"We could see our real selves:" The COVID-19 syndemic and the transition to telehealth for a school-based prevention program for newcomer Latinx immigrant youth.

Newcomer Latinx immigrant youths in the United States are currently in a syndemic of increased risk of behavioral health concerns, disparities in access to related services, and are disproportionately impacted by the COVID-19 pandemic. This study used qualitative inquiry to examine the impact that the transition to telehealth had on a school-based group prevention program for immigrant youth, Fuerte, within the context of this syndemic. Data included semi-structured interviews with group leaders, and focus groups with youth program participants. Themes indicated both positive and negative impacts of the transition to telehealth on program component implementation, youth participant engagement, and youth participant social connectedness. Despite the telehealth model, youth participants reported that they felt socially connected to each other through the program. This study's results provide implications for the potential value and drawbacks of a telehealth prevention model for newcomer immigrant youth, as well as deepening understanding of how virtual behavioral health programs may operate in socially isolating contexts around the world.

Intolerance of Uncertainty and Health-Related Anxiety in Youth amid the COVID-19 Pandemic: Understanding and Weathering the Continuing Storm.

The COVID-19 pandemic is a public health crisis that continues to impact individuals worldwide. While children may be less susceptible to severe medical complications, they are nonetheless vulnerable to stress and anxiety associated with the pandemic. However, current understanding of psychological functioning and potential strategies to mitigate distress amid a pandemic is naturally limited. Consequently, this article is an attempt to fill that gap. Existing literature on pandemics, health-related anxieties, intolerance of uncertainty, and psychopathological sequelae is summarized within the context of the COVID-19 outbreak. Conclusions from the empirical data and emerging theoretical models are reviewed and synthesized. Finally, several potentially engaging and effective examples of developmentally appropriate interventions targeting intolerance of uncertainty and health-related anxieties in pediatric patients during the peri- and post-pandemic periods are described.

Radiology Trainees' Perceptions of Speaking up Culture Related to Safety and Unprofessional Behavior in Their Work Environments.

OBJECTIVE. The purpose of this study was to compare radiology trainees' perceptions of the culture regarding speaking up about patient safety and unprofessional behavior in the clinical environment and to assess the likelihood that they will speak up in the presence of a medical hierarchy. MATERIALS AND METHODS. The study included radiology trainees from nine hospitals who attended a communication workshop. Trainees completed questionnaires assessing their perceptions of the support provided by their clinical environment regarding speaking up about patient safety and unprofessional behavior. We also queried their likelihood of speaking up within a team hierarchy about an error presented in a hypothetical clinical vignette. RESULTS. Of 61 participants, 58 (95%) completed questionnaires. Of these 58 participants, 84% felt encouraged by colleagues to speak up about safety concerns, and 57% felt encouraged to speak up about unprofessional behavior (p < .001). Moreover, 17% and 34% thought speaking up about safety concerns and unprofessional behavior, respectively, was difficult (p < .02). Trainees were less likely to agree that speaking up about unprofessional behavior (compared with speaking up about safety concerns) resulted in meaningful change (66% vs 95%; p < .001). In a vignette describing a sterile technique error, respondents were less likely to speak up to an attending radiologist (48%) versus a nurse, intern, or resident (79%, 84%, and 81%, respectively; p < .001). Significant predictors of the likelihood of trainees speaking up to an attending radiologist included perceived potential for patient harm as a result of the error (odds ratio [OR], 6.7; p < .001), perceptions of safety culture in the clinical environment (OR, 5.0; p = .03), and race or ethnicity (OR, 3.1; p = .03). CONCLUSION. Radiology trainees indicate gaps in workplace cultures regarding speaking up, particularly concerning unprofessional behavior and team hierarchy.

"Se extraña todo:" Family separation and reunification experiences among unaccompanied adolescent migrants from Central America.

