Trauma-focused cognitive behavioral therapy with Puerto Rican youth in a post-disaster context: Tailoring, implementation, and program evaluation outcomes.

PURPOSE: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has not yet been systematically evaluated in the Caribbean context, particularly with Hispanic youth exposed to multiple disasters. The objective of this project was twofold: 1) to train mental health providers in Puerto Rico in TF-CBT as part of a clinical implementation project within the largest managed behavioral health organization (MBHO) on the island, and 2) to conduct a program evaluation to determine the feasibility of implementation and the effectiveness of the treatment. METHOD: Fifteen psychologists were trained in TF-CBT. These psychologists then provided TF-CBT to 56 children and adolescents, ages 5-18, in community-based mental health clinics and one primary care clinic with a co-located psychologist in Puerto Rico. The mean number of traumatic events reported by youth referred for TF-CBT was 4.11. RESULTS: Thirty-six out of 56 children enrolled in the project (64.3%) successfully completed all components of TF-CBT. Results demonstrated large effect sizes for reduction in youth-reported posttraumatic stress symptoms (PTSS) (Cohen's d = 1.32), depressive symptoms (Cohen's d = 1.32), and anxiety symptoms (Cohen's d = 1.18). CONCLUSIONS: These results suggest that it was feasible to train providers in TF-CBT, that providers were able to deliver TF-CBT in community-based settings both in person and via telehealth (due to the COVID-19 pandemic), and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in Puerto Rico in a post-disaster context. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for Hispanic youth and disaster-affected youth in the Caribbean.

Sexual Risk Behavior among Adolescents Seeking Treatment for Posttraumatic Stress Disorder: Exploring Psychosocial & Symptom Correlates.

Adolescents exposed to trauma experience disproportionate rates of HIV/STI. However, integrated treatment for trauma and sexual risk behavior is rare. To inform integrated prevention efforts, the current study describes prevalence and correlates of sexual risk behavior among adolescents seeking treatment for symptoms of posttraumatic stress and substance use disorders. Adolescents aged 13-18 years (N = 135; 88% female) with histories of interpersonal violence exposure completed pre-treatment questionnaires in a randomized controlled trial of an integrated psychotherapy for trauma and substance use symptomology. Adolescents reported high rates of sexual risk behaviors relative to national estimates and general mental health treatment samples. Symptoms of reexperiencing, substance use, and peer deviance were related to sexual risk behavior beyond the influence of other trauma symptoms. Individual and contextual psychosocial factors may be stronger predictors of sexual risk behavior than posttraumatic stress disorder symptoms among adolescents with trauma symptomology. Integrated interventions targeting traumatic stress, substance use, and sexual risk behavior concurrently may prevent revictimization and HIV/STI incidence among trauma-exposed youth.

Implementation of an Evidence-Based Psychotherapy for Trauma-Exposed Children in a Lower-Middle Income Country: the Use of Trauma-Focused Cognitive Behavioral Therapy in El Salvador.

Central American youth are at a high risk for experiencing trauma and related psychosocial problems. Despite this, few studies of evidence-based trauma-focused interventions with this population exist. The objective of this project was twofold: 1) to train providers in El Salvador in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) as part of a clinical implementation project within a non-governmental organization, and 2) to conduct program evaluation to determine the feasibility of implementation and the effectiveness of the treatment. Fifteen Salvadoran psychologists were trained in TF-CBT who then provided TF-CBT to 121 children and adolescents ages 3-18 in community-based locations. The mean number of traumas reported by youth was 4.39. Results demonstrated large effect sizes for reduction in youth-reported trauma symptoms (Cohen's d = 2.04), depressive symptoms (Cohen's d = 1.68), and anxiety symptoms (Cohen's d = 1.67). Our program evaluation results suggest that it was feasible to train providers in TF-CBT, that providers were in turn able to deliver TF-CBT in community-based settings, and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in El Salvador. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for youth in Latin American countries.

