Not niche: eating disorders as an example in the dangers of overspecialisation.

Labelling specific psychiatric concerns as 'niche' topics relegated to specialty journals obstructs high-quality research and clinical care for these issues. Despite their severity, eating disorders are under-represented in high-impact journals, underfunded, and under-addressed in psychiatric training. We provide recommendations to stimulate broad knowledge dissemination for under-acknowledged, yet severe, psychiatric disorders.

Timing matters in (mis)identifying moderators and mediators of digital interventions for eating disorders: Commentary on McClure et al. (2023).

This commentary addresses the challenges in identifying consistent moderators and mediators of psychological treatments for eating disorders (EDs), as highlighted by McClure et al. (International Journal of Eating Disorders, 2023) in their systematic review. Specifically, we discuss the often-overlooked importance of temporal context (when an intervention is delivered), alongside sociodemographic and symptom type (for whom an intervention is delivered), in understanding and optimizing treatment engagement and effectiveness. We outline how individuals' fluctuating levels of motivation and receptivity across different "pivotal moments" in the help-seeking process-including initial outreach and self-screening, ongoing care engagement, and post-discharge-can dynamically impact interventions' relevance and impacts. We also overview how Just-In-Time Adaptive Interventions in digital mental health interventions can be harnessed to simultaneously consider "when" and "for whom" ED interventions can exert the greatest benefits. We conclude with several recommendations for conducting ED intervention and implementation research that integrate timing into support delivery and study design, enabling a deeper understanding of not just how and for whom, but when, ED interventions can be most effective.

Accessibility and Utility of an Electronic Self-Guided Safety Plan for Adolescents.

OBJECTIVE: Suicidal thoughts and behaviors are a leading cause of death, injury, and hospitalization among adolescents. Few evidence-based interventions exist, and these tend to be inaccessible for most youth. Electronic safety plan interventions represent a new avenue to disseminate an evidence-based suicide prevention tool. However, it is not clear whether youth find electronic, self-guided safety plans helpful, nor whether they will use the resulting safety card when experiencing suicidal thoughts or urges. This study examines adolescents' perceptions and use of an electronic, self-guided safety plan intervention. METHOD: We recruited 322 adolescents with a past-year history of suicidal thoughts or behaviors, ages 13-17 (55.9% white and non-Hispanic; majority reporting diverse sexual orientations and genders) online via social media to participate in this two-part longitudinal study. At baseline, participants completed the electronic safety plan interventions and reported on key aspects of its usefulness and areas of improvement. Participants reported their use and perceptions of the plan one month later. RESULTS: Results suggested that adolescents understood, liked, and believed they would use a self-guided safety plan. One month later, about ⅓ of youth who experienced suicidal thoughts or urges used their safety card. Open-ended responses highlighted several features that adolescents enjoyed, including clarity, ease of use, and privacy. Participants also highlighted key areas for improvement, including formatting and language. CONCLUSION: This study provides initial support for adolescent use of electronic self-guided safety plans. Next steps include updating this intervention based on youth feedback and testing the effectiveness of this tool using gold standard research methods.

Is There a Place for Cognitive Restructuring in Brief, Self-Guided Interventions? Randomized Controlled Trial of a Single-Session, Digital Program for Adolescents.

