Background: This narrative concept-generating review proposes a theoretical and heuristic framework for conceptualizing established and emerging interventions for posttraumatic stress disorder (PTSD) including three categories: top-down/conscious (e.g., cognitive processing therapy, CPT), bottom-up/non-conscious (e.g., pharmacotherapy) and hybrid/conscious and non-conscious integration (e.g., eye movement desensitization and reprocessing, EMDR). The categorization offers a preliminary novel classification of well established and emerging interventions, while highlighting gaps in current treatment approaches. Methods: Clinical guidelines and review articles from 2008 through 2026 were used to create the framework; PubMed and Google Scholar databases were searched for relevant meta-analyses, systematic reviews, narrative reviews, and randomized clinical trials. A total of 27 treatment modalities were included presenting effect size data from 43 published articles. Results: Treatments across categories present mixed results for efficacy. While guideline recommended treatments offer more robust evidence, many understudied emerging interventions exhibit preliminary efficacy. At the intersection of conscious and non-conscious approaches, hybrid modalities may present unique potential benefits. However, superiority determinations between modalities cannot be made and further empirical validation of categorization is needed. Conclusions: The proposed framework highlights the need for increased investigation of treatments that address PTSD as an interconnected whole-body disorder to potentially expand care options.

School psychologists have an ethical responsibility to deliver direct and indirect services that meet the needs of increasingly diverse U.S. youth while also working to address systemic inequities. As a core school psychology service, it is critical for consultation to evolve to explicitly integrate social justice values. Although scholars have articulated the potential for consultation as a tool for social justice, little is known about consultants' experiences related to social justice and consultation training and practice. The purpose of this study was to provide a current understanding of consultants' (N = 144) training, practices, beliefs, and confidence related to social justice-oriented consultation and related approaches. Findings indicated that participants received less training and felt less confident engaging in social justice-oriented consultation compared to related approaches. Thematic analysis findings highlighted key themes related to barriers and facilitators in employing social justice, systems-level and multicultural consultation in schools. Finally, results demonstrated relationships between consultants' training and their beliefs and confidence in using consultation as a tool for social justice. Implications for training, practice, and research are discussed.

Teachers play a vital role in promoting children's social-emotional and behavioral development through evidence-based practices (EBP). Research consistently demonstrates that school-based indirect service delivery (i.e. consultation or coaching) is a viable means for improving teachers' EBP implementation and concomitant student outcomes. That said, an important and often overlooked aspect of indirect service delivery is ensuring that teachers generalize EBPs learned through consultation and coaching. In particular, no meta-analysis has explored how school-based indirect service may be used to improve critical student outcomes via generalized teacher practices. Thus, the current study synthesized and summarized the extant literature examining the effects of indirect service promoting teacher EBPs on student generalization and target outcomes. Comprehensive search strategies (i.e. searching electronic databases, gray literature sources, and hand searching 15 relevant journals) yielded 1577 abstracts that were screened and reviewed for potential inclusion. In total, 11 single-case design studies that met inclusion criteria were meta-analyzed to evaluate the impacts of school-based consultation and coaching on student generalization and target outcomes. Findings revealed significant improvements for both student generalization (LRRi = 0.51) and target (LRRi = 0.71) outcomes. Additionally, the moderating impacts of student and classroom characteristics were explored across all child outcomes. Results also revealed that consultation and coaching significantly improved student social skills (LRRi = 0.47) and behavioral competence (LRRi = 0.70). Additionally, the impacts of consultation and coaching on student outcomes were particularly pronounced for students with disabilities and students receiving in Head Start settings. Future directions, limitations, and practical implications are discussed.

Outcome reporting bias (ORB) is a form of publication bias resulting from a primary study authors' reporting results for significant outcomes in a meta-analysis (Rothstein et al., 2006). The current study extended Egger's regression test while handling the dependence from multiple effect sizes per study. We compared methods for handling within-study dependence simultaneously (multivariate) versus separately (univariate) and compared the performance of estimation models including RVE, MLMA, and MLMA-RVE. In addition to real data analysis examples, the simulation study explored five characteristics of meta-analytic data in their impact on results. According to the findings, the multivariate model enhances power and the use of RVE or MLMA+RVE with multivariate models worked best. More results, limitations, and directions for future research are discussed.

