Addressing mental health, earlier in pediatric primary care: Introduction to the special section.

Leading national health organizations have declared pediatric mental health an urgent public health issue. Pediatric primary care is an ideal setting to improve mental health in young children; however, various existing barriers limit the effective identification of social-emotional risk among toddlers. This special section of Families, Systems, & Health includes four articles that identify multilevel barriers and facilitators to population-level early childhood mental health screening, identification, and referral and describe implementation strategies that may be used to improve pediatric mental health. In the first article, authors describe clinicians' concerns regarding the social-emotional screening of young children. In the second article, authors highlight the potential for a transdiagnostic screening tool for assessing toddler irritability that may support clinical decision making. In the third article, authors use information gathered from clinicians to generate a logic model that can guide the implementation of screening and referral for toddlers with elevated social-emotional risk. In the fourth article, authors explore caregivers' perceptions of other factors, such as effectiveness, demand, and cost, of the proposed intervention, that may impact their service engagement. Together, these articles outline a plan for facilitating early childhood mental health screening, identification, and referral that has the potential for reducing the prevalence of pediatric mental health diagnoses. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Equity in Psychosocial Outcomes and Care for Racial and Ethnic Minorities and Socioeconomically Disadvantaged People With Diabetes.

The role of social determinants of health (SDOH) in promoting equity in diabetes prevalence, incidence, and outcomes continues to be documented in the literature. Less attention has focused on disparities in psychosocial aspects of living with diabetes and the role of SDOH in promoting equity in psychosocial outcomes and care. In this review, the authors describe racial/ethnic and socioeconomic disparities in psychosocial aspects of living with diabetes, discuss promising approaches to promote equity in psychosocial care, and provide future research directions.

Peer-support intervention for African American and Latino parents to improve the glycemic control trajectory among school-aged children with type 1 diabetes: A pilot and feasibility protocol.

Background Type 1 diabetes (T1D) is a common, chronic pediatric health condition with complicated management demands. African American and Latino children with T1D have troubling disparities in glycemic outcomes and acute complications. While there are empirically supported behavioral interventions to support disease management in youth with T1D, there are few that specifically aim to reduce health disparities in this population. While collaborative parent involvement with the child with T1D management tasks is important to promote optimal glycemic outcomes during childhood, our formative research identified multiple individual, family, and broader system factors that impede or facilitate collaborative parental involvement among African American and Latino parents of children with T1D. Methods This paper describes the development, design, and study protocol for the Type 1 Diabetes Empowerment And Management (TEAM) pilot trial. The TEAM intervention is a novel, group-based behavioral intervention designed to enhance collaborative involvement in T1D management for African American and Latino parents of children aged 5-10. This randomized pilot trial's primary aim is to evaluate the TEAM intervention's feasibility and acceptability. The secondary aim is to examine preliminary intervention outcomes (i.e., children's HbA1c, treatment adherence, collaborative parent involvement in T1D management, parent/child quality of life, and parent's diabetes-related distress, depressive symptoms, and self-efficacy) compared to usual T1D care. Discussion The trial will provide preliminary information about whether optimizing appropriate parent involvement during the school-age years may increase T1D treatment adherence and stabilize or improve glycemic control in African American and Latino school-aged children.

Diabetes distress and HbA1c in racially/ethnically and socioeconomically diverse youth with type 1 diabetes.

BACKGROUND: Diabetes distress, the emotional burden of caring for the chronic demands of diabetes, has not been well described in children and preadolescents with type 1 diabetes (T1D). This gap is particularly evident among youth of lower socioeconomic status (SES) and/or racial/ethnic minorities. Since these groups are more likely to have disparities in health outcomes and healthcare related to their diabetes, factors that could potentially improve glycemic and other diabetes-related outcomes should be studied closely. OBJECTIVE: We hypothesized that (a) diabetes distress levels would be elevated in children with markers of lower SES and those of racial/ethnic minorities, and (b) higher HbA1c would be predicted by higher diabetes distress levels, when controlling for race/ethnicity, SES, and clinical covariates. METHODS: One hundred and eighty-seven youth age 9 to 13 with T1D completed age-appropriate Problem Areas in Diabetes (PAID) questionnaires using a web-based portal during routine diabetes care visits. RESULTS: PAID scores were significantly elevated in youth who had surrogate markers of lower SES and who were from racial/ethnic minority backgrounds. In multivariate models including race/ethnicity or the SES variables and controlling for clinical covariates, the factor most predictive of higher HbA1c was elevated PAID score. CONCLUSIONS: Diabetes distress is elevated in a younger population of children with T1D who are from racial/ethnic minority backgrounds or have markers of lower SES. Interventions that target distress and/or expand the safety net in these populations could potentially improve glycemic outcomes.

