One Small Step at a Time: Implementing Continuous Quality Improvement in Child and Youth Mental Health Services

Continuous quality improvement (CQI) is increasingly being adopted by health care, including child and youth mental health services. As part of the commitment to ongoing quality improvement, child and youth mental health teams in the Fraser region in British Columbia undertook CQI projects over a one year period (2007–2008). The projects covered a range of domains and service features and staff gained experience in developing projects. Patience, management support and ongoing dialogue were key elements in the implementation of CQI. Three projects are highlighted to illustrate how teams developed their own unique projects and the outcomes.     

Adolescents' Willingness to Seek Psychological Help: Promoting and Preventing Factors

Although a relatively high percentage of Australian adolescents experience mental health problems, many disturbed adolescents do not receive the help they require, and only a small proportion of adolescents seek professional psychological help. The present study examined adolescents' willingness to seek help and investigated factors that promote and prevent adolescents from seeking help for a mental illness from both formal and informal sources. Secondary school students (254 in number) from schools in Brisbane, Australia completed a questionnaire that examined the relationship between demographic and psychological variables, attitudes toward mental illness, and willingness to seek help for a mental illness. Results suggest that adolescents with greater adaptive functioning, fewer perceived barriers to help seeking, and higher psychological distress were more willing to seek help from formal and informal sources for a mental illness. Greater social support also predicted willingness to seek help from informal sources. Although attitudes toward mental illness did not influence willingness to seek help, less stigmatising attitudes were related to higher knowledge of mental illness, being female, and higher levels of social support. Implications for the present study focus on enhancing the ability of mental health interventions to increase adolescents' willingness to seek psychological help.Received PhD from The University of Queensland     

Factors that Influence Mental Health Stigma Among 8th Grade Adolescents

Unmet mental health need is a significant problem for adolescents. Although stigma is identified as a major barrier to the use of mental health services among youth, there is limited research on this topic. In-depth interviews (n=57) among a sample of 8th grade students in a suburban, mid-Atlantic community portray adolescent mental health attitudes and how these views are shaped. Satisfactory personal experiences with mental health services as well as accurate mental health knowledge contribute to positive mental health attitudes among teens. The anticipation of negative responses towards mental health care-seeking from family members, peers, and school staff are key factors in teens’ comfort and willingness to address mental health concerns. The research provides critical information on the factors that contribute to the development of stigma and emphasizes the need to address stigma in youth mental health education, programs, and treatment plans. Authors are affiliated with the Johns Hopkins Bloomberg School of Public Health, Department of Population and Family Health Sciences. Dr. Chandra has a background in adolescent health, and is particularly interested in improving the accessibility and appropriateness of youth mental health services and involving young people in the translation of research into practice. Dr. Minkovitz is interested in improving preventive service delivery, enhancing quality of care, and understanding maternal factors that influence children’s receipt of health care     

De/valuing youth work: Revealing tensions in professional identity development while enhancing and applying mental health literacy

Thirteen preservice youth work students participated in learning experiences designed to enhance literacies in mental health. The aim of this grounded theory study was to explicate the process of mental health literacy enhancement and application to child and youth care practice. Sixty-two unique sources of data were used in analyses. Findings suggest that mental health literacies are intertwined with the process of developing a professional identity. In this article, the subcategory de/valuing youth work is explained and involves participants managing a confusing role, adopting a misfit stance, battling and building a seat at the interprofessional table, and valuing professional contributions. Implications for professional identity development, professionalization and mental health education are offered.     

