Rumination mediates associations between microaggressions and sleep quality in Black Americans: the toll of racial microstressors.

Disparities in health outcomes between Black and White Americans are well-documented, including sleep quality, and disparities in sleep may lead to disparities in health over the life course. A meta-model indicates that cognitive processes may underly the connection between race and poor sleep quality, and ultimately, health disparities. That is, there are race-specific stressors that disproportionately affect Black Americans, which are associated with poor health through biological, cognitive, and behavioral mechanisms (e.g., sleep). Among these race-specific stressors is discrimination, which has been linked to poor sleep quality, and there is a body of literature connecting perseverative cognition (e.g., rumination and worry or vigilance) to poor sleep. Microaggressions, a more subtle but pervasive form of discrimination, are another race-specific stressor. Although less research has considered the connection of microaggressions to perseverative cognition, there are some studies linking microaggressions to health outcomes and sleep. Therefore, using a cross-sectional survey, we tested the following hypotheses: racism-related vigilance and rumination would mediate the relationship between discrimination and poor sleep as well as between microaggressions and poor sleep among Black Americans (N = 223; mean age = 35.77 years, 53.8% men, 86% employed, 66.8% with college degree or higher education). Results of seven parallel mediation models showed that neither rumination nor racism-related vigilance mediated a relationship between discrimination and poor sleep quality. However, rumination partially mediated relationships between the six microaggression sub-scales and poor sleep quality: there were significant indirect effects for Foreigner/Not Belonging (ß = .13, SE = 0.03, 95% CI 0.08, 0.20), Criminality (ß = .11, SE = 0.03, 95% CI 0.05, 0.17), Sexualization (ß = .10, SE = 0.03, 95% CI 0.05, 0.17), Low-Achieving/Undesirable (ß = .10, SE = 0.03, 95% CI 0.05, 0.15), Invisibility (ß = .15, SE = 0.04, 95% CI 0.08, 0.23), and Environmental Invalidations (ß = .15, SE = 0.04, 95% CI 0.08, 0.23). Overall, these findings indicate support for the meta-model, demonstrating a specific pathway from racial microstressors to poor sleep quality. Furthermore, these results suggest the importance of developing clinical and community approaches to address the impact of microaggressions on Black Americans' sleep quality.

Trauma exposure and associated sleep problems in Black adolescent and young adult students attending an alternative high school.

OBJECTIVE: Given the dearth of literature examining the link between trauma exposure and sleep among youth and young adults of color, the current study examined the association between individual types of trauma exposure, accumulation within subtypes of trauma exposure, and overall cumulative trauma exposure with sleep problems in a sample of Black students attending an alternative high school. METHOD: Participants were recruited from an alternative high school in a large, southeastern city in the United States, of which all students qualify for free/reduced lunch. The sample included 101 students (53% female) ages 16-24 (M = 17.86 years, SD = 1.36) who identified as Black. RESULTS: Participants reported a high rate of trauma exposure (M = 6.03 unique traumatic experiences, SD = 2.63). Linear regression models showed that exposure to more overall cumulative trauma and to interpersonal loss was significantly associated with higher levels of insomnia symptoms. Threats to health were significantly related to daytime sleepiness. Other threats to safety were associated with restless legs syndrome symptoms. CONCLUSIONS: Adolescence and young adulthood are a time of complex sleep-related issues. Black youth and young adults have elevated risk of trauma exposure and sleep problems; therefore, targeted assessment and intervention are warranted. Clinicians and researchers addressing sleep in youth and young adults, and those working within alternative school settings, should also consider a trauma-informed lens to optimize outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating skills for psychological recovery with gunshot injury survivors in a hospital-based early intervention program.

