Adolescent Health Services Research Articles

Self-disclosure by adolescents in therapy for eating difficulties: A Q-Methodology study.

Facilitating client self-disclosure is essential to therapeutic effectiveness. Given the long-term consequences of eating difficulties for adolescents, there is a need for more research on self-disclosure in this group. This study investigated factors likely to influence adolescents' decisions to self-disclose during psychological therapy for eating difficulties using Q-methodology. Participants (n = 28), recruited through child and adolescent mental health services in the UK, completed a task that involved sorting 47 statements to represent their viewpoint on self-disclosure. The 28 completed sorts were subjected to a by-participant factor analysis in order to identify distinct viewpoints in the sample. Three distinct factors were extracted. One factor emphasised the importance of therapist self-disclosure on decisions to disclose. In contrast, another factor placed more emphasis on the influence of eating disorder identity and readiness to change on disclosure decisions. The third factor placed emphasis on the quality of the therapeutic relationship and readiness to change as having most influence. Given the absence of a unifying factor representing what influences the decision to disclose, clinicians should ensure they explore with young people what might influence their decision to disclose.

Quarantweens - the impact of COVID-19 restrictions on preteen health and wellbeing in Ireland

Abstract Background The COVID-19 pandemic has been dubbed the “biggest public health crisis since the Second World War”. In Ireland, schools were closed for 141 days, dramatically altering the day to day lives of children in Ireland. This research aimed to evaluate the overall wellbeing of schoolchildren in Ireland and capture the prevalence and factors contributing to poor mental health. Methods A cross-sectional study was performed based on data from the Growing Up in Ireland COVID-19 web survey of the ’08 Infant cohort. Mental Health Inventory-5 scores were used to assess children at risk of mental health disorders. Logistic regression examined associations between various demographic and psychosocial factors and risk of mental health disorders. Results This study included 2,867 primary caregiver- child dyads. Almost 25% of 12/13-year-olds were at risk of mental health disorders (MHDs). An adjusted logistic regression model found associations between being at higher risk of MHDs and factors such as reduced physical activity levels (OR 1.35, 95% CI 1.10-1.66), spending less time outdoors (OR 1.48, 95% CI 1.18-1.85), increased screen-time (OR 1.35, 95% CI 1.09-1.67) and increased arguments with PCGs (OR 3.44, 95% CI 2.78-4.27). Having a trusted adult confidante reduced the risk of MHD (OR 0.25, 95% CI 0.14-0.45). Conclusions The prevalence of 12/13-year olds at elevated risk of MHD was high, indicating an urgent need for enhancement of child and adolescent mental health services in Ireland. Physical activity, time outdoors and supportive relationships with primary caregivers were positively associated with reduced MHD risk. Key messages • Children were impacted by the COVID-19 restriction measures in a way that was disproportionate to their risk. • To reduce the risk of poor mental health outcomes for a generation of “quarantweens” we need to place children front-andcentre of our response as we recover from COVID-19.

Utilizing Advocacy to Promote the Adoption and Implementation of Medicaid Policies That Increase Insurance Coverage Among Adolescents

PurposeThe Promise of Adolescence: Realizing Opportunity for All Youth report recommends several Medicaid policies to increase insurance coverage among adolescents: approve Medicaid expansion; eliminate the 5-year Medicaid waiting period for lawfully present adolescent immigrants; increase Medicaid reimbursement rates for adolescent health services to the level of Medicare; and ensure coverage and sufficient reimbursement of comprehensive health services. We designed this study to identify key advocates and factors relevant to adoption and implementation of the recommended Medicaid policies in Nebraska to highlight opportunities for additional advocacy. MethodsWe conducted semistructured interviews January 2022 with 28 adolescent health and health-care access experts in Nebraska, including representatives from health care, education, government, and nonprofit sectors. We recorded the interviews and transcribed them verbatim, then coded data using NVivo software and identified key themes. ResultsParticipants were unable to identify any Medicaid advocates or advocacy work focused on adolescents, but they did identify 35 organizations working to improve insurance coverage in Nebraska. Coordinated multisector, statewide coalitions secured the adoption of Medicaid expansion through a citizen-supported ballot initiative. Barriers to successful implementation include limited Medicaid outreach to citizens and lawfully present immigrants. Low state government support for increasing Medicaid reimbursement rates and providing comprehensive health services, coupled with the absence of coordinated advocacy, hinder the adoption of these recommendations. DiscussionAdvocacy efforts should be implemented to increase adoption and implementation of Medicaid policies recommended to increase adolescents' insurance coverage. These efforts must be built on a foundation of knowledge of state government practices and must utilize sustained partnership among multisector advocates, including adolescent-serving professionals.

