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Schools offer an advantageous setting for the prevention, early identification, and treatment of mental health problems for youth. However, school mental health (SMH) services are typically not based on evidence for effectiveness, nor are they efficiently delivered, with SMH practitioners (SMHPs) able to only treat a small number of students in need. The current study evaluated the feasibility, acceptability, efficiency, and outcomes of a four-session assessment, engagement, problem-solving, and triage strategy for SMHPs that aimed to improve efficiency while being based on elements of evidence-based care. The study, conducted in 15 US school districts in three states, used stratified random assignment to assign 49 high schools and their participating SMHP(s) to either the Brief Intervention for School Clinicians (BRISC; N = 259 students) or services as usual (SAU; N = 198 students). SMHPs implemented BRISC elements with adequate to excellent fidelity and reported the strategy was feasible and well-aligned with presenting problems. Students assigned to BRISC reported significantly greater engagement in SMH at 2 months and completion of SMH treatment by 6 months. BRISC-assigned SMHPs reported significantly greater treatment completion after four sessions (53.4%) compared to SAU (15.4%). Students in the BRISC condition also reported significantly greater reduction in problem severity as evaluated by the Youth Top Problems Assessment. No differences were found for anxiety or depression symptoms or overall functioning. Results indicate that BRISC is a feasible early intervention and triage strategy that may aid in more efficient provision of SMH services with no compromise to SMH effectiveness. [For the corresponding grantee submission, see ED627858.]

Multidisciplinary teams of school- and community-employed mental health, health, and educational staff work together in schools to offer a full continuum of mental health promotion, prevention, early intervention, and treatment services and supports. Intentional teaming structures and practices are essential to ensure teams deliver effective, coordinated services and supports. The current study investigated the extent to which continuous quality improvement strategies improved school mental health team performance during a 15-month national learning collaborative for 24 school district teams. All teams significantly improved their average teaming performance from baseline to the end of the collaborative (t(20) = -5.20, p < 0.001). Plan-Do-Study-Act (PDSA) cycles allowed teams to rapidly evaluate specific quality improvement changes to improve their performance. Teams with the most improvement focused on increasing multidisciplinary team membership, avoiding duplication and promoting efficiency, and connecting to community mental health providers/resources.

Objective: Suicide prevention programs help college staff and students identify students at-risk for suicide. "Kognito" is an online, simulation-based suicide prevention program. The purpose of the current study was to evaluate "Kognito's" effectiveness in changing suicide prevention attitudes and behavior. Participants: 170 college students and 140 college staff completed the training module and three surveys. Methods: College staff and students from 24 public, private, and community colleges and universities in Maryland completed "Kognito" modules and pre-, post-, and 3-month follow-up assessments. Results: Both college staff and students exhibited significant improvements in reported Preparedness, Likelihood, and Self-Efficacy in gatekeeper attitudes. Students reported significant gains in gatekeeper intervention behaviors. Conclusions: The current results suggest that "Kognito" is associated with attitudinal change for college staff and students, but only college students demonstrated statistically significant behavioral impact for both being more likely to ask about suicide and refer peers to counseling.

The Center for School Mental Health Assistance at the University of Maryland recently completed a review of evidence-based prevention and treatment programs that can be used by school mental health clinicians. Based on the review, a school-based program operating in 22 Baltimore City schools has purchased and trained clinicians in a number of protocols for evidence-based interventions. We present findings from this review and make pragmatic recommendations for school mental health programs to overcome the challenges associated with the use of evidence-based interventions.KEY WORDS: evidence-based prevention; treatment programs; school mental health.

Nobody wants to be here. In remedial English, earning no credit, stuck. Now--after months of commas, clauses, and four-paragraph essays--students have one last chance to write their way out. Twenty students sit at computers, poised to start the final in-class essay for English 002 at Montgomery College. Anybody can enroll here, and all kinds do. In 85 minutes the students must craft a thesis and clear topic sentences, using evidence to support their opinions. They have to answer one of three questions, about their assigned book, "The Absolutely True Diary of a Part-Time Indian," by Sherman Alexie, or their difficulty in mastering goals for the course, such as "Write and edit sentences that observe the conventions of standard American English." The students in English 002 stand at higher education's threshold. If they make it through, they advance to college-level courses that count toward a degree. Otherwise they must decide whether to try again, running down their financial aid, or give up on college and make do without it. For now, they all belong to the second-chance club known as remedial education. They're here because something, somewhere, went wrong. They didn't care about school, or school didn't care about them. For some, reading or writing never came easily. Maybe they didn't speak English as children. Or they lacked money, guidance, opportunity. Courses like English 002 are supposed to catch them all up. It's a lot to ask. Many students have a long way to go, and their obstacles are hardly confined to the classroom. Nationally, of the students who place into remediation--as many as 90 percent at some community colleges--only about a quarter go on to earn a degree. Here, past failures have worn some students down, and the prospect of success seems to frighten them. Several hope to attend four-year colleges and pursue careers, yet some have struggled to pull clear of bad circumstances or habits. Others are just drifting through.

