Recommendations for increasing equitable psychosocial outcomes for children and adolescents

Recommendations for increasing equitable psychosocial outcomes for children and adolescents

Approximately 30% of young people are affected by deteriorating mental health by the end of adolescence, with anxiety typically appearing in childhood and depression during the teenage years, but the problem is more severe for young blacks and Latinos.

Although mental health problems such as depression and anxiety are prevalent in children and adolescents, it is also one of the least treated health issues, and for the black and Hispanic population, this unhealthy treatment is even more severe.

In a recent research paper, researchers suggested recommendations to improve equality and outcomes when treating ethnically diverse children and adolescents for depression and anxiety.

Writing Psychological research and clinical practiceAuthors – some Established a care delivery program For children and adolescents with these problems Racial/ethnic disparities in psychosocial treatment were examined in 4 factors: the health system, the intervention being provided, the providers, and the patients.

Overall, approximately 30% of young adults are affected by declining mental health by the end of adolescence, with anxiety typically appearing in childhood and depression during the teenage years. For black and Latino youth, these problems are more acute, for multiple reasons, and underpinned by structural racism, the authors said, and chronic stress caused by exposure to violence, poverty, and inadequate neighborhoods.

These young people are less likely to start care, more likely to finish treatment prematurely, and less likely to receive high-quality depression care.

At the health system level, a number of factors combine to create barriers to accessing care. There may be a limited number of providers within certain neighborhoods as well as a limited number of mental health providers who take Medicaid. For families with low socioeconomic levels, parents and caregivers may have inflexible work schedules and may have difficulty getting regular and ongoing treatment appointments during normal business hours. Lack of transportation or dependence on public transportation is another barrier.

The setting in which care is provided is another potential barrier, with the authors writing that families often prefer a primary care office over a specialized mental health setting, which may be seen as more of a stigma.

It is also not known whether treatments used for anxiety and depression, such as cognitive behavioral therapy and interpersonal psychotherapy, work as well in diverse pediatric patients as they do in white patients. Most trials of evidence-based treatments do not report outcomes by background, possibly due to lower enrollment numbers for black and Latinx patients.

However, adaptations of treatments were successful, the authors said, such as matching the racial and ethnic background between provider and patient, translating material, increasing parental involvement, and using culturally appropriate language.

Notably, two of the four authors of the paper are also the creators of a treatment program that targets both anxiety and depression in 8 to 12 sessions. The program, Brief Behavioral Therapy, has been used in primary care, where young people with depression and anxiety first present with physical complaints, such as headaches and stomachaches. The primary care setting may also be seen as more appropriate from a health system and motivation point of view.

While based on cognitive behavioral therapy (CBT), the BBT program represents a tiered approach in an effort to increase equity. CBT contains a wide range of techniques, some of which will likely not be used if diverse patients finish treatment early. So the BBT approach focuses on only two basic behavioral deficits that anxious and depressed teens share: a decrease in their level of threat avoidance and an increase in their behavior toward rewarding life experiences.

The authors wrote: “Young people and parents are encouraged to (a) determine the extent to which anxiety/depression interferes with functioning, and (b) collaborate with their provider to develop personal plans to engage or re-engage in these critical life tasks.” In addition, the timing of BBT sessions is flexible and the program can be adapted to the preferences of the provider and parents.

The The model has been evaluated In a randomized controlled trial with 185 young adults with anxiety and/or depression; 56.8% of youth receiving BBT improved compared to 28.2% of youth who received an assisted referral to a community outpatient mental health center. In addition, the effects were more pronounced for Hispanic youth (76.5% in BBT compared to 7.1% of referred youth). However, the total number of Latino youth enrolled in the study was small, which limited the results.

The researchers identified a number of recommendations to improve the delivery of mental health care to different populations, including:

  • Provide training in reducing implicit bias and trauma-informed approaches to care
  • More flexibility in methods and timing of care delivery
  • Participation and integration of mental health providers into other care settings
  • Promote equitable reimbursement for mental health providers and increase Medicaid for low-income families.

The researchers plan a number of iterative modifications to the model at the system, provider, and patient level, and also plan to modify the training materials to “explicitly discuss minority stress, socioeconomic stress, and experiences with racism as chronic and acute stress.”

reference

Weersing VR, Gonzalez A, Hatch B, Lynch FL. Promoting racial/ethnic equality in psychosocial treatment outcomes for child and adolescent anxiety and depression. Psychological Practice Res Clin. 2022; 4 (3): 80–88; doi: 10.1176/appi.prcp.20210044

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