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This study examines whether risk factors associated with child externalizing behavior symptoms differ between two similar low-income, urban communities, using baseline parent data of 154 African American youth (ages 9-15) participating in the Collaborative HIV-Prevention and Adolescent Mental Health Project (CHAMP) family program. Separate multiple regression analyses of each city sample indicated that greater child externalizing symptoms were associated with increasing parenting hassles for New York families (n = 46), but greater parent mental health symptoms for participants in Chicago (n = 108). Understanding such distinctions between communities is an important first step toward tailoring services to unique community needs. (Contains 1 figure and 5 tables.)

Background: Children in Sub-Saharan Africa are burdened by significant unmet mental health needs. Across the region, high rates of poverty, HIV/AIDS, food insecurity, stigma, and an inadequate health safety net system exacerbate serious child behavioral health needs and impede an effective response. Disruptive behavioral disorders are particularly concerning as they persist through adolescence and adulthood. Hence, addressing the context-specific social influences on child behavioral health is critical given that children in the region comprise more than half of the total regional population. Against this backdrop, this study protocol describes a randomized clinical trial that will examine the mechanisms by which economic empowerment and family strengthening interventions targeting social, familial, and context-specific drivers affect the mental health of children in Uganda. Methods: The study uses an experimental, longitudinal design across 30 cluster-randomized primary schools to compare single and combination intervention options; influences of economic empowerment and family strengthening on economic, perceptual, and functioning mediators; and context-specific moderators. The study will be conducted with 900 Ugandan children in mid-upper primary school (10-14 years). The three study conditions (n = 300 each) are: (1) economic empowerment only (EE only), (2) multiple family group-based family strengthening only (MFG-based FS only), and (3) combined EE + MFG-based FS. The interventions will be provided for 12 months; and assessments will occur at baseline, 12, 24, and 36 months. Conclusion: Children in Sub-Saharan Africa are burdened by significant unmet mental health needs, including disruptive behavior disorders that persist through adolescence and adulthood if left untreated. The proposed study will examine the mechanisms by which economic empowerment and family strengthening interventions targeting social, familial and context-specific drivers affect the mental health of children in mid-upper primary schools in Uganda. Findings from this study can inform group, community, and population approaches that are needed for scalable solutions to address the social drivers negatively impacting child behavioral health in low-resource settings, including in Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the self‐report frequency of inter‐agency collaboration about children's mental health issues is associated with the self‐report frequency of using research evidence in children's mental health policy and program decision making in mental health agencies (MHAs). Data Sources: Primary data were collected through web‐based surveys of state (N = 221) and county (N = 117) MHA officials. Design: The primary independent variable was a composite score quantifying the frequency of collaboration about children's mental health issues between officials in MHAs and six other state agencies. The dependent variables were composite scores quantifying the frequency of research use in children's mental health policy and program decision making in general and for specific purposes (i.e., conceptual, instrumental, tactical, imposed). Covariates were composite scores quantifying well‐established determinants of research use (e.g., agency leadership, research use skills) in agency policy and program decision making. Data Methods: Separate multiple linear regression models estimated associations between frequency of inter‐agency collaboration and research use scores, adjusting for other determinants of research use, respondent state, and other covariates. Data from state and county officials were analyzed separately. Principal Findings: The frequency of inter‐agency collaboration was positively and independently associated with the frequency of research use in children's mental health policy making among state (β = 0.22, p = 0.004) and county (β = 0.39, p < 0.0001) MHA officials. Inter‐agency collaboration was also the only variable significantly associated with the frequency of research use for all four specific purposes among state MHA officials, and similar findings we observed among county MHA officials. The magnitudes of associations between inter‐agency collaboration and frequency of research use were generally stronger than for more well‐established determinants of research use in policy making. Conclusions: Strategies that promote collaboration between MHA officials and external agencies could increase the use of research evidence in children's mental health policy and program decision making in MHAs. [ABSTRACT FROM AUTHOR]

The purpose of this commentary was to describe the barriers and facilitators to mental health screening efforts for children between age 5 and 18 years within three primary care clinics in poverty-impacted communities as part of an integrated care model. Three screeners, two women and one male, participated in a screening effort between September and December 2015. Screeners were interviewed about their perceptions of barriers and facilitators to screening. Organizational, family, and screener-level factors were found to influence delivery of screenings to children. Given the benefits of screening in primary care settings, identifying barriers to these initiatives and ways to address them pre-emptively could potentially alter the developmental trajectory and outcomes of children at risk for serious mental health conditions. [ABSTRACT FROM AUTHOR]

Objective: This article describes Phase 1 of a pilot that aims to develop, implement, and test an intervention to educate and simultaneously engage highly stressed Latino parents in child mental health services. A team of Spanish-speaking academic and community co-investigators developed the intervention using a community-based participatory research approach and qualitative methods. Method: Through focus groups, the team identified parents’ knowledge gaps and their health communication preferences. Results: Latino parents from urban communities need and welcome child mental health literacy interventions that integrate printed materials with videos, preferably in their native language, combined with guidance from professionals. Conclusion: A 3-minute video in Spanish that integrates education entertainment strategies and a culturally relevant format was produced as part of the intervention to educate and simultaneously engage highly stressed Latino parents in child mental health care. It is anticipated that the intervention will positively impact service use among this group. [ABSTRACT FROM AUTHOR]

