A school-based post-Katrina therapeutic intervention.

The current study presents the implementation of a set of school based interventions in a greater New Orleans school district one year following Hurricane Katrina. The interventions included adaptation and implementation of evidence based treatments in a crisis situation with at-risk youth which involved training and clinical challenges. 386 students found to have significant depressive and/or disruptive disorder symptoms received treatment from the School Therapeutic Enhancement Program (STEP). Further, a district-wide mental health needs assessment of middle and high school students (N = 11,861) screened for behavioral and emotional difficulties at the beginning and end of the school year provided a benchmark for community youth's emotional and behavioral distress. High-need intervention students demonstrated clinically significant lower levels of emotional and behavioral problems, depression and inattention in comparison to pre-treatment levels as indicated by multiple informants (i.e., self, parent, teacher). Self-reported distress levels were also lower than screening group students at post-test. These findings support the efficacy of a school-based intervention for youth struggling with the aftereffects of a highly disruptive natural disaster. Implications for utilizing a flexible adaptation of an evidence-based training model involving coaching and consultation are discussed.

Improving Youth Mental Health through Family-Based Prevention In Family Homeless Shelters.

This exploratory study examines changes in suicidal ideation among a sample (N = 28) of homeless youth, ages 11-14, residing within family shelters in a large metropolitan area. Changes in suicidal ideation from pretest to posttest are compared across two group approaches to delivering HIV prevention. Youth and their families participating in the HOPE Family Program, incorporating a family strengthening approach, are compared to those receiving a traditional health education-only approach. Multivariate analyses reveal that youth in the HOPE Family Program were 13 times more likely to report a decrease of suicidal ideation. These findings indicate that health education programs integrating a family strengthening approach hold promise for positively impacting mental health outcomes for vulnerable youth.

Professional Experience Related to Self-Assessed Teaching Effectiveness Among Physical Therapist Clinical Instructors.

INTRODUCTION: Physical therapist (PT) students learn through clinical practice with the supervision of a clinical instructor (CI). Clinical instructors have teaching, education, and practice experiences that can positively affect their self-assessed clinical teaching effectiveness (CTE), which may improve learning outcomes for students. REVIEW OF LITERATURE: Identifying CI experiences, such as specific teaching, education, or practice expertise, as they relate to effective clinical teaching may be beneficial in the selection of PT CIs and allow instructors to focus on professional experiences that will elevate their self-assessed teaching abilities. SUBJECTS: The study included 851 PTs from a large geographical area. The participants had varying educational, clinical, and professional experiences and each had been a CI for at least 1 student clinical education experience. METHODS: Specific PT CI professional experiences associated with CTE were determined through a correlation study using quantitative data collected online through a validated survey instrument, the Clinical Teaching Effectiveness Questionnaire. This study examined degree earned, PT residency and PT fellowship training, the American Board of Physical Therapy Specialties (ABPTS), American Physical Therapy Association (APTA) Credentialed Clinical Instructor Program (CCIP) level 1 and level 2, years of clinical experience, number of students taught, and number of years of clinical teaching. RESULTS: Results indicated that a higher level of self-assessed CTE was associated with ABPTS certification, CCIP level 1 and level 2, and a higher number of students mentored by a CI. Physical therapist residency training, PT fellowship training, years of clinical experience, and number of years of clinical teaching were not related to self-assessed CTE. DISCUSSION AND CONCLUSION: Specific teaching, clinical, and practice experiences were related to CTE. To increase PT CI CTE, CIs are encouraged to consider ABPTS certification, CCIP level 1 and level 2, and mentoring students regularly. The PT profession, APTA, and Doctor of Physical Therapy programs should support these endeavors.

Youth Substance Use in a Context of Family Homelessness.