Children with disabilities who reside in rural areas are at increased risk for social emotional difficulties and it is vital that the most effective interventions are provided in these areas given their needs and the fact that resources may be sparse. In this article, a meta-analysis of case study design studies targeting social emotional interventions for young children with disabilities in rural areas was conducted. In this research we specifically focused on studies with children with or at risk for disabilities that employed single-case design (SCD) methodology in rural settings to evaluate the effects of early childhood interventions on children’s social–emotional and behavioral outcomes. A total of 1946 articles, and 9 studies met criteria for inclusion in the meta-analyses; these studies were analyzed for effects to estimate the overall effects of rural child-focused effects on preschool children’s social-behavioral competence and pro-social skills. Interventions across both outcomes were significant with studies that included the parent or teachers in the intervention having more robust effects on outcomes. Additionally, according to moderation analyses, results were more pronounced if external researchers were the implementers of the interventions compared to natural implementers, if parents were involved in interventions, and for students with disabilities when compared to nondisabled peers. Practical implications, study limitations, and future directions are discussed.

School-based consultation or coaching may be used to promote teachers' use of various classroom management practices and interventions. An important aspect of school-based consultation and coaching is ensuring teachers generalize their use of evidence-based practices that were trained through consultation. However, the extent to which teachers generalize practices trained through consultation or coaching is somewhat unclear. As such, the purpose of this meta-analysis was twofold: (a) synthesize the existing school-based consultation literature to determine the extent to which teachers generalize practices they learned through consultation and coaching and (b) make a call to action for researchers to collect generalization data in consultation and coaching research. Seventeen studies were identified for review, in which results indicated school-based consultation and coaching to be effective for promoting teachers' generalization of EBPs (LRRi = 0.82) as well as target outcomes (LRRi = 1.15). Specific implementation supports (i.e., in situ training and behavioral skills training) significantly contributed to teachers' generalization, with specific practices (i.e., behavior specific praise) being more generalizable. Furthermore, moderation analyses were conducted to delineate aspects of consultation and coaching that are more likely to promote teachers' generalized outcomes. Limitations, future directions, and implications for research and practice are described.

Building an alliance is a well-documented and critical therapeutic process. Considerable evidence has established a significant relationship between the quality of the alliance among a therapist and their client and changes in clients' behavior. Like the therapeutic alliance, school-based coaches and teachers navigate their working relationship with the goal of modifying or altering practices in the classroom to promote youth's healthy functioning. Yet, little is known about the coach-teacher alliance. Using data from two randomized controlled trials examining the efficacy of classroom management coaching interventions, this study explored whether the alliance between teachers and the coach in the studies predicted teachers' implementation of classroom management strategies. Results from 83 teachers working with one coach indicated that the coach, but not teachers', report of the overall quality of the alliance significantly predicted teachers' use of proactive classroom management practices. The findings add to the existing literature on the importance of the coach-teacher alliance in the coaching process. Limitations of the study and implications for research and practice are discussed.Impact StatementCoaching is a commonly used in schools to support teachers' implementation of new practices. This study found that the alliance between one coach and teachers during coaching for classroom management significantly predicted teachers' use of effective strategies. This study highlights the importance of focusing on relationships when school-based coaches (e.g., school psychologists, school personnel) are working with educators to adopt and use interventions.

