Reimagining Social and Emotional Supports in Schools for Immigrant Students: A Contextual and Structural Approach.

Immigrant students and families experience disproportionate exposure to trauma, immigration-related stress, structural inequities, and poor access to mental health and social services which can lead to mental health inequities. Immigrant students and their families also have many strengths that can buffer potential negative mental health outcomes. Schools, which address social and emotional development in addition to academic achievement, are critical institutions that can play a unique role in enhancing the strengths and responding to the needs of immigrant students and families. In this review, we adapt the Behavioral Model for Vulnerable Populations to acknowledge the contextual and macro-level factors (e.g., relevant policies, environmental influences, and structural factors) and the predisposing, enabling, and need factors that immigrant students and families experience and impact access to school mental health and social services. We discuss school-based interventions that show efficacy for improving mental health outcomes and focus on addressing acculturative stress among immigrant students. We also discuss models to address social determinants of health need among immigrant students and families within schools, including the community schools model applied to immigrant students and families. We conclude this review by providing recommendations and strategies for pediatricians and schools to transform school-based supports for immigrant students and families and promote equitable outcomes. Our recommendations include incorporating multi-level school supports for addressing mental health, social need, and acculturative stress among immigrant students, along with reinforcing the strengths of immigrant students, and promoting school collaborations with pediatricians, school-based health centers, and trusted community partners.

Commercially Sexually Exploited Adolescent Girls: The Association Between Externalizing Disorders and Parental Incarceration with Suicide Attempts.

Commercial sexual exploitation (CSE) is a significant public health concern disproportionately affecting ethnoracially minoritized girls. Despite strong associations of CSE with suicide attempts, little is known about correlates of suicide among girls with CSE histories. Elevated rates of externalizing disorders (i.e., attention-deficit/hyperactivity disorder [ADHD], disruptive behavior disorders [DBD], conduct disorder [CD]) were observed among CSE youth, particularly in ethnoracially minoritized samples. Youth with CSE histories are frequently affected by parental incarceration, which is correlated with risk for suicide attempts. We tested cross-sectional simultaneous associations of externalizing disorders and parental incarceration with number of suicide attempts among 360 ethnoracially diverse girls affected by CSE (Mean age = 18.86). ADHD, DBD, and maternal incarceration were positively associated with number of suicide attempts. Findings implicate clinical/familial correlates of suicide attempts in this marginalized group, suggesting early suicide prevention efforts may improve traction on this problem by focusing on individual and family level factors.

Parental Legal System Involvement, Positive Childhood Experiences, and Suicide Risk.

OBJECTIVES: To examine whether adverse parental legal system involvement (incarceration, arrest) was associated with suicide risk, accounting for other adverse childhood experiences, and whether there was a moderating relationship between positive childhood experiences (PCEs) and parental legal system involvement in suicide risk. METHODS: This cross-sectional study used 2-year follow-up data from the Adolescent Brain Cognitive Development Study when children were age 11 to 12 years. Outcomes were lifetime suicidal ideation, attempts, and nonsuicidal self-injury (NSSI). Exposures were parent incarceration or arrest. We used generalized linear models to estimate the relative risk of suicide outcomes from adverse parent legal involvement and whether there was an interaction between parent legal system involvement and PCE count, controlling for adverse childhood experiences and demographic factors. RESULTS: Among our sample (n = 10 532;), 687 children (6.5%) reported parent incarceration and 1265 (12.0%) reported parent arrest. Suicidal ideation was the most frequent risk outcome (n = 490; 4.7%). Children whose parents had been incarcerated had a relative risk of suicidal ideation of 1.74 (95% CI: 1.32-2.31). Children whose parents had been arrested had a relative risk of suicidal ideation of 1.89 (95% CI: 1.53-2.37) and a relative risk of suicide attempt of 2.69 (95% CI: 1.7-4.25). Parental incarceration/arrest were not associated with NSSI. PCEs were associated with reduced relative risk of suicidal ideation and NSSI, though there was no significant interaction between PCEs and adverse parent legal system involvement exposures. CONCLUSIONS: Parental legal system involvement may negatively affect child mental health. Strengthening PCEs in childhood may mitigate suicide-related risks.

Counseling Center and Therapist Effects on Changes in Suicidal Ideation among College Students Receiving Services on Campus: Comparisons across International Status, Race, Gender, and Sexual Orientation.

