Editorial: The Impact of Policy on Children's Mental Health: The Case of Immigration.

Most of the policy debates in the United States center around ideological and political beliefs. This is particularly the case in regard to immigration, specifically undocumented immigration, where there is much polarization of viewpoints. The focus of this debate is largely on the direct or material impact of such policies on reducing or accommodating immigration. These policies largely erect or lower legal or socioeconomic barriers for immigrants and as a consequence hope to impact decisions to pursue entry into the United States. Though immigration is technically a federal responsibility, many states have weighed in with state-level policies on both sides of the debate. This is not unusual for many areas of national policy where there are regional differences, which can set up comparative studies of policy analysis and impact.

Editors' Note: Third Annual Report Regarding JAACAP's Antiracist Journey.

In 2020, we wrote to you of our dedication and vision for JAACAP "to be antiracist at every level."1 Over the last 3 years, we have pursued initiatives "to reshape the Journal to pursue this vision."2,3 In this article, we provide an update on these goals and initiatives (Figure 1). With the launching of our new open access journal, JAACAP Open,4 in late 2022, we now extend these initiatives to both scientific journals in the JAACAP family and aspire to be a leader among mental health journals in our intentional pursuit of antiracist policies and practices.

Psychiatric medications prescribed on-campus and off-campus for university students: Differences in demographics, types of medication, and satisfaction with services.

Objective: To describe the use of psychiatric medication and related health service utilization among college students receiving care on- and off-campus. Participants and methods: 3959 students from a large southern university participated in the Healthy Minds Study in May 2018. Results: Of students surveyed, 17.6% took psychiatric medication in the last year. Of these students, 22.0% received prescriptions on-campus, 61.7% received prescriptions off-campus, 6.4% received them both on- and off-campus, and 9.9% took medication without a prescription. Nonwhite, international, and younger students were more likely to utilize on-campus rather than off-campus psychiatric medication services (p < .05). Satisfaction with health services did not differ by location. Conclusions: The majority of students received psychiatric prescriptions off- rather than on-campus. While satisfaction with both on- and off-campus health services is equally high, minority, international, and younger students are more likely to seek care on- rather than off-campus.

Cultural Factors in Disaster Response Among Diverse Children and Youth Around the World.

PURPOSE OF REVIEW: Disasters and traumatic events are ever present globally but disproportionally impact culturally diverse low resource environments. Culture is an important context through which people experience disasters, develop adaptive strategies, and process external aid and support. This is even more critical for children and youth who are in the process of forming their cultural/ethnic identities. This review identifies literature on these important aspects of culture in disaster response. RECENT FINDINGS: The literature supports that culture influences the experience of disasters, the development of coping and adaptational approaches, and the acceptability of external aid and support, especially mental health services. Cultural humility, awareness, and sensitivity are crucial in addressing the traumatic impact of disasters in children and youth, especially in the areas of the world that are most at risk for them.

Editorial: Dismantling Structural Racism in Children's Mental Health Services: How Do We Do It?

As our society becomes more sensitized to the reach and extent of structural racism embedded in our institutions, it is important that we do serious and intentional work to undo the harmful policies and practices resulting from this multicentury process. Structural racism is both endemic and epidemic in nature. As relates to children's mental health, there is literature that supports the presence of serious racial/ethnic disparities in both the quantity and quality of children' mental health services as a result of structural racism in our service system.1,2.

Trauma and US Minority Children and Youth.

PURPOSE OF REVIEW: This paper reviews the literature on the prevalence, risk factors, and effects of traumatic experiences on the mental health outcomes of minority youth in the USA. RECENT FINDINGS: The USA has an increasing number of children and youth from minority backgrounds. Research reveals that traumatic experiences disproportionately affect minority youth. These experiences include historical/generational trauma, immigration and acculturation stressors, natural and manmade disasters, experiences of discrimination, family violence, and community violence. The COVID-19 pandemic has also disproportionately affected minority youth resulting in illness and hospitalizations. Despite the higher incidence of trauma exposure, minority youth are less likely to access medical and mental health care. These disparities are resulting in increasing rates of depression, anxiety, post-traumatic stress, substance use disorders, and suicide in minority youth. Recognizing and understanding the impact of trauma is critical to the healthy development and successful functioning of minority youth, and to the success of our nation.

Editorial: Mental Health and Schools: Has the Time Arrived?

The focus of public discourse around schools over the past 2 decades in the United States has been around the response to or prevention of school shooting incidents. This often became a rallying cry to compensate for a recent history of tragic events (mass shootings and school shootings as a subset) that seem to have no end nor sufficient political will to pursue definitive deterrents.1 However, in recent months, we have faced a new experience around the role that schools have in promoting the mental health of our youths as a result of the COVID-19 pandemic. Schools all around the country were forced to shut down to prevent the spread of the virus, and students have had to rapidly shift to online learning from home, with at best parental assistance, isolated from their teachers, peers, and the familiar environment and structure of schools. Many have reported rising problems with myriad educational challenges, with students falling behind academically, struggling to learn through virtual environments or distance technologies, experiencing increasing frustration with learning, along with their parents, and increasing expressions of distress from social isolation and loneliness.2 These experiences have been associated with worsening and parallel mental health challenges, including worsening impact of attention-deficit/hyperactivity disorder (ADHD), worsening depressive and anxiety symptoms, children on the autism spectrum battling multiple changes, with rising youth psychiatric hospitalizations.3,4 The only children who have seemed to do better are those with social anxiety symptoms, who are temporarily protected from their daily stress triggers, but who will face them with a heightened vengeance once the pandemic is over.

