Strengths Model for Youth (SM-Y) Case Management: Initial Findings on Youth Outcomes.

Case management is a widely utilized service in both youth and adult outpatient community mental health settings. Despite its widespread use, previous findings suggest that youth case management often lacks empirically tested models or frameworks. This article presents the results of a pilot study that involved adapting the Strengths Model, an adult case management model, for the child and adolescent outpatient community mental health population. The newly adapted model, known as the Strengths Model for Youth (SM-Y), was implemented in an urban community mental health center across five different youth case management teams. To assess changes over time in youth receiving SM-Y case management, marginal maximum likelihood multilevel modeling with adaptive Gaussian quadrature methods was applied. The study focused on three domains: socialization, education, and hospitalization. Utilizing the logit link function and Bernoulli conditional distribution due to the binary nature of the outcome data, three individual trajectories were drawn for socialization, education, and hospitalization. Positive findings indicated increases in socialization and educational performance among children and adolescents.

Growing stronger together: Sharing a story of culturally responsive evaluation with indigenous families and communities.

BACKGROUND: Gaps exist in understanding how to create and conduct culturally responsive evaluations. This information is particularly critical when working with evidence-based programs and when involving populations that have and continue to experience oppression and trauma. OBJECTIVE: We share our story of developing and carrying out a culturally responsive evaluation of an EBP, Strengthening Families Program (SFP), with Indigenous families. PARTICIPANTS AND SETTING: A collective storytelling approach was used based on reflections from the evaluation team and key implementation staff. METHODS: We used a collective storytelling approach, organizing the content around six previously identified principles of Indigenous research (Tsosie et al., 2022). RESULTS: Emerging themes, supported by quotes throughout, illustrate the importance of organizing the integration of culture into the evaluation through the six principles of Indigenous research: respect, relationship, relevance, reciprocity, responsibility, and representation. CONCLUSION: Working toward a culturally responsive evaluation allowed for the creation of more meaningful connections with Indigenous community partners and families. It also acknowledged insights that partners and families bring to the work and encouraged multi-directional learning to occur between evaluators, partners, and families.

Growing stronger together: Implementing the Strengthening Families Program with Indigenous communities.

BACKGROUND: Child welfare agencies commonly seek to use evidence-based programs (EBPs) for their demonstrated results. Challenges remain in adapting programs to fit for Indigenous populations. We suggest that relationality holds promise as a guide in the implementation of EBPs with Indigenous families and children. OBJECTIVE: We provide the story of a culturally integrated implementation of the EBP, Strengthening Families Program (SFP), with Indigenous families. PARTICIPANTS AND SETTING: Insights from the staff who implemented SFP, project leadership and a community steering committee were brought together to create the collective implementation story. METHODS: A relational approach was used in thematic analysis with a focus on the three Rs - responsibility, respect, and reciprocity- that support Indigenous knowledge organization. RESULTS: Findings offer insight into cultural integrations in the implementation of SFP. The program centered Indigenous and community identities through meals, gifts, parenting practice examples and discussions tailored by each group of families and staff. Practices related to responsibility, respect and reciprocity each proved to be essential concepts in the relationship building among caregivers, children, SFP staff, project leadership, and community supporters that led to program success. CONCLUSION: Cultural integration created a space that reflected Indigenous knowledge relationality. It respected the uniqueness among groups of families who participated in the evidence-based SFP. Our story supports the importance of having Indigenous staff and group leaders to guide cultural integration in relationship with tribal communities.

A qualitative exploration of caregivers' experiences with the Attachment and Biobehavioral Catch-up (ABC) parenting program.

