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Bradley Stein @bradleydstein.bsky.social · 3h

Really important research about a school mental health intervention. Studies without significant findings often have a hard time getting published, but its just as important to know what interventions don't seem to have a significant benefit as knowing what interventions do.

Dr Lucy Foulkes @lucyfoulkes.bsky.social · 5d

New paper from my group, led by Carolina Guzman Holst

This is a secondary analysis of data from the high-quality MYRIAD trial, a universal school-based mindfulness intervention

Summary below (🧵)

acamh.onlinelibrary.wiley.com/doi/10.1002/...

Adolescents' trajectories of mental health in the MYRIAD trial

Abstract
Background
This study explored adolescent's mental health trajectories over the course of a school-based mindfulness-based intervention trial (MYRIAD). It examined whether intervention condition (mindfulness vs. teaching-as-usual), individual-level and contextual-level factors were associated with different trajectories.

Methods
This pre-registered study used data from 11- to 14-year-olds who participated in the MYRIAD trial. We used growth mixture models to examine distinct trajectories in risk for depression, social-emotional-behavioural functioning, and wellbeing (co-primary outcomes), and anxiety (secondary outcome), across pre-intervention, post-intervention and 12-month follow up (ns = 7198–7727). We then used multinomial and binomial logistic regression models to examine factors associated with individual trajectory membership.

Results
Distinct trajectories emerged for each outcome: A five-trajectory model best explained the changes in risk for depression, whilst four-trajectory models best explained changes in social-emotional-behavioural functioning, wellbeing, and anxiety. While 69%–80% of adolescents followed stable low-problem trajectories for each outcome, 11%–23% experienced stable high-problem trajectories, 2%–16% experienced increasing-problem trajectories and 1%–5% experienced decreasing-problem trajectories. Receiving the mindfulness intervention was not associated with any mental health trajectory in models adjusted for confounders. Several individual-level factors, including executive functioning difficulties and risk of mental health problems at baseline, and school-level factors, such as school climate, predicted adolescents' classification into different trajectories, but they did not vary according to intervention group.

Conclusions
Individual differences in mental health trajectories emerged over the course of a 1-year mindfulness-based intervention, with most adolescents experiencing low-stable problem trajectories for each outcome. However, the intervention itself had no impact on individual trajectory membership, mirroring null results found in the main trial. Our findings suggest that universal interventions may not be sensitive enough to address the diverse needs of all students, however, tailoring interventions to address a range of different individual and contextual factors might maximise their impact.

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Bradley Stein @bradleydstein.bsky.social · 2d

Read the full NIMH supported study with my @rand.org colleagues Amy Mahler and Rosanna Smart here: www.jaacap.org/article/S089...

Teachers’ Reports of Attention-Deficit/Hyperactivity Disorder Medication Changes During Stimulant Shortages: National Survey Results

Attention-deficit/hyperactivity disorder (ADHD), a common childhood-onset disorder, is associated with impulsivity, impaired attention and executive function, and poor academic performance.1 Stimulant...

www.jaacap.org

Bradley Stein @bradleydstein.bsky.social · 2d

Pediatricians, child psychiatrists and educators need to work together to help families find solutions—like pharmacy navigation and behavioral supports—so kids don’t fall behind during medication shortages

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Bradley Stein @bradleydstein.bsky.social · 2d

These differences mean the shortage could deepen existing gaps in academic achievement and behavioral health for children already facing challenges and barriers to care

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Bradley Stein @bradleydstein.bsky.social · 2d

Teachers in these schools were significantly more likely to report students having to stop their medication—over 77% in majority-minority schools and 76% in schools with mostly low-income students.

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Bradley Stein @bradleydstein.bsky.social · 2d

New research alert: The nationwide stimulant shortage didn’t affect all schools equally. Our new national study in JAACAP found much higher rates of ADHD medication interruption in schools where most students are from racial/ethnic minorities or low-income backgrounds.

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Reposted by Bradley Stein

RAND @rand.org · 3d

The number of people initiating and continuing medication treatment for opioid use disorder declined in the six months after Medicaid unwinding began.

New study: https://bit.ly/42vlomV

Medicaid Unwinding Associated with Less Medication Treatment for Opioid Use Disorder

The end of pandemic-era enrollment enhancements for Medicaid was associated with a rise in the number of people ending medication treatment for opioid use disorder, as well as a decrease in the number...

www.rand.org

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Bradley Stein @bradleydstein.bsky.social · 6d

Read the full NIMH supported study here with co-authors Skyler Hulser and Brendan Saloner from @brownpublichealth.bsky.social : www.healthaffairs.org/doi/full/10....

