Increased anxiety and emotional lability in a patient with SDHB gene mutation paraganglioma: a call to multidisciplinary approach.

Paragangliomas are neuroendocrine tumors that have the potential to secrete catecholamines. They have been linked to genetic mutations in the mitochondrial succinate dehydrogenase (SDH) complex. Patients can experience both physical symptoms and psychiatric symptoms like anxiety, depression, and psychosis. These symptoms can occur as paroxysmal episodes with periods of increased catecholamine secretion. We describe a patient with SDHB gene mutation, who has been diagnosed with a jugular paraganglioma, and was brought to the hospital under Baker Act for threats made online. Since diagnosis this patient has been experiencing both anxiety and post-traumatic stress disorder (PTSD). The patient and a family member report increased emotional lability, and the patient reports multiple daily episodes of anxiousness. This case outlines the connection between paragangliomas and psychiatric symptoms, the impact they can have on patients' daily lives, and the importance of addressing the possibility of these symptoms and establishing a multispecialty healthcare team at the time of diagnosis.

The Behavioral Health Needs of Youth With Preexisting Psychiatric Disorders in the Aftermath of COVID-19.

Children and adolescents with psychiatric disorders are a sizable population of children and youth with special health care needs. While the capabilities of behavioral health resources to meet these youth's needs were already strained, the Coronavirus Disease 2019 (COVID-19) pandemic extended resource limitations just as this subgroup of children and youth with special health care needs faced new stressors and potential exacerbations of their underlying psychiatric illnesses. In this article, we provide a brief narrative review of the factors' manifestations with an emphasis upon their disproportionate impact upon children of color and their families and particularly those from disadvantaged communities. We proceed to provide policy proposals for addressing these disparities. These include raising reimbursement for behavioral health services, increasing telehealth care delivery, reducing inter-state licensing requirements, increasing community-based services, and addressing social determinants of health. Conclusions and directions for strengthening behavioral health service delivery capabilities and addressing systemic injustices are made.

Providencia alcalifaciens in a patient with a staghorn calculus: a novel presentation.

A member of the Enterobacteriaceae family, Providencia alcalifaciens is typically recognized as a source of gastrointestinal illness. Although its pathogenicity is not well known, many studies have suggested its mechanism of action involves the invasion of the intestinal mucosal layer. Although P. alcalifaciens is a urease producing microorganism, it has not been associated with the formation of a staghorn calculus in the setting of a urinary tract infection. This organism is neither commonly pursued in research or investigation nor is it commonly tested for in the clinical setting. This is especially true when combined with other disease processes, such as calculus formation. The advancement of antibiotic resistance, such as carbapenemase-producing strains, should bring more attention and routine investigation to this organism in the acute stage of infection. In this case report we introduce a 43-year-old Cuban female, who presents with a left-sided staghorn calculi and urine culture positive for carbapenemase-producing P. alcalifaciens.

Engagement in Trauma-Specific CBT for Youth Post-9/11.

Treatment participation was examined among youth enrolled in an evaluation of cognitive behavioral therapy (CBT) for trauma following the 9/11 World Trade Center disaster. Staff at nine agencies serving a predominantly low-income ethnically diverse population were trained to deliver CBT and structured engagement strategies. Four hundred and forty-five youth ages 5-19 were eligible for CBT, and 417 (94%) received at least one treatment session. Pretreatment and treatment show rates and overall dose were examined. Treatment participation rates were higher than those typically reported in community studies of children's mental health services. Regression analyses indicated variability across sites in treatment show rates with the highest rates at where services were delivered in schools. However, sites, demographic factors and trauma symptoms accounted for a small amount of variance in treatment participation overall. The study suggests structured engagement strategies, linked to evidence-based treatments may improve treatment participation for youth.

Quantitative Analysis of the Texas Music Educators Association (TMEA) All-State Choral Audition Music.