In the face of childhood adversity, services and interventions can improve a child's life trajectory by promoting healthy development, enhancing protective factors, and building resilience through stable and supportive relationships. One such service, a specific and highly researched home visiting intervention, Attachment and Biobehavioral Catch-up (ABC), is often provided to families through home visiting service programs. This qualitative descriptive study examines the experiences of caregivers (N = 18) who received ABC as part of a statewide early childhood initiative in one midwestern state. Participants provided insight into the context of their lives before and during the intervention. They described their perspectives of the utility of the program and its influence on their family's behaviors and interactions. Findings demonstrate that coaching support bolstered caregivers' confidence in effective strategies and guided them through caregiving challenges. Caregivers observed growth in their caregiving practices, their infants' and young children's social and emotional skills, and their dyadic caregiver-child relationships, demonstrating the benefits of participating in and completing the ABC intervention.

Ante las circunstancias adversas en la niñez, los servicios e intervenciones pueden mejorar la trayectoria de vida de un niño promoviendo un desarrollo saludable, mejorando los factores de protección y generando fortaleza a través de relaciones estables y de apoyo. Uno de tales servicios, una intervención específica de visita a casa, bien investigada, el Alcance de la Bio-Conducta de Afectividad (ABC), se les proporciona a menudo a familias a través de programas que prestan el servicio de visitas a casa. Este descriptivo estudio cualitativo examina las experiencias de quienes prestan el cuidado (N = 18) que recibieron el ABC como parte de una iniciativa estatal sobre la temprana niñez en un estado del medio oeste. Los participantes aportaron ideas en cuanto al contexto de sus vidas antes y durante la intervención. Describieron sus perspectivas acerca de la utilidad del programa y las influencias de este sobre los comportamientos e interacciones de sus familias. Los resultados demuestran que el apoyo de entrenamiento reforzó la confianza de quienes prestan el cuidado en estrategias eficaces y los guió a través de los retos en la prestación del cuidado. Los cuidadores notaron crecimiento en sus prácticas de prestación del cuidado, las habilidades sociales y emocionales de sus niños, así como en las relaciones diádicas entre cuidador y niño, lo cual demuestra los beneficios de participar y completar la intervención ABC.

Face à l'adversité de l'enfance, les services et les interventions peuvent améliorer la trajectoire de vie d'un enfant en promouvant un développement sain, en améliorant les facteurs de protection, et en construisant une résilience au travers de relations stables et favorables. Un de ces services, une intervention à domicile spécifiques et ayant fait l'objet de nombreuses recherches, le Rattrapage Biocomportemental d'Attachement (soit en anglais Attachment Biobehavioral Catchup ici abrégé ABC), est souvent offert aux familles au travers de programmes de visite à domicile. Cette étude descriptive qualitative examine les expériences de personnes prenant soin d'enfant (N = 18) qui ont reçu l'ABC parce qu'il fait partie d'une initiative d'enfance précoce dans un état, dans un état du centre des Etats-Unis d'Amérique. Les participant(2)s ont donné un aperçu du contexte de leurs vies avant et durant l'intervention. Ils ont décrit leurs perspectives quant à l'utilité du programme et son influence sur les comportements et les interactions de leur famille. Les résultats démontrent que le soutien d'un coach a renforcé leur confiance en des stratégies efficaces et les ont guidés au travers des défis qu'il y a à prendre soin d'un enfant. Les participant(e)s ont observé une croissance dans leurs pratiques de soin, dans les compétences sociales et émotionnelles des enfants et dans leur relation dyadique personne prenant soin de l'enfant-enfant, prouvant ainsi les bénéfices qu'il y a à participer et à terminer l'intervention ABC.

Evidence Based Practice in Systems of Care for Children with Complex Mental Health Needs.

Purpose: Community-based social work with families and youth with complex behavioral health needs highlights challenges to incorporating empirical evidence into routine practice. This article presents a framework for integrating evidence in community-based Systems of Care for these children and their families.Method: This article reviews research on various approaches to integrating evidence into children's behavioral health and community-based care and contextualizes it within dominant paradigms of Systems of Care (SoC) and Wraparound principles.Results: Based on this review, this article proposes the Evidence-Based Practice in Systems of Care (EBP in SoC) model. The model describes how to incorporate evidence into every aspect of community-based SoCs for children with mental health concerns.Discussion and Conclusion: Discussion of the model will focus on implications of using the framework for practitioners, mental health organizations, communities, and state and federal administration and policymaking.