The American Academy of Pediatrics recommends pediatric providers routinely screen for, assess, and treat substance use and substance use disorders among adolescents, a process called "Screening, Brief Intervention, and Referral to Treatment," or "SBIRT." Because there are limited data on how Maryland pediatric practices have adopted SBIRT, a quality improvement initiative was developed within the Maryland Adolescent and Young Adult Health Collaborative Improvement and Innovation Network using a "Plan/Do/Study/Act" approach. A 2-part provider training was conducted regarding screening and motivational interviewing, and the "CRAFFT" screening tool was integrated into the practice's electronic medical record. Results from evaluation demonstrated significant improvements in provider knowledge, attitudes, and screening behavior. The association between substance use and sexual behavior suggests a need for further expansion of this model with inclusion of sexual health screening. Overall, this study demonstrates that SBIRT implementation into a general pediatric practice is highly feasible, acceptable, and shows preliminary effectiveness. [ABSTRACT FROM AUTHOR]

Youth with problem gambling behaviors are susceptible to serious academic, behavioral, and mental health consequences including school failure, criminal involvement, and depression. Coupled with increased exposure to gambling formats, issues related to youth gambling have been deemed a serious public health issue requiring increased prevention efforts. However, the literature is limited in terms of evidence-based gambling prevention programs warranting the development of The Maryland Smart Choices Program (MD-Smart Choices), a gambling prevention program for middle and high school youth. This 3-session, 45-min program was developed for implementation in Baltimore City Public Schools, an urban and predominately African American district with specific aims to engage students, encourage positive behavior, and facilitate learning related to gambling disorder. Pre-post program participation assessments were collected from 72 students across 5 different schools. Results yielded significant increases in student awareness and knowledge following participation in MD-Smart Choices. Focus group data collected from program facilitators suggested high student engagement and participation, program feasibility, and ease of implementation. Study implications and future directions are discussed. [ABSTRACT FROM AUTHOR]

Gary Pavela, director of student judicial programs at the University Maryland at College Park, is an expert on how colleges can assist troubled students. In a forthcoming installment of his weekly newsletter on campus law and policy, the "Synfax Weekly Report," Mr. Pavela discusses Monday's shootings at Virginia Tech. Among other observations, he says administrators' ability to identify violent offenders is limited. "We're pretty good at predicting how cows will behave," he writes. "But people live in both an idealized world and the physical world around them. The complexity of that mental interaction remains beyond the scope of our best predictive models." In this interview, he discusses how administrators and faculty members are limited in what they can do to help students they're concerned about. He also describes ways of removing a troubled student from a campus.

Few studies have examined recovery from opiate and cocaine dependence without treatment, referred to as "natural recovery," "spontaneous recovery," and "spontaneous remission." The present study examined the relationship between network characteristics and cessation of heroin, cocaine, and crack use in a sample of underclass inner-city injection drug users in Baltimore, Maryland. Participants were enrolled in an experimental human immunodeficiency virus (HIV) preventive intervention. Between the baseline and follow-up interviews, which averaged 5.2 months, 24 (7%) of 335 participants reported ceasing to use heroin, cocaine, and crack. Individuals who had reported cessation of drug use at follow-up had reported at baseline a smaller proportion of their network members with whom they used drugs (p < .02). Using multiple logistic regression analyses and adjusting for baseline drug use, enrollment in drug treatment, and demographic and background variables, cessation of drug use was associated with a lower proportion of personal network members in one's drug network (odds ratio [OR] = 25.4, p < .05). The data from this study suggest that network members have potential for social influence on the cessation of drug use. [ABSTRACT FROM AUTHOR]

As part of a longitudinal surveillance program, 35 members of a larger cohort of 77 Gulf War I veterans who were victims of depleted uranium (DU) “friendly fire” during combat underwent a 3-day clinical assessment at the Baltimore Veterans Administration Medical Center (VAMC). The assessment included a detailed medical history, exposure history, physical examination, and laboratory studies. Spot and 24-h urine collections were obtained for renal function parameters and for urine uranium (U) measures. Blood U measures were also performed. Urine U excretion was significantly associated with DU retained shrapnel burden (8.821 μg U/g creatinine [creat.] vs. 0.005 μg U/g creat., p = .04). Blood as a U sampling matrix revealed satisfactory results for measures of total U with a high correlation with urine U results (r = .84) when urine U concentrations were ≥0.1 μg/g creatinine. However, isotopic results in blood detected DU in only half of the subcohort who had isotopic signatures for DU detectable in urine. After stratifying the cohort based on urine U concentration, the high-U group showed a trend toward higher concentrations of urine β2 microglobulin compared to the low-U group (81.7 v. 69.0 μg/g creat.; p = .11 respectively) and retinol binding protein (48.1 vs. 31.0 μg/g creat.; p = .07 respectively). Bone metabolism parameters showed only subtle differences between groups. Sixteen years after first exposure, this cohort continues to excrete elevated concentrations of urine U as a function of DU shrapnel burden. Although subtle trends emerge in renal proximal tubular function and bone formation, the cohort exhibits few clinically significant U-related health effects. [ABSTRACT FROM AUTHOR]

The article describes a districtwide revision of grammar teaching practices and how rhetorical tools were applied in a variety of high school classrooms to improve writing and reading comprehension in Maryland. It was apparent from the start that the grammar initiative needed to include ongoing staff development and meaningful curricular changes. The teachers had the opportunity to reflect on their own grammar knowledge and their classroom practices and to hear about new linguistic grammar. In the initiative's pilot year, 2004-2005, the teachers taught the ten patterns and integrated them into instruction in literature and composition.

As storms become increasingly intense and frequent due to climate change, we must better understand how they alter environmental conditions and impact species. However, storms are ephemeral and provide logistical challenges that prevent visual surveys commonly used to understand marine mammal ecology. Thus, relatively little is known about top predators' responses to such environmental disturbances. In this study, we utilized passive acoustic monitoring to characterize the response of bottlenose dolphins to intense storms offshore Maryland, USA between 2015 and 2017. During and following four autumnal storms, dolphins were detected less frequently and for shorter periods of time. However, dolphins spent a significantly higher percentage of their encounters feeding after the storm than they did before or during. This change in foraging may have resulted from altered distributions and behavior of their prey species, which are prone to responding to environmental changes, such as varied sea surface temperatures caused by storms. It is increasingly vital to determine how these intense storms alter oceanography, prey movements, and the behavior of top predators.