INTRODUCTION: Young voices experience a multitude of physiological and hormonal changes that can impact vocal production. Singing an ensemble voice part that demands more than an adolescent laryngeal structure can readily support may be detrimental to vocal health and enjoyment. OBJECTIVES: This study analyzes the musical range, tessitura, cycle dose, short-term recovery dose, and time dose of choral selections for the popular and competitive Texas Music Educators Association (TMEA) All-State competition as a means of informing successful audition and rehearsal practices. METHODS: An expanded model based on previous work by Stefan Thurmer, Ingo Titze, and John Nix is used to analyze the TMEA All-State Large-School, Treble, and Tenor-Bass choral audition music. Each vocal part's pitches are subdivided by the piece's smallest common rhythmic duration and converted to hertz for equal weighting. Quartile analysis is used to define tessitura as the inclusive range between the first and third quartiles. RESULTS: This method reveals the musical range, tessitura, cycle dose, short-term recovery dose, and time dose in an objective manner that can be compared with individual voices for best fit using similar individual metrics and the voice range profile. DISCUSSION: Vocal characteristics that individual singers should possess to successfully navigate the exacting All-State audition and rehearsal process are described based on data interpretation. Teachers and conductors can prepare their students for success by evaluating these factors ahead of time and assigning parts based on information gleaned from these methods.

Clinical Presentation of a Patient With Tuberculous Myocarditis: Case Report and Review of Literature.

Tuberculous myocarditis has a high mortality rate and is often associated with a delay in the diagnosis because of the low index of suspicion and insidious course. Most of the reported cases predominantly occur in young, immunocompetent patients. Delays in diagnosis may result in fatal complications. Through this case report, we aim to shed light on some of the clinical features of tuberculous myocarditis and promote a high index of suspicion for early diagnosis and timely management.

Impact of Empowerment Training on the Professional Work of Family Peer Advocates.

A pilot study using a prospective design examined the impact of a collaboratively developed training model, called the Parent Empowerment Program (PEP), for professionally-employed family peer advocates who work with caregivers of children with mental health needs. This training used a combination of didactic, practice exercises, and group discussion. It targeted specific mental health knowledge content and collaborative skills to facilitate the work of family peer advocates in empowering caregivers. Co-delivered by a family peer advocate and clinician, the training consisted of a 40-hour face-to-face training, followed by six monthly face-to-face booster sessions. A total of 15 advocates participated in assessments conducted at baseline and post-training. This group of experienced family peer advocates showed no significant increase in knowledge about mental health content, but post-training assessments indicated increased collaborative skills and mental health services self-efficacy. This initial evaluation has implications for expanding training and support for the emergent workforce of professionally-employed family peer advocates in children's mental health.

Cultural processes in parenting and youth outcomes: examining a model of racial-ethnic socialization and identity in diverse populations.

We review and summarize the findings across 7 studies contained in the special section titled, "Racial-Ethnic Socialization, Identity, and Youth Outcomes: Excavating Culture." These studies represent a significant advance for research in issues related to the impact of racial-ethnic socialization and identity on child outcomes. All 7 studies attempted to test in whole or part a hypothetical model in which ethnic-racial socialization in families of color is related to child psychosocial and academic outcomes directly and indirectly through effects on self-system variables such as racial-ethnic identity and self-esteem. Two types of racial socialization messages were of particular interest: messages that promote cultural pride (referred to as ethnic or cultural socialization) and messages that address children's exposure to discrimination (referred to as racial socialization). Collectively, the studies suggest that ethnic-racial socialization processes are related to youth outcomes through indirect associations with ethnic-racial identity and self-esteem. Findings were most consistent in the studies with African American youth and some aspects of the model were not supported for American Indian and Chinese youth. Ethnic and racial group differences and directions for future research are discussed.

Cultural Pride Reinforcement as a Dimension of Racial Socialization Protective of Urban African American Child Anxiety.

