Reimagining traumatic stress studies as a participatory science grounded in critical self-reflection: A call to action.

Recognizing the need for a transformative shift to advance scholarship and practice focused on traumatic stress, this paper emerged from a special invited panel at the 38th Annual Meeting of the International Society for Traumatic Stress Studies (ISTSS). The panel brought together scholars from interdisciplinary backgrounds, including psychology, public health, and social work, to share their unique perspectives and experiences harnessing a collaborative, critical, and strengths-based lens in research. This piece invites the field to consider the importance of cultural humility as a foundational, nonnegotiable practice in traumatic stress studies. Details about participatory science and healing-centered practice are presented along with key questions to support the application of these frameworks in studies of traumatic stress.

Participatory science as a decolonizing methodology: Leveraging collective knowledge from partnerships with refugee and immigrant communities.

OBJECTIVES: The major global problems of our day, including mass displacement, climate change, violence, and pandemic, necessitate global solutions. In a world where injustice and inequities are rampant, psychologists stand at the precipice of social change and action, with an opportunity to unambiguously decolonize our research methodologies, and engage in scholarship that provides immediate benefits to communities. METHOD: Participatory methods offer an opportunity to co-create an empowering, equitable, inclusive, and ethical science in partnership with communities. RESULTS: This special issue on Collaborative and Participatory Research to Promote Engagement, Empowerment, and Resilience for Immigrant and Refugee Youth, Families, and Communities highlights exemplary interdisciplinary work that has emerged in learning from and working in partnership with immigrant and refugee youth, families, and communities. CONCLUSIONS: The special issue offers six major components of participatory methodologies that provide a roadmap to decolonizing psychological science, recognize the potentials for innovation and impact, and advance the field. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A systematic review of socioecological factors, community violence exposure, and disparities for Latinx youth.

Community violence exposure poses a public health risk exacerbated by immigration-related stressors and environmental factors, including systemic racism and interpersonal discrimination, socioeconomic disparities, and anti-immigrant laws and policies, that disproportionately impact Latinx-immigrant and systematically minoritized youth. Using the ecological-transactional model of community violence as a conceptual framework, this systematic review was conducted to examine research on exposure to community violence, risk and protective factors, and associated health and mental health sequelae among Latinx youth. The initial search generated 2,152 articles, 291 of which were reviewed for detailed evaluation; ultimately, 59 articles were included. Mexican-origin youth and adolescent samples were the most represented in research studies. Across several studies, Latinx youth reported high rates of violence exposure and poor health or mental health outcomes. The findings revealed important gaps in socioecological factors, with a dearth of evidence establishing macrosystem factors or culturally salient and immigrant-related factors. Notable risk and protective factors at various ecological levels were identified and discussed as key opportunities for future research and points of intervention or prevention efforts for Latinx-immigrant and systematically minoritized youth.

Co-Occurring Youth Profiles of Adverse Childhood Experiences and Protective Factors: Associations with Health, Resilience, and Racial Disparities.

It is important to understand racial/ethnic differences in adverse childhood experiences (ACEs), given their relationship to long-term physical and mental health, and the public health cost of the significant disparities that exist. Moreover, in order to inform interventions and promote resilience, it is critical to examine protective factors that mitigate the relationship between adversity and poor health. The current study utilized latent transition analyses (LTA) to examine co-occurring profiles of ACEs and protective factors (from school, family, and community contexts) and links to health outcomes among 30,668 Black (10.4%), Latinx (12.3%), and White youth (77.3%) ages 12-17 (52.5% male) who participated in the 2011-12 National Survey of Children's Health (NSCH). Results suggested that greater adversity was associated with worse health, while more access to protective factors was associated with better health. White youth had consistently lower endorsement of ACEs, greater access to protective factors, and better health compared to their Black and Latinx counterparts. Efforts to improve child health and racial/ethnic disparities in research and practice must consider adversity, protective factors, and the systemic inequities faced by racial/ethnic minority youth in the United States.

Patterns of Family, School, and Community Promotive Factors and Health Disparities Among Youth: Implications for Prevention Science.

