[Rapid assistance for victims of acute violence-Current treatment in outpatient trauma clinics in Germany]. / Schnelle Hilfen für Betroffene von akuter Gewalt ­ aktuelle Versorgung in Traumaambulanzen in Deutschland.

BACKGROUND: Assistance following acute violence was previously regulated by the Victim Compensation Act (OEG). At the beginning of the current year it was replaced by the Social Code XIV (SGB XIV). The SGB XIV defines new groups of beneficiaries, outpatient trauma clinics must be provided nationwide and binding criteria for the quality of care were established. The aim of this study was to map the current status of care in outpatient trauma clinics in accordance with the requirements of the new SGB XIV. With respect to new beneficiaries, the status of services for victims of human trafficking was recorded as an example. METHODS: Outpatient clinics that provide rapid assistance under the OEG or SGB XIV were surveyed on structural and content-related aspects of their work. An online survey consisting of 10 thematic modules was used. Data were obtained from a total of N = 110 outpatient clinics (response rate 50%). RESULTS: The participating outpatient clinics reported a wide range in terms of the number of staff and the number of people seeking counselling. Some of the outpatient clinics reported deficits with respect to structural aspects, such as the waiting time for the initial consultation and specific training in trauma treatment for staff. The majority of outpatient clinics were uncertain about how to deal with victims of human trafficking. DISCUSSION: Outpatient trauma clinics appear to reach their target population and provide appropriate services for their care; however, a significant number of outpatient clinics need to make improvements in order to fulfil the quality criteria of SGB XIV and provide adequate care to new groups of beneficiaries.

[Trauma and memory-A contribution to the current debate in law and psychotherapy]. / Trauma und Erinnerung ­ ein Beitrag zur aktuellen Debatte in Recht und Psychotherapie.

The recall of memories of past events, experiences and emotions is a complex process. When experiencing traumatic events, as is the case with sexual violence, a host of additional complexities and difficulties arise. This becomes especially important in court cases which rely mostly or exclusively on the testimony of the victim, where the problem of the fallibility of memory takes center stage. Some research studies emphasize the possibility of inducing, altering or suppressing memories, especially in the context of psychotherapy. This has led to the unfortunate reality that the testimony of victims who have undergone psychotherapy is often considered to be unreliable. This in turn can lead to the impression that a decision has to be made between treatment of the adverse effects of traumatic events and maximizing the chances for a conviction of the perpetrator in court. This article introduces some central concepts of our current understanding of memory and gives an overview of the relevant scientific literature and debate. Following this, it examines the dilemma as it pertains to the different groups of all involved parties (i.e., victims, members of the judiciary and psychotherapists). Lastly, it proposes a framework of how to approach a solution to this problem by focusing on research in critical areas, expansion of therapy guidelines and documentation procedures as well as communication of these efforts to all parties involved.

Impact of the COVID-19 pandemic on workplace violence at an academic emergency department.

STUDY OBJECTIVES: COVID-19 brought unique challenges; however, it remains unclear what effect the pandemic had on violence in healthcare. The objective of this study was to identify the impact of the pandemic on workplace violence at an academic emergency department (ED). METHODS: This mixed-methods study involved a prospective descriptive survey study and electronic medical record review. Within our hospital referral region (HRR), the first COVID-19 case was documented on 3/11/2020 and cases peaked in mid-November 2020. We compared the monthly HRR COVID-19 case rate per 100,000 people to the rate of violent incidents per 1000 ED visits. Multidisciplinary ED staff were surveyed both pre/early-pandemic (April 2020) and mid/late-pandemic (December 2020) regarding workplace violence experienced over the prior 6-months. The study was deemed exempt by the Mayo Clinic Institutional Review Board. RESULTS: There was a positive association between the monthly HRR COVID-19 case rate and rate of violent ED incidents (r = 0.24). Violent incidents increased overall during the pandemic (2.53 incidents per 1000 visits) compared to the 3 months prior (1.13 incidents per 1000 visits, p < .001), as well as compared to the previous year (1.24 incidents per 1000 patient visits, p < .001). Survey respondents indicated a higher incidence of assault during the pandemic, compared to before (p = .019). DISCUSSION: Incidents of workplace violence at our ED increased during the pandemic and there was a positive association of these incidents with the COVID-19 case rate. Our findings indicate health systems should prioritize employee safety during future pandemics.