OBJECTIVE: Examine center- and therapist-level factors that may impact suicide ideation outcomes for college students with minoritized identities. METHOD: Data were drawn from a 2015-2017 data set collected from 136 university counseling centers that were part of the Center for Collegiate Mental Health. This study used a three-level model in hierarchical linear modeling with clients (Level 1; N = 122,212), clients nested in therapists (Level 2; N = 2,574), and therapists nested in counseling centers (Level 3; N = 120). RESULTS: Racially/ethnically minoritized students were 20%, LGBQ + students were 100% more likely, and women students were 20% less likely to have suicidal ideation at the first session, compared to White, male, heterosexual domestic students. LGBQ + students were 20%, and international students were 50% more likely to have suicidal ideation in the last session, compared to White, male, heterosexual domestic students. Cross-level interactions revealed that when therapists had a higher percentage of international students on their caseload, international students had decreased suicidal ideation. Similarly, when therapists had a higher percentage of male students on their caseload, their male students had decreased suicidal ideation. CONCLUSIONS: Findings from this study support the importance of experience and competence in working with minoritized students, as therapists who had more international and men students on their caseload fared better in decreasing the suicide ideation of respective students. This suggests that continued exposure to the unique challenges faced by particular minoritized groups of college students can enhance the quality of care delivered by therapists.

Community Members' Perceptions of a Resource-Rich Well-Being Website in California During the COVID-19 Pandemic: Qualitative Thematic Analysis.

BACKGROUND: To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. OBJECTIVE: This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. METHODS: After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. RESULTS: Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) "Feels like home"-experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) "It's a one-stop-shop"-judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. CONCLUSIONS: The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too "professional" or "clinical." The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma.

Examining the relationship between suicide ideation frequency and intergenerational acculturative conflict between Mexican descent college students and their caregivers using the interpersonal theory of suicide.

INTRODUCTION: Suicide is the third leading cause of death among US young adults, with significant racial/ethnic disparities related to the risk for suicide among Latine young adults. Despite the elevated risk for suicide, culturally relevant risk factors are not well-known. Intergenerational acculturative conflict (IAC) among Latine youth is a sociocultural factor associated with suicide ideation. METHOD: Although widely cited, the interpersonal theory of suicide (IPTS) lacks consistent support among Latine groups. The following cross-sectional study examined relationships between IAC categories (cultural preference, autonomy, and dating/staying out late), IPTS risk factors (i.e., thwarted belongingness and perceived burdensomeness), and suicide ideation frequency among 376 Mexican descent college students sampled using participant pools and snowball sampling (73.7% female: Mage = 19.88). RESULTS: Mediation analyses supported the hypotheses that IPTS risk factors partially explained the links between IAC categories and suicide ideation frequency. CONCLUSIONS: These findings advance our understanding of how sociocultural constructs, such as IAC, influence the IPTS and future advancements in culturally responsive treatments for suicide.

Impact of Family, Neighborhood, and Schools on Behavioral Health Needs of Justice-Involved Latinx Adolescents.

Latinx adolescents are overrepresented in the justice system and have high untreated behavioral health needs. We examined the family as well as promotive and inhibitive environments (i.e., neighborhood and school) and their associations on behavioral health among 181 first-time justice-involved Latinx adolescents. Results showed that more optimal caregiver-adolescent attachment was associated with fewer behavioral health needs; more negative caregiver-adolescent communication with greater behavioral health needs. Increased neighborhood disadvantage and negative school interactions served as inhibitive environments and were associated with greater behavioral health needs. Moderation analyses indicated that negative communication was associated with greater behavioral health needs among dyads with large acculturation differences but not for dyads close in acculturation. Findings underscore the need to assess the family relationships and communication, promotive/inhibitive environments, and acculturation differences when determining how to meet behavioral health needs among justice-involved Latinx adolescents.

Risk and Protective Factors Associated with Self-Cutting Behavior Among Adolescents at First Contact with the Juvenile Court.

