The objectives are to discuss the role of research in child global mental health and the need to expand research capacity in low- and middle-income countries (LMICs), and to describe research-training and capacity-building efforts in child global mental health in LMICs supported by the NIMH.

Abstract Background While resilience has generated a lot of interest in mental health, operationalizing the construct of resilience remains an important challenge. This study aims to evaluate the concordance of two resilience scales that evaluate intrapersonal aspects of resilience in adolescents. Methods Cross-sectional evaluation of internal consistency, concordance, and correlation of the Individual Protective Factors Index Questionnaire (IPFI) and the Adolescent Resilience Scale (ARS) in sixth grade students of three low-income public schools in Colombia. Results 325 adolescents (41.5% female) participated in the study (72.5% response rate). Mean age was 12.1 years (standard deviation [SD]: 1.04). Of a possible score from 1–4, the mean adjusted IPFI score was 3.3 (SD: 0.3; Cronbach’s alpha: 0.87). Of a possible score from 21–105, the total ARS score was 76.4 (SD 13.0; Cronbach’s alpha: 0.82); both distributions were non-normal and left-skewed. The Lin’s concordance correlation coefficient was 0.34 and the Spearman correlation coefficient was 0.52 (p-value < 0.0001 for both). Notably, 10 adolescents (3.1% of the sample) had a score in the lowest quartile in one of the two instruments, and a score in the highest quartile in the other instrument. Conclusions There was low concordance between the scales, with notable lack of overlap in who was identified as having “low” levels of resilience. To better elucidate and operationalize the construct of resilience, studies using resilience scales should consider greater focus in understanding what aspects of the construct are being measured and how they relate to meaningful variables (well-being, risk of illness, etc.).

The current pandemic has disproportionately affected the mental health of already-vulnerable young people: youth of color, immigrant, LGBTQ+, and refugee populations, and others who traditionally experience healthcare inequities. Financial hardships, systemic discrimination, cultural stigma, and lack of skilled practitioners are among the numerous global barriers to youth mental health and culturally competent care. Importantly, vulnerable populations have particularly limited access to mental health care, yet most continue to attend some form of school in person or virtually.

