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Despite great advancements in the development of evidence-based treatments (EBTs) for youth mental health problems, few EBTs have been adopted by or successfully implemented in schools. This is of concern, as schools are the most common entry point for youth mental health services. Modular psychotherapies may be a particularly good fit for the school context given their flexible nature. This study examined the experiences of school counselors implementing of a modular therapy. School counselors (n = 20) were recruited from a larger randomized controlled effectiveness trial in five school districts. Counselors participated in semi-structured interviews, and content analysis was used to elucidate barriers and facilitators to successful implementation of the protocol. Barriers and facilitators fell into four broad categories, consistent with the Consolidated Framework for Implementation Research: (1) intervention components, (2) school setting, (3) school counselors, and (4) study-specific processes. School counselors generally found the flexible nature of the protocol to be a good fit for their students and emphasized the benefits of training and ongoing consultation. Counselors highlighted many logistical barriers specific to the school counseling setting (e.g., lack of time, space, and competing job demands). Findings underscore the need for the development, testing, and implementation of brief and flexible mental health treatments that are tailored through school stakeholder engagement.

Objective: Transgender adolescents experience adversity accessing mental healthcare, which is exacerbated by transgender-specific mental health provider shortages in the United States. Factors associated with variability in transgender-specific mental health provider availability across states – especially at the macro-social level – have yet to be identified, hindering efforts to address these shortages. To remedy this gap, we queried whether transgender-specific adolescent mental health provider availability varied by states' transgender-specific policy climate. Method: We quantified states' policy climate by factor-analyzing tallies of the presence/absence of 33 transgender-specific state laws/policies in six domains: parental/relationship recognition, nondiscrimination, education, healthcare, criminal justice, and identity documentation. We then tested whether states' transgender-specific policy climate was associated with rates of transgender-specific adolescent mental health providers – identified via Psychology Today – per transgender adolescent in all 50 states and the District of Columbia. Results: Transgender-specific adolescent mental health provider availability was substantially lower in states with more restrictive laws/policies for transgender people (rate ratio = 0.65, 95% CI [0.52, 0.81], p =.00017), controlling for state-level conservatism, religiosity, and urbanicity. States' transgender-specific policy climate was unrelated to rates of adolescent Attention-Deficit/Hyperactivity Disorder-specialty providers, Oppositional Defiant Disorder-specialty providers, and youth mental health provider shortages broadly, providing evidence for result specificity. Conclusions: Transgender adolescents appear to have access to considerably fewer transgender-specific mental health providers in states with more restrictive laws/policies for transgender people, which may compound their already high mental health burden in these contexts. Intervention and policy efforts are needed to address these shortages, particularly in states with increasingly prohibitive laws/policies targeting transgender adolescents. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse (TGD) adolescents and their caregivers have highlighted the dearth of providers trained in gender-affirming practices as a critical treatment barrier, yet little is known about their specific experiences in mental health therapy. The present study sought to elucidate these experiences. Qualitative description was employed to analyze data from 105 clinical interviews completed with TGD adolescents (n = 49; ages 11–20) and/or their caregivers (n = 65; ages 36–84) seeking medical gender transition services at a pediatric gender program in the U.S. Participants highlighted satisfactory experiences with therapists they perceived as gender-affirming and who actively involved caregivers in therapy. Several participants reported unhelpful experiences with therapists viewed as non-affirming. In a few cases, caregivers were alienated from therapy when therapists told them to affirm their adolescent's gender in highly directive ways. Findings underscore the need to train therapists in gender-affirming practices and highlight the importance of thoughtfully engaging caregivers in therapy. [ABSTRACT FROM AUTHOR]

