John S. Carlson

Background/Objectives: Children in early childhood experience higher rates of suspension and expulsion than K–12 students, with persistent racial disparities. Methods: This retrospective descriptive observational study examined exclusionary practices among children ages 0–5 reported by providers participating in a state-level Infant and Early Childhood Mental Health Consultation (IECMHC) initiative within the United States. Results: Providers (n = 689) reported that 3.50% of children were excluded in the 12 months prior to service initiation (1.90% suspended; 1.60% expelled), with higher rates among older children (ages 3–5), males, and Black, Indigenous, People of Color (BIPOC) children. Among a subset of providers of children (n = 395) receiving child-and-family-focused (CFF) consultation, only 28 were expelled (7.09%), with the highest rate observed in children ages 30–36 months. Children expelled during CFF consultation more frequently exhibited atypical protective factors, elevated behavioral concerns, aggression at referral, and higher cumulative adverse childhood experiences (ACEs). Conclusions: Findings suggest that CFF consultation may help mitigate childcare exclusionary practices when children present with severe social-emotional-behavioral challenges. Important considerations for future childcare research and prevention efforts are provided.

Background/Objectives: The effects of online physical activity (PA) interventions on executive function (EF) and Attention-Deficit Hyperactivity Disorder (ADHD) symptoms are promising; nonetheless, their benefits for Latinx youth remain unclear. Methods: This study explores levels of adherence, cognitive and behavioral outcomes and acceptability of an online PA intervention, Zing Performance, among a Latinx youth sample; only a few of the participants completed their condition (n = 6). Results: There was wide variability in adherence levels at mid-treatment (n = 5) and high-level adherence at post-treatment (n = 2). A Mann–Whitney test yielded a statistically significant (p = 0.004) improvement in the treatment group’s inattention symptoms at mid-treatment (n = 5), compared to the Waitlist Control; (WLC; n = 6). EF and hyperactivity/impulsivity were not significantly different. Further, pre-, mid- and post-participant trajectory data revealed that one participant benefited significantly from treatment, one participant demonstrated little to no response to treatment, and most of the WLC participants remained in the severity ranges throughout the 12 weeks. The parents of the two children who completed treatment reported high levels of acceptability informally and on the quantitative measure. Conclusions: Exploratory findings support further investigation of Zing among Latinx families with cultural consideration to study procedures. The lessons learned from this study are valuable for future research procedures and interventions with this marginalized population.

Background: A growing body of literature examines the utility of emotion-focused parenting programs, as behaviorally based programs currently dominate the parenting literature. Few of those studies examine differences in how Black parents may benefit. This mixed-methods pilot study examined preliminary fidelity, efficacy, and acceptability of Tuning in to Kids (TIK), an emotion-focused parenting program targeting parenting practices and children’s emotion regulation through a strengths-based approach. Methods: Pre, post, and one-month follow-up measurements were collected from 21 parents in the United States who were randomly assigned to a treatment (i.e., TIK) or waitlist control group. They were assessed across several self-report parent measures (parental emotion regulation, emotion socialization parenting practices and beliefs) and parent-report of children’s social-emotional competence. Parents in the TIK group completed interviews to further understand their experience participating in the intervention. Results: Descriptive analyses showed general improvements and positive change in parenting practices, beliefs, parental emotion regulation, and children’s self-regulation. Large effect sizes indicate reductions of parents emotion dismissing and distressed reactions to children’s negative emotions. TIK was overall rated as a highly acceptable intervention. Parent interviews offer essential information to provide context to Black parents’ experiences utilizing TIK as well as themes related to challenges in raising Black children with self-regulation difficulties. Conclusions: Overall, these preliminary mixed-methods outcomes suggest that TIK is a promising parenting program to improve Black parents’ emotion regulation, emotion coaching beliefs and positive parenting practices. Further research is needed to investigate the effectiveness of TIK and other emotion-focused parenting programs with Black parents and assess the necessity of future cultural adaptations.

Selective mutism (SM) is a rare childhood anxiety disorder which may be markedly detrimental to a child’s academic and social functioning if left untreated. Cognitive–behavioral treatments for social anxiety disorders have been found to be effective for SM, yet a paucity of published studies have explored manualized treatment approaches carried out by novice clinicians. The purpose of the present study was to examine the adherence, effectiveness, and acceptability of a condensed, 16-session version of Integrated Behavior Therapy for Selective Mutism (IBTSM; Bergman, 2013), the first manualized treatment for SM. A nonconcurrent multiple-baseline single-case design was used across five children diagnosed with SM, exclusively anxious subtype. IBTSM was implemented with excellent adherence (M = 98%) over an average of 19 weeks (range = 16–22 weeks). Visual analyses of weekly caregiver ratings of social anxiety and speaking behaviors did not demonstrate a replicated intervention effect; however, Tau-U effect sizes and Reliable Change Index (RCI) calculations demonstrated significant individual improvements in social anxiety and speaking behaviors over time on several measures. Three children (60%) no longer met diagnostic criteria for SM following treatment. All caregivers rated IBTSM as acceptable, with specific endorsements of acceptability in the areas of time required and treatment quality.

