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Depression among individuals who have been racially and ethnically minoritized in the United States can be vastly different from that of non-Hispanic White Americans. For example, African American adults who have depression rate their symptoms as more severe, have a longer course of illness, and experience more depression-associated disability. The purpose of this review was to conceptualize how structural racism and cumulative trauma can be fundamental drivers of the intergenerational transmission of depression. The authors propose that understanding risk factors for depression, particularly its intergenerational reach, requires accounting for structural racism. In light of the profoundly different experiences of African Americans who experience depression (i.e., a more persistent course of illness and greater disability), it is critical to examine whether an emerging explanation for some of these differences is the intergenerational transmission of this disorder due to structural racism.

Despite evidence that school mental health can enhance access to care for students from marginalized racial/ethnic groups, disparities remain in the appropriateness, quality, effectiveness, and outcomes of school mental health services. Implementation strategies hold some promise for addressing the disparities that emerge as result of inequitable implementation of mental health services. However, without explicitly examining implementation strategies through an equity lens, it is unclear the extent to which they will promote equitable implementation or student outcomes. Thus, the goal of the current paper is to describe the Adapting Strategies to Promote Implementation Reach and Equity framework, a generalizable process for adapting implementation strategies to explicitly center the goal of reducing disparities in implementation and service recipient outcomes. We outline a three-step process for incorporating an equity lens into implementation strategies and provide examples of how this framework can be applied to implementation strategies in school mental health. We also discuss examples of projects where implementation strategies were intentionally paired with school mental health programs to enhance racial equity. Implications and recommendations for school mental health and implementation research and practice are discussed.

Implementation strategies used to enhance the implementation of interventions during efficacy and effectiveness studies are rarely reported. Tracking and reporting implementation strategies during these phases has potential to improve future research studies and real-world implementation. We present an exemplar of how this might be executed by specifying and reporting the implementation strategies that were used during a school-based efficacy trial, Project POWER, which tested a trauma-informed prevention program delivered by a university research team, community members, and school staff facilitators in 29 schools. Following the conclusion of the 4-year trial, core Project POWER research team members identified the implementation strategies that supported intervention delivery during the trial using an established taxonomy of school-based implementation strategies. The actors, actions, action targets, temporality, dose, and implementation outcomes were specified using established implementation strategies reporting guidelines. The research team identified 37 implementation strategies that were used during the Project POWER trial. Most strategies fell within the categories of Train and Educate Stakeholders, Use Evaluative and Iterative Strategies, and Develop Stakeholder Interrelationships. Actors included members of the research team and partner schools. Strategies were used multiple times during the preparation and implementation phases. Action targets were most often characteristics of individuals, implementation process, and characteristics of the inner setting. Strategies predominantly targeted the implementation outcomes of fidelity, acceptability, feasibility, and adoption. This study provided evidence that implementation strategies are used and can be identified in efficacy research using a retrospective approach. Identifying and specifying implementation strategies used during the initial phases of the translational research pipeline can inform the implementation strategies that are carried forward, adapted, or discontinued in future trials and routine practice to improve implementation and effectiveness outcomes.

Objective: Mental health services are often implemented in settings in which mental health is not the primary mission. Schools, primary care clinics, criminal justice and child welfare institutions, and senior centers have been increasingly adding mental health care to their compendium of services owing to the high rates of mental health needs in these settings. Despite numerous challenges to implementing mental health practices in settings where mental health care has not traditionally been a part of the service model, the demand for mental health services in these settings is growing. Implementation science offers a lens through which to understand unique challenges and potential solutions to implementing mental health services in these settings, with the ultimate goal of ensuring the implementation of evidence-based services. Method and Results: In this conceptual article, we discuss common overarching barriers to implementing evidence-based mental health interventions in nonspecialty mental health settings, such as workforce challenges, competing priorities, and financial considerations. Then, using examples from schools and primary care, we elucidate unique contextual considerations and implementation challenges in these settings. Finally, we articulate a research agenda for advancing implementation of evidence-based practices in nonspecialty mental health including highlighting promising implementation strategies (e.g., task shifting, adaptation) and the most relevant implementation outcomes to assess in these contexts (e.g., appropriateness, feasibility). Conclusions: Given that nonspecialty mental health settings deliver a large proportion of mental health care to traditionally underserved populations, there are important public health implications to advancing research in this area and ensuring implemented services are evidence-based. Keywords: dissemination, implementation, implementation science, nonspecialty mental health, Mental health services are increasingly implemented in settings in which mental health is not the primary mission. In the United States, schools, primary care practices, criminal justice and child welfare [...]

