Peer-Delivered Models for Caregivers of Children and Adults with Health Conditions: A Review

Peer-delivered health models may hold important benefits for family members, yet their prevalence, components, and outcomes are unknown. We conducted a review of peer-delivered services for families of children and adults with serious health problems. Studies of interventions published between 2000 and 2016 were included if the intervention contained a component for family members. Of 88 studies that were assessed for their eligibility, five met criteria. Familial components included information about the health condition and management, strategies to enhance communication and stress, and the provision of emotional support. Outcomes were largely favorable, including reductions in distress and symptoms of trauma, enhanced quality of life, and positive perceptions of the peer therapeutic alliance. Peer-delivered services for family members may hold important benefits to caregivers; however, the research base remains thin. A research agenda to develop and examine these models is discussed.     

Long Term Outcomes to Family Caregiver Empowerment

The Vanderbilt Caregiver Empowerment Project evaluated a training program designed to enhance empowerment of caregiver and their subsequent involvement in the mental health treatment of their children. The intervention utilized a multi-component parent training curriculum that was designed to enhance: (a) knowledge of the service system; (b) skills needed to interact with the mental health system; and (c) the caregiver' s mental health services self-efficacy designed to improve caregivers beliefs in their ability to collaborate with service providers. The resulting increased empowerment was hypothesized to increase caretaker involvement, which should affect service use and ultimately the mental health status of the child. A randomized design was used to test the effectiveness of this model with caregivers of children receiving mental health services. The results one-year after the training replicated the intermediate outcomes of the project conducted 3-months after the training. The initial training continued to significantly influence the parent's knowledge and mental health services self-efficacy. However, the intervention had no effect on caregiver involvement in treatment, service use or the mental health status of the children.     

Caregiver Factors Predicting Service Utilization Among Youth Participating in a School-based Mental Health Intervention

Large numbers of children and adolescents experience diagnosable psychiatric disturbances; however, the majority of those with need do not utilize mental health services. Characteristics of caregivers are important predictors of which youth will access and continue to use services over time. In recent years school-based mental health intervention programs have played a key role in identifying youth with mental health needs and linking them to treatment. In this study we sought to identify the caregiver demographic and contextual factors that predict days of service use among youth participating in a school-based mental health intervention program. Our sample included 85 youth ages 5–18 and their caregivers. We analyzed the data using bivariate and multivariate Poisson regressions with caregiver factors as the independent variables and days of service as the dependant variable. We found significant bivariate and multivariate associations for every caregiver demographic (sex, age, race) and contextual (education, employment, income, insurance, health, strain, and was it the caregivers idea to seek treatment) factor that was examined. In this study we identified the caregiver factors that are likely important in predicting youth service utilization even when steps have been taken to improve identification and access.     

Preliminary Outcomes of a Multi-site,School-based Modular Intervention for Adolescents Experiencing Mood Difficulties

Many evidence-based programs to address the emotional needs of youth experiencing mood difficulties are based on implementing “manualized” interventions. This approach often presents feasibility challenges in the school setting. In contrast, modular strategies, which involve implementing the most effective practices for specific emotional/behavioral problems, may be more feasible. Research, however, on the feasibility, acceptability, and effectiveness of modular approaches in schools to address youth experiencing mood difficulties is lacking. The multi-site current study tested the effectiveness, feasibility, and acceptability of a modular intervention approach delivered in schools for youth presenting with mood disorder symptoms. The pilot study included 20 participants (ages 12–16) and parents/caregivers for each student. Data were collected at baseline, throughout treatment, and following intervention or end of school year. The intervention, called the Student Emotional and Educational Development (SEED) project, included a modularized manual of efficacious and common practice elements for the treatment of mood disorders among adolescents. Decision making protocols guided provision of specific modules based on baseline and treatment data. Statistically significant differences were found between pretest and posttest assessments with modest to large effect sizes for youth and/or parents’ report of mood-related symptoms, including reduced symptoms of depression, anxiety and inattention. Clinically significant findings were also detected with more than 50 % of participants demonstrating reliable improvement on a global assessment of mental health symptoms. With regards to feasibility, these results were achieved with an average of nine, 45-min sessions across 2–3 months, and a subsample of participants overwhelmingly supported the acceptability of SEED. Although limited by the lack of a controlled comparison and small sample size, findings from this pilot study suggest this modular intervention focused on internalizing symptoms in students can be feasibly implemented in the school setting, is acceptable to students, and holds promise for improving their psychosocial functioning.     

