Suicide Prevention Among High School Students: Evaluation of a Nonrandomized Trial of a Multi-stage Suicide Screening Program

Background

Suicide is a leading cause of death among youth. Suicide screening programs aim to identify mental health issues and prevent death by suicide.

Objective

The present study evaluated outcomes of a multi-stage screening program implemented over 3 school years in a moderately-sized Midwestern high school.

Methods

One hundred ninety-three 9th-grade students were screened in the program. Students who screened positive were referred to mental health services and followed. Suicide-related thoughts and behaviors among 9th-grade students in the school with screening were compared to those of students in a similar school without screening.

Results

There was a significant increase in utilization of mental health services among students who screened positive and a decrease in rates of suicidal ideation and attempts among 9th-grade students at the school with screening.

Conclusions

This multi-stage screening program shows promise in addressing suicide-related behaviors in schools. Randomized trials are needed to confirm program efficacy.

     

Paths to improving engagement among racial and ethnic minorities in addiction health services

Background

Members of racial and ethnic minority groups are most likely to experience limited access and poor engagement in addiction treatment. Research has been limited on the role of program capacity and delivery of comprehensive care in improving access and retention among minorities with drug abuse issues. The goal of this study was to examine the extent to which access and retention are enhanced when racial and ethnic minorities receive care from high-capacity addiction health services (AHS) programs and via coordination with mental health and receipt of HIV testing services.

Methods

This multilevel cross-sectional analysis involved data from 108 programs merged with client data from 2011 for 13,478 adults entering AHS. Multilevel negative binomial regression models were used to test interactions and indirect relationships between program capacity and days to enter treatment (wait time) and days in treatment (retention).

Results

Compared to low-capacity programs and non-Latino and non-African American clients, Latinos and African Americans served in high-capacity programs reported shorter wait times to admission, as hypothesized. African Americans also had longer treatment retention in high-capacity programs. Receipt of HIV testing and program coordination of mental health services played an indirect role in the relationship between program capacity and wait time.

Conclusions

Program capacity and coordinated services in AHS may reduce disparities in access to care. Implications for supporting low-capacity programs to eliminate the disparity gap in access to care are discussed.

     

A Multilevel Model to Examine Adolescent Outcomes in Outdoor Behavioral Healthcare: The Parent Perspective

Background

Outdoor Behavioral Healthcare (OBH) has arisen to fill a gap in mental health treatment. While research shows large positive changes in adolescent self-reports, little is known about predictors of change, longitudinal outcomes, and parent-reports of change.

Objective

This study sought to identify treatment outcomes up to 18 months post-discharge and predictors of change for parents of adolescent clients in OBH treatment.

Methods

Parents of 659 adolescents from four OBH programs were invited to complete questionnaires at intake, discharge, and 6 and 18 months post-discharge. A regression was conducted to examine change during treatment, and a multilevel model to examine trajectories of change post-treatment.

Results

OBH participants entered treatment with clinically significant levels of emotional and behavioral dysfunction, made significant change during the program, and discharged within the “normal” range of functioning. Post-discharge scores indicated that clients remained in the “normal” range of functioning 6 and 18 months post-discharge. The regression analysis found that parent intake scores and attachment disorders were predictive of in-treatment change. The MLM found that parent perceptions of treatment gains and adoption status were significant predictors of functioning post-discharge.

Conclusions

Results are in-line with previous research suggesting that OBH may be helpful to adolescents experiencing a wide range of presenting problems, and adds new insights as well. Parent-reports parallel the dramatic changes in adolescent self-reports documented throughout OBH literature; data up to 18 months post-treatment shows healthy functioning per the parent perspective; and adoption and attachment appear to play a role in outcome trajectories.

     

Increasing Youth Engagement in Residential Group Care: A Mixed Methods Pilot Study of a Youth-Guided Incentive Program

Background

Lack of engagement in child welfare services is a salient issue impeding client outcomes. Research findings indicate that providing incentives may be a promising strategy for enhancing client engagement.

Objective

In response to low youth engagement and repeated re-entry into care, a Southeastern child welfare agency developed an incentive program aimed at increasing youths’ participation and success in meeting treatment goals. This mixed methods study examined elements of effective implementation and the effectiveness of the incentive program piloted in a group home serving adolescent boys (n?=?16).