OBJECTIVE: Self-guided digital mental health interventions (DMHIs) teaching empirically supported skills (e.g. behavioral activation) have demonstrated efficacy for improving youth mental health, but we lack evidence for the complex skill of cognitive restructuring (CR). METHOD: We conducted the first-ever RCT testing a CR DMHI ("Project Think") against an active control (supportive therapy; "Project Share") in collaboration with public schools. Pre-registered outcomes were DMHI acceptability and helpfulness post-intervention, as well as internalizing symptoms and CR skills use from baseline to seven-month follow-up, in the full sample and the subsample with elevated symptoms. RESULTS: Participants (N = 597; MAge = 11.99; 48% female; 68% White) rated both programs highly on acceptability and helpfulness. Both conditions were associated with significant internalizing symptom reductions across time in both samples, with no significant condition differences. CR skills use declined significantly across time for Project Share youths but held steady across time for Project Think youths in both samples; this pattern produced a significant condition difference favoring Project Think within the elevated sample at seven-month follow-up. CONCLUSION: Internalizing symptoms declined comparably for Think and Share participants. Consequently, future research should examine whether encouraging youths to share their feelings produces symptom improvements, and whether a single-session, self-guided CR DMHI produces beneficial effects relative to more inert control conditions. Further, the decline in CR skills use for Project Share youths versus sustained CR use by Project Think youths raises questions about the natural time course of youths' CR use and the impact of these DMHIs on that course. ClinicalTrials.gov Registration: NCT04806321.

Evaluating a treatment selection approach for online single-session interventions for adolescent depression.

BACKGROUND: The question 'what works for whom' is essential to mental health research, as matching individuals to the treatment best suited to their needs has the potential to maximize the effectiveness of existing approaches. Digitally administered single-session interventions (SSIs) are effective means of reducing depressive symptoms in adolescence, with potential for rapid, large-scale implementation. However, little is known about which SSIs work best for different adolescents. OBJECTIVE: We created and tested a treatment selection algorithm for use with two SSIs targeting depression in high-symptom adolescents from across the United States. METHODS: Using data from a large-scale RCT comparing two evidence-based SSIs (N = 996; ClinicalTrials.gov: NCT04634903), we utilized a Personalized Advantage Index approach to create and evaluate a treatment-matching algorithm for these interventions. The two interventions were Project Personality (PP; N = 482), an intervention teaching that traits and symptoms are malleable (a 'growth mindset'), and the Action Brings Change Project (ABC; N = 514), a behavioral activation intervention. RESULTS: Results indicated no significant difference in 3-month depression outcomes between participants assigned to their matched intervention and those assigned to their nonmatched intervention. The relationship between predicted response to intervention (RTI) and observed RTI was weak for both interventions (r = .39 for PP, r = .24 for ABC). Moreover, the correlation between a participants' predicted RTI for PP and their predicted RTI for ABC was very high (r = .79). CONCLUSIONS: The utility of treatment selection approaches for SSIs targeting adolescent depression appears limited. Results suggest that both (a) predicting RTI for SSIs is relatively challenging, and (b) the factors that predict RTI for SSIs are similar regardless of the content of the intervention. Given their overall effectiveness and their low-intensity, low-cost nature, increasing youths' access to both digital SSIs may carry more public health utility than additional treatment-matching efforts.

Realizing the untapped promise of single-session interventions for eating disorders.

OBJECTIVE: Multilevel treatment barriers prevent up to 80% of individuals experiencing eating disorders (EDs) from accessing care. This treatment gap creates a critical need to identify interventions that are accessible, easily completable, and optimized for effectiveness by targeting core mechanisms linked to ED onset and maintenance. We propose single-session interventions (SSIs) as a promising path toward catalyzing innovation in the development of accessible, effective ED interventions. SSIs are structured programs that intentionally involve one encounter with a program or provider; they may serve as stand-alone or adjunctive clinical supports. All SSIs are built to acknowledge that any session might be someone's last-and that any single session can nonetheless yield meaningful clinical benefit. METHOD: We define SSIs, summarize research supporting their utility for ED symptoms and other mental health problems, and recommend future directions for work in this domain. RESULTS: Single-session interventions may hold promise to reduce some ED symptoms and risk factors, including restrictive eating and negative body image. Steps toward realizing this promise include (1) testing whether existing evidence-based SSIs (e.g., for depression) can also reduce EDs, risk factors, and symptoms; (2) developing novel SSIs that target modifiable ED risk factors and symptoms largely unaddressed by SSIs, such as purging and binge eating; (3) studying diverse implementation pathways; (4) capitalizing on SSIs' transdiagnostic utility to broaden funding opportunities; and (5) educating ED researchers and clinicians about SSIs. DISCUSSION: Understanding the strengths and limits of mechanism-targeted SSIs for ED-related problems could be a low-risk, high-reward avenue toward reducing EDs at scale. PUBLIC SIGNIFICANCE: Most individuals experiencing EDs never access any form of treatment, creating an urgent need to identify ED interventions built to overcome barriers to engaging with care. This Forum article introduces SSIs as a promising path to rapidly developing and testing accessible, evidence-based ED supports; supplementing existing ED treatment models; and reducing the individual, familial, and societal burdens of EDs at scale.

