ABSTRACT Background Low-intensity mental healthcare addresses prevalent mental health issues, eliminates barriers to treatment access and bridges the service gap. Objective This pilot study explored the feasibility, acceptability and initial effectiveness of Low-intensity Acceptance and Commitment Therapy (Li-ACT) for youth experiencing subthreshold to mild and moderate psychological distress provided by paraprofessionals known as Well-being Practitioners (WPs). Method A total of 406 participants were involved: 268 participants aged 12–17 (151 females, 117 males, M = 14.06 years) and 138 participants aged 18–24 (97 female, 41 male, M = 21.29 years). Participants attended seven individual weekly, 60-minute sessions and one follow-up session after six weeks. Results Repeated ANOVA results showed significant improvements in psychological distress and flexibility, quality of life, and therapeutic alliance over time. Effect sizes ranged from small to large for participants under 18 and moderate to large for those aged 18 and above. Mixed ANOVA results suggested different patterns of change among clinical/non-clinical subgroups. The overall recovery rate was 34.07%, with 26.17% for 12–17-year-olds and 69.7% for 18–24-year-olds. Qualitative feedback indicated the acceptability and feasibility of Li-ACT across age groups, with suggestions for improvement. Conclusions Li-ACT was acceptable, feasible and potentially effective. The practical implications of the findings are discussed.

ABSTRACT Background: Transgender and gender expansive (TGE) youth have seen both an increase in access to mental health and medical services in the previous two decades, and also a sharp increase in bills limiting access to care and supports in the past 3 years. Objective: Psychologists have a unique role to play in working with TGE youth, as we have been trained in research methodology, clinical practice and human behavior. As such, psychologists can effectively advocate for the best practices when working with TGE youth. Results: In this article, we provide a brief overview of general concerns of TGE youth from a mental health perspective and then outline various ways in which psychologists can use their training and experience to advocate for best practices when working with TGE youth utilizing a social justice framework.

ABSTRACT Background Acute psychiatric hospitalizations are costly and associated with significant impairment in adolescence. A substantial proportion of adolescents require rehospitalization within the first 24 months following discharge, yet the research literature does not provide clear guidance on which adolescents are at greatest risk and what symptoms specifically drive this elevated risk level. Objective This study aimed to (1) characterize adolescents at greatest risk of rehospitalization and (2) identify symptoms that contribute to the greatest risk of rehospitalization over the course of 3, 12, and 24 months post-discharge. Method Patients (N = 508; ages 13–17; 56% female; 50% sexual minority; 83% racial minority) completed self-report measures of symptom severity during the first 48 h of admission to psychiatric hospitalization. Latent profile analyses were conducted to identify distinct clinical profiles within the sample. Electronic medical records were reviewed to determine if participants were rehospitalized during the subsequent 24 months. Survival analyses were conducted to determine which latent profile and symptoms were associated with the greatest odds of re-admission in the short-term (3 months) and longer-term (12 and 24 months) post-discharge. Results: Three profiles emerged: Higher Severity & Many Previous Hospitalizations (n = 94; HSMPH), Higher Severity & Few Previous Hospitalizations (n = 305; HSFPH), and Lowest Severity & No Previous Hospitalizations (n = 109; LSNPH). Risk of rehospitalization differed between profiles during the first 12 (p = .003) and 24 months (p = .003), such that the rehospitalization risk for HSMH > HSFH (HR 12-month = 1.68, HR 24-month = 1.61, ps = .045) and HSFH > LS (HR 12-month = 2.38, HR 24-month = 2.13, ps< .035). Irritability was associated with greater odds of rehospitalization during the first 12 months post-discharge among participants with previous hospitalizations (n = 399; HR = 1.08, p = .032). Irritability was associated with a greater frequency of rehospitalizations across 24 months in the full sample (N = 508; IRR = 1.08, p = .005). Conclusion Irritability increases the risk of rehospitalization during the first-year post-discharge among adolescents with the highest clinical severity.