Health Affairs Journal

www.healthaffairs.org

Bradley Stein @bradleydstein.bsky.social · 6d

These treatment settings all matter for recovery, meaning broader Medicaid access offered more pathways for people with SUD to get help when needed most, critical when the overdose crisis was intensifying

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Bradley Stein @bradleydstein.bsky.social · 6d

Even 6+ years later, treatment rates remained higher than pre-expansion, showing sustained improvements—not just a one-time bump.

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Bradley Stein @bradleydstein.bsky.social · 6d

Treatment episodes for SUD surged across the board in the first 2-3 years after expansion: overall rates up 39–40% after 2–5 years, with strong gains across the board, in residential, intensive outpatient, and non-intensive outpatient care.

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Bradley Stein @bradleydstein.bsky.social · 6d

New research led by @jcmecon.bsky.social of @georgemasonu.bsky.social in @healthaffairs.bsky.social finds Medicaid expansion has yielded lasting gains in access to specialty substance use disorder (SUD) treatment—benefiting thousands experiencing drug or alcohol problems.

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Bradley Stein @bradleydstein.bsky.social · 8d

See the full paper with co-authors Jon Cantor, Ryan McBain, Aaron Kofner, Fang Zhang, Alyssa Burnett, Josh Breslau. Melissa Kilberti, Ateev Mehrota from @brownpublichealth.bsky.social and Hao Yu from @deptpopmed.bsky.social here: jamanetwork.com/journals/jam...

Cell Phone Bans in a National Sample of US Public School Principals

This cross-sectional study reports the national prevalence of public-school cell phone bans and how they vary by school characteristics.

jamanetwork.com

Bradley Stein @bradleydstein.bsky.social · 8d

Thanks to the NIMH for funding this work and shout-out to all the school leaders who responded to the @rand.org American School Leader Panel!

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Bradley Stein @bradleydstein.bsky.social · 8d

Policymakers and school boards: are you considering neighborhood context when crafting phone policies? Open dialogue with parents, teachers, and students is key to making effective rules

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Bradley Stein @bradleydstein.bsky.social · 8d

These differences raise important questions on equity and the impacts for different student populations— teens using phones more freely at school could see impacts on learning and mental health. Middle and high school principals face tough choices balancing safety, independence, and distractions.

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Bradley Stein @bradleydstein.bsky.social · 8d

And most elementary schools stick to strict bans: over 81% only allow phones on campus if students keep them put away all day. By high school, policies get much looser—many let students use phones outside class or at teacher discretion.

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Bradley Stein @bradleydstein.bsky.social · 8d

Our national analysis found schools in higher-income communities are more likely to allow phones than those in high-poverty neighborhoods.

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Bradley Stein @bradleydstein.bsky.social · 8d

New Research Alert: Did you know nearly all U.S. public schools restrict student cell phone use—but the types of bans are very different depending on the school? Our recent paper, led by led by my @rand.org colleague Jon Cantor, just published in @jamahealthforum.com examines this issue

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Bradley Stein @bradleydstein.bsky.social · 13d

Such an important topic. Great to see @parcka.bsky.social diving into this with my @rand.org colleague Liz!

PARCKA @parcka.bsky.social · 13d

Talking with youth about substance use isn’t easy. Dr. Elizabeth D’Amico shares how Motivational Interviewing #MI can help build trust. 🩷🎧 Listen to the newest episode of Let’s Talk About Drugs in the Intermountain West #LTAD now!

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Bradley Stein @bradleydstein.bsky.social · 15d

Want all the numbers? Check out the NIDA and Foundation for Opioid Response Efforts supported study here:

journals.lww.com/journaladdic...

Bradley Stein @bradleydstein.bsky.social · 15d

Bottom line: Medicaid unwinding wasn’t just a paperwork issue- it disrupted effective treatment of opioid use disorder for thousands. Policymakers must find ways to protect coverage and care continuity as insurance rules evolve.

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Bradley Stein @bradleydstein.bsky.social · 15d

Did other insurance types like commercial insurance and Medicare, or paying out-of-pocket pocket fill the gap? Turns out, they didn’t: overall, more people ended up going without effective treatment.

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Bradley Stein @bradleydstein.bsky.social · 15d

In states with the greatest Medicaid disenrollment, the changes were greatest: ending episodes rose +5.5%, and new starts fell nearly -4% after unwinding.

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Bradley Stein @bradleydstein.bsky.social · 15d

Our national study led by @rand.org colleague Rachel Landis in the American Society of Addiction Medicine’s Journal of Addiction Medicine found that after unwinding, more Medicaid buprenorphine treatment episodes ended (+3%), and fewer Medicaid treatment episodes started (-2.6%).

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