Faculty Bibliography

Childhood anxiety is common, yet approximately half of youth do not receive treatment due to stigma, mistrust of the mental health service system, extensive wait lists for services and provider shortages. Alternative models and modes of treatment are needed. This paper describes the development of an alternative treatment that incorporates cognitive behavioral components for anxiety into an adaptive/therapeutic riding program delivered by certified riding instructors in a horse stable that offers horseback riding and therapeutic horsemanship programs. Using PracticeWise®, a well-established database of evidence-based mental health practices for youth, we identified five therapeutic elements that are the most commonly examined in rigorous research for childhood anxiety, and integrated them into a manualized program of adaptive riding sessions. Excellent fidelity to the intervention (98.7% mean score) and high inter-rater reliability (k = 0.92) were achieved. This approach has implications for expanding access to and engagement in adaptive/therapeutic riding interventions.

Describe hospitalization rates in children with elevated symptoms of mania and determine predictors of psychiatric hospitalizations during the 96 month follow-up. Eligible 6-12.9 year olds and their parents visiting 9 outpatient mental health clinics were invited to be screened with the Parent General Behavior Inventory 10-item Mania Scale. Of 605 children with elevated symptoms of mania eligible for follow-up, 538 (88.9%) had ≥ 1 of 16 possible follow-up interviews and are examined herein. Multivariate Cox regression indicated only four factors predicted hospitalizations: parental mental health problems (HR 1.80; 95% CI 1.21, 2.69); hospitalization prior to study entry (HR 3.03; 95% CI 1.80, 4.43); continuous outpatient mental health service use (HR 3.73; 95% CI 2.40, 5.50); and low parental assessment of how well treatment matched child's needs (HR 3.97; 95% CI 2.50, 6.31). Parental perspectives on mental health services should be gathered routinely, as they can signal treatment failures.

Equine-assisted services include novel approaches for treating children's mental health disorders, one of which is anxiety (Latella & Abrams, 2019). Reining in Anxiety is a manualized approach to adaptive riding drawing on evidence-based cognitive behavioral therapy elements for youth with anxiety. This intervention was delivered by PATH Certified Therapeutic Riding Instructors (CTRIs) in a randomized pilot study. Fidelity checklists, developed to match the core components of the manualized intervention, were collected by independent observers. Fidelity scores addressed an average of 98.7% of components, well beyond the threshold for high fidelity (e.g. >80%) established in the literature (Garbancz et al., 2014). These findings show that the PATH CTRIs trained in the Reining in Anxiety intervention for this study, with supervision and implementation supports, delivered this intervention with high fidelity. This has important implications for expanding access to evidence-based community mental health services beyond traditional clinic settings and providers, and for addressing the gap between the need for and use of evidence-based youth mental health services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Between 15% to 20% of youth meet diagnostic criteria for anxiety, yet most do not receive treatment due to workforce shortages, under-detection, or barriers that dissuade families from seeking services in traditional settings. Equine-assisted services (EAS) include several promising approaches to reach populations who do not access traditional therapies. Few studies using rigorous methods have been conducted on EAS for youth. This study examined feasibility and outcomes of a 10-session Cognitive Behavioral Therapy (CBT)-based adaptive riding intervention (hereafter called Reining in Anxiety) delivered by trained equine professionals. Forty-one youth 6- 16 years of age were recruited from GallopNYC, an adaptive horseback riding center in the NYC metro area. Youth were randomized to an experimental group (n=22) or services as usual (n=19), a standard adaptive riding group (services as usual or SAU). Severity of anxiety symptoms, anxiety in close relationships, and emotional self-efficacy were assessed at baseline and at the end of treatment. Fidelity to the manual was excellent, ranging from 88.9% to 100%. There was a non-significant trend in the experimental group towards greater improvement with higher number of sessions completed. Youth in the Reining in Anxiety group displayed significant reductions in anxiety (t=4.426, df=38, p=0.042) and improvement in emotional self-efficacy at posttest (t=4.132, df=38, p=0.049) in comparison to the SAU group. No significant differences were found between groups for anxiety in close relationships. This study suggests that a CBT-based adaptive riding intervention delivered by non-mental health equine professionals following a detailed manual can reduce youth anxiety symptoms and be delivered with fidelity by riding instructors. These findings have implications for families seeking non-traditional services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Early neural development and maternal health have critical long-term effects on children's mental health and outcomes later in life. As child mental disorders continue to rise nationwide, a number of states are considering new ways of investing in the critical early childhood period to prevent later poor outcomes and reduce the burden on the mental health system. Because most state mental health authorities (SMHAs) have no dedicated mental health dollars to devote to this early, crucial period of child development, building coalitions is key to implementing prevention and promotion programming. The authors describe two issues-coalition building and contractual considerations-that should be considered as SMHAs develop these types of policies or plan new prevention and promotion initiatives. Coalition building includes establishing the structural conditions for implementing a prevention or promotion initiative, resolving workforce issues (i.e., who will carry the program out), and engaging communities and families in the effort. Contractual considerations include establishing agreed-upon measures and metrics to monitor outcomes, assigning accountability for those outcomes, and delineating realistic time frames for these investments before expecting improved outcomes. The promise of moving services upstream to support early childhood development, to prevent mental health issues from derailing children's development, and to promote children's well-being are goals that are within reach.

The prevalence of mental health problems among children (ages 0-21) in the United States remains unacceptably high and, post-COVID-19, is expected to increase dramatically. Decades of psychological knowledge about effective treatments should inform the delivery of better services. Dissemination and implementation (D&I) science has been heralded as a solution to the persistent problem of poor quality services and has, to some extent, improved our understanding of the contexts of delivery systems that implement effective practices. However, there are few studies demonstrating clear, population-level impacts of psychological interventions on children. Momentum is growing among communities, cities, states, and some federal agencies to build "health in all policies" to address broad familial, social, and economic factors known to affect children's healthy development and mental health. These health policy initiatives offer a rare opportunity to repurpose D&I science, shifting it from a primary focus on evidence-based practice implementation, to a focus on policy development and implementation to support child and family health and well-being. This shift is critical as states develop policy responses to address the health and mental health impacts of the COVID-19 pandemic on already-vulnerable families. We provide a typology for building research on D&I and children's mental health policy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

This introductory article describes the genesis of the Festschrift for Leonard Bickman and of this Festschrift special issue entitled, The Future of Children's Mental Health Services. The special issue includes a collection of 11 original children's mental health services research articles, broadly organized in accordance with three themes (i.e., Improving Precision and Use of Service Data to Guide Policy and Practice, Implementation and Dissemination, and Preparing for Innovation), followed by an interview-style article with Bickman. Then follows a featured manuscript by Bickman himself, three invited commentaries, and a compilation of letters and notes in which colleagues reflect on his career and on their experiences of him. The introduction concludes with a few thoughts about the future of children's mental health services portended by the extraordinary scholarly contributions of Bickman and those who have been inspired by him.