Listen, don't tell: Partnership and adaptation to implement trauma-focused cognitive behavioral therapy in low-resourced settings.

Clinical psychological science has developed many efficacious treatments for diverse emotional and behavioral difficulties encountered by children and adolescents, although randomized trials investigating these treatments have disproportionally been conducted by American, university-based research labs. The subsection of the world population involved in these studies, however, represents very few people among those in need of psychological services whose voices, perspectives, and orientations to therapy have not generally been reflected in well-funded research trials. Dissemination and implementation of evidence-based services designed to meet the needs of this broader global population, therefore, may require cultural and contextual adaptation to be successful. The current article describes the implementation of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in 3 separate low-resourced settings (rural South Carolina, Puerto Rico, and El Salvador) utilizing the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework and guided by a community-based participatory research framework. Emphasis is placed on description of program development, building collaborative and responsive partnerships, and the use of implementation strategies to guide continuous quality improvement. Program evaluation data comparing baseline to posttreatment trauma symptoms and treatment completion rates for all sites are also presented, which suggests that treatment was associated with a large reduction in symptoms, exceeding that noted in many TF-CBT randomized trials. The implications of attention to context, adaptation, and methods of building partnerships with global communities are discussed, with a particular focus on propelling more refined models and controlled studies in the future. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Risk reduction through family therapy (RRFT): Protocol of a randomized controlled efficacy trial of an integrative treatment for co-occurring substance use problems and posttraumatic stress disorder symptoms in adolescents who have experienced interpersonal violence and other traumatic events.

Decades of research demonstrate that childhood exposure to traumatic events, particularly interpersonal violence experiences (IPV; sexual abuse, physical abuse, witnessing violence), increases risk for negative behavioral and emotional outcomes, including substance use problems (SUP) and posttraumatic stress disorder (PTSD). Despite this well-established link-including empirical support for shared etiological and functional connections between SUP and PTSD -the field has been void of a gold standard treatment for adolescent populations. To address this gap, our team recently completed a large randomized controlled trial to evaluate the efficacy of Risk Reduction through Family Therapy (RRFT), an integrative and exposure-based risk-reduction and treatment approach for adolescents who have experienced IPV and other traumatic events. The purpose of this paper is to provide a detailed description of the design and methods of this RCT designed to reduce SUP, PTSD symptoms, and related risk behaviors, with outcomes measured from pre-treatment through 18 months post-entry. Specifically, the recruitment and sampling procedures, assessment measures and methods, description of the intervention, and planned statistical approaches to evaluating the full range of outcomes are detailed. Clinical and research implications of this work are also discussed.

Safety and Efficacy of Exposure-Based Risk Reduction Through Family Therapy for Co-occurring Substance Use Problems and Posttraumatic Stress Disorder Symptoms Among Adolescents: A Randomized Clinical Trial.