A Single-Session Workshop to Enhance Emotional Awareness and Emotion Regulation for Graduate Students: A Pilot Study

Emerging adults are at substantial risk for developing or worsening psychopathology and university students appear to be particularly vulnerable. Interventions targeted at these young adults that can mitigate transdiagnostic causal risk factors or burgeoning mental health problems have the potential to make a large impact. We aimed to develop and pilot test an accessible, single-session, transdiagnostic group intervention with the goals of enhancing emotion regulation skills and reducing risk for mental health problems in graduate students. The intervention included psychoeducation, skills instruction (e.g., mindful emotion awareness, cognitive flexibility, countering emotion-driven behaviors), group discussion, and supervised practice based on content from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. The pilot program demonstrated strong feasibility and acceptability. Baseline, 1-month, and 3-month follow-up surveys also suggested benefits for reducing emotional avoidance and suppression, increasing use of cognitive reappraisal, and reducing symptoms of depression and neuroticism. Graduate students have seldom been the beneficiaries of university-based intervention and prevention research. Furthermore, most college and university mental health centers do not have the capacity to provide psychoeducation, preventative, or early intervention services to the many students who need or could benefit from them. Results suggest that future iterations of this intervention could address such barriers to meaningfully supporting emerging adults in graduate school.     

Engagement With Personalized Feedback for Emotional Distress Among College Students at Elevated Suicide Risk

Depression and suicidal ideation have substantially increased among college students, yet many students with clinically significant symptoms do not perceive their distress as warranting mental health services. Personalized feedback (PF) interventions deliver objective data, often electronically, comparing an individual’s reported symptoms or behaviors to a group norm. Several studies have shown promise for PF interventions in the context of mood and depression, yet little is known regarding how, and for whom, mood-focused PF interventions might be best deployed. The primary aim of this study was to examine the sociodemographic, clinical, and treatment-seeking factors associated with reviewing PF reports on emotional distress among college students (N = 1,673) screening positive for elevated suicide risk and not receiving mental health treatment. Results indicated that PF engagement was greatest among those with higher depression scores, and those reporting privacy/stigma concerns as barriers to treatment. Sexual minority students were more likely to review their PF than heterosexual students. Taken together, PF interventions may be a useful tool for engaging those with greater clinical acuity, and those hesitant to seek in-person care. Further research is warranted to examine the circumstances in which PF interventions might be used in isolation, or as part of a multitiered intervention strategy.     

Balancing Elder Care Responsibilities and Work: The Impact on Emotional Health

The current study investigated the effects of balancing elder care and work on emotional health. Responses from 43 retired caregivers, 211 not retired caregivers, 49 retired non-caregivers, and 224 not retired non-caregivers, who had participated in the national Health and Retirement Study, served as the data base. Results indicate that Caregiver Status (Caregiver vs. Non-caregiver) and Retirement Status (Retired vs. Not Retired) interact, depending on the measure of emotional health. The relationship between the number of depression symptoms reported and Caregiver Status depended on whether the respondent was also retired or employed; a significant interaction was not found when emotional health was measured with one overall item. A significant difference was not found between employed caregivers and employed non-caregivers, in terms of emotional health. Employed caregivers who gave more caregiving hours did report poorer emotional health than employed caregivers who gave fewer hours. Female caregivers reported more depression symptoms than male caregivers. The results suggest that employers may need to develop interventions which may help caregivers who are highly involved with caregiving responsibilities.     