Objective: Gender minority youth (i.e., children/adolescents whose gender identity and/or expression is inconsistent with their birth-assigned sex) experience elevated rates of emotional and behavioral problems relative to cisgender youth (who identify with their birth-assigned sex), which are not intrinsic to gender identity but attributable to unique minority stressors. Although empirically supported treatments have proven effective in treating these mental health concerns generally, randomized controlled trials have not examined effects for gender minority youth. Method: To address this gap, we pooled data from clinically referred youth (N = 432; M(SD)age = 10.6(2.2); 55.1% White) assigned to empirically supported treatment conditions across four previous randomized controlled trials of modular psychotherapy. A proxy indicator of gender identity (i.e., youth's wish to be the opposite sex) was used to classify gender minority (n = 64) and cisgender (n = 368) youth. Youth- and caregiver-reported pretreatment internalizing and externalizing problems, treatment effectiveness on these domains, and treatment acceptability were compared across groups. Results: Gender minority youth reported more severe pretreatment internalizing and externalizing problems compared to cisgender youth; in contrast, their caregivers reported less severe problems. Although treatment was equally effective for both groups on most outcomes, gender minority youth's caregiver-reported externalizing problems improved more slowly and less reliably, and their self-reported internalizing problems were more likely to remain clinically elevated. Furthermore, gender minority youth reported lower treatment satisfaction. Conclusions: While findings suggest that empirically supported treatments may effectively address many mental health problems for gender minority youth, they also underscore the need for treatment enhancements that improve acceptability and outcomes. What is the public health significance of this article?: This study examined the effectiveness and acceptability of empirically supported mental health treatments for gender minority youth (who endorsed a wish to be the opposite sex) and cisgender youth. Gender minority youth reported more severe problems before treatment, demonstrated slower improvement in caregiver-reported behavior problems, and endorsed lower treatment satisfaction. Findings support the potential need for provider-focused trainings relevant to gender minority youth. [ABSTRACT FROM AUTHOR]

Background: Hundreds of youth psychotherapy randomized trials have generated scores of helpful empirically supported treatments (ESTs). However, the standardized structure of many ESTs and their focus on a single disorder or homogeneous cluster of problems may not be ideal for clinically referred youths who have comorbidity and whose treatment needs may shift from week to week. This concern has prompted development of flexible transdiagnostic, modular youth psychotherapies. One of these, designed for efficient training and implementation, is FIRST-a transdiagnostic intervention built on five empirically supported principles of change (i.e., feeling calm, increasing motivation, repairing thoughts, solving problems, and trying the opposite) and targeting common internalizing and externalizing youth mental health disorders and problems. FIRST has shown promise in improving youth mental health in three open trials. Now, in a more rigorous test, we seek to (1) conduct a randomized controlled trial comparing FIRST to usual care in real-world clinical practice settings; (2) examine a promising candidate mediator of change-regulation of negative emotions; and (3) explore variables that may influence clinicians' treatment implementation., Methods: This is an assessor-naïve randomized controlled effectiveness trial in youth outpatient community clinics in New England and Texas. Using double randomization, clinic-employed clinicians and treatment-referred youths (7-15 years old) are independently randomly allocated (1:1) to FIRST or usual care. We aim to recruit 212 youth participants, all referred through normal community pathways, with elevated symptoms of anxiety, depression, conduct problems, or post-traumatic stress. This study will test the effectiveness of FIRST compared to usual care on mental health outcomes, examine whether those outcomes are mediated by regulation of negative emotions, and explore clinician factors that may be associated with FIRST implementation and outcomes. Session recordings are coded to assess treatment fidelity., Discussion: This study will evaluate the effectiveness of FIRST in youth community mental health settings, relative to the care usually provided in those settings. If FIRST is found to be effective, it could offer an efficient and practical method to increase use of empirically supported treatment principles in real-world practice contexts., Trial Registration: NIH Clinical Trials Registry, NCT04725721. Registered 27 January 2021, https://clinicaltrials.gov/ct2/show/study/NCT04725721., Competing Interests: Competing interests JRW and SKB are authors of the treatment protocol FIRST. All other investigators declare no conflicts of interest.