Designing and scaling up integrated youth mental health care

Mental ill‐health represents the main threat to the health, survival and future potential of young people around the world. There are indications that this is a rising tide of vulnerability and need for care, a trend that has been augmented by the COVID‐19 pandemic. It represents a global public health crisis, which not only demands a deep and sophisticated understanding of possible targets for prevention, but also urgent reform and investment in the provision of developmentally appropriate clinical care. Despite having the greatest level of need, and potential to benefit, adolescents and emerging adults have the worst access to timely and quality mental health care. How is this global crisis to be addressed? Since the start of the century, a range of co‐designed youth mental health strategies and innovations have emerged. These range from digital platforms, through to new models of primary care to new services for potentially severe mental illness, which must be locally adapted according to the availability of resources, workforce, cultural factors and health financing patterns. The fulcrum of this progress is the advent of broad‐spectrum, integrated primary youth mental health care services. They represent a blueprint and beach‐head for an overdue global system reform. While resources will vary across settings, the mental health needs of young people are largely universal, and underpin a set of fundamental principles and design features. These include establishing an accessible, “soft entry” youth primary care platform with digital support, where young people are valued and essential partners in the design, operation, management and evaluation of the service. Global progress achieved to date in implementing integrated youth mental health care has highlighted that these services are being accessed by young people with genuine and substantial mental health needs, that they are benefiting from them, and that both these young people and their families are highly satisfied with the services they receive. However, we are still at base camp and these primary care platforms need to be scaled up across the globe, complemented by prevention, digital platforms and, crucially, more specialized care for complex and persistent conditions, aligned to this transitional age range (from approximately 12 to 25 years). The rising tide of mental ill‐health in young people globally demands that this focus be elevated to a top priority in global health.     

Assessment of physical activity in youth

Despite much progress with physical activity assessment, the limitations concerning the accurate measurement of physical activity are often amplified in young people due to the cognitive, physiological, and biomechanical changes that occur during natural growth as well as a more intermittent pattern of habitual physical activity in youth compared with adults. This mini-review describes and compares methods to assess habitual physical activity in youth and discusses main issues regarding the use and interpretation of data collected with these techniques. Self-report instruments and movement sensing are currently the most frequently used methods for the assessment of physical activity in epidemiological research; others include heart rate monitoring and multisensor systems. Habitual energy expenditure can be estimated from these input measures with varying degree of uncertainty. Nonlinear modeling techniques, using accelerometry perhaps in combination with physiological parameters like heart rate or temperature, have the greatest potential for increasing the prediction accuracy of habitual physical activity energy expenditure. Although multisensor systems may be more accurate, this must be balanced against feasibility, a balance that shifts with technological and scientific advances and should be considered at the beginning of every new study.     

The rise of creative youth development

ABSTRACT

Creative youth development (CYD) is a dynamic area of community arts education that successfully bridges youth development and arts education. CYD is an intentional, holistic practice that combines hands-on artmaking and skill building in the arts with development of life skills to support young people in successfully participating in adolescence and navigating into adulthood. Young people in CYD programs exhibit high levels of artistic skill and accomplishment along with increased self-esteem and sense of belonging. CYD participants are immersed in a broad array of rigorous artistic endeavors, including creating documentary films, researching and reporting on community issues through radio broadcasts, writing and staging new theatrical works, and engaging in thoughtful critique of one another's visual art work. The impact for youth of program participation extends beyond pride in artistic accomplishment. Throughout the United States, teen participants in CYD programs assert that the programs saved their lives, putting them on positive trajectories and away from gangs, drug use, crime, and ennui. This article provides a definition for the term creative youth development, describes core characteristics of CYD programs, and briefly describes four CYD programs. It provides background on the origins and history of creative youth development, including current advances in the field and signs the field is coalescing. The article describes creative youth development in the larger contexts of arts education and of education reform. Lastly, the article discusses policy, funding, and research needs and opportunities and provides questions for consideration.     