Treatment participation was examined among youth enrolled in an evaluation of cognitive behavioral therapy (CBT) for trauma following the 9/11 World Trade Center disaster. Staff at nine agencies serving a predominantly low-income, ethnically diverse population were trained to deliver CBT and structured engagement strategies. A total of 445 youth ages 5 to 19 were eligible for CBT, and 417 (94%) received at least one treatment session. Pretreatment and treatment show rates and overall dose were examined. Treatment participation rates were higher than those typically reported in community studies of children’s mental health services. Regression analyses indicated variability across sites in treatment show rates with the highest rates at sites where services were delivered in schools. However, sites, demographic factors, and trauma symptoms accounted for a small amount of variance in treatment participation overall. The study suggests that structured engagement strategies, linked to evidence-based treatments, may improve treatment participation for youth. [ABSTRACT FROM PUBLISHER]

We evaluate the mid-intervention (8 weeks) and short-term (16 weeks) impact of a culturally adapted multiple family group (MFG) intervention, "Amaka Amasanyufu," on the mental health of children with disruptive behavior disorders (DBDs) and primary caregivers in Uganda. We analyzed data from the Strengthening mental health and research training in Sub-Saharan Africa (SMART) Africa−Uganda study. Schools were randomized to the following: a control group; an MFG facilitated by parent peers (MFG-PP); or an MFG facilitated by community health workers (MFG:CHW). All participants were blinded to interventions provided to other participants and study hypotheses. At 8 weeks and 16 weeks, we evaluated differences in depressive symptoms and self-concept among children and in mental health and caregiving-related stress among caregivers. Three-level linear mixed-effects models were fitted. Pairwise comparisons of post-baseline group means were performed using the Sidak adjustment for multiple comparisons and standardized mean differences. Data from 636 children with DBDs and caregivers (controls: n = 243, n = 10 schools; MFG-PP: n = 194, n = 8 schools; MFG-CHW: n = 199, n = 8 schools) were analyzed. There were significant group-by-time interactions for all outcomes, and differences were observed mid-intervention, with short-term effects at 16 weeks (end-intervention). MFG-PP and MFG-CHW children had significantly lower depressive symptoms and higher self-concept, whereas caregivers had significantly lower caregiving-related stress and fewer mental health problems, than controls. There was no difference between intervention groups. Amaka Amasanyufu MFG intervention is effective for reducing depressive symptoms and improving self-concept among children with DBDs while reducing parental stress and mental health problems among caregivers. Given the paucity of culturally adapted mental health interventions, this provides support for adaptation and scale-up in Uganda and other low-resource settings. SMART Africa (Strengthening Mental Health Research and Training); https://clinicaltrials.gov/: NCT03081195. [ABSTRACT FROM AUTHOR]

• Examining key influences in sub-Saharan Africa is important to guide investments in child mental health and family support. • Parental supervision, widowhood, and family size are significantly associated with child behavioral challenges in Uganda. • Study results also suggest that children living in divorced or widowed families may benefit from additional family-level support. • Caregivers may also benefit from programs that provide tools for effective parental supervision. • Contextually relevant family strengthening interventions may be considered to address child behavioral challenges in Uganda. This exploratory study sought to examine the extent to which family-level factors are associated with disruptive behavioral disorder (DBD) symptoms, including oppositional defiant disorder (ODD) and conduct disorder (CD) among school children in Uganda, a low-resource country in SSA. The examination of key influences within the SSA context is important to guide needed investments in mental health care and family-level support. Importantly, identifying families at higher risk can inform the development of contextualized family interventions that reinforce positive parenting practices. We analyzed baseline data (N = 2110) from the NIH-funded Strengthening Mental health And Research Training in Africa (SMART Africa) scale-up study in Southwestern Uganda. Children aged 8–13 and their caregivers were recruited from 30 public primary schools. DBDs were examined using the DBD rating scale, Iowa Conners, and Impairment scales. Logistic regression analysis using cluster adjusted robust standard errors to adjust for within-school clustering was conducted to assess the association between DBD symptoms and family-level factors, including parenting practices, marital status, and family size. Results indicate that poor parental supervision (OR = 1.17; CI: 1.13, 1.21; P <.001), divorced families (OR = 1.33; CI: 1.03, 1.72; P <.05), and widowed families (OR = 1.48; CI: 1.10, 2.00; P <.01) were associated with higher DBD symptoms among children. On the other hand, caregiver age (OR = 0.99; CI: 0.98, 0.99; P <.01) was associated with lower DBD symptoms among children. Moreover, caregiver employment and parental education were not statistically significant in the model. Findings from the study reveal an association between family-level factors and behavioral difficulties among children in Uganda suggesting that divorced and widowed families may benefit from additional support in caring for children. Moreover, caregivers may also benefit from programs that provide tools for effective parental supervision. [ABSTRACT FROM AUTHOR]