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Separating children from families has deleterious effects on children's mental health and well-being, which is highly relevant for youth in juvenile detention and other out-of-home residential placements. Despite growth in the evidence of family-based interventions in mitigating adverse behavioral health outcomes for justice involved adolescents (JIA), gaps remain in intervention dissemination for JIA; this particularly true for those leveraging digital health technologies, a need that has intensified with the COVID-19 pandemic. Use of digital health technologies for JIAs is pressing to address structural barriers in maintaining JIA-family connections, but also to improve treatment access for detained JIAs. Court systems' capacity to support use of digital health tools, such as telehealth, appear promising. Data on the use of tele-conferencing in U.S. juvenile and family courts were collected from 456 juvenile justice professionals as part of a larger study on judicial decision making. Results suggest overwhelming adoption of video-conferencing for court hearings with only 40% of respondents reporting family court use prior to the onset of COVID-19, but majority (91%) now reporting its routine use. Youth participate from a range of settings, including detention, other residential placement, community-based behavioral health and in-home settings. The COVID-19 pandemic has created a shift in the uptake of video-conferencing platforms that could hold promise for future larger scale use across the juvenile justice system. Findings underscore feasibility and acceptability of technology requirements in key settings that should be leveraged for broad scale implementation of empirically supported family-based interventions to advance behavioral health equity for JIA.

Youth in the United States are experiencing rising rates of anxiety, depression, and other mental health challenges, yet many remain underserved due to systemic barriers such as poverty, limited access to care, and shortages in the mental health workforce. Schools and primary care clinics are trusted, community-based settings that offer strategic opportunities for early identification, prevention, and intervention. As part of a public health approach, integrating digital mental health tools into these settings can support broad access, enhance mental health literacy, and promote help-seeking behaviors among all students. When co-designed with youth and embedded within existing care systems, these tools offer a scalable, proactive solution to support well-being across diverse school-aged populations. This protocol describes the design and implementation of a stepped-wedge clinical trial to evaluate the Connected for Wellness mobile app, a youth- and caregiver-facing digital mental health intervention. Developed using participatory informatics and human-centered design principles, the app provides culturally relevant content in English and Spanish. Features include self-guided wellness activities, well-being screeners, psychoeducational videos, and localized service directories. Machine learning algorithms personalize content recommendations based on user inputs and behavioral patterns. This trial uses a stepped-wedge cluster randomized design across 20 community-based sites (10 high schools and 10 primary care clinics) in 2 counties in California. These counties were selected for their high proportions of underserved youth populations. All youth aged 13 to 22 years and their caregivers will be invited to access the app. Sites are randomized into 2 implementation waves. The app is introduced site-wide as a universal public health intervention supported by on-site navigators and peer ambassadors. The primary outcomes are derived from a cascade-of-care framework, including identification of mental health need, referral to services, initiation of services, and engagement (defined as ≥3 treatment visits). Data will be collected via anonymous in-app analytics, monthly World Health Organization-Five Well-Being Index assessments, and deidentified electronic health and administrative records. Generalized linear mixed models will be used to evaluate differences in cascade outcomes between pre- and postimplementation phases while accounting for clustering and site-level variability. As of May 2025, the mobile app has been finalized, institutional review board approvals have been secured, and all study sites have been recruited. Participant recruitment is projected to begin in August 2025. Data collection and initial analyses will begin in early 2026, with preliminary findings expected by October 2026. This study tests a novel digital health intervention integrated into trusted care systems. If effective, the Connected for Wellness mobile app may serve as a scalable strategy to reduce disparities in mental health care access and engagement for youth across the United States. ClinicalTrials.gov NCT06122688; https://clinicaltrials.gov/study/NCT06122688. PRR1-10.2196/73721.

