Applying the extension for community healthcare outcomes (ECHO) model to promote collaborative and effective school mental health services.

School staff increasingly seek to implement evidence-based school mental health services to promote student mental health. However, barriers to accessing programming and support mean that implementing these programs is difficult. Popular strategies to address these challenges, like one time professional development, often fail to be effective or sustainable. This study used mixed methods to evaluate how a set of training activities-sequential online learning modules combined with interprofessional telementoring, following the extension for community healthcare outcomes (ECHO) model-influenced provision of school mental health services. School counselors, nurses, psychologists, and social workers (n = 46) participated in training activities, which included nine, cohort-based ECHO sessions and 12 modules. We used a concurrent mixed methods design in which quantitative (implementation data and pre-post surveys) and qualitative (posttraining focus groups with a subset of participants, n = 11) data were used to evaluate training. Quantitative results indicated statistically significant pre-post improvements in participants' clinical self-efficacy (d = .83) and knowledge of evidence-based practices (d = .37). Qualitative data corroborated quantitative results. Post training, focus groups described positive reactions, learning, and behavior change, particularly with respect to equitable service provision and interprofessional teaming. ECHO appeared to facilitate the application of evidence-based strategies to real-life practice and improved participants' understanding of effective coordination of services. Taken together, findings suggest that group-based telementoring may be a high-impact strategy for supporting the implementation of effective, culturally specific, and collaborative school mental health services. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social acceptance from peers and youth mentoring: Implications for addressing loneliness and social isolation.

Youth mentoring may be able to support lonely and socially isolated youth. This study examined the association between participating in youth mentoring programs and mentee perception of social acceptance from peers. Regression models considered the association between mentoring and peer social acceptance in terms of demographics, program features, and baseline peer relationship quality for 693 youth from 27 mentoring programs. The construct validity of a social acceptance scale was explored. The scale suggested two factors of peer social acceptance. No significant changes in peer social acceptance were observed before and after participating in mentoring programs. Trends in social acceptance indicated that positive/negative feelings in the mentor-mentee relationship were associated with positive/negative indicators of peer social acceptance. Mentoring programs may be able to help prevent loneliness and social isolation through positive aspects of the mentor-mentee relationships, but additional intervention activities are likely necessary to support lonely and socially isolated youth.

Supporting School Mental Health Providers: Evidence from a Short-Term Telementoring Model.

Background: To support student mental health, school staff must have knowledge of evidence-based practices and the capacity to implement them. One approach used to address this challenge is a group-based telementoring model called Extension for Community Healthcare Outcomes (ECHO). In other applications (e.g., healthcare settings), ECHO has been shown to increase healthcare professionals' self-efficacy and knowledge of evidence-based practices leading to improved patient outcomes. Objectives: This study examined the potential for ECHO to be used as a method for increasing school staff engagement and knowledge of evidence-based school mental health practices. Methods: Using a quasi-experimental design, this study compared outcomes across two professional development experiences aimed at promoting school staff ability to provide evidence-based mental health services. School staff from four school districts participated in a school mental health training initiative. All participants (N = 57) had access to asynchronous, online mental health modules. A sub-sample (n = 33) was also offered monthly ECHO sessions. Results: Tests of group difference in outcomes revealed significant increases in engagement with online learning (d = 0.58) and satisfaction (d = 0.82) for those who participated in ECHO as compared to those who did not. Knowledge about evidence-based practices was not significantly different between groups. Conclusions: Results suggest that group-based telementoring may be a promising approach for improving engagement and satisfaction with training initiatives aimed at promoting evidence-based school mental health practices. However, further study of ProjectECHO using experimental designs is needed to make causal inferences about its effect on provider outcomes.

Roles and Functions of School Mental Health Professionals Within Comprehensive School Mental Health Systems.

