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Background: The majority of youth with mental health needs do not receive therapy services to treat their disorder, and unmet need is particularly high among racial and ethnic minorities and economically disadvantaged families in the population at large. Investigating whether these patterns emerge within systems of care can reveal opportunities to expand therapy access and utilization. Objective: This study examines multilevel predictors of receipt of therapy within the Children's Mental Health Initiative (CMHI), the largest federally-funded effort in the United States to serve youth with significant emotional or behavioral disturbance, to determine whether disparities in therapy use persist within this specialized population that has been connected to a service array. Method: Using data from 1604 youth aged 10-17 in 33 CMHI-funded system of care sites, the relationship between youth, family and site-level variables and the receipt of outpatient therapy in the first 6 months of service were examined using a multilevel model. Results: Youth who were African American, had caregivers with less education, were in families at or below the poverty level, or lived in sites that served a higher rate of families below the poverty level were less likely to receive needed therapy services after controlling for age, gender, and symptomatology. Conclusions: Despite the CMHI's success in connecting the majority of enrolled youth to therapy services, treatment disparities persist along racial and socioeconomic lines. These findings identify youth and communities that may require additional strategies and attention to better connect youth to needed therapy services.

Background: Surrogate Decision-Makers (surrogates) are frequently employed in decision-making for critically ill adults. There are insufficient data considering the surrogate experience, stress, and potential for mitigation. Methods: An anonymous online survey queried (1) medical situation (2) total stress (3) demographics (4) potential factors, including sources of information about patient wishes, external sources of support or competing stressors, and their interactions with the medical team through the experience. Results: 108 respondents were included; 91 completed all items. Most respondents ranked their experience as a surrogate as one of the most stressful experiences of their lives; this was associated with whether it was an end-of-life decision (P =.003), Respondent Religion (P =.015), or religious or spiritual beliefs (P =.024), and having their own health problems (P =.008). On individual Likert responses, surrogates reported significant stress mitigation when they felt they had been helpful (P <.001), knew the patient's wishes (P =.0011), specifically discussed patient wishes (P <.001), or patient's wishes were documented (P <.001). Items about surrogate-team interaction also met significance, including the physician being communicative and available (P <.001), respectful (P =.007), honest (P <.001), and validating (P =.001). Conclusions: Surrogate stress is an evolving area for research. Significant factors included relationship with the medical team, making this an important area for HPM to play a key role in mitigating surrogate stress. [ABSTRACT FROM AUTHOR]

Domestic and community violence are two pervasive societal issues. While research indicates significant connections between these forms of violence, detailed exploration of their co-occurrence and specific characteristics within intervention and prevention programs remains lacking. Understanding these complex interactions is crucial, as many programs are not designed to address the diverse manifestations of violence simultaneously. They often focus on one type, potentially overlooking the broader spectrum of violence that individuals might experience or contribute to. This study aims to illuminate the frequency and nature of these violence types within the context of intervention efforts. To bridge this gap, we engaged in a systematic, secondary analysis, delving into 1,943 conflicts documented across 25 CeaseFire program sites in Chicago between 2000 and 2015. Data included information from mediation forms regularly completed by CeaseFire staff post-mediation. Our primary focus encompassed a content analysis of these cases to establish a baseline occurrence of domestic violence within violence mediations. Subsequently, we probed the prevalence and intricate interplay between community and domestic violence, exploring potential bidirectional influences. Of the 1,943 conflicts mediated among program sites in Chicago, 151 conflicts displayed signs of interconnection with community violence, falling into the categories of retaliation or intervention. In summation, the findings underscore the entwined nature of domestic and community violence, often transitioning from one form (primarily domestic) to another (typically community-based) in the form of escalating retaliatory behaviors. Violence prevention and intervention endeavors must consider the plausible escalation patterns stemming from interconnected violence forms, significantly shaping mediation strategies. [ABSTRACT FROM AUTHOR]

In spite of common public condemnations of domestic violence, survey research suggests that citizens aware of actual abuse often believe they cannot or should not personally respond. Through in-depth interviews with 20 local citizens across the political spectrum, we sought to explore this dynamic more carefully by better understanding community interpretations of domestic violence and its appropriate response. This paper explores ten specific views identified in these interviews as potentially relevant to citizen action (or inaction) in response to known abuse. After examining subtle consequences of each belief, we explore broader implications for community mobilization and propose several ways of facilitating a more thoughtful and extensive deliberation about domestic violence among the general public. (Contains 2 tables and 4 footnotes.)

