The relationship between school mental health service use in high school and educational outcomes of adolescents with psychiatric disorders.

This study aimed to examine the relationship between school mental health service use in high school and educational outcomes of adolescents with psychiatric disorders. The sample included 2617 adolescents who were enrolled in eighth grade in a large urban school district in the United States, were enrolled in Medicaid during eighth grade, and had a mental health diagnosis. Psychiatric hospitalization, school enrollment, school absences, out-of-school suspensions, school dropouts, and school exits for negative reasons were examined as mental health and educational outcomes. Compared with adolescents who used school mental health services for 2 years following eighth grade, adolescents who did not use school mental health service during the high school years had a significantly lower annual number of days enrolled in school and higher rates of exiting school for negative reasons such as school dropout and long-term hospitalization. Our findings support the positive role of school mental health care delivery in high schools in preventing negative educational outcomes for adolescents with psychiatric disorder.

Implementation Science and Practice-Oriented Research: Convergence and Complementarity.

Implementation science is the scientific study of methods to promote the uptake of research findings and other evidence-based practices in routine care, with the goal of improving the quality and effectiveness of health services (Bauer et al., 2015). In addition to this common goal, practice-oriented psychotherapy research (and researchers) and implementation science (and scientists) share a common focus on the people and the places where treatment happens. Thus, there exists strong potential for combining these two approaches. In this article, we provide a primer on implementation science for psychotherapy researchers and highlight important areas and examples of convergence and complementarity between implementation science and practice-oriented psychotherapy research. Specifically, we (a) define and describe the core features of implementation science; (b) discuss similarities and areas of complementarity between implementation science and practice-oriented psychotherapy research; (c) discuss a case example that exemplifies the integration of implementation science and practice-oriented research; and (d) propose directions for future research and collaborations that leverage both implementation science and practice-oriented research.

The Intergenerational Impact of Structural Racism and Cumulative Trauma on Depression.

Depression among individuals who have been racially and ethnically minoritized in the United States can be vastly different from that of non-Hispanic White Americans. For example, African American adults who have depression rate their symptoms as more severe, have a longer course of illness, and experience more depression-associated disability. The purpose of this review was to conceptualize how structural racism and cumulative trauma can be fundamental drivers of the intergenerational transmission of depression. The authors propose that understanding risk factors for depression, particularly its intergenerational reach, requires accounting for structural racism. In light of the profoundly different experiences of African Americans who experience depression (i.e., a more persistent course of illness and greater disability), it is critical to examine whether an emerging explanation for some of these differences is the intergenerational transmission of this disorder due to structural racism.

Implementing evidence-based practices in nonspecialty mental health settings.

OBJECTIVE: Mental health services are often implemented in settings in which mental health is not the primary mission. Schools, primary care clinics, criminal justice and child welfare institutions, and senior centers have been increasingly adding mental health care to their compendium of services owing to the high rates of mental health needs in these settings. Despite numerous challenges to implementing mental health practices in settings where mental health care has not traditionally been a part of the service model, the demand for mental health services in these settings is growing. Implementation science offers a lens through which to understand unique challenges and potential solutions to implementing mental health services in these settings, with the ultimate goal of ensuring the implementation of evidence-based services. METHOD AND RESULTS: In this conceptual article, we discuss common overarching barriers to implementing evidence-based mental health interventions in nonspecialty mental health settings, such as workforce challenges, competing priorities, and financial considerations. Then, using examples from schools and primary care, we elucidate unique contextual considerations and implementation challenges in these settings. Finally, we articulate a research agenda for advancing implementation of evidence-based practices in nonspecialty mental health including highlighting promising implementation strategies (e.g., task shifting, adaptation) and the most relevant implementation outcomes to assess in these contexts (e.g., appropriateness, feasibility). CONCLUSIONS: Given that nonspecialty mental health settings deliver a large proportion of mental health care to traditionally underserved populations, there are important public health implications to advancing research in this area and ensuring implemented services are evidence-based. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Increasing access to mental health supports for healthcare workers during the COVID-19 pandemic and beyond through a novel coaching program.

