Implementation Of Mental Health Intervention Research Articles

Mental healthcare in paediatric epilepsy clinics: implementation by non-mental health professionals

ObjectivesResearch has shown that children with epilepsy often experience mental health disorders but face barriers to effective care. One solution is to train healthcare professionals within paediatric epilepsy services to...

Adolescent Mental Health Interventions: A Review of Psychological and an Islamic Approach

Mental health programs among adolescents are conducted with various approaches based on the program's objectives and the target population's needs which impact mental health and well-being. The objective of this review is to examine the implementation of mental health intervention of the psychological and Islamic approaches in maintaining mental health among adolescents. This review's main sources are articles from databases, Scopus, Eric, ProQuest, and Google Scholar. Most psychological approaches emphasize emotional well-being in interventions, while Islamic approach, viewed mental health care holistically. This includes obeying religious teachings which positively impact teenagers' well-being. The exploration of adolescent self-development, including social well-being and emotional, spiritual, and religious values is important to increase the effectiveness of mental health interventions among adolescents. Both Psychological and Islamic approaches can be applied in promoting mental health interventions. Mix-method approaches such as Islamic Cognitive Behavioural Therapy (ICBT) can be explored for modifying negative thoughts while incorporating spiritual and religious practice.

Research on Intelligent Decision Support System for Student Management and Mental Health Intervention in Higher Education Institutions

Abstract The intelligent management system of colleges and universities is an important display of the informationization construction of colleges and universities. Aiming at the life trajectory and life information of students in colleges and universities, this paper combines data mining and other technologies, adopts Python language and MySQL database technology, and improves on the Flask framework to develop an intelligent decision support system for student management and mental health intervention. The study takes student achievement abnormality detection and mental health intervention as an example, uses the improved K-Means algorithm and Apriori algorithm to mine and analyze the relevant data, and discusses the specific application of the intelligent decision support system. The sample students can be divided into three different types of academic performance: excellent, ordinary, and difficult. Precision teaching can be implemented according to the different types of students. Only 3% of the students had more obvious and serious psychological problems, while 80% of the students had a relatively healthy psychological state. Moreover, the correlation rules between student information and mental health status are analyzed, which can aid in the implementation of mental health interventions. The intelligent system of student management can provide the most direct and effective evidence for academic administrators in making decisions on teaching plans, thus making student education more targeted, personalized, and predictive.

School Leaders’ Response to Rising Mental Health Concerns: A Collaborative School-Based Social Worker Pilot

Mental health challenges among students remain a complex and widespread problem facing school leaders. Though schools are a front-line pathway for providing mental health services, many struggling youth are not receiving the professional help they need (Atkins, Hoagwood, Kutash, & Seidman, 2010; Findlay, 2017). Creative and collaborative solutions are needed to bridge the mental health gap. School leader support is essential to the successful implementation of mental health interventions (Forman, Olin, Hoagwood, Crowe, & Saka, 2009). This paper summarizes the novel approach taken by school and community leaders in one rural Ontario community who jointly piloted a school-based social worker (SBSW) role to support secondary schools in two districts. Interviews with five district leaders (four involved in designing the intervention and the SBSW who piloted the role) reveal conditions necessary for the pilot to take place, as well as leader involvement in setting up, supporting, monitoring the new role. Interviews highlighted multiple ways which the pilot improved student mental well-ness: one-on-one and group counselling sessions, charting fresh pathways networks of support available to students, creating a safe space for student and staff drop-ins, among other benefits to schools and stakeholders involved in the pilot. Results also detail three challenges leaders encountered along the way: stakeholder agreement, role clarity, and the temporary design of the role. Findings underscore how school-based social workers show promise in addressing rising mental health challenges.

