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Objective: This study utilised digital technology to assess the clinical needs of young people presenting for care at headspace centres across Australia. Method: 1490 young people (12–25 years) who presented to one of 11 headspace services from four geographical locations (urban New South Wales, urban South Australia, regional New South Wales, and regional Queensland) completed a digital multidimensional assessment at initial presentation. Characteristics were compared between services and geographical locations. Results: We identified major variation in the demographics, and the type and severity of needs across different services. Individuals from regional services were more likely to be younger, of Aboriginal and Torres Strait Islander origin, and present with psychotic-like symptoms and suicidality, while those in urban areas were more likely to have previously sought help and have problematic alcohol use. Further differences in age, distress, depressive symptoms, psychotic-like experiences, trauma, family history, alcohol use, education/employment engagement, and days out of role were identified between different urban sites. Conclusions: The variability between services provides insight into the heterogeneity of youth mental health populations which has implications for appropriate early intervention and prevention service provisions. We propose that integrating digital technologies has the potential to provide insights for smarter service planning and evaluation. [ABSTRACT FROM AUTHOR]

Health halo effects are a form of biased processing, wherein a particular product claim bleeds over to other categories of analysis or to an overall healthier impression. This study tests whether the term tobacco-free nicotine triggers a health halo effect. Through an experiment with middle school youth (n = 599), we vary the flavor (tobacco vs. fruit) and nicotine source information (nicotine/tobacco-free nicotine/nicotine from tobacco) on the warning label of the vaping product participants viewed. We evaluate product measures (nicotine content beliefs, nicotine source beliefs, and risk perceptions) and comparative nicotine source misperceptions (addictiveness, safety, and risk). Findings show that the term tobacco-free nicotine triggers inaccurate nicotine content beliefs, nicotine source beliefs, and misperceptions associated with addictiveness, safety, and risk. We conclude with theoretical and regulatory implications. [ABSTRACT FROM AUTHOR]

Background: Children exposed to household challenges (i.e., parental substance use, incarceration, and mental illness) are among the groups most vulnerable to sexual risk-taking in adolescence. These behaviors have been associated with a range of negative outcomes later in life, including substance abuse, low educational attainment, and incarceration. Adapting an evidence-based intervention (EBI) to be suitable for this population is one strategy to address the needs of this group. Methods: In this study, we describe the use of the Intervention Mapping for Adaption (IM-Adapt) framework to adapt an evidence-based, sexual health intervention (Focus on Youth with Informed Children and Parents). We describe the actions taken at each step of the IM-Adapt process which are to assess needs, search for EBIs, assess fit and plan adaptions, make adaptions, plan for implementation and plan for evaluation. Results: Key changes of the adapted intervention include the incorporation of trauma-informed principles and gender inclusive language, standardization of the session length, and modernization of the content to be more appropriate for our priority population. Conclusions: The adapted intervention shows promise toward meeting the behavioral health needs of Black youth exposed to household challenges. Our process and approach can serve as a model for researchers and practitioners aiming to extend the reach of EBIs. [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]

Emerging literature has highlighted the importance of discerning general and strategic organizational context (OC) factors (e.g., leadership and climate) and their interaction effect on individual implementation behaviors (e.g., attitudes toward evidence-based practices; EBPs) in youth mental healthcare. This study aimed to examine how leadership and climate (general and strategic) are associated with implementer attitudes toward EBPs across the individual and organizational levels and their interaction effect in schools. A series of multilevel models (MLMs) were fitted on a diverse sample of schools actively implementing universal prevention programs for youth mental health (441 implementers from 52 schools). The organization-level aggregates and individual educators' perceptions of general and strategic leadership and climate, and their interaction terms, were entered as level-2 and level-1 predictors of four attitudinal dimensions (Requirement, Openness, Appeal, and Divergence) based on their level of measurement. At the organizational level, higher levels of strategic leadership and climate, but not their general counterparts, were consistently associated with more favorable attitudes in all four dimensions. At the individual/within-school level, higher levels of perceived general and strategic leadership and climate were associated with more favorable attitudes of Requirement and Openness. At the organizational/between-school level, general climate moderated the positive effect of strategic climate on implementers' perception of appeal and divergence of EBPs. Our findings indicate that leaders should make data-based decisions to allocate resources on strategic and/or general leadership and climate to foster favorable staff attitudes toward EBPs based on the level of measurement, implementation-specificity, and attitudinal dimensions. [ABSTRACT FROM AUTHOR]

With growing diversity within the U.S. population and notable barriers to accessing behavioral health care, marginalized youth are placed at risk for developing psychosocial and mental health problems. Promoting evidence-based interventions (EBIs) through school-based mental health services may improve accessibility and quality of care for marginalized youth facing mental health disparities. Culturally sensitive interventions (CSIs) may further improve engagement with and effectiveness of EBIs with marginalized youth. In this article, we provide guidelines for advancing CSIs when implementing and adapting EBIs with marginalized youth in schools. First, we emphasize inclusive strategies for advancing CSIs with marginalized youth in schools, focusing on antiracist adaptations to interventions and using a community-based participatory research approach when implementing EBIs. Following, we discuss techniques for tailoring CSIs to more effectively support marginalized youth and their families with school-based prevention and treatment. Specifically, we recommend using the Adapting Strategies for Promoting Implementation Reach and Equity framework as a guide to promote equitable implementation as well as key strategies for engaging marginalized youth and their families with school-based EBIs. Ultimately, we offer these guidelines to address disparities and inform more equitable practice in youth mental health care—and to motivate future studies advancing culturally responsive services with marginalized youth in schools. Public Policy Relevance Statement: Promoting evidence-based interventions (EBIs) through school-based mental health services may improve accessibility and quality of care for marginalized youth facing mental health disparities. Inclusive and culturally sensitive EBIs may be especially useful for addressing inequities in marginalized youths' mental health outcomes. We provide guidelines and practical recommendations for implementing and adapting inclusive and culturally sensitive EBIs with marginalized youth in schools. [ABSTRACT FROM AUTHOR]

In Canada, sexual and gender minority youth use opioids at disproportionately high rates. Yet, little is known about the distinct contexts of opioid use within this group, challenging capacity to develop well founded policy and practice supports. This case study aims to examine – in depth – the experiences and contexts of opioid use among a sample of four sexual and gender minority youth in Vancouver, Canada. Qualitative data from photovoice methods and in-depth, semi-structured interviews were collected in 2019. Analysis adopted a reflexive thematic approach from a critical interpretive standpoint, informed by minority stress theory. Three interconnected themes were constructed: (i) minoritised contexts of entry into and continuation of opioid use; (ii) mental health-maintaining and stress-mitigating effects of opioid use in the context of minoritisation; and (iii) intersections of stigma, violence and poverty with opioid use and minoritisation. Findings suggest that the health of sexual and gender minority youth who use opioids is shaped by minority stress and overlapping forms of structural marginalisation. They signal the need for responsive strategies that hold promise in supporting this population, including advancing integrated approaches to substance use and mental health care alongside interventions targeted towards the social and structural determinants of health. [ABSTRACT FROM AUTHOR]

