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Weiss MD, Richards EC, Bien-Aime D, Witkowski T, Williams P, Holmes KE, Cortes DE, Tepper MC, Wang PS, Aldis R, Carson N, Cook BL. The Development of a Brief but Comprehensive Therapeutic Assessment Protocol for the Screening and Support of Youth in the Community to Address the Youth Mental Health Crisis. Brain Sci 2024; 14:1134. [PMID: 39595897 PMCID: PMC11591985 DOI: 10.3390/brainsci14111134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 11/02/2024] [Accepted: 11/06/2024] [Indexed: 11/28/2024] Open
Abstract
OBJECTIVE The objective of this study was to explore the acceptability and feasibility of a therapeutic assessment protocol for the Screening and Support of Youth (SASY). SASY provides brief but comprehensive community-based screening and support for diverse youth in the community. METHODS SASY screening evaluates symptoms, functioning and clinical risk. The Kiddie Computerized Adaptive Test was used to evaluate seven different diagnoses and symptom severity. The Weiss Functional Impairment Rating Scale-Self was used to measure functional impairment. Measures were scored according to nationally developed norms. An algorithm was developed to aggregate symptom and function ratings into an overall score for clinical risk. The results are discussed with participants in a motivational interview designed to promote insight, followed by the opportunity for the participant to engage in an online intervention. Protocol changes necessitated by social distancing during the pandemic led to innovative methods including the use of a QR code for recruitment, integration of both online and offline participation, and expansion from in-person recruitment within the schools to virtual engagement with youth throughout the community. The final sample included disproportionately more Black or African American and Hispanic youth as compared to school and community statistics, suggesting that optimization of online and offline methods in research may facilitate the recruitment of diverse populations. Qualitative interviews indicated that the screening and feedback raised youth awareness of their wellbeing and/or distress, its impact on their functioning, and engagement with options for improved wellbeing. CONCLUSIONS The emergence of innovative methods optimizing the advantages of both online and offline methods, developed as a necessity during the pandemic, proved advantageous to the feasibility and acceptability of community-based recruitment of at-risk, minoritized youth.
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Affiliation(s)
- Margaret Danielle Weiss
- Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139, USA; (E.C.R.); (D.B.-A.); (T.W.); (P.W.); (K.E.H.); (D.E.C.); (R.A.); (N.C.); (B.L.C.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Eleanor Castine Richards
- Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139, USA; (E.C.R.); (D.B.-A.); (T.W.); (P.W.); (K.E.H.); (D.E.C.); (R.A.); (N.C.); (B.L.C.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Danta Bien-Aime
- Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139, USA; (E.C.R.); (D.B.-A.); (T.W.); (P.W.); (K.E.H.); (D.E.C.); (R.A.); (N.C.); (B.L.C.)
| | - Taylor Witkowski
- Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139, USA; (E.C.R.); (D.B.-A.); (T.W.); (P.W.); (K.E.H.); (D.E.C.); (R.A.); (N.C.); (B.L.C.)
| | - Peyton Williams
- Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139, USA; (E.C.R.); (D.B.-A.); (T.W.); (P.W.); (K.E.H.); (D.E.C.); (R.A.); (N.C.); (B.L.C.)
| | - Katie E. Holmes
- Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139, USA; (E.C.R.); (D.B.-A.); (T.W.); (P.W.); (K.E.H.); (D.E.C.); (R.A.); (N.C.); (B.L.C.)