Importance: No empirically supported treatments have been evaluated to address co-occurring substance use problems (SUP) and posttraumatic stress disorder (PTSD) symptoms among adolescents in an integrative fashion. This lack is partially owing to untested clinical lore suggesting that delivery of exposure-based PTSD treatments to youth with SUP might be iatrogenic. Objective: To determine whether an exposure-based, integrative intervention for adolescents with SUP and PTSD symptoms-risk reduction through family therapy (RRFT)-resulted in improved outcomes relative to a treatment-as-usual (TAU) control condition consisting primarily of trauma-focused cognitive behavioral therapy. Design, Setting, and Participants: This randomized clinical trial enrolled 124 participants who were recruited from November 1, 2012, through January 30, 2017. Adolescents (aged 13-18 years) who engaged in nontobacco substance use at least once during the past 90 days, experienced at least 1 interpersonal traumatic event, and reported 5 or more PTSD symptoms were enrolled. Blinded assessments were collected at baseline and at 3, 6, 12, and 18 months after baseline. Recruitment and treatment took place in community-based child advocacy centers in the Southeastern United States. Data were analyzed from August 2 through October 4, 2018, and were based on intention to treat. Interventions: Participants were randomized to receive RRFT (n = 61) or TAU (n = 63). Main Outcomes and Measures: Primary outcomes focused on number of nontobacco substance-using days measured with the timeline follow-back method and PTSD symptom severity using the UCLA (University of California, Los Angeles) PTSD Reaction Index for DSM-IV completed by adolescents and caregivers. Secondary outcomes focused on marijuana, alcohol, and polysubstance use and PTSD criterion standard (re-experiencing, avoidance, and hyperarousal) symptom severity. Results: In all, 124 adolescents (mean [SD] age, 15.4 [1.3] years; 108 female [87.1%]) were randomized. For primary outcomes relative to TAU, RRFT yielded significantly greater reductions in substance-using days from baseline to month 12 (event rate [ER], 0.28; 95% CI, 0.12-0.65) and month 18 (ER, 0.10; 95% CI, 0.04-0.24). Significant reductions in PTSD symptoms were observed within groups for RRFT from baseline to months 3 (ß = -9.25; 95% CI, -12.95 to -5.55), 6 (ß = -16.63; 95% CI = -20.40 to -12.87), 12 (ß = -17.51; 95% CI, -21.62 to -13.40), and 18 (ß = -19.02; 95% CI, -23.07 to -14.96) and for TAU from baseline to months 3 (ß = -9.62; 95% CI, -13.16 to -6.08), 6 (ß = -13.73; 95% CI, -17.43 to -10.03), 12 (ß = -15.53; 95% CI, -19.52 to -11.55), and 18 (ß = -13.88; 95% CI, -17.69 to -10.09); however, between-group differences were not observed. Conclusions and Relevance: In this study, RRFT and TAU demonstrated within-group improvements in SUP and PTSD symptoms, with greater improvement for substance use and PTSD avoidance and hyperarousal symptoms among adolescents randomized to RRFT compared with TAU. No evidence of the worsening of SUP was observed in either condition. These results suggest that this exposure-based treatment is safe, feasibly delivered by community-based clinicians, and offers an effective approach to inform clinical practice. Trial Registration: ClinicalTrials.gov Identifier: NCT01751035.

Disaster Exposure and Mental Health Among Puerto Rican Youths After Hurricane Maria.

Importance: Quantifying the magnitude of disaster exposure and trauma-related symptoms among youths is critical for deployment of psychological services in underresourced settings. Hurricane Maria made landfall in Puerto Rico on September 20, 2017, resulting in massive destruction and unprecedented mortality. Objective: To determine the magnitude of disaster exposure and mental health outcomes among Puerto Rican youths after Hurricane Maria. Design, Setting, and Participants: Survey study in which a school-based survey was administered to each public school student at all schools in Puerto Rico between February 1 and June 29, 2018 (5-9 months after Hurricane Maria). Of the 226 808 students eligible to participate, 96 108 students completed the survey. Main Outcomes and Measures: Participants were assessed for exposure to hurricane-related stressors, posttraumatic stress disorder (PTSD), and depressive symptoms, using standardized self-report measures administered in Spanish. Descriptive statistics were compiled for all outcome variables, as was the frequency of individuals reporting clinically elevated symptoms of PTSD or depression. Differences in these statistics across sexes were also examined via t tests. Correlations between demographic, geographic, and main outcome variables were also calculated, and regressions were conducted to examine their association with symptoms of PTSD. Results: A total of 96 108 students participated in the study (42.4% response rate; 50.3% female), representative of grades 3 to 12 across all 7 educational regions of Puerto Rico. As a result of the hurricane, 83.9% of youths saw houses damaged, 57.8% had a friend or family member leave the island, 45.7% reported damage to their own homes, 32.3% experienced shortages of food or water, 29.9% perceived their lives to be at risk, and 16.7% still had no electricity 5 to 9 months after the hurricane. Overall, 7.2% of youths (n = 6900) reported clinically significant symptoms of PTSD; comparison of the frequency of reporting clinically elevated symptoms of PTSD across sex yielded a significant difference (t = 12.77; 95% CI of the difference, 0.018-0.025; P < .001), with girls (8.2%) exceeding the clinical cutoff score more often than boys (6.1%). Finally, similar analysis of differences in depression between sexes was also significant (t = 17.56; 95% CI of the difference, 0.31-0.39; P < .001), with girls displaying higher mean (SD) scores (2.72 [3.14]) than boys (2.37 [2.93]). Demographic and risk variables accounted for approximately 20% of variance in symptoms of PTSD (r2 = 0.195; 95% CI, 0.190-0.200). Conclusions and Relevance: Survey results indicate that Hurricane Maria exposed Puerto Rican youths to high levels of disaster-related stressors, and youths reported high levels of PTSD and depressive symptoms. Results are currently being used by the Puerto Rico Department of Education to inform targeted and sustainable evidence-based practices aimed at improving mental health outcomes for Puerto Rico's youths.