HUBUNGAN PENGETAHUAN, JARAK POSYANDU, DAN SUMBER INFORMASI DENGAN MINATNYA REMAJA KE POSYANDU DI WILAYAH KERJA UPTD PUSKESMAS PENYANDINGAN

Adolescent posyandu is one form of Community Resource Health Effort (UKBM) which is managed and organized from, by, for and with the entire community including adolescents in empowering the community and providing convenience in obtaining health services for adolescents to improve the degree of health and healthy life skills of adolescents. T This type of research is observational research that is analytical in nature with a cross sectional design or approach. The sample in this study was adolescents aged 12 years to 18 years with a sample of 75 respondents. The type of data uses primary data, The results of bivariate research on the relationship between Knowledge, Posyandu Distance, and Information Sources with Adolescents' Interest in Posyandu based on the chi square statistical test of p-value knowledge 0.021 < 0.05, posyandu distance p-value 0.021 <0.05 and p-value information sources 0.027< 0.05 can be concluded that there is a relationship between knowledge, posyandu distance, and information sources simultaneously with adolescent interest in going to posyandu in the UPTD work area of the Ogan Komering Ulu Regency Pairing Health Center in 2023. The advice to the leadership of UPTD Puskesmas Penyandingan is to increase information about the Youth Posyandu by involving community leaders, health workers to provide counseling and counseling, as well as distributing brochures, billboards, and advertisements in print and electronic media so that the public knows the importance of the Youth Posyandu

Experiences of ethnic minoritised young people in a specialist child and adolescent mental health service: A qualitative analysis as part of a mixed methods service evaluation.

There have been several reports of inequalities for ethnic minoritised service users across National Health Service mental health services in the United Kingdom. This research aims to explore the perspectives and experiences of young people from ethnic minoritised groups accessing psychological therapy in a National Specialist Child and Adolescent Mental Health Service in England. Semi-structured interviews were conducted to investigate how young people perceived their ethnicity and how it was considered during psychological therapy. Nine young people were interviewed, and a thematic analysis was conducted. Qualitative analysis revealed five themes: (1) adolescence, ethnicity, and identity; (2) ethnicity as a meaningful part of the therapeutic intervention; (3) therapeutic alliance to facilitate dialogue; (4) aversion to ethnicity exploration; and (5) treading lightly: a fine line between sensitive and overly cautious. The study illustrated the complexity of considering ethnicity in therapy due to conflicting views and preferences and the need for further research.

Understanding how social norms influence access to and utilization of adolescent sexual and reproductive health services in Northern Nigeria.

