Mixed-methods needs assessment for development of school-based mental health implementation science capacity in low- and middle-income countries: Vietnam as a case example.

Worldwide, the majority of youth reside in low- and middle-income countries (LMIC). School-based mental health (SBMH) services are particularly important in LMIC, in part because of LMIC's limited mental health infrastructure. Among the challenges to developing SBMH in LMIC are limited implementation science (IS) capacity, critical for identifying barriers to evidence-based intervention (EBI) use and dissemination, etc., specific to the local country context. A key step in IS capacity development is conducting a needs assessment, to identify barriers (and their solutions) to IS development itself within the local context. The present study conducted an IS needs assessment focused on SBMH in the Southeast Asian LMIC of Vietnam. Seventy-five Vietnamese mental health professionals in SBMH-related fields participated in a mixed-methods study. Vietnamese SBMH researchers and practitioners most likely to have experience and/or interest in IS were selected for study recruitment. Professionals' formal understanding of and experience with IS as a scientific field was highly limited. However, after reading a brief but detailed description of IS, participants' interest in IS training was high, and their mean rating of its potential utility for Vietnam to develop SBMH was 4.7 on a 1-5 scale. Participants also reported on barriers and potential solutions for EBI use in SBMH in Vietnam. Contrary to expectations, the most frequent and severe barriers were not financial but related to limited stakeholder engagement. Overall, these and other study results provide some suggestions how IS capacity to support SBMH may be most efficiently developed in settings such as Vietnam. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Feasibility and Acceptability of Engaging Significant Adults in Youth Sexual and Relationship Violence Prevention Work.

Relationship and sexual violence (RSV) disproportionately affect youth in immigrant and other marginalized communities yet few prevention initiatives are truly grounded in their experiences. The current study represents a pilot implementation evaluation of youth-led workshops to engage significant adults (parents, grandparents, aunts, adult siblings, community leaders) as RSV prevention partners in diverse communities in a large urban area. The current mixed methods evaluation examined the perceptions of 66 adults and six youth leaders of four, day-long adult training workshops. Results showed high feasibility and acceptability and an important role for significant adults in enhancing RSV prevention.

Behavioral health engagement and treatment strategies: Pediatric chief resident perspectives.

INTRODUCTION: Despite increasing evidence that use of the "common factors" and "common elements" approaches are effective in improving patient outcomes, and calls for pediatricians to address patient behavioral health concerns, little is known about pediatrician knowledge, perceptions, and use of these approaches. METHOD: Pediatric chief residents from all 210 pediatric residency programs in the United States were surveyed to investigate their knowledge, attitudes, practices, and training related to use of engagement and treatment strategies that comprise the common factors and common elements approaches to delivering behavioral health care. RESULTS: The usable response rate was 38%. Most respondents indicated they believe pediatricians should address behavioral health issues and that common factors and common elements would be useful and feasible in clinical practice. Most indicated low levels of familiarity with common factors and common elements and dissatisfaction with training in these areas. CONCLUSION: Additional training and other implementation supports, such as dissemination of implementation guidelines and mechanisms for technical assistance, will be needed in order to increase pediatrician use of these approaches. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychotropic Medication Prescribing in Primary Care: Pediatric Chief Resident Perspectives.

OBJECTIVE: Evidence-based treatments for mental health concerns include psychopharmacological and psychosocial approaches. Pediatrics organizations indicate psychopharmacology needs to be a component of training. This study investigated the status of training in psychotropic medication prescribing through a national survey of pediatric chief residents. METHOD: Pediatric chief residents (one per residency program) completed a survey (response rate = 60.2%, 127/211) about their attitudes, knowledge, comfort, practice, and training around prescribing psychotropic medication in primary care. Quantitative data included descriptive statistics and correlational analyses to explore relationships between variables; qualitative data were examined through classical content analysis. RESULTS: Almost half of respondents reported prescribing sometimes or often. Frequency of prescribing varied by mental health condition, with highest frequency for attention-deficit/hyperactivity disorder. About two-thirds of respondents reported having at least some/average knowledge. About half of respondents reported being uncomfortable with prescribing; respondents were most uncomfortable with prescribing antianxiety, mood stabilizing, and antipsychotic medications, and with discontinuing medication; about half indicated their competence in progress-monitoring needed improvement. Concurrent psychosocial treatment was perceived as very useful, although often inaccessible to patients. Prescribing frequency was related to knowledge, comfort, progress-monitoring competence, and training quality; training quality was related to knowledge and comfort. Over 60% rated their training as not at all or only somewhat adequate. CONCLUSIONS: Pediatric chief residents reported having knowledge of psychotropic medication issues, but experience a general discomfort, especially with discontinuing medication, and with medications other than stimulants. Most thought their training needed improvement in terms of comprehensiveness and clinical practice experiences.

