Aaron Hogue, Alexandra MacLean, Molly Bobek, Nicole Porter, Lila Bruynesteyn, Amanda Jensen-Doss, Craig E Henderson
{"title":"Pilot Trial of Online Measurement Training and Feedback in Family Therapy for Adolescent Behavior Problems.","authors":"Aaron Hogue, Alexandra MacLean, Molly Bobek, Nicole Porter, Lila Bruynesteyn, Amanda Jensen-Doss, Craig E Henderson","doi":"10.1080/15374416.2022.2051529","DOIUrl":"10.1080/15374416.2022.2051529","url":null,"abstract":"<p><strong>Objective: </strong>Pragmatic procedures for sustaining high-fidelity delivery of evidence-based interventions are needed to support implementation in usual care. This study tested an online therapist training system, featuring observational coder training and self-report fidelity feedback, to promote self-report acumen and routine use of family therapy (FT) techniques for adolescent behavior problems.</p><p><strong>Method: </strong>Therapists (N = 84) from nine substance use and mental health treatment sites reported on 185 adolescent clients. Therapists submitted baseline data on FT technique use with clients, completed a workshop introducing the 32-week training system, and were randomly assigned by site to Core Training versus Core Training + Consultation. Core Training included a therapist coder training course (didactic instruction and mock session coding exercises in 13 FT techniques) and fidelity feedback procedures depicting therapist-report data on FT use. Consultation convened therapists and supervisors for one-hour monthly sessions with an external FT expert. During the 32 weeks of training, therapists submitted self-report data on FT use along with companion session audiotapes subsequently coded by observational raters.</p><p><strong>Results: </strong>Therapist self-report reliability and accuracy both increased substantially during training. Observers reported no increase over time in FT use; therapists self-reported a decrease in FT use, likely an artifact of their improved self-report accuracy. Consultation did not enhance therapist self-report acumen or increase FT use.</p><p><strong>Conclusions: </strong>Online training methods that improve therapist-report reliability and accuracy for FT use may confer important advantages for treatment planning and fidelity monitoring. More intensive and/or different training interventions appear needed to increase routine FT delivery.</p>","PeriodicalId":48350,"journal":{"name":"Journal of Clinical Child and Adolescent Psychology","volume":" ","pages":"850-865"},"PeriodicalIF":4.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9535038/pdf/nihms-1794808.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41152346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stefanie Sequeira, Tamar Carmel, Brenden Tervo-Clemmens, E Kale Edmiston
{"title":"Future Directions in the Mental Health of Transgender Youth: Towards a Social-Affective Developmental Model of Health Disparity.","authors":"Stefanie Sequeira, Tamar Carmel, Brenden Tervo-Clemmens, E Kale Edmiston","doi":"10.1080/15374416.2023.2272972","DOIUrl":"10.1080/15374416.2023.2272972","url":null,"abstract":"<p><p>Mental health disparities in transgender and gender diverse (TGD) youth are well-documented. These disparities are often studied in the context of minority stress theory, and most of this research focuses on experiences of trauma and discrimination TGD youth experience after coming out. However, TGD youth may be targets of violence and victimization due to perceived gender nonconformity before coming out. In this Future Directions, we integrate research on attachment, developmental trauma, and effects of racism and homophobia on mental health to propose a social-affective developmental framework for TGD youth. We provide a clinical vignette to highlight limitations in current approaches to mental health assessment in TGD youth and to illustrate how using a social-affective developmental framework can improve clinical assessment and treatment approaches and deepen our understanding of mental health disparities in TGD people.</p>","PeriodicalId":48350,"journal":{"name":"Journal of Clinical Child and Adolescent Psychology","volume":" ","pages":"866-876"},"PeriodicalIF":4.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71428025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Transdiagnostic Sleep and Circadian Intervention for Adolescents Plus Text Messaging: Randomized Controlled Trial 12-month Follow-up.","authors":"Emily A Dolsen, Lu Dong, Allison G Harvey","doi":"10.1080/15374416.2021.1978295","DOIUrl":"10.1080/15374416.2021.1978295","url":null,"abstract":"<p><strong>Objective: </strong>The Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C) was developed to improve sleep and circadian functioning in adolescents. This study examined the 12-month effects for TranS-C compared with psychoeducation (PE). We also investigated whether a text messaging intervention can promote maintenance of treatment effects.