A Regional Survey on Residents' Preferences on Patient-Centered Medical Home Design in Rural Areas.

OBJECTIVES: This study aims to explore the rural residents' preferences on various aspects of the patient-centered medical home (PCMH) model and the associated physical environment features. BACKGROUND: The PCMH model has gained popularity as an innovative care model that intends to improve patient experience and outcomes while reducing costs. Yet few studies focused on patients' perspective, even less considered the needs of the rural communities. METHOD: Using a convenience sample, an exploratory survey was completed by 362 rural residents in the Midwestern region. Survey items were designed to gather information on both rural residents' preferences for five key PCMH attributes (comprehensive, patient-centered, coordinated, accessible, and quality) and of the physical environment that supports these attributes. Analyses were arranged along these key attributes. RESULTS: Results indicated that residents' demographics affect their preferences for spatial features for PCMH. The three most important environmental factors for PCMH for the rural residents are the privacy, extra chairs in the exam room for family, and space that supports information sharing and communication among patient, family, and healthcare staff. Through structural equation modeling analysis, residents' preferences on comprehensive care, patient-centered care, coordinated care, quality, and safety have shown to affect their preference for the space features. The open-ended survey shows that rural residents are mostly satisfied with their current healthcare environment in terms of supporting patient-centered care, while other aspects still have room for future improvement. CONCLUSIONS: Overall, this exploratory study identified important attributes of the physical environment that can support PCMH from rural residents' perspective.

Viral Cre-LoxP tools aid genome engineering in mammalian cells.

BACKGROUND: Targeted nucleases have transformed genome editing technology, providing more efficient methods to make targeted changes in mammalian genome. In parallel, there is an increasing demand of Cre-LoxP technology for complex genome manipulation such as large deletion, addition, gene fusion and conditional removal of gene sequences at the target site. However, an efficient and easy-to-use Cre-recombinase delivery system remains lacking. RESULTS: We designed and constructed two sets of expression vectors for Cre-recombinase using two highly efficient viral systems, the integrative lentivirus and non-integrative adeno associated virus. We demonstrate the effectiveness of those methods in Cre-delivery into stably-engineered HEK293 cells harboring LoxP-floxed red fluorescent protein (RFP) and puromycin (Puro) resistant reporters. The delivered Cre recombinase effectively excised the floxed RFP-Puro either directly or conditionally, therefore validating the function of these molecular tools. Given the convenient options of two selections markers, these viral-based systems offer a robust and easy-to-use tool for advanced genome editing, expanding complicated genome engineering to a variety of cell types and conditions. CONCLUSIONS: We have developed and functionally validated two viral-based Cre-recombinase delivery systems for efficient genome manipulation in various mammalian cells. The ease of gene delivery with the built-in reporters and inducible element enables live cell monitoring, drug selection and temporal knockout, broadening applications of genome editing.

Predictors and moderators in the randomized trial of multifamily psychoeducational psychotherapy for childhood mood disorders.