Examining the initial usability,acceptability and feasibility of a digital mental health intervention for college students in India

Generalised anxiety disorder (GAD) is prevalent among college students in India; however, barriers like stigma, treatment accessibility and cost prevent engagement in treatment. Web- and mobile-based, or digital, mental health interventions have been proposed as a potential solution to increasing treatment access. With the ultimate goal of developing an engaging digital mental health intervention for university students in India, the current study sought to understand students' reactions to a culturally and digitally adapted evidence-based cognitive behavioural therapy (CBT) for GAD intervention. Specifically, through theatre testing and focus groups with a non-clinical sample of 15 college students in India, the present study examined initial usability, acceptability and feasibility of the “Mana Maali Digital Anxiety Program.” Secondary objectives comprised identifying students' perceived barriers to using the program and eliciting recommendations. Results indicated high usability, with the average usability rating ranking in the top 10% of general usability scores. Participants offered actionable changes to improve usability and perceived acceptability among peers struggling with mental health issues. Findings highlight the benefits of offering digital resources that circumvent barriers associated with accessing traditional services. Results build on existing evidence that digital interventions can be a viable means of delivering mental healthcare to large, defined populations.     

Understanding the Behavioral Determinants of Mental Health Service Use by Urban, Under-Resourced Black Youth: Adolescent and Caregiver Perspectives

Black adolescents with mental health problems are less likely than non-Black adolescents with mental health problems to receive treatment, primarily for non-financial reasons including negative perceptions of services and providers, and self-stigma associated with experiencing mental health problems. To better understand these obstacles, 16 adolescents and 11 caregivers, recruited from two K-8th grade elementary-middle schools, participated in four focus groups guided by the unified theory of behavior to explore mental health help-seeking behaviors and perceptions of mental health services. In the focus groups, caregivers acknowledged more positive attitudes about seeking mental health services than adolescents, but both expected the experience of actually doing so to be negative. Adolescents and caregivers also acknowledged social norms that inhibit their mental health help-seeking. Therefore, we conclude that interventions targeting expectancies and social norms might increase the connection of urban, under-resourced Black adolescents and their families to mental health services, and be particularly important given the long-term consequences of untreated mental health problems for this group.     

Telephone-Based Behavioral Activation for Improving Sleep Quality in Family Caregivers of People With Dementia: A Pilot Randomized Controlled Trial

Sleep disturbances are common among family caregivers of people with dementia (PWD). Although behavioral activation (BA) shows the potential to improve sleep quality, to date, evidence for this treatment’s feasibility and efficacy for family caregivers of PWD is limited. Therefore, this study pilot tested an evidence-based BA protocol for improving sleep quality in Chinese family caregivers of PWD. The BA intervention involved eight weekly individual telephone-based sessions designed to teach caregivers specific BA techniques. Sleep quality and depression were measured using the Chinese versions of the Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiologic Studies Depression (CES-D) Scale, respectively. This study also measured leisure activity, positive aspect of caregiving, caregiving burden, health status, and relationship satisfaction. All participants were asked to complete the assessments on paper at baseline and immediately after the intervention. After completing the pilot randomized controlled trial, semistructured interviews were conducted to explore participants’ experiences participating in the BA intervention. A total of 71 family caregivers of PWD (35 in the intervention group and 36 in the control group) were recruited. The majority of participants were female (n = 53, 74.65%), and their mean age was 54.07 years (SD = 10.95). Compared with controls, caregivers in the intervention group displayed significantly greater improvement in sleep quality, as well as perceptions of positive aspects of caregiving and reduction of depression. Most participants were very satisfied with the intervention. These findings suggest that individual telephone-based BA interventions are feasible, acceptable, and effective in improving sleep quality and psychological health in family caregivers of PWD. These results contribute to the literature by providing evidence for developing effective, accessible, and sustainable BA interventions for family caregivers of PWD.     

