Consideration of racism experiences in the implementation of trauma-focused therapy in primary care.

OBJECTIVE: To understand providers' perceptions of how a patient's experience of racism may impact the successful implementation of a brief posttraumatic stress disorder (PTSD) treatment in the safety net integrated primary care setting. To conduct a developmental formative evaluation prior to a hybrid type I effectiveness-implementation trial. DATA SOURCES AND STUDY SETTING: From October 2020 to January 2021, in-depth qualitative interviews were conducted with integrated primary care stakeholders (N = 27) at the largest safety net hospital in New England, where 82% of patients identify as racial or ethnic minorities. STUDY DESIGN: Interviews with clinical stakeholders were used to (a) contextualize current patient and provider experiences and responses to racism, (b) consider how racism may impact PTSD treatment implementation, (c) gather recommendations for potential augmentation to the proposed PTSD treatment (e.g., culturally responsive delivery, cultural adaptation), and (d) gather recommendations for how to shift the integrated primary care practice to an antiracist framework. DATA COLLECTION/EXTRACTION METHODS: Interview data were gathered using remote data collection methods (video conferencing). Participants were hospital employees, including psychologists, social workers, primary care physicians, community health workers, administrators, and operations managers. We used conventional content analysis. PRINCIPAL FINDINGS: Clinical stakeholders acknowledged the impact of racism, including racial stress and trauma, on patient engagement and noted the potential need to adapt PTSD treatments to enhance engagement. Clinical stakeholders also characterized the harms of racism on patients and providers and provided recommendations such as changes to staff training and hiring practices, examination of racist policies, and increases in support for providers of color. CONCLUSIONS: This study contextualizes providers' perceptions of racism in the integrated primary care practice and provides some suggestions for shifting to an antiracist framework. Our findings also highlight how racism in health care may be a PTSD treatment implementation barrier.

Editors' Best of 2022.

There is, in the content of the Journal, an embarrassment of riches, and picking a "best" seems to demand a certain qualification: is the "best" the most interesting, most surprising, most educational, most important, most provocative, most enjoyable? How to choose? We are hardly unbiased and can admit to a special affection for the ones that we and the authors worked hardest on, hammering version after version into shape. Acknowledging these biases, here are the 2022 articles that we think deserve your attention or at least a second read.

The Impact of COVID-19 on Anxiety Disorders in Youth: Coping with Stress, Worry, and Recovering from a Pandemic.

The primary objective of this article is to consider the impact of the coronavirus disease-19 pandemic on pediatric anxiety from both a clinical and system-of-care lens. This includes illustrating the impact of the pandemic on pediatric anxiety disorders and consideration of factors important for special populations, including children with disabilities and learning differences. We consider the clinical, educational, and public health implications for addressing mental health needs like anxiety disorders and how we might promote better outcomes, particularly for vulnerable children and youth.

Unpacking the Layers: Dismantling Inequities in Substance Use Services and Outcomes for Racially Minoritized Adolescents.

Minoritized youth have lower prevalence rates of substance use disorders (SUD) compared with White peers, but proportionally those that are diagnosed are less likely to engage in specialized care and there are few culturally responsive treatments or programs available. We examine social determinants of SUD, with emphasis on the impact of trauma, including racial trauma, and include an intersectional approach incorporating race, ethnicity, and gender. This review of the literature highlights evidence-based effective clinical practice as examples for the field in developing therapeutic approaches to SUD for this population.

Juvenile Justice, Technology and Family Separation: A Call to Prioritize Access to Family-Based Telehealth Treatment for Justice-Involved Adolescents' Mental Health and Well-Being.

Separating children from families has deleterious effects on children's mental health and well-being, which is highly relevant for youth in juvenile detention and other out-of-home residential placements. Despite growth in the evidence of family-based interventions in mitigating adverse behavioral health outcomes for justice involved adolescents (JIA), gaps remain in intervention dissemination for JIA; this particularly true for those leveraging digital health technologies, a need that has intensified with the COVID-19 pandemic. Use of digital health technologies for JIAs is pressing to address structural barriers in maintaining JIA-family connections, but also to improve treatment access for detained JIAs. Court systems' capacity to support use of digital health tools, such as telehealth, appear promising. Data on the use of tele-conferencing in U.S. juvenile and family courts were collected from 456 juvenile justice professionals as part of a larger study on judicial decision making. Results suggest overwhelming adoption of video-conferencing for court hearings with only 40% of respondents reporting family court use prior to the onset of COVID-19, but majority (91%) now reporting its routine use. Youth participate from a range of settings, including detention, other residential placement, community-based behavioral health and in-home settings. The COVID-19 pandemic has created a shift in the uptake of video-conferencing platforms that could hold promise for future larger scale use across the juvenile justice system. Findings underscore feasibility and acceptability of technology requirements in key settings that should be leveraged for broad scale implementation of empirically supported family-based interventions to advance behavioral health equity for JIA.

Opportunities to Integrate Mobile App-Based Interventions Into Mental Health and Substance Use Disorder Treatment Services in the Wake of COVID-19.

The COVID-19 pandemic has heightened concerns about the impact of depression, anxiety, alcohol, and drug use on public health. Mobile apps to address these problems were increasingly popular even before the pandemic, and may help reach people who otherwise have limited treatment access. In this review, we describe pandemic-related substance use and mental health problems, the growing evidence for mobile app efficacy, how health systems can integrate apps into patient care, and future research directions. If equity in access and effective implementation can be addressed, mobile apps are likely to play an important role in mental health and substance use disorder treatment.