Limited research exists about factors that influence the sustainability of preventive school mental health interventions when research support ends. This study assessed barriers and facilitators to sustaining RAP (Relax, be Aware, do a Personal rating) Club, a trauma-informed universal mental health intervention, in urban schools following efficacy trial implementation. Between 2016 and 2018, 13 Baltimore City schools implemented RAP Club. We evaluated RAP Club sustainability using semi-structured interviews with administrators (n = 10) and school staff trained to deliver the intervention (n = 11), as well as review of intervention fidelity logs (n = 137) and notes from supervision calls (n = 10) with school staff and research team members who implemented the program. Although most school staff described RAP Club as acceptable and beneficial, none of the 13 schools sustained the intervention. Barriers to sustainability included low self-efficacy among school staff trained to deliver the intervention, school staff turnover, logistical challenges with space and time in the regular school calendar to deliver the program, insufficient funding to sustain the program outside of the research context, and limited planning and ongoing communication between school personnel and researchers about sustainability. Recommendations for increasing post-trial program sustainability include developing sustainability plans with schools during the pre-implementation phase, enhancing ongoing support for school staff during the implementation phase, and using academic-community partnerships to facilitate sustainability and intervention scale-up during the post-implementation phase. Increasing sustainability of beneficial school-based mental health programs has the potential to reduce mental health disparities and promote health equity.

Purpose: The System for Observing Play and Recreation in Communities (SOPARC) is a valid, reliable method for understanding how people engage in physical activity (PA) in various permanent settings (e.g., parks) and contexts. However, its utility, reliability, and validity in temporary spaces has not been examined. Temporary spaces can provide PA opportunities often absent in low-income communities due to inadequate safe permanent PA spaces. Play Streets involve temporary closure of streets or other publicly accessibly spaces (e.g., parking lots, open-fields) to create safe play spaces for a specified time-period. We describe the utility, reliability, and validity of using SOPARC to assess PA in temporary spaces like Play Streets. Method: Trained SOPARC/iSOPARC (iPad App) research staff completed systematic observations during Play Streets occurring in four diverse low-income rural U.S. communities during summer 2017. Results: We successfully used iSOPARC to document PA and how spaces were used at Play Streets (n = 16), confirming its utility, reliability, and validity. Unlike observations of permanent spaces, target areas could not be pre-established since play spaces often changed during set-up, requiring time onsite to identify target areas and boundaries. Play areas frequently appeared and/or disappeared during Play Streets, and this was systematically addressed by using physical target area boundaries instead of activities. Conclusions: Understanding how temporary spaces are used for PA is critical for promoting their use. SOPARC/iSOPARC methods are useful in a Play Streets' context; however, systematic methods and training are needed to address inherent unpredictable and dynamic changes within and across target areas.

This study aimed to examine the relationship between school mental health service use in high school and educational outcomes of adolescents with psychiatric disorders. The sample included 2617 adolescents who were enrolled in eighth grade in a large urban school district in the United States, were enrolled in Medicaid during eighth grade, and had a mental health diagnosis. Psychiatric hospitalization, school enrollment, school absences, out-of-school suspensions, school dropouts, and school exits for negative reasons were examined as mental health and educational outcomes. Compared with adolescents who used school mental health services for 2 years following eighth grade, adolescents who did not use school mental health service during the high school years had a significantly lower annual number of days enrolled in school and higher rates of exiting school for negative reasons such as school dropout and long-term hospitalization. Our findings support the positive role of school mental health care delivery in high schools in preventing negative educational outcomes for adolescents with psychiatric disorder. [ABSTRACT FROM AUTHOR]

Feedback is a crucial form of information for learners. With the availability of new educational technologies, the manner in which feedback is delivered has changed tremendously. Existing research on the learning outcomes of the content and nature of computer mediated feedback is limited and contradictory. "Signals" is an educational data-mining technology for student success where instructors can send students elaborate feedback. Hence, this paper examines the content and nature dimensions of feedback in "Signals" with two studies. Study one identifies how the instructors who used this technology define its feedback function. Study two identifies the types of feedback that were included in the messages sent to students. Both studies employ content analysis method; study one examines the transcripts of interviews with instructors, and study two examines the feedback messages composed by instructors. Results indicate that while instructors perceive "Signals" as a tool to primarily provide motivational and summative feedback, student success was related to the type, and performance or outcome orientation of both summative and formative feedback students received. The results and implications of both studies are further discussed and future directions are proposed.

Academic analytics helps address the public's desire for institutional accountability with regard to student success, given the widespread concern over the cost of higher education and the difficult economic and budgetary conditions prevailing worldwide. Purdue University's Signals project applies the principles of analytics widely used in business intelligence circles to the problem of improving student success within a course and, hence, improving the institution's retention and graduation rates over time. Through its early stages, the Signals project's success has demonstrated the potential of academic analytics. Those early efforts have led to additional projects to develop: (1) Student success algorithms (SSAs) customized by course; (2) Intervention messages sent to students; and (3) New strategies for identifying students at risk. The premise behind Signals is fairly simple--utilize the data collected by instructional tools to determine in real time which students might be at risk, partially indicated by their effort within a course. Through analytics, the institution mines large data sets continually collected by these tools and applies statistical techniques to predict which students might be falling behind. The goal is to produce "actionable intelligence"--in this case, guiding students to appropriate help resources and explaining how to use them. Early reviews by administrators, faculty, and students have been positive, as has empirical data on the system's impact. The Signals system is based on a Purdue-developed SSA designed to provide students early warning--as early as the second week of the semester--of potential problems in a course by providing near real-time status updates of performance and effort in a course. Each update provides the student with detailed, positive steps to take in averting trouble. By no means is Purdue unique in its interest in academic analytics. Institutions across the world, large and small, public and private, research and teaching, have begun forays into various data source modeling strategies in an effort to find actionable data to support their goals. This article offers a snapshot of the experience at Purdue. (Contains 4 figures and 5 endnotes.)

