William M. Bannon

Inner-city child mental health service use: the real question is why youth and families do not use services.

Objective: This study examines pathways to urban child mental health care as well as explores reasons why care was not received. Methods: A single group longitudinal design was used to study initial attendance rates at an outpatient child mental health clinic and identify factors associated with initial service use for urban children and their families. Results: Approximately one-third of families (n = 82) do not follow up with care despite their child being referred and an initial appointment scheduled. Yet, three-quarters of those who did not attend a first session still wanted services when interviewed. Factors most significantly related to service use were social support and parental skill efficacy. Miscommunication between adult caregiver and provider was the most often cited reason for non-attendance. Conclusions: There is a significant unmet need for care along with identification of significant barriers to access. Empirical findings can serve as the basis for modifying urban child mental health service delivery systems.

Building Protective Factors to Offset Sexually Risky Behaviors among Black Youths: A Randomized Control Trial

OBJECTIVES To test the effectiveness of the CHAMP among black South Africans in KwaZulu-Natal, South Africa. METHODS A randomized control trial was conducted in KwaDedangendlale, South Africa, among youths (ages 9-13) and their families (245 intervention families rearing 281 children and 233 control families rearing 298 children). The CHAMPSA intervention targeted HIV risk behaviors by strengthening family relationship processes as well as targeting peer influences through enhancing social problem solving and peer negotiation skills for youths. RESULTS Among caregivers in the control and experimental conditions, significant intervention group differences were revealed regarding HIV transmission knowledge, less stigma toward HIV-infected people, caregiver monitoring-family rules, caregiver communication comfort, caregiver communication frequency and social networks. Among youths, data revealed that control and experimental groups were significantly different for children in AIDS transmission knowledge and less stigma toward HIV-infected people. CONCLUSIONS CHAMPSA enhances a significant number individual, family and community protective factors that can help youths avoid risky behaviors leading to HIV-positive status.

Gender and the effects of an economic empowerment program on attitudes toward sexual risk-taking among AIDS-orphaned adolescent youth in Uganda.

PURPOSE This article examines gender differences in attitudes toward sexual risk-taking behaviors of acquired immune deficiency syndrome (AIDS)-orphaned youth participating in a randomized control trial testing an economic empowerment intervention in rural Uganda. METHODS Adolescents (average age 13.7 years) who had lost one or both parents to AIDS from 15 comparable schools were randomly assigned to either an experimental (n=135) or a control condition (n=142). Adolescents in the experimental condition, in addition to usual care, also received support and incentives to save money toward secondary education. RESULTS Findings indicate that although adolescent boys and girls within the experimental condition saved comparable amounts, the intervention appears to have benefited girls, in regard to the attitudes toward sexual risk-taking behavior, in a different way and to a lesser extent than boys. CONCLUSIONS Future research should investigate the possibility that adolescent girls might be able to develop equally large improvements in protective attitudes toward sexual risk taking through additional components that address gendered social norms.

Understanding inner city child mental health need and trauma exposure : Implications for preparing urban service providers

This article presents the results of a study documenting the complex mental health needs of 95 inner city youth consecutively referred for mental health care. An ecological perspective of mental health need guides the presentation of issues and stressors that occur at the level of the individual child; within the family, school, and community; and within the larger service system context. Findings related to the intersection between child mental health needs and trauma exposure are described. In addition, the level of service involvement of these children is presented. Results reveal low rates of ongoing service involvement despite multiple, complex presenting mental health issues and significant levels of trauma exposure. Implications for urban service delivery and recommendations to prepare service providers are drawn.

Are Barriers to Service and Parental Preferences Match for Services Related to Urban Child Mental Health Service Use

The authors sought to examine how parental preference match for service and various types of barriers to service relate to involvement in urban child mental health care. A single-group longitudinal design was used to examine whether service use at an outpatient child mental health clinic was related to parents receiving the type of service they reported wanting for their child at intake and various types of barriers to service. Families who received the service parents reported wanting for their child attended on average 2 treatment sessions more, whereas barriers were unrelated to service use. Considering parent preference for child mental health service may be an effective strategy in increasing service involvement in urban child mental health care.

