Black Moms Matter: A Qualitative Approach to Understanding Barriers to Service Utilization at a Children's Advocacy Center Following Childhood Abuse.

Black families are significantly less likely to receive evidence-based trauma treatment services; however, little is known about factors impacting engagement, particularly at Children's Advocacy Centers (CACs). The goal of this study is to better understand barriers and facilitators of service utilization for Black caregivers of CAC referred youth. Participants (n = 15) were randomly selected Black maternal caregivers (ages 26-42) recruited from a pool of individuals who were referred to receive CAC services. Black maternal caregivers reported barriers to accessing services at CACs including a lack of assistance and information in the referral and onboarding process, transportation issues, childcare, employment hours, system mistrust, stigma associated with the service system, and outside stressors such as stressors related to parenting. Maternal caregivers also shared suggestions for improving services at CACs including increasing the length, breadth, and clarity of investigations conducted by child protection services and law enforcement (LE) agencies, providing case management services, and having more diverse staff and discussing racial stressors. We conclude by identifying specific barriers to the initiation and engagement in services for Black families, and we provide suggestions for CACs seeking to improve engagement of Black families referred for trauma-related mental health services.

Preliminary findings of problematic sexual behavior-cognitive-behavioral therapy for adolescents in an outpatient treatment setting.

BACKGROUND: The lack of empirical support for interventions commonly used to treat adolescents with problematic sexual behaviors (PSB) has led to restrictive policies and interventions largely based on perceptions of these youth as younger versions of adult sex offenders, without consideration for developmental and etiological differences between populations. OBJECTIVE: This study's aim is to evaluate a low-intensity outpatient treatment regarding the reduction of internalizing symptoms and externalizing behaviors to include, PSB. PARTICIPANTS & SETTING: The study examined outcomes for 31 adolescents who completed Problematic Sexual Behavior - Cognitive Behavioral Therapy for Adolescents (PSB-CBT-A) at a Children's Advocacy Center between 2013 and 2016. METHODS: Evaluation of PSB and other symptomology was conducted through pre- and post-treatment administration of standardized instruments. RESULTS: Adolescent PSB-CBT-A treatment completers demonstrated a trend towards statistical significance in reduction of PSB on the YSBPI from 5.33 (SD = 6.86) at pre-treatment to 0.17 (SD = 0.41) at completion. Additionally, significant reductions in caregiver-reported youth internalizing and externalizing problems were associated outcomes of completing PSB-CBT-A (t(13) = 5.00, p < .001 and t(13) = 2.34, p = .036, respectively). CONCLUSIONS: The promising results achieved in this study support further exploration of low-intensity outpatient treatment interventions for adolescents with PSB.

Sociodemographic and Incident Variables as Predictors of Victim Injury From Intimate Partner Violence: Findings From Police Reports.

Predictors of victim injury from intimate partner violence (IPV) were investigated using 1,292 police reports collected in South Carolina in 2009/2010. All cases were opposite sex adults. Results from bivariate statistics showed that IPV cases with ( n = 649) and without visible injuries ( n = 643) differed on victim gender, victim race, type of relationship, and perpetrator's alcohol use. Results from a logistic regression analysis predicting victim injury showed higher odds ratios for males, Whites, and couples identified as cohabitants. Although most victims, including most injured victims, were Black women, males and Whites were overrepresented in the injured group.

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.

The Structured Trauma-Related Experiences and Symptoms Screener (STRESS): Development and Preliminary Psychometrics.

The Structured Trauma-Related Experiences and Symptoms Screener (STRESS) is a self-report instrument for youth of age 7-18 that inventories 25 adverse childhood experiences and potentially traumatic events and assesses symptoms of post-traumatic stress disorder using the revised criteria published in the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5). The STRESS can be administered by computer such that questions are read aloud and automatic scoring and feedback are provided. Data were collected on a sample of 229 children and adolescents of age 7-17 undergoing a forensic child abuse and neglect evaluation. The purpose of the current study was to examine preliminary psychometric characteristics of the computer-administered STRESS as well as its underlying factor structure in relation to the four-factor DSM-5 model. Results provide initial support for the use of the STRESS in assessing adverse and potentially traumatic experiences and traumatic stress in children and adolescents.

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.

Veterans' attitudes toward work and disability compensation: associations with substance abuse.

INTRODUCTION: Veterans deemed disabled for conditions resulting from, or aggravated by, their service in the military are eligible for service-connected disability payments. Despite many positive effects of disability payments, one concern is that Veterans with psychiatric conditions who receive disability payments are less likely to be employed compared to those who are denied benefits. Little is known about the attitudes of substance using Veterans, for whom work is a particularly important part of recovery, toward work and disability compensation. METHODS: This study compared the responses of Veterans with (n=33) and without substance use problems (n=51) to questions about work's significance and its relationship to disability payments. T- and chi-square tests were conducted to determine if Veterans with substance use problems differed from the others on work-related attitudes and perceptions of the relation between work and Veterans' benefits. RESULTS: Veterans endorsed high levels of agreement with statements that working would lead to loss of benefits. Veterans with substance use agreed more strongly that they would rather turn down a job offer than lose financial benefits. CONCLUSIONS: The greater preference for disability payments among substance-using Veterans may reflect a realistic concern that they are particularly likely to have difficulty maintaining employment. The widespread concern among Veterans that work will lead to loss of VA disability payments is striking given the ambiguity about how likely loss of benefits actually is, and should be addressed during the service-connection application process.

