Michelle Evans-Chase

Maternal and infant risk characteristics, including postpartum depression, infrequent neonatal intensive care unit (NICU) visitation, low gestational age, low birthweight, and prolonged NICU hospitalization, were examined as potential predictors of lower levels of maternal-infant bond or affective connection among mothers of NICU infants, while controlling for civil status and number of siblings. A correlational longitudinal design was used with a convenience sample of 101 mother-infant dyads in a university hospital NICU. Measures included the Maternal Attachment Inventory (MAI), the Edinburgh Postnatal Depression Scale, and medical record data. Multiple regression analyses, chi-square tests, and analyses of variance (ANOVA) were employed. Although the primary hypothesis was not supported, post hoc analyses showed that postpartum depression was associated with decreased maternal bond or affective connection. Mothers who developed clinical postpartum depression between Times 1 and 2 demonstrated the greatest decline in bond or connection compared to those with persistent or absent depression. Several MAI items were more normally distributed than total scores, highlighting specific attachment challenges in the NICU context. These findings suggest the need for targeted clinical interventions to address processes that may disrupt maternal-infant bond in high-risk NICU populations. The implications for disenfranchised populations, including non-White and lower socioeconomic status (SES) groups, are also discussed.

Purpose: Given the increasing demand for mental health resources and challenges associated with engaging adolescents in therapy, it is crucial to evaluate alternative intervention modalities that empower parents to manage child behavior and enhance parental competency. This study evaluates the effectiveness of a parental guidance book on these outcomes. Method: A convenience sample of 128 Israeli parents were randomly assigned to experimental or control group. After pretest, treatment parents read a guidebook, and after 1 month, both groups were re-assessed. Multiple regression was used to test hypotheses. Results: Treatment parents reported significant improvements in parental competency and reductions in reported child behavior symptoms compared to controls. Frequency and number of strategies predicted an increase in parents’ sense of competency and control. Discussion: Substantial effect sizes indicate that structured, self-administered guidance can benefit parenting practices and outcomes. Findings support broader implementation of such interventions, particularly where traditional therapeutic resources are scarce or inaccessible.

BACKGROUND Clinical anxiety is the most common mental health disorder experienced by youth and young adults and one associated with poor physical, psychosocial, and educational outcomes. Those who seek treatment face multiple barriers to care, particularly youth under the age of 18 and those from minoritized gender and sexual orientation communities. Intensive Outpatient Programming (IOP) is one treatment model for youth with more complex mental health needs that may be well suited to treat clinical anxiety. Delivered remotely, it may also help to address barriers and enable programs to deliver treatment that is not limited by the clinical expertise of local populations. OBJECTIVE The objective of the quality improvement (QI) analysis reported here was to assess changes in anxiety among youth and young adults attending a remote intensive outpatient program. QI efforts are conducted as part of regular program procedures for monthly stakeholder reports and to inform clinical and programmatic decisions. METHODS The Generalized Anxiety Disorder (GAD-7) scale is used as part of ongoing QI efforts to assess changes in anxiety between intake and discharge. Repeated measures t-tests were used in this analysis to test changes in anxiety between intake and discharge and paired chi-square tests were used to test changes in clinical symptoms. One-way ANOVA and independent t-tests were employed to test differences among groups defined by age, gender, and sexual orientation. For the current analyses, N=516 cases were selected using criteria that included an age limit of 25 years, a diagnosis of anxiety and a minimum of 18 hours of treatment RESULTS Clients ranged in age from 11 to 25 (M=16 years, SD=3.64). Over a third were female (39%), 22% were male, 20% were gender expansive and 21% were transgender; 51% identified as a member of an LGBQ+ community and 28% identified as heterosexual or straight. Anxiety scores were, on average, 5½ points lower at discharge [t477=-19.69, P<.001], equating to a large effect (Cohen’s d = -0.90). Of the n=262 clients who reported moderate to severe symptoms at intake, 68% crossed the clinical threshold to minimal to mild symptoms at discharge [McNemar X2 (N=409), P<.001]. There were no significant differences among groups defined by age [F2,474=0.92, P=.40], gender [F7,377=0.76, P=.62] or sexual orientation [F7,366 =0.31, P=.95], nor was there a difference between transgender and cisgender clients [t382=-0.36, P=.72]. CONCLUSIONS These findings suggest that IOP delivered remotely may be an effective way to treat clinical anxiety in youth and young adults presenting with complex mental health needs. Capitalizing on the opportunities offered by the remote platform to deliver treatment plans responsive to unique intersections of developmental, identity, and diagnostic needs may help to ensure equivalent treatment outcomes among youth with a variety of needs and from varied demographic groups. CLINICALTRIAL N/A