</p><p><strong>Method: </strong>At the baseline, adolescents (58% female, average age = 14.8 years) with an eveningness chronotype were randomized to TranS-C (n = 89) or PE (n = 87). At 6-month follow-up, participants were randomized to receive text messages that had repeated treatment information (n = 47), text messages that prompted the recall of treatment information (n = 50), or no text messages (n = 47).</p><p><strong>Results: </strong>Relative to PE, TranS-C was associated with a reduced eveningness (<i>b</i> = 2.06, <i>p</i> = .005, <i>d</i> = 0.29) from the baseline to a 12-month follow-up. TranS-C treatment effects, relative to PE, were augmented by receiving text messages, compared to no text messages, for eveningness from baseline to 12-month follow-up (<i>b</i> = 1.38, <i>p</i> = .008, <i>d</i> = 0.28) and from 6- to 12-month follow-up (<i>b</i> = 1.07, <i>p</i> = .046, <i>d</i> = 0.21). Neither TranS-C nor text messages were significantly associated with other primary outcomes. TranS-C and text messages were significantly associated with improvements on selected secondary sleep and health outcomes through follow-up.</p><p><strong>Conclusions: </strong>For adolescents with an eveningness chronotype, improved sleep and circadian functioning on selected outcomes were maintained over 12 months for TranS-C compared with PE. Text messages boosted the effects of TranS-C through 12-month follow-up.</p>","PeriodicalId":48350,"journal":{"name":"Journal of Clinical Child and Adolescent Psychology","volume":" ","pages":"750-762"},"PeriodicalIF":4.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9213566/pdf/nihms-1740112.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9700969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexandra H Bettis, Rachel A Vaughn-Coaxum, Hannah R Lawrence, Jessica L Hamilton, Kathryn R Fox, Astraea Augsberger
{"title":"Key Challenges and Potential Strategies for Engaging Youth with Lived Experience in Clinical Science.","authors":"Alexandra H Bettis, Rachel A Vaughn-Coaxum, Hannah R Lawrence, Jessica L Hamilton, Kathryn R Fox, Astraea Augsberger","doi":"10.1080/15374416.2023.2264389","DOIUrl":"10.1080/15374416.2023.2264389","url":null,"abstract":"<p><p>Centering the perspectives of youth with lived experience (YWLE) in psychopathology is critical to engaging in impactful clinical research to improve youth mental health outcomes. Over the past decade there has been a greater push in clinical science to include community members, and especially community members with lived experience, in all aspects of the research process. The goal of this editorial is to highlight the need for and importance of integrating YWLE into every stage of clinical science research, from idea generation to interpretation and dissemination of research findings. We identify five key problems associated with pursuing research on adolescent mental health without involvement of YWLE and propose strategies to overcome barriers to youth engagement in clinical science research. We conclude with a call to action, providing guidance to clinical scientists, institutions, and funding agencies in conducting research on youth psychopathology with YWLE.</p>","PeriodicalId":48350,"journal":{"name":"Journal of Clinical Child and Adolescent Psychology","volume":" ","pages":"1-14"},"PeriodicalIF":4.2,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11052921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61565532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kara A Fox, Elizabeth Nick, Jacqueline Nesi, Eva H Telzer, Mitchell J Prinstein
{"title":"Why Haven't You Texted Me Back? Adolescents' Digital Entrapment, Friendship Conflict, and Perceived General Health.","authors":"Kara A Fox, Elizabeth Nick, Jacqueline Nesi, Eva H Telzer, Mitchell J Prinstein","doi":"10.1080/15374416.2023.2261543","DOIUrl":"10.1080/15374416.2023.2261543","url":null,"abstract":"<p><strong>Objective: </strong>Many adolescents feel pressure to be constantly available and responsive to others via their smartphones and social media. This phenomenon has been understudied using quantitative methods, and no prior study has examined adolescents' specific stress about meeting digital availability expectations within a best friendship, or entrapment. The present study offers an important preliminary examination of this unique digital stressor in a developmental context by examining prospective associations between digital entrapment, psychosocial adjustment, and health in adolescence.