Objective: To develop targeted treatment for young people experiencing mental illness, a better understanding of the biological, psychological, and social changes is required, particularly during the early stages of illness. To do this, large datasets need to be collected using standardized methods. A harmonized data collection protocol was tested in a youth mental health research setting to determine its acceptability and feasibility. Method: Eighteen participants completed the harmonization protocol, including a clinical interview, self‐report measures, neurocognitive measures, and mock assessments of magnetic resonance imaging (MRI) and blood. The feasibility of the protocol was assessed by recording recruitment rates, study withdrawals, missing data, and protocol deviations. Subjective responses from participant surveys and focus groups were used to examine the acceptability of the protocol. Results: Twenty‐eight young people were approached, 18 consented, and four did not complete the study. Most participants reported positive subjective impressions of the protocol as a whole and showed interest in participating in the study again, if given the opportunity. Participants generally perceived the MRI and neurocognitive tasks as interesting and suggested that the assessment of clinical presentation could be shortened. Conclusion: Overall, the harmonized data collection protocol appeared to be feasible and generally well‐accepted by participants. With a majority of participants finding the assessment of clinical presentation too long and repetitive, the authors have made suggestions to shorten the self‐reports. The broader implementation of this protocol could allow researchers to create large datasets and better understand how psychopathological and neurobiological changes occur in young people with mental ill‐health. [ABSTRACT FROM AUTHOR]

This article focuses on the rationale, design and methods of an effectiveness-implementation hybrid type I randomized trial of eHealth Familias Unidas Mental Health, a family-based, online delivered intervention for Hispanic families to prevent/reduce depressive and anxious symptoms, suicide ideation/behaviors, and drug use in Hispanic youth. Utilizing a rollout design with 18 pediatric primary care clinics and 468 families, this study addresses intervention effectiveness, implementation research questions, and intervention sustainment, to begin bridging the gap between research and practice in eliminating mental health and drug use disparities among Hispanic youth. Further, we will examine whether intervention effects are partially mediated by improved family communication and reduced externalizing behaviors, including drug use, and moderated by parental depression. Finally, we will explore whether the intervention's impact on mental health and drug use, as well as sustainment of the intervention in clinics, varies by quality of implementation at clinic and clinician levels. Trail registration: ClinicalTrials.gov Identifier: NCT05426057, First posted June 21, 2022. [ABSTRACT FROM AUTHOR]

The article focuses on the increasing mental health concerns among children and youth in Alberta and the need for strategic coordination and monitoring of mental health service outcomes. Topics include the impact of the COVID-19 pandemic on youth mental health, the importance of patient-oriented outcome measures, the lack of a unified approach to patient-oriented research in Canada, and the need for a cross-ministry youth mental health strategy.

Youth in communities of color are disproportionately affected by the current mental health crisis, as highlighted in the recent Declaration of National Emergency by the American Academy of Child and Adolescent Psychiatry (AACAP), the American Academy of Pediatrics (AAP), and the Children's Hospital Association (CHA).1 The structural racism that Black youth encounter is a social determinant of health that contributes to inequitable access to evidence-based mental health services. Black youth in the United States experience inequities in financial hardships, access to educational resources, and the undue burden of the coronavirus disease 2019 (COVID-19) pandemic, further exacerbating an already outsized mental health burden.2 [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the impact of a multi‐faceted, harm minimisation program addressing youth alcohol change and risky drinking behaviours in rural Australia. The role and influence of a multi‐tiered community approach to changing alcohol cultures is examined. Setting: An alcohol culture change project for young people (12–18 years) was implemented in rural Victoria. It was informed by the Alcohol Cultures Framework, comprising community‐wide events and youth‐focused activities, co‐designed with young people. The approach aimed at maximising engagement and reducing alcohol‐related harm by targeting the shared activities and drinking practices of young people, parents and the community. Participants: Participants (n = 446) provided feedback specific to three key program activities for promoting alcohol change. Design: Mixed methods: Feedback sheets were collected, and interviews and focus groups were conducted with program participants. Results: Participants indicated that the program had informed their understanding of the way people in their region drink, and the social norms and practices around alcohol that encourage risky drinking. It influenced their short‐ and medium‐term reactions, learnings and activities relating to alcohol consumption. The impact of the program was greatest in adults than young people although reflective learning and some behaviour change were evident across all age groups and community clusters. Conclusion: Community‐wide health promotion events offer participants a deeper understanding of the ways in which dominant alcohol cultures inform the practices and activities of young people within a broader community context. Ensuring health promotion programs within a whole‐of‐community approach are established longer term, is recommended. [ABSTRACT FROM AUTHOR]

Filipino Americans accounted for 2.9 million (16%) of the total U.S. Asian American population. As one of the fastest growing Asian immigrant groups, it is important to examine factors that could be targeted in interventions to better aid this community. Objectives: This study provided a unique perspective into the lives of Filipino American youth by utilizing a specific measure developed to assess different areas of enculturation among their Filipino American caregivers. The primary objectives of this study were to examine the associations among parental enculturation with parenting practices and youth internalizing and externalizing behaviors using regression analyses. Method: This study focused on 131 Filipino American families who participated in the Filipino Family Health Initiative. Results: Our hypotheses were partially supported. Interpersonal norms was positively associated with harsh/inconsistent discipline, while conservatism was positively associated with appropriate discipline and praise/incentives. Connection with homeland was negatively associated with youth behavioral symptoms, while interpersonal norms was positively associated with youth behavioral symptoms. Inconsistent with hypotheses, connection with homeland was negatively associated with appropriate discipline. Conclusions: This highlighted the need for better understanding of the cultural experiences and values of Filipino American parents when working with Filipino American children in clinical and research settings. Public Significance Statement: This study highlighted the unique impact of different enculturation domains on parenting practices and youth behavioral symptoms among Filipino American families. Given the associations with positive and negative parenting, these cultural factors are important to consider throughout the therapeutic process to promote youth well-being. [ABSTRACT FROM AUTHOR]

An estimated 1.8% of U.S. adolescents identify as transgender, and when using expansive language to include diverse identities along the gender continuum (e.g., nonbinary, gender fluid), rates may be notably higher. Gender-diverse youth (GDY) experience significantly elevated rates of depression, anxiety, suicidality, and eating disorders relative to the general population. Youth with autism spectrum disorders also appear to report diverse gender identities at higher rates than neurotypical youth. Gender-minoritized stress, including distal (e.g., transgender related stigma and discrimination) and proximal (e.g., social or familial rejection due to gender-diverse identity) stressors, increase risk for mental health disorders among GDY, and gender affirmation mitigates risk. Gender-affirming medical and behavioral health care is associated with enhanced resilience and positive mental health outcomes for GDY. [ABSTRACT FROM AUTHOR]

