Systems of Care and the Prevention of Mental Health Problems for Children and their Families: Integrating Counseling Psychology and Public Health Perspectives

The purpose of this paper is to present systems of care as an example of how counseling psychology and public health overlap with regards to prevention and intervention approaches for children\u27s mental health. A framework for prevention is presented as is the state of children\u27s mental health promotion, with a particular focus on ecological and systemic approaches to children\u27s mental health and how these approaches cut across multiple perspectives. Systems of care are highlighted as an example of the congruence of prevention and ecological or systemic approaches to address the mental health promotion of children and their families, with the potential to impact at the universal, selective, and indicated levels of risk. Results from a longitudinal outcome study of a school-based system of care are presented to exemplify the positive outcomes experienced by children. An increase in the awareness and implementation of systems of care across mental health perspectives is recommended, along with continued research from the public health and counseling psychology communities focused on which prevention and intervention services within systems of care work, why they work, and how they can be improved upon

Parenting Stress as a Mediator of Exposure to Potentially Traumatic Events and Behavioral Health Outcomes in Children and Youth

The research team has been examining parenting stress, defined as stress that parents feel in their parenting role, as a mediator of behavioral health outcomes for children exposed to potentially traumatic events. The results of our studies demonstrate the interplay between a child’s exposure to potentially traumatic events and their parent/caregiver’s report of stress related to parenting their child

Predictors of Parenting and Infant Outcomes for Impoverished Adolescent Parents

Adolescent mothers and their children are at risk for a myriad of negative outcomes. This study examined risk and protective factors and their impact on a sample (N = 172) of impoverished adolescent mothers. Multiple regression analyses revealed that depressed adolescent mothers report higher levels of parenting stress and that their children are more at risk for maltreatment and are developmentally behind other babies. In addition, adolescent mothers with restricted social support have babies who are at higher risk for maltreatment. Finally, mothers who were older during pregnancy were more likely to stay in school. Implications for program development are discussed

An Examination of Exposure to Traumatic Events and Symptoms and Strengths for Children Served in a Behavioral Health System of Care

The present study examined how exposure to traumatic events impacts children with severe emotional disturbance who are being served in a school-based system of care. Multilevel growth curve models were used to examine the relationships between a child’s history of traumatic events (physical abuse, sexual abuse, or domestic violence) and behavioral and emotional strengths, internalizing problem behaviors, or externalizing problem behaviors over 18 months. Results indicate that children receiving services (N = 134) exhibited increased emotional and behavioral strengths and decreased internalizing and externalizing problem behaviors from enrollment to 18 months follow-up. Children with a history of traumatic events improved more slowly than children without such a history on both strengths and internalizing problem behaviors, even after controlling for dosage of services received and other characteristics previously found to predict outcomes. Gender was also related to improvement in internalizing symptoms. Results highlight the continued need to assess the impact of exposure to traumatic events for children served in a system of care

The Impact of Youth and Family Risk Factors on Service Recommendations and Delivery in a School-Based System of Care

The present study examines the impact of child and family risk factors on service access for youth and families in a school-based system of care. Regression analyses examined the relationships between risk factors and services recommended, services received, and dosage of services received. Logistic regression analyses examined the relationship between risk factors and whether or not youth received specific types of services within the system of care. Results revealed that youth with a personal or family history of substance use had more services recommended than youth without these risk factors, while youth with a family history of substance use received more services. Youth with a history of substance use received a significantly higher dosage of services overall. Finally, history of family mental illness was associated with receiving mental health and operational services (e.g., family advocacy, emergency funds). Implications and limitations are discussed. Systems of care were developed in response to the need for more appropriate and accessible preventive and treatment services for children with severe emotional and behavioral difficulties and their families. In 1992, the United States Congress established the Comprehensive Community Mental Health Services (CMHS) for Children and Their Families Program, which has provided funding to 126 communities over the past 14 years for the development of local systems of care.1 A system of care is a coordinated network of community-based services and supports that is created to meet the challenges of children

Comparing early-childhood and school-aged systems of care for children with emotional and behavioral difficulties: risk, symptom presentation, and outcomes

OBJECTIVES : Most large-scale evaluations of systems of care (SOCs) have focused on school-aged populations, with limited research examining early childhood SOCs. As a result, little is known about how risk profiles, symptom presentation, and outcomes may vary between early childhood and school-aged SOC participants. This descriptive study uses data from two SOCs—an early childhood SOC (EC-SOC) and a school-aged SOC (SA-SOC)—to examine the differences across age groups in how children and families present to SOCs and the extent to which risk factors and symptoms change over six months of enrollment. METHOD : Participants were 184 children in the EC-SOC (mage = 3.91) and 142 children in the SA-SOC (mage = 9.36). Families completed measures assessing risk factors and functioning at enrollment and at six-month follow up. Descriptive analyses measured the presence of risk factors and symptoms at enrollment and follow-up. Correlations were computed to determine the associations between symptom measures. RESULTS : Results identified areas of similarity and difference between families presenting for SOCs at different developmental stages. Younger children experienced greater behavioral problems (Hedge’s g = 0.52, p< 0.001) with more associated caregiver stress (Hedge’s g range = 0.34–0.62, p < 0.01) and strain (Hedge’s g = 0.34, p= 0.005). Trauma was more strongly associated with child and caregiver symptoms among younger children. Greater change in symptom measures was observed for the EC-SOC. CONCLUSIONS : Findings highlight the importance of providing services in early childhood and provide guidance for SOC service provision at different ages.The preparation of this paper was supported, in part, by the first author’s National Institutes of Health T32-funded postdoctoral training fellowship (T32DA019426-13). The New London Building Blocks project was supported by a grant from the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration. The Rhode Island Positive Educational Partnership project was supported through a cooperative agreement by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration to the State of Rhode Island Department of Children, Youth, and Families.https://link.springer.com/journal/108262020-08-05hj2020Psycholog

