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Children’s Behavioral Health

HomeTopicsChildren’s Behavioral Health

A Pillar of Our Work


Children’s behavioral health has long been a concern of the Global Alliance. Indeed, family therapy, group therapy, the community mental health movement, and a variety of initiatives aimed at improving services and treatment for children had their origins in our organization.

We remain committed to efforts to promote children’s behavioral health, to prevent mental health disorders, to the delivery of behavioral health services in a manner that is consistent with our values and beliefs, and to the creation and adoption of policies to address issues that affect the behavioral health and well-being of children.

According to the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey, approximately 13% of young people ages 8 to 15 had a diagnosable mental disorder within the previous year, and 20% of young people between the ages of 13 and 18 either currently, or at some point during their life, have had a seriously debilitating mental disorder.

An estimated $247 billion is spent each year on treatment and management of childhood mental disorders. Furthermore, there are significant disparities in mental health status and care for young people belonging to racial and ethnic minority populations and those with refugee or immigrant status. 

Forum on Promoting Children’s Cognitive, Affective, and Behavioral Health 

In 2014, in recognition of growing concern about children’s behavioral health and health disparities, the Global Alliance began sponsoring the National Academies Board on Children, Youth, and Families to support the Forum on Promoting Children’s Cognitive, Affective, and Behavioral Health (C-CAB). The Forum engages in dialogue and discussion to connect prevention, treatment, and implementation science with settings where children are seen and cared for. These settings include health care, schools, social service and child welfare, and juvenile justice. Past president, Debbie Klein-Walker, and Global Alliance board treasurer, Bill Beardslee, represent the Global Alliance on the Forum.

C-CAB Forum Reports & Commentaries

What can you do?

  • Read the reports of the Forum on Promoting Children’s Cognitive, Affective, and Behavioral Health.
  • Know the warning signs and symptoms for mental illness in children.
  • Support local violence prevention, community-building, and/or early childhood programs.
  • Advocate for policies and programs that support mental health promotion and the prevention of behavioral health problems.

Research on Children’s Behavioral Health in AJO


Under poverty and conflict: Well-being of children living in the east of Turkey

Abstract

Children living in armed conflict zones are often exposed to political violence and other risk factors that may be caused or exacerbated by the conflict, such as poverty and family violence. If left untreated, these experiences may cause psychological problems throughout life. This study investigated the psychological well-being of children living in the low-intensity armed conflict zone in Turkey in relation to their adverse experiences. We collected data from 409 caregivers for their children (236 girls) aged 5.5 to 18 years (mean [M] = 11.50, standard deviation [SD] = 3.65). Caregivers provided information regarding their children’s emotional and behavioral problems (internalizing, externalizing, and total problems; posttraumatic stress symptoms [PTSS]), income, family violence, and armed conflict experiences. Caregivers reported moderate levels of problems among children. The prevalence of borderline/clinical (T ≥ 60) scores was 14.3% for internalizing, 12.6% for externalizing, and 14% for total problems and 7.9% for PTSS. Notably, almost all families resided in extreme poverty. The prevalence of family violence was 36%. Children were frequently exposed to conflict-related events. Hierarchical regressions showed that after controlling for the role of demographic variables and other risk factors, income predicted total problem level (β = −.10), and family violence (βs = .17 to .26) and armed conflict (βs = .13 to .20) experiences predicted internalizing, externalizing, and total problems and PTSS levels. Our findings suggest that family violence and armed conflict pose a significant risk to children’s psychological well-being and inform intervention strategies and policy decisions to promote welfare in such disadvantaged contexts.

Citation

Kara, B., & Selçuk, B. (2019). Under poverty and conflict: Well-being of children living in the east of Turkey. American Journal of Orthopsychiatry, 90(2), 246–258.

Childhood sexual abuse and attachment insecurity: Associations with child psychological difficulties

Abstract

Childhood sexual abuse (CSA) is considered an important public health concern that can derail the developmental course of children. Given that children rely upon their attachment figures when they experience upsetting events, attachment organization may play a critical role in predicting victims’ adaptation to CSA. To date, no studies have delineated the unique and interactive contributions of these two risk factors in the prediction of psychopathology. The aims of this study were to examine attachment in CSA victims and a comparison group and to assess the contributions of each risk factor to child psychological difficulties. Participants included 111 children aged 7–13, of whom 43 were CSA victims. Children completed an attachment interview and reported on their depressive symptoms. Their mothers reported on children’s externalizing symptoms, internalizing symptoms, dissociation, and sexualized behavior. Our key findings showed that child victims of CSA were more likely to be classified as having insecure and disorganized attachment. Further, insecure attachment was the primary factor associated with higher self-reported depressive symptoms in all children and that CSA was associated with more parent-reported child externalizing problems, sexualizing problems, and dissociation.

Citation

Ensink, K., Borelli, J. L., Normandin, L., Target, M., & Fonagy, P. (2020). Childhood sexual abuse and attachment insecurity: Associations with child psychological difficulties. American Journal of Orthopsychiatry, 90(1), 115–124.

Investigating racial differences in clusters of adverse childhood experiences

Abstract

Many researchers have examined the cumulative effects of adverse childhood experiences (ACEs) and found that higher levels of ACEs increase the risk for worsening health conditions. Recent research has moved beyond the simple counting of ACEs, to develop a more nuanced understanding of the ways in which ACEs are experienced. Despite evidence that ACEs are experienced differentially by race, limited attention has been paid to these differences. The objective of the current study is to understand whether groupings of ACEs are experienced similarly across racial groups. A subsample of Latinx, Black, and White children were drawn from the National Survey of Children’s Health 2016 data release was used as the sample (N = 43,711). The primary measure included in the study were 9 ACE indicators available in the survey. We use descriptive and latent class analysis to examine whether similar clusters of ACEs appear across racial groups. We found that White children had lower exposure to specific ACEs as well as total number of ACEs compared to non-Latinx Black and Latinx Children. In addition, there was not configural similarity between race/ethnic groups and the latent class structure of ACE exposure varies by child race/ethnicity, suggesting important differences by child race. Understanding the disparities in children’s experiences can inform screening and intervention development.

Citation

Maguire-Jack, K., Lanier, P., & Lombardi, B. (2020). Investigating racial differences in clusters of adverse childhood experiences. American Journal of Orthopsychiatry, 90(1), 106–114.

Emotional understanding, aggression, and social functioning among preschoolers

Abstract

Evidence suggests that emotional understanding (EU) assists in the regulation of aggression, which in turn, predicts better social functioning. Although the links among EU, aggression, and social functioning have been preliminarily explored, significant gaps remain in our comprehension of the factors that could qualify these links (e.g., impact of developmental stage, type of aggression, type of social functioning, and different dimensions of EU). Here we conduct a multidimensional assessment of EU, aggression, and social functioning within a sample of aggressive preschoolers (n = 24) and a matched comparison group (n = 26; N = 50, 26 girls; Mage = 53.83 months, SDage = 3.73). We assessed EU using a behavioral assessment and social functioning via teacher-report. We conducted all analyses through the use of two measures of children’s aggression—first, we compared children identified as aggressive by preschool teachers to those in the nonaggressive comparison group. Second, we used teacher-reported continuous measures of children’s physical and relational aggression. Relative to the comparison group, the aggressive group demonstrated lower expressive EU, higher receptive EU, lower peer acceptance, and lower prosocial behavior. Analyses of continuous measures revealed a more complicated pattern of associations among aggression, EU, and social functioning. Higher physical aggression predicted greater peer victimization among females, and expressive EU was only associated with higher peer acceptance among the aggressive group.

