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Objectives: Many Mexican American families are immigrants who reside in under-resourced, urban communities, where they are at risk for numerous stressors, ranging from poverty to community violence. This paper analyzed qualitative data from Mexican American urban youth to explore their perspectives on neighborhood stressors, psychosocial difficulties and coping. Methods: A community-based participatory research approach was used with Mexican American youth from a Chicago neighborhood to explore personally salient experiences of living in their community. In collaboration with a community organization serving this neighborhood, 32 youth ranging from ages 12–18 with differing risk levels for violence and resilience participated in focus group sessions. Participants were asked about and discussed a wide range of topics covering (a) neighborhood characteristics and experiences; (b) psychosocial functioning and youth empowerment; (c) connection to school and community; and (d) family and cultural experiences. Results: Based on content analyses, three themes emerged related to stress (i.e., violence, gangs and the police, poverty) and coping strategies (i.e., avoidant, aggressive, and active coping). While pervasive stress appeared consistent across all groups, coping styles and psychological sequelae varied across the youth. Conclusions: The study demonstrates the importance of incorporating culturally relevant strategies, such as reframing, support seeking, and engaging familism, when developing interventions for use in this population. Furthermore, maximizing social supports by providing access to appropriate mentors and supportive peers should be a focus of educational programming and intervention with these youth. Finally, the authors offer a discussion of how these results might inform future community-based research. [ABSTRACT FROM AUTHOR]

Empirical inquiry has demonstrated the benefits of autonomy-supportive parenting practices and harms of parental psychological control for youth development and wellbeing, though specific sources of variation in use of these practices remains unclear. Individual differences in parenting practices may be related to physiological stress reactivity; more importantly, the coordination of stress responses across multiple physiological systems within the autonomic nervous system (ANS) may account for differences in parenting practices. Guided by the autonomic space model of ANS functioning, this study investigates the role of mothers' physiological stress response in relation to autonomy-supportive and controlling parenting practices. Sixty-eight mothers (Mage = 40.88, SD = 6.97) of young adolescents watched their children participate in a stressful laboratory-based public speaking task. Changes from baseline in mothers' skin conductance level (SCL reactivity) and respiratory sinus arrhythmia (RSA reactivity) were calculated. Youth reported perceptions of mothers' promotion of volitional functioning, promotion of independence, and psychological control. Physiological measures interacted such that mothers who experienced higher SCL reactivity engaged in more youth-reported psychological control when RSA scores showed little to no change from baseline to stressful task, but less psychological control when RSA scores decreased from baseline to challenge. Thus, this asynchronous pattern of ANS activity was associated with a parenting practice that typically inhibits developmentally appropriate autonomy among young adolescents, suggesting that mothers' parenting behaviors are associated with the coordinated physiological stress response of the two ANS systems. Highlights: Mothers' parasympathetic and sympathetic nervous system activity assessed while children participated in a stressful task. Uncoordinated activity of two physiological branches was associated with controlling parenting practices. Reactivity amongst multiple physiological branches should be tested to understand variation in parenting practices. [ABSTRACT FROM AUTHOR]

Offering a family involvement program is a typical approach for helping students with or at-risk for emotional and behavioral disorders and other behaviors of concern. The present paper examines evidence-based parental involvement programs in the United States and Korea. Several differences exist between programs in the two countries including evaluation, collaboration, the support of the government and related institutions, differences in perception of administrators, and the professional staff. The authors suggested several recommendations including considering the requirements of guidance for developing effective programs, designing ways to evaluate programs, encouraging collaboration, preparing qualified professional staff, and developing culturally appropriate programs for children and youth with special needs. [ABSTRACT FROM AUTHOR]

This paper describes a feasibility study of a peer-delivered prevention intervention to identify mothers at high risk for depression and facilitate engagement in mental health services for their emotional health. Sixteen family peer advocates and their supervisors partnered with academic researchers over a period of 6 months to develop a four-session intervention that focused on identifying symptoms of depression, providing education about depression and treatment, actively linking caregivers to treatment for their own emotional health, and assisting caregivers in becoming active participants in their mental health care. Collaborating with peers to develop the model enhanced its perceived relevance and utility, and resulted in an intervention that was complimentary to their roles and the mission of peer-delivered support services. Peer/professional partnerships may be beneficial for enhancing the feasibility and acceptability of research efforts; the impact of peers' participation in the current project and the need for future research to develop and study peer-delivered models is discussed. [ABSTRACT FROM AUTHOR]

