Scoping Review: Digital Mental Health Interventions for Children and Adolescents Affected by War.

OBJECTIVE: More than 200 million children and adolescents live in countries affected by violent conflict, are likely to have complex mental health needs, and struggle to access traditional mental health services. Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support. We performed a scoping review to map existing digital mental health interventions relevant for children and adolescents affected by war, to examine the strength of the evidence base, and to inform the development of future interventions. METHOD: Based on a pre-registered strategy, we systematically searched MEDLINE, Embase, Global Health, APA PsychInfo, and Google Scholar from the creation of each database to September 30, 2022, identifying k = 6,843 studies. Our systematic search was complemented by extensive consultation with experts from the GROW Network. RESULTS: The systematic search identified 6 relevant studies: 1 study evaluating digital mental health interventions for children and adolescents affected by war, and 5 studies for those affected by disasters. Experts identified 35 interventions of possible relevance. The interventions spanned from universal prevention to specialist-guided treatment. Most interventions directly targeted young people and parents or carers/caregivers and were self-guided. A quarter of the interventions were tested through randomized controlled trials. Because most interventions were not culturally or linguistically adapted to relevant contexts, their implementation potential was unclear. CONCLUSION: There is very limited evidence for the use of digital mental health interventions for children and adolescents affected by war at present. The review provides a framework to inform the development of new interventions. DIVERSITY & INCLUSION STATEMENT: We actively worked to promote sex and gender balance in our author group. STUDY PREREGISTRATION INFORMATION: Digital mental health interventions for children and young people affected by war: a scoping review; https://osf.io/; hrny9.

Impulsivity profiles across five harmonized longitudinal childhood preventive interventions and associations with adult outcomes.

This study aimed to parse between-person heterogeneity in growth of impulsivity across childhood and adolescence among participants enrolled in five childhood preventive intervention trials targeting conduct problems. In addition, we aimed to test profile membership in relation to adult psychopathologies. Measurement items representing impulsive behavior across grades 2, 4, 5, 7, 8, and 10, and aggression, substance use, suicidal ideation/attempts, and anxiety/depression in adulthood were integrated from the five trials (N = 4,975). We applied latent class growth analysis to this sample, as well as samples separated into nonintervention (n = 2,492) and intervention (n = 2,483) participants. Across all samples, profiles were characterized by high, moderate, low, and low-increasing impulsive levels. Regarding adult outcomes, in all samples, the high, moderate, and low profiles endorsed greater levels of aggression compared to the low-increasing profile. There were nuanced differences across samples and profiles on suicidal ideation/attempts and anxiety/depression. Across samples, there were no significant differences between profiles on substance use. Overall, our study helps to inform understanding of the developmental course and prognosis of impulsivity, as well as adding to collaborative efforts linking data across multiple studies to better inform understanding of developmental processes.

Family Matters: The Effects of Multigenerational Community Violence Exposure on Family Functioning.

Exposure to community violence is known to be associated with a host of maladaptive outcomes in both youth and adult populations. Though frequently examined in other interpersonal violence literature, family functioning has yet to be examined as an outcome in community violence literature. The current study begins to address this need by exploring the impact of parent and child's exposure to community violence on parents' perception of family functioning. Two hundred parent-child dyads (sons Mage =12.39, SD = 1.22 at baseline; mothers Mage = 42.79, SD = 9.21 at Wave 5) living in under-resourced, urban neighborhoods completed self-report questionnaires about their exposure (i.e., direct or indirect) to violent events in their community within the last year. The parents then completed an additional self-report questionnaire about their perception of family functioning at one year and three years post community violence exposure, respectively. Results of general linear modeling showed that at one- and three-years post-direct and indirect exposure, family cohesion and family communication was highest when 1) neither the parent nor child were exposed and when 2) only the child was exposed. Family functioning was at its lowest levels when the group included a parent who reported direct or indirect exposure to community violence. The results highlight a need to provide family-based psychosocial interventions to families exposed to violence to help preserve both individual and family functioning after exposure.

Predicting implementation of the PAX Good Behavior Game + MyTeachingPartner interventions.

Introduction: Effective classroom management is critical to creating a classroom environment in which social, emotional, and academic learning can take place. The present study investigated the association between early career, early elementary teachers' occupational health (job stress, burnout, and perceived teaching ability) and perceptions of program feasibility in relation to their implementation dosage and quality of two evidence-based classroom management programs implemented together: the PAX Good Behavior Game (GBG) and MyTeachingPartner (MTP) intervention. Methods: Teachers provided information on their occupational health at the start of the school year and were then randomized to the PAX GBG + MTP condition or control condition. Teachers' perceptions of the feasibility of the program, implementation dosage, and implementation quality of the intervention were measured at the end of the school year for the 94 intervention teachers. Results: Teachers participated in more MTP coaching cycles when they reported that the combined PAX GBG + MTP program was feasible. Although there were no main effects of occupational health on implementation, the associations between job stress and implementation quality were moderated by perceptions of feasibility. Discussion: Findings highlight the complexity of factors influencing the implementation of evidence-based programs in school settings.