At present, the mental healthcare system cannot meet the demand for services, and the need‐to‐access gap is widest among children and adolescents. Single session interventions (SSIs) are brief, intentional, and mechanism‐targeted programs that have shown promise in increasing the reach of effective, evidence‐based services; yet, a wide gap still remains due to structural barriers (e.g., lack of awareness, workforce shortages). The present paper posits the integration of SSIs and mentor‐delivered programs as a promising future step to further overcome the inaccessibility of youth mental health services. Capitalizing on the advantages of mentoring relationships (e.g., the associated interpersonal benefits and mentors' pre‐existence in most community settings) has the potential to complement and enhance the value of SSIs, and to expand the acceptability and reach of evidence‐based mental health services. In this paper, we discuss the anticipated benefits of mentor‐delivered SSIs, as well as cautionary considerations related to the proposed model. To conclude, we highlight the necessary implementation and research implications. [ABSTRACT FROM AUTHOR]

Aim: To describe the implementation and outcomes of a combined individual placement and support (IPS) and vocational peer work program for young people with mental ill‐health. Methods: This uncontrolled pilot study co‐located IPS workers and vocational peer workers within two integrated youth mental health services (provided to clients aged 15–25 years old). Employment outcomes included job placements (working 15 hours or more per week in a paid competitive job in the open employment market) and sustained employment (employed for at least 26 weeks). Participants who required additional assistance also received peer work. Results: Of the 326 young people enrolled, 195 (59.8%) achieved competitive employment, including 157 (48.2%) in funder‐approved placements. Among those in approved placements, 87 (55.4%) achieved sustained employment. For the 116 participants additionally receiving vocational peer work, 54 (46.6%) worked in funder‐approved placements, of whom 27 (50.0%) achieved sustained employment. Among 210 participants who did not receive peer work, 103 (49.0%) worked in funder‐approved placements, of whom 60 (58.3%) achieved sustained employment. Conclusions: The program achieved positive vocational outcomes and good fidelity to the IPS model. Approximately half of young people had employment placements, with a relatively high proportion maintained over time. The similar proportion of placements for those who did and did not receive peer work was encouraging given the IPS team determined that the former group needed additional support. Recommendations include upskilling the workforce, a data linkage system to obtain placement evidence, and using implementation science methodologies to understand how IPS programs are successfully embedded. This demands a coordinated effort between governments and funders, policymakers, services, and professional bodies. [ABSTRACT FROM AUTHOR]

Aim: This study examined satisfaction with accessibility, staff attitudes, personal outcomes service components of youth‐oriented mental health service, Headspace, and those components' associations with psychological distress and functional status at intake, service utilization patterns and demographic characteristics at middle and end of treatment. Methods: Data were collected between March 2016 and June 2018 from 112 participants (12–25 years) who consented and completed at least seven sessions at the Headspace youth integrated‐care centre in Israel using the centre's registries and the Youth Service Satisfaction Scale. Results: Headspace participants attended an average of 12 sessions (SD = 3.12), they waited up to 2 weeks for their first intake (n = 57; 73%), after which most were offered a psychotherapy session (n = 80, 71%) within 2 months. Participants' satisfaction with Headspace was above the mid‐point for all service aspects. The overall effect for time was not significant, F(1) = 1.14, p >.05. However, a significant increase in satisfaction with personal outcomes was found between the middle and the end of treatment, F(2,4) = 3.11, p <.05 compared to all other aspects. The length of waiting time, level of distress, number of sessions attended by parents and age were correlated with satisfaction. Correlations were found with waiting time, distress level, number of sessions attended by parents and age. Conclusions: High levels of satisfaction with Headspace service aspects strengthens the evidence for areas of importance in designing youth mental health services: youth‐friendly staff, general environment, accessibility and outcomes achievement. [ABSTRACT FROM AUTHOR]

Youth experiencing homelessness (YEH) have high rates of both mental and physical health concerns, including a higher rate of sexual assault, pregnancy and STIs as compared to youth in the general population. YEH face multiple barriers in accessing care, resulting in reliance on Emergency Departments (ED). The use of the pediatric ED by YEH in Canada, including for sexual and reproductive (SRH) concerns, is not well described; additionally, there is no Canadian data exploring the effects of the COVID-19 pandemic/lockdown on ED presentations by this population. Study aims: 1) To review YEH pediatric ED presentation chief complaints (CC); 2) To compare data between pre and post COVID-19 pandemic timelines. Electronic medical records (EMR) were retrospectively reviewed chart review design was used using the EMR was searched over a 45-month period (05/01/18 to 01/31/22) for any ED encounters for: 1) patients identifying youth shelter address as place of residence; 2) the terms "shelter", "homeless", "street-involved", "street-youth". Data was recorded into RedCap. Descriptive statistics were used, as well as comparative analysis of 2 time periods: 1) "pre-COVID" 05/01/18-03/15/20; 2) "post-COVID lockdown" 03/16/21-01/31/22. This study was approved by the REB. A total of 1103 encounters (patient mean age 16.58 yrs) were included in analysis. Over the 45-month time period, CCs were evenly split between mental health concerns (n=562, 50.9%) and physical concerns (n=541, 49%). Patient SRH concerns represented 5% (n=58) of all encounters (see Figure 1). When comparing timelines, there were significantly fewer presentations in the months "post COVID-lockdown" (n=465) as compared to "pre-COVID" (n=638). There was a significant reduction in mental health related CCs, with no significant change in physical related CCs including SRH related concerns (Table 1). YEH utilize the pediatric ED for both their mental and physical healthcare, including concerns related to SRH. Lower attendance to the pediatric ED for mental health related concerns following the pandemic lockdown, while physical health encounters remained steady, may reflect increased barriers to care and/or novel methods of mental health care delivery post-pandemic. The results of this study will inform the creation of an outpatient outreach program to better meet the needs of this population, when possible, outside of the pediatric ED. [ABSTRACT FROM AUTHOR]

Background: As mental health in adulthood is related to mental status during adolescence, school-based interventions have been proposed to improve resilience. The objective of this study was to build a simulation model representing the natural history of mental disorders in childhood, adolescence and youth to estimate the cost-effectiveness of the UPRIGHT school-based intervention in promoting resilience and mental health in adolescence. Methods: We built a discrete event simulation model fed with real-world data (cumulative incidence disaggregated into eight clusters) from the Basque Health Service database (609,381 individuals) to calculate utilities (quality-adjusted life years [QALYs]) and costs for the general population in two scenarios (base case and intervention). The model translated changes in the wellbeing of adolescents into different risks of mental illnesses for a time horizon of 30 years. Results: The number of cases of anxiety was estimated to fall by 5,125 or 9,592 and those of depression by 1,269 and 2,165 if the effect of the intervention lasted 2 or 5 years respectively. From a healthcare system perspective, the intervention was cost-effective for all cases considered with incremental cost-utility ratios always lower than €10,000/QALY and dominant for some subgroups. The intervention was always dominant when including indirect and non-medical costs (societal perspective). Conclusions: Although the primary analysis of the trial did not did not detect significant differences, the UPRIGHT intervention promoting positive mental health was dominant in the economic evaluation from the societal perspective. Promoting resilience was more cost-effective in the most deprived group. Despite a lack of information about the spillover effect in some sectors, the economic evaluation framework developed principally for pharmacoeconomics can be applied to interventions to promote resilience in adolescents. As prevention of mental health disorders is even more necessary in the post-coronavirus disease-19 era, such evaluation is essential to assess whether investment in mental health promotion would be good value for money by avoiding costs for healthcare providers and other stakeholders. [ABSTRACT FROM AUTHOR]