Purpose: The systematic review and meta-analysis evaluated the effectiveness of self-management interventions on classroom behaviors and academic outcomes. Methods: Review procedures followed Campbell Collaboration guidelines to search, select, and extract data from published and unpublished studies employing an experimental/quasi-experimental comparison group or single-case experimental design assessing the effects of a self-management intervention in schools. Seventy-five single-case design studies (236 participants; 456 effects) and 4 comparison group studies (422 participants; 11 effects) were included. Results: Single-case results indicated self-management interventions positively impacted challenging behaviors (LRRi = 0.69 [0.59, 0.78]) and academic outcomes (LRRi = 0.58 [0.41, 0.76]). A significant main effect for improving challenging behaviors was revealed in group design studies (g = 0.63 [0.08, 1.17]). Discussion: Limitations, including methodological shortcomings in the single-group design studies and the small number of comparison group studies, should be considered when interpreting findings. Implications for practice and future research are discussed.

Early childhood educators are tasked with supporting young children's academic, behavioral, and social-emotional through the use of evidence-based practices (EBPs). Unfortunately, early childhood educators may struggle with consistent implementation of EBPs. When this occurs, school-based consultation may be beneficial in promoting early childhood educators' use of effective classroom management practices and interventions. A critical aspect of school-based consultation is ensuring that early childhood educators generalize strategies they have been trained to use through consultation. However, the extent to which early childhood educators generalize skills trained through consultation across settings, children, and other evidence-based practices is unclear. Therefore, the purpose of this meta-analysis was to synthesize the existing school-based consultation literature in early childhood settings to determine the extent to which early childhood educators generalize skills trained through consultation. A total of 12 studies including 39 educator consultees and 171 effects comprised our final sample. Three-level hierarchical models with robust variance estimation were used to pool both Log Response Ratios and Tau effect sizes for analyses. Overall results indicated school-based consultation had a positive and significant impact on educator generalization of EBPs (LRRi = 0.95; Tau = 0.79). Further, particular implementation supports (e.g., in situ training) significantly contributed to EBP generalization. These results suggest school-based consultation to be an effective means for promoting early childhood educator generalization of EBPs. Implications for research and practice and future research directions are discussed.

For young children with early social-emotional difficulties, early intervention is imperative. A number of interventions are available for young children to promote social-emotional competencies. Yet, little is known regarding the impact of early childhood interventions among rural children. Rural communities have several barriers which impede access to early intervention, and rural children often are at increased risk for social-emotional difficulties. Thus, the purpose of this article is to conduct a meta-analysis of single case design studies of social-emotional interventions that have been implemented within rural settings with young children, in an effort to determine the effects and types of early interventions specific to young children in rural areas. A total of 7 studies with 26 participants and 53 effects comprised the final sample. Findings indicated that all interventions, representing three different component types (i.e., teacher/parent behavior management training, social-emotional competency training, parent involvement/enhancement), produced positive social-emotional outcomes (i.e., improved prosocial behavior and decreased disruptive behavior). Moderating variables (e.g., child characteristics, intervention implementer) that may impact intervention effectiveness were also studied and one variable was significant; specifically, studies published in journals had more impact on outcomes than those which were not published. Implications for future research and policy are provided.

Healthy relationships between parents and teachers are essential to addressing children’s emotional and behavioral concerns. The current meta-analysis examined the effects of family–school engagement interventions on parent–teacher relationships. Twenty-three group-design studies yielding 58 effects comprised the current sample. Random effect models were estimated to calculate pooled effect size estimates, and mixed effect models were conducted for moderation analyses. Overall, results revealed that family–school engagement interventions had a small, but significant effect on parent–teacher relationships (δ = 0.23, SE = 0.09, p < 0.05). This finding was consistent across mesosystemic characteristics of parent–teacher relationships including joining (δ = 0.25, SE = 0.09, p < 0.05) and parent–teacher communication (δ = 0.34, SE = 0.10, p < 0.01). However, no significant results were revealed for relational prerequisites (δ = 0.05, SE = 0.12, p = 0.67). Interventions were found to be significantly moderated by child behavior concerns (i.e., effects were higher for families of students with externalizing concerns) and community type (i.e., effects were more pronounced in rural areas). Results were not significantly moderated by child/family race or child age, indicating that interventions positively impacted parent–teacher relationships regardless of child/family race and child age. These findings demonstrate the benefits of family–school engagement interventions in promoting parent–teacher relationships and have key implications for school personnel.