Project Body Neutrality: Piloting a digital single-session intervention for adolescent body image and depression.

OBJECTIVE: Eating disorders and depression impact youth at alarming rates, yet most adolescents do not access support. Single-session interventions (SSIs) can reach youth in need. This pilot examines the acceptability and utility of a SSI designed to help adolescents improve functionality appreciation (a component of body neutrality) by focusing on valuing one's body based on the functions it performs, regardless of appearance satisfaction. METHOD: Pre- to post-intervention data were collected, and within-group effect sizes and 95% confidence intervals were computed, to evaluate the immediate effects of the SSI on hopelessness, functionality appreciation, and body dissatisfaction. Patterns of use, demographics, program feedback, and responses from within the SSI were collected. RESULTS: The SSI and all questionnaires were completed by 75 adolescents (ages: 13-17 years, 74.70% White/Caucasian, 48.00% woman/girl) who reported elevated body image and mood problems. Analyses detected significant pre-post improvements in hopelessness (dav = 0.60, 95% CI: 0.35-0.84; dz = 0.77, 95% CI: 0.51-1.02), functionality appreciation (dav = 0.72, 95% CI: 0.46-0.97; dz = 0.94, 95% CI: 0.67-1.21), and body dissatisfaction (dav = 0.61, 95% CI: 0.36-0.86; dz = 0.76, 95% CI: 0.50-1.02). The SSI was rated as highly acceptable, with a mean overall score of 4.34/5 (SD = 0.54). Qualitative feedback suggested adolescents' endorsement of body neutrality concepts, including functionality appreciation, as personally-relevant, helpful targets for intervention. DISCUSSION: This evaluation supports the acceptability and preliminary effectiveness of the Project Body Neutrality SSI for adolescents with body image and mood concerns. PUBLIC SIGNIFICANCE: Results suggest the acceptability and utility of a digital, self-guided, single-session intervention-Project Body Neutrality-for adolescents experiencing co-occurring depressive symptoms and body image disturbances. Given the intervention's low cost and inherent scalability, it may be positioned to provide support to youth with limited access to traditional care.

Serving the Underserved? Uptake, Effectiveness, and Acceptability of Digital SSIs for Rural American Adolescents.

OBJECTIVE: Rural teens are less likely to access care for depression than urban teens. Evidence-based digital single-session interventions (SSIs), offered via social media advertisements, may be well suited to narrowing this gap in treatment access and increasing access to support for adolescents living in rural areas. We evaluated the viability of using social media-based advertisements to equitably recruit adolescents living in rural areas with elevated depression symptoms to digital SSIs; we sought to characterize and assess whether SSI completion rates and acceptability differed for adolescents living in rural versus more urban areas, across three intervention conditions (two active, evidence-based SSIs; one placebo control); and we tested whether digital SSIs differentially reduced depressive symptoms. METHOD: We used pre-intervention and three-month follow up data from 13- to 16-year-old adolescents (N = 2,322; 88% female; 55% non-Hispanic White) within a web-based randomized control trial of three free, digital SSIs (ClinicalTrials.gov identifier: NCT04634903) collected eight months into the COVID-19 pandemic in the United States. RESULTS: Digital SSIs reached adolescents at population-congruent rates; however, social media ads resulted in relative underrepresentation of youths from rural areas who hold minoritized racial/ethnic identities. Adolescents living in rural areas also completed digital SSIs at similar rates to their urban peers, found SSIs equivalently as acceptable, and reported comparable depression symptom reductions as youth living in urban areas. CONCLUSION: Digital SSIs and their dissemination through social media may offer a promising means of narrowing the gap between access to evidence-based mental health support between adolescents living in rural and urban areas; however, targeted efforts are warranted to reach racially minoritized youths in rural U.S. counties.

