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The present study examined the cumulative effects of risk and protective factors on internalizing and externalizing problems for a sample of youth who were diagnosed with a severe emotional disturbance and enrolled in an urban school-based system of care. The sample included 139 Latino and African American children (ages 5-19; 65 % male) and their families. After controlling for demographic variables, the results of hierarchical multiple regression analyses revealed that cumulative risk and protection were significantly related to internalizing problem behaviors, and cumulative protection was negatively related to externalizing problem behaviors. The findings support the importance of including or increasing strength building approaches, in addition to risk reduction, in order to maximize prevention and intervention efforts for system-of-care populations.

Children's exposure to potentially traumatic events is related to negative mental health outcomes. To promote more positive outcomes, protective factors that can buffer the impact of these experiences need to be identified. The present study examined whether lower parental stress might function as a protective factor for children enrolled in a behavioral health system of care. Specifically, the relationship between a history of interpersonal trauma (physical abuse, sexual abuse, and witnessing domestic violence) and internalizing and externalizing problem behaviors were examined, as was the role of parenting stress in helping to explain this relationship. The sample included African American and Latino children (ages 5-19) from low-income families, who have a serious emotional disturbance, and received services in a school-based system of care. Results of path analyses revealed that parenting stress mediated the relationship between trauma exposure and internalizing problem behaviors. For the relationship between trauma exposure and externalizing problem behaviors, mediation approached significance. The findings suggest that family factors, such as parenting stress, could be potential modifiable protective factors for these children. Systems of care can use this information to encourage the implementation of more family-focused treatments and interventions.

We conducted an exploratory research study looking at fathering interactions as they relate to the wraparound care given by the Partnership for Kids or PARK Project, a school-based system of care in Bridgeport, Connecticut. The questions posed by our research focused on how fathers' positive interaction measured by their levels of engagement and accessibility can moderate the effect of the school-based system of care intervention on the mental health outcomes of children with serious emotional disturbances. We found that, although not statistically significant, children's access to their father did have a moderating effect on CBCL scores for internalizing behaviors and total problems. There was very small change in CBCL scores for externalizing behaviors. Further, the moderating effect of father accessibility and father engagement had a lasting effect as a moderator through 12 months into the intervention, especially with regard to internalizing behavior scores.

Whereas research on caregiving is well documented, less is known about gender inequalities in caregiver stress, coping mechanisms, and health outcomes, all of which may vary by race, ethnicity, and socioeconomic status. This scoping review investigated racial and ethnic disparities using the Stress Process Model among male caregivers. Several databases were searched including Academic Search Premier, Medline Complete, APA PsycInfo, CINHAL, Google, ProQuest, and Web of Science. Included were peer-reviewed articles in English, published from 1990 to 2022. A total of nine articles fulfilled inclusion criteria. Most of the articles indicated that compared to White male caregivers, African American male caregivers provided more hours of care, assisted with more activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and experienced more financial stress. In terms of coping style, one study found African American male caregivers, compared to White male caregivers, held negative religious beliefs. Another study showed that they were at a higher risk for stroke than their White counterparts. The search revealed a dearth of studies on racial disparities in stress, coping, and health outcomes among male caregivers. Further research is needed on the experiences and perspectives of male minority caregivers. © 2023 by the authors.

The present study examines the impact of child and family risk factors on service access for youth and families in a school-based system of care. Regression analyses examined the relationships between risk factors and services recommended, services received, and dosage of services received. Logistic regression analyses examined the relationship between risk factors and whether or not youth received specific types of services within the system of care. Results revealed that youth with a personal or family history of substance use had more services recommended than youth without these risk factors, while youth with a family history of substance use received more services. Youth with a history of substance use received a significantly higher dosage of services overall. Finally, history of family mental illness was associated with receiving mental health and operational services (e.g., family advocacy, emergency funds). Implications and limitations are discussed.

The present study examined how exposure to traumatic events impacts children with severe emotional disturbance who are being served in a school-based system of care. Multilevel growth curve models were used to examine the relationships between a child's history of traumatic events (physical abuse, sexual abuse, or domestic violence) and behavioral and emotional strengths, internalizing problem behaviors, or externalizing problem behaviors over 18 months. Results indicate that children receiving services (N = 134) exhibited increased emotional and behavioral strengths and decreased internalizing and externalizing problem behaviors from enrollment to 18 months follow-up. Children with a history of traumatic events improved more slowly than children without such a history on both strengths and internalizing problem behaviors, even after controlling for dosage of services received and other characteristics previously found to predict outcomes. Gender was also related to improvement in internalizing symptoms. Results highlight the continued need to assess the impact of exposure to traumatic events for children served in a system of care.

Children with emotional and behavioral disturbance often have difficulties in multiple symptom domains. This study investigates the relationships between child symptoms and caregiver strain and parenting stress among 177 youth and their caregivers participating in a school-based system of care. Youth were grouped by symptom domain and included those with low scores on both internalizing and externalizing symptoms, those with only high internalizing symptoms, those with only high externalizing symptoms, and those with high symptoms levels in both internalizing and externalizing domains. Results revealed significant group differences on measures of caregiver strain and parenting stress. Caregivers of youth with symptoms in both internalizing and externalizing domains reported the highest levels of strain and stress; however, there was some variation in group differences by caregiver outcome. The results of this study emphasize the importance of providing not only services for youth but also support services for their caregivers.

Research supports that office referral data is useful in informing programmatic decisions and planning interventions such as Positive Behavior Supports (PBS). Knowledge of patterns of office referrals may facilitate development of interventions that target specific groups. This study examines patterns in office referrals within an urban district by gender, race/ ethnicity and grade. Findings reveal that there are differences by grade that appear to be related to developmental level, with more referrals for aggression in younger students (grades K-6), disrespectful behavior in middle school students (grades 7-8), and attendance problems in high school students. Gender differences in the rate and type of referrals were found, with significantly more referrals for boys' delinquent/aggressive behavior, which may relate to how schools define unacceptable behavior and the data collection method. Finally, there were significantly more referrals for African American/black students than Hispanic students, suggesting that schools consider racial differences when developing behavioral expectations.

Impaired autonomic modulation and baroreflex sensitivity (BRS) have been reported during and after COVID-19. Both impairments are associated with negative cardiovascular outcomes. If these impairments were to exist undetected in young men after COVID-19, they could lead to negative cardiovascular outcomes. Fatigue is associated with autonomic dysfunction during and after COVID-19. It is unclear if fatigue can be used as an indicator of impaired autonomic modulation and BRS after COVID-19. This study aims to compare parasympathetic modulation, sympathetic modulation, and BRS between young men who had COVID-19 versus controls and to determine if fatigue is associated with impaired autonomic modulation and BRS. Parasympathetic modulation as the high-frequency power of R-R intervals (lnHFR-R), sympathetic modulation as the low-frequency power of systolic blood pressure variability (LFSBP), and BRS as the -index were measured by power spectral density analysis. These variables were compared between 20 young men who had COVID-19 and 24 controls. Independent t-tests and Mann-Whitney U tests indicated no significant difference between the COVID-19 and the control group in: lnHFR-R, P=0.20; LFSBP, P=0.11, and -index, P=0.20. Fatigue was not associated with impaired autonomic modulation or BRS. There is no difference in autonomic modulations or BRS between young men who had COVID-19 compared to controls. Fatigue did not seem to be associated with impaired autonomic modulation or impaired BRS in young men after COVID-19. Findings suggest that young men might not be at increased cardiovascular risk from COVID-19-related dysautonomia and impaired BRS.