Training-of-Trainers Neuroscience and Mental Health Teacher Education in Liberia Improves Self-Reported Support for Students.

Education programs have been central to reestablishing social norms, rebuilding public educational institutions, and addressing public attitudes toward mental illness in Liberia following a protracted civil war and the Ebola epidemic. The aim of this study was to determine if a program combining an understanding of neuroscience with mental health literacy content could increase teachers' awareness of students' mental health issues and produce changes in teacher attitudes and classroom practices. A tiered Training-of-Trainers approach was employed. The first workshop trained 24 Liberian secondary science teachers in the neurobiology of learning, memory, emotions, stress and adolescent brain development. A Leadership Team formed from eight of the Tier I participants then adapted the curriculum, added in more mental health literacy content and led four Tier II workshops and four follow-up Refresher sessions. Participants completed a neuroscience knowledge test and surveys assessing stigma, general perceptions of people with mental illness, and burnout. A subset of Tier II teachers participated in a structured interview at the Refresher time point. Teachers in both tiers acquired basic neuroscience knowledge. Tier I, but not Tier II teachers significantly improved their surveyed attitudes toward people with mental illness. No changes were found in overall teacher burnout. Despite these survey results, the interviewed Tier II teachers self-reported behavioral changes in how they approached their teaching and students in their classrooms. Interviewees described how they now understood social and emotional challenges students might be experiencing and recognized abnormal behaviors as having a biopsychosocial basis. Teachers reported reduced use of verbal and corporal punishment and increased positive rewards systems, such as social and emotional support for students through building relationships. Refresher discussions concurred with the interviewees. In contrast to previous teacher mental health literacy programs which did not bring about a change in helping behaviors, this pilot program may have been successful in changing teacher knowledge and self-reported behaviors, improving teacher-student relationships and decreasing harsh discipline. The combination of basic neuroscience concepts with training on how to recognize mental health issues and refer students should be investigated further as a strategy to promote teacher mental health literacy.

Tiered Neuroscience and Mental Health Professional Development in Liberia Improves Teacher Self-Efficacy, Self-Responsibility, and Motivation.

After acquiring knowledge of the neuroscience of learning, memory, stress and emotions, teachers incorporate more cognitive engagement and student-centered practices into their lessons. However, the role understanding neuroscience plays in teachers own affective and motivational competencies has not yet been investigated. The goal of this study was to investigate how learning neuroscience effected teachers' self-efficacy, beliefs in their ability to teach effectively, self-responsibility and other components of teacher motivation. A pilot training-of-trainers program was designed and delivered in Liberia combining basic neuroscience with information on social, emotional, behavioral and mental health issues faced by students. Tier I of the professional development was a 2 weeks workshop led by a visiting neuroscientist. A subset of the 24 Tier I secondary science teachers formed a Leadership Team who adapted the content to the Liberian context and subsequently led additional workshops and follow-up sessions for the Tier II secondary science teachers. Science teachers in both tiers completed the affective-motivational scales from the internationally vetted, multiscale Innovative Teaching for Effective Learning Teacher Knowledge Survey from the OECD. Tier II teachers completed the survey in a pre-post-delayed post design. Tier I teachers completed the survey after the workshop with their attitudes at that time and separately with retrospective projections of their pre-workshop attitudes. Ten of the 92 Tier II teachers participated in structured interviews at follow-up. Statistical analysis of survey data demonstrated improved teacher self-efficacy, self-responsibility for student outcomes, and motivation to teach. Qualitatively, teachers expressed more confidence in their ability to motivate students, engage them through active learning, and manage the class through positive rather than negative reinforcement. Teachers' own self-regulation improved as they made efforts to build supporting relationships with students. Together, these results demonstrated that (i) teacher affective-motivational attitudes can be altered with professional development, (ii) basic neuroscience, as knowledge of how students learn, can improve teacher competency, and (iii) a training-of-trainers model can be effective in a low and middle income country for disseminating neuroscience knowledge, increasing teachers' knowledge of students' social and emotional needs, and promoting educational improvement.

Contributions of Neuroscience Knowledge to Teachers and Their Practice.