Foster youth experience high rates of unmet mental health and substance use needs, while simultaneously facing numerous barriers to accessing and engaging in community-based services. Behavioral intervention technologies (BITs) are promising for overcoming some of the barriers to service engagement, particularly when designed in collaboration with the intended users. This study describes lessons learned from a 31-month process of co-designing FostrSpace (Chorus Innovations, Inc), a BIT to address social determinants of health and behavioral health needs among foster youth. Our overall aim is to provide a roadmap for other scholars wishing to co-design BITs with minoritized youth that have the potential to address social determinants of health and increase access to and engagement in behavioral health care. The co-design process of creating FostrSpace included 5 phases: design, development, launch, testing and evaluation, and iterative refinement. We describe the activities conducted during each phase, as well as the resultant FostrSpace application. In-application FostrSpace usage data were collected as part of a quality improvement effort to iteratively refine the application; during registration, all youth signed a user agreement that detailed data usage. FostrSpace usage data were collected from 40 youth (32/40, 78% aged 18-26 years; 8/40, 20% 13-17 years). Based on the resource needs checklist at sign-up, youth sought resources in the domains of emotional wellness (29/40; 72.5%), health care (17/40, 42.5%), housing (16/20, 40%), transportation (15/40, 37.5%), employment (15/40, 37.5%), school (13/40, 32.5%), food (12/40, 30%), family (11/40, 27.5%), and legal (7/40, 17.5%) resources, or other or not sure (16/20, 40%). Fifteen youth accessed support from the personal care navigator. Fourteen youth completed the emotional wellness questionnaire (EWQ) and identified substance use, depression, anger and irritability, mania, anxiety, somatic symptoms, and sleep problems as areas of concern. Seven of these youth initiated behavioral health services with a FostrSpace clinician. Engaging in participatory co-design of BITs with foster youth and other minoritized communities requires careful attention to power dynamics. Creating a space where co-designers feel there is mutual benefit to engaging in the process and it is psychologically safe to share their experiences is crucial for success. We describe lessons learned from engaging in this co-design work, including how it relates to decisions about the technology (eg, balancing youth privacy with the burden of the login process), working with third-party developers (eg, ensuring technology development partners have sufficient knowledge about the population you are co-designing with to meaningfully engage with them), and considerations for the strategic embedding of technology-based interventions within existing systems of care to promote uptake.

Data from emerging adults (ages 18–29, N = 900) in the National Comorbidity Survey Replication Study was used to examine the influence of childhood and emerging adult religiosity and religious-based decision-making, and childhood adversity, on alcohol use. Childhood religiosity was protective against early alcohol use and progression to later abuse or dependence, but did not significantly offset the influence of childhood adversity on early patterns of heavy drinking in adjusted logistic regression models. Religiosity in emerging adulthood was negatively associated with alcohol use disorders. Protective associations for religiosity varied by gender, ethnicity and childhood adversity histories. Higher religiosity may be protective against early onset alcohol use and later development of alcohol problems, thus, should be considered in prevention programming for youth, particularly in faith-based settings. Mental health providers should allow for integration of clients’ religiosity and spirituality beliefs and practices in treatment settings if clients indicate such interest.

Objectives: We assess whether posttraumatic stress disorder (PTSD) varies in prevalence, diagnostic criteria endorsement, and type and frequency of potentially traumatic events (PTEs) among a nationally representative US sample of 5071 non-Latino whites, 3264 Latinos, 2178 Asians, 4249 African Americans, and 1476 Afro-Caribbeans. Methods: PTSD and other psychiatric disorders were evaluated using the World Mental Health-Composite International Diagnostic Interview (WMH-CIDI) in a national household sample that oversampled ethnic/racial minorities (n = 16,238) but was weighted to produce results representative of the general population. Results: Asians have lower prevalence rates of probable lifetime PTSD, whereas African Americans have higher rates as compared with non-Latino whites, even after adjusting for type and number of exposures to traumatic events, and for sociodemographic, clinical, and social support factors. Afro-Caribbeans and Latinos seem to demonstrate similar risk to non-Latino whites, adjusting for these same covariates. Higher rates of probable PTSD exhibited by African Americans and lower rates for Asians, as compared with non-Latino whites, do not appear related to differential symptom endorsement, differences in risk or protective factors, or differences in types and frequencies of PTEs across groups. Conclusions: There appears to be marked differences in conditional risk of probable PTSD across ethnic/racial groups. Questions remain about what explains risk of probable PTSD. Several factors that might account for these differences are discussed, as well as the clinical implications of our findings. Uncertainty of the PTSD diagnostic assessment for Latinos and Asians requires further evaluation.

