assess the effectiveness of a school-based mental health awareness program among school age children. Methods: This was a quantitative study that recruited 178 parents and 150 students from different levels (Grades 5-10) attended the awareness activity at two middle schools in Oman. A convenient sampling approach was utilized. Results: There was a significant different in mood and feelings score between the grades (P = 0.001); with grade 10 being the highest disturbed mood changes (M = 23.25, SD = 5.54). The results also showed that 55% of students experienced anxiety. From the analysis, it was found that grade 10 (M = 36.15, SD = 18.43, P = 0.05) reported higher anxiety than others groups. The results indicated also a strong correlation between experience of bullying and mental health problems (r = 0.85). The evaluation of awareness program indicated that 91% of parents reported improvement in knowledge; 89% suggested that many information they were not aware of before. 92% rated the video as informative. 93% agreed that the program activities were entertaining and informative. 92% reported that the activity increased their awareness to observe the changes in their children emotional wellbeing. 98% of parents enjoyed the activities and rated the overall program as effective and very interesting. Conclusion: There is a dire need to conduct various awareness programs in the community. Such programs are not only helpful in improving the community knowledge on the factors influencing children's mental health, but also assist in identifying the mental health problems at early stage; which may empower them to seek early management for their children. This study suggests an establishment of a mental health program for children in Oman to identify the cases, assess the mental problems affecting children at different ages and refer them for further support and management. [ABSTRACT FROM AUTHOR]

Background: In low- and middle-income settings, many people with mental health problems cannot or do not access psychiatric services. Few studies of people with epilepsy and mental problems have evaluated the effectiveness of a predominantly psycho-social intervention, delivered by lay community workers. The aim of this study was to assess the effectiveness of a community-based complex mental health intervention within informal urban communities while simultaneously addressing social determinants of mental health among disadvantaged people with severe and common mental disorders (CMDs), and epilepsy. Methods: In this observational, prospective cohort study set in Uttarakhand, India, the lay-worker led intervention included psychoeducation, behavioural activation, facilitation of access to care, and facilitated psycho-social support groups. Participants were categorised as having a severe or CMD or epilepsy and assessed 5 times over 24 months using primary outcome measures, including the Patient Health Questionnaire (PHQ9) (severity of depression), the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the Recovery Star, and scoring of a bespoke Engagement Index. Analysis included descriptive statistics as well as hierarchical linear regression models to report fixed effects as regression coefficients. Results: Among the 297 (baseline) participants only 96 people (31%) regularly used psychotropic medication (at least 4 weeks) and over 60% could not or did not consult a psychiatrist at all in the study period. Nonetheless, people with CMDs showed a significant reduction in their depression severity (PHQ9: B = -6.94, 95% CI -7.37 to -6.51), while people with severe mental disorders (SMDs) showed a significant reduction in their disability score (WHODAS 2.0: B = -4.86, 95% CI - 7.14 to- 2.57). People with epilepsy also reduced their disability score (WHODAS 2.0: B = -5.22, 95% CI -7.29 to -3.15). Conclusion: This study shows significant improvements in mental health, depression, recovery, disability and social engagement for people with common and SMDs, and epilepsy, through a community-based intervention that was nonpharmaceutical. It provides preliminary evidence of the value of predominantly psycho-social interventions implemented by lay health workers among people with limited or no access to psychiatric services. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the feasibility of an 18-week exercise program for adolescents with cerebral palsy (CP). Fourteen individuals aged 16-25 (GMFCS I-III) performed aerobic and strength exercises at their community leisure centre up to three times a week. A physiotherapist provided instruction at the first session and between 2-4 times thereafter. The fitness instructor on duty provided supervision when required. Feasibility of the exercise program was explored through an exercise logbook and participant feedback questionnaire. Gross motor function, muscle strength, aerobic capacity and the Timed Up and Go test were assessed at baseline, 6, 12 and 18 weeks. Quality of life and self-esteem were measured at baseline, 12 and 18 weeks. Participants completed a mean 14.8 (range 5-23) weeks of the exercise program and a mean of 31 (range 10-52) sessions. The results of the feedback questionnaire suggested that the exercise program was mostly well accepted. Adverse effects (muscle soreness and fatigue) were reported by three participants. Results indicated the feasibility of a community exercise program for adolescents with CP and recommendations for sustainable exercise programs for this group were provided. [ABSTRACT FROM AUTHOR]