This study explored the influence of social norms on the access and utilization of sexual and reproductive health services by adolescents. Apart from individual and environmental barriers, social norms influence contraceptive decisions and ultimately sexual and reproductive health outcomes. Social norms that shape group behavior describe acceptable standards of behavior and evoke sanctions when such behavior standards are not adhered to. Sexually active adolescents in Nigeria have a relatively low level of modern contraceptive use being influenced by social norms. Scaling up adolescent reproductive health interventions that integrate normative change for a wider impact of programs remains challenging. Using data from 18 communities, 188 married and unmarried adolescents (F52% and M48%) and 69 (F37%; M63%) reference group participants were purposively sampled and participated in a social norms exploration intervention study conducted through focus group discussion and in-depth interviews between October and November 2019. The Advancing Learning and Innovation on Gender Norms (ALIGN) Social Norms Exploration Tool (SNET) was adapted for the data collection into discussion guides and vignettes. Pilot testing of the tools informed review and validation prior to actual data collection. Low contraceptive uptake by adolescents was characterized by early and forced marriage in childhood; a prominent practice enshrined in social norms around girl-childchastity, family honor, and disapproval of pre-marital sex and pregnancy out of wedlock. The understanding of harmful social norms, normative change actors, and potential norm-shifting factors for contraceptive decisions by adolescents is essential for effective adolescent sexual and reproductive health interventions for wider impact and adaptive programming in behavior change interventions for improving the access to and utilization of modern contraceptives by adolescents for improved sexual health outcomes, the attainment of the Family Planning (FP) 2030 commitment and universal health coverage policy.

Working together towards overcoming transgenerational trauma – Using cognitive analytic therapy with child-caregiver dyads

Children, young people, and families who seek support from community CAMHS have experienced a disproportional number of childhood adverse experiences. Many families continue to endure uncertainty and adversity due to global events and political context (e.g. racism, poverty, and gender-based violence). Building trust within this context requires therapists to work in trauma-informed ways that focus on establishing effective therapeutic relationships. Cognitive analytic therapy (CAT) is an approach that mainly focuses on relationship patterns to help people overcome psychological distress and develop positive ways of relating that encourage emotional wellbeing. Whilst offering therapy within a child and adolescent mental health service, I have extended the use of CAT to focus on both the young person’s relationships and the relationship between caregiver-child; also referred to as a child-caregiver ‘dyad’. Theoretically, working dyadically offers advantages over individual therapy including providing opportunities to influence and overcome transgenerational patterns that may not be possible within individual sessions with young people. I have termed this way of working ‘Dyadic CAT’ and propose that there are several adaptations to individual CAT that therapists may consider when offering a dyadic intervention including: (a) identifying what to work on within therapy, (b) exploring ways of factoring in power imbalances, and (c) balancing the needs of three learners to promote discovery within therapy. CAT with dyads may also benefit from an additional phase focused on creating a ‘safe base’ prior to the reformulation phase. Early outcomes and anecdotal evidence indicate that CAT can be a successful intervention for caregiver-child dyads in promoting change and healing from transgenerational trauma. Further practice-based research is needed to develop the structure and practice of Dyadic CAT including the integration of other relational theories.

‘Understanding our family’: Co-producing empowering & non-blaming stories with families in a CAMHS inpatient unit

The influence and importance of a family on children and young people’s mental health and wellbeing has been well documented (Kana’Iaupuni et al., 2005). Therefore, when children and young people encounter mental health services it is vital that a family focused perspective is prioritised (Gross & Goldin, 2008). However, efforts to consider and explore family dynamics in the context of children’s lives have often been blaming and overly expert (Dallos, 2019). There have been some attempts to move away from individualistic understandings of children’s distress to more family functional formulations (Dallos, et al., 2020). Nonetheless, there remains very little literature and evidence around involving families in co-producing psychological formulations in a non-blaming, transparent and empowering way, but in particular this scarcity is evident in inpatient child and adolescent mental health services (CAMHS). The present paper will outline a co-produced family focused formulation called ‘Understanding Our Family’ developed for inpatient CAMHS settings by the authors. ‘Understanding Our Family’ is informed by the Power Threat Meaning Framework (Johnstone, et al., 2018) to provide an alternative understanding to what brings families into contact with inpatient settings and to offer a de-stigmatising and empowering narrative to families subject to multiple stressors and complex systems. The present article discusses and critically interrogates the challenges and opportunities of developing, implementing, and embedding this approach within a CAMHS inpatient setting in the North of England.