Immigration Trauma among Hispanic Youth: Missed by Trauma Assessments and Predictive of Depression and PTSD Symptoms.

Few quantitative studies have examined the rate of exposure to traumatic events during immigration among Hispanics or its relation to mental health outcomes. Failing to capture traumatic events that occur during immigration may impede investigations of trauma and related mental health disparities with Hispanics. In order to better understand the need for immigration-related trauma assessment, interviews were conducted with 131 immigrant Hispanic youth. First, youth completed a comprehensive trauma assessment interview. Items were added to the interview to assess if each traumatic event occurred during the process of immigration. An immigration-focused module was then added to the end of the assessment. A substantial minority of youths reported experiencing a traumatic event during immigration (n = 39; 29.8%). The majority of these were not captured by the standard trauma assessment (n = 32; 82.1% of those with in-transit trauma). Of these, the majority stated that the process of immigration itself was traumatic, but had not indicated experiencing any event assessed during the standard trauma assessment (n = 28; 87.5% of those with unidentified in-transit trauma). The traumatic events that were not captured during the standard trauma assessment significantly predicted both depression (p < .001) and PTSD symptoms (p = .012). Results suggest that standard trauma assessments may not capture traumatic events that occur during immigration for Hispanic youth. Failing to capture these events during trauma assessment may have large implications for research on trauma-related mental health disparities, as the events that were not captured overlapped significantly with depression and PTSD.

Pocas investigaciones cuantitativas han examinado la tasa de trauma que ocurre entre Hispanos durante el proceso de inmigración a los Estados Unidos. Cuando evaluaciones de trauma no capturan trauma de inmigración, puede impedir investigaciones de disparidades de salud mental y trauma para Hispanos. Para entender mejor la necesidad de incluir componentes de inmigración en evaluaciones de trauma, se entrevistaron 131 adolescentes Hispanos. Primero, los adolescentes cumplieron una entrevista comprensiva y estándar de trauma. Se añadieron preguntas a la entrevista para determinar si el evento ocurrió durante inmigración. Luego, se añadió una sección enfocada en inmigración. Una menoridad sustancial de adolescentes indicó trauma durante inmigración (n = 39; 29.8%). La mayoría de estos casos no se capturaron durante la evaluación estándar (n = 32; 82.1% de los quienes indicaron trauma durante inmigración). De estos, la mayoría indicaron que fue el proceso de inmigración que fue traumático (n = 28; 87.5% de los quienes no indicaron trauma durante la evaluación estándar). Los eventos los cuales no se capturaron en la evaluación estándar correlacionaron con síntomas ambos de depresión (p < .001) y estrés postraumático (p = .012). Los resultados sugieren que evaluaciones estándares de trauma no capturan eventos traumáticos que ocurren durante inmigración para adolescentes Hispanos. Además, el no capturar estos eventos tal vez tiene implicaciones para investigaciones de disparidades de trauma y salud mental, porque los eventos que no se capturaron correlacionaron con depresión y el estrés postraumático.

A Pilot Study of Trauma-Focused Cognitive-Behavioral Therapy Delivered via Telehealth Technology.