OBJECTIVE: This study examines the relationship between family processes and youth substance use debuts among a sample of youth residing in urban family homeless shelters. METHOD: Data regarding shelter experiences, youth and family characteristics, and the use of three substances (i.e., cigarettes, alcohol, and marijuana) were gathered from a sample of youth (11-14 years) and their respective parents residing in an urban family homeless shelter system. Multinomial logistic regression analysis was used to examine the influences on youth substance use. RESULTS: Of the 198 youth included in the statistical analysis, 72% (n=143) reported no substance use debuts, while 18% (n=35) indicated one and 10% (n=20) indicated two to three substance use debuts. Within the final model, greater substance use debut was associated with being older (13-14 vs. 11-12; OR=7.5; 95% CI =1.8-30.9) and stressors exposure (OR=4.8; 95% CI =1.5-14.7). Furthermore, youth of adult caretakers that reported low levels of the three family processes considered were almost four and a half more likely (OR=4.4; 95% CI =1.2-16.5) to have made two to three substance use debuts. CONCLUSIONS: Family processes may be a particularly important intervention target toward reducing the rate of substance use among youth residing in urban family homeless shelters.

Multiple family groups: an engaging intervention for child welfare-involved families.

Differences between child welfare- and non-child welfare-involved families regarding barriers to child mental health care, attendance, program satisfaction, and relationship with facilitators are examined for a multiple family group service delivery model aimed at reducing childhood disruptive behaviors. Although child welfare-involved caregivers reported more treatment barriers and less program satisfaction than non-child-welfare-involved families, no significant differences exist between groups on average total sessions attended and attendance rates over time.

It Takes a Village to Deliver and Test Child and Family-Focused Services.

OBJECTIVES: The purpose of this article is to highlight the benefits of collaboration in child focused mental health services research. METHOD: Three unique research projects are described. These projects address the mental health needs of vulnerable, urban, minority children and their families. In each one, service delivery was codesigned, interventions were co-delivered and a team of stakeholders collaboratively tested the impact of each one. RESULTS: The results indicate that the three interventions designed, delivered, and tested are associated with reductions in youth mental health symptoms. CONCLUSION: These interventions are feasible alternatives to traditional individualized outpatient treatment.

Cultural Pride Reinforcement as a Dimension of Racial Socialization Protective of Urban African American Child Anxiety.

The study objective was to examine how parental endorsement of cultural pride reinforcement messages may explain African American child anxiety. Data were gathered from 72 African American parents and their elementary school-aged children. Results indicated stronger parental endorsement of cultural pride reinforcement messages predicted less child anxiety. Additionally parental endorsement of these messages moderated the relationship between child mental health risk factor exposure and child anxiety. Specifically in the presence of high exposure, children of parents who endorsed high levels of cultural pride reinforcement messages had significantly lower anxiety scores relative to children of parents who endorsed low levels of these messages. Findings indicated parental endorsement of these messages may be an important factor in explaining African American child anxiety.

Building protective factors to offset sexually risky behaviors among black youths: a randomized control trial.

OBJECTIVES: To test the effectiveness of the CHAMP among black South Africans in KwaZulu-Natal, South Africa. METHODS: A randomized control trial was conducted in KwaDedangendlale, South Africa, among youths (ages 9-13) and their families (245 intervention families rearing 281 children and 233 control families rearing 298 children). The CHAMPSA intervention targeted HIV risk behaviors by strengthening family relationship processes as well as targeting peer influences through enhancing social problem solving and peer negotiation skills for youths. RESULTS: Among caregivers in the control and experimental conditions, significant intervention group differences were revealed regarding HIV transmission knowledge, less stigma toward HIV-infected people, caregiver monitoring-family rules, caregiver communication comfort, caregiver communication frequency and social networks. Among youths, data revealed that control and experimental groups were significantly different for children in AIDS transmission knowledge and less stigma toward HIV-infected people. CONCLUSIONS: CHAMPSA enhances a significant number individual, family and community protective factors that can help youths avoid risky behaviors leading to HIV-positive status.

Seeking help a second time: parents'/caregivers' characterizations of previous experiences with mental health services for their children and perceptions of barriers to future use.

This study examines the relationship between urban parents'/caregivers' previous experiences obtaining mental health care for their children and their perceptions of barriers to their children's use of services in the future. Assessments of prior treatment outcome and aspects of relationships with former providers were linked to endorsements of doubt about the utility of treatment as a potential barrier to the children's use of services in the future and the number of barriers parents endorsed. Implications for urban child mental health service delivery are drawn.

Post-9/11 helpseeking by New York City parents on behalf of highly exposed young children.