Gun violence is a serious public health problem that places surviving victims at increased risk for a variety of mental health problems, including posttraumatic stress disorder (PTSD) and depression. Recognizing that many gunshot injury survivors lack access to mental health care in the early aftermath of a shooting, there has been growing interest in the use of early, preventive mental health interventions to help prevent long-term mental health complications like PTSD as part of routine care for survivors in acute medical settings, where initial outreach to survivors may be more successful. This study evaluates clinical outcomes associated with one such early intervention-Skills for Psychological Recovery (SPR)-provided to gunshot injury survivors as part of a hospital-based early intervention program embedded in a Level 1 trauma center in the Midwestern United States. Clinic data from 100 survivors (74.0% male, 78.0% Black/African American) who received SPR were included in the present study. Results suggest that receiving SPR in the early aftermath of a shooting is associated with statistically significant reductions in both PTSD, F(1, 26.77) = 22.49, p < .001, and depression, F(1, 29.99) = 6.49, p = .016, symptoms. Outcomes did not vary as a function of either PTSD risk status or intervention delivery method (i.e., in-person, telehealth). These findings support the effectiveness and acceptability of SPR as an early intervention for gunshot injury survivors when delivered as part of a hospital-based early intervention program. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Disseminating early interventions for disaster mental health response using the ECHO model.

Extension for Community Healthcare Outcomes (ECHO)-based telementoring was evaluated for disseminating early disaster interventions, Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR), to school professionals throughout rural, disaster-affected communities further affected by COVID-19. PFA and SPR complemented their Multitiered System of Support: PFA complemented tier 1 (universal) and SPR tier 2 (targeted) prevention. We evaluated the outcomes of a pretraining webinar (164 participants, January 2021) and four-part PFA training (84 participants, June 2021) and SPR training (59 participants, July 2021) across five levels of Moore's continuing medical education evaluation framework: (1) participation, (2) satisfaction, (3) learning, (4) competence, and (5) performance, using pre-, post-, and 1-month follow-up surveys. Positive training outcomes were observed across all five levels, with high participation and satisfaction throughout, and high use at the 1-month follow-up. ECHO-based telementoring may successfully engage and train community providers in these underused early disaster response models. Recommendations regarding training format and using evaluation to improve training are provided.

Timing of Early-Life Stress and the Development of Brain-Related Capacities.

Early-life stress (ELS) poses risks for developmental and mental health problems throughout the lifespan. More research is needed regarding how specific ELS experiences influence specific aspects of neurodevelopment. We examined the association between ELS, defined as severe adversity (e.g., domestic violence, caregiver drug use) and severe relational poverty (e.g., caregiver neglect, lack of caregiver attunement), occurring during the first 2 months of life and a variety of brain-related, clinician-rated functions, including self-regulation and relational capacities. Interdisciplinary clinicians using the Neurosequential Model of Therapeutics (NMT), an approach to clinical problem solving, reported on the timing and type of treatment-seeking children's (N = 2,155; 8-10 years) stressful experiences during four developmental periods: Perinatal (0-2 months), Infancy (2-12 months), Early Childhood (13 months to 4 years), and Childhood (4-11 years). They also reported on children's current functioning in 32 brain-related domains (e.g., sleep, arousal, impulsivity, empathy, concrete cognition). Non-negative matrix factorization (NMF) was conducted on the 32 brain-related domains to identify latent factors, yielding four factors comprising Sensory Integration, Self-Regulation, Relational, and Cognitive functioning. Regularized hierarchical models were then used to identify associations between ELS and each latent factor while controlling for stress occurring during subsequent developmental periods, and children's current degree of relational health. ELS (stress occurring during the first 2 months of life), specifically a severe lack of positive relational experiences (e.g., caregiver neglect, lack of caregiver attunement), was associated with the Sensory Integration and Self-Regulation factors. The Relational factor was better explained by stress occurring during childhood, and the Cognitive factor by stress occurring during infancy and childhood. Implications for how the timing and type of stress experiences may influence brain-related outcomes that are observed in clinical settings are discussed. Future directions include longitudinal follow-ups and greater specification of environmental variables, such as types of interventions received and when they were received, that may interact with ELS experiences to influence brain-related outcomes.

Beyond the ACE score: Examining relationships between timing of developmental adversity, relational health and developmental outcomes in children.

