Development and preliminary evaluation of a self-guided, internet-based tool for coping with stress and trauma: Life Improvement for Teens (LIFT).

Implementation issues often interfere with delivery of evidence-based interventions for students exposed to trauma. To improve uptake of evidence-based techniques for such students, a partnership of interventionist scientists, research and development experts, and students created a self-paced, confidential, online curriculum. This article describes the program and results of an open trial in 5 schools that serve primarily ethnic minority youth in urban settings. Fifty-one middle and high school students completed surveys before and after the program, as well as within the program, to assess emotional and behavioral symptoms (depressive, anxiety, posttraumatic stress disorder [PTSD] symptoms and behavior) and purported mechanisms of action (coping, cognitions, emotional self-efficacy). Results indicated the program was feasible and acceptable, with moderate satisfaction. Despite low power in this study, we observed changes in several hypothesized mechanisms of action. In addition, we observed promising improvements in PTSD symptoms, emotional problems, and total behavioral difficulties. These findings offer the promise of using a self-help web-based tool to augment and enhance usual school support services. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Cross-Site Partnership to Examine Implementation and Sustainability of a School-Based Trauma Program.

Objectives: Schools have been identified as an ideal setting for increasing access to mental health services particularly for underserved minority youth. The emerging field of implementation science has begun to systematically investigate strategies for more efficiently integrating evidence-based practices into community settings. Significantly less translational research has focused specifically on the school setting. To address this need, we examined the implementation of a school-based trauma intervention across three distinct regions. Design: We conducted key informant interviews guided by Mendel's Framework of Dissemination in Health Services Intervention Research with multiple school stakeholders to examine what school organizational characteristics influence the adoption and implementation process and sustainability of Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Participants were selected from schools in three geographic regions in the United States: Western, Midwestern, and Southern. Results: Our findings reveal that while sites had some common organizational factors that appeared to facilitate implementation, regions differed in how they compensated for less robust implementation domains. Across all regions, school stakeholders recognized the need for services to support students impacted by trauma. In the Western region, there was no centralized district policy for implementation; therefore, implementation was facilitated by school-level change agents and supervision support from the district mental health unit. In the Midwestern region, centralized district policies drove implementation. In both the Midwestern and Southern regions, implementation was facilitated by collaboration with a local mental health agency. Conclusions: This study contributes to the paucity of empirical information on the organizational factors that influence the implementation of evidence-based mental health interventions in schools. Our findings reveal that different implementation strategies across policies, structures, and resources can result in implementation of a school-based intervention. Frameworks such as Mendel's can be helpful in identifying areas of strength and improvement of implementation within a school organization.

Applying a Trauma Informed School Systems Approach: Examples from School Community-Academic Partnerships.

Objectives: Schools can play an important role in addressing the effects of traumatic stress on students by providing prevention, early intervention, and intensive treatment for children exposed to trauma. This article aims to describe key domains for implementing trauma-informed practices in schools. Design: The Substance Abuse and Mental Health Administration (SAMHSA) has identified trauma-informed domains and principles for use across systems of care. This article applies these domains to schools and presents a model for a Trauma-Informed School System that highlights broad macro level factors, school-wide components, and tiered supports. Community partners from one school district apply this framework through case vignettes. Results: Case 1 describes the macro level components of this framework and the leveraging of school policies and financing to sustain trauma-informed practices in a public health model. Case 2 illustrates a school founded on trauma-informed principles and practices, and its promotion of a safe school environment through restorative practices. Case 3 discusses the role of school leadership in engaging and empowering families, communities, and school staff to address neighborhood and school violence. Conclusions: This article concludes with recommendations for dissemination of trauma-informed practices across schools at all stages of readiness. We identify three main areas for facilitating the use of this framework: 1) assessment of school staff knowledge and awareness of trauma; 2) assessment of school and/or district's current implementation of trauma-informed principles and practices; 3) development and use of technology-assisted tools for broad dissemination of practices, data and evaluation, and workforce training of clinical and non-clinical staff.

Statewide implementation of an evidence-based trauma intervention in schools.

The goal of the current article is to describe the implementation and outcomes of an innovative statewide dissemination approach of the evidence-based trauma intervention Cognitive Behavioral Intervention for Trauma in Schools (CBITS). In the context of a 2-year statewide learning collaborative effort, 73 CBITS groups led by 20 clinicians from 5 different school-based mental health provider organizations served a total of 350 racially and ethnically diverse (66.9% Hispanic, 26.2% Black/African American, 43.7% White, and 30.1% Other), majority female (61%) children, averaging 12.2 years (SD = 2.4, range 8-19). Of the 350 children who began CBITS, 316 (90.3%) successfully completed treatment. Children demonstrated significant reductions in child posttraumatic stress disorder (PTSD) symptoms (42% reduction, d = .879) and problem severity (25% reduction, d = .396), and increases in child functioning, t(287) = -3.75, p < .001 (5% increase, d = .223). Findings point to the need, feasibility, and positive impact of implementing and scaling up school-based interventions for students suffering from posttraumatic stress. (PsycINFO Database Record

Smartphone Applications for Mental Health.