Out of work and house and home: Contested youth in an english homeless hostel

Drawing on fieldwork in England, this article considers a group of unemployed teenagers in occasional residence at a hostel for the homeless, examining their attitudes to work, welfare and adulthood. Interactions between the hostel staff and these young people are discussed. Staff and residents are shown to be at odds over how best to make sense of and respond to the problems of homelessness and unemployment. The residents, most of them in their mid to late teens, could be said to be growing up under extremely difficult circumstances, but growing up allthe same. They might even be described as growing up faster than others their age – of necessity. Nevertheless, I suggest that their present difficulties are not always something these young people want to be too grown up about, if they can help it. Out of work and away from home, being young is one of the few things that they have going for them, and it provides them with a way of coping with the problems they face.     

Positive youth development profiles of cross-age peer mentors

To engage more youth in service, we require further research on the characteristics of youth who serve, particularly disadvantaged youth with limited access to formal service opportunities. This study investigated the positive youth development characteristics of New Zealand youth who decided to mentor younger peers in the Stars program for the first time (n = 109), those who returned to mentor for a subsequent year (n = 48), and similar youth not involved in Stars (n = 51) to determine what characteristics differentiate these groups. Returning mentors had the highest levels of social competency and involvement and a strong leadership orientation. New mentors had the second highest levels of leadership orientation but the lowest levels of social competency and involvement. The propensity for leadership in mentors was associated with having many positive adult role models. Strategies to engage more young people in service as cross-age peer mentors are discussed.     

Living with disabilities in Austria--with a special focus on the capital

Life expectancy, especially in the older age groups, is growing enormously due to better social and medical care. According to published data on disabled people (1997), about 30 % of the total population (7,119,000) in Austria suffer from at least one physical disability. In this study, data from a micro census as well as a report from the Federal Ministry for Social Security and Generations is analyzed to illuminate the situation of impaired people with a focus on the capital Vienna. Among other results, it is anticipated that a large number of disabled people receive no help at all. About every 7th person regularly receives care, every 10th receives daily support. Care intensity increases with age showing a clear progression from the age of 60 onwards. 88% of the main supporting individuals are related to the handicapped person being supported. Women generally exhibit a much higher participation in nursing. The socio-political developments are discussed.     

Ethnic identity on display: West Indian youth and the creation of ethnic boundaries in high school

The black immigrant population in New York City has grown exponentially since 1990, such that West Indians now compose the majority of the black population in several neighbourhoods. This article examines how this ethnic density manifests among youth in high school, and how it has influenced ethnic identity formation among second-generation West Indians. My findings are based on twenty-four interviews and eight months of participant observation in two Brooklyn high schools from 2003 to 2004. The results show that in both schools, Caribbean island identities have become a ‘cool’ commodity within peer groups. Further, although it was important to express pride in one's island identity, these young people often blurred their national origin boundaries by drawing on Jamaican popular culture as way of projecting a unified ‘West Indian identity’. The research also uncovers evidence of a de-stigmatization of Haitianness as a way to incorporate them as cultural insiders into the larger Caribbean collective.     

Biographies for Artistic and Social Intervention: A Youth-Driven Project

This article discusses how biographical materials may be used in youth arts education projects to develop new methodologies and approaches that can stimulate artistic and social intervention in contemporary urban communities, thus changing the field of arts education policy at the community level. Through their creation of Artistic Society Projects, a group of young people from the arts education project Bando à Parte: Youth Cultures, Arts and Social Inclusion (O Teatrão, Coimbra, Portugal) have created a voice that may be used to transform their own communities. The starting points for this transformation are the young peoples’ biographical paths. The influence of youth on education policy may be strategically understood in the context of formal and nonformal school curricula. How can youth use their biographies to develop specific contributions both to change in individual behaviors and to social change in urban communities, influencing arts education policies to instigate action? The exploration of these processes through the work of artistic creation, inspired by collected biographical materials, represents a contribution to ongoing reflection on the issues of memory, identity, youth resistance, and community change in urban settings, influencing the ways in which arts education policy is understood and implemented.     

