Engaging Parents in Mental Health Services: A Qualitative Study of Community Health Workers' Strategies in High Poverty Urban Communities.

Empirical engagement-promoting strategies in child and family mental health services have been identified largely within the context of clinic-based services delivered by mental health professionals. However, the magnitude of unmet youth mental health need necessitates expanding the scope of mental health services, and the associated engagement strategies, beyond traditional models and service providers. The present study aimed to extend our understanding of engagement strategies to a school-based mental health service model, using a community health worker (CHW) workforce implementing an early intervention program with parents and school-aged children (K-4) in high poverty urban communities. Qualitative semi-structured individual interviews were conducted with 16 CHWs to capture their descriptions of the engagement strategies they utilized with parents throughout program implementation. Transcripts were coded and themes were identified following procedures for thematic analysis. Thematic analyses revealed ten themes describing a range of engagement strategies falling into two overarching categories: (1) rapport building, and (2) responsive delivery. Themes within the rapport building category included non-judgmental supportive listening, increasing social proximity, praise, privacy and confidentiality, and leveraging relationships. Themes within the responsive delivery category included flexibility, consistency, advocacy, incentives, and meeting needs. Findings provide preliminary evidence regarding the ability of CHWs to identify and implement a range of engagement strategies with parents and families that parallel empirically-based engagement strategies in traditional services. These findings speak to the potential of this workforce to engage underserved families in mental health services, underscoring the important role for CHWs in reducing mental health disparities.

A Community-Based Organization Model to Promote Latinx Immigrant Mental Health Through Advocacy Skills and Universal Parenting Supports.

The unique mental health context of children in Latinx immigrant families calls for innovative community-based intervention strategies. We use an ecological public health approach to highlight the importance of community-based organization (CBO) settings, the critical role of community-based paraprofessionals (i.e., non-clinicians, near-peers) and capacity-building, and the expansion of mental health promotion strategies to include realistic, day-to-day supports for Latinx immigrant parents and families. This realigns mental health with the goals and mission of trusted spaces, like CBOs, that can offer more equitable and non-stigmatized access for Latinx immigrant families. We draw upon two strength-based and empowerment-focused interventions that utilize community-based workforces to promote positive parenting skills (Partners Achieving Student Success-PASS; Mehta et al., 2019) and self-advocacy skills (Community Advocacy Project-CAP; Sullivan & Bybee, 1999) to provide the conceptual framework for Family Mental Health Advocacy (FMHA). FMHA aligns mental health promotion with the advocacy mission of CBOs, engages CBO staff with feasible mental health "messages," and empowers immigrant parents as critical change agents in the lives of their children. We acknowledge the challenges associated with implementing mental health promotion strategies and providing workforce support, as well as the importance of local and national policy influences.

A Longitudinal Mixed Method Approach for Assessing Implementation Context and Process Factors: Comparison of Three Sites from a Housing First Implementation Strategy Pilot.

BACKGROUND: Implementation science's focus on establishing implementation strategy effectiveness has overshadowed the need to understand differential performance of such strategies under various conditions. Methods allowing for assessment between implementation context and process can help address this gap. This paper provides a detailed description of a mixed method procedure for assessing factors related to the implementation context and process intersection, which was developed as part of the pilot study of the Housing First Technical Assistance and Training (HFTAT) Program, a multifaceted strategy designed to support Housing First model implementation. METHODS: The HFTAT was pilot tested among a sample of three organizations. Our mixed method approach combines two tools often used in implementation research-the Stages of Implementation Completion and the Consolidated Framework for Implementation Research-in a novel way. Several stages to analysis were completed, starting with a separate analysis of data pertaining to each measure and then two levels of mixed method analysis. RESULTS: The approach provided a better understanding of the issues that impacted the implementation guided by the HFTAT, suggesting: (1) individual determinants seemed to have a bigger impact based on the number of SIC phases they affected, (2) implementation context and process were connected through climate-related factors in the inner setting that made the sites more or less responsive to addressing identified barriers, and (3) there is a need to better assess context factors to identify areas where implementation drivers should be better targeted to facilitate change, and this is supported by prior research. CONCLUSIONS: Understanding the underlying factors impacting a setting's performance related to a specific implementation strategy has potential to improve decision-making and optimize future implementation efforts. The approach likely be as successful combining the SIC with other determinant frameworks and should be utilized at the onset of an implementation project to maximize its usefulness.