Citation

Laurent, G., Hecht, H. K., Ensink, K., & Borelli, J. L. (2020). Emotional understanding, aggression, and social functioning among preschoolers. American Journal of Orthopsychiatry, 90(1), 9–21.

The father’s role in risk and resilience among Mexican-American adolescents

Abstract

Research suggests fathers are important to adolescent well-being, yet there is limited information regarding how fathering is associated with adolescent risk and resilience in Mexican American families. This cross-sectional study utilized a structural equation model to examine whether parent–child alienation mediated the relations between parental displays of warmth and hostility and the outcomes of adolescent resilience and delinquency in Mexican American families (N = 272). Results indicated that adolescent-perceived alienation from parents was a significant predictor of both resilience and delinquency. Additionally, alienation mediated the relations between father warmth and resilience and father warmth and delinquency, as well as the relations between mother hostility and adolescent outcomes. Implications for theory and practice are discussed.

Citation

O’Gara, J. L., Calzada, E. J., & Kim, S. Y. (2020). The father’s role in risk and resilience among Mexican-American adolescents. American Journal of Orthopsychiatry, 90(1), 70-77.

Racial/ethnic differences in alcohol use trajectories among adolescents involved in child welfare

Abstract

This study examined racial/ethnic differences in growth trajectories of alcohol use for a nationally representative sample of U.S. adolescents in the child welfare system (CWS), and how individual, family, and child welfare (i.e., proximal) factors predicted alcohol use trajectories for these adolescents. The study included 1,080 Hispanic, African American, and White adolescents aged 11 to 14 years old (at baseline) from the National Survey of Child and Adolescent Well-Being dataset, which is a nationally representative sample of U.S. children in the CWS. Latent growth modeling was used to determine alcohol use growth over 36 months, and multigroup analyses were conducted to examine racial/ethnic differences on alcohol use trajectories and the proximal factors predicting these trajectories. Findings indicated that CWS adolescents demonstrated similar trends in alcohol use growth and initiation compared to adolescents in the general population, especially the Hispanic CWS adolescents. This may reflect an overall shift in nativity status of Hispanic youth in the overall U.S. population. African American adolescents had the fewest significant predictors; this may suggest that factors more relevant for these adolescents and their alcohol use are missing from CWS research. Family-level factors were found to differentially affect use for CWS adolescents compared to adolescents in the general population. Overall, these findings point to a need for improvements in the assessment of CWS adolescents of color in research and practice settings to fully capture the complexity of experiences for these youth and their families.

Citation

Huang, C. Y., & Connell, C. M. (2019). Racial/ethnic differences in alcohol use trajectories among adolescents involved in child welfare. American Journal of Orthopsychiatry, 89(4), 524-533.

The subjective importance of children’s participation rights: A discrimination perspective

Abstract

This study examined how children appraise the importance of their participation rights—that is, the right to express their views and the right to be heard—and whether such appraisals vary as a function of perceived discrimination in the school environment. The sample comprised 1,006 children (9.6–14.3 years of age; 51% boys) from 14 public primary schools in Geneva, Switzerland. Results indicate that a majority of children considered their participation rights as very important. Children’s appraisals of these rights varied marginally between classes and schools. Moreover, children’s individual-level appraisals were sensitive to their perceptions of discrimination in the school environment, in that higher levels of perceived discrimination were associated with a greater subjective importance attached to participation rights. This suggests that appropriate measures must be taken to implement participation rights in such a manner that all children—including those who feel discriminated against—will be protected by, and fully able to enjoy, their participation rights.

Citation

Burger, K. (2019). The subjective importance of children’s participation rights: A discrimination perspective. American Journal of Orthopsychiatry, 89(1), 65-76.

Emotional understanding, aggression, and social functioning among preschoolers

Abstract

Evidence suggests that emotional understanding (EU) assists in the regulation of aggression, which in turn, predicts better social functioning. Although the links among EU, aggression, and social functioning have been preliminarily explored, significant gaps remain in our comprehension of the factors that could qualify these links (e.g., impact of developmental stage, type of aggression, type of social functioning, and different dimensions of EU). Here we conduct a multidimensional assessment of EU, aggression, and social functioning within a sample of aggressive preschoolers (n = 24) and a matched comparison group (n = 26; N = 50, 26 girls; Mage = 53.83 months, SDage = 3.73). We assessed EU using a behavioral assessment and social functioning via teacher-report. We conducted all analyses through the use of two measures of children’s aggression—first, we compared children identified as aggressive by preschool teachers to those in the nonaggressive comparison group. Second, we used teacher-reported continuous measures of children’s physical and relational aggression. Relative to the comparison group, the aggressive group demonstrated lower expressive EU, higher receptive EU, lower peer acceptance, and lower prosocial behavior. Analyses of continuous measures revealed a more complicated pattern of associations among aggression, EU, and social functioning. Higher physical aggression predicted greater peer victimization among females, and expressive EU was only associated with higher peer acceptance among the aggressive group.

Citation

Laurent, G., Hecht, H. K., Ensink, K., & Borelli, J. L. (2018). Emotional understanding, aggression, and social functioning among preschoolers. American Journal of Orthopsychiatry. Advance online publication.

Commitment to school and learning among youth in residential care: The role of mother and father support and parents’ divorce

Abstract

Commitment to school, commitment to learning, and educational expectations have been shown to contribute to positive outcomes among youth in the general population. However, it is an underexamined phenomenon among youth in care. This study examines the contribution of mother and father support and the moderating role of parents’ marital status to commitment to school and learning among youth in residential care settings (RCSs) in Israel. The study was based on the reports of a random cluster sample of 1,409 adolescents (Grades 8 to 12) in 16 educational RCSs for youth from underprivileged backgrounds, who completed structured questionnaires. In line with social capital theories, the findings showed that, after controlling for youth background characteristics and grades at school, both father and mother support were linked positively with youth commitment to school and learning among the whole sample. The findings showed that although there was a positive significant relationship between father support and commitment to school and learning among youth in married-parent families, the link was insignificant among adolescent children of divorced parents. However, the interaction between divorce and mother support was insignificant. These findings highlight the importance of nurturing parent-youth relationships in RCSs and suggest circumstances in which father support is at risk to be less beneficial to youth in RCSs—a risk that should be considered by the care system as a target for prevention and intervention programs.

Citation

Fridman-Teutsch, A., & Attar-Schwartz, S. (2018). Commitment to school and learning among youth in residential care: The role of mother and father support and parents’ divorce. American Journal of Orthopsychiatry. Advance online publication.