Method

A semi-structured focus group with service providers (n?=?7) was used to inform the development of the pilot incentive program. We used a time-series design to measure youth perceptions of the therapeutic alliance with their therapists and weekly goal attainment. Baseline data was collected for 6 weeks (phase one) followed by 6 weeks of the incentive program (phase two).

Results

Results of qualitative analyses revealed four themes related to therapeutic engagement, and two themes related to intervention implementation. Providers emphasized the importance of youth-driven care and building a strong therapeutic alliance. Findings also suggest that staff buy-in is critical to the success of intervention implementation. These results, along with suggested strategies for effective implementation, informed the development of the piloted incentive program. Results of simulation modeling analyses of time series data showed significant increases in therapeutic alliances and goal attainment following the incentive program.

Conclusions

This study provides preliminary support for the use of incentive programs to facilitate youth engagement in residential programs.

     

Homeless Adolescents’ Perceptions of Positive Development: A Comparative Study

Background

While some recent research has addressed homeless youth from a strengths-based approach, comparative studies of homeless and non-homeless youth from a strengths perspective are few; research that includes youth’s views on positive youth development are also limited.

Objective

Addressing these gaps and using an inductive approach, adolescents’ views on positive development and their strengths were solicited. This study investigated the qualitative differences in views on doing well, strengths and positive development from two youth samples: youth who were homeless and resident youth involved in a 4-H program.

Methods

Thirty-eight adolescents participated in focus groups, including five groups from a homeless shelter and five groups from a 4-H program. Content analysis of the narrative responses was conducted.

Results

Differences between homeless and 4-H adolescents were found in the areas of happiness, family support, identity, personal strengths, and risk avoidance. Homeless youth revealed adaptation to limiting ecologies (e.g., non-supportive parents) as they sought out other supportive relationships instead and adjusted their views of happiness. Homeless adolescents demonstrated more internal self-awareness compared to 4-H adolescents.

Conclusions

By recognizing and capitalizing on the unique perspectives and strengths of adolescents from divergent environments, positive youth development and strengths-based programs and theory can more effectively benefit youth from diverse backgrounds. Understanding youth’s views that have normative and non-normative experiences (i.e., non-homeless and homeless) helps further expand the boundaries of developmental models and address how to promote thriving in youth from various contexts.

     

Perceived benefits of the hepatitis C peer educators: a qualitative investigation

Background

Although opioid-dependent patients are disproportionately impacted by hepatitis C (HCV), many do not receive treatment. In addition to HCV treatment-access barriers, substance-using patients may be reluctant to pursue treatment because of wariness of the medical system, lack of knowledge, or stigma related to HCV treatment. Implementation of a formal peer education program is one model of reducing provider- and patient-level barriers to HCV treatment, by enhancing mutual trust and reducing stigma.

Methods

We used thematic qualitative analysis to explore how 30 HCV patients and peer educators perceived a HCV peer program within an established methadone maintenance program in the USA.

Results

Participants unanimously described the program as beneficial. Participants described the peer educators’ normalization and dispelling of myths and fears around HCV treatment, and their exemplification of HCV treatment success, and reductions in perceived stigma. Peer educators described personal benefits.

Conclusions

These findings indicate that HCV peer educators can enhance HCV treatment initiation and engagement within opioid substitution programs.

     

Completion rates and psychosocial intervention effectiveness in an Australian substance use therapeutic community

Background

Program attrition is a major problem in substance use treatment. It is not clear which client and treatment variables are related to successful completion. This study aimed to identify client variables associated with Therapeutic Community (TC) completion. A secondary aim was to investigate changes in entry and exit scores on psychosocial outcome measures.

Methods

Retrospective quantitative analysis of data collected from 193 Australian TC residents, over 3.5 years. Variables measured included: demographics; Depression, Anxiety, Stress Score (DASS-21) and World Health Organisation Quality of Life 8 questions (WHOQOL-8).

Results

Completion rates were 30.6%. High Money WHOQOL-8 scores, suggestive of minimal financial stressors, positively predicted completion. Multivariate analyses showed that negative predictors of completion were: amphetamine being primary substance of concern, aggression, high Relationship WHOQOL-8 scores, suggestive of positive relationships, and younger or older age. Those in the program demonstrated clinically significant psychological improvement and significant improvement in all quality of life scores over time. The degree of psychometric improvement was most pronounced in those who completed the course, with the exception of depression, stress, and money problems.

