Faculty Bibliography

Family-based interventions have been shown to improve behavioral and justice-related outcomes for youth. There has been less focus on whether family-based interventions are effective at reducing youth recidivism, especially for newer or lesser known interventions. To address this gap, we conducted a systematic review of studies utilizing family-based interventions to address recidivism for youth involved in the juvenile justice system. Of the identified 3,497 unique articles, 235 full-text articles were reviewed and 31 met criteria for inclusion in the review. A variety of family-based interventions were used, including both widely known (e.g., multisystemic therapy) and lesser known interventions. Most studies demonstrated significant reductions in recidivism, with some mixed findings depending on the type of charge, assessment timepoint, measure of recidivism, or moderating factors. The findings from this review corroborate prior research on the effectiveness of well known interventions for reducing recidivism and highlight the promise of newer interventions. The results also highlight the need for additional research in this area, as well as a greater focus on better understanding the moderating factors that may affect treatment outcomes.

PURPOSE/OBJECTIVE:performed with autistic youth with varying presentations. METHODS:administration and results were analyzed and compared across relevant clinical characteristics, including age, language level, and autism severity. RESULTS:results were highly correlated with existing measures, parent-child agreement was relatively low and variable across subgroups of autistic youth. CONCLUSIONS:adaptations are likely necessary to improve accessibility, linguistic clarity, and diagnostic specificity and will be important to promote scalable, equitable MH screening for autistic youth.

Youth with developmental disabilities (DD) are often at increased suicide risk. However, clinician guidance on suicide prevention practices specific to the DD population is rarely available, which may result in care disparities. The current study examined whether rates of standard suicide risk screening in two pediatric emergency departments (ED) differed for youth with and without DD. Then, using data from a NIMH-funded initiative, we compared youth with and without DD on demographic, visit, and clinical characteristics to identify possible factors related to differences in screening rates. Disparities in the completion of suicide risk screening with youth with DD were identified in standard care but few differences were found across groups to suggest a rationale, holding important clinical and research implications.

Autistic youth visit the emergency department (ED) for psychiatric concerns, including suicidal ideation and behavior, at elevated rates. However, clinicians often report low levels of training and confidence in addressing suicide risk in autistic youth. In this pilot study, clinicians in a pediatric psychiatric emergency service were trained on community- and evidence-informed recommendations to improve suicide-related care for autistic youth and provided with resources to use with autistic youth for a 3-month period. Ratings on attitudes and confidence were obtained from ten providers before and after the training/implementation period and compared. Ratings of feasibility and utility of strategies and resources were obtained from 15 providers after training/implementation and analyzed. While no changes were found across attitudes items, confidence scores were significantly higher after the training/implementation period than before, particularly in the area of suicide risk assessment. Feasibility and utility ratings were generally high, with endorsement patterns aligning with common organizational and systems-level barriers. This pilot study demonstrated that targeted training and evidence-informed recommendations to improve suicide-related care for autistic youth were associated with increased clinician confidence. As research continues in the development of adapted suicide risk assessment tools and management strategies for autistic youth, it is important that both clinical guidance on best practices is provided and that systems-level barriers are addressed.

Autistic youth often present to the emergency department with psychiatric concerns, including suicidal thoughts and behaviors. While implementation of suicide prevention practices is essential in the emergency department, guidelines specific to the autism population are not available and suicide risk assessment and management for autistic youth may be challenging for providers. This pilot study evaluated pediatric emergency medicine (PEM) physician training, attitudes, and confidence in assessing and managing suicide risk in autistic compared to non-autistic patient populations. We also explored the relationship between prior training and confidence. PEM physicians’ confidence in providing suicide-related care was significantly lower for autistic compared to non-autistic youth. Prior training in autism, but not in youth suicide, predicted confidence. Results suggest improved supports for emergency department providers are needed to promote suicide risk identification and intervention for autistic youth.