The study objective was to examine how parental endorsement of cultural pride reinforcement messages may explain African American child anxiety. Data were gathered from 72 African American parents and their elementary school-aged children. Results indicated stronger parental endorsement of cultural pride reinforcement messages predicted less child anxiety. Additionally parental endorsement of these messages moderated the relationship between child mental health risk factor exposure and child anxiety. Specifically in the presence of high exposure, children of parents who endorsed high levels of cultural pride reinforcement messages had significantly lower anxiety scores relative to children of parents who endorsed low levels of these messages. Findings indicated parental endorsement of these messages may be an important factor in explaining African American child anxiety.

Parents' ethnic-racial socialization practices: a review of research and directions for future study.

Recently, there has been an emergence of literature on the mechanisms through which parents transmit information, values, and perspectives about ethnicity and race to their children, commonly referred to as racial or ethnic socialization. This literature has sought to document the nature of such socialization, its antecedents in parents' and children's characteristics and experiences, and its consequences for children's well-being and development. In this article, the authors integrate and synthesize what is known about racial and ethnic socialization on the basis of current empirical research, examining studies concerning its nature and frequency; its child, parent, and ecological predictors; and its consequences for children's development, including ethnic identity, self-esteem, coping with discrimination, academic achievement, and psychosocial well-being. The authors also discuss conceptual and methodological limitations of the literature and suggest directions for future research.

Parent Depression and Anger in Peer-Delivered Parent Support Services.

Knowledge about parents who seek peer-delivered parent support services in children's mental health is limited. In this prospective study, characteristics of 124 parents who sought peer parent advocate services related to their children's behavioral difficulties are described. This urban sample consisted primarily of low-income mothers of color, 80% of whom were caring for children with clinically significant behavioral problems. Of these parents, 64% endorsed clinically significant levels of depressive symptoms at baseline. Linear mixed effects models were used to examine associations between parent depression and anger expression with working alliances with peer advocates. No independent or combined effects of parent depression or anger expression on working alliance were found. However, adjusting for family demographic factors, caregiver strain and child symptoms, parent depression interacted with anger expression to influence working alliances, primarily around agreement and mutual engagement on goals. Among parents who endorsed clinically significant depressive symptoms, anger expression did not influence working alliance but among non-depressed parents, anger expression was negatively associated with working alliance. Implications for training peer parent advocates to more effectively engage low income parents are discussed.

The Development and Evaluation of a Parent Empowerment Program for Family Peer Advocates.

Family-to-family services are emerging as an important adjunctive service to traditional mental health care and a vehicle for improving parent engagement and service use in children's mental health services. In New York State, a growing workforce of Family Peer Advocates (FPA) is delivering family-to-family services. We describe the development and evaluation of a professional program to enhance Family Peer Advocate professional skills, called the Parent Engagement and Empowerment Program (PEP). We detail the history and content of PEP and provide data from a pre/post and 6-month follow up evaluation of 58 FPA who participated in the first Statewide regional training effort. Self-efficacy, empowerment, and skills development were assessed at 3 time points: baseline, post-training, and 6-month follow-up. The largest changes were in self-efficacy and empowerment. Regional differences suggest differences in Family Peer Advocate workforce across areas of the state. This evaluation also provides the first systematic documentation of Family Peer Advocate activities over a six-month period. Consistent with peer specialists within the adult health care field, FPA in the children's mental health field primarily focused on providing emotional support and service access issues. Implications for expanding family-to-family services and integrating it more broadly into provider organizations are described.

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The Application of Behavior Change Theory to Family-Based Services: Improving Parent Empowerment in Children's Mental Health.