The purpose of this study was to find out the differences in the attitude of young people who reached adulthood toward their health during a period of moderate (epidemic) and strong (wartime) deprivation of comfortable life and a surge of national consciousness that changed egocentric accents to subjective general ones. The use of methods of theoretical, systematic and comparative analysis, supplemented by statistical and correlational research, has shown: young people have hardly changed their own SCH after the deployment of tragic actions in their country: they have accumulated and directed the mental potential to achieve freedom, national self-identity and passionarity. At the same time, SCH has receded into the background and has not given way at all to the mass life-saving, protective or other egoistic patterns expected at the beginning of the study. The international significance of the article is that, for the first time in science, the authors have begun to study SCH in the context of a global conflict that has unexpectedly affected personal self-preservation motives and increased attention to one's health. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to gain an in-depth understanding of perceptions of mental illnesses (especially psychosis), help-seeking, barriers to help-seeking, and opportunities to facilitate help-seeking in the African Nova Scotian Community. Methods: A qualitative interpretive narrative approach, using the focus group method, was employed to engage African Nova Scotians in discussions on their perceptions and beliefs about mental illnesses and help-seeking in their communities. Youth in Early Intervention services, their caregivers, youth in the community, their caregivers, community leaders, and health service providers, were recruited from four locations in the Halifax Regional Municipality. A total of 75 individuals (37 female, 38 male) participated in the study. Narrative emplotment was used to analyse data from focus groups. Results: Findings from focus groups were categorized based on four areas of discussion: (a) perceptions about psychosis and other mental illnesses among youth, caregivers, service providers and community leaders (b) beliefs about help-seeking among youth, caregivers, services providers and community leaders; (c) barriers and facilitators to seeking help for mental illnesses; and (d) the content and format of educational resources to educate and support youth, families and communities. Conclusions: Stigma surrounding mental illnesses in the community, lack of knowledge of illness and available services, concerns regarding negative involvement with police, or dismissal of difficulties by health care providers represent significant barriers to help-seeking in this community. Additionally, barriers include a lack of trust in health care services and a dearth of African Nova Scotian service providers. Bolstering capacity of community organizations to support and educate individuals around illness as well as fostering collaboration between health services and community organizations could reduce barriers to care. Future research should focus on examining ways to engage African Nova Scotians in collaboration with existing community organizations. [ABSTRACT FROM AUTHOR]

The article presents the results of research on the main individual behavior problems of Ukrainian youth in the conditions of Russian political and military aggression since 2014. Research is aimed at issues of adaptation potential, social and psychological security, psychological health, and well-being of young people from all geographic regions of Ukraine. The concept of "socially determined coping constructs" is proposed and the influence of interpersonal behavior style on the resourcefulness and adaptive potential of youth in the conditions of military operations is determined. Prognostic indicators of young people's experience of security in the conditions of an unpredictable long-term scenario of military aggression are concise. It has been proved that adaptation potential is a factor of preservation of psychological health that is methodologically considered within the paradigm of humanistic psychology within the range of the concept of resilience, psychological well-being, and personal maturity. Interpersonal behavior can be considered by us as a developed form of interaction of personal genesis and social induced predisposition of a certain objectified relation. Adaptation potential is determined as a social-psychological integral hierarchical-parity formation that ensures homeostasis of mature functioning of personality within the conditions of social stress induced by the activity of adaptation capabilities, their latency, timeliness, correspondence with subjective resources, and vectors of social actualization. There has been an empirical establishment of predictors determining the impact of special features of the style of interpersonal behavior on index of perceived stress, index of coping resources, positive attitude to others, autonomy, environment management, personal development, life goals, self-perception, psychological well-being, inclusion, control, risk acceptance, and resilience. The results of our research became the basis for determination of the phenomenon of interpersonal behavior as predictor of the triad: interpersonal communication, adaptation potential, and psychological health of youth. [ABSTRACT FROM AUTHOR]

The aim of this paper is to report our notes from the field on using movement toward goals at an aggregate level as an inference of service effectiveness. Analysis of routinely collected data from UK youth mental health services was conducted (N = 8,172, age M = 13.8, 67% female, 32% male) to explore the impact of including goal‐based outcome data in combined calculations of standardized measures based on the principles of reliable change ("measurable change"). Due to the broad nature of standardized measures, inferred validity becomes diluted in any team or service level aggregate analysis. To make inferences that are closer to the person's interpretation of their difficulties, we argue that Idiographic Patient Reported Outcome Measures (I‐PROMs) counterbalance these limitations. This is supported by our findings. The measurable change metric is the first step towards enabling national analysis of aggregated I‐PROMs. I‐PROMs, supplemented by standardized measures should be used to consider service evaluation. [ABSTRACT FROM AUTHOR]

The field has spent more than 50 years investing in the quality of youth mental healthcare, with intervention science yielding roughly 1,300 efficacious treatments. In the latter half of this period, concurrent efforts in implementation science have developed effective methods for supporting front-line service organizations and therapists to begin to bridge the science to service gap. However, many youths and families still do not benefit fully from these strategic investments due to low treatment engagement: nearly half of youths in need of services pursue them, and among those who do, roughly another half terminate prematurely. The negative impact of low engagement is substantial, and is disproportionally and inequitably so for many. We contend that to build a robust and "finished" bridge connecting science and service, the field must go beyond its two historical foci of designing interventions and preparing therapists to deliver them, to include an intentional focus on the youths and families who participate in these interventions and who work with those therapists. In this paper, we highlight the significance of treatment engagement in youth mental healthcare and discuss the current state of the literature related to four priorities: conceptualization, theory, measurement, and interventions. Next, we offer an example from our own program of research as one illustration for advancing these priorities. Finally, we propose recommendations to act on these priorities. [ABSTRACT FROM AUTHOR]

A substantial body of evidence suggests that young people, including those at the crucial transition points between 16 and 24, now face severe mental health challenges. In this article, we analyse data from 10 waves of a major UK longitudinal household cohort study, Understanding Society, to examine the relationship between income and anxiety and depression among 16- to 24-year-olds. Using random effects logistic regression (Model 1) allowing for whether the individual was depressed in the previous period as well as sex, age, ethnicity, whether the individual was born in the UK, region, rurality, highest qualification, marital status, employment status and attrition, we find a significant and inversely monotonic adjusted association between average net equivalised household income quintiles and clinical threshold levels of depressive symptoms SF-12 Mental Component Summary (MCS score ≤45.6). This means that being in a higher income group is associated with a reduced likelihood of clinically significant depressive symptoms, allowing for observable confounding variables. Using a 'within-between' model (Model 2), we find that apart from among those with the very highest incomes, increases in average net equivalised household income over the course of childhood and adolescence are significantly associated with reduced symptoms of anxiety and depression as measured by a higher SF-12 MCS score. Compared with previous reviews, the data presented here provides an estimate of the magnitude of effect that helps facilitate microsimulation modelling of impact on anxiety and depression from changes in socioeconomic circumstances. This enables a more detailed and complete understanding of the types of socioeconomic intervention that might begin to address some of the causes of youth mental health problems. [ABSTRACT FROM AUTHOR]