ABSTRACT Background Schools are the primary context for mental health services for youth in the United States and a critical setting for increasing access to mental health care, especially for youth from low income and historically minoritized communities. However, numerous barriers to implementing evidence-based practices persist for chronically underserved youth in schools. Establishing strong collaborations with community partners is essential for successful implementation. Objective This conceptual overview offers the ACCESS model as a resource for school-partnered training and consultation efforts, in contrast to previous applications that emphasized community mental health and inpatient contexts. Method Drawing from our groups’ collective decades of partnering with school and community members to deliver evidence-based practice training and consultation support in underserved schools and reflecting on our collaborations with community mental health agencies contracted to provide mental health services in schools, we outline a practical model for partners to provide training and implementation support in the school context. Specifically, we have described applications of the ACCESS model in training and consultation in partnership with leaders, service providers, and educators working in underserved school settings. The ACCESS model provides guidance for trainers and implementers to Assess and adapt training content, Convey the basics during initial training, provide Consultation to facilitate learning and behavior change, Evaluate work samples to assess EBP fidelity, Study outcomes, and foster Sustainment of practices over time. Conclusion The ACCESS model offers a practical roadmap for school-partnered EBP implementation, outlining each step and providing concrete guidance for psychologists with applied examples from our work. This authorship team represents co-developers of the ACCESS model and three distinct research groups that have provided training and consultation in partnership with numerous public-school systems. Throughout, we emphasize how school-academic partnerships can support implementation in underserved schools.

ABSTRACT Background Due to systemic racism, low-income Black youth experience both heightened stressors that contribute to behavioral health difficulties and a disparity in access to empirically supported and culturally relevant services. Black scholars and communities have long pushed for antiracist approaches, but those calls have gone largely ignored by the behavioral health field, as evidenced by marked deficits in training clinicians to understand and challenge racist practices steeped in our field. Objective Despite a renewed call across behavioral health, there are few applied models for how to incorporate antiracism in training beyond a single “diversity” class. Training from this lens and within community settings is essential not only to increase equitable access to services for low-income Black families and other marginalized groups, but also to shift the behavioral health field to systems-level dialogue and action. This paper describes the development of a child-focused behavioral health practicum in a community setting as a potential model for other sites seeking to implement an antiracist lens. Method The setting for the current study is Boys & Girls Clubs of Southeastern Michigan, a youth-serving community organization with clubs across the Metro Detroit area with proximity to multiple training programs and universities. The practicum is examined across three phases – preparation, implementation, and expansion – evaluated through Shelton and colleagues’ (2021) antiracism implementation science framework. Results Across each phase, we identify both areas of alignment and opportunities within an antiracism lens. In examining each phase, we demonstrate the feasibility of our antiracist training model, which was well-accepted by both trainees and nearly 1000 families served in our first practicum year. Conclusions While this paper provides actionable steps for practicum sites to implement antiracist approaches, extending such approaches to broader systemic change and resistance within the field of behavioral health is necessary for equitable research and practice.

ABSTRACT Background Trauma, acculturation stressors, and discrimination are among many factors that place Latinx children and adolescents living in the United States at high risk for mental health distress and suicidal behavior. Despite these well-documented risk factors, mental health providers struggle to continuously engage Latinx youth and families in mental health care, including evidence-based treatments for addressing suicidal behaviors such as Dialectical Behavior Therapy for Adolescents (DBT-A). One barrier to engagement is access to such effective treatments. Objective While highlighting inequities and resulting mental health disparities for Latinx communities, this article shares a call to action that contextualizes suicidal behaviors of Latinx youth within oppression and marginalization and identifies effective, flexible, and culturally attuned ways to increase access to and utilization of DBT-A. Methods Five recommendations are proposed for implementing a culturally and linguistically attuned application of DBT-A. Results These five recommendations guided the creation of the DBT-A Bilingual Spanish (DBT-ABS) multifamily skills group, increasing access for Latinx adolescents with Spanish speaking caregivers. Conclusion Understanding and addressing disparities, supporting and training bilingual clinicians, and contextualizing DBT in cultural humility and collaborative participation facilitate efforts for increasing access to evidence based care.