Improving understanding of how mentoring works: Measuring multiple intervention processes.

The objective is to develop and test dimensionality and validity of a new measure of five mentoring intervention processes drawn from emphases across prior mentoring efforts that might be the basis for effects: identification with the mentor, social and emotional support, teaching and education, and advocacy, and shared time and activity. Partial validation of value was drawn from moderation role in a meta-analysis of mentoring (Tolan, Henry, Lovegrove, Schoeny, & Nichols, 2014. J. Exp. Criminol., 10, 179-201). Data collected of candidate items completed by 740 mentors and 302 mentees (mean age = 16.59 years) were subjected to confirmatory factor analyses based on the five theorized dimensions. Scales derived from best-fitting solutions were examined for convergent validity in relation to other indicators of mentoring relationship qualities. A bifactor model with five specific factors was supported for adult mentor reports while a simplified single factor model fit youth reports. Correlations between derived scale scores and validity indicators of mentoring relationship qualities were consistent with expectations. Multiple activities that comprise mentoring can be identified in adult mentor reports but not youth reports. This scale provides a promising basis for testing how variation in emphasis during mentoring affects impact and help guide training emphases.

Scaling up Evidence-Based Interventions Within the US Public Health Market.

The Mapping Advances in Prevention Science IV (MAPS-IV) Translation Research Task Force report provides an important enumeration of challenges and potential opportunities for improving extent of implementation of evidenced based interventions. The aspiration is for scientifically based prevention to be implemented widely enough to show population level shifts in incidence and prevalence. The MAPS-IV Task Force report by Fagan and colleagues (2019) provides a thoughtful and informative report that notes important exemplars towards that goal as well as key challenges and suggests strategies for greater impact across five publicly funded systems affecting human development. Comments are offered that center around the value of embedding prevention science within often larger and more sustained social and political forces as well as embracing scaling up within the complex funding streams in which prevention will be sustainable at scale. These include increasing attention to practical considerations that can affect how prevention is viewed, appreciated, and likely utilized as well as the ongoing challenge of how to relate evidenced based programs with the more prevalent and often preferred approaches of those deciding what is funded and what is actually implemented. This valuable contribution to Society for Prevention Research and prevention science is characterized as an important step toward strategies that might plausibly move prevention from primarily demonstration efforts to sustainable public health strategies integrated into the major systems of influence on human development.

The influence of parenting practices and neighborhood characteristics on the development of childhood aggression.

The present study examined the way in which neighborhood impoverishment, neighborhood social processes, and parenting practices relate to the development of aggressive behavior among children aged 6-8 years raised in low-income neighborhoods. A total of 424 children (male = 207, female = 217) and their families participated in the study. Hierarchical linear regression revealed that neighborhood impoverishment, neighborhood social processes, and parental monitoring/supervision were associated with childhood aggression 2 years later. Neighborhood social processes did not mediate the relation between neighborhood impoverishment and childhood aggression, nor did parental monitoring/supervision mediate the relation between neighborhood characteristics and childhood aggression. Children residing in neighborhoods with substantial poverty are at greater risk of developing aggressive behavior. Strong neighborhood social processes and high levels of parental supervision/monitoring are associated with lower levels of aggression. Despite the protective benefits of neighborhood social processes and high-quality parenting, neighborhood economic deprivation continues to elevate risk of developing aggressive behavior.

Understanding development of African American boys and young men: Moving from risks to positive youth development.

African American boys and young men in the United States face challenges unique to being a male and an ethnic minority in our society. Despite the marginalization of African American boys and young men, this article argues that African American boys and young men, like other individuals, are in large proportion able to overcome adversity and utilize positive youth development assets and resources, and that focusing on capabilities and strengths is worthy of primary emphasis (Lerner, Dowling, & Anderson, 2003; Stevenson, 2016). García Coll and colleagues' (1996) integrative model of developmental competencies in minority children lays the groundwork for conceptualizing the profound influence of racism, economic disadvantage, oppression, segregation, and other trauma-inducing experiences on the development of African American boys and young men. We extend that framework by adding notions of positive development and adaptive calibration to contextual challenges to account for prosocial development of African American boys and young men. We present descriptive and experimental research support for this approach and argue that it has the potential for increasing the validity, sophistication, and utility of developmental research on about African American boys and young men are presented. (PsycINFO Database Record

Examining the effects of emotional and cognitive desensitization to community violence exposure in male adolescents of color.