Conclusion

The findings provide an understanding of specific predictors of program completion which may help to identify high-risk clients and inform program improvement. Early attrition rates may be reduced by monitoring and supporting high-risk clients. Overall, psychometric improvement occurred amongst both completers and non-completers overtime but is most prominent amongst course completers, with the exception of depression, stress, and money problems. Future research could potentially focus on amphetamine users and shortened TC programs, focusing on acute psychosocial intervention.

     

Relationship Education for Youth in High School: Preliminary Evidence from a Non-controlled Study on Dating Behavior and Parent–Adolescent Relationships

Background

Relationship education (RE), often employed for adults, has become increasingly available for teenagers. However, non-romantic relationships are rarely assessed as a potential outcome domain influenced by RE.

Objective

Informed by life course theory and the ecological systems perspective, this study examines the influence of RE on both dating and parent–adolescent relationships, and the associations between such changes.

Methods

Using a one-sample, non-controlled design, we conducted repeated measures analysis of covariance, and hierarchical linear regression analyses to examine the influence of RE participation on 3658 ethnically diverse adolescents’ knowledge and use of healthy skills in their parent–adolescent and dating relationships and whether these changes are linked.

Results

Results indicate significant and positive influences on participants’ knowledge and use of healthy relationship skills in their parent–adolescent and dating relationships. Further, results indicate that change in the current dating relationship is associated with concurrent change in the parent–adolescent relationship.

Conclusion

The results of this study provide preliminary evidence for a spillover effect of relationship education efforts, which are traditionally focused on the youth dating relationships, to parent–adolescent relationship dynamics. Future research considering multiple domains of RE outcomes for youth is warranted and future RE development and implementation may consider integrating parents to maximize program outcomes.

     

Cost-effectiveness analysis of the diarrhea alleviation through zinc and oral rehydration therapy (DAZT) program in rural Gujarat India: an application of the net-benefit regression framework

Background

This study evaluates the cost-effectiveness of the DAZT program for scaling up treatment of acute child diarrhea in Gujarat India using a net-benefit regression framework.

Methods

Costs were calculated from societal and caregivers’ perspectives and effectiveness was assessed in terms of coverage of zinc and both zinc and Oral Rehydration Salt. Regression models were tested in simple linear regression, with a specified set of covariates, and with a specified set of covariates and interaction terms using linear regression with endogenous treatment effects was used as the reference case.

Results

The DAZT program was cost-effective with over 95% certainty above $5.50 and $7.50 per appropriately treated child in the unadjusted and adjusted models respectively, with specifications including interaction terms being cost-effective with 85–97% certainty.

Discussion

Findings from this study should be combined with other evidence when considering decisions to scale up programs such as the DAZT program to promote the use of ORS and zinc to treat child diarrhea.

     

Evaluation of a Life Skills Program to Prevent Adolescent Alcohol Use in Two European Countries: One-Year Follow-Up

Background

Life skills programs are effective tools to combat youth substance use. However there is a lack of studies concerning their effectiveness in Europe.

Objective

This study investigated the 1 year follow up effects and the program implementation of a life skills school-based intervention (IPSY: Information + Psychosocial Competence = Protection) aimed at preventing alcohol use, in German and Italian adolescents.

Methods

Participants were 1131 German (57 % intervention group, mean age 10.45 years, 54 % females), and 159 Italian adolescents (45 % intervention group, mean age 11.14 years, 50 % females). Using a quasi-experimental design, data were gathered before the intervention (t1), after (2–7 months later, t2), and 1 year after the post-test (t3), thus covering a time span of about 1.5 years. MANOVAs and ANOVAs with repeated measurements were performed.

Results

IPSY was well accepted in both the German and Italian schools. German and Italian youth who participated in the program decreased their consumption of wine. German youth who participated in the IPSY-program decreased their expected alcohol consumption and increased their knowledge of assertive behaviors, school involvement, and resistance to peer pressure, compared to the control group. Italian youth in the intervention group also increased in assertive behaviors and the perception of being appreciated by others, relative to the control group. In both countries, beer consumption, communication skills and problem solving were not affected.