Professional family peer advocates are increasingly employed by public mental health systems to deliver family-to-family support that reduces barriers families face in accessing children's mental health care. These services, however, are neither uniformly available nor standardized. This pilot study describes the process, content and context of family-to-family support services. Simulating a parent seeking services, a trained standardized parent participated as a client in meetings with advocates in four programs and collected data through structured observations, a structured survey, and session audiotapes. The 'walk-through' process was determined to be feasible and acceptable to family peer advocates as a way of evaluating services. Four family peer advocates provided an average of 25 services during each 2-session simulation with the standardized parent, including the following: information and educational support, instruction and skills development, emotional and affirmational support, instrumental support, and advocacy. Findings also revealed variability in the range of services provided and identified challenges in aspects of service provision, such as boundaries of advocate roles, availability of confidential service environments, and addressing crises and parent concerns about child safety. This paper provides the first in-depth look at services provided by this emerging workforce. [ABSTRACT FROM AUTHOR]

This article presents a case study on perceived conflict and its outcomes on implementing a system of programs and services for child development support. A multi-level collaboration model is used to deeply examine aspects of conflicts perceived by professionals responsible for implementing the system at the national, state, and local levels. This research adopted a single case approach with qualitative methods using semi-structured interviews and exploratory thematic analysis. A total of 29 professionals working at social development and health ministries, state departments, and one municipality participated in this study. The results show that professionals perceive one main unresolved conflict at each of the ecological levels. These conflicts are related to an informalized collaboration agreement between the Ministry of Social Development and the Ministry of Education, an interrupted resource flow from the national level to local level, and an unmanageable internal pressure at the state level. Furthermore, the compensatory strategies they use to deal with these conflicts are ineffective and lead to negative implementation outcomes. We suggest that future research should explore systemic conflict for the collaboration processes among the professionals to improve, thus increasing the quality of system implementation. Highlights: Professionals perceive one main unresolved conflict at each of the three ecological levels examined. Conflicts are related to informalized agreements between ministries, interrupted resource flow from the national level, and pressure from the local level. Professionals use compensatory strategies to cope with unresolved conflicts. The compensatory strategies identified are ineffective and lead to negative implementation outcomes. Findings reveal opportunities for future research to explore systemic conflict to better understand and improve collaboration processes. [ABSTRACT FROM AUTHOR]

Between the years of 2003–2015, the Programme for International Student Assessment (PISA) has identified a global trend signalling a decline in a sense of school belonging for secondary school students. Research has identified several factors that are positively related to school belonging, such as teacher support and academic motivation. However, little empirical research has been conducted to evaluate the relevant school belonging variables holistically and to assess their socio-ecological levels (e.g., student, microsystem, mesosystem) relative to the student. The purpose of this study is to assess the significant predictive variables within each socio-ecological level regarding school belonging. For this purpose, this study used data collected by PISA in 2015, focusing on data from 309,785 15-year-old students attending 12,668 schools in 52 countries around the world. Hierarchical multiple regression analysis was conducted to a) examine the empirical support for a layered structure of sense of school belonging, b) explore the contributions of variables in each layer of the socio-ecosystem to explain the variability in sense of school belonging and c) examine potential variations in this ability across schools and countries. The models provided support for the existence of such layers but also for some underlying relationships across the variables in the layers of the socio-ecosystem. The study then concludes with a discussion of the implications of the findings for school leaders, teachers and parents with respect to how school belonging approaches and strategies can be absorbed into existing practices and operations at school. Highlights: Student, or individual intrapersonal factors, can have significant impact on a student's perception of belonging. The strongest individual factors were collaboration dispositions (i.e., enjoying and valuing cooperation with others). Findings suggest a significant negative relationship between school belonging and test anxiety. It can be concluded that there are various systemic influences of school belonging. [ABSTRACT FROM AUTHOR]

