Seonyeong Kim

Adapting evidence‐based interventions (EBIs) to be sensitive to populations who have experienced trauma has been shown to improve engagement, retention, satisfaction, and effectiveness. Compared to civilian mothers, military‐connected mothers (MCM)—including service members, veterans, or their partners—face greater exposure to trauma across the life course, leading to mental health and parenting challenges. These may adversely affect their children's mental health and perpetuate generational trauma. EBIs aligned with people's life experiences and cultural backgrounds are critical to supporting the mental wellbeing and parental functioning of MCM. Informed by the Framework for Reporting Adaptations and Modifications‐Enhanced and utilizing rapid qualitative analysis—a rigorous method for quickly identifying key interview themes—this paper describes the process of adapting an innovative EBI, Parenting‐STAIR (P‐STAIR), which targets maternal trauma, emotion regulation, and parenting. Transcripts from interviews with administrators, clinicians, and MCM at clinics serving military families were systematically summarized, organized into matrices, and analyzed. Four emergent themes informed adaptations to P‐STAIR: (a) streamlined treatment and enhanced engagement, (b) flexibility and responsiveness, (c) mental health stigma reduction, and (d) military cultural relevance. Considering these priorities, which were expressed across participant groups, P‐STAIR was shortened from 23 sessions to a brief, modular 12–16‐session intervention that can be personalized to individual needs and uses approachable language (e.g., distress vs. trauma), which aims to reduce the impact of stigma on engagement and retention. A standalone guide was developed to accompany the intervention manual, which may help clinicians better understand the unique experiences of military families. The outcome of this process, PSTAIR‐M, is a briefer, modular intervention we anticipate will be suitable for delivery to MCM.

Despite the critical role of mental health services in suicide prevention, disparities in service utilization persist across various individual and social determinants of health. This study identifies key factors and intersectional patterns associated with mental healthcare use among young adults with past-year suicidal ideation, by developing machine learning-based artificial intelligence to improve predictive accuracy while ensuring interpretability for clinicians and policymakers. Utilizing cross-sectional data from the 2015–2020 National Survey on Drug Use and Health, we analyzed 11,018 US young adults aged 18–34 who reported past-year suicidal ideation. Random Forest and Shapley Additive Explanations identified the strongest predictors of mental healthcare utilization among 23 individual and social determinants of health. The decision tree model visualized prediction of utilization rates across intersectional characteristics. Findings indicate that depression, race/ethnicity, sexual orientation, and private health insurance were the strongest predictors of service use. Individuals without depression, males, Black, Indigenous, and People of Color, heterosexual individuals, and individuals without private health insurance were significantly less likely to seek care. These findings highlight the current intersectional disparities in mental healthcare utilization among young adults at risk of suicide. Expanding culturally competent care and promoting equitable access to mental healthcare for young adults at risk are crucial steps in addressing these disparities.

Transition-age youth exiting foster care (TAY) are at high risk for housing instability, with nearly half experiencing homelessness before age 26. Multi-level factors are associated with greater risk, including individual, social, and geographic contexts. This study explored experiences of TAY in a large region of Texas to identify drivers of housing stability during the transition out of care. Youth aged 18–25 who were connected to the region’s foster care transition center were recruited to participate in a mixed-methods, semi-structured interview (n = 25). Youth were prompted to identify networks of up to 20 people who had provided support over the past year. Interview questions explored what happened when youth turned 18, including changes in their housing situations, and delved into relationships with the network members. An iterative coding process was used to create a matrix to examine housing transitions and social supports within and across cases, then identify themes and subthemes. Housing instability was common, with 13 of 25 participants reporting episodes of homelessness after turning 18. Abrupt transitions were driven by systemic factors related to placement settings, strict rules, and a lack of available housing options. Social network data illuminated the close link between housing and the social network, along with the importance of “housing-capable” adults who helped prevent homelessness. Findings call for the development of more youth-friendly housing options for TAY transitioning out of care and interventions that help to build enduring social supports.