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In the U.S., fewer than half of children and adolescents who report mental disorders receive care and the needs of those who receive care have yet to be explored. There is a scarcity of studies examining the needs of adolescents with mental conditions and at risk for suicide. Learning directly from the adolescents can fill in this gap by providing insight that clinicians and researchers lack about adolescents' experience. This study uses Photovoice, a Community-Based Participatory Research method that involves focus groups and the use of cameras by participants to visually capture their reality and express their ideas through photographs. By using Photovoice, this study aims to provide an opportunity for adolescents to voice their own perspectives and for researchers and clinicians to gain an understanding of adolescents' life experience away from the treatment setting, as well as their experience as consumers of mental health services. Four participants, including two 15 year olds and two 17 year olds, were recruited from a mental health clinic in New York City. Parental consent and adolescent assent were collected per Institutional Review Board requirements. Thematic analysis was used to identify and report response patterns. Four themes emerged: (i) sense of self, (ii) family, (iii) suicidal ideation and (iv) treatment. Findings suggest that Photovoice is valued by adolescents and leads to critical thinking, self-reflection, discovering strengths and social support. Adolescents reported feeling empowered, which is the ultimate goal of Photovoice. Photovoice presents a powerful opportunity to be used as therapeutic strategy with adolescents that demands further research.

Innovative combination HIV-prevention and microfinance interventions are needed to address the high incidence of HIV and other STIs among women who use drugs. Project Nova is a cluster-randomized, controlled trial for drug-using female sex workers in two cities in Kazakhstan. The intervention was adapted from prior interventions for women at high risk for HIV and tailored to meet the needs of female sex workers who use injection or noninjection drugs. We describe the development and implementation of the Nova intervention and detail its components: HIV-risk reduction, financial-literacy training, vocational training, and a matched-savings program. We discuss session-attendance rates, barriers to engagement, challenges that arose during the sessions, and the solutions implemented. Our findings show that it is feasible to implement a combination HIV-prevention and microfinance intervention with highly vulnerable women such as these, and to address implementation challenges successfully.

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