Healing is not linear: Using photography to describe the day-to-day healing journeys of undergraduate women survivors of sexual violence.

The purpose of this study was to describe the day-to-day healing processes of women who experienced undergraduate sexual violence. We engaged 19 women in a photo-elicitation experience with follow-up individual interviews to identify themes of both healing and darker moments in survivors' everyday lives. Healing was found to function on a continuum influenced by darker moments (i.e., moments that elicited fear, anxiety, loneliness, guilt, anger, and worthlessness) and healing moments (i.e., rebuilding moments of self-care, self-love, connection, hope, peace, and freedom). Responses to darker moments included feeling overwhelmed, disconnected, and intentional vulnerability. Healing moments were influenced by self-reflection, authentic interactions, and resource utilization. The photographs taken in this study shed light on the impact of sexual violence in women's daily lives long after these traumatic and unjust experiences. This knowledge can be used to foster a sense of universality in survivors who are currently struggling and growing after their experiences as well as give service providers greater insight into what survivors' day-to-day needs may be.

Prescription Opioid Misuse After a Recent Sexual Assault: A Randomized Clinical Trial of a Video Intervention.

BACKGROUND AND OBJECTIVES: Prescription opioid (PO) misuse is increasing and is associated with overdose. Individuals who experienced a recent sexual assault are at risk for increased substance use, yet limited interventions target PO misuse after sexual assault. The current study examined the efficacy of video interventions on PO misuse after sexual assault. METHODS: Adolescent girls and women (n = 154) were recruited in the context of a sexual assault medical forensic exam in the emergency department. Effects of a prevention of post-rape stress (PPRS) video and a pleasant imagery and relaxation instruction (PIRI) video were compared with treatment as usual (TAU) during a sexual assault medical forensic exam on PO misuse. Participants reported if they had used POs for non-medical purposes since the sexual assault at 1.5 month follow-up. RESULTS: Results from a logistic regression analysis indicated that participants with a prior sexual assault were less likely to misuse prescription opioids 1.5 months after the assault in the PIRI condition compared with TAU. There were no main effects for video condition and no interactions for the PPRS condition on PO misuse. DISCUSSION AND CONCLUSIONS: Providing the PIRI video, or teaching other types of mindfulness or relaxation exercises, may be warranted as a secondary prevention for individuals during the sexual assault medical forensic exam for those with a prior sexual assault history. SCIENTIFIC SIGNIFICANCE: This research provides an initial examination of the impact of mindfulness skills recently after traumatic event exposure on PO misuse. (Am J Addict 2019;28:376-381).

Current care for victims of sexual violence and future sexual assault care centres in Belgium: the perspective of victims.

BACKGROUND: Sexual violence is a global health problem. After ratifying the Convention of Istanbul in 2016, this Belgian study was set up to map the perspective of victims of rape on the current sexual violence care provision in Belgium and to inquire on their need for more specialised and holistic care in future Sexual Assault Care Centres. METHODS: Sixteen rape victims participated in this sub-study. A mixed-method design (questionnaire, in-depth interview or small focus group) was applied depending on the time elapsed between rape and participation. Descriptive Thematic Framework Analysis was performed in duo. RESULTS: The participants thought it of utmost importance that every victim should receive all medical, psychological and forensic care without necessarily having to involve the police first. They stated that the current Belgian sexual violence care provision could be much more patient-centred, specifically the forensic examination and psychological care. Alongside medical and psychological consequences, victims emphasised the high personal financial and relational burden of sexual violence. The holistic care offered in Sexual Assault Care Centres was perceived to enhance the recovery process of victims of sexual violence. Their doors should be open to all victims and their relatives. They should not only provide acute care for the victim, but also improve victims' reintegration into society while reducing their personal costs significantly. CONCLUSION: All care for victims of sexual violence, especially forensic and psychological care, needs drastic improvement in Belgium. All participants agreed that having specialised, multidisciplinary and longitudinal care in a Sexual Assault Care Centre that would be open 24/7 for everyone, victims and their significant others, would be an improvement to the currently available care all over Belgium. TRIAL REGISTRATION: This research was registered on April 1st 2016. Registration number B670201628242.

