Firearm Safe Storage in Rural Families: Community Perspectives About Ownership and Safety Messaging.

Firearm-related injuries are the leading cause of death among youth in the United States, and rates of firearm-related suicide in rural youth are more than double those in urban youth. Although safe firearm storage has been shown to reduce firearm injuries, little is known about how to culturally tailor such interventions for rural families in the United States. Informed by community-based participatory methods, focus groups and key informant interviews were conducted to design a safe storage prevention strategy for rural families. Participants included a broad array of community stakeholders (n = 40; 60% male, 40% female; age 15-72, M = 36.9, SD = 18.9) who were asked to identify acceptable messengers, message content, and delivery mechanisms that were perceived as respectful to the strengths of rural culture. Independent coders analyzed qualitative data using an open coding technique. Emerging themes included (1) community norms, values, and beliefs about firearms; (2) reasons for ownership; (3) firearm safety; (4) storage practices; (5) barriers to safe storage; and (6) suggested intervention components. Firearms were described as a "way of life" and family tradition in rural areas. Owning firearms for hunting and protection influenced family storage decisions. Intervention strategies that use respected firearm experts as messengers, refer to locally derived data, and that reflect community pride in firearm safety and responsible ownership may improve the acceptability of prevention messages in rural areas.

Computerized Suicide Prevention Clinical Training Simulations: A Pilot Study.

Purpose: Mental health providers are well-positioned to engage in suicide prevention efforts, yet implementation depends on skill acquisition and providers often report feeling underprepared. This pilot study explored the acceptability, feasibility, and preliminary effectiveness of three suicide prevention-focused simulations with virtual clients. Method: Students (n=22) were recruited from a MSW program, completed pre- and post-test surveys, and engaged with three simulated trainings: 1) suicide risk assessment, 2) safety planning, and 3) motivating a client to treatment. Results: Simulations were reported to be acceptable and feasible, with strong student desire and need for greater suicide prevention training. We observed significant improvements over time in clinical skills via simulated training scores and perceptions of clinical preparedness. Discussion: Preliminary findings indicate simulated training with virtual clients is promising and suggest the three suicide prevention simulations may be useful, scalable, and effective in social work training programs and beyond.

National trends in non-fatal suicidal behaviors among adults in the USA from 2009 to 2017.

BACKGROUND: The age-adjusted rate of suicide death in the USA has increased significantly since 2000 and little is known about national trends in non-fatal suicidal behaviors (ideation, plan, and attempt) among adults and their associated sociodemographic and clinical characteristics. This study examined trends in non-fatal suicidal behaviors among adults in the USA. METHODS: Data were obtained from adults 18-65 years of age who participated in the National Survey on Drug Use and Health (NSDUH), including mental health assessment, from 2009 to 2017 (n = 335 359). Examinations of data involved trend analysis methods with the use of logistic regressions and interaction terms. RESULTS: Suicidal ideation showed fluctuation from 2009 to 2017, whereas suicide plan and attempt showed significantly positive linear trends with the odds increasing by an average of 3% and 4%, respectively. Suicide plan increased the most for females and adults ages 18-34, and attempt increased the most for adults with drug dependence. Both plan and attempt increased the most among adults who either had mental illness but were not in treatment or had no mental illness. CONCLUSIONS: Given attempted suicide is the strongest known risk factor for suicide death, reducing non-fatal suicidal behaviors including attempt are important public health and clinical goals. The interactional findings of age, sex, mental health status, and drug dependence point toward the importance of tailoring prevention efforts to various sociodemographic and clinical factors.

Mental health provider perspectives of the COVID-19 pandemic impact on service delivery: a focus on challenges in remote engagement, suicide risk assessment, and treatment of psychosis.

