ABSTRACT Background Parents influence children’s access and engagement in mental health therapy, through factors like parent attitudes and session attendance. This is especially true for transgender and gender-diverse (TGD) youth, who benefit most from affirming therapy – compared to non-affirming therapy – which is tailored to support a client’s gender and linked with enhanced treatment engagement. To support TGD youth’s ability to engage in optimal treatment, it is important to understand parent’s influence on youth’s therapy experiences. Objective Analyze qualitative data from TGD youth, parents, and therapist to (1) understand how parents influence therapist’s ability to provide affirming therapy and (2) develop research-guided recommendations for therapists. Methods Mental health therapists (N = 52) who recently completed training on affirming practices for working with TGD youth responded to open-ended survey questions about how parents influence their work with TGD youth. A subset of these therapists (n = 16) completed semi-structured interviews on using affirming practices three months post-training. Interviews with TGD youth (N = 6; ages 14–22) treated by therapists trained in affirming therapy and parents (N = 3) were conducted eight months post-training. Responses and interview transcripts were analyzed via rapid and traditional content analysis, identifying ways parents influence affirming therapy and strategies to work with parents. Results Parents influenced affirming therapy in several ways, representing five overarching themes: parents’ beliefs about gender or affirming therapy; parents’ therapy involvement; parents’ emotions; parents’ knowledge about gender or affirming therapy; and family dynamics. Strategies for working with parents included: exposure, parent training, resources, support groups, and therapist training. Discussion We offer five recommendations for therapists working with parents of TGD youth to enhance their ability to provide affirming therapy: expose parents to TGD people through stories; train parents in gender affirmation; provide trustworthy resources; connect parents with support groups; and enhance therapists’ ability to navigate parent-child conflicts.

ABSTRACT Background Executive functioning challenges, including difficulties with flexible thinking, goal setting and planning, are common among neurodivergent children, especially those identified with autism and/or attention-deficit/hyperactivity disorder. Executive functioning problems are linked to poorer academic achievement and are exacerbated by poverty. Importantly, executive functioning is responsive to intervention. Objective This pragmatic study compared the effectiveness of two school-based executive functioning interventions for children with autism and/or attention-deficit/hyperactivity disorder in Title 1 (low-income-serving) school settings to improve accessibility of effective interventions. Methods 148 children (82% male) in 3rd–5th grades were cluster-randomized by school (N = 24) to receive Unstuck and On Target (Unstuck), a cognitive-behavioral program, or Parents and Teachers Supporting Students, a behavior-management program considered best practice for children with attention-deficit/hyperactivity disorder. Both programs targeted executive functioning, were matched for dosage, and were delivered in small groups by school staff, with parent and teacher training to support generalization. The sample (attention-deficit/hyperactivity disorder N = 98; autism N = 50) was ethnically and socioeconomically diverse. The primary outcome was executive functioning behaviors assessed through masked classroom observations. Secondary outcomes were masked executive functioning tasks, and a parent report measure. Treatment fidelity, acceptability, potential moderation of family income, age, and cognitive functioning were assessed. Results Both interventions were implemented with high fidelity and were well-liked by children and parents, with Unstuck receiving higher acceptability ratings. Child executive functioning improved across both interventions and on all outcomes. There was limited moderation by income, and outcomes improved following intervention, even after accounting for income. Conclusions School staff can effectively deliver both Unstuck and Parents and Teachers Supporting Students in low-income community schools to improve executive functioning. These accessible, low-cost options address income-based health disparities by providing an alternative to clinic-based care. The interventions show promise for broader applications in schools. Clinical Trials registry Community Based Intervention for Children with ADHD and ASD; clinicaltrials.gov (NCT03003286) 9/13/2014.

