RESUMO
While randomized controlled trials of trauma-focused cognitive behavioral therapy (TF-CBT) have demonstrated efficacy for youth with posttraumatic stress disorder, TF-CBT effectiveness trials typically show attenuated outcomes. This decrease in effectiveness may be due to the differences in sociodemographic characteristics of youth in these trials; youth in efficacy trials are more often white and middle-income, whereas youth in effectiveness trials are more often racial/ethnic minorities, of low socioeconomic status (SES) and live in high crime neighborhoods. In this study-drawn from an effectiveness trial of TF-CBT in community mental health clinics across Philadelphia-we describe the sociodemographic characteristics of enrolled youth. We measured neighborhood SES by matching participants' addresses to American Community Survey data from their Census tracts, housing stability using the National Outcomes Measurement System, and neighborhood violence using police department crime statistics. Our results suggest that the majority of youth presenting for TF-CBT in mental health clinics in the City of Philadelphia live in poor and high-crime neighborhoods, experience substantial housing instability, and are predominantly ethnic and racial minorities. Thus, youth presenting for treatment experience significant racial and socioeconomic adversity. We also explored the association between these characteristics and youth symptom severity upon presenting for treatment. These factors were not associated with youth symptom severity or overall mental health functioning in our sample (with small effect sizes and p > .05 for all). Implications for future research, such as the need for efficacy and effectiveness trials to more fully characterize their samples and the need for pragmatic trials are discussed.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Serviços Comunitários de Saúde Mental/organização & administração , Transtornos de Estresse Pós-Traumáticos/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Philadelphia , Características de Residência , Índice de Gravidade de Doença , Fatores Socioeconômicos , Transtornos de Estresse Pós-Traumáticos/etnologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto JovemRESUMO
The primary objective of the current study was to examine the perspective of firearm stakeholders, including firearm safety course instructors, members of law enforcement, and firearm retailers, with regard to the implementation of an evidence-based approach to firearm safety promotion, the Firearm Safety Check, as a universal suicide prevention strategy in pediatric primary care. Twelve firearm stakeholders participated in semi-structured interviews. Using an integrated analytic approach, several themes emerged from the interviews. With regard to acceptability of the intervention, participants generally found counseling caregivers to store firearms safely and the provision of firearm locking mechanisms to be acceptable, but expressed concern about screening for firearm ownership in health systems. Participants identified distinct roles of responsibility for firearm advocacy groups, firearm owners, healthcare clinicians, and caregivers with regard to the promotion and execution of safe firearm storage. Participants called for partnerships between healthcare systems and firearm stakeholders, and also identified potential threats to these partnerships, including lack of trust firearm owners may have in health systems and the government. Finally, participants suggested strategies for preventing firearm-related suicides. Findings support a growing body of literature suggesting the value in researchers, health systems, and firearm stakeholders partnering around a shared agenda of firearm safety promotion as a strategy to prevent suicide.
Assuntos
Armas de Fogo/estatística & dados numéricos , Propriedade/estatística & dados numéricos , Prevenção do Suicídio , Adulto , Criança , Aconselhamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pais , Atenção Primária à Saúde/organização & administração , Pesquisa Qualitativa , Gestão da Segurança/métodosRESUMO
It is critical for urban youth with post-traumatic stress disorder (PTSD) living in poverty to have access to evidence-based interventions for their traumatic stress. However, there is limited research on the effectiveness of these interventions when provided in urban, community settings. The objectives of the current study are to (a) evaluate the effectiveness of trauma-focused cognitive behavioral therapy delivered from 2013 to 2016 in 15 behavioral health agencies on youth (N = 114) PTSD as well as general mental health symptoms and functioning, and (b) benchmark these clinical outcomes against other published efficacy and effectiveness trials. Effectiveness data are from the Philadelphia County Community Behavioral Health System, a system that has invested significantly in the training and ongoing support of clinicians providing high-quality trauma services to youth since 2012. From baseline to last assessment, youth PTSD symptom severity (d = 0.34), PTSD functional impairment (d = 0.38), and overall mental health problem severity (d = 0.29) improved. The effect sizes of improvements were smaller than effect sizes observed in efficacy and effectiveness studies. This study is the first benchmarking study of TF-CBT and provides preliminary findings with regard to the effectiveness, and transportability, of TF-CBT to urban community settings that serve youth in poverty.