Psychosocial Characteristics of Student Veterans with Service-Related Disabilities: Implications for Further Research and Occupational Therapy Involvement

The purpose of this study was to assess how post-9/11 university student veterans differ from nonveteran university students on four mental health indicators. In comparison to a demographically matched sample of nonveteran students, it was found that veterans in this study had significantly higher levels of depression and post-traumatic stress symptomatology and non-significantly lower levels of engagement in meaningful activities and meaning in life. This non-experimental study indicates that mental health differences between student veterans and their nonveteran peers do exist, and argues for the inclusion of occupational therapy services for student veterans.     

Counseling Older Adults with Dementia: A Survey of Therapists in Massachusetts

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.     

Behavioral Activation Disseminated by Non–Mental Health Professionals,Paraprofessionals, and Peers: A Systematic Review

There is a striking disparity between the number of individuals with significant mental health concerns and those who are able to access care globally. One promising solution to expanding the mental health taskforce is task-sharing, or employing nonspecialists in the delivery of evidence-based interventions. Behavioral activation (BA), a brief intervention that focuses on scheduling rewarding activities into one’s daily life, may have promise for delivery using task-sharing approaches due to its straightforward, flexible nature. The aim of this systematic review was to examine the current state of the literature on non-specialist-delivered BA and evaluate the evidence base of this approach. Three databases (Pubmed, PsycInfo, and Cochrane) were searched, and all articles were screened for inclusion criteria by two research assistants, included the review of titles, abstracts, and full-text. The final dataset consisted of 13 research studies, represented through 15 articles. A meta-analysis was conducted to examine the overall pooled effects of peer-delivered BA on depressive symptoms (the most widely examined clinical outcome). Studies reported on effectiveness and implementation outcomes of non-specialist-delivered BA for depression, substance use, loneliness, trauma survivors, and individuals with comorbid physical health conditions. Results provide initial support for the effectiveness of BA utilizing a task-sharing approach, and highlight the feasibility and acceptability of using nonspecialists to deliver BA in a variety of contexts, including low-resource settings.     

School-Based Mental Health Services: A Research Review

This paper provides a synthetic review of research on school-based mental health services. Schools play an increasingly important role in providing mental health services to children, yet most school-based programs being provided have no evidence to support their impact. A computerized search of references published between 1985 and 1999 was used to identify studies of school-based mental health services for children. Study inclusion was determined by (i) use of randomized, quasi-experimental, or multiple baseline research design; (ii) inclusion of a control group; (iii) use of standardized outcome measures; and (iv) baseline and postintervention outcome assessment. The application of these criteria yielded a final sample of 47 studies on which this review is based. Results suggest that there are a strong group of school-based mental health programs that have evidence of impact across a range of emotional and behavioral problems. However, there were no programs that specifically targeted particular clinical syndromes. Important features of the implementation process that increase the probability of service sustainability and maintenance were identified. These include (i) consistent program implementation; (ii) inclusion of parents, teachers, or peers; (iii) use of multiple modalities; (iv) integration of program content into general classroom curriculum; and (v) developmentally appropriate program components. Implications of these findings and directions for future research are discussed.     

The Development,Pilot, and Process Evaluation of a Parent Mental Health Literacy Intervention Through Community Sports Clubs