This study investigated predictors and moderators of mood symptoms in the randomized controlled trial (RCT) of Multi-Family Psychoeducational Psychotherapy (MF-PEP) for childhood mood disorders. Based on predictors and moderators in RCTs of psychosocial interventions for adolescent mood disorders, we hypothesized that children's greater functional impairment would predict worse outcome, whereas children's stress/trauma history and parental expressed emotion and psychopathology would moderate outcome. Exploratory analyses examined other demographic, functioning, and diagnostic variables. Logistic regression and linear mixed effects modeling were used in this secondary analysis of the MF-PEP RCT of 165 children, ages 8 to 12, with mood disorders, a majority of whom were male (73%) and White, non-Hispanic (90%). Treatment nonresponse was significantly associated with higher baseline levels of global functioning (i.e., less impairment; Cohen's d = 0.51) and lower levels of stress/trauma history (d = 0.56) in children and Cluster B personality disorder symptoms in parents (d = 0.49). Regarding moderators, children with moderately impaired functioning who received MF-PEP had significantly decreased mood symptoms (t = 2.10, d = 0.33) compared with waitlist control. MF-PEP had the strongest effect on severely impaired children (t = 3.03, d = 0.47). Comprehensive assessment of demographic, youth, parent, and familial variables should precede intervention. Treatment of mood disorders in high-functioning youth without stress/trauma histories and with parents with elevated Cluster B symptoms may require extra therapeutic effort, whereas severely impaired children may benefit most from MF-PEP.

Theory meets practice: the localization of wraparound services for youth with serious emotional disturbance.

This study identified statewide variation in implementation of wraparound for children on the severe emotional disturbance (SED) Waiver in Kansas. SED Waivers allow Community Mental Health Centers (CMHC) to offer an array of community-based services to high risk youth. Qualitative methods, including interviews, reviews of charts and billing records, and a survey, were employed. Stratified random sampling was used to select seven CMHCs, and random sampling was used to select individual cases for interviews. Although CMHCs shared similar wraparound philosophy and service initiation processes, each developed their own localized wraparound model within the confines of Medicaid eligibility and documentation rules. Eight models for wraparound team composition were identified. Findings demonstrate implementation of wraparound with fidelity to a central model is difficult on a large scale. The balance of standardized wraparound practices, localized innovations, and agency compliance with Medicaid is essential for optimizing children's mental health services.

Effects of alpha particle radiation on gene expression in human pulmonary epithelial cells.

The general public receives approximately half of its exposure to natural radiation through alpha (α)-particles from radon ((222)Rn) gas and its decay progeny. Epidemiological studies have found a positive correlation between exposure to (222)Rn and lung carcinogenesis. An understanding of the transcriptional responses involved in these effects remains limited. In this study, genomic technology was employed to mine for subtle changes in gene expression that may be representative of an altered physiological state. Human lung epithelial cells were exposed to 0, 0.03, 0.3 and 0.9Gy of α-particle radiation. Microarray analysis was employed to determine transcript expression levels 4h and 24h after exposure. A total of 590 genes were shown to be differentially expressed in the α-particle radiated samples (false discovery rate (FDR)≤0.05). Sub-set of these transcripts were time-responsive, dose-responsive and both time- and dose-responsive. Pathway analysis showed functions related to cell cycle arrest, and DNA replication, recombination and repair (FDR≤0.05). The canonical pathways associated with these genes were in relation to pyrimidine metabolism, G2/M damage checkpoint regulation and p53 signaling (FDR≤0.05). Overall, this gene expression profile suggests that α-particle radiation inhibits DNA synthesis and subsequent mitosis, and causes cell cycle arrest.

Packaging HIV- or FIV-based lentivector expression constructs and transduction of VSV-G pseudotyped viral particles.

