"Give up your mic": Building capacity and sustainability within community-based participatory research initiatives.

Community-based participatory research (CBPR) partnerships strive to promote community capacity building and sustainability, yet initiatives often suffer when grants or relationships with academic partners end. To address these concerns, researchers hoping to develop truly sustainable CBPR partnerships should consider factors that promote the development of community capacity and, ultimately, independence. In this first-person account, using perspectives gathered from FAVOR, a Connecticut-based family-led advocacy organization and an academic researcher, we examine the practices and experiences of the members of a CBPR partnership focused on using community voice to inform changes in the state's children's behavioral health system of care. These practices ultimately led to FAVOR developing the necessary skills to assume full ownership of the community data-gathering initiative, ensuring that the initiative would be sustained. Through the perspectives of five FAVOR staff and an academic researcher, we describe the factors that contributed to the organization being able to develop the capacity to independently continue their community data-gathering initiative, including description of the training process and staff members' perspectives on training, autonomy, community value, and lessons learned. We use these stories and experiences to provide recommendations for other partnerships striving to promote capacity building and sustainability through community ownership of the research process.

Utilizing a CBPR approach to assess the impact of COVID-19 on individuals who receive publicly funded behavioral health services.

The coronavirus disease pandemic has highlighted significant gaps in community mental health services, placing vulnerable individuals at greater risk for mental health and substance use difficulties via disrupting their wellness journey. Guided by a wellness framework, a needs assessment was conducted among adult consumers of behavioral health services to understand their needs during the pandemic and to help develop and strengthen service delivery strategies. A team of three university researchers and four Consumer Researchers, who receive services at a publicly funded community mental health center, engaged in a community-based participatory project in which 13 focus groups were conducted with 51 consumers. Several themes emerged from a thematic analysis of transcripts regarding consumer well-being and healthcare needs, coping strategies employed, and the accessibility, benefits, and perception of clinical and support services during the pandemic. Results highlighted strengths in service delivery and areas in need of enhancement. Findings may inform similar community services that seek to enhance delivery of care among vulnerable populations.

Needs of Youth Enrolled in a Statewide System of Care: A Latent Class Analysis.

Objective: Access to wraparound care coordination within systems of care (SOC) is increasing nationwide for youth with emotional and behavioral disorders and their families. Though wraparound care coordination serves a broad population of youth who experience a variety of complex needs, less is known about the impact of wraparound services based on these specified needs. Using latent class analysis, the current study aimed to first identify classes of youth based on their presenting needs and then examine the impact of class membership on treatment experiences and outcomes at baseline and six-month follow-up. Method: Caregiver-reported data from 1,243 youth enrolled in wraparound care coordination services within a statewide SOC were used. Latent class analysis was used to determine classes of youth needs and regression results examined whether baseline characteristics, child and family team meeting characteristics, mental health outcomes, and perceptions of care differed based on identified classes. Results: Results revealed five distinct classes of youth needs: Behavioral Needs, ADHD-related Behavior Needs, Educational Needs, Mental Health Needs, and Multi-Needs. Overall participants saw improvement in all follow-up outcomes. Significant between-class differences were also found in all outcome categories measured. Conclusion: The current results further solidify the benefits of comprehensive wraparound care within a SOC. Additionally, understanding youth's needs and their impact on treatment services allows for more targeted care for youth and their families.

Needs of Caregivers of Youth Enrolled in a Statewide System of Care: A Latent Class Analysis.

Objective: Systems of care (SOC) provide a coordinated array of services to youth with serious emotional and behavioral problems and their families. Little is known about what caregiver-specific needs at presentation to care may contribute to use of and engagement with care coordination and subsequent youth and family outcomes. This study aimed to determine latent classes of youth enrolled in wraparound care coordination within a statewide SOC based on caregiver needs impacting youth functioning and identify the relationship between class membership and characteristics of participation in Child and Family Team meetings (CFTs) and mental health outcomes at six-month follow-up. Method: Participants were 703 youth (Mage = 11.21, SD = 3.67) and their caregivers that had information about caregiver needs and received a six-month follow-up assessment. Latent class analysis determined latent classes of families based on caregiver service needs at presentation to care, and differences in participation in care coordination and youth outcomes at 6-month follow up based on class membership was examined. Results: Results indicated four classes of caregivers: Physical Health Needs, No Needs, Basic Needs, and Mental Health/Trauma Needs. Class membership was associated with size of the CFT, number of CFTs attended by the youth, percentage of CFTs with a natural support present, and percentage of CFTs that occurred in the family's home. Class membership was associated with caregiver ratings of objective strain at 6-month follow-up. Conclusion: Assessing caregiver needs at presentation to care can provide direction for care coordinators to more directly target areas of family need through wraparound and individualize services.

