Adolescent, parent, and provider attitudes toward a machine learning based clinical decision support system for selecting treatment for youth depression.

BACKGROUND: Machine learning based clinical decision support systems (CDSSs) have been proposed as a means of advancing personalized treatment planning for disorders, such as depression, that have a multifaceted etiology, course, and symptom profile. However, machine learning based models for treatment selection are rare in the field of psychiatry. They have also not yet been translated for use in clinical practice. Understanding key stakeholder attitudes toward machine learning based CDSSs is critical for developing plans for their implementation that promote uptake by both providers and families. METHODS: In Study 1, a prototype machine learning based Clinical Decision Support System for Youth Depression (CDSS-YD) was demonstrated to focus groups of adolescents with a diagnosis of depression (n = 9), parents (n = 11), and behavioral health providers (n = 8). Qualitative analysis was used to assess their attitudes towards the CDSS-YD. In Study 2, behavioral health providers were trained in the use of the CDSS-YD and they utilized the CDSS-YD in a clinical encounter with 6 adolescents and their parents as part of their treatment planning discussion. Following the appointment, providers, parents, and adolescents completed a survey about their attitudes regarding the use of the CDSS-YD. RESULTS: All stakeholder groups viewed the CDSS-YD as an easy to understand and useful tool for making personalized treatment decisions, and families and providers were able to successfully use the CDSS-YD in clinical encounters. Parents and adolescents viewed their providers as having a critical role in the use the CDSS-YD, and this had implications for the perceived trustworthiness of the CDSS-YD. Providers reported that clinic productivity metrics would be the primary barrier to CDSS-YD implementation, with the creation of protected time for training, preparation, and use as a key facilitator. CONCLUSIONS: Machine learning based CDSSs, if proven effective, have the potential to be widely accepted tools for personalized treatment planning. Successful implementation will require addressing the system-level barrier of having sufficient time and energy to integrate it into practice.

Multiple Perspectives on Motivating Parents in Pediatric Primary Care to Initiate Participation in Parenting Programs.

OBJECTIVE: To use multiple perspectives to identify the key components of pediatric primary care conversations for motivating parents to utilize parenting programs. We aim to develop an actionable framework that primary care clinicians (PCCs) can follow for effective conversations with parents. METHODS: We conducted focus groups and interviews with researchers (n = 6) who have experience delivering parenting interventions through primary care, clinical personnel in federally qualified health centers (FQHCs) (n = 9), parents of 3-5-year olds who receive services at a FQHC pediatric clinic (n = 6), and parent educators (n = 5). Groups and interviews were informed by nominal group technique, and researchers triangulated consolidated strategies across the groups. RESULTS: Key strategies for PCCs to motivate parents to utilize parenting programs followed three steps: 1) learning about a parent's questions and concerns, 2) sharing resources, and 3) following up. PCCs can learn about parents' needs by empathizing, listening and responding, and asking questions that acknowledge parents' expertise. When sharing resources, PCCs can motivate participation in parenting programs by explaining each resource and its benefits, providing options that support parents' autonomy, and framing resources as strengthening rather than correcting parents' existing strategies or skills. Finally, PCCs can continue to engage parents by scheduling follow-up conversations or designating a staff member to check-in with parents. We provide examples for each strategy. CONCLUSIONS: Findings provide guidance from multiple perspectives on strategies to motivate parents in pediatric primary care setting for utilizing parenting programs.

Adolescent, parent, and provider attitudes toward a machine-learning based clinical decision support system for selecting treatment for youth depression.

