Online parenting interventions can reduce barriers to receiving support for parenting during early childhood. As parents with mental health challenges are at greater risk of experiencing such barriers, increasing access to novel supports for child behavior and parenting is critically important for promoting health equity for parents and their young children. The present study tested the effects of an online parenting intervention, the Family Check-Up Online (FCU-O), on parenting skills, self-efficacy, and parent stress at a 12-month follow-up and whether improvements to parenting self-efficacy (PSE) explained intervention effects on parenting skills. The FCU-O is a mobile web-based parenting support app that includes telehealth coaching support. Participants were 356 parents of toddler to preschool-age children who endorsed either depressive symptoms or current or past substance misuse at baseline. Parents who were predominantly White and non-Hispanic (72%) and female (93%) were randomized to the FCU-O or a waitlist control. The FCU-O was associated with significant improvements to PSE and parenting skills, including positive behavior support, limit setting, and proactive parenting. Additionally, improvements to PSE partially mediated direct effects of the FCU-O on positive behavior support, limit setting, proactive parenting, and parent stress. Our findings have implications for the utility of online parenting interventions for underserved families and support the importance of promoting PSE to maximize intervention benefits. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The Foreword by Dr. Jobes highlights the centrality of the K-12 school setting for playing a key role in youth suicide prevention. Leveraging nearly three decades of research and practice on school-based suicide prevention, this special issue of School Mental Health by editors Drs. Kurt Michael and Amy Brausch is focused on advancing the field by compiling research on universal, secondary, and tertiary supports within the school context to ameliorate the consistently high rates of suicidal thoughts, behaviors, and completions experienced by youths since the turn of the century. Both Drs. Brausch and Michael drew upon their extensive history with school-based partnerships for preventing youth suicide as the impetus for this special issue on contemporary research and the state of the field. Preeminent school-based suicide prevention scholars answered their call to action by broadly covering the suicide prevention continuum, including identification and assistance of at-risk youth, universal prevention strategies, targeted prevention approaches, multi-tiered programming, post-hospitalization school reintegration, and postvention. The research conducted spans various methodological approaches, including systematic reviews, formative and qualitative research, descriptive and correlational research, and experimental studies. Our review and synthesis of the articles herein highlight six emergent themes in school-based suicide prevention: (1) implementing school-wide initiatives, (2) promoting connectedness and belonging for all youth, (3) screening and identifying at-risk youth in need of assistance, (4) strengthening the community stakeholder ecosystem, (5) preparing and responding to suicide in schools, and (6) leveraging implementation science to enhance knowledge translation from research to practice. After briefly summarizing each of these themes, we conclude with a discussion of the key gaps that remain in school-based suicide prevention and directions for future research and practice.

BackgroundSuicidal ideation is increasing among university students. Despite growing demand for services, university counseling centers (UCCs) face limited resources to meet the complex needs of students who are suicidal. ObjectiveThe Comprehensive Adaptive Multisite Prevention of University Student Suicide (CAMPUS) Trial evaluates 4 treatment sequences within UCCs to develop evidence-based treatment guidelines. MethodsThe CAMPUS Trial consists of a feasibility study followed by a sequential multiple-assignment randomized trial (SMART). The original CAMPUS protocol was modified during the COVID-19 pandemic to accommodate new UCC tele–mental health services, including remote treatment, assessments, and monitoring. A smaller-scale feasibility study was conducted to (1) evaluate implementation of hybrid telehealth and in-person interventions and (2) fine-tune online procedures. Following the feasibility study, university students (aged 18-25 years) seeking UCC services with moderate to severe suicidal ideation will enroll in the CAMPUS Trial. Student participants are randomly assigned to 1 of 4 treatment sequences with 2 stages of intervention. In stage 1, students receive 4 to 6 weeks of either (1) a suicide-focused treatment—Collaborative Assessment and Management of Suicidality—or (2) enhanced treatment as usual. Treatment responders enter the maintenance phase. In stage 2, nonresponders are rerandomized for an additional 1 to 8 weeks of (1) Collaborative Assessment and Management of Suicidality or (2) an intensive skills-based treatment—dialectical behavior therapy for UCC settings. UCC counselors will enroll in the CAMPUS Trial to complete measures about their experience working with students who are suicidal. CAMPUS Trial administration includes representation from all sites to facilitate cross-site coordination and an advisory board of stakeholders from all UCCs to facilitate treatment implementation. ResultsStudent participant recruitment began on October 25, 2022, and ended on May 16, 2024. As of November 2024, data collection for the SMART was ongoing with active study participants. Data collection was completed in November 2024, and as of April 2025, data analysis is underway. Full results will be available in 2025. ConclusionsThe CAMPUS Trial offers a model for future SMARTs for the treatment of suicidal thoughts or behaviors (or both) across various settings. The results will inform treatment guidelines for students presenting with suicidality at UCCs. Trial RegistrationClinicalTrials.gov NCT04707066; http://clinicaltrials.gov/ct2/show/NCT04707066 International Registered Report Identifier (IRRID)DERR1-10.2196/68441

