Behavioral Health Outcomes Research Articles

AT THE INTERSECTION OF CULTURE AND MENTAL HEALTH

Abstract Although mental health disorders affect people across the lifespan, older adults face unique issues associated with accessing mental health treatment. These structural and psychosocial challenges are further exacerbated among older racial and ethnic minorities. Often compared to their white counterparts, racial and ethnic minority older adults face specific cultural factors and other systemic barriers that create stark disparities in diagnosis, treatment, and access to care. Increasing research on identifying barriers to treatment for older racial and ethnic minority adults has been recognized as an integral component in enhancing treatment access to improve behavioral health outcomes among these marginalized groups. Therefore, this review article aims to investigate the intersection of mental health and culture through the lens of three racial and ethnic minority groups in the United States – Blacks/African-Americans, Asian Americans, and Latinos. Authors provide unique insights on the differing needs of these under-researched communities by exploring psychiatric comorbidity, experiences with seeking, accessing, and engaging in treatment, and the unique cultural and psychosocial factors that affect treatment outcomes for these diverse groups. Future directions and recommendations to provide appropriate mental healthcare to Black/African-American, Asian American, and Latino communities are discussed with special attention placed on cultural adaptations, models of care, prevention, and practical strategies that can be implemented to reduce disparities and increase health equity.

Repercussions of a Raid: Health and Education Outcomes of Children Entangled in Immigration Enforcement

AbstractInterior immigration enforcement in the U.S. has rapidly increased over the past two decades, including increased Immigration and Customs Enforcement (ICE) activity and the revival of workplace raids under the Trump administration. We contribute to the body of research that aims to better understand the consequences of immigration enforcement for children in targeted communities, including on their education, health, and socioemotional well‐being. We employ a mixed methods research design to investigate the effects of the sweeping April 2018 Morristown, Tennessee immigration raid on children's health and education outcomes. We utilize linked, longitudinal health and education data on children and a quasi‐experimental design to analyze the effects of the raid on those residing in close proximity to the raid. Interview data from community members and organizations in the affected area aid in better understanding how the raid unfolded and the mechanisms through which a community trauma such as this might affect children both directly and indirectly. Our results indicate negative effects across multiple education and behavioral health outcomes for children of immigrants living in the area targeted by the raid, including a substantial spike in absences from school in the month of the raid and significant increases in exclusionary disciplinary actions and in diagnoses of substance use disorder, depression, self‐harm, suicide attempts or ideation, and sexual abuse in the year following the raid.

Family interventions to improve mental, emotional, and behavioral health outcomes among Latinx youth: A systematic review

BackgroundThe Latinx population is the largest and fastest-growing segment of the U.S. While the vast majority of Latinx children are US-born, over half are growing up in a family where they live with at least one foreign-born parent. Despite research showing that Latinx immigrants are less likely to experience mental, emotional, and behavioral (MEB) health issues (e.g., depression, conduct disorder, substance misuse), their children have one of the country's highest rates of MEB disorders. To address the MEB health of Latinx children and their caregivers, culturally grounded interventions have been developed, implemented, and tested to promote MEB health. The purpose of this systematic review is to identify these interventions and summarize their findings. MethodsWe searched PubMed, PsycINFO, ERIC, Cochrane library, Scopus, HAPI, ProQuest, and ScienceDirect databases from 1980 through January 2020 as part of a registered protocol (PROSPERO) following PRISMA guidelines. Our inclusion criteria were randomized controlled trials of family interventions among a predominantly Latinx sample. We assessed the risk of bias in the included studies using the Cochrane Risk of Bias Tool. FindingsInitially, we identified 8,461 articles. After going through the inclusion criteria, twenty-three studies were included in the review. We found a total of 10 interventions, with Familias Unidas and Bridges/Puentes having the most information available. Overall, 96% of studies demonstrated to be effective in addressing MEB health, namely substance use, alcohol and tobacco use, risky sexual behaviors, conduct disorder, and internalizing symptoms among Latinx youth. Most interventions focused on improving parent–child relationships as the main mechanism to improve MEB health among Latinx youth. DiscussionOur findings show that family interventions can be effective for Latinx youth and their families. It is likely that including cultural values such as familismo and issues related to the Latinx experience such as immigration and acculturation can help the long-term goal of improving MEB health in Latinx communities. Future studies investigating the different cultural components that may influence the acceptability and effectiveness of the interventions are warranted.