</p><p><strong>Method: </strong>Students in a rural, lower-income school district in the southeastern US (<i>n</i> = 714; 53.8% female; 45.9% White, 22.7% Black, 24.0% Hispanic/Latino) completed self-report measures of digital entrapment, perceived general health, friendship conflict, and depressive symptoms at two timepoints, one year apart.</p><p><strong>Results: </strong>Digital entrapment, which 76.3% of the sample reported experiencing, was associated prospectively with higher levels of friendship conflict and worse perceived general health one year later among boys, but not girls. Findings suggest that digital entrapment is an extremely common experience for adolescents that may disproportionally affect boys. Entrapment was not prospectively associated with depressive symptoms.</p><p><strong>Conclusions: </strong>Results offer insight into how boys may have different social media experiences significant to their development and health, while much work exploring gender differences in social media use thus far has elucidated negative effects for girls. Boys may perceive and respond to novel social norms of digital environments differently such that digital entrapment has the potential to be detrimental to their friendships and health.</p>","PeriodicalId":48350,"journal":{"name":"Journal of Clinical Child and Adolescent Psychology","volume":" ","pages":"1-11"},"PeriodicalIF":4.2,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10995108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41152415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deepika Bose, Jeremy W Pettit, Jennifer S Silk, Cecile D Ladouceur, Thomas M Olino, Erika E Forbes, Greg J Siegle, Ronald E Dahl, Phillip C Kendall, Neal D Ryan, Dana L McMakin
{"title":"Therapeutic Alliance, Attendance, and Outcomes in Youths Receiving CBT or Client-Centered Therapy for Anxiety.","authors":"Deepika Bose, Jeremy W Pettit, Jennifer S Silk, Cecile D Ladouceur, Thomas M Olino, Erika E Forbes, Greg J Siegle, Ronald E Dahl, Phillip C Kendall, Neal D Ryan, Dana L McMakin","doi":"10.1080/15374416.2023.2261547","DOIUrl":"10.1080/15374416.2023.2261547","url":null,"abstract":"<p><strong>Objective: </strong>Positive associations between therapeutic alliance and outcome (e.g. youth symptom severity) have been documented in the youth anxiety literature; however, little is known about the conditions under which early alliance contributes to positive outcomes in youth. The present study examined the relations between therapeutic alliance, session attendance, and outcomes in youths (<i>N</i> = 135; 55.6% female) who participated in a randomized clinical trial testing the efficacy of cognitive-behavioral therapy or client-centered therapy for anxiety.</p><p><strong>Method: </strong>We evaluated a conceptual model wherein: (1) early alliance indirectly contributes to positive outcomes by improving session attendance; (2) alliance-outcome associations differ by intervention type, with stronger associations in cognitive-behavioral therapy compared to client-centered therapy; and (3) alliance-outcome associations vary across outcome measurement timepoints, with the effect of early alliance on outcomes decaying over time.</p><p><strong>Results: </strong>Contrary to hypotheses, provider ratings of early alliance predicted greater youth-rated anxiety symptom severity post-treatment (i.e. worse treatment outcomes). Session attendance predicted positive youth-rated outcomes, though there was no indirect effect of early alliance on outcomes through session attendance.</p><p><strong>Conclusions: </strong>Results show that increasing session attendance is important for enhancing outcomes and do not support early alliance as a predictor of outcomes.</p>","PeriodicalId":48350,"journal":{"name":"Journal of Clinical Child and Adolescent Psychology","volume":" ","pages":"1-11"},"PeriodicalIF":4.2,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10995113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cynthia Brown, Matthew Lerner, Jenna Stadheim, Connor Kerns, Lauren Moskowitz, Elizabeth Cohn, Amy Drahota, Latha Soorya, Allison Wainer
{"title":"Provider Self-Reported Use and Usefulness of Intervention Strategies for Externalizing Behaviors in Youths with ASD.","authors":"Cynthia Brown, Matthew Lerner, Jenna Stadheim, Connor Kerns, Lauren Moskowitz, Elizabeth Cohn, Amy Drahota, Latha Soorya, Allison Wainer","doi":"10.1080/15374416.2023.2251163","DOIUrl":"10.1080/15374416.2023.2251163","url":null,"abstract":"<p><strong>Objective: </strong>To examine predictors of implementation and perceived usefulness of four empirically supported strategies for treating externalizing behavior in youths with ASD.