Mental health concerns are on the rise among youth, contributing to a growing need for school-based mental health services. However, challenges to service provision arise due, in part, to workforce shortages, service fragmentation, and inefficient allocation of staff time. The current study describes the professional competencies and time allocation of four school-based mental health professions (i.e., school counselors, school psychologists, school social workers, and school nurses) in order to demonstrate how schools can leverage the skills of their existing staff to coordinate a comprehensive approach to support student mental health. First, we identified the core clinical competencies needed to implement the key features of comprehensive school mental health systems. Then, we crosswalked these clinical competencies with the training standards of the four professions. Finally, we conducted a systematic review of the literature to understand how these professionals' time is allocated, as well as their responsibilities related to the provision of mental health services. Results demonstrated that, although all four professions receive training in most of the core competencies needed to implement comprehensive school mental health services, their skillsets are often underutilized in day-to-day practice. Thus, we concluded that there are at least two untapped opportunities for school leaders to support student mental health-first, maximize the use of school mental health professionals through task-shifting (i.e., reassigning tasks less central to mental health service delivery to other staff), and second, implement an integrated model of school mental health services to efficiently leverage the mental health training of professionals. Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-022-09535-0.

Examining heterogeneity in mentoring: Associations between mentoring discussion topics and youth outcomes.

The current study aims to apply a staged approach to document heterogeneity in discussions in mentoring relationships, chiefly, discussion topics from weekly mentoring sessions with undergraduate women mentors (n = 40), then link each of the eight topics (relationships with friends, family, teachers, and romantic relationships, as well as goals, academic skills, academic problems, and hopes for the future) to developmental outcomes for middle school girls (n = 41) who participated in a school-based mentoring program. In doing so, the authors hope to better understand the mechanisms that influence variability in mentoring treatment effects. Mentoring dyads engaged in unstructured one-on-one sessions and structured group meetings across the 2018-2019 academic year. The primary predictors for this study are weekly mentor-reported discussion topics and activities addressed during unstructured one-on-one mentoring sessions, with 11 social-emotional, academic, and behavioral outcomes measured via pre- and postsurveys administered by research assistants to mentees during the fall and spring. A series of 11 path analyses indicate small to moderate associations, both beneficial and negative, between key discussion topics, such as hopes for the future, family relationships, and goals, and several mentee-reported outcomes of interest at the end of the intervention, including extrinsic motivation, life satisfaction, and self-esteem. Study findings provide information about heterogeneity in mentoring practices to inform how various mechanisms of mentoring (e.g., discussions focused on relationships, goals and skills, and strengths) influence developmentally-relevant effects for youth.

A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals.

Background: Infectious diseases (ID) and antimicrobial stewardship (AS) improve Staphylococcus aureus bacteremia (SAB) outcomes. However, many small community hospitals (SCHs) lack on-site access to these services, and it is not known if ID telehealth (IDt) offers the same benefit for SAB. We evaluated the impact of an integrated IDt service on SAB outcomes in 16 SCHs. Methods: An IDt service offering IDt physician consultation plus IDt pharmacist surveillance was implemented in October 2016. Patients treated for SAB in 16 SCHs between January 2009 and August 2019 were identified for review. We compared SAB bundle adherence and outcomes between patients with and without an IDt consult (IDt group and control group, respectively). Results: A total of 423 patients met inclusion criteria: 157 in the IDt group and 266 in the control group. Baseline characteristics were similar between groups. Among patients completing their admission at an SCH, IDt consultation increased SAB bundle adherence (79% vs 23%; odds ratio [OR], 16.9; 95% CI, 9.2-31.0). Thirty-day mortality and 90-day SAB recurrence favored the IDt group, but the differences were not statistically significant (5% vs 9%; P = .2; and 2% vs 6%; P = .09; respectively). IDt consultation significantly decreased 30-day SAB-related readmissions (9% vs 17%; P = .045) and increased length of stay (median [IQR], 5 [5-8] days vs 5 [3-7] days; P = .04). In a subgroup of SAB patients with a controllable source, IDt appeared to have a mortality benefit (2% vs 9%; OR, 0.12; 95% CI, 0.01-0.98). Conclusions: An integrated ID/AS telehealth service improved SAB management and outcomes at 16 SCHs. These findings provide important insights for other IDt programs.

