Using policy codesign to achieve multi-sector alignment in adolescent behavioral health: a study protocol.

BACKGROUND: Policymaking is quickly gaining focus in the field of implementation science as a potential opportunity for aligning cross-sector systems and introducing incentives to promote population health, including substance use disorders (SUD) and their prevention in adolescents. Policymakers are seen as holding the necessary levers for realigning service infrastructure to more rapidly and effectively address adolescent behavioral health across the continuum of need (prevention through crisis care, mental health, and SUD) and in multiple locations (schools, primary care, community settings). The difficulty of aligning policy intent, policy design, and successful policy implementation is a well-known challenge in the broader public policy and public administration literature that also affects local behavioral health policymaking. This study will examine a blended approach of coproduction and codesign (i.e., Policy Codesign), iteratively developed over multiple years to address problems in policy formation that often lead to poor implementation outcomes. The current study evaluates this scalable approach using reproducible measures to grow the knowledge base in this field of study. METHODS: This is a single-arm, longitudinal, staggered implementation study to examine the acceptability and short-term impacts of Policy Codesign in resolving critical challenges in behavioral health policy formation. The aims are to (1) examine the acceptability, feasibility, and reach of Policy Codesign within two geographically distinct counties in Washington state, USA; (2) examine the impact of Policy Codesign on multisector policy development within these counties using social network analysis; and (3) assess the perceived replicability of Policy Codesign among leaders and other staff of policy-oriented state behavioral health intermediary organizations across the USA. DISCUSSION: This study will assess the feasibility of a specific approach to collaborative policy development, Policy Codesign, in two diverse regions. Results will inform a subsequent multi-state study measuring the impact and effectiveness of this approach for achieving multi-sector and evidence informed policy development in adolescent SUD prevention and treatment.

Strategies for enacting health policy codesign: a scoping review and direction for research.

BACKGROUND: Strategies for supporting evidence-informed health policy are a recognized but understudied area of policy dissemination and implementation science. Codesign describes a set of strategies potentially well suited to address the complexity presented by policy formation and implementation. We examine the health policy literature describing the use of codesign in initiatives intended to combine diverse sources of knowledge and evidence in policymaking. METHODS: The search included PubMed, MEDLINE, PsychInfo, CINAHL, Web of Science, and Google Scholar in November 2022 and included papers published between 1996 and 2022. Terms included codesign, health, policy, and system terminology. Title and abstracts were reviewed in duplicate and included if efforts informed policy or system-level decision-making. Extracted data followed scoping review guidelines for location, evaluation method, health focus, codesign definition, description, level of health system user input, sectors involved, and reported benefits and challenges. RESULTS: From 550 titles, 23 citations describing 32 policy codesign studies were included from multiple continents (Australia/New Zealand, 32%; UK/Europe, 32%; South America, 14%; Africa, 9%; USA/Canada 23%). Document type was primarily case study (77%). The area of health focus was widely distributed. Policy type was more commonly little p policy (47%), followed by big p policy (25%), and service innovations that included policy-enabled funding (25%). Models and frameworks originated from formal design (e.g., human-centered or participatory design (44%), political science (38%), or health service research (16%). Reported outcomes included community mobilization (50%), policy feasibility (41%), improved multisector alignment (31%), and introduction of novel ideas and critical thinking (47%). Studies engaging policy users in full decision-making roles self-reported higher levels of community mobilization and community needs than other types of engagement. DISCUSSION: Policy codesign is theoretically promising and is gaining interest among diverse health sectors for addressing the complexity of policy formation and implementation. The maturity of the science is just emerging. We observed trends in the association of codesign strategies and outcomes that suggests a research agenda in this area could provide practical insights for tailoring policy codesign to respond to local contextual factors including values, needs, and resources.

Formal youth mentoring relationships in the context of risk: What is the role of caregiver-mentor collaboration?