ObjectivesParticipants will become familiar with the Mental and Behavioral Health Services Team in the Unaccompanied Minors Program in the Office of Refugee and Resettlement (ORR). Participants will be able to identify the challenges in delivering mental health care to a large, transient, population of children exposed to significant trauma, who arrive in the United States without a parent or legal guardian. Participants will learn ways to become involved in the care of migrant children.MethodsThis presentation will describe the mission of the Mental and Behavioral Health Services Team in the Division of Health for Unaccompanied Children (UC) in the ORR. The presenters will share information about the perils of the journey to the United States, the care of migrant children after referral from border control until re-unification with sponsors, and the logistical hurdles in identifying sponsors and establishing ongoing care after reunification or long-term foster care placement. We will discuss the challenges of delivering preventative and clinical mental health services during COVID-19, during large influxes of children, and in unique populations such as during the Afghanistan evacuation. Finally, we will discuss ways in which we are continuously improving our program with partners in academic and governmental agencies.ResultsBetween January 2021 and February 2022, over 150,000 UCs were referred to ORR care. While awaiting reunification with an identified sponsor, the majority of the children are cared for in over 200 state-licensed shelters scattered throughout the continental United States. The medical teams are charged with providing for their physical and mental health. The mental health team guides the care of these children through various methods, including the monitoring of documentation and consultation with care programs, ORR colleagues, and community mental health providers.ConclusionsChildren who arrive in the United States without parents/guardians present with unique mental health needs. Cultural sensitivity and trauma-informed approaches to care are essential in meeting these needs. ORR continues to evolve to meet these challenges and invites child and adolescent psychiatrists in the community to engage with this population.IMM, SP, TRA ObjectivesParticipants will become familiar with the Mental and Behavioral Health Services Team in the Unaccompanied Minors Program in the Office of Refugee and Resettlement (ORR). Participants will be able to identify the challenges in delivering mental health care to a large, transient, population of children exposed to significant trauma, who arrive in the United States without a parent or legal guardian. Participants will learn ways to become involved in the care of migrant children. Participants will become familiar with the Mental and Behavioral Health Services Team in the Unaccompanied Minors Program in the Office of Refugee and Resettlement (ORR). Participants will be able to identify the challenges in delivering mental health care to a large, transient, population of children exposed to significant trauma, who arrive in the United States without a parent or legal guardian. Participants will learn ways to become involved in the care of migrant children. MethodsThis presentation will describe the mission of the Mental and Behavioral Health Services Team in the Division of Health for Unaccompanied Children (UC) in the ORR. The presenters will share information about the perils of the journey to the United States, the care of migrant children after referral from border control until re-unification with sponsors, and the logistical hurdles in identifying sponsors and establishing ongoing care after reunification or long-term foster care placement. We will discuss the challenges of delivering preventative and clinical mental health services during COVID-19, during large influxes of children, and in unique populations such as during the Afghanistan evacuation. Finally, we will discuss ways in which we are continuously improving our program with partners in academic and governmental agencies. This presentation will describe the mission of the Mental and Behavioral Health Services Team in the Division of Health for Unaccompanied Children (UC) in the ORR. The presenters will share information about the perils of the journey to the United States, the care of migrant children after referral from border control until re-unification with sponsors, and the logistical hurdles in identifying sponsors and establishing ongoing care after reunification or long-term foster care placement. We will discuss the challenges of delivering preventative and clinical mental health services during COVID-19, during large influxes of children, and in unique populations such as during the Afghanistan evacuation. Finally, we will discuss ways in which we are continuously improving our program with partners in academic and governmental agencies. ResultsBetween January 2021 and February 2022, over 150,000 UCs were referred to ORR care. While awaiting reunification with an identified sponsor, the majority of the children are cared for in over 200 state-licensed shelters scattered throughout the continental United States. The medical teams are charged with providing for their physical and mental health. The mental health team guides the care of these children through various methods, including the monitoring of documentation and consultation with care programs, ORR colleagues, and community mental health providers. Between January 2021 and February 2022, over 150,000 UCs were referred to ORR care. While awaiting reunification with an identified sponsor, the majority of the children are cared for in over 200 state-licensed shelters scattered throughout the continental United States. The medical teams are charged with providing for their physical and mental health. The mental health team guides the care of these children through various methods, including the monitoring of documentation and consultation with care programs, ORR colleagues, and community mental health providers. ConclusionsChildren who arrive in the United States without parents/guardians present with unique mental health needs. Cultural sensitivity and trauma-informed approaches to care are essential in meeting these needs. ORR continues to evolve to meet these challenges and invites child and adolescent psychiatrists in the community to engage with this population.IMM, SP, TRA Children who arrive in the United States without parents/guardians present with unique mental health needs. Cultural sensitivity and trauma-informed approaches to care are essential in meeting these needs. ORR continues to evolve to meet these challenges and invites child and adolescent psychiatrists in the community to engage with this population.

Reciprocal learning in the field of global mental health is a multidirectional exchange of research advancements requiring sharing of ideas and collaboration. The objective of this Symposium is to present examples of reciprocal learning that illustrate how novel interventions for improving child and maternal mental health service delivery in low-resource settings were translated into other settings around the world. Siham Sikander, PhD, will present the "Thinking Healthy Program" (THP), an evidence-based intervention to reduce perinatal depression and improve health outcomes for mothers and children delivered by nonspecialists in low-resource settings. Keng-Yen Huang, PhD, will present the ParentCorps professional learning program (PCPLP), a school-based early childhood intervention to train teachers and families in evidence-based strategies to promote children's social-emotional and behavioral regulation skills. John Naslund, PhD, will present pilot data from the "Enabling translation of Science to Service to ENhance Depression CarE (ESSENCE)" study, which uses digital technology to train community health workers to deliver a brief evidence-based psychological treatment for depression in primary care. Brandon Kohrt, MD, PhD, will present on the "UNICEF-WHO Ensuring Quality in Psychological Support (EQUIP)" initiative to evaluate competencies of nonspecialists delivering mental health services, including competencies for the care of children and adolescents. Finally, Andrea Horvath Marques, MD, will review lessons learned and discuss how this knowledge can further inform child and adolescent mental health research and the field as a whole. Three of the 4 interventions discussed were developed in a low- or middle-income country (LMIC), including Pakistan and India, and at least 2 have been translated to high-income countries like the United States. Similarly, 2 interventions have been endorsed by the World Health Organization for their use in low-resource settings globally, and the other 2 are in the process of being scaled-up further. Reciprocal learning in global mental health expands the benefit of research innovations to diverse contexts, communities, and populations, equitably improving mental health and shaping future research.