BACKGROUND: The COVID-19 pandemic has been impacting the need, utilization, and delivery of mental health services with greater challenges being faced by clients and providers. With many clients facing reduced access to services and social isolation, a focus on suicide risk assessment and prevention is critical. Concern is particularly increased for clients with schizophrenia spectrum disorders given data show suicide rates are disproportionately high for those with psychosis in comparison to the general population. Provider perspectives of challenges in service delivery are needed to inform efforts to improve access, feasibility, and quality of mental health care throughout the evolving pandemic. This study explored mental health provider perspectives of client challenges in service utilization and provider challenges in service delivery, including remote engagement, suicide risk assessment, and treatment of psychosis. METHODS: Data were collected from social work mental health providers (n = 12) in United States community mental health setting. Providers consented to participate and responded to questions about service delivery experiences in late 2020 and in relation to COVID-19. Demographic and practice-related provider data were explored descriptively using SPSS and qualitative data using open coding and grounded theory methods in Dedoose. RESULTS: Among the 9 providers who engaged in remote service delivery, 7 (77.8%) experienced challenges in remote engagement with clients and 8 (88.9%) experienced challenges in treatment of psychosis. Among the 7 providers who engaged in remote suicide assessment, 4(57%) experienced challenges. Qualitative themes emerged including logistic (e.g., technology access and use), engagement (e.g., virtual rapport-building and limited remote services), and clinical (e.g., difficulty assessing suicide risk, internal stimuli, abnormal involuntary movement, and affect) challenges in service delivery. CONCLUSIONS: Provider perspectives are essential to inform efforts to build resources and problem-solve challenges and barriers that both providers and clients face throughout various shifts in mental health service delivery. Findings emphasize the need to troubleshoot client access to technology, bolster support for providers to prevent burnout, and greater provider training to improve skills in remote engagement, assessment, and treatment, particularly in relation to psychosis and suicide prevention. Study implications are not only critical for the evolving COVID-19 pandemic, but also in preparation for ongoing shifts in service delivery as technology evolves.

Examining Organizational Factors Supporting the Adoption and Use of Evidence-Based Interventions.

The purpose of this study was to develop a greater understanding of the factors influencing the adoption of evidence-based interventions in outpatient mental health clinics serving youth. An improved understanding of these factors can potentially improve efforts to ensure effective adoption, implementation, and sustainment of evidence-based interventions, and thus improve treatment for youth in mental health settings. This explanatory cross-sectional study involves secondary data analysis of a longitudinal randomized control intervention trial. The SEM- based model that was tested supported the primary hypothesis that a more supportive organizational climate with greater readiness for change is more likely to improve the chances for the adoption of evidence-based interventions in outpatient mental health clinics serving youths.

Correction to: Cognitive behavioral therapy for primary care depression and anxiety: a secondary meta-analytic review using robust variance estimation in meta-regression.

The original version of this article unfortunately contained a typo in the second author surname. The author surname was incorrectly listed as Borhneimer. The correct name should be Bornheimer.

Outcomes Associated With Adapting a Research-Supported Treatment for Children With Behavior Disorders.

PURPOSE: The aims of this study are to describe an adaptation process of a research-supported treatment (RST) for children with oppositional defiant disorder and to examine provider attitudes toward RSTs prior to and following this process. METHOD: Providers from 14 agencies in New York State delivered the adapted RST, following training. Attitudes toward RSTs were measured by the Evidence-Based Practice Attitude Scale at baseline and posttest. RESULTS: Openness toward RSTs decreased from baseline to posttest. The majority of providers reported modifications to the structure and process of the intervention. DISCUSSION: To improve the uptake and usability of RSTs in practice, future research must further address adaptation processes and their relationships to attitudes toward RSTs.

Getting to the table: Agency characteristics and evidence-based intervention adoption in children's mental health care.