Adolescent Health Knowledge of Family Physicians

Background: There are certain life periods when physicians are more cautious with their patients. However, health needs are often disregarded throughout the adolescent era, even though it is a time when fast changes occur in many facets of life, including physical, psychological, cognitive, and social development. This study aimed to contribute to the improvement of adolescent health by measuring the degree of knowledge of family physicians (FPs) on adolescent health services.
 Material-Method: The was a descriptive-cross-sectional design study. A questionnaire was given to 2200 FPs by e-mail and 344 accepted to participate. The questionnaire had a 13% response rate. 
 Results: Women made up 56.4% of the participants (n=194) and the average age of the participants was 38.77 years (SD: 10.08) (min: 25, max: 80). Two hundred fifteen (62.5%) of the FPs who participated in the survey, had encountered adolescent patients. A statistical correlation was found between having children and the idea that questions should be asked with one-word answers to the target to obtain answers in the adolescent age group (p

Strengthening quality in sexual, reproductive, maternal, and newborn health systems in low- and middle-income countries through midwives and facility mentoring: an integrative review

BackgroundThere is an urgent global call for health systems to strengthen access to quality sexual, reproductive, maternal, newborn and adolescent health, particularly for the most vulnerable. Professional midwives with enabling environments are identified as an important solution. However, a multitude of barriers prevent midwives from fully realizing their potential. Effective interventions to address known barriers and enable midwives and quality sexual, reproductive, maternal, newborn and adolescent health are less well known. This review intends to evaluate the literature on (1) introducing midwives in low- and middle-income countries, and (2) on mentoring as a facilitator to enable midwives and those in midwifery roles to improve sexual, reproductive, maternal, newborn and adolescent health service quality within health systems.MethodsAn integrative systematic literature review was conducted, guided by the Population, Intervention, Comparison, Outcome framework. Articles were reviewed for quality and relevance using the Gough weight-of-evidence framework and themes were identified. A master table categorized articles by Gough score, methodology, country of focus, topic areas, themes, classification of midwives, and mentorship model. The World Health Organization health systems building block framework was applied for data extraction and analysis.ResultsFifty-three articles were included: 13 were rated as high, 36 as medium, and four as low according to the Gough criteria. Studies that focused on midwives primarily highlighted human resources, governance, and service delivery while those focused on mentoring were more likely to highlight quality services, lifesaving commodities, and health information systems. Midwives whose pre-service education met global standards were found to have more efficacy. The most effective mentoring packages were comprehensive, integrated into existing systems, and involved managers.ConclusionsEffectively changing sexual, reproductive, maternal, newborn and adolescent health systems is complex. Globally standard midwives and a comprehensive mentoring package show effectiveness in improving service quality and utilization.Trial registrationThe protocol is registered in PROSPERO (CRD42022367657).

The effectiveness of combined approaches towards improving utilisation of adolescent sexual and reproductive health services in Kenya: a quasi-experimental evaluation

Adolescent sexual and reproductive health (ASRH) services are key to improving the health of adolescents. This study aimed to establish the effectiveness of an intervention that combined activities in health facilities and communities in Kenya to increase utilisation of ASRH services. A quasi-experimental evaluation design was used to assess the effectiveness of the intervention. Using a stratified cluster sampling approach, two cross-sectional household surveys targeting girls aged 15–19 were conducted at baseline (September 2019) and endline (December 2020) in intervention and comparison. We combined the difference-in-difference approach to analyse the net change in outcomes between intervention and comparison arms of the study at baseline and endline and coarsened exact matching for variables that were significantly different to address the imbalance. There were a total of 1011 participants in the intervention arm and 880 in the comparison arm. Descriptive results showed a net increase of 12.7% in intervention sites in the knowledge of misconceptions about sex, pregnancy, and contraception, compared to 10.4% in the control site. In the multivariate regression analysis, two outcomes remained significant: decreases in adolescents’ discomfort when seeking ASRH services because of either fear of parents (aPR = 0.58, 95% CI = 0.42–0.79, P = 0.001) or a lack of support from their partner (aPR = 0.25, 95% CI = 0.08–0.82, P = 0.023). The intervention combining a facility and community approach was not effective in increasing the use of ASRH information and services. Possible reasons for this are explored.