ABSTRACT Background Provider motivation to engage in evidence-based intervention training has been identified as a potential key influence on evidence-based intervention implementation. However, the study of provider motivation has been limited by the lack of validated instruments that measure the extent of provider motivation to engage in evidence-based intervention training. Objective This study aimed to: (1) characterize the factor structure of the newly developed Provider Motivation Inventory with mental health therapists and teachers prior to engaging in autism evidence-based intervention training; (2) examine psychometric properties of the identified Provider Motivation Inventory factors (i.e. internal consistency & convergent validity); and (3) assess service setting and provider-level factors that are associated with Provider Motivation Inventory scores. Method Data were drawn from a baseline assessment (N = 384) from a Hybrid Type 3 implementation-effectiveness trial testing the effectiveness of two implementation strategies within the context of autism evidence-based intervention implementation in mental health programs and education services. Exploratory factor analyses were used to examine the factor structure of the Provider Motivation Inventory, Cronbach’s alpha values were used to assess internal consistency of the derived factors, convergent validity was assessed by examining correlations between the derived factors and theoretically related variables, and multilevel regression models were used to test service and provider-level variables as predictors of the factors. Results The Provider Motivation Inventory was best represented by three factors (i.e. Desire to Learn; Motivation to Engage in Training Activities; and Self-Efficacy for Learning) that demonstrated good-to-excellent internal consistency and convergent validity. Service setting was associated with Motivation to Engage in Training ;(clinic > schools). Conclusion The Provider Motivation Inventory has the potential to advance implementation science by facilitating the measurement of an understudied implementation determinant. Future research is needed to assess the validity of the Provider Motivation Inventory across clinical populations and service contexts.

ABSTRACT Background Although the suicide rate for children ages 8–12 is increasing, there is not a developmentally adapted suicide risk screener for children younger than 10. Current practices to screen preteen children for suicide risk often include unstructured interviewing and/or suicide risk screeners that are validated for use with older children. It is clinically important to understand the limitations of existing suicide risk screeners when they are used with preteens to inform the design of developmentally appropriate measures and to tailor support for clinicians. Objective To characterize the rate at which clinicians in an outpatient crisis clinic indicated that they felt the Ask Suicide-Screening Questions (ASQ) was developmentally inappropriate for children between the ages of 6 and 12. Methods We analyzed electronic medical record data from an outpatient psychiatric crisis clinic, including a suicide risk screening interface that allows clinicians to administer the screener during a clinical encounter or indicate that they feel it is developmentally inappropriate. Results The percentages of suicide risk screening instances where the clinician marked the ASQ as developmentally inappropriate were 72.5% for 6-year-olds, 55.8% for 7-year-olds, 30.1% for 8-year-olds, 11.5% for 9-year-olds, 4.9% for 10-year-olds, 0.9% for 11-year-olds, and 0.5% for 12-year-olds. These results were similar in analyses stratified by race, but the ASQ was determined to be developmentally inappropriate significantly more often for boys than girls (p < .001; 2.8% of screens with girls aged 6–12 vs. 9.0% of screens with boys aged 6–12). Conclusions These findings clearly highlight the urgent need to design and test a developmentally adapted suicide risk screener that can be used with preteen children, especially those who are age 10 and younger.

ABSTRACT Background Suicide is the second leading cause of death among youth ages 15–24. Sexual minority (SM) youth are at higher risk for suicidal thoughts, behavior, and non-suicidal self- injury than their heterosexual peers. Part of understanding this disparity includes accounting for the role of social drivers of health. The increased risk of suicide and self-harm for SM youth is driven by experiences of minority stress and discrimination that is embedded in society. Recognizing the impact of these factors is essential to inform the delivery of evidence-based interventions for SM youth who are receiving care for suicide prevention. Objective To describe the process for developing a behavioral fit analysis when working with SM youth who are at risk for suicide, with an emphasis on the role of social drivers of health that may overlap with SM identity as it contributes to suicide risk. Method A brief review of the literature is provided on the topics of minority stress and existing screening and assessment approaches for suicidal youth. The benefits of a behavioral fit analysis are described and how this supplements existing evidence-based tools. A fictional case example is included to illustrate the direct application of this organizational framework. Results A case example of a fictional SM youth is provided with an accompanying fit analysis and treatment plan. Implications for generalization to clinical practice are described, complemented with resources and suggestions for clinicians. Conclusions The use of a behavioral fit analysis balances a nomothetic and idiographic approach to a case conceptualization for SM youth at risk for suicide and incorporates the impact of social drivers of health on the use of evidence-based treatments.