| | - Dharma E. Cortes
- Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139, USA; (E.C.R.); (D.B.-A.); (T.W.); (P.W.); (K.E.H.); (D.E.C.); (R.A.); (N.C.); (B.L.C.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Miriam C. Tepper
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA;
- New York State Psychiatric Institute, New York, NY 10032, USA
| | - Philip S. Wang
- Center for Learning Health Systems, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Department of Psychiatry, Harvard University, Boston, MA 02115, USA
| | - Rajendra Aldis
- Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139, USA; (E.C.R.); (D.B.-A.); (T.W.); (P.W.); (K.E.H.); (D.E.C.); (R.A.); (N.C.); (B.L.C.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Nicholas Carson
- Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139, USA; (E.C.R.); (D.B.-A.); (T.W.); (P.W.); (K.E.H.); (D.E.C.); (R.A.); (N.C.); (B.L.C.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Benjamin Le Cook
- Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139, USA; (E.C.R.); (D.B.-A.); (T.W.); (P.W.); (K.E.H.); (D.E.C.); (R.A.); (N.C.); (B.L.C.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
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Gray SE, Carter M, Harper A. Effectiveness of an evidenced-based cognitive behavioral therapy intervention for adolescents in a school setting. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12448. [PMID: 38403988 DOI: 10.1111/jcap.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/10/2023] [Accepted: 12/23/2023] [Indexed: 02/27/2024]
Abstract
PROBLEM The adolescent years are a formative time when rapid hormonal and physical changes stimulate the developing mind. Exposure to poverty, abuse, violence, and lack of peer and social support causes an increase in vulnerability to the development of mental health problems. The COVID-19 pandemic has also exacerbated symptoms of depression and anxiety. Regardless of the risk factors, anxiety and depression continue to be significant health problems, affecting thousands of adolescents yearly in the United States. The first-line treatment recommendation for managing anxiety and depression symptoms is cognitive behavioral therapy (CBT). However, access to a provider for CBT treatment is not always an option for many reasons. METHODS This pilot evidenced-based practice project aims to increase access to skills acquired through CBT and improve adolescents' mental health by implementing a brief and evidenced-based CBT program in a school setting. The CBT program for this project is the Creating Opportunities for Personal Empowerment (COPE) for Teens program consisting of seven 50-55-min sessions. The COPE program was delivered to 22 students in a 7th-grade health class. The Generalized Anxiety Disorder 7-Item and Patient Health Questionnaire-9 Modified for Adolescents measured anxiety and depression scores at baseline, post-intervention, and 2-month follow-up. FINDINGS Results indicate clinically significant improvements in anxiety and depression scores and showed participant satisfaction. CONCLUSIONS COPE in the school setting offers a low-risk solution to improving behaviors and emotional intelligence. COPE is a cost-effective solution to the mental health provider shortage.
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Affiliation(s)
- Sarah E Gray
- College of Nursing, The University of Tennessee, Knoxville, USA
| | - Michaela Carter
- College of Nursing, The University of Tennessee, Knoxville, USA
| | - Amanda Harper
- College of Nursing, The University of Tennessee, Knoxville, USA
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Harper A, Brewer TL. A homeschool-based cognitive behavioral program to improve adolescent mental health. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 35:179-188. [PMID: 34951077 DOI: 10.1111/jcap.12364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/01/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022]
Abstract
PROBLEM Anxiety and depression are prevalent in the adolescent population and can have significant consequences. Treatment recommendations are established but rates of utilization remain low, often due to a lack of access to mental health providers. Availability of mental health services in a school-based setting may increase access, but homeschooled children do not have access to these services. Additionally, the COVID-19 pandemic has increased the number of homeschooled children and compounded the problem of adolescent mental health disorders. METHODS This pilot evidence-based practice project aimed to increase access to cognitive behavioral therapy (CBT) in adolescents. Eight students from a local homeschool cooperative participated in the Creating Opportunities for Personal Empowerment (COPE) program. A Friedman test was used to evaluate median differences on anxiety and depression screening instruments at baseline, program completion, and 1 month after the program. Students also completed an adapted COPE program evaluation. RESULTS Median scores on screening instruments decreased from pre-COPE to 1 month after, although results were not statistically significant. Students reported that the COPE program was helpful, and they learned new ways to deal with their thoughts, feelings, and behaviors. CONCLUSION COPE is a feasible option to increase access to CBT in a homeschool setting.
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Affiliation(s)
- Amanda Harper
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
| | - Tracy L Brewer
- College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
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Rich BW, Stager SL. Mindful BALANCE (breathe act learn about 'now' care everyday): A pilot project for depressed female adolescents. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 34:125-132. [PMID: 33616309 DOI: 10.1111/jcap.12308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 11/19/2020] [Accepted: 01/29/2021] [Indexed: 12/21/2022]
Abstract
PROBLEM Major depressive episodes in adolescent females have increased during the past decade, placing them at risk to engage in unhealthy lifestyle behaviors, unsafe thoughts, suicidal ideation, and lethal actions. Mindfulness, a tool for stress management, is underutilized. METHODS Mindful BALANCE (Breathe Act Learn About 'Now' Care Everyday), a group therapy pilot program introduced a variety of mindfulness activities. The extended mindfulness followed the Creating Opportunities for Personal Empowerment (COPE), a Cognitive Behavioral Therapy Skills Building (CBSB) Healthy Lifestyle program. The pilot program was offered in an outpatient mental health department for 7 weeks. FINDINGS Mindful BALANCE is a feasible program as an adjunct to individualized psychotherapy. Six subjects engaged without absence with a completion rate of 83%. Six subjects had pre- and post-scores for depression and anxiety decrease. Mindfulness practice was reported to decrease the perception of stress. CONCLUSION Mindful BALANCE decreased perceived depression and anxiety symptoms while positively impacting healthy activities in adolescent females. Further research is necessary to readdress feasibility and extended mindfulness components in improving global well-being and diminishing suicide risk.
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Affiliation(s)
- Beverly Waldman Rich
- Emma Pendleton Bradley Hospital, Providence, Rhode Island, USA.,Rhode Island College, Providence, Rhode Island, USA
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