Scaling evidence-based interventions (EBI) for children and families across healthcare systems can expand public health impact. Research has identified EBI adoption determinants. However, less understood are characteristics of agencies that opt in across the stages of adoption. This study examined the relationship between agency (N=69) characteristics (e.g., revenue) and four adoption stages during a large-scale trial of an EBI for children with significant behavioral difficulties and their families. 48 (70%) of agencies demonstrated interest, 28 (41%) scheduled an informational meeting, 20 (29%) received training, and 16 (22%) demonstrated EBI uptake. Analyses indicated no differences in characteristics and initial interest. However, agencies with small-sized revenue had significantly reduced odds at other adoption stages. Implications for strategies to bring EBI access to scale are discussed.

Provider Attitudes, Organizational Readiness for Change, and Uptake of Research Supported Treatment.

PURPOSE: As implementation and evaluation of research supported treatment (RST) expands across diverse mental health settings, it is essential to understand the facilitators and inhibitors of uptake. The current study examined the relationships between organizational readiness for change, attitudes toward RST, and use of RST among a sample primarily of social workers. METHODS: Participants included 158 providers from public child mental health outpatient clinics in the New York metropolitan area. Data were analyzed using structural equation modeling. RESULTS: Use of RST was greater among providers who were younger and had fewer years of professional experience. Both organizational need for change and climate directly and indirectly related to use of RST through attitudes toward RST (partial mediator). DISCUSSION: The organizational context is an important factor that relates to attitudes toward and use of RST in practice. Future research is needed to continue examining factors of RST uptake and sustainability.

Parental Wellbeing, Parenting and Child Development in Ghanaian Families with Young Children.

Approximately one-third of early childhood pupils in Ghana are struggling with meeting basic behavioral and developmental milestones, but little is known about mechanisms or factors that contribute to poor early childhood development. With a lack of developmental research to guide intervention or education program and policy planning, this study aimed to address these research gaps by examining a developmental mechanism for early childhood development. We tested a mediational mechanism model that examined the influence of parental wellbeing on parenting and children's development. Two hundred and sixty-two Ghanaian parents whose children attended early childhood classes (nursery to 3rd grade) were recruited. Data were gathered through parent interviews and Structural Equation Modeling was utilized to examine pathways of the model. Results support the mediational model that Ghanaian parents' depression was associated with less optimal parenting, and in turn greater child externalizing behavioral problems. This study adds new evidence of cross cultural consistency in early childhood development.

Multiple family group service delivery model for children with disruptive behavior disorders: Impact on caregiver stress and depressive symptoms.

Disproportionately high rates of caregiver stress and depression are found among poverty-impacted communities, with high levels of caregiver stress and depression putting youth at heightened risk for the onset and perpetuation of disruptive behavior disorders. The purpose of this study was to examine the effects of a behavioral parent training program called the 4Rs and 2Ss for Strengthening Families Program (4R2S) on caregiver stress and depressive symptoms among 320 youth aged seven to 11 and their families assigned to either the 4R2S or services as usual (SAU) condition. Among caregivers with clinically significant scores at baseline, 4R2S participants manifested significantly reduced scores on the stress and depressive symptom scores to SAU participants at 6-month follow-up. Findings suggest that 4R2S may reduce caregiver stress and depressive symptoms among those caregivers initially manifesting clinically significant levels of stress or depressive symptoms.

Who is accessing family mental health programs? Demographic differences before and after system reform.

Childhood mental health disorders are on the rise in the United States. To ensure equitable access to care, it is important to examine the characteristics of children and families who access services. This study compares the demographic characteristics of two samples of families who participated in National Institute of Mental Health-funded studies of a Multiple Family Group model, entitled the 4Rs and 2Ss Multiple Family Group (4Rs and 2Ss) in New York City. One sample is currently receiving services, and the other received services a decade ago. Significant differences in demographic characteristics were found between the two samples pertaining to child race, child nativity, caregiver age, primary caregiver, caregiver marital status, caregiver race, caregiver education, caregiver employment, and family income. Families currently engaging in the public mental health service system are primarily White, and are less disadvantaged than families a decade ago. These differences are examined in light of changing policy and epidemiological trends, and potential unintended consequences are discussed.