Conclusions

Our study suggests that life skills-based programs may be a useful tool in the prevention of risk behaviors in adolescence in a broader European context.

     

Pharmacotherapy Adherence for Pediatric Anxiety Disorders: Predictors and Relation to Child Outcomes

Background

Pharmacotherapy is considered an evidenced-based treatment for anxious youth. There is a need to better understand the relation between medication adherence and child outcomes.

Objective

This study prospectively examined: (1) baseline predictors of adherence and (2) the relation between medication adherence and clinical outcomes in children and adolescents with anxiety disorders.

Method

Participants were 349 youth randomized to sertraline, pill placebo, or sertraline plus cognitive behavioral therapy in the Child/Adolescent Anxiety Multimodal Study and followed over 12 weeks. The measure of pharmacotherapy adherence used was pharmacotherapist (PT) ratings of adherence at each session. Four domains of baseline predictors were examined (demographics, child clinical variables, family/parent variables, and treatment variables).

Results

Multiple regression analyses revealed few significant predictors of adherence. The most robust predictors of greater adherence were living with two parents and parents’ positive expectations that medication would lead to better outcomes. PTs ratings of higher adherence predicted higher global functioning at post treatment and treatment responder status.

Conclusions

In order to increase adherence, improving expectations and instilling hope for positive outcomes and problem solving ways to overcome pragmatic barriers associated with single parent families is recommended.

ClinicalTrials.gov Number

NCT00052078.

     

Impact of Home-Delivered Meals on Nutrition Status and Nutrient Intake among Older Adults in Central Texas

Objective

This study aimed to measure changes in nutrition risk and nutrient intake after older adults received home-delivered meals (HDM) for 3 months.

Design

This study used a pre-posttest study design, with data collected before and after 3 months of HDM services.

Setting

Two HDM programs that serve the metropolitan areas of Austin and San Antonio, Texas.

Participants

Study participants were aged 60 years or older, without dementia or terminal illness, and receiving HDM in Austin, Texas and San Antonio, Texas for 3 months.

Measurements

The Nutrition Screening Initiative (NSI) and Mini Nutrition Assessment-Short Form (MNA-SF) were used to assess nutritional risk. The National Cancer Institute Diet History Questionnaire II (DHQ II) was used to assess nutrient intake over the past month.

Results

After receiving 3 months of HDM, nutrition status significantly improved as measured by the NSI and MNA-SF. More participants met or exceeded the recommended dietary allowances (RDA) for magnesium and zinc after receiving HDM compared to before receiving HDM. Dietary supplement intake was associated with a higher nutritional risk.

Conclusion

Improvements in nutrition status were found after 3 months of receiving HDM, whereas intake of most nutrients did not change significantly. Results of this study provide further evidence that HDM can reduce nutritional risk of older adults, and may inform HDM programs on the differences of NSI and/or MNA-SF to assess nutritional risk of clients.

     

Promotive Factors and Psychosocial Adjustment Among Urban Youth

Background

Urban youth are often exposed to compounded risk factors which make them more vulnerable to negative outcomes. Research examining promotive factors which may reduce vulnerabilities to poor psychosocial adjustment among this population is limited.

Objective

The current study addresses this limitation by examining the impact of self-efficacy and positive expectations about the future, as promotive factors, on levels of depressive and anxious symptomatology, sense of belonging, and friendship among a sample of urban youth.

Methods

Data are from 1202 4th and 5th grade students enrolled at 27 elementary schools in a high poverty, high minority school district in the Southeastern United States.

Results

Using ordinary least squares regression, analyses reveal that promotive factors are significant predictors of psychosocial adjustment and thus have implications for improving negative outcomes among urban minority youth.

Conclusions

The findings suggests that interventions aimed at increasing self-efficacy and positive expectations about the future may reduce child and adolescent vulnerability to negative outcomes associated with poor psychosocial adjustment.

     

Effect of a 6-month brisk walking program on walking endurance in sedentary and physically deconditioned women aged 60 or older: A randomized trial

Background

Walking endurance is a predictor of healthy ageing.

Objective

To examine if a 6-month brisk walking program can increase walking endurance in sedentary and physically deconditioned older women.