Differential item functioning of the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) by race/ethnicity

BackgroundAcculturation is a complex multidimensional construct that plays an important role in various outcomes across many domains (e.g., psychological, behavioral, social, and developmental). While there are many acculturation measures for specific racial/ethnic groups, few multigroup measures exists. Even fewer have been psychometrically evaluated for differential item functioning (DIF; e.g., measurement invariance). This is a critical step in determining whether item properties are equivalent across groups and thus, whether scores obtained from different groups are in fact comparable. MethodsThe Acculturation, Habits, and Interests, Multicultural Scale for Adolescents (AHIMSA) was completed by first and second generation participants identifying as White, Hispanic, or Asian (n = 1399). The scale can be used to compute scores on four acculturation orientation subscales: Assimilated, Separated, Integrated, and Marginalized. Racial/ethnic DIF was evaluated for the Assimilation, Integration, and Separation subscales. ResultsAnalyses revealed racial/ethnic DIF was present for two items on the Separation scale based on McFadden’s pseudo R2. No DIF was identified for the Assimilation and Integration scales. Supplemental analyses revealed no evidence of longitudinal DIF or by generation status and some DIF by sex for Assimilation and Integration. Based on evaluation of test characteristic curves and DIF plots, it was determined that DIF was trivial and could likely be ignored. ConclusionsPsychometric properties were generally equivalent across the three racial/ethnic groups for each of the subscales evaluated. This indicates that scores obtained from each subscale could be compared across racial/ethnic groups. By establishing cross-group usability of the scale, racial/ethnic differences in acculturation orientation can be examined, and, more importantly, used in the context of research on related mental, physical, and behavioral health outcomes.

Gender Disparity in the Wake of the Pandemic: Examining the Increased Mental Health Risks of Substance Use Disorder and Interpersonal Violence for Women

The global COVID-19 pandemic has profoundly impacted women compared to men in the workplace, creating gender disparity associated with mental health. In occupational fields where women comprise nearly three quarters of the workforce, outcomes of increased depression and psychological distress have resulted, creating even greater gender disparity in terms of mental health risks. These include an exponential increase in substance use associated with mental health issues for which continued stigma and negative perceptions of mental health conditions and substance use have prevented the pursuit of treatment. Further, the increased occurrence of interpersonal violence experienced by women during COVID-19 also presents considerable comorbidity with mental health issues. Research also shows a significant relationship for women between severe intimate partner violence and substance use. It is imperative that gender disparity associated with mental health risks be addressed within the current crisis and that we better prepare for the future to ensure inclusive and accessible resources within workplaces and improved behavioral health outcomes.

Comparing Marijuana and Opioid Misuse and Behavioral Health Outcomes in Moderate-Severe Traumatic Brain Injury

<h3>Research Objectives</h3> To operationalize cut points for "Opioid Misuse" and "Marijuana Use" using the Traumatic Brain Injury Model Systems (TBIMS) Pain Collaborative Dataset and to describe the interaction of opioid misuse and marijuana on behavioral and psychosocial outcomes. <h3>Design</h3> Cross-sectional analysis of TBIMS Pain Collaborative data. <h3>Setting</h3> Community. <h3>Participants</h3> Persons with TBI (n =2,314) enrolled in the TBIMS National Database who completed the Pain Collaborative survey. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Proportion of opioid misusers as classified by reporting using more than the prescribed dosage of opioids or using non-prescribed opioids; distribution of opioid misuse across categories of marijuana use; proportion and significance of substance and alcohol use and clinically significant PTSD (PTSD checklist-5), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and sleep quality (Pittsburg Sleep Quality Index). <h3>Results</h3> Among opioid users (n = 898, 38.8% of sample), there were 106 (11.8% of opioid users) who reported misusing opioids. There was statistically significant variation among the different Opioid misuse/Marijuana Categories in demographics (age), injury characteristics (cause of injury, GCS) and behavioral/psychosocial measures such as substance/alcohol use, PTSD symptoms, depression, anxiety, and sleep quality (p< 0.01). Those who misused opioids and/or used marijuana had higher rates of clinically significant behavioral outcomes than those who did not misuse opioids/and or used marijuana. <h3>Conclusions</h3> It is important to understand how people use opioids and marijuana after TBI as there is an association with poorer behavioral health outcomes among substance users. These findings can help clinicians discuss the impacts of substance use on health outcomes with individuals with TBI and chronic pain. <h3>Author(s) Disclosures</h3> This work was supported by two grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPTB0017). NIDILRR is a center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

