Youth Care Research Articles

“I stayed on the street, as if there was no COVID-19”: enacting practices of care with youth at risk of violence and social exclusion in Portugal

As the COVID-19 pandemic unfolded, a world of carelessness was made visible. Public health guidelines against the spread of COVID-19 (e.g., school closures, staying home, social distancing) have substantially affected youth’s health and well-being and highlighted the need for context-specific understandings of infection, risk, and care. Our research aims to contribute to a deeper understanding of the impacts of COVID-19 on boys and girls serving educational measures and placed in the custody of the juvenile justice system in Portugal during the pandemic. Sustained by the use of ethnographic principles and methods along with participatory techniques, this article uncovers complex entanglements between the public health measures to mitigate contagion and the dynamics that exacerbated socio-spatial dynamics of social exclusion and isolation, educational and (mental) health inequities, and lived and practiced forms of violence by youth-serving tutelary measures in Portugal’s six educational centers. Following Tronto’s feminist ethical–political proposal of care, I argue that COVID-19 became a lens to access youth care needs — self-care, care for others, care as essential work of nurturing affective trajectories and solidarities and promoting positive and non-violent relationships. By caring for youth stories, the engagement of researchers and professionals in this action-oriented research aimed to promote the enactment of practices of care with youth in the Portuguese detention centers as a way to positively affect their inhabited present, promote healthier lives and nurture the construction of caring and non-violent post-pandemic futures.

50 Co-designing an intervention with asylum seeking youth to improve access to healthcare in Canada using human-centered design

Abstract Background Asylum seeking youth in Canada and the United States face multiple barriers to accessing healthcare, leaving them at greater risk of worse health outcomes. In a previous study, we found that limited knowledge of the Canadian health care system and few navigation supports were a key barrier to care for asylum seeking youth, yet no youth-developed intervention existed to support this population. Human-centered design (HCD) develops meaningful interventions with communities who have been historically marginalized. Objectives This study sought to co-design an intervention to increase youth empowerment and access to health care for asylum seeking youth in Canada. Design/Methods This was a community-based participatory-action research (CBPAR) study, and combined human-centered design (HCD) methodologies. We obtained research ethics board approval for this study (#SMH REB 22-117). In partnership with two community organizations that supported asylum seeking youth in a large Canadian city, a youth advisory board was created. In multiple co-creation sessions over a calendar year, an intervention was developed in rapid prototyping sessions and refined with feedback, to develop a final pilot intervention. Results A total of 7 asylum-seeking youth participated in the youth advisory board, ranging in age from 12-19, representing 3 different languages and included youth who self-identified with chronic medical conditions. Over a 15-month period, they participated in 6 co-creation sessions to develop a multi-lingual, web-based tool; youth specifically stated they did not believe an app would be helpful, but rather a resource that could be easily accessed. The youth advisory board shared they had limited understanding of the Canadian healthcare system, as well as interim and provincial health insurance. Youth felt the tool should answer questions about how health insurance worked, be brightly colored, use dyslexia-friendly font and be easily saved on a smartphone as an image. A multi-lingual wallet card was developed for youth to easily present at healthcare encounters, particularly if they did not have provincial health insurance, to help youth communicate their coverage, language and needs. Conclusion To our knowledge, we developed the first co-designed tool in Canada for youth asylum seekers, by youth, to improve and empower youth to receive health care services they are entitled to through navigation support. Given the high degree of marginalization faced by asylum seeking youth, this intervention has the promise to improve health outcomes. Feasibility and acceptability of this study will be evaluated in subsequent studies.

Telehealth Outreach Program for Child Traumatic Stress: Strategies for Long-Term Sustainability

