Increasing Access to Care by Delivering Mental Health Services in Schools: The School-Based Support Program

It is widely estimated that approximately 25% of school age youth face mental and behavioral health challenges. The vast majority of these youth are insufficiently treated, leaving them vulnerable to negative school outcomes such as attendance, behavioral, and academic problems. One common barrier to treatment is a lack of access to appropriate and consistent care including assessment and intervention. Often when students are identified in schools as potentially struggling with mental health issues, the child is referred out to the community for treatment. While well-intended, this approach is largely unsuccessful if families face challenges such as a language barrier, a lack of transportation or health insurance, or lack of flexibility with their jobs leaving them unable to make appointments. A unique school–community partnership in North Carolina attempted to overcome these obstacles by bringing mental health services to youth at the school campuses. The School-Based Support program largely mitigated problems with access to care and made a positive impact on school outcomes for youth. This report from the field describes the consequences of untreated mental health problems among children, barriers to receiving mental health treatment, and ways student mental health needs are currently addressed in schools. We then detail how the School-Based Support program was formed through a school–community partnership, the program components, evaluation results, and a case example

Neural fate of seen and unseen faces in visuospatial neglect: A combined event-related functional MRI and event-related potential study

This is a post print version of the article. The official published version can be obtained from the link below.To compare neural activity produced by visual events that escape or reach conscious awareness, we used event-related MRI and evoked potentials in a patient who had neglect and extinction after focal right parietal damage, but intact visual fields. This neurological disorder entails a loss of awareness for stimuli in the field contralateral to a brain lesion when stimuli are simultaneously presented on the ipsilateral side, even though early visual areas may be intact, and single contralateral stimuli may still be perceived. Functional MRI and event-related potential study were performed during a task where faces or shapes appeared in the right, left, or both fields. Unilateral stimuli produced normal responses in V1 and extrastriate areas. In bilateral events, left faces that were not perceived still activated right V1 and inferior temporal cortex and evoked nonsignificantly reduced N1 potentials, with preserved face-specific negative potentials at 170 ms. When left faces were perceived, the same stimuli produced greater activity in a distributed network of areas including right V1 and cuneus, bilateral fusiform gyri, and left parietal cortex. Also, effective connectivity between visual, parietal, and frontal areas increased during perception of faces. These results suggest that activity can occur in V1 and ventral temporal cortex without awareness, whereas coupling with dorsal parietal and frontal areas may be critical for such activity to afford conscious perception. Right parietal damage may cause a loss of awareness for contralateral (left) sensory inputs, such as hemispatial neglect and extinction (1–3). Visual extinction is the failure to perceive a stimulus in the contralesional field when presented together with an ipsilesional stimulus (bilateral simultaneous stimulation, BSS), even though occipital visual areas are intact and unilateral contralesional stimuli can be perceived when presented alone. It reflects a deficit of spatial attention toward the contralesional side, excluding left inputs from awareness in the presence of competing stimuli (2, 3). Spatial attention involves a complex neural network centered on the right parietal lobe (4, 5), but how parietal and related areas interact with sensory processing in distant cortices is largely unknown. Here we combined event-related functional MRI (fMRI) and event-related potentials (ERPs) to study the regional pattern and temporal course of brain activity produced by seen and unseen stimuli in a patient with chronic neglect and extinction caused by parietal damage. In keeping with intact early visual areas in such patients, behavioral studies suggest that some residual processing may still occur for contralesional stimuli without attention, or without awareness, including “preattentive” grouping (e.g., refs. 6 and 7) and semantic priming (e.g., ref. 8). It has been speculated (3, 9) that such effects might relate to separate cortical visual streams, with temporal areas extracting object features for identification, and parietal areas encoding spatial locations and parameters for action (10). Because neglect and extinction follow parietal damage, residual perceptual and semantic processing still might occur in occipital and temporal cortex without awareness, in the absence of normal integration with concomitant processing in parietal regions. Our study tested this hypothesis by using event-related imaging and electrophysiology measures, which are widely used to study mechanisms of normal attention (11, 12). There have been few imaging (e.g., ref. 13) or ERP (e.g., ref. 14) studies in neglect, and most examined activity at rest or during passive unilateral visual stimulation, rather than in relation to awareness or extinction on bilateral stimulation. However, a recent ERP study (15) found signals evoked by perceived, but not extinguished, visual stimuli in a parietal patient. By contrast, functional imaging in another patient (16) showed activation of striate cortex by extinguished stimuli, although severe extinction on all bilateral stimuli precluded any comparison with normal perception. In our patient we used both fMRI and ERPs during a similar extinction task to determine the neural correlates of two critical conditions: (i) when contralesional stimuli are extinguished, and (ii) when the same stimuli are seen. Stimulus presentation was arranged so as to obtain a balanced number of extinguished and seen contralesional events across all bilateral trials. Like Rees et al. (16), we used face stimuli to exploit previous knowledge that face processing activates fusiform areas in temporal cortex (e.g., refs. 17 and 18), and elicits characteristic potentials 170–200 ms after stimulus onset (e.g., refs. 19–21) in addition to other visual components such as P1 and N1 (e.g., ref. 11). We reasoned that such responses might help trace the neural fate of contralesional stimuli (seen or extinguished) at both early and later processing stages in the visual system