When perfectionists adopt health behaviors: perfectionism and self-efficacy as determinants of health behavior, anxiety and depression

BackgroundThe study aims to show interrelations between self-efficacy, perfectionism (adaptive and maladaptive), health behavior, and mental health outcomes such as anxiety and depression as an exponent in maintaining optimal health. In the analyses, we focused on one category of health behaviors – preventive practices.Participants and procedureOf the gathered data, 295 complete datasets were analyzed (age: M = 28.16, SD = 9.41; 72.8% participants female). We pro-posed two path models with personality traits (as exogenous variables) and health behaviors (as endogenous variables) in predicting depression and anxiety.ResultsMultiple regression analysis revealed that maladaptive perfectionism and generalized self-efficacy significantly predicted health behaviors in general and mental health outcomes whereas adaptive perfectionism and generalized self-efficacy were significant predictors of preventive practices. The path analyses showed that generalized self-efficacy and perfectionism are related directly to mental health outcomes as well as indirectly, through health behaviors. Interestingly, we found a negative indirect effect of an interaction between generalized self-efficacy and preventive practices as well as of an interac-tion between adaptive perfectionism and preventive practices on mental health outcomes. The model fitted well with the data.ConclusionsThe findings show that a balanced and more holistic approach to maintaining health is beneficial for people high in self-efficacy in comparison with high focus on disease prevention. Additionally, the results demonstrate that adaptive perfec-tionists and people high in self-efficacy may also be prone to anxiety and depression (not just maladaptive perfectionists) when their health focus is too narrow.

Mental health differences between multiracial and monoracial college students in the United States: Emerging racial disparities.

Multiracial individuals appear to be at higher risk for mental health problems; however, more research is needed to confirm these racial disparities among young adult college populations. We analyzed data from the Health Minds Study (N = 99728 young adult college students aged 18-34), collected online across 140 college campuses from September 2020 to June 2021. We used multivariable logistic regression to examine associations between multiracial identity and several mental health outcomes, including mental and behavioral health (depression, anxiety, languishing, perceived need, loneliness), self-injurious behaviors (non-suicidal self-injury, suicidal ideation, suicide plan, suicide attempt), and history of lifetime psychiatric disorders, adjusting for age and gender. Almost a tenth of the weighted sample were multiracial. Multiracial students had greater odds of all mental and behavioral health outcomes, self-injurious behaviors (though only marginally significant for suicide attempt), and most lifetime psychiatric disorders. Multiracial young adult college students were more likely to have mental health problems than their monoracial counterparts, calling for targeted preventive interventions on college campuses to address these mental health disparities.

Improving physical and psychological outcomes of cardiac patients using the Naluri app: A study protocol for a randomized controlled trial

Background: Coronary artery disease (CAD) continues to be a significant burden to public health. Poor treatment and management can lead to more severe cardiac events that could result in death or disability. Early interventions like cardiac rehabilitation programs can provide patients the required knowledge, skills and support to recover from and prevent more cardiac events. Electronic health (eHealth) interventions have potential to complement hospital-based rehabilitation programs. This study aims to investigate the effectiveness of the Naluri app in improving health behaviours, clinical and psychological outcomes in a sample of cardiac patients in Malaysia. Methods: This study is a two-arm, parallel, superiority randomized control trial to be conducted at the Malaysian National Heart Institute. A total of 200 patients will be randomly assigned to either a 16-week theory-based Naluri app in addition to usual care (treatment) or to usual care only (control). Outcomes will be measured at baseline and at 16 weeks. Health behaviour outcomes include physical activity and diet. Clinical outcomes include BMI, hemoglobin A1c (HbA1c), and lipid levels. Psychological outcomes include anxiety, depression, and health related quality of life (HRQOL). The Naluri app theoretical framework is based on the Health Action Process Approach (HAPA) theory. Risk perception, self-efficacy, planning, intentions, outcome expectancies, illness perceptions and psychological outcomes will be measured using self-reported measures. Discussion: This trial will determine the effectiveness of the Naluri app intervention in improving various outcomes of cardiac patients after four months. It will provide data on the applicability of the HAPA theory in Mobile health (mHealth) intervention and the acceptance and efficacy of mHealth as a cardiac rehabilitation program for patients in Malaysia. The results may inform the potential implementation of the app for use with patients with other chronic illnesses like diabetes, stroke, and depression. Registration: Australia New Zealand Clinical Trials Registry (14/01/2019, ACTRN12619000104156).