Aboriginal youth,hip hop and the politics of identification

This paper explores the identity work taking place around contemporary subcultural hip hop amongst Australian indigenous youth in two disadvantaged urban locations. Previous work on Aboriginal hip hop has been attentive to the interface between tradition and modernity. However, existing scholarship has lacked a deeper ethnographic understanding of the dynamics between youth and parent cultures, and the tensions between the two generations. This article is based on research with young hip hop enthusiasts, community activists and educators. It deals with the cultural politics of identification and sees hip hop practice as associated with a process in which Aboriginality is crystallized as a principal affiliation and as offering an account for experiences of social marginalization. Far from being an outlet for expressing a prior or essential Aboriginality, hip hop as cultural practice is associated with the production of particular identifications.     

Forecasting youth adjustment at age 15 from school readiness profiles at 54 months

ABSTRACT

A person-oriented approach examined the extent to which patterns of school readiness across social and cognitive domains in 944 typically-developing 54-month-old children forecast academic achievement, social-emotional development, risk taking, and executive functioning at age 15. Prior work identified six distinct profiles of school readiness at 54 months that predicted group differences in achievement in first grade, as well as achievement and social-emotional outcomes in fifth grade. After controlling for demographics, early language skills, and home and school factors, the 54-month readiness profiles demonstrated different performance on risk-taking and executive function behaviors assessed at age 15. Children with attention problems at 54 months were most likely to believe that peers were engaging in risky behaviors and to have smoked more than 2 cigarettes by age 15. Children with low working memory and low to average social skills at 54 months were outperformed by their peers on working memory and executive function tasks at age 15. Results are discussed in terms of continuity in forms of developmental function.     

High School Gay-Straight Alliances (GSAs) and Young Adult Well-Being: An Examination of GSA Presence, Participation, and Perceived Effectiveness

Gay-Straight Alliances (GSAs) are student-led, school-based clubs that aim to provide a safe environment in the school context for lesbian, gay, bisexual, and transgender (LGBT) students, as well as their straight allies. The present study examines the potential for GSAs to support positive youth development and to reduce associations among LGBT-specific school victimization and negative young adult well-being. The sample includes 245 LGBT young adults, ages 21-25, who retrospectively reported on the presence of a GSA in their high school, their participation in their school's GSA, and their perceptions of whether or not their GSA was effective in improving school safety. Findings revealed that the presence of a GSA, participation in a GSA, and perceived GSA effectiveness in promoting school safety were differentially associated with young adult well-being and in some cases, buffered the negative association between LGBT-specific school victimization and well-being. Implications for future research and schools are discussed.     

High School Gay–Straight Alliances (GSAs) and Young Adult Well-Being: An Examination of GSA Presence,Participation, and Perceived Effectiveness

Gay–Straight Alliances (GSAs) are student-led, school-based clubs that aim to provide a safe environment in the school context for lesbian, gay, bisexual, and transgender (LGBT) students, as well as their straight allies. The present study examines the potential for GSAs to support positive youth development and to reduce associations among LGBT-specific school victimization and negative young adult well-being. The sample includes 245 LGBT young adults, ages 21–25, who retrospectively reported on the presence of a GSA in their high school, their participation in their school's GSA, and their perceptions of whether or not their GSA was effective in improving school safety. Findings revealed that the presence of a GSA, participation in a GSA, and perceived GSA effectiveness in promoting school safety were differentially associated with young adult well-being and, in some cases, buffered the negative association between LGBT-specific school victimization and well-being. Implications for future research and schools are discussed.     