Many adolescents and adults do not seek treatment for mental health symptoms. Smartphone applications (apps) may assist individuals with mental health concerns in alleviating symptoms or increasing understanding. This study seeks to characterize apps readily available to smartphone users seeking mental health information and/or support. Ten key terms were searched in the Apple iTunes and Google Play stores: mental health, depression, anxiety, schizophrenia, bipolar, trauma, trauma in schools, post traumatic stress disorder (PTSD), child trauma, and bullying. A content analysis of the first 20 application descriptions retrieved per category was conducted. Out of 300 nonduplicate applications, 208 (70%) were relevant to search topic, mental health or stress. The most common purported purpose for the apps was symptom relief (41%; n = 85) and general mental health education (18%; n = 37). The most frequently mentioned approaches to improving mental health were those that may benefit only milder symptoms such as relaxation (21%; n = 43). Most app descriptions did not include information to substantiate stated effectiveness of the application (59%; n = 123) and had no mention of privacy or security (89%; n = 185). Due to uncertainty of the helpfulness of readily available mental health applications, clinicians working with mental health patients should inquire about and provide guidance on application use, and patients should have access to ways to assess the potential utility of these applications. Strategic policy and research developments are likely needed to equip patients with applications for mental health, which are patient centered and evidence based.

Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts.

Shared decision making (SDM) interventions aim to improve client autonomy, information sharing, and collaborative decision making, yet implementation of these interventions has been variably perceived. Using interviews and focus groups with clients and clinicians from mental health clinics, we explored experiences with and perceptions about decision support strategies aimed to promote SDM around psychotropic medication treatment. Using thematic analysis, we identified themes regarding beliefs about participant involvement, information management, and participants' broader understanding of their epistemic expertise. Clients and clinicians highly valued client-centered priorities such as autonomy and empowerment when making decisions. However, two frequently discussed themes revealed complex beliefs about what that involvement should look like in practice: (a) the role of communication and information exchange and (b) the value and stability of clinician and client epistemic expertise. Complex beliefs regarding these two themes suggested a dynamic and reflexive approach to information management. Situating these findings within the Theory of Motivated Information Management, we discuss implications for conceptualizing SDM in mental health services and adapt Siminoff and Step's Communication Model of Shared Decision Making (CMSDM) to propose a Communication-centered Epistemic Model of Shared Decision Making (CEM-SDM).

A web-based platform to support an evidence-based mental health intervention: lessons from the CBITS web site.

OBJECTIVE: To explore the role of Web-based platforms in behavioral health, the study examined usage of a Web site for supporting training and implementation of an evidence-based intervention. METHODS: Using data from an online registration survey and Google Analytics, the investigators examined user characteristics and Web site utilization. RESULTS: Site engagement was substantial across user groups. Visit duration differed by registrants' characteristics. Less experienced clinicians spent more time on the Web site. The training section accounted for most page views across user groups. Individuals previously trained in the Cognitive-Behavioral Intervention for Trauma in Schools intervention viewed more implementation assistance and online community pages than did other user groups. CONCLUSIONS: Web-based platforms have the potential to support training and implementation of evidence-based interventions for clinicians of varying levels of experience and may facilitate more rapid dissemination. Web-based platforms may be promising for trauma-related interventions, because training and implementation support should be readily available after a traumatic event.

Engaging parents in evidence-based treatments in schools: Community perspectives from implementing CBITS.

This study explored parent engagement in an evidence-based treatment, the Cognitive Behavioral Intervention for Trauma in Schools (CBITS), which was delivered in a school setting. To examine the successes and challenges in engaging parents in this school-based program, we conducted qualitative interviews by phone to obtain data from clinicians, parents, and other school personnel across eleven schools from 3 different regions of the United States. Almost all of these schools served low-income and ethnically diverse communities. We describe general impressions of parent engagement, parent reactions and preferences with regard to CBITS, barriers to parent engagement, and how to overcome barriers from multiple perspectives. Parent engagement across schools varied, with extensive outreach and relatively good parent engagement in CBITS described in some schools, while in other schools, efforts to engage parents were not as consistent. Implications for future efforts to engage parents in school-based treatments are discussed.

The Role of Teachers in School-Based Suicide Prevention: A Qualitative Study of School Staff Perspectives.

In response to concerns over youth suicide, there has been an increase in school-based suicide prevention programs. However, we know little about teacher perspectives on school-based suicide prevention and mental health programs. This study examined teacher roles in the implementation of a district-wide suicide prevention program through focus groups and interviews with middle school teachers, administrators, and other school personnel. Study results highlighted teachers' critical role in detecting students at risk for suicide. Factors that appeared to facilitate teacher participation in the suicide prevention program included well-defined crisis policies and procedures, communication of these procedures, collaboration across staff, and the presence of on-campus mental health resources. Participants identified a need for direct teacher training on risk factors for suicide, crisis response, and classroom management. Other strategies for improving suicide prevention efforts included in-school trainings on mental health resources and procedures, regular updates to these trainings, and greater visibility of mental health staff.