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare complication after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) adenoviral vector vaccination. In British Columbia (BC), Canada, a provincial clinical care pathway was developed to guide clinicians in evaluating for VITT among patients who present with thrombocytopenia or thrombosis symptoms within 4 to 28 days after adenoviral vector vaccine exposure. All patients had enzyme-linked immunosorbent assay (ELISA) testing for platelet factor 4 (PF4) antibodies, and all cases with positive PF4-ELISA or d-dimer levels ≥2.0 mg/L fibrinogen equivalent units (FEU) had further testing for platelet-activating PF4 antibodies using a modified serotonin release assay (SRA). Between 1 May and 30 June 2021, 37% of 68 patients investigated for VITT had thrombosis, but only 3 had VITT confirmed by PF4-ELISA and SRA. Platelet counts, d-dimer levels, and ELISA optical density values were significantly different between those with and without VITT. Three patients had thrombocytopenia and thrombosis with d-dimer levels >4.0 mg/L FEU but had negative PF4-ELISA and SRA results. Patients with VITT were treated successfully with IV immunoglobulin, nonheparin anticoagulants, and corticosteroids. Our pathway demonstrated that thrombosis is common among patients investigated for VITT and that PF4-ELISA testing is necessary to confirm VITT in those presenting with thrombosis and thrombocytopenia.

In this article, we explore the experiences of people who carry monetary sanction (or penal) debt across eight U.S. states. Using 519 interviews with people sentenced to fines and fees, we analyze the mental and emotional aspects of their experiences. Situating our analysis within research on the social determinants of health and the stress universe, we suggest that monetary sanctions create an overwhelmingly palpable sense of fear, frustration, anxiety, and despair. We theorize the ways in which monetary sanctions function as both acute and chronic health stressors for people who are unable to pay off their debts, highlight the mechanisms linking penal debt with mental and emotional burdens, and generalize our findings using national data from the U.S. Federal Reserve. We find that the system of monetary sanctions generates a great deal of stress and strain that becomes an internalized punishment affecting many realms of people's lives.

Background: Person-centered health care is becoming the norm which has prompted a need for educating academic and health care professionals upstream to embed this culture and philosophy in graduates prior to beginning their role in a professional health care setting. The Planetree International Certification for Excellence in Person-Centered Care is recognized as the highest mark of achievement an organization can earn, demonstrating a commitment to include patients, families, staff, and the community in the planning process to improve overall health and well-being. Previously the Planetree certification had been reserved for health care enterprises. This article highlights the journey of the first academic institution to achieve the Planetree Silver Certification level of recognition.Methods: Gap analyses of curriculum, culture, operations, student resources, and data for evidence-based evaluation were systematically undertaken.Results: After 18 months of collaboration, multiple site visits by Planetree leaders, and the compilation of a 550+ page self-study detailing the methodology used to address each Planetree standard of person centeredness, the National University, former School of Health and Human Services achieved the level of Planetree Certified Silver recognition.Conclusions: Achieving sustained success remains a continuum of efforts and embraces the journey to the destination while celebrating successes along the way. Early faculty engagement and “grass roots” efforts were sought to lead the National University former School of Health and Human Services toward the first-of-a-kind academic Planetree Silver Certification. Efforts are underway in seeking the Planetree Gold Certification level.