Most research on youth mentoring relationships has focused on the mentor-mentee dyad, yet caregivers play an important role in supporting these relationships. Drawing on a large, multisite sample of youth in formal mentoring programs (N = 2165), this study investigated associations between caregiver-mentor collaboration and mentoring relationship outcomes in the context of environmental and individual youth risk factors. Analysis of novel quantitative measures assessing caregivers' experiences of the mentoring relationships revealed two factors reflecting caregivers' collaboration with mentors (caregiver involvement and mentor backing), and three factors reflecting caregivers' perceptions of mentor effectiveness (meeting youth needs, advocating for youth, and supporting youth behavior). Results indicated that greater caregiver involvement was associated with higher-quality and longer-lasting mentoring relationships. Few associations between risk and mentoring relationships were observed; however, indirect effects indicated that youth environmental risk was positively associated with caregiver involvement, which, in turn, was positively associated with mentoring relationship outcomes.

Climate change anxiety and mental health: Environmental activism as buffer.

A growing body of research has documented the phenomenon of climate change anxiety (CCA), defined broadly as negative cognitive, emotional, and behavioral responses associated with concerns about climate change. A recently validated scale of CCA indicated two subscales: cognitive emotional impairment and functional impairment (Clayton & Karazsia, 2020). However, there are few empirical studies on CCA to date and little evidence regarding whether CCA is associated with psychiatric symptoms, including symptoms of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD), and whether engaging in individual and collective action to address climate change could buffer such relationships. This mixed methods study draws on data collected from a sample of emerging adult students (ages 18-35) in the United States (N = 284) to address these gaps. Results indicated that both CCA subscales were significantly associated with GAD symptoms, while only the Functional Impairment subscale was associated with higher MDD symptoms. Moreover, engaging in collective action, but not individual action, significantly attenuated the association between CCA cognitive emotional impairment and MDD symptoms. Responses to open-ended questions asking about participants' worries and actions related to climate change indicated the severity of their worries and, for some, a perception of the insignificance of their actions relative to the enormity of climate change. These results further the field's understanding of CCA, both in general and specifically among emerging adults, and suggest the importance of creating opportunities for collective action to build sense of agency in addressing climate change.

Adverse childhood experiences: Examining latent classes and associations with physical, psychological, and risk-related outcomes in adulthood.

BACKGROUND: Adverse childhood experiences (ACEs) are a public health crisis, affecting nearly half of children in the United States. Long-term effects of ACEs on psychological well-being, engagement in risk behaviors, and physical health have been observed. Moreover, many individuals exposed to ACEs are also affected by an accumulation of stressors due to broader structural inequities. OBJECTIVE: The current study examined heterogeneity in patterns of ACEs, explored how these patterns varied based on race/ethnicity, biological sex, and socioeconomic status, and assessed how ACE patterns were associated with physical health, mental health, and risk-related outcomes in adulthood. PARTICIPANTS: Drawing on the Add Health dataset, survey data from Waves I, III, IV (n = 12,288) were analyzed. Mean age of participants was 28.3 (SD = 1.9), more than half were female (54.4%), and a little less than half identified as youth of color (46.7%). METHOD: Multigroup latent class analysis explored heterogeneity in ACE exposure and variations based on structural inequities. Latent class regression assessed associations between ACE classes and outcomes. RESULTS: A four-class solution was identified. Class sizes and latent structures differed by biological sex. Among males and females, the low adversity class had more positive physical health, mental health, and risk-related outcomes compared to all classes, while the childhood maltreatment and high adversity/community violence classes engaged in more risk-related behaviors. Very small to medium effects were observed. CONCLUSION: Findings highlight the importance of examining heterogeneity in ACE exposure, and how patterns of ACEs may differentially affect outcomes in adulthood.

Knowledge of Chosen Family History and Depressive Symptoms in Sexual Minority Women.