The current study examined pathways in a model of desensitization, the Pathologic Adaptation Model, in adolescent males of color. Specifically, the current study examined depressive symptoms and deviant beliefs as mediators of the association between community violence exposure and subsequent violent behavior. The current study included 250 African-American (67%) and Latino (33%) male adolescents (T1 mean age = 15.32) from the Chicago Youth Development Study. Consistent with the Pathologic Adaptation Model, results demonstrated that depressive symptoms mediated the association between the quadratic violence exposure term in middle adolescence and violent behaviors in late adolescence, but the direction of the mediation effect was dependent upon the levels of violence exposure in middle adolescence. However, deviant beliefs were not found to be a significant mediator. Emotional desensitization effects may increase the likelihood of violence perpetration in adolescent males exposed to community violence, and the implications for future research and intervention efforts are discussed. (PsycINFO Database Record

Examining the Pathologic Adaptation Model of Community Violence Exposure in Male Adolescents of Color.

The current study examined a model of desensitization to community violence exposure-the pathologic adaptation model-in male adolescents of color. The current study included 285 African American (61%) and Latino (39%) male adolescents (W1 M age = 12.41) from the Chicago Youth Development Study to examine the longitudinal associations between community violence exposure, depressive symptoms, and violent behavior. Consistent with the pathologic adaptation model, results indicated a linear, positive association between community violence exposure in middle adolescence and violent behavior in late adolescence, as well as a curvilinear association between community violence exposure in middle adolescence and depressive symptoms in late adolescence, suggesting emotional desensitization. Further, these effects were specific to cognitive-affective symptoms of depression and not somatic symptoms. Emotional desensitization outcomes, as assessed by depressive symptoms, can occur in male adolescents of color exposed to community violence and these effects extend from middle adolescence to late adolescence.

Family Functioning and High Risk Adolescents' Aggressive Behavior: Examining Effects by Ethnicity.

The relationship between family functioning and adolescents' physical aggression has been well established, but whether these relationships might differ by ethnicity has received less attention. Ethnic variations may be important for targeting prevention programs to specific youth and families. This study examined the longitudinal relationship between family cohesion, parental monitoring, and physical aggression using data from the Multisite Violence Prevention Project sample of high-risk youth (elevated aggression). Participants were 1,232 high-risk middle school students (65% male; 70% African American; 15% Hispanic). Meaningful demographic variations were identified. After controlling for intervention condition and study site, family cohesion was significantly negatively related to physical aggression, more so for Hispanic youth. Parental monitoring was negatively associated with physical aggression for African American youth only. Our findings point to the importance of developing culturally sensitive family interventions to prevent physical aggression in middle school.

Developmental trajectories of aggression, prosocial behavior, and social-cognitive problem solving in emerging adolescents with clinically elevated attention-deficit/hyperactivity disorder symptoms.

Middle school is a critical yet understudied period of social behavioral risks and opportunities that may be particularly difficult for emerging adolescents with attention-deficit/hyperactivity disorder (ADHD) given their childhood social difficulties. Relatively few ADHD studies have examined social behavior and social-cognitive problem solving beyond the elementary years, or examined aspects of positive (prosocial) behavior. The current study examined how middle school students with clinically elevated ADHD symptoms differ from their non-ADHD peers on baseline (6th grade) and age-related changes in prosocial and aggressive behavior, and the extent to which social-cognitive problem solving strategies mediate these relations. Emerging adolescents with (n = 178) and without (n = 3,806) clinically elevated, teacher-reported ADHD-combined symptoms were compared longitudinally across 6th through 8th grades using parallel process latent growth curve modeling, accounting for student demographic characteristics, oppositional-defiant disorder (ODD) symptoms, deviant peer association, school climate, and parental monitoring. Sixth graders with elevated ADHD symptoms engaged in somewhat fewer prosocial behaviors (d = -0.44) and more aggressive behavior (d = 0.20) relative to their peers. These small social behavioral deficits decreased but were not normalized across the middle school years. Contrary to hypotheses, social-cognitive problem solving was not impaired in the ADHD group after accounting for co-occurring ODD symptoms and did not mediate the association between ADHD and social behavior during the middle school years. ADHD and social-cognitive problem solving contributed independently to social behavior, both in 6th grade and across the middle school years; the influence of social-cognitive problem solving on social behavior was highly similar for the ADHD and non-ADHD groups.