NIH has acknowledged and committed to ending structural racism. The framework for NIH's approach, summarized here, includes understanding barriers; developing robust health disparities/equity research; improving its internal culture; being transparent and accountable; and changing the extramural ecosystem so that diversity, equity, and inclusion are reflected in funded research and the biomedical workforce.

Objective Digital monitoring technologies (e.g., smartphones and wearable devices) provide unprecedented opportunities to study potentially harmful behaviors such as suicide, violence, and alcohol/substance use in real‐time. The use of these new technologies has the potential to significantly advance the understanding, prediction, and prevention of these behaviors. However, such technologies also introduce myriad ethical and safety concerns, such as deciding when and how to intervene if a participant's responses indicate elevated risk during the study? Methods We used a modified Delphi process to develop a consensus among a diverse panel of experts on the ethical and safety practices for conducting digital monitoring studies with those at risk for suicide and related behaviors. Twenty‐four experts including scientists, clinicians, ethicists, legal experts, and those with lived experience provided input into an iterative, multi‐stage survey, and discussion process. Results Consensus was reached on multiple aspects of such studies, including: inclusion criteria, informed consent elements, technical and safety procedures, data review practices during the study, responding to various levels of participant risk in real‐time, and data and safety monitoring. Conclusions This consensus statement provides guidance for researchers, funding agencies, and institutional review boards regarding expert views on current best practices for conducting digital monitoring studies with those at risk for suicide—with relevance to the study of a range of other potentially harmful behaviors (e.g., alcohol/substance use and violence). This statement also highlights areas in which more data are needed before consensus can be reached regarding best ethical and safety practices for digital monitoring studies.

Untreated childhood mental illness has significant social and health effects and represents a major contributor to the global burden of disease. Schools are vital settings for the delivery of mental health (MH) programs integrating a regularly attended location, a nurturing environment, and uniquely attuned staff, who are often the first to identify signs of illness in children. Learning about various global school-based mental health interventions (SMHI) and understanding implementation barriers and facilitators will strengthen the ability of providers, researchers, and policymakers to identify, adapt, scale up, or develop effective interventions. This presentation aims to describe clinical and research experiences in developing SMHI in resource-limited settings (RLS) around the globe. It will explore interventions in various stages of development, attempting to elucidate questions of effectiveness, as well as barriers and facilitators of success.

Background: Emerging researchers in low- and middle-income countries (LMIC) face many barriers, including inadequacies in funding, international exposure and mentorship. In 2012, the National Institute of Mental Health (NIMH) funded five research hubs aimed at improving the research core for evidence-based mental health interventions, enhancing research skills in global mental health, and providing capacity building (CB) opportunities for early career investigators in LMIC. In this paper emerging researchers contextualize their experiences. Case presentation: Each of the five hubs purposively selected an emerging researcher who had experienced more than one hub-related CB opportunity and actively participated in hub-related clinical trial activities. The five 'voices' were invited to contribute narratives on their professional backgrounds, CB experience, challenges and successes as an emerging mental health researcher, and suggestions for future CB activities. These narratives are presented as case studies. CB activities provided broader learning opportunities for emerging researchers. Benefits included the receipt of research funding, hands-on training and mentorship, as well as exposure to networks and collaborative opportunities on a global scale. To overcome ongoing challenges of access to funding, mentoring, networking and global exposure, the emerging voices recommend making mentorship and training opportunities available to a wider range of emerging mental health researchers. Conclusions: Investing in CB is not enough to ensure sustainability and leave a legacy unless it is accompanied by ongoing mentorship and international exposure. Financial investment in building research capacity, promotion of mentorship and supervision, and international networking are essential to yield well-prepared young investigators in LMIC as experienced by these rising stars. Governments and policymakers should prioritize educational policies to support the continuous development and international engagement of emerging researchers. This can advance strategies to deal with one of most important and costly problems faced by healthcare systems in LMIC: the mental health treatment gap.

The objective of this presentation is to evaluate the efficacy of a school-based intervention to enhance resilience in at-risk youth living in urban low-income neighborhoods with significant community violence.

