Emotional impacts of racial discrimination on caregiver-child dyads: Can mentalizing-focused parenting groups buffer against racism-related stress?

Black and Latinx caregivers face high risk for parenting stress and racism-related stress due to experiences of racial discrimination (RD). This study aimed to explore the associations between RD, parenting stress, and psychological distress in caregiver-child dyads, as well as the impact of a mentalizing-focused group intervention on caregivers' experiences of RD distress. Ethnoracially minoritized caregivers of children aged 5-17 years old participated in a non-randomized clinical trial (N = 70). They received either a 12-session mentalizing-focused group parenting intervention or treatment-as-usual in outpatient psychiatry. We assessed self-reported frequency and distress related to RD, parenting stress, and psychological distress at baseline (T1) and post-intervention (T2). Caregiver- and self-reported child psychological distress were also measured. The results showed that greater RD frequency and greater RD distress separately predicted higher overall parenting stress and parental role-related distress. Greater RD distress was linked to increased psychological distress in caregivers. Similarly, greater RD frequency and distress among caregivers were associated with higher caregiver-reported, but not self-reported, child psychological distress. No significant changes in RD distress were observed between T1 and T2 for either of the treatment groups. These findings highlight the exacerbating role of RD on parenting stress and psychological distress among ethnoracially minoritized caregivers and their children.

Diversifying Clinical Child and Adolescent Psychology: A Change Gonna Come.

OBJECTIVES: Workforce diversity is an ongoing challenge in the field of clinical child and adolescent psychology. This article discusses individual, institutional, and nonspecific factors that contribute to a lack of diversity among clinical child and adolescent psychologists and offers suggestions to diversify and advance the field of clinical child and adolescent mental health. METHOD: Seventeen professors, licensed psychologists, faculty, and clinicians in the field of clinical child and adolescent psychology answered questions about workforce diversity and who is permitted access to the field. No formal research was conducted. RESULTS: Individual factors included: racial discrimination and microaggressions, feelings of isolation, otherness, and not belonging. Institutional factors included: racism in academia, racial underrepresentation, ethnocentric and culturally-biased training, biased admissions selection processes, financial barriers, and lack of institutional commitment. Nonspecific factors were: values misalignment, hidden expectations, suboptimal mentoring, and limited research opportunities. CONCLUSIONS: Drawing on recent scholarship and the Contexts, Actions, and Outcomes (CAO) Model, we recommend institutional changes in programs, policies, practices, resources, climate, partnerships, and inquiry to improve diversity in the field of clinical child and adolescent psychology.

Culturally Responsive Telepsychology & mHealth Interventions for Racial-Ethnic Minoritized Youth: Research Gaps and Future Directions.

Telepsychology and mHealth (TPmH) services for youth and their families have become increasingly prevalent in recent years. However, significant limitations in theory, research, and policy introduce questions about the effectiveness of such interventions, particularly for racial-ethnic minoritized youth and their families, who already contend with inequities in mental health treatment access and outcomes. Although TPmH have the potential to reduce barriers to mental health services in ways that may benefit racial-ethnic minoritized youth and their families, the mental health field must first grapple with limitations in culturally responsive TPmH work to avoid perpetuating existing mental health inequities. As such, this article begins by briefly reviewing extant literature on (1) TPmH for youth, (2) culturally adapted or culturally responsive evidence-based interventions for racial-ethnic minoritized youth and families, and (3) the intersection of TPmH and culturally responsive interventions. Informed by the gaps identified by this review, we provide recommendations for future directions in culturally responsive TPmH for racial-ethnic minoritized youth and families. These recommendations have been organized into four overarching categories: (1) conceptual and theoretical recommendations, (2) research priorities, (3) practice and policy recommendations, and (4) engagement and access recommendations. These recommendations offer novel ideas for researchers, clinicians, funding agencies, policy-makers, and other key stakeholders and are intended to facilitate equity in TPmH for racial-ethnic minoritized youth and their families.

Connection During COVID-19: Pilot Study of a Telehealth Group Parenting Intervention.