Ecological-Systems Contributors to Internalizing Symptoms in a US Sample of Adolescents During the COVID-19 Pandemic.

OBJECTIVE: Internalizing problems are common in adolescence and increased substantially during the COVID-19 pandemic. Although rates of anxiety and depression have since improved, the general increase in the prevalence of mental health problems and disruptions to mental health services during the COVID-19 pandemic has resulted in huge gaps in care. Although research has primarily focused on proximal correlates of internalizing problems, a growing literature suggests that factors outside youths' immediate microsystems are equally crucial for their mental well-being. Thus, it is important to investigate multisystemic correlates of internalizing problems to inform individual and community-based interventions to address the current mental health burden. METHOD: Leveraging secondary data from a nationally diverse U.S. sample of 2,954 adolescents (ages 13-16), we examined the associations between factors at multiple levels of youths' ecologies - spanning indicators of threat and deprivation - and their depression and anxiety symptoms during the COVID-19 pandemic. Furthermore, in follow-up exploratory analyses, we examined if these associations differed by adolescents' racial/ethnic groups. RESULTS: Consistent with socioecological models, we found that indicators of threat and deprivation in the adolescents' immediate home and more distal neighborhood environments were associated with depression and anxiety symptoms. The patterns of associations were similar across racial/ethnic groups in multigroup structural equation models. Additionally, we found that mean levels of internalizing symptoms and socioecological predictors significantly differed across racial/ethnic groups. CONCLUSION: These findings have important implications for understanding multi-level contributors to adolescent mental health, which may inform research, practice, and policy.

Structural Correlates of Mental Health Support Access among Sexual Minority Youth of Color during COVID-19.

Many youth with mental health needs cannot access treatment, with multiply-marginalized youth, such as sexual minority youth of Color (SMYoC), experiencing both structural and identity-related barriers to care. The COVID-19 pandemic threatens to exacerbate multi-level treatment access barriers facing SMYoC youth nationwide. However, little large-scale research has examined access to mental health care among SMYoC across the United States, either during or prior to the pandemic. Such work is critical to understanding and ameliorating barriers in this domain. Using data from adolescents who self-identified as SMYoC and who endorsed a desire for mental health support during the COVID-19 pandemic (N = 470, ages 13-16, from 43 U.S. states), we examined associations between state-level, structural factors (income inequality; mental health-care provider shortage; anti-Black racism; homophobia; and the interaction between anti-Black racism and homophobia) and SMYoC mental health treatment access. Multinomial logistic regressions revealed state-level mental health-care provider shortage as the only significant predictor of SMYoC reporting they never (versus always) accessed mental health support during the COVID-19 pandemic. SMYoC living in areas with both lower homophobia and lower anti-Black racism were more likely to report always (versus sometimes) accessing mental health treatment. Results highlight the critical importance of considering diverse structural factors and applying an intersectional lens when exploring barriers to mental health treatment among multiply-marginalized youth. In locations where provider shortages are less severe, cultural stigma - including anti-Black racism and homophobia - may still pose challenges for SMYoC in need of mental health care.

Expanding the reach of psychosocial services for youth: Untapped potential of mentor-delivered single session interventions.

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.

Gender and Racial/Ethnic Disparities in Undergraduate and Graduate Students' Mental Health and Treatment Use Amid the COVID-19 Pandemic.