BACKGROUND: The association between developmental adversity and children's functioning is complex, particularly given the multifaceted nature of adverse experiences. The association between the timing of experience and outcomes is underresearched and clinically under-appreciated. We examine how the timing of both adverse (including potentially traumatic) events and relational poverty are associated with developmental outcomes. METHOD: Clinicians using the Neurosequential Model of Therapeutics (NMT), an approach to clinical problem solving, reported on the timing of children's developmental experiences, their degree of current relational health, and current functioning in key brain-mediated domains (N = 3523 6- to 13-year-old children). A regularized hierarchical model produced stable and generalizable estimates regarding associations between the timing of experiences across four developmental periods: Perinatal (0-2 mos), Infancy (2-12 mos), Early Childhood (13 mos to 4 years), and Childhood (4 to 11 years) and current functioning. RESULTS: Perinatal developmental experiences were more strongly associated with compromised current functioning than such experiences occurring during other periods. Perinatal relational poverty was a stronger predictor than perinatal adversity. During subsequent developmental periods, the influence of relational poverty diminished, while the influence of adversity remained strong throughout early childhood. Current relational health, however, was the strongest predictor of functioning. CONCLUSION: Findings expand the understanding of the association between the timing of adversity and relationally impoverished experiences and children's functioning. Although early life experiences are significantly impactful, relationally enriched environments may buffer these effects.

A Meta-Analysis of the Impact of Natural Disasters on Internalizing and Externalizing Problems in Youth.

Although exposure to natural disasters can lead to diverse mental health (MH) outcomes in youth, most child disaster MH research has focused on posttraumatic stress symptoms (PTSS). To highlight the likelihood of other MH outcomes, we meta-analyzed studies that have examined other (non-PTSS) internalizing and externalizing behavior problems in youth exposed to natural disasters. We used PRISMA guidelines to systematically gather studies that have examined the association between natural disaster exposure and non-PTSS internalizing and/or externalizing problems in samples of children and adolescents. Analyses of random effects models of 62 studies examining non-PTSS internalizing problems and 26 studies examining externalizing problems showed exposure to natural disasters was significantly associated with non-PTSS internalizing, rmean = .18, k = 70, and externalizing problems, rmean = .08; k = 31, in youth. Moderator analyses revealed a stronger association between disaster exposure and non-PTSS internalizing problems in countries with a "medium" Human Development Index (HDI) ranking, r = .56, than in countries with "high," r = .15, and "very high," r = .16, HDI rankings. We also found a stronger association between disaster exposure and externalizing problems in countries with a medium HDI ranking, r = .54, versus high, r = .05, and very high, r = .04, HDI rankings, and based on parent, r = .16, compared to child, r = -.01, report. Results support the need for assessment of multiple postdisaster MH outcomes to inform comprehensive interventions. We also include a discussion of the state of the disaster MH research.

Recalling a Devastating Tornado: Qualities of Child Recollections and Associations with Mental Health Symptoms.

Trauma recollections often contain trauma-related cognitive and emotional processing. Research examining indicators of such processing in children's trauma recollections and their association with mental health symptoms is limited. Fifty 8 to 12-year-old children provided two open-ended recollections about (1) challenging/"bad" things and (2) positive/ "good" things that happened to them 1-year post experiencing an EF-5 tornado. Children completed exposure and mental health symptom measures (PTSD, anxiety, depression). Transcripts were coded for indicators of processing: coherence, positive and negative emotion terms, and resolutions. Age, gender, SES, family tornado-related discussion frequency, verbal ability, tornado-specific psychotherapy receipt, and exposure were controlled. Coherence and positive emotion were positively associated and resolutions were negatively associated with mental health symptoms when children discussed the "bad" things. Children's processing and mental health symptoms were unrelated when children discussed the "good" things. The measured indicators of children's processing may reflect children's meaning-making efforts and have implications for adjustment.

Do sleep problems mediate the link between adverse childhood experiences and delinquency in preadolescent children in foster care?