Oregon's Public Mental Health System includes a continuum of small community - based residential programs offering mental health treatment and 24/7 personal care support for adults experiencing severe mental illness. A team of several mental health paraprofessionals working under the direction of the facility administrator and the Master level therapist strive to gently challenge residents to set personally meaningful goals, practice functional skill and slowly take charge of their lives in the community. The author asserts that the manner in which daily operational and behavioral challenges are resolved by the team, affects residents' lives not less than strictly therapeutic interventions. This paper has a twofold aim: 1) To characterize leadership, organization and staff communication as building blocks of the collaborative, person-centered and strength-based residential treatment; 2) To show how clinical and administrative processes must interplay to create a spirt of recovery and optimism in the home-like community residential facilities. [ABSTRACT FROM AUTHOR]

Background: Pasung is the term used in Indonesia and a number of other countries for seclusion and restraint of people with mental illness in the community, usually at home by their family. While pasung has been banned because it is contrary to human rights, its practice continues to exist within the community, particularly where community mental health services are limited, and in the absence of adequate social support, and pervasive negatives beliefs about mental illness. It is essential to understand the reasons for the ongoing use of pasung and to examine potential solutions. Methods: A systematic review and narrative synthesis of peer-reviewed international literature was conducted to identify the socio-cultural contexts for pasung use, and interventions to address it. The analysis draws on the socio-ecological framework, which focused on relationships between the individual and their environment. Result: Fifty published articles were included in the review; all studies were conducted in Asia and Africa, with 32 undertaken in Indonesia. Most studies were qualitative (n = 21). Others included one case–control study, one cross-sectional study, and seven surveys; only four studies examined the application of an intervention, and each used a pre and post methodology. Of these, two studies tested psychoeducational interventions which aimed to overcome family burden due to pasung, and each suggested a community mental health approach. The remaining two studies evaluated the intervention of 'unlocking'; one study used a community-based culturally sensitive approach, and the other used a community-based rehabilitation program. Reasons for pasung given by family appear to be as a last resort and in the absence of other supports to help them care for the person with severe mental illness. Conclusion: The findings highlight that a mixture of individual, interpersonal, community and policy interventions are needed to reduce the use of pasung. While consumer and carer involvement as part of a socio-ecological approach is understood to be effective in reducing pasung, an understanding of how to elaborate this in the management of pasung remains elusive. Review Registration CRD42020157543: CRD [ABSTRACT FROM AUTHOR]

The unique mental health context of children in Latinx immigrant families calls for innovative community‐based intervention strategies. We use an ecological public health approach to highlight the importance of community‐based organization (CBO) settings, the critical role of community‐based paraprofessionals (i.e., non‐clinicians, near‐peers) and capacity‐building, and the expansion of mental health promotion strategies to include realistic, day‐to‐day supports for Latinx immigrant parents and families. This realigns mental health with the goals and mission of trusted spaces, like CBOs, that can offer more equitable and non‐stigmatized access for Latinx immigrant families. We draw upon two strength‐based and empowerment‐focused interventions that utilize community‐based workforces to promote positive parenting skills (Partners Achieving Student Success‐PASS; Mehta et al., 2019) and self‐advocacy skills (Community Advocacy Project‐CAP; Sullivan & Bybee, 1999) to provide the conceptual framework for Family Mental Health Advocacy (FMHA). FMHA aligns mental health promotion with the advocacy mission of CBOs, engages CBO staff with feasible mental health "messages," and empowers immigrant parents as critical change agents in the lives of their children. We acknowledge the challenges associated with implementing mental health promotion strategies and providing workforce support, as well as the importance of local and national policy influences. Highlights: CBOs offer more equitable and non‐stigmatized access to services for Latinx immigrant families.Mental health promotion models need to leverage the skills of paraprofessional workforces.Family Mental Heath Advocacy (FMHA) draws from strength‐based and empowerment‐focused interventions.FMHA engages CBO staff in how to promote parent self‐advocacy skills and provide parenting supports. [ABSTRACT FROM AUTHOR]