Associations of ethnic/racial discrimination with internalizing symptoms and externalizing behaviors among juvenile justice-involved youth of color.

INTRODUCTION: Youth of color (e.g., Black/African American and Latinx/Hispanic) are overrepresented in the juvenile justice system and experience greater health disparities compared to non-Hispanic White youth. Ethnic/racial discrimination (ERD) is a risk marker for poor mental health and behavioral outcomes among youth of color, and traumatic stress and emotion dysregulation have been implicated in these pathways. Despite the relevance of these factors for justice-involved youth of color, understanding of their interrelations within this demographic is lacking. METHODS: Participants were 173 recently arrested adolescents (86% African American; 45% girls; ages 13-18) on probation in a large Midwest city in the United States. Participants completed surveys assessing ERD, traumatic stress, emotion dysregulation, internalizing symptoms, and externalizing behaviors. Using linear regression and path analysis, this study tested the cross-sectional links among two types of ERD (i.e., interpersonal experiences and perceptions of group experiences), traumatic stress symptoms, emotion dysregulation, and internalizing symptoms and externalizing behaviors. RESULTS: Interpersonal ERD (e.g., hearing racial insults) was associated with increased internalizing symptoms and externalizing behaviors; for internalizing symptoms, the relation was stronger for girls than boys. Gender differences were partially accounted for by traumatic stress symptoms and emotion dysregulation. CONCLUSIONS: This study offers new insights into ERD experiences among juvenile justice-involved youth of color, gender differences in ethnic/racial discrimination experiences, and the potential value of gender-sensitive and culturally responsive programming in strengthening youths' ability to cope with ERD.

Examining Correctional Staff Members' Engagement in Rehabilitation as Part of Their Everyday Practices in Short-term Juvenile Detention.

Research on the rehabilitation of juvenile justice-involved youth is often focused on specific evidence-based interventions. Less attention has been paid to everyday interactions that correctional staff members have with detained youth and, further, how these may align with trauma-informed care principles and thus encourage a more supportive setting. Using an ethnographic case study approach, this study addressed this gap in knowledge by documenting the nature of rehabilitative practices as they naturally occurred in the context of short-term detention staff members' daily routine and interactions with detained youth. This study found evidence for three primary forms of routine rehabilitative practices: (a) promotion of youths' emotional safety and well-being, (b) provision of rights-based information and explanations, and (c) encouraging youths' success in and beyond detention. These practices were observed across several key setting contexts: (a) staff-led group activities, (b) routine contact between individual youth and staff (e.g., formal procedures, informal conversations), and (c) staff-only spaces. Our findings highlight the need for ongoing research to effectively translate promising intervention approaches, such as trauma-informed care, into juvenile detainment settings.

American Indian Researcher Perspectives on Qualitative Inquiry About and Within American Indian Communities.

It is presumed that Indigenous researchers are optimally positioned to conduct research about or within their own or other Indigenous communities. However, these researchers may still experience challenges, barriers, and distressing events that are important to identify. Qualitative inquiry may be a particularly vulnerable context for Indigenous researchers given the nature of data collection methods and an emphasis on researcher-participant relationships. This paper details the personal reflections of two American Indian (AI) researchers who carried out qualitative research focused on AI issues and/or communities. The first project examined undergraduate students' opinions of the use of AI imagery in the form of a race-based university mascot. The second was a study of the mental health needs of AI youth and families in an urban community. Several themes characterized both of their experiences and might be generalizable to others working in these contexts: (a) coping with racism and microaggressions; (b) the role and impact of identity politics; (c) community insider/outsider tension; and (d) managing personal distress associated with the research topics and process. These themes are discussed to illuminate ways that Indigenous researchers, engaged in research on Indigenous topics and/or with Indigenous communities, are challenged and affected by their work.

