Community-based participatory research with Black people and Black scientists: the power and the promise.

Community-based participatory research (CBPR) is a collaborative approach that involves active participation and input from members of the community on all aspects of the research process. CBPR is an important research method as it can empower communities to work with academicians and other scholars for more robust and culturally appropriate interventions. Although CBPR is useful regardless of race or ethnicity, it is particularly important for Black scientists and communities. This is because CBPR seeks to address social and health inequities by engaging with historically excluded communities, as well as to produce research that is relevant to the community. Successful CBPR initiatives can improve Black mental health through collaboration, empowerment, and cultural sensitivity, as the current under-representation of Black scientists hampers mental health equity efforts. Equal funding of Black scientists is key to conducting community-engaged research. We discuss CBPR and its importance for Black mental health, case studies of CBPR conducted by Black scientists, Black leaders, and community members, and what is necessary for Black people to attain mental health in an inherently racist society.

Mental Health Disparities Among College Students of Color.

PURPOSE: Understanding the mental health needs of students of color is a growing priority on college and university campuses nationwide. This study aims to capture the state of mental health among students of color, including the prevalence of mental health problems and treatment utilization. METHODS: The sample is comprised of 43,375 undergraduate and graduate students at 60 institutions that participated in the survey-based Healthy Minds Study from 2012 to 2015. These data include over 13,000 students of color; we look separately at African-American, Latinx, Asian/Asian American, and Arab/Arab American students. Data are analyzed at the individual level using bivariate and multivariate modeling to elucidate variations across race/ethnicity. We examine symptom prevalence (measured by validated screens such as the Patient Health Questionnaire-9 for depression), help-seeking behaviors, and related factors (including knowledge and stigma). RESULTS: Across race/ethnicity, we find modest variation in symptom prevalence and larger variation in service utilization. Overall, treatment use is lower among students of color relative to white students, even when controlling for other variables in regression models. Asian/Asian American students have the lowest prevalence of treatment, at only 20% among those with apparent mental health conditions. Attitudes related to mental health treatment also vary significantly and help to explain the primary findings. CONCLUSIONS: College students of color represent a disparities population based on greater levels of unmet mental health needs relative to white students. This paper takes an important step toward understanding these needs and points to implications for future research and practice.

Spirituality and religious coping in African American youth with depressive illness.

The research team completed a secondary data analysis of primary data from a 2 phase depression treatment engagement behavioral trial to assess African American adolescents reported experiences of spiritual and religious coping when dealing with depression. The team utilized data collected from twenty-eight youth who participated in focus groups or individual interviews. Qualitative data were analyzed using thematic techniques for transcript-based analysis to identify the key patterns and elements of the study participants' accounts and to extract 6 primary themes. The main themes are reported in this manuscript and include; "Religion as Treatment Incentive", "Prayer & Agency", "Mixed Emotions", "Doesn't Hurt, Might Help", "Finding Support in the Church", and "Prayer and Church: Barriers to Treatment?" Overall, the data suggested that religion and spirituality play a key role in African American adolescents' experiences of depression. As well, it is surmised that these factors may be important for improving treatment seeking behaviors and reducing racial mental health disparities in this population of youth.

The Significance of Strategic Community Engagement in Recruiting African American Youth & Families for Clinical Research.

We present baseline data and describe the utility of a community engaged, culturally relevant approach to recruiting African American youth and families for phase I of The AAKOMA Project. The AAKOMA Project is a two phase treatment development study to improve mental health service use among depressed African American youth. We completed capacity building activities using a community engaged framework and Community Based Participatory Research (CBPR) methods. Replicating the (Alvarez et al. in West J Nurs Res 28:541-560, 2006) model of systematic community out-reach enhanced our ability to effectively recruit partners and evaluate outreach efforts as demonstrated by our Recruitment Success Factor (RSF-i.e. 'an adjusted ratio of eligible participant yield to contacts made'). Using the chi-square goodness-of-fit statistic; we compared the RSFs of the various modes of participant study entry to determine which was most effective. Our target enrollment was 56 persons. We recruited 130 and enrolled 57. Our baseline data is drawn from a gender balanced and socioeconomically diverse sample who participated in youth focus groups and individual interviews and adult focus groups. We identified 3 study participant referral modes (self-referral, provider referral and participant-to-participant referral) with multiple sources per mode and an overall RSF of 0.41. Study findings support the effectiveness of assiduous and systematic community interaction, reflective review of recruitment efforts and the importance of disseminating information on strategic recruitment processes for engaging diverse populations in clinical research.