Parents raising children with autism spectrum disorder (ASD) have been found to experience higher levels of stress and to face more challenges in the marital relationship than other parents. This study aimed to investigate how such couples cope with the stress and challenges of family life. Our qualitative study was based on semi-structured interviews with 42 parents (29 mothers and 13 fathers) of children and adolescents with ASD. Following Bodenmann's systemic transactional model (STM), we used thematic analysis to interpret the interview data and explore how couples coped. We found that study participants employed three types of coping strategies to reduce stress and strengthen the marital relationship. First, individual coping met the need for parents to find respite or "me time." Second, dyadic coping provided a way for members of a couple to support each other and find joint solutions to family challenges. Finally, social support coping played a key role in connecting parents with much needed resources, while allowing them to enjoy some respite and quality time as a couple. Our findings highlight the importance of simultaneously considering individual, dyadic, and social factors for providing a more comprehensive picture of the marital adjustment process. Highlights: Study participants used individual, dyadic, and social coping strategies. Equity between partners and individual respite time were key factors in strengthening the marital relationship. Communication and flexibility were key components of dyadic coping. Social support from relatives and professionals was a crucial factor in marital adjustment. [ABSTRACT FROM AUTHOR]

This study aimed to examine the complex relations between two known predictors of bystander decisions in bullying incidents—empathy and family contextual factors—and bystander help-seeking from two preferred choices (i.e., adults and peers). In particular, we examined the mediating role of cognitive and affective empathy on the relation between parental attachment and bystander help-seeking in 826 adolescents in the 6th and 9th grade (49.9% female) using four bullying/acts of aggression scenarios. Results indicated that affective, but not cognitive, empathy served as a partial mediator for the relationship in boys, suggesting that both empathy and the family context can play a role in bystander decisions to intervene. On the other hand, empathy did not serve as a mediator for girls, suggesting that girls do not need the added push of empathy in order to intervene in bullying situations. Results suggest emphasizing home-school collaboration for boys, in particular, in bullying prevention programs in order to maximize efforts of bystanders. Highlights: For boys, parental attachment was directly related to both peer and adult help-seeking. Indirectly, parental attachment was related to adult help-seeking through affective empathy. For girls, parental attachment was directly related to peer help-seeking, but not adult help-seeking. Parental attachment was also indirectly related to peer help-seeking through affective, but not cognitive empathy. Developing socio-emotional competencies and skills, particularly affective empathy, familial interventions may provide students, especially boys, with the ability to engage in prosocial responses during bullying situations. [ABSTRACT FROM AUTHOR]

Objectives: There is growing recognition that it is important to involve youth and caregivers in the implementation of evidence-based treatments (EBTs). This study explored how youth and caregivers who received trauma-focused cognitive-behavioral therapy (TF-CBT) in a public behavioral health system perceived the concept of EBT, their experience with treatment, their perceptions of TF-CBT, and whether their perceptions varied as a function of clinical improvement. Methods: Participants were eight youth (aged 10–17) and nine caregivers/legal guardians who received TF-CBT in community mental health centers. Semi-structured interviews were conducted post-treatment and symptoms were assessed at pre- and post-treatment. An integrated approach was used to analyze the interview data and the reliable change index was used to assess whether youth and caregivers' impressions varied as a function of clinical improvement. Results: Participants rarely had exposure to the term "evidence-based" and often had the misconception that evidence referred to personal experience. Youth and caregivers found the concept of receiving treatment supported by research appealing but did not like the specific term "evidence-based" and worried that treatment guided by research alone may not individualize to their needs. Personal stories were noted as a good way to market TF-CBT and the therapist emerged as an important advocate for promoting this treatment approach. Clinical improvement was associated with the perception of therapists as collaborative and with trauma narrative completion. Conclusions: Findings suggest that language and how therapists communicate EBTs to youth and caregivers may be important for targeted implementation strategies. Highlights: This study used mixed methods to explore youth and caregiver perceptions of evidence-based treatments. Participants rarely had exposure to the term "evidence-based" and found it unappealing. Marketing treatment to youth and caregivers requires careful language and explanation. Therapists should be selective in their explanations of treatment to engage youth and caregivers. [ABSTRACT FROM AUTHOR]