Cultural adaptation of interventions for common mental disorders

Most psychological interventions are developed and the evidence for their efficacy established in Western contexts. Such interventions often need to be culturally adapted when they are used in populations other than those for which they were developed. Cultural adaptation is the systematic modification of an evidence-based treatment or intervention protocol to consider the patient's language, culture, and context. 1 Bernal G Jiménez-Chafey MI Domenech Rodríguez MM Cultural adaptation of treatments: a resource for considering culture in evidence-based practice. Prof Psychol Res Pract. 2009; 40: 361-368 Crossref Scopus (449) Google Scholar Cultural adaptation is widely accepted as essential for the effective implementation of mental health interventions and achievement of mental health equity globally and within populations challenged by health disparities. 2 Wang Z Yang G Guo Y Harnessing the opportunity to achieve health equity in China. Lancet Public Health. 2021; 6: e867-e868 Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar , 3 Ellis DM Draheim AA Anderson PL Culturally adapted digital mental health interventions for ethnic/racial minorities: a systematic review and meta-analysis. J Consult Clin Psychol. 2022; 90: 717-733 Crossref Scopus (4) Google Scholar , 4 Harper Shehadeh M Heim E Chowdhary N Maercker A Albanese E Cultural adaptation of minimally guided interventions for common mental disorders: a systematic review and meta-analysis. JMIR Ment Health. 2016; 3: e44 Crossref Google Scholar However, no systematic overview of studies of culturally sensitive interventions in people of Chinese descent, who represent more than a sixth of the global population had been done Efficacy of culturally adapted interventions for common mental disorders in people of Chinese descent: a systematic review and meta-analysisPsychological interventions can be transported across cultures with appropriate modifications. Adaptations to interventions can be made by modifying evidence-based interventions, or in culturally specific ways that are rooted in the sociocultural context. However, findings are limited by the insufficient reporting of interventions and cultural adaptations. Full-Text PDF Open Access

The relationship between mindfulness and mental distress in Chinese people during the COVID-19 pandemic: Moderating effects of infection severity of region and mediating effects of resilience and self-efficacy

The current study investigated the moderating effects of COVD-19 infection severity of region of residence, and the mediating effects of resilience and self-efficacy, on the relationship between mindfulness and mental distress during the COVID-19 pandemic. A total of 1,220 participants from 107 cities in China took part in a cross-sectional survey. The data were collected during the early stages of the COVID-19 pandemic (from April 10 to June 10, 2020). The final sample comprised of 1,201 participants with a mean age of 29.62 (SD = 12.72; Range = 18–78). Participants were categorized into high, moderate, and low infection-severity areas according to the numbers of infected people and deaths in their residential areas as of April 16, 2020. The findings showed that mindfulness, resilience, and self-efficacy were negatively associated with the mental distress indicators of stress, anxiety, and depression and that mindfulness, resilience, and self-efficacy positively correlated to one another. COVID-19 infection severity in one's region of residence did not moderate the negative associations between mindfulness and stress, anxiety and depression, while resilience and self-efficacy mediated the negative relationship between mindfulness and mental distress. This study therefore sheds light on some of the mechanisms by which mindfulness helps individuals maintain good mental health in times of adversity. The inclusion of mindfulness, resilience, and self-efficacy in the design and implementation of mental health intervention in response to the pandemic and future public health crisis may help mitigate some of the mental problems related to the COVID-19 and future pandemics.

Meta-synthesis of qualitative research on the barriers and facilitators to implementing workplace mental health interventions

PurposeThere has been a rapid increase in the number of mental health interventions implemented in the workplace. The efficacy of these interventions has been mixed. The factors influencing implementation may offer insights to why some interventions fail to be effective. MethodWe conducted a meta-synthesis of qualitative research on the barriers and facilitators to implementing workplace mental health interventions. We evaluated the quality of evidence using CASP and CERQual and synthesized our data using thematic analysis. Results33 studies were included in the review. A broad range of interventions were reflected in the studies, a majority of which were implemented at the individual level and in health care settings. Facilitators included positive disclosure by line managers, completion of intervention in work time, scheduling flexibility and trainer credibility. Barriers included managers not prioritising interventions, lack of suitable training of facilitators, competing priorities, workload issues and staff shortages. No findings were judged to be very well supported (i.e., high confidence). ConclusionEvidence surrounding the implementation of mental health interventions in the workplace is weak, and studies are limited to high income countries, with a bias towards healthcare and public sector settings. We call for a taxonomy of implementation issues specifically for workplace mental health to advance knowledge and practice.