The "Our Voice" Method: Participatory Action Citizen Science Research to Advance Behavioral Health and Health Equity Outcomes.

Citizen science research that more fully engages the community can systematically involve people from under-resourced groups to create practical health-enhancing improvements across physical, social and food environments. Exemplary health equity-focused outcomes include key health behaviors (e.g., healthy eating or physical activity) and community-level changes (e.g., public transit to food shops) that are central to health promotion while being demonstrably impacted by local environmental contexts. Yet, few examples of this approach are readily available for application within complex, community-based settings. In this paper, we present the Our Voice (OV) four-step method to demonstrate an integrated participatory citizen science approach and its usability for action-focused researchers and community health practitioners. In addition, we present a summary of the major research, processes, and community outcomes, with examples drawn from nutrition and healthy food access areas, among others. Finally, we explore the hallmark features of the OV method that effectively engage citizen scientists, empowering action and fostering solution-building across social and environmental structures impacting community health. Expanding research that marries participatory research philosophies with innovative citizen science methods, supported by systematic data collection, visualization, and delivery technologies, in turn provides a powerful toolkit for tackling local to global health equity challenges.

P032 The Health Belief Model for Shift Workers Scale: The development and validation of a novel metric for use in shift working populations

Abstract Introduction Shift work is associated with circadian misalignment, sleep loss and suboptimal health behaviours, which may contribute to longer term negative health outcomes. interventions based on behavioural models may improve health behaviours in shift workers. To implement and evaluate these interventions, a validated metric based on behavioural theory specifically for use with shift workers would be beneficial. The present study aimed to develop and evaluate the Health Belief Model for Shift Workers (HBM-SW) scale. Methods The HBM-SW development involved a seven-step process, including a literature review, expert panel analysis, cognitive interviews with shift workers, and administration to pilot sample of shift workers (n=153). Validation of the HBM-SW was compared to Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire and Food Frequency Questionnaire. Results Utilising exploratory factor analysis for factor identification and item reduction, the developed scale loaded on seven factors in line with the theoretical framework of the Health Belief Model Perceived Threat, Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, Self-Efficacy and Health Motivation. The HBM-SW showed good – excellent (α =0.74-0.93) internal consistency and moderate – good (ICC =0.64-0.89) test re-test reliability. Using health behaviour outcome measures, the HBM-SW scale showed meaningful correlations with sleep quality, sleep duration, diet quality and leisure time physical activity, and acceptable validity and reliability. Conclusion Further testing should be conducted in a larger sample to facilitate confirmatory factor analysis. The Health Belief Model for Shift Workers scale is likely to be beneficial for in future studies of interventions for shift workers.

Understanding the longitudinal relationship between substance use and violent victimization among street-based women who exchange sex in Baltimore, Maryland.

Women who exchange sex (WES) experience extensive interpersonal violence from multiple perpetrators. Violence towards WES contributes to poor mental and behavioral health outcomes, including high rates of drug use. However, it is difficult to disentangle the temporal relationship between drug use and violence among WES. We used data from 251 WES, who completed baseline and 6-month follow up surveys. WES reported baseline sociodemographic characteristics, including homelessness and hunger. Participants reported their drug use by type and violent experiences by perpetrator at each time point. We conducted a path analysis examining the associations between drug use and violent victimization over time. Participants were on average 37.8 years old, non-Hispanic White (57.4%) and experiencing high levels of structural vulnerability (59.4% homelessness; 58.6% weekly hunger). Drug use and violence were significantly correlated within each time point. Prospectively, baseline violent victimization was significantly associated with drug use (ß (SE)=0.13 (0.06)) and violence (ß (SE)=0.47 (0.05)) at follow up. Baseline drug use was associated with drug use at follow up (ß (SE)=0.45 (0.05)) but was not significantly associated with violence at follow up (ß (SE)=0.10 (0.06)). Violence and drug use are closely linked in this population; and violence appears to facilitate sustained drug use. Interventions to address the dual epidemics of violence and substance use in this population should address underlying trauma as well as socio-structural drivers of violence as well as tailored harm reduction services for this population.