ABSTRACT Background Suicide is a leading cause of death and significant concerns for adolescents and young adults. Dialectical Behavior Therapy for Adolescents (DBT-A) is an evidence-based intervention that effectively reduces life-threatening behaviors. Limited research examines the impact of adding individualized skills coaching sessions (ISCS) to the DBT-A model, a novel intervention referred to in this paper as “Enhanced DBT-A.” This study evaluates the effectiveness of Enhanced DBT-A in reducing suicidality over 1 year of treatment in an outpatient and intensive outpatient setting. Objective Determine the effectiveness of ISCS in reducing suicidal ideation (SI) and behavior among adolescents in comprehensive DBT (as evidenced by standardized measures including the PHQ-A, C-SSRS, and BRFL-A). Methods Participants (n = 47, M age = 17.8 years), who were predominantly white (85.1%) and female (78.7%), engaged in Enhanced DBT-A services, including individual therapy, group skills training, phone coaching, and ISCS. Participants completed assessment batteries at intake, 6 months, and 1 year, and the outcome measures assessed participants’ severity and intensity of SI, reasons for living, and depressive symptoms. Results Mixed-effects analyses revealed significant improvements in SI and some improvements in reasons for living, and depressive symptoms across the first year of treatment, with the most substantial gains occurring within the first 6 months. Importantly, participation in more ISCS was associated with greater reductions in SI, as measured by the C-SSRS. Conclusion These results suggest that Enhanced DBT-A may provide added benefits beyond standard DBT-A by offering participants additional, individualized opportunities to engage in skill acquisition, rehearsal, and application. Trial Registration: ClinicalTrials.gov Identifier: NCT07256496; Compass Behavioral Health Protocol Record: Pro00078098.

ABSTRACT Background Schools play an important role in child and adolescent suicide prevention efforts and many states have begun to mandate suicide prevention education for school staff. Objective This study explored school staff’s (N = 1509) perceptions of the impact of a brief virtual suicide prevention course titled: SOS for School Staff. Method This study used an online posttest and three-month follow-up to explore school staff’s (N = 1509) perceptions via a posttest and follow-up measuring preparation, confidence, and knowledge. Results In this study, most school staff agreed that the training increased their preparation (85.4%), confidence (86.2%), and knowledge (89.7%) about responding to a suicide disclosure. Approximately one-third of the respondents used the training content three months after the training, but there was a low response rate for the follow-up. Conclusion This is a promising suicide prevention training for school staff, who report it improves preparation to identify youth in distress, confidence at engaging youth in caring conversations, and knowledge of how to respond to a student’s disclosure of suicidal thoughts and behaviors; however, larger follow-up studies are required.

ABSTRACT Background Adolescents encounter self-harm and suicide depictions on short-form video platforms during sensitive periods of identity formation. On TikTok, highly stylized presentations can render suffering legible, relatable, and socially valued, shaping how pain is understood, remembered, and performed. Objective To synthesize how peer-reviewed literature characterizes aestheticized self-harm and suicide on TikTok and to describe interpretive pathways through which these depictions may become symbolically available to adolescents. Method A qualitative narrative synthesis was conducted on 26 peer-reviewed studies published from 2018 to 2025, identified through database searching in psychology and biomedicine and forward citation searching. Reported findings were analyzed inductively and then refined through a theory-sensitized thematic approach within a constructivist, symbolic narrative suicidology frame. The synthesis does not advance causal claims or estimate prevalence. Results Across studies, TikTok portrayals repeatedly involved five interlocking processes. First, aestheticization of pain packaged distress as affect-forward, stylized micro-narratives that travel easily. Second, narrative collapse configured closed-future arcs that present despair as inevitable, sometimes crystallizing suicidal scripts. Third, emotional contagion and identification amplified affect through mirroring, parasocial intimacy, and affiliation with pain-defined publics. Fourth, habituation, normalization, and accommodation shifted responses from alarm toward familiarity, with distress incorporated at the level of everyday schemas. Fifth, romanticization and social reward conferred visibility and engagement that reinforced curated vulnerability and the symbolic durability of pain. Together, these processes describe a recursive ecology in which algorithmically sequenced, affect-congruent material can make stylized suffering emotionally salient, narratively coherent, and socially valuable, enabling suicidal meanings to be integrated into self-understanding. Conclusion The literature maps platform conditions and interpretive pathways that shape which stories about pain are easiest to find, feel, perform, and remember. Implications include narrative-informed prevention, transparency about recommendation systems, and empirical testing of strategies that elevate recovery-oriented, Papageno-consistent content and visible help-seeking scripts.