OBJECTIVE: The COVID-19 pandemic has resulted in considerable stress for families, placing parents at risk for heightened psychological distress, while prompting widespread changes in mental health service delivery. This study evaluated treatment engagement, acceptability, and psychiatric distress among participants in the telehealth adaptation of the Connecting and Reflecting Experience (CARE) program after the onset of COVID-19. METHODS: CARE is a transdiagnostic, bigenerational, mentalizing-focused group parenting intervention based out of an outpatient child mental health clinic in an underserved urban community. Individuals participating in CARE during the clinic's transition to telehealth services were recruited for participation in this pre-post design pilot study. Participants (N=12) completed self-report surveys before and after their first telehealth group session and at their 20-week follow-up. Quantitative and qualitative measures were used to evaluate psychiatric symptoms, treatment engagement, and preliminary acceptability of the adaptation. RESULTS: Self-reported mood and anxiety symptoms decreased significantly after 20 weeks of telehealth therapy. Participants reported high levels of therapeutic alliance and group cohesion in the telehealth format. Results also showed minimal participant-reported privacy concerns and a trend toward increased treatment engagement. CONCLUSIONS: These findings have implications regarding the acceptability of teletherapy interventions for caregivers of children during this period of heightened vulnerability and limited access to social support and health services. They also are relevant to establishing the preliminary acceptability of mentalizing-focused parenting inventions delivered via telehealth.

Liberatory Media Literacy as Protective Against Posttraumatic Stress for Emerging Adults of Color.

Emerging adults (i.e., age 18-25 years) of color in the United States are exposed to race/ethnicity-related traumatic events in online settings. Although an emerging literature documents the mental health consequences of such online exposures among adolescents, the association between these exposures and symptoms of posttraumatic stress disorder (PTSD) remains understudied in emerging adults. Furthermore, little is known about strengths-based factors that may be protective for emerging adults of color faced with such exposures. The current study aimed to fill these gaps by examining the potential of liberatory media literacy (i.e., the ability to critically read, evaluate, support, and create media and technology that represents people of color in their full humanity) to ameliorate the association between exposure to traumatic events online and PTSD symptoms. Emerging adults of color (N = 325, Mage = 22.24, 56.0% male) were recruited to complete a self-report online survey that assessed exposure to race/ethnicity-related traumatic events in online settings, liberatory media literacy, and PTSD symptoms. The results of moderation analysis indicated that increased exposure to traumatic events online was associated with higher PTSD symptoms, ß = .22, and that the inclusive media and technology component of liberatory media literacy was protective in this association, ß = .19. However, these effects were small, f2 = .22-.23. The potential of liberatory media literacy as a strengths-based asset for emerging adults of color are discussed. Increasing inclusive media and technology skills may be an important target for intervention.

Racial identity and changes in psychological distress using the multidimensional model of racial identity.

OBJECTIVES: Researchers have noted that racial identity-the personal significance and meaning of race (Sellers, Chavous, & Cooke, 1998)-may serve as a protective factor against the impact of racism-related stress and promote psychological well-being for African American young adults. One limitation of prior research is the failure to examine how changes in racial identity may relate to changes in psychological well-being over time, specifically those racial identity beliefs that are proposed to be stable. This study examined racial identity and its association with changes in overall psychological distress among African American college students. METHOD: The sample included 171 African American college students (69% female) attending a predominately White institution in the southeastern United States using 5 waves of data collected over 3 years. RESULTS: Latent curve modeling revealed increases in racial centrality, private regard, and nationalist ideology, and decreases in public regard and assimilationist, humanist, and oppressed minority ideologies (comparative fit index range: 0.94-1.00; root-mean-square error of approximation range: .00-.07). Growth curve modeling also revealed that initial levels of racial identity predicted changes in psychological distress. Of note, higher initial levels of private regard were associated with sharper declines in psychological distress over time (ß = .37, Sz E = .17, p = .027). Additionally, individuals with lower initial levels of public regard experienced greater declines in psychological distress over time as compared to individuals with higher levels of public regard (ß = .60, SE = .15, p < .001). CONCLUSION: Findings suggest that racial identity dimensions that are proposed to be stable may change over time. These results also suggest that initial levels of racial identity variables (i.e., racial regard) predict later rates of change in psychological distress. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Impostor phenomenon and mental health: The influence of racial discrimination and gender.

The impostor phenomenon (IP), or feelings of intellectual incompetence, reflects a maladaptive set of cognitions, which pose a significant psychological risk for African American emerging adults. In light of recent evidence suggesting that personal and sociocultural factors may influence the association between IP and psychological adjustment, this study used 2 waves of data to examine the extent to which gender and racial discrimination moderated the association between IP and indices of mental health among 157 African American college students (69% women; mean age = 18.30) attending a predominantly White institution. Analyses revealed that young African American women reporting higher frequencies of racial discrimination and women reporting lower levels of distress resulting from racial discrimination were most vulnerable to negative mental health outcomes, particularly at higher levels of IP. These findings suggest that IP may interact with gender and racial discrimination experiences to influence mental health outcomes. We discuss how these findings can be utilized to inform treatment of African American emerging adults experiencing IP and the importance of considering how gender and discrimination may intersect to exacerbate feelings of intellectual incompetence. (PsycINFO Database Record

Online Racial Discrimination, Suicidal Ideation, and Traumatic Stress in a National Sample of Black Adolescents.