Maternal depression, maltreatment history, and child outcomes: The role of harsh parenting

Abstract

The link between maternal depression and negative child outcomes has been well-established; however, less is known regarding the impact of harsh parenting on child outcomes, especially for women living with depressive symptoms and whom also experienced child maltreatment. The purpose of this study was to examine harsh parenting practices as a mediator in this known association, in order to examine factors associated with negative child outcomes and to explore a reduction in future transmission of risk. Mediation analyses were conducted with 2 samples of mother–child dyads at separate time points (child age 6: n = 325; and youth age 12: n = 213) using data collected from the Longitudinal Studies of Child Abuse and Neglect. Only women who reported a history of childhood maltreatment were included in this study. Positive, significant associations were found between maternal depressive symptoms and child internalizing and externalizing symptoms at both ages. Further, partial mediation was established among maternal depressive symptoms, child outcomes, and harsh parenting practices. Analyses demonstrated that mothers with depressive symptoms and a history of maltreatment reported use of psychological and physical aggression with their children (age 6) and youth (age 12). Findings from this study bolstered existing research on maternal depression and child outcomes and extended current knowledge of the role of harsh parenting for children age 6 and youth age 12.

Citation

Wolford, S. N., Cooper, A. N., & McWey, L. M. (2018). Maternal depression, maltreatment history, and child outcomes: The role of harsh parenting. American Journal of Orthopsychiatry. Advance online publication.

Inclusive early childhood development (IECD): A twin-tracking approach to advancing behavioral health and social justice

Abstract

As our American Orthopsychiatric Association (AOA) transforms into a Global Alliance for Behavioral Health and Social Justice (GABHSJ), early childhood development (ECD), and, particularly, inclusive early childhood development (IECD) persists as a prime pathway toward enhancing behavioral health and social justice. As we systematically and intentionally include consideration of the rights and needs of young children with disabilities and their families in our research, practice, and policy, a twin-track (TT) approach that simultaneously considers universal factors alongside disability-specific factors can enhance our conceptualization of problems and solutions. In the context of the sustainable development goals (SDGs) of the UN 2030 Agenda for Sustainable Development and its commitment to “leave no one behind,” behavioral health and social justice enhancements derive from “mainstreaming” disability matters into diverse universal policies and programs. Elaborated in the triple-twin-track approach is a call for balancing child-centeredness, family focus, and community concerns as well as integrating the special and deepening knowledge of infants and young children with extant social policy and practice.

Citation

Wertlieb, D. (2018). Inclusive early childhood development (IECD): A twin-tracking approach to advancing behavioral health and social justice. American Journal of Orthopsychiatry. Advance online publication.

Nurturing the hope of youth in care: The contribution of mentoring

Abstract

Hope has long been viewed as important to individuals attempting to overcome obstacles. Overall hope is the combination of one’s appraisal of capability and determination to achieve goals (Agency) and identifying viable routes to reach them (Pathway) (Snyder, 1994). The main goal of this study was to examine the incremental contribution of mentoring to hope among youth on the verge of leaving care above and beyond related personal characteristics and placement history. The sample included 148 adolescents in residential care in Israel who had adult mentors (ages 16–19). Results showed that lower levels of parental education and being in a welfare residential placement were associated with decreased levels of hope. Mentoring length and various mentoring functions (“role model,” “parental figure,” and “independence promoter”) were found to have a significant contribution to the prediction of hope above and beyond associated individual and placement variables. Based upon these findings, residential care leaders should recruit and select mentors for longevity, and train mentors to serve as role models and parental figures who focus on independent living in order to influence hope among youth who are about to leave care.

Citation

Sulimani-Aidan, Y., Melkman, E., & Hellman, C. M. (2018). Nurturing the hope of youth in care: The contribution of mentoring. American Journal of Orthopsychiatry. Advance online publication.

Youth-serving institutional resources and neighborhood safety: Ties with positive youth development

Abstract

Neighborhoods are critical contexts for adolescent development, but little attention has been paid to how neighborhood characteristics play a role in positive youth development (PYD), notably among predominantly African American youth. This study examined distinct features of the neighborhood, including youth-serving institutional resources (YSI) and safety, as they relate to PYD among adolescents from low-income neighborhoods in an urban setting (n = 491, 68.6% African American). Because neighborhood experiences during adolescence often differ based on gender, we also examined moderation by gender. Results from cross-sectional, multilevel data suggest that neighborhood safety, YSIs, and gender are differentially associated with indicators of PYD (i.e., hope, mastery, friend support). The pattern of results suggested that when associated with mastery, YSIs may compensate for low-safety neighborhoods for adolescent females but not males. In terms of associations with friend support, YSIs may foster the development of PYD in low-safety neighborhoods for males but not females. Limitations of the current study and implications for future research are discussed.

Citation

Anderson, S., McDermott, E. R., Elliott, M. C., Donlan, A. E., Aasland, K., & Zaff, J. F. (2018). Youth-serving institutional resources and neighborhood safety: Ties with positive youth development. American Journal of Orthopsychiatry, 88(1), 78-87.

Proactive aggression in early school-aged children with externalizing behavior problems: A longitudinal study on the influence of empathy in response to distress

Abstract

The course of proactive aggressive behavior may be affected by empathy in response to sadness and distress of others. The aim of the current study is to examine empathy in response to sadness and distress and its relation to proactive and reactive aggression in a clinical sample of children with externalizing behavior problems. At baseline (T1) and 12 months later (T2), parents and teachers of 104 six- and seven-year-old children completed the Instrument for Reactive and Proactive Aggression. At T1, parents and teachers also reported empathy in response to sadness and distress on the Griffith Empathy Measure. Findings show that low levels of parent-reported empathy at baseline were specifically associated with high parent-reported proactive aggression but not with reactive aggression. Similarly, low teacher-reported empathy was specifically related to high teacher-reported proactive aggression. Furthermore, high parent-reported but not teacher-reported empathy at baseline was associated with low proactive aggression at 12 months after controlling for proactive aggression at baseline. The conclusions support the notion that in the study of the course of aggression in clinical groups, the distinction between proactive and reactive aggression as well as the study of empathy in response to distress is relevant for a better understanding and might be taken into account in the development of future interventions.

Citation

Deschamps, P. K., Verhulp, E. E., de Castro, B. O., & Matthys, W. (2018). Proactive aggression in early school-aged children with externalizing behavior problems: A longitudinal study on the influence of empathy in response to distress. American Journal of Orthopsychiatry, 88(3), 346-353.

Childhood psychopathic personality and callous–unemotional traits in the prediction of conduct problems

Abstract

This study analyzed data from a prospective longitudinal study of Swedish preschoolers to examine whether psychopathic traits and concurrent conduct problems predict future conduct problems (CP) across 1- and 2-year follow-ups into early childhood. We tested the predictive ability of psychopathic traits while controlling for concurrent CP, and also by combining psychopathic traits with concurrent CP. A community sample of 1,867 preschoolers (47% girls) ages 3 to 5 years at baseline was recruited from a Swedish medium-sized municipality. Results from multivariate regression analyses showed that psychopathic traits alone (without co-occurring CP) did not consistently predict continuing childhood CP, but did so, among both boys and girls, in combination with concurrent conduct problems. It is important to note that, the combination of concurrent CP and the entire psychopathic personality, that is, a 3-dimensional psychopathic construct, was a stronger predictor of continuing childhood CP than the combination of concurrent CP and Callous–Unemotional (CU) traits among boys but not among girls.