While neuroscience has elucidated the mechanisms underpinning learning and memory, accurate dissemination of this knowledge to teachers and educators has been limited. This review focuses on teacher professional development in neuroscience that harnessed the power of active-learning strategies and best educational practices resulting in increased teacher and student understanding of cognition and brain function. For teachers, the experience of learning a novel subject in an active manner enabled them to subsequently teach using similar strategies. Most important, participants viewed neuroscience as a frame for understanding why active-learning pedagogies work to engage and motivate students. Teachers themselves made connections applying neuroscience concepts to understand why learner-centered pedagogies are effective in promoting higher order thinking and deep learning in their students. Teachers planned and embraced pedagogies involving modeling, experimentation, discussion, analysis, and synthesis, increasing classroom cognitive engagement. Comprehending that everyone is in charge of changing their own brains is a tremendously powerful idea that may motivate science and non-science teachers to provide students opportunities to actively engage with content. Neuroscience courses for preservice and in-service teachers, provided as collaborations between scientists and teacher educators, can result in improved science education, pedagogy, and understanding of neuroscience.

Health system preparedness for integration of mental health services in rural Liberia.

BACKGROUND: There are increasing efforts and attention focused on the delivery of mental health services in primary care in low resource settings (e.g., mental health Gap Action Programme, mhGAP). However, less attention is devoted to systematic approaches that identify and address barriers to the development and uptake of mental health services within primary care in low-resource settings. Our objective was to prepare for optimal uptake by identifying barriers in rural Liberia. The country's need for mental health services is compounded by a 14-year history of political violence and the largest Ebola virus disease outbreak in history. Both events have immediate and lasting mental health effects. METHODS: A mixed-methods approach was employed, consisting of qualitative interviews with 22 key informants and six focus group discussions. Additional qualitative data as well as quantitative data were collected through semi-structured assessments of 19 rural primary care health facilities. Data were collected from March 2013 to March 2014. RESULTS: Potential barriers to development and uptake of mental health services included lack of mental health knowledge among primary health care staff; high workload for primary health care workers precluding addition of mental health responsibilities; lack of mental health drugs; poor physical infrastructure of health facilities including lack of space for confidential consultation; poor communication support including lack of electricity and mobile phone networks that prevent referrals and phone consultation with supervisors; absence of transportation for patients to facilitate referrals; negative attitudes and stigma towards people with severe mental disorders and their family members; and stigma against mental health workers. CONCLUSIONS: To develop and facilitate effective primary care mental health services in a post-conflict, low resource setting will require (1) addressing the knowledge and clinical skills gap in the primary care workforce; (2) improving physical infrastructure of health facilities at care delivery points; and (3) implementing concurrent interventions designed to improve attitudes towards people with mental illness, their family members and mental health care providers.

The Role of Fear-Related Behaviors in the 2013-2016 West Africa Ebola Virus Disease Outbreak.

The 2013-2016 West Africa Ebola virus disease pandemic was the largest, longest, deadliest, and most geographically expansive outbreak in the 40-year interval since Ebola was first identified. Fear-related behaviors played an important role in shaping the outbreak. Fear-related behaviors are defined as "individual or collective behaviors and actions initiated in response to fear reactions that are triggered by a perceived threat or actual exposure to a potentially traumatizing event. FRBs modify the future risk of harm." This review examines how fear-related behaviors were implicated in (1) accelerating the spread of Ebola, (2) impeding the utilization of life-saving Ebola treatment, (3) curtailing the availability of medical services for treatable conditions, (4) increasing the risks for new-onset psychological distress and psychiatric disorders, and (5) amplifying the downstream cascades of social problems. Fear-related behaviors are identified for each of these outcomes. Particularly notable are behaviors such as treating Ebola patients in home or private clinic settings, the "laying of hands" on Ebola-infected individuals to perform faith-based healing, observing hands-on funeral and burial customs, foregoing available life-saving treatment, and stigmatizing Ebola survivors and health professionals. Future directions include modeling the onset, operation, and perpetuation of fear-related behaviors and devising strategies to redirect behavioral responses to mass threats in a manner that reduces risks and promotes resilience.

Fear factor: The unseen perils of the Ebola outbreak.

As illustrated powerfully by the 2013-2016 Ebola outbreak in western Africa, infectious diseases create fear and psychological reactions. Frequently, fear transforms into action - or inaction - and manifests as "fear-related behaviors" capable of amplifying the spread of disease, impeding lifesaving medical care for Ebola-infected persons and patients with other serious medical conditions, increasing psychological distress and disorder, and exacerbating social problems. And as the case of the US micro-outbreak shows, fear of an infectious-disease threat can spread explosively even when an epidemic has little chance of materializing. Authorities must take these realities into account if they hope to reduce the deadly effects of fear during future outbreaks.