ABSTRACT Background Globally, one in seven 10–19-year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group. In low- and middle-income countries (LMICs), many children and adolescents face serious mental health disorders, including disruptive behavioral disorders (DBDs), which often begin in childhood and adolescence. Between 2016 and 2021, a large cluster randomized controlled trial was conducted in Uganda under the SMART Africa initiative to examine the impact and implementation of the Multiple Family Group (MFG) intervention for children with behavioral problems and their families. The intervention proved efficacious in reducing impaired functioning and had the potential to improve family dynamics, whether delivered by community members or parents. With limited mental health experts in Uganda, understanding the fidelity of this mental health intervention with task shifting will be critical. Objective This study systematically assesses the fidelity of the MFG intervention, focusing on the dose dimension, which includes the frequency and duration of intervention sessions and adherence to the intervention manual. Methods The fidelity assessment was embedded within the SMART Africa trial and conducted after every MFG session for facilitators and caregivers and at 25% of the sessions (sessions 4, 8, 12, and 16) by research staff. Facilitators and participants completed a 5-minute fidelity assessment checklist at the end of each session, while independent fidelity observations were conducted for 25% of the sessions by trained research assistants. Data were analyzed to assess the relationship between planned and actual implementation. Results In this study, the MFG intervention included 1,290 participants and caregivers, with children having an average age of 12 years and most caregivers being female with a primary education. Each session had an average attendance of over 70%, with 33% of participants attending all 15 sessions and 77.4% attending at least 11 sessions, indicating good adherence. Participants completed 16,470 fidelity assessment surveys, showing excellent coverage of intervention content (95%-100%), which improved over time. Research assistants reported high fidelity, with 567 assessments showing 93%-98% coverage. Facilitators filled out 2,189 surveys, with a mean session component coverage of 98.6%. Conclusion The fidelity assessment indicates that the MFG intervention was well-delivered in Uganda. High adherence and positive feedback affirm the intervention’s successful implementation and support for task shifting mental health interventions while maintaining high fidelity in countries with limited mental health experts.

ABSTRACT Background Nearly half a million youth make contact with the juvenile legal system (JLS) within the United States each year, with many of these youth experiencing behavioral health challenges. Yet, the extent of federal research funding to improve outcomes for youth in the JLS is unknown. Objective The present study sought to provide a 30-year (1990–2019) evaluation of National Institutes of Health (NIH)-funded projects to examine overall trends in funding patterns (e.g. funding across the decades, types of institutes and mechanisms) and study-level characteristics (e.g. types of research designs, types of outcomes assessed, and types of JLS involvement of youth participants) of projects focused on youth involved in the JLS. Method We conducted a search using NIH’s database of all extramural research grants awarded between fiscal years 1990 and 2019. Extraction criteria focused on grant-related and study characteristics found in the publicly available project information and abstracts. Results Two hundred and three grants ultimately met inclusion criteria. Although total inflation-adjusted funding per decade increased over time, funding per project was the highest during the 1990s. Across all three decades, NIDA was the largest funder of JLS-focused projects, and R-series grants were the most predominant. Substance use and delinquency were the most frequent outcomes assessed. Conclusion Our results may suggest that researchers have been able to partially capitalize on the increased interest in research focused on youth involved in the JLS; however, there is further opportunity to improve, including in funding per project and focus outside of substance use and delinquency.

ABSTRACT Background A Community-Based Learning Collaborative (CBLC) is a training/implementation package for evidence-based treatments (EBTs) involving multidisciplinary professionals to improve a community’s response to trauma and the sustained adoption of EBTs. While CBLCs improve community-, organization-, and clinician-level factors for implementation and result in positive treatment outcomes, they require more investment than the standard Learning Collaborative (LC) model. Objective Research is needed to examine CBLC and LC treatment outcomes to inform decision-making on the selection of effective and cost-efficient training/implementation packages. This study aims to address this gap by examining the impact of training type (CBLC vs LC) on TF-CBT outcomes. Method This study involved 441 community therapists participating in a TF-CBT LC (n = 188) or CBLC (n = 253). Analyses compared TF-CBT outcomes for 660 youth, ages 8–18. Results Mixed effect linear regressions with youth nested within therapists demonstrated no sample differences across models for child age or PTS at pre-treatment. Youth in the CBLC were more likely to be White, exhibit depressive symptoms at pre-treatment, and complete post-treatment assessments. Across both models, youth demonstrated significant decreases in PTS and depressive symptoms. The interaction of outcomes by training was not significant for depression, suggesting equivalent outcomes for the CBLC and LC. However, the significant interaction for PTS suggests the LC-trained therapists had better outcomes for youth than the CBLC. Conclusions The LC and CBLC for TF-CBT have similar effects on child depression, with the LC demonstrating more efficient results for the treatment of PTS. The multidisciplinary training within the CBLC may support accurate identification of depressive symptoms after a traumatic event as well as treatment retention.