Home-Based Telemental Health: A Proposed Privacy and Safety Protocol and Tool.

Objectives: To describe the development of a protocol and practical tool for the safe delivery of telemental health (TMH) services to the home. The COVID-19 pandemic forced providers to rapidly transition their outpatient practices to home-based TMH (HB-TMH) without existing protocols or tools to guide them. This experience underscored the need for a standardized privacy and safety tool as HB-TMH is expected to continue as a resource during future crises as well as to become a component of the routine mental health care landscape. Methods: The authors represent a subset of the Child and Adolescent Psychiatry Telemental Health Consortium. They met weekly through videoconferencing to review published safety standards of care, existing TMH guidelines for clinic-based and home-based services, and their own institutional protocols. They agreed on three domains foundational to the delivery of HB-TMH: environmental safety, clinical safety, and disposition planning. Through multiple iterations, they agreed upon a final Privacy and Safety Protocol for HB-TMH. The protocol was then operationalized into the Privacy and Safety Assessment Tool (PSA Tool) based on two keystone medical safety constructs: the World Health Organization (WHO) Surgical Safety Checklist/Time-Out and the Checklist Manifesto.Results: The PSA Tool comprised four modules: (1) Screening for Safety for HB-TMH; (2) Assessment for Safety During the HB-TMH Initial Visit; (3) End of the Initial Visit and Disposition Planning; and (4) the TMH Time-Out and Reassessment during subsequent visits. A sample workflow guides implementation. Conclusions: The Privacy and Safety Protocol and PSA Tool aim to prepare providers for the private and safe delivery of HB-TMH. Its modular format can be adapted to each site's resources. Going forward, the PSA Tool should help to facilitate the integration of HB-TMH into the routine mental health care landscape.

Rapid creation of child telemental health services during COVID-19 to promote continued care for underserved children and families.

The COVID-19 pandemic prompted the rapid transformation of child mental health services from mostly in-person to fully remote delivery at an urban safety-net hospital. No-show rates substantially declined when implementing video visits, and the volume of service delivery was unchanged compared to prepandemic in-person visits. In addition, no-show rates for telehealth sessions did not increase over time. Recommendations for telehealth quality assurance and improvement to best respond to children and families with existing mental health needs and limited resources during disasters and in their aftermath are suggested. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Transition of Academic Mental Health Clinics to Telehealth During the COVID-19 Pandemic.

OBJECTIVE: A consortium of 8 academic child and adolescent psychiatry programs in the United States and Canada examined their pivot from in-person, clinic-based services to home-based telehealth during the COVID-19 pandemic. The aims were to document the transition across diverse sites and to present recommendations for future telehealth service planning. METHOD: Consortium sites completed a Qualtrics survey assessing site characteristics, telehealth practices, service use, and barriers to and facilitators of telehealth service delivery prior to (pre) and during the early stages of (post) the COVID-19 pandemic. The design is descriptive. RESULTS: All sites pivoted from in-person services to home-based telehealth within 2 weeks. Some sites experienced delays in conducting new intakes, and most experienced delays establishing tele-group therapy. No-show rates and use of telephony versus videoconferencing varied by site. Changes in telehealth practices (eg, documentation requirements, safety protocols) and perceived barriers to telehealth service delivery (eg, regulatory limitations, inability to bill) occurred pre-/post-COVID-19. CONCLUSION: A rapid pivot from in-person services to home-based telehealth occurred at 8 diverse academic programs in the context of a global health crisis. To promote ongoing use of home-based telehealth during future crises and usual care, academic programs should continue documenting the successes and barriers to telehealth practice to promote equitable and sustainable telehealth service delivery in the future.

Structural Inequities and the Impact of COVID-19 on Latinx Children: Implications for Child and Adolescent Mental Health Practice.

In the United States, the Latinx community (Latinx is a gender-neutral term to describe any person of Latin American descent or heritage) is a heterogeneous population with diverse cultural origins, different migratory experiences, and different socioeconomic and educational realities. The disruptions to daily life and the associated stresses of the 2019 novel coronavirus disease (COVID-19) pandemic have been perhaps most acutely felt by Black and Latinx children from low-income families, including first-generation and undocumented immigrants.1 Structural inequities, such as the lack of employer-sponsored insurance in the service and retail industries; barriers to applying for public benefits, even for those who qualify; chronic poverty; and the lack of linguistically and culturally effective services have contributed to the disproportionate impact. In this article, the authors consider how structural inequities have rendered Latinx children particularly vulnerable to the devastating physical and psychological effects of the pandemic, identify risk and protective factors that are related to mental health outcomes, and recommend ways in which child and adolescent psychiatrists can respond to the escalating needs.

Inequity and the disproportionate impact of COVID-19 on communities of color in the United States: The need for a trauma-informed social justice response.

COVID-19 has had disproportionate contagion and fatality in Black, Latino, and Native American communities and among the poor in the United States. Toxic stress resulting from racial and social inequities have been magnified during the pandemic, with implications for poor physical and mental health and socioeconomic outcomes. It is imperative that our country focus and invest in addressing health inequities and work across sectors to build self-efficacy and long-term capacity within communities and systems of care serving the most disenfranchised, now and in the aftermath of the COVID-19 epidemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).