The COVID-19 pandemic led to heightened anxiety, distress, and burnout among healthcare workers and faculty in academic medicine. Penn Medicine launched Coping First Aid (CFA) in March 2020 in response to the pandemic. Informed by Psychological First Aid principles and therapeutic micro skills, CFA was designed as a tele-mental healthcare service for health system employees and their families delivered by trained lay volunteer coaches under the supervision of licensed mental health clinicians. We present an overview of the model, feasibility and utilization data, and preliminary implementation and effectiveness outcomes based on cross sectional coach (n = 22) and client (n = 57) self-report surveys with a subset of program users in the first year. A total of 44 individuals completed training and were certified to coach. Over the first 24 months of the program, 513 sessions occurred with 273 clients (119 sessions were no-shows or canceled). Follow-up appointments were recommended in 52.6% (n = 270) of sessions and 21.2% (n = 109) of clients were referred for professional mental health care. Client survey respondents reported CFA was helpful; 60% were very or extremely satisfied, and 74% indicated they would recommend the program. Our preliminary findings suggest that CFA was feasible to implement and most clients found the service beneficial. CFA provides a model for rapidly developing and scaling mental health supports during and beyond the pandemic.

Specifying and Reporting Implementation Strategies Used in a School-Based Prevention Efficacy Trial.

BACKGROUND: Implementation strategies used to enhance the implementation of interventions during efficacy and effectiveness studies are rarely reported. Tracking and reporting implementation strategies during these phases has potential to improve future research studies and real-world implementation. We present an exemplar of how this might be executed by specifying and reporting the implementation strategies that were used during a school-based efficacy trial, Project POWER, which tested a trauma-informed prevention program delivered by a university research team, community members, and school staff facilitators in 29 schools. METHODS: Following the conclusion of the 4-year trial, core Project POWER research team members identified the implementation strategies that supported intervention delivery during the trial using an established taxonomy of school-based implementation strategies. The actors, actions, action targets, temporality, dose, and implementation outcomes were specified using established implementation strategies reporting guidelines. RESULTS: The research team identified 37 implementation strategies that were used during the Project POWER trial. Most strategies fell within the categories of Train and Educate Stakeholders, Use Evaluative and Iterative Strategies, and Develop Stakeholder Interrelationships. Actors included members of the research team and partner schools. Strategies were used multiple times during the preparation and implementation phases. Action targets were most often characteristics of individuals, implementation process, and characteristics of the inner setting. Strategies predominantly targeted the implementation outcomes of fidelity, acceptability, feasibility, and adoption. CONCLUSIONS: This study provided evidence that implementation strategies are used and can be identified in efficacy research using a retrospective approach. Identifying and specifying implementation strategies used during the initial phases of the translational research pipeline can inform the implementation strategies that are carried forward, adapted, or discontinued in future trials and routine practice to improve implementation and effectiveness outcomes.

Multilevel Barriers and Facilitators to Sustainability of a Universal Trauma-Informed School-Based Mental Health Intervention Following an Efficacy Trial: A Qualitative Study.

Limited research exists about factors that influence the sustainability of preventive school mental health interventions when research support ends. This study assessed barriers and facilitators to sustaining RAP (Relax, be Aware, do a Personal rating) Club, a trauma-informed universal mental health intervention, in urban schools following efficacy trial implementation. Between 2016-2018, 13 Baltimore City schools implemented RAP Club. We evaluated RAP Club sustainability using semi-structured interviews with administrators (n=10) and school staff trained to deliver the intervention (n=11), as well as review of intervention fidelity logs (n=137) and notes from supervision calls (n=10) with school staff and research team members who implemented the program. Although most school staff described RAP Club as acceptable and beneficial, none of the 13 schools sustained the intervention. Barriers to sustainability included low self-efficacy among school staff trained to deliver the intervention, school staff turnover, logistical challenges with space and time in the regular school calendar to deliver the program, insufficient funding to sustain the program outside of the research context, and limited planning and ongoing communication between school personnel and researchers about sustainability. Recommendations for increasing post-trial program sustainability include developing sustainability plans with schools during the pre-implementation phase, enhancing ongoing support for school staff during the implementation phase, and using academic-community partnerships to facilitate sustainability and intervention scale-up during the post-implementation phase. Increasing sustainability of beneficial school-based mental health programs has the potential to reduce mental health disparities and promote health equity.

Targeting of Enrollment Assistance Resources in Health Insurance Television Advertising: A Comparison of Spanish- Vs. English-Language Ads.

