Using the life course health development model to address pediatric mental health disparities.

TOPIC: Early-life experiences, the transmission of health and disease within families, and the influence of cumulative risks as well as protective factors throughout life shape the trajectory of health, including mental health. Long-term health trajectories established early in life are influenced by biologic, social, and environmental factors. Negative trajectories may be more salient if exposures to adversity occur during critical developmental periods. PURPOSE: The purpose of this brief is to (a) review pediatric health disparities related to depression and the intergenerational transmission of pediatric depression using a Life Course Health Development (LCHD) model and (b) provide recommendations for pediatric mental health research. SOURCES: Peer-reviewed papers available for PubMed, CINAL, and Medline. Other sources include published books, papers, and gray materials. CONCLUSIONS: The LCHD model is a perspective to guide and foster new scientific inquiry about the development of mental health outcomes over the life course. The model enables synthesis of mental health, nursing, and public health, linking mental health prevention, risk reduction, and treatment in children.

Are we practicing what we preach? Family partnership in therapeutic residential care for children and youth.

This study presents a tiered conceptualization of family partnership developed by the Family-Run Executive Director Leadership Association (FREDLA) with examples of strategies from the literature. This sub-study was part of an overarching systematic review project that aimed to review the literature on family partnership in relation to youth outcomes. The tiers of family partnership include family involvement (i.e., family's inclusion in their child's care); family engagement (i.e., collaboration between TRC and families); family-driven (i.e., families as full partners). This review included thirty studies (n=23 family involvement, n=7 family engagement, n=0 family-driven). The most common family involvement methods were family therapy and family visits to the program, primarily delivered face-to-face. The most common family engagement method was activities, therapies, and skill building occurring at the home with family present. Methods of measuring family partnership primarily included the use of administrative data. Implications for research and practice include the provision of research that evaluates the effects of family partnership on outcomes important in the TRC setting and the development of research-practice and family-research collaborations to increase the uptake of effective family partnering methods.

Parents' Perspectives in Accessing Psychiatric Residential Treatment for Children and Youth: Differential Experiences by Funding Source.

Objective: There are well-documented disparities in access to mental health care for children and youth with significant behavioral health needs. Few studies that explored the differential experiences of families who use private vs public sources of financing (i.e., insurance and funding) in accessing residential treatment (RT) for children and youth. This study aimed to examine the lived experiences of families accessing psychiatric residential treatment (RT) and contextualize these experiences based on source of financing. Methods: Twenty parents completed two interviews about their experiences with RT including the process for gaining access, length of stay, and aftercare. Parents were also asked about barriers (e.g., custody relinquishment), and facilitators (e.g., policies in the state) to accessing RT. Data were analyzed using content analysis. Results: There were three distinct groups of families in the study. The first group includes lower income families whose children had public health coverage before needing RT. The second group comprises middle-income families whose children had private coverage but lived in states where there were no RTs that accepted private insurance or private payment and who did not have the means to send their child to RT in another state. The final group included higher income families with private insurance and enough private resources to overcome the limitations of insurance and state policies. This study illuminates key barriers and hardships for families accessing RT: 1) waiting long waiting periods and navigating complex systems; 2) inadequate lengths of stay; and 3) inadequate aftercare and support in the community transition. Conclusions: This study is among the first to examine how access to RT differs by whether a family has access to public or private resources. Taken together, these findings support the importance of insurance and financing for families accessing RT for their children and the need for systemic changes in policies and practices to reduce disparities in access.

Adverse Childhood Experiences, Depression, and Intimate Partner Violence Among Chinese Immigrant Women: Mediation by Social and Partner Support.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with an increased risk of depression and intimate partner violence (IPV). Social support and partner support may help explain this association. Few researchers have focused on Chinese immigrant women, who are less likely than native-born women to seek help for mental health challenges and IPV. OBJECTIVE: The purpose of this study was to examine the mediation effects of social and partner support on the relationship between (a) ACEs and (b) depressive symptoms and IPV among Chinese immigrant women living in the United States. METHODS: This is a secondary analysis of data from 475 Chinese immigrant women recruited online. Depressive symptoms, IPV, ACEs, perceived social support, and perceived partner support were measured cross-sectionally. Mediation analyses were conducted to test the mediating role of social and partner support on the associations between ACEs and depressive symptoms and IPV. RESULTS: Social support and partner support fully mediated the relationship between ACEs and depressive symptoms. However, partner support only partially mediated the relationship between ACEs and IPV. DISCUSSION: ACEs indirectly affect depressive symptoms by undermining both general perceptions of support and perceived partner support. The findings of this study underscore the critical influence of a lack of partner support in mediating the effects of ACEs on Chinese immigrant women's risk of IPV. Promoting strong existing support networks, creating new support resources, and improving partner relationships are important targets for interventions to mitigate the effects of ACEs on depression and IPV in Chinese immigrant women.