Trauma Symptoms and Relationship With Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care.

Systems of care (SOCs) are comprehensive, community-based services for youth with emotional and behavioral disorders. For these youth, little is known about how trauma symptoms influence participation in SOC care coordination through the Child and Family Team (CFT) meeting. The current study assessed the extent to which exposure to potentially traumatic events (PTEs) and trauma symptoms were associated with participation in CFTs and youth and family outcomes. Participants were 464 youth (M age = 11.02, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning, PTEs, and trauma symptoms at enrollment and 6-month follow-up. Care coordinators completed surveys assessing CFT characteristics following each meeting and assessments of youth functioning. Moderated multiple regression analyses tested the conditional effects of youth trauma symptoms on the relationships between CFT characteristics and youth and caregiver outcomes. Trauma symptoms moderated the relationship between the number of days to the first CFT meeting and youth impairment and the relationship between CFT meeting duration and youth impairment. Results suggest the presence of trauma and other contextual factors contributed to difficulty in initiating services and to changes in youth impairment. Implications for the provision of trauma-informed SOC services are discussed.

Tell it to Me Straight: The Benefits (and Struggles) of a Consumer-driven Assessment Process.

Community-based Participatory Research (CBPR), where consumers participate in the design and execution of an evaluation, holds promise for increasing the validity and usefulness of evaluations of services. However, there is no literature comparing methods and outcomes of studies conducted by professional evaluators with those conducted through a consumer-driven evaluation process. We attempt to fill this gap by presenting the methods and results from a qualitative evaluation conducted by professional evaluators along with one conducted by a team of consumer researchers who engaged in a CBPR process. This paper includes: (a) methods, and findings that emerged from these evaluations each tasked with examining similar issues within the same community; (b) description of the process used to train the team of consumer researchers whose economic and educational backgrounds are different than most evaluators; and (c) lessons learned about how to prepare for and work with common barriers to implementing a CBPR evaluation.

Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial.

BACKGROUND: General medical hospitals provide care for a disproportionate share of patients who misuse substances. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance misuse. OBJECTIVE: To determine the effectiveness of three strategies for implementing motivational interviewing for substance misuse with general medical inpatients. DESIGN: Type 3 hybrid effectiveness-implementation randomized controlled trial (Clinical Trials.gov: NCT01825057). PARTICIPANTS: Thirty-eight providers (physicians, physician assistants, nurses) from 13 general medical inpatient services, and 1173 of their patients admitted to an academically affiliated acute care hospital. INTERVENTIONS: Implementation strategies included (1) a continuing medical education workshop on detection of substance misuse and provision of a motivational interview; (2) workshop plus bedside supervision (apprenticeship condition); and (3) a workshop plus ability to place a medical order for an interview from a consultation-liaison service (consult condition). MAIN MEASURES: Primary outcomes were the percentage of study-eligible patients who received an interview for substance misuse and the integrity (adherence, competence) of the interviews. The secondary outcome was the percent of patient statements within the interviews that indicated motivation for reducing substance misuse. KEY RESULTS: 20.5% of patients in the consult condition received an interview, compared to 0.8% (Hedge's g = 1.49) and 3.0% (Hedge's g = 1.26) in the respective workshop only and apprenticeship conditions (p < 0.001). Motivational interviews in the consult condition were performed with more fundamental motivational interviewing adherence and competence than the other conditions. Most statements made by patients during the interviews favored reducing substance misuse, with no differences between conditions. CONCLUSIONS: Providers' ability to place an order to have experts from the consultation-liaison service deliver a motivational interview was a more effective implementation strategy than a workshop or apprenticeship method for ensuring motivational interviewing is available to medical inpatients who misuse substances. TRIAL REGISTRY: NCT01825057.