Assuntos
Benchmarking , Terapia Cognitivo-Comportamental/normas , Serviços de Saúde Comunitária , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Adolescente , Criança , Feminino , Humanos , Masculino , Philadelphia , Resultado do TratamentoRESUMO
OBJECTIVE: Promoting safe firearm storage in pediatric primary care is one way to address youth suicide by firearm. The study objective was to determine the perspectives of primary care physicians (PCPs) and leaders of primary care practices regarding the acceptability and use of screening, counseling, and firearm locks-all components of an adapted evidence-based intervention known as the Firearm Safety Check. METHODS: In 2016, an online survey was conducted in two large US health systems. PCPs (nâ¯=â¯204) and leaders (nâ¯=â¯57) from 83 clinics were invited to participate. Respondents included 71 clinics (86%), 103 PCPs (50%), and 40 leaders (70%). Main outcomes included acceptability (6-point Likert scale, with higher scores indicating better acceptability) and use of the 3 intervention components (4-point Likert scale, with higher scores indicating greater use), as measured by an adapted validated instrument. RESULTS: Analyses were conducted in 2017. PCP acceptability of screening (meanâ¯=â¯4.28; standard deviation [SD]â¯=â¯1.12) and counseling (meanâ¯=â¯4.56; SDâ¯=â¯0.89) were high, but acceptability for firearm lock provision was more neutral (meanâ¯=â¯3.78; SDâ¯=â¯1.16). Most PCPs endorsed sometimes screening (85%) and counseling (80%). Few PCPs offered firearm locks to caregivers (15%). Leaders reported consistent information. CONCLUSION: The acceptability of screening for firearms and safe storage counseling was high; both components were used commonly but not routinely. The acceptability of providing firearm locks was neutral, and use was rarely endorsed. This study provides important insights about areas of focus for future implementation efforts from policy and research perspectives.
Assuntos
Atitude do Pessoal de Saúde , Aconselhamento/estatística & dados numéricos , Armas de Fogo , Médicos/psicologia , Médicos/estatística & dados numéricos , Segurança/estatística & dados numéricos , Adulto , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Pediatria , Atenção Primária à Saúde , Inquéritos e Questionários , Texas , Prevenção do SuicídioRESUMO
Importance: The rate of youth suicide has increased steadily over the past several decades due, in part, to an increase in suicide by firearm. Implementation of evidence-based approaches to increase safe firearm storage practices are important for reducing youth suicide. Objective: To assess the needs of stakeholders who would be affected by implementing an evidence-based approach to firearm safety promotion-Firearm Safety Check, which includes screening for the presence of firearms in the home, brief motivational interviewing-informed counseling regarding safe firearm storage, and provision of free firearm locks-in pediatric primary care settings. Design, Setting, and Participants: In this qualitative study, 58 stakeholders were interviewed over a 7-month period across 9 stakeholder groups from 2 large and diverse health systems. Participants included parents of youth; physicians; nurses and nurse practitioners; leaders of pediatric primary care practices, behavioral health, and quality improvement; system leaders; third-party payers; and members of national credentialing bodies. Data analysis were conducted from September 2017 to April 2018. Main Outcomes and Measures: Interview guides were informed by the Consolidated Framework for Implementation Research. An integrated analysis approach was used in which a priori attributes of interest were identified (Consolidated Framework for Implementation Research constructs, eg, intervention characteristics), and an inductive approach was used with regard to new themes that emerged. Results: A total of 58 stakeholders were interviewed (mean [SD] age, 48.38 [10.65] years; 27 men and 31 women). Stakeholders indicated that firearm safety promotion is a health system priority and reported favorable perceptions of the Firearm Safety Check approach for suicide prevention. The importance of leveraging existing infrastructures, such as electronic health record systems and brevity, were frequently noted. Distribution of firearm locks was endorsed as the most complicated component to implement. Conclusions and Relevance: By including multiple service system stakeholder perspectives, these results support the development of implementation strategies to change clinician, organization, and system behaviors around firearm safety promotion in pediatric primary care as a universal suicide prevention strategy.
Assuntos
Armas de Fogo/normas , Atenção Primária à Saúde/métodos , Segurança/normas , Prevenção do Suicídio , Adulto , Feminino , Pessoal de Saúde/educação , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Pediatria , Pesquisa QualitativaRESUMO
With a randomized field experiment of 587 first-graders, we tested an educational intervention designed to promote interactions between children and parents relating to math. We predicted that increasing math activities at home would increase children's math achievement at school. We tested this prediction by having children engage in math story time with their parents. The intervention, short numerical story problems delivered through an iPad app, significantly increased children's math achievement across the school year compared to a reading (control) group, especially for children whose parents are habitually anxious about math. Brief, high-quality parent-child interactions about math at home help break the intergenerational cycle of low math achievement.