Pilot evaluation of a targeted intervention for peer-victimized youth.

OBJECTIVE: Due to the limited effectiveness of extant prevention and intervention strategies, the current study is an initial evaluation of a cognitive behavioral group intervention, originally designed to treat symptoms of depression and anxiety, for youth who experienced peer victimization. METHODS: Twelve third- through fifth-grade youth participated in the intervention, and their data were compared with 12 youth who were a part of a naturalistic control group. Additionally, school-wide data are reported to provide overall school trends. RESULTS: Whereas the intervention group participants exhibited decreases in relational victimization, depressive symptoms, and passive coping, the control group participants exhibited nonsignificant increases in relational victimization, depressive symptoms, and passive coping. School-wide data also indicated overall increases in relational victimization and depressive symptoms, but no changes in passive coping. CONCLUSION: Findings suggest that cognitive behavioral group interventions may provide a promising avenue for addressing the mental health needs of victimized elementary school-age youth.

Establishing Sexual Assault Care Centres in Belgium: health professionals' role in the patient-centred care for victims of sexual violence.

BACKGROUND: Having ratified the Convention of Istanbul, the Belgian federal government commits itself to the foundation of Sexual Assault Care Centres (SACC). In the light of researching the feasibility of these centres, this study aimed to evaluate the care for victims of sexual violence (SV) in Belgian hospitals anno 2016 as well as to formulate recommendations for the intended model. METHODS: Between April and October 2016, a questionnaire was distributed to 159 key health professionals active in 17 different hospitals attached to an AIDS Referral Centre. The survey covered four parts, i.e. the health professionals' profile, their knowledge, attitude and practices, an assessment of the hospital's policy and the caregivers' opinion on the care for victims of SV and on the intended SACCs. Subsequently, a descriptive analysis using 'IBM SPSS Statistics 23' was performed. RESULTS: A total of 60 key health professionals representing 15 different hospitals completed the questionnaire resulting in a response rate of 38%. The results showed a lack of knowledge and practical experience of caregivers' regarding the care for SV victims. Approximately 30% of responders face personal or professional difficulties upon provision of care to victims of SV. Participants evaluate the current care as good, despite the limited psychosocial support, follow-up, insight for the needs of vulnerable groups and support for family, relatives and health professionals. Yet, the majority of health professionals appraise the SACCs as the best approach for both victims and caregivers. CONCLUSIONS: By introducing a SACC, the Belgian federal government aims to provide holistic and patient-centred care for victims of SV. Essential in patient-centred health care is an extensive and continuous education, training and supervision of health professionals concerning the care for victims, support for family, relatives and caregivers. At the end and as a result of a participatory process with many professional experts as well as victims, a specific Belgian model, adjusted to the health care system anno 2016 was developed for piloting. The main challenges in establishing SACCs are situated at the institutional and policy level. Collaborating with other institutions and further research are herewith required.

Violence towards people with mental illness: Assessment, risk factors, and management.

AIM: Violence is an important problem for clinicians, for public health, and for victims. Aside from greater risk of perpetrating violence, people with mental illness are also more commonly victimized than the general population. However, guidance on the assessment and management of violent victimization in clinical settings is limited. METHODS: We carried out a review and consolidation of clinical and research literature on violent victimization in people with mental illness. RESULTS: Assessment of mental state in someone who has been victimized should evaluate both historical factors (such as pattern, timing, perpetrator characteristics, and contextual factors) and clinical factors (including affective and cognitive changes). CONCLUSION: Concerted clinical and policy attention to factors that might increase vulnerability, such as alcohol use, lack of support, and the social environment, could improve outcomes.