Significant barriers exist in access to evidence-based, trauma-focused treatment among youth from economically disadvantaged backgrounds, those living in rural areas, and belonging to a racial and ethnic minority group, despite the high prevalence rates of trauma exposure among these underserved groups. The present study is proof-of-concept pilot of trauma-focused cognitive-behavioral therapy (TF-CBT) delivered to underserved trauma-exposed youth ( N = 15) via telehealth technology (i.e., via one-on-one videoconferencing), aimed at addressing barriers in access to TF treatment. This pilot study provides preliminary evidence of the ability to successfully deliver TF-CBT via a telehealth delivery format. Results demonstrated clinically meaningful symptom change posttreatment (large effect sizes for youth-reported ( d = 2.93) and caregiver-reported ( d = 1.38) reduction in posttraumatic stress disorder symptoms), with no treatment attrition (0% dropout). These findings are promising in showing treatment effects that are comparable with TF-CBT delivered in an in-person, office-based setting and an important first step in determining how to best address the mental health needs of trauma-exposed youth with barriers in access to care.

Efficacy of Naltrexone for the Treatment of Alcohol Dependence in Latino Populations.

OBJECTIVE: Naltrexone has been identified as a promising psychopharmacological treatment for alcohol dependence. Previous studies have suggested that its efficacy may vary based on ethnic background. The current study examined the efficacy of naltrexone in the treatment of alcohol dependence in Latino adults, a previously unexplored population. METHOD: This was a secondary analysis of the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study. The overall COMBINE sample consisted of 1,383 adult participants who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for alcohol dependence, including 155 Latinos, who are the focus of this report. Consistent with the main trial, primary drinking outcomes, including percentage of days abstinent (PDA) and time to first heavy drinking day (TTHD), were examined. In addition, we examined the effects of naltrexone on a clinically relevant secondary outcome measure, global clinical outcome of alcohol consumption and alcohol-related problems. RESULTS: As seen with the subsample of African Americans from the COMBINE Study, results of the present analysis indicated that there were no significant effects of naltrexone on PDA and TTHD despite these significant effects in the original study. However, contrary to findings in the African American subsample, for Latino participants naltrexone was a significant predictor of a good global clinical outcome (i.e., abstinence or moderate drinking without problems). CONCLUSIONS: Naltrexone was not significantly associated with improvements in the primary drinking outcomes of PDA or TTHD at the end of treatment or at follow-up. However, Latinos appeared to benefit from naltrexone as demonstrated by improved ratings of global clinical outcome. These results indicate mixed findings for the efficacy of naltrexone among Latinos in the COMBINE Study.

Racial/ethnic differences in trauma exposure and mental health disorders in adolescents.

OBJECTIVE: Research has cited increased prevalence of mood disorders, anxiety disorders, and exposure to interpersonal violence for Hispanics and non-Hispanic Black adolescents, as well as ethnic differences in externalizing behavior (e.g., substance use, delinquency). The current study combined these areas by examining racial/ethnic differences in mental health correlates of trauma exposure. METHOD: Interviews were conducted to assess polyvictimization, posttraumatic stress disorder (PTSD), major depressive disorder (MDD), substance use, and delinquency in a nationally representative sample of adolescents (N = 3,614; 15.4% non-Hispanic Black; 11.3% Hispanic; 64.9% non-Hispanic White). RESULTS: Hispanic and non-Hispanic Black adolescents endorsed greater polyvictimization than non-Hispanic Whites; however, differences in MDD and PTSD were only significant when assessed with symptom counts. Non-Hispanic Black adolescents reported the least drug use. Non-Hispanic Black and Hispanic adolescents endorsed more delinquency than non-Hispanic White adolescents. Polyvictimization only accounted for ethnic disparities in delinquency. CONCLUSION: Trauma-related disparities may differ across internalizing and externalizing concerns. Subsequent research should continue to examine other factors that may contribute to racial/ethnic differences in trauma sequelae. (PsycINFO Database Record

Polyvictimization, income, and ethnic differences in trauma-related mental health during adolescence.