Strategies for monitoring mentoring relationship quality to predict early program dropout.

We examined data from a nationally implemented mentoring program over a 4-year period, to identify demographic and relationship characteristics associated with premature termination. Data were drawn from a sample of 82,224 mentor and mentees. We found matches who reported shared racial or ethnic identities were associated with lower likelihood of premature termination as was mentee's positive feelings of the relationship. We also found that, if data were used as a screening tool, the data were suboptimal for accuracy classifying premature closure with sensitivity and specificity values equal to 0.43 and 0.75. As programs and policymakers consider ways to improve the impact of mentoring programs, these results suggest programs consider the types of data being collected to improve impact of care.

Promoting mentoring relationships through joint decisions: Evidence from a national mentoring program.

School-based mentoring programs are one of the most popular types of prevention programs offered to support students' social-emotional and academic success. Because a high-quality mentoring relationship is thought to be a mechanism for improving youth outcomes, we investigated how mentor- and mentee-relationship quality develops over time. In addition, we examined how relationship development varied as a function of three approaches to selecting mentoring activities (i.e., mentor-directed, program-directed, or jointly determined). We used a random-intercepts crossed-lagged panel model to test how mentor and mentee reports of relationship quality developed over three time points across one school year. Data were gathered from 2014 to 2018 and included 47,699 youth (56% female; 51% Black or Hispanic) who participated in Big Brothers Big Sisters-which provides school-based mentoring services to youth across the U.S. Results indicated that mentors' positive appraisals of the mentoring relationships led to positive appraisals from the mentee at the subsequent time point. In addition, when mentors and mentees jointly determined activities, we found evidence that mentors' and mentees' positive appraisals at one time point led to positive appraisals at the following time point. These results suggest that school-based mentoring programs should consider ways to support joint decision-making among mentors and mentees participating in school-based mentoring programs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mentees and their mothers: The association between maternal relationship difficulties and targeted outcomes of mentoring.

Maternal relationship characteristics have been found to impact academic and behavioral outcomes for youth. However, less is known about how and through what mechanisms these characteristics impact outcomes for mentored youth. In this study, we examined if mentoring relationship quality mediated the relations between maternal relationship characteristics and academic and behavioral outcomes targeted by mentoring programs. Data were drawn from 205 participants who participated in a mentoring program that pairs adolescent girls with college women mentors for 1 year of mentoring. Mentoring relationship quality was the hypothesized mechanism of change and was included in the analysis as a mediator. Results revealed that maternal relationship characteristics (i.e., maternal quality communication/trust and maternal alienation) were directly related to academic and behavioral outcomes of mentoring. The relationship between maternal relationship characteristics and behavioral outcomes was mediated by mentoring relationship quality. Results suggested that girls with stronger maternal quality communication and trust as well as girls who felt more alienated from their mothers may benefit more from mentoring. Results can be used to inform mentor training to include a focus on relationship development with girls experiencing a variety of relational difficulties with their mothers to help improve targeted mentoring outcomes.

A National Study of Mentoring Program Characteristics and Premature Match Closure: the Role of Program Training and Ongoing Support.

Mentoring programs are a popular approach to preventing problem behavior and promoting positive youth development. However, mentoring relationships that end prematurely may have negative consequences for youth. Previous research has investigated match-level indicators of premature match closure, highlighting possible individual mentor- or mentee-level characteristics that might influence the match staying together. However, less work has investigated the importance of program-level variables in match retention. Mentor training and support may be one key modifiable program-level feature that could curtail the risk of premature match closure. In this study, we used data from a national survey of youth mentoring programs (N = 1451) to examine training and other potential predictors of premature match closures (Garringer et al. 2017). We used a Bayesian Additive Regression Trees (BART) model to predict program-reported premature match closure rates from a set of four training-related variables and 26 other covariates (e.g., program size, budget, demographic composition). Findings indicate that the set of predictors explained about one-fifth of the variation in reported rate of premature match closure (cumulative pseudo R2 = .21), and the strongest, and only statistically significant, predictor of premature match closure was the frequency of ongoing training and support contacts per month. Overall, findings indicate that there is substantial noise in predicting program-reported premature match closure, but program-reported provision of ongoing training and support seems to emerge as a relatively stable signal in the noise.