There has been a record surge of unaccompanied immigrant minors (UAMs) entering the United States, with 86% of those apprehended at the US-Mexico border originating from the Central American countries of El Salvador, Guatemala, and Honduras. A majority of immigrant children are separated from either one or both parents at various points during the migration process. Although average separations last 4 or more years, and may be deeply distressing, there is little research on family separations among Central American UAMs. Further, little is known about the developmental impact of separations from extended family networks, or about reunification. To address these empirical gaps, this study used community-participatory qualitative methods to deeply explore the lived experiences and emotional repercussions of family separation and reunification. The sample included 42 adolescents who had all recently migrated to the Western United States from Central America. Thematic analyses revealed that separation experiences are distressing, multifaceted, and have important developmental implications for Central American UAMs. Results illustrate the socioemotional toll that family separation and reunification can have on this vulnerable population, and highlight the need for culturally responsive, developmentally informed, and contextually appropriate care focused on family reunification in order to foster healthy psychosocial adjustment among UAMs.

Implementation of Technology-Delivered Diabetes Self-care Interventions in Clinical Care: a Narrative Review.

PURPOSE OF REVIEW: Evidence is growing for the positive effects of technology-delivered diabetes self-care interventions on behavioral and clinical outcomes. However, our understanding of how to effectively implement these interventions into routine clinical practice is limited. This article provides an overview of the methods and results of studies examining the implementation of technology-delivered diabetes self-care interventions into clinical care. We focus specifically on patient-facing behavioral interventions delivered with technology (e.g., text messaging, apps, websites). RECENT FINDINGS: Eleven articles were included in the review. Most studies (n = 9) examined barriers and facilitators to implementation, while about half (n = 5) integrated the intervention into clinical care and evaluated implementation and/or effectiveness. Only six studies applied a theory or framework. The most common determinants of implementation were time constraints for clinic staff, familiarity with technology, knowledge of the intervention, and perceived value. We found substantial variation in implementation outcomes, including which were reported, how they were assessed, and the results. In the four studies that evaluated effectiveness, hemoglobin A1c improved. Successful implementation of technology-delivered interventions has the potential to transform healthcare delivery and improve diabetes health on a population level. Promising strategies to address common determinants of implementation include appointing a clinic champion, developing staff training and educational materials, and adapting intervention processes to the clinic context. Future research should evaluate these implementation strategies to understand when and how they impact outcomes. Frameworks such as Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) can help ensure outcomes are systematically reported and allow for comparison across studies.

Unsolicited Patient Complaints Identify Physicians with Evidence of Neurocognitive Disorders.

OBJECTIVES: Determine whether words contained in unsolicited patient complaints differentiate physicians with and without neurocognitive disorders (NCD). METHODS: We conducted a nested case-control study using data from 144 healthcare organizations that participate in the Patient Advocacy Reporting System program. Cases (physicians with probable or possible NCD) and two comparison groups of 60 physicians each (matched for age/sex and site/number of unsolicited patient complaints) were identified from 33,814 physicians practicing at study sites. We compared the frequency of words in patient complaints related to an NCD diagnostic domain between cases and our two comparison groups. RESULTS: Individual words were all statistically more likely to appear in patient complaints for cases (73% of cases had at least one such word) compared to age/sex matched (8%, p < 0.001 using Pearson's χ2 test, χ2 = 30.21, df = 1) and site/complaint matched comparisons (18%, p < 0.001 using Pearson's χ2 test, χ2 = 17.51, df = 1). Cases were significantly more likely to have at least one complaint with any word describing NCD than the two comparison groups combined (conditional logistic model adjusted odds ratio 20.0 [95% confidence interval 4.9-81.7]). CONCLUSIONS: Analysis of words in unsolicited patient complaints found that descriptions of interactions with physicians with NCD were significantly more likely to include words from one of the diagnostic domains for NCD than were two different comparison groups. Further research is needed to understand whether patients might provide information for healthcare organizations interested in identifying professionals with evidence of cognitive impairment.

Neighborhood Context, Family Cultural Values, and Latinx Youth Externalizing Problems.