The effect of childhood trauma, psychiatric diagnoses, and mental health services on school dropout among U.S.-born and immigrant youth is examined using data from the Collaborative Psychiatric Epidemiology Surveys, a nationally representative probability sample of African Americans, Afro-Caribbeans, Asians, Latinos, and non-Latino Whites, including 2,532 young adults, aged 21-29. The dropout prevalence rate was 16% overall, with variation by childhood trauma, childhood psychiatric diagnosis, race/ethnicity, and nativity. Childhood substance and conduct disorders mediated the relation between trauma and school dropout. Likelihood of dropout was decreased for Asians, and increased for African Americans and Latinos, compared to non-Latino Whites as a function of psychiatric disorders and trauma. Timing of U.S. immigration during adolescence increased risk of dropout.

Purpose: Unaccompanied immigrant children (UIC) experience significant mental health concerns, particularly posttraumatic stress. This is a vulnerable population, yet little systematic research has examined the effectiveness of evidence-based models such as cognitive behavioral therapy (CBT) to meet their needs. Integrating religious beliefs and spirituality into therapy could elucidate better understandings of traumatic stress, and posttraumatic cognitions when working with UIC with strong faith traditions/beliefs. Methods: We report on modifications made to a pre-existing treatment, consisting of integrating religious and spiritual themes, to engage and work with UIC participants in a pilot study of Mindfulness-Based CBT. Thematic analysis of therapy notes evaluated the implementation process for integrating religious and spiritual themes. Three composite vignettes illustrate how religiosity and spirituality were salient for UIC participants in this pilot study, and how these were integrated into therapy to address posttraumatic cognitions and symptoms. We assessed changes in PTSD symptom severity and posttraumatic cognitions for UIC and in comparison, to non-UIC participants using the Child PTSD Symptom Scale and the Posttraumatic Cognitions Inventory. Results: Religiosity and spirituality were important for coping and conceptualizations of trauma, served as facilitators for engaging UIC in therapy, and related to improving posttraumatic cognitions and symptoms. Conclusion: Religious identity and spirituality can be important for meaning making, trauma cognitions and symptoms, and can be important to explore in therapy with unaccompanied immigrant children and adolescents. Clinical Trial Registration: Not applicable.

For many teens, trauma can lead to problems with addiction. Now, for the first time ever, two mental health experts offer a powerful, integrative program to effectively treat teens with these often co-occurring issues. Based in cognitive behavioral therapy (CBT) and mindfulness--two proven-effective therapies for addiction and mental health issues--Treating Co-occurring Adolescent PTSD and Addiction is essential for anyone working with this high-risk population.

Abstract Poor sleep during adolescence is a public health concern that may be especially important to address among youth in juvenile correctional facilities, who tend to experience greater mental health challenges, substance use disorders, and traumatic stress exposure. However, evidence for addressing sleep in correctional settings is limited. Using de-identified composite clinical cases, this paper describes challenges and opportunities for addressing sleep disorders (i.e. insomnia) and promoting sleep health (i.e. improving duration, regularity, and behaviors) among adolescents in long-term juvenile correctional facilities. These clinical cases highlight common presenting problems and underscore the need for integrated sleep and mental health interventions as well as adaptations to enhance feasibility and efficacy of behavioral sleep treatment and sleep health promotion in juvenile correctional contexts. We conclude by summarizing clinical, research, and policy implications for addressing adolescent sleep problems and promoting sleep health and well-being in these contexts.

In June 2019, with support from department leadership, a small group (two faculty, one resident, and two staff members) at the University of California, San Francisco (UCSF) Department of Psychiatry and Behavioral Sciences founded the Climate Change and Mental Health Task Force [5]. Education: established annual departmental Grand Rounds on climate change and mental health; gave multiple local and national presentations, including at the 2021 Association for Academic Psychiatry, American Psychiatric Association, American Academy of Child and Adolescent Psychiatry, and Academy for Consult-Liaison Psychiatry Annual Meetings; inserted several lectures into the existing residency didactic footprint and launched a 4-hour curriculum for first-year psychiatry residents covering the effects of climate change across the lifespan as well as impact on communities and environmental justice; developed climate change and mental health content that was integrated into the medical school curriculum. Next steps include formally partnering with the University of California Center for Climate, Health and Equity housed at UCSF and expanding collaborations with advocacy, clinical, and environmental community organizations, which will amplify the Task Force’s reach and impact and expand the focus on mental health.