Dyadic report of relationship quality in school-based mentoring: Effects on academic and behavioral outcomes.

Mentoring, a common support practice for middle schoolers, can have varying effects on student academic and behavioral outcomes depending on the type of mentoring and quality of relationship formed. Although research has examined mentees' perception of relationship quality in mentoring relationships, fewer studies have looked at both mentor and mentee reports. The present study aims to explore how the interaction of mentor and mentee perceptions of the relationship quality is associated with student academic and behavioral outcomes. Major findings include the significant association between mentor-reported relationship quality and academic outcomes for mentees, as well as some associations mentee- and mentor-reported relationship quality and behavioral outcomes. Results illustrate the importance of training in mentoring programs, as well as how mentee- versus mentor-report of the relationship may impact outcomes in distinct ways. This study can improve understanding of mentor-mentee relationships, which may improve student academic and behavioral outcomes.

Is Life Satisfaction an Antecedent to Coping Behaviors for Adolescents?

Adolescence is a critical developmental stage to develop coping behaviors. However, little is known about the longitudinal relations between coping behaviors and subjective well-being factors in adolescents. Situated within a positive psychology framework and supported by well-being theories, this study aims to investigate if life satisfaction is an antecedent to predict four specific types of coping behaviors (two approach coping: social support seeking and problem solving; and two avoidant coping: internalizing and externalizing coping behaviors) in early adolescents? A cross-lagged panel design was applied with three-wave data with six months apart between each wave. At the baseline, a total of 897 adolescents participated (52.1% female) in the study with 451 students in the 7th grade and 446 students in the 8th grade. The majority of the student body were European American (58.5%), followed by African American (29.4%) and a small percentage of other minority groups (2.9% Asian or Pacific Islander, 1.4% Hispanic, 1.1% Native American, and 6.3% other racial groups). Results showed that life satisfaction predicted all coping behaviors in the expected directions across at least one 6-month period between three waves. Reciprocal relations were found between life satisfaction and social support seeking and also between life satisfaction and internalizing coping behaviors from Time 1 to Time 2. Overall the results support that life satisfaction can be an antecedent to coping behaviors. Gender differences were further tested through multi-group comparison and the major findings include: (1) life satisfaction predicted all coping behaviors for females but only two approach coping behaviors for males from Time 1 to Time 2; (2) life satisfaction predicted two coping behaviors (social support seeking, externalizing coping behaviors) across Time 2 and Time 3 for females only. Taken together, life satisfaction appeared to be a more robust predictor of coping behaviors in female adolescents. Research implications are discussed.

Strengthening and Expanding Child Services in Low Resource Communities: The Role of Task-Shifting and Just-in-Time Training.

In the United States, the demand for child mental health services is increasing, while the supply is limited by workforce shortages. These shortages are unlikely to be corrected without significant structural changes in how mental health services are provided. One strategy for bridging this gap is task-shifting, defined as a process by which services that are typically delivered by professionals are moved to individuals with less extensive qualifications or training. Although task-shifting can increase the size of the workforce, there are challenges related to training new workers. In this paper, we propose Just-In-Time Training (JITT) as one strategy for improving task-shifting efforts. We define JITT as on-demand training experiences that only include what is necessary, when it is necessary, to promote competent service delivery. We offer a proof of concept from our own work shifting counseling and academic support tasks from school mental health professionals to pre-baccalaureate mentors, citing lessons learned during our iterative process of JITT development. We conclude with a series of key considerations for scaling up the pairing of task-shifting and JITT, including expanding the science of JITT and anticipating how task-shifting and JITT would work within the context of dynamic mental health service systems.

Risks and rewards of school-based mentoring relationships: A reanalysis of the student mentoring program evaluation.

