Implementing trauma-informed care in a special education setting: An initial exploration of a multi-tiered model.

Implementing trauma-informed care in a special education environment serving youth from historically marginalized communities with high levels of exposure to potentially traumatic events (PTEs) requires a systematic tiered approach consistent with public health guidelines. Little is known about the implementation of this framework in special education settings where youth have significant emotional and behavioral difficulties. To address this need, a consultant-community partnership was forged between a hospital providing mental health services and a therapeutic day school that serves a special education cooperative. The current case study explores the design and implementation of a three-tiered model of trauma-informed care in a special education setting. This study will address the specific practices implemented at each tier, discuss successes and challenges, and summarize future directions for research, practice, and policy.

Parental Attitudes on Social Media Monitoring for Youth: Cross-Sectional Survey Study.

Background: Online environments dominate the daily lives of American youth and pose evolving challenges to their health and well-being. Recent national poll data indicate that social media overuse, internet safety, and online bullying are among parents' top child health concerns, particularly during the COVID-19 pandemic. While parents are uniquely positioned to help youth navigate social media, their attitudes on monitoring media use may be impacted by a myriad of personal and family factors. Objective: This study aimed to examine factors associated with parental attitudes about monitoring social media use among youth. Methods: Data were analyzed from the Voices of Child Health in Chicago Parent Panel Survey, administered to parents over the web and by telephone. Parents with at least 1 child aged ≥11 years responded to questions about bullying and social media monitoring from May to July 2020. The primary outcome was their response to the following question: "Do you think parents should monitor their children's use of social media platforms such as Facebook, Twitter, and Instagram?" Bivariate analyses and multivariable logistic regression were used to examine parental agreement with frequent social media monitoring and concerns about bullying, adjusted for sociodemographic characteristics. Analyses were weighted to represent the parent population of Chicago. Results: Among 1613 survey respondents, the analyzed sample included 808 parents with at least 1 child aged ≥11 years. Overall, 62.9% (n=566) of parents agreed with frequent parental monitoring of their children's social media use. Compared with parents aged ≤35 years, parents who were >35 years old were significantly less likely to agree with frequent social media monitoring (adjusted odds ratio [aOR] 0.45, 95% CI 0.25-0.81). Parents expressing a high level of concern regarding the effects of bullying were more likely to agree with frequent monitoring of youth social media (aOR 2.15, 95% CI 1.24-3.73). Conclusions: Parents' personal characteristics and concerns about bullying may influence their attitudes toward monitoring social media use among youth. Given the potential impact of these attitudes on parental monitoring behaviors and the subsequent health impact on youth, pediatricians should consider these factors when counseling about bullying and social media. Child health professionals can support families in developing a safe media use plan that fits family circumstances.

Potentially Traumatic Events, Socioemotional and Adaptive Functioning: Associations with Self-Regulatory Skills in a Community Sample of Primarily Black and Latinx 3-5-year-olds.

Early childhood is a heightened risk period for exposure to potentially traumatic events (PTEs) and a critical period for the development of foundational self-regulatory competencies that have potential cascading effects on future socioemotional functioning. This cross-sectional study examined associations between PTE exposure and socioemotional and adaptive functioning, and self-regulatory skills, in a community-based sample of 280 primarily Black and Latinx 3-5-year-olds. Results supported direct relations between PTE exposure and socioemotional and adaptive functioning. Attentional regulation was associated with PTEs and internalizing behaviors, externalizing behaviors, and adaptive behaviors. There was also a significant association of emotional regulation on the relationship between PTEs and internalizing and externalizing behaviors, but not adaptive functioning. Findings have implications for early intervention and educational and public policy, including the importance of scaffolding the development of self-regulatory skills among preschoolers with high PTE exposure.

Acceptability and initial promise of trainings for community stakeholders serving refugee and immigrant families.