A model of integrated health care in a poverty-impacted community in New York City: Importance of early detection and addressing potential barriers to intervention implementation.

Disruptive behavior disorders (DBDs) are chronic, impairing, and costly behavioral health conditions that are four times more prevalent among children of color living in impoverished communities as compared to the general population. This disparity is largely due to the increased exposure to stressors related to low socioeconomic status including community violence, unstable housing, under supported schools, substance abuse, and limited support systems. However, despite high rates and greater need, there is a considerably lower rate of mental health service utilization among these youth. Accordingly, the current study aims to describe a unique model of integrated health care for ethnically diverse youth living in a New York City borough. With an emphasis on addressing possible barriers to implementation, integrated models for children have the potential to prevent ongoing mental health problems through early detection and intervention.

The impact of caregiver treatment satisfaction upon child and parent outcomes.

BACKGROUND: Parental perceptions about treatment influence their child's engagement in and ongoing utilization of mental health services, but less is known about the association between caregiver expectancies and family outcomes. The literature is particularly lacking with families of color, who are at high risk for the onset and perpetuation of disruptive behaviors. METHODS: The purpose of this study was to examine caregiver treatment satisfaction amongst 320 youth of color aged 7 to 11 and their families who were assigned to either a Multiple Family Group intervention or services as usual condition. Caregiver stress was measured by the Parenting Stress Index Short-Form full scale and child oppositional defiant behaviors were measured using the Iowa Connors Rating Scale-Oppositional/Defiant subscale both at baseline and post-test. Satisfaction with treatment was measured using the Metropolitan Area Child Study process measures program satisfaction subscale at post-test. RESULTS: The two main effects models that focused on satisfaction with treatment was predictive of parental stress and child oppositional defiant behaviors independently. Satisfaction with treatment accounted for 31% of the variance in child oppositional behavior and 24% of parental stress improvements across time holding all covariates constant. CONCLUSIONS: Our findings support previous research that shows parental expectancies, including treatment satisfaction, are powerful mechanisms of treatment outcomes for children with DBDs as well as parental emotional health. Further, parental expectancies may be enhanced by the involvement of families in the development of treatment approaches for children and a greater focus on caregiver emotional health for the benefit of the family as a whole.

Trajectories of suicidal risk among individuals with first-episode psychosis: Relationship to recovery and symptoms.

This study examined trajectories of suicide-risk and their relationship to symptoms, recovery, and quality of life over time. Data was obtained from the Recovery after an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study. 404 individuals with first-episode psychosis (FEP) completed measures of suicide-risk, depression, positive symptoms, recovery, and quality of life at baseline, 6mo, 12mo, 18mo, and 24mo. Latent class analysis was used to identify temporal trajectories of suicide-risk. General linear mixed models for repeated measures were used to examine the relationship between the latent trajectories of suicide-risk and clinical variables. Results identified three latent trajectories of suicide-risk (low-risk, worsening, and improving). The low-risk and improving classes experienced improvements in depression, positive symptoms, quality of life, and recovery over time. The worsening class experienced improvements in positive symptoms and quality of life, but no change in depression or recovery. These results suggest that some individuals with FEP are at risk for persistent depression and worsening suicide-risk during treatment despite experiencing improvements in positive symptoms and quality of life. These findings have important clinical implications, as persistent depression and worsening suicide-risk might be masked by the primary focus on positive symptoms and quality of life in most FEP clinics.

A call to action: informing research and practice in suicide prevention among individuals with psychosis.

Although it is well established that individuals living with psychosis are at increased risk for suicidal ideation, attempts, and death by suicide, several gaps in the literature need to be addressed to advance research and improve clinical practice. This Call-to-Action highlights three major gaps in our understanding of the intersection of psychosis and suicide as determined by expert consensus. The three gaps include research methods, suicide risk screening and assessment tools used with persons with psychosis, and psychosocial interventions and therapies. Specific action steps to address these gaps are outlined to inform research and practice, and thus, improve care and prognoses among persons with psychosis at risk for suicide.