Highlights: Only known study focused on operationalizing mental well‐being for men and boysConcept mapping was used to develop a definition of men and boys' mental well‐being.Eight areas emerged as important aspects when defining men and boy's mental well‐being.Socio‐environmental and emotional well‐beings were the overarching domains of mental well‐being. A primary purpose of many prevention‐oriented interventions is to improve the general well‐being and quality of life for individuals and their communities. Unfortunately, well‐being is often poorly defined, with definitions embracing related issues of quality of life, happiness, and physical health. Mental well‐being as a concept is also poorly defined, particularly for different population groups. As part of a larger study to assess community‐level prevention efforts aimed at men and boys, a participatory approach was used to operationalize mental well‐being from a male‐centered, community‐based perspective using concept mapping. A set of 96 statements perceived as important aspects of mental well‐being for men and boys were developed and sorted by 90 participants from the study communities. The 8‐cluster solution was selected as the most parsimonious and the best conceptual fit in relation to the mental well‐being concept, namely, positive self‐worth, supportive community, community connections, positive masculinity, responsive institutions, strong social connection, dignity and respect, and safety. These eight clusters of mental well‐being, which were classified into two overarching domains of socio‐environmental and emotional well‐being, can provide a basis by which to assess community‐based programs aimed at this population. [ABSTRACT FROM AUTHOR]

This study aims to explore the effectiveness of clinical treatment for male survivors of childhood sexual abuse (CSA) who deal with depression, anxiety, stress, and posttraumatic stress disorder (PTSD). Secondary data was used in the study, and a one-group pretest-posttest design was employed to compare pretest (n = 346) with posttest (n = 91) scores. The analysis shows statistically significant improvements with respect to depression, anxiety, stress, and PTSD after treatment. There was no statistically significant difference between individual and mixed treatment (including group and individual counselling) regarding alleviating mental health symptoms. Treatment appeared to have a positive effect on reducing mental health symptoms for sexually abused adult males. This exploratory study can be used for the generation of evidence-based knowledge for treatment and its ability to reduce negative mental health symptoms for adult male survivors of CSA. However, the findings are limited due to methodological limitations, such as the absence of a comparison group, small sample size, and self-report data. The study's findings should be understood as a preliminary contribution to the limited empirical research on the therapeutic utility of a male-specific treatment modality based on trauma-focused cognitive and behavioral therapies (TF-CBT) and the gender role strain paradigm (GRSP). [ABSTRACT FROM AUTHOR]

Development of a multicomponent mental health consultation program for a countywide Head Start program is described. The consultation program incorporates strategies from the evidence‐based practice, Teacher–Child Interaction Training (TCIT). Through large group professional development trainings before the school year, comprehensive feedback reports based on observations, and in‐class coaching via modeling and performance feedback on teachers' use of TCIT skills, the consultation program served 55 Head Start classrooms with 789 children. Outcome data are presented on teachers' improvement in TCIT skill use and the relative effectiveness of two coaching methods (i.e., modeling and performance feedback) used during consultation. Results from multilevel modeling analyses indicated that teachers improved in the use of multiple observed TCIT skills between the initial and midyear assessment (i.e., increased frequency of labeled praises, reflections, behavioral descriptions, and commands that were complied with; decreased frequency of commands that children did not have an opportunity to comply with). Additionally, teachers who received coaching in the form of performance feedback, in comparison to modeling, exhibited greater gains in the frequency of labeled praises and commands that resulted in compliance. Discussion focuses on implementation of evidence‐based practice in large‐scale preventative early interventions, study limitations, and directions for future research. [ABSTRACT FROM AUTHOR]