Adolescents involved in juvenile legal system are at increased risk for self-cutting behavior, however, correlates associated with elevated risk remain underresearched, particularly among youth with first involvement with the court. This study utilized an epidemiological two-year longitudinal study involving 401 adolescents at first contact with the court (Mage = 14.47; SDage = 1.94 years; 43% female; 42% Latinx/Hispanic) and an involved caregiver. Study aims examined key prospective psychosocial correlates of self-cutting behavior. Baseline assessments captured individual and family level risk and protective factors; self-cutting behavior was assessed longitudinally every four months post-baseline for 24 months. Psychosocial correlates of self-cutting behavior included adolescent affect dysregulation, post-traumatic stress disorder symptoms, impulsive decision making, anxiety and depression symptoms. Significant protective factors included positive communication with caregiver and family, higher self-esteem, and having a caring and supportive family. These findings suggest that internalizing symptoms as well as difficulties with emotion regulation and impulsive decision making are correlated with heightened risk for self-cutting behavior among adolescents involved in the juvenile legal system. The findings also suggest that individual and family level protective factors, like positive communication and a supportive family, are associated with decreased risk for self-cutting behavior among adolescents at first contact with the court.

Promoting Racial/Ethnic Identity in Child and Adolescent Mental Health Treatments.

Over the last decade, state and city legislative efforts have underscored that racism is a public health crisis. These legislative shifts have been in concert with several professional medical organizations, including the National Academy of Medicine, the United States Department of Health and Human Services, the Centers for Disease Control, and the National Institute of Health, which have collectively called for structural change to address race inequity in health, from research to patient care. The adverse effects of racism (eg, interpersonal, structural, institutional, and internalized) on health have been documented to include negative effects across the lifespan and developmental continuum, particularly for ethnoracially minoritized youth. Indeed, several studies have specifically identified racism's impact on youths' psychosocial functioning and emotional well-being, particularly around anxiety, depression, and academic functioning. The effects of interpersonal racism on mental health in adolescents and, in particular, Black youth is telling. Although the child and adolescent mental health establishment and literature have advocated for strengths-based (eg, cultural assets) and community engaged (eg, community-based participatory research) frameworks to advance evidence-based treatments for diverse communities, the development of culturally responsive and antiracist interventions remain a gap in our treatment armamentarium for ethnoracially minoritized youth. As in other papers, we have highlighted the criticality of health equity, cultural humility, and culturally informed and responsive clinical practices. We have also underscored that, as a field, child mental health practitioners need to move toward being antiracist to truly address well-being, a shift that requires pivoting toward approaches that promote racial/ethnic identity (REI), which includes racial/ethnic connectedness and racial/ethnic pride. Race-conscious interventions, particularly those that focus on racial/ethnic connectedness and racial/ethnic pride, can not only be protective and health promoting in their ability to mitigate the emotional harms of experiencing racism, but can also foster social-emotional functioning and successful academic outcomes among ethnoracially minoritized individuals.

Practitioner Review: Common elements in treatments for youth suicide attempts and self-harm - a practitioner review based on review of treatment elements associated with intervention benefits.

BACKGROUND: Adopting a common elements approach, this practitioner review aims to highlight specific treatment elements that are common to interventions with demonstrated benefits in randomized controlled trials (RCTs) for reducing suicide attempts and self-harm in youth. Identification of common treatment elements among effective interventions offers a key strategy for clarifying the most robust features of effective interventions and improving our ability to implement effective treatment and decrease the lag between scientific advances and clinical care. METHODS: A systematic search of RCTs evaluating interventions targeting suicide/self-harm in youth (ages 12-18) yielded a total of 18 RCTs assessing 16 different manualized interventions. An open coding process was used to identify common elements present within each intervention trial. Twenty-seven common elements were identified and classified into format, process, and content categories. All trials were coded for the inclusion of these common elements by two independent raters. RCTs were also classified into those where trial results supported improvements in suicide/self-harm behavior (n = 11 supported trials) and those without supported evidence (n = 7 unsupported trials). RESULTS: Compared with unsupported trials, the 11 supported trials shared the following elements: (a) inclusion of therapy for both the youth and family/caregivers; (b) an emphasis on relationship-building and the therapeutic alliance; (c) utilization of an individualized case conceptualization to guide treatment; (d) provided skills training (e.g. emotion regulation skills) to both youth and their parents/caregivers; and (e) lethal means restriction counseling as part of self-harm monitoring and safety planning. CONCLUSIONS: This review highlights key treatment elements associated with efficacy that community practitioners can incorporate in their treatments for youth presenting with suicide/self-harm behaviors.

Culturally responsive assessment of suicidal thoughts and behaviors in youth of color.