Background: Heterogeneous mental health outcomes during the COVID-19 pandemic are documented in the general population. Such heterogeneity has not been systematically assessed in youth with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDD). To identify distinct patterns of the pandemic impact and their predictors in ASD/NDD youth, we focused on pandemic-related changes in symptoms and access to services. Methods: Using a naturalistic observational design, we assessed parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) Adapted For Autism and Related neurodevelopmental conditions (AFAR). Cross-sectional AFAR data were aggregated across 14 European and North American sites yielding a clinically well-characterized sample of N = 1275 individuals with ASD/NDD (age = 11.0 ± 3.6 years; n females = 277). To identify subgroups with differential outcomes, we applied hierarchical clustering across eleven variables measuring changes in symptoms and access to services. Then, random forest classification assessed the importance of socio-demographics, pre-pandemic service rates, clinical severity of ASD-associated symptoms, and COVID-19 pandemic experiences/environments in predicting the outcome subgroups. Results: Clustering revealed four subgroups. One subgroup—broad symptom worsening only (20%)—included youth with worsening across a range of symptoms but with service disruptions similar to the average of the aggregate sample. The other three subgroups were, relatively, clinically stable but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Distinct combinations of a set of pre-pandemic services, pandemic environment (e.g., COVID-19 new cases, restrictions), experiences (e.g., COVID-19 Worries), and age predicted each outcome subgroup. Limitations: Notable limitations of the study are its cross-sectional nature and focus on the first six months of the pandemic. Conclusions: Concomitantly assessing variation in changes of symptoms and service access during the first phase of the pandemic revealed differential outcome profiles in ASD/NDD youth. Subgroups were characterized by distinct prediction patterns across a set of pre- and pandemic-related experiences/contexts. Results may inform recovery efforts and preparedness in future crises; they also underscore the critical value of international data-sharing and collaborations to address the needs of those most vulnerable in times of crisis. [ABSTRACT FROM AUTHOR]

Background: In Canada, it is recommended that youth limit screen time to less than two hours per day, yet, the majority of youth are reportedly spending a significantly higher amount of time in front of a screen. This is particularly concerning given that these recommendations do not take into account smartphone devices, which is the most common screen time technology of choice for the younger generations. This study implements an innovative approach to understanding screen time behavior and aims to investigate the unique relationship between smartphone specific screen time and physical health outcomes. Methods: This cross-sectional study is part of the Smart Platform, a digital epidemiological and citizen science initiative. 436 youth citizen scientists, aged 13–21 years, provided all data via their own smartphones using a custom-built smartphone application. Participants completed a 124-item baseline questionnaire which included validated self-report surveys adapted to collect data specifically on smartphone use (internet use, gaming, and texting), demographic characteristics, and physical health outcomes such as weight status and self-rated health. Binary regression models determined the relationship between smartphone use and physical health outcomes. Results: Overall participants reported excessive smartphone use in all categories. 11.4% and 12% of the 436 youth participants reported using their smartphone excessively (greater than 2 h per day) during the week and weekend respectively for gaming and were over 2 times more likely than their peers to fall within an overweight/obese BMI status. Excessive weekend gaming was also associated with self-rated health where participants were over 2 times more likely than their peers to report poor self-rated health. Conclusions: The results indicate that excessive screen time on smartphones does have complex associations with youth health. Further investigation with more robust study designs is needed to inform smartphone-specific screen time guidelines for youth. [ABSTRACT FROM AUTHOR]

Aims: Physical activity interventions are recommended for community‐based youth mental health services to prevent physical health disparities. Implementation is challenging, and studies focusing on the methods to achieve change are needed. This study aims to identify the context, implementation strategies, and implementation outcomes that illustrate how physical activity interventions were implemented within an early intervention service in Australia. Methods: A theoretically informed case study was undertaken. Data from a community‐based youth mental health service that delivers an early psychosis programme were collected between July and November 2020. Three data sources were accessed (1) interviews with service managers, mental health clinicians and exercise physiologists; (2) document review of organizational policies and procedures; and (3) survey using the Program Sustainability Assessment Tool. The implementation outcomes investigated were acceptability, fidelity, penetration, and sustainability. Framework analysis was used, and a logic model developed guided by an established template, to interpret findings. Results: Forty‐three contextual factors and 43 implementation strategies were identified. The data suggests that creating a new clinical team and auditing and feedback are critical for implementation. High levels of acceptability and sustainability were described, while fidelity of implementation was difficult to establish, and penetration was low. Conclusions: The relationship between constructs suggests several mechanisms underpinned implementation. These include changing professional beliefs, establishing new organizational norms, augmenting existing work processes, and aligning physical activity with priorities of the mental healthcare system and existing work tasks. This case study provides direction for future health service planning of physical activity interventions in community‐based youth mental health service. [ABSTRACT FROM AUTHOR]

• Most youth fail to pass at least 1 out of 11 fit criteria for utility ATVs. • Youth are not recommended to ride utility ATVs. • Engine size, top speed, and youth's age are poor indicators of youth-ATV fit. Problem: Utility All-Terrain Vehicles (ATVs) are one major cause of youth injuries and fatalities on farms. Utility ATVs have heavy weights and fast speeds that require complex maneuvering. Youth's physical capabilities may not be sufficient to perform those complex maneuvers correctly. Therefore, it is hypothesized that most youth engage in ATV-related incidents because they ride vehicles unfit for them. There is a need to assess ATV-youth fit based on youth anthropometry. Method: This study focused on evaluating potential inconsistencies between the operational requirements of utility ATVs and the anthropometric measures of youth through virtual simulations. Virtual simulations were performed to assess 11 youth-ATV fit guidelines proposed by several ATV safety advocacy organizations (National 4-H council, CPSC, IPCH, and FReSH). In total, 17 utility ATVs along with male-and-female-youth of nine ages (8 to 16 years old) and three height percentiles (5th, 50th, and 95th) were evaluated. Results: The results demonstrated a physical mismatch between ATVs' operational requirements and youth's anthropometry. For example, male-youth aged 16 of the 95th height percentile failed to pass at least 1 out of the 11 fit guidelines for 35 % of all vehicles evaluated. The results were even more concerning for females. Female youth 10 years old and younger (from all height percentiles) failed to pass at least one fit guideline for all ATVs evaluated. Discussion: Youth are not recommended to ride utility ATVs. Practical Applications: This study provides quantitative and systematic evidence to modify current ATV safety guidelines. Furthermore, youth occupational health professionals could use the present findings to prevent ATV-related incidents in agricultural settings. [ABSTRACT FROM AUTHOR]