Cumulative traumatic migration experiences are compounded by escalating chronic distress related to the current sociopolitical climate for refugee and immigrant children and families. The aim of this open trial was to conduct a preliminary evaluation of You're Not Alone, a rapidly mounted, strengths-based, community-focused capacity building training initiative for stakeholders interacting with refugee and immigrant children and families in the Chicago area. Trainings, based on Trauma-Informed Care (TIC) and psychological first aid frameworks, adapted education and universal health promotion strategies for population-specific chronic traumatic stress. Two groups of participants (N = 948), who attended either mandatory (n = 659 educators) or voluntary (n = 289 community stakeholders) trainings, completed surveys at pretraining, post-training, and 6-week follow-up. Outcome indices included participant satisfaction, acceptability of training model, and changes in knowledge, attitudes, and behaviors. Over 90% of participants reported satisfaction and acceptability of trainings. For educators, hierarchical linear modeling analyses demonstrated significant increases in trauma knowledge, refugee and immigrant-specific knowledge, positive attitudes toward TIC over time, and a decrease in negative attitudes toward immigrants. Over 95% of participants indicated that they learned and intended to use new strategies to help serve refugee and immigrant children and families. At follow-up, over 80% of those who completed the survey had utilized at least one strategy, and over 55% indicated that they were using resources that they learned about in the training. This study demonstrates that capacity-building trainings swiftly developed and disseminated to community stakeholders can produce positive change in knowledge, attitudes, and practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The impact of COVID-19 on immigrant and refugee families: Qualitative perspectives from newcomer students and parents.

COVID-19 has exacerbated the challenges that newcomer refugee and immigrant families face. While many of the supports that schools typically offer were disrupted by the pandemic, school-based assistance remains critical in this challenging context. In addition to education-related challenges, many newcomer families have been disproportionately impacted across financial, employment, and health contexts. The present study highlights the perspectives of newcomer families to understand their experiences, stressors, and ability to cope during the pandemic, as well as how their school communities can offer support to mitigate the potential for increased disparities. Qualitative interviews were conducted with 14 parents (Mage = 38.68) and 13 students (Mage = 14.31) engaged in a school-based intervention for newcomer students. Among students, 71.4% were identified as male, and the majority of caregivers were mothers (85.7%). Newcomer families reported significant challenges due to COVID-19, including difficult social-emotional adjustment, financial challenges, and significant academic difficulties. Themes also emerged related to sources of support and coping. Implications for how schools can further support newcomer families given these challenges and strengths are considered. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

You're not alone: A public health response to immigrant/refugee distress in the current sociopolitical context.

Recent political events and policy changes in the United States have fueled antirefugee/immigrant rhetoric and an increase of xenophobic harassment and intimidation, which together present a significant threat to the physical and mental health of refugee/immigrant children and families. This article aims to provide an overview of how the current sociopolitical context threatens the public health of refugee and immigrant communities and to describe the role of psychologists in advocating for social justice and responding to this urgent public health need through interprofessional collaboration and translation of scientific knowledge into multilevel intervention development. The case study of the You're Not Alone (YNA) initiative describes swiftly mobilized advocacy efforts (e.g., press conference, webinars, resources development and dissemination) and participatory development and roll-out of community capacity-building trainings to address the needs of refugee/immigrant children and families. Trainings aimed to raise awareness of the refugee/immigrant experience and to equip refugee/immigrant community members and providers across a variety of public sectors to implement culturally responsive and trauma-informed strategies to promote resilience, respond to distress, and prevent mental health crises. Between March 2017 and June 2018, a total of 1,642 individuals attended 48 training events. The role of psychologists in future policy and advocacy efforts to promote mental health among refugee/immigrant families is discussed as well as implications for how other marginalized communities affected by the current sociopolitical climate might benefit from broadening the scope of this public health response. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Working on Womanhood (WOW): A participatory formative evaluation of a community-developed intervention.

The well-documented disparities in availability, accessibility, and quality of behavioral health services suggest the need for innovative programs to address the needs of ethnic minority youth. The current study aimed to conduct a participatory, formative evaluation of "Working on Womanhood" (WOW), a community-developed, multifaceted, school-based intervention serving primarily ethnic minority girls living in underserved urban communities. Specifically, the current study aimed to examine the feasibility, acceptability, and initial promise of WOW using community-based participatory research (CBPR) and represented the third phase of a community-academic partnership. Qualitative and quantitative data were collected from 960 WOW participants in 21 urban public schools, as well as WOW counselors, parents, and school staff over the course of one academic year. Results demonstrated evidence of acceptability of WOW and noteworthy improvements for WOW participants in targeted outcomes, including mental health, emotion regulation, and academic engagement. Findings also indicated several challenges to implementation feasibility and acceptability, including screening and enrollment processes and curriculum length. Additionally, we discuss how, consistent with participatory and formative research, findings were used by program implementers to inform program improvements, including modifications to screening processes, timelines, curriculum, and trainings - all in preparation for a rigorous effectiveness evaluation.