Background: School safety is fundamental to fostering positive outcomes for children. Violence remains a critical public health issue with 8.1% of elementary and 21.8% of middle school students reporting daily or weekly bullying in 2015–16. Similarly, over half of lifetime mental health concerns become evident before age 14. Thus, elementary school is a key time for comprehensive school safety interventions. Yet, interventions are rarely delivered with fidelity in community settings. Evidence-based interventions must be complemented by implementation strategies to achieve desired public health outcomes. Methods: We develop and test an intervention focused on promoting a positive school climate guided by a school-based 3-person leadership team (3-PLT) using a hybrid Type II design. The 3-PLT includes a School Resource Officer, (SRO), administrator and mental health services professional as a newly appointed climate specialist (CS). The interventions to be delivered include 1) Restorative justice, 2) Mental Health First Aid and 3) Crime Prevention Through Environmental Design. The CS will lead the team and coordinate implementation through a process of interactive problem solving and supports, consistent with the implementation facilitation strategy. We will conduct a cluster randomized controlled trial with staged entry over two school years in Genesee County, Michigan (n = 20 elementary schools, with 10 participating per school year). We will use a combination of data sources including data collected by schools (e.g., discipline data), a student survey, and a teacher survey. We will also conduct a process evaluation and assess implementation and sustainability through focus groups with key stakeholders, teachers, and students. Finally, we will conduct a cost-benefit analysis. Discussion: Results from both the behavioral outcome and implementation strategy evaluations are expected to have significant implications for school safety and student well-being. This study adopts a unique approach by integrating three evidence-based programs and incorporating implementation facilitation led by the CS as part of the 3-PLT to support intervention delivery and enhance public health impact among schools in disadvantaged communities with students at risk of poor health outcomes. This study aims to create a comprehensive, well-integrated model intervention that is sustainable and can be translated to similar high-risk settings. Trial registration: Trial was retrospectively registered, registration ISRCTN1226421, May 16, 2019. [ABSTRACT FROM AUTHOR]

This study aims to analyze Positive Education as a possible pedagogical alternative to the conventional educational system. Due to the high rates of mental disorders among young people around the world, the school emerges as a privileged space offering an extraordinary opportunity to reach out to a large number of children and young people and to combat this phenomenon. Positive Education integrates scientifically validated guidelines from Positive Psychology and aims to promote students' well-being and academic success. After the conceptual presentation of Positive Education, this study demonstrates several current researches, through a Systematic Review of Literature done at the Online Knowledge Library (B-on). The investigations analyzed indicate that through the application of program-based intervention with scientific evidence that promote well-being in the educational community, the school can in fact be a positive institution that promotes mental health. [ABSTRACT FROM AUTHOR]

Context: With increased depression, anxiety, and loneliness, communities need resources that support a culture of mental and emotional (M&E) well-being. Because other resources, such as Mental Health First Aid, require substantial time commitment and focus on intervening during crises and suicidality, rural community members developed COMET (Changing Our Mental and Emotional Trajectory), a universal community-based training program, to move upstream to prevent M&E health crises. COMET Community Training (CT) teaches people how to initiate a supportive interaction for a potentially emotional conversation using the simple, seven-item COMET conversational guide. The COMET Train the Trainer (T4T) equips community members to serve as their own local CT trainers. Objective: Describe training implementation and evaluation. Study Design: Survey and field notes. Setting: Rural communities. Population Studied: COMET CT and T4T attendees. Intervention/Instrument: Both trainings are 90-120 minutes. CT covers the local epidemiology of mental health, being "the other person", instruction on COMET questions, role-play, and resources for follow-up. T4T includes program development and training tips. Trainees complete pre- and post-surveys. Outcome Measures: For CTs, the number and location of trainings, participant demographics, assessment of training structure, and intentions to use. For T4T, outcomes also include relevance of materials and preparedness to conduct community member training. Results: Fifteen people completed COMET T4T. Most (93%) T4T trainees identify as female. Mental health care (40%) and the agricultural industry (25%) were the most common professional categories. 80% agreed/strongly agreed they feel prepared to deliver the CT. More time to practice was a main strategy to improve the T4T. Over 300 people have attended 25 CTs. Of these, 76% reported they were likely to use the COMET questions to engage an acquaintance or co-worker after training compared to 48% before. 81% reported a 7 or higher on a scale of 1-10 for likelihood of using the COMET questions in the next 3 months. Conclusions: COMET aims to prevent M&E health crisis, complement efforts in primary and behavioral health practice settings, and fill a public M&E health gap, particularly in rural communities. The COMET T4T and CT are accessible to diverse and hard-to-reach community members and are increasing in demand. Evaluation results offer useful modifications to strengthen the program. [ABSTRACT FROM AUTHOR]