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.

Cognitive, affective, and behavioral responses to witnessed versus experienced violence.

Cognitive, affective, and behavioral responses to experiencing or witnessing violence were examined in a sample of 263 inner-city youth (94% African American, 49% male, M(age) = 12.06, SD = 1.61, 52% 5th graders, 48% 8th graders). The youth participated in Wave 1 of a larger, longitudinal study for which they completed the Social Competence Interview (SCI; Ewart, Jorgensen, Suchday, Chen, & Matthews, 2002), a process whereby the youth relive witnessing or experiencing a recent act of violence. The interview was audiotaped and coded for emotional responses, goals, and coping behaviors. Adolescents who had been victimized were angry; expressed concerns about being negatively evaluated by self and others; expressed revenge goals; and coped by using primary engagement, social support, and aggressive strategies. Adolescents who had witnessed violence were fearful, concerned about others being harmed and losing relationships, focused on survival, and coped by using avoidant strategies. Responses were similar across gender. Where interactions existed, differences between responses to victimization and witnessing violence were more pronounced among middle, versus early, adolescents. These results suggest that more attention should be given to coping processes associated with the different types of violence youth encounter.

The longitudinal consistency of mother-child reporting discrepancies of parental monitoring and their ability to predict child delinquent behaviors two years later.

This study examined the longitudinal consistency of mother-child reporting discrepancies of parental monitoring and whether these discrepancies predict children's delinquent behaviors 2 years later. Participants included 335 mother/female-caregiver and child (46% boys, >90% African American; age range 9-16 years [M = 12.11, SD = 1.60]) dyads living in moderate-to-high violence areas. Mother-child discrepancies were internally consistent within multiple assessment points and across measures through a 2-year follow-up assessment. Further, mothers who at baseline consistently reported higher levels of parental monitoring relative to their child had children who reported greater levels of delinquent behaviors 2 years later, relative to mother-child dyads that did not evidence consistent discrepancies. This finding could not be accounted for by baseline levels of the child's delinquency, maternal and child emotional distress, or child demographic characteristics. This finding was not replicated when relying on the individual reports of parental monitoring to predict child delinquency, suggesting that mother-child reporting discrepancies provided information distinct from the absolute frequency of reports. Findings suggest that mother-child discrepancies in reports of parental monitoring can be employed as new individual differences measurements in developmental psychopathology research.

Whose depression relates to discrepancies? Testing relations between informant characteristics and informant discrepancies from both informants' perspectives.

This study examined whether mothers' and children's depressive symptoms were each uniquely related to mother-child rating discrepancies on a multidimensional dyadic construct: domains associated with parental monitoring (i.e., Child Disclosure, Parental Knowledge, and Parental Solicitation). Participants included a community sample of 335 mother/female-caregiver and child dyads (182 girls, 153 boys; 9-16 years old). Children's depressive symptoms were consistently related to each of the three domains of mother-child discrepancies. Mothers' depressive symptoms were related to perceived discrepancies in two domains (Child Disclosure and Parental Knowledge). Furthermore, these relations could not be accounted for by other informant characteristics (maternal stress, child age, child gender, child ethnicity). Findings provide important empirical support for theory suggesting that both informants' perspectives meaningfully contribute to their discrepancies in perceived behavior. Consideration of both informants' perspectives leads to valuable information as to whether any particular characteristic is an important correlate of discrepancies.

Screening and prevention of alcohol and drug use disorders in women.

Today a variety of treatments are available for women with SUDs. They range from psychosocial interventions such as motivational enhancement therapy, cognitive-behavioral therapy, and 12-step recovery to pharmacotherapies such as buprenorphine, methadone, and naltrexone. Although the general public remains skeptical of SUD treatment, national studies consistently find it to be both clinically and economically efficacious. In Oregon, for example, researchers found that every dollar invested in drug treatment saved taxpayers dollars 5.60. By the time a woman walks through the door of a drug treatment program, however, her disorder is likely to be firmly engrained. The medical practitioner's office provides an ideal setting for screening and early identification of high-risk alcohol and other drug use and abuse. A variety of reliable and valid self-report measures are available. Sadly, however, the majority of health providers still do not routinely screen patients for alcohol or drug problems. The consequences can be severe, particularly for women. Although efforts have focused on practitioner education and strategies to address practical barriers to implementation (eg, time, resources), much less attention has focused on the pessimistic views of practitioners about SUDs and treatment efficacy. New strategies are needed to enhance practitioner feelings of self-efficacy about their ability to identify and intervene early in the progression from alcohol use to abuse to dependence.