Assessment of Barriers and Facilitators to Prescribing HIV Preexposure Prophylaxis by Primary Care Providers.

ABSTRACT: HIV preexposure prophylaxis (PrEP) is a highly effective class of drugs used to prevent the transmission of HIV-1. Despite its high efficacy, the uptake of PrEP has been very low. This project sought to understand the barriers and facilitators to prescribing PrEP in a community health clinic in a Midwestern state.

Web-Based Parent Training in Parents with Adolescents Admitted to Psychiatric Residential Treatment: A Mixed-Methods Study.

Despite intensive treatment, adolescents discharged from residential treatment (RT) often do not maintain treatment gains in the community. Providing support and education to caregivers through parent training may ameliorate the loss of treatment gains. Successful parent training programs have been delivered to this population; however, these interventions were delivered in-person, posing significant barriers affecting reach, access, and engagement. A convergent mixed methods design was used to assess the acceptability, appropriateness, and feasibility of a web-based parent training in a sample of parents (N = 20) with adolescents admitted to RT. Parents completed two interviews and an end-of-program survey. Parents completed at least 80% of the assigned modules and felt that PW was easy to use and that the features facilitated learning. Parents reported practicing the skills in their daily lives and found it beneficial to have a partner to practice with. Consistent with previous studies, parents perceived the delivery method as a strength because the web-based delivery circumvented multiple known barriers to in-person interventions. A large subset of parents related to the scenarios, while a small subset of parents felt the modules were challenging to relate to because of the severity of their adolescent's mental health challenges. Overall, findings indicate that web-based parent training programs may be an acceptable, appropriate, and feasible adjuvant evidence-based support. However, tailoring the intervention content is necessary to create a more relatable intervention that captures the breadth and severity of mental health challenges adolescents in RT face.

Lessons From the Field: Strategies for Success in Obtaining Grant Funding.

OBJECTIVE: To summarize a preconference workshop that focused on how to be successful in obtaining funding by making one's scholarship innovative and significant. METHOD: In 2021, at the annual American Psychiatric Nurses Association (APNA) Conference, a panel of nurse scholars reflected on and discussed how to make grant proposals innovative and significant. Two moderators posed questions to five panelists at different stages in their research trajectories about four key research concepts: idea conception, framing for the funding agency, significance, and innovation. RESULTS: Conceptualizing an innovative, scholarly idea starts with a passion for the topic, a team of experts and scholarly community, and time to think and delve into the literature. For funding opportunities, start small, read the funding announcements thoroughly and carefully, and make sure it is the right fit. Strategies to illustrate significance include avoiding generalizations, maintaining objectivity, being clear about impact, and using strength-based language. Contemplate the many facets of innovation as well as balance innovation and feasibility. CONCLUSIONS: Inclusion of challenges in composing significance and innovation sections of grant proposals offers knowledge for psychiatric nurse researchers to add to their toolkits as they seek funding and conduct research and scholarship.

Variation in Evidence-Based Practices Among Youth-Serving Residential Treatment Facilities.

BACKGROUND: Residential treatment is among the most intensive and expensive settings for children with behavioral health challenges; yet, the extent to which evidence-based practices are used in these settings is unknown. AIM: The purpose of this study was to describe the extent which family therapy, case management, telehealth, peer support, and family psychoeducation are provided in residential treatment using data from the National Mental Health Services Survey (N-MHSS). Organizational factors-region, ownership, payment, licensing/accreditation, and facility size-were examined in relation to evidence-based practices to understand disparities in care. METHODS: This was a secondary analysis of publicly available data from the 2018 N-MHSS. A subpopulation was created consisting of residential facilities that served children (N = 576). Descriptive statistics were used to describe the sample, and Cohen's h was calculated to determine patterns of evidence-based practice utilization. RESULTS: Evidence-based practices from most to least prevalent were family therapy (76%), family psychoeducation (74%), case management (71.1%), telehealth (17.2%), and peer support (8.7%). The provision of evidence-based practices was not evenly distributed. There were primarily small to moderate differences by organizational factors, including region (i.e., Northeast, Midwest), ownership status (i.e., for-profit), payment type (i.e., self-pay, private insurance), licensing/accreditation (Department of Family and Children Services), and facility capacity (>251 clients served per year). CONCLUSION: Findings demonstrate a need for research-practice partnerships to determine the barriers that prevent effective evidence-based practices from being implemented in the residential treatment setting.

