Scoping Review: Digital Mental Health Interventions for Children and Adolescents Affected by War.

OBJECTIVE: Over 200 million children and adolescents live in countries affected by violent conflict, are likely to have complex mental health needs, and struggle to access traditional mental health services. Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support. We performed a scoping review to map existing digital mental health interventions relevant for children and adolescents affected by war, examine the strength of the evidence base, and inform the development of future interventions. METHOD: Based on a pre-registered strategy, we systematically searched MEDLINE, Embase, Global Health, APA PsychInfo, and Google Scholar from the creation of each database to 30th September 2022, identifying k=6,843 studies. Our systematic search was complemented by extensive consultation with experts from the GROW Network. RESULTS: The systematic search identified 6 relevant studies: one evaluating digital mental health interventions for children and adolescents affected by war and five for those affected by disasters. Experts identified 35 interventions of possible relevance. The interventions spanned from universal prevention to specialist-guided treatment. Most interventions directly targeted young people and parents/carers and were self-guided. A quarter of the interventions were tested through randomized controlled trials. Because most interventions were not culturally or linguistically adapted to relevant contexts, their implementation potential was unclear. CONCLUSION: There is very limited evidence for the use of digital mental health interventions for children and adolescents affected by war at present. The review provides a framework to inform the development of new interventions.

Impulsivity profiles across five harmonized longitudinal childhood preventive interventions and associations with adult outcomes.

This study aimed to parse between-person heterogeneity in growth of impulsivity across childhood and adolescence among participants enrolled in five childhood preventive intervention trials targeting conduct problems. In addition, we aimed to test profile membership in relation to adult psychopathologies. Measurement items representing impulsive behavior across grades 2, 4, 5, 7, 8, and 10, and aggression, substance use, suicidal ideation/attempts, and anxiety/depression in adulthood were integrated from the five trials (N = 4,975). We applied latent class growth analysis to this sample, as well as samples separated into nonintervention (n = 2,492) and intervention (n = 2,483) participants. Across all samples, profiles were characterized by high, moderate, low, and low-increasing impulsive levels. Regarding adult outcomes, in all samples, the high, moderate, and low profiles endorsed greater levels of aggression compared to the low-increasing profile. There were nuanced differences across samples and profiles on suicidal ideation/attempts and anxiety/depression. Across samples, there were no significant differences between profiles on substance use. Overall, our study helps to inform understanding of the developmental course and prognosis of impulsivity, as well as adding to collaborative efforts linking data across multiple studies to better inform understanding of developmental processes.

Family Matters: The Effects of Multigenerational Community Violence Exposure on Family Functioning.

Exposure to community violence is known to be associated with a host of maladaptive outcomes in both youth and adult populations. Though frequently examined in other interpersonal violence literature, family functioning has yet to be examined as an outcome in community violence literature. The current study begins to address this need by exploring the impact of parent and child's exposure to community violence on parents' perception of family functioning. Two hundred parent-child dyads (sons Mage =12.39, SD = 1.22 at baseline; mothers Mage = 42.79, SD = 9.21 at Wave 5) living in under-resourced, urban neighborhoods completed self-report questionnaires about their exposure (i.e., direct or indirect) to violent events in their community within the last year. The parents then completed an additional self-report questionnaire about their perception of family functioning at one year and three years post community violence exposure, respectively. Results of general linear modeling showed that at one- and three-years post-direct and indirect exposure, family cohesion and family communication was highest when 1) neither the parent nor child were exposed and when 2) only the child was exposed. Family functioning was at its lowest levels when the group included a parent who reported direct or indirect exposure to community violence. The results highlight a need to provide family-based psychosocial interventions to families exposed to violence to help preserve both individual and family functioning after exposure.

Psychosis Symptom Trajectories Across Childhood and Adolescence in Three Longitudinal Studies: An Integrative Data Analysis with Mixture Modeling.