Service-Related Barriers and Facilitators in an Early Childhood System of Care: Comparing the Perspectives of Parents and Providers.

Systems of care (SOCs) have the potential to enhance underserved families' access to integrated health and support services. Most scholarship on SOCs has involved school-aged children and adolescents. Thus, research is needed to better understand barriers to, and facilitators of, families' access to services during early childhood. The present study included a community-based participatory approach in understanding services for families of children under age six years with severe emotional and behavioral problems. We analyzed data from two focus groups with caregivers (n = 7) and three focus groups with service providers (n = 22). Our thematic analysis of participants' responses revealed five primary barriers to family service access, including challenges associated with transition planning. In comparison, participants described four primary facilitators of family service access, including providers' adoption of "whole-family" service delivery approaches. Findings indicated areas of convergence and divergence in caregivers' and providers' responses. We discuss limitations and potential implications.

Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care.

Systems of care (SOC) have relied on the wraparound care process to individualize community-based services for children and youth with serious emotional and behavioral difficulties. A core element of wraparound care is Child and Family Team meetings (CFTs), which are designed to give youth and families a leadership role in developing and guiding their plan of care. The National Wraparound Initiative (NWI) has identified Practice Standards regarding CFT implementation. This study examined CFT characteristics and the association between those characteristics and youth and family outcomes in a statewide SOC. Participants were 363 youth (Mage  = 10.89, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning and symptoms at enrollment and 6-month follow-up. Care coordinators completed a survey assessing CFT implementation and characteristics following each meeting. Multiple regression analyses were used to examine the relationship between CFT characteristics and youth and caregiver outcomes. Results indicated that a higher number of CFTs was associated with poorer outcomes, while a higher percentage of natural supports at meetings was associated with better youth outcomes. Number of days to the first CFT was associated with greater caregiver strain. Implications for CFT implementation within wraparound are discussed.

Examining the service-related experiences and outcomes of caregivers involved in a system of care who experienced everyday discrimination.

Individuals who report everyday experiences of discrimination are at heightened risk for adverse health outcomes and tend to report underutilization of health services. Systems of care (SOCs) have the potential to engage members of minority groups and to reduce health disparities. We examined the service-related experiences of predominantly Latinx caregivers enrolled in a SOC for their children with severe psychological health needs. We used independent samples t-tests and regression analyses to compare relations among service access, perceived service characteristics, and caregiver stress according to whether caregivers reported frequent or infrequent discrimination. The frequent discrimination group scored significantly higher on dimensions of stress and had greater dosage than the infrequent group. There were no differences in relations between service characteristics and outcomes by group. Findings indicated important differences in the service-related experiences and outcomes of caregivers who reported frequent and infrequent discrimination. We discuss limitations and implications.

Reflections on a Community Psychology Setting and the Future of the Field.

The 50th anniversary of the Swampscott Conference offers an opportunity to reflect on a community psychology setting, The Consultation Center at Yale, that was formed in response to the 1963 Community Mental Health Act and the 1965 Swampscott Conference. The Center has flourished as a community psychology setting for practice, research, and training for 39 of the 50 years since Swampscott. Its creation and existence over this period offers an opportunity for reflection on the types of settings needed to sustain the field into the future.

Health, emergency department use, and early identification of young children exposed to trauma.

BACKGROUND: Childhood trauma is an important public health problem with financial, physical health, and mental health repercussions. Emergency departments (EDs) are often the first point of contact for many young children affected by emotionally or psychologically traumatic events (e.g., neglect, separation from primary caregiver, maltreatment, witness to domestic violence within the family, natural disasters). STUDY OBJECTIVES: Describe the prevalence of physical health symptoms, ED use, and health-related problems in young children (birth through 5 years) affected by trauma, and to predict whether or not children experiencing trauma are more likely to be affected by health-related problems. METHODS: Community-based, cross-sectional survey of 208 young children. Traumatic events were assessed by the Traumatic Events Screening Inventory - Parent Report Revised. Child health symptoms and health-related problems were measured using the Caregiver Information Questionnaire, developed by ORC Macro (Atlanta, GA). RESULTS: Seventy-two percent of children had experienced at least one type of traumatic event. Children exposed to trauma were also experiencing recent health-related events, including visits to the ED (32.2%) and the doctor (76.9%) for physical health symptoms, and recurring physical health problems (40.4%). Children previously exposed to high levels of trauma (four or more types of events) were 2.9 times more likely to report having had recently visited the ED for health purposes. CONCLUSIONS: Preventing recurrent trauma or recognizing early trauma exposure is difficult, but essential if long-term negative consequences are to be mitigated or prevented. Within EDs, there are missed opportunities for identification and intervention for trauma-exposed children, as well as great potential for expanding primary and secondary prevention of maltreatment-associated illness, injury, and mortality.