Background: Youth experiencing high-acuity mental health symptoms often require highly restrictive levels of care (ie, inpatient care) that removes them from the relationships and activities essential for healthy development. An alternative treatment gaining evidence in its ability to support this population is the intensive outpatient programming (IOP) model. Understanding the experiences of adolescents and young adults during IOP treatment episodes may enhance clinical responsiveness to changing needs and protect against transfer to inpatient care. Objective: The objective of the analysis reported here was to identify heretofore unrecognized treatment needs of adolescents and young adults attending a remote IOP to help the program make clinical and programmatic decisions that increase its ability to support the recovery of program participants. Methods: Treatment experiences are collected weekly via electronic journals as part of ongoing quality improvement efforts. The journals are used by clinicians proximally to help them identify youth in crisis and distally to help them better understand and respond to the needs and experiences of program participants. Journal entries are downloaded each week, reviewed by program staff for evidence of the need for immediate intervention, and later deidentified and shared with quality improvement partners via monthly uploads to a secure folder. A total of 200 entries were chosen based on inclusion criteria that focused primarily on having at least one entry at 3 specified time points across the treatment episode. Overall, 3 coders analyzed the data using open-coding thematic analysis from an essentialist perspective such that the coders sought to represent the data and thus the essential experience of the youth as closely as possible. Results: Three themes emerged: mental health symptoms, peer relations, and recovery. The mental health symptoms theme was not surprising, given the context within which the journals were completed and the journal instructions asking that they write about how they are feeling. The peer relations and recovery themes provided novel insight, with entries included in the peer relations theme demonstrating the central importance of peer relationships, both within and outside of the therapeutic setting. The entries contained under the recovery theme described experience of recovery in terms of increases in function and self-acceptance versus reductions in clinical symptoms. Conclusions: These findings support the conceptualization of this population as youth with both mental health and developmental needs. In addition, these findings suggest that current definitions of recovery may inadvertently miss supporting and documenting treatment gains considered most important to the youth and young adults receiving care. Taken together, youth-serving IOPs may be better positioned to treat youth and assess program impact through the inclusion of functional measures and attention to fundamental tasks of the adolescent and young adult developmental periods.

Background: Youth and young adults face barriers to mental health care, including a shortage of programs that accept youth and a lack of developmentally sensitive programming among those that do. This shortage, along with the associated geographically limited options, has contributed to the health disparities experienced by youth in general and by those with higher acuity mental health needs in particular. Although intensive outpatient programs can be an effective option for youth with more complex mental health needs, place-based intensive outpatient programming locations are still limited to clients who have the ability to travel to the clinical setting several days per week. Objective: The objective of the analysis reported here was to assess changes in depression between intake and discharge among youth and young adults diagnosed with depression attending remote intensive outpatient programming treatment. Analysis of outcomes and the application of findings to programmatic decisions are regular parts of ongoing quality improvement efforts of the program whose results are reported here. Methods: Outcomes data are collected for all clients at intake and discharge. The Patient Health Questionnaire (PHQ) adapted for adolescents is used to measure depression, with changes between intake and discharge regularly assessed for quality improvement purposes using repeated measures t tests. Changes in clinical symptoms are assessed using McNamar chi-square analyses. One-way ANOVA is used to test for differences among age, gender, and sexual orientation groups. For this analysis, 1062 cases were selected using criteria that included a diagnosis of depression and a minimum of 18 hours of treatment over a minimum of 2 weeks of care. Results: Clients ranged in age from 11 to 25 years, with an average of 16 years. Almost one-quarter (23%) identified as nongender binary and 60% identified as members of the lesbian, gay, bisexual, transgender, queer (LGBTQ+) community. Significant decreases (mean difference –6.06) were seen in depression between intake and discharge (t967=–24.68; P<.001), with the symptoms of a significant number of clients (P<.001) crossing below the clinical cutoff for major depressive disorder between intake and discharge (388/732, 53%). No significant differences were found across subgroups defined by age (F2,958=0.47; P=.63), gender identity (F7,886=1.20; P=.30), or sexual orientation (F7,872=0.47; P=.86). Conclusions: Findings support the use of remote intensive outpatient programming to treat depression among youth and young adults, suggesting that it may be a modality that is an effective alternative to place-based mental health treatment. Additionally, findings suggest that the remote intensive outpatient program model may be an effective treatment approach for youth from marginalized groups defined by gender and sexual orientation. This is important given that youth from these groups tend to have poorer outcomes and greater barriers to treatment compared to cisgender, heterosexual youth.