BACKGROUND/UNASSIGNED:Unaccompanied migrant youths are at elevated risk for exposure to trauma and related mental health challenges, but there is minimal evidence guiding best practices. We conducted a systematic review of quantitative studies that examined mental health evaluation and treatment services for unaccompanied migrant youths resettled in the United States (US). METHODS/UNASSIGNED:In accordance with the PRISMA 2020 statement, a literature search was conducted for empirical studies in nine databases and publicly available search engines. Citation tracking also assisted in identifying additional studies, including from the gray literature. The study protocol was pre-registered (PROSPERO ID: CRD42023396805). Inclusion criteria required that studies be published between January 1, 2000 and November 11, 2024 and report quantitative results that evaluate mental health status or mental health treatment outcomes for youths (younger than 18 years) who were unaccompanied when they arrived in the US. Descriptive, narrative synthesis was used for analysis of results. Mixed Method Appraisal Tool was used to appraise study quality. RESULTS/UNASSIGNED: = 1494 children)-six cohort studies (retrospective or prospective), five cross-sectional, one non-controlled trial, and one program evaluation-met inclusion criteria. Ten evaluated mental health using diverse questionnaires and most focused on trauma-related symptoms. Three focused on mental health treatment. Findings demonstrated heterogeneous methods of evaluating mental health symptoms and implementing treatment services for unaccompanied migrant youths, although many indicated high rates of reported traumatic exposure. Most reported higher rates of trauma-related and internalizing symptoms and all treatment studies demonstrated initial promise. Likely due to difficulty in accessing unaccompanied migrant youths, most studies used convenience samples limiting generalizability of findings. CONCLUSIONS/UNASSIGNED:Rigorous studies with comprehensive collection of sociodemographic characteristics are needed to inform the development of evidence-based services that accurately detect and effectively treat mental health challenges among unaccompanied migrant youths.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Unaccompanied migrant youths often confront traumatic experiences elevating their risk for mental health symptoms. However, United States-based research on mental health services for this population, particularly Indigenous youths, is limited. Objectives were to examine mental health screening and referral, characteristics associated with referrals, and clinical rationale for screening result/referral discordance. METHODS:All unaccompanied migrant youths with pediatric intake visits at a healthcare-legal clinic between 3/2020-2/2023 were included (N=100). Retrospective cohort data were extracted from medical chart and program registry, including pediatricians' rationale for referrals. Chi-square and t-tests were used to compare rates of screening, evaluation, and discordant referrals by sociodemographic characteristics. Logistic regression was used to identify associations with mental health referral. Exploratory analyses examined referrals by Indigenous group. RESULTS:Youths had a mean (SD) age of 17.5 (2.5) years, most were assigned male at birth (66 [66%]), from Central America (83 [83%]), and one-third were Indigenous. Odds of mental health referral were higher for youths who were assigned female at birth (adjusted OR, 3.00 [95% confidence interval, 1.13-7.87), non-Indigenous (adjusted OR, 2.73; 95% confidence interval, 1.01-7.40), and reported more trauma types (adjusted OR, 1.38; 95% confidence interval, 1.02-1.87). One-third of referrals were for trauma or mental health symptoms identified by pediatricians, but not screeners. CONCLUSION/CONCLUSIONS:Most unaccompanied migrant youths had mental health referrals, one-third of which were for mental health symptoms undetected by screeners at pediatric visit. Findings highlight sociodemographic differences in mental health referrals, with non-Indigenous and female youths having higher odds of referral.

OBJECTIVE:Rates of suicide, anxiety, and depression have soared in US youth, and professional organizations strongly urge earlier identification, particularly in pediatric emergency departments (PEDs). However, there are few commonly used suicide screeners that also identify other mental health (MH) problems. A new, electronically administered instrument, the K-CAT, screens for suicide and multiple MH problems. We hypothesized that the K-CAT would enhance suicide identification compared with routine screening and identify significant anxiety and depression in youth presenting with non-MH chief complaints. METHODS:This observational study was conducted in 2 PEDs. Eligible youth were 7 to 17 accompanied by a caregiver without: severe medical concerns, difficult behaviors, limited verbal language, or only a psychiatric complaint. Of the 341 eligible, 241 (70.7%) were screened, and 228 both presented with a non-MH problem and had complete K-CAT data. A Fisher exact test determined whether suicidal behaviors/ideation rates differed between the K-CAT and retrospective chart review data. RESULTS:Seventy-four or 32.46% of youth scored positive for suicide, anxiety, and/or depression on the K-CAT. Females were more likely to screen positive (P<0.001). Compared with the retrospective data, more youth were identified with suicide risk by the K-CAT (3.95% vs. 0%; P=0.004). Youth identified by the K-CAT were 62.5% female and 33.3% 7 to 11 years. CONCLUSIONS:The K-CAT increases the identification of suicidal ideation and behaviors overall and in younger children. It identifies significant rates of depression and anxiety in youth and could be an important first step in identifying MH problems in youth.

BACKGROUND:The prevalence of trauma among individuals with HIV has prompted efforts to integrate trauma-informed care (TIC) into HIV care and treatment to improve health outcomes. A TIC Implementation Model, developed by a US capacity-building organization focuses on organizational changes, aligning cultural and physical environments, emphasizing values like safety and trustworthiness, engaging leadership, and training staff in skills-based TIC services. Despite growing research, gaps remain in understanding the relationship between organizational capacity, provider knowledge, and the dosage of technical assistance (TA) required to sustain TIC integration. Researchers investigated how the project team adapted the type and amount of TA based on initial Cultural Assessment scores (measuring core TIC values) and its impact on Implementation Status scores. METHODS:This study focuses on eight of 20 HIV care agencies in New Jersey that had largely met their TIC implementation goals by Spring 2022. As part of the TIC Implementation Model to measure agency capacity and implementation progress over time, agency staff and clients completed a Cultural Assessment (n = 72) and Physical Assessment (n = 43); staff completed a Pre/Post Training Survey (n = 296); and implementation teams at 8 agencies completed an Implementation Status Assessment Tool. Additionally, TA Logs capturing the details of TA meetings with the eight agencies were recorded by project staff. Data from these tools were analyzed in aggregate by agency using descriptive and correlational analyses. RESULTS:Results demonstrated responsive TA correlated with agencies' baseline capacity. Agencies with lower capacity received significantly more frequent and extended TA encounters, which were associated with higher implementation scores and improvements in cultural environments for staff and clients (e.g., new protocols for staff response plans). CONCLUSIONS:These findings underscore the importance of tailored TA in fostering diverse organizational cultures conducive to TIC implementation. For HIV care agencies, successful TIC implementation can impact health behaviors and outcomes for clients impacted by trauma. The TIC Implementation Model significantly advanced organizations' ability to transform their culture and systems, increasing their capacity to implement and sustain TIC integration. These results align with existing research that emphasizes when time is invested to shift organizational culture and develop leadership, new practices can effectively be implemented and scaled-up.