Recognition of pediatric mental health concerns often depends on assessment by parents, educators, and primary care professionals. Therefore, a psychosocial screening instrument suitable for routine use in schools and primary care is needed. The Pediatric Quality of Life (PedsQL) and the Strengths and Difficulties Questionnaire (SDQ) are widely used for screening but lack adolescent-specific mental health measures. MyHEARTSMAP is an instrument assessing aspects of youth psychosocial health via four domains: Psychiatry, Function, Social, and Youth Health. We evaluated MyHEARTSMAP convergent validity with PedsQL and SDQ among 122 child-parent dyads participating in a larger concussion study. Convergent validity was assessed via correlations: MyHEARTSMAP Psychiatry and Function domains correlated strongly (r ≥ 0.44) and Social domain correlated weakly (r ≤ 0.25) to corresponding PedsQL and SDQ subscales, while Youth Health domain correlated moderately (r ≥ 0.31) to the tools' total scales. In conclusion, MyHEARTSMAP converges with PedsQL and SDQ, and benefits from the inclusion of adolescent-specific psychosocial measures. [ABSTRACT FROM AUTHOR]

This work provides an overview of injury patterns in Canadian children and youth aged 1 to 17 years. Self-reported data from the 2019 Canadian Health Survey on Children and Youth were used to calculate estimates for the percentage of Canadian children and youth who experienced a head injury or concussion, broken bone or fracture, or serious cut or puncture within the last 12 months, overall and by sex and age group. Head injuries and concussions (4.0%) were the most commonly reported, but the least likely to be seen by a medical professional. Injuries most frequently occurred while engaging in sports, physical activity or playing. [ABSTRACT FROM AUTHOR]

Objective: To assess children with cerebral palsy using the Common Brief Core Set of International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY). Study Design: Cross-sectional study Place and Duration of Study: Children Hospital & Institute of Child Health, Lahore Pakistan, from Nov 2020 to Jan 2021. Methodology: Fifty-nine children with cerebral palsy (CP) aged 0-18 years were included. Common Brief Core Set of International Classification of Functioning, Disability, and Health in Children and Youth (ICF-CY) was administered to children with cerebral palsy to assess their functional status. Strengths and weaknesses in body structure, body function, activity and participation and environmental factors were evaluated using the Common Brief Core Set of ICF-CY. Results: The majority of study participants were 38(64.4%), were spastic quadriplegic. Periventricular leukomalacia was noted in 36(67.9%) cases on MRI brain. Moderate to severe impairment was noted in body functions like intellectual function 46(78%). In addition, 26(44.1%) children with cerebral palsy had mild to moderate impairment in walking, while 4(6.8 %) could walk without any impairment. Social attitudes, construct, and design of buildings were the major barriers affecting the functionality of children with cerebral palsy. Conclusion: It was found that the Common Brief Core Set of ICF-CY in children with different types of cerebral palsy is a useful tool for assessing their functional level. [ABSTRACT FROM AUTHOR]

Background: Stigma associated with mental health challenges is a major barrier to service seeking among youth. Understanding how stigma impacts service-seeking decisions from the perspectives of youth remains underexplored. Such research is necessary to inform effective stigma reduction. Objective: This study aims to understand how stigma influences service seeking among youth with mental health challenges. Methods: Qualitative inquiry was taken using youth engagement, underpinned by pragmatism. Data were collected via 4 virtual focus groups with 22 purposively selected youth participants with lived experience of mental health challenges in Ontario, Canada. Focus group guides were developed collaboratively among research team members, including youth co-researchers. Data were analyzed inductively using reflexive thematic analysis. Results: Three main themes were constructed from the data: point of entry into the system, being biomedicalized or trivialized, and paving the way for non-stigmatizing services. Initial contact with the mental healthcare system was seen to be affected by stigma, causing participants to delay contact or be refused services if they do not fit with an expected profile. Participants described a constant negotiation between feeling 'sick enough' and 'not sick enough' to receive services. Once participants accessed services, they perceived the biomedicalization or trivialization of their challenges to be driven by stigma. Lastly, participants reflected on changes needed to reduce stigma's effects on seeking and obtaining services. Conclusion: A constant negotiation between being 'sick enough' or 'not sick enough' is a key component of stigma from the perspectives of youth. This tension influences youth decisions about whether to seek services, but also service provider decisions about whether to offer services. Building awareness around the invisibility of mental health challenges and the continuum of wellness to illness may help to break down stigma's impact as a barrier to service seeking. Early intervention models of care that propose services across the spectrum of challenges may prevent the sense of stigma that deters youth from accessing and continuing to access services. [ABSTRACT FROM AUTHOR]

We examine the development of youth sociopolitical consciousness and agency in an eighth-grade science classroom as students of color engage in critical speculative design activities, exploring the multi-scalar, racial realities and possibilities of the science and engineering of pervasive digital technologies—specifically involving the entanglement of lightwaves and melanin in computer vision and artificial intelligence (AI) technologies. Through case studies of two girls of color (ES and GS), we analyze the youths' learning pathways across three instructional phases: threading practices (learners' sociopolitical interpretation); weaving practices (learners' coordination of multiple ways of knowing and being in relation to their interpretation); and patternmaking practices (learners' visions of more just patterns, practices, and politics through speculative design). Our analyses show how youth use their felt, cultural, and community knowledges, as well as their developing scientific knowledge of physics, to confront and analyze manifestations of racial bias in technologies. The findings highlight the significance of teachers' pedagogical support and providing opportunities for meaningful transdisciplinary science investigations and speculative designing for more just and thriving futures. The Critical Speculative Design Pedagogy framework developed suggests how such activities in the classroom can cultivate equitable, expansive science learning that is consequential to youth and their communities. [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]

Despite the growing number of youths with mental health needs entering the juvenile justice system, few studies have been conducted on direct care workers' (DCW) perceptions of youth with mental health issues. This study examined the perceptions of DCW at an all-male juvenile residential treatment facility for at-risk youth. Specifically, the study used both quantitative and qualitative techniques to survey DCW on their perceptions of youth with and without mental health issues, as well as their work with both populations. The findings suggest that DCW perceive youth with mental health issues less favorably than youth without mental health issues. They also report their work performance to be less effective with youth mental health issues compared to their work with youth without mental health issues. DCW further suggest more resources and training for work with youth who have severe mental health issues, to properly address their needs. [ABSTRACT FROM AUTHOR]

Introduction: We investigated the value of systematic client feedback in youth mental health and addiction care. In the present study, we examined whether a client feedback intervention would result in improved therapeutic alliance and treatment outcomes. Methods: Two hundred and four adolescents participated in the study using a – non-randomized – between-group A/B design. In the first study group, 127 patients were offered 4 months of treatment as usual (TAU), and in the second study group, 77 patients received the client feedback intervention as an add-on to TAU during 4 months. Results: Youths who received systematic client feedback in addition to TAU did not show better treatment outcomes or better alliance ratings after 4 months than youths receiving TAU only. Sensitivity analyses, in which we compared the more adherent patients of the second study group with patients receiving TAU, did not show significant beneficial effects of client feedback either. Also, the client feedback intervention did not result in lower rates of early treatment drop-out. Discussion/Conclusion: Our results cautiously suggest that client feedback does not have incremental effects on alliance and the treatment outcome for youth in mental health and addiction treatment. Moreover, our study highlights the challenges of implementing client feedback in clinical practice and the need for additional research addressing these challenges. [ABSTRACT FROM AUTHOR]