School personnel perspectives on their school's implementation of a school-based suicide prevention program.

Youth suicide is a national public health priority, with policymakers highlighting schools as an ideal setting in which to deliver suicide prevention programs. Over the past decade, the number of schools implementing such programs has grown substantially, yet little is known about how successfully such programs are being implemented. This study examines the implementation of a district-wide suicide prevention program through key informant interviews with school personnel. Schools with higher rates of implementing district protocols for at-risk students had an organized system to respond to at-risk students, a process for effectively responding to students who were at-risk for suicide, and strong administrative support. In contrast, schools that had lower rates of implementing district protocols relied on a handful of individuals for suicide prevention activities and had limited administrative support. Attention to organizational factors leading to successful implementation of school-based suicide prevention programs may enhance the role of schools in national adolescent suicide prevention efforts.

Language in pediatric epilepsy.

PURPOSE: This study examined the severity and range of linguistic impairments in young, intermediate, and adolescent youth with epilepsy and how these deficits were associated with illness effects, nonverbal intelligence, psychopathology, and reading. METHODS: Tests of language, intelligence, achievement, and structured psychiatric interviews were administered to 182 epilepsy youth, aged 6.3-8.1, 9.1-11.7, and 13.0-15.2 years, as well as to 102 age- and gender-matched normal children. Parents provided demographic, seizure-related, and behavioral information on their children. RESULTS: Significantly more epilepsy subjects had language scores 1 standard deviation (SD) below average than the age-matched control groups did. The intermediate and adolescent epilepsy groups also had significantly lower mean language scores compared to their matched controls. The older compared to the younger epilepsy groups had more language impairment and a wider range of linguistic deficits. Longer duration of illness, childhood absence epilepsy, psychiatric diagnosis, and socioeconomic status were associated with linguistic deficits in the young group. Prolonged seizures, lower Performance IQ, and minority status predicted low language scores in the intermediate epilepsy group. In the adolescent group, language impairment was associated with poor seizure control, decreased Performance IQ, and lower socioeconomic status. Linguistic and reading deficits were significantly related in each epilepsy group. CONCLUSIONS: The age-related increase in linguistic impairment, different profiles of predictors in each age group, and the relationship of linguistic deficits with poor reading skills have important clinical, developmental, theoretical, and academic implications.

Obstacles to mental health care in pediatric epilepsy: insight from parents.

This exploratory study compared the responses of 20 Caucasian and 20 Hispanic mothers of children with epilepsy about possible obstacles to mental health care (MHC) for their children before and after they read a brochure on the neurobehavioral comorbidities of epilepsy. The intervention significantly increased the mothers' knowledge of the behavior and cognitive comorbidities of pediatric epilepsy and their treatment. Baseline differences in the attitude toward MHC and the stigma of epilepsy between Hispanic and Caucasian mothers were no longer apparent after the intervention. Irrespective of ethnicity, the mothers also became significantly more aware that their children did not want to have epilepsy-related behavior and learning difficulties. Efficient use of time spent in doctors' waiting rooms to educate parents about the neurobehavioral comorbidities of epilepsy can address the lack-of-knowledge barrier to MHC. However, the study's findings suggested a need to determine if there are specific obstacles to MHC in pediatric epilepsy.

Childhood absence epilepsy: behavioral, cognitive, and linguistic comorbidities.

PURPOSE: Evidence for a poor psychiatric, social, and vocational adult outcome in childhood absence epilepsy (CAE) suggests long-term unmet mental health, social, and vocational needs. This cross-sectional study examined behavioral/emotional, cognitive, and linguistic comorbidities as well as their correlates in children with CAE. METHODS: Sixty-nine CAE children aged 9.6 (SD = 2.49) years and 103 age- and gender-matched normal children had semistructured psychiatric interviews, as well as cognitive and linguistic testing. Parents provided demographic, seizure-related, and behavioral information on their children through a semi-structured psychiatric interview and the child behavior checklist (CBCL). RESULTS: Compared to the normal group, 25% of the CAE children had subtle cognitive deficits, 43% linguistic difficulties, 61% a psychiatric diagnosis, particularly attention deficit hyperactivity disorder (ADHD) and anxiety disorders, and 30% clinically relevant CBCL broad band scores. The most frequent CBCL narrow band factor scores in the clinical/borderline range were attention and somatic complaints, followed by social and thought problems. Duration of illness, seizure frequency, and antiepileptic drug (AED) treatment were related to the severity of the cognitive, linguistic, and psychiatric comorbidities. Only 23% of the CAE subjects had intervention for these problems. CONCLUSIONS: The high rate of impaired behavior, emotions, cognition, and language and low intervention rate should alert clinicians to the need for early identification and treatment of children with CAE, particularly those with longer duration of illness, uncontrolled seizures, and AED treatment.