(147) Optimizing Patient Interactions to Improve Behavioral Health Outcomes

(147) Optimizing Patient Interactions to Improve Behavioral Health Outcomes

Reproductive Coercion in Heterosexual and Sexual Minority Emerging Adults: Prevalence and Behavioral Health Impact.

Reproductive coercion (RC) is a type of intimate partner violence (IPV) characterized by partner interference with contraception or reproductive decision-making. Despite sexual minority people's vulnerability to other forms of IPV, limited research has examined reproductive coercion in this population. Research on behavioral health impacts of reproductive coercion is also lacking, especially for sexual minorities. This study addressed these gaps by examining the occurrence and behavioral health impact of reproductive coercion among emerging adults, including both heterosexual and sexual minority people. In 2020, survey data were collected with emerging adults (aged 18-24 years) at a university in the southeastern United States (N = 387). We conducted bivariate analyses to explore associates of reproductive coercion and logistic regression to identify risk factors. We then conducted linear regression to investigate relationships between reproductive coercion and behavioral health outcomes, in the full sample and in separate models based on sexual attraction. One in 15 sampled students (6.3%) had experienced reproductive coercion. Sexual attraction was a significant risk factor for reproductive coercion, with increased rates among plurisexual (i.e., attracted to people of multiple genders) compared to monosexual students, in both bivariate (χ2(2) = 7.57, p = .023) and regression analyses (B = 1.25, p = .012). Reproductive coercion was associated with worse behavioral health outcomes in bivariate and regression analyses (anxiety: B = 3.77, p = .001; depression: B = 3.26, p = .010; alcohol use: B = 2.32, p < .001). In separate linear regression models based on sexual attraction, RC was significantly associated with behavioral health indicators for participants who were attracted only to men and those attracted to people of multiple genders but not for participants who were attracted only to women. Findings indicated increased RC risk for plurisexual students compared to monosexuals and showed significant associations between RC and behavioral health outcomes, with differential effects based on sexual attraction. These novel findings support the need for continued research on RC, inclusive of nuanced conceptualizations of sexuality.

Health Misinformation Exposure and Health Disparities: Observations and Opportunities.

The concepts of health misinformation and health disparities have been prominent in public health literature in recent years, in part because of the threat that each notion poses to public health. How exactly are misinformation proliferation and health disparities related, however? What roles might misinformation play in explaining the health disparities that we have documented in the United States and elsewhere? How might we mitigate the effects of misinformation exposure among people facing relatively poor health outcomes? In this review, we address such questions by first defining health disparities and misinformation as concepts and then considering how misinformation exposure might theoretically affect health decision-making and account for disparate health behavior and health outcomes. We alsoassess the potential for misinformation-focused interventions to address health disparities based on available literature and call for future research to address gaps in our current evidence base.

Evaluating resilience in terms of COVID-19 related behavioral health among Latinx adults during the coronavirus pandemic

ABSTRACT The mental and behavioral health burden resulting from COVID-19 has disproportionately affected the Latinx population. Yet, no work has investigated the influence of resilience as a protective factor against COVID-19 related consequences. The aim of the current study was to evaluate resilience in relation to COVID-19 related fear, anxiety symptoms, COVID-19 anxiety-related sleep disturbances, and depression among Latinx persons (178 Latinx persons [31.5% female, M age = 34.1 years, SD = 8.2]). It was hypothesized that greater levels of resilience would be associated with lower levels of all COVID-19 related behavioral health outcomes above and beyond the variance accounted for by years living in the United States (U.S.), degree of COVID-19 exposure, sex, age, education, and COVID-19 related work and financial troubles and home-life distress. Results indicated that greater levels of resilience were associated with lower levels of COVID-19 related fear (ΔR 2 = .06, p < .001), anxiety symptoms (ΔR 2 = .03, p = .005), COVID-19 anxiety-related sleep disturbances (ΔR 2 = .06, p < .001), and depression (ΔR 2 = .04, p = .001). Overall, the present study is the first to document the potential importance of resilience in relation to common and clinically significant COVID-19 behavioral health problems among Latinx persons.