Development and Testing of a Spiritual Resourcefulness Scale: Holistic Expansion in Operationalizing the Resourcefulness Construct.

Purpose: Research supports holistic expansion of the construct of resourcefulness by adding spiritual practices to the existing personal and social dimensions. This study describes the development and testing of items to measure spiritual resourcefulness. Methods/Design: Study phases were: (1) focus group development of item stems and responses; (2) expert testing; (3) scale construction; (4) field testing in 234 family caregivers; and (5) psychometric analysis to identify items for inclusion in a final scale. Findings: A focus group developed 40 item stems with potential responses reflecting three conceptual components of spiritual practices (rational, ritualistic, and relational). Content experts selected the best response for each item. A six-point Likert scale consistent with the Resourcefulness Scale© was constructed. Data from field testing were factor analyzed. The best solution revealed two factors containing 12 items. Ritualistic and relational items loaded together (44.7% variance explained). Rational items loaded separately (19.5% variance explained). Higher-order factor analysis indicated the two subscales reflected a single construct (71.93% variance explained; r = .44, p < .001). Conclusion: Availability of a psychometrically sound measure of spiritual resourcefulness is critical to expand resourcefulness training interventions to be more holistic. Clinical interventions can be enriched by including strategies to enhance personal, social, and spiritual resourcefulness skills.

"The worst time of my life": Treatment-related stress and unmet needs of women living with infertility.

Approximately 12% of women in the United States have difficulty getting pregnant or carrying a pregnancy to term (i.e., infertility). Infertility permeates women's lives and is psychologically, socially and financially burdensome. This study aimed to describe women's experiences regarding infertility and explore factors that women find helpful to alleviate their fertility-related stressors. Using purposive sample, we conducted in-depth qualitative interviews with infertile women. Participants reported multiple infertility treatment-related stressors including (a) difficulty accessing infertility treatment due to financial issues, geographic disparities, and healthcare provider factors; (b) challenges during infertility treatment related to painful, embarrassing, confusing treatments, side effects, and healthcare providers' failures to fully address women's needs. The stories and findings add to a body of literature that elucidate significant stressors that women encounter in their fertility journey including a desire for empathetic, understandable, and effective treatment and support, and the crucial role of healthcare providers.

Differences among Caregivers on Coping Resources and Mental Health.

Given the growing number of family members who provide care to adults with a disability or illness, this study examined differences in coping resources and mental health among family caregivers of persons with various health conditions. Within the context of Ensel and Lin's stress paradigm, 234 family caregivers participated in an online study by completing validated measures of resourcefulness, spiritual practices, caregiver burden, anxiety, and depression. Caregivers were categorized into nine groups according to their care recipient's condition. The groups differed significantly on burden and resourcefulness. Greatest burden and lowest resourcefulness were found in caregivers of persons with traumatic brain injury, stroke, and dementia. Caregivers across all groups were found to be at a similarly high risk for anxiety and depression. These results provide insights for tailoring interventions for caregivers, particularly those whose care recipients have traumatic brain injury, stroke, or dementia, who may benefit from resourcefulness training.

Caregivers of Persons with Diverse Health Conditions: Demographics and Burden of Care.

Although caregiver identity theory asserts there is no single generic caregiver identity, comparisons on demographic characteristics and burden of care have not been made among caregivers of persons with various health conditions. Using social media to access study participants, this cross-sectional study of 234 family caregivers of persons with various health conditions examined their demographic characteristics (age, gender, and race/ethnicity) and burden of care (daily care hours and caregiving years) using online data collection. Nine groups of caregivers were formed by the care recipient's health condition. Caregiver groups were similar in gender (95% women) and race/ethnicity (88% white), and differed on age (F=4.74; p<.001) daily care hours, and caregiving years (F's=2.76 and 2.84; p<.01). The findings suggest that caution is needed when recruiting caregivers through social media as the sample may not represent all caregivers. However, differences by care recipient condition on age and burden of care warrant further consideration.