Delinquency in Adolescent Girls: Using a Confluence Approach to Understand the Influences of Parents and Peers.

Determining the interdependence of family and peer influences on the development of delinquency is critical to defining and implementing effective interventions. This study explored the longitudinal relationship among harsh punishment, positive parenting, peer delinquency, and adolescent delinquency using data from a sub-sample of the Pittsburgh Girls Study. Participants were 622 adolescent girls (42% European American, 53% African American); families living in low-income neighborhoods were oversampled. After controlling for the effects of race, living in a single parent household, and receipt of public assistance, harsh punishment and peer delinquency in early adolescence were positively related to delinquency in mid-adolescence. No significant main effects of positive parenting or interaction effects between parenting and peer delinquency were observed. Thus, the effects of harsh parenting and peer delinquency are independent and perhaps additive, rather than interdependent. Results indicate the continued importance of targeting both parenting and peer relationships to prevent delinquency in adolescent girls.

Mentoring Programs to Affect Delinquency and Associated Outcomes of Youth At-Risk: A Comprehensive Meta-Analytic Review.

OBJECTIVES: To conduct a meta-analytic review of selective and indicated mentoring interventions for effects for youth at risk on delinquency and key associated outcomes (aggression, drug use, academic functioning). We also undertook the first systematic evaluation of intervention implementation features and organization and tested for effects of theorized key processes of mentor program effects. METHODS: Campbell Collaboration review inclusion criteria and procedures were used to search and evaluate the literature. Criteria included a sample defined as at-risk for delinquency due to individual behavior such as aggression or conduct problems or environmental characteristics such as residence in high-crime community. Studies were required to be random assignment or strong quasi-experimental design. Of 163 identified studies published 1970 - 2011, 46 met criteria for inclusion. RESULTS: Mean effects sizes were significant and positive for each outcome category (ranging form d =.11 for Academic Achievement to d = .29 for Aggression). Heterogeneity in effect sizes was noted for all four outcomes. Stronger effects resulted when mentor motivation was professional development but not by other implementation features. Significant improvements in effects were found when advocacy and emotional support mentoring processes were emphasized. CONCLUSIONS: This popular approach has significant impact on delinquency and associated outcomes for youth at-risk for delinquency. While evidencing some features may relate to effects, the body of literature is remarkably lacking in details about specific program features and procedures. This persistent state of limited reporting seriously impedes understanding about how mentoring is beneficial and ability to maximize its utility.

Development of cities mentor project: an intervention to improve academic outcomes for low-income urban youth through instruction in effective coping supported by mentoring relationships and protective settings.

This manuscript summarizes an iterative process used to develop a new intervention for low-income urban youth at risk for negative academic outcomes (e.g., disengagement, failure, drop-out). A series of seven steps, building incrementally one upon the other, are described: 1) identify targets of the intervention; 2) develop logic model; 3) identify effective elements of targets; 4) vet intervention with stakeholders; 5) develop models for sustaining the intervention; 6) develop measures of relevant constructs currently missing from the literature; 7) assess feasibility and usability of the intervention. Methods used to accomplish these steps include basic research studies, literature reviews, meta-analyses, focus groups, community advisory meetings, consultations with scholarly consultants, and piloting. The resulting intervention provides early adolescents in low-income urban communities with a) training in contextually relevant coping, b) connection to mentors who support youth's developing coping strategies, and c) connection to youth-serving community organizations, where youth receive additional support.

Effects of the SAFE Children preventive intervention on developmental trajectories of attention-deficit/hyperactivity disorder symptoms.

This study examined whether a family-based preventive intervention for inner-city children entering the first grade could alter the developmental course of attention-deficit/hyperactivity disorder (ADHD) symptoms. Participants were 424 families randomly selected and randomly assigned to a control condition (n = 192) or Schools and Families Educating Children (SAFE) Children (n = 232). SAFE Children combined family-focused prevention with academic tutoring to address multiple developmental-ecological needs. A booster intervention provided in the 4th grade to randomly assigned children in the initial intervention (n =101) evaluated the potential of increasing preventive effects. Follow-up occurred over 5 years with parents and teachers reporting on attention problems. Growth mixture models identified multiple developmental trajectories of ADHD symptoms. The initial phase of intervention placed children on more positive developmental trajectories for impulsivity and hyperactivity, demonstrating the potential for ADHD prevention in at-risk youth, but the SAFE Children booster had no additional effect on trajectory or change in ADHD indicators.

More than afterthoughts and details: maintenance and booster effects as critical elements of intervention research.