Deliberative dialogue with Ibero-American universities on interventions in student mental health during the COVID-19 pandemicDiálogo deliberativo com universidades ibero-americanas sobre intervenções em saúde mental dos estudantes na pandemia de COVID-19

RESUMENObjetivo.Contextualizar una síntesis de evidencia sobre intervenciones en salud mental estudiantil durante la pandemia de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) por medio de un diálogo deliberativo con universidades iberoamericanas.Métodos.Se realizó previamente una síntesis de evidencia y un diálogo sincrónico, que consistió en la discusión en subgrupos acerca del diseño y aplicación de las intervenciones en salud mental. Se realizó un análisis de datos dialógicos y se sintetizó por temas.Resultados.Cincuenta y siete miembros de 17 universidades iberoamericanas públicas y privadas participaron en el encuentro. En el diseño de las intervenciones, se percibe la salud mental como desatendida, y visibilizada con la pandemia. La detección de necesidades es la que orienta las intervenciones y rara vez se utiliza evidencia científica para diseñarlas. Se considera importante conformar un equipo interdisciplinario con capacitación continua para diseñar un programa específico, que cubra también familias y personal docente y administrativo. En la aplicación, existen problemas como la saturación de los servicios por la alta demanda y la falta de recursos básicos de los estudiantes. Es innegable la influencia del contexto macro e institucional por la disposición de recursos. El diálogo fue percibido como oportunidad para construir un consolidado nuevo de intervenciones.Conclusiones.Este diálogo permitió enriquecer la descripción de intervenciones en salud mental estudiantil durante la pandemia de COVID-19 ya descritas en la literatura, aunque llevarlas a la práctica en nuestro contexto supone hacer frente a la deuda por la desatención previa y las altas necesidades básicas insatisfechas.

Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework.

Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. Methods: Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a 'tailored blueprint' methodology. Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. Plain language abstract: This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health service.

Assessing College Students' Perceptions of and Intentions to Use a Mobile App for Mental Health

Introduction: College students face high rates of depression, anxiety, and suicide. Therefore, the focus of this study was to examine college students' intention to use a mental health app provided by the university, called MySSP, through use of the unified theory of acceptance and use of technology (UTAUT). Materials and Methods: An online survey was developed based on responses to focus groups previously conducted by the authors regarding MySSP. A multiple linear regression was conducted to test the associations between the UTAUT variables and behavioral intention. In addition, moderation analyses were conducted to explore the effects of depression, anxiety, stigma, and quality of life as moderators. Results: Results suggest that performance expectancy (PE) (t = 3.088, p = 0.003) and social influence (SI) (t = -2.163, p = 0.03) were the only significant predictors of behavioral intention. The only significant moderator was stigma in the relationship between effort expectancy and behavioral intention (b = -1.6081, standard error (SE) = 0.7454, confidence interval (CI): -3.0691 to -0.1472) as well as facilitating conditions (FCs) and behavioral intention (b = -2.2292, SE = 0.8580, CI: -3.9110 to -0.5475). Conclusions: This study provides an initial exploration of college students' intentions to use MySSP. The results suggest that successful interventions include features related to PE (usefulness) and SI (norms), which should be focused on when developing and testing apps for mental health. Additionally, the stigma of mental health has significant negative impacts on the adoption of mental health apps and should be considered in implementation of mental health interventions geared toward college students.

Student, teacher, and caregiver perceptions on implementing mental health interventions in Ugandan schools.