In the United States, school-based mentoring programs are a large and widely funded form of mentoring. Despite widespread support, meta-analyses indicate that the effects of school-based mentoring programs are small. One hypothesis for these results is that school-based mentors are not able to develop a sufficiently high-quality relationship with mentees to produce the hypothesized positive effects. This study presents a reanalysis of a large randomized controlled trial of school-based mentoring and examines the estimated effect of mentoring as a function of mentee-reported relationship quality using a novel statistical approach. Although we found that average effect sizes were near zero and consistent with researchers' original findings, our findings also indicate that low relationship quality is associated with some harmful effects, particularly on misconduct, and that as relationship quality improves, so do effects. However, we found that this association decelerates and resulted in small, positive effects for some outcomes. These results suggest that that poor relationship quality may produce harmful effects and a strong relationship may not be sufficient to produce moderate, positive academic and behavioral outcomes in a school-based mentoring context. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Finding the Sweet Spot: Investigating the Effects of Relationship Closeness and Instrumental Activities in School-based Mentoring.

School-based mentoring programs are popular prevention programs thought to influence youth development; but rigorous evaluations indicate that these programs often have small effects on youth outcomes. Researchers suggest that these findings may be explained by (a) mentors and mentees failing to develop a close relationship and (b) mentors not setting goals or focusing on specific skills necessary improve outcomes. We assessed these explanations using data from approximately 1360 mentor and mentee pairs collected through a national study of school-based mentoring (called, "The Student Mentoring Program"). Specifically, we tested the influence of mentee-reported relationship quality and mentor-reported use of goal-setting and feedback-oriented activities on academic, behavioral, and social-emotional outcomes. Results suggested that youth reported relationship quality was associated with small to medium effects on outcomes. Moreover, goal-setting and feedback-oriented activities were associated with moderate to large effects on outcomes. We also found significant interactions between relationship quality and goal-setting and feedback-oriented activities on youth outcomes. We conclude that there appears to be a "sweet-spot" wherein youth outcomes are maximized. The results of this study suggest a need for school-based mentoring programs to monitor and support mentors in developing a close relationship while also providing opportunities to set goals and receive feedback.

Yoga Kernels: A Public Health Model for Developing and Disseminating Evidence-Based Yoga Practices.

Many people are drawn to yoga for its potential health benefits. With its rising popularity, yoga could become a widely used public health intervention, but its success depends on finding evidence-based yoga practices that are acceptable and feasible for a large segment of the population. Complexity and variability create barriers to the adoption and maintenance of yoga practices. In an effort to improve the study, adoption, and maintenance of therapeutic practices used in the context of public health interventions, we introduce the concept of "yoga kernels," defined as discrete, evidence-based yoga practices that are amenable to scientific study and can be effectively disseminated as a public health intervention. Yoga is reviewed from the standpoint of a public health intervention using the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) model. This model is designed to improve the successful adoption and maintenance of generalizable, evidence-based interventions. In response to the challenges to the adoption and maintenance of yoga practices, we propose that a potentially fruitful direction for yoga research is moving away from studying yoga classes to studying specific yoga practices that are simpler and easier for the general public to use. Yoga kernels could be a unifying concept to identify therapeutic uses of yoga and help people adopt and maintain these practices as part of a systematic public health strategy.

Identification of predicted individual treatment effects in randomized clinical trials.

In most medical research, treatment effectiveness is assessed using the average treatment effect or some version of subgroup analysis. The practice of individualized or precision medicine, however, requires new approaches that predict how an individual will respond to treatment, rather than relying on aggregate measures of effect. In this study, we present a conceptual framework for estimating individual treatment effects, referred to as predicted individual treatment effects. We first apply the predicted individual treatment effect approach to a randomized controlled trial designed to improve behavioral and physical symptoms. Despite trivial average effects of the intervention, we show substantial heterogeneity in predicted individual treatment response using the predicted individual treatment effect approach. The predicted individual treatment effects can be used to predict individuals for whom the intervention may be most effective (or harmful). Next, we conduct a Monte Carlo simulation study to evaluate the accuracy of predicted individual treatment effects. We compare the performance of two methods used to obtain predictions: multiple imputation and non-parametric random decision trees. Results showed that, on average, both predictive methods produced accurate estimates at the individual level; however, the random decision trees tended to underestimate the predicted individual treatment effect for people at the extreme and showed more variability in predictions across repetitions compared to the imputation approach. Limitations and future directions are discussed.