The COVID-19 pandemic has negatively impacted numerous people?s mental health and created new barriers to services. To address the unknown effects of the pandemic on accessibility and equality issues in mental health care, this study aimed to investigate gender and racial/ethnic disparities in mental health and treatment use in undergraduate and graduate students amid the COVID-19 pandemic. The study was conducted based on a largescale online survey (N = 1,415) administered during the weeks following a pandemic-related university-wide campus closure in March 2020. We focused on the gender and racial disparities in current internalizing symptomatology and treatment use. Our results showed that in the initial period of the pandemic, students identified as cis women (p < .001), non-binary/genderqueer (p < .001), or Hispanic/Latinx (p = .002) reported higher internalizing problem severity (aggregated from depression, generalized anxiety, intolerance of uncertainty, and COVID-19-related stress symptoms) compared to their privileged counterparts. Additionally, Asian (p < .001) and multiracial students (p = .002) reported less treatment use than White students while controlling for internalizing problem severity. Further, internalizing problem severity was associated with increased treatment use only in cisgender, non-Hispanic/Latinx White students (pcis man = 0.040, pcis woman < 0.001). However, this relationship was negative in cis-gender Asian students (pcis man = 0.025, pcis woman = 0.016) and nonsignificant in other marginalized demographic groups. The findings revealed unique mental health challenges faced by different demographic groups and served as a call that specific actions to enhance mental health equity, such as continued mental health support for students with marginalized gender identities, additional COVID-related mental and practical support for Hispanic/Latinx students and promotion of mental health awareness, access, and trust in non-White, especially Asian, students are desperately needed.

Technology Matters: Online, self-help single session interventions could expand current provision, improving early access to help for young people with depression symptoms, including minority groups.

Current mental health service provision for young people was primarily designed based on an assumption of repeat attendance to enable access to interventions. This applies to in-person therapy and, in recent years, digitally provided apps and programmes. Yet, discontinuation after only one or two attendances or uses is a common problem. However, there is a different model, which is intentionally designing provision without assuming repeat attendance, that is, single session interventions. Evidence from the United States, where a suite of digital, self-help single session interventions, accessible anonymously, have been designed, indicates that these are helpful to young people with reductions in depression symptoms at up to 9 months later. These interventions also have had better reach into currently underserved populations (e.g. LGBTQ+ and ethnic minority adolescents). Therefore, these may be a potentially helpful way to expand existing provision at scale, enabling all young people to access evidence-based help quickly.

Secondary effects of body dissatisfaction interventions on adolescent depressive symptoms: A meta-analysis.

OBJECTIVE: Depression is a leading cause of disability among adolescents, yet existing treatments are variably effective, suggesting needs to identify novel intervention targets. Body dissatisfaction (BD) may be a promising, but understudied, target: BD is common among adolescents; prospectively associated with future depression; and modifiable through intervention. BD interventions are typically evaluated in terms of impacts on eating disorders, but many trials also measure depression-related secondary outcomes. However, BD intervention effects on depression have not been systematically examined. We, therefore, conducted a meta-analysis to estimate secondary effects of BD interventions on depression symptoms and related outcomes in adolescents (ages 12-19). METHOD: Our systematic review included randomized controlled trials (RCTs) published between January 2006 and December 2020. Across-group effect sizes were analyzed using robust variance estimation. Preregistered methods, data, and analytic code are available at https://osf.io/734n8/. RESULTS: The meta-analysis included 13 RCTs, 50 effect sizes, and 6,962 participants. BD interventions led to significant postintervention reductions in depression-related outcomes versus control conditions (g = -0.19 at postintervention, 95% confidence interval: -0.07, -0.31, p = .005). No evidence emerged for moderators of this meta-analytic effect. DISCUSSION: Overall, BD-focused interventions significantly reduced adolescent depression, with mean postintervention effect sizes comparable to those observed for interventions targeting depression explicitly. Results are bolstered by preregistered methods and robustness checks. Limitations include a lack of data on participants' sexual and gender identities and a significant risk of bias in the underlying literature. Future research on BD interventions should measure depression symptom severity as a secondary outcome.