We describe the development of a parent empowerment program (PEP) using a community-based participatory research approach. In collaboration with a group of dedicated family advocates working with the Mental Health Association of New York City and state policy makers, academic researchers took an iterative approach to crafting and refining PEP to better prepare family advocates to help bridge the gaps in service access among children with emotional and behavioral problems. Despite the growth of family-led, family support programs nationally, research that demonstrates the positive benefits of such programs is scarce in the children's mental health literature. The PEP model is based on research data about barriers families face in mental health service utilization (e.g., stigma, perceptions of providers, attitudes towards mental illness, service availability, etc.). PEP is premised on (a) the concept of empowerment as a process, (b) the need to engage parents in becoming active agents of change, and (c) the application of an integrated framework to empower parents, called the Parents as Agents of Change model. Our paper focuses on describing the application of a Unified Theory of Behavior Change as a theoretical framework to help activate parents as change agents in meeting their children's mental health needs. Based on an integrated model of grassroots driven Principles of Parent Support and research-based Unified Theory of Behavior Change, PEP's Parents as Agents of Change model provides a conceptual framework for testing the effectiveness of family support services in children's mental health, a much-needed area for future research.

The Role of Racial Socialization in Relation to Parenting Practices and Youth Behavior: An Exploratory Analysis.

Racial socialization is receiving research attention because of growing evidence that it can be a protective developmental process in African American families. The present study was an exploration of the relationship of parental mental health, discipline effectiveness, monitoring and racial socialization strategies on child externalizing behaviors in a sample of 140 African American parent/caregivers. Findings indicated that certain types of racial socialization-particularly, spirituality and religious coping-in conjunction with discipline effectiveness was related to child behavior problems. Specifically, among parents who felt they used more effective discipline strategies, moderate to high rates of spiritual and religious coping were associated with a reduction of child behavior problems. These findings support the hypothesis that racial socialization is an important aspect of parenting in African American families that can be associated with the effective management of children's behavior. Implications for parenting interventions and future research are discussed.

The Protective Effect of Adult Mental Health Upon the Utilization of Racial Socialization Parenting Practices.

The purpose of this paper is to examine the impact of parental mental health and types of racial socialization. The sample consisted of 169 African-American parents and their children (ages 9-11) who participated in a federally funded research project, "Knowledge about the African American Research Experience" (KAARE). Bivariate analyses revealed significant positive relationships between parent mental health status and two forms of racial socialization: spiritual/religious coping, and racial awareness teaching, while multivariate analyses supported the positive association between parental mental health and spiritual/religious coping. These results suggest that parental characteristics may influence the use of specific types of racial socialization to assist youth in coping with discriminatory societal messages.

An Introduction to Parenting and Mental Health Services Utilization Among African American Families: The Role of Racial Socialization.

The articles in this special issue are a significant contribution to the literature pertaining to racial socialization, which is defined as messages parents communicate about race and culture, how African Americans are perceived societally, and how to cope with discrimination due to their skin color. More specifically, these articles examine the relationship between racial socialization and parental mental health status, child socio-behavioral functioning, and the utilization of mental health and prevention services for both parent and child. Overall, the results of these articles indicate that various racial socialization practices do indeed influence key variables such as the child's behavioral functioning and decision-making, parental mental health status, and the receipt of prevention and mental health services. Implications of these findings suggest that racial socialization beliefs and practices may in fact influence the health and functioning of African American youth and families.

The Effect of Racial Socialization on Urban African American Use of Child Mental Health Services.

OBJECTIVE: To examine how parental endorsement of racial socialization parenting practices relates to child mental health service use among an urban sample of African American families. METHODS: A cross-sectional sample of urban African American parents (n = 96) provided ratings of their beliefs concerning various dimensions of racial socialization constructs, i.e., spiritual or religious coping (SRC), extended family caring (EFC), cultural pride reinforcement (CPR), and assessed regarding their use of child mental health services. RESULTS: At the multivariate level, the use of child mental health services was significantly positively associated with moderate levels of endorsement of SRC and EFC. Inversely, scores in the moderate range of CPR were associated with a reduced likelihood of child mental health service use. CONCLUSION: Parental endorsement of racial socialization parenting practices appear to play a salient role in child mental health service use among an urban African American families. Further research with larger and more representative samples should be pursued.