The vast majority of children and adolescents in low and middle-income countries (LMICs) lack access to interventions for mental health problems. Schools provide a critical platform for evidence-based intervention delivery for young people. However, a significant need exists to understand the implementation context and strategies for delivering school mental health interventions in LMICs. We conducted a focused ethnography to explore students', teachers', and caregivers' perspectives on implementing evidence-based mental health interventions (EBIs) within a widespread violence prevention program in Uganda. Data collection occurred in Kampala, Uganda, using two schools that have previously implemented an evidence-based violence prevention program widely used in Ugandan schools schools, the Good School Toolkit (GST). Trained, local researchers facilitated four focus group discussions (FGDs) with caregivers (n = 22), four FGDs with teachers (n = 25), and in-depth interviews with primary school students (n = 12). Verbatim transcripts were analyzed using a framework analysis approach. Participants revealed a school culture that promotes schools' responsibility to students beyond academics, including positive teacher-student relationships. Participants recommended an implementation process that trains teachers and students in screening and referral, peer group delivery, and is accompanied by a school-wide approach to stigma reduction and mental health literacy. Participants fundamentally agreed that teachers could be trained as intervention facilitators. This study highlights the potential advantage of leveraging an existing intervention that already addresses implementation factors, such as school culture, as a fertile platform for implementing interventions for child and adolescent mental health in LMICs. Despite the growth of implementation research for child and adolescent mental health, the study of implementation science for child and adolescent mental health in low and middle-income countries (LMICs) remains scarce. Schools provide a critical platform for evidence-based intervention delivery for young people. However, a significant need exists to understand the implementation context and strategies for delivering school mental health interventions in LMICs. This study provides rich qualitative data describing the context and influences for the successful implementation of mental health interventions in LMIC schools. We conducted interviews and focus groups with teachers, students, and caregivers to determine their perspectives on implementing evidence-based mental health interventions (EBIs) within a widespread violence prevention program in Uganda. Participants revealed a school culture promoted by the existing program that promotes schools' responsibility to students beyond academics, including positive teacher-student relationships. Findings suggest the existing program provides fertile ground for the successful implementation of evidence-based mental health interventions in schools.

Requirements of Mental Health Services During the COVID-19 Outbreak: A Systematic Review

Objectives: After the outbreak of a new viral disease in Wuhan, China, in late December 2019, COVID-19 in a very short time and rapidly became a global pandemic. Through a systematic review, the present paper investigated the requirements of Mental Health Services during the COVID-19 outbreak. Methods: A comprehensive search was conducted through PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and Scopus. PsychINFO and CINAHL data banks were also searched. The primary roots for the development of the search strategy developed based on the keywords of “Covid”, “mental health”, “care”, “services”. All relevant studies were included without any limitation of publication time or the papers’ language as it was not possible to conduct a formal systematic review given the nature of the publications. Instead, it was decided to conduct a mixed systematic and complementary narrative review covering different interested domains. Results: Out of 80 papers, after excluding duplications, 58 articles were selected for the refinement process. Three refining steps based on the titles, abstracts, and full texts led to data extraction from 4 eligible papers. Considering the importance of the problem, related findings, key points, and research findings were summarized and presented in terms of critical components of infrastructure and resources, including policy for at-risk groups, different approaches to mental health service delivery, indirect contexts for mental health service delivery, follow-up attitudes, and complementary research. The results of the study indicate that many studies considered the consequences of physical aspects and diagnostic symptoms. Thus, aspects of mental health have been either less focused or even neglected. In mental health consequences, immediate attention and intensive programs to assess mental health, preparation for support and treatment, and prevention services are emphasized. Conclusion: During the implementation of mental health interventions, to improve services and to consider the limitations and challenges of implementing programs, it is necessary to pay attention to the attitudes of target groups and their preference

Identifying pathways for large-scale implementation of a school-based mental health programme in the Eastern Mediterranean Region: a theory-driven approach.