Objective: This study examines the acceptability and preliminary efficacy of Positive Adaptations for Trauma and Healing (PATH), a manualized treatment for Latino youth and their caregivers. PATH is a culturally adapted program that incorporates a trauma model, positive psychology, and resilience. Method: Latino youth (N = 16) recruited from an urban community clinic participated in PATH with their caregiver. Pre- and postintervention measures on trauma symptoms, resilience, depression, caregiver’s view of their youth’s well-being, and positive and negative emotions were gathered. Following the intake meetings (1 to 3), the families participated in 10 90-minute weekly group sessions (total of 3 groups). Caregiver groups were conducted in Spanish, and youth in English. Results: At pretest, 56% of the youth endorsed clinically significant symptoms on the UCLA PTSD Index (M = 34.2, SD = 11.2); the percentage dropped to 0% at posttest (M = 17.3, SD = 7.6). Youth reported pre- to posttest reductions on the Child Depression Inventory (mean difference [Mdiff] = 7.3; p = .004) and externalizing (Mdiff = 6.1; p < .001) and internalizing (Mdiff = 9.4; p < .001) behaviors on the caregiver-reported Child Behavior Checklist. Overall, there was high treatment engagement (93% attendance over 10 weeks). Conclusion: This novel treatment engaged a community-based Latino sample. The results suggest high acceptability and significant reduction in trauma symptoms and associated symptoms. This study included a small number of participants and results should be interpreted with caution. Future iterations will target larger number of participants to further assess feasibility.

The goal of this presentation is to compare the performance of two resilience evaluation measures in a Colombian high-risk adolescent school sample group and their association with mental disorder-screening scores.

Introduction: Despite an increasing number of studies, there is debate whether antidepressants have a favorable benefit/risk balance in depressed youth.Areas covered: A systematic search identified 23 systematic reviews and meta-analyses published between 2010-2016. More than 30 controlled clinical trials were conducted in adolescents, but only a few in pre-pubertal patients. About one-third of the trials were severely statistically underpowered. Most studies failed to detect differences from placebo, but a few found fluoxetine effective. Although no suicide occurred in these studies, antidepressants increased suicidality risk (including suicidal ideation and behavior) versus placebo (OR=2.39). Only two placebo-controlled trials with acceptable statistical power were publicly funded: both showed efficacy of fluoxetine, and one found a higher incidence of suicidality (OR=3.7, 95% C.I. 1.00-13.7).Expert opinion: In youth, antidepressants have, on average, a small therapeutic effect. The high placebo response is exacerbated by the large number of sites in many industry-funded studies. There is evidence that fluoxetine leads to greater and faster improvement than placebo or psychotherapy in adolescents. Considering both the high response to non-specific interventions and safety concerns, antidepressants should be used cautiously in youth, and limited to patients with moderate-to-severe depression for whom psychosocial interventions are either ineffective or not feasible.

This presentation aims to discuss clinical experiences and evidence of efficacy of school-based resilience-building interventions in youth who are exposed to wars, community violence, and other traumatic experiences in resource-poor settings.

Schizophrenia is increasingly recognized as a neurodevelopmental disorder with altered connectivity among brain networks. In the current study we examined large-scale network interactions in childhood-onset schizophrenia, a severe form of the disease with salient genetic and neurobiological abnormalities. Using a data-driven analysis of resting-state functional magnetic resonance imaging fluctuations, we characterized data from 19 patients with schizophrenia and 26 typically developing controls, group matched for age, sex, handedness, and magnitude of head motion during scanning. This approach identified 26 regions with decreased functional correlations in schizophrenia compared to controls. These regions were found to organize into two function-related networks, the first with regions associated with social and higher-level cognitive processing, and the second with regions involved in somatosensory and motor processing. Analyses of across- and within-network regional interactions revealed pronounced across-network decreases in functional connectivity in the schizophrenia group, as well as a set of across-network relationships with overall negative coupling indicating competitive or opponent network dynamics. Critically, across-network decreases in functional connectivity in schizophrenia predicted the severity of positive symptoms in the disorder, such as hallucinations and delusions. By contrast, decreases in functional connectivity within the social-cognitive network of regions predicted the severity of negative symptoms, such as impoverished speech and flattened affect. These results point toward the role that abnormal integration of sensorimotor and social-cognitive processing may play in the pathophysiology and symptomatology of schizophrenia.

The goal of this session is to understand the association between resilience and mental illness and identify a school-based intervention to enhance resilience in at risk youth living in urban low-income neighborhoods, with significant community violence. Colombia’s armed conflict has led to widespread violence and forced displacement of people to marginalized neighborhoods surrounding major cities in which children are victims of both the armed conflict and community violence, with no access to mental health services. Building resilience in childhood may reduce psychopathology, particularly in at risk populations and in resource-poor environments such as the ones observed in this study.