This study examines factors related to helpseeking among New York City parents on behalf of their young children after the September 11th terrorist attacks. Data were gathered from 180 parents about their children (under age 5) through in-depth parent interviews 9-12 months postdisaster. Parents were asked to describe their children's disaster-related experiences, their own and their children's mental health status, and post-9/11 helpseeking behavior for their children. Predictors of parental helpseeking for children's services included the emergence of new fears in children since 9/11, parent symptoms of depression, and parents' own helpseeking. The strongest predictor was children's direct exposure to the attacks. Fifteen percent (n = 27) of parents sought services for their very young children. Findings suggest that following 9/11, a familial orientation to helpseeking combined with children's specific disaster-related experiences may provide a basis for seeking services for young children, rather than children's apparent mental health status.

Understanding inner city child mental health need and trauma exposure: implications for preparing urban service providers.

This article presents the results of a study documenting the complex mental health needs of 95 inner city youth consecutively referred for mental health care. An ecological perspective of mental health need guides the presentation of issues and stressors that occur at the level of the individual child; within the family, school, and community; and within the larger service system context. Findings related to the intersection between child mental health needs and trauma exposure are described. In addition, the level of service involvement of these children is presented. Results reveal low rates of ongoing service involvement despite multiple, complex presenting mental health issues and significant levels of trauma exposure. Implications for urban service delivery and recommendations to prepare service providers are drawn.

Missing data within a quantitative research study: How to assess it, treat it, and why you should care.

Missing data typically refer to the absence of one or more values within a study variable(s) contained in a dataset. The development is often the result of a study participant choosing not to provide a response to a survey item. In general, a greater number of missing values within a dataset reflects a greater challenge to the data analyst. However, if researchers are armed with just a few basic tools, they can quite effectively diagnose how serious the issue of missing data is within a dataset, as well as prescribe the most appropriate solution. Specifically, the keys to effectively assessing and treating missing data values within a dataset involve specifying how missing data will be defined in a study, assessing the amount of missing data, identifying the pattern of the missing data, and selecting the best way to treat the missing data values. I will touch on each of these processes and provide a brief illustration of how the validity of study findings are at great risk if missing data values are not treated effectively.

Engaging families in child mental health services.

To increase the involvement of urban youth and families who need mental health services, child mental health agencies and providers might consider the following: (1) examining intake procedures and developing interventions to target specific barriers to service use; (2) providing training and supervision to providers to increase a focus on engagement in the first face-to-face meetings with youth and families; (3) providing service delivery options with input from consumers regarding types of services offered. Involvement of youth and their families is a primary goal that must receive as much attention as any other part of the service delivery process. One might argue that without youth and family participation, effective services never will be provided to youth and families in need.

Parent medication concerns predict underutilization of mental health services for minority children with ADHD.

OBJECTIVE. Disparities in attention deficit hyperactivity disorder (ADHD) treatment are recognized with minority children using services less than nonminority children. The authors examine minority parents' knowledge and perceptions of ADHD as they relate to service utilization. METHODS. Using a longitudinal cohort design, parents of children with untreated ADHD were surveyed regarding their knowledge and perceptions of ADHD and then followed for 3 to 6 months to determine whether they used services. RESULTS. Seventy parents of 5- to 18-year-old children with untreated ADHD were enrolled. Of the 70 children, 33 (47.1%) had not attended any mental health appointments and 51 (72.9%) had not used any treatments by 3- to 6-month follow-up. Logistic regression indicated that increasing age and medication concerns were associated with less follow-up at mental health appointments (P < .05) and less utilization of treatments (P < .05). CONCLUSIONS. The results of this study highlight the importance of addressing medication concerns, when referring minority children to mental health services or offering treatments.

Correlates of Externalizing Behavior Symptoms Among Youth Within Two Impoverished, Urban Communities.

The current study examines whether risk factors associated with child externalizing behavior symptoms differ between two similar low-income urban communities, using baseline parent data of 154 African American youth (ages 9-15) participating in the Collaborative HIV-Prevention and Adolescent Mental Health Project (CHAMP) family program. Separate multiple regression analyses of each city sample indicated that greater child externalizing symptoms were associated with increasing parenting hassles for New York families (n = 46), but greater parent mental health symptoms for participants in Chicago (n = 108). Understanding such distinctions between communities is an important first step towards tailoring services to unique community needs.