The Appa Health App for Youth Mental Health: Development and Usability Study.

Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appa's 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers' characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. Participants reported finding Appa helpful, with 100% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program.

Predicting obsessive-compulsive disorder episodes in adolescents using a wearable biosensor-A wrist angel feasibility study.

Obsessive-compulsive disorders (OCD) are marked by distress, negative emotions, mental processes and behaviors that are reflected in physiological signals such as heart rate, electrodermal activity, and skin temperature. Continuous monitoring of physiological signals associated with OCD symptoms may make measures of OCD more objective and facilitate close monitoring of prodromal symptoms, treatment progress and risk of relapse. Thus, we explored the feasibility of capturing OCD events in the real world using an unobtrusive wrist worn biosensor and machine learning models. Nine adolescents (ages 10-17 years) with mild to moderate-severe OCD were recruited from child and adolescent mental health services. Participants were asked to wear the biosensor in the lab during conditions of rest and exposure to OCD symptom-triggering stimuli and for up to 8 weeks in their everyday lives and register OCD events. We explored the relationships among physiological data, registered OCD events, age, OCD symptom severity and symptom types. In the machine learning models, we considered detection of OCD events as a binary classification problem. A nested cross-validation strategy with either random 10-folds, leave-one-subject-out, or leave-week(s)-out in both layers was used. We compared the performance of four models: logistic regression, random forest (RF), feedforward neural networks, and mixed-effect random forest (MERF). To explore the ability of the models to detect OCD events in new patients, we assessed the performance of participant-based generalized models. To explore the ability of models to detect OCD events in future, unseen data from the same patients, we compared the performance of temporal generalized models trained on multiple patients with personalized models trained on single patients. Eight of the nine participants collected biosensor signals totaling 2, 405 h and registered 1, 639 OCD events. Better performance was obtained when generalizing across time compared to across patients. Generalized temporal models trained on multiple patients were found to perform better than personalized models trained on single patients. RF and MERF models outperformed the other models in terms of accuracy in all cross-validation strategies, reaching 70% accuracy in random and participant cross-validation. Our pilot results suggest that it is possible to detect OCD episodes in the everyday lives of adolescents using physiological signals captured with a wearable biosensor. Large scale studies are needed to train and test models capable of detecting and predicting episodes. ClinicalTrials.gov: NCT05064527, registered October 1, 2021.

Predictors of transitioning to adult mental health services and associated costs: a cross-country comparison

BackgroundYoung people are at risk of falling through the care gap after leaving child and adolescent mental health services (CAMHS) despite an ongoing need for mental health support. Currently, little...

Functional Outcomes Among Young People With Trajectories of Persistent Childhood Psychopathology

Understanding which children in the general population are at greatest risk of poor functional outcomes could improve early screening and intervention strategies. To investigate the odds of poor outcomes in emerging adulthood (ages 17 to 20 years) for children with different mental health trajectories at ages 9 to 13 years. Growing Up in Ireland is a longitudinal, nationally representative population-based cohort study. Data collection began in August 2007 and was repeated most recently in September 2018. All results were weighted to account for sampling bias and attrition and were adjusted for socioeconomic factors. Data analysis took place from October 2022 to April 2023. Four latent classes captured variation in mental health in children aged 9 and 13 years, based on the parent-completed Strengths and Difficulties Questionnaire. Classes included no psychopathology, internalizing, externalizing, and high (comorbid) psychopathology. Those who remained in the same class from ages 9 to 13 years were included. Poor functional outcomes in emerging adulthood were measured at approximate ages 17 years (range, 16 to 18 years) and 20 years (range, 19 to 21 years). Outcomes included poor mental health, poor physical health, social isolation, heavy substance use, frequent health service use, poor subjective well-being, and adverse educational/economic outcomes. Of 5141 included participants, 2618 (50.9%) were male. A total of 3726 (72.5%) were classed as having no childhood psychopathology, 1025 (19.9%) as having persistent externalizing psychopathology, 243 (4.7%) as having persistent internalizing psychopathology, and 147 (2.9%) as having persistent high psychopathology. Having any childhood psychopathology was associated with poorer functional outcomes in emerging adulthood. The internalizing group had elevated odds of most outcomes except for heavy substance use (range of odds ratios [ORs]: 1.38 [95% CI, 1.05-1.81] for frequent health service use to 3.08 [95% CI, 2.33-4.08] for poor mental health). The externalizing group had significantly elevated odds of all outcomes, albeit with relatively small effect sizes (range of ORs: 1.38 [95% CI, 1.19-1.60] for frequent health service use to 1.98 [95% CI, 1.67-2.35] for adverse educational/economic outcomes). The high psychopathology group had elevated odds of all outcomes (nonsignificantly for frequent health service use), though with wide confidence intervals (range of ORs: 1.53 [95% CI, 1.06-2.21] for poor physical health to 2.91 [95% CI, 2.05-4.12] for poor mental health). Female participants with any psychopathology had significantly higher odds of poor physical health and frequent health service use compared with male participants with any psychopathology. In this longitudinal cohort study, childhood psychopathology was associated with a widespread pattern of functional impairment in emerging adulthood. Findings point to the need for a wider range of preventive interventions in child and adolescent mental health services.