Background: Machine-learning based clinical decision support systems (CDSSs) have been proposed as a means of advancing personalized treatment planning for disorders, such as depression, that have a multifaceted etiology, course, and symptom profile. However, machine-learning based models for treatment selection are rare in the field of psychiatry. They have also not yet been translated for use in clinical practice. Understanding key stakeholder attitudes toward machine learning-based CDSSs is critical for developing plans for their implementation that promote uptake by both providers and families. Methods: In Study 1, a machine-learning based Clinical Decision Support System for Youth Depression (CDSS-YD) was demonstrated to focus groups of adolescents with a diagnosis of depression (n = 9), parents (n = 11), and behavioral health providers (n = 8). Qualitative analysis was used to assess their attitudes towards the CDSS-YD. In Study 2, behavioral health providers were trained in the use of the CDSS-YD and they utilized the CDSS-YD in a clinical encounter with 6 adolescents and their parents as part of their treatment planning discussion. Following the appointment, providers, parents, and adolescents completed a survey about their attitudes regarding the use of the CDSS-YD. Results: All stakeholder groups viewed the CDSS-YD as an easy to understand and useful tool for making personalized treatment decisions, and families and providers were able to successfully use the CDSS-YD in clinical encounters. Parents and adolescents viewed their providers as having a critical role in the use the CDSS-YD, and this had implications for the perceived trustworthiness of the CDSS-YD. Providers reported that clinic productivity metrics would be the primary barrier to CDSS-YD implementation, with the creation of protected time for training, preparation, and use as a key facilitator. Conclusions: The CDSS-YD has the potential to be a widely accepted and useful tool for personalized treatment planning. Successful implementation will require addressing the system-level barrier of having sufficient time and energy to integrate it into practice.

An example of implementing a safety protocol in remote intervention and survey research with college students.

INTRODUCTION: This article draws attention to the need for open evaluation and reporting on safety protocols in survey and intervention research. We describe a protocol for responding to those who indicate increased risk of self-harm (i.e. suicidality or potentially lethal alcohol use) as an example and report on the outcome of our procedures. METHODS: Participants were first-year college students (n = 891) participating in an intervention trial for binge drinking. We describe the protocol, provide descriptive outcomes, and examine whether participant sex, attrition, or study intervention condition were related to endorsing items that indicated risk for suicidality or potentially lethal alcohol use. RESULTS: Of the 891 participants, 167 (18.7%) were identified as being at risk in one or more study wave. Of those, we were able to successfully contact 100 (59.9%), 76 (45.5%) by phone, and 24 (14.4%) by email. Of those 100, 78 accepted mental health resources as a result of outreach. Participant sex, attrition, and intervention condition were not related to risk. DISCUSSION: This article may aid other research teams in developing similar protocols. Strategies to reach an even greater proportion of high-risk participants are needed. A body of literature documenting published safety protocols in research and the associated outcomes would help to identify opportunities for improvement.

How is Time Alone Introduced? Experiences and Preferences of Adolescents and Parents.

PURPOSE: Time alone between health care providers and adolescent patients is a core element of quality adolescent primary care, yet not all adolescents receive this care. Clinicians' apprehension about how best to introduce time alone may contribute to lower levels of time alone. This study aims to understand how adolescent patients and their parents or guardians experience the introduction of time alone during adolescent preventive visits. METHOD: We conducted semistructured interviews with adolescents, aged 11-17 years (n = 35) and a parent or guardian of the adolescent (n = 35) across metropolitan and nonmetropolitan areas of Minnesota. We used thematic analysis to describe (1) parent and adolescent experiences learning about time alone for the first time and (2) parent and adolescent reactions to this experience. RESULTS: Key findings from this study suggest that adolescents prefer a universal application of time alone with an option to opt out (e.g., "At this age, I always ask parents to step out for a few minutes, are you okay with that?"), rather than opt in (e.g., "Would you like your parent to step out?"). Parents noted that time alone should not be a surprise but rather should be presented as routine, so they are not left to wonder if time alone was offered to their adolescent for a particular reason. DISCUSSION: Findings suggest universal presentation of time alone with the option for adolescents to opt out may improve acceptability of time alone and support delivery of highquality care.

Provider Facilitation of Parent-Adolescent Health Communication: Findings From a National Survey.

INTRODUCTION: Primary care providers are well-positioned to facilitate parent-adolescent health communication. We examined provider-facilitated parent-adolescent health communication prevalence and associations with parent-adolescent health communication. METHOD: Using data from a national survey of parent-adolescent dyads (n = 853), we calculated the prevalence of provider-facilitated parent-adolescent health communication about 11 topics as a result of adolescent's last preventive visit. We examined correlates of of provider-facilitatedparent-adolescent communication and associations with with parent-adolescent communication. RESULTS: Eighteen percent of adolescents reported that a provider helped them talk with their parent about a health concern, with little variability by adolescent, parent, or provider characteristics. Prevalence of parent-adolescent communication because of an adolescent's last preventive visit ranged between 38.4% and 79.5%. Provider facilitation was positively associated with parent-adolescent communication for all topics. DISCUSSION: Given the low prevalence of provider-facilitated-parent-adolescent health communication and positive associations between provider facilitation and parent-adolescent communication about multiple important health-related topics, efforts to improve this practice could be beneficial.