[Patients assaulted in psychiatric institutions: Literature review and clinical implications]. / Patients agressés en milieu psychiatrique : revue de la littérature et implications cliniques.

BACKGROUND: The psychiatric ward is a place where all forms of violence are treated. Occasionally, this violence involves acts of aggression between patients in emergency psychiatric units or hospital wards. Such events can lead to the development or worsening of posttraumatic stress disorder. METHODS: To establish the context, we first examined the epidemiology data concerning posttraumatic stress disorder in psychiatric patients who were frequently exposed to assaults. Secondly, we examined the issue of sexual and physical assaults between patients receiving treatment in a psychiatric ward. In this context, we studied possible occurrence of posttraumatic stress disorder associated with exposure to assaults of this kind. RESULTS: In certain cases, potentially traumatic exposure to violence was unknown to the medical staff or not taken into consideration. This would induce a risk of later development of posttraumatic stress disorder that would not be treated during the stay in psychiatry. CONCLUSION: To date, few scientific studies have focused on the proportion of patients assaulted by other patients during treatment in a psychiatric ward and the subsequent development of peritraumatic reactions and/or posttraumatic stress disorder associated with these assaults. We know that an insufficient number of public and private health institutions report the existence of such facts to the competent authorities. Also, a minority of clinicians and caregivers are trained in screening and management of trauma victims. Yet, these issues are particularly relevant in the scope of public health and health promotion.

Challenges in interprofessional collaboration: experiences of care providers and policymakers in a newly set-up Dutch assault centre.

BACKGROUND: Sexual and family violence are problems that affect many women and men, and the negative health consequences of violence are numerous. As adequate acute interprofessional care can prevent negative health consequences and improve forensic medical examination, a Centre for Sexual and Family Violence was set up. AIM: We aimed to improve our understanding of the challenges in interprofessional collaboration in a newly set-up centre for sexual and family violence. METHODS: We conducted a qualitative study with semi-structured interviews about the experiences with interprofessional collaboration of 16 stakeholders involved in the Centre for Sexual and Family Violence Nijmegen. Participants were selected by purposive sampling. RESULTS: Participants found that the interprofessional collaboration had improved communication and competences. However, there were challenges too. Firstly, the interprofessional collaboration had brought parties closer together, but the collaboration also forced professionals to strongly define their boundaries. Mutual trust and understanding needed to be built up. Secondly, a balance had to be struck between pursuing the shared vision - which was to improve quality of care for victims - and giving space to organizations' and professionals' own interest. Thirdly, care for victims of sexual and family violence could be demanding on healthcare providers in an emotional sense, which might jeopardize professional's initial motivation for joining the Centre for Sexual and Family Violence Nijmegen. CONCLUSION: The interprofessional collaboration in an assault centre improves quality of care for victims, but there are also challenges. The tasks of an assault centre are to create opportunities to discuss professional roles and professional interests, to build up good interpersonal relations in which trust and understanding can grow, to formulate a strong and shared victim-centred vision and to support care providers with training, feedback and supervision.

Mechanisms Through Which Supportive Relationships with Parents and Peers Mitigate Victimization, Depression and Internalizing Problems in Children Bullied by Peers.

This study investigated how supportive relationships with peers and parents protect children against ongoing victimization, internalizing problems and depression. The longitudinal data set tracked progress of 111 children recruited for the trial of Resilience Triple P, and previously bullied by peers. Informants included children, parents and teachers. Higher levels of facilitative parenting (warm parenting that supports peer relationships) and peer acceptance predicted lower later levels of both depression and victimization over time. Higher levels of child friendedness predicted lower levels of child reports of internalizing problems. Children's friendships, acceptance by same sex peers and facilitative parenting all played moderating roles in protecting against ongoing victimization and internalizing problems. Peer acceptance mediated the relationships between facilitative parenting and victimization. Facilitative parenting mediated the relationship between peer acceptance and depression. It was concluded that supportive relationships with parents and peers play important and complementary roles in protecting children against ongoing victimization and depression.