Background: There are high documented rates of exposure to traumatic events and mental health disorders among youths yet existing disparities in access to care for racial and ethnic minority youths and youths in rural communities. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based behavioral health therapy for children. The delivery of TF-CBT via telehealth can decrease access to care barriers. An interdisciplinary clinical team developed a training program to guide clinicians to effectively provide TF-CBT via telehealth. The goal of this study was to describe variation in implementation processes of the telehealth TF-CBT program and identify barriers and facilitators to program implementation post-training, which were utilized to develop implementation strategies for intervention sustainability. Methods: Using a mixed-methods approach, data were collected on telehealth implementation processes and facilitators and barriers to the delivery of telehealth TF-CBT. This study was guided by an adapted implementation science framework, namely the Exploration, Preparation, Implementation, Sustainment model. Interviews and surveys were completed with clinical site leaders who had participated in the telehealth TF-CBT training. Results: Throughout clinical sites, there was varied adoption and penetration of the telehealth TF-CBT program. Facilitators to implementation included leadership and site staff buy in, community needs, and training resources, while barriers included funding, available logistical resources, and child and family involvement. Conclusions: The feedback gained from this project assisted in the development of implementation strategies for increased adoption and sustainment of TF-CBT delivered via telehealth. Strategies include ongoing interactive assistance and resource support, enhanced training for stakeholders, and program adaptations, with the goal to increase access to quality mental health care for underserved populations.

A scoping review on barriers and facilitators to harm reduction care among youth in British Columbia, Canada

BackgroundProgressive harm reduction policies have been implemented in British Columbia, Canada. However, youth who use drugs face barriers to receiving harm reduction care, resulting in increasing opioid-related hospitalizations and drug toxicity deaths. This scoping review collates peer-reviewed evidence to understand the barriers and facilitators faced by youth who use drugs when accessing harm reduction programming in British Columbia, Canada.MethodsThis scoping review entailed conducting a systematic search of relevant databases to identify relevant articles. Articles were included if they: (i) contained youth falling between the ages of 12 and 26 years old; (ii) explored accessibility, barriers, and/or facilitators to harm reduction care or related topics; (iii) were empirical research articles using primary data (i.e., reviews, grey literature, theoretical or conceptual papers, books, etc. were excluded); and (iv) were available in the English language, given the geographic focus on British Columbia.ResultsA total of 398 sources were identified and ultimately, data from 13 sources were charted and extracted. When investigating barriers to harm reduction care among youth, four themes emerged: self-stigma, service navigation, service delivery, and negative provider interactions. Furthermore, in exploring factors that facilitate harm reduction care for youth, four themes surfaced: ability to meet basic needs, positive provider interactions, social networks, and risk mitigation guidance.ConclusionsThe expansion of harm reduction services in 2016 did not fully address accessibility challenges faced by youth who use drugs. Barriers continue to hinder harm reduction engagement, while supportive networks, positive provider interactions, and the ability to meet basic needs facilitated sustained access. Tailored policy interventions rooted in equity are crucial to improving access to harm reduction services for youth who use drugs.

Challenges Experienced by Youths Leaving Kinship Foster Care in Johannesburg, South Africa

Young people who leave kinship foster care in South Africa typically encounter greater difficulties transitioning to adulthood when compared to their peers who grow up with their biological parents. The aim of this study was to explore the challenges experienced by youths leaving kinship foster care in the City of Johannesburg Metropolitan Municipality, Gauteng, South Africa. The study used a qualitative approach and exploratory, descriptive and contextual research designs. Twenty-three participants were selected by using purposive sampling. The researchers utilised semi-structured interviews as an in-depth data collection tool. Thematic analysis was used to analyse the data. The findings demonstrated that although youths leaving kinship foster care had access to education, some were unable to finish their secondary education. In addition, the findings showed that poverty and job insecurity were some of the challenges experienced by youths leaving kinship foster care. Furthermore, the findings indicated that youths leaving kinship foster care required social support services such as educational and financial support. Thus, the study recommends developing initiatives to improve school completion rates for youths in kinship foster care; establishing financial support programmes; creating job placement services; offering comprehensive social support; and advocating for policy reforms to help these youths transition to adulthood and independent living.

Unveiling Disparities: Exploring Overmedication of Black Foster Care Youth and How Implicit Bias Contributes

Background:Black youth are overrepresented in the foster care system, and research is needed to reveal the impact of their overmedication (Cénat et al., 2021; Dettlaff & Boyd, 2020; Godoy et al., 2022; Lee et al., 2015; Montgomery, 2022; Williams-But‐ ler, 2023).Objective:This article examines misdiagnoses, overprescribed psychotropics, and off-label medication use to address behavioral concerns (American Civil Liberties Union Maryland v. Maryland, 2023; Cullins & Moore, 2020; Fadus et al., 2020; Mizock & Harkins, 2011) and investigates the contribution of implicit bias to find equitable and nondiscriminatory solutions.Methods:A systematic literature review was conducted to identify themes surrounding racial disparities within the child welfare system. Articles that were published within the last five years were prioritized except for those with unique findings or a specific lens of inquiry. Foundational references such as relevant legislation were also used to support the research questions.Findings:The literature reveals significant and clear disparities in the treatment of Black youth within the child welfare system. Black foster care youth are often medicated at disproportionately high rates.Conclusions:The findings suggest that more culturally intelligent interventions are necessary to ensure Black foster care youth receive adequate and appropriate assessment and treatment.

