Dana Rusch

Understanding caregivers' help-seeking for Latino children's mental health care use

Background:Latino children have persistent low rates of mental health service use. Understanding the factors that influence caregivers’ decisions about whether to use mental health care for their children can help explain why. Objective:The objective of this study was to investigate the factors reported by the primary caregiver that could help classify Puerto Rican children into users versus nonusers of mental health services and mental health versus school sector care, among users. Subjects:Data were collected from a random Puerto Rican community sample of caregiver–child dyads. Measures:Version-IV of the Computerized Diagnostic Interview for Children (DISC) was used to assess psychiatric disorders in children. The Service Assessment for Children and Adolescents (SACA) was used to examine the types of services used for mental health problems. Statistical Methods:The Classification and Regression Tree (CART) approach was used to develop a simple model simulating caregivers’ decision-making around taking children for mental health care and the setting for care. Results:The classification model of use versus no use of mental health service suggested 3 significant predictors: childs level of impairment, parental concern, and childs difficulty in performing schoolwork. The classification model of sector of care, mental health versus school setting, identified 1 significant predictor, any disruptive disorder diagnosis. Conclusion:Assisting caregivers in linking a childs impairment with need for mental health care might be a mechanism to reduce childrens unmet need. Approaches such as CART, used to identify factors predicting consumer choices in marketing, might be useful to select strategies for social campaigns targeted toward decreasing unmet need.

Future Directions for Dissemination and Implementation Science: Aligning Ecological Theory and Public Health to Close the Research to Practice Gap

Dissemination and implementation science (DI) has evolved as a major research model for childrens mental health in response to a long-standing call to integrate science and practice and bridge the elusive research to practice gap. However, to address the complex and urgent needs of the most vulnerable children and families, future directions for DI require a new alignment of ecological theory and public health to provide effective, sustainable, and accessible mental health services. We present core principles of ecological theory to emphasize how contextual factors impact behavior and allow for the reciprocal impact individuals have on the settings they occupy, and an alignment of these principles with a public health model to ensure that services span the prevention to intervention continuum. We provide exemplars from our ongoing work in urban schools and a new direction for research to address the mental health needs of immigrant Latino families. Through these examples we illustrate how DI can expand its reach by embedding within natural settings to build on local capacity and indigenous resources, incorporating the local knowledge necessary to more substantively address long-standing mental health disparities. This paradigm shift for DI, away from an overemphasis on promoting program adoption, calls for fitting interventions within settings that matter most to childrens healthy development and for utilizing and strengthening available community resources. In this way, we can meet the challenge of addressing our nations mental health burden by supporting the needs and values of families and communities within their own unique social ecologies.

Examining the Effects of Mexican Serial Migration and Family Separations on Acculturative Stress, Depression, and Family Functioning

This study examined the role of parent-child separations during serial migration to the United States in predicting individual- and family-level outcomes in Mexican immigrant families. We assessed parents’ subjective appraisals of their family’s separation and reunion experiences to explore associations with self-reported acculturative stress, depression and family functioning. Data were collected from an urban, low-income community sample of Mexican immigrant parents (N = 53). Seventy percent (N = 37) of the parents experienced a separation from at least one child during immigration. Separated status parents reported significantly higher levels of acculturative stress, but no significant differences were found between separated and nonseparated status parents on depression or family functioning. Findings also revealed that negative appraisals of the family’s reunion experience were associated with higher levels of acculturative stress, depression, and unhealthy family functioning. We discuss the implications for future research to address the mental health of Mexican immigrant families in the United States.

Building Capacity Within Community-Based Organizations: New Directions for Mental Health Promotion for Latino Immigrant Families in Urban Poverty

By 2050, Latino school-aged youth are projected to outnumber their non-Latino white peers (Fry & Gonzales, 2008). One in every four youth below 18 has at least one foreign-born parent, with 37 % of 40 million foreign-born in the US of Latin American descent (Grieco et al., 2012). Despite the fact that immigrant mental health has been an urgent national priority for over a decade (Flores et al., 2002; Pumariega & Rothe, 2010), it appears clear that the community mental health system cannot address this alone (Bringewatt & Gershoff, 2010; Huang et al., 2005) and falls short of strengthening natural supports within communities (Alegrı́a et al., 2010). Barriers to medical care thwart specialty referrals (Flores et al., 2005; Beniflah et al., 2013), and a dearth of bilingual, culturally competent providers exacerbates slow dissemination of empirically supported treatments into community mental health settings (Stagman & Cooper, 2010). We propose that high rates of mental health need and low service utilization among Latino immigrant families (DeRose et al., 2007; Kataoka et al., 2002; RAND, 2001) call for service models within non-specialty settings that build upon natural resources toward reducing risk factors and improving outcomes. Mental Health Risk Factors for Immigrant Families