The significance of youth suicide as a public health concern is underscored by the fact that it is the second-leading cause of death for youth globally. While suicide rates for White groups have declined, there has been a precipitous rise in suicide deaths and suicide-related phenomena in Black youth; rates remain high among Native American/Indigenous youth. Despite these alarming trends, there are very few culturally tailored suicide risk assessment measures or procedures for youth from communities of color. This article attempts to address this gap in the literature by examining the cultural relevancy of currently widely used suicide risk assessment instruments, research on suicide risk factors, and approaches to risk assessment for youth from communities of color. It also notes that researchers and clinicians should consider other, nontraditional but important factors in suicide risk assessment, including stigma, acculturation, and racial socialization, as well as environmental factors like health care infrastructure and exposure to racism and community violence. The article concludes with recommendations for factors that should be considered in suicide risk assessment for youth from communities of color. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Contributions of Multilevel Family Factors to Emotional and Behavioral Problems among Children with Oppositional Defiant Disorder in China.

Oppositional defiant disorder (ODD) is one of the most prevalent childhood mental health disorders and is extremely affected by family factors. However, limited studies have addressed the issue from the perspective of family systems. The current study examines the associations between multilevel family factors (i.e., family cohesion/ adaptability at system level, mother-child and father-child attachment at a dyadic level, and child self-esteem at an individual level) and emotional and behavioral problems among children with ODD in China. The participants were 256 Chinese children with ODD and their parents and class master teachers. A multiple-informant approach and structural equation model were used. The results revealed that system level factors (family cohesion/adaptability) were associated with child emotional and behavior problems indirectly through factors at the dyadic level (mother-child attachment) and the individual level (child self-esteem) in sequence. Mother-child, but not father-child, attachment, mediated the linkage between family cohesion/adaptability and the emotional problems of children with ODD. Moreover, child self-esteem mediated the association between mother-child attachment and child emotional and behavioral problems. The findings of the present study underscored that multilevel family factors are uniquely related to emotional and behavioral problems in children with ODD.

Risk profiles of suicide attempts among girls with histories of commercial sexual exploitation: A latent class analysis.

BACKGROUND: Girls impacted by commercial sexual exploitation (CSE) in the juvenile legal system are three times more likely to have suicide attempts than girls without histories of exploitation. Yet, research on risk profiles and correlates that contribute to elevated suicide risk among girls with CSE histories remains scant. OBJECTIVE: We sought to examine suicide attempts profiles among CSE-impacted girls in the juvenile legal system. PARTICIPANTS AND SETTING: We partnered with a specialty court for CSE-impacted youth in Los Angeles County. METHODS: Data were collected from case files of the 360 girls participating in the court from 2012 to 2016. Latent class analysis was used to identify their profiles of risk indicators. RESULTS: Four risk profiles for suicide attempts emerged: (1) Parental Incarceration (PI; 30 %), (2) Child Welfare Contact (CWC; 25 %), (3) Disruptive Behavior and Sleep Problems (DBS; 25 %), and (4) Pervasive Risk (PR; 22 %). Among youth in the PI group, 5 % had a suicide attempt; however, contrary to our hypothesis, no youth in the CWC group had a suicide attempt. Rates of suicide attempt were significantly higher among youth in the DBS group, as 14 % had a suicide attempt. As hypothesized, youth in the PR were associated with higher risk of suicide attempts, with 28 % reporting a prior suicide attempt. CONCLUSIONS: Findings underscore the need for standardized suicide screenings and treatment referrals for girls with CSE histories and suggest an important opportunity for multidisciplinary collaboration with courts to improve suicide prevention strategies. The present study also supports the importance of examining risk across the socioecological context.

Equitable suicide prevention for youth impacted by the juvenile legal system.

Suicide is the second leading cause of death for adolescents in the United States. Despite the already alarmingly high rates of suicide attempts among adolescents, youth involved in the juvenile legal system (JLS) are up to three times more likely to have suicide attempts than their peers not impacted by the JLS. This public health crisis is also a matter of health equity, knowing that ethnoracially minoritized youth, mainly Black and Latinx youth, have disproportionate contact with the JLS. In order to disrupt the current elevated rates of suicide among Black and Latinx youth involved in the JLS, there needs to be more concerted efforts to improve assessment and suicide prevention efforts in the JLS. There are various potential touch points of care for suicide prevention and the Sequential Intercept Model (SIM), which outlines community-based responses to the involvement of people with mental and substance use disorders in the criminal justice system, can be used as a strategic planning tool to outline possible equitable interventions across these various touch points. Our purpose is to provide a comprehensive picture of gaps and equitable opportunities for suicide prevention across each intercept of the SIM. We provide recommendations of priorities to promote health equity in suicide prevention for ethnoracially minoritized youth impacted by the JLS.