Anorexia nervosa with comorbid autism spectrum disorder: Optimizing care for youth, caregivers, and health care providers

Anorexia nervosa with comorbid autism spectrum disorder: Optimizing care for youth, caregivers, and health care providers

“Surviving against the odds. The impact of peer support workers on a chronically suicidal adolescent in secure residential youth care: a single case report from the Netherlands”

ABSTRACT Background The use of peer support workers to support suicidal adolescents is underdeveloped. This study focuses on the effects of a one-year intervention with peer support workers on a chronically suicidal adolescent residing in a secure residential youth care facility in the Netherlands. Moreover, we explore the mechanisms that underpin the role of peer support workers in detail. Method This study employed a single case study design. We conducted seven semi-structured interviews with staff, peer support workers, and a chronically suicidal adolescent. The interviews were analysed using a thematic analysis. Results The results indicate that the suicidal tendencies of the adolescent decreased significantly one year after the peer support intervention compared to the initial baseline. Working mechanisms that underpinned the peer support intervention emphasized building meaningful and trust-based relationships, providing recognition and hope, and practical support from a recovery-oriented perspective. Conclusion The results suggest that peer support has a beneficial impact on the adolescent and treatment teams. Peer support workers contribute to a sense of belonging and connection, coping with suicidality, rediscovering life goals, and improving adolescent self-management. Barriers and facilitators to implementing peer support workers are also discussed.

Intersectoral Collaboration in Support of Youth in Residential Care: A Scoping Review of Effects, Barriers and Good Practices

ABSTRACT This research was conducted as part of an action research project supporting intersectoral care experiments in Flanders for minors in residential care. This article details some of the questions the stakeholders in this project had at the start of such a project, as well as the results from a scoping literature review conducted to answer these questions. This scoping literature review was conducted on four databases, returning 23 articles providing information on the effects of, good practices of, or barriers for intersectoral care for looked-after minors. Results show that research on this specific topic for this population is scarce, mostly qualitative, and mostly from the perspective of staff rather than clients. Reports on the effects of intersectoral initiatives seem cautiously encouraging. Many possible obstacles for coordinated or shared care have been identified, with difficulties in communication, information sharing and lack of shared vision as prominent ones. Many potentially good practices have however also been identified in this review that can help collaborative partners overcome several of the barriers.

Academic achievement among youth in foster care

This disproportionate rate of academic achievement among youth in foster care raises significant concerns given the social and economic benefits that earning a high school diploma provides over the course of an individual’s life. This study examines the relationship between a youth’s foster care experience (removal reason, number of placements, total number of days in foster care, connection to adult mentor, substance abuse, and dual-system involvement) and academic achievement across gender, race, ethnicity, and disabilities using the Adoption and Foster Care Analysis and Reporting (AFCARS) data and the National Youth in Transition Database (NYTD). This study found that several factors including gender, race, ethnicity, disability, connection to adult mentor, substance abuse referral, and dual-system involvement (incarceration) were associated with academic achievement. It is clear from the data that youth involved in the foster care system need increased support during their educational tenure. Low academic achievement rates among youth in foster care need to be addressed with more effectual, balanced, deliberate supportive resources, such as special education/disability services, mentoring programs, and independent living services (ILS) that connect youth in foster care to supports that will help them earn a high school diploma and increased the likelihood that they would go on to postsecondary education opportunity.

Residential treatment program outcome evaluation: one agency’s discoveries about performance measurement

ABSTRACT This paper explores the design and implementation of a comprehensive, continuous outcome evaluation for youth in therapeutic residential care (TRC) to measure program efficacy, based on The Joint Commission (TJC) accreditation guidelines. Over a 10-year implementation period, researchers analyzed changes in 281 residential care youth from baseline to reassessment after 4–6 months in treatment. The primary assessment instruments included the SASSI-A2, the FACES III, the Measure of Psychosocial Development (MPD), the Behavioral and Emotional Rating Scale (BERS), and the Youth Comprehensive Risk Assessment (YCRA). Results indicated reductions in the risk areas of self-harm, conduct disorder behaviors, and substance abuse. Significant increases occurred in psychosocial development, family engagement, and personal strengths. However, results also revealed continued low levels of youth development in trust vs mistrust, ego integrity vs despair, willingness to disclose loss of control, recognition of negative consequences of substance misuse, and response to conduct disorder treatments. Implications and recommendations for ongoing program evaluation, staff development, and institutional change are discussed.