Assessing the Availability and Utilisation of Adolescent Reproductive Health Services in Northern Region of Ghana

Youth-friendly sexual and reproductive health services involved range of Sexual and Reproductive Health services that are delivered to the specific needs, vulnerabilities, and desires of young people. This study aims to determine the availability and utilization of adolescent sexual and reproductive health services among youths in selected districts and municipalities in the Northern Region of Ghana. A descriptive cross-sectional study design was conducted in four selected districts using a mixed method of quantitative and qualitative approaches to data collections. Both male and female adolescent and young person aged 10-24 years were selected by simple random sampling through balloting. Convenient sampling was used to select four health workers for interviews. Quantitative data was analysed using descriptive and inferential statistics, and qualitative analysis was done using manual thematic analysis. The qualitative data was collected using an unstructured interview guide and analysed with thematic analysis. Findings showed average age was 16.64 years, and 70.5% had good knowledge score of SRH services availability. Types of SRH services provided include counselling and education on SRH issues, STIs screening, diagnosis, and management. About 69.8% have ever visited the health facilities for SRH service, and 36.1% covered more than an hour before accessing SRH services. About 21% had access contraceptives and family planning services. Barriers to accessing SRH services were attributed to; cost of healthcare (21.9%), long queues at facilities (15.3%), and distance to healthcare facility (12.4%). Associated factors were sex (OR = 1.72; 95%CI 1.16-2.57; p = 0.007), father educational attainment (OR = 2.03; 95%CI 1.35-3.03; p = 0.0001), and district of residence (OR = 5.72; 95%CI 2.01-16.25; p = 0.0005). Most adolescents and young people from the study findings had increased knowledge score on the types and availability of SRH services in the district health facilities. But utilization of the SRH services was low because, the point of delivery of these SRH services were far, and most have to cover long distance. Keywords: Adolescent, Availability, Utilization, Reproductive Health Service, Ghana.

Association of Food Insecurity Status with Resolution of Mental Health Conditions in Children and Adolescents.