Caregiver-Youth intergeneration acculturation conflict moderates the relationship between depression severity and suicidality among female Mexican-Descent college students.

OBJECTIVE: Suicide is the second leading cause of death among college-age students in the U.S., with disparities in suicide ideation and attempts among Latinas. The current study aims to examine if depression severity predicts suicide ideation and attempts and to examine if caregiver intergeneration acculturation conflict (IAC) moderates this link. PARTICIPANTS: A sample of 246 Mexican-descent female college students. METHODS: Self-reported measures for depression severity, male and female caregiver IAC, and suicide ideation and attempts in the previous 12-months were ascertained. RESULTS: In our sample, 31.1% endorsed suicide ideation and 15.9% suicide attempts. Controlling for age, both male and female caregiver IAC moderated the relationship between depression severity and suicide ideation. A similar moderation pattern emerged for the suicide attempts outcome. CONCLUSIONS: Understanding this exacerbating contextual factor can help inform prevention/intervention efforts targeting Mexican-descent college students who are experiencing depressive symptoms by focusing on decreasing IAC with both caregivers.Suicide is the second leading cause of death among emerging adults, defined as 18-29-year-olds,1 in the United States (U.S.) and is responsible for more deaths than any single major medical illness.2 Significant gender and ethnic/racial disparities have been well-documented and highlight that Latina emerging adults experience some of the highest rates of suicide ideation (SI) and suicide attempts (SA) and the greatest increases in SA over time, when compared to non-Latinx White, female emerging adults.3,4 In fact, recent research suggests that Latina college students report a 1.7% prevalence rate of suicide attempts compared to 1.2% among non-Latina White college students and data trends report a nearly double increase in the percent of suicide attempts from 2011 to 2015 (from 0.9% to 1.7%) for Latinas versus a minimal change (from 1.1% to 1.2%) among non-Latina White college students.4 Key research examining this disparity have cited that elevated depressive symptoms, which are also experienced at higher levels among Latinx groups in the U.S.,5 are strongly linked to SI and SA among Latinx college students and emerging adults.6,7 Developmentally, the highest risk period for the onset of SI and SA is during late adolescence or emerging adulthood8 and deaths due to suicide increase as adolescents move into emerging adulthood.2,9 Emerging adulthood is an even riskier developmental period for minoritized college students, like Latinx college students, because this period is marked by identity formation processes that are exacerbated by intercultural interactions on college campuses and cultural expectations at home.10 These data underscore the significance of detecting how unique contextual factors may interact with elevated depressive symptoms, and importantly, how these factors are associated with the increased suicide risk among Latinx college-age youth, as they represent a high-risk developmental and ethnic group.

An Ecodevelopmental Framework for Engaging Diverse Youth in Foster Care and Their Families Into Technology-Based Family Intervention Research Trials.

Family-based interventions delivered via telehealth are a promising mode for overcoming barriers to behavioral health treatment among youth in foster care and their families. There is a dearth of research, however, regarding effectiveness of these interventions for youth in foster care, who commonly exhibit complex behavioral health treatment needs. Clinical research in this area directly relates to equity in service access and quality for these youth and families, with numerous barriers and enabling factors to consider in order to improve engagement in clinical trials and bolster the evidence base. We present a framework to better understand the multi-systemic factors impacting youth and family engagement in clinical research on family-based telehealth interventions, drawing on relevant theory, including the bioecological model and ecodevelopmental theory. We also draw on our experiences conducting technology-based clinical research through the Family Telehealth Project, an evaluation of a brief family-based affect management intervention designed specifically for youth in foster care and their families, as a case example. Recommendations for promoting engagement in clinical research on family-based telehealth interventions with diverse youth in foster care and their families are provided.

Racial Discrimination Experienced by Black Parents: Enduring Mental Health Consequences for Adolescent Youth.