Association between COVID-19-related loneliness or worry and symptoms of anxiety and depression among first-year college students.

OBJECTIVE: To examine the relationship between COVID-19-related distress and mental health among first-year college students. PARTICIPANTS: Data for this longitudinal study (n = 727) were collected before the school year (August 2019), end of fall semester (December 2019), and soon after the university suspended in-person instruction (April 2020). METHODS: We used multivariable log-linear and logistic regressions to examine continuous and dichotomous outcomes on the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale. RESULTS: The most consistent predictor of during-pandemic mental health was feeling extremely isolated (versus not at all), which was associated with increased symptom severity of depression (proportional change[95% CI] = 2.43[1.87, 3.15]) and anxiety (2.02[1.50, 2.73]) and greater odds of new moderate depression (OR[95% CI] = 14.83[3.00, 73.41]) and anxiety (24.74[2.91, 210.00]). Greater COVID-19-related concern was also related to increased mental health symptoms. CONCLUSIONS: Results highlight the need for mental health services during crises that lead to social isolation.

Opportunities to Improve Adolescent Sexual and Reproductive Health Services in Primary Care Clinics.

Primary care providers are well positioned to address the sexual and reproductive health (SRH) needs of adolescents; however, gaps often exist in the delivery of quality SRH services in primary care. Our objective was to identify specific opportunities to improve the delivery of adolescent SRH services in primary care. We conducted in-depth interviews with 25 primary care providers from various disciplines across rural and urban areas of Minnesota and conducted thematic analysis of transcribed data. Participants identified salient opportunities in three areas: (1) training and resources for providers (e.g., related to minor consent laws or addressing sensitive subjects), (2) practices and procedures (e.g., time-alone procedures and policies for confidential screening and sharing test results), and (3) education for adolescents (e.g., knowing their rights and accessing confidential SRH services). Study findings provide actionable opportunities to improve delivery of adolescent SRH services in primary care.

Development of a Shelter-based Health Empowerment Program for Pregnant and Parenting Youth Experiencing Homelessness.

BACKGROUND: Pregnancy and parenthood are common among youth experiencing homelessness and are associated with significant health risk for both parent and child. Yet, little is known regarding how to best promote health among this vulnerable population. OBJECTIVES: To understand stakeholder perceptions of needs and factors required for successful implementation of a shelter-based health empowerment program for pregnant and parenting youth experiencing homelessness and their children. METHODS: Applying frameworks from implementation science, we conducted interviews and focus groups with three groups of stakeholders (youth experiencing homelessness [n = 17], shelter staff [n = 8], community experts [n = 5]). We used qualitative content analysis to identify program content areas and design elements required for successful implementation. We then used a consensus-building process to engage community stakeholders in selecting and adapting an evidence-informed intervention. RESULTS: Stakeholders described several desired content areas for a group-based curriculum: sexual and reproductive health, mental health and child health. With respect to program design, stakeholders emphasized adaptability; a strengths-based, culturally responsive, and trauma-informed approach; a skills-oriented focus; staff training; access to health care; and the integration of youth voices. Driven by these findings, our community-based team proposed a health empowerment program with three elements: 1) a weekly health empowerment group, 2) health training and support for shelter staff, and 3) shelter-based health care services. CONCLUSIONS: Our study is among the first to assess the health care needs of pregnant and parenting youth in shelter, and to describe factors associated with the development and implementation of a shelter-based health empowerment program specifically targeting this vulnerable population.

35-Year-Old Parents Do Not Approve of 17-Year-Olds' Cigarette, Marijuana, or Alcohol Use: U.S. National Data 1993-2018.