Intersectional disparities in access to mental health services among youth aging out of foster care

BackgroundYouth aging out of the child welfare system lack support in accessing needed mental health care, as do youth of color and LGBTQ ​+ ​youth in the general population. Similar disparities may exist among youth aging out of foster care who hold intersecting social identities. ObjectiveThis study aimed to explore the presence of mental health care access disparities among youth aging out of foster care using an intersectional lens. Participantsand Setting: The current study was a cross-sectional, exploratory analysis of secondary data from the Jim Casey Youth Opportunities Initiative (JCYOI) dataset. The sample included 2650 youth aging out of care. MethodsThe current study utilized bivariate tests to explore the association between access to mental health care and key variables, a rate ratio to measure access disparities, and logistic regression to determine the main effect of identity on mental health care access. FindingsLower rates of mental health care access were found among youth of color compared to White youth and among LGBTQ ​+ ​youth compared to non-LGBTQ ​+ ​youth. Disparities increased when youth of color also identified as LGBTQ+, however identity was not a significant predictor of mental health care access when controlling for insurance coverage and other variables. ConclusionsDisparities in access to needed mental health care found in the general population are also present among youth aging out of foster care. These findings suggest the need for targeted efforts from practitioners to ensure equitable access to mental health care for transition aged youth.

Dr. M. van Dorp, I will stand by you: A shared journey towards seclusion reduction in secure residential youth care (Vrije Universiteit Amsterdam, 12 juni 2024)

Dr. M. van Dorp, I will stand by you: A shared journey towards seclusion reduction in secure residential youth care (Vrije Universiteit Amsterdam, 12 juni 2024)

SILENT GROUP SANDPLAY ACTIVATES HEALING

BackgroundThis paper describes the effect of silent group Sandplay (SP) with early adolescents as observed and reported in circumstances of deprivation, neglect and abuse. ObjectiveThe objective was to explore with childcare staff, group SP as an intervention with early adolescent participants. Participants and SettingNine childcare staff participated in an in-depth SP exploration involving a series of six group SP sessions with five children at a child protection organisation in a resource-constrained context. MethodsGroup SP offered in a particular way in a protective child and youth care environment facilitated an opportunity for inner processing and self-discovery. In-depth semi-structured interviews with childcare staff conducted both before and after group SP provided descriptions of the SP experience for both children and adult participants. ResultsThe before-SP reports of the children’s behaviour and demeanour highlighted wounding and after-SP observations indicated healing patterns. The before-SP topics included overwhelmedness, vulnerability, constrained resources, the need for change and culturally appropriate, accessible interventions. Themed descriptions after SP included a newfound desire to play and activation of healing for both child and adult participants. Healing processes indicated a desire to play, cooperation, openness, increased awareness, adaptation, grounding and belonging. The implications are potentially far-reaching in terms of the accessibility, efficiency and cultural suitability of providing group SP in child protection and community-based settings, particularly in contexts of deprivation, neglect and abuse.

Using Neuropsychological Profiling to Tailor Mental Health Care for Children and Youth: a Quality Improvement Project to Measure Feasibility.

Precision child and youth mental healthcare has great potential to improve treatment success by tailoring interventions to individual needs. An innovative care pathway in a pediatric mental health outpatient clinic was designed to allow for neuropsychology data to be integrated in psychotherapeutic care. This paper describes the feasibility of this new pathway, including implementation outcomes, acceptability, and potential for future integration. The target population was outpatients 6-17years old referred for individual treatment to a tertiary outpatient mental health (OPMH) clinic. The new care pathway was co-developed by neuropsychologists and mental health practitioners. A logic model was created to guide the evaluation, which was informed by the Reach Effectiveness Adoption Implementation Maintenance framework. As part of the logic model, a stepped assessment protocol was implemented, and reports on neuropsychological function were shared with patients, caregivers, and care providers. Evaluation data were collected from phone surveys, questionnaires, a focus group, and administrative records. Forty-two patients scheduled to receive therapy over a 6-month period were offered the opportunity to participate in the new care pathway and 39 (93%) agreed. Self-reported outcome data showed that 83% of patients and 94% of caregivers valued neuropsychology-informed care, with some describing it as transformative. Almost all practitioners (91%) reported that the project added value to their clinical care. There were no adverse effects on participants nor the flow of patients through the system. Neuropsychology-informed pediatric OPMH care was feasible and well-received. Clinical effectiveness should be studied in an experimental trial.