PURPOSE: The purpose of the present study was to investigate ethnic differences in trauma-related mental health symptoms among adolescents, and test the mediating and moderating effects of polyvictimization (i.e., number of types of traumas/victimizations experienced by an individual) and household income, respectively. METHODS: Data were drawn from the first wave of the National Survey of Adolescents-replication study (NSA-R), which took place in the US in 2005 and utilized random digit dialing to administer a telephone survey to adolescents ages 12-17. Participants included in the current analyses were 3312 adolescents (50.2 % female; mean age 14.67 years) from the original sample of 3614 who identified as non-Hispanic White (n = 2346, 70.8 %), non-Hispanic Black (n = 557, 16.8 %), or Hispanic (n = 409, 12.3 %). Structural equation modeling was utilized to test hypothesized models. RESULTS: Non-Hispanic Black and Hispanic participants reported higher levels of polyvictimization and trauma-related mental health symptoms (symptoms of posttraumatic stress and depression) compared to non-Hispanic Whites, though the effect sizes were small (γ ≤ 0.07). Polyvictimization fully accounted for the differences in mental health symptoms between non-Hispanic Blacks and non-Hispanic Whites, and partially accounted for the differences between Hispanics and non-Hispanic Whites. The relation between polyvictimization and trauma-related mental health symptoms was higher for low-income youth than for high-income youth. CONCLUSIONS: Disparities in trauma exposure largely accounted for racial/ethnic disparities in trauma-related mental health. Children from low-income family environments appear to be at greater risk of negative mental health outcomes following trauma exposure compared to adolescents from high-income families.

Trauma-focused cognitive-behavioral therapy for children and adolescents: assessing the evidence.

OBJECTIVE: Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a conjoint parent-child treatment developed by Cohen, Mannarino, and Deblinger that uses cognitive-behavioral principles and exposure techniques to prevent and treat posttraumatic stress, depression, and behavioral problems. This review defined TF-CBT, differentiated it from other models, and assessed the evidence base. METHODS: Authors reviewed meta-analyses, reviews, and individual studies (1995 to 2013). Databases surveyed were PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, PILOTS, the ERIC, and the CINAHL. They chose from three levels of research evidence (high, moderate, and low) on the basis of benchmarks for number of studies and quality of their methodology. They also described the evidence of effectiveness. RESULTS: The level of evidence for TF-CBT was rated as high on the basis of ten RCTs, three of which were conducted independently (not by TF-CBT developers). TF-CBT has demonstrated positive outcomes in reducing symptoms of posttraumatic stress disorder, although it is less clear whether TF-CBT is effective in reducing behavior problems or symptoms of depression. Limitations of the studies include concerns about investigator bias and exclusion of vulnerable populations. CONCLUSIONS: TF-CBT is a viable treatment for reducing trauma-related symptoms among some children who have experienced trauma and their nonoffending caregivers. Based on this evidence, TF-CBT should be available as a covered service in health plans. Ongoing research is needed to further identify best practices for TF-CBT in various settings and with individuals from various racial and ethnic backgrounds and with varied trauma histories, symptoms, and stages of intellectual, social, and emotional development.

Guidelines for establishing a telemental health program to provide evidence-based therapy for trauma-exposed children and families.

Although similar rates of traumatic experiences exist in both rural and urban settings, mental health resources available to those living in rural areas are often scarce. Limited resources pose a problem for children and families living in rural areas, and several barriers to service access and utilization exist including reduced anonymity, few "after hours" services, decreased availability of evidence-based treatments, few specialty clinics, and expenses associated with travel, taking time off work, and provision of childcare. As a solution, the authors discuss the utility, use, and set-up of a telemental health program within an existing community outreach program. Suggestions for establishing a telemental health clinic are presented along with guidelines for the delivery of trauma-focused, cognitive-behavioral therapy (TF-CBT) via telemental health videoconferencing technology. Specific guidelines discussed include (1) establishing and using community partnerships, (2) Memoranda of Understanding (MOU), (3) equipment setup and technological resources, (4) videoconferencing software, (5) physical setup, (6) clinic administration, (7) service reimbursement and start-up costs, (8) therapy delivery modifications, and (9) delivering culturally competent services to rural and remote areas.

