Jaime Ballard

More than one in three US parents use corporal punishment to discipline their children. The objective of this study is to add to a greater understanding of factors associated with self‐reported corporal punishment, based on two survey items: one that asked about use of spanking and one that asked about hitting out of anger. The second objective was to examine the longitudinal relationship between parents' self‐reported use of spanking at age 35 and their self‐reports of hitting out of anger 5 years later. To accomplish these objectives, national US Monitoring the Future Panel Study data were used as follows. Objective 1: data collected in 1993–2020 from parents age 35 with child(ren) ages 2–12 at home. Objective 2: data collected in 1998–2020 from parents age 40 with child(ren) ages 7–17 at home. We conducted multinomial logistic regression to accomplish the objectives. Most factors significantly associated with increased odds of reporting spanking at age 35 differed from the factors associated with increased odds of reporting hitting out of anger at age 35. Reporting spanking at age 35 was associated with greater odds of reporting hitting out of anger at age 40 (aOR = 2.10, 95% CI: 1.71, 2.58). Depressive symptoms (aOR = 1.24, 95% CI: 1.09, 1.40) and disordered alcohol use (aOR = 1.55, 95% CI: 1.14, 2.11) were associated with greater odds of reporting hitting out of anger. Future research should continue to examine whether different types of corporal punishment have different determinants, whether and in what ways corporal punishment may escalate over time, and whether measurement error may impact this research.

The authors highlight the experience of Marshallese American families, including elevated mental health concerns and low access to mental health care. They describe the process used to identify toys that could create a culturally inclusive classroom...

Background: Pediatric mental health emergency department (ED) visits are increasing at 6% to 10% per year, at substantial cost, while 13% of youth with psychiatric hospitalizations are readmitted in the following weeks. Hospitals do not have the resources to meet escalating youth’s mental health needs. Intensive outpatient (IOP) programs, which provide multiple hours of care each week, have the power to reduce the number of patients in need of hospitalized care and provide a step-down option for patients discharging from ED’s in order to prevent readmissions. Objective: The purpose of this program evaluation was to assess (1) whether youth and young adult ED admission rates decreased following participation in a remote IOP program and (2) whether there were differences in readmission rates between youth and young adults by gender identity, sexual orientation, race, or ethnicity. Methods: Data were collected from intake and 3-month postdischarge surveys for 735 clients who attended at least 6 sessions of a remote IOP program for youth and young adults. Patients reported if they had been admitted to an ED within the previous 30 days and the admission reason. Over half (407/707, 57.6%) of clients were adolescents and the rest were young adults (300/707, 42.4%; mean age 18.25, SD 4.94 years). The sample was diverse in gender identity (329/687, 47.9% female; 196/687, 28.5% male; and 65/669, 9.7% nonbinary) and sexual orientation (248/635, 39.1% heterosexual; 137/635, 21.6% bisexual; 80/635, 10.9% pansexual; and 170/635, 26.8% other sexual orientation) and represented several racial (9/481, 1.9% Asian; 48/481, 10% Black; 9/481, 1.9% Indigenous; 380/481, 79% White; and 35/481, 7.2% other) and ethnic identities (112/455, 24.6% Hispanic and 28/455, 6.2% other ethnic identity). Results: Mental health–related ED admissions significantly decreased between intake and 3 months after discharge, such that 94% (65/69) of clients with a recent history of mental health–related ED admissions at IOP intake reported no mental health–related ED admissions at 3 months after discharge from treatment (χ21=38.8, P<.001). There were no differences in ED admissions at intake or in improvement at 3 months after discharge by age, gender, sexuality, race, or ethnicity. Conclusions: This study documents a decrease in ED admissions between intake and 3 months after discharge among both youth and young adults who engage in IOP care following ED visits. The similar outcomes across demographic groups indicate that youth and young adults experience similar decreases after the current tracks of programming. Future research could conduct a full return-on-investment analysis for intensive mental health services for youth and young adults.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The youth mental health crisis in the United States continues to worsen, and research shows poor treatment outcomes for youth in mental health care. Despite the rise in predictive and personalized treatment, there has been a lack of research conducted with youth. Due to the complex developmental milestones of these periods, there is a need to better understand initial clinical presentation and predictors of treatment engagement to more effectively identify and tailor beneficial treatments. Objective: This quality improvement investigation sought to identify subgroups of clients attending remote intensive outpatient (IOP) treatment based on clinical acuity data at intake to determine the predictors of outcomes for clients who present in complex developmental periods and with co-occurring conditions. The identification of these subgroups was used to inform programmatic decisions within the remote IOP system for which this quality improvement analysis was conducted. Methods: Data were collected as part of ongoing quality improvement initiatives at a remote IOP for youth and young adults. Clients (N=2924) discharged between July 2021 and February 2023. A latent profile analysis was conducted using five indicators of clinical acuity at treatment entry, and the resulting profiles were assessed for associations with demographic predictors and treatment engagement outcomes. Results: Four profiles of clinical acuity emerged: a low acuity profile, characterized by minimal anxiety, depression, and self-harm, and three high acuity profiles defined by moderately severe depression and anxiety but differentiated by rates of self-harm. Age, gender, transgender identity, and sexual orientation were significantly related to profile membership. Clients identifying as sexual and gender marginalized populations were more likely to be classified into high acuity profiles relative to the low acuity profile, while race was unrelated to profile membership. Profile membership was significantly associated with treatment engagement: youth and young adults in the low acuity and high acuity + low self-harm profiles attended an average of 4-5 fewer treatment sessions relative to youth in the high acuity + moderate self-harm and high acuity + high self-harm profiles, ꭓ2(3) = 27.65, P < .001. Individuals in the high acuity + low self-harm profile completed treatment at a significantly lower rate relative to the other two high acuity profiles, ꭓ2(3) = 13.41, P = .004. Finally, those in the high acuity + high self-harm profile were significantly less likely to disengage early relative to youth in all other profiles, ꭓ2(3) = 71.12, P < .001. Conclusions: This investigation represents a novel application of distilling salient variables around which to proactively assign clients to clinical programming. Identifying subgroups that differentially engage in treatment is a critical first step towards personalizing treatment within complex populations. Clinical Trial: NA