Psychotic-like experiences (PLEs) are common throughout childhood, and the presence of these experiences is a significant risk factor for poor mental health later in development. Given the association of PLEs with a broad number of mental health diagnoses, these experiences serve as an important malleable target for early preventive interventions. However, little is known about these experiences across childhood. While these experiences may be common, longitudinal measurement in non-clinical settings is not. Therefore, in order to explore longitudinal trajectories of PLEs in childhood, we harmonized three school-based randomized control trials with longitudinal follow-up to identify heterogeneity in trajectories of these experiences. In an integrative data analysis (IDA) using growth mixture modeling, we identified three latent trajectory classes. One trajectory class was characterized by persistent PLEs, one was characterized by high initial probabilities but improving across the analytic period, and one was characterized by no reports of PLEs. Compared to the class without PLEs, those in the improving class were more likely to be male and have higher levels of aggressive and disruptive behavior at baseline. In addition to the substantive impact this work has on PLE research, we also discuss the methodological innovation as it relates to IDA. This IDA demonstrates the complexity of pooling data across multiple studies to estimate longitudinal mixture models.

Predicting implementation of the PAX Good Behavior Game + MyTeachingPartner interventions.

Introduction: Effective classroom management is critical to creating a classroom environment in which social, emotional, and academic learning can take place. The present study investigated the association between early career, early elementary teachers' occupational health (job stress, burnout, and perceived teaching ability) and perceptions of program feasibility in relation to their implementation dosage and quality of two evidence-based classroom management programs implemented together: the PAX Good Behavior Game (GBG) and MyTeachingPartner (MTP) intervention. Methods: Teachers provided information on their occupational health at the start of the school year and were then randomized to the PAX GBG + MTP condition or control condition. Teachers' perceptions of the feasibility of the program, implementation dosage, and implementation quality of the intervention were measured at the end of the school year for the 94 intervention teachers. Results: Teachers participated in more MTP coaching cycles when they reported that the combined PAX GBG + MTP program was feasible. Although there were no main effects of occupational health on implementation, the associations between job stress and implementation quality were moderated by perceptions of feasibility. Discussion: Findings highlight the complexity of factors influencing the implementation of evidence-based programs in school settings.

Revisiting the effectiveness of repetitive transcranial magnetic stimulation treatment in depression, again.

Following on from the publication of the Royal Australian and New Zealand Journal of Psychiatry Mood Disorder Clinical Practice Guidelines (2020) and criticisms of how these aberrantly addressed repetitive transcranial magnetic stimulation treatment of depression, questions have continued to be raised in the journal about this treatment by a small group of authors, whose views we contend do not reflect the broad acceptance of this treatment nationally and internationally. In fact, the evidence supporting the use of repetitive transcranial magnetic stimulation treatment in depression is unambiguous and substantial, consisting of an extensive series of clinical trials supported by multiple meta-analyses, network meta-analysis and umbrella reviews. Importantly, the use of repetitive transcranial magnetic stimulation treatment in depression has also been subject to a series of health economic analyses. These indicate that repetitive transcranial magnetic stimulation is a cost-effective therapy and have been used in some jurisdictions, including Australia, in support of public funding. An argument has been made that offering repetitive transcranial magnetic stimulation treatment may delay potentially effective pharmacotherapy. In fact, there is considerably greater danger of the opposite happening. Repetitive transcranial magnetic stimulation is as, if not more effective, than antidepressant medication after two unsuccessful medication trials and should be a consideration for all patients under these circumstances where available. There is no meaningful ongoing debate about the use of repetitive transcranial magnetic stimulation treatment in depression - it is a safe, effective and cost-effective treatment.

PROTOCOL: The effectiveness, implementation and cost effectiveness of mentoring programmes in reducing anti-social, violent and offending behaviour in children aged 17 years and below: A mixed method systematic review.

This is the protocol for a Campbell systematic review. The review will address the following research questions: What is the evidence on the effects of adult mentoring programmes in reducing anti-social, violent and offending behaviour in children aged under 18 years? Are these effects sustained after the end of mentoring? Which aspects/features of adult mentoring programmes promote the reduction of anti-social, violent and criminal behaviour in children aged under 18 years? What are the hindering factors/barriers that affect the successful implementation of adult mentoring programmes in children aged under 18 years? What are the supporting factors/facilitators that contribute to the successful implementation of adult mentoring programmes in children aged under 18 years? What is the evidence on programme costs and incremental cost effectiveness? (The incremental (or marginal cost) is the cost of providing the intervention over and above the cost of usual services).

Improving understanding of how mentoring works: Measuring multiple intervention processes.