Improving Decisions About Transport to the Emergency Department for Assisted Living Residents Who Fall.

Background: Residents of assisted living facilities who fall may not be seriously ill or injured, but policies often require immediate transport to an emergency department regardless of the patient's condition. Objective: To determine whether unnecessary transport can be avoided. Design: Prospective cohort study. Setting: One large county with a single system of emergency medical services. Participants: Convenience sample of residents in 22 assisted living facilities served by 1 group of primary care physicians. Intervention: Paramedics providing emergency medical services followed a protocol that included consulting with a physician by telephone. Measurements: The number of transports after a fall and the number of time-sensitive conditions in nontransported patients. Results: Of the 1473 eligible residents, 953 consented to participate in the study (mean age, 86 years; 76% female) and 359 had 840 falls in 43 months. The protocol recommended nontransport after 553 falls. Eleven of these patients had a time-sensitive condition. At least 7 of them received appropriate care: 4 requested and received transport despite the protocol recommendation, and 3 had minor injuries that were successfully managed on site. Three additional patients had fractures that were diagnosed by outpatient radiography. The final patient developed vomiting and diarrhea, started palliative care, and died 60 hours after the fall. At least 549 of the 553 patients (99.3% [95% CI, 98.2% to 99.8%]) with a protocol recommendation for nontransport received appropriate care. Limitation: The resources required for this program will preclude use in some locations. Conclusion: Shared decision making between paramedics and primary care physicians can prevent transport to the emergency department for many residents of assisted living facilities who fall. Primary Funding Source: None.

An examination of the reciprocal relations between life satisfaction and social problem solving in early adolescents.

Theoretical and emerging empirical advances in the life satisfaction (LS) and social problem solving (SPS) literature suggest that LS and SPS may have bidirectional relations. The main purpose of this study was to test the hypothesis of bidirectionality between LS and two components of the SPS, orientation (SPS-O) and skills (SPS-S). Two waves of data were collected from a sample of 733 adolescents at a middle school over a 6-month period. Cross-lagged panel analysis results showed that statistically, LS significantly predicted SPS-O and SPS-S after six months; however, neither SPS-O nor SPS-S significantly predicted LS after six months. These findings suggest LS may function as an antecedent of SPS-O and SPS-S among early adolescents, which lead to a main implication that both SPS and LS could be the direct aims of educational and psychological programs to promote SPS development in early adolescents. Additional implication and future directions are discussed.

Life satisfaction and maladaptive behaviors in early adolescents.

This study explored the directionality of the relations between global life satisfaction (LS) and internalizing and externalizing behaviors using a sample of regular education students who were initially enrolled in Grade 7 (n = 470). Self-report measures of internalizing and externalizing behaviors and LS were administered on 2 occasions, 6 months apart, to students from a Southeastern U.S. middle school. Short-term longitudinal analyses revealed that neither externalizing behaviors nor internalizing behaviors at Time 1 predicted LS at Time 2. However, LS at Time 1 predicted externalizing behaviors at Time 2. LS at Time 1 also predicted internalizing behaviors at Time 2, but the results were moderated by student gender. At higher levels of LS, boys reported lower levels of internalizing behaviors at Time 2. The overall results suggested that lower levels of LS are an antecedent of increased maladaptive behaviors among early adolescents. Alternatively, higher levels of LS may be a protective factor against subsequent externalizing behaviors among boys and girls and internalizing behaviors among boys. Furthermore, the results provide further support for the discriminant validity of positive and negative measures of mental health and suggest that LS measures may provide useful information for comprehensive adolescent health screening and monitoring systems.