Type 1 diabetes self-management behaviors among emerging adults: Racial/ethnic differences.

BACKGROUND: Emerging adulthood is a vulnerable period for poor blood glucose control and self-management behaviors (SMBs) among individuals with type 1 diabetes. Racial/ethnic minority young adults have poorer glycemic outcomes than non-Hispanic whites; however, little is known about possible racial/ethnic differences in frequency of SMBs among emerging adults (EAs). OBJECTIVE: To examine racial/ethnic differences in SMBs and to determine associations between SMBs and blood glucose control. METHODS: A sample of EAs (ages 18-25 years; N = 3456) from the type 1 diabetes exchange registry was used to conduct multivariate analyses to examine (a) racial/ethnic differences in SMBs and (b) associations between SMBs and blood glucose control for each racial/ethnic group. RESULTS: Compared to non-Hispanic whites, African Americans and Hispanics less frequently took an insulin bolus for snacks, less frequently checked blood glucose with a meter, and were more likely to not use insulin to carbohydrate ratios. African Americans also less frequently checked blood glucose prior to mealtime boluses and more frequently missed insulin doses. SMBs that were associated with blood glucose control across groups were frequency of checking blood glucose at mealtime, missing an insulin dose, and checking blood glucose with a meter. CONCLUSIONS: Promoting two SMBs: checking blood glucose and taking insulin doses as needed among African American EAs may be important to address racial disparities in glycemic outcomes. Future research should evaluate possible social and contextual mechanisms contributing to low engagement in these behaviors among African Americans to inform strategies to address racial differences in glycemic outcomes.

Barriers and Facilitators to Involvement in Children's Diabetes Management Among Minority Parents.

OBJECTIVE: This study aimed to describe parents' perceptions of the factors that facilitate or are barriers to their involvement in children's type 1 diabetes (T1D) management among African American and Latino parents. METHODS: African American and Latino parents (N = 28) of 5- to 9-year-old children with T1D completed audio-recorded, semi-structured interviews that were transcribed and analyzed using thematic analysis. Themes were identified that aligned with the theoretically-derived Capability-Opportunity-Motivation-Behavior (COM-B) framework. RESULTS: Parents described Capability-based facilitators of parent involvement, including positive stress management, religious/spiritual coping, organizational/planning skills, and diabetes knowledge. Capability-based barriers included child and parent distress. Interpersonal relationships, degree of flexibility in work environments, and access to diabetes technologies were both Opportunity-based facilitators and barriers; and Opportunity-based barriers consisted of food insecurity/low financial resources. Parents' desire for their child to have a "normal" life was described as both a Motivation-based facilitator and barrier. CONCLUSIONS: African American and Latino families described helpful and unhelpful factors that spanned all aspects of the COM-B model. Reinforcing or targeting families' unique psychological, interpersonal, and environmental strengths and challenges in multilevel interventions has potential to maximize parental involvement in children's diabetes management.

Developing a Policy Brief on Child Mental Health Disparities to Promote Strategies for Advancing Equity among Racial/Ethnic Minority Youth.

Research has identified a broad range of risk factors during early childhood that have neurobiological consequences and negatively affect children's mental health. Such risk factors disproportionately affect racial/ethnic minority youth. Disparities in children's mental health service use have also been documented for minority youth. Yet, compared with the focus on strategies to address health disparities (including mental health disparities) during adulthood, very little work has concentrated on addressing the roots of health disparities that occur in childhood. The purpose of this commentary is to describe the development and dissemination of a policy brief for policy advocates. The goal of this work is to help achieve the implementation of evidence-based programs, practices, and policies that target and modify risk factors to reduce disparities in child mental health burden.

Translating research to support practitioners in addressing disparities in child and adolescent mental health and services in the United States.

Despite increased recognition of disparities in youth mental health, racial/ethnic disparities in mental health burden and in mental health service use persist. This phenomenon suggests that research documenting disparities alone has not led to extensive action in practice settings in order to significantly reduce disparities. In this commentary, we present a framework to actively target this research-to-practice gap by describing the development of a resource titled, "Addressing the Mental Health Needs of Racial and Ethnic Minority Youth-A Guide for Practitioners." We begin by presenting social justice as the impetus for eliminating disparities and then reviewing current knowledge and efforts aimed at reducing disparities. Subsequently, we describe knowledge transfer frameworks and goals guiding our work. Finally, we detail the steps taken in our approach to translation and implications for subsequent dissemination of this guide. Translation focused on evidence-based information on (a) mechanisms that contribute to disparities, and (b) strategies for providers to address disparities in their work. We reflect on the framework guiding our translation to offer future directions for others interested in bridging research and action. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Review of Community-Engaged Research in Pediatric Diabetes.