When is Psychotherapy Brief? Considering Sociodemographic Factors, Problem Complexity, and Problem Type in U.S. Adolescents.

Objective: When psychotherapy is brief (1-2 sessions), "early dropout" - defined as premature treatment discontinuation due to financial or structural barriers - is a commonly assumed cause. However, there are several possible reasons why treatment may be brief, including youth-level factors such as psychopathology complexity or problem type. Better characterizing whether factors beyond financial and structural barriers predict adolescents' receipt of briefer (versus longer-term) treatment may guide efforts to retain specific youth in longer-term services - and disseminate intentionally brief interventions to youth potentially positioned to benefit.Method: Using data from the 2017 SAMHSA National Survey on Drug Use and Health, we examined whether sociodemographic disadvantage (minority race, low-income, government assistance), perceived problem type, and psychopathology complexity (1 versus multiple problem types) related to psychotherapy length (1-2 versus 3-24+ sessions) among adolescents receiving outpatient psychotherapy (N = 1,601; ages 12-17; 60.59% white; 64.50% female).Results: Among adolescents beginning outpatient psychotherapy, 23.36% ended treatment after 1-2 sessions. Psychopathology complexity predicted greater likelihood of receiving >2 sessions, after adjusting for specific problem type (χ2 = 75.14, p < .001, OR = 1.80). Further, although certain problem types (e.g., depression, anxiety, and anger control) were associated with increased likelihood of greater treatment length, these findings did not hold after accounting for psychopathology complexity. No sociodemographic factors significantly predicted treatment length.Conclusions: Structural and financial barriers alone may not explain when and why youth psychotherapy is brief. Additional factors, such as psychopathology complexity, may be important and potentially primary contributors to treatment duration among youth who access outpatient services. Future research may examine whether youth with less comorbidity differentially benefit from intentionally brief interventions, along with strategies for retaining youth who might benefit from longer-term care - such as those with multiple co-occurring problems - in treatment.

Predicting Mental Health Treatment Access Among Adolescents With Elevated Depressive Symptoms: Machine Learning Approaches.

A large proportion of adolescents experiencing depression never access treatment. To increase access to effective mental health care, it is critical to understand factors associated with increased versus decreased odds of adolescent treatment access. This study used individual depression symptoms and sociodemographic variables to predict whether and where adolescents with depression accessed mental health treatments. We performed a pre-registered, secondary analysis of data from the 2017 National Survey of Drug Use and Health (NSDUH), a nationally representative sample of non-institutionalized civilians in the United States. Using four cross-validated random forest models, we predicted whether adolescents with elevated past-year depressive symptoms (N = 1,671; ages 12-17 years) accessed specific mental health treatments in the previous 12 months ("yes/no" for inpatient, outpatient, school, any). 53.38% of adolescents with elevated depressive symptoms accessed treatment of any kind. Even with depressive symptoms and sociodemographic factors included as predictors, pre-registered random forests explained < 0.00% of pseudo out-of-sample deviance in adolescent access to inpatient, outpatient, school, or overall treatments. Exploratory elastic net models explained 0.80-2.50% of pseudo out-of-sample deviance in adolescent treatment access across all four treatment types. Neither individual depressive symptoms nor any socioeconomic variables meaningfully predicted specific or overall mental health treatment access in adolescents with elevated past-year symptoms. This study highlights substantial limitations in our capacity to predict whether and where adolescents access mental health treatment and underscores the broader need for more accessible, scalable adolescent depression treatments.

The impact of COVID-19 on U.S. adolescents: loss of basic needs and engagement in health risk behaviors.