Importance: Because of increased suicide rates among Black youth in the past 2 decades, there is a dire need for research on suicidal ideation and risk factors in this population. Objective: To examine the direct and indirect associations between online racial discrimination and suicidal ideation through posttraumatic stress disorder symptoms among Black adolescents living in the US, with consideration of potential differential associations by gender and age. Design, Setting, and Participants: This cross-sectional study used data drawn from the first wave of the National Survey of Critical Digital Literacy. Black adolescents aged 11 to 19 years were selected from a nationally representative probability-based sample. Data were collected from October 2020 to December 2020 and analyzed from August 2021 to October 2021. Main Outcomes and Measures: Hypotheses of the current study were formulated during research design and grounded in empirical literature. The individual online racial discrimination subscale (Online Victimization Scale), the UCLA Child/Adolescent posttraumatic stress disorder Reaction Index for DSM-5, and an item from the second edition of the Children's Depression Inventory were used to assess constructs. Mediation was assessed through mediation models with path analyses using structural equation modeling. Results: Among a total 525 participants, 265 were girls (50.5%) and 251 were boys (47.8%); the mean (SD) age was 14.8 (2.5) years. Findings from structural equation modeling analysis indicated that individual online racial discrimination was associated with posttraumatic stress disorder symptoms (ß = 0.49, SE = 0.06, P < .001), and posttraumatic stress disorder symptoms were associated with suicidal ideation (ß = 0.51, SE = 0.06, P < .001). Posttraumatic stress disorder was identified as a full mediator between online racial discrimination and suicide (ß = 0.25, SE = 0.04, P < .001). No differences by gender or age were found. Furthermore, no significant direct association between online racial discrimination and suicidal ideation was found. Conclusions and Relevance: This study found an association between individual online racial discrimination and posttraumatic stress disorder symptoms and between posttraumatic stress disorder symptoms and suicidal ideation. These risk factors are important to consider in continuing studies of the cause of suicidal ideation for Black adolescents in the US.

Developing culturally-adapted mobile mental health interventions: a mixed methods approach.

Background: Black young adults suffer from psychological distress at either similar or greater rates than that of White Americans, yet they are seven times less likely to have access to or receive effective treatments. Fortunately, mobile-health (mHealth) technology may transform mental health services and address disparities in mental healthcare. The current study utilized focus groups of Black young adults to inform the development of culturally-adapted mHealth using quantitative and qualitative approaches. Methods: The study utilized a mixed-methods approach, in that qualitative (i.e., mini focus groups, n=11) and quantitative methods (i.e., self-report surveys) were used to explore the research questions. Participants included African American young adults (n=38, Mage =21). Participants completed self-report questionnaires prior to focus group facilitation. Correlational analyses were used to answer the quantitative research questions, and thematic analysis was used to answer the qualitative research questions. Results: The qualitative findings highlighted that sociocultural experiences impact mental health and treatment seeking attitudes. Despite these findings, participants highlighted a variety of desired features and content that should be incorporated into future culturally-adapted mHealth interventions. Participants also highlighted both positive and negative aspects of current mHealth technologies for mental health. Finally, the study found that on average, participants had positive attitudes towards mental health, mental health treatments, and utilizing mHealth for mental health. Participants also had strong desires for culturally-adapted mHealth interventions. Bivariate correlations also revealed significant associations between vicarious online racial discrimination and mHealth attitudes, as well as racial identity and mHealth attitudes. Conclusions: In summary, the current study highlights that there is an urgent need for mHealth technology for mental health symptoms for African American young adults and presents a variety of features, content, and design/development considerations for future researchers.

The Associations Between Internalized Racism, Racial Identity, and Psychological Distress.

Internalized racism, or the acceptance of negative stereotypes about one's own racial group, is associated with psychological distress; yet, few studies have explored the longitudinal impact of internalized racism on the psychological well-being of African American emerging adults. Furthermore, racial identity's role as a protective factor in the context of internalized racism remains unclear. This study examined the longitudinal impact of internalized racism on psychological distress (depressive and anxiety symptoms) and the moderating role of racial identity beliefs among 171 African American emerging adults. Full cross-lagged panel models revealed no main effects of internalized racism beliefs on psychological distress. However, several racial identity beliefs moderated the relationship between internalized racism beliefs and changes in psychological distress over a year later. Initial levels of alteration of physical appearance, internalization of negative stereotypes, and hair change internalized racism beliefs were related to subsequent psychological distress, but only for those with certain levels of racial centrality, private regard, public regard, and assimilationist, humanist, and nationalist ideology beliefs. These findings suggest that, over time, internalized racism and racial identity beliefs can combine to influence the psychological well-being of African American emerging adults.