Frontline Perspectives from the Implementation of Evidenced-Informed Interventions to Improve Behavioral Health and HIV Outcomes Among Black Men Who Have Sex with Men in the United States.

The perspectives and contributions of frontline staff are critical to the success of integrated HIV and behavioral health services in the United States (US). In this analytic essay, we share five key priority areas from frontline staff at four diverse sites funded by the Health Resources and Services Administration to support the implementation of interventions to improve HIV and behavioral health outcomes among Black men who have sex with men (BMSM) living with HIV. The five main priorities focused on: (1) COVID-19 pandemic adaptations; (2) recruitment/enrollment; (3) retention; (4) frontline self-care; and (5) replication considerations. Projects had to be nimble and innovative in their delivery of services; leverage existing infrastructure; and they had to try multiple approaches to reach BMSM and modify/drop them as needed. Future implementers should expect to support frontline staff self-care given the added stress of working under COVID-19 pandemic conditions and in communities with limited and uncoordinated behavioral health services.

Medical progress and life cycle choices

In this paper, I show how medical progress, conceptualized as increasing effectiveness of health spending in reducing health deficits, affects optimal lifetime health behavior and health outcomes. To that end, I set up a stochastic life cycle model with endogenous health and longevity, calibrate it for an average American in the year 2010, and use counterfactual computational experiments to examine behavior and outcomes at lower and higher levels of medical efficacy. I begin with the standard health deficit model and the consideration of optimal health expenditure and savings. I then extend the model towards choices of occupation, unhealthy consumption, and retirement. When medical effectiveness increases by 50 percent, the benchmark American is predicted to display 23 percent fewer health deficits at age 65, retire more than 10 years later, live more than 7 years longer, and experience a 10 percent increase in the value of life at age 65. Richer and better educated individuals are predicted to benefit more from medical progress in terms of reduced morbidity and increased longevity.

HARNESSING CHILD AND ADOLESCENT PSYCHIATRY EXPERTISE THROUGH BEHAVIORAL HEALTH EDUCATION IN COLLABORATIVE CARE PROGRAMS AND PEDIATRICS RESIDENCY TRAINING INTERVENTIONS

Collaborative care is a model of behavioral health integration that promises to improve behavioral health outcomes in primary care settings. Significant gaps in the basic education of primary care providers (PCPs) and child and adolescent psychiatrists limit broad dissemination of the collaborative care model. Innovations are needed to address the training gap among child and adolescent psychiatry trainees, as well as pediatric trainees, particularly around integrated models such as collaborative care.

Disparities in Pediatric Mental and Behavioral Health Conditions.

Mental and behavioral health conditions are common among children and adolescents in the United States. The purpose of this state-of the-art review article is to describe inequities in mental and behavioral health care access and outcomes for children and adolescents, characterize mechanisms behind the inequities, and discuss strategies to decrease them. Understanding the mechanisms underlying these inequities is essential to inform strategies to mitigate these health disparities. Half of United States children with a treatable mental health disorder do not receive treatment from a mental health professional. Children and adolescents in racial, ethnic, sexual, sex, and other minority groups experience inequities in access to care and disparities in outcomes for mental and behavioral health conditions. Suicide rates are nearly twice as high in Black compared to White boys 5 to 11 years old and have been increasing disproportionately among adolescent Black girls 12 to 17 years old. Children identifying as a sexual minority have >3 times increased odds of attempting suicide compared to heterosexual peers. Adverse experiences of children living as part of a minority group, including racism and discrimination, have immediate and lasting effects on mental health. Poverty and an uneven geographic distribution of resources also contribute to inequities in access and disparities in outcomes for mental and behavioral health conditions. Strategies to address inequities in mental and behavioral health among United States children include investing in a diverse workforce of mental health professionals, improving access to school-based services, ensuring equitable access to telehealth, and conducting quality improvement with rigorous attention to equity.