Faculty Bibliography

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)

A growing body of research is documenting the impact of parental legal status on familial and child well-being in the U.S. This study adds to the literature by examining the relation of legal vulnerability with the health and mental health of Bangladeshi immigrant parents and their children. A cross-sectional study with 73 immigrant Bangladeshi families was conducted in New York City. Parents reported on legal status indicators, perceived stressors, health, and child mental health indicators. Parents with greater legal vulnerability reported significantly greater immigration-related stressors and poorer perceived health outcomes for themselves and their children in comparison with parents having less legal vulnerability. Immigration stressors explained a significant amount of variance in parent symptoms of depression, tension, and sleep problems and child mental health indicators, beyond the variance explained by acculturation stress and financial stress. Practitioners should be aware that legal vulnerability and associated immigration stressors are adversely associated with Bangladeshi health and mental health.

As more young people feel safe to outwardly identify as transgender or gender expansive (TGE), meaning that their gender identity does not align with the sex they were assigned at birth, an increasing number of youth who identify as TGE seek gender-affirming medical care (GAMC). GAMC raises a number of ethical questions, such as the capacity of a minor to assent or consent, the role of parents or legal guardians in decisions about treatment, and implications for equitable access to care when differing parental or custodial viewpoints are present. These questions are further complicated by the difficulties in explaining the limits of long-term research in GAMC, with regard to the preservation of fertility, for example. We present two de-identified composite case studies to highlight dilemmas that may arise and offer recommendations to better support patient- and family-centered decision making for GAMC. These include employing a multidisciplinary shared decision-making approach, disentangling informed consent and assent from chronological age, developing a consistent approach to the assessment of decisional capacity, and developing age-appropriate informational materials.