School mental health (SMH) services have rapidly reached countless of school-age students in recent years. The increase in services have positively impacted student mental health and academic outcomes. However, there is still a demand for comprehensive services to support all students in need. Students with disabilities are often excluded from the school mental health discussion yet experience mental health concerns at higher rates than students in general education. In many cases, schools are unprepared and uncertain how to best support students with disabilities. We take a historical perspective of school mental health and provide specific considerations for schools and special educators to include, adapt, or modify services specifically students with a range of disabilities. We communicate best practices within the field of special education and how to apply those practices within SMH.

This study is a longitudinal subgroup analysis of two intervention groups (N = 188 teacher-student dyads in K-3rd grade) from a larger randomized controlled trial of First Step Next, an SEL program delivered over 30 consecutive school days. We tested how teachers' education and years of experience impacted program dosage and students' social skills and how teachers' program satisfaction, working alliance, and dosage influenced social skills. Teachers' education was associated with more dosage but not with social skills. Years of experience did not influence dosage or social skills. More dosage was linked with improved social skills. The effect of program satisfaction on social skills significantly differed between levels of working alliance. Our results contribute to understanding the interconnection between teachers' characteristics and implementation with program outcomes. Findings highlight the need to conduct process research to investigate program satisfaction and working relationship in relation to program effectiveness.Impact StatementThis study found that teachers' academic attainment, not years of experience, was associated with successfully delivering an SEL program for K-3rd grade students, First Step Next (FSN). The analyses also revealed that students who received FSN were more likely to improve their social skills when their teachers were highly satisfied with FSN and had very strong working relationships with FSN coaches. The findings extend the evidence for teachers effectively delivering SEL programs and underscore the importance of investing in program satisfaction and working alliance to optimize the effectiveness of FSN on children's social skills improvement.

Adolescent substance misuse is a persistent concern in the USA and student substance possession on campus presents as an increasing challenge for administrators. This study seeks to understand how students are differentially disciplined for substance possession based on substance type and student race/ethnicity in US schools. Based a national sample of 99,181 students (Grades 6 through 12) from 3285 schools across school years 2012–13 to 2018–19, we used descriptive analysis to explore how students possessing alcohol, tobacco, or drugs on campus on their first referral were disciplined. Using multi-level logistic modeling, we assessed to what extent use of exclusionary discipline (i.e., out-of-school suspension [OSS], in-school suspension [ISS]) varied by year, substance type, and student race/ethnicity (i.e., White/Caucasian, African American/Black, Hispanic/Latino/a/e). Descriptive results indicate that management of substance possession in schools relies heavily on exclusion over other actions. Results from multi-level models for OSS and ISS demonstrated shifts in use of each action over time, significantly different rates by substance type possessed, and a significant student race/ethnicity by substance interaction. Findings suggest that alternative approaches to exclusion for substance possession have not been widely implemented; however, the use of exclusion may be shifting from OSS to the use of ISS for these students. Suggestions for coherent, preventive programming for substance misuse and for planning alternative, supportive responses are reviewed.

IntroductionYoung people with intellectual disabilities (ID) are at an increased risk for experiencing mental health issues compared to their peers without disabilities. Further, there are limited resources available to help accurately assess mental health disorders and that are accessible for adolescents with ID.MethodThis paper describes the iterative development and pilot testing of the Diagnostic Interview for Adolescents and Adults with Intellectual Disabilities (DIAAID). The authors utilized Evidence Center Design and Universal Design principals to develop the DIAAID; a multi-informant diagnostic interview.ResultsThe DIAAID development resulted in the creation of 15 adolescents disorder interviews and 24 caregiver disorder interviews. Preliminary results suggest that the DIAAID is a feasible and accessible diagnostic interview for adolescents with ID and their caregivers.DiscussionLessons learned from DIAAID implementation and future areas research are discussed.