Psychoeducational groups for youth attention-deficit hyperactivity disorder: a family medicine pilot project

Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioural disorder of youth and is estimated to affect ～4% of school-age children. Although medication is the most common and efficacious treatment for ADHD, some experts believe that multimodal treatment strategies help children improve symptoms more than medicine alone. Psychoeducational strategies focus on educating youth and families about a given disorder. This study compared youth who participated with their parents in a five-session, one-hour psychoeducational group at a family medicine clinic and those who received customary treatment and were on a waiting list for the intervention. Findings of youth behaviour from parent and teacher perspectives were compared at the outset of the group and one month after group completion using the Vanderbilt scales. Results revealed that youth in both conditions improved over the two months of the study from the parent perspective in terms of all ADHD symptoms (e.g. inattention, hyperactivity/impulsivity) and in terms of school functioning. However, no gains were made in youth functioning or ADHD behaviour from the teacher perspective. Youth in the treatment group made modest gains in school performance from the parent perspective when compared with youth in the control condition. The results suggest that parents of ADHD youth should be involved in the treatment process to maximise the likelihood of improvement. Psychoeducational groups can be of modest benefit to help educate parents and youth regarding the challenges of ADHD management.     

We rely on the common sense of young people

The principles of the primary prophylaxis, analogous to the program "Harm Reduction", are presented. The basis for placing this work on broad footing was the rapid assessment of the situation with the use of narcotic drugs in the city (the number of users exceeded 10,000 per 238,000 inhabitants) with a tendency towards a sharp decrease of the age of the users (9-13 years). The experience of work on the training of medical personnel, directly contacting with blood and thus considered to be a risk group, taking into account risky professional behavior (potentially dangerous), was accumulated. The training activities among students of medical schools proved to be effective. They became the best volunteers and leaders among young people. Adolescents aged 14-18 years were enlisted as volunteers: they worked in different places usually attended by young people and invited drug addicts to the anonymous examination room. The role of local mass media in educating the public on of the problems of the prevention of HIV infection is discussed. As a result, the activation of the youth movement in support of the program "Anti-AIDS" and an increase in the number of people in target groups coming to the anonymous examination room are noted.     

Possessed and dispossessed youth: Spirit possession of school children in Northwest Madagascar

Spirit possession is a common experience shared by many women in northwest Madagascar. In the town of Ambanja, possession by volatile and dangerous Njarinintsy spirits is an affliction which strikes young, adolescent schoolgirls. When Njarinintsy is contrasted with tromba, another well-known class of spirits found in this region, it becomes clear that Njarinintsy possession is a relatively recent phenomenon, and its victims form a discrete and unusual group. These girls are, in essence, young migrants, who have moved alone to town in order to attend school. Close examination of their experiences reveals that these young girls must cope, on their own, with the conflicts and contradictions that plague the shift from rural to town life, and from youth to adulthood. Such problems are further complicated by those associated with educational policy in Madagascar. These children, more than any other members of this community, suffer from the contradictions of a fragmented world. Possession provides them with a means through which to express the chaos inherent in their daily lives.     

The role of school medicine doctors in health education in Croatia--past, present and future

Croatia never had a separate vocation (occupation) of a health educator. Health education is one of the main tasks in the long tradition of preventive work of doctors-school medicine specialists. Additionally, in the school curriculum in the Republic of Croatia the health-educational contents are integrated into various subjects, and are conducted by teachers. However, there are requests to introduce a new subject into schools called Health Education. We asked physicians of school medicine their opinion on the introduction of this new subject. 30% of the physicians were dissatisfied with the current condition, 10% were satisfied, while there were no very satisfied school medicine doctors. They believe that health education goals are oriented solely to passing on knowledge (facts), while efforts are not done to change habits and attitudes of young people. They recognize themselves as persons mostly involved in health education in schools. Half of the school medicine doctors believe that the school curriculum should contain both a separate subject as well as integration of health education into other subjects. Before introducing any changes into healthcare or education system, it is necessary to examine the attitudes of students and parents, to direct the changes towards the promotion of the cooperation between the healthcare system, education, civil society, school and community where investing into the health of young people is done through comprehensive and holistic programmes.     