OBJECTIVE: Despite evidence linking experiences of racial discrimination by Black parents and problem behaviors in youth, little is known about the mechanisms that explain this link. To elucidate these developmental pathways, a serial mediation model was tested, in which Black parents' experiences of racial discrimination were hypothesized to predict increased parental depression and parent-child conflict in early adolescence, which in turn would be associated with youth depression, anxiety, and conduct problems in early to mid-adolescence. METHOD: Participants were 252 Black parent-child dyads. Youth (56% female) were on average 11.98 years old at study entry (wave 1). Parents and youth completed questionnaires during a home-based assessment at wave 1 and were assessed again 1 and 2 years later (waves 2 and 3). RESULTS: Black parents' experiences of racial discrimination at wave 1 were linked to higher levels of parent-child conflict at wave 2 (0.20; 95% CI [0.05, 0.33]), which in turn predicted greater youth-reported depression at wave 3 (0.30; 95% CI [0.15, 0.47]). There was a significant indirect effect of racial discrimination on youth-reported depression via parent-child conflict (indirect effect: 0.06, 95% CI [0.02, 0.10]). Findings were replicated across multiple outcomes (ie, depression, anxiety, conduct problems) and multiple informants (ie, youth report, parent report). There was no evidence to support a serial mediation model via parental depression and then parent-child conflict. CONCLUSION: This study identified a developmental pathway from Black parents' experiences of racial discrimination to adolescent problem behaviors via parent-child conflict. Findings may inform interventions aimed at promoting resilience in parents and youth faced with pervasive racism. CLINICAL TRIAL REGISTRATION INFORMATION: Substance Use Screening and Prevention for Adolescents in Pediatric Primary Care (SKY); https://clinicaltrials.gov/; NCT03074877.

An Intersectional-Contextual Approach to Racial Trauma Exposure Risk and Coping Among Black Youth.

Black youth experience racial discrimination at higher rates than other racial/ethnic groups in the United States. To identify how racism can simultaneously serve as a risk factor for adverse childhood experience (ACE) exposure, a discrete type of ACE, and a post-ACE mental health risk factor among Black youth, Bernard and colleagues (2021) proposed the culturally informed ACEs (C-ACE) model. While an important addition to the literature, the C-ACE model is framed around a single axis of race-based oppression. This paper extends the model by incorporating an intersectional and ecodevelopmental lens that elucidates how gendered racism framed by historical trauma, as well as gender-based socialization experiences, may have implications for negative mental health outcomes among Black youth. Clinical and research implications are discussed.

Black Youth Suicide Crisis: Prevalence Rates, Review of Risk and Protective Factors, and Current Evidence-Based Practices.

Suicide is the second leading cause of death among adolescents and young adults. Historically, Black youths have experienced lower rates of suicide; however, recent data point to significant racial disparities. In this article, the authors review current suicide rates, including alarming new data suggesting that suicide rates are two times higher among Black children ages 5-12 compared with White children in that age range. A clinically focused summary of socioecological risk and protective factors associated with suicide among Black youths, with particular attention on structural drivers and culturally relevant factors, is provided. Current evidence-based reviews suggest that dialectical behavior therapy is the only well-established treatment against self-harm and suicide among youths. However, it is unknown whether current established treatments work for Black youths, because Black youths are rarely included in randomized controlled trials. The authors conclude by reviewing emerging treatments developed and tested specifically for Black youths.

Co-Occurring Psychopathology Moderates Social Skills Improvement in a Randomized Controlled Trial of a Collaborative School-Home Intervention for Children with ADHD.

OBJECTIVE: Children with ADHD often exhibit marked impairment in their social skills, but evidence-based psychosocial interventions for ADHD have shown limited efficacy in remediating these deficits. Co-occurring psychopathology exacerbates social deficits in children with ADHD and is a plausible moderator of treatment response. To identify factors contributing to variable social skills treatment response, we examined co-occurring externalizing, depression, and anxiety symptoms as moderators of social skills outcomes in a randomized controlled trial of the Collaborative Life Skills (CLS) program, an evidence-based collaborative school-home ADHD intervention. METHOD: Participants were 159 children with ADHD (M age = 8.35 years, 28.3% female) at 27 schools in an urban public school district. Twenty-three schools were randomly assigned to CLS or usual services, with an additional four schools assigned to Spanish-adapted CLS or usual services. Multi-informant measures of co-occurring psychopathology and social skills were collected at baseline and post-treatment. RESULTS: Parent-rated externalizing and depression symptoms moderated treatment effects on social skills, whereby higher symptomatology in each domain was unrelated to social skills improvement in the CLS group but predicted worsening social skills in response to usual services. In contrast, teacher-rated anxiety moderated treatment effects on social skills, whereby higher anxiety predicted greater social skills improvement in response to CLS but was unrelated to social skills outcomes following usual services. CONCLUSIONS: Findings reflect novel evidence that child psychopathology domains exhibit unique moderating effects on social skills treatment response in children with ADHD. We discuss implications for optimizing evidence-based interventions to target social impairment in this population.