Gender and the effects of an economic empowerment program on attitudes toward sexual risk-taking among AIDS-orphaned adolescent youth in Uganda.

PURPOSE: This article examines gender differences in attitudes toward sexual risk-taking behaviors of acquired immune deficiency syndrome (AIDS)-orphaned youth participating in a randomized control trial testing an economic empowerment intervention in rural Uganda. METHODS: Adolescents (average age 13.7 years) who had lost one or both parents to AIDS from 15 comparable schools were randomly assigned to either an experimental (n=135) or a control condition (n=142). Adolescents in the experimental condition, in addition to usual care, also received support and incentives to save money toward secondary education. RESULTS: Findings indicate that although adolescent boys and girls within the experimental condition saved comparable amounts, the intervention appears to have benefited girls, in regard to the attitudes toward sexual risk-taking behavior, in a different way and to a lesser extent than boys. CONCLUSIONS: Future research should investigate the possibility that adolescent girls might be able to develop equally large improvements in protective attitudes toward sexual risk taking through additional components that address gendered social norms.

The Role of Racial Socialization in Relation to Parenting Practices and Youth Behavior: An Exploratory Analysis.

Racial socialization is receiving research attention because of growing evidence that it can be a protective developmental process in African American families. The present study was an exploration of the relationship of parental mental health, discipline effectiveness, monitoring and racial socialization strategies on child externalizing behaviors in a sample of 140 African American parent/caregivers. Findings indicated that certain types of racial socialization-particularly, spirituality and religious coping-in conjunction with discipline effectiveness was related to child behavior problems. Specifically, among parents who felt they used more effective discipline strategies, moderate to high rates of spiritual and religious coping were associated with a reduction of child behavior problems. These findings support the hypothesis that racial socialization is an important aspect of parenting in African American families that can be associated with the effective management of children's behavior. Implications for parenting interventions and future research are discussed.

The Protective Effect of Adult Mental Health Upon the Utilization of Racial Socialization Parenting Practices.

The purpose of this paper is to examine the impact of parental mental health and types of racial socialization. The sample consisted of 169 African-American parents and their children (ages 9-11) who participated in a federally funded research project, "Knowledge about the African American Research Experience" (KAARE). Bivariate analyses revealed significant positive relationships between parent mental health status and two forms of racial socialization: spiritual/religious coping, and racial awareness teaching, while multivariate analyses supported the positive association between parental mental health and spiritual/religious coping. These results suggest that parental characteristics may influence the use of specific types of racial socialization to assist youth in coping with discriminatory societal messages.

An Introduction to Parenting and Mental Health Services Utilization Among African American Families: The Role of Racial Socialization.

The articles in this special issue are a significant contribution to the literature pertaining to racial socialization, which is defined as messages parents communicate about race and culture, how African Americans are perceived societally, and how to cope with discrimination due to their skin color. More specifically, these articles examine the relationship between racial socialization and parental mental health status, child socio-behavioral functioning, and the utilization of mental health and prevention services for both parent and child. Overall, the results of these articles indicate that various racial socialization practices do indeed influence key variables such as the child's behavioral functioning and decision-making, parental mental health status, and the receipt of prevention and mental health services. Implications of these findings suggest that racial socialization beliefs and practices may in fact influence the health and functioning of African American youth and families.

The Effect of Racial Socialization on Urban African American Use of Child Mental Health Services.

OBJECTIVE: To examine how parental endorsement of racial socialization parenting practices relates to child mental health service use among an urban sample of African American families. METHODS: A cross-sectional sample of urban African American parents (n = 96) provided ratings of their beliefs concerning various dimensions of racial socialization constructs, i.e., spiritual or religious coping (SRC), extended family caring (EFC), cultural pride reinforcement (CPR), and assessed regarding their use of child mental health services. RESULTS: At the multivariate level, the use of child mental health services was significantly positively associated with moderate levels of endorsement of SRC and EFC. Inversely, scores in the moderate range of CPR were associated with a reduced likelihood of child mental health service use. CONCLUSION: Parental endorsement of racial socialization parenting practices appear to play a salient role in child mental health service use among an urban African American families. Further research with larger and more representative samples should be pursued.