Parental Cultural Affiliation and Youth Mental Health Service Use

Studies indicate that African American, Asian/Pacific Islander, and Latino youth have higher rates of unmet mental health needs and lower rates of mental health service utilization compared to non-Hispanic White youth, suggesting that obstacles may exist in the help-seeking and service utilization pathway for minority youth. Parental cultural factors may significantly impact youth service use, and acculturation is one way to measure adherence to culture specific values, beliefs, attitudes, and behaviors. In this study, parental acculturation level, conceptualized as cultural affinity to 1) mainstream American culture and 2) an alternative culture, were examined as potential mediators of the relationship between race/ethnicity and youth service use. The current subsample (n=1364) was drawn from the Patterns of Care study, a larger study of at-risk youth who were active to at least one of five public sectors of care. Our subsample included all youth aged 6–17 who were African American, Asian/Pacific Islander, Latino, or Non-Hispanic Whites (66.6% male). The results indicate that parental acculturation level as measured by affinity to an Alternative Culture was a partial mediator in the relationship between race/ethnicity and mental health service use for Asian/Pacific Islander and Latino youth. Doctoral student in the SDSU/UCSD Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 100, San Diego CA, graduate research assistant, Child and Adolescent Services Research Center, Children’s Hospital, San Diego, 3020 Children’s Way (MC 5033), San Diego, CA 92123 Assistant Professor of Psychology, San Diego State University; Assistant Adjunct Professor of Psychiatry, University of California, San Diego, Research Scientist, Child and Adolescent Services Research Center, San Diego, 3020 Children’s Way (MC 5033), San Diego, CA 92123 Research Scientist, Child and Adolescent Services Research Center, Children’s Hospital, San Diego, Assistant Professor of Psychology, University of San Diego; Adjunct Assistant Professor of Psychiatry, University of California, San Diego, 3020 Children’s Way (MC 5033), San Diego, CA 92123 Research Professor of Psychiatry and Family and Community Medicine at the University of New Mexico, Adjunct Professor of Psychiatry at the University of California, San Diego; Emeritus Professor of Sociology at San Diego State University; Senior Research Scientist at the Child and Adolescent Services Research Center, Children’s Hospital, San Diego, 3020 Children’s Way (MC 5033), San Diego, CA 92123     

Integrating a youth participation model in a youth mental health service: Challenges and lessons learned

Youth participation in mental health settings is fundamental to service design and delivery, and is beneficial for the young people involved as well as the organisation. This paper presents the findings of an evaluation of a youth participation model where tiered participation was attempted in a clinical youth mental health setting. To inform the ongoing development and improvement of a youth participation model, an evaluation was conducted consisting of three focus groups with the youth consultants, consultations with management about the implementation of the tiered participation model, and a review of records. The purpose of this evaluation was to identify possible barriers to implementation early on so these could be addressed and a youth participation model that meets the needs of all key stakeholders could be developed. The findings of this evaluation and the way in which these findings informed the model's development are discussed.     

青年流动人口教育健康效应及群体差异研究

在“健康中国”战略背景下,如何更充分地发挥青年流动人口的健康人力资本效用,值得关注。本研究基于2014年流动人口动态监测调查社会融合专题调查数据,采用Logistic回归和OLS回归方法,就受教育程度对青年流动人口不同健康指标的影响进行了分析。研究表明：青年流动人口受教育程度由初中向高中提升能够促进正向健康自评,但高等教育加剧了健康随时间推移而变差的感知;女性、农业户籍、80后青年流动人口的健康状况更明显地受到受教育程度的影响。研究建议：通过缩小城乡教育质量差距、加强多元化心理健康支持、提高流动人口社会融合水平等举措,提升青年流动人口的人力资本质量,促进青年流动人口全面发展。     

Overcoming Challenges to Using Evidence-Based Interventions in Schools

The Center for School Mental Health Assistance at the University of Maryland recently completed a review of evidence-based prevention and treatment programs that can be used by school mental health clinicians. Based on the review, a school-based program operating in 22 Baltimore City schools has purchased and trained clinicians in a number of protocols for evidence-based interventions. We present findings from this review and make pragmatic recommendations for school mental health programs to overcome the challenges associated with the use of evidence-based interventions.She received her doctorate in childclinical psychology from the University of Missouri-Columbia. Her research interests are in the area of the development, prevention, and treatment of juvenile delinquency and youth externalizing disorders.who does research in the area of childrens mental health services and the implementation of wraparound services in real-world settings.University of Maryland School of Medicine. His research is in the area of testing the effectiveness of School Mental Health Programs and the effects of community violence on youth mental health.involved in research related to school mental health, school-based health centers, and prevention of risky behavior among adolescents.Postdoctoral fellow at the time of the study.Postdoctoral fellow at the time of the study.     

Correlates of Externalizing Behavior Symptoms Among Youth Within Two Impoverished,Urban Communities

This study examines whether risk factors associated with child externalizing behavior symptoms differ between two similar low-income, urban communities, using baseline parent data of 154 African American youth (ages 9–15) participating in the Collaborative HIV-Prevention and Adolescent Mental Health Project (CHAMP) family program. Separate multiple regression analyses of each city sample indicated that greater child externalizing symptoms were associated with increasing parenting hassles for New York families (n = 46), but greater parent mental health symptoms for participants in Chicago (n = 108). Understanding such distinctions between communities is an important first step toward tailoring services to unique community needs.     