Assessment and management of depression and suicidality: Pediatric resident perspectives on training and practice.

INTRODUCTION: Primary care is a common access point for children and adolescents with depression and suicidality concerns. In this setting, pediatricians typically function as front-line providers given barriers that patients face in accessing mental health clinicians. METHOD: This study surveyed chief residents from all pediatric residency programs in the United States (N = 214) to evaluate (a) their attitudes, knowledge, practices, and comfort in managing depression and suicidality concerns in primary care, and (b) the relationship between residency training processes and pediatric residents' practices, knowledge, and comfort related to identifying and managing depression and suicidality. RESULTS: The usable response rate was 37.6%. The large majority of respondents are involved in evaluation and management of depression and suicidality; yet many respondents reported a lack of knowledge and comfort in these roles. CONCLUSIONS: Recommendations for pediatric residency program training processes are discussed, including the potential added value of colocating mental health clinicians into the primary care continuity training clinic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Behavioral Health Training in Pediatric Residency Programs: A National Survey of Training Directors.

OBJECTIVE: To identify perceptions of behavioral health (BH) training in pediatric residency programs, the degree of involvement from behavioral health providers (BHPs), and opportunities for and barriers to innovation in training. METHOD: A tailored design methodology was used to target all pediatric residency program directors in the United States (N = 214). Participants were identified from the Electronic Residency Application Service website of the Association of American Medical Colleges and were asked to complete a 22-item item survey on BH training. RESULTS: A 69.2% usable response rate (N = 148) was obtained. A total of 62.8% of directors described training in the developmental-behavioral pediatrics (DBP) rotation as optimal; 36% described BH training in the residency program as a whole (i.e., outside the DBP rotation) as optimal. Only 20.3% described "common factors" training as optimal, and the quality of training in this area was positively and significantly related to the quality of BH training in the residency program as a whole (χ = 35.05, p < 0.001). The quality of common factors training was significantly higher in programs that had embedded BHPs (i.e., psychologists and social workers) in the continuity clinic than programs that did not (χ = 7.65, p = 0.04). Barriers to quality training included instructional content, instructional methods, stakeholder support, and resources. CONCLUSION: Despite substantial improvement in residency training in BH over the last decade, additional improvement is needed. Barriers to continued improvement include training content, training methods, support from faculty and administrator stakeholders, and resource issues. Strategies derived from implementation science have the potential to address these barriers.

Conscious sedation/local anesthesia in the office-based surgical and procedural facility.

The safety, efficacy, and rapid recovery of conscious sedation/local anesthesia make this anesthetic technique useful in the ambulatory setting. The care of the sedated patient requires a team effort. The individual role and responsibility of patient, surgeon, anesthesia provider, and nursing staff are discussed. Using data obtained from a series of 1400 consecutive cases, the authors' experience with conscious sedation/local anesthesia is presented. The current technique, using low-dose propofol, is described in detail. Using conscious sedation, the patient's level of consciousness is depressed, but respiratory drive and airway reflexes are maintained and anesthesia is provided by infiltration of local anesthetic.

Implementation science and school psychology.

The APA Division 16 Working Group on Translating Science to Practice contends that implementation science is essential to the process of translating evidence-based interventions (EBIs) into the unique context of the schools, and that increasing attention to implementation will lead to the improvement of school psychological services and school learning environments. Key elements of implementation and implementation science are described. Four critical issues for implementation science in school psychology are presented: barriers to implementation, improving intervention fidelity and identifying core intervention components, implementation with diverse client populations, and implementation in diverse settings. What is known and what researchers need to investigate for each set of issues is addressed. A discussion of implementation science methods and measures is included. Finally, implications for research, training and practice are presented.