Health Impact of Participation for Vulnerable Youth With Disabilities.

OBJECTIVE: We investigated the mental health impact of participation for youth with disabilities (YWD) in the child welfare system who had experienced victimization in the previous year. METHOD: Nationally representative data were obtained from the second National Survey of Child and Adolescent Well-Being. Our sample consisted of 247 YWD ages 11-17 yr. Multivariable probit regression analysis and a robust variance estimator were used to test the relationships among disability status, participation, and clinical depression. RESULTS: The probability of reporting clinical depression was 4 times higher for victimized YWD who reported lower breadth of participation than for victimized YWD who reported higher breadth of participation (6% vs. 26%; p = .03). CONCLUSION: Occupational therapy aimed at increasing opportunities for engagement in activities may enhance the mental health of the most vulnerable YWD. Participation in meaningful activities can improve both overall health and transition to independence for vulnerable YWD.

Rape Messaging.

When feminists began advocating for rape reform in the 1970s, the rape message was clear: rape was not a crime to be taken seriously because women lie. After decades of criminal law reform, the legal requirement that a woman vigorously resist a man's sexual advances to prove that she was raped has largely disappeared from the statute books, and, in theory, rape shield laws make a woman's prior sexual history irrelevant. Yet, despite what the law dictates, rape law reforms have not had a "trickle-down" effect, where changes in law lead to changes in attitude. Women are still believed to be vindictive shrews so police continue to code rape allegations as "unfounded," and prosecutors continue to elect not to prosecute many rape cases. To many, "no" can sometimes still mean "yes." In short, criminal law reforms have only marginally succeeded at deterring rape and increasing conviction rates for rape. At the same time, criminal law reforms have entrenched gender norms and endorsed the message that acquaintance rapes are less worthy of harsh punishment. This Article argues against further ex post criminal law reforms and posits that efforts should shift to ex ante public health interventions. This Article draws from recent successful experiences with public health interventions in destigmatizing AIDS and denormalizing tobacco and advocates for a robust public health campaign to denormalize rape. It presents a detailed proposal for changing rape messaging, denormalizing rape, and ensuring better outcomes for victims.

Cyberbullying Prevention and Intervention Efforts: Current Knowledge and Future Directions.

Bullying is a serious public health concern that is associated with significant negative mental, social, and physical outcomes. Technological advances have increased adolescents' use of social media, and online communication platforms have exposed adolescents to another mode of bullying- cyberbullying. Prevention and intervention materials, from websites and tip sheets to classroom curriculum, have been developed to help youth, parents, and teachers address cyberbullying. While youth and parents are willing to disclose their experiences with bullying to their health care providers, these disclosures need to be taken seriously and handled in a caring manner. Health care providers need to include questions about bullying on intake forms to encourage these disclosures. The aim of this article is to examine the current status of cyberbullying prevention and intervention. Research support for several school-based intervention programs is summarised. Recommendations for future research are provided.

Feasibility of Training Frontline Therapists in Prolonged Exposure: A Randomized Controlled Pilot Study of Treatment of Complex Trauma in Diverse Victims of Crime and Violence.

The study aims were to determine whether prolonged exposure (PE) improved mental health and was feasible to implement by frontline clinicians in a culturally diverse sample with complex trauma. Seventy-one individuals were randomly assigned to PE or person-centered therapy (PCT). Outcome measures were administered at baseline and sessions 3, 6, 9, and 12. Mixed modeling was used to regress outcome measures on time, treatment group, and number of visits. Individuals who received PE showed significant moderate association with decline in reported posttraumatic stress disorder (PTSD) symptoms as noted by the PTSD Checklist for DSM-5 (p = 0.05) compared with PCT. Results indicated improved scores on all measures at each follow-up time point compared with baseline (p ≤ 0.01). PE was feasible, shown by positive recruitment and ability of clinicians to effectively implement and maintain treatment fidelity. Findings suggest that PE can be effective for treating complex trauma when used by clinicians in community settings.