The relationship between physical activity and mental health among adolescents in six middle-income countries: A cross-sectional study

Physical inactivity and poor mental health are emerging worldwide youth problems. Using the Global School-based Health Survey, this secondary data analysis study examined the link between physical activity and adolescent mental health among 23,372 adolescents between 11 and 17 years of age in six middle-income countries. The authors assessed physical activity by participation in (a) exercise for 60 min and (b) walking/biking in any day of a week in the past 7 days. The authors assessed mental health by the presence of (a) loneliness, (b) anxiety, (c) depression, (d) suicidal ideation, and (e) suicide attempts in the past 12 months. There was a low prevalence of physical activity among the participants. In general, there was a low prevalence of 12-month mental health problems among adolescents. Further research may incorporate physical activity to promote positive youth mental health for possible cost-effective interventions.     

当前青年面临的压力及其应对方式

当前中国青年面临的压力主要有 :价值冲突压力、选择压力、就业和工作压力、学业压力等、婚恋压力以及人际关系压力等。在各种压力下 ,青年人的身心健康状况受到了不同程度的影响。青年人应采取适当的应对方式来平衡自己的心态 ,以应付所面临的各种压力     

Youth-Guided Youth Engagement: Participatory Action Research (PAR) With High-Risk,Marginalized Youth

Engaging youth who live with high-risk, marginalized conditions presents a significant challenge in our society, considering the prevalence of disconnect and distrust they often experience within their social environments/systems. Yet, meaningful youth engagement is a key concept not only for youth development, but also for a systems change to more effectively support high-risk youth and families. This article presents a framework of youth engagement developed over 9 months, using participatory action research (PAR) with 16 youth leaders in a community-based research team. Although this framework has incorporated the youth leaders’ lived experiences, talents, and voices, positive youth development (PYD) and social justice youth development (SJYD) have theoretically contextualized our research. Youth leaders guided the framework's development, including the identification of key themes/dimensions, definitions, and practical examples. The framework's three components—“Basis” (philosophy and principles), “What” (goals/outcomes), and “How” (actions/processes/pathways to change)—are supported by nine themes described in this article.     

Rationale and Strategies for Central Involvement of Educators in Effective School-Based Mental Health Programs

Unfortunately, for many mental health professionals classroom teachers and other educators are, at best, viewed primarily or solely as useful sources of information about a child, and their broader, invaluable roles as members of the mental health team are diminished or dismissed. This article examines the conceptual rationale and empirical support for central involvement of educators (especially classroom teachers) in effective mental health services, and in effective expanded school-based mental health programs. The importance of partnerships with educators for school-wide mental health promotion efforts, as well as for the success of primary and secondary prevention initiatives, are highlighted. Effective strategies and recommendations for enhancement of educator-mental health professional collaboration are included.     

Acculturation Strategies and Mental Health in Gay,Lesbian, and Bisexual Youth

In this article, we examine the impact of acculturation strategies on minority stress and mental health in lesbian, gay, or bisexual (LGB) youth in Flanders, Belgium. Building on previous identity minority studies and on the social stress model, we investigate how LGB youth acculturate within both the LGB subculture and mainstream society and how this correlates with their mental health. Our sample is taken from an online survey and represents 561 LGB youth aged 14 through 21. The four traditional acculturation strategies are represented in this population (integration, separation, marginalization, assimilation). Bisexual boys are mostly absent from separation and integration strategies; gay and lesbian youth in middle adolescence are significantly more represented in the separation strategy compared to their late adolescence counterparts. Further, our findings suggest the relevance of identification with the LGB community, especially for internalized negative attitudes toward homosexuality. LGB youth who identify with the LGB community score significantly lower on this internalized homonegativity.     

Homeless Youth Seeking Health and Life-Meaning Through Popular Culture and the Arts

This pilot study demonstrates the roles of popular culture, media and the arts in the health and self-esteem of homeless youth. Reflecting focus group findings from a representative sample of street and sheltered youth, this article provides a qualitative assessment of what they advocated as an effective intervention that would promote the receipt of health services within their vulnerable community. Unlike alienating disease models where adverse health behaviors and outcomes determine intervention success or failure, a culturally-sensitive approach which provided skills mentoring and engaged the youth as health advocates seemed likely to produce important recovery incentives and enhanced health outcomes.     