PURPOSE OF REVIEW: Community-engaged research (CER), which is characterized by collaborations between researchers and community partners, is a promising approach to bridge the gaps in translating research evidence into care settings and to address health disparities. This review describes CER in investigations focused on pediatric diabetes. RECENT FINDINGS: Studies were focused on African American, Hispanic, and Native American youth. Most studies aimed to develop and evaluate preventive interventions for type 2 diabetes. Across studies, the community partners and organizations that collaborated with researchers were diverse (e.g., youth, schools). In most studies, community partners participated in developing behavioral, psychosocial, or public health interventions, and/or participant recruitment. Fewer studies reported intensive involvement in other aspects of the research (e.g., grant writing, publication). The findings suggested that CER is a feasible approach for engaging community partners in the development of interventions and participant recruitment in studies focused on diabetes among minority youth.

Estimated Prevalence of Psychiatric Comorbidities in U.S. Adolescents With Depression by Race/Ethnicity, 2011-2012.

PURPOSE: Comorbid psychiatric conditions in adolescents with depression are a public health concern. However, little is known about the prevalence of comorbidities in separate racial/ethnic groups. This study estimated the national prevalence of comorbidities for black, Hispanic, and white adolescents separately, and compared the prevalence of comorbidities between adolescents with and without depression. METHODS: This secondary analysis used data from the 2011-2012 National Survey of Children's Health, a nationally representative, cross-sectional survey of U.S. youth. We restricted the sample to 12-17 year olds, and obtained unweighted and weighted descriptive statistics. Using weighted probit regression models, we examined differences in prevalence of comorbidities by adolescents with and without depression for each racial/ethnic group. RESULTS: For black, Hispanic, and white adolescents with depression, the prevalence of comorbidities ranged from 8% to 61% and varied by race/ethnicity (e.g., depression and anxiety were comorbid for 47% of black, 54% of Hispanic, and 59% of white adolescents). For all racial/ethnic groups, adolescents with depression had a higher prevalence of attention deficit hyperactivity disorder than adolescents without depression. However, only black and Hispanic adolescents with depression had a significantly higher prevalence of anxiety and behavior problems than their counterparts without depression. In each racial/ethnic group, the prevalence of autism spectrum disorder did not differ between adolescents with and without depression. CONCLUSIONS: This study detected important differences in the prevalence of comorbid psychiatric conditions by race/ethnicity. Findings highlight the need for targeted interventions for black and Hispanic adolescents with depression that concurrently treat anxiety and behavior problems.

Considering Culture: A Review of Pediatric Behavioral Intervention Research in Type 1 Diabetes.

PURPOSE OF REVIEW: Type 1 diabetes (T1D) incidence in youth is growing across all racial/ethnic backgrounds, with the most marked increase in African-American youth under 5. Underrepresented racial/ethnic minorities are at an increased risk for health complications. This review focuses on the reported disparities, demographics of samples in behavioral interventions, and study design considerations. RECENT FINDINGS: Recruitment data from two ongoing behavioral intervention trials for young children with T1D are presented to compare enrolled/non-enrolled individuals and to discuss culturally appropriate study design considerations. Data were compared to the demographics of children (ages 1-6) with T1D in the clinic populations from the recruitment sites. Enrolling a representative sample and designing culturally appropriate behavioral interventions are important for generalizability, yet there is a gap between the individuals participating in T1D research and those who are most negatively affected by T1D. Suggestions are offered for ways to expand inclusion of diverse samples in behavioral intervention research in T1D.

Screening and support for emotional burdens of youth with type 1 diabetes: Strategies for diabetes care providers.

Multiple sources of burden for youth with type 1 diabetes (T1D) impact key outcomes including quality of life, self-management, and glycemic control. Professional diabetes organizations recommend diabetes care providers screen for psychosocial and behavioral challenges and implement strategies to support youth with T1D. The purpose of this article is to review the literature and recommend practical strategies medical providers can use for screening and behavioral support for youth with diabetes and their families. As part of their routine medical care, diabetes care providers are well-positioned to identify and intervene to address emotional distress related to the burdens of living with diabetes. In collaboration with multidisciplinary team members, including psychologists and mental health professionals, medical providers may be able to successfully implement brief behavioral strategies for screening and providing emotional support.