Fear-related behaviors in situations of mass threat.

This Disaster Health Briefing focuses on the work of an expanding team of researchers that is exploring the dynamics of fear-related behaviors in situations of mass threat. Fear-related behaviors are individual or collective behaviors and actions initiated in response to fear reactions that are triggered by a perceived threat or actual exposure to a potentially traumatizing event. Importantly, fear-related behaviors modulate the future risk of harm. Disaster case scenarios are presented to illustrate how fear-related behaviors operate when a potentially traumatic event threatens or endangers the physical and/or psychological health, wellbeing, and integrity of a population. Fear-related behaviors may exacerbate harm, leading to severe and sometimes deadly consequences as exemplified by the Ebola pandemic in West Africa. Alternatively, fear-related behaviors may be channeled in a constructive and life-saving manner to motivate protective behaviors that mitigate or prevent harm, depending upon the nature of the threat scenario that is confronting the population. The interaction between fear-related behaviors and a mass threat is related to the type, magnitude, and consequences of the population encounter with the threat or hazard. The expression of FRBs, ranging from risk exacerbation to risk reduction, is also influenced by such properties of the threat as predictability, familiarity, controllability, preventability, and intentionality.

The Effects of Runaway-Homeless Episodes on High School Dropout.

This article uses data from the National Longitudinal Survey of Youth 1997 to examine the relationship between running away from home between the ages of 12 and 14 and dropping from high school among youth. Propensity score matching was conducted in estimating the effect of running away on high school dropout while controlling for confounding factors, such as familial instability and socioemotional health risks. The findings suggest that having runaway-homeless episodes have a detrimental effect on academic achievement.

Children's mental health policies in the United States: perspectives from advocates and state leaders.

BACKGROUND: Previous research suggests a disconnect on both policy and practice between advocates and state leaders in child mental health. AIM: To compare advocates' and state leader's perspectives and understanding on the three main themes in children's mental health policies: (i) state's initiatives to empower and engage families and youth in policy and practice; (ii) state's fiscal support for family and youth driven services; and (iii) policy challenges to improving children's mental health services and outcomes. STUDY DESIGN: This study draws on data from national surveys of State Children's Mental Health Directors (2006) and of state affiliates of Mental Health America (2007). RESULTS: The findings from 38 responses representing 19 states suggest differences between state leaders and advocates on their understanding of family and youth engagement, service access, quality and fiscal supports. While state directors and advocates seem to have similar understanding on the existence of states' efforts related to evidence-based practices, many advocates are unaware of the specifics of the strategies that states undertook or funded. Advocates also did not know which types of settings were eligible for reimbursement for children's services. CONCLUSIONS: Advocates lack some information that is vital to fulfilling their role. Policymakers seem unaware of key challenges that families face and therefore appear to be without critical information that fuels the agenda for advocates. The challenge for both set of actors is how to get beyond this information asymmetry to advance efforts to improve mental health.

Racial and ethnic disparities in the continuation of community-based children's mental health services.

This paper examines racial and ethnic disparities in continuation of mental health services for children and youth in California and how English language proficiency moderates the effect of race/ethnicity on the continuation of service. While previous research indicated racial/ethnic or geographic disparities in accessing mental health services among children and youth, few studies specifically focused on the continuation of mental health care. The authors used administrative data from California county mental health services users under age 25. Applying logistic regression, English language proficiency was found to be the major determinant of continuation of mental health services in this age group. With the exception of children of Asian descent, non-English speaking children and youth of diverse racial/ethnic background were significantly less likely to continue receiving mental health services compared with White English-speaking peers, even after controlling for sociodemographic, clinical and county characteristics.

The status of states' policies to support evidence-based practices in children's mental health.

OBJECTIVE: This study examined the efforts of states' mental health authorities to promote the use of evidence-based practices through policy. METHODS: Data were drawn from three components of a national study, including a survey of state children's mental health directors (N=53), which was developed using a three-step process that involved stakeholders. RESULTS: Data from the directors' survey revealed that over 90% of states are implementing strategies to support the use of evidence-based practices. The scope of these efforts varies, with 36% reporting statewide reach. Further, states' strategies for implementing evidence-based practices are often not accompanied by comparable efforts to enhance information systems, even though enhancing such systems can bolster opportunities for successful implementation. CONCLUSIONS: Variability in the adoption of evidence-based practices, poor attention to information systems, and inconsistent fiscal policies threaten states' efforts to improve the quality of children's mental health services.