Latinx youth living in the United States reside in a myriad of cultural and neighborhood contexts, yet little is known regarding how cultural values influence behavior problems across neighborhood contexts. Using a person-environment fit framework, the present study explored the degree to which youth cultural values were associated with their externalizing problems, and the degree to which this association was shaped by their neighborhood's socioeconomic status (SES), and Latinx and immigrant concentration. The sample comprised of 998 Latinx youth (Female = 54.2%), ages 10 to 14 years old (Mage = 11.8), from three large United States metropolitan areas. Multilevel modeling methods indicated that increased fit between youth cultural values and neighborhood Latinx and immigrant concentration was associated with fewer externalizing problems, but only in higher SES neighborhoods. The results support the importance of studying social determinants of Latinx youth behavioral health, and provide implications for both neighborhood-level and individual-level prevention and intervention programming.

Processes for Identifying and Reviewing Adverse Events and Near Misses at an Academic Medical Center.

BACKGROUND: Conferences, processes, and/or meetings in which adverse events and near misses are reviewed within clinical programs at a single academic medical center were identified. METHODS: Leaders of conferences, processes, or meetings-"process leaders"-in which adverse events and near misses were reviewed were surveyed. RESULTS: On the basis of responses from all 45 process leaders, processes were classified into (1) Morbidity and Mortality Conferences (MMCs), (2) Quality Assurance (QA) Meetings, and (3) Educational Conferences. Some 22% of the clinical programs used more than one of these three processes to identify and review adverse events and near misses, while 10% had no consistent participation in any of them. Explicit criteria for identifying and selecting cases to be reviewed were used by 58% of MMCs and 69% of QA Meetings. The explicit criteria used by MMCs and QA Meetings varied widely. Many MMCs (54%, 13/24), QA Meetings (54%, 7/13), and Educational Conferences (70%, 7/10) did not review all the adverse events or near misses that were identified, and several MMCs (46%, 6/13), QA Meetings (29%, 2/7), and Educational Conferences (57%, 4/7) had no other process within their clinical program by which to review these remaining cases. CONCLUSIONS: There was wide variation regarding how clinical programs identify and review adverse events and near misses within the MMCs, QA Meetings, and Educational Conferences, and some programs had no such processes. A well-designed, coordinated process across all clinical areas that incorporates accepted approaches for event analysis may improve the quality and safety of patient care.

Amplitude Control of the Spin-Triplet Supercurrent in S/F/S Josephson Junctions.

Josephson junctions made with conventional s-wave superconductors and containing multiple layers of ferromagnetic materials can carry spin-triplet supercurrent in the presence of certain types of magnetic inhomogeneity. In junctions containing three ferromagnetic layers, the triplet supercurrent is predicted to be maximal when the magnetizations of the adjacent layers are orthogonal, and zero when the magnetizations of any two adjacent layers are parallel. Here we demonstrate on-off control of the spin-triplet supercurrent in such junctions, achieved by rotating the magnetization direction of one of the three layers by 90°. We obtain "on-off" ratios of 5, 7, and 19 for the supercurrent in the three samples that have been studied so far. These observations directly confirm one of the most salient predictions of the theory, and they pave the way for applications of spin-triplet Josephson junctions in the nascent area of "superconducting spintronics".

Using Coworker Observations to Promote Accountability for Disrespectful and Unsafe Behaviors by Physicians and Advanced Practice Professionals.

BACKGROUND: Health care team members are well positioned to observe disrespectful and unsafe conduct-behaviors known to undermine team function. Based on experience in sharing patient complaints with physicians who subsequently achieved decreased complaints and malpractice risk, Vanderbilt University Medical Center developed and assessed the feasibility of the Co-Worker Observation Reporting System(SM) (CORS (SM)) for addressing coworkers' reported concerns. METHODS: VUMC leaders used a "Project Bundle" readiness assessment, which entailed identification and development of key people, organizational supports, and systems. Methods involved gaining leadership buy-in, recruiting and training key individuals, aligning the project with organizational values and policies, promoting reporting, monitoring reports, and employing a tiered intervention process to address reported coworker concerns. RESULTS: Peer messengers shared coworker reports with the physicians and advanced practice professionals associated with at least one report 84% of the time. Since CORS inception, 3% of the medical staff was associated with a pattern of CORS reports, and 71% of recipients of pattern-related interventions were not named in any subsequent reports in a one-year follow-up period. CONCLUSIONS: Systematic monitoring of documented co-worker observations about unprofessional conduct and sharing that information with involved professionals are feasible. Feasibility requires organizationwide implementation; co-workers willing and able to share respectful, nonjudgmental, timely feedback designed initially to encourage self-reflection; and leadership committed to be more directive if needed. Follow-up surveillance indicates that the majority of professionals "self-regulate" after receiving CORS data.