The mental health literacy of parents may be critical in facilitating positive child and adolescent mental health outcomes. The purpose of this study was to develop, pilot, and evaluate a targeted parent mental health literacy intervention through community sports clubs. Sixty six parents (M_age?=?44.86?±?5.2 years) participated in either a brief mental health literacy intervention workshop delivered through community sporting clubs (n?=?42) or a community-matched control group (n?=?24). Participants’ mental health literacy was assessed at baseline, post-intervention and at 1 month follow-up. A mixed methods process evaluation was conducted with intervention participants to determine the acceptability and feasibility of the intervention. Participants in the experimental group showed greater increases in depression literacy, anxiety literacy, knowledge of help seeking options and confidence to assist an adolescent experiencing a mental health disorder, compared to those in the control group. Post-intervention changes in the experimental group were maintained at 1 month follow-up. A mixed methods process evaluation revealed that parents found the intervention content engaging, relevant to their needs, and practically useful in terms of actively supporting adolescent mental health. Findings provide evidence that a brief, targeted intervention through community sports clubs might be a particularly useful method of improving parental mental health literacy and facilitating positive youth mental health outcomes.     

Endorsement of proactively aggressive caregiving strategies moderates the relation between caregiver mental health and potentially harmful caregiving behavior

This research tested the proposition that the oft-reported relation between caregiver mental health outcomes (i.e., resentment, depression) and potentially harmful caregiver behavior (PHB) would be mediated or moderated by caregiver endorsement of proactively aggressive caregiving strategies (PA). Caregiver resentment was the strongest predictor of PHB in the sample of 417 informal caregivers who resided with their care recipients; in fact, resentment mediated the impact of caregiver depression, thus suggesting that depressed affect was associated with PHB only if depressed caregivers resented their caregiving burdens. As predicted, caregiver endorsement of PA moderated the relation between resentment and PHB, such that links between these two constructs were strongest when caregivers were high in both resentment and PA. Endorsement of PA also mediated the relations between demographic or contextual variables (i.e., income, care recipient dementia) and PHB. Implications of these results for research and intervention are discussed.     

Improving oral reading fluency with a peer-mediated intervention

This study examined the effects of an experimentally derived, peer-delivered reading intervention on the oral reading fluency of a first-grade student who had been referred for poor reading fluency. Same-grade peers were trained to lead the target student through a structured intervention protocol based on the results of a brief experimental analysis. Results indicated that reading improvements were obtained and are discussed in terms of selecting efficient interventions for use by peers.     

Depressed and Anxious COPD Patients: Predictors of Psychotherapy Engagement from a Clinical Trial

This study examined patient-level factors associated with engagement in mental health treatment in a sample of medically ill patients with clinically significant symptoms of depression and/or anxiety. A total of 248 patients was enlisted from a randomized controlled trial of cognitive-behavioral therapy for depression and anxiety in patients with chronic obstructive pulmonary disease (COPD). Logistic regression analysis was used to predict mental health engagement, defined as attending at least one intervention session. Results indicated that patient-perceived mastery over COPD was negatively related to mental health engagement. Further, mastery was the only significant predictor of mental health engagement after controlling for patient demographic characteristics, severity of COPD, depression, and anxiety. To improve engagement for medically ill patients with comorbid mental health difficulties, clinicians should explore patients’ attitudes about their mental health within the context of their perceived ability to cope with their medical disease.     

Feasibility of a Telephone Intervention for HIV Patients and Their Informal Caregivers

Objectives: To assess the feasibility of a telephone intervention for HIV-positive patients and their caregivers. Methods: HIV-positive participants, some co-enrolled with their informal caregiver, enrolled in this randomized study. Intervention-arm participants (124 patients and 76 caregivers; dyads assigned to same arm) received up to 12 scheduled calls from an interventionist over 6 months. Results: An average of 7.6 (SD = 3.0) calls to each participant was completed; 66.5% received at least 6 calls; 43.0% received more than 75% of the intervention (defined as ‘study adherent’). Having a higher T-cell count was associated with call adherence (p = .014); cocaine use was associated with reduced call adherence for both patients (p = .019) and caregivers (p = .083). Common telephone themes included problems with mood, relationships, finances, housing, and work; interventions (e.g., referral for mental health care) were initiated in response to these. Participant satisfaction was high, and many reported benefits from the intervention. Conclusions: Using a telephone intervention with HIV-positive patients and their caregivers is a feasible and potentially beneficial intervention.