Trial design

Randomized controlled trial.

Setting

Women recruited from public meetings aimed at promoting physical activity in women aged 60 or older.

Subjects

121 women aged 65.7 ± 4.3 years, with sedentary lifestyle (Physical Activity Questionnaire for the Elderly score < 9.4), and a 6-minute walking distance (6MWD) below normal value based on their gender, age, and body weight, and weight.

Methods

Women were randomly assigned to a 150 min/week brisk walking program (two supervised sessions and one session on their own per week) for six months (exercisers) (n=61) or a control group with physical activity allowed freely (n=60).

Outcome

The primary outcome was relative change in 6MWD.

Results

54/61 exercisers and 55/60 control subjects completed the program and data analysis was possible for 51 exercisers and 47 controls. At baseline, 6MWD was on average 23.1% and 22.5% below age-matched norms in exercisers and controls, respectively. Attendance rate for supervised sessions was 92% in exercisers. The 6MWD increased more significantly in exercisers than in controls (mean increase of 41.5% vs 11.0 %; p<0.0001). Over the 6-month program, 38 exercisers (74.5%) vs 5 controls (10.6%) had a 6MWD over the age-matched norm (p<0.0001). Exercisers with the highest tertile of 6MWD improvement (>46%) were those with baseline lowest values of 6MWD (p=0.001) and highest values of body mass index (BMI) (p<0.01).

Conclusion

Present results support recommendation that brisk walking programs should be encouraged to improve walking endurance in physically deconditioned women aged 60 or older, especially in those with high BMI.

     

Adverse Childhood Experiences,Coping Resources,and Mental Health Problems among Court-Involved Youth

Background

Mental health problems are gaining attention among court-involved youth with emphasis on the role of childhood adversity, but assessment lags.

Objective

The present study uses a commonly delivered assessment tool to examine mental health problems (current mental health problem, mental health interfered with probation goals, and suicide ideation) as a function of an expanded set of adverse childhood experiences (ACEs; childhood maltreatment, family dysfunction, and social disadvantage). Adaptive coping resources–impulse control, aspirations, and social support–were tested as both direct contributors and moderators of the influence of ACEs on mental health.

Methods

Using a diverse sample of youth on probation (N = 5378), this study utilized logistic regression models to test contributions of the three domains of childhood adversity–childhood maltreatment, family dysfunction, and social disadvantage. These models also examined the moderating roles of coping resources.

Results

Childhood maltreatment emerged as the strongest contributor to mental health problems, with significant moderation from social support. Youth aspirations were inversely related to mental health problems and moderated the relation with ACEs and mental health problems that interfered with probation.

Conclusions

Assessment and mitigation of the detrimental effects of childhood maltreatment are important considerations in the intervention programs that target mental health outcomes of court-involved youth. Intervention programs to prevent recidivism and improve mental health should improve impulse control and aspirations.

     

The contributions and future direction of Program Science in HIV/STI prevention

Background

Program Science is an iterative, multi-phase research and program framework where programs drive the scientific inquiry, and both program and science are aligned towards a collective goal of improving population health.

Discussion

To achieve this, Program Science involves the systematic application of theoretical and empirical knowledge to optimize the scale, quality and impact of public health programs. Program Science tools and approaches developed for strategic planning, program implementation, and program management and evaluation have been incorporated into HIV and sexually transmitted infection prevention programs in Kenya, Nigeria, India, and the United States.

Conclusion

In this paper, we highlight key scientific contributions that emerged from the growing application of Program Science in the field of HIV and STI prevention, and conclude by proposing future directions for Program Science.

     

Individually tailored dietary counseling among old home care clients - Effects on nutritional status

Objective

To evaluate the effect of individually tailored dietary counseling on nutritional status among home care clients aged 75 years or older.

Design

Non-randomised controlled study.

Setting and participants

The study sample consisted of 224 home care clients (≥ 75 years) (intervention group, n = 127; control group, n = 100) who were at protein-energy malnutrition (PEM) or risk of PEM (MNA score <24 and plasma albumin <35 g/L).

Intervention

Individually tailored dietary counseling; the persons were instructed to increase their food intake with energy-dense food items, the number of meals they ate and their consumption of energy-, protein- and nutrient-rich snacks for six months.