Community and treatment engagement for depressed African American youth: the AAKOMA FLOA pilot.

This manuscript focuses on the recruitment efforts and pilot testing of a culturally tailored motivational interviewing intervention associated with the AAKOMA Project, a 2-phase treatment engagement intervention trial for depressed African American adolescents and families. The research team used strategic community engagement as reported in other research derived from AAKOMA. For the pilot study, the research team recruited 23 youth, enrolled 17 youth and randomized 16 of those youth to either the intervention or a delayed control group. Findings indicated that success in recruiting and retaining African American youth was sustained from earlier strategic engagement during Phase I of the project and that schools and self referrals were the largest referral sources. Pilot intervention findings highlight the preliminary utility of the intervention (100% of youth completing the intervention initiated depression treatment compared to 75% of the delayed control group) and factors that support the recruitment and engagement of a typically difficult to reach population (depressed African American youth and families). Overall, findings set the stage for further intervention development and testing in larger samples.

Early Career Boot Camp: a novel mechanism for enhancing early career development for psychologists in academic healthcare.

The purpose of this article is to describe a pilot mentoring program for Early Career Psychologists (ECPs) working in Academic Health Centers (AHCs) and synthesize the lessons learned to contribute to future ECP and AHC career development training programs. The authors describe an early career development model, named the Early Career Boot Camp. This intensive experience was conducted as a workshop meant to build a supportive network and to provide mentorship and survival tools for working in AHCs. Four major components were addressed: professional effectiveness, clinical supervision, strategic career planning, and academic research. Nineteen attendees who were currently less than 5 years post completion of doctoral graduate programs in psychology participated in the program. The majority of boot camp components were rated as good to excellent, with no component receiving below average ratings. Of the components offered within the boot camp, mentoring and research activities were rated the strongest, followed by educational activities, challenges in AHCS, and promotion and tenure. The article describes the purpose, development, implementation, and assessment of the program in detail in an effort to provide an established outline for future organizations to utilize when mentoring ECPs.

Spirituality vis-a-vis Islam as prerequisite to Arab American well being: the implications of Eurocentrism for mainstream psychology.

Due to the historical preponderance of racial and/or intellectual homogeneity in the field of psychology, Eurocentrism set the "gold standard" for its method of intervention. As such, it might be argued that psychology remains a bastion of Eurocentric thought despite the globalization of knowledge and the influx of racially and ethnically diverse scientists into the research endeavor. At the same time and the significant increase in the immigrant Arab population, Arab Americans remain a less familiar component of society. Among the various Arab populations, spirituality through Islam is fundamental. Thus, psychologists would be remiss to exclude a critical aspect of Arab American life from intervention when it is essential to well-being.

Juvenile mental health courts for adjudicated youth: role implications for child and adolescent psychiatric mental health nurses.

TOPIC: Juvenile mental health courts for adjudicated youth. PURPOSE: To describe the role of psychiatric nurses in reducing mental health disparities for adjudicated youth via juvenile mental health courts. SOURCES: ISI Web of Knowledge; Sage Journals Online; HighWire; PubMed; Google Scholar and Wiley Online Library and websites for psychiatric nursing organizations. Years included: 2000-2010. CONCLUSIONS: Juvenile mental health courts may provide a positive and effective alternative to incarceration for youth with mental health problems with psychiatric nurses playing a key role in program implementation.

"Mama just won't accept this": adult perspectives on engaging depressed African American teens in clinical research and treatment.

This manuscript focuses on qualitative data collected for AAKOMA Project, a 2-phase treatment engagement intervention trial for depressed African American adolescents and families. Data are presented from our phase I study of adult perspectives on African American adolescent depression, depression treatment, and research engagement. The research team conducted four focus groups (N = 24) and generated major themes from the data including ideas regarding the manifestations of depression in African American youth and psychosocial barriers to participation in depression research and treatment. Findings indicate that success in recruiting and retaining African American youth in depression research and treatment may include using innovative means to overcome the culturally embedded attributions of depression to non-biological causes, beliefs about the cultural insensitivity of treatments and challenges in the logistics of obtaining care. Adults report that encouraging youth and familial involvement in treatments and research should include targeted, community-partnered activities involving diverse staff in leadership roles and including community members as equal partners.

Pathways to success for psychologists in academic health centers: from early career to emeritus.

Careers in academic health centers (AHCs) come with a unique set of challenges and rewards. Building a stable and rewarding career as a psychologist in an AHC requires the efforts of a whole team of players and coaches. This paper outlines the characteristics of AHCs and the general skills psychologists need to thrive in this type of setting. Advice specific to each stage of career development (early, mid, and late) is offered, highlighting the themes of coaching and teamwork that are critical to success in an AHC.