Pilot and feasibility study of a parenting intervention delivered by parent peers.

Preventive parenting interventions delivered by parent peer specialists may be a viable alternative to professional-led interventions and offer an advantage of increasing access in medically underserved areas. The objective of this pilot study was to assess the feasibility and preliminary outcomes of a 10-session, peer specialist-delivered preventive parenting intervention (Smart and Secure Children) for child disruptive behavior. The intervention was evaluated among a small sample of parents (N = 15) of preschoolers (2-5 years) residing in medically underserved communities. Pediatricians referred families to the intervention, which was delivered in primary care practices within medically underserved communities. To determine feasibility, we calculated percentages of pediatricians who referred parents to the intervention, parent peer specialists who completed 40-h interventionist and leadership training, and the average number of sessions attended by parents. Enrolled parents completed questionnaires assessing child disruptive behavior, parenting stress and parenting competence at pre-and post-intervention. Descriptive statistics demonstrated the majority of pediatricians within the clinics referred families, and all parent peer specialists completed training to deliver the intervention. On average, 60% of sessions were attended by parents. Pairwise t-tests showed pre-to-post-intervention improvements in number of child disruptive behaviors perceived as a problem by parents, parenting stress and parenting competence. No significant change was found in parent-reported frequency of child disruptive behaviors. Results suggests adequate feasibility of the Smart and Secure Children Intervention, and that it holds promise for improving parenting stress and competence, and decreasing the number of child behaviors that are perceived as a problem by parents. Future directions for research are discussed.

Social Determinants of Health and Racial/Ethnic Disparities in Type 2 Diabetes in Youth.

PURPOSE OF REVIEW: Pervasive disparities in T2DM among minority adults are well-documented, and scholars have recently focused on the role of social determinants of health (SDOH) in disparities. Yet, no research has summarized what is known about racial/ethnic disparities in youth-onset T2DM. This review summarizes the current literature on racial/ethnic disparities in youth-onset T2DM, discusses SDOH that are common among youth with T2DM, and introduces a conceptual model on the possible role of SDOH in youth-onset T2DM disparities. RECENT FINDINGS: Minority youth have disparities in the onset of T2DM, quality of life, and family burden. Low family income and parental education and high youth stress are common negative SDOH among families of youth with T2DM. No studies have examined the role of SDOH in racial/ethnic disparities in youth-onset T2DM. Future research should examine whether SDOH contribute to disparities in T2DM prevalence and psychosocial outcomes among minority youth.

Diabetes-Specific and General Life Stress and Glycemic Outcomes in Emerging Adults With Type 1 Diabetes: Is Race/Ethnicity a Moderator?

Objective: This study examines whether race/ethnicity moderates relationships of (a) diabetes stress and general life stressors with (b) diabetes outcomes of glycemic control and diabetic ketoacidosis (DKA) among emerging adults (aged 18-25 years) with type 1 diabetes (T1D). Method: Using a T1D Exchange Registry sample of non-Hispanic White, African American, and Hispanic emerging adults (N = 3,440), multiple group analyses were used to determine whether race/ethnicity moderates the relationships between stress and diabetes outcomes. Results: The relationships between the two stress types and glycemic control did not differ between African American and non-Hispanic Whites. However, as compared with non-Hispanic Whites, the association between higher diabetes-specific stress and poorer glycemic control was significantly stronger for Hispanics, and Hispanics had poorer glycemic control when they experienced a relatively fewer number of general life stressors than non-Hispanic Whites. The relationships between the type of stress (diabetes-specific and general stress) and DKA did not differ across racial/ethnic groups. Conclusions: Future research should evaluate possible mechanisms that contribute to the different relationships of stress with glycemic control among Hispanics compared with non-Hispanic Whites.

Maternal Depression and Parent Management Training Outcomes.

This study examines the impact of maternal depression on reductions in children's behavior problems severity following implementation of the Brief Behavioral Intervention-a brief, manualized parent management training treatment. The parents of 87 children aged 2-6 years of age received parent management training at a metropolitan hospital. Parents of participants completed measures of externalizing behavior and maternal depression. The association between pre-post treatment change in externalizing behavior and maternal depression was examined using an autoregressive cross-lagged model. Results showed that self-reported maternal depressive symptoms at pre-treatment negatively influenced the overall magnitude of reduction of reported externalizing behaviors in children following treatment. Results indicate that aspects of family functioning not specifically targeted by parent management training, such as maternal depression, significantly affect treatment outcomes. Clinicians providing parent management training may benefit from assessing for maternal depression and modifying treatment as indicated.