Little is known about whether type 1 (IFNγ), 2 (IL-4/IL-13), or 3 (IL-17A/IL-22) cytokines affect the susceptibility of keratinocytes (KC) to viruses. These immune pathways predominate in various skin diseases: lupus, atopic dermatitis (AD), and psoriasis, respectively. Janus kinase inhibitors (JAKi) are approved to treat both AD and psoriasis, and are in clinical development for lupus. We evaluated whether these cytokines alter viral susceptibility of KC and determined if this effect is modulated by treatment with JAKi. Viral susceptibility to vaccinia virus (VV) or herpes simplex virus-1 (HSV-1) ± JAKi was assessed in immortalized and primary human KC pretreated with cytokines. Exposure to type 2 (IL-4 + IL-13) or the type 3 (IL-22) cytokines significantly increased KC viral susceptibility. Specifically, there was a peak increase of 12.2 ± 3.1-fold (IL-4 + IL-13) or 7.7 ± 2.8-fold (IL-22) in VV infection as measured by plaque number. Conversely, IFNγ significantly reduced susceptibility to VV (63.1 ± 64.4-fold). The IL-4 + IL-13-induced viral susceptibility was reduced (44 ± 16%) by JAK1 inhibition, while the IL-22-enhanced viral susceptibility was diminished (76 ± 19%) by TYK2 inhibition. IFNγ-mediated resistance to viral infection was reversed by JAK2 inhibition (366 ± 294% increase in infection). Cytokines expressed in AD skin (IL-4, IL-13, IL-22) increase KC viral susceptibility while IFNγ is protective. JAKi that target JAK1 or TYK2 reversed cytokine-enhanced viral susceptibility, while JAK2 inhibition reduced the protective effects of IFNγ. [ABSTRACT FROM AUTHOR]

This article discusses how Purdue University is changing the academic behavior of struggling students. At Purdue, they've developed Signals as a means of helping students better understand where they stand gradewise early enough so that they can seek help and raise their grade or drop the course without the penalty of a failing grade. They knew that many of their large first-year classes had significant numbers of students who earned "D"s or "F"s and that many of these same classes had instructors who utilize a central course management system (CMS ). They also knew, through some data mining, that many of those instructors kept students' grades in the CMS gradebook--meaning that a student could look up his or her grades on assignments at any time. What became clear to them was that these three things could operate in a coordinated effort that could result in higher levels of student success. Thus was born Signals, a system that allows for the integration of assignment grades and attendance behavior, both of which can be recorded in the University's CMS, with students' use of academic resources and help labs. Through combining this information in a way that provides feedback to students, they can help them understand both their current grades in their classes and what they can do to earn a higher grade while there is still time to act.

Purpose: The System for Observing Play and Recreation in Communities (SOPARC) is a valid, reliable method for understanding how people engage in physical activity (PA) in various permanent settings (e.g., parks) and contexts. However, its utility, reliability, and validity in temporary spaces has not been examined. Temporary spaces can provide PA opportunities often absent in low-income communities due to inadequate safe permanent PA spaces. Play Streets involve temporary closure of streets or other publicly accessibly spaces (e.g., parking lots, open-fields) to create safe play spaces for a specified time-period. We describe the utility, reliability, and validity of using SOPARC to assess PA in temporary spaces like Play Streets. Method: Trained SOPARC/iSOPARC (iPad App) research staff completed systematic observations during Play Streets occurring in four diverse low-income rural U.S. communities during summer 2017. Results: We successfully used iSOPARC to document PA and how spaces were used at Play Streets (n = 16), confirming its utility, reliability, and validity. Unlike observations of permanent spaces, target areas could not be pre-established since play spaces often changed during set-up, requiring time onsite to identify target areas and boundaries. Play areas frequently appeared and/or disappeared during Play Streets, and this was systematically addressed by using physical target area boundaries instead of activities. Conclusions: Understanding how temporary spaces are used for PA is critical for promoting their use. SOPARC/iSOPARC methods are useful in a Play Streets' context; however, systematic methods and training are needed to address inherent unpredictable and dynamic changes within and across target areas. [ABSTRACT FROM AUTHOR]