The set of studies in this special section bring into relief the importance of due attention to maintenance effects and use of boosters as critical components of intervention planning and evaluation, requiring theoretical and analytic forethought and direction. While some trends can be identified across these included reports and the other few studies of boosters in child psychopathology intervention, the main implication of work to date is to highlight the need to consider maintenance and booster effects analyses as more than afterthoughts of technical interest primarily. In addition, this collection of studies includes treatment and prevention efforts focused on a shared topic, which is rare in child psychopathology topical collections. This juxtaposition helps illuminate some of the many considerations that could influence how maintenance effects and booster contributions might be tested. It is hoped that further work will occur that builds on these exemplary efforts.

The protective role of ethnic identity for urban adolescent males facing multiple stressors.

Having a connection to one's ethnic heritage is considered a protective factor in the face of discrimination; however, it is unclear whether the protective effects are persistent across multiple stressors. Furthermore, the dimensions of ethnic identity that reflect group pride/connection (affirmation) and exploration of the meaning of group membership (achievement) may operate differently in the face of stress. The present study examined the moderating role of ethnic identity affirmation and achievement on concurrent and longitudinal relationships between exposure to stress (discrimination, family hardship, exposure to violence) and antisocial behavior in a sample of 256 Black and Latino male youth (70% Black) living in low-income urban neighborhoods. Using regression analysis, concurrent associations were examined at age 18, and longitudinal associations were tested 18 months later. We found that, among youth experiencing discrimination, high levels of achievement and low levels of affirmation predicted greater aggressive behavior and delinquency. Low affirmation also predicted more criminal offending in the face of discrimination. The two dimensions operated similarly in the context of family stress, in which case high levels of affirmation and achievement predicted lower levels of antisocial behavior. The findings suggest a differential role of the two dimensions of ethnic identity with respect to discrimination; furthermore, the coping skills that may be promoted as youth make meaning of their ethnic group membership may serve as cultural assets in the face of family stress.

The Role of Stress Exposure and Family Functioning in Internalizing Outcomes of Urban Families.

Although research suggests that stress exposure and family functioning are associated with internalizing problems in adolescents and caregivers, surprisingly few studies have investigated the mechanisms that underlie this association. To determine whether family functioning buffers the development of internalizing problems in stress-exposed families, we assessed the relation between stress exposure, family functioning, and internalizing symptoms among a large sample of inner-city male youth and their caregivers living in poverty across five waves of data collection. We hypothesized that stress exposure and family functioning would predict development of subsequent youth and caregiver internalizing problems and that family functioning would moderate this relation, with higher functioning families demonstrating greater resiliency to stress exposure. We used a longitudinal, prospective design to evaluate whether family functioning (assessed at waves one through four) activated or buffered the effects of stress exposure (assessed at wave one) on subsequent internalizing symptoms (assessed at waves four and five). Stress from Developmental Transitions and family functioning were significant predictors of depressive symptoms and anxiety in youth; however, family functioning did not moderate the relation. Family functioning mediated the relation between stress from Daily Hassles and internalizing outcomes suggesting that poor parenting practices, low structure, and low emotional cohesion activate depression and anxiety in youth exposed to chronic and frequent everyday stressors. Surprisingly, only family functioning predicted depressive symptoms in caregivers. Results validate the use of a comprehensive, multi-informant assessment of stress when investigating internalizing outcomes in youth and support using family-based interventions in the treatment and prevention of internalizing.

The longitudinal relationship between peer violence and popularity and delinquency in adolescent boys: examining effects by family functioning.

Mapping the relationship of peer influences and parental/family characteristics on delinquency can help expand the understanding of findings that show an interdependence between peer and family predictors. This study explored the longitudinal relationship between two characteristics of peer relationships (violence and perceived popularity) with subsequent individual delinquency and the moderating role of family characteristics (cohesion and parental monitoring) using data from the Chicago Youth Development Study. Participants were 364 inner-city residing adolescent boys (54% African American; 40% Hispanic). After controlling for the effects of age and ethnicity, peer violence is positively related to boys' delinquency. The effect of popularity depends on parental monitoring, such that the relationship between popularity and delinquency is positive when parental monitoring is low, but there is no relationship when parental monitoring is high. Furthermore, parental monitoring contributes to the relationship between peer violence and delinquency such that there is a stronger relationship when parental monitoring is low. Additionally, there is a stronger relationship between peer violence and delinquency for boys from high cohesive families. Findings point to the value of attention to multiple aspects of peer and family relationships in explaining and intervening in the risk for delinquency. Furthermore, findings indicate the importance of family-focused interventions in preventing delinquency.