Adverse consequences related to unresolved mental health issues underscore the importance of identifying factors that impede resolution of mental health conditions. Although studies have identified food insecurity as a risk factor for the diagnosis of mental health conditions, its impact on unresolved mental health issues is not understood. The objective of this study is to investigate the association of food insecurity status with resolution of depression, anxiety, and behavioral/conduct problems in children and adolescents. Using National Survey of Children's Health 2016 to 2019, logistic regression analyses examined the relationship of food insecurity status with the diagnosis and resolution of depression, anxiety, and behavioral/conduct problems in children (aged 5-11 years) and adolescents (aged 12-17 years). Mild, moderate, and severe food insecurity were significantly associated with higher odds of being diagnosed with depression, anxiety, and behavioral/conduct problems. Severe food insecurity was significantly associated with higher odds of unresolved behavioral/conduct problems in children (adjusted odds ratio [aOR], 10.09; 95% confidence interval [CI], 2.99-34.04), after adjustment for demographic covariates. In adolescents, severe food insecurity was significantly related to greater odds of unresolved depression (aOR, 6.64; 95% CI, 2.13-20.70), anxiety (aOR, 3.27; 95% CI, 1.31-8.14), and behavioral/conduct problems (aOR, 5.57; 95% CI, 2.09-14.85). These associations of severe food insecurity with unresolved mental health conditions were significant even after adjustment for the receipt of mental health care. Mild and moderate food insecurity were not significantly associated with unresolved mental health conditions. The findings suggest that severe food insecurity is associated with increased odds of unresolved mental health conditions in children and adolescents. This study highlights the importance of tailoring interventions to provide appropriate mental health services for children and adolescents from severely food insecure households.

Assessment of Factors Influencing Utilization of Reproductive Health Services for Adolescents and Youth in Samburu County, Kenya

Background: Globally, around 16 million teenagers give birth each year, with 95% of them coming from upcoming nations in developing nations like Kenya, youths deal with a variety of sexual and reproductive health issues. Youth in Kenya frequently experience serious health issues like unintended pregnancy, unsafe abortions, and sexually transmitted infections.
 Objective: The study aimed to assess factors influencing the use of youth-friendly reproductive health services among youths and adolescents in Samburu County, Kenya.
 Methods: The study employed an analytical cross-sectional study design. The Chi-square test for independence and binary logistic regression were employed to establish a relationship between independent and dependent variables.
 Results: From this study, the presence of a reproductive health facility (OR=2.4,95%CI=0.220-0.801) and community mobilization campaigns (OR=4.7,95%CI=0.093-0.485) increased the odds of utilizing youth-friendly reproductive health services. The presence of peer pressure (OR=2,95%CI=0.266-0.971), healthcare providers' poor attitude (OR=2.1,95%CI=0.276-0.881), and lack of privacy (OR=2,95%CI=0.290-0.974) reduced the odds of utilizing youth-friendly reproductive health services.
 Conclusion: In this study, the utilization of youth-friendly reproductive health services was 40.6%. The presence of a reproductive health facility, having visited a reproductive health facility, the presence of religious influence, and community mobilization campaigns increased the odds of utilizing youth-friendly reproductive health services. The presence of peer pressure, being male and single in the marital status category, healthcare providers' poor attitude, and lack of privacy reduced the odds of utilizing youth-friendly reproductive health services.

How clinical psychologists respond to child safeguarding dilemmas: A qualitative study

AbstractThis research aimed to explore how clinical psychologists respond to child safeguarding dilemmas, with special attention to the role of psychology in child welfare. Transcripts from 20 semi‐structured interviews with clinical psychologists working in Child and Adolescent Mental Health Services in England were analysed using a qualitative framework approach. In these interviews, two family case vignettes were used to examine how psychologists respond to child safeguarding dilemmas. We identified three overarching themes: operating within a system of stretched resources; characterising who is considered ‘supportable’ by psychological services; and challenges around conceptualising and responding to risk. Clinical psychologists viewed social services as responsible for family cases with safeguarding concerns and were reluctant to engage in high‐risk cases where stability in the home was not yet established. They saw their role in child welfare primarily as sense‐makers for families, by offering a contextualised explanation/formulation for the presenting difficulties.

Debate: Child and adolescent mental health services: time to take the lead in prevention of psychosis in youth.

Children and adolescents are at risk of developing mental disorders that have lifelong consequences. This debate piece argues that youth meeting the criteria for clinical high risk for psychosis cannot be assessed and treated with the same tools as adults, given that they often present with different patterns and timecourse of symptoms, age-specific comorbidities and follow different pathways to care. It looks at the key role that Child and Adolescent Mental Health Services and other professionals can play by using an age-specific approach to detecting and preventing psychosis.