Objectives: In early adolescence, developmental tasks lead boys and girls to oscillate between the search for and the fear of solitude, between feelings of loneliness and the need for peer contact. Adopting a multidimensional and person-centred approach, the aim of the present study was to distinguish different clusters related to profiles of solitude attitudes and loneliness and to evaluate the role of relational and socio-demographic variables as predictors of cluster belonging. Methods: Measures of loneliness, attitudes towards aloneness, friendship quality, self-esteem and rejection sensitivity were collected in a population of 656 Italian native and immigrant early adolescents. Results: Three clusters emerged, differently predicted by relational and socio-demographic variables. An adaptive and normative profile was found for the Aversion to aloneness and the constructive solitude clusters, while a more maladaptive profile emerged for the non-constructive solitude cluster. Conclusions: The results are discussed in the light of the developmental challenges that early adolescents face. [ABSTRACT FROM AUTHOR]

Objectives: Despite extensive research supporting the efficacy of certain youth mental health treatments over others, actual use of these interventions in clinical practice continues to be low. Efforts focused on the dissemination and implementation of evidence-based services (EBS) may be aided by utilization of the theory of planned behavior (TPB) to explore behavioral change related to parents' treatment-related decision-making. Methods: The current study describes the investigation of consumer perspectives on EBS within a TPB framework through a content validation process (interviews with caregivers, theme generation through template analysis, item modification and evaluation) that sought collaboration with multiple stakeholders (caregivers, a university panel, mental health workers, parent advocates) for connecting research with practice. Results: Such detailed efforts resulted in the development of the Parent Engagement in Evidence-Based Services (PEEBS) survey questionnaire, consisting of 66 consumer-centric statements that were guided by the TPB and evidenced adequate language appropriateness, content validity, and readability scores. Survey items organized into five domains both consistent with (attitudes, perceived behavioral control, subjective norms, behavioral intention) the TPB in addition to general treatment factors that parents cited towards seeking EBS. Pilot data from a small sample (n = 30) of parents indicated preliminary and acceptable feasibility, interpretability, and varying levels of internal consistency for the PEEBS. Conclusions: Following the development and refinement of items, future studies focused on the psychometric properties of the measure are warranted. [ABSTRACT FROM AUTHOR]

Single case design research on family centered positive behavior support (PBS) over the past 20 years has provided evidence of the approaches acceptability, effectiveness and durability when implemented with families of children with developmental disabilities and problem behavior. Although quality of life is a key tenet of PBS, only a few studies of PBS with families have measured quality of life outcomes. The purpose of this study is to present family functioning results from the second half of a longitudinal study that investigated the consequential validity of an ecological approach to family centered PBS. The approach aimed to transform coercive into constructive family processes in family routines during a process of comprehensive assessment, multicomponent plan design and implementation support in collaboration with families. Ten families of children with developmental disabilities participated. Settings were 32 family routines, with two to four routines per family. Family functioning measures were family quality of life, parental stress, parental locus of control and social support. A repeated measures, quasi-experimental group design across mothers and fathers evaluated the statistical significance of changes in family functioning when comparing baseline to intervention and follow-up phases. Results evidenced significant improvements for mothers in family quality of life and parental stress during intervention and follow-up, and in parental locus of control during follow-up. Results evidenced significant improvements for fathers in parental stress during intervention and follow-up, but no significant improvements in family quality of life or parental locus of control. Results are discussed in terms of contributions to the literature, implications for practice, limitations, and future research. [ABSTRACT FROM AUTHOR]

Therapy homework includes tasks given to clients to complete outside of session to facilitate new knowledge/skills or to advance treatment goals. Homework completion, an important element of parent engagement in child mental health (MH) treatment, has been associated with improved child outcomes. The current pilot study assessed the design/assign phase of the therapy homework process to examine a) the extent to which therapists implemented engagement strategies with parents and b) whether therapist deployment of engagement strategies in early treatment predicted subsequent parent participation in homework planning. We included an ethnically-diverse sample of 10 therapists and 11 parent/child dyads receiving community-based MH services who participated in a pilot intervention study. Two observational coding systems were developed to code treatment session recordings for the extent to which a) therapists implemented engagement strategies with parents and b) parents contributed to therapy homework planning. Findings revealed low extensiveness of therapist implementation of engagement strategies with parents. As hypothesized, therapist use of engagement strategies (Collaboration, Empowerment, and Psychoeducation) in early treatment significantly predicted subsequent parent homework planning (sharing perspective on homework planning). However, therapist use of Alliance was unrelated to parent homework planning. These preliminary results suggest that therapist implementation of engagement strategies in early treatment may promote parent participation in homework planning, which is an important precursor to homework completion. This pilot study suggests potential future directions for both research on and training for community-based therapists in implementing successful strategies to promote parent homework planning in child MH treatment. [ABSTRACT FROM AUTHOR]