Latinx adults, especially immigrants, face higher uninsurance and lower awareness of the Affordable Care Act's (ACA) provisions and resources compared to other racial/ethnic groups. Television advertising of ACA health plans has directed many consumers to application assistance and enrollment, but little is known about how ads targeted Latinx consumers. We used Kantar Media/CMAG data from the Wesleyan Media Project to assess Spanish- vs. English-language ad targeting strategies and to assess which enrollment assistance resources (in person/telephone vs. online) were emphasized across three Open Enrollment Periods (OEP) (2013-14, 2014-15, 2015-16). We examined differences in advertisement sponsorship and volume of Spanish- versus English-language ads across the three OEPs. State-based Marketplaces sponsored 47% of Spanish-language airings; insurance companies sponsored 55% of English-language airings. The proportion of Spanish-language airings increased over time (8.8% in OEP1, 11.1% in OEP2, 12.0% in OEP3, p <.001). Spanish-language airings had 49% lower (95%CI: 0.50,0.53) and 2.20 times higher odds (95%CI: 2.17,2.24) of mentioning online and telephone/in-person enrollment assistance resources, respectively. While there was a significant decrease in mention of telephone/in-person assistance over time for English-language airings, these mentions increased significantly in Spanish-language airings. Future research should examine the impact of the drastic federal cuts to ACA outreach and marketing.

Factors that Influenced Adoption of a School-Based Trauma-Informed Universal Mental Health Intervention.

We know little about why school administrators choose to adopt preventive mental health interventions within the context of school-based prevention trials. This study used a qualitative multiple-case study design to identify factors that influenced the adoption of a trauma-informed universal intervention by urban public school administrators during an efficacy trial. Semi-structured interviews were conducted with 15 school administrators who adopted a trauma-informed mindfulness intervention called RAP (Relax, be Aware, and do a Personal Rating) Club as part of their participation in a school-based trial with eighth graders. Findings indicated that administrators adopted RAP Club to provide support for students affected by trauma and prevent students from engaging in unhealthy coping behaviors. Examples of contextual factors that contributed to adoption included a lack of trauma-informed mental health programs within schools, inadequate district funding for preventive school mental health services, and the perceived benefits of engaging in a university-community partnership. The study's findings suggest strategies to increase school program adoption in the context of research and, more broadly, for implementation science.

Assessing Physical Activity in Temporary Spaces: Application of SOPARC / iSOPARC® for Play Streets.

Purpose: The System for Observing Play and Recreation in Communities (SOPARC) is a valid, reliable method for understanding how people engage in physical activity (PA) in various permanent settings (e.g., parks) and contexts. However, its utility, reliability, and validity in temporary spaces has not been examined. Temporary spaces can provide PA opportunities often absent in low-income communities due to inadequate safe permanent PA spaces. Play Streets involve temporary closure of streets or other publicly accessibly spaces (e.g., parking lots, open-fields) to create safe play spaces for a specified time-period. We describe the utility, reliability, and validity of using SOPARC to assess PA in temporary spaces like Play Streets. Method: Trained SOPARC/iSOPARC (iPad App) research staff completed systematic observations during Play Streets occurring in four diverse low-income rural U.S. communities during summer 2017. Results: We successfully used iSOPARC to document PA and how spaces were used at Play Streets (n = 16), confirming its utility, reliability, and validity. Unlike observations of permanent spaces, target areas could not be pre-established since play spaces often changed during set-up, requiring time onsite to identify target areas and boundaries. Play areas frequently appeared and/or disappeared during Play Streets, and this was systematically addressed by using physical target area boundaries instead of activities. Conclusions: Understanding how temporary spaces are used for PA is critical for promoting their use. SOPARC/iSOPARC methods are useful in a Play Streets' context; however, systematic methods and training are needed to address inherent unpredictable and dynamic changes within and across target areas.

Come together, play, be active: Physical activity engagement of school-age children at Play Streets in four diverse rural communities in the U.S.

Across the U.S., Play Streets - temporary street closures creating safe places for play for a few hours- are being implemented in urban areas during summer. Play Streets have never been implemented or evaluated in rural communities but have the potential to address challenges residents face accessing safe physical activity opportunities in these areas. Community organizations in four diverse low-income rural communities (selected to represent African American, American Indian, Latino, or White, non-Hispanic populations) received mini-grants in 2017 to implement four, three-hour Play Streets during the summer focusing on school-aged children in elementary-to-middle school. Physical activity was measured using Digi-walker (Yamax-SW200) pedometers and the System for Observing Play and Recreation in Communities (SOPARC/iSOPARC). Sixteen Play Streets were implemented in rural Maryland, North Carolina, Oklahoma, and Texas communities during June-September 2017. A total of 370 children (mean age = 8.81 years [SD = 2.75]; 55.0% female) wore pedometers across all 16 Play Streets (µâ€¯= 23.13 [SD = 8.59] children/Play Street). School-aged children with complete data (n = 353) wore pedometers for an average of 92.97 min (SD = 60.12) and accrued a mean of 42.08 steps/min (SD = 17.27), with no significant differences between boys (µâ€¯= 43.82, SD = 15.76) and girls (µâ€¯= 40.66, SD = 18.34). iSOPARC observations revealed no significant differences in child activity by sex; however, male teens were more active than female teens. Most adults were sedentary during Play Streets according to pedometer and iSOPARC data. Children in diverse rural communities are physically active at Play Streets. Play Streets are a promising intervention for promoting active play among children that lack safe opportunities to be active.