Recent work on intergenerational memory has revealed a positive association between family of origin knowledge and wellbeing in adolescents. However, little is known about the generalizability of these data, as significantly less attention has focused on autobiographical memory sharing and wellbeing in historically marginalized communities. Given the high incidence of familial rejection and abandonment within the LGBTQIA + community, close relationships with individuals outside of one's family of origin, chosen families, often serve as an important source of social support. This study sought to examine the relationship between knowledge of a close non-family member and wellbeing among emerging adult sexual minority women (SMW) according to their gender presentation. A community sample from New York City comprised of heterosexual women (n = 50), masculine-presenting SMW (n = 50), and feminine presenting SMW (n = 50) completed measures associated with their knowledge of their family of origin, knowledge of a close non-family member, as well as self-reported measures of depression, emotion regulation, and socio-demographic questions. Family of origin knowledge was associated with lower levels of depression only among heterosexual women. However, heterosexual and SMW who knew more about their close non-family member reported lower levels of depression. Additionally, emotion regulation (cognitive reappraisals) mediated the relationship between knowing more about one's chosen family and lower depressive symptom severity among heterosexual women, but this relationship was only significant for SMW who were at least moderately open about their sexuality. These findings extend the literature on the benefits of memory sharing to historically marginalized communities by showing that memory sources outside of one's family of origin may be particularly important. Additionally, these data begin to shed light on potential mediating factors, such as emotion regulation and openness about one's sexual identity, that underlie the links between memory sharing and metrics of wellbeing. Taken together, in contexts in which there may not be opportunities to learn about family history from one's family of origin, it appears that access to stories from someone close outside of one's family is also associated with lower levels of depression.

Uncertainty in the Time of Corona: Precautionary Adherence, Fear, and Anxiety in New York City During the COVID-19 Pandemic.

ABSTRACT: The recent COVID-19 pandemic is having profound impacts on every sector of society, and New York City (NYC) emerged as an early epicenter of the disease. Given the novelty and scale of the disease, information surrounding COVID-19 has been marked by considerable uncertainty and confusion. Although various factors have been associated with COVID-19 distress, little is known about the relations between levels of intolerance of uncertainty (IU) and anxiety symptoms and behaviors. This cross-sectional study sought to examine potential correlates and pathways between anxiety and precautionary behaviors with the two levels of IU: prospective and inhibitory. Individuals from NYC (N = 99) completed an online survey through Amazon Mechanical Turk. Findings revealed that fear of COVID-19 accounts for associations between prospective IU and greater anxiety symptoms and behaviors, whereas precaution adherence accounts for associations between prospective IU and reduced anxiety symptoms and behaviors. In addition, precaution adherence accounts for associations between inhibitory IU and greater anxiety symptoms and behaviors. The results shed light on ways in which variations in IU may be associated with anxiety symptoms and behaviors in the context of COVID-19 and future pandemic scenarios.

Natural mentoring relationships among survivors of caregiver childhood abuse: findings from the Add Health Study.

Social support promotes resilience to adverse childhood events, but little is known about the role of natural mentors-caring, nonparental adults-in the lives of childhood abuse survivors. The current study draws from a large, longitudinal, nationally representative sample (Add Health) to examine the prevalence and characteristics of natural mentoring relationships for adolescents with a history of caregiver childhood abuse, and the extent to which these relationships are associated with psychological and health outcomes in adulthood. Among the sample (n = 12,270), 28.82% and 4.86% reported caregiver childhood physical and sexual abuse, respectively. Youth who reported caregiver childhood physical abuse were more likely than those who did not endorse abuse to report having a natural mentor, but their mentoring relationships were characterized by lower interpersonal closeness, shorter duration, and less frequent contact. Exposure to caregiver childhood abuse was associated with adverse outcomes during adulthood, including antisocial behavior, physical health limitations, and suicidality; the presence of a natural mentor did not buffer the negative impact of trauma on adult outcomes. However, longer mentoring relationships during adolescence buffered the strength of the association between both caregiver physical and sexual abuse during childhood and suicidality during early adulthood.

