Child mental health in Jordanian orphanages: effect of placement change on behavior and caregiving

Background: To assess the mental health and behavioral problems of children in institutional placements in Jordan to inform understanding of current needs, and to explore the effects of placement change on functioning and staff perceptions of goodness-of-fit. Methods: An assessment was completed of 134 children between 1.5? 12 years-of-age residing in Jordanian orphanages. The Child Behavior Checklist was used to assess prevalence rates of problems across externalizing and internalizing behavior and DSM-IV oriented subscales. Also included was caregiver perceived goodness-of-fit with each child, caregiving behavior, and two placement change-clock variables; an adjustment clock measuring time since last move, and an anticipation clock measuring time to next move. Results: 28% were in the clinical range for the internalizing domain on the CBCL, and 22% for the externalizing domain. The children also exhibited high levels of clinical range social problems, affective disorder, pervasive developmental disorder, and conduct problems. Internalizing problems were found to decrease with time in placement as children adjust to a prior move, whereas externalizing problems increased as the time to their next age-triggered move drew closer, highlighting the anticipatory effects of change. Both behavioral problems and the change clocks were predictive of staff perceptions of goodness-of-fit with the children under their care. Conclusions: These findings add to the evidence demonstrating the negative effects of orphanage rearing, and highlight the importance of the association between behavioral problems and child-caregiver relationship pathways including the timing of placement disruptions and staff perceptions of goodness-of-fit

Possible Selves on Probation: The Role of Future-oriented Identity Beliefs in Promoting Successful Outcomes for Adolescents on Probation

Probation officers report that motivational processes, such as future-orientation and self-concept, are key factors in program participation and success. This dissertation consists of three studies that explored the role of possible selves, a specific form of future-oriented self-concepts, in promoting successful outcomes for youth who are court-ordered to probation. Using survey and administrative data from the Social Processes in Probation Study (SPPS), the first study explored a hypothesized model of how possible selves characteristics affect adolescent probation outcomes (e.g., probation compliance, recidivism, school engagement). This study found that adolescent possible selves were significantly related to probation outcomes, although not always in the manner expected nor as reported for other adolescent populations. Higher counts of possible selves and their characteristics were consistently associated with poorer outcomes for youth on probation. However, further analyses uncovered a complex network of interactions between the characteristics of possible selves, wherein certain combinations of these characteristics transmitted a mixture of beneficial and risky effects for certain outcomes and under certain conditions. Building upon the knowledge gained in the first study, the second study examined the relationship between possible selves and probation outcomes within the context of parental support and probation tactics. Three potential pathways were tested: (A) direct effects, independent of external factors; (B) meditated effects on the relationship of external factors on outcomes; and (C) moderated effects on the relationship of external factors on outcomes. Findings of this study did not support either a mediated or moderated pathway for any of the probation outcomes. However, the data suggest an interaction trend between probation tactics and possible selves for the outcome of rearrests, suggesting that supportive probation tactics may be of importance to lowering risk of rearrest for youth with limited possible selves. For the outcomes of rearrest and of school problems, possible selves had a significant direct effect, even after controlling for perceived parental support and probation tactics. The final study used a grounded theory approach to examine the process through which possible selves translated into behavioral action for adolescents on probation. The data suggest a process involving four phases of action: initial goal development, creation of identity-driven goals, planned action, and sustained progress. During Phase 1, initial goal development occurs as future-oriented thinking emerges following social interactions about the future. During Phase 2, goals integrate with identities to create motivational synergy, helping youth move toward taking action. During Phase 3, goals translate into planned actions through a specific skill set that involves understanding the pathway and steps needed to achieve the goal. During Phase 4, youth engage in sustained pursuit of progress by accessing resources for support, including help to negotiate short-term versus long-term desires, encouragement that bolstered efficacy beliefs, and accountability that communicated that the youth and their goal mattered. Throughout the process, the presence of role models with whom youth identify were important to the development of goals, plans, and perseverance. Implications for practice and policy with this population are discussed

Latinos’ Conceptualization of Depression, Diabetes, and Mental Health–Related Stigma

Depression and diabetes are two of the most common health conditions experienced by those from Latino backgrounds. However, community-based stigma toward these health conditions may discourage those experiencing symptoms of depression or diabetes from seeking professional assistance. To assess stigma in the Latino community toward these common health conditions, a community-based sample of 469 Latino participants in a major urban area in the [Southwestern United States — Houston, TX] completed a face-to-face survey using an experimental vignette methodology. Participants were asked to name the problem that the subject of the vignette was experiencing based on the symptoms described in the vignette. This survey also inquired about public stigma toward individuals experiencing symptoms of depression and/or diabetes. Results indicate that although the majority (60%) of the sample were able to correctly identify symptoms of depression, it was more difcult for them to identify symptoms of depression with co-occurring diabetes. Overall levels of public stigma toward those experiencing depression were moderate, and co-occurring symptoms of diabetes did not moderate stigma toward those experiencing depression. These fndings indicate a need for intervention approaches within the Latino community to increase health literacy related to depression and type 2 diabetes, as well as an ongoing need to reduce stigma toward those experiencing symptoms of depression. Implications for future research, practice, and health promotion are discussed

Stigma toward cocaine use in Mexico City: does gender matter?