PURPOSE: Parents' attitudes about adolescent substance use likely guide their parenting behaviors. This study documents prevalence of parents' disapproval of adolescent substance use and characteristics associated with disapproval. METHODS: Survey data from national samples of 35-year-old parents from the U.S. Monitoring the Future study were collected 1993-2018. Multivariable logistic regression examined predictors of disapproving attitudes about substance use by a hypothetical 17-year-old child, including occasional marijuana use or drunkenness, and regular cigarette, marijuana, or alcohol use. RESULTS: Across all cohorts, rates of disapproving attitudes ranged from 93.7% disapproving of getting drunk occasionally to 97.2% disapproving of regular cigarette use, with some erosion in disapproval for some substances across cohorts. Parents' own recent abstinence from substance use predicted greater odds of disapproval. CONCLUSIONS: The overwhelming majority of 35-year-old parents disapprove of adolescent substance use. Prevention and public health messaging can support parenting by sharing this important information.

Post-Identification Approaches to Addressing Health-Related Social Needs in Primary Care: A Qualitative Study.

BACKGROUND: Social determinants of health play a fundamental role in a patient's health status. In recent years, health systems across the nation have implemented numerous strategies aimed at identifying and addressing the health-related social needs of the patients they serve. Despite the influx of peer-reviewed research highlighting outcomes of specific health-related social needs interventions, the spectrum of practices utilized by primary care clinics has not been established. OBJECTIVE: To determine the range of ways primary care clinics address health-related social needs after identification and initial contact with a frontline staff person is completed. DESIGN: We conducted 12 semi-structured, in-person interviews with staff from purposively sampled clinics. If the interview included more than one staff person, all participants were interviewed together. PARTICIPANTS: Twenty-one administrative staff and frontline clinic personnel with experience in 24 separate primary care clinics in the Minneapolis-St. Paul, Minnesota metropolitan area. APPROACH: Interviews focused on the range of health-related social needs processes utilized by clinics, including staff titles, referral procedures, and barriers to addressing needs. Interview recordings were transcribed and coded using thematic analysis. KEY RESULTS: Thematic analysis identified variation in four key areas involving how clinics address patients' health-related social needs after identification and initial contact by frontline staff: clinic personnel involved in addressing needs, clinic referral processes, "resource" and "success" definitions, and barriers to accessing community-based supports. CONCLUSIONS: This study describes the large variation in primary care clinic practices to address health-related social needs after they are identified. The results suggest challenges to standardization and real-world application of previously published studies. Our findings also highlight the opportunity for improved relationships between health systems and community-based agencies.

Correlates of Sexual and Reproductive Health Discussions During Preventive Visits: Findings From a National Sample of U.S. Adolescents.

PURPOSE: This study examines characteristics of healthcare delivery, providers, and adolescents associated with provider-adolescent discussions about sexual and reproductive health (SRH) during preventive visits. METHODS: Data were from a 2019 national internet survey of U.S. adolescents ages 11-17 years and their parents. Adolescents who had a preventive visit in the past 2 years (n = 853) were asked whether their provider discussed each of eight SRH topics at that visit: puberty, safe dating, gender identity, sexual orientation, whether or not to have sex, sexually transmitted infections including human immunodeficiency virus, birth control methods, and where to get SRH services. Eight multivariable logistic regression models were examined (one for each SRH topic as the outcome), with each model including modifiable healthcare delivery and provider characteristics, adolescent beliefs, behaviors, and demographic characteristics as potential correlates. RESULTS: Provider-adolescent discussions about SRH topics at the last preventive visit were positively associated with face-to-face screening about sexual activity for all eight topics (range of adjusted odds ratios [AORs] = 3.40-9.61), having time alone with the adolescent during that visit (seven topics; AORs = 1.87-3.87), and ever having communicated about confidentiality with adolescents (two topics; AORs = 1.88-2.19) and with parents (one topic; AOR = 2.73). Adolescents' perception that a topic was important to discuss with their provider was associated with provider-adolescent discussions about seven topics (AORs = 2.34-5.46). CONCLUSIONS: Findings that provider-adolescent discussions about SRH during preventive visits were associated with modifiable practices including time alone between providers and adolescents and screening about sexual activity can inform efforts to improve the delivery of adolescent SRH services within primary care.

Parents' Sources of Adolescent Sexual Health Information and Their Interest in Resources From Primary Care.

