Using policy codesign to achieve multi-sector alignment in adolescent behavioral health: a study protocol

Background: Policymaking is quickly gaining focus in the field of implementation science as a potential opportunity for aligning cross-sector systems and introducing incentives to promote population health, including substance use disorders (SUD) and their prevention in adolescents. Policymakers are seen as holding the necessary levers for realigning service infrastructure to more rapidly and effectively address adolescent behavioral health across the continuum of need (prevention through crisis care, mental health, and SUD) and in multiple locations (schools, primary care, community settings). The difficulty of aligning policy intent, policy design, and successful policy implementation is a well-known challenge in the broader public policy and public administration literature that also affects local behavioral health policymaking. This study will examine a blended approach of coproduction and codesign (i.e., Policy Codesign), iteratively developed over multiple years to address problems in policy formation that often lead to poor implementation outcomes. The current study evaluates this scalable approach using reproducible measures to grow the knowledge base in this field of study. Methods: This is a single-arm, longitudinal, staggered implementation study to examine the acceptability and short-term impacts of Policy Codesign in resolving critical challenges in behavioral health policy formation. The aims are to (1) examine the acceptability, feasibility, and reach of Policy Codesign within two geographically distinct counties in Washington state, USA; (2) examine the impact of Policy Codesign on multisector policy development within these counties using social network analysis; and (3) assess the perceived replicability of Policy Codesign among leaders and other staff of policy-oriented state behavioral health intermediary organizations across the USA. Discussion: This study will assess the feasibility of a specific approach to collaborative policy development, Policy Codesign, in two diverse regions. Results will inform a subsequent multi-state study measuring the impact and effectiveness of this approach for achieving multi-sector and evidence informed policy development in adolescent SUD prevention and treatment

Strategies for enacting health policy codesign: a scoping review and direction for research

Abstract Background Strategies for supporting evidence-informed health policy are a recognized but understudied area of policy dissemination and implementation science. Codesign describes a set of strategies potentially well suited to address the complexity presented by policy formation and implementation. We examine the health policy literature describing the use of codesign in initiatives intended to combine diverse sources of knowledge and evidence in policymaking. Methods The search included PubMed, MEDLINE, PsychInfo, CINAHL, Web of Science, and Google Scholar in November 2022 and included papers published between 1996 and 2022. Terms included codesign, health, policy, and system terminology. Title and abstracts were reviewed in duplicate and included if efforts informed policy or system-level decision-making. Extracted data followed scoping review guidelines for location, evaluation method, health focus, codesign definition, description, level of health system user input, sectors involved, and reported benefits and challenges. Results From 550 titles, 23 citations describing 32 policy codesign studies were included from multiple continents (Australia/New Zealand, 32%; UK/Europe, 32%; South America, 14%; Africa, 9%; USA/Canada 23%). Document type was primarily case study (77%). The area of health focus was widely distributed. Policy type was more commonly little p policy (47%), followed by big p policy (25%), and service innovations that included policy-enabled funding (25%). Models and frameworks originated from formal design (e.g., human-centered or participatory design (44%), political science (38%), or health service research (16%). Reported outcomes included community mobilization (50%), policy feasibility (41%), improved multisector alignment (31%), and introduction of novel ideas and critical thinking (47%). Studies engaging policy users in full decision-making roles self-reported higher levels of community mobilization and community needs than other types of engagement. Discussion Policy codesign is theoretically promising and is gaining interest among diverse health sectors for addressing the complexity of policy formation and implementation. The maturity of the science is just emerging. We observed trends in the association of codesign strategies and outcomes that suggests a research agenda in this area could provide practical insights for tailoring policy codesign to respond to local contextual factors including values, needs, and resources

Formal Youth Mentoring Relationships in the Context of Risk: What is the Role of Caregiver-Mentor Collaboration?

Most research on youth mentoring relationships has focused on the mentor-mentee dyad, yet caregivers play an important role in supporting these relationships. Drawing on a large, multisite sample of youth in formal mentoring programs (N = 2165), this study investigated associations between caregiver-mentor collaboration and mentoring relationship outcomes in the context of environmental and individual youth risk factors. Analysis of novel quantitative measures assessing caregivers\u27 experiences of the mentoring relationships revealed two factors reflecting caregivers\u27 collaboration with mentors (caregiver involvement and mentor backing), and three factors reflecting caregivers\u27 perceptions of mentor effectiveness (meeting youth needs, advocating for youth, and supporting youth behavior). Results indicated that greater caregiver involvement was associated with higher-quality and longer-lasting mentoring relationships. Few associations between risk and mentoring relationships were observed; however, indirect effects indicated that youth environmental risk was positively associated with caregiver involvement, which, in turn, was positively associated with mentoring relationship outcomes

Climate change anxiety and mental health: Environmental activism as buffer

International audienceA growing body of research has documented the phenomenon of climate change anxiety (CCA), defined broadly as negative cognitive, emotional, and behavioral responses associated with concerns about climate change. A recently validated scale of CCA indicated two subscales: cognitive emotional impairment and functional impairment (Clayton & Karazsia, 2020). However, there are few empirical studies on CCA to date and little evidence regarding whether CCA is associated with psychiatric symptoms, including symptoms of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD), and whether engaging in individual and collective action to address climate change could buffer such relationships. This mixed methods study draws on data collected from a sample of emerging adult students (ages 18–35) in the United States (N = 284) to address these gaps. Results indicated that both CCA subscales were significantly associated with GAD symptoms, while only the Functional Impairment subscale was associated with higher MDD symptoms. Moreover, engaging in collective action, but not individual action, significantly attenuated the association between CCA cognitive emotional impairment and MDD symptoms. Responses to open-ended questions asking about participants’ worries and actions related to climate change indicated the severity of their worries and, for some, a perception of the insignificance of their actions relative to the enormity of climate change. These results further the field’s understanding of CCA, both in general and specifically among emerging adults, and suggest the importance of creating opportunities for collective action to build sense of agency in addressing climate change

Connecting Youth: the Role of Mentoring Approach

While formal youth mentoring can positively influence youth connectedness, little research has studied the specific approaches mentors engage in that support mentee social development. This study examines how mentors\u27 specific approaches are uniquely associated with youth connection outcomes in formal community-based mentoring. Participants were 766 youth, ranging in age from 11 to 14 (M = 12.29), 56.7% female, and racially/ethnically diverse (41.0% Black/African American, 21.4% Hispanic/Latinx, 20.0% White, 10.2% Multiracial/Multiethnic, 5.9% Native American, 1.2% other race, and 0.4% Asian/Pacific Islander). Person-centered analyses revealed three mentoring profiles which were differentially associated with youth outcomes: Status Quo Mentors, who reported low-to-moderate levels of closeness within the mentor-mentee dyad, low levels of connecting their mentees with programs and people in their community, and low levels of mediating for their mentees; Close Connectors, who reported moderate-to-high levels of closeness, moderate-to-high levels of connecting, and low levels of mediating; and Connector-Mediators, who reported moderate levels of closeness, connecting, and mediating. Youth mentored by Close Connectors demonstrated the greatest benefit, with significant improvements in parent-child relationship quality, extracurricular activity involvement, and help-seeking. Results suggest that community-based mentoring programs that emphasize connecting youth within their communities may be more effective in enhancing youth support networks