Citation

Frogner, L., Gibson, C. L., Andershed, A.-K., & Andershed, H. (2018). Childhood psychopathic personality and callous–unemotional traits in the prediction of conduct problems. American Journal of Orthopsychiatry, 88(2), 211-225.

Characteristics of foster care history as risk factors for psychiatric disorders among youth in care

Abstract

This study evaluates foster care history characteristics as risk factors for psychopathology. We examine characteristics of youths’ foster care histories separately and as a gestalt (i.e., identification of latent classes). Six mental health disorders and lifetime suicide attempt were assessed via in-person interviews with a representative sample of older adolescents in California foster care (n = 706). Information on respondents’ foster care histories were obtained from state administrative data. Half of the sample (47.3%) screened positive for a psychiatric disorder and 1/4 (25.2%) had attempted suicide. When assessed individually, placement instability predicted posttraumatic stress disorder (PTSD), alcohol and substance use problems, and suicide attempt. Primary placement type and maltreatment type were also associated with 1 or more psychiatric disorders. When foster care characteristics were considered in concert, 6 latent classes were identified: veterans, returners, treated stayers, midrangers, late stayers, and disquieted drifters. Three latent classes (returners, late stayers, and disquieted drifters) were at increased risk of psychiatric problems relative to 1 or more of the other latent classes. Both separate foster care characteristics and the gestalt of youths’ foster care histories identified risks of psychiatric problems. Results from these analyses can inform the development of risk assessment tools.

Citation

Okpych, N. J., & Courtney, M. E. (2018). Characteristics of foster care history as risk factors for psychiatric disorders among youth in care. American Journal of Orthopsychiatry, 88(3), 269-281.

Mental health services as a vital component of psychosocial recovery for victims of child trafficking for commercial sexual exploitation

Abstract

There has been a plethora of outcomes associated with child trafficking for commercial sexual exploitation; however little attention has been paid to how outcomes are addressed for children who are placed into residential aftercare recovery programs following their identification as victims. Field-based qualitative research was undertaken in South and Southeast Asia, and involved interviews with 213 representatives from U.N. and governmental agencies, nongovernmental organizations, and residential aftercare recovery programs. Findings highlight the mental health needs of child victims of trafficking for commercial sexual exploitation, describe the availability and quality of mental health services and supports in aftercare programs to address prevailing needs and repair the psychological damage caused by trafficking, and report on lessons learned pertaining to elements of good practice and related challenges associated with the availability and quality of mental health services and supports. It concludes by highlighting the implications of the findings for mental health policy and practice and offers suggestions for further research.

Citation

Rafferty, Y. (2018). Mental health services as a vital component of psychosocial recovery for victims of child trafficking for commercial sexual exploitation. American Journal of Orthopsychiatry, 88(3), 249-260.

Individual and neighborhood stressors, sleep problems, and symptoms of anxiety and depression among Latino youth

Abstract

Limited research has examined the relation between exposure to stressors and internalizing symptoms among Latino adolescents, including factors that account for this relation. This study examined whether sleep played a role in the relation between exposure to neighborhood- (i.e., neighborhood disadvantage) and individual-level (i.e., negative life events) stressors and symptoms of anxiety and depression among a sample of 144 low-income, Latino adolescents (54% males, mean age = 16.25, SD = 1.46) attending a charter high school in a large, Midwestern city. The bias corrected bootstrap method was used to evaluate indirect effects. Significant findings indicated an indirect effect via sleep problems in the link between negative life events and anxiety. Alternative models were also explored. Results suggest that sleep problems are important to consider for interventions among Latino youth, particularly those exposed to neighborhood and individual stressors, as this may also have implications for reducing internalizing symptoms among this population.

Citation

Rubens, S. L., Gudiño, O. G., Fite, P. J., & Grande, J. M. (2018). Individual and neighborhood stressors, sleep problems, and symptoms of anxiety and depression among Latino youth. American Journal of Orthopsychiatry, 88(2), 161-168.

Direct and indirect effects of child abuse and environmental stress: A lifecourse perspective on adversity and depressive symptoms

Abstract

There is a great deal of evidence about the mental health implications of physical child abuse and environmental stressors, or hardships that people experience at the household and neighborhood level (e.g., neighborhood violence; economic hardship, substance abuse, or conflict among family members). Yet, studies often focus on either abuse or environmental stress, not both, or examine abuse and environmental stressors as a combined set of experiences. Less is known, therefore, about how child abuse and environmental stress might work as either distinct or interrelated risks to diminish mental health over time. In this longitudinal study, we used path analyses to examine the cumulative effects of physical child abuse and environmental stressors on adult depressive symptoms among a sample of children followed into adulthood (N = 356). The goal was to assess whether chronic physical child abuse remains an independent predictor of adult outcomes once we accounted for the cumulative effects of household and neighborhood stressors across the lifecourse. Cumulative measures of physical child abuse and environmental stress each independently predicted a higher likelihood of adult depressive symptoms (ß = .122, p < .01 and ß = .283, p < .001, respectively). After accounting for adolescent depressive symptoms, only cumulative environmental stressors independently predicted depressive symptoms (ß = .202, p < .001). Tests of the indirect effect of cumulative environmental stress on the relationship between cumulative physical abuse and adult depressive symptoms were marginally statistically significant. Results add to literature that examines child abuse, adversity, and lifecourse perspectives on health.

Citation

Sousa, C., Mason, W. A., Herrenkohl, T. I., Prince, D., Herrenkohl, R. C., & Russo, M. J. (2018). Direct and indirect effects of child abuse and environmental stress: A lifecourse perspective on adversity and depressive symptoms. American Journal of Orthopsychiatry, 88(2), 180-188.

Adaptation and implementation of a trauma-focused cognitive behavioral intervention for girls in child welfare

Abstract

This study describes the process of adapting and implementing Girls Aspiring toward Independence (GAIN), a trauma-focused, group-based therapy adapted from Cognitive Behavioral Intervention for Trauma in Schools (CBITS) for girls in child welfare. Descriptive data were examined on 3 outcomes: posttraumatic stress disorder (PTSD), depression, and social problem-solving skills among adolescent girls in the child welfare system. Qualitative and quantitative methods were utilized to inform the adaptation of the CBITS intervention, evaluate feasibility, treatment fidelity, and acceptability, and to test the effects of the intervention. Girls ages 12 to 18 (N = 27) were randomly assigned to the experimental and usual care conditions. Participants’ symptoms of PTSD and depression and social problem-solving skills were evaluated at pre, post- (3 months), and follow-up (6 months) assessments. Adaptations for GAIN were primarily related to program structure. Data indicated that the program was receptive to girls in child welfare and that it was feasible to recruit, randomize, assess outcomes, and implement with adequate fidelity. Retention was more successful among younger girls. Descriptive initial data showed greater reductions in the percentage of girls with PTSD and depression, and modest increases in social problem-solving skills in the experimental versus usual care condition. Despite the growth of knowledge in dissemination and implementation research, the application of trauma-focused empirically supported treatment to child welfare populations lags behind. A large-scale RCT is needed to determine if GAIN is effective in reducing mental health problems and social problem-solving in the child welfare population.

Citation

Auslander, W., McGinnis, H., Tlapek, S., Smith, P., Foster, A., Edmond, T., & Dunn, J. (2017). Adaptation and implementation of a trauma-focused cognitive behavioral intervention for girls in child welfare. American Journal of Orthopsychiatry, 87(3), 206-215.

