Cheryl Anne Boyce

Early Identification and Intervention: Head Start's Response to Mental Health Challenges

Serving low-income children from birth to age five and their families, Head Start is a primary venue for identification and intervention in the area of child mental health. However, recent research has demonstrated that the knowledge base regarding prevalence, developmental course, and predictive power of child mental health problems is lacking for young children in general and low-income, diverse populations in particular. Head Starts agency-level data is often discrepant from both national estimates and small, intensive studies of similar populations, perhaps for reasons related to availability of community services and professional staff, as well as concerns about stigmatization. Following on recent expert recommendations, new collaborative Federal initiatives are underway to increase our understanding of the types, trajectories, and treatments of mental health problems affecting the vulnerable children served by Head Start. The paper concludes with a call to action for the field in the area of young childrens mental health.

Using Different Measures, Informants, and Clinical Cut-Off Points to Estimate Prevalence of Emotional or Behavioral Disorders in Preschoolers: Effects on Age, Gender, and Ethnicity

The early identification and remediation of emotional or behavior disorders are high priorities for early-childhood researchers and are based on the assumption that problems such as school failure can be averted with early screening, prevention, and intervention. Presently, prevalence, severity, and topography of mental health needs among low-income preschoolers and their families have not been well documented. Tools for screening and intervention for behavior problems in preschool children are few and many of those tools have not been studied within diverse Head Start systems. In this study, five instruments of symptoms and functional impairment, completed by teachers and two completed by parents, were obtained on a sample of 1,781 Head Start children from diverse racial and ethnic backgrounds from the Head Start Mental Health Research Consortium. Clinical cut-off scores were used to identify children who could be considered at relatively serious risk for emotional or behavioral disorders. At-risk classifications using clinical cut-offs at both 1.0 and 1.5 standard deviations for each measure were examined singly and in combination and then compared to the overall sample for age, gender, and ethnicity. Identification of children considered at risk ranged from a low of 1% to a high of 38%, with evidence of differential effects on age, gender, or ethnicity for some individual measures, but these tended to diminish when combinations of symptom and impairment measures were used. Implications for choosing instruments to establish eligibility for emotional or behavioral disorders in preschoolers are discussed.

Issues for Developmental Research Among Racial/Ethnic Minority and Immigrant Families

As the United States becomes increasingly diverse and the inclusion of children, women, and ethnic minorities in research is encouraged for clinical research (National Institutes of Health, 1998, 2001), researchers are increasingly responsible for examining the role of social context and cultural processes in mental health and illness among racially and ethnically diverse families including immigrant and nonimmigrant families. Strong theoretical frameworks, developmental approaches, and innovative methodologies are available to determine why and how cultural processes matter for mental health across the life span. The task, however, requires an expansion on and refinement of traditional demographic indicators and cultural variables such as acculturation and racial identity to examine complex social and cultural processes in greater detail. Conceptual advances in recent culturally relevant and developmentally sensitive longitudinal studies and national surveys suggest the potential of new methodologies to inform efforts to reduce health disparities for mental health. Future research on specific cultural processes across the life span may uncover critical periods of risk and vulnerability, potential for resilience, as well as optimal opportunities for mental health prevention and treatment among racial/ethnic minority and immigrant families.

Disentangling Health Disparities Through National Surveys

The changing social and cultural dimensions of the US population have required innovative methodologies to fully understand the health of diverse communities. Whereas previous small and large-scale community surveys have contributed to our knowledge, national surveys provide novel opportunities to examine health disparities both in health and use of health services. The US Department of Health and Human Services (DHHS) has supported an agenda for health disparities research that examines differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions among specific populations in the United States.

Burgeoning Directions for the Prevention of Youth Violence

Despite focused efforts toward the prevention of youth violence within the United States, it continues to adversely affect the lives of children and families within our communities and society at large. The articles in this issue address risk and protective factors that affect violence among urban youth to inform prevention and treatment. Pathways to youth violence are complex and may begin early. Prevention efforts in school, family, and community settings that address risk and protective factors within a socially, culturally, and ecologically valid context early in human development are crucial. While challenges remain for the prevention of youth violence, research suggests opportunities to improve our efforts. Federal agency initiatives in partnership with communities are currently underway to increase the knowledge base and advance prevention of youth violence among diverse populations.