Emerging adults face an increasingly complicated financial climate, which necessitates that they possess dynamic financial decision-making skills. With an increased understanding of emerging adults’ financial decision-making processes and what influences their financial decisions, parents, financial counselors, and other individuals can better prepare emerging adults to be financially independent. This qualitative study explored how emerging adults make financial decisions by asking questions about their habits and preferences as well as responding to two hypothetical, financial-related dilemma scenarios. Participants engaged in interactive learning sessions where they were able to share their responses in a group setting. Findings indicated that participants consulted media and their parents the most when they needed advice or additional information to make financial decisions. Based on this study’s findings, it is recommended that financial literacy programs involve emerging adults’ families and leverage the influence of media when teaching financial knowledge and skills.

Background: Early treatment dropout among youths and young adults (28%-75%) puts them at risk for poorer outcomes. Family engagement in treatment is linked to lower dropout and better attendance in outpatient, in-person treatment. However, this has not been studied in intensive or telehealth settings. Objective: We aimed to examine whether family members’ participation in telehealth intensive outpatient (IOP) therapy for mental health disorders in youths and young adults is associated with patient’s treatment engagement. A secondary aim was to assess demographic factors associated with family engagement in treatment. Methods: Data were collected from intake surveys, discharge outcome surveys, and administrative data for patients who attended a remote IOP for youths and young adults, nationwide. Data included 1487 patients who completed both intake and discharge surveys and either completed or disengaged from treatment between December 2020 and September 2022. Descriptive statistics were used to characterize the sample’s baseline differences in demographics, engagement, and participation in family therapy. Mann-Whitney U and chi-square tests were used to explore differences in engagement and treatment completion between patients with and those without family therapy. Binomial regression was used to explore significant demographic predictors of family therapy participation and treatment completion. Results: Patients with family therapy had significantly better engagement and treatment completion outcomes than clients with no family therapy. Youths and young adults with ≥1 family therapy session were significantly more likely to stay in treatment an average of 2 weeks longer (median 11 weeks vs 9 weeks) and to attend a higher percentage of IOP sessions (median 84.38% vs 75.00%). Patients with family therapy were more likely to complete treatment than clients with no family therapy (608/731, 83.2% vs 445/752, 59.2%; P<.001). Different demographic variables were associated with an increased likelihood of participating in family therapy, including younger age (odds ratio 1.3) and identifying as heterosexual (odds ratio 1.4). After controlling for demographic factors, family therapy remained a significant predictor of treatment completion, such that each family therapy session attended was associated with a 1.4-fold increase in the odds of completing treatment (95% CI 1.3-1.4). Conclusions: Youths and young adults whose families participate in any family therapy have lower dropout, greater length of stay, and higher treatment completion than those whose families do not participate in services in a remote IOP program. The findings of this quality improvement analysis are the first to establish a relationship between participation in family therapy and an increased engagement and retention in remote treatment for youths and young patients in IOP programing. Given the established importance of obtaining an adequate dosage of treatment, bolstering family therapy offerings is another tool that could contribute to the provision of care that better meets the needs of youths, young adults, and their families.