Effectiveness of school-based mental health playgroups for diagnosable and at-risk preschool children

Abstract

Risk factors during preschool years, such as poverty and unattended social/emotional problems, are known to have a strong negative influence on children’s later functioning. This study aimed to investigate the effectiveness of an on-site integrated school-based mental health services and consultation program for preschool children and their families. The sample consisted of 47 children and parents in 3 childcare centers who came from low-socioeconomic, urban backgrounds. Parents provided questionnaire data on children’s social-emotional functioning at 2 assessment times. Children’s ages ranged between 2 and 4 years at Time 1. Approximately half of the sample consisted of children who were selected for and received twice-weekly peer play psychotherapy (PPP) and, at-times, other mental health services from clinicians (playgroup [PG] children). The other half of the sample consisted of better functioning non-playgroup (NPG) children from the same centers. When PG and NPG were compared at Time1, the PG children were significantly behind the NPG children justifying their assignment to PG. However, at Time 2, the difference between PG and NPG was no longer significant on vital measures of adaptation, revealing the ways in which Relationships for Growth & Learning (RfGL) Program arguably led to ‘catch up’. PG children’s behavioral problems and total symptomatology decreased significantly from Time 1 to Time 2. Higher dosage of PPP was linked with higher social competence and decreased behavioral problems. Areas of gain differed between internalizing and externalizing children, indicating that intervention was helpful to different types of children. Clinical and research implications were discussed.

Citation

Bekar, Ö., Shahmoon-Shanok, R., Steele, M., Levy, J., deFressine, L., Giuseppone, K., & Steele, H. (2017). Effectiveness of school-based mental health playgroups for diagnosable and at-risk preschool children. American Journal of Orthopsychiatry, 87(3), 304-316.

Stability and change in callous-unemotional traits: Longitudinal associations with potential individual and contextual risk and protective factors

Abstract

This longitudinal study examines developmental heterogeneity in callous-unemotional (CU) traits in a large sample of school-age children in Cyprus. Latent Class Growth Analysis revealed 4 trajectory groups of CU traits across 3 time points: stable high, increasing, decreasing, and low. Findings suggested that children in the stable high CU trajectory were more likely to (a) exhibit high and stable levels of conduct problems, attention-deficit/hyperactivity disorder symptoms, impulsivity and narcissism, (b) experience low parental involvement and high parental distress, (c) report low peer support and school connectedness, and (d) score lower on academic performance, executive functioning, social competence, and self-regulation compared to children with low, decreasing, and increasing CU traits. These findings were verified by both parent and child reports. Repeated analysis of variance suggested that increases and decreases in CU traits were associated with similar changes in conduct problems, narcissism, impulsivity, and maternal involvement. Further, children in the decreasing trajectory group were not differentiated from children in the low risk group on measures of executive functioning, academic performance, school connectedness, and peer social support at the last wave of measurement. These findings provide evidence for the importance of taking longitudinal change into account for understanding developmental heterogeneity in CU traits and the association of these traits with possible protective (e.g., stable high maternal involvement) and risk (e.g., decreases in maternal involvement and increases in conduct problems, impulsivity and narcissism) variables.

Citation

Fanti, K. A., Colins, O. F., Andershed, H., & Sikki, M. (2017). Stability and change in callous-unemotional traits: Longitudinal associations with potential individual and contextual risk and protective factors. American Journal of Orthopsychiatry, 87(1), 62-75.

Comprehensive grief care for children and families: Policy and practice implications

Abstract

Since the 1998 publication of the groundbreaking Adverse Childhood Experiences (ACE) Study conducted by the Centers for Disease Control and Prevention and Kaiser Permanente, increased research and funding has focused on mitigating experiences that place children at risk for developmental disruption. Surprisingly, the death of a parent, sibling, or other important attachment figure—often noted as one of the most disruptive and potentially traumatic experiences for a child—has received relatively little attention in these efforts. This article explores the current landscape of support for grieving children and families— including significant barriers to care and gaps in empirical knowledge. Given the complexity of the issue and the nascent state of the childhood bereavement field, it is fertile ground for social innovations that challenge current norms. In addition, the argument is made for a strengths-based, wellness approach to childhood bereavement that seizes upon opportunities to both promote adaptive adjustment and prevent further complications of unaddressed grief and trauma.

Citation

Griese, B., Burns, M. R., Farro, S. A., Silvern, L., & Talmi, A. (2017). Comprehensive grief care for children and families: Policy and practice implications. American Journal of Orthopsychiatry, 87(5), 540-548.

Renewing our commitment to the most vulnerable children and families

Abstract

Comments on the original article by Michael Wald (see record 2017-42208-003) regarding [main topic in original article]. In his article, Wald calls for the government to design a system of services to strengthen parenting to promote healthy child development. He calls for a new set of policies to support parents, particularly parents of the most vulnerable children—children without adequate protection and children subjected to both poverty and the adversities associated with poverty. More than ever, it is critical for the country to come together and stand with children and families who have been too often left behind, forgotten, and in the shadows. This commentary draws attention to three steps we all need to take as we embark on this new journey.

Citation

Lombardi, J. (2017). Renewing our commitment to the most vulnerable children and families. American Journal of Orthopsychiatry, 87(5), 557-558.

The correlation between exposure to neighborhood violence and perpetration of moderate physical violence among Arab-Palestinian youth: Can it be moderated by parent–child support and gender?

Abstract

In the current study, we examined the role of parent–child support as a protective factor that moderates the correlation between exposure to neighborhood violence and perpetration of moderate physical violence among 3,187 Arab-Palestinian adolescents who live in Israel (aged 12 to 18), from 21 different schools who were selected randomly. The probability sampling method was a nonproportional multistage stratified cluster sample. We also examined gender differences across this protective process. Participants completed a structured, anonymous self-report questionnaire. The findings of the study reveal that 47.3% of the adolescents had perpetrated moderate physical violence against others at least once during the month preceding the study. Moreover, exposure of adolescents to violence in their neighborhood correlated significantly and positively with perpetration of moderate physical violence. A moderation analysis was tested and found that this correlation was stronger among adolescents who had poor parent–child support than among those who had strong parent–child support. Furthermore, the findings reveal that the correlation of exposure to neighborhood violence with perpetration of moderate physical violence was not moderated by gender. However, parent–child support correlated strongly with lower levels of perpetration of moderate physical violence among males than females. The findings of the study highlight the critical role of parental factors in decreasing violent behaviors among adolescents (especially boys) as well as among adolescents who are at risk for exposure to violence in their neighborhoods. In light of the findings, we recommend that practitioners working with these adolescents include parents in intervention programs.

Citation

Massarwi, A. A. (2017). The correlation between exposure to neighborhood violence and perpetration of moderate physical violence among Arab-Palestinian youth: Can it be moderated by parent–child support and gender? American Journal of Orthopsychiatry, 87(4), 452-462.