Symptom variation on the trauma symptom checklist for children: a within-scale meta-analytic review.

Trauma exposure in youth is widespread, yet symptom expression varies. The present study employs a within-scale meta-analytic framework to explore determinants of differential responses to trauma exposure. The meta-analysis included 74 studies employing samples of youth exposed to traumatic events and who completed the Trauma Symptom Checklist for Children (TSCC). Mean weighted T scores across all TSCC subscales for U.S. samples ranged between 49 and 52. Youth outside the U.S. reported higher posttraumatic stress, anxiety, and depressive symptoms, whereas those exposed to sexual abuse reported the highest posttraumatic stress, anxiety, depressive, and dissociative symptoms. Higher female representation in samples was associated with higher symptoms on all TSCC subscales except anger. In contrast, ethnic minority representation was associated with lower depressive symptoms. Moderator analyses revealed that sexual abuse, increased percentage of females, and older age were all associated with higher posttraumatic symptoms. The present meta-analytic results help elucidate some of the divergent findings on symptom expression in youth exposed to traumatic events.

School-Based Behavioral Health Programming for Newcomer Youth: A Scoping Review.

OBJECTIVE: Newcomer youth experience health disparities in accessing behavioral health services. School-based mental health programming is proposed a potential solution to address these disparities. The present study uses a scoping review methodology to examine the state-of-the-art of the evidence base for school-based mental health programming for newcomer youth. Studies were categorized into a tiered typology using the framework established by the National Center for School Mental Health. METHODS: Several databases were examined as well as the results of one scoping and two systemic recent reviews. RESULTS: A total of 37 studies were included in the present analysis, over half from the last decade. Most studies were conducted in the United States and Europe, and most programs were focused on mental health promotion and wellness (Tier 1) or were multi-tiered. Programming for younger children, especially those in early childhood settings, were underrepresented. CONCLUSIONS: While the literature is promising regarding programming for newcomer youth, particularly the advent of complex multi-tiered programming, many gaps still remain. For example, most programs do not provide information on how programming was adapted for different groups of newcomers with different cultural and contextual needs. Tier 1 programs lack theoretical foundations or theories of change in the design of programming. Further, more research is needed for a group with rising numbers across high- and middle-income countries, particularly for programming targeting early and middle childhood.

Suppression of a salient distractor protects the processing of target features.

We are often bombarded with salient stimuli that capture our attention and distract us from our current goals. Decades of research have shown the robust detrimental impacts of salient distractors on search performance and, of late, in leading to altered feature perception. These feature errors can be quite extreme, and thus, undesirable. In search tasks, salient distractors can be suppressed if they appear more frequently in one location, and this learned spatial suppression can lead to reductions in the cost of distraction as measured by reaction time slowing. Can learned spatial suppression also protect against visual feature errors? To investigate this question, participants were cued to report one of four briefly presented colored squares on a color wheel. On two-thirds of trials, a salient distractor appeared around one of the nontarget squares, appearing more frequently in one location over the course of the experiment. Participants' responses were fit to a model estimating performance parameters and compared across conditions. Our results showed that general performance (guessing and precision) improved when the salient distractor appeared in a likely location relative to elsewhere. Critically, feature swap errors (probability of misreporting the color at the salient distractor's location) were also significantly reduced when the distractor appeared in a likely location, suggesting that learned spatial suppression of a salient distractor helps protect the processing of target features. This study provides evidence that, in addition to helping us avoid salient distractors, suppression likely plays a larger role in helping to prevent distracting information from being encoded.

Using large language model to guide patients to create efficient and comprehensive clinical care message.