Psychotropic medications are commonly prescribed to school-aged youth for the management of mental health concerns. This paper describes the current state of evidence for psychotropic medications in school-aged youth. More specifically, the following sections summarize relevant medication research trials and practice parameters pertaining to psychotropic medication prescribing as well as the specific medications indicated for a range of commonly presenting disorders and symptom clusters in school-aged youth. For each of these disorders and symptom clusters, key findings pertaining to the current state of science and practice are highlighted for the purpose of offering patients, clinicians, researchers, and policymakers with nuanced considerations for the role of psychopharmacology within the context of a larger “whole-child” approach to care that relies on the collaboration of providers and services across systems of care to promote optimal child and family health and wellness. The paper concludes with a discussion about supporting the use of medication treatments in schools, including considerations for ensuring effective family-school-health system collaboration to best meet youth mental health needs.

Background: Numerous barriers to mental health utilization exist for families of children who present with serious emotional and behavioral challenges. Evidence-based practices that facilitate equitable outcomes across diverse populations are essential to identify. This study examined possible differential service outcomes in a Medicaid-funded, parent-to-parent intervention called Parent Support Partner (PSP). Method: Data from four hundred and sixty-four parents who received PSP services were evaluated for possible demographic differences in service completion. Within-group analyses were utilized for an analysis of outcomes (parent change, child functioning; treatment acceptability) within a subset (N = 153) of those who completed services. Results: No racial disparities were found in those who completed PSP (43%) when compared to those who did not (57%). Regression analyses uncovered significant improvements in parent competence and confidence, as well as overall child functioning (global functioning across domains such as school, home, behaviors). Consistent with identifying evidence-based practices, findings were seen consistently across the diverse sample of those who completed PSP services. Improvements in parents’ sense of competence and confidence were correlated with perceptions of treatment acceptability. Discussion: PSP is an innovative and promising intervention with demonstrated high levels of acceptability found to increase parent confidence and self-competence to advocate for treatments that can improve the mental health functioning of their child. Future investigations of factors associated with increasing PSP service completion and outcomes in larger and more diverse populations are necessary. Implications for considering and possibly adopting this evidence-informed practice within the nursing profession are provided.

Developing social-emotional skills can improve children's happiness, experiences, and ability to establish positive relationships. Children from low-income families experience higher risk factors than their middle- and upper-class counterparts. Hence, fostering these skills early at home and in the classroom is essential. Past research demonstrates various interventions to reduce problem behaviors and improve emotional socialization in children, as well as the impact of educating parents on effective emotion socialization practices. Tuning in to Kids Online (TIKOL) is an emotion socialization parenting program aiming to support parents' understanding of children's social-emotional development and employ an emotion coaching style to help children understand, label, and regulate their emotions. This study examined the engagement, effectiveness, and acceptability of TIKOL in a small sample of Head Start parents. Findings support the use of TIKOL to improve parents' emotion coaching practices, reduce parents' distressing reactions to children's behavior, and reduce parent-reported child conduct problems.

Children from low-income families experience greater developmental risk factors, suggesting the need for evidence-based social-emotional interventions to support children and their families. This study explored the engagement, effectiveness, and acceptability of an unstudied online version of an evidence-based emotion-focused intervention – Tuning in to Kids Online (TIKOL). This pilot study within a small Head Start sample demonstrated that parents watched, on average, 97% of the ten modules across the program duration, and all reported using “quite a few” of the parenting skills taught. Outcome data revealed significant improvements in employing an emotion coaching parenting style. Distressing reactions and parent-reported child conduct problems both decreased. There were no significant reductions in emotion dismissing beliefs. High levels of treatment acceptability were reported. Treatment engagement, effectiveness, and acceptability findings from this pilot TIKOL intervention study support the need to study this accessible, online version of a well-supported parenting program approach.

Cost, scheduling, and implementation competency are barriers to accessing traditional evidence-based behavioral interventions for childhood selective mutism (SM). Brief, or intensive, interventions are a disruptive innovation to traditional therapy given the use of fewer sessions during a short-term time period. This study explored the acceptability, integrity, and effectiveness (i.e., single-case replicated AB design) of an intensive summer camp consisting of a 5-day behavioral therapy for 25 children with SM. Caregiver-rated treatment acceptability ratings and family interviews support intensive summer day camp as an acceptable intervention approach for SM. Additionally, results revealed that counselors and parents implemented SM behavioral therapy during camp with impressive integrity (>90%) after receiving training about SM behavioral therapy from an SM expert clinician. Effect size calculations of counselor-rated daily behavior ratings revealed reductions in anxiety during camp for 18 of the 25 campers. Significant caregiver-rated improvements in speaking behaviors were reported for 9 out of 14 campers with data available for analysis at the 3-month follow-up. This pilot feasibility study is the first to investigate intensive summer day camp as a treatment approach for SM and implications for future research are discussed.