Perceived Racial Discrimination, Psychological Distress, and Suicidal Behavior in Adolescence: Secondary Analysis of Cross-Sectional Data from a Statewide Youth Survey.

Developmental, clinical, and epidemiological research have demonstrated the salience of perceived racial discrimination (PRD) as a contributor to negative mental health outcomes in adolescence. This article summarizes secondary analyses of cross-sectional data from a large-scale youth survey within a predominantly rural state, to estimate the prevalence and strength of the association between PRD and serious psychological distress (SPD), suicidal ideation, and prior suicidal attempts. Data from 93,812 students enrolled in 6th, 8th, 10th, or 12th grade within 129 school districts across Kentucky were examined, to determine prevalence rates for subgroups within the cohort. Logistic regression analyses assessed the differences and established comparative strength of the association among these variables for racial/ethnic subgroups. PRD was self-reported at high rates across several demographic subgroups and was most evident among Black (24.5%) and Asian (22.1%) students. Multiracial students experienced the highest rates of both SPD and suicidality (ideation and prior attempt). Both for the entire cohort and for each racial/ethnic subgroup, PRD was significantly associated with an increased likelihood of negative mental health outcomes, although the strength of these associations varied across the subgroups and developmental levels. The implications for early intervention and prevention are discussed.

Integrated (one-stop shop) youth health care: best available evidence and future directions.

Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. Where evaluated, young people report having benefited from and being highly satisfied with these services. Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery.

Latent class analysis of need descriptors within an Irish youth mental health early intervention program toward a typology of need.

AIM: Significant overlap and comorbidity has been demonstrated among young people with mental health problems. This paper examined demographic characteristics, heterogeneity of need descriptors and services provided among young people (12-25 years) engaging in brief interventions at Jigsaw in the Republic of Ireland. METHOD: Between 1 January 2013 and 31 December 2013, a total of 2571 young people sought help from 1 of 10 Jigsaw sites. Of these, 1247 engaged in goal-focused brief interventions, typically consisting of one to six face-to-face sessions. Descriptive statistics were used to summarize social and demographic factors. Latent class analysis was used to cluster young people into relevant typologies of presenting issues. Multinomial logistic regression was then performed to determine significant predictors of class membership. RESULTS: The most common age of young people was 16. More women (59.6%) than men engaged in brief interventions, 56% attended school, 74% lived with their family of origin or with one parent, and 54.2% came from families where parents were married. Using established fit criteria, four relevant typologies emerged: Developmental (26.8%), Comorbid (15.8%), Anxious (42.7%) and Externalising (14.6%). Predictors varied by class membership, but general family problems and lack of adult support emerged as the strongest predictors for all classes. CONCLUSION: This study demonstrated that the mental health needs of young people in Ireland are significant and diverse. Because Jigsaw favours a more descriptive approach to problem identification, the four typologies suggest a need to determine program capacity in engaging youth with heterogeneous presenting issues and to tailor brief interventions to each group's clinical profiles.

Performance of the CORE-10 and YP-CORE measures in a sample of youth engaging with a community mental health service.

This article assesses the performance and psychometric properties of two versions of the Clinical Outcomes in Routine Evaluation (CORE) measures that assess psychological distress: the Young Person's CORE (YP-CORE) for 11-16 year olds and the CORE-10 for those 17 or older. The sample comprised 1592 young people aged 12-25 who completed the YP-CORE and CORE-10 during their initial engagement with an early intervention service. Total and average scores were examined for both measures. Gender and age differences were evaluated using t-tests and analysis of variance. The factor structures were assessed with principal axis and confirmatory factor analyses. Multigroup confirmatory factor analyses were then employed to evaluate measurement invariance across age and gender. Analyses were supportive of the CORE measures as reliable instruments to assess distress in 12-25 year olds. Based upon eigenvalues in combination with the comparative fit index, the Tucker-Lewis Index, and the root-mean-square error of approximation, both measures were unidimensional. Analysis indicated the factor structure, loadings, item thresholds, and residuals were invariant across age and gender, although partial support for strict invariance was found for gender among 12-16 year olds. Results are compared to previous studies and discussed in the context of program planning, service delivery, and evaluation. Copyright © 2016 John Wiley & Sons, Ltd.

Youth engagement with an emerging Irish mental health early intervention programme (Jigsaw): participant characteristics and implications for service delivery.

BACKGROUND/AIMS: The transition to adulthood represents a critical period which influences mental health problems, but access to and utilisation of mental health services by young people is poor. Jigsaw is a response to the challenge of transforming how young people access mental health support and attain positive outcomes. This article presents an overview of the characteristics of young people engaging with this service. METHOD: Data about young people who engage with Jigsaw are captured through an online system designed to record salient clinical, case management, service delivery, and outcome information. Participant characteristics are summarised to portray the young people who engaged with the service for the first time during 2013 (N = 2420). RESULTS: The majority of young people engaging with Jigsaw were female, aged 15-17 years, and were referred by their parents. Over half were in full-time education, although many 21-25-year-olds were unemployed. Young people presented with a range of difficulties which varied by age and gender. They reported high levels of distress, with age and gender having a significant impact on their well-being. CONCLUSIONS: This study provides emerging evidence to support the need for an early intervention component within the system of mental health care.