Abstract Background Challenging classroom behaviors can interfere with student social and academic functioning and may be harmful to everyone in schools. Self‐management interventions within schools can address these concerns by helping students develop necessary social, emotional, and behavioral skills. Thus, the current systematic review synthesized and analyzed school‐based self‐management interventions used to address challenging classroom behaviors. Objectives The current study aimed to inform practice and policy by (a) evaluating the effectiveness of self‐management interventions at improving classroom behaviors and academic outcomes and (b) examining the state of research for self‐management interventions based on existing literature. Search Methods Comprehensive search procedures included electronically searching online databases (e.g., EBSCO Academic Search Premier, MEDLINE, ERIC, PsycINFO), hand‐searching 19 relevant journals (e.g., School Mental Health, Journal of School Psychology), reference‐list searching 21 relevant reviews, and searching gray literature (e.g., contacting authors, searching online dissertation/theses databases and national government clearinghouses/websites). Searches were completed through December of 2020. Selection Criteria Included studies employed either a multiple group‐design (i.e., experimental or quasi‐experimental) or single‐case experimental research design and met the following criteria: (a) utilized a self‐management intervention, (b) conducted in a school setting, (c) included school‐aged students, and (d) assessed classroom behaviors. Data Collection and Analysis Standard data collection procedures expected by the Campbell Collaboration were used in the current study. Analyses for single‐case design studies incorporated three‐level hierarchical models to synthesize main effects, and meta‐regression for moderation. Further, robust variance estimation was applied to both single‐case design and group‐design studies to account for dependency issues. Main Results Our final single‐case design sample included 75 studies, 236 participants, and 456 effects (i.e., 351 behavioral outcomes and 105 academic outcomes). Our final group‐design sample included 4 studies, 422 participants, and 11 total behavioral effects. Most studies occurred in the United States, in urban communities, in public schools, and in elementary settings. Single‐case design results indicated that self‐management interventions significantly and positively impacted both student classroom behaviors (LRRi = 0.69, 95% confidence interval [CI] [0.59, 0.78]) and academic outcomes (LRRi = 0.58, 95% CI [0.41, 0.76]). Single‐case results were found to be moderated by student race and special education status, whereas intervention effects were more pronounced for African American students (F = 5.56, p = 0.02) and students receiving special education services (F = 6.87, p = 0.01). Single‐case results were not found to be moderated by intervention characteristics (i.e., intervention duration, fidelity assessment, fidelity method, or training). Despite positive findings for single‐case design studies, risk of bias assessment indicated methodological shortcomings that should be considered when interpreting findings. A significant main effect of self‐management interventions for improving classroom behaviors was also revealed for group‐design studies (g = 0.63, 95% CI [0.08, 1.17]). However, these results should be interpreted with caution given the small number of included group‐design studies. Implications for Policy, Practice, and Research The current study, conducted using comprehensive search/screening procedures and advanced meta‐analytic techniques, adds to the large amount of evidence indicating that self‐management interventions can be successfully used to address student behaviors and academic outcomes. In particular, the use specific self‐management elements (i.e., self‐determining a performance goal, self‐observing and recording progress, reflecting on a target behavior, and administering primary reinforcers) should be considered within current interventions as well as in the development of future interventions. Future research should aim to assess the implementation and effects of self‐management at the group or classroom‐level within randomized controlled trials.

IMPORTANCE:Patient age, comorbidity burden, and disease severity at presentation are the major factors associated with surviving COVID-19. Hospital-level factors including ICU occupancy may confer additional risk to individual patients, particularly at times of maximal stress on healthcare systems. The interaction of patient- and hospital-level factors over time during pandemic disease remains an area of active exploration. OBJECTIVE:To determine the impact of patient and hospital risk factors during episodic surges, characterize severity distribution between waves, and evaluate patient-level impact of ICU capacity on COVID-19 survivorship. DESIGN:Retrospective cohort study. SETTING:Four acute care hospitals within an integrated healthcare network in San Diego, California. PARTICIPANTS:All patients (18+ y.o.) admitted with a positive PCR test for SARS-CoV-2 or ICD-10 code for COVID-19 from March 1, 2020 through June 30, 2021. MAIN OUTCOME(S) AND MEASURE(S):Patient survivorship and length of stay. RESULTS:Six thousand eight hundred fifty-one patients were evaluated in this large cohort series. Patient level factors associated with mortality included: severity at admission (WHO Clinical Progression Score [WCPS]), age, gender, BMI, marital status, language preference, Elixhauser score, elevated laboratory (d-dimer, ferritin, LDH) or lower absolute lymphocyte count. When adjusting for patient age alone, survivorship during surges was also inversely associated with ICU occupancy, though this correlation was not present when adjusted for patient-level factors. CONCLUSIONS AND RELEVANCE:Patient age, comorbidity burden, and severity at the time of presentation are the major factors associated with surviving COVID-19. Hospital-level factors including ICU occupancy may confer additional risk to individual patients, particularly at times of maximal stress on healthcare systems.