The objective is to develop and test dimensionality and validity of a new measure of five mentoring intervention processes drawn from emphases across prior mentoring efforts that might be the basis for effects: identification with the mentor, social and emotional support, teaching and education, and advocacy, and shared time and activity. Partial validation of value was drawn from moderation role in a meta-analysis of mentoring (Tolan, Henry, Lovegrove, Schoeny, & Nichols, 2014. J. Exp. Criminol., 10, 179-201). Data collected of candidate items completed by 740 mentors and 302 mentees (mean age = 16.59 years) were subjected to confirmatory factor analyses based on the five theorized dimensions. Scales derived from best-fitting solutions were examined for convergent validity in relation to other indicators of mentoring relationship qualities. A bifactor model with five specific factors was supported for adult mentor reports while a simplified single factor model fit youth reports. Correlations between derived scale scores and validity indicators of mentoring relationship qualities were consistent with expectations. Multiple activities that comprise mentoring can be identified in adult mentor reports but not youth reports. This scale provides a promising basis for testing how variation in emphasis during mentoring affects impact and help guide training emphases.

Randomized trial testing the integration of the Good Behavior Game and MyTeachingPartner™: The moderating role of distress among new teachers on student outcomes.

A growing body of research documents the effectiveness of classroom management programs on a range of student outcomes, yet few early-career teachers receive training on these practices prior to entering the classroom. Moreover, few studies have attended to how variations in teacher distress or level of classroom misbehavior affects training benefits. This study reports findings from a randomized trial of a teacher training program that combined two evidence-based programs (Good Behavior Game [GBG] and MyTeachingPartner™ [MTP]) to determine their impact on novice teachers and their students. In addition, the current study reports findings on moderated impacts by initial teacher distress as well as the overall classroom level of misbehavior. The sample included 188 early-career teachers (grades K-3) in their first three years of teaching from three large, urban school districts. Analyses indicated that intervention had no main effects, but yielded moderated impact depending on the combination of the baseline levels of classroom disruptive behavior and teacher distress; it appears that the program impacts were greatest in the highest risk circumstance (i.e., high teacher stress and elevated challenging student behaviors). For those classrooms, those assigned to intervention evidence improved behavior and student achievement compared to control counterparts by the spring of the training year, relative to the fall baseline (d = 0.18-0.70 depending on outcome). This study is significant in that it highlights effects during a critical window of training and coaching for early career teachers and the need to consider teacher and classroom contextual factors that may moderate professional development efforts.

Commentary: Enabling efficient and full application of prevention strategies for population mental health - reflections on Dodge (2020).

Dodge (2020) provides a challenging and compelling formulation for more systematic determination of prevention component selection. The essay reminds us that population impact should be front and center in prevention specifically and public health organization in general. Dodge brings forth numerous issues in the science and the application of knowledge about prevention that warrant more research support and study. These issues include the need to recognize the existence of and increase the number of proven programs, the need for better and more extensive knowledge about impact variation across populations, and more attention to strengths and capabilities as guides for prevention. His essay also reminds us of the nuance and complexities in attempting to compare effect sizes and cost-benefit ratios of universal versus selective efforts. In addition, he provides compelling rationale for formalization of how prevention is organized and implemented in local community efforts. Further, in refocusing on the centrality of population effects in intervention application, Dodge also reminds us of the attendant principles of health equity and social justice in how we implement and judge the benefits of interventions. This essay provides a compelling argument for a strategy to realize the potential of the accumulating evidence of prevention as vital for addressing mental health and development.

Family Support and Connection Groups: Long-Term Benefits for Inner-City Children?

Relatively few prevention trials have had long-term follow-up to determine if immediate impact translates to and explains long-term impact. The present report summarizes the long-term influence (measured when students are near the end of high school) of the SAFEChildren preventive intervention, which was applied during first grade. This program aims to facilitate and support developmental management, school-family connection, and social support among neigbhors through family groups and student tutoring and is focused on familes raising children in inner-city neighborhoods. Of the 424 families randomly assigned prior to first grade to intervention or no-intervention control, outcome data on at least one outcome was obtained for 375 (88.4%). Results indicate no long-term direct effects and a single mediated effect, with those in the intervention less likely to engage in risky sexual practices. Similar but non-significant trends were found for alcohol use and violence. These mixed results may suggest that family focused intervention that is relatively brief is not adequate to protect against multiple and ongoing developmental risk that arises in such communities. The limited impact is discussed in light of the uncertainty of subsequent condition on initial preventive benefits and the developmental ecology of the inner city. Implications for preventive intervention programming and for long-term evaluation are also addressed.