Background and Objective: The students studying at the universities of medical sciences deal with numerous stressors during their educational experiences in the healthcare settings, which lead to poor mental health status and low performance. Regarding the role of students in the provision, maintenance and promotion of community health, this study was aimed to determine the self-assessment of mental health among students of Iran University of Medical Sciences. Materials and Methods:In this descriptive-analytical study, 300 students of the 8600 Iranian medical sciences students were randomly selected. The data collection was performed using a demographic form and a researcher-made questionnaire on self-assessment of mental health, validity and reliability of which were obtained. Data was analyzed by SPSS 16 using descriptive index and analytical tests at a significant level of 0.05. Results: The mean and standard deviation of self-assessment of students' mental health was 89.08±13.12. Also 14.7% of the students reported their mental health as poor, 70.3% as moderate and 15% as good. The mean age of the students was 25±6.21 years. The mean score of dimensions of ability to overcome anger and anger, the ability to balance the rest and activity and the ability to overcome anxiety were 3.1±0.08, 3.13±0.97 and 3.16±1.1 respectively. Also, there was a significant relationship between gender and hookah consumption with mental health (P<0.01 and P<0.009). Conclusion: Due to the low level of mental health in the dimensions of overcoming anger and anxiety and the student's role in securing and improving community health. The design of educational and promotional interventions to increase the anxiety management and anger management skills in the students is necessary to improve mental health of students. [ABSTRACT FROM AUTHOR]

Task shifting from trained clinicians to community health workers (CHWs) is a central, primary health care strategy advocated by global health policy planners in resource-poor settings where trained health professionals are scarce. The evidence base for the efficacy of these programs, however, is limited—in particular, research that identifies their potential unintended consequences. Based on sustained ethnographic study of CHWs working for AIDS projects in South Africa at the height of the country's AIDS epidemic, this article identifies how structural and local factors produced unintended consequences for CHW programs. These consequences were (a) CHWs moonlighting for multiple organizations, (b) CHWs freelancing in communities without regulation, and (c) adverse patient outcomes resulting from uncoordinated care. These consequences stemmed from structural elements of a bureaucratically weak health system and from local grassroots dynamics that jeopardized long-term CHW program sustainability and eroded national health goals. [ABSTRACT FROM AUTHOR]

Objective: Individuals with serious mental illness experience excess mortality related to general medical comorbidities. Reverse-integrated and reverse-colocated models of care have been proposed as a system-level solution. Such models integrate primary care services within behavioral health settings. Further understanding of consumer perspectives on these models is needed to ensure that models adequately engage consumers on the basis of their expressed needs. This qualitative study examined the perspectives of English- and Spanish-speaking individuals with serious mental illness on their current experience with the management of their medical care and on a hypothetical reverse-colocated care model.Methods: Semistructured interviews were conducted in a purposive sample of 30 individuals with serious mental illness recruited from two outpatient mental health clinics affiliated with a comprehensive community-based program. The interview assessed the participant's current experience with the management of their health care, followed by a vignette describing a reverse--colocated care model and questions to elicit the participant's reaction to the vignette. An inductive thematic analysis was employed.Results: Consumers expressed positive views of the potential for working with trusted staff, increased communication, and access to care through reverse colocation. Reflections on current health management experience were notable for an emphasis on self-efficacy and receipt of support for self-management strategies from mental health clinicians.Conclusions: Study findings add to prior literature indicating support for assistance with management of general medical health in the mental health setting among individuals with serious mental illness. Key themes similar to those in previous studies generate hypotheses for further evaluation. [ABSTRACT FROM AUTHOR]