</p><p><strong>Method: </strong>Participants were 557 providers in the United States with experience treating externalizing behavior in youths with ASD. Generalized estimating equations were used to determine whether self-reported use and usefulness of four empirically supported intervention strategies (functional communication training, functional behavior analysis, visual tools/supports, token economy) were predicted by key provider characteristics: professional discipline, experience, and practice specialization (across three indices) in ASD. Post-hoc contrasts were performed to identify provider groups reporting the greatest use and usefulness of the four strategies.</p><p><strong>Results: </strong>Strategies were most often used by providers with behavioral backgrounds, though perceived usefulness of strategies varied by providers' professional discipline. Compared to providers with more than 10 years of experience, less experienced providers endorsed the highest average use and usefulness of almost all strategies. Regarding ASD practice specialization, a lower volume of ASD cases, treating fewer youths with ASD over a 5-year period, and having a higher proportion of practice time working with youths with ASD reported were associated with greater use and usefulness of the strategies.</p><p><strong>Conclusions: </strong>Empirically supported strategies are widely used by and perceived as useful by providers who treat youths with ASD and co-occurring externalizing behaviors. Use and usefulness varies based on provider discipline, experience, and ASD practice specialization.</p>","PeriodicalId":48350,"journal":{"name":"Journal of Clinical Child and Adolescent Psychology","volume":" ","pages":"1-15"},"PeriodicalIF":4.2,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10937329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10236038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vanesa M Perez, Nancy A Gonzales, Jenn-Yun Tein, Mariam Hanna Ibrahim, Linda J Luecken, Sandra Losoya
{"title":"Dispositional Active Coping Predicts Patterns of Adolescents' Cortisol Responsivity in the Context of School-related Stressors.","authors":"Vanesa M Perez, Nancy A Gonzales, Jenn-Yun Tein, Mariam Hanna Ibrahim, Linda J Luecken, Sandra Losoya","doi":"10.1080/15374416.2021.1969651","DOIUrl":"10.1080/15374416.2021.1969651","url":null,"abstract":"<p><strong>Objective: </strong>The goal of this study was to examine the direct and conditional effects of active coping and prior exposure to school-related stressors on cortisol reactivity and recovery in response to an academically salient, social stress task.</p><p><strong>Method: </strong>Participants included N= 758 adolescents (50% male; M age = 12.03 years, SD = .49) enrolled in the 7th grade in Title 1 middle schools. Adolescents were predominantly ethnic minorities (62% Hispanic, 12% non-Hispanic White, 11% non-Hispanic Black, 7% Native American, and 8% \"other\"). Youth completed self-reported assessments of their dispositional use of active coping strategies, prior exposure to school hassles, pubertal status, medication use, and relevant demographic information. In addition, youth engaged in an academically salient group public speaking task adapted for adolescents and provided salivary cortisol sample pre-task, immediately post-task, 15-, and 30-minutes post-task.</p><p><strong>Results: </strong>Results from piecewise latent growth curve modeling revealed that active coping independently predicted lower cortisol reactivity to the stress task. Furthermore, active coping was associated with slower cortisol recovery when adolescents reported not having experienced any school hassles in the past three months and faster recovery when having experienced several school hassles in the past three months. Results from multinomial logistic regressions revealed that greater use of active coping strategies was less likely to predict a hyper-reactive pattern of cortisol responding compared to other patterns.</p><p><strong>Conclusion: </strong>Findings provide support for active coping as a way to promote adaptive physiological responding to school-related stressors among ethnically diverse youth residing in low-income communities.</p>","PeriodicalId":48350,"journal":{"name":"Journal of Clinical Child and Adolescent Psychology","volume":"52 5","pages":"604-615"},"PeriodicalIF":4.2,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8940737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10271835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Genevieve M Davison, Lawrence T Monocello, Kim Lipsey, Denise E Wilfley