Scaling up Evidence-Based Interventions Within the US Public Health Market.

The Mapping Advances in Prevention Science IV (MAPS-IV) Translation Research Task Force report provides an important enumeration of challenges and potential opportunities for improving extent of implementation of evidenced based interventions. The aspiration is for scientifically based prevention to be implemented widely enough to show population level shifts in incidence and prevalence. The MAPS-IV Task Force report by Fagan and colleagues (2019) provides a thoughtful and informative report that notes important exemplars towards that goal as well as key challenges and suggests strategies for greater impact across five publicly funded systems affecting human development. Comments are offered that center around the value of embedding prevention science within often larger and more sustained social and political forces as well as embracing scaling up within the complex funding streams in which prevention will be sustainable at scale. These include increasing attention to practical considerations that can affect how prevention is viewed, appreciated, and likely utilized as well as the ongoing challenge of how to relate evidenced based programs with the more prevalent and often preferred approaches of those deciding what is funded and what is actually implemented. This valuable contribution to Society for Prevention Research and prevention science is characterized as an important step toward strategies that might plausibly move prevention from primarily demonstration efforts to sustainable public health strategies integrated into the major systems of influence on human development.

The influence of parenting practices and neighborhood characteristics on the development of childhood aggression.

The present study examined the way in which neighborhood impoverishment, neighborhood social processes, and parenting practices relate to the development of aggressive behavior among children aged 6-8 years raised in low-income neighborhoods. A total of 424 children (male = 207, female = 217) and their families participated in the study. Hierarchical linear regression revealed that neighborhood impoverishment, neighborhood social processes, and parental monitoring/supervision were associated with childhood aggression 2 years later. Neighborhood social processes did not mediate the relation between neighborhood impoverishment and childhood aggression, nor did parental monitoring/supervision mediate the relation between neighborhood characteristics and childhood aggression. Children residing in neighborhoods with substantial poverty are at greater risk of developing aggressive behavior. Strong neighborhood social processes and high levels of parental supervision/monitoring are associated with lower levels of aggression. Despite the protective benefits of neighborhood social processes and high-quality parenting, neighborhood economic deprivation continues to elevate risk of developing aggressive behavior.

Fathers' Criminal Behavior and Involvement With Children: The Moderating Role of Family Relationships.

OBJECTIVE: Research indicates that fathers' criminal behavior can be problematic for children through multiple pathways, yet few studies have examined the effect of fathers' kinship networks in this process. This study examines the association between fathers' criminal behavior and involvement with their children and the extent to which a father's relationships with individuals in his extended family network moderate this association. METHOD: Hierarchical linear modeling was used to predict fathers' involvement using data from a longitudinal intergenerational study of 335 children and 149 low-income, minority fathers. Measures included 8 father-involvement outcomes, a measure of fathers' criminal behavior, and 2 moderator variables. RESULTS: High-quality relationships between fathers and their male relatives moderated the negative effect of criminal behavior on measures of fathers' involvement. Criminal behavior was only associated with decreasing levels of father involvement when fathers had low-quality relationships with male relatives. CONCLUSIONS: Strong and affirmative relationships-with male relatives specifically-may attenuate the adverse effects of antisocial and criminal behavior on fathers' involvement in at-risk families. Implications for tailoring practice to improve relationships between fathers and male relatives and to enhance fathers' prosocial involvement are noted.

Understanding development of African American boys and young men: Moving from risks to positive youth development.