BACKGROUND: Adverse childhood experiences (ACEs) are associated with multiple mental and physical health problems. Yet, mechanisms by which ACEs confer risk for specific problems are largely unknown. Children in foster care typically have multiple ACEs and high rates of negative sequelae, including delinquent behaviors. Mechanisms explaining this link have not been explored in this population. Impaired sleep has been identified as a potential mechanism by which ACEs lead to delinquency in adolescents, because inadequate sleep may lead to poor executive function and cognitive control - known risk factors for delinquency. METHODS: Interviews were conducted with 516 maltreated children in foster care, ages 9-11 years, and their caregivers regarding child exposure to ACEs, sleep problems, engagement in delinquent acts, symptoms of posttraumatic stress disorder, and current psychotropic medication use. ACEs data were also obtained from child welfare case records. RESULTS: After controlling for age, gender, race/ethnicity, placement type (residential, kin, foster), length of time in placement, posttraumatic stress symptoms, and current psychotropic medication use, sleep partially mediated the association between ACEs and delinquency. CONCLUSIONS: Although delinquency is likely multiply determined in this population, improving sleep may be one important strategy to reduce delinquency.

The blind men and the elephant: Identification of a latent maltreatment construct for youth in foster care.

Child maltreatment is a major public health concern due to its impact on developmental trajectories and consequences across mental and physical health outcomes. Operationalization of child maltreatment has been complicated, as research has used simple dichotomous counts to identification of latent class profiles. This study examines a latent measurement model assessed within foster youth inclusive of indicators of maltreatment chronicity and severity across four maltreatment types: physical, sexual, and psychological abuse, and neglect. Participants were 500 foster youth with a mean age of 12.99 years (SD=2.95years). Youth completed survey questions through a confidential audio computer-assisted self-interview program. A two-factor model with latent constructs of chronicity and severity of maltreatment revealed excellent fit across fit indices; however, the latent constructs were correlated 0.972. A one-factor model also demonstrated excellent model fit to the data (χ2 (16, n=500)=28.087, p=0.031, RMSEA (0.012-0.062)=0.039, TLI=0.990, CFI=0.994, SRMR=0.025) with a nonsignificant chi-square difference test comparing the one- and two-factor models. Invariance tests across age, gender, and placement type also were conducted with recommendations provided. Results suggest a single-factor latent model of maltreatment severity and chronicity can be attained. Thus, the maltreatment experiences reported by foster youth, though varied and complex, were captured in a model that may prove useful in later predictions of outcome behaviors. Appropriate identification of both the chronicity and severity of maltreatment inclusive of the range of maltreatment types remains a high priority for future research.

Clinical improvements in adopted children with fetal alcohol spectrum disorders through neurodevelopmentally informed clinical intervention: A pilot study.

Research on early intervention for young children (infants and toddlers) with fetal alcohol spectrum disorders (FASD), particularly children with comorbid maltreatment experiences, is limited. Existing research has primarily focused on structuring environments to be responsive to the needs experienced by children with FASD rather than improving their functioning. The purpose of this study is to present outcomes from an early psychosocial intervention with 10 adopted, maltreated young children diagnosed with FASD, aged 10-53 months (M = 35 months), and their adoptive parents. The potential for early, targeted interventions to improve developmental outcomes for children with prenatal alcohol exposure was examined, as well as improving the skills of and reducing stress experienced by their adoptive parents. Based on the outcomes of a neurodevelopmentally informed assessment protocol, the 10 children whose data are presented were recommended to receive a range of regulatory, somatosensory, relational, and cognitive enrichments. As part of their treatment, children and caregivers received Child-Parent Psychotherapy (CPP), and caregivers (here, adoptive parents) also received Mindful Parenting Education (MPE). Related-samples Wilcoxon signed-rank tests indicated that scores of several measures of child developmental functioning improved from pre- to post-intervention and that parents' caregiving skills improved while their caregiving stress decreased. Reliable change analyses indicated that change observed from pre- to post-intervention was reliable. The promise of using neurodevelopmentally informed assessment strategies to sequence interventions for young children with diverse neurodevelopmental insults is discussed.

Positive Psychology and Disaster Mental Health: Strategies for Working with Children and Adolescents.

Positive psychology concepts and principles can be incorporated into preparedness, crisis response, and recovery phases of disaster mental health efforts to address the needs of children, adolescents, and families. This article articulates general developmental considerations for applying positive psychology in disaster mental health contexts and discusses how 5 essential elements of immediate and midterm mass trauma intervention identified by Hobfoll et al. (2007) may be infused in applications of positive psychology for children and adolescents. Specific strategies for working with children, adolescents, and their families in home, community, and school contexts are drawn in part from disaster mental health resources developed jointly by the National Child Traumatic Stress Network and National Center for Posttraumatic Stress Disorder, including the Psychological First Aid Field Operations Guide (Brymer et al., 2006), the Skills for Psychological Recovery Field Operations Guide (Berkowitz et al., 2010), and the Psychological First Aid for Schools Field Operations Manual (Brymer et al., 2012). Two case examples illustrate the use of positive psychology principles.