BACKGROUND Youth experiencing high-acuity mental health symptoms often require highly restrictive levels of care (ie, inpatient care) that removes them from the relationships and activities essential for healthy development. An alternative treatment gaining evidence in its ability to support this population is the intensive outpatient programming (IOP) model. Understanding the experiences of adolescents and young adults during IOP treatment episodes may enhance clinical responsiveness to changing needs and protect against transfer to inpatient care. OBJECTIVE The objective of the analysis reported here was to identify heretofore unrecognized treatment needs of adolescents and young adults attending a remote IOP to help the program make clinical and programmatic decisions that increase its ability to support the recovery of program participants. METHODS Treatment experiences are collected weekly via electronic journals as part of ongoing quality improvement efforts. The journals are used by clinicians proximally to help them identify youth in crisis and distally to help them better understand and respond to the needs and experiences of program participants. Journal entries are downloaded each week, reviewed by program staff for evidence of the need for immediate intervention, and later deidentified and shared with quality improvement partners via monthly uploads to a secure folder. A total of 200 entries were chosen based on inclusion criteria that focused primarily on having at least one entry at 3 specified time points across the treatment episode. Overall, 3 coders analyzed the data using open-coding thematic analysis from an essentialist perspective such that the coders sought to represent the data and thus the essential experience of the youth as closely as possible. RESULTS Three themes emerged: mental health symptoms, peer relations, and recovery. The mental health symptoms theme was not surprising, given the context within which the journals were completed and the journal instructions asking that they write about how they are feeling. The peer relations and recovery themes provided novel insight, with entries included in the peer relations theme demonstrating the central importance of peer relationships, both within and outside of the therapeutic setting. The entries contained under the recovery theme described experience of recovery in terms of increases in function and self-acceptance versus reductions in clinical symptoms. CONCLUSIONS These findings support the conceptualization of this population as youth with both mental health and developmental needs. In addition, these findings suggest that current definitions of recovery may inadvertently miss supporting and documenting treatment gains considered most important to the youth and young adults receiving care. Taken together, youth-serving IOPs may be better positioned to treat youth and assess program impact through the inclusion of functional measures and attention to fundamental tasks of the adolescent and young adult developmental periods.

BACKGROUND Youth and young adults face barriers to mental health care, including a shortage of programs that accept youth and a lack of developmentally sensitive programming among those that do. This shortage, along with the associated geographically limited options, has contributed to the health disparities experienced by youth in general and by those with higher acuity mental health needs in particular. Although intensive outpatient programs can be an effective option for youth with more complex mental health needs, place-based intensive outpatient programming locations are still limited to clients who have the ability to travel to the clinical setting several days per week. OBJECTIVE The objective of the analysis reported here was to assess changes in depression between intake and discharge among youth and young adults diagnosed with depression attending remote intensive outpatient programming treatment. Analysis of outcomes and the application of findings to programmatic decisions are regular parts of ongoing quality improvement efforts of the program whose results are reported here. METHODS Outcomes data are collected for all clients at intake and discharge. The Patient Health Questionnaire (PHQ) adapted for adolescents is used to measure depression, with changes between intake and discharge regularly assessed for quality improvement purposes using repeated measures t tests. Changes in clinical symptoms are assessed using McNamar chi-square analyses. One-way ANOVA is used to test for differences among age, gender, and sexual orientation groups. For this analysis, 1062 cases were selected using criteria that included a diagnosis of depression and a minimum of 18 hours of treatment over a minimum of 2 weeks of care. RESULTS Clients ranged in age from 11 to 25 years, with an average of 16 years. Almost one-quarter (23%) identified as nongender binary and 60% identified as members of the lesbian, gay, bisexual, transgender, queer (LGBTQ+) community. Significant decreases (mean difference –6.06) were seen in depression between intake and discharge (t967=–24.68; P<.001), with the symptoms of a significant number of clients (P<.001) crossing below the clinical cutoff for major depressive disorder between intake and discharge (388/732, 53%). No significant differences were found across subgroups defined by age (F2,958=0.47; P=.63), gender identity (F7,886=1.20; P=.30), or sexual orientation (F7,872=0.47; P=.86). CONCLUSIONS Findings support the use of remote intensive outpatient programming to treat depression among youth and young adults, suggesting that it may be a modality that is an effective alternative to place-based mental health treatment. Additionally, findings suggest that the remote intensive outpatient program model may be an effective treatment approach for youth from marginalized groups defined by gender and sexual orientation. This is important given that youth from these groups tend to have poorer outcomes and greater barriers to treatment compared to cisgender, heterosexual youth.

