Administration and Policy in Mental Health and Mental Health Services Research最新文献

{"title":"Community Health Worker-Delivered Mental Health Interventions for Latine Populations in the U.S.: A Systematic Literature Review.","authors":"Erika L Gustafson, Jacqueline O Moses, Eliana Pimentel, Davielle Lakind, Viviana Uribe, Dillon Thorpe, Gabriella Bobadilla, Lily Caglianone, Grayson J Dickinson, Dale Smith, Jennifer Westrick, Lisa Sánchez-Johnsen","doi":"10.1007/s10488-025-01459-6","DOIUrl":"https://doi.org/10.1007/s10488-025-01459-6","url":null,"abstract":"<p><p>The United States (US) faces a mental health crisis characterized by persistent unmet mental health needs, provider shortages, and pronounced mental health inequities for systematically marginalized communities, including the Latine population. Integrating community health workers (CHWs) into mental healthcare delivery via task-shifting is one promising approach to address longstanding inequities in treatment access. Yet, most studies of CHW mental health models have been conducted outside of the US, necessitating an evaluation of the evidence base for these models domestically, and in particular, their use with Latines living in the US. This systematic review examines the evidence for CHW-delivered mental health interventions for US-based Latines. In total, 27 articles (25 trials) met the eligibility criteria. The majority of interventions were delivered in Spanish to immigrant populations. The most common mental health targets included depression, stress, and parenting or the parent-child relationship. Common intervention components included psychoeducation, general coping skills, behavior management, case management, communication skills, relaxation, and problem solving. The majority of studies found that CHW-delivered interventions led to significant mental health symptom improvements. However, there was a high risk of bias across studies. Thus, there is promising preliminary evidence supporting CHW-delivered mental health interventions for US Latines, but more rigorous evaluation of these models is needed.</p>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Facilitators to Implementing a School-Based Social and Emotional Learning Program for Rural Children in China: A Qualitative Study Using the Consolidated Framework for Implementation Research.","authors":"Linyun Fu, Yibin Yang, Alida Bouris","doi":"10.1007/s10488-025-01460-z","DOIUrl":"https://doi.org/10.1007/s10488-025-01460-z","url":null,"abstract":"<p><p>Rural children in mainland China, particularly those whose parents migrate for economic opportunities, face distinct mental, emotional, and behavioral (MEB) challenges. With few mental health professionals available to address rural student's MEB needs, task-shifting approaches that rely on teacher-led interventions, such as the evidence-based Social and Emotional Learning (SEL) program, are a promising alternative. However, little is known about the implementation determinants of teacher-led SEL programs in rural China, a key gap for sustaining and scaling effective programs. The present study qualitatively explored the contextual determinants of implementing the Positive Growth Curriculum (PGC), an efficacious, teacher-led SEL program delivered to 648 fifth graders in two rural schools in southwest China. We conducted in-depth interviews with all N = 15 schoolteachers and administrators who implemented PGC, with questions guided by the Consolidated Framework for Implementation Research. Interviews were audio recorded and two independent coders conducted Rapid Qualitative Analysis. Codes were organized into four major themes detailing how contextual determinants shaped the acceptability, appropriateness, feasibility, fidelity, and sustainability of PGC. Findings indicated that innovation facilitators, e.g., relative advantage, low complexity, intervention design, and perceived effectiveness, facilitated PGC acceptability and appropriateness (Theme 1) and implementation strategies, e.g., training, facilitation and champions, were vital for ensuring fidelity (Theme 2). However, despite high teacher motivation and buy-in, feasibility and sustainability were threatened by inner setting pressures and administrative burdens that prioritize student's academic success over their SEL (Theme 3) and a lack of community buy-in and low governmental funding for SEL initiatives, two outer setting determinants (Theme 4). These barriers led some teachers to question if they are the optimal deliverers for SEL curricula. Potential PGC adaptations are discussed, as are possible implementation strategies and adjunctive interventions to sustain and scale effective teacher-led programs that can support rural students' MEB health and academic success.