BACKGROUND: Foreign-born children rarely use traditional school mental health services. Comprehensive programs that combine mental health services with academic, economic, and socioemotional supports reach more foreign-born children and improve wellbeing. However, little practical guidance exists regarding how to best combine these diverse services. METHODS:To identify essential service components and their organization, we interviewed 92 parents, school staff, mental health providers, and community agency staff from 5 school-linked mental health programs designed specifically to serve immigrant and refugee youth. RESULTS:Foreign-born parents did not distinguish between academic, behavioral, and emotional help for their children; these western categorizations of functioning were not meaningful to them. Consequently, programs needed to combine 4 components, organized in a pyramid: family engagement, assistance with basic needs, assistance with adaptation to a new culture, and emotional and behavioral supports. Family engagement was the foundation upon which all other services depended. Assistance with economic and cultural stressors directly promoted emotional wellbeing and helped parents trust clinical mental health interventions. CONCLUSIONS:Specific strategies to implement the 4 essential components include home visits by program staff, a one-stop parent center located in the school to help with basic needs, working with cultural brokers, and informed consent procedures that clearly explain recommended care without requiring immigrant and refugee parents to internalize western conceptualizations of psychopathology. Future evaluations should assess the cost and effectiveness of these strategies. These data are essential to advocate payment for these nonclinical services by traditional funding mechanisms. Citation:McNeely CA, Sprecher K, Bates-Fredi D, Price OA, Allen CD. Identifying essential components of school-linked mental health services for refugee and immigrant children: a comparative case study.A pproximately 2.2 million school-aged children in the United States are foreign born 1 and an additional 11.8 million have at least one foreign-born parent. 2 Foreign-born children comprise a diverse group, including immigrants, asylum seekers, and refugees. Arriving from dozens of nations, some have no prior formal education or exposure to English a Research Professor, (cmcneely@utk.edu), College

Children’s social networks comprise a variety of social partners who interact with the child in unique ways and contribute distinctly to her social and emotional development. This study examines the structure of children’s social networks from four different ethnic groups (Kamba, Kikuyu, Luo, and Maasai) residing in an informal urban settlement in Kenya. Twenty boys and 24 girls ( M = 40 months) were observed on three different weekdays for 2 hr each day, to assess children’s experiences across daylight hours. Children’s social networks predominantly consisted of nonrelative children and nonrelative adults. However, larger social networks did not necessarily mean more highly involved members. Peers were observed to be in close proximity and to engage in play and conversation with the focal children more often than did adult social partners. The findings have implications for intervention programs that focus predominantly on nuclear family members, as they may overlook important roles that other social network members play in children’s lives. The low occurrence of play between adults and children in this study is consistent with studies in other non-Western contexts, where play is generally not considered part of parents’ role nor a fundamental characteristic of parent–child interactions.

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Background: Louisiana is historically one of the lowest-performing states in terms of health outcomes in the United States. Hurricane Katrina led to a decrease in available health care resources, with a larger impact on resources for those living below the poverty line. Subsequently, the coronavirus disease 2019 (COVID-19) pandemic has been shown to have had disproportionately large impacts on minority communities, uninsured populations, and rural communities-all of which are found in Louisiana. Methods: This review focuses on the unique challenges of health care in Louisiana, the influence of COVID-19 on physician burnout, and methods of reducing work exhaustion for those in the health care field. Results: A national survey showed that physician satisfaction decreased from June 29, 2021, through September 26, 2021, compared to before the pandemic. A critical component in the provision of the essential services of public health is the ability to build and sustain a clinically skilled and diverse physician workforce. Maintaining well-being and retaining the physician workforce are prerequisites to the equitable provision of access to health care services. Conclusion: Maintaining one's own wellness is critical to occupational sustainability, particularly when unique stressors such as those encountered during the COVID-19 pandemic are present. The future of a vital health care system depends on physicians maintaining healthy habits and seeking help when burnout symptoms are recognized, both at the individual and institutional level.