Peritraumatic dissociation and peritraumatic emotional predictors of PTSD in Latino youth: results from the Hispanic family study.

This is the 1st study to examine peritraumatic dissociation and peritraumatic emotions as they predict symptoms and diagnosis of posttraumatic stress disorder (PTSD) in Latino youth. Our aim was to test the hypothesis that the degree of peritraumatic dissociation would predict the number of PTSD symptoms and PTSD clinical diagnosis when the influences of other salient factors were statistically controlled. We also explored the possible contributions of peritraumatic emotional responses to PTSD symptomatology and PTSD diagnosis. We expected that peritraumatic dissociation would emerge as a significant predictor of PTSD. A total of 204 Latino youth (mean age = 12.37 years) completed semistructured individual clinical interviews with bilingual research assistants. These interviews assessed trauma exposure, peritraumatic responses, and current psychopathology. A linear regression analysis demonstrated significant relationships between lifetime number of traumatic events, peritraumatic dissociation, shame, and number of PTSD symptoms endorsed. Significant inverse (protective) relationships were demonstrated between anger and guilt and current PTSD symptomatology. Logistic regression analysis demonstrated significant relationships between peritraumatic dissociation, shame, lifetime number of traumatic events experienced, and PTSD diagnosis. The analyses examined both the number of PTSD symptoms as well as diagnosis of PTSD while simultaneously controlling for age, lifetime exposure to traumatic events, time residing in the United States, and gender. These results support an increasingly robust body of empirical literature suggesting that the peritraumatic dissociative and emotional responses to trauma are important predictors of future PTSD diagnosis. Possible cultural factors contributing to the dissociative responses in Latino youth and clinical implications are discussed.

Reducing substance use risk and mental health problems among sexually assaulted adolescents: a pilot randomized controlled trial.

The current study reports results from a pilot randomized controlled trial evaluating the feasibility and efficacy of Risk Reduction through Family Therapy (RRFT) for reducing substance use risk and trauma-related mental health problems among sexually assaulted adolescents. Thirty adolescents (aged 13-17 years; M = 14.80; SD = 1.51) who had experienced at least one sexual assault and their caregivers were randomized to RRFT or treatment as usual (TAU) conditions. Participants completed measures of substance use, substance use risk factors (e.g., family functioning), mental health problems (i.e., posttraumatic stress disorder, depression, and general internalizing/externalizing symptoms) and risky sexual behavior at four time points (baseline, posttreatment, and 3- and 6-month follow-up). Mixed-effects regression models yielded significantly greater reductions in substance use, specific substance use risk factors, and (parent-reported) PTSD, depression, and general internalizing symptoms among youth in the RRFT condition relative to youth in the TAU condition. However, significant baseline differences in functioning between the two conditions warrant caution in interpreting between-groups findings. Instead, emphasis is placed on replication of feasibility findings and within-group improvements over time among the RRFT youth.

Parental child abuse potential and subsequent coping competence in disadvantaged preschool children: moderating effects of sex and ethnicity.

This study evaluated the effects of abuse potential in parents on subsequent coping competence domains in their children, using a model empirically supported in a high-risk community sample by Moreland and Dumas (2007). Data from an ethnically diverse sample of 579 parents enrolled in the PACE (Parenting Our Children to Excellence) program was used to evaluate whether parental child abuse potential assessed at pre-intervention negatively contributed to child affective, achievement, and social coping competence in preschoolers one year later, and whether these associations were moderated by sex or ethnicity. Cross-sectional results indicated that parental child abuse potential was negatively related to child affective and achievement coping competence, after accounting for variance associated with child behavior problems. However, child abuse potential was not predictive of subsequent coping competence in any domain after controlling for previous levels of child coping competence. No moderating effects were found for sex and ethnicity, but results showed main effects of sex and ethnicity in cross-sectional analyses. Clinical implications and future directions are discussed.