Intergenerational continuity of adverse childhood experiences in homeless families: Unpacking exposure to maltreatment versus family dysfunction

Abstract

Despite the expanding research on adverse childhood experiences (ACEs) and corpus of studies on intergenerational maltreatment in high-risk families, studies have not examined intergenerational ACEs more broadly, much less in severely disadvantaged families. This study investigated the intergenerational continuity of ACEs in mothers and young children aged 4 to 6 years living in emergency homeless shelters. It also examined whether unpacking ACEs into categories of exposure to maltreatment versus family dysfunction affected intergenerational continuity patterns or child socioemotional problems in school. Negative parenting, in the form of observed inept coercive discipline with children, and cumulative sociodemographic risk were examined as additional predictors of child ACEs and socioemotional problems. Mothers (N = 95; aged 20–45; 64.2% African American, 3.2% African Native, 11.6% Caucasian, 7.4% biracial/multiracial, and 13.6% other) completed questionnaires on parent and child ACEs and cumulative risk factors. They participated in videotaped parent–child interactions rated for observed coercive discipline, and teachers provided reports of children’s socioemotional problems. Results indicated that higher parental ACEs predicted higher child ACEs, with higher numbers of parental ACEs in either category (maltreatment or family dysfunction) predicting higher levels of child ACEs in both categories. However, child exposure to maltreatment, but not family dysfunction, significantly predicted elevations in children’s socioemotional problems. Findings underscore the role of intergenerational childhood adversity in homeless families and also emphasize that unpacking ACEs in children may illuminate key areas of vulnerability for school adjustment.

Citation

Narayan, A. J., Kalstabakken, A. W., Labella, M. H., Nerenberg, L. S., Monn, A. R., & Masten, A. S. (2017). Intergenerational continuity of adverse childhood experiences in homeless families: Unpacking exposure to maltreatment versus family dysfunction. American Journal of Orthopsychiatry, 87(1), 3-14.

Physical family violence and externalizing and internalizing behaviors among children and adolescents

Abstract

Family violence has been associated with various negative outcomes among children and adolescents. Yet, less is known about how unique forms of physical family violence contribute to externalizing and internalizing behaviors based on a child’s developmental stage. Using data from the Illinois Families Study and administrative Child Protective Services data, we explored the relation between 3 types of physical family violence victimization and externalizing and internalizing behaviors among a sample of 2,402 children and adolescents. After including parent and family level covariates in Poisson regressions, we found that a unique form of family violence victimization was associated with increased externalizing behaviors among children at each age group: exposure to physical intimate partner violence (IPV) among children ages 3–5, exposure to the physical abuse of a sibling among children ages 6–12, and child physical abuse among adolescents ages 13–18. No form of physical family violence was significantly associated with internalizing behaviors for children in any age group. Including exposure to the child maltreatment of a sibling is crucial when attempting to contextualize children’s responses to family violence and providing comprehensive services in an effort to enhance the well-being of all children in a family.

Citation

Renner, L. M., & Boel-Studt, S. (2017). Physical family violence and externalizing and internalizing behaviors among children and adolescents. American Journal of Orthopsychiatry, 87(4), 474-486.

Stressful life events and perceived parental control in formerly homeless families: Impact on child-internalizing symptoms

Abstract

Research has neglected the potential role of perceived parental control as a moderator between stressful life events (SLEs) and child-internalizing symptoms. Using secondary data from the Early Risers “Skills for Success” Program (August, Realmuto, Hektner, & Bloomquist, 2001), this study examined the impact of perceived parental control on the association between SLEs and child internalizing symptoms in formerly homeless families. The sample consisted of 137 families with 223 children between 4 and 12 years of age (M = 8.1, SD = 2.3) living in supportive housing sites in Minneapolis, Minnesota. Participants completed measures assessing the number of SLEs experienced (e.g., unemployment of parent, death of loved one, serious illness, homelessness), perceived parental control, and child-internalizing symptoms. In this sample, 65% of children (n = 144) experienced at least 1 SLE with an average experience of 2 SLEs (M = 2.0, SD = 1.9, range = 0–7). A regression analysis found that experiencing more SLEs and a perceived absence of parental control over child behavior were positively associated with child-internalizing symptoms. A significant interaction between SLEs and perceived absence of parental control over child behavior in predicting child internalizing symptoms was also found. These findings suggest that children of parents who model appropriate control are more likely to experience fewer internalizing symptoms in response to SLEs.

Citation

Utržan, D. S., Piehler, T. F., Gewirtz, A. H., & August, G. J. (2017). Stressful life events and perceived parental control in formerly homeless families: Impact on child-internalizing symptoms. American Journal of Orthopsychiatry, 87(3), 317-325.

Helping America’s most vulnerable children and parents

Abstract

This article focuses on ways the government should allocate resources in order to support America’s most vulnerable children and parents. Government policies on helping children seek to achieve many outcomes, but four are especially important: (a) protecting children’s basic physical safety and mental safety (i.e., sense of emotional security in relationships with one’s parents) during childhood; (b) ensuring that children do not suffer from serious mental health problems that impair their adjustment and ability to function well at home, at school, and in social relations; (c) helping all children acquire the academic skills needed for economic “success” (i.e., having the capacity to earn a “middle class” income); and (d) increasing equal opportunity for economic and social mobility. In trying to achieve these four outcomes, policymakers must decide how to allocate resources among programs that focus primarily on the child, such as preschool and K-12 education; programs seeking to improve parenting, such as home visiting; and programs that provide economic resources, such as cash and subsidies, to families. This article elaborates on this approach.

Citation

Wald, M. S. (2017). Helping America’s most vulnerable children and parents. American Journal of Orthopsychiatry, 87(5), 549-556.

Parenting stress as a mediator of trauma exposure and mental health outcomes in young children

Abstract

Exposure to potentially traumatic events (PTEs) significantly impacts outcomes for children in behavioral health systems of care (SOCs). The present study built on previous research that found parenting stress influences outcomes for children exposed to PTEs. The sample included 184 young children and their families who were enrolled in an early childhood SOC. Path analyses demonstrated that parenting stress mediated the relationship between the number of PTEs a child experienced and caregiver-reported internalizing/externalizing problem behaviors at baseline. Parenting stress also mediated PTEs and internalizing problem behaviors at 6 months. In response to the culmination of these studies, we discuss ways SOCs can support parents to help alleviate parenting stress.

Citation

Whitson, M. L., & Kaufman, J. S. (2017). Parenting stress as a mediator of trauma exposure and mental health outcomes in young children. American Journal of Orthopsychiatry, 87(5), 531-539.

Obsessive–compulsive disorder in African American children and adolescents: Risks, resiliency, and barriers to treatment

Abstract

Obsessive–compulsive disorder (OCD) is a serious condition that remains understudied in ethnoracial minority populations. The presence of OCD and the individual, familial, and cultural factors that influence this condition can interfere with healthy development and cause lifelong disability. To date, there has not been a single published research article focused on OCD in African American youth. Ethnic and racial minorities with OCD are underrepresented or altogether absent from treatment centers and research studies, although evidence suggests that OCD may be particularly persistent in these populations. This article reviews risk factors, protective factors, and barriers to treatment in African American children and adolescents with OCD. This review conceptualizes cultural differences in symptomology, low income, reduced access to care, racism, and mental health stigma, as risk factors. Also discussed are the roles of family factors in the development and maintenance of the disorder, including family accommodations, conflictual family communication, and parenting styles. Potential protective factors are also examined, including a positive ethnic identity, social support, present-centered time orientation, and religious communities. Implications of findings are discussed. There is an urgent need for research to understand the needs of African American children and adolescents with OCD.