This study attempts to identify a threshold in the bias of potential evapotranspiration (PET) forcing data beyond which output from hydrological models will be significantly impacted. The sensitivity of a widely used conceptual rainfall-runoff model to systematic errors in PET inputs is investigated for a sample of 57 US catchments across energy- and water-limited regions. PET forcing data are biased by a constant factor ranging from +/- 5% to +/- 25%. The sensitivity of hydrologic models to PET data quality was found to be primarily driven by the long-term ratio of actual evapotranspiration (AET) to PET of catchments, which determines the energy availability of catchments. Energy-limited catchments were more sensitive to PET errors than water-limited catchments, and the PET error threshold was found to decrease along the water- to energy-limited continuum. Moreover, model performance of rainfall-runoff models was found to be more sensitive to negative PET biases than to positive PET biases. In practice, this means negatively biased PET causes catchments to artificially shift toward energy limitation, resulting in higher model sensitivity. Given the decreasing pattern of PET error threshold in catchments along the water- to energy-limited continuum, energy availability of catchments can be used as a predictor for the requirements of accuracy in PET data for conceptual hydrological models. (C) 2021 American Society of Civil Engineers.

ABSTRACT Given that consultation has consistently yielded benefits for clients and consultees, it is likely an effective method of promoting family-school engagement. Thus, this meta-analysis examined the effects of consultation-based family-school engagement on child and parent outcomes, and complementary intervention methods used in conjunction with consultation. This study also sought to advance consultation research via a contemporary meta-analytic technique, robust variance estimation (RVE). Analyses yielded significant effects of consultation-based family-school engagement on children’s social-behavioral competence (δ = 0.34), mental health (δ = 0.37), and academic achievement (δ = 0.27). Significant effects for parent practices (δ = 0.53), parent attitudes (δ = 0.49), and relational outcomes (δ = 0.37) were also found. Complementary intervention methods revealed significant effects across various child, parent, and relational outcomes. Results indicate benefits of consultation-based family-school engagement for key outcomes and have implications for utilizing complementary methods to augment the net effects of consultation for valuable stakeholders.

This article introduces the special issue, Recent Methodological Advancements in Indirect Service Delivery. The authors first highlight salient aspects of each of the five articles included in the special issue to emphasize their unique contributions to the consultation literature. Next, we organize the articles into two main themes to discuss findings, implications and future directions for consultation research and practice. Specifically, we highlight innovative statistical approaches and novel assessment methods within the special issue. Collectively, these articles showcase current innovations, practices and issues within school-based consultation research and provide multiple directions for researchers, consultants, and school-based partners to consider.

Gender minority youth experience bullying victimization at concerningly high rates. The current study sought to unmask potentially unique bullying victimization experiences and perceived prevalence of bullying for Transgender, fluid gender, and gender questioning students. Results revealed that all three gender minority groups were significantly more likely to report being bullied in comparison to cis male students. Transgender and fluid gender students also reported significantly higher prevalence rates of teasing and bullying within their schools. No significant differences between gender minority subgroups were found for either perceived prevalence or bullying victimization experiences. However, Transgender students reported consistently higher rates of victimization in comparison to fluid gender and gender questioning students. Limitations, future directions, and practice implications for school-based personnel are discussed. IMPACT STATEMENT Gender minority youth are frequently bullied by school peers. The current study adds to research in this area by exploring the unique bullying experiences and perceived prevalence of bullying from Transgender, fluid gender, and gender questioning students. School personnel can play a critical role in addressing school bullying through prevention and intervention efforts aimed at supporting the needs of gender minority youth.