Case file coding of child maltreatment: Methods, challenges, and innovations in a longitudinal project of youth in foster care.

State social service agency case files are a common mechanism for obtaining information about a child's maltreatment history, yet these documents are often challenging for researchers to access, and then to process in a manner consistent with the requirements of social science research designs. Specifically, accessing and navigating case files is an extensive undertaking, and a task that many researchers have had to maneuver with little guidance. Even after the files are in hand and the research questions and relevant variables have been clarified, case file information about a child's maltreatment exposure can be idiosyncratic, vague, inconsistent, and incomplete, making coding such information into useful variables for statistical analyses difficult. The Modified Maltreatment Classification System (MMCS) is a popular tool used to guide the process, and though comprehensive, this coding system cannot cover all idiosyncrasies found in case files. It is not clear from the literature how researchers implement this system while accounting for issues outside of the purview of the MMCS or that arise during MMCS use. Finally, a large yet reliable file coding team is essential to the process, however, the literature lacks training guidelines and methods for establishing reliability between coders. In an effort to move the field toward a common approach, the purpose of the present discussion is to detail the process used by one large-scale study of child maltreatment, the Studying Pathways to Adjustment and Resilience in Kids (SPARK) project, a longitudinal study of resilience in youth in foster care. The article addresses each phase of case file coding, from accessing case files, to identifying how to measure constructs of interest, to dealing with exceptions to the coding system, to coding variables reliably, to training large teams of coders and monitoring for fidelity. Implications for a comprehensive and efficient approach to case file coding are discussed.

Mental Health Interventions for Children in Foster Care: A Systematic Review.

Children in foster care have high rates of adverse childhood experiences and are at risk for mental health problems. These problems can be difficult to ameliorate, creating a need for rigorous intervention research. Previous research suggests that intervening with children in foster care can be challenging for several reasons, including the severity and complexity of their mental health problems, and challenges engaging this often transitory population in mental health services. The goal of this article was to systematically review the intervention research that has been conducted with children in foster care, and to identify future research directions. This review was conducted on mental health interventions for children, ages 0 to 12, in foster care, using ERIC, CINAHL, PsycINFO, PubMed, ProQuest's Dissertation and Theses Database, Social Services Abstracts, and Social Work Abstracts. It was restricted to interventions that are at least "possibly efficacious" (i.e., supported by evidence from at least one randomized controlled trial). Studies were evaluated for risk of bias. Ten interventions were identified, with diverse outcomes, including mental health and physiological. Six interventions were developed for children in foster care. Interventions not developed for children in foster care were typically adapted to the foster context. Most interventions have yet to be rigorously evaluated in community-based settings with children in foster care. Little research has been conducted on child and family engagement within these interventions, and there is a need for more research on moderators of intervention outcomes and subgroups that benefit most from these interventions. In addition, there is not consensus regarding how to adapt interventions to this population. Future research should focus on developing and testing more interventions with this population, rigorously evaluating their effectiveness in community-based settings, determining necessary adaptations, and identifying which interventions work best for whom.

Interview and recollection-based research with child disaster survivors: Participation-related changes in emotion and perceptions of participation.