Standardized training and credentialing is increasingly important to states and healthcare systems. Workforce shortages in children's mental health can be addressed through training and credentialing of professional peer parents (called family peer advocates or FPAs), who deliver a range of services to caregivers. A theory-based training program for FPAs targeting skills and knowledge about childhood mental health services (Parent Empowerment Program, or PEP) was developed through a partnership among a statewide family-run organization, state policy leaders, and academic researchers. Prior studies by this team using highly-experienced family peer advocates (who were also co-developers of the training program) as trainers found improvements in knowledge about mental health services and self-efficacy. In 2010, to meet demands and scale the model, a training of trainers (TOT) model was developed to build a cohort of locally-trained FPAs to deliver PEP training. A pre/post design was used to evaluate the impact of TOT model on knowledge and self-efficacy among 318 FPAs across the state. Participants showed significant pre-post (6 month) changes in knowledge about mental health services and self-efficacy. There were no significant associations between any FPA demographic characteristics and their knowledge or self-efficacy scores. A theory-based training model for professional peer parents working in the children's mental health system can be taught to local FPAs, and it improves knowledge about the mental health system and self-efficacy. Studies that evaluate the effectiveness of different training modalities are critical to ensure that high-quality trainings are maintained. [ABSTRACT FROM AUTHOR]

As many as 20% of children are need in of mental health services but only a small percentage receive them. Primary care pediatricians are often the first providers to see these children so it is critical to understand how they manage their care. Therefore, we developed a vignette-based survey to obtain data about pediatricians' mental health-related diagnostic accuracy, confidence and comfort level in diagnosis and management, and decisions related to care. Pediatricians (N = 106) responded to one of two vignettes, one describing a child with symptoms consistent with ADHD, inattentive type, and the other with symptoms of a depressive disorder. Overall diagnostic accuracy was ~60%, although pediatricians who received the ADHD vignette indicated greater confidence in their diagnosis and greater likelihood of providing treatment themselves. Those who received the ADHD vignette were also more likely to conduct a next level assessment and not to refer to a specialist. Participant characteristics, other than level of interest in mental health, were generally not associated with accuracy, confidence, comfort level, and decisions. Neither years in practice nor completion of a residency rotation in developmental and behavioral pediatrics yielded significant differences in or correlations with diagnosis and management. Consistent with previous reports, pediatric primary care providers vary in their responses to mental health concerns, depending upon the symptom presentation. Primary care providers in our study also appear to value consultation with mental health specialists, supporting the importance of interprofessional collaboration in caring for children with mental health related concerns. [ABSTRACT FROM AUTHOR]

Youth mental health (YMH) services are greatly underutilized, particularly for migrant youth. Collaborative models of care offer promising avenues, but research on these treatment modalities is still scarce, particularly for migrants. The goal of this exploratory study is to better understand quality of care including factors improving access to care and collaborative YMH services use, efficacy and satisfaction, for this vulnerable population. This qualitative study relies on a multi-informants (youth, parents, clinicians) and multiple case study design to explore YMH collaborative services for migrant youth living in an urban setting (Montreal, Canada). Participants are five young patients (12-15 years old), one of their parents and their primary care therapist ( N = 15). They come from migrant families, have a psychiatric diagnosis and have been receiving mental health services in a collaborative care setting for at least 6 months. Transcripts of semi-structured interviews for the five triads were thematically analyzed to draw similarities and contrasts between actors, across and within case-studies. Based on these findings, four themes emerged concerning the optimal care setting for collaborative YMH services for migrant families: (1) providing an equilibrium between communication, collaboration and privacy/confidentiality, (2) special attention to ensuring the continuity of care and the creation of a welcoming environment where trusting relationships can develop, (3) the inclusion of family intervention, and (4) the provision of collaborative decision-making pathways to care, addressing interprofessional and interinstitutional collaboration as well as cultural differences in explanatory models and values. [ABSTRACT FROM AUTHOR]