Stigma toward those using cocaine and other substances remains a barrier to treatment and social inclusion. As part of a larger study exploring stigma toward those experiencing symptoms of various DSM5 diagnoses an experimental vignette methodology was used to examine factors associated with stigma toward individuals using cocaine in Mexico. Results from the subset of 66 individuals who were randomly assigned a vignette featuring cocaine use indicate that the gender of person using cocaine was not associated with differential levels of stigma. Lower levels of stigma were reported by respondents who had familiarity with mental health and substance use issues and by those endorsing higher levels of spirituality. Having a high school education or beyond was associated with greater stigma. Public health and education efforts are needed to inform community members and service providers about how stigma could affect addiction treatment and recovery. Implications for practice and research are explored

Why Culture and Context Matters: Examining Differences in Mental Health Stigma and Social Distance Between Latino Individuals in the United States and Mexico

This study examines the influence of cultural context on social distance and perceptions of stigma towards mental health conditions among Latino populations in Houston, TX, USA and Mexico City, Mexico. We employed a community-based experimental vignette survey to assess perceptions towards individuals experiencing symptoms of alcohol misuse, depression, and psychosis. Participants (n = 513) from Houston and Mexico City were asked about their willingness to accept community members experiencing mental health symptoms in various social roles, their perceptions of stigma related to these symptoms, anticipated danger, possible positive outcomes, and the community member’s ability to change. Findings demonstrate significant differences in stigma perceptions between Latino respondents in the US and in Mexico. Houston participants reported lower public stigma and perceived dangerousness of someone with mental health concerns compared to respondents in Mexico City. Furthermore, the cultural context may influence the association between various dimensions of stigma, with some inverse relationships occurring based on location of data collection. Findings illuminate the complex interplay between cultural context, mental health symptoms, and stigma, and underscores the need for culturally nuanced interventions to reduce mental health stigma and promote service utilization in Latino communities

Public Stigma Toward Schizophrenia Within Latino Communities in the United States

Public stigma toward those experiencing symptoms of schizophrenia in the general population is high; yet research into such stigma within the diverse Latino communities remains under-investigated. This study employed a randomized experimental vignette methodology to assess various domains of public stigma toward individuals experiencing psychosis and/or diabetes within Latino communities. A communitybased sample of 243 Latino adults participated. Contrary to our expectations, respondents who were more sympathetic toward those with mental health problems tended to score higher on public stigma. The belief that a person was responsible for their own mental health problems was associated with higher levels of stigma. Results indicate that perceptions of dangerousness toward someone experiencing psychosis were common, and the perception that a person was responsible for their mental health problems was associated with higher levels of stigma Results emphasize the complex nature of stigma within the diverse Latino communities and the need for ongoing research

Child Mental Health in Jordanian Orphanages: Effect of Placement Change on Behavior and Caregiving

Background: To assess the mental health and behavioral problems of children in institutional placements in Jordan to inform understanding of current needs, and to explore the effects of placement change on functioning and staff perceptions of goodness-of-fit. Methods: An assessment was completed of 134 children between 1.5–12 years-of-age residing in Jordanian orphanages. The Child Behavior Checklist was used to assess prevalence rates of problems across externalizing and internalizing behavior and DSM-IV oriented subscales. Also included was caregiver perceived goodness-of-fit with each child, caregiving behavior, and two placement change-clock variables; an adjustment clock measuring time since last move, and an anticipation clock measuring time to next move. Results: 28% were in the clinical range for the internalizing domain on the CBCL, and 22% for the externalizing domain. The children also exhibited high levels of clinical range social problems, affective disorder, pervasive developmental disorder, and conduct problems. Internalizing problems were found to decrease with time in placement as children adjust to a prior move, whereas externalizing problems increased as the time to their next age-triggered move drew closer, highlighting the anticipatory effects of change. Both behavioral problems and the change clocks were predictive of staff perceptions of goodness-of-fit with the children under their care. Conclusions: These findings add to the evidence demonstrating the negative effects of orphanage rearing, and highlight the importance of the association between behavioral problems and child-caregiver relationship pathways including the timing of placement disruptions and staff perceptions of goodness-of-fit

Ethical Considerations in Global Mental Health Research: Lessons Learned From Binational U.S.–Mexico Collaborations

Binational research is critical to better understand the health, mental health, and health outcomes of immigrant communities. Binational studies are often difficult to conduct, however, due to cost, challenges with participant recruitment and data collection, lack of appropriate cross-cultural instruments, and challenges ensuring ethical reviews and approval in both counties. This research note discusses ethical issues navigating institutional review board (IRB) procedures while striving to maintain the highest ethical protection for participants when engaging in binational behavioral sciences research between México and the United States. We discuss the need to clarify requirements for international research between México and the United States and navigating differences that may exist or emerge between IRBs in México and the United States. We provide some recommendations to assist researchers in ensuring IRB approval for their research protocols and ethical protection for their participants