Citation

Williams, M. T., & Jahn, M. E. (2017). Obsessive–compulsive disorder in African American children and adolescents: Risks, resiliency, and barriers to treatment. American Journal of Orthopsychiatry, 87(3), 291-303.

Profiles of youth in therapeutic group care: Associations with involuntary psychiatric examinations and readmissions

Abstract

The study aims were to identify distinct subgroups among youth placed in therapeutic group care (TGC) and to examine the effect of specific constellations of risk factors on readmission to residential mental health care and involuntary psychiatric examination among youth in TGC. Several administrative databases were merged to examine outcomes for youth placed in TGC during fiscal year FY04-05 through FY07-08 (N = 1,009). Latent class analysis (LCA) was conducted. Two classes were identified: youth with multiple needs (Class 1) and lower risk youth (Class 2). Class 1 represented 45% of youth in TGC. Compared with Class 2, these youth had a greater probability of having physical health problems, parents with substance abuse problems, and more extensive histories of maltreatment. Compared with Class 2, youth with multiple needs were almost twice more likely to exhibit self-injurious behavior leading to involuntary mental health examinations, but they were less likely to be readmitted to a residential mental health care of higher level of restrictiveness, such as state inpatient psychiatric programs (SIPPs). Youth placed in Florida TGC represent a heterogeneous population and services tailored to these youth’s needs are important. Youth with multiple risk factors would benefit from interventions that would address multiple areas of risk. Lower risk youth (Class 2) would benefit from interventions that would focus on promoting mental health, especially among those who have experienced threatened harm, and providing services and supports necessary for stabilizing these youth in the community.

Citation

Yampolskaya, S., & Mowery, D. (2017). Profiles of youth in therapeutic group care: Associations with involuntary psychiatric examinations and readmissions. American Journal of Orthopsychiatry, 87(1), 76-85.

2016 Special Edition Articles

New frontiers in building mental, emotional, and behavioral health in children and youth: Introduction to the special section

Abstract

The passage of the Patient Protection and Affordable Care Act (ACA; 2010) has had tremendous influence on behavioral health in the United States (Alker & Chester, 2015). Shortly after its passage, the editors of this special section became interested in examining the provisions of the ACA related to care for mental, emotional, and behavioral disorders in children and youth and synthesizing their implications in the context of other contemporary trends in children’s behavioral health promotion. We first developed a white paper with the goal of increasing our own understanding of these issues and their possible influence on the status quo of designing, implementing, financing, and evaluating behavioral health services for children and their families. From our discussions came the idea of developing a special section in the American Journal of Orthopsychiatry featuring input from researchers who have been exploring these issues and who have tangible and relevant examples of “new frontiers” in building mental, emotional, and behavioral health for children and youth. The result is the current special section, the purpose of which is to highlight the importance of prevention in behavioral health and to explore examples of efforts that have used a broad public health approach to prevention and early intervention in mental, emotional, and substance use disorders in children and youth. Before introducing the seven articles in this special section, we describe in detail our foundational thinking about building mental, emotional, and behavioral health for children and youth, as expressed in our initial white paper on this topic.

Citation

Evans, M. E., Bruns, E. J., Armstrong, M. I., Hodges, S., & Hernandez, M. (2016). New frontiers in building mental, emotional, and behavioral health in children and youth: Introduction to the special section. American Journal of Orthopsychiatry 86, 103-108.

Toxic stress, behavioral health, and the next major era in public health

Abstract

Before the development of the germ theory in the late 19th century, infectious illnesses were largely uncontrollable and caused significant mortality. Implementing public hygiene, preventive, and treatment interventions created remarkable improvements in population health. Today’s U.S. public health crises involve threats to health and human capital evidenced by multiple indicators of deteriorating wellbeing. These problems result from the interaction of risk and protective factors. Specifically, we argue that the interaction of genetic vulnerability and toxic stress are antecedents to a developmental cascade that undermines healthy development and human capital. We review relevant literature, summarize effective strategies to prevent or ameliorate this deterioration, and outline a theory of the mechanisms currently undermining our health. A series of strategies that we believe will constitute the next major era in public health are discussed, involving actions at the individual/family, community and societal level to reduce risk and strengthen protective factors.

Citation

Shern, D.L.; Blanch, A.K.; & Steverman, S.M. (2016). Toxic stress, behavioral health, and the next major era in public health. American Journal of Orthopsychiatry 86, 109-123.

Launching forward: The integration of behavioral health in primary care as a strategy for promoting young child wellness

Abstract

In 2008, the Substance Abuse and Mental Health Services Administration (SAMHSA) created a national grant program, Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health), to improve behavioral health and developmental outcomes for young children through the incorporation of prevention and wellness promotion practices in key early childhood settings. Project LAUNCH supports states, tribal nations, and territories to improve coordination across early childhood systems and implement 5 core strategies of prevention and promotion. This article focuses on the lessons learned from 1 of the 5 core strategies: integration of behavioral health into primary care for young children. This paper analyzes the experiences of a sample of Project LAUNCH grantees, describing 10 common elements of integration approaches and exploring some of the challenges of promoting health and preventing social, emotional, and behavioral problems at a population level.

Citation

Oppenheim, J.; Steward, W.; Zoubak, E.; Donato, I.; Huang, L. & Hudock, W. (2016). Launching forward: The integration of behavioral health in primary care as a strategy for promoting young child wellness. American Journal of Orthopsychiatry 86, 124-131.

Building and evidence-based multitiered system of supports for high-risk youth and communities

Abstract

The mental, emotional and behavioral health problems of high-risk youth and youth living in high-risk communities are not inevitable and can be prevented. A shift from the nation’s focus on treating disease and illness after it occurs to a concentrated effort on preventing the root causes of these problems is needed. Prevention science suggests a comprehensive multitiered approach that provides evidence-based prevention supports for children and youth at each developmental stage and across multiple social contexts is likely to result in the greatest health impact and return on investment. However, actually implementing this approach at a neighborhood level has remained a challenge and an ongoing research gap especially in high-risk communities. This article describes a process and provides a case study example for implementing a comprehensive, multitiered approach in a high-risk community. This includes assessing and prioritizing the specific needs of individuals and communities; selecting evidence-based programs based upon assessed needs; and creating a continuum of programs to improve the health and well-being of youth across developmental age spans, social contexts, and levels of risk. Operational details and challenges for organizing and implementing this comprehensive approach are also described. We estimate that the collective impact of a multitiered evidence-based approach, implemented with fidelity, could conservatively result in a 30 to 40% reduction in problem behaviors.

Citation

Kingston, Beverly E., Mihalic, Sharon F., Sigel, Eric J. (2016). Building and evidence-based multitiered system of supports for high-risk youth and communities. American Journal of Orthopsychiatry 86, 132-143.