</p>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Simulation Model to Estimate Local Prevalence Based on Screening Data.","authors":"Katherine M Cooper, Leah Ramella, Esther Boama-Nyarko, Slawa Rokicki, Lulu Xu, Grace A Masters, Nancy Byatt, Thomas I Mackie, R Christopher Sheldrick","doi":"10.1007/s10488-025-01454-x","DOIUrl":"https://doi.org/10.1007/s10488-025-01454-x","url":null,"abstract":"<p><p>To develop screening guidelines, the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) Evidence to Decision (EtD) framework recommends careful assessment of both test accuracy and the downstream consequences of screening. To tailor recommendations to a specific context, GRADE EtD recommends ensuring that all assumptions and inputs on which the original recommendations are based are appropriate to the novel setting. Perinatal depression screening offers a notable example where evidence-based screening guidelines are recommended at a national level, yet implementation necessarily occurs in specific contexts. Methods to examine the generalizability of assumptions underlying screening recommendations are needed. The GRADE EtD framework demonstrates how local prevalence can be combined with evidence on screening sensitivity and specificity to estimate the number of true positive, false positive, true negative, and false negative results. In turn, these estimates can be linked to evidence of benefit and harm, such as potential benefits from treatment or stigma from false positive identification. To estimate benefit at a local level, we developed a simulation model that expresses prevalence as a function of sensitivity, specificity, and the proportion of patients who screen positive. We then identified published systematic reviews and meta-analyses of (a) perinatal depression prevalence, (b) screening accuracy, (c) implementation of screening in clinical settings. We then used a participatory form of simulation modeling to estimate prevalence at a local level-a necessary first step to evaluation net benefit-and to explore alternative hypotheses through sensitivity analyses. We identified meta-analyses of prevalence and screening accuracy, as well as 14 screening studies with data sufficient to inform key questions. Simulation models estimated local prevalence as a function of positive screening rates and published estimates of sensitivity and specificity. These prevalence estimates displayed marked heterogeneity, including frequent implausible impossible values (e.g., prevalence < 0%). Findings suggest that screening data are insufficient to estimate local prevalence and that sensitivity and specificity are not stable properties of screening questionnaires. Instead, study-level differences in context may be influential, such as variation in patients' willingness to disclose depression symptoms across settings. Results highlight the opportunity for simulation modeling to inform evidence synthesis and decision-making.</p>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes of Mental Health Professionals Towards the Use of Routine Outcome Monitoring in Psychotherapeutic Inpatient Settings: A Thematic Analysis.","authors":"Julia Barbara Krakowczyk, Martin Teufel, Eva-Maria Skoda, Christoph Jansen, Tania Lalgi, Lennart Martens, Ulrike Dinger, Wolfgang Lutz, Alexander Bäuerle","doi":"10.1007/s10488-025-01455-w","DOIUrl":"https://doi.org/10.1007/s10488-025-01455-w","url":null,"abstract":"<p><p>Routine outcome monitoring (ROM) involves the systematic recording of patient-reported outcome measures to monitor treatment progress and outcomes within psychotherapy. It represents an evidence-based approach to enhance psychotherapeutic treatment outcomes. However, it remains a rather controversial topic among mental health care professionals (MHP), resulting in its limited use in clinical practice, especially in inpatient settings. This qualitative interview study aimed to gain a comprehensive understanding of MHP attitudes towards ROM and its implementation within psychotherapeutic inpatient settings in Germany. In this study, semi-structured interviews were conducted with MHP working in the psychotherapeutic inpatient setting in the German healthcare system. Three independent researchers inductively coded the data, and thematic codebook analysis was used to evaluate the data iteratively. In total, 20 participants (14 medical doctors, and 6 clinical psychologists) with varying levels of working experience participated in the present study. The general attitude towards ROM and its implementation was predominantly positive, with ROM being perceived as a helpful feature to support psychotherapeutic inpatient treatment. However, possible pitfalls requiring careful consideration were highlighted, such as the risk of potential misuse and additional workload. The insights of the present study contribute to the ongoing discourse of ROM in mental health care. The study highlights the importance of proper implementation strategies and transparent communication regarding the relevance, aims, and use of ROM. Moreover, it highlights potential risks and perceived disadvantages associated with ROM, which may be related to implementation barriers and possible negative attitudes among MHP.