To understand the current state of research, a systematic review and meta-analysis were conducted to synthesize the effects of suicide prevention gatekeeper training (GKT) on participant behavioral intention to intervene and participant suicide intervention behaviors. Included studies examined GKT with adult participants and measured either behavioral intention to conduct a suicide intervention or the utilization of suicide intervention skills. Searches yielded a total of 43 studies from 46 reports, comprising 21,720 participants. To quantify change over time, the standardized mean gain effect size metric was utilized. Large effect sizes were found for behavioral intention from pre-training to post-training (1.03, 95% CI [0.80, 1.25]) and short-term follow-up (0.78, 95% CI [0.59, 0.97]). Smaller effect sizes were found for intervention behavior from pre-training to short-term (0.33, 95% CI [0.21, 0.46]) and long-term follow-up (0.22, 95% CI [0.14, 0.30]). Although this meta-analysis reveals a positive effect for GKT on behavioral outcomes, the low methodological quality of the currently available evidence limits the ability to draw conclusions from the synthesis. This work informs policymakers and interventionists on best practices for GKT and highlights that additional, rigorous research is needed.

Amid a proliferation of highly potent opioids, school systems have sought to invest in programs for preventing substance misuse. School teams often prioritize early screening and intervention to prevent student substance misuse; however, given the limited resources of many schools, it is crucial to understand the extent to which commonly available data and existing frameworks are relevant for prevention efforts. In this study, we examined (a) how commonly available data on substance misuse (office discipline referrals [ODRs]) relate to self-reported substance misuse and (b) how positive behavioral interventions and supports (PBIS) implementation across tiers relates to these substance-related outcomes. We found that self-reported substance misuse is significantly related to substance-related ODRs, but that self-report rates are much higher than ODR rates. We also found that Tier 2 PBIS implementation was associated with significantly lower rates of both self-reported substance misuse and substance-related ODRs. These findings suggest that aspects of PBIS implementation could be beneficial in preventing substance misuse, but more research is needed to understand what specific school-based practices best address these student behavioral health needs.

Major depression is characterized by an episodic course with symptom manifestations differing across episodes. Previous work has found that symptom presentation differs across age. However, studies of symptom presentation have largely focused on symptoms in individual episodes, requiring further investigation of longitudinal symptom change. This study explored the impact of the initial age of onset, the number of episodes, and age of onset of each episode on individual depressive symptoms, while accounting for episode severity. We used data from the Oregon Adolescent Depression Project (N = 629) examining participants with at least one major depressive episode, assessed by diagnostic interview, across a 15-year follow-up. Multilevel logistic regression models revealed that approximately 20-25% of the main effects were significant and some were qualified by cross-level interactions. However, only a few associations remained robust after correcting for multiple comparisons. Specifically, older initial age of onset was associated with fatigue, younger initial age of onset for the first episode was associated with suicidal ideation, and a lower episode number was associated with weight loss. These findings highlight potential initial age of onset and scar effects influencing symptom manifestation, but require replication.

The demand for preventive and easily implemented interventions to address the needs of children with significant behavioral challenges in general education settings is well-documented. First Step to Success is an evidenced-based program to address challenging behavior in preschool and elementary-school settings with a 20-year history of successful implementation (Walker et al., 1997; Walker et al., 2014b). A revision of the intervention, called First Step Next (Walker et al., 2015), was designed to (1) standardize the program components across preschool and elementary settings; (2) make the program more user friendly for implementers, including parents; and (3) increase the program’s efficacy by adding new components and updating existing ones. The current study used a mixed-method approach to compare process data collected from a previous efficacy trial of the original preschool version of First Step (Feil et al., 2014) to the revised version (First Step Next; Feil et al., 2020). Overall procedural fidelity ratings were high for both program variations. Further, alliance and satisfaction ratings, as per parent- and teacher-report, were acceptable, although there were some divergent findings between parent and teacher perspectives at the item level. This study provides support for the feasibility of successfully implementing First Step Next with young children and their families in preschool settings.