Measurements

The Mini Nutritional Assessment (MNA), Body Mass Index (BMI) and plasma albumin were used to determine nutritional status at the baseline and after the six-month intervention.

Results

The mean age of the home care clients was 84.3 (SD 5.5) in the intervention group and 84.4 (SD 5.3) in the control group, and 70 percent were women in both groups. After the six-month nutritional intervention, the MNA score increased 2.3 points and plasma albumin 1.6 g/L in the intervention group, against MNA score decreased -0.2 points and plasma albumin -0.1 g/L in the control group.

Conclusions

Individually tailored dietary counseling may improve nutritional status among older home care clients.

     

Measuring Educational Outcomes for At-Risk Children and Youth: Issues with the Validity of Self-Reported Data

Background

Youth programs often rely on self-reported data without clear evidence as to the accuracy of these reports. Although the validity of self-reporting has been confirmed among some high school and college age students, one area that is absent from extant literature is a serious investigation among younger children. Moreover, there is theoretical evidence suggesting limited generalizability in extending findings on older students to younger populations.

Objective

The purpose of this study is to examine the validity of academic and attendance self-reporting among children and youth.

Method

This study relies on original data collected from 288 children and youth using Big Brothers Big Sisters enrollment and assessment data, paired with school-records from two local school divisions. Initially, we utilized percent agreement, validity coefficients, and average measures ICC scores to assess the response validity of self-reported academic and attendance measures. We then estimated the affects of several moderating factors on reporting agreement (using standardized difference scores). We also accounted for cross-informant associations with child reported GPA using a moderated multiple regression model.

Results

Findings indicate that children and youth report their individual grades and attendance poorly. Particularly, younger and lower performing children are more likely to report falsely. However, there is some evidence that a mean construct measure of major subjects GPA is a slightly more valid indicator of academic achievement.

Conclusion

Findings suggest that researchers and practitioners should exercise caution in using self-reported grades and attendance indicators from young and low-performing students.

     

Media Managing Mood: A Look at the Possible Effects of Violent Media on Affect

Background

The potential impact of violent media on children’s emotional well-being has been a source of controversy for several decades. To date evidence for a negative impact of violent media on emotional well-being has been mixed and increasingly connected to a “replication crisis” throughout psychological science.

Objective

The current study examines concurrent and prospective relationships between violent media use and symptoms of depression and anxiety in a sample of 536 mostly Hispanic youth (309 males, age range 10–14).

Methods

Youth and parents were surveyed regarding social environment, media use and mental health. 302 youth responded to a 1-year follow-up.

Results

Results indicated that neither violent television use nor violent video game use predicted anxiety or depression concurrently or depression prospectively with this sample.

Conclusions

The impact of media violence use on child mood symptoms appears to be minimal. Further research may wish to focus on particular at-risk groups.

     

Effects of an Afterschool Early Literacy Intervention on the Reading Skills of Children in Public Housing Communities

Background

Afterschool programs (ASPs) in the United States have been implemented in low income neighborhoods to enable at-risk youth to access educational support services to increase academic skills. However, mixed findings about the ASPs positively affecting academic performance suggests a need for additional evaluative studies.

Objective

The current study examines the effects of literacy training on the reading skills of kindergarten to third grade students who were enrolled in a community-based ASP in four public housing neighborhoods. Participants received structured literacy and reading training, individual tutoring, and a choice-based book distribution program.

Method

Assignment to treatment and comparison groups was based on residence in public housing neighborhoods. We implemented a quasi-experimental design to compare improvements in reading proficiency among ASP literacy program participants in four public housing neighborhoods and a comparable group of students residing in two other public housing neighborhoods without this ASP. Participants were enrolled in grades K to 3 (n = 543). The study lasted for 4 years, and an intent-to-treat approach was used to analyze outcomes.

Results

Mixed-effects models indicated that among a full sample and propensity-score matched sample, ASP participants demonstrated significantly better reading proficiency than comparison group participants over time.

Conclusions

Study findings provide preliminary evidence that it is possible to impact reading proficiency for very high-risk students in the early grades of elementary school. ASPs that target literacy among low-income students could play an important role in boosting student achievement, and therefore in narrowing the achievement gap as young people progress through school.