Background: COVID-19 exacerbated a growing mental health crisis among youths and young adults, worsened by a lack of existing in-person options for high-acuity care. The emergence and growth of remote intensive outpatient programs (IOPs) is a solution to overcome geographic limitations to care. However, it remains unclear whether remote IOPs engender equivalent clinical outcomes among youths with public insurance (eg, Medicaid) versus private insurance (eg, commercial) given the disparities found in previous research on place-based treatment in both clinical and engagement outcomes. Objective: This analysis sought to establish, as part of ongoing quality improvement efforts, whether engagement and clinical outcomes among adolescents and young adults attending remote IOP treatment differed between youths with public and those with private insurance. The identification of disparities by payer type was used to inform programmatic decisions within the remote IOP system for which this quality improvement analysis was conducted. Methods: Pearson chi-square analyses and independent 2-tailed t tests were used to establish that the 2 groups defined by insurance type were equivalent on clinical outcomes (depression, suicidal ideation, and nonsuicidal self-injury [NSSI]) at intake and compare changes in clinical outcomes. McNemar chi-square analyses and repeated-measure 2-tailed t tests were used to assess changes in clinical outcomes between intake and discharge in the sample overall. In total, 495 clients who attended the remote IOP for youths and young adults in 14 states participated in ≥7 treatment sessions, and completed intake and discharge surveys between July 2021 and April 2022 were included in the analysis. Results: Overall, the youths and young adults in the remote IOP attended a median of 91% of their scheduled group sessions (mean 85.9%, SD 16.48%) and reported significantly fewer depressive symptoms at discharge (t447=12.51; P<.001). McNemar chi-square tests of change indicated significant reductions from intake to discharge in suicidal ideation (N=470, χ21=104.4; P<.001), with nearly three-quarters of youths who reported active suicidal ideation at intake (200/468, 42.7%) no longer reporting it at discharge (142/200, 71%), and in NSSI (N=430, χ21=40.7; P<.001), with more than half of youths who reported NSSI at intake (205/428, 47.9%) reporting lower self-harm at discharge (119/205, 58%). No significant differences emerged by insurance type in attendance (median public 89%, median private 92%; P=.10), length of stay (t416=−0.35; P=.73), or reductions in clinical outcomes (depressive symptom severity: t444=−0.87 and P=.38; active suicidal ideation: N=200, χ21=0.6 and P=.49; NSSI frequency: t426=−0.98 and P=.33). Conclusions: Our findings suggest that youths and young adults who participated in remote IOP had significant reductions in depression, suicidal ideation, and NSSI. Given access to the same remote high-acuity care, youths and young adults on both public and private insurance engaged in programming at comparable rates and achieved similar improvements in clinical outcomes.

BACKGROUND COVID-19 exacerbated a growing mental health crisis among youth and young adults, made worse by a lack of existing in-person options for high-acuity care. The emergence and growth of remote intensive outpatient programs (IOP) is one solution to overcoming geographic limitations to care. However, it is still unclear whether remote IOP engenders equivalent clinical outcomes among youth with public insurance (e.g., Medicaid) versus private insurance (e.g., commercial), given the disparities found in previous research of place-based treatment in both clinical and engagement outcomes. OBJECTIVE The analysis upon which the following report is based sought to establish, as part of ongoing quality improvement efforts, whether engagement and clinical outcomes among adolescents and young adults attending remote IOP treatment differed between those with public versus private insurance. Identification of disparities by payor type were used to inform programmatic decisions within the remote IOP system for which this quality improvement analysis was conducted. METHODS Pearson’s chi-square analyses and independent t-tests were used to establish that the two groups defined by insurance type were equivalent on clinical outcomes (depression, suicidal ideation, non-suicidal self-injury) at intake and to compare change in clinical outcomes. McNemar’s chi-square analysis and repeated-measures t-tests were used to assess changes in clinical outcomes between intake and discharge in the sample as a whole. A total of N=495 clients who attended the remote IOP for youth and young adults in 14 states, who participated in seven or more treatment sessions and who completed both intake and discharge surveys between July 2021 and April 2022 were included in analysis. RESULTS Overall, the youth and young adults in the remote IOP attended 90% of their scheduled group sessions (SD=16.48%) and reported significantly fewer depression symptoms at discharge (t447=12.51, P<.001). McNemar’s chi square tests of change indicated significant reductions from intake to discharge in suicidal ideation (X21, 470=19.2, P<.001), with nearly three quarters of youth who reported suicidal ideation at intake (n=201) no longer reporting it at discharge (n=143), and in NSSI (X21, 430=40.65, P<.001), with more than half of youth reporting NSSI at intake (n=206) reporting lower self−harm at discharge (n=120). No significant differences emerged by insurance type in attendance (Public Mdn=89%, Private Mdn=92%; P=.099), length of stay (t416= −.35, P=.73), or reductions in clinical outcomes [depressive symptom severity (t444= −.87, P=.38), active suicidal ideation (X21, 233=.03, P=.88), NSSI frequency (t426= −.98, p=.33)]. CONCLUSIONS Findings suggest that remote IOP is a feasible and effective treatment solution for youth and young adults who are struggling with depression, suicidal ideation, and NSSI. Furthermore, when given access to the same accessible, high−acuity care, youth and young adults on both public and private insurance can be engaged in programming at comparable rates and achieve similar improvements in clinical outcomes. CLINICALTRIAL N/A