Anti-Black Structural Racism Goes Online: A Conceptual Model for Racial Health Disparities Research.

Anti-Black racism is an established social determinant of racial health disparities in the United States. Although the majority of research on racism examines in-person individual-level experiences, a majority of Americans engage online and may therefore be exposed to racism directly or indirectly in online contexts. Research suggests that the structural technological features of online contexts may be especially powerful in perpetuating and enacting racism, often in inconspicuous or automated ways. However, there is a paucity of literature that articulates how structural online racism may be an important catalyst for racial health disparities, despite emerging evidence of racism embedded in our technological infrastructures. Therefore, the purpose of this article is to articulate the basis for investigating online racism as a form of structural racism with growing implications for racial health disparities in the digital age. We first define the structural features of online settings that generate and reinforce inequities among racial groups in the United States. Next, we propose a conceptual model detailing potential mechanisms through which structural online racism may translate into racial health disparities. Finally, we discuss ways in which exposures to online racism could be measured in order to capture their structural nature. Implications and future directions for research on online racism as a form of structural racism and corresponding policy for the reduction of racial health disparities are highlighted.

Prioritizing environmental health risks in the UAE.

This article presents the results of a comparative environmental risk-ranking exercise that was conducted in the United Arab Emirates (UAE) to inform a strategic planning process led by the Environment Agency-Abu Dhabi (EAD). It represents the first national-level application of a deliberative method for comparative risk ranking first published in this journal. The deliberative method involves a five-stage process that includes quantitative risk assessment by experts and deliberations by groups of stakeholders. The project reported in this article considered 14 categories of environmental risks to health identified through discussions with EAD staff: ambient and indoor air pollution; drinking water contamination; coastal water pollution; soil and groundwater contamination; contamination of fruits, vegetables, and seafood; ambient noise; stratospheric ozone depletion; electromagnetic fields from power lines; health impacts from climate change; and exposure to hazardous substances in industrial, construction, and agricultural work environments. Results from workshops involving 73 stakeholders who met in five separate groups to rank these risks individually and collaboratively indicated strong consensus that outdoor and indoor air pollution are the highest priorities in the UAE. Each of the five groups rated these as being among the highest risks. All groups rated soil and groundwater contamination as being among the lowest risks. In surveys administered after the ranking exercises, participants indicated that the results of the process represented their concerns and approved of using the ranking results to inform policy decisions. The results ultimately shaped a strategic plan that is now being implemented.

Race-Related Traumatic Events Online and Mental Health Among Adolescents of Color.

PURPOSE: Viral videos of the detainment of undocumented immigrants in cages and police killings of unarmed citizens are two of the most pressing traumatic events facing adolescents of color. However, little is known about whether these online experiences are linked to mental health outcomes. This study examines the association between exposure to such events online and mental health in a sample of African American and Latinx adolescents. METHODS: Data were collected from a national sample of 302 African American and Latinx adolescents aged 11-19 years. Participants reported their exposure to traumatic events online (TEO), depressive symptoms, post-traumatic stress disorder (PTSD) symptoms, and other sociodemographics. Multiple regression analyses were conducted. RESULTS: Analyses indicated a significant association between TEO and both PTSD symptoms and depressive symptoms, indicating that more frequent experiences of TEO were associated with higher levels of PTSD symptoms and depressive symptoms. In addition, regression analyses further indicated that girls reported higher PTSD and depressive symptoms than boys. Latinx participants also reported increased depressive symptoms. CONCLUSIONS: This study extends recent research that suggests police killings, as well as viewing distressing news directed at members of one's own racial-ethnic group or those who share the same immigration status, are related to poor mental health outcomes. Researchers should also explore what protective factors may buffer youth against the outcomes typically associated with these events.

Using probabilistic terrorism risk modeling for regulatory benefit-cost analysis: application to the Western hemisphere travel initiative in the land environment.