Research suggests that some types of trauma research can be conducted safely with children ages 10 and older. The aim of this project was to learn more about potential risks or benefits of conducting research with younger children and with child disaster survivors, specifically about research that includes children providing trauma recollections. Fifty 8- to 12-year-old children who experienced a devastating tornado participated in an in-person interview that included both individual and joint (mother-child) recollections of their tornado experiences 1 year after exposure. These 50 children also rated 3 emotions at 3 time points and rated their perceptions (e.g., benefit and regret) of research post-participation. Children (N = 28) also participated in phone surveys 3 months later to assess persistent participation-related emotions and perceptions. Child reported that emotions worsened from pre- to during participation; however, reports of emotions returned to preparticipation levels post-participation and remained so at the 3-month follow-up. Sixty-four percent of children reported at least some participation benefit and no participation regret immediately postparticipation, as did 89.3% at the 3-month follow-up. Four percent of children reported some participation regret (no benefit) postparticipation, and 0% 3 months later. No children requested to stop participating, and none required postresearch connection with crisis services. Posttraumatic stress symptom severity, tornado exposure, and age were largely unrelated to child-reported emotions and perceptions of research. Results indicate that carefully planned and executed disaster-related research that includes children providing recollections can be conducted with preadolescents with little risk and some benefit.

Longitudinal Assessment of Self-Harm Statements of Youth in Foster Care: Rates, Reporters, and Related Factors.

Self-harm in youth is a risk factor related to mental health and future morbidity, yet, relatively little is known about the rates and course of self-harm in youth residing in foster care. This study examined self-harm talk in foster youth based on caregiver and child report for 135 children between the ages of 8- and 11-years old. Longitudinal data on course of self-harm talk from both youth and caregivers also are provided. Caregivers identified that 24% of youth participants had disclosed a desire to die or to hurt themselves. Youth self-report revealed that 21% of children indicated a desire for self-harm, and rates of self-harm from both reporters decreased over time. While overall rates were similar across reporters, findings show discrepancies between youth self-report and caregiver report within individuals. Also, caregivers for youth in residential facilities were more likely to report youth self-harm talk than caregivers from foster home settings.

Using Multiple Informants to Assess Child Maltreatment: Concordance Between Case File and Youth Self-Report.

To understand the psychosocial implications of child maltreatment, methods used to document prevalence must be clear. Yet, rates of maltreatment found in child self-report are generally inconsistent with data found in case files from state social service agencies. Although self-reports and case file reports of abuse disagree on occurrence of specific events, it is unclear if reporters agree when overall categories of abuse are considered. This study investigated differences between case file and youth report of abuse by examining four types of abuse: physical, sexual, neglect, and psychological, in a within-subjects design using a sample of 97 youth in foster care aged 8 to 22. Case files were coded for the presence of any indication of each type of abuse. Self-report of abuse was also assessed for any indication of each type of abuse. Results indicated that, overall, youth reported more physical and psychological abuse, and younger youth reported more sexual abuse than documented in their file. Implications for research and service provision for maltreated youth are discussed.

Towards successful Dissemination of Psychological First Aid: a study of provider training preferences.

Dissemination of Psychological First Aid (PFA) is challenging considering the complex nature of disaster response and the various disaster mental health (DMH) trainings available. To understand challenges to dissemination in community mental health centers (CMHCs), interviews were conducted with nine DMH providers associated with CMHCs. Consensual qualitative analysis was used to analyze data. Interviews were targeted toward understanding organizational infrastructure, DMH training requirements, and training needs. Results clarified challenges to DMH training in CMHCs and factors that may promote buy-in for trainings. For example, resources are limited and thus allocated for state and federal training requirements. Therefore, including PFA in these requirements could promote adoption. Additionally, a variety of training approaches that differ in content, style, and length would be useful. To conclude, a conceptual model for ways to promote buy-in for the PFA Guide is proposed.

Strategies for Longitudinal Research with Youth in Foster Care: A Demonstration of Methods, Barriers, and Innovations.

Longitudinal research on youth in foster care is important, but often challenging to accomplish. To assist the field, a thorough description of the development of the SPARK (Studying Pathways to Adjustment and Resilience in Kids) project, a longitudinal research project on the mechanisms of resilience for foster youth and their caregivers, is presented. Authors explain the difficult task for researchers in accessing youth in foster care and suggest strategies for success. Recruitment approaches for foster youth and their families are also provided along with examples of effective techniques. Data collection concerns are discussed, and the authors provide recommendations for researchers to consider when asking youth sensitive questions. Finally, data collection on academic information from teachers and how the SPARK project works with the academic community to gain information on school functioning for youth in the project is described. Suggestions for methodology utilized in future research along with examples of innovative adjustments to typical research procedures are provided as guidance for how research on maltreated youth can be conducted.