Reaching underserved youth: A pilot implementation of a skills-based intervention in short-term juvenile detention.

Despite a clear need, psychological interventions are lacking in detention facilities. In particular, efforts to implement such interventions in short-term juvenile detainment are virtually absent from scholarly literature. However, short-term juvenile detention facilities (JDFs) serve as important settings for intervention. Detained youth in JDFs present with a variety of charges/offenses, from truancy to murder and vary with regard to their history of contact with the system and the length of their detainment. The present study provides an overview of a brief skills-based intervention implemented in a group-based format with detained adolescents in a JDF, in an effort to examine youths' engagement, buy-in, and perceived obstacles in such settings. Preliminary findings from our pilot intervention effort informed our understanding of youths' engagement, buy-in, and perceived relevance and utility of the intervention.

Collaboration with Urban Community Stakeholders: Refining Paraprofessional-led Services to Promote Positive Parenting.

This paper describes the process of a community-academic partnership to navigate implementation challenges for a school-based service model led by paraprofessionals to promote positive parenting in high poverty urban communities. We describe the process by which we (a) identified implementation challenges, (b) sustained a university-community collaboration to redesign the paraprofessional service model, and (c) assessed the feasibility of the new model involving four social service agencies in 16 schools with over 600 families. The structure and process of the collaboration and refinement are described with attention to who was best positioned to engage in the collaboration and how the partnership worked to balance scientific rigor with responsiveness to paraprofessional workforce strengths. Feasibility data indicated that the revised model was successfully implemented by paraprofessional staff; 92.2% of possible staff monthly reports were completed and discussion of key goals was incorporated into 94.2% of interactions. Continual monitoring provided critical feedback from stakeholders as we drew on and interpreted these various sources of information to build and refine the service model. We suggest that these processes are critical steps to bridge the research-to-practice gap, by promoting practices that are aligned with the needs of children and families, and the staff who serve them.

A qualitative study to explore paraprofessionals' role in school-based prevention and early intervention mental health services.

This study explored the role of paraprofessionals within a school-based prevention and early intervention program to promote children's engagement in learning and positive parenting practices. Study aims were designed to understand how paraprofessionals perceive their role in high-need communities and how they define their work within schools. Two focus groups were conducted with school family liaisons (SFLs) during the 2015-2016 school year. Transcribed audio recordings were coded using thematic analysis wherein 2 authors coded independently, followed by audited discussion and final consensus codes. SFLs acknowledged the importance of serving high-need communities and relationship building was central to their role. They leveraged contextual knowledge (culture, language, and neighborhood) to engage parents, allowing them to serve as effective advocates for parents/families in the school setting. Findings support the importance of paraprofessionals in prevention-focused services and highlight how leveraging shared experiences and prioritizing relationship building facilitates their work as advocates within schools.

"Changing the text": modeling council capacity to produce institutionalized change.

Collaboration is a ubiquitous approach to change, but is notoriously difficult and not definitively linked to desirable outcomes. Not surprisingly, the collaboration literature is replete with numerous facilitators and barriers to collaborative efforts. The current study aimed to develop a parsimonious model of factors influencing the success of collaborative efforts both internal and external to the council, including, (a) features of the council environment, (b) intermediate outcomes including the empowerment of members in the council context and the degree to which councils have generated social capital and (c) the extent to which collaborative efforts are occurring in a community context supportive of their aims. In particular, this study examines whether these factors affect the extent to which councils are positioned to achieve institutionalized change, or changes "in the text" that govern front line providers' (e.g., police, advocates) practices in the community response to intimate partner violence. Results suggest that perceived member empowerment, generation of social capital, and supportive community context are the most important predictors of the extent to which councils foster shifts in institutionalized change. Features of the council environment are only indirectly related to the degree to which institutionalized change is ultimately fostered as mediated by the generation of social capital. This suggests that the ability of members to act as change agents and the extent to which those in power support council efforts figure more prominently to facilitate or constrain council efforts than council functioning itself.