The German Communities That Care Youth Survey: dimensionality and validity of risk factors.

Communities That Care (CTC) is an evidence-based community change strategy for supporting healthy youth development. One of its key elements is the development of a community profile to identify and prioritise risk factors for health and behavioural problems in adolescents based on the CTC Youth Survey. The strategy was originally developed and evaluated in the United States. An adapted version of the survey has been used in Germany since its first implementation in 2008. However, the dimensionality and validity of the adapted risk factor scales have not yet been evaluated. Therefore, this study aimed to confirm the assumed unidimensional structure and to establish the concurrent criterion validity of each risk factor. A sample of 1,911 adolescents attending grades six to eleven in Lower-Saxony, Germany, was used to evaluate 23 risk factor scales of the German CTC Youth Survey covering the domains peer/individual, family, school, and community. Confirmatory factor analysis was used to assess the dimensional structure of all risk factors with sufficient item numbers. Goodness of fit was determined using CFI, SRMR, and RMSEA. Latent regression analysis tested the concurrent criterion validity of all unidimensional risk factors. For this, violent and delinquent behaviour, substance use, and depressive symptomatology were regressed on each risk factor. All evaluable risk factors demonstrated acceptable to good model fit regarding unidimensionality and predicted violent and delinquent behaviour, and substance use better than depressive symptomatology. Regarding the peer/individual risk factors, there are particularly high correlations with violent and delinquent behaviour, and substance use. In contrast, two risk factors were not correlated with substance use, whilst two other risk factors were not correlated with depressive symptomatology. Overall, the results indicate that most risk factors demonstrate unidimensionality and are valid in terms of concurrent criterion validity. Although some risk factors were not correlated with every outcome, they still predicted most outcomes, suggesting that the CTC Youth Survey is a viable tool for communities to assess their community risk profile. Risk factors that did not demonstrate unidimensionality or concurrent criterion validity should be monitored in future surveys and interpreted with caution until further evidence is available.

The effect of bipolar effective disorder and low socio-economic status on juvenile delinquents in Pakistan

Bipolar disorder remains a significant taboo in Pakistan, particularly among juvenile delinquents, leading to their social segregation. The prevalence of this mood disorder in Pakistani youth is concerning, largely due to limited awareness and inadequate mental health resources for children and adolescents. Economic instability, family conflict, and lack of access to care contribute to chronic stress, delaying the diagnosis and treatment of bipolar disorder. This study aimed to explore the relationship between socio-economic status and bipolar disorder in juvenile offenders, focusing on the role of social support. We included 220 children, aged 12 to 18, diagnosed with severe bipolar disorder. Most lived with both biological parents, while some were in single-parent households due to separation or loss. Our findings indicated that low socio-economic status significantly impacts mental health and personality development. Factors such as financial instability, inadequate housing, and lack of access to quality healthcare increase feelings of inferiority, leading to higher rates of bipolar disorder. Notably, 88.4% of participants exhibited extreme symptoms, with a higher prevalence in males (55%) than females (29%). The delinquency rate was significant, with 56% of boys and 32% of girls involved in criminal activities. These results suggest a strong correlation between low socio-economic status and the severity of bipolar disorder in juvenile delinquents. Many young individuals resort to crime due to unmet basic needs, reinforcing the idea that socio-economic challenges directly influence mental health outcomes. Overall, these findings underscore the urgent need for improved mental health care and support for vulnerable youth in Pakistan.