Antecedents of Treatment Resistant Depression in Children Victimized by Peers.

Children victimized by peers are at increased risk of ongoing depression. This study investigates treatment resistant depression in children victimized by peers, following participation in a targeted cognitive behavioral family intervention. The sample comprised 39 children aged 6-12 years with elevated depression compared with a general sample, prior to the intervention. Six months after the intervention, 26 were no longer depressed and 13 were still depressed. This study investigated the differentiation of these two groups on the basis of parenting and child factors. Children with treatment resistant depression were discriminated from other children by lower levels of peer support and facilitative parenting immediately after the intervention. It was concluded that ongoing support from parents and peers is needed to reduce the risk of ongoing depression even if victimization has been reduced. Further research could develop a comprehensive profile of children at risk of depression following peer victimization.

A theory for aftercare of human trafficking survivors for nursing practice in low resource settings.

Research on aftercare for human trafficking survivors highlights the limited knowledge of the needs of survivors; the evaluation of current aftercare; and the process of recovery navigated by the survivor in aftercare (Oram et al., 2012; Locke, 2010; Hacker & Cohen, 2012). Furthermore there has been a transition in aftercare where the victim or survivor, who before was seen as a passive victim of circumstance of their life and in need of therapeutic intervention, is now seen as having an active role in their recovery, thus facilitating recovery (Hacker & Cohen, 2012). The need for a theory grounded in survivor's voices therefore motivated this grounded theory study underpinned by Freire's (1970) Pedagogy of the oppressed. The aim of the theory is to inform nursing care of human trafficking survivors in low resource settings. The findings elicit a theoretical model of the renewed self, and the conditions that facilitate this process in care of human trafficking survivors. The recommendations of this paper may improve the nursing care provided to human trafficking survivors and equip nurses and other health professionals with the knowledge and skills to promote the renewing of human trafficking survivors.

Linguistic Analysis as a Method for Assessing Symptoms After Sexual Trauma Among Female Adolescent Psychiatric Inpatients.

Using a sample of female psychiatric inpatient adolescents, the current study aimed to extend this literature to an adolescent sample for the first time by examining if linguistic markers and their subcategories (cognitive process words, pronoun use, and somatosensory detail) in a trauma account are related to trauma symptomology and recovery during inpatient care. Results indicated that greater use of body words and fewer insight words were related to increased trauma symptoms at admission. In addition, use of fewer cognitive process words at admission predicted greater symptom change at discharge, extending previous research findings to an adolescent sample. Findings suggest that linguistic analysis may be an important component of adolescent trauma symptom assessment and treatment monitoring.

[Intervention and Therapy for Perpetrators and Victims of Bullying: A Systematic Review]. / Intervention und Therapie für Täter und Opfer von Schulbullying: Ein systematisches Review.

Intervention and Therapy for Perpetrators and Victims of Bullying: A Systematic Review Bullying is a form of repeated and aggressive behavior with serious consequences for victims and perpetrators, who often suffer from their experiences long after the bullying episodes have ended. However, the therapeutic treatment of bullying and its consequences represents a neglected topic in bullying research. Objective of the present article is to review publications systematically describing targeted interventions for the treatment of bullying (for victims and perpetrators) and associated disorders. The selection process consisted of a comprehensive systematic search in national and international databases that identified 34 targeted interventions in 31 publications from 14 different countries. The review of ten interventions featuring a controlled design revealed that in particular treatments on both the individual and socio-ecological level (particularly parents) are effective. The remaining 24 treatments lack a controlled evaluation. Two thirds of the interventions focus on victims. In contrast to the treatment of perpetrators, the emphasis here lies on group therapy. Although treatments of bullying apply a range of therapeutic approaches and methods, cognitive behavioral therapy is represented most prominently. As a conclusion one can observe an existing lack of research in evidence-based targeted interventions for the treatment of bullying and its consequences for victims and perpetrators. To our knowledge, this is the first systematic review of therapeutic interventions for bullying in children and adolescents.