Heterogeneity in temporal self-appraisals following exposure to potentially traumatic life events: A latent profile analysis.

BACKGROUND: People tend to believe that they continuously improve over time. In fact, Temporal Self-Appraisal Theory ("Chump to Champ") has found that people are motivated to derogate their past selves in favor of their present selves. Studies on temporal self-appraisals following trauma is less clear, with some studies showing perceived improvement whereas other studies show appraisals of decline. METHOD: Utilizing Latent Profile Analysis (LPA), we tested for discrete patterns of temporal self-appraisals in undergraduate college students (N = 740) following trauma exposure. We then explored various trauma-related characteristics as predictors of profile membership. RESULTS: LPA revealed three distinct profiles of appraisal styles (Profile 1: optimistic, Profile 2: chump to champ, Profile 3: pessimistic). The optimistic profile was associated with lower levels of PTSD and depression symptoms, whereas the optimistic and chump to champ profiles were associated with greater trauma centrality. LIMITATIONS: Findings are limited in that this study utilized cross-sectional data from a sample of predominantly undergraduate females, thus conclusions regarding temporal relations among study constructs cannot be made and findings may not generalize to other populations. CONCLUSION: Temporal self-appraisals following trauma exposure may reflect prototypical patterns in which individual appraise adaptation to potentially traumatic stress and may confer risk for psychopathology. Such findings have implications for approaches to intervention with clinical and non-clinical populations following trauma exposure.

Connecting Youth: The Role of Mentoring Approach.

While formal youth mentoring can positively influence youth connectedness, little research has studied the specific approaches mentors engage in that support mentee social development. This study examines how mentors' specific approaches are uniquely associated with youth connection outcomes in formal community-based mentoring. Participants were 766 youth, ranging in age from 11 to 14 (M = 12.29), 56.7% female, and racially/ethnically diverse (41.0% Black/African American, 21.4% Hispanic/Latinx, 20.0% White, 10.2% Multiracial/Multiethnic, 5.9% Native American, 1.2% other race, and 0.4% Asian/Pacific Islander). Person-centered analyses revealed three mentoring profiles which were differentially associated with youth outcomes: "Status Quo Mentors," who reported low-to-moderate levels of closeness within the mentor-mentee dyad, low levels of connecting their mentees with programs and people in their community, and low levels of mediating for their mentees; "Close Connectors," who reported moderate-to-high levels of closeness, moderate-to-high levels of connecting, and low levels of mediating; and "Connector-Mediators," who reported moderate levels of closeness, connecting, and mediating. Youth mentored by "Close Connectors" demonstrated the greatest benefit, with significant improvements in parent-child relationship quality, extracurricular activity involvement, and help-seeking. Results suggest that community-based mentoring programs that emphasize connecting youth within their communities may be more effective in enhancing youth support networks.

Pain centrality mediates pain self-efficacy and symptom severity among individuals reporting chronic pain.

Chronic pain is consistently associated with the presence of mental health disorders. Although previous research has shown relations between low levels of self-efficacy with chronic pain severity as well as comorbid mental health symptoms, the link between self-efficacy and mental health symptoms in chronic pain is not well understood. This study examined whether pain centrality, the extent to which pain is viewed as central to self-identity, may underlie these associations. Individuals with a diagnosis of chronic pain (N = 89) recruited through MTurkcompleted self-report measures including demographics, self-efficacy, pain centrality, pain severity, depression, and anxiety. Pain severity was associated with higher levels of pain centrality, depression, anxiety, and lower levels of self-efficacy. Path analysis demonstrated pain centrality significantly mediated the relationship between self-efficacy and pain severity, depression, and anxiety. Future studies would benefit from testing whether modifying pain centrality beliefs shift perceptions of control as well as pain and psychological outcomes.

Posttraumatic stress symptoms and access to services among human rights advocates: The mediating roles of organizational encouragement of support seeking and occupation-related appraisals.