ObjectiveThe purpose of this study was to assess the implementation of suicide-focused treatments delivered via a hybrid telemental health (TMH) and in-person format.MethodThis study was conducted at four university counseling centers (UCCs) across the United States. Treatment-seeking clients were recruited from their local UCCs and participated in adaptive treatment strategies (ATSs) involving Treatment as Usual (TAU), Collaborative Assessment and Management of Suicidality (CAMS), and Dialectical Behavior Therapy (DBT). Implementation outcomes, including appropriateness, acceptability, feasibility, fidelity, safety, and client satisfaction, were assessed. UCC clinicians participated in qualitative interviews focused on implementation of TMH for clients presenting with suicidal ideation (SI).ResultsOverall, treatments delivered via hybrid format were reported to be appropriate, acceptable, feasible, and satisfactory by clinicians and clients. Implementation of TMH was reported to be equivalent to in-person treatment across multiple measurement methods.ConclusionResults from this study demonstrate that TMH is an implementable treatment modality for addressing suicidality, particularly for college students presenting to UCCs with SI. This study has implications for real-world clinical settings planning to offer hybrid treatment modalities to address SI.Trial registration: ClinicalTrials.gov identifier: NCT04728815.ConclusionResults from this study demonstrate that TMH is an implementable treatment modality for addressing suicidality, particularly for college students presenting to UCCs with SI. This study has implications for real-world clinical settings planning to offer hybrid treatment modalities to address SI.Trial registration: ClinicalTrials.gov identifier: NCT04728815.

The pathoplasty model posits that personality influences the manifestation of psychopathology but has rarely tested the influence on the symptomatic expression of depression. We tested pathoplastic effects of personality on depressive symptoms in five cross-sectional samples varying in age, specific measures of personality, and specific measures of depression. Tests of pathoplastic effects were conducted using moderated nonlinear factor analysis. Across samples, we found little evidence for pathoplastic effects of personality on depressive symptoms. We found minimal evidence that personality is associated with the structure of the depression construct (i.e., loadings to indicators). Lower levels of positive emotionality were associated with greater likelihood of endorsing sleep problems, beyond the influence of overall depression severity, but was inconsistent across sleep items. Although we found minimal influence of personality on depression symptom manifestation, longitudinal work can examine similar issues in younger and older samples and examine more dimensions of personality.

Early intervention efforts have been effective in reducing disruptive behaviors and the probability of poor developmental outcomes. Early interventions include common practice elements to improve social functioning and decrease problem behaviors that disrupt the teaching-learning process. The First Step Next intervention has been well validated across early childhood and early elementary settings. In the present article, we provide a best-evidence synthesis of five randomized controlled replication studies between 2009 and 2021. Collectively, these studies show the intervention has resulted in small to large effect sizes and statistically significant improvements, compared with students randomized to control conditions, on multiple indicators of prosocial and problem behavior. The current synthesis focuses on a range of outcomes across elementary and preschool populations, as well as implementation fidelity and social validity ratings, to help school professionals in determining whether First Step Next might be useful in their efforts to support students at risk of school failure.

The purpose of this study was to evaluate the degree to which personalized cognitive strategy instruction (PCSI) assisted students with prolonged concussion symptoms (PCS) to achieve functional and academic-related goals. It was hypothesized that goal attainment on collaboratively developed functional goals and selected scores on the pre/post outcome measurements would improve following the delivery of PCSI. A non-concurrent multiple baseline design was utilized across three female participants ages 13-16. The weekly status tracking measurement of participant performance served as the primary measurement analysed to determine the existence of a functional relation between the addition of PCSI to psychoeducation and the achievement of participant outcome. Although visual analysis of the plotted status tracking data did not support the existence of a functional relation, all three participants met or exceeded functional goals on their goal attainment scales. A Tau-U analysis supported a small treatment effect. The positive response to the intervention from two of the three participants in addition to goal attainment for all three participants suggests PCSI has potential to mitigate cognitive challenges in adolescents with PCS. Implications for future research and methods to promote ecological measurement of intervention effects are discussed.

Legalization of use and retail sales of recreational marijuana in U.S. states and the associated potential increase in access to marijuana and normalization of its use by adults could lead to increased use by adolescents. Studies have found that states with legal recreational marijuana have higher rates of adolescent use and frequency of use compared to states without legal use. We examined changes in student office discipline referrals (ODRs) for substance use offenses in Oregon middle and high schools before and after the legalization of recreational marijuana relative to comparison schools in other states. We found that rates of substance use related ODRs in middle schools increased by 0.14 per 100 students (30% of the mean) with legalization relative to comparison schools. This increase was moderated by the presence of a marijuana outlet within one mile of the school. We found no statistically discernible changes in high school ODRs. Marijuana use in adolescence has been linked to negative health and social consequences, including academic problems, mental health issues, and impaired driving. Potential adverse impact on adolescents and investments in school-based prevention programs could be important considerations for policymakers and public health officials when evaluating marijuana legalization.