Children’s Responses to Hypothetical Provocation by Peers: Coordination of Assertive and Aggressive Strategies

Children often respond to aggression by peers with assertive bids or aggressive retaliation. Little is known, however, about whether and how children coordinate these strategies across different types of provocation. The present study examined endorsement of aggressive and assertive responses to hypothetical physical, relational, and verbal provocation in a sample of lower-income children (N = 402, M age = 10.21, SD = 1.46). Latent-profile analysis revealed 3-class models for both aggression and assertion, each reflecting low, moderate, and high levels of endorsement. There was no association between children’s reported use of aggression and assertion. For example, children who endorsed high levels of aggression were equally likely to be classified as low, moderate, or high on assertive responding. For both assertion and aggression, parental ratings of children’s externalizing behavior and social skills differed across the low and high groups. No such differences were found between the low and moderate groups, despite the latter groups endorsing markedly higher levels of assertive and aggressive responses. This pattern of findings may be due, in part, to the situation specificity of children’s responding. Our findings hint at the complexity of children’s behavioral repertoires and contribute to a growing literature that suggests the need for intervention models that consider both social skills and social situations.

Randomized Controlled Trial of Exercise for ADHD and Disruptive Behavior Disorders.

PURPOSE The objective of this study is to test the feasibility and impact of a 10-wk after-school exercise program for children with attention deficit hyperactivity disorder and/or disruptive behavior disorders living in an urban poor community. METHODS Children were randomized to an exercise program (n = 19) or a comparable but sedentary attention control program (n = 16). Cognitive and behavioral outcomes were collected pre-/posttest. Intent-to-treat mixed models tested group-time and group-time-attendance interactions. Effect sizes were calculated within and between groups. RESULTS Feasibility was evidenced by 86% retention, 60% attendance, and average 75% maximum HR. Group-time results were null on the primary outcome, parent-reported executive function. Among secondary outcomes, between-group effect sizes favored exercise on hyperactive symptoms (d = 0.47) and verbal working memory (d = 0.26), and controls on visuospatial working memory (d = -0.21) and oppositional defiant symptoms (d = -0.37). In each group, within-group effect sizes were moderate to large on most outcomes (d = 0.67 to 1.60). A group-time-attendance interaction emerged on visuospatial working memory (F[1,33] = 7.42, P < 0.05), such that attendance to the control program was related to greater improvements (r = 0.72, P < 0.01), whereas attendance to the exercise program was not (r = 0.25, P = 0.34). CONCLUSIONS Although between-group findings on the primary outcome, parent-reported executive function, were null, between-group effect sizes on hyperactivity and visuospatial working memory may reflect adaptations to the specific challenges presented by distinct formats. Both groups demonstrated substantial within-group improvements on clinically relevant outcomes. Findings underscore the importance of programmatic features, such as routines, engaging activities, behavior management strategies, and adult attention, and highlight the potential for after-school programs to benefit children with attention deficit hyperactivity disorder and disruptive behavior disorder living in urban poverty where health needs are high and services resources few.

A qualitative study to explore paraprofessionals’ role in school-based prevention and early intervention mental health services

This study explored the role of paraprofessionals within a school-based prevention and early intervention program to promote childrens engagement in learning and positive parenting practices. Study aims were designed to understand how paraprofessionals perceive their role in high-need communities and how they define their work within schools. Two focus groups were conducted with school family liaisons (SFLs) during the 2015-2016 school year. Transcribed audio recordings were coded using thematic analysis wherein 2 authors coded independently, followed by audited discussion and final consensus codes. SFLs acknowledged the importance of serving high-need communities and relationship building was central to their role. They leveraged contextual knowledge (culture, language, and neighborhood) to engage parents, allowing them to serve as effective advocates for parents/families in the school setting. Findings support the importance of paraprofessionals in prevention-focused services and highlight how leveraging shared experiences and prioritizing relationship building facilitates their work as advocates within schools.