OBJECTIVE: To examine sources of information used by parents to facilitate parent-adolescent communication about sexual and reproductive health (SRH), parents' preferences for receiving SRH information through primary care, and factors associated with parents' interest in primary-care-based SRH information (ie, resources recommended or offered in the primary care setting). METHODS: In this cross-sectional study, a nationally representative sample of 11-17-year-old adolescents and their parents (n = 1005 dyads) were surveyed online; 993 were retained for these analyses. Parents were asked about their use of 11 resources to help them talk with their adolescents about SRH and rated the likelihood of using specific primary-care-based resources. We used multivariable logistic regression to examine characteristics associated with parent interest in primary-care-based SRH resources. RESULTS: Only 25.8% of parents reported receiving at least a moderate amount of SRH information from primary care; half (53.3%) reported receiving no SRH information from their adolescent's provider. Parents received the most information from personal connections (eg, spouse/partner, friends). Most parents (59.1%) reported being likely to utilize a primary-care-based resource for SRH information. Parents who previously received SRH information from primary care sources had greater odds of reporting they would be likely to utilize a primary-care-based resources (AOR = 4.06, 95% CI: 2.55-6.46). CONCLUSIONS: This study provides insights into parents' sources of information for communicating with their adolescents about SRH and ways primary care practices might increase support for parents in having SRH conversations with their adolescents. Future studies are needed to establish clinical best practices for promoting parent-adolescent communication about SRH.

Feasibility of a novel, brief parenting intervention in primary care clinics.

INTRODUCTION: Primary care provides a nonstigmatizing service setting in which parents routinely seek care and advice related to their children's behavior. To make care truly accessible for all families, multiple methods and approaches should be available, including brief interventions. The objective of this project was to evaluate the feasibility and acceptability of a novel brief program called Behavior Checker. METHOD: This feasibility evaluation is based on in-depth interviews with personnel (N = 19) from two safety-net clinics in which Behavior Checker was tested. RESULTS: Clinic personnel found the program useful and acceptable, citing ease of use and reporting it addressed an existing need. Providers indicated that the program led to more behavioral health conversations with parents and that these were more efficient than without the program. CONCLUSION: Behavior Checker appeals to providers and clinics as a first-line approach to address parenting and children's behavioral needs. The program's effectiveness should be examined. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Main outcomes of M-bridge: A sequential multiple assignment randomized trial (SMART) for developing an adaptive preventive intervention for college drinking.

Objective: The goal was to develop a universal and resource-efficient adaptive preventive intervention (API) for incoming first-year students as a bridge to indicated interventions to address alcohol-related risks. The aims were to examine: (a) API versus assessment-only control, (b) the different APIs (i.e., 4 intervention sequences) embedded in the study design, and (c) moderators of intervention effects on binge drinking. Method: A sequential multiple assignment randomized trial (SMART) included two randomizations: timing (summer before vs. first semester) of universal personalized normative feedback and biweekly self-monitoring and, for heavy drinkers, bridging strategy (resource email vs. health coaching invitation). Participants (N = 891, 62.4% female, 76.8% White) were surveyed at the end of first and second semesters. The primary outcome was binge drinking frequency (4+/5+ drinks for females/males); secondary outcomes were alcohol consequences and health services utilization. Results: API (vs. control) was not significantly associated with outcomes. There were no differences between embedded APIs. Among heavy drinkers, the resource email (vs. health coach invitation) led to greater health services utilization. Moderator analyses suggested students intending to pledge into Greek life benefited more from any API (vs. control; 42% smaller increase from precollege in binge drinking frequency). Conclusions: Although overall effects were not significant, students at high risk (i.e., entering fraternities/sororities) did benefit more from the intervention. Furthermore, the resource email was effective for heavier drinkers. A technology-based strategy to deliver targeted resource-light interventions for heavy drinkers may be effective for reducing binge drinking during the transition to college. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Sexual and Reproductive Health Discussions During Preventive Visits.