Globally there is a substantial burden of mental health problems among children and adolescents. Task-shifting/task-sharing mental health services to non-specialists, e.g. teachers in school settings, provide a unique opportunity for the implementation of mental health interventions at scale in low- and middle-income countries (LMICs). There is scant information to guide the large-scale implementation of school-based mental health programme in LMICs. This article describes pathways for large-scale implementation of a School Mental Health Program (SMHP) in the Eastern Mediterranean Region (EMR). A collaborative learning group (CLG) comprising stakeholders involved in implementing the SMHP including policymakers, programme managers and researchers from EMR countries was established. Participants in the CLG applied the theory of change (ToC) methodology to identify sets of preconditions, assumptions and hypothesized pathways for improving the mental health outcomes of school-aged children in public schools through implementation of the SMHP. The proposed pathways were then validated through multiple regional and national ToC workshops held between January 2017 and September 2019, as the SMHP was being rolled out in three EMR countries: Egypt, Pakistan and Iran. Preconditions, strategies and programmatic/contextual adaptations that apply across these three countries were drawn from qualitative narrative summaries of programme implementation processes and facilitated discussions during biannual CLG meetings. The ToC for large-scale implementation of the SMHP in the EMR suggests that identifying national champions, formulating dedicated cross-sectoral (including the health and education sector) implementation teams, sustained policy advocacy and stakeholders engagement across multiple levels, and effective co-ordination among education and health systems especially at the local level are among the critical factors for large-scale programme implementation. The pathways described in this paper are useful for facilitating effective implementation of the SMHP at scale and provide a theory-based framework for evaluating the SMHP and similar programmes in the EMR and other LMICs.

An overview of systematic reviews on mental health promotion, prevention, and treatment of common mental disorders for refugees, asylum seekers, and internally displaced persons.

BackgroundMigrants who have been forced to leave their home, such as refugees, asylum seekers, and internally displaced persons (IDP), are likely to experience stressors which may lead to mental health problems. The efficacy of interventions for mental health promotion, prevention, and treatment may differ in this population.ObjectivesWith this overview of systematic reviews, we will map the characteristics and methodological quality of existing systematic reviews and registered systematic review protocols on the promotion of mental health and prevention and treatment of common mental disorders among refugees, asylum seekers, and IDPs. The findings from this overview will be used to prioritise and inform future Cochrane reviews on the mental health of involuntary migrants.MethodsWe searched Ovid MEDLINE (1945 onwards), Ovid Embase (1974 onwards), Ovid PsycINFO, ProQuest PTSDpubs, Web of Science Core Collection, Cochrane Database of Systematic Reviews, NIHR Journals Library, CRD databases (archived), DoPHER, Epistemonikos, Health Evidence, 3ie International Initiative for Impact Evaluation, and PROSPERO, to identify systematic reviews of mental health interventions for involuntary migrants. We did not apply any restrictions on date, language, or publication status to the searches. We included systematic reviews or protocols for systematic reviews of interventions aimed at refugees, asylum seekers, and internally displaced persons. Interventions must have been aimed at mental health promotion (for example, classroom‐based well‐being interventions for children), prevention of mental health problems (for example, trauma‐focussed Cognitive Behavioural Therapy to prevent post‐traumatic stress disorder), or treatment of common mental disorders and symptoms (for example, narrative exposure therapy to treat symptoms of trauma). After screening abstracts and full‐text manuscripts in duplicate, we extracted data on the characteristics of the reviews, the interventions examined in reviews, and the number of primary studies included in each review. Methodological quality of the included systematic reviews was assessed using AMSTAR 2.Main resultsThe overview includes 23 systematic reviews and 15 registered systematic review protocols.Of the 23 published systematic reviews, meta‐analyses were conducted in eight reviews. It was more common for the search strategy or inclusion criteria of the reviews to state that studies involving refugees were eligible for inclusion (23/23), than for asylum seekers (14/23) or IDPs (7/23) to be explicitly mentioned. In most reviews, study eligiblity was either not restricted by participant age (9/23), or restricted to adults (10/23). Reviews commonly reported on studies of diagnosis or symptoms of post‐traumatic stress disorder or trauma (11/23) and were less likely to report on depression or anxiety (6/23). In 15 reviews the intervention of interest was focused on/ specific to psychological therapy. Across all 23 reviews, the interventions most commonly identified from primary studies were general Cognitive Behavioural Therapy, Narrative Exposure Therapy, and a range of different integrative and interpersonal therapies. Even though many reviews included studies of participants without a diagnosis of a mental health problem, they often assessed mental health treatments and did not usually distinguish between promotion, prevention, and treatment in the review aims.Together the 23 systematic reviews included 336 references, of which 175 were unique primary studies. Limitations to the methodological quality of reviews most commonly related to reporting of selection criteria (21/23), absence of a protocol (19/23), reporting of study design (20/23), search strategy (22/23), and funding sources of primary studies (19/23).Authors' conclusionsGaps exist in the evidence on mental health interventions for refugees, asylum seekers, and internally displaced persons. Most reviews do not specify that internally displaced persons are included in the selection criteria, even though they make up the majority of involuntary migrants worldwide. Reviews specific to mental health promotion and prevention of common mental disorders are missing, and there is more evidence available for adults or mixed populations than for children. The literature is focused on post‐traumatic stress disorder and trauma‐related symptoms, with less attention for depression and anxiety disorders. Better quality systematic reviews and better report of review design and methods would help those who may use these reviews to inform implementation of mental health interventions.