Stakeholders' perspectives on community-based participatory research to enhance mental health services.

Historically, consumers of mental health services have not been given meaningful roles in research and change efforts related to the services they use. This is quickly changing as scholars and a growing number of funding bodies now call for greater consumer involvement in mental health services research and improvement. Amidst these calls, community-based participatory research (CBPR) has emerged as an approach which holds unique promise for capitalizing on consumer involvement in mental health services research and change. Yet, there have been few discussions of the value added by this approach above and beyond that of traditional means of inquiry and enhancement in adult mental health services. The purpose of this paper is to add to this discussion an understanding of potential multilevel and multifaceted benefits associated with consumer-involved CBPR. This is accomplished through presenting the first-person accounts of four stakeholder groups who were part of a consumer-involved CBPR project purposed to improve the services of a local community mental health center. We present these accounts with the hope that by illustrating the unique outcomes associated with CBPR, there will be invigorated interest in CBPR as a vehicle for consumer involvement in adult mental health services research and enhancement.

Reporting Perinatal Substance Use to Child Protective Services: Obstetric Provider Perspectives on the Impact on Care.

Objective: To understand obstetric provider perspectives on child protective services (CPS)-mandated reporting requirements and how they affect care for pregnant and postpartum patients with opioid use disorder (OUD). Methods: Key informant interviews were conducted virtually with obstetricians, nurse practitioners, and social workers caring for obstetric patients (n = 12). Providers were asked about their experience as mandated reporters working with patients with OUD. Transcripts were independently coded by two staff, and content analysis was used to identify themes. Results: Our analysis resulted in six thematic areas, including CPS-mandated strengths, concerns related to CPS reporting requirements, implementation of mandates, supporting patients after CPS report, communication between stakeholders, and the impact on care. Providers noted that the fear of CPS involvement causes some patients to delay or not engage in care. Other patients are hesitant to accept medications for OUD for fear of CPS involvement. The inconsistencies in how reporting mandates are applied and how CPS handles cases make communication about the policies challenging for providers and create anxiety for patients. Conclusions: The results of this study indicate that mandated reporting requirements and the potential for CPS involvement are perceived to have minimal positive effects on perinatal individuals with OUD and may negatively affect patients and their care. Clinicaltrials.gov number: NCT04240392.

The effects of cumulative risk and protection on problem behaviors for youth in an urban school-based system of care.

The present study examined the cumulative effects of risk and protective factors on internalizing and externalizing problems for a sample of youth who were diagnosed with a severe emotional disturbance and enrolled in an urban school-based system of care. The sample included 139 Latino and African American children (ages 5-19; 65 % male) and their families. After controlling for demographic variables, the results of hierarchical multiple regression analyses revealed that cumulative risk and protection were significantly related to internalizing problem behaviors, and cumulative protection was negatively related to externalizing problem behaviors. The findings support the importance of including or increasing strength building approaches, in addition to risk reduction, in order to maximize prevention and intervention efforts for system-of-care populations.

Relationships between Child Emotional and Behavioral Symptoms and Caregiver Strain and Parenting Stress.

Children with emotional and behavioral disturbance often have difficulties in multiple symptom domains. This study investigates the relationships between child symptoms and caregiver strain and parenting stress among 177 youth and their caregivers participating in a school-based system of care. Youth were grouped by symptom domain and included those with low scores on both internalizing and externalizing symptoms, those with only high internalizing symptoms, those with only high externalizing symptoms, and those with high symptoms levels in both internalizing and externalizing domains. Results revealed significant group differences on measures of caregiver strain and parenting stress. Caregivers of youth with symptoms in both internalizing and externalizing domains reported the highest levels of strain and stress; however, there was some variation in group differences by caregiver outcome. The results of this study emphasize the importance of not only providing services for youth, but also providing support services for their caregivers.