African American boys and young men in the United States face challenges unique to being a male and an ethnic minority in our society. Despite the marginalization of African American boys and young men, this article argues that African American boys and young men, like other individuals, are in large proportion able to overcome adversity and utilize positive youth development assets and resources, and that focusing on capabilities and strengths is worthy of primary emphasis (Lerner, Dowling, & Anderson, 2003; Stevenson, 2016). García Coll and colleagues' (1996) integrative model of developmental competencies in minority children lays the groundwork for conceptualizing the profound influence of racism, economic disadvantage, oppression, segregation, and other trauma-inducing experiences on the development of African American boys and young men. We extend that framework by adding notions of positive development and adaptive calibration to contextual challenges to account for prosocial development of African American boys and young men. We present descriptive and experimental research support for this approach and argue that it has the potential for increasing the validity, sophistication, and utility of developmental research on about African American boys and young men are presented. (PsycINFO Database Record

Disagreement in Parental Reports of Father Involvement.

Despite agreement on the value of father involvement in children's lives, research has been limited due to the exclusion of fathers in studies, questionable validity of mothers' reports on father involvement, and simple measures of fathering behavior. Our study extends previous research by comparing reports of father involvement using robust, multidimensional father involvement measures. Data from 113 fathers and 126 mothers reporting on 221 children were used to assess father involvement. Results indicate that fathers reported significantly higher levels of involvement than mothers reported. Findings from hierarchical linear models suggest that race/ethnicity and mothers' reports of positive relationship quality were associated with smaller discrepancies in reports of father involvement, whereas nonmarried partnerships, older children, father residence, and biological status predicted larger discrepancies. Our study demonstrates the importance of obtaining father involvement reports directly from fathers and why father involvement should be assessed as a multidimensional construct to examine fathering behavior.

Alternatives to Randomized Control Trial Designs for Community-Based Prevention Evaluation.

Multiple factors may complicate evaluation of preventive interventions, particularly in situations where the randomized controlled trial (RCT) is impractical, culturally unacceptable, or ethically questionable, as can occur with community-based efforts focused on inner-city neighborhoods or rural American Indian/Alaska Native communities. This paper is based in the premise that all research designs, including RCTs, are constrained by the extent to which they can refute the counterfactual and by which they can meet the challenge of proving the absence of effects due to the intervention-that is, showing what is prevented. Yet, these requirements also provide benchmarks for valuing alternatives to RCTs, those that have shown abilities to estimate preventive effects and refute the counterfactual with limited bias acting in congruence with community values about implementation. In this paper, we describe a number of research designs with attending examples, including regression discontinuity, interrupted time series designs, and roll-out randomization designs. We also set forth procedures and practices that can enhance their utility. Alternative designs, when combined with such design strengths, can provide valid evaluations of community-based interventions as viable alternatives to the RCT.

Examining the effects of emotional and cognitive desensitization to community violence exposure in male adolescents of color.

The current study examined pathways in a model of desensitization, the Pathologic Adaptation Model, in adolescent males of color. Specifically, the current study examined depressive symptoms and deviant beliefs as mediators of the association between community violence exposure and subsequent violent behavior. The current study included 250 African-American (67%) and Latino (33%) male adolescents (T1 mean age = 15.32) from the Chicago Youth Development Study. Consistent with the Pathologic Adaptation Model, results demonstrated that depressive symptoms mediated the association between the quadratic violence exposure term in middle adolescence and violent behaviors in late adolescence, but the direction of the mediation effect was dependent upon the levels of violence exposure in middle adolescence. However, deviant beliefs were not found to be a significant mediator. Emotional desensitization effects may increase the likelihood of violence perpetration in adolescent males exposed to community violence, and the implications for future research and intervention efforts are discussed. (PsycINFO Database Record

Examining the Pathologic Adaptation Model of Community Violence Exposure in Male Adolescents of Color.

The current study examined a model of desensitization to community violence exposure-the pathologic adaptation model-in male adolescents of color. The current study included 285 African American (61%) and Latino (39%) male adolescents (W1 M age = 12.41) from the Chicago Youth Development Study to examine the longitudinal associations between community violence exposure, depressive symptoms, and violent behavior. Consistent with the pathologic adaptation model, results indicated a linear, positive association between community violence exposure in middle adolescence and violent behavior in late adolescence, as well as a curvilinear association between community violence exposure in middle adolescence and depressive symptoms in late adolescence, suggesting emotional desensitization. Further, these effects were specific to cognitive-affective symptoms of depression and not somatic symptoms. Emotional desensitization outcomes, as assessed by depressive symptoms, can occur in male adolescents of color exposed to community violence and these effects extend from middle adolescence to late adolescence.