Empirically derived subtypes of serious emotional disturbance in a large adolescent sample.

PURPOSE: The heterogeneity of serious emotional disturbance has been thoroughly documented among adolescents with nationally representative data derived from structured interviews, although use of these interviews may not be feasible within the context of brief and self-administered school surveys. This study seeks to identify distinct subtypes of serious emotional disturbance in a large school-based sample. METHODS: A total of 108,736 students fully completed the K6 scale that was included on the 2012 Kentucky Incentives for Prevention Survey. Latent class analysis was used to derive subtypes of serious emotional disturbance among students receiving a positive screen (n = 15,147). To determine significant predictors of class membership, adjusted rate ratios and 95 % confidence intervals were calculated using multinomial logistic regression. RESULTS: A four-class model was the most parsimonious, with four distinct subtypes emerging that varied by both symptom type and severity: comorbid moderate severity, comorbid high severity, anxious moderate severity, and depressed high severity. Age, gender, race/ethnicity, family structure, substance use, antisocial behavior, role impairments, and peer victimization were significant predictors of class membership, although the magnitude of these effects was stronger for the two high severity groups. CONCLUSIONS: Our results suggest heterogeneity of serious emotional disturbance by both symptom type and severity. Prevention programs may benefit by shifting focus from specific disorders to the core features of serious emotional disturbance, including psychological distress, high comorbidity, and role impairments.

The performance of the K6 Scale in a large school sample.

Timely prevalence data of psychiatric morbidity among adolescents in small areas remains vital for mental health policy planning at the regional and local levels. Furthermore, effective regional policy planning also requires the measurement of psychiatric morbidity using clinically validated instruments. The K6 scale was therefore included on the 2012 administration of the Kentucky Incentives for Prevention Survey as a measure of serious emotional disturbance in the past 30 days. Principal axis and confirmatory factor analyses were performed to determine the unidimensional structure of the K6 in a school-based sample of Kentucky students (n = 108,736). The documented cutoff of 13 on the K6 was then used to screen Kentucky students for serious emotional disturbance, estimate the state prevalence, and define epidemiologic correlates. Overall, the K6 performed well, with factor analyses confirming the 1-factor solution of the K6. Based upon the established cutoff, the prevalence of serious emotional disturbance was 13.9% in Kentucky. Grade, gender, race and ethnicity, and family structure emerged as significant predictors in a multivariable logistic regression model. Substance abuse, antisocial behavior, role impairments, and peer victimization were significantly higher among students with a positive screen. These results indicate the K6 is particularly useful for inclusion in large epidemiologic surveys that have limited space and logistics that demand timely administration.

Transforming youth mental health services and supports in Ireland.

BACKGROUND: Young people in the Republic of Ireland do not have access to appropriate mental health services and supports, necessitating transformational change in delivery systems. AIMS: Describe ongoing development and change efforts facilitated by Headstrong--The National Centre for Youth Mental Health. METHODS: Discusses findings from a national needs assessment, core strategies within the change initiative, progress in system-building, and preliminary descriptive and outcome data. RESULTS: Five demonstration sites comprised of four counties and a city neighbourhood are operational and preliminary data are promising with respect to implementation and outcomes. CONCLUSION: Effective change initiatives require vision and leadership, competence- and capacity-building, participative planning and engagement, adequate and thoughtfully deployed resources, and a comprehensive change management approach.

Jigsaw: engaging communities in the development and implementation of youth mental health services and supports in the Republic of Ireland.

BACKGROUND: Irish young people exhibit high levels of psychological distress, but community-based services and supports are often unavailable or inaccessible. AIM: To describe efforts to engage communities in systematic and data-based processes of planning, programme design, implementation, and evaluation. METHOD: Details system-building initiatives in five communities (four counties and a distressed urban site) that will serve as a springboard for full national deployment. RESULTS: Extensive community engagement and planning has occurred in all sites, systems change efforts grounded in detailed business plans have begun, and process and outcome evaluation is underway. CONCLUSION: Needs and resource assessment processes confirmed the magnitude of need, but also suggested the creative re-allocation of local resources. Young people provided invaluable guidance for system design. Creating and sustaining a culture of innovation at each site was challenging, requiring leadership and continuous dialogue.

The relationship between implementation fidelity and educational outcomes in a school-based family support program: development of a model for evaluating multidimensional full-service programs.

There is increasing recognition of the need for evaluations that identify program processes or mediators and assess degree of program implementation rather than focusing solely on outcome evaluation. This paper describes the application of complementary qualitative and quantitative evaluation procedures to assess the degree of implementation of multi-component family support programs for improving educational outcomes for at risk youth, and to assess the relationship between program implementation and outcomes. The qualitative evaluation involved prolonged engagement to identify common program domains or mediators. Using a method called Innovation Configuration Analysis, levels of implementation of program domains were explicated as well as an overall Implementation Fidelity Index. Strong positive relationships were found between overall program implementation and program-level outcomes achieved by student participants.