OBJECTIVE: This study aims to investigate the feasibility of using Large Language Models (LLMs) to engage with patients at the time they are drafting a question to their healthcare providers, and generate pertinent follow-up questions that the patient can answer before sending their message, with the goal of ensuring that their healthcare provider receives all the information they need to safely and accurately answer the patient's question, eliminating back-and-forth messaging, and the associated delays and frustrations. METHODS: We collected a dataset of patient messages sent between January 1, 2022 to March 7, 2023 at Vanderbilt University Medical Center. Two internal medicine physicians identified 7 common scenarios. We used 3 LLMs to generate follow-up questions: (1) Comprehensive LLM Artificial Intelligence Responder (CLAIR): a locally fine-tuned LLM, (2) GPT4 with a simple prompt, and (3) GPT4 with a complex prompt. Five physicians rated them with the actual follow-ups written by healthcare providers on clarity, completeness, conciseness, and utility. RESULTS: For five scenarios, our CLAIR model had the best performance. The GPT4 model received higher scores for utility and completeness but lower scores for clarity and conciseness. CLAIR generated follow-up questions with similar clarity and conciseness as the actual follow-ups written by healthcare providers, with higher utility than healthcare providers and GPT4, and lower completeness than GPT4, but better than healthcare providers. CONCLUSION: LLMs can generate follow-up patient messages designed to clarify a medical question that compares favorably to those generated by healthcare providers.

Physician Specialty Differences in Unprofessional Behaviors Observed and Reported by Coworkers.

Importance: Because unprofessional behaviors are associated with patient complications, malpractice claims, and well-being concerns, monitoring concerns requiring investigation and individuals identified in multiple reports may provide important opportunities for health care leaders to support all team members. Objective: To examine the distribution of physicians by specialty who demonstrate unprofessional behaviors measured through safety reports submitted by coworkers. Design, Setting, and Participants: This retrospective cohort study was conducted among physicians who practiced at the 193 hospitals in the Coworker Concern Observation Reporting System (CORS), administered by the Vanderbilt Center for Patient and Professional Advocacy. Data were collected from January 2018 to December 2022. Exposure: Submitted reports concerning communication, professional responsibility, medical care, and professional integrity. Main Outcomes and Measures: Physicians' total number and categories of CORS reports. The proportion of physicians in each specialty (nonsurgeon nonproceduralists, emergency medicine physicians, nonsurgeon proceduralists, and surgeons) who received at least 1 report and who qualified for intervention were calculated; logistic regression was used to calculate the odds of any CORS report. Results: The cohort included 35 120 physicians: 18 288 (52.1%) nonsurgeon nonproceduralists, 1876 (5.3%) emergency medicine physicians, 6743 (19.2%) nonsurgeon proceduralists, and 8213 (23.4%) surgeons. There were 3179 physicians (9.1%) with at least 1 CORS report. Nonsurgeon nonproceduralists had the lowest percentage of physicians with at least 1 report (1032 [5.6%]), followed by emergency medicine (204 [10.9%]), nonsurgeon proceduralists (809 [12.0%]), and surgeons (1134 [13.8%]). Nonsurgeon nonproceduralists were less likely to be named in a CORS report than other specialties (5.6% vs 12.8% for other specialties combined; difference in percentages, -7.1 percentage points; 95% CI, -7.7 to -6.5 percentage points; P < .001). Pediatric-focused nonsurgeon nonproceduralists (2897 physicians) were significantly less likely to be associated with a CORS report than nonpediatric nonsurgeon nonproceduralists (15 391 physicians) (105 [3.6%] vs 927 [6.0%]; difference in percentages, -2.4 percentage points, 95% CI, -3.2 to -1.6 percentage points; P < .001). Pediatric-focused emergency medicine physicians, nonsurgeon proceduralists, and surgeons had no significant differences in reporting compared with nonpediatric-focused physicians. Conclusions and Relevance: In this cohort study, less than 10% of physicians ever received a coworker report with a concern about unprofessional behavior. Monitoring reports of unprofessional behaviors provides important opportunities for health care organizations to identify and intervene as needed to support team members.

Study protocol: Collaboration Oriented Approach to Controlling High blood pressure (COACH) in adults - a randomised controlled trial.