Implementing the Bounce Back trauma intervention in urban elementary schools: A real-world replication trial.

The current study provides the first replication trial of Bounce Back, a school-based intervention for elementary students exposed to trauma, in a different school district and geographical area. Participants in this study were 52 1st through 4th graders (Mage = 7.76 years; 65% male) who were predominately Latino (82%). Schools were randomly assigned to immediate treatment or waitlist control. Differential treatment effects (Time × Group Interaction) were found for child-reported posttraumatic stress disorder (PTSD) and parent-reported child coping, indicating that the immediate treatment group showed greater reductions in PTSD and improvements in coping compared with the delayed group. Differential treatment effects were not significant for depression or anxiety. Significant maintenance effects were found for both child-reported PTSD and depression as well as parent-reported PTSD and coping for the immediate treatment group at follow-up. Significant treatment effects were also found in the delayed treatment group, showing reductions in child-reported PTSD, depression, and anxiety as well as parent-reported depression and coping upon receiving treatment. In conclusion, the current study suggests that Bounce Back is an effective intervention for reducing PTSD symptoms and improving coping skills, even among a sample experiencing high levels of trauma and other ongoing stressors. (PsycINFO Database Record

A pilot demonstration of comprehensive mental health services in inner-city public schools.

BACKGROUND: National policy statements increasingly espouse the delivery of comprehensive mental health services in schools. In response to the limited evidence supporting this recommendation, the purpose of this study was to assess the need for, and feasibility, desirability, and outcomes of a full model of comprehensive mental health services in 2 public elementary schools in inner-city neighborhoods. METHODS: The program, based upon a national model for comprehensive school mental health services, comprised universal and indicated preventive as well as clinical interventions designed to target needs identified in a baseline screening survey. The program was implemented over 1 school year by mental health professionals in collaboration with school teachers. Mental health outcomes comparing baseline to follow-up data were assessed in multiple domains among students and teachers. RESULTS: After 1 year of intervention, students had significantly fewer mental health difficulties, less functional impairment, and improved behavior, and reported improved mental health knowledge, attitudes, beliefs, and behavioral intentions. Teachers reported significantly greater proficiency in managing mental health problems in their classrooms. School staff overwhelmingly endorsed satisfaction with the program. CONCLUSION: If the observed favorable findings from this pilot demonstration can be replicated in methodologically rigorous studies, additional support would be garnered for national policy recommendations about comprehensive school mental health services.

Predictor and moderator effects in the treatment of oppositional defiant disorder in pediatric primary care.

OBJECTIVE: To examine predictors and moderators of parent-training outcomes for treatment of Oppositional Defiant Disorder (ODD) in pediatric primary care. METHODS: Parents of 117 children with ODD, ages 3-6 years, seen in primary care received either a minimal intervention bibliotherapy treatment (MIT), or a 12-session parenting program led by a nurse or psychologist. RESULTS: More initial total life stress, parenting distress, internalizing problems, functional impairment, and difficult temperament were associated with more improvement, but families scoring lower on those variables had fewer behavior problems at posttreatment and follow-up. Gender was a significant moderator, with more improvement for girls than boys in the nurse-led group but more improvement for boys than girls in the MIT group. Less well-educated mothers treated by psychologists showed the greatest change. CONCLUSIONS: Predictors and moderators may play a role in deciding, which families receive a particular form of treatment for ODD in primary care.

Treating oppositional defiant disorder in primary care: a comparison of three models.

OBJECTIVE: To determine if a nurse-led or psychologist-led parent-training program was more successful than a minimal intervention in treating early childhood Oppositional Defiant Disorder (ODD) in pediatric primary care. METHODS: Twenty-four practices were randomized to conditions in which parents of 117, 3- to 6.11-year-olds with ODD received the 12-session Webster-Stratton Incredible Years program led by primary care nurses or clinical psychologists, or to a minimal intervention group in which parents received only the companion book to the treatment program. RESULTS: There was improvement across posttreatment and 12-month follow-up for all groups, but no overall treatment group effects. There was a dose effect, with a reliable, clinically significant gain after seven sessions on the Eyberg intensity scale, and nine sessions on the Child Behavior Checklist externalizing scale. CONCLUSIONS: There is little advantage to the therapist-led treatment over bibliotherapy unless parents attend a significant number of sessions.