Review: Delivering mental health support within schools and colleges - a thematic synthesis of barriers and facilitators to implementation of indicated psychological interventions for adolescents.

Increasing the role of schools and colleges in the provision of mental health services for young people has the potential to improve early intervention and access to treatment. We aimed to understand what factors influence the successful implementation of indicated psychological interventions within schools and colleges to help guide increased provision of mental health support within education settings. Systematic search for studies that have reported barriers or facilitators to the implementation of indicated interventions for adolescent emotional disorders delivered within schools and further education/sixth form colleges (CRD42018102830). Databases searched were EMBASE, MEDLINE, PsycINFO, CINAHL, British Nursing Index, ASSIA, ERIC and British Education Index. A thematic synthesis of factors reported to impact implementation was conducted. Two thousand five hundred and sixty-nine records and 177 full texts were screened. Fifty studies were identified for inclusion, all of which were of school-based interventions. Eleven analytic themes were developed encompassing intervention characteristics, organisational capacity, training and technical assistance, provider characteristics and community-level factors. Findings indicate the need to select appropriate interventions, consider logistical challenges of the school context and provide training and supervision to enable staff to deliver interventions with fidelity. However, structural and environmental support is required for these facilitators to have the greatest impact on successful implementation. Implementing indicated school-based mental health interventions is challenging. Those involved in planning school-based mental health initiatives must be alert to the impact of factors on multiple interacting levels. There is a lack of research on implementing mental health support within further education and sixth form colleges. Increased utilisation of schools and colleges as a setting for early intervention has been proposed as a means of improving access to mental health treatment, but successful implementation of mental health interventions within educational settings is challenging. Based on a synthesis of current evidence, we recommend that young people and education professionals should be involved in the selection of school-based interventions to ensure they are acceptable and practical to deliver within the logistical constraints of the school environment. Those delivering interventions within schools, as well as staff involved in identifying young people who might benefit from these interventions, must receive high-quality ongoing training and support. Senior school leaders play an important role in championing mental health interventions and developing a school culture that prioritises mental well-being. Health and education policy should be designed to promote a cross-sector focus on the emotional health of young people. There is a lack of evidence on the implementation of indicated psychological interventions within sixth form and further education colleges.