A Call to Action for Health Disparities in Boys and Men: Innovative Research on Addiction, Trauma, and Related Comorbidities

The authors reflect on health disparities which are seen in boys and men in the U.S. who are members of racial or ethnic minority groups or socioeconomically disadvantaged groups. They suggest that health disparities in males have been understudied despite the fact that they warrant attention. They argue that research needs to be conducted to uncover and resolve health disparities which are seen among minority and socioeconomically disadvantaged boys and men in the U.S.

Integrating translational neuroscience to improve drug abuse treatment for adolescents.

Adolescence is an exciting and challenging period of maturation, rapid brain development, and developmental changes in neurobiological, neurocognitive, and neurobehavioral processes. Although behavioral therapies available for adolescent substance abuse have increased, effectiveness research in this area lags considerably behind that of clinical research on treatment for drug-abusing adults. Behavioral treatment approaches show significant promise for treating drug-abusing adolescents, but many have not incorporated innovations in neuroscience on brain development, cognitive processes, and neuroimaging. Linking developmental neuroscience with behavioral treatments can create novel drug abuse interventions and increase the effectiveness of existing interventions for substance-abusing adolescents. Contemporary research on brain development, cognition, and neuroscience is ripe for translation to inform developmentally sensitive drug abuse treatments for adolescents. Neuroscientists and interventionists are challenged to build mutual collaborations for integration of neuroscience and drug abuse treatment for adolescents.

Maternal and Child Health Disparities: Considering the Influence of Fathers

Disparities in many maternal and child health outcomes persist in the United States. Mothers and children who live in poverty are at higher risk for a variety of mental, physical, emotional, and behavioral health problems, including depression, obesity, child maltreatment, teenage problem behaviors, drug abuse, and lower educational attainment.1 Moreover, the 2010 US Census revealed that 20% of children in the United States are living in poverty with an overrepresentation of African American and Hispanic children.2 Boys born to African American or Hispanic mothers may be disproportionately at risk for experiencing negative health outcomes depending on their socioeconomic status in combination with other individual, family, community and environmental factors.3 While the focus on mothers and children is essential and important for public health, the role of fathers has been often overlooked. Fathers can offer additional health and economic resources, including access to quality health care. Through tangible and emotional support for mothers, fathers can provide a healthy start for their sons prenatally and over the life course. When paternal resources are absent or insufficient, the health and development of mothers and sons may suffer. To adequately assess health disparities in boys and men, data on father characteristics and resources is a critical component.4 Father and son playing. Printed with permission of Corbis. The National Children’s Study (NCS),5 mandated by the Children’s Health Act of 2000, is the largest and most detailed study in the United States focused on children’s health and development. It will examine the relationships between environmental exposures and genetics on growth, development and health, including health disparities among children in the United States from prenatal to adulthood. The NCS Vanguard Study serves as a paradigm for the future NCS Main Study with the inclusion of fathers in data collection and measures that assess father involvement and its impact on maternal and child health disparities. The inclusion of fatherhood data in large, national surveys allows for sufficient statistical power to examine meaningful factors related to paternal support for mothers and sons among diverse racial, ethnic, and socioeconomic status groups. Although research suggests that the engagement, accessibility and involvement of fathers with their sons may influence child socioemotional, cognitive, and health outcomes, fatherhood data has lagged behind that on the role of mothers. Recruitment and retention of fathers from diverse families along with mothers and sons present a difficult but worthwhile challenge to public health researchers. Novel data and analyses on fathers and sons have exciting potential to inform the future of maternal, paternal, child, and family health disparities.

Sex, Ethnicity, and CVD Among Women of African Descent

The authors report no relationships that could be construed as a conflict of interest. The views expressed in this article are those of the authors and do not necessarily represent the views of the National, Heart, Lung, and Blood Institute, National Institutes of Health, or the U.S. Department of Health and Human Services. From the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA. Correspondence: W. L. Barfield (whitney. barfield@nih.gov).

Selecting the Appropriate Research Mechanism: Finding the Right Match

The Federal government supports research activities through various mechanisms that range in scope and budget. Within the Public Health Service alone there are over 100 mechanisms for an investigator to choose. Each mechanism has a specific purpose, set of guidelines and eligibility criteria. Therefore it is crucial to select the appropriate research mechanism that matches the research, the investigator, and the budget. A Funding Opportunity Announcement (FOA) is a Program Announcement or Request for Application that is posted to Grants.gov and the NIH Guide. (See Chap. 3 for a full discussion of FOAs.) When a FOA has been announced, it includes instructions on what type of mechanisms of support are available.