Engagement in children's mental health treatment is strikingly low. This might be due to differences in perspectives about what it means to be engaged in treatment as well as the strategies that are most effective at engaging families, as little is known about how well consumers' perspectives map onto current models of engagement and the empirical literature. This qualitative study examined family perspectives of (1) aspirational and actual engagement in treatment, (2) barriers that impeded engagement, and (3) engagement strategies they recommended their providers and agencies use. Four focus groups were conducted with 20 caregivers (ages 24-75), and 11 youth and young adults (ages 15-23). All participants were currently or formerly enrolled in children's mental health services. Data were analyzed through consensual qualitative research methods. Findings revealed that youth and caregivers' definitions of engagement included both attitudinal and behavioral components. Numerous barriers impeded components of aspirational engagement, and agency- and provider-related barriers were most pervasive. Youth reported more attitudinal barriers, whereas caregivers reported more behavioral barriers. Participants described advocacy (e.g., taking direct action to influence treatment) as a key engagement component; however, such advocacy often involved treatment non-adherence that could be interpreted by providers as disengagement. Families recommended strategies to strengthen the therapeutic relationship and build trust that are empirically supported. However, families described many experiences in which providers did not use these empirically supported strategies. Families also described some theoretically supported engagement strategies as having a negative impact on engagement. In sum, the findings suggest that providers should take an empowering family-centered treatment approach where they seek to understand and build upon clients' engagement perspectives. [ABSTRACT FROM AUTHOR]

Despite ongoing public calls for reform, the mental health needs of many children with psychological, emotional and behavioral disorders remain unmet. In response, providers continue to seek effective alternatives to institutional treatment by implementing comprehensive systems of care. The Children's Enhancement Project (CEP) is a collaborative effort to provide holistic, community-based mental health services for children with an individualized, flexible, family-driven approach. We conducted a process evaluation of CEP's early stage development and implementation utilizing both qualitative stakeholder interviews and quantitative survey components. The current article describes that evaluation and highlights the challenges and potential solutions encountered in developing a system of care. The lessons learned regarding system of care development, including the importance of a shared vision, establishing programmatic guidelines, achieving collaboration, and addressing sustainability concerns, are discussed. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between religiosity and conduct problems in a racially diverse sample of high school aged adolescents (ages 13-19) who attended public schools in a large metropolitan area. The results of the study found racial and gender differences in religiosity: African American adolescents were more likely to attend church, describe themselves as very religious and use Collaborative and Deferring religious coping styles; they were less likely to use Self-Directing religious coping styles when compared to Caucasian adolescents. Females were more likely to be involved in church activities, use a Collaborative religious coping style and tended to be less likely to use a Self-Directing religious coping style when compared to males. The results of multiple regression analyses, after controlling for race, gender, and self-reported religiousness found that Self-Directing and Deferring religious coping styles were risk factors for conduct problems; there was no relationship between Collaborative religious coping and conduct problems. The findings from the study provide additional support for the importance of considering religiosity, race and gender when examining mental health outcomes in adolescents and have implications for the development of mental health interventions for adolescents. [ABSTRACT FROM AUTHOR]

Information from multiple sources is recommended when assessing students' emotions and behaviors. Relatively few studies about cross informant agreement of behavioral and emotional strengths exist, especially for students with special education needs. The purpose of this study was to extend the cross informant agreement research of the Behavioral and Emotional Rating Scale (BERS-2) with a sample of Finnish parents, teachers and students. First, we studied the cross informant agreement of students' behavioral and emotional strengths between informants. Second, we explored the agreement separately for students with and without special education needs. Finally, we studied the convergent and divergent (discriminant) correlations of the Finnish BERS-2. The results show that the cross informant agreement of students' behavioral and emotional strengths were small to large with correlation coefficients ranging from .11 to .58 between different informants. The cross informant correlations, however, were higher in magnitude for students who receive special education support ( r = .29 to .78) than for those students who do not receive support ( r = −.02 to .45). Mean convergent correlations were higher than mean divergent correlations. The results suggest that the Finnish BERS-2 is a reliable measure in assessing student strengths across informants. The limitations, future research directions, and implications are discussed. [ABSTRACT FROM AUTHOR]