As with standard plasmid vectors, it is possible to transfect lentivectors in plasmid form into cells with low-to-medium efficiency to obtain transient expression of effectors. Packaging lentiviral expression constructs into pseudoviral particles, however, enables up to 100% transduction, even with difficult-to-transfect cells, such as primary, stem, and differentiated cells. Moreover, the lentiviral delivery does not produce the specific cellular responses typically associated with chemical transfections, such as cell death resulting from toxicity of the transfection reagent. When transduced into target cells, the lentiviral construct integrates into genomic DNA and provides stable expression of the small hairpin RNA (shRNA), cDNA, microRNA or reporter gene. Target cells stably expressing the effector molecule can be isolated using a selectable marker contained in the expression vector construct such as puromycin or GFP. After pseudoviral particles infect target cells, they cannot replicate within target cells because the viral structural genes are absent and the long terminal repeats (LTRs) are designed to be self-inactivating upon transduction. There are three main components necessary for efficient lentiviral packaging. 1. The lentiviral expression vector that contains some of the genetic elements required for packaging, stable integration of the viral expression construct into genomic DNA, and expression of the effector or reporter. 2. The lentiviral packaging plasmids that provide the proteins essential for transcription and packaging of an RNA copy of the expression construct into recombinant pseudoviral particles. This protocol uses the pPACK plasmids (SBI) that encode for gag, pol, and rev from the HIV or FIV genome and Vesicular Stomatitis Virus g protein (VSV-G) for the viral coat protein. 3. 293TN producer cells (derived from HEK293 cells) that express the SV40 large T antigen, which is required for high-titer lentiviral production and a neomycin resistance gene, useful for reselecting the cells for maintenance. An overview of the viral production protocol can be seen in Figure 1. Viral production starts by co-transfecting 293TN producer cells with the lentiviral expression vector and the packaging plasmids. Viral particles are secreted into the media. After 48-72 hours the cell culture media is harvested. Cellular debris is removed from the cell culture media, and the viral particles are precipitated by centrifugation with PEG-it for concentration. Produced lentiviral particles are then titered and can be used to transduce target cells. Details of viral titering are not included in this protocol, but can be found at: http://www.systembio.com/downloads/global_titer_kit_web_090710.pdf. This protocol has been optimized using the specific products indicated. Other reagents may be substituted, but the same results cannot be guaranteed.

Mental health service use by children with serious emotional and behavioral disturbance: results from the LAMS study.

OBJECTIVE: The study described service utilization among children with emotional and behavioral disorders making a first visit to outpatient mental health clinics in four Midwest cities. METHODS: Data were from the Longitudinal Assessment of Manic Symptoms study. A total of 707 youths aged six to 12 years 11 months and their parents completed diagnostic assessments; demographic information and mental health service use was self-reported. Analyses examined the relationship of demographic variables, diagnoses, impairment, and comorbidity with type and level of services utilized. RESULTS: Utilization was multimodal; half the youths had received outpatient and school services during their lifetime. Factors unrelated to need (age, sex, race, and insurance) were associated with service type. Children with a bipolar spectrum disorder had higher use of inpatient services than those with depressive or disruptive disorders and were more likely to currently use two or more services. More than half of youths with bipolar or depressive disorders had lifetime use of both medication and therapy, whereas youths with a disruptive behavior disorder were more likely to have used only therapy. Impairment and comorbidity were not related to service utilization. CONCLUSIONS: Use of services began at a very young age and occurred in multiple service sectors. Type of service used was related to insurance and race, underscoring the need for ongoing disparities research. Contrary to findings from administrative data analyses, use of medication alone was infrequent. The low rate of use of combination therapy suggests that clinicians and families need to be educated about the effectiveness of multimodal treatment.

Factors influencing service utilization and mood symptom severity in children with mood disorders: effects of multifamily psychoeducation groups (MFPGs).

This study investigated the impact of psychoeducation on service utilization and mood symptom severity in children with mood disorders. Parents' knowledge of mood disorders, beliefs about treatment, and perceptions of children's need for treatment were hypothesized to mediate the relationship between psychoeducation and service utilization and between psychoeducation and mood symptom severity. Linear mixed effects modeling and joint significance test for mediation were used in secondary data analyses of the multifamily psychoeducation group (MFPG) study, a randomized controlled trial of 165 children ages 8 to 12 years with mood disorders. A majority of those sampled were male (73%) and White, non-Hispanic (90%), and the median range of family income was $40,000-$59,000. Participation in MFPG significantly improved quality of services utilized, mediated by parents' beliefs about treatment. Participation in MFPG also significantly improved severity of child's mood symptoms, mediated by quality of services utilized. MFPG appears to be a psychoeducational intervention that helps parents to become better consumers of the mental health system who access higher quality services. Children's symptom severity decreases as a result.