Parenting a Child in Residential Treatment: Mother's Perceptions of Programming Needs.

The purpose of this study was to describe the experiences and perspectives of mothers with children in residential treatment (RT) regarding parenting, discharge planning, and home-based safety. One-hour interviews were conducted over the phone with 15 mothers. Transcripts were analyzed using a content analysis approach. Three themes were generated including parenting a child in RT, unprepared for discharge, and crisis intervention in the home. This study contributes insight into the lives of an underserved population with implications to inform future research interventions and clinical guidelines to address the needs of families with children in RT.

Family resilience and flourishment: Well-being among children with mental, emotional, and behavioral disorders.

Approximately 20% of children and adolescents in the United States are affected by mental, emotional, and behavioral (MEB) disorders. Child flourishment and family resilience contribute to healthy family development, including the promotion of child MEB wellbeing. Identifying factors that promote child flourishment and family resilience are critical. This study aimed to determine the prevalence and parenting factors associated with family resilience and child flourishment among children aged 6-17 years with MEB disorders. This was a secondary analysis of the 2016-2017 National Survey of Children's Health. The sample consisted of parents and their children (n = 1,900, weighted n = 5,375,670). Data were weighted to be representative of the US population and analyzed using descriptive statistics and linear regression. We found that only 6.3% of children aged 6-17 with an MEB were optimally flourishing. Parental aggravation was negatively associated with child flourishment, and parental coping was positively associated with child flourishment. In total, 66.5% of families with children exhibited resilience. Parental coping and availability of parental emotional support were positively associated with family resilience. Potential interventions that leverage study findings include parent training to increase parental emotional regulation (e.g., increase frustration tolerance, coping skills) and family navigation services to increase parental support (e.g., emotional support, coping skills) through the child's treatment trajectory. Overall, this study provides evidence of a disparity in flourishment in America's youth with MEB disorders, and despite this adversity, families are resilient.

A Qualitative Metasynthesis of Mothers' Adverse Childhood Experiences and Parenting Practices.

INTRODUCTION: Despite the known prevalence and detrimental health outcomes associated with adverse childhood experiences (ACEs), extant literature has rarely focused on the impact of ACEs on mothers' parenting practices. The purpose of this metasynthesis was to synthesize qualitative studies to understand how mothers with a history of ACEs parent their children. METHOD: A systematic search was conducted across five databases with 11 studies meeting eligibilty criteria. Relevant data were extracted and analyzed with qualitative description. RESULTS: Six subthemes and three themes emerged from the data. Themes included breaking the cycle, parent and child well-being, and supporting mothers. All mothers described strategies to protect their children, with some describing hypervigilant parenting practices. Mothers discussed worries about appropriate discipline and a pervasive fear of community-based services for fear of removal of the child. Across studies, mothers described their current support system and offered several suggestions for formal support services. DISCUSSION: This metasynthesis provides the synthesized perspectives of traumatized mothers' parenting practices, which may inform future interventions.

Prevalence and risk factors of intimate partner violence among Chinese immigrant women.

AIMS: To investigate the prevalence and risk factors of intimate partner violence among Chinese immigrant women residing in the USA. DESIGN: A cross-sectional study using the online survey approach. METHODS: A total of 475 Chinese immigrant women were recruited online between April-June 2019. We measured past year intimate partner violence, sociodemographic, relationship-related and immigration-related factors, religion, social support, acculturation, adverse childhood experiences, and gender role beliefs. RESULTS: Twenty-one percent of Chinese immigrant women experienced past year intimate partner violence. Younger age, cohabiting relationship, lower levels of relationship satisfaction and social support, older age at arrival, longer length of stay, religious belief, and adverse childhood experiences were associated with the occurrence of intimate partner violence. CONCLUSION: Chinese immigrant women experience higher rates of intimate partner violence compared with other populations of women. Future research is still needed to elucidate abused Chinese immigrant women's violence experiences, help-seeking behaviours, availability of resources and needs for services to tailor prevention and intervention programs culturally. IMPACT: The findings added to our understanding of intimate partner violence among this largest Asian immigrant group. Modifiable risk factors such as social support should be targeted in future preventions and interventions for abused Chinese immigrant women residing in the USA.