Analysis Identifies Key Components in Adolescent Mental Health Care

Back to table of contents Previous article Next article Clinical & ResearchFull AccessAnalysis Identifies Key Components in Adolescent Mental Health CareTerri D’ArrigoTerri D’ArrigoSearch for more papers by this authorPublished Online:14 Aug 2019https://doi.org/10.1176/appi.pn.2019.8b22AbstractInterventions that aim to develop interpersonal skills deliver the most consistent positive results across multiple outcomes.A meta-analysis in Pediatrics has found that three components of adolescent mental health programs are consistently effective across multiple outcomes: those geared toward improving interpersonal skills, developing emotional regulation, and providing alcohol and drug education.Sarah Skeen, Ph.D., a senior researcher at Stellenbosch University in South Africa, and colleagues analyzed data from 158 studies of psychosocial interventions administered to adolescents aged 10 to 19 years old. They found that components that focused on building interpersonal skills consistently delivered positive results across multiple outcomes, notably on overall mental health, depression and anxiety prevention, and substance use prevention.“Developing skills to improve interpersonal relationships is highly relevant for improving adolescent mental health outcomes, and our findings indicate that including these skills in multi-outcome interventions designed to promote mental health and prevent mental disorders and risk behaviors is a valuable strategy,” the researchers wrote.Components focused on teaching adolescents emotional regulation improved mental health and reduced symptoms of depression and anxiety. Alcohol and drug education had positive effects on mental health and aggression. However, this education was not associated with a positive effect on substance use, for reasons unknown to the researchers.To ensure culturally appropriate implementation of mental health interventions for adolescents, low- and middle-income countries should determine how best to apply the interventions themselves, says Molly McVoy, M.D.in South Africa, and colleagues analyzed data from 158 studies of psychosocial interventions administered to adolescents aged 10 to 19 years old. They found that components that focused on building interpersonal skills consistently delivered positive results across multiple outcomes, notably on overall mental health, depression and anxiety prevention, and substance use prevention.“Developing skills to improve interpersonal relationships is highly relevant for improving adolescent mental health outcomes, and our findings indicate that including these skills in multi-outcome interventions designed to promote mental health and prevent mental disorders and risk behaviors is a valuable strategy,” the researchers wrote.Components focused on teaching adolescents emotional regulation improved mental health and reduced symptoms of depression and anxiety. Alcohol and drug education had positive effects on mental health and aggression. However, this education was not associated with a positive effect on substance use, for reasons unknown to the researchers.Molly McVoy, M.D., a training director and assistant professor of child and adolescent psychiatry at University Hospitals in northeast Ohio, noted the practical implications of the research. “Every psychiatrist who works with teenagers can put interpersonal relationship-building skills and emotional regulation at the top of the list [to achieve] for resilience,” said McVoy, who was not involved in the research.The meta-analysis was conducted to aid the development of a universally delivered intervention as part of the Helping Adolescents Thrive initiative, which is sponsored by the World Health Organization and the United Nations Children’s Fund. To that end, the study authors noted an important caveat to their findings: Nearly all of the studies in the meta-analysis were conducted in high-income countries. Therefore, it will be essential to track implementation if and when these interventions are adapted for use in low- and middle-income countries to ensure that they are implemented in culturally appropriate ways, the researchers wrote.McVoy suggested that the best way to ensure culturally appropriate implementation is for low- and middle-income countries to determine how to apply the components themselves. “More wealthy countries coming in and trying to insert their approach, even if it’s evidence based, is not sustainable and does not go well,” she said. In a commentary accompanying the study, Glenn Thomas, Ph.D., of the Department of Psychiatry and Behavioral Health at Nationwide Children’s Hospital in Columbus, Ohio, wrote that effective implementation and sustainability may require resources that are unavailable in low-income communities.“This maintains disparity in access to mental health resources, with the unintended consequence being that economically marginalized families are even less likely to be exposed to high-quality interventions,” Thomas wrote. “If we are to close the gap in social determinants of health, a concerted effort to fund and implement prevention and evaluate effectiveness and transportability is imperative.”This study was funded by the World Health Organization. ■“Adolescent Mental Health Program Components and Behavior Risk Reduction: A Meta-Analysis” is posted here. “Universal Mental Health Prevention for Adolescents: Real-World Implications” is posted here. ISSUES NewArchived

Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation

PurposeShared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental health interventions. A randomised controlled trial of a user- and carer-informed training package in the United Kingdom to enhance SDM in care planning in secondary mental health care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, carer, mental health professional and organisational levels.MethodsA longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental health service users, carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically.ResultsThe process evaluation demonstrated that despite buy-in from those delivering care planning in mental health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention.ConclusionsFuture aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of health care relationships and include elements which seek to address these directly.

The Capabilities Approach: Fostering contexts for enhancing mental health and wellbeing across the globe.

Concerted efforts have been made in recent years to achieve equity and equality in mental health for all people across the globe. This has led to the emergence of Global Mental Health as an area of study and practice. The momentum that this has created has contributed to the development, implementation and evaluation of services for priority mental disorders in many low- and middle-income countries.This paper discusses two related issues that may be serving to limit the success of mental health initiatives across the globe, and proposes potential solutions to these issues. First, there has been a lack of sophistication in determining what constitutes a ‘good outcome’ for people experiencing mental health difficulties. Even though health is defined and understood as a state of ‘wellbeing’ and not merely an absence of illness, mental health interventions tend to narrowly focus on reducing symptoms of mental illness. The need to also focus more broadly on enhancing subjective wellbeing is highlighted. The second limitation relates to the lack of an overarching theoretical framework guiding efforts to reduce inequalities and inequities in mental health across the globe. This paper discusses the potential impact that the Capabilities Approach (CA) could have for addressing both of these issues. As a framework for human development, the CA places emphasis on promoting wellbeing through enabling people to realise their capabilities and engage in behaviours that they subjectively value. The utilization of the CA to guide the development and implementation of mental health interventions can help Global Mental Health initiatives to identify sources of social inequality and structural violence that may impede freedom and individuals’ opportunities to realise their capabilities.

Implementation Science in School Mental Health: Key Constructs in a Developing Research Agenda.

In this paper, we propose an implementation science research agenda as it applies to school mental health (SMH). First, we provide an overview of important contextual issues to be considered when addressing research questions pertinent to the implementation of mental health interventions in schools. Next, we critically review three core implementation components: (a) professional development and coaching for school professionals regarding evidence-based practices (EBPs); (b) the integrity of EBPs implemented in schools; and (c) EBP sustainment under typical school conditions. We articulate research questions central to the next generation of research in each of these areas as well as methods to address such questions. Our intent in doing so is to contribute to a developing blueprint to guide community-research partnerships as well as funding agencies in their efforts to advance implementation science in SMH.

Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providers.

BackgroundRecent global mental health research suggests that mental health interventions can be adapted for use across cultures and in low resource environments. As evidence for the feasibility and effectiveness of certain specific interventions begins to accumulate, guidelines are needed for how to train, supervise, and ideally sustain mental health treatment delivery by local providers in low- and middle-income countries (LMIC).Model and case presentationsThis paper presents an apprenticeship model for lay counselor training and supervision in mental health treatments in LMIC, developed and used by the authors in a range of mental health intervention studies conducted over the last decade in various low-resource settings. We describe the elements of this approach, the underlying logic, and provide examples drawn from our experiences working in 12 countries, with over 100 lay counselors.EvaluationWe review the challenges experienced with this model, and propose some possible solutions.DiscussionWe describe and discuss how this model is consistent with, and draws on, the broader dissemination and implementation (DI) literature.ConclusionIn our experience, the apprenticeship model provides a useful framework for implementation of mental health interventions in LMIC. Our goal in this paper is to provide sufficient details about the apprenticeship model to guide other training efforts in mental health interventions.