Human rights advocates are routinely exposed to direct and secondary trauma. In addition, a growing body of research has found that trauma exposure in human rights work is associated with depression, burnout, and posttraumatic stress disorder (PTSD) in human rights advocates. Despite the potential mental health risks associated with advocacy, little is known about the ways in which organizational and individual factors contribute to mental health symptoms, such as PTSD, in this population. Human rights advocates (N = 346) completed an online survey assessing access to psychological services, perceived organizational encouragement of support seeking, occupation-related appraisals, and symptoms of PTSD. Structural equation modeling revealed an indirect association between access to psychological services and lower levels of PTSD through perceived organizational encouragement of support seeking and less negative occupation-related appraisals. This study is the first to demonstrate that access to mental health support in human rights organizations may contribute to a reduction in PTSD symptoms when advocates feel a sense of efficacy and support from their organization to seek help. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Scalp recorded spike ripples predict seizure risk in childhood epilepsy better than spikes.

In the past decade, brief bursts of fast oscillations in the ripple range have been identified in the scalp EEG as a promising non-invasive biomarker for epilepsy. However, investigation and clinical application of this biomarker have been limited because standard approaches to identify these brief, low amplitude events are difficult, time consuming, and subjective. Recent studies have demonstrated that ripples co-occurring with epileptiform discharges ('spike ripple events') are easier to detect than ripples alone and have greater pathological significance. Here, we used objective techniques to quantify spike ripples and test whether this biomarker predicts seizure risk in childhood epilepsy. We evaluated spike ripples in scalp EEG recordings from a prospective cohort of children with a self-limited epilepsy syndrome, benign epilepsy with centrotemporal spikes, and healthy control children. We compared the rate of spike ripples between children with epilepsy and healthy controls, and between children with epilepsy during periods of active disease (active, within 1 year of seizure) and after a period of sustained seizure-freedom (seizure-free, >1 year without seizure), using semi-automated and automated detection techniques. Spike ripple rate was higher in subjects with active epilepsy compared to healthy controls (P = 0.0018) or subjects with epilepsy who were seizure-free ON or OFF medication (P = 0.0018). Among epilepsy subjects with spike ripples, each month seizure-free decreased the odds of a spike ripple by a factor of 0.66 [95% confidence interval (0.47, 0.91), P = 0.021]. Comparing the diagnostic accuracy of the presence of at least one spike ripple versus a classic spike event to identify group, we found comparable sensitivity and negative predictive value, but greater specificity and positive predictive value of spike ripples compared to spikes (P = 0.016 and P = 0.006, respectively). We found qualitatively consistent results using a fully automated spike ripple detector, including comparison with an automated spike detector. We conclude that scalp spike ripple events identify disease and track with seizure risk in this epilepsy population, using both semi-automated and fully automated detection methods, and that this biomarker outperforms analysis of spikes alone in categorizing seizure risk. These data provide evidence that spike ripples are a specific non-invasive biomarker for seizure risk in benign epilepsy with centrotemporal spikes and support future work to evaluate the utility of this biomarker to guide medication trials and tapers in these children and predict seizure risk in other at-risk populations.

"I'm Having a Little Struggle With This, Can You Help Me Out?": Examining Impacts and Processes of a Social Capital Intervention for First-Generation College Students.

Social capital plays a key role in college and career success, and research indicates that a dearth of on-campus connections contributes to challenges first-generation college students face in effectively navigating the college environment. This study investigates a novel intervention that focuses on the development of skills and attitudes to empower first-generation college students to cultivate social capital and on-campus connections during the transition to college. A mixed methods, explanatory design was used to evaluate impacts and processes of the intervention among first-generation college students (n = 164) in the context of an ethnically diverse, urban, public university in the Northeast. Results indicated that students who participated in the intervention demonstrated improved attitudes and behaviors around seeking support in college, closer relationships with instructors, and higher GPAs at the end of their first year in college. These results suggest the potential benefits of a relatively scalable approach to supporting the needs of first-generation college students.