Background and purposeThis study investigated whether isoflurane ameliorates neurological sequelae after germinal matrix hemorrhage (GMH) through activation of the cytoprotective sphingosine kinase/sphingosine-1-phosphate receptor/Akt pathway.MethodsGMH was induced in P7 rat pups by intraparenchymal infusion of bacterial collagenase (0.3 U) into the right hemispheric germinal matrix. GMH animals received 2% isoflurane either once 1 hour after surgery or every 12 hours for 3 days. Isoflurane treatment was then combined with sphingosine-1-phosphate receptor-1/2 antagonist VPC23019 or sphingosine kinase 1/2 antagonist N,N-dimethylsphingosine.ResultsBrain protein expression of sphingosine kinase-1 and phosphorylated Akt were significantly increased after isoflurane post-treatment, and cleaved caspase-3 was decreased at 24 hours after surgery, which was reversed by the antagonists. Isoflurane significantly reduced posthemorrhagic ventricular dilation and improved motor, but not cognitive, functions in GMH animals 3 weeks after surgery; no improvements were observed after VPC23019 administration.ConclusionsIsoflurane post-treatment improved the neurological sequelae after GMH possibly by activation of the sphingosine kinase/Akt pathway.

This review evaluates the mechanism of volatile anesthetics as cardioprotective agents in both clinical and laboratory research and furthermore assesses possible cardiac side effects upon usage. Cardiac as well as non-cardiac surgery may evoke perioperative adverse events including: ischemia, diverse arrhythmias and reperfusion injury. As volatile anesthetics have cardiovascular effects that can lead to hypotension, clinicians may choose to administer alternative anesthetics to patients with coronary artery disease, particularly if the patient has severe preoperative ischemia or cardiovascular instability. Increasing preclinical evidence demonstrated that administration of inhaled anesthetics - before and during surgery - reduces the degree of ischemia and reperfusion injury to the heart. Recently, this preclinical data has been implemented clinically, and beneficial effects have been found in some studies of patients undergoing coronary artery bypass graft surgery. Administration of volatile anesthetic gases was protective for patients undergoing cardiac surgery through manipulation of the potassium ATP (KATP) channel, mitochondrial permeability transition pore (mPTP), reactive oxygen species (ROS) production, as well as through cytoprotective Akt and extracellular-signal kinases (ERK) pathways. However, as not all studies have demonstrated improved outcomes, the risks for undesirable hemodynamic effects must be weighed against the possible benefits of using volatile anesthetics as a means to provide cardiac protection in patients with coronary artery disease who are undergoing surgery.

The American Journal of Community Psychology (AJCP) was founded in 1973 and has since its inception has been the flagship journal for the Society of Community Research and Action. AJCP publishes leading scholarship in community psychology and social action research. This special issue celebrates the 50 years of scholarship in AJCP by curating and assembling previously published articles in virtual special issues (VSIs) with accompanying commentaries. Nine VSIs were compiled as part of this special issue. Each of these VSIs were organized around themes that are of critical importance to community psychology and each VSI summarizes what has been learned from their included articles and future directions for the field. In this paper, we introduce this special issue on this collection of VSIs, discussing how each of these VSIs endeavor to push the field forward. Highlights: This special issue celebrates 50 years of the American Journal of community psychology.Nine virtual special issues (VSI) curated previously published papers in AJCP.We summarize these VSI introductions and discuss how each calls for future directions for the field. [ABSTRACT FROM AUTHOR]

This article describes a feminist intervention to raise awareness about, and problematize, the pervasive experience of silencing, as reported by women, people of color, students, people identifying as gay, lesbian, bisexual, transgender, and queer (GLBTQ), people with national origins outside of North America, and people with disabilities, within the Society for Community Research and Action (SCRA). A theater-based intervention was designed and scripts were written from real-life experiences that defined and described the problem of silencing as structural. We highlight three main points that emerged from intervention: (a) nontraditional approaches that step outside the cultural norms of a setting have great potential for raising awareness; (b) questions of power, privilege, and voice continue to be central considerations when using feminist-based anti-oppression methods; and (c) although acts of silencing can occur at the individual level, they thrive in an environment in which power, privilege, and historical inequities operate invisibly (without being named, acknowledged, or addressed). (Contains 5 footnotes.)

Community psychologists have a long-standing interest in promoting systems change to improve the lives of individuals and communities. To more fully illuminate a multilevel model of those factors involved in the promotion of systems change, the current study examined individual- and organizational-level characteristics related to health care providers' implementation of a desired reform in the community response to intimate partner violence, namely, universal screening practices. Efforts to reform the health care system's response to domestic violence prove to be difficult. The current study surveyed 209 providers across 12 health care settings to examine those factors related to reform implementation. Findings indicate that individual characteristics (perceived capacity to screen and positive beliefs about screening) and the presence of an organizational climate for implementation (e.g., consequences for implementation or failure to implement, resources to support implementation, policies and procedures consistent with desired practices) affect the extent to which health care providers engage in routine screening practices. The implications of these findings for promoting systems change, in general, and the health care system's response to domestic violence, in particular, are discussed. (Contains 4 tables and 5 footnotes.)