It Takes a Village to Deliver and Test Child and Family-Focused Services:

Objectives: The purpose of this article is to highlight the benefits of collaboration in child focused mental health services research. Method: Three unique research projects are described. These projects address the mental health needs of vulnerable, urban, minority children and their families. In each one, service delivery was codesigned, interventions were co-delivered and a team of stakeholders collaboratively tested the impact of each one. Results: The results indicate that the three interventions designed, delivered, and tested are associated with reductions in youth mental health symptoms. Conclusion: These interventions are feasible alternatives to traditional individualized outpatient treatment.

Creating mechanisms for meaningful collaboration between members of urban communities and university-based HIV prevention researchers

Summary This article provides a description of a Community/University Collaborative Board, a formalized partnership between representatives from an inner-city community and university-based researchers. This Collaborative Board oversees a number of research projects focused on designing, delivering and testing family-based HIV prevention and mental health focused programs to elementary and junior high school age youth and their families. The Collaborative Board consists of urban parents, school staff members, representatives from community-based agencies and university-based researchers. One research project, the CHAMP (Collaborative HIV prevention and Adolescent Mental health Project) Family Program Study, an urban, family-based HIV prevention project will be used to illustrate how the Collaborative Board oversees a community-based research study. The process of establishing a Collaborative Board, recruiting members and developing subcommittees is described within this article. Examples of specific issues addressed by the Collaborative Board within its subcommittees, Implementation, Finance, Welcome, Research, Grant writing, Curriculum, and Leadership, are detailed in this article along with lessons learned.

Cultural Pride Reinforcement as a Dimension of Racial Socialization Protective of Urban African American Child Anxiety.

The study objective was to examine how parental endorsement of cultural pride reinforcement messages may explain African American child anxiety. Data were gathered from 72 African American parents and their elementary school-aged children. Results indicated stronger parental endorsement of cultural pride reinforcement messages predicted less child anxiety. Additionally parental endorsement of these messages moderated the relationship between child mental health risk factor exposure and child anxiety. Specifically in the presence of high exposure, children of parents who endorsed high levels of cultural pride reinforcement messages had significantly lower anxiety scores relative to children of parents who endorsed low levels of these messages. Findings indicated parental endorsement of these messages may be an important factor in explaining African American child anxiety.

Parent Medication Concerns Predict Underutilization of Mental Health Services for Minority Children With ADHD

Objective. Disparities in attention deficit hyperactivity disorder (ADHD) treatment are recognized with minority children using services less than nonminority children. The authors examine minority parents’ knowledge and perceptions of ADHD as they relate to service utilization. Methods. Using a longitudinal cohort design, parents of children with untreated ADHD were surveyed regarding their knowledge and perceptions of ADHD and then followed for 3 to 6 months to determine whether they used services. Results. Seventy parents of 5- to 18-year-old children with untreated ADHD were enrolled. Of the 70 children, 33 (47.1%) had not attended any mental health appointments and 51 (72.9%) had not used any treatments by 3- to 6-month follow-up. Logistic regression indicated that increasing age and medication concerns were associated with less follow-up at mental health appointments (P < .05) and less utilization of treatments (P < .05). Conclusions. The results of this study highlight the importance of addressing medication concerns, when referring minority children to mental health services or offering treatments.

The Role of Racial Socialization in Relation to Parenting Practices and Youth Behavior: An Exploratory Analysis

SUMMARY Racial socialization is receiving research attention because of growing evidence that it can be a protective developmental process in African American families. The present study was an exploration of the relationship of parental mental health, discipline effectiveness, monitoring and racial socialization strategies on child externalizing behaviors in a sample of 140 African American parent/caregivers. Findings indicated that certain types of racial socialization—particularly, spirituality and religious coping—in conjunction with discipline effectiveness was related to child behavior problems. Specifically, among parents who felt they used more effective discipline strategies, moderate to high rates of spiritual and religious coping were associated with a reduction of child behavior problems. These findings support the hypothesis that racial socialization is an important aspect of parenting in African American families that can be associated with the effective management of childrens behavior. Implications for parenting interventions and future research are discussed.