Substance Use Attitudes among Urban Black Adolescents: The Role of Parent,Peer, and Cultural Factors

This study examined the influence of perceived parental, peer, and cultural factors on Black American adolescent attitudes toward substance use. One-hundred-eight Black American youth (grades 9–12) from economically disadvantaged urban neighborhoods of New York, completed self-report measures on: (a) parent-child involvement, parental supervision, and parent attitudes toward high risk behaviors; (b) peer bonds and peer attitudes toward high risk behaviors; and (c) ethnic identity, parental racial socialization, and extended family support. Youth disapproval of substance use was positively associated with higher perceived levels of peer and parental disapproval of high risk behaviors, parental supervision, and ethnic identity. Youth who reported parental messages about racial discrimination without balanced parental messages about racial pride and racial equality were more likely to approve substance use. Assistant Professor in the Department of Preventive Medicine and Community Health, State University of New York Downstate Medical Center. Her research interests include socio-cultural factors in the prevention of youth substance use, sexual risk, and violence. Director, Center for Ethics Education and Marie Ward Doty Professor of Psychology at Fordham University. Current research interests include research ethics with vulnerable populations, including children and adolescents.     

Life Skill Service Needs: Perspectives of Homeless Youth

The present study describes the service needs related to life skill development from the perspective of sheltered homeless youth. Qualitative semistructured life narrative interviews addressing the use of services at an emergency shelter were administered to 30 youth. All youth were residig in an emergency shelter located in a large metropolitan area at the time of interview. Youth identified factors that influence their ability to access and utilize services, categorized as service availability, factors serving as access and/or barriers to services and lack of available services. Youth identify service delivery approaches and staff characteristics as impacting service delivery. Services such as counseling and childcare were identified as facilitating development and acquisition of life skills.     

Contextual Socioeconomic Status and Mental Health Counseling Use Among US Adolescents with Depression

Most adolescents with depressive disorders do not receive any mental health services, even though effective treatments exist. Although research has examined numerous individual-level factors associated with mental health service use among depressed adolescents, less is known about the role of contextual factors. This study examines the relationship between contextual-level socioeconomic status (SES) and clinic-based mental health counseling use among US adolescents with high depressive symptoms in urban and suburban areas. Data from the first two waves of the National Longitudinal Study of Adolescent Health (N = 1,133; 59 % female) were analyzed using multilevel logistic models in which adolescents were nested within counties. After controlling for individual-level predisposing, enabling, and need characteristics, as well as county racial/ethnic composition, county SES was positively associated with clinic-based counseling use among depressed youth. A one standard deviation increase in the county affluence index was associated with 43 % greater odds of receiving any clinical counseling services. Furthermore, the positive relationship between county affluence and clinical counseling use was no longer significant after controlling for the county supply of mental health specialist physicians. The results indicate that county residential context is a key correlate of mental health service use among depressed adolescents, such that those who live in lower SES counties with fewer mental health specialists are less likely to receive treatment.     

Examining Perceptions About Mental Health Care and Help-Seeking Among Rural African American Families of Adolescents

Rural African American children living in poverty have a higher prevalence rate of mental health disorders than their urban counterparts. While access to mental health services is lacking in resource scarce rural communities, African American rural residents may also be the most likely to confront significant barriers to care and help-seeking. Studies of mental health help-seeking behavior among rural families are rare, even rarer are studies of African Americans living in these areas. To address this gap, the current study examined perceptions about help-seeking for adolescents with mental health problems among rural African American families. Data were obtained from African American mothers in rural Georgia to assess their perceptions of the mental health service system, help-seeking processes, and service experiences. A mixed-method approach was implemented, integrating a quantitative survey (n = 163) with qualitative interviews (subsample n = 21). Most of the mothers expressed confidence in mental health care providers’ to help. Preferred sources of support, however, were family, church, and schools. Community stigma towards children with mental health problems and their families was a frequently endorsed perceived barrier to help-seeking. Although cultural mistrust was one of the two most frequently endorsed barriers in the survey, it did not emerge as a universal barrier to help-seeking for the mothers in this sample. Implications for research, policy, and practice include addressing family concerns about stigma, preferences for informal support and non-specialty services in addressing adolescents’ mental health problems, and building community resources to enable all youth to participate in community life.