This article presents a framework for using probabilistic terrorism risk modeling in regulatory analysis. We demonstrate the framework with an example application involving a regulation under consideration, the Western Hemisphere Travel Initiative for the Land Environment, (WHTI-L). First, we estimate annualized loss from terrorist attacks with the Risk Management Solutions (RMS) Probabilistic Terrorism Model. We then estimate the critical risk reduction, which is the risk-reducing effectiveness of WHTI-L needed for its benefit, in terms of reduced terrorism loss in the United States, to exceed its cost. Our analysis indicates that the critical risk reduction depends strongly not only on uncertainties in the terrorism risk level, but also on uncertainty in the cost of regulation and how casualties are monetized. For a terrorism risk level based on the RMS standard risk estimate, the baseline regulatory cost estimate for WHTI-L, and a range of casualty cost estimates based on the willingness-to-pay approach, our estimate for the expected annualized loss from terrorism ranges from $2.7 billion to $5.2 billion. For this range in annualized loss, the critical risk reduction for WHTI-L ranges from 7% to 13%. Basing results on a lower risk level that results in halving the annualized terrorism loss would double the critical risk reduction (14-26%), and basing the results on a higher risk level that results in a doubling of the annualized terrorism loss would cut the critical risk reduction in half (3.5-6.6%). Ideally, decisions about terrorism security regulations and policies would be informed by true benefit-cost analyses in which the estimated benefits are compared to costs. Such analyses for terrorism security efforts face substantial impediments stemming from the great uncertainty in the terrorist threat and the very low recurrence interval for large attacks. Several approaches can be used to estimate how a terrorism security program or regulation reduces the distribution of risks it is intended to manage. But, continued research to develop additional tools and data is necessary to support application of these approaches. These include refinement of models and simulations, engagement of subject matter experts, implementation of program evaluation, and estimating the costs of casualties from terrorism events.

Augmenting Buried in Treasures with in-home uncluttering practice: Pilot study in hoarding disorder.

Hoarding disorder is characterized by difficulty parting with possessions and by clutter that impairs the functionality of living spaces. Cognitive behavioral therapy conducted by a therapist (individual or in a group) for hoarding symptoms has shown promise. For those who cannot afford or access the services of a therapist, one alternative is an evidence-based, highly structured, short-term, skills-based group using CBT principles but led by non-professional facilitators (the Buried in Treasures [BIT] Workshop). BIT has achieved improvement rates similar to those of psychologist-led CBT. Regardless of modality, however, clinically relevant symptoms remain after treatment, and new approaches to augment existing treatments are needed. Based on two recent studies - one reporting that personalized care and accountability made treatments more acceptable to individuals with hoarding disorder and another reporting that greater number of home sessions were associated with better clinical outcomes, we tested the feasibility and effectiveness of adding personalized, in-home uncluttering sessions to the final weeks of BIT. Participants (n = 5) had 15 sessions of BIT and up to 20 hours of in-home uncluttering. Reductions in hoarding symptoms, clutter, and impairment of daily activities were observed. Treatment response rate was comparable to rates in other BIT studies, with continued improvement in clutter level after in-home uncluttering sessions. This small study suggests that adding in-home uncluttering sessions to BIT is feasible and effective.

Racism, Racial Resilience, and African American Youth Development: Person-Centered Analysis as a Tool to Promote Equity and Justice.

Racism constitutes a significant risk to the healthy development of African American youth. Fortunately, however, not all youth who experience racism evidence negative developmental outcomes. In this chapter, we examine person-centered analysis (PCA)-a quantitative technique that investigates how variables combine across individuals-as a useful tool for elucidating racial and ethnic protective processes that mitigate the negative impact of racism. We review recent studies employing PCA in examinations of racial identity, racial socialization, and other race-related experiences, as well as how these constructs correlate with and impact African American youth development. We also consider challenges and limitations of PCA and conclude with a discussion of future research and how PCA might be used to promote equity and justice for African American and other racial and ethnic minority youth who experience racism.

Evaluating the Reliability of Emergency Response Systems for Large-Scale Incident Operations.

The ability to measure emergency preparedness-to predict the likely performance of emergency response systems in future events-is critical for policy analysis in homeland security. Yet it remains difficult to know how prepared a response system is to deal with large-scale incidents, whether it be a natural disaster, terrorist attack, or industrial or transportation accident. This research draws on the fields of systems analysis and engineering to apply the concept of system reliability to the evaluation of emergency response systems. The authors describe a method for modeling an emergency response system; identifying how individual parts of the system might fail; and assessing the likelihood of each failure and the severity of its effects on the overall response effort. The authors walk the reader through two applications of this method: a simplified example in which responders must deliver medical treatment to a certain number of people in a specified time window, and a more complex scenario involving the release of chlorine gas. The authors also describe an exploratory analysis in which they parsed a set of after-action reports describing real-world incidents, to demonstrate how this method can be used to quantitatively analyze data on past response performance. The authors conclude with a discussion of how this method of measuring emergency response system reliability could inform policy discussion of emergency preparedness, how system reliability might be improved, and the costs of doing so.