An event-related potential study of cross-modal morphological and phonological priming

The current work investigated whether differences in phonological overlap between the past- and present-tense forms of regular and irregular verbs can account for the graded neurophysiological effects of verb regularity observed in past-tense priming designs. Event-related potentials were recorded from 16 healthy participants who performed a lexical-decision task in which past-tense primes immediately preceded present-tense targets. To minimize intra-modal phonological priming effects, cross-modal presentation between auditory primes and visual targets was employed, and results were compared to a companion intra-modal auditory study (Justus, T., Larsen, J., de Mornay Davies, P., Swick, D. (2008). Interpreting dissociations between regular and irregular past-tense morphology: evidence from event-related potentials. Cognitive, Affective, Behavioral Neuroscience, 8, 178–194.). For both regular and irregular verbs, faster response times and reduced N400 components were observed for present-tense forms when primed by the corresponding past-tense forms. Although behavioral facilitation was observed with a pseudopast phonological control condition, neither this condition nor an orthographic-phonological control produced significant N400 priming effects. Instead, these two types of priming were associated with a post-lexical anterior negativity (PLAN). Results are discussed with regard to dual- and single-system theories of inflectional morphology, as well as intra- and cross-modal prelexical priming

Ectopic Expression of Zmiz1 Induces Cutaneous Squamous Cell Malignancies in a Mouse Model of Cancer

Cutaneous squamous cell carcinoma (SCC) is the second most common form of cancer in the human population, yet the underlying genetic mechanisms contributing to the disease are not well understood. We recently identified Zmiz1 as a candidate oncogene in nonmelanoma skin cancer through a transposon mutagenesis screen. Here we show that transposon-induced mutations in Zmiz1 drive expression of a truncated transcript that is similar to an alternative endogenous ZMIZ1 transcript found to be overexpressed in human SCCs relative to normal skin. We also describe an original mouse model of invasive keratoacanthoma driven by skin-specific expression of the truncated Zmiz1 transcript. Unlike most mouse models, Zmiz1-induced skin tumors develop rapidly and in the absence of promoting agents such as phorbol esters. In addition, we found that the alternative Zmiz1 isoform has greater protein stability than its full-length counterpart. Finally, we provide evidence that ZMIZ1 is overexpressed in a significant percentage of human breast, ovarian, and colon cancers in addition to human SCCs, suggesting that ZMIZ1 may play a broader role in epithelial cancers

Appalachian Transition: A cross sector approach to regional transition.

Appalachia is made up of many mountains, many communities and many different sectors of work. The Appalachian Transition Fellows based out of the Highlander Education Center have spent 9 months working throughout central Appalachia to build cross sector bridges and to help further a positive growth in the region’s economy. Through the fellowship people are working with different models of transition, including value chains, worker owner cooperatives, local food initiatives, policy making, etc. In this session we will be breaking out into different groups each led by one or two fellows to talk about various ways these different models could be beneficial in different communities in Appalachia. There is value in working not only across county and state lines, but also working across economic sector boundaries. This is a workshop to understand the different models being used and to further discuss how to growth between these models for a more diverse and stronger Appalachian economy

Higher media multi-tasking activity is associated with smaller gray-matter density in the anterior cingulate cortex

Media multitasking, or the concurrent consumption of multiple media forms, is increasingly prevalent in today’s society and has been associated with negative psychosocial and cognitive impacts. Individuals who engage in heavier media-multitasking are found to perform worse on cognitive control tasks and exhibit more socio-emotional difficulties. However, the neural processes associated with media multi-tasking remain unexplored. The present study investigated relationships between media multitasking activity and brain structure. Research has demonstrated that brain structure can be altered upon prolonged exposure to novel environments and experience. Thus, we expected differential engagements in media multitasking to correlate with brain structure variability. This was confirmed via Voxel-Based Morphometry (VBM) analyses: Individuals with higher Media Multitasking Index (MMI) scores had smaller gray matter density in the anterior cingulate cortex (ACC). Functional connectivity between this ACC region and the precuneus was negatively associated with MMI. Our findings suggest a possible structural correlate for the observed decreased cognitive control performance and socio-emotional regulation in heavy media-multitaskers. While the cross-sectional nature of our study does not allow us to specify the direction of causality, our results brought to light novel associations between individual media multitasking behaviors and ACC structure differences