The effect of minority status and social context on the development of depression and anxiety: a longitudinal study of Puerto Rican descent youth

Few longitudinal studies have explored to date whether minority status in disadvantaged neighborhoods conveys risk for negative mental health outcomes, and the mechanisms possibly leading to such risk. We investigated how minority status influences four developmental mental health outcomes in an ethnically homogeneous sample of Puerto Rican youth. We tested models of risk for major depressive disorder (MDD) and generalized anxiety disorder (GAD), depressive and anxiety symptoms (DAS), and psychological distress, as Puerto Rican youth (aged 5‐13 years) transitioned to early adulthood (15‐29 years) in two sites, one where they grew up as a majority (the island of Puerto Rico), and another where they were part of a minority group (South Bronx, New York). At baseline, a stratified sample of 2,491 Puerto Rican youth participated from the two sites. After baseline assessment (Wave 1), each youth participant and one caregiver were assessed annually for two years, for a total of three time points (Waves 1‐3). From April 2013 to August 2017, participants were contacted for a Wave 4 interview, and a total of 2,004 young people aged 15 to 29 years participated in the assessment (response rate adjusted for eligibility = 82.8%). Using a quasi‐experimental design, we assessed impacts of minority status on MDD, GAD, DAS and psychological distress. Via mediation analyses, we explored potential mechanisms underlying the observed relationships. Data from 1,863 Puerto Rican youth (after exclusion of those with MDD or GAD during Waves 1‐3) indicated links between minority status and higher rates of lifetime and past‐year GAD, DAS and past 30‐day psychological distress at Wave 4, and a marginal trend for MDD, even after adjustments. Childhood social support and peer relationships partially explained the differences, as did intercultural conflict, neighborhood discrimination, and unfair treatment in young adulthood. The experience of growing up as a minority, as defined by context, seemingly elevates psychiatric risks, with differences in social relationships and increased social stress as mediators of this relationship. Our findings suggest that interventions at the neighborhood context rather than at the individual level might be important levers to reduce risks for the development of mood disorders in minority youth.     

Infraspecific genetic variation in Biscutella laevigata (Brassicaceae): new focus on Irene Manton's hypothesis

 Genetic variation in 42 populations throughout the range of Biscutella laevigata L. (Brassicaceae), a morphologically variable central European species, has been investigated by enzyme electrophoresis with three loci (Amy1, Amy2, and Gpi2). Genetic identities and the Fitch-Margoliash tree suggest differentiation into four regional groups: 1) a northwestern diploid group (northern France and northern Germany), 2) a northeastern diploid group (southern Germany, Upper Austria, northern Lower Austria, Poland, and Romania), 3) a central diploid group in southern Lower Austria corresponding to subspecies austriaca, and 4) a southern tetraploid group in Alpine areas of France, Germany, Switzerland, Austria, Italy, and Slovenia corresponding to subspecies laevigata. Geographically isolated diploid relic populations that are genetically depauperate are found in the NW and NE diploid groups. On the other hand, the diploid relic subspecies austriaca from the NE Prealps and Alps is highly variable. Subspecies laevigata appears to be a genetical autotetraploid with multiple origins involving several diploid progenitors (the NW diploids, subspecies austriaca and B. prealpina). Received April 6, 2001; accepted March 6, 2002 Published online: October 14, 2002 Addresses of the authors: Karin Tremetsberger (e-mail: k.tremetsberger@gmx.net), Christiane K?nig, Rosabelle Samuel, Tod F. Stuessy, Department of Higher Plant Systematics and Evolution, Institute of Botany, University of Vienna, Rennweg 14, A-1030 Vienna, Austria. Wilhelm Pinsker, Institute of Medical Biology, University of Vienna, Waehringerstra?e 10, A-1090 Vienna, Austria.