Posttraumatic Stress among Young Urban Children Exposed to Family Violence and Other Potentially Traumatic Events

This study examines the relationship between the number of types of traumatic events experienced by children 3 to 6 years old, parenting stress, and children\u27s posttraumatic stress (PTS). Parents and caregivers provided data for 154 urban children admitted into community-based mental health or developmental services. By parent and caregiver report, children experienced an average of 4.9 different types of potentially traumatic events. Nearly one quarter of the children evidenced clinically significant PTS. Posttraumatic stress was positively and significantly related to family violence and other family-related trauma exposure, nonfamily violence and trauma exposure, and parenting stress. Additionally, parenting stress partially mediated the relationship between family violence and trauma exposure and PTS. This study highlights the need for early violence and trauma exposure screening in help-seeking populations so that appropriate interventions are initiated

Associations between police harassment and distrust in and reduced access to healthcare among Black sexual minority men: A longitudinal analysis of HPTN 061

Objective: Evaluate associations between racialized and homophobia-based police harassment (RHBPH) and healthcare distrust and utilization among Black Sexual Minority Men (BSMM). Methods: We utilized data from a longitudinal cohort study from HIV Prevention Trials Network (HPTN) 061 with baseline, six and 12 month follow-up assessments. Using multivariable analysis, we evaluated associations between RHBPH and healthcare distrust and utilization reported at the 6 and 12 month visits. Results: Of 1553 BSMM present at baseline, 1160 were available at six-month follow-up. In multivariable analysis, increasing frequency of RHBPH was associated with increasing levels of distrust in healthcare providers (aOR 1.31, 95% CI: 1.00, 1.74) and missing 50% or more of healthcare visits at six-month follow-up (aOR 1.93, 95% CI: 1.09, 3.43). Conclusions: Recent experiences of RHBPH are associated with reduced trust in and access to healthcare among BSMM, with more frequent RHBPH associated with greater vulnerability.</p

Daratumumab plus lenalidomide and dexamethasone in relapsed/ refractory multiple myeloma: extended follow-up of POLLUX, a randomized, open-label, phase 3 study

In POLLUX, daratumumab (D) plus lenalidomide/dexamethasone (Rd) reduced the risk of disease progression or death by 63% and increased the overall response rate (ORR) versus Rd in relapsed/refractory multiple myeloma (RRMM). Updated efficacy and safety after >3 years of follow-up are presented. Patients (N = 569) with ≥1 prior line received Rd (lenalidomide, 25 mg, on Days 1–21 of each 28-day cycle; dexamethasone, 40 mg, weekly) ± daratumumab at the approved dosing schedule. Minimal residual disease (MRD) was assessed by next-generation sequencing. After 44.3 months median follow-up, D-Rd prolonged progression-free survival (PFS) in the intent-to-treat population (median 44.5 vs 17.5 months; HR, 0.44; 95% CI, 0.35–0.55; P < 0.0001) and in patient subgroups. D-Rd demonstrated higher ORR (92.9 vs 76.4%; P < 0.0001) and deeper responses, including complete response or better (56.6 vs 23.2%; P < 0.0001) and MRD negativity (10–5; 30.4 vs 5.3%; P < 0.0001). Median time to next therapy was prolonged with D-Rd (50.6 vs 23.1 months; HR, 0.39; 95% CI, 0.31–0.50; P < 0.0001). Median PFS on subsequent line of therapy (PFS2) was not reached with D-Rd versus 31.7 months with Rd (HR, 0.53; 95% CI, 0.42–0.68; P < 0.0001). No new safety concerns were reported. These data support using D-Rd in patients with RRMM after first relapse

Yawn Contagion and Empathy in Homo sapiens

The ability to share others' emotions, or empathy, is crucial for complex social interactions. Clinical, psychological, and neurobiological clues suggest a link between yawn contagion and empathy in humans (Homo sapiens). However, no behavioral evidence has been provided so far. We tested the effect of different variables (e.g., country of origin, sex, yawn characteristics) on yawn contagion by running mixed models applied to observational data collected over 1 year on adult (>16 years old) human subjects. Only social bonding predicted the occurrence, frequency, and latency of yawn contagion. As with other measures of empathy, the rate of contagion was greatest in response to kin, then friends, then acquaintances, and lastly strangers. Related individuals (r≥0.25) showed the greatest contagion, in terms of both occurrence of yawning and frequency of yawns. Strangers and acquaintances showed a longer delay in the yawn response (latency) compared to friends and kin. This outcome suggests that the neuronal activation magnitude related to yawn contagion can differ as a function of subject familiarity. In conclusion, our results demonstrate that yawn contagion is primarily driven by the emotional closeness between individuals and not by other variables, such as gender and nationality