INTRODUCTION: Hypertension, the clinical condition of persistent high blood pressure (BP), is preventable yet remains a significant contributor to poor cardiovascular outcomes. Digital self-management support tools can increase patient self-care behaviours to improve BP. We created a patient-facing and provider-facing clinical decision support (CDS) application, called the Collaboration Oriented Approach to Controlling High BP (COACH), to integrate home BP data, guideline recommendations and patient-centred goals with primary care workflows. We leverage social cognitive theory principles to support enhanced engagement, shared decision-making and self-management support. This study aims to measure the effectiveness of the COACH intervention and evaluate its adoption as part of BP management. METHODS AND ANALYSIS: The study design is a multisite, two-arm hybrid type III implementation randomised controlled trial set within primary care practices across three health systems. Randomised participants are adults with high BP for whom home BP monitoring is indicated. The intervention arm will receive COACH, a digital web-based intervention with effectively enhanced alerts and displays intended to drive engagement with BP lowering; the control arm will receive COACH without the alerts and a simple display. Outcome measures include BP lowering (primary) and self-efficacy (secondary). Implementation preplanning and postevaluation use the Consolidated Framework for Implementation Research and Reach-Effectiveness-Adoption-Implementation-Maintenance metrics with iterative cycles for qualitative integration into the trial and its quantitative evaluation. The trial analysis includes logistic regression and constrained longitudinal data analysis. ETHICS AND DISSEMINATION: The trial is approved under a single IRB through the University of Missouri-Columbia, #2091483. Dissemination of the intervention specifications and results will be through open-source mechanisms. TRIAL REGISTRATION NUMBER: NCT06124716.

Effects of a Patient Portal Intervention to Address Diabetes Care Gaps: Protocol for a Pragmatic Randomized Controlled Trial.

BACKGROUND: Despite the potential to significantly reduce complications, many patients do not consistently receive diabetes preventive care. Our research team recently applied user-centered design sprint methodology to develop a patient portal intervention empowering patients to address selected diabetes care gaps (eg, no diabetes eye examination in last 12 months). OBJECTIVE: This study aims to evaluate the effect of our novel diabetes care gap intervention on completion of selected evidence-based diabetes preventive care services and secondary outcomes. METHODS: We are conducting a pragmatic randomized controlled trial of the effect of the intervention on diabetes care gaps. Adult patients with diabetes mellitus (DM) are recruited from primary care clinics affiliated with Vanderbilt University Medical Center. Participants are eligible if they have type 1 or 2 DM, can read in English, are aged 18-75 years, have a current patient portal account, and have reliable access to a mobile device with internet access. We exclude patients with medical conditions that prevent them from using a mobile device, severe difficulty seeing, pregnant women or women who plan to become pregnant during the study period, and patients on dialysis. Participants will be randomly assigned to the intervention or usual care. The primary outcome measure will be the number of diabetes care gaps among 4 DM preventive care services (diabetes eye examination, pneumococcal vaccination, hemoglobin A1c, and urine microalbumin) at 12 months after randomization. Secondary outcomes will include diabetes self-efficacy, confidence managing diabetes in general, understanding of diabetes preventive care, diabetes distress, patient portal satisfaction, and patient-initiated orders at baseline, 3 months, 6 months, and 12 months after randomization. An ordinal logistic regression model will be used to quantify the effect of the intervention on the number of diabetes care gaps at the 12-month follow-up. For dichotomous secondary outcomes, a logistic regression model will be used with random effects for the clinic and provider variables as needed. For continuous secondary outcomes, a regression model will be used. RESULTS: This study is ongoing. Recruitment was closed in February 2022; a total of 433 patients were randomized. Of those randomized, most (n=288, 66.5%) were non-Hispanic White, 33.5% (n=145) were racial or ethnic minorities, 33.9% (n=147) were aged 65 years or older, and 30.7% (n=133) indicated limited health literacy. CONCLUSIONS: The study directly tests the hypothesis that a patient portal intervention-alerting patients about selected diabetes care gaps, fostering understanding of their significance, and allowing patients to initiate care-will reduce diabetes care gaps compared with usual care. The insights gained from this study may have broad implications for developing future interventions to address various care gaps, such as gaps in cancer screening, and contribute to the development of effective, scalable, and sustainable approaches to engage patients in chronic disease management and prevention. TRIAL REGISTRATION: ClinicalTrials.gov NCT04894903; https://classic.clinicaltrials.gov/ct2/show/NCT04894903. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56123.