Across the United States, the COVID-19 pandemic created myriad challenges for youth and families, including losses of basic needs which may be associated with increased use of maladaptive coping behaviors. In a sample of 2491 U.S. youth (ages 13-16), demographic differences in loss of basic needs and maladaptive coping were assessed using regression models. More than 21% of adolescents endorsed losing one or more basic needs (e.g., loss of access to food or shelter) and 83% endorsed use of maladaptive coping strategies (e.g., using drugs or alcohol; self-harming behaviors) during the COVID-19 pandemic. Although adolescents with both majority and minority identities reported losing basic needs and engaging in maladaptive coping behaviors, minoritized youth reported more basic needs losses (ps < 0.05) and greater reliance on maladaptive coping strategies (ps < .05) than their non-minoritized peers. Furthermore, adolescents who endorsed losing basic needs were more likely to also endorse engaging in maladaptive coping behaviors (p < .05). Healthcare providers and teachers must consider basic need losses while structuring emotional and behavioral supports for youth during and beyond the COVID-19 pandemic.

Embracing Scientific Humility and Complexity: Learning "What Works for Whom" in Youth Psychotherapy Research.

Clinical psychological scientists have spent decades attempting to understand "what works for whom" in the context of youth psychotherapy, toward the longstanding goal of personalizing psychosocial interventions to fit individual needs and characteristics. However, as the articles in this Special Issue jointly underscore, more than 50 years of psychotherapy research has yet to help us realize this goal. In this introduction to the special issue, we outline how and why "aspiration-method mismatches" have hampered progress toward identifying moderators of youth psychotherapy; emphasize the need to embrace etiological complexity and scientific humility in pursuing new methodological solutions and propose individual and structural strategies for better-aligning clinical research methods with the goal of personalizing mental health care for youth with diverse identities and treatment needs.

Brief, Non-Pharmacological, Interventions for Pediatric Anxiety: Meta-Analysis and Evidence Base Status.

In 1998, Ost published [One-session treatment of specific phobias-a rapid and effective method] [in Swedish] giving rise to the idea that brief, intensive, and concentrated psychosocial interventions could exhibit public health impact. At this juncture, and per criteria of the Society for Clinical Child and Adolescent Psychology, there are data supporting that brief, non-pharmacological intervention [prescriptions] for pediatric anxiety can be considered well-established or probably efficacious. In addition, data from 76 randomized controlled trials (N = 17,203 youth) yield an overall mean effect size of 0.19 on pediatric anxiety outcomes (pre-post). Note, however, that effect sizes vary significantly. These data point to the capacity for clinical change coming from in-vivo exposures for specific phobias (~3 h, one session), CBT with social skills training (~3 h, six sessions for indicated prevention and early intervention), and CBT-based parent training (~6 h, eight digital modules with clinician support). Given such evidence, we recommend efforts be made to establish ways to position such treatment innovations for rapid deployment facilitated by high-quality training, monitoring, technical assistance, and ongoing disclosures.

Future Directions in Single-Session Youth Mental Health Interventions.

The United States spends more money on mental health services than any other country, yet access to effective psychological services remains strikingly low. The need-to-access gap is especially wide among children and adolescents, with up to 80% of youths with mental health needs going without services, and the remainder often receiving insufficient or untested care. Single-session interventions (SSIs) may offer a promising path toward improving accessibility, cost-effectiveness, and completion rates for youth mental health services. SSIs are structured programs that intentionally involve only one visit or encounter with a clinic, provider, or program; they may serve as stand-alone or adjunctive clinical services. A growing body of evidence supports the capacity of SSIs to reduce and prevent youth psychopathology of multiple types. Here, we provide a working definition of SSIs for use in future research and practice; summarize the literature to date on SSIs for child and adolescent mental health; and propose recommendations for the future design, evaluation, and implementation of SSIs across a variety of settings and contexts. We hope that this paper will serve as an actionable research agenda for gauging the full potential of SSIs as a force for youth mental health.