</p>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Keeping Our ACT Team Together: Supervisory Strategies to Promote Workforce Retention.","authors":"Mimi Choy-Brown, William Carlson, Nathaniel J Williams, Lynette Studer, Sheetal Digari","doi":"10.1007/s10488-025-01458-7","DOIUrl":"https://doi.org/10.1007/s10488-025-01458-7","url":null,"abstract":"<p><p>Strategies are urgently needed to address the mental health workforce crisis in the United States that threatens essential care for people living with psychiatric disabilities. Assertive Community Treatment (ACT) is a cornerstone of community mental health care and workforce turnover negatively impacts patient experiences and outcomes. The present study aims to examine malleable supervisory strategies for reducing the intention to leave among the ACT workforce in order to reduce voluntary turnover. A cross-sectional observational survey of the largest sample yet of ACT team members (N = 334) from 80 ACT teams working in four States assessed team-level and team members' supervision characteristics theorized to predict supervisory working relationships and team members' intention to leave their positions. Unadjusted and adjusted hierarchical linear regression models examined factors at multiple levels (i.e., team member, team) in relation to team members' intention to leave and accounted for the clustering of team members within teams. Adjusted models indicated that team member and team factors were negatively associated with team members' intention to leave. Specifically, higher levels of transformational leadership and strong supervisory working alliances had a significant association with reduced intention to leave. Additionally, empirically supported supervision strategies and transformational leadership were significantly associated with stronger supervisory working alliances. Strategic workforce investment in the development of ACT team leaders and their use of transformational leadership and empirically supported supervision strategies may represent a promising pathway to promote strong supervisory working alliances and retention of essential ACT team members.</p>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility in Community Mental Health Research: A Scoping Review.","authors":"Clara Johnson, Carla Valero Martínez, Celine Lu, Sharon Kiche, Rashed AlRasheed, Priya Dahiya, Noah S Triplett, Kirstyn N Smith-LeCavalier, Anna Testorf, Shannon Dorsey","doi":"10.1007/s10488-025-01457-8","DOIUrl":"https://doi.org/10.1007/s10488-025-01457-8","url":null,"abstract":"<p><p>Feasibility, the degree to which an innovation is successfully carried out in a given setting, is key to whether an intervention will be implemented as planned and is connected to implementation success and service outcomes. In settings with limited resources, feasibility may be a particularly important determinant of whether an intervention is adopted and/or sustained over time. However, there is limited consensus on how to define, measure, and report feasibility in research conducted in community mental health settings. Following guidance from Arksey and O'Malley (2005), Levac et al. (2010), and Westphaln et al. (2021), the current scoping review aims to synthesize how trials conducted in community mental health settings describe the rationale, definition, measurement approach, and results of feasibility. The search included articles from Medline, PsycInfo, CENTRAL, Global Health, and Global Index Medicus and was conducted in September 2023. Included articles referenced feasibility and had each of the following: (1) delivery of an evidence-based psychotherapy (EBP) in a community mental health setting, (2) participants with elevated mental health symptomatology, and (3) implementation and/or clinical outcomes. Through data extraction, data synthesis, and qualitative content analysis, the authors identified feasibility definitions, measures, results, and explanations as well as intervention characteristics. Sixty-one articles across 20 countries were included. Articles included a wide range of EBPs delivered to individuals across the life span in community mental health settings. While all studies reported some level of feasibility of an intervention or trial, only 60.7% described a rationale for examining feasibility, 11.5% defined feasibility, 73.8% measured