Highlights• Task-shifting refers to redistributing tasks from professionals to workers who have less training.• Task-shifting may be a key strategy in expanding child services in low resource communities.• Just-in-Time Training (JITT) refers to efficient, on-demand training experiences. • JITT may strengthen task-shifting efforts.• Task-shifting and JITT involve unique ethical considerations.Abstract In the United States, the demand for child mental health services is increasing, while the supply is limited by workforce shortages. These shortages are unlikely to be corrected without significant structural changes in how mental health services are provided. One strategy for bridging this gap is task-shifting, defined as a process by which services that are typically delivered by professionals are moved to individuals with less extensive qualifications or training. Although task-shifting can increase the size of the workforce, there are challenges related to training new workers. In this paper, we propose Just-In-Time Training (JITT) as one strategy for improving task-shifting efforts. We define JITT as ondemand training experiences that only include what is necessary, when it is necessary, to promote competent service delivery. We offer a proof of concept from our own work shifting counseling and academic support tasks from school mental health professionals to prebaccalaureate mentors, citing lessons learned during our iterative process of JITT development. We conclude with a series of key considerations for scaling up the pairing of task-shifting and JITT, including expanding the science of JITT and anticipating how task-shifting and JITT would work within the context of dynamic mental health service systems.
Exposure to adverse events is prevalent among youths and robustly associated with risk for depression, particularly during adolescence. The Dimensional Model of Adversity and Psychopathology (DMAP) distinguishes between adverse events that expose youths to deprivation versus threat, positing unique mechanisms of risk (cognitive functioning deficits for deprivation, and altered fear and emotion learning for threat) that may require different approaches to intervention. We examined whether deprivation and threat were distinctly associated with behavioral measures of cognitive processes and autonomic nervous system function in relation to depression symptom severity in a community sample of early adolescents (n = 117; mean age 12.73 years; 54.7% male). Consistent with DMAP, associations between threat and depression symptoms, and between economic deprivation and depression symptoms, were distinctly moderated by physiological and cognitive functions, respectively, at baseline but not follow-up. Under conditions of greater cognitive inhibition, less exposure to deprivation was associated with lower symptom severity. Under conditions of blunted resting-state autonomic response (electrodermal activity and respiratory sinus arrhythmia), greater exposure to threat was associated with higher symptom severity. Our findings support the view that understanding risk for youth depression requires parsing adversity: examining distinct roles played by deprivation and threat, and the associated cognitive and biological processes.
In this qualitative case study, the authors identify, name, and critique multi‐level contextual factors in relation to Black, Indigenous, and People of Color college student leaders’ and the authors’ own critical consciousness development applying Harrel’s Difference Framework, and Critical Race Theory. Located in a Northern California Sundown Town, the authors utilize focus groups, Photovoice data, and critical ethnography to document organizational and institutional responses towards student leaders’ and the authors’ involvement in multicultural programming and a Black Lives Matter Freedom School. Across data sources, the authors chronicle instances of the following: (1) devaluing through unpaid student labor, (2) distancing and siloing of multicultural student organizations on campus, (3) denial of the use of harmful and misinformed programmatic practices, and (4) defensiveness on the part of the administration regarding student narratives. Findings highlight implications within higher education surrounding addressing historic racial inequity, and illustrate the trauma invoked by ameliorative and premature institutional responses.
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