Aim: The need for youth‐friendly early intervention services to meet the mental health, substance use, primary care, and other social needs of adolescents and young adults is well‐documented. This article describes Youth Wellness Hubs Ontario, a province‐wide initiative in Ontario, Canada to build and implement a one‐stop‐shop model of integrated youth services. Methods: We describe the development of Youth Wellness Hubs Ontario, in the context of global youth mental health system transformation, as well as pan‐Canadian youth mental health system change. We also describe Youth Wellness Hubs Ontario's values and services. Results: The demonstration phase of Youth Wellness Hubs Ontario was initiated in 2017–2018. Youth Wellness Hubs Ontario is co‐created with youth for youth aged 12–25 years old across diverse community contexts. Youth Wellness Hubs Ontario centres engagement and equity, and offers developmentally‐appropriate services in an integrated, community‐based walk‐in format. As an initiative committed to continuous learning and quality improvement, Youth Wellness Hubs Ontario offers evidence‐based and evidence‐generating services, and measurement‐based care. Youth Wellness Hubs Ontario is supported by backbone resources with expertise in implementation science, health equity, Indigenous practices, youth and family engagement, evaluation, and knowledge translation. In 2020 Youth Wellness Hubs Ontario secured sustainable funding for the first 10 locations and scale‐up began in 2021, with 10 additional locations in development. Conclusions: Youth Wellness Hubs Ontario demonstrates the feasibility of integrated mental health and substance use early intervention services, offered in the context of a broad range of health and social services. [ABSTRACT FROM AUTHOR]

Aim: Groups facilitated by peer workers have been shown to be effective in improving recovery‐related outcomes in adult populations. However, limited research has explored the involvement of peer workers in groups in youth mental health services. This qualitative study aimed to explore young people's experiences of participating in groups co‐facilitated by youth peer workers and clinicians. Methods: Semi‐structured interviews were conducted with 13 young people aged 15–25 years who had attended groups conducted in‐person and online at a tertiary youth mental health service. Young people were receiving individual support through the service for a range of mental health concerns. Groups were conducted by two clinicians and a youth peer worker who had used the same service and had undergone training in Intentional Peer Support®. An inductive approach using open, process, in vivo and pattern coding was used to identify key themes. Concept mapping was used to explore the relationships between them. Results: Nine overarching themes were identified that highlighted the unique and complementary contributions of youth peer worker and clinician roles. The sharing of lived experience by youth peer workers facilitated young people's engagement in group discussions, hope for the future, and sense of belonging, whereas clinical input created a sense of safety, structure and purpose. Conclusions: These findings support the value of a co‐facilitation model in improving the engagement and recovery outcomes for young people experiencing mental health challenges. [ABSTRACT FROM AUTHOR]

Validly characterizing youth mental health phenomena requires evidence-based approaches to assessment. An evidence-based assessment cannot rely on a "gold standard" instrument but rather, batteries of instruments. These batteries include multiple modalities of instrumentation (e.g., surveys, interviews, performance-based tasks, physiological readings, structured clinical observations). Among these instruments are those that require soliciting reports from multiple informants: People who provide psychometrically sound data about youth mental health (e.g., parents, teachers, youth themselves). The January 2011 issue of the Journal of Clinical Child and Adolescent Psychology (JCCAP) included a Special Section devoted to the most common outcome of multi-informant assessments of youth mental health, namely discrepancies across informants' reports (i.e., informant discrepancies). The 2011 JCCAP Special Section revolved around a critical question: Might informant discrepancies contain data relevant to understanding youth mental health (i.e., domain-relevant information)? This Special Issue is a "sequel" to the 2011 Special Section. Since 2011, an accumulating body of work indicates that informant discrepancies often contain domain-relevant information. Ultimately, we designed this Special Issue to lay the conceptual, methodological, and empirical foundations of guidelines for integrating multi-informant data when informant discrepancies contain domain-relevant information. In this introduction to the Special Issue, we briefly review the last 12 years of research and theory on informant discrepancies. This review highlights limitations inherent to the most commonly used strategies for integrating multi-informant data in youth mental health. We also describe contributions to the Special Issue, including articles about informant discrepancies that traverse multiple content areas (e.g., autism, implementation science, measurement validation, suicide). [ABSTRACT FROM AUTHOR]

First, the analytic models used to characterize informant discrepancies allow researchers to determine the incremental value of informant discrepancies, relative to the informants' reports used to describe the discrepancies. Observations About Informant Discrepancies Observation #1: I B Informant discrepancies commonly manifest when comparing multiple informants' reports about youth mental health. b i In three key respects, the 60 years of research on informant discrepancies provides us with a great deal of data about this clinical phenomenon. This means that whether researchers detect domain-relevant information in informant discrepancies may be dictated by their practices for selecting (a) multi-informant instruments to assess youth mental health domains, and (b) validity criteria for detecting domain-relevant informant discrepancies. [Extracted from the article]

Researchers strategically assess youth mental health by soliciting reports from multiple informants. Typically, these informants (e.g., parents, teachers, youth themselves) vary in the social contexts where they observe youth. Decades of research reveal that the most common data conditions produced with this approach consist of discrepancies across informants' reports (i.e., informant discrepancies). Researchers should arguably treat these informant discrepancies as domain-relevant information: data relevant to understanding youth mental health domains (e.g., anxiety, depression, aggression). Yet, historically, in youth mental health research as in many other research areas, one set of paradigms has guided interpretations of informant discrepancies: Converging Operations and the Multi-Trait Multi-Method Matrix (MTMM). These paradigms (a) emphasize shared or common variance observed in multivariate data, and (b) inspire research practices that treat unique variance (i.e., informant discrepancies) as measurement confounds, namely random error and/or rater biases. Several yearsw ago, the Operations Triad Model emerged to address a conceptual problem that Converging Operations does not address: Some informant discrepancies might reflect measurement confounds, whereas others reflect domain-relevant information. However, addressing this problem requires more than a conceptual paradigm shift beyond Converging Operations. This problem necessitates a paradigm shift in measurement validation. We advance a paradigm (Classifying Observations Necessitates Theory, Epistemology, and Testing [CONTEXT]) that addresses problems with using the MTMM in youth mental health research. CONTEXT optimizes measurement validity by guiding researchers to leverage (a) informants that produce domain-relevant informant discrepancies, (b) analytic procedures that retain domain-relevant informant discrepancies, and (c) study designs that facilitate detecting domain-relevant informant discrepancies. [ABSTRACT FROM AUTHOR]

Co-designing research-informed guidelines with youth for adapting research methods to other contexts has received little research attention. We report on guidelines co-designed with youth for adapting arts-based methods (ABM) for youth mental health (MH) research in online environments. Seven youth co-researchers participated in 3 co-design workshops and 2 graphic recording focus groups. Data analysis involved a thematic analysis approach. We identified one overarching theme (sustaining mindful presence when conducting research) and 4 subthemes (creating a safe space, youth having a say, facilitating meaningful engagement, paying receptive attention throughout the research process). Facilitating participants' authentic expression in online environments requires: 1) Letting youth self-identify; 2) incorporating diversity and inclusion; 3) providing accommodations, recognition, and compensation; 4) language considerations; 5) offering ABM training and resources for creating art; 6) using virtual platforms youth use; 7) being mindful of ethical considerations and technology fatigue; 8) addressing barriers in accessing and using technology; 9) providing choice in type of ABM and research methods used; and 10) providing options for communicating during research activities and for engaging in research outside of allotted time (e.g., email, group chat). These research-informed guidelines can be useful for conducting youthMH research and other youth research in online environments. [ABSTRACT FROM AUTHOR]