Engaging depressed African American adolescents in treatment: lessons from the AAKOMA PROJECT.

The authors describe and illustrate means of engaging depressed African American adolescents in treatment. Twenty-eight youth participated in focus groups or individual interviews. Using grounded theory and transcript based analysis, they derived 5 themes describing African American adolescents' experience of depression and suggested mechanisms for improving African American youth treatment engagement. Practitioners can educate African American youth about depression as a medical disorder, build trust, and apply innovative approaches to recognizing differential manifestations of depression in African American youth.

Ethnic differences among adolescents beginning treatment for depression.

This study examines ethnic/racial differences at the start of treatment among participants in the Treatment for Adolescents with Depression Study (TADS). African American and Latino youth were compared to Caucasian youth on symptom presentation and cognitive variables associated with depression. Contrary to hypothesis, there were no significant differences in symptom presentation as measured by the interview-based items of the Children's Depression Rating Scale--Revised (CDRS-R). However, African American and Latino youth were both rated as demonstrating more severe symptoms on the observational items of the CDRS-R compared to Caucasian youth. In terms of cognitive variables associated with depression, African Americans reported fewer negative cognitive biases compared to Caucasians, but cognitive biases were significantly correlated with depression severity across ethnic groups.

The child and adolescent psychiatry trials network (CAPTN): infrastructure development and lessons learned.

BACKGROUND: In 2003, the National Institute of Mental Health funded the Child and Adolescent Psychiatry Trials Network (CAPTN) under the Advanced Center for Services and Intervention Research (ACSIR) mechanism. At the time, CAPTN was believed to be both a highly innovative undertaking and a highly speculative one. One reviewer even suggested that CAPTN was "unlikely to succeed, but would be a valuable learning experience for the field." OBJECTIVE: To describe valuable lessons learned in building a clinical research network in pediatric psychiatry, including innovations intended to decrease barriers to research participation. METHODS: The CAPTN Team has completed construction of the CAPTN network infrastructure, conducted a large, multi-center psychometric study of a novel adverse event reporting tool, and initiated a large antidepressant safety registry and linked pharmacogenomic study focused on severe adverse events. Specific challenges overcome included establishing structures for network organization and governance; recruiting over 150 active CAPTN participants and 15 child psychiatry training programs; developing and implementing procedures for site contracts, regulatory compliance, indemnification and malpractice coverage, human subjects protection training and IRB approval; and constructing an innovative electronic casa report form (eCRF) running on a web-based electronic data capture system; and, finally, establishing procedures for audit trail oversight requirements put forward by, among others, the Food and Drug Administration (FDA). CONCLUSION: Given stable funding for network construction and maintenance, our experience demonstrates that judicious use of web-based technologies for profiling investigators, investigator training, and capturing clinical trials data, when coupled to innovative approaches to network governance, data management and site management, can reduce the costs and burden and improve the feasibility of incorporating clinical research into routine clinical practice. Having successfully achieved its initial aim of constructing a network infrastructure, CAPTN is now a capable platform for large safety registries, pharmacogenetic studies, and randomized practical clinical trials in pediatric psychiatry.

Ethnic Differences in Attributions and Treatment Expectancies for Adolescent Depression.

Studies suggest that ethnicity and socioeconomic factors may relate to differences in treatment expectancies and the attributions made for emotional or behavioral problems. We examined ethnic differences in (1) parents' attributions about the causes of adolescent behavioral and emotional problems and (2) treatment expectancies among 236 adolescent participants who enrolled in a 36-week randomized controlled trial for depression. Controlling for education and income, European American parents were more likely to endorse beliefs reflecting physical causes of depression than African American parents. There were no ethnic differences for beliefs reflecting external, familial, or community factors. Ethnic differences were observed in the treatment expectancies reported by parents, but not adolescents, with African American parents more likely than European Americans and Other minorities to endorse positive expectations for CBT. These findings may have implications for understanding discrepancies in mental health service use.

Factors associated with recruitment and screening in the Treatment for Adolescents With Depression Study (TADS).