Adherence to Recommended Care in Type-1 Diabetes Mellitus Among Adolescents and Youths Attending the Diabetes Camp in Ogun State, Nigeria

Background: Adolescents and youths living with Type 1 diabetes mellitus (T1DM) are known to have challenges in managing the condition and may be prone to poor glycaemic control and complications. Objectives: To assess the level and adequacy of care for adolescents and youths living with T1DM. Methods: A cross-sectional, descriptive study was conducted among adolescents and youths living with T1DM who attended the 2023 Ogun Youth Diabetes Camp. An interviewer-administered questionnaire was used to obtain information. Results: Twenty-five participants with a mean age of 18.0±3.9 years (range 13-24 years) were recruited, with 80% being females. The mean HbA1c was 7.1 ± 1.8%, and in-camp postprandial glucose values were mostly high (76%). The mean age at diagnosis of T1DM was 11.7±4.8 years. One participant had T1DM for < 2 years, 11 for 2-5 years, and 13 for > 5 years. Among those who had lived with T1DM for more than 5 years, ten had been referred to a dietitian, nine to an ophthalmologist, and two to a neurologist. One participant had been screened for thyroid disorder. Conclusion: The adolescents and youths living with T1DM in this survey had suboptimal glycaemic control, and evaluation by their care providers during clinic visits was also suboptimal. Therefore, they may be at increased risk of developing complications. It is recommended that all stakeholders lend timely and aggressive support to these individuals to ensure adequate management and prevent complications.

Policing of youth in the hospital

BackgroundEach year millions of children seek care in emergency departments, many of whom are from marginalized and minoritized groups who lack access to primary and preventive care. Law enforcement personnel are also commonly present in pediatric and adult emergency departments serving in a range of roles. Therefore, pediatric emergency departments sit at the nexus of the health system and the legal system for many vulnerable youth and families. ObjectiveHerein, we explore several common specific legal issues surrounding policing of youth in the hospital setting: patient privacy and disclosure of information, questioning and visitation restriction, autonomy and decision making, restraints and use of force, and patient property. MethodsOur team of legal scholars and clinician researchers examined the literature on policing of youth in healthcare settings and patients' legal rights in healthcare settings through searches using PubMed, Westlaw, and Lexis. FindingsThrough rigorous analysis of the medical literature, legal scholarship, and relevant case law, several important themes were identified which present challenges to clinicians caring for vulnerable children. Conclusions and relevancePediatric clinicians, highly trained professionals in the medical and social care of youth and children, are often unaware of legal rules and procedures that guide law enforcement interaction with youth. This lack of knowledge may result in unknowing and unwitting violations of patients' rights while also compromising the quality of health care provided. Therefore, it is imperative that clinicians are educated on their roles and their institutions' roles in safeguarding patients' privacy and autonomy while still promoting effective collaboration with law enforcement.

Psychometric Validation of the Brief Outcome Survey: A Transdiagnostic Tool for Measurement-Based Care

ABSTRACT Background Measurement-based care (MBC) is a fundamental component of evidence-based psychotherapy that has the potential to improve the landscape of behavioral and mental health (BMH) care for youth and families. Objective The purpose of this study was to assess the reliability, validity, and clinical utility of the Brief Outcome Survey (BOS) when used as part of a comprehensive MBC approach during a course of evidence-based psychotherapy. Method The BOS is a three-item transdiagnostic tool designed to measure the impact of youth’s symptoms/conditions on functioning. Demographic and clinical data were obtained via a retrospective chart review of 75,000+ unique patient encounters over a period of 15 years. Internal consistency, test re-test reliability, construct validity, validity generalization, and clinical utility were assessed. Results Data were analyzed from 8,665 youth (Mage = 11.8 years; 57.2% biological female). The internal consistency coefficient (e.g. Cronbach’s alpha) ranged from 0.80–0.83 (first and second BOS administration). The single measure intraclass correlation coefficient was 0.66 (p < .001). Intraclass correlations between the BOS and the PHQ-9, GAD-7, and CY-BOCS were moderate. No significant differences were found by age. Cronbach’s alphas for the age groups ranged from 0.79–0.82. BOS scores were higher at baseline for biological females compared to males, t(8235) = 2.29, p < .001. Similarly, BOS scores were higher at baseline for youth receiving public versus private health insurance benefits, t(8032) = 2.29, p < .05. A one-way ANOVA revealed significant differences in BOS scores by diagnosis group and Cronbach’s alpha for the BOS was above 0.80 across all five diagnosis groups analyzed. Conclusions The BOS demonstrated evidence of strong psychometric properties and clinical utility, as a session-by-session transdiagnostic MBC tool.