Adverse Childhood Experiences and Mental Health among Women Experiencing Intimate Partner Violence.

This study described the frequency of different adverse childhood experience (ACE) types described by women with recent IPV and examined the effects of each ACE type on women's mental health. Over 70% of women reported parental separation or divorce, over 40% reported childhood sexual assault, and around 40% had a mother who was treated violently. Childhood physical abuse and sexual assault were associated with more severe posttraumatic stress disorder or depressive symptoms. Comprehensive interventions that address not only the effects of IPV but also the enduring effects of ACEs are needed to promote mental health for survivors of IPV.

"Fighting Tooth and Nail": Barriers to Accessing Adolescent Mental Health Treatment from Mothers Perspectives.

Residential treatment (RT) serves 311,000 children and adolescents per year and has been described as a "last resort" by families, healthcare providers, and insurance payors as it is highly disruptive and costly. The purpose of this study was to explore mothers' accounts of the strategies and services they used before admitting their adolescent to RT as well as to understand the barriers they encountered in their adolescent's treatment trajectory. This was a cross-sectional study in which 15 mothers of adolescents currently or previously in RT completed 1-h phone interviews. Data were analyzed using content analysis generating two themes and seven subthemes. The first theme, 'the lead up to residential treatment,' consists of descriptions of the treatment modalities before RT and mothers' initial impressions of RT. The second theme, "fighting tooth and nail," consists of descriptions of mothers' actions to get their adolescent the mental health services they needed as well as the barriers they navigated along the way. While their adolescents were serious threats to themselves and others, mothers reported encountering significant obstacles to accessing RT, including substantial societal and financial barriers. While there is no shortage of evidence-based practices available that are effective in reducing disruptive behaviors in children, there are still macro-level implementation barriers that families are navigating to access mental health treatment for their child.

Keeping it together for the kids: New mothers' descriptions of the impact of intimate partner violence on parenting.

BACKGROUND: Intimate partner violence (IPV) affects 1 in 3 US women with the effects of IPV detectable for several generations. While IPV is known to have significant impacts on maternal-child outcomes, little is known about the mother's perspectives of the interplay between perinatal IPV exposure, parenting styles, and safety strategies. METHODS: This secondary analysis of semi-structured, longitudinal qualitative interview data explored with pregnant women their histories of IPV, their parenting practices, and safety strategies. Data were derived from a randomized controlled trial, DOVE, with 22 interviews from 11 women collected during pregnancy and 12 or 24 months postpartum. RESULTS: Data were analyzed using constant comparative analysis resulting in three themes: "broken spirit," "I want better for my kids and me," and "safety planning as an element of parenting." Women described at baseline having a "broken spirit" due to their experiences with household and family chaos and childhood abuse. However, when mothers ended the abusive relationship, they described a better life and several strategies to protect themselves and their children. During their final interviews, mothers discussed how their lives improved after ending the relationship as well as safety planning strategies they employed like looking for "red flags" in potential partners, struggles with finding trustworthy childcare, and stockpiling money should they choose to end the relationship. CONCLUSION: These rich data add new information about how mothers of very young children navigate difficult parenting and safety decisions in the context of lifetime traumatic events and provide insights relevant for practice and research with this highly-vulnerable group of IPV survivors.

Stress and Depressive Symptoms Among Demographically Diverse American Pregnant Women.

Pregnancy is a sensitive period of life where mental health is of utmost importance to the mother's and child's well-being peripartum and beyond. To better prevent and treat common mental health conditions such as depressive symptoms and perceived stress (defined in this study to encompass psychological and physiological (heart rate variability (HRV)) dimensions), it is crucial to examine and report differences in mental health outcomes among demographically diverse pregnant women. Therefore, the purpose of this secondary analysis (N = 79) was to determine if there are differences in mental health outcomes between pregnant women who differ across demographic factors, as well as to determine if demographic factors predict mental health outcomes when controlling for other demographic variables. Findings indicate that there were significant differences in depressive symptoms and perceived stress by all demographic factors except age. Marital status and total household income were the only significant predictors of depressive symptoms and perceived stress, respectively, when all other factors were controlled. There were no significant differences or correlations between demographic variables and HRV. Pregnant women may be predisposed to adverse mental health outcomes, illustrating the need for more refined interventions that are sensitive to pre-existing factors.