{"title":"Evidence Base Update on Behavioral Treatments for Overweight and Obesity in Children and Adolescents.","authors":"Genevieve M Davison, Lawrence T Monocello, Kim Lipsey, Denise E Wilfley","doi":"10.1080/15374416.2023.2251164","DOIUrl":"10.1080/15374416.2023.2251164","url":null,"abstract":"<p><strong>Objective: </strong>This review provides an update to a previous Evidence Base Update addressing behavioral treatments for overweight and obesity in children and adolescents.</p><p><strong>Method: </strong>Articles were identified through a systematic search of the biomedical literature in PubMed/MEDLINE (1946-), Elsevier EMBASE (1947-), SCOPUS (1823-), Clarivate Web of Science Core Collection (WOS, 1900-), PsycINFO (1800-), The Cochrane Library and Clinicaltrials.gov published between June 2014 and August 2022.</p><p><strong>Results: </strong>Family-based treatment (FBT) remains a <i>well-established</i> treatment for overweight and obesity in children and is now <i>well-established</i> in adolescents and toddlers. Parent-only behavioral treatment remains <i>well-established</i> in children and is now <i>well-established</i> among adolescents and children. <i>Possibly effective treatments</i> continue to include FBT-parent only for adolescents, and behavioral weight loss (BWL) with a family component for adolescents, children, and toddlers. Several variations of FBT and BWL can now be considered <i>possibly effective</i> including FBT+motivational interviewing, FBT+social facilitation maintenance, group-based FBT, low-dose FBT, BWL+stress management, and camp-based BWL. Cognitive behavioral treatment (CBT) for adolescents also met criteria for <i>possibly effective treatments</i>. Current research has also established that behavioral treatments can be effectively delivered in alternative settings (e.g. primary care) and through alternative mediums (e.g. telehealth).</p><p><strong>Conclusions: </strong>Research continues to support the use of multicomponent lifestyle interventions in accordance with recent recommendations from the American Academy of Pediatrics, the American Psychological Association, and the United State Preventative Services Task Force. However, more work is needed to ensure appropriate access for children with comorbid medical and psychiatric disorders and children from socially, politically, and economically marginalized groups.</p>","PeriodicalId":48350,"journal":{"name":"Journal of Clinical Child and Adolescent Psychology","volume":"52 5","pages":"589-603"},"PeriodicalIF":4.2,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10586458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10287192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chantelle Roulston, Sarah McKetta, Maggi Price, Kathryn R Fox, Jessica L Schleider
{"title":"Structural Correlates of Mental Health Support Access among Sexual Minority Youth of Color during COVID-19.","authors":"Chantelle Roulston, Sarah McKetta, Maggi Price, Kathryn R Fox, Jessica L Schleider","doi":"10.1080/15374416.2022.2034633","DOIUrl":"10.1080/15374416.2022.2034633","url":null,"abstract":"<p><p>Many youth with mental health needs cannot access treatment, with multiply-marginalized youth, such as sexual minority youth of Color (SMYoC), experiencing both structural and identity-related barriers to care. The COVID-19 pandemic threatens to exacerbate multi-level treatment access barriers facing SMYoC youth nationwide. However, little large-scale research has examined access to mental health care among SMYoC across the United States, either during or prior to the pandemic. Such work is critical to understanding and ameliorating barriers in this domain. Using data from adolescents who self-identified as SMYoC and who endorsed a desire for mental health support during the COVID-19 pandemic (<i>N</i> = 470, ages 13-16, from 43 U.S. states), we examined associations between state-level, structural factors (income inequality; mental health-care provider shortage; anti-Black racism; homophobia; and the interaction between anti-Black racism and homophobia) and SMYoC mental health treatment access. Multinomial logistic regressions revealed state-level mental health-care provider shortage as the only significant predictor of SMYoC reporting they <i>never</i> (versus <i>always</i>) accessed mental health support during the COVID-19 pandemic. SMYoC living in areas with both lower homophobia <i>and</i> lower anti-Black racism were more likely to report <i>always</i> (versus <i>sometimes</i>) accessing mental health treatment. Results highlight the critical importance of considering diverse structural factors and applying an intersectional lens when exploring barriers to mental health treatment among multiply-marginalized youth. In locations where provider shortages are less severe, cultural stigma - including anti-Black racism and homophobia - may still pose challenges for SMYoC in need of mental health care.</p>","PeriodicalId":48350,"journal":{"name":"Journal of Clinical Child and Adolescent Psychology","volume":"52 5","pages":"649-658"},"PeriodicalIF":4.2,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9452605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10273253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}