Exposure to traumatic events and the behavioral health of children enrolled in an early childhood system of care.

Children may be exposed to numerous types of traumatic events that can negatively affect their development. The scope to which studies have examined an array of events among young children has been limited, thereby restricting our understanding of exposure and its relationship to behavioral functioning. The current cross-sectional study describes traumatic event exposure in detail and its relationship to behavioral health among an at-risk sample of young children (N = 184), under 6 years of age, upon enrollment into an early childhood, family-based, mental health system of care. Caregivers completed home-based semistructured interviews that covered children's exposure to 24 different types of traumatic events and behavioral and emotional functioning. Findings indicated that nearly 72% of young children experienced 1 or more types of traumatic events. Multiple regression model results showed that exposure was significantly associated with greater behavioral and emotional challenges with children's age, gender, race/ethnicity, household income, and caregiver's education in the model. These findings highlight the prevalence of traumatic exposures among an at-risk sample of young children in a system of care and suggest that this exposure is associated with behavioral and emotional challenges at a young age.

An Examination of Exposure to Traumatic Events and Symptoms and Strengths for Children Served in a Behavioral Health System of Care.

The present study examined how exposure to traumatic events impacts children with severe emotional disturbance who are being served in a school-based system of care. Multilevel growth curve models were used to examine the relationships between a child's history of traumatic events (physical abuse, sexual abuse, or domestic violence) and behavioral and emotional strengths, internalizing problem behaviors, or externalizing problem behaviors over 18 months. Results indicate that children receiving services (N = 134) exhibited increased emotional and behavioral strengths and decreased internalizing and externalizing problem behaviors from enrollment to 18 months follow-up. Children with a history of traumatic events improved more slowly than children without such a history on both strengths and internalizing problem behaviors, even after controlling for dosage of services received and other characteristics previously found to predict outcomes. Gender was also related to improvement in internalizing symptoms. Results highlight the continued need to assess the impact of exposure to traumatic events for children served in a system of care.

Understanding Racial-Ethnic Disparities in Wraparound Care for Youths With Emotional and Behavioral Disorders.

OBJECTIVE: Systems of care (SOCs) were developed to increase access to and quality of care for children with emotional and behavioral difficulties and their families through the provision of coordinated, community-based, culturally competent, family-driven services. SOCs focus on wraparound care that is individualized to meet each family's needs. Previous research has illustrated significant disparities in outcomes of nonwraparound care on the basis of youths' race-ethnicity. This study aimed to fill a research gap by examining disparities in outcomes for families receiving wraparound care coordination within an SOC. METHODS: This exploratory study examined racial-ethnic disparities in outcomes observed at intake, during service provision, and at 6-month follow-up among 1,138 youths and their caregivers who participated in wraparound care coordination as part of a statewide SOC between 2016 and 2020. Analyses of variance and regression analyses were executed to investigate whether receiving services and/or the youths' racial-ethnic identity predicted differences in behavioral health outcomes and characteristics of or satisfaction with care. Caregiver-reported outcomes were assessed with the Ohio Scales for Youth, the Child Trauma Screen, and the Caregiver Strain Questionnaire. RESULTS: Results revealed few racial-ethnic disparities in the characteristics and outcomes of care coordination among participants at intake or in family involvement in the wraparound process. Participants across groups reported similar and significant improvement in outcomes. However, the results indicated some disparities in satisfaction with care. CONCLUSIONS: Results revealed the positive impact of care coordination on the health and well-being of youths and caregivers across racial-ethnic groups.

Predictors of Parenting and Infant Outcomes for Impoverished Adolescent Parents.

Adolescent mothers and their children are at risk for a myriad of negative outcomes. This study examined risk and protective factors and their impact on a sample (N=172) of impoverished adolescent mothers. Multiple regression analyses revealed that depressed adolescent mothers report higher levels of parenting stress, and that their children are more at risk for maltreatment and are developmentally behind other babies. In addition, adolescent mothers with restricted social support have babies who are at higher risk for maltreatment. Finally, mothers who were older during pregnancy were more likely to stay in school. Implications for program development are discussed.