Giving a voice to youth and promoting their health and well-being is essential for successful future communities. However, millions of youth, particularly in low-to middle-income countries, are misunderstood, lack a voice, and face many challenges, which maintains their disengagement. As approaches for youth engagement evolve, this paper presents an innovative, qualitative methodology to engage vulnerable youth (NEETs - acronym for youth who are Not in Education, Employment or Training) in identifying and ranking their needs and giving them a voice to contribute to prevention programming. Drawing on principles of empowerment theory, the paper expands on the popular youth-adult partnerships' literature by injecting a new engagement approach that focuses on (i) using a literature-based community needs assessment, (ii) engaging vulnerable youth in small group discussion to rank their needs, (iii) comparing rankings between groups, (iv) creating spaces for youth to include other pressing issues not identified in the literature, and (iv) comparing rankings across surrounding communities. The ideas presented demonstrate that the Needs Ranking activity, as an engagement and data collection tool, may be particularly relevant in gathering viewpoints and opinions of underserved youth. These youth are traditionally not well represented through the more conventional and common methods currently employed in research and community development such as local government community development board meetings and needs assessments, and research interviews. The paper also creates awareness around the Needs Ranking activity as a viable and verifiable qualitative approach in youth engagement. [ABSTRACT FROM AUTHOR]

Background: Clinical staging proposes that youth-onset mental disorders develop progressively, and that active treatment of earlier stages should prevent progression to more severe disorders. This retrospective cohort study examined the longitudinal relationships between clinical stages and multiple clinical and functional outcomes within the first 12 months of care. Methods: Demographic and clinical information of 2901 young people who accessed mental health care at age 12–25 years was collected at predetermined timepoints (baseline, 3 months, 6 months, 12 months). Initial clinical stage was used to define three fixed groups for analyses (stage 1a: 'non-specific anxious or depressive symptoms', 1b: 'attenuated mood or psychotic syndromes', 2+: 'full-threshold mood or psychotic syndromes'). Logistic regression models, which controlled for age and follow-up time, were used to compare clinical and functional outcomes (role and social function, suicidal ideation, alcohol and substance misuse, physical health comorbidity, circadian disturbances) between staging groups within the initial 12 months of care. Results: Of the entire cohort, 2093 young people aged 12–25 years were followed up at least once over the first 12 months of care, with 60.4% female and a baseline mean age of 18.16 years. Longitudinally, young people at stage 2+ were more likely to develop circadian disturbances (odds ratio [OR]=2.58; CI 1.60–4.17), compared with individuals at stage 1b. Additionally, stage 1b individuals were more likely to become disengaged from education/employment (OR=2.11, CI 1.36–3.28), develop suicidal ideations (OR=1.92; CI 1.30–2.84) and circadian disturbances (OR=1.94, CI 1.31–2.86), compared to stage 1a. By contrast, we found no relationship between clinical stage and the emergence of alcohol or substance misuse and physical comorbidity. Conclusions: The differential rates of emergence of poor clinical and functional outcomes between early versus late clinical stages support the clinical staging model's assumptions about illness trajectories for mood and psychotic syndromes. The greater risk of progression to poor outcomes in those who present with more severe syndromes may be used to guide specific intervention packages. [ABSTRACT FROM AUTHOR]

Background: While there is growing research considering the experiences of transgender youth whose identities align with the gender binary, especially among young trans women, there are significantly fewer studies that accurately capture data about nonbinary youth, and even fewer studies capturing the experiences of transgender and gender diverse (TGD) youth of color. The purpose of this research was to assess the prevalence of sexual health behaviors, mental health challenges, substance use, and healthcare utilization among Black/African American, Latinx, Asian/Pacific Islander, indigenous and multi-racial/ethnic TGD youth, who have been largely underrepresented in research. Methods: A total of 108 TGD youth ages 16–24 were recruited into the Trans Youth of Color Study (TRUTH). Each participant completed a 90-min survey administered by a research assistant with more sensitive information collected using ACASI. In addition to a completing a survey administered by research staff, participants also participated in specimen collection, which included urine sampling to assess recent substance use without a prescription, self-collected rectal/frontal and throat swabs to test for gonorrhea and chlamydia, and a blood draw to test for recent use of drugs, gonorrhea and chlamydia, and syphilis. The sample was recruited at public venues, community outreach and referral, through social media outreach, and via participant referral. Cross-sectional analyses were from a single study visit. Results: Compared to rates among their cisgender peers, participants reported experiencing adverse social and structural determinants of health—e.g. food insecurity (61%), housing instability (30%), and limited access to healthcare (26% had no place to go for healthcare)—and elevated rates of illicit drug use (19–85%), mental health problems (e.g. 60% self-reported depression), and involvement in sexual risk-related behaviors (e.g. among those reporting penetrative sex 57–67% reported sex without a condom). Conclusions: This study adds descriptions of both mental and sexual health outcomes of a non-clinical sample of TGD youth to the literature, particularly among young transgender men and gender nonbinary youth, who have frequently been excluded from previous studies of sexual health. The findings document experiences and behaviors among TGD youth that contribute to mental and sexual health concerns, including rates of substance use, and healthcare utilization. [ABSTRACT FROM AUTHOR]

Background: Children and youth are an important population group requiring specific policies to address their needs. In Australia, most children and youth are doing well, however, certain equity groups are not. To address child and youth health equity in policy, applying a social determinants of health approach is considered best practice. For over 10 years governments in Australia have been called upon to address the social determinants of health, however, there has been limited action. Health and education departments are typically most involved in policy development for children and youth. To date, there have been limited systematic analyses of Australian child and youth health policies, and selected education wellbeing policies, with a social determinants of health and health equity focus and this study aims to contribute to addressing this gap. Methods: Policy analysis was conducted across 26 Australian child and youth health policies, and selected education wellbeing policies. We used an existing prior coding framework to understand the extent the social determinants of health and health equity were addressed. All policies were strategic level and only included if dated 2009 onwards. Results: Across 26 selected policies only 10% of strategies addressed the social determinants of health, demonstrating a lack of policy action. However, there is relatively even focus on all developmental stages, and an increased focus on youth. Equity is acknowledged across most policies with some groups receiving more attention including Aboriginal and Torres Strait Islander children. The social determinants of health addressed, to some degree, include early childhood development, education, parental workplace conditions, healthy settings, and housing, those least mentioned include public transport and regulation. Conclusion: This study demonstrates a lack of policy action on the social determinants of health within Australian child and youth health policy, and selected education wellbeing policies. Rather, the application of a siloed, and predominantly acute care approach. However, there is recognition of equity across all policies; an emphasis on housing as a determinant of health; and a link between health and education departments through education wellbeing policies, specifically addressing the issue of mental health. [ABSTRACT FROM AUTHOR]