BACKGROUND The youth mental health crisis in the United States continues to worsen, and research has shown poor mental health treatment engagement. Despite the need for personalized engagement strategies, there is a lack of research involving youth. Due to complex youth developmental milestones, there is a need to better understand clinical presentation and factors associated with treatment engagement to effectively identify and tailor beneficial treatments. OBJECTIVE This quality improvement investigation sought to identify subgroups of clients attending a remote intensive outpatient program (IOP) based on clinical acuity data at intake, to determine the factors associated with engagement outcomes for clients who present in complex developmental periods and with cooccurring conditions. The identification of these subgroups was used to inform programmatic decisions within this remote IOP system. METHODS Data were collected as part of ongoing quality improvement initiatives at a remote IOP for youth and young adults. Participants included clients (N=2924) discharged between July 2021 and February 2023. A latent profile analysis was conducted using 5 indicators of clinical acuity at treatment entry, and the resulting profiles were assessed for associations with demographic factors and treatment engagement outcomes. RESULTS Among the 2924 participants, 4 profiles of clinical acuity were identified: a low-acuity profile (n=943, 32.25%), characterized by minimal anxiety, depression, and self-harm, and 3 high-acuity profiles defined by moderately severe depression and anxiety but differentiated by rates of self-harm (high acuity+low self-harm: n=1452, 49.66%; high acuity+moderate self-harm: n=203, 6.94%; high acuity+high self-harm: n=326, 11.15%). Age, gender, transgender identity, and sexual orientation were significantly associated with profile membership. Clients identified as sexually and gender-marginalized populations were more likely to be classified into high-acuity profiles than into the low-acuity profile (eg, for clients who identified as transgender, high acuity+low self-harm: odds ratio [OR] 2.07, 95% CI 1.35-3.18; P<.001; high acuity+moderate self-harm: OR 2.85, 95% CI 1.66-4.90; P<.001; high acuity+high self-harm: OR 3.67, 95% CI 2.45-5.51; P<.001). Race was unrelated to the profile membership. Profile membership was significantly associated with treatment engagement: youth and young adults in the low-acuity and high-acuity+low–self-harm profiles attended an average of 4 fewer treatment sessions compared with youth in the high-acuity+moderate–self-harm and high-acuity+high–self-harm profiles (ꭓ23=27.6, P<.001). Individuals in the high-acuity+low–self-harm profile completed treatment at a significantly lower rate relative to the other 2 high-acuity profiles (ꭓ23=13.4, P=.004). Finally, those in the high-acuity+high–self-harm profile were significantly less likely to disengage early relative to youth in all other profiles (ꭓ23=71.12, P<.001). CONCLUSIONS This investigation represents a novel application for identifying subgroups of adolescents and young adults based on clinical acuity data at intake to identify patterns in treatment engagement outcomes. Identifying subgroups that differentially engage in treatment is a critical first step toward targeting engagement strategies for complex populations.