Using communities that care for community child maltreatment prevention

Abstract

The prevention of mental, emotional, and behavioral (MEB) disorders among children and adolescents is a national priority. One mode of implementing community-wide MEB prevention efforts is through evidence-based community mobilization approaches such as Communities That Care (CTC). This article provides an overview of the CTC framework and discusses the adaptation process of CTC to prevent development of MEBs through preventing child abuse and neglect and bolstering child well-being in children aged 0 to 10. Adaptations include those to the intervention itself as well as those to the evaluation approach. Preliminary findings from the Keeping Families Together pilot study of this evolving approach suggest that the implementation was manageable for sites, and community board functioning and community adoption of a science-based approach to prevention in pilot sites looks promising. Implications and next steps are outlined.

Citation

Salazar, A., Haggerty, K., de Haan, B., Catalano, R., Vann, T., Vinson, J., & Lansing, M. (2016). Using communities that care for community child maltreatment prevention. American Journal of Orthopsychiatry 86, 144-155.

Fostering SMART partnerships to develop an effective continuum of behavioral health services and support in schools

Abstract

The education sector offers compelling opportunities to address the shortcomings of traditional mental health delivery systems and to prevent and treat youth mental, emotional, and behavioral (MEB) problems. Recognizing that social and emotional wellness is intrinsically related to academic success, schools are moving to adopt multi-tier frameworks based on the public health model that provide a continuum of services to all children, including services to address both academic and MEB problems. In this article, we review the potential value of multi-tier frameworks in facilitating access to, and increasing the effectiveness of, mental health services in schools, and review the empirical support for school-based mental health interventions by tier. We go on to describe a community–academic partnership between the Seattle Public Schools and the University of Washington School Mental Health Assessment, Research, and Training (SMART) Center that exemplifies how multi-tier educational frameworks, research and evidence, and purposeful collaboration can combine to improve development and implementation of a range of school-based strategies focused on MEB needs of students. Finally, we present a set of 10 recommendations that may help guide other research and practice improvement efforts to address MEB problems in youth through effective school mental health programming.

Citation

Bruns, Eric J.; Duong, Mylien T.; Lyon, Aaron R.; Pullmann, Michael D.; Cook, Clayton R.; Cheney, Douglas; McCauley, Elizabeth. (2016). Fostering SMART partnerships to develop an effective continuum of behavioral health services and support in schools. American Journal of Orthopsychiatry 86, 156-170.

Using public health strategies to shape early childhood policy

Abstract

There is clear evidence that ensuring safe, stimulating, and nurturing caregiving environments for young children may be one of the most impactful health promotion strategies available, with lifelong and intergenerational benefits. Supports and interventions in the early years of life may in fact be the most effective way to improve school performance, increase high school graduation rates, job performance, and adult productivity. A public health approach to early childhood well-being, as opposed to the needs of children being addressed in multiple siloes, may be a more effective strategy that will lead to smarter investments and increasing financial commitments. Louisiana is used as a case study, with examples of strategies organized by the 3 core functions of public health.

Citation

Nagle, Geoffrey A.; Usry, Lindsay R. (2016). Using public health strategies to shape early childhood policy. American Journal of Orthopsychiatry 86, 171-178.

Can behavioral health drive its own reformation? The challenges of shifting direction

Abstract

This paper is designed to provide a broad-view perspective on at least some of the implications of the Affordable Care Act for children’s behavioral health. Historical trends in behavioral health have tended to isolate both consumers of services (including children, youth and families) and practitioners from the larger world of healthcare, with decidedly mixed results. This paper uses the concept of path dependence to highlight the multiple challenges facing child behavioral health as it moves forward. The paper builds its recommendations on the 4 pillars of sustainable change: politics, practice, economics, and science. In a changing health care environment, behavioral health has to transform. The paper concludes with some observations on the kinds of transformative change required to move in new directions.

Citation

Morris, John A. (2016). Can behavioral health drive its own reformation? The challenges of shifting direction. American Journal of Orthopsychiatry 86, 179-185.

Children come first? A brief history of children’s mental health services

Abstract

This article provides a brief history on the evolution of child mental health services. From 1961 when modern day mental health programming began with the Joint Commission on Mental Health and Illness to key developments in children ‘s mental health services and prevention in modern day.

Citation

Levine, Murray. (2015). Children come first? A brief history of children’s mental health services. American Journal of Orthopsychiatry 85(5):S22-S28.

Poverty and adolescent depressive symptoms

Abstract

Longitudinal data on non-Hispanic White children from the Panel Study of Income Dynamics (N = 1,056) were used to examine whether the relationship between poverty (early childhood poverty, poverty persistence, and current poverty) and adolescent depressive symptoms (measured by the Children’s Depression Inventory and the Internalizing Index) can be explained by the mother’s own childhood depression and family characteristics measured during the child’s first year of life. Associations between poverty and depressive symptoms among adolescents were explained by mother’s childhood depression and whether the adolescent had lived with both parents during the first year of life. The findings highlight the need for appropriate treatment of childhood depression so as to reduce the adverse consequences in adulthood and for the next generation.

Citation

Butler, Amy C. (2014). Poverty and adolescent depressive symptoms. American Journal of Orthopsychiatry 84(1):82-94.

Family context, victimization, and child trauma symptoms: Variations in safe, stable, and nurturing relationships during early and middle childhood

Abstract

Based on a nationally representative sample of 2,017 children age 2–9 years, this study examines variations in “safe, stable, and nurturing” relationships (SSNRs), including several forms of family perpetrated victimization, and documents associations between these factors and child trauma symptoms. Findings show that many children were exposed to multiple forms of victimization within the family (such as physical or sexual abuse, emotional maltreatment, child neglect, sibling victimization, and witnessing family violence), as evidenced by substantial intercorrelations among the different forms of victimization. Moreover, victimization exposure was significantly associated with several indices of parental dysfunction, family adversity, residential instability, and problematic parenting practices. Of all SSNR variables considered, emotional abuse and inconsistent or hostile parenting emerged as having the most powerful independent effects on child trauma symptoms. Also, findings supported a cumulative risk model, whereby trauma symptom levels increased with each additional SSNR risk factor to which children were exposed. Implications for research and practice are discussed.

Citation

Turner, H., Finkelhor, D., Ormrod, R., Hammy, S., Leeb, R., Mercy, J., & Holt, M. (2012). Family context, victimization, and child trauma symptoms: Variations in safe, stable, and nurturing relationships during early and middle childhood. American Journal of Orthopsychiatry 82(2):209-219.

Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis

Abstract

Childhood exposure to victimization is prevalent and has been shown to contribute to significant immediate and long‐term psychological distress and functional impairment. Children exposed to interpersonal victimization often meet criteria for psychiatric disorders other than posttraumatic stress disorder (PTSD). Therefore, this article summarizes research that suggests directions for broadening current diagnostic conceptualizations for victimized children, focusing on findings regarding victimization, the prevalence of a variety of psychiatric symptoms related to affect and behavior dysregulation, disturbances of consciousness and cognition, alterations in attribution and schema, and interpersonal impairment. A wide range of symptoms is common in victimized children. As a result, in the current psychiatric nosology, multiple comorbid diagnoses are necessary—but not necessarily accurate—to describe many victimized children, potentially leading to both undertreatment and overtreatment. Related findings regarding biological correlates of childhood victimization and the treatment outcome literature are also reviewed. Recommendations for future research aimed at enhancing diagnosis and treatment of victimized children are provided.

Citation

D’Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & van der Kolk, B. (2012). Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry 82(2):187-200.

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