OBJECTIVES: To quantify adolescent- and parent-perceived importance of provider-adolescent discussions about sexual and reproductive health (SRH), describe prevalence of provider confidentiality practices and provider-adolescent discussions about SRH topics during preventive visits, and identify missed opportunities for such conversations. METHODS: We used data from a national Internet survey of 11- to 17-year-old adolescents and their parents. Data were weighted to represent the noninstitutionalized US adolescent population. Adolescents who had a preventive visit in the past 2 years and their parents reported on perceived importance of provider-adolescent discussions about SRH topics: puberty, safe dating, gender identity, sexual orientation, sexual decision-making, sexually transmitted infections and HIV, methods of birth control, and where to get SRH services. Adolescents and parents reported whether they had ever discussed confidentiality with the adolescent's provider. Adolescents reported experiences at their most recent preventive visit, including whether a provider spoke about specific SRH topics and whether they had time alone with a provider. RESULTS: A majority of adolescents and parents deemed provider-adolescent discussions about puberty, sexually transmitted infections and HIV, and birth control as important. However, fewer than one-third of adolescents reported discussions about SRH topics other than puberty at their most recent preventive visit. These discussions were particularly uncommon among younger adolescents. Within age groups, discussions about several topics varied by sex. CONCLUSIONS: Although most parents and adolescents value provider-adolescent discussions of selected SRH topics, these discussions do not occur routinely during preventive visits. Preventive visits represent a missed opportunity for adolescents to receive screening, education, and guidance related to SRH.

Binge drinking before and after a COVID-19 campus closure among first-year college students.

PURPOSE: The COVID-19 pandemic is associated with reports of increased substance use. College students are a population of concern for high risk binge drinking and their behavior may be particularly impacted by COVID-19 campus closures. Therefore, we examine first-year college students' binge drinking soon after their university's pandemic-related suspension of in-person operations. METHODS: Students from a single campus (N = 741; age: M = 18.05, SD = 0.22) completed one assessment in April-May 2020 post-campus closure (March 2020) including theoretically-informed measures (e.g., drinking motives, norms) and two items of self-reported pre- and post-closure binge drinking frequency, the focus of these analyses. RESULTS: About half of students consistently reported not binge drinking pre- and post-closure; 6.75% reported a consistent frequency of binge drinking pre- and post-closure. Many (39.41%) reported lower 30-day binge drinking post-campus closure compared to their pre-closure reports; few (4.18%) reported higher 30-day binge drinking frequency post-campus closure. Students reporting lower binge drinking post-closure showed differences in coping, social, and enhancement drinking motives and isolation. Students reporting greater post-closure binge drinking reported higher perceived drinking norms and were more likely to be in Greek life. CONCLUSION: This study demonstrates self-reported patterns in binge drinking among first-year college students at the point of COVID-19 campus closures. Pandemic-related college closures may have been a temporary environmental intervention on this high-risk behavior for some students. Although many students were not binge drinking, some continued binge drinking after closure and may benefit from preventive interventions.

Key Subgroup Differences in Age-Related Change From 18 to 55 in Alcohol and Marijuana Use: U.S. National Data.

OBJECTIVE: This study examined age-related change in alcohol use, marijuana use, and the association between the two, from ages 18 to 55, in a national longitudinal sample. METHOD: Data were from national Monitoring the Future study participants (N = 11,888) who were high school seniors in 1976-1980 and were eligible to respond to the age 55 survey in 2013-2017. Time-varying effect modeling was used to model past-30-day prevalence and associations between alcohol and marijuana across ages 18-55, overall and by sex, race/ethnicity, and college attendance. RESULTS: Marijuana prevalence peaked at age 18 and was lowest in the late 40s; alcohol prevalence peaked at age 22 and was lowest in the early 40s. Associations between alcohol and marijuana use were strongest at age 18. Significant differences were observed by sex, race/ethnicity, and college attendance (e.g., women's use was lower and decreased faster in the late 30s than men's; White respondents' alcohol and marijuana use were higher and peaked before Black respondents'; compared with non-attenders, college attenders' use was higher for alcohol but lower for marijuana). The alcohol and marijuana use association was strongest at ages 18-20 for most subgroups, except Black respondents, for whom the association was strongest at age 30. CONCLUSIONS: Longitudinal data showed patterns of alcohol and marijuana use across adulthood. Such patterns highlight sociodemographic risk factors across the life span, ages that should be targeted for clinician awareness and intervention efforts, and populations at particular risk of harm from alcohol and marijuana co-use during adulthood.