feasibility, and 67.2% reported descriptive statistics to accompany the level of feasibility found. Our results highlight the lack of clear and consistent rationales, definitions, measurement approaches, and results of feasibility in research conducted in community mental health settings. To improve the conceptualization and study of feasibility, we propose guidelines for future researchers to consider when examining feasibility. The guidelines include providing a clear definition of feasibility (i.e., the extent to which an EBP is possible in a certain context; Proctor et al., 2011), combining reflective and formative measures of feasibility to assess how feasible an intervention is and why it is deemed feasible (respectively), considering when in the implementation process researchers are engaged, involving multiple voices in the measures of feasibility, and exploring the impact of feasibility on other implementation outcomes as well as clinical outcomes.</p>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Youth and Young Adult Peer Support in Mental Health Services: A Systematic Review.","authors":"Kimberly Hoagwood, Charlotte Gendler, Nicole Davies, Kelly Davis, Prameela Boorada, Robbie Lettieri, Kelly Kelleher","doi":"10.1007/s10488-025-01451-0","DOIUrl":"https://doi.org/10.1007/s10488-025-01451-0","url":null,"abstract":"<p><p>Serious workforce shortages in youth mental health widen the gap between demand and use, and exacerbate health disparities. A strategy to address this is training and integrating youth and young adult (Y/YA) peers to deliver services. This paper reviews international scientific studies on Y/YA services targeting mental health conditions or health promotion. We applied systematic criteria including controlled designs (RCTs or quasi-experimental), active intervention delivered by a young person, key search terms, and peer-reviewed publication between 2012 and 2023. The review yielded 32 studies meeting criteria, encompassing six domains: eating disorders, health promotion, depression/anxiety, suicidal risk, serious mental illness (SMI) and \"other.\" The most consistent evidence for effectiveness was for eating disorders; findings in the other domains were mixed. Training manuals, fidelity measurement, reporting of demographic data, and consistency in outcome measurement were largely absent, limiting both replicability and generalizability. The acceleration of scientific attention to youth/young adult peer services over the past decade and emerging support for its effectiveness is encouraging, however, and it bodes well for mitigating workforce shortages and, more importantly, for improving the quality of services for young people.</p>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144493395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns and Disparities in Met Needs in Community Mental Health Services: Exploring the Utility of the Ontario Modified Met Needs Index.","authors":"Frank Sirotich, Kamalpreet Rakhra, Jerome Iruthayarajah, Janet Durbin, Ravi Menezes, Lin Fang, Jennifer Zosky","doi":"10.1007/s10488-025-01456-9","DOIUrl":"https://doi.org/10.1007/s10488-025-01456-9","url":null,"abstract":"<p><p>Assessing client needs is integral to improving outcomes in community mental health services, yet tools to evaluate the extent to which needs are met remain underutilized. This study examines patterns of met needs and disparities across sociodemographic groups using the Ontario Common Assessment of Need (OCAN), a standardized tool adapted from the Camberwell Assessment of Need (CAN) and widely implemented in Ontario, Canada. Specifically, we applied the Ontario Modified Met Needs Index (OMMNI), a ratio-based metric, to measure the extent to which identified needs were addressed over the course of care. Using longitudinal OCAN data from 4,537 clients engaged in assertive community treatment, case management, early psychosis intervention, and supportive housing programs, we calculated OMMNI scores based on both staff- and client-completed assessments. Results showed that 74% of staff-identified needs and 72% of client-identified needs were met or remained met. At the domain level, safety-related needs had the highest rates of being met (≥ 85%), while sexual expression, intimate relationships, company, daytime activities and psychological distress were least consistently addressed (< 70%). Disparities in staff assessments were observed for younger clients and those with unspecified service languages, while disparities in client assessments were noted for clients identifying as transgender or non-binary. These findings underscore variability in addressing diverse client needs, highlighting opportunities to enhance person-centered care. The OMMNI holds potential as a practical tool for measuring met needs, identifying disparities, informing service planning, and supporting quality improvement. Further validation is needed to ensure its applicability across populations and service contexts.