Ethnicity differences in child and parental outcomes following involvement the PACE program.

This study investigated ethnic differences in the extent to which engagement (i.e., attendance and quality of participation) in the PACE (Parenting our Children to Excellence) program predicted positive child and parent outcomes. PACE is an 8-week preventive intervention aimed at parents of preschool children. The study investigated the relation of engagement to outcomes in an ethnically diverse sample of 298 African American and 280 European American parents. Overall results demonstrated that engagement in PACE significantly improved child and parent outcomes for both African American and European American participants. Some improvements were evident at post-assessment already and were maintained or became stronger at a one-year follow-up assessment, whereas others only became evident at follow-up. Specifically, results revealed that attendance in PACE significantly improved child coping competence and parenting stress for both the African American and European American samples. PACE attendance also significantly improved child behavior problems, parental satisfaction and parental efficacy for the European American sample. Findings indicate that PACE is a promising intervention for parents of African American and Caucasian preschoolers; although further research and program refinement is necessary in order to understand the mechanisms with the PACE intervention that seem to vary for African American compared to Caucasian families.

Rural adults' use of health-related information online: data from a 2006 National Online Health Survey.

OBJECTIVE: The objective of this study was to examine access and use of health-related information online in rural versus nonrural Internet users, using national data from the 2006 Pew Internet and American Life Project. MATERIALS AND METHODS: A national telephone survey of 2,928 adults in August 2006 yielded a sample of 1,992 adults who use the Internet regularly. A structured interview was administered to assess frequency of Internet use and access and use of health-related information online. RESULTS: Most Internet-using rural adults search for health-related information online; two-thirds seek information about specific medical problems and over half seek information about treatment. Three-fifths of rural adults surveyed stated that online health-related information affected the decisions they made in health maintenance and managing treatment of an illness. More than one-third reported being significantly helped by information they found, whereas one-fourth reported being confused. Comparisons between rural and nonrural Internet users suggested that rural users were more likely to seek information about smoking cessation (χ(2)[1, N=1,990]=7.91, p<0.01) and mental health issues (χ(2)[1, N=1,988]=3.71, p=0.05), less likely to seek information about a particular doctor or hospital (χ(2)[1, N=1,983]=15.49, p<0.001), and more likely to report being helped (χ(2)[1, N=1,534]=5.24, p<0.05)-but also confused (χ(2)[1, N=1,592]=9.83, p<0.01)-by information they found. CONCLUSIONS: Rural Americans are increasingly using the Internet to acquire information about chronic disease, mental health, doctors, and treatment options. Priorities should include further development and rigorous evaluation of online resources to ensure high-quality, more direct tailoring of resources to rural families and development of tools to assist consumers in assessing the credibility of online information.

Risk reduction for substance use and trauma-related psychopathology in adolescent sexual assault victims: findings from an open trial.

Limited attention has been paid to the development and evaluation of interventions that reduce risk for substance use, while also targeting trauma-related psychopathology among maltreated adolescents. Risk Reduction through Family Therapy (RRFT) is a multicomponent treatment that integrates principles and interventions from existing empirically supported treatments. The purpose of the current study was to evaluate the feasibility of implementation and initial efficacy of RRFT through an open pilot trial involving a small sample (N = 10) of female adolescents (aged 13-17 years) who had experienced at least one memorable sexual assault in their lifetime. Measures of substance use and substance use risk factors (e.g., family functioning), posttraumatic stress disorder (PTSD), and depression symptoms were assessed pre- and posttreatment as well as at 3-month and 6-month posttreatment follow-up assessments. Results demonstrated reductions in multiple areas, including substance use and related risk factors, PTSD, and depression symptoms, which were maintained through follow-up. Clinical implications and future directions with this line of research are discussed.