OBJECTIVE: To examine factors associated with eligibility and randomization and consider the efficiency of recruitment methods. METHOD: Adolescents, ages 12 to 17 years, were telephone screened (N = 2,804) followed by in-person evaluation (N = 1,088) for the Treatment for Adolescents With Depression Study. Separate logistic regression models, controlling for site, examined whether sex, age, race, or source of recruitment was associated with eligibility, providing written consent, or randomization. Efficiency was calculated from the number of completed telephone screens per each enrolled participant. RESULTS: Older adolescents were less likely to be eligible at telephone screening (odds ratio [OR] 0.81). Regardless of race, eligible adolescents who were referred by a professional had higher odds of presenting in-person for consent (OR 1.56). African Americans had statistically lower odds of providing consent (OR 0.67), particularly if recruited by advertisement (OR 0.54). Females were more likely to be diagnosed with major depressive disorder (OR 1.69). No significant differences were found between randomized participants and eligible adolescents who withdrew from the study before randomization. CONCLUSIONS: These findings underscore the importance of using multiple strategies to recruit adolescents for clinical trial participation and enhancing sensitivity to cultural variations, especially when reaching out to depressed African Americans.

Expression and treatment of depression among Haitian immigrant women in the United States: clinical observations.

Existing research demonstrates that culture has a profound impact on the expression and manifestation of mental illness, especially on depressive disorders among ethnically diverse populations. Currently, little research has focused on the Haitian population, despite the growing number of Haitians living in the United States. This paper discusses clinical observations of the expression of depression among Haitian immigrant women living in the United States. Specifically, this paper examines three distinctive types of depression (pain in the body, relief through God, and fighting a winless battle), explains their symptoms, and provides case examples to illustrate the expression of each type of depression. Additionally, the paper describes treatment processes for each type of depression and makes recommendations to mental health providers with respect to each type of depression. The information provided in this paper highlights the importance of a more systematic and scientific investigation of depression among Haitian women, men, and youths in the United States.

Pilot test of cooperative learning format for training mental health researchers and black community leaders in partnership skills.

To support reduction of racial disparities in mental health diagnosis and treatment, mental health researchers and black community-based organization (CBO) leaders need training on how to engage in collaborative research partnerships. In this study, we pilot tested a series of partnership skills training modules for researchers and CBO leaders in a collaborative learning format. Two different sets of three modules, designed for separate training of researchers and CBO leaders, covered considering, establishing and managing mental health research partnerships and included instructions for self-directed activities and discussions. Eight CBO leaders participated in 10 sessions, and six researchers participated in eight sessions. The effectiveness of the training content and format was evaluated through standardized observations, focus group discussions, participant evaluation forms and retrospective pre-/posttests to measure perceived gains in knowledge. Participants generally were satisfied with the training experience and gained new partnership knowledge and skills. Although the CBO leaders were more engaged in the cooperative learning process, this training format appealed to both audiences. Pilot testing demonstrated that: 1) our modules can equip researchers and CBO leaders with new partnership knowledge and skills and 2) the cooperative learning format is a well-received and suitable option for mental health research partnership training.

Family first: the development of an evidence-based family intervention for increasing participation in psychiatric clinical care and research in depressed African American adolescents.

Researchers have documented health disparities for African American and other youth of color in the area of mental health. In accordance with calls for the development of innovative methods for use in reducing these disparities, the purpose of this article is to describe the development of an evidence-based intervention targeting the use of psychiatric clinical care by African American families. The authors summarize current research in the areas of perceived and demonstrated bias in the provision of mental health services, the significance of the problem of low African American participation in psychiatric clinical research and care, and evidence-based approaches to conducting family-oriented research to address adolescent mental illness in this population. This discussion is followed by a description of the development of an intervention to improve familial treatment engagement and plans to test the intervention. The article is provided as a foundation for carefully defined plans to address the unmet mental health needs of depressed African American adolescents within a culturally relevant familial context.

Using and teaching evidence-based medicine: the Duke University child and adolescent psychiatry model.

Evidence-based medicine (EBM) is defined as a set of processes that facilitate the conscientious, explicit, and judicious integration of individual clinical expertise with the best available external clinical evidence from systematic research in making decisions about the care of individual patients. EBM focuses not only on grading the strength of the evidence but also on the processes and tools that are necessary for clinicians to continually upgrade their knowledge and skills for those problems encountered in daily practice. This article, authored by members of the Duke Pediatric Psychiatry EBM Seminar Team, (1) describes EBM as applied to the training of child and adolescent psychiatrists in the Division of Child and Adolescent Psychiatry, Department of Psychiatry at Duke University Medical Center; (2) presents a simplified discussion of EBM as a technology for training and patient care; (3) discusses the basic principles and procedures for teaching EBM in the setting of a multidisciplinary training program; and (4) briefly mentions two training and research initiatives that are furthered by incorporating EBM.