Stress and A1c Among People with Diabetes Across the Lifespan.

Stress is known to negatively affect health and is a potentially serious barrier to diabetes-related health outcomes. This paper synthesizes what is known about stress and glycemic control among people with type 1 and type 2 diabetes across the lifespan. Chronic stress-especially in relation to living with diabetes-was most strongly associated with A1c, particularly among subgroups that face disproportionate stress, such as minority groups or adolescents/young adults. Mechanisms of the stress-A1c association include physiological, psychological, behavioral, and environmental links. Understanding the dimensions of stress as they relate to health in diabetes can be of significant clinical importance, and interventions targeting mechanisms that either exacerbate or buffer stress have reported modest improvements in A1c.

Relationships of Shared Decision Making with Parental Perceptions of Child Mental Health Functioning and Care.

Experts encourage parents and practitioners to engage in shared decision making (SDM) to provide high quality child mental health care. However, little is known regarding SDM among families of children with common mental health conditions. The objectives of this study were to examine associations between parental report of SDM and parental perceptions of (a) receiving child mental health care and (b) child mental health functioning. We analyzed cross-sectional data on children with a common mental health condition (attention-deficit hyperactivity disorder, oppositional-defiant or conduct disorder, anxiety, or depression) from the 2009/2010 National Survey of Children with Special Healthcare Needs (N = 9,434). The primary independent variable was parent-reported SDM, and the dependent variables were parental perception of (a) their child receiving all needed mental health care (b) their children's impairment in school attendance and extracurricular activity participation, and (c) severity of their children's mental health condition. Multivariate logistic and multinomial regression analyses were conducted. Greater parent-reported SDM was associated with parental perceptions of receiving all needed child mental health care and children not having school or extracurricular impairment. Greater SDM was also associated with perceptions of children having a mild mental health condition compared to children having a moderate or severe condition. Findings provide a basis for future longitudinal and intervention studies to examine the benefit of SDM for improving parental perceptions of the quality of child mental health care and mental health functioning among children with common mental health conditions.

Systematic Review of Engagement in Culturally Adapted Parent Training for Disruptive Behavior.

This article reviews the literature reporting engagement (enrollment, attendance, and attrition) in culturally adapted parent training for disruptive behavior among racial/ethnic minority parents of children ages 2-7 years. The review describes the reported rates of engagement in adapted interventions and how engagement is analyzed in studies, methods to develop adaptations, and adaptations that have been implemented. Seven studies were identified. Parental engagement varied across and within studies. Only one study examined whether adaptations improved engagement compared to non-adapted intervention. Frequent methods to develop adaptations were building partnerships or conducting interviews/focus groups with minority parents or community members. Adaptations included addressing cultural beliefs (perceptions of parenting skills), values (interdependence), or experiences (immigration) that affect parenting or receptivity to interventions; ensuring racial/ethnic diversity of interventionists; and addressing cultural relevancy and literacy level of materials. Future research should examine engagement in adapted interventions compared to non-adapted interventions and examine factors (e.g., immigration status) that may moderate impact on engagement.

Shared decision making among parents of children with mental health conditions compared to children with chronic physical conditions.

High quality care in pediatrics involves shared decision making (SDM) between families and providers. The extent to which children with common mental health disorders experience SDM is not well known. The objectives of this study were to examine how parent-reported SDM varies by child health (physical illness, mental health condition, and comorbid mental and physical conditions) and to examine whether medical home care attenuates any differences. We analyzed data on children (2-17 years) collected through the 2009/2010 National Survey of Children with Special Health Care Needs. The sample consisted of parents of children in one of three child health categories: (1) children with a chronic physical illness but no mental health condition; (2) children with a common mental health condition but no chronic physical condition; and (3) children with comorbid mental and chronic physical conditions. The primary dependent variable was parent-report of provider SDM. The primary independent variable was health condition category. Multivariate linear regression analyses were conducted. Multivariate analyses controlling for sociodemographic variables and parent-reported health condition impact indicated lower SDM among children with a common mental health condition-only (B = -0.40; p < 0.01) and children with comorbid conditions (B = -0.67; p < 0.01) compared to children with a physical condition-only. Differences in SDM for children with a common mental health condition-only were no longer significant in the model adjusting for medical home care. However, differences in SDM for children with comorbid conditions persisted after adjusting for medical home care. Increasing medical home care may help mitigate differences in SDM for children with mental health conditions-only. Other interventions may be needed to improve SDM among children with comorbid mental and physical conditions.