</p>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-Method, Partner-Engaged Process to Document Adaptations for ATTAIN NAV: Family Navigation for Autism and Mental Health.","authors":"Isaac Bouchard, Kassandra Martinez, Pollyanna Gomez-Patino, Felice Navarro, Lauren Brookman-Frazee, Kimberly J Holmquist, Sonya Negriff, Miya Barnett, Sarabeth Broder-Fingert, Nicole A Stadnick","doi":"10.1007/s10488-025-01452-z","DOIUrl":"https://doi.org/10.1007/s10488-025-01452-z","url":null,"abstract":"<p><p>Autistic youth often experience co-occurring mental health needs, yet they have multi-level barriers to accessing needed care. To address these barriers, the ATTAIN NAV (Access to Tailored Autism Integrated Care through Family Navigation) intervention was co-designed with caregiver and healthcare partners and delivered by lay health navigators to facilitate access to and engagement with mental health services for school-age autistic youth. This manuscript describes the multi-method, partner-engaged, longitudinal adaptation process to (1) identify intervention content and implementation refinements prior to the hybrid trial and (2) track ongoing research, intervention, and implementation adaptations during the trial and their impacts on study outcomes. The adaptation processes used the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (Miller et al., 2021) to guide data collection and evaluation approaches. From the qualitative co-design activities with caregivers (n = 5), primary care providers (n = 6), developmental care clinicians (n = 4), and health informatics staff (n = 3), several intervention content and implementation adaptations were identified and integrated prior to the trial. From the longitudinal adaptation tracking process during the trial, a total of 19 adaptations were documented throughout the implementation trial. The adaptations were related to maintaining the feasibility and acceptability of the study procedures (32%), increasing family recruitment/engagement (26%), increasing the acceptability of the intervention components (16%), increasing physician recruitment/engagement (11%), expanding mental health resources (5%), complying with partnered healthcare organization policy (5%), and increasing navigator workflow efficiency (5%). Findings offer a structured and replicable approach adoptable by non-traditional mental health intervention and implementation research.</p>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness Analysis of School Nurse Delivered Interventions to Reduce Student Anxiety: Evidence from the CALM Study.","authors":"Clive Belfield, Lillian Blanchard, Kelly Drake, Golda Ginsburg","doi":"10.1007/s10488-025-01453-y","DOIUrl":"https://doi.org/10.1007/s10488-025-01453-y","url":null,"abstract":"<p><p>Childhood anxiety imposes substantial economic burdens on families, schools, and medical services. Interventions to reduce anxiety may be economically valuable, particularly if they can be delivered at low cost. This study examined the cost-effectiveness of two school nurse-delivered anxiety interventions for elementary school children: CALM (Child Anxiety Learning Modules, cognitive behavioral skills) and CALM-R (relaxation skills). In this pilot randomized controlled trial (RCT) 30 school nurses delivered CALM or CALM-R to 54 children with elevated anxiety. CALM and CALM-R demonstrated intervention affordability, with nurse training and nurse delivery costs at $560 and $630 respectively per child. At baseline, we found significant economic resources used by school systems, families, and health systems to support students with anxiety ($3,660-$5,350 per child). At three-month follow-up, total resource use- including intervention costs and all other services -- was lower for children in CALM but higher for CALM-R. For CALM, the implementation cost was more than offset by subsequent resource savings. Moreover, at three month follow up, responder status per child was higher for CALM (60%) than for CALM-R (35%). Thus, CALM students required fewer resources and experienced greater clinical benefits than students in CALM-R. Incremental Cost-Effectiveness Analysis showed that CALM was more cost-effective than CALM-R: the cost per incremental responder student was $6,291 lower. CALM has a high probability of acceptance across all positive values of willingness to pay for anxiety reduction. Evidence from this study indicates that cognitive behavioral skills delivered by school nurses may offer a cost-effective response to childhood anxiety.</p>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}