Practice parameter for cultural competence in child and adolescent psychiatric practice.

The United States faces a rapidly changing demographic and cultural landscape, with its population becoming increasingly multiracial and multicultural. In consequence, cultural and racial factors relating to mental illness and emotional disturbances deserve closer attention and consideration. This Practice Parameter outlines clinical applications of the principle of cultural competence that will enable child and adolescent mental health clinicians to better serve diverse children, adolescents, and their families.

Culture and development in children and youth.

Although culture has long been recognized as having a significant impact on human development and its variations, many child and adolescent psychiatrists and mental health clinicians assume a universal nonvariance to normal development, with the risk of identifying variations as pathologic. This article reviews the conceptual basis for the role of culture in human development, particularly psychosocial and cognitive development, presents evidence and support from field observations of children in diverse cultures, and discusses the emerging evidence from the field of cultural neuroscience. Implications for these different perspectives on future research, childhood education, and even intercultural relations are presented.

Acculturation, development, and adaptation.

The rapidly changing demographic landscape of the United States, brought about by immigration, has resulted in an increasingly multiracial and multicultural population. These changes have become accentuated by the phenomenon of globalization, which occurs when there is an acceleration of movement of people, ideas, and products between nations, which also brings about an increase in the complexity of everyday problems. This article discusses the concept of identity formation and how the stresses of immigration and acculturation and the factors of resiliency and risk affect immigrant children, adolescents, and their families, so that clinicians treating these populations can be prepared to understand divergent, and often well-hidden, world views, which may cause intrafamilial conflicts and interfere with the child's developmental process.

Culturally informed child psychiatric practice.

Child and adolescent psychiatrists are already serving an increasing population of culturally and ethnically diverse patients and families in their practices and in different agency settings. This article discusses adaptations to practice that enable child and adolescent psychiatrists to address the diverse clinical and cultural needs of this emerging population. Special attention is given to work in psychotherapy and in agency settings where diverse children and youth are found in large numbers.

Racial and ethnic disparities in pediatric mental health.

Disparities remain in mental health status and care for racial and ethnic minority youth, despite national attention to disparity reduction. This article offers a comprehensive picture of the status of pediatric disparities, by addressing the major areas affecting minority youth mental health, including: prevention of problems, need for services, access to care, mental health treatment types, and treatment outcomes. The authors address relevant factors in the family, community and socioeconomic context, and describe various local and national programs that aim to tackle the obstacles and fill the gaps in high-quality care for racial/ethnic minority youth. The article concludes by offering recommendations for improvement that acknowledge the importance of understanding preferences and attitudes toward treatment, ensuring that screening and diagnosis is appropriate to minority youth, and ensuring that evidence-based programs are available at multiple levels to best service children and succeed in addressing their needs.

Leaving no children or families outside: the challenges of immigration.

This study addresses potentially stressful events that accompany the process of immigration for children and their families. Acculturation stress, combined with service disparities, may contribute to a higher risk for psychopathology among immigrant children and youth, as compared to their parents. Culturally informed, evidence-based treatment and preventive interventions that meet the mental health and cultural needs of immigrant children and families have the potential to minimize this higher risk of adverse mental health consequences.

Beyond point and level systems: moving toward child-centered programming.

Many residential treatment facilities and child inpatient units in the United States have been structured by way of motivational programming such as the point and/or level systems. On the surface, they appear to be a straightforward contingency management tool that is based on social learning theory and operant principles. In this article, the authors argue that the assumptions upon which point and level systems are based do not hold up to close empirical scrutiny or theoretical validity, and that point and level system programming is actually counterproductive with some children, and at times can precipitate dangerous clinical situations, such as seclusion and restraint. In this article, the authors critique point and level system programming and assert that continuing such programming is antithetical to individualized, culturally, and developmentally appropriate treatment, and the authors explore the resistance and barriers to changing traditional ways of "doing things." Finally, the authors describe a different approach to providing treatment that is based on a collaborative problem-solving approach and upon which other successful models of treatment have been based.

Effects of open-label atomoxetine on African-American and Caucasian pediatric outpatients with attention-deficit/hyperactivity disorder.

BACKGROUND: Data on the management of attention-deficit/hyperactivity disorder (ADHD) in African-American children and adolescents are limited. METHODS: This study sought to evaluate the tolerability, safety, and efficacy of atomoxetine hydrochloride in the management of ADHD in African-American children and adolescents by conducting a post hoc subgroup analysis of 2 multicenter, open-label studies. RESULTS: Atomoxetine was safe and well tolerated, with >or=3.0% of African-Americans and Caucasians discontinuing treatment because of adverse events. A significantly higher proportion of Caucasians reported >or=1 treatment-emergent adverse event, including vomiting (7.2% vs 1.2%; P=.037) and fatigue (6.1% vs 0%; P=.012). No serious safety concerns were observed. Changes from baseline in height, weight, and hemodynamic variables were modest and similar in both racial subgroups. African-Americans and Caucasians showed significant improvement from baseline to end point in the mean ADHD Rating Scale-IV-Parent Version: Investigator Administered and Scored (ADHDRS-IV-P:I). Scores decreased by 20.1 in African-Americans and by 19.55 in Caucasians, without significant between-group differences. Patients in both racial groups experienced similar, significant improvements in ADHDRS-IV-P:I inattention and hyperactivity-impulsivity symptoms, Clinical Global Impression-ADHD-Severity, and Conners' Parent Rating Scale-Revised: Short Form. CONCLUSIONS: Atomoxetine exhibited similar tolerability, safety, and efficacy profiles in African-Americans and Caucasians with ADHD.