Integrating Spirituality and Religious Beliefs in a Mindfulness Based Cognitive Behavioral Therapy for PTSD with Latinx Unaccompanied Immigrant Children.

Purpose: Unaccompanied immigrant children (UIC) experience significant mental health concerns, particularly posttraumatic stress. This is a vulnerable population, yet little systematic research has examined the effectiveness of evidence-based models such as cognitive behavioral therapy (CBT) to meet their needs. Integrating religious beliefs and spirituality into therapy could elucidate better understandings of traumatic stress, and posttraumatic cognitions when working with UIC with strong faith traditions/beliefs. Methods: We report on modifications made to a pre-existing treatment, consisting of integrating religious and spiritual themes, to engage and work with UIC participants in a pilot study of Mindfulness-Based CBT. Thematic analysis of therapy notes evaluated the implementation process for integrating religious and spiritual themes. Three composite vignettes illustrate how religiosity and spirituality were salient for UIC participants in this pilot study, and how these were integrated into therapy to address posttraumatic cognitions and symptoms. We assessed changes in PTSD symptom severity and posttraumatic cognitions for UIC and in comparison, to non-UIC participants using the Child PTSD Symptom Scale and the Posttraumatic Cognitions Inventory. Results: Religiosity and spirituality were important for coping and conceptualizations of trauma, served as facilitators for engaging UIC in therapy, and related to improving posttraumatic cognitions and symptoms. Conclusion: Religious identity and spirituality can be important for meaning making, trauma cognitions and symptoms, and can be important to explore in therapy with unaccompanied immigrant children and adolescents. Clinical Trial Registration: Not applicable.

Mental health and adaptation among newcomer immigrant youth in United States educational settings.

Schools play a vital role in the acculturation process of newly migrated youth. Social and academic factors within school settings predict a wide variety of adaptation outcomes. Age and grade also impact the ways that school experiences can shape the post-migration adjustment trajectories of migrant youth. Negative school experiences can exacerbate migration trauma, whereas positive school experiences play an important protective role in overcoming migration-related challenges and adjusting to a new cultural context. Emerging research also suggests that the school environment presents a valuable opportunity for service delivery, as students are readily accessible during the school day which reduces systemic barriers to engagement. Socio-emotional prevention and intervention can address migration trauma, foster resiliency, and help lead the way to acculturative and academic success. Teachers, counselors, coaches and mentors who engage with newcomer immigrant youth in schools can play a pivotal role in easing migration-related challenges by encouraging positive emotional attachments, linking to resources, and helping to navigate new systems. These professionals benefit from specialized training on the unique needs and best practices for supporting the learning, engagement, development, and adaptation of newcomer youth.

Attention as a multi-level system of weights and balances.

This opinion piece is part of a collection on the topic: "What is attention?" Despite the word's place in the common vernacular, a satisfying definition for "attention" remains elusive. Part of the challenge is there exist many different types of attention, which may or may not share common mechanisms. Here we review this literature and offer an intuitive definition that draws from aspects of prior theories and models of attention but is broad enough to recognize the various types of attention and modalities it acts upon: attention as a multi-level system of weights and balances. While the specific mechanism(s) governing the weighting/balancing may vary across levels, the fundamental role of attention is to dynamically weigh and balance all signals-both externally-generated and internally-generated-such that the highest weighted signals are selected and enhanced. Top-down, bottom-up, and experience-driven factors dynamically impact this balancing, and competition occurs both within and across multiple levels of processing. This idea of a multi-level system of weights and balances is intended to incorporate both external and internal attention and capture their myriad of constantly interacting processes. We review key findings and open questions related to external attention guidance, internal attention and working memory, and broader attentional control (e.g., ongoing competition between external stimuli and internal thoughts) within the framework of this analogy. We also speculate about the implications of failures of attention in terms of weights and balances, ranging from momentary one-off errors to clinical disorders, as well as attentional development and degradation across the lifespan. This article is categorized under: Psychology > Attention Neuroscience > Cognition.