A 40-Day Journey to Better Health: Utilizing the DanielFast to Improve Health Outcomes in Urban Church-Based Settings.

Background: As the costs associated with obesity increase, it is vital to evaluate the effectiveness of chronic disease prevention among underserved groups, particularly in urban settings. This research study evaluated Philadelphia area Keystone First members and church participants enrolled in a group health education program to determine the impact of the Daniel Fast on physical health and the adoption of healthy behaviors. Methods: Participants attended six-weekly health education sessions in two participating churches, and were provided with a digital healthy eating platform. Results: There was a statistically significant decrease from baseline to post assessment for weight, waist circumference and cholesterol. Participants reported a significant improvement in their overall well-being, social and physical functioning, vitality and mental health. Conclusion: Results of this study demonstrate that dietary recommendations and comprehensive group health education delivered in churches and reinforced on a digital platform can improve physical health, knowledge and psychosocial outcomes.

Assessing the Content of Television Health Insurance Advertising during Three Open Enrollment Periods of the ACA.

Television advertising has been a primary method for marketing new health plans available under the Affordable Care Act (ACA) to consumers. Data from Kantar Media's Campaign Media Analysis Group were used to analyze advertising content during three ACA open enrollment periods (fall 2013 to spring 2016). Few advertisement airings featured people who were elderly, disabled, or receiving care in a medical setting, and over time airings increasingly featured children, young adults, and people exercising. The most common informational messages focused on plan choice and availability of low-cost plans, but messages shifted over open enrollment cycles to emphasize avoidance of tax penalties and availability of financial assistance. Over the three open enrollment periods, there was a sharp decline in explicit mentions of the ACA or Obamacare in advertisements. Overall, television advertisements have increasingly targeted young, healthy consumers, and informational appeals have shifted toward a focus on financial factors in persuading individuals to enroll in marketplace plans. These advertising approaches make sense in the context of pressures to market plans to appeal to a sufficiently large, diverse group. Importantly, dramatic declines over time in explicit mention of the law mean that citizens may fail to understand the connection between the actions of government and the benefits they are receiving.

The relationship between childhood adversity and food insecurity: 'It's like a bird nesting in your head'.

OBJECTIVE: Adverse childhood experiences, including abuse, neglect and household instability, affect lifelong health and economic potential. The present study investigates how adverse childhood experiences are associated with food insecurity by exploring caregivers' perceptions of the impact of their childhood adversity on educational attainment, employment and mental health. DESIGN: Semi-structured audio-recorded in-person interviews that included (i) quantitative measures of maternal and child health, adverse childhood experiences (range: 0-10) and food security using the US Household Food Security Survey Module; and (ii) qualitative audio-recorded investigations of experiences with abuse, neglect, violence and hunger over participants' lifetimes. SETTING: Households in Philadelphia, PA, USA. SUBJECTS: Thirty-one mothers of children <4 years old who reported low or very low household food security. RESULTS: Twenty-one caregivers (68 %) reported four or more adverse childhood experiences, and this severity was significantly associated with reports of very low food security (Fisher's exact P=0·021). Mothers reporting emotional and physical abuse were more likely to report very low food security (Fisher's exact P=0·032). Qualitatively, participants described the impact of childhood adverse experiences with emotional and physical abuse/neglect, and household substance abuse, on their emotional health, school performance and ability to maintain employment. In turn, these experiences negatively affected their ability to protect their children from food insecurity. CONCLUSIONS: The associations between mothers' adverse experiences in childhood and reports of current household food security should inspire researchers, advocates and policy makers to comprehensively address family hardship through greater attention to the emotional health of caregivers. Programmes meant to address nutritional deprivation and financial hardship should include trauma-informed approaches that integrate behavioural interventions.