ABSTRACT Background Asian American (AA) youth experience more mental health difficulties than their non-Asian peers. Suicide has been the leading cause of death among AA youth in the U.S. since 2016. Despite these alarming statistics, AA youth and adults are less likely to seek mental health services compared with other groups. Objective To culturally adapt Youth Mental Health First Aid (YMHFA) training for AA parents following the Participatory Culture-Specific Consultation framework, and evaluate the effectiveness of the training. Method Utilizing a quasi-experimental design with a control group, we recruited 137 AA parents (M age = 47.5, SD age = 6.67) with children aged 8 to 20, and placed them in the experimental group (n = 68) or the waitlist control group (n = 69) based on their preferred training dates. We assessed whether participants in the experimental group exhibited improvements in knowledge (mental health literacy), attitudes (attitudes toward seeking psychological services, help-seeking intentions, stigma, confidence in using Mental Health First Aid [MHFA] skills, and intentions to use MHFA skills), behavior (mental health service use, engaging in MHFA behaviors, and parent-child relationships), and perceived improvements in youth mental health compared to the waitlist control group. We also examined if these improvements persisted at the four-month follow-up. Results Participants in the experimental group reported significant improvements in mental health service utilization, help-seeking intentions, confidence in using MHFA skills, intentions to engage in MHFA skills to support youth with depression, and reduced stigma, compared with the waitlist control group. These improvements were maintained at the four-month follow-up. No significant effect was found on attitudes toward help-seeking. Conclusions The culturally adapted YMHFA training demonstrated promise in improving attitudes and mental health service utilization among AA parents. A randomized controlled trial design is needed to further evaluate the effectiveness of YMHFA training among AA parents. Trial Registration: ClinicalTrials.gov NCT07135479, which focuses on South Asian Americans.

ABSTRACT Background Consistent evidence finds supportive, affirming parents have a significant positive impact on LGBTQ + youth mental health. Yet few studies have examined the experiences of parents of LGBTQ + youth with mental health service needs, a notable gap in the literature given the considerable proportion of LGBTQ + youth with mental health difficulties. Objectives The current study aimed to characterize the experiences of parents of LGBTQ + youth in navigating services for their child to inform future parent-focused resource and intervention development. Methods A sample of N = 12 parents of LGBTQ + children (ages 9–17) with a history of mental health service use residing in the Southeastern U.S. were recruited to participate in one of three semi-structured focus group interviews. Focus group interviews were audio recorded and transcribed; data were coded using flexible and reflexive six-step thematic analysis approach. Results Three key themes emerged: (1) parents’ challenges related to accessing and navigating mental health services for their LGBTQ + children, (2) parents’ need for their own resources and support as they navigate these challenges, and (3) parent-identified recommendations to improve LGBTQ + youth and family support. Subthemes highlighted the complexities parents face given their dual role in both affirming their child’s identities as well as supporting their child’s mental health needs, particularly within the sociopolitical context of the Southeastern U.S. Conclusion Findings demonstrate the need for affirming and accessible mental health resources for LGBTQ + youth and families in Southeastern U.S. as well as the need for parent-focused resources to better support parents of LGBTQ + youth experiencing mental health problems. Based on parents’ perspectives, we offer a set of recommendations for child and adolescent mental healthcare providers and organizations for supporting LGBTQ + youth and families.