Depression, suicide intent, and plan among adults presenting in an emergency department after making a suicide attempt: Exploratory differences by psychosis symptom experience.

Rates of suicide are significantly higher for individuals with schizophrenia spectrum disorders (SSDs) than those in the general population. With limited understandings of factors contributing to engaging in a suicide attempt among the psychosis population in the literature, the current study sought to preliminarily explore depression, suicide intent, and suicide plan among adults with and without psychosis symptom experiences who presented to an emergency department (ED) after making a suicide attempt. Electronic health record data were collected from the ED of an academic healthcare system in the Midwestern United States between 2011 and 2022. Patients included 1178 adults who arrived after making a suicide attempt. Trained research assistants conducted chart reviews and data were explored in SPSS28. A significantly smaller proportion of patients with psychosis had depressive symptoms and endorsed having suicide intent prior to their attempt in comparison to patients without psychosis. A smaller trending (p < .10) proportion of patients with psychosis endorsed having a suicide plan prior to their attempt than those with psychosis. Exploratory findings highlight the importance of EDs assessing for suicide risk beyond traditional approaches among patients with psychosis symptom experiences, including considerations for the potential of individuals not experiencing depression, suicide intent, or a suicide plan. Future research is particularly needed to examine psychosis symptomatology and the experience of distress as potential contributing factors to suicide behavior and death among patients with psychosis symptoms to better inform suicide risk assessment and intervention efforts.

A cognitive-behavioral suicide prevention treatment for adults with schizophrenia spectrum disorders in community mental health: Preliminary findings of an open pilot study.

Suicide is a leading cause of death among schizophrenia spectrum disorder populations. This open pilot study examined a modified cognitive-behavioral suicide prevention treatment for clients in community mental health. Providers (n=5) were trained to deliver the treatment and clients (n=5) received it in 10 individual therapy sessions. Clients experienced improvements in suicide ideation, depression, hopelessness, general symptoms of psychosis, entrapment, defeat, approaches to coping, psychological stress, impulsivity, and the number of treatment barriers from baseline to post-treatment. Qualitative findings reinforced quantitative results of client improvements and provided important suggestions to strengthen the intervention and its delivery in community mental health.

Psychometric properties of the mock interview rating scale for schizophrenia and other serious mental illnesses.

Background: Over the past 10 years, job interview training has emerged as an area of study among adults with schizophrenia and other serious mental illnesses who face significant challenges when navigating job interviews. The field of mental health services research has limited access to assessments of job interview skills with rigorously evaluated psychometric properties. Objective: We sought to evaluate the initial psychometric properties of a measure assessing job interview skills via role-play performance. Methods: As part of a randomized controlled trial, 90 adults with schizophrenia or other serious mental illnesses completed a job interview role-play assessment with eight items (and scored using anchors) called the mock interview rating scale (MIRS). A classical test theory analysis was conducted including confirmatory factor analyses, Rasch model analysis and calibration, and differential item functioning; along with inter-rater, internal consistency, and test-retest reliabilities. Pearson correlations were used to evaluate construct, convergent, divergent, criterion, and predictive validity by correlating the MIRS with demographic, clinical, cognitive, work history measures, and employment outcomes. Results: Our analyses resulted in the removal of a single item (sounding honest) and yielded a unidimensional total score measurement with support for its inter-rater reliability, internal consistency, and test-retest reliability. There was initial support for the construct, convergent, criterion, and predictive validities of the MIRS, as it correlated with measures of social competence, neurocognition, valuing job interview training, and employment outcomes. Meanwhile, the lack of correlations with race, physical health, and substance abuse lent support for divergent validity. Conclusion: This study presents initial evidence that the seven-item version of the MIRS has acceptable psychometric properties supporting its use to assess job interview skills reliably and validly among adults with schizophrenia and other serious mental illnesses. Clinical Trial Registration: NCT03049813.