BACKGROUND Pediatric mental health emergency department (ED) visits are increasing at 6% to 10% per year, at substantial cost, while 13% of youth with psychiatric hospitalizations are readmitted in the following weeks. Hospitals do not have the resources to meet escalating youth’s mental health needs. Intensive outpatient (IOP) programs, which provide multiple hours of care each week, have the power to reduce the number of patients in need of hospitalized care and provide a step-down option for patients discharging from ED’s in order to prevent readmissions. OBJECTIVE The purpose of this program evaluation was to assess (1) whether youth and young adult ED admission rates decreased following participation in a remote IOP program and (2) whether there were differences in readmission rates between youth and young adults by gender identity, sexual orientation, race, or ethnicity. METHODS Data were collected from intake and 3-month postdischarge surveys for 735 clients who attended at least 6 sessions of a remote IOP program for youth and young adults. Patients reported if they had been admitted to an ED within the previous 30 days and the admission reason. Over half (407/707, 57.6%) of clients were adolescents and the rest were young adults (300/707, 42.4%; mean age 18.25, SD 4.94 years). The sample was diverse in gender identity (329/687, 47.9% female; 196/687, 28.5% male; and 65/669, 9.7% nonbinary) and sexual orientation (248/635, 39.1% heterosexual; 137/635, 21.6% bisexual; 80/635, 10.9% pansexual; and 170/635, 26.8% other sexual orientation) and represented several racial (9/481, 1.9% Asian; 48/481, 10% Black; 9/481, 1.9% Indigenous; 380/481, 79% White; and 35/481, 7.2% other) and ethnic identities (112/455, 24.6% Hispanic and 28/455, 6.2% other ethnic identity). RESULTS Mental health–related ED admissions significantly decreased between intake and 3 months after discharge, such that 94% (65/69) of clients with a recent history of mental health–related ED admissions at IOP intake reported no mental health–related ED admissions at 3 months after discharge from treatment (χ21=38.8, P<.001). There were no differences in ED admissions at intake or in improvement at 3 months after discharge by age, gender, sexuality, race, or ethnicity. CONCLUSIONS This study documents a decrease in ED admissions between intake and 3 months after discharge among both youth and young adults who engage in IOP care following ED visits. The similar outcomes across demographic groups indicate that youth and young adults experience similar decreases after the current tracks of programming. Future research could conduct a full return-on-investment analysis for intensive mental health services for youth and young adults.

BACKGROUND The youth mental health crisis in the United States continues to worsen, and research shows poor treatment outcomes for youth in mental health care. Despite the rise in predictive and personalized treatment, there has been a lack of research conducted with youth. Due to the complex developmental milestones of these periods, there is a need to better understand initial clinical presentation and predictors of treatment engagement to more effectively identify and tailor beneficial treatments. OBJECTIVE This quality improvement investigation sought to identify subgroups of clients attending remote intensive outpatient (IOP) treatment based on clinical acuity data at intake to determine the predictors of outcomes for clients who present in complex developmental periods and with co-occurring conditions. The identification of these subgroups was used to inform programmatic decisions within the remote IOP system for which this quality improvement analysis was conducted. METHODS Data were collected as part of ongoing quality improvement initiatives at a remote IOP for youth and young adults. Clients (N=2924) discharged between July 2021 and February 2023. A latent profile analysis was conducted using five indicators of clinical acuity at treatment entry, and the resulting profiles were assessed for associations with demographic predictors and treatment engagement outcomes. RESULTS Four profiles of clinical acuity emerged: a low acuity profile, characterized by minimal anxiety, depression, and self-harm, and three high acuity profiles defined by moderately severe depression and anxiety but differentiated by rates of self-harm. Age, gender, transgender identity, and sexual orientation were significantly related to profile membership. Clients identifying as sexual and gender marginalized populations were more likely to be classified into high acuity profiles relative to the low acuity profile, while race was unrelated to profile membership. Profile membership was significantly associated with treatment engagement: youth and young adults in the low acuity and high acuity + low self-harm profiles attended an average of 4-5 fewer treatment sessions relative to youth in the high acuity + moderate self-harm and high acuity + high self-harm profiles, ꭓ2(3) = 27.65, P < .001. Individuals in the high acuity + low self-harm profile completed treatment at a significantly lower rate relative to the other two high acuity profiles, ꭓ2(3) = 13.41, P = .004. Finally, those in the high acuity + high self-harm profile were significantly less likely to disengage early relative to youth in all other profiles, ꭓ2(3) = 71.12, P < .001. CONCLUSIONS This investigation represents a novel application of distilling salient variables around which to proactively assign clients to clinical programming. Identifying subgroups that differentially engage in treatment is a critical first step towards personalizing treatment within complex populations. CLINICALTRIAL NA