Increasing knowledge of factors that promote health among youth from diverse backgrounds is an important step towards addressing health disparities. Although many promotive factors have been identified individually, there is an overabundance of research on risk factors, and a comparable dearth of knowledge regarding the influence of combinations of promotive factors. The current study examined how promotive factors across family, school, and community contexts co-occur to promote health among youth of different race/ethnicity. Utilizing a nationally representative sample of Black (10%), Latinx (12%), and White (77%) youth ages 12-17 (N = 30,668), latent class analysis was employed to identify classes of youth who endorsed homogenous patterns of promotive factors. Associations between class membership and health were explored. Each subsample was best characterized by its own 4-class model, with significant differences in patterns of promotive factors experienced by Black, Latinx, and White youth. Youth health outcomes also varied significantly by class membership (p < .05). Greater access to more promotive factors was associated with better health, and low access to community and school promotive factors was associated with worse health. Results suggest that increasing promotive factors in school, family, and community settings may help to prevent poor health outcomes; however, jointly addressing discrimination against racial/ethnic minority youth through education, policy, and practice is also needed to address health disparities.

Trauma-Responsive Care in a Pediatric Setting: Feasibility and Acceptability of Screening for Adverse Childhood Experiences.

Adverse childhood experiences (ACEs) have demonstrable negative effects on long-term physical and mental health. Low-income and ethnic minority communities face significant disparities in exposure to ACEs. Pediatric settings offer an opportune context to identify and address ACEs, with the potential to reduce barriers in access to resources and services. The current study examined the feasibility and acceptability of screening infants and their parents for ACEs at a community medical clinic. Feasibility data indicated that 151 (92%) of the 164 unique patients that presented for well-child visits for infants (4- to 12-months) across a 13-month period were screened for infant and parent ACEs. Of these 151 patients, 47% met eligibility (infants with 1 + ACEs, parents with 2 + ACEs) deemed intermediate risk and indicated referral to prevention services. The majority of referred families (77%) accepted prevention services, including appointments with bilingual and bicultural wellness navigators who provided a cultural bridge and access to resources that could address patients' social determinants of health. Qualitative interviews with providers expand upon screening acceptability. Implications for integrated behavioral health, ACEs screening, and trauma-responsive prevention in a pediatric setting are discussed.

Using Community-Based Participatory Research and Human-Centered Design to Address Violence-Related Health Disparities Among Latino/a Youth.

High rates of exposure to violence and other adversities among Latino/a youth contribute to health disparities. The current article addresses the ways in which community-based participatory research (CBPR) and human-centered design (HCD) can help engage communities in dialogue and action. We present a project exemplifying how community forums, with researchers, practitioners, and key stakeholders, including youths and parents, integrated HCD strategies with a CBPR approach. Given the potential for power inequities among these groups, CBPR + HCD acted as a catalyst for reciprocal dialogue and generated potential opportunity areas for health promotion and change. Future directions are described.

Photography and Social Media Use in Community-Based Participatory Research with Youth: Ethical Considerations.

Community-based participatory researchers increasingly incorporate photography and social media into their work. Despite its relative infancy, social media has created a powerful network that allows individuals to convey messages quickly to a widespread audience. In addition to its potential benefits, the use of social media in research also carries risk, given the fast pace of exchanges, sharing of personal images and ideas in high accessibility, low privacy contexts and continually shifting options and upgrades. This article contributes to the literature examining ethical considerations for photography and social media use in community-based participatory research. We describe three key ethical dilemmas that we encountered during our participatory photography project with Latina/o youth: (a) use and content of images and risk; (b) incentives and coercion; and (c) social media activity and confidentiality. We provide our responses to these challenges, contextualized in theory and practice, and share lessons learned. We raise the question of how to contend with cultural shifts in boundaries and privacy. We propose that evaluating participant vulnerability versus potential empowerment may be more fitting than the standard approach of assessing risks and benefits. Finally, we recommend upholding the principles of participatory research by co-producing ethical practices with one's participants.

Dismantling racism through partnership with resettled refugee communities.

The enormous and ever-increasing problem of forced displacement warrants the attention of psychological science to play a role in leading efforts to address the needs of refugee communities. As a nation of immigrants, the United States has a long and complicated history of refugee admissions, including both generous and racist policies and sentiments. Examining the past can increase our capacity to transform the future. Taking conscious action to dismantle racism is of central importance to begin to make reparations and find pathways toward healing. Recognizing the instrumental role of systemic forces, three guideposts to support an antiracist foundation for research and practice in psychology are drawn from existing frameworks and applied to the case of refugees. These include (a) remembrance as an act of historical and sociopolitical analysis, (b) truth-telling to engage in critical self-reflection within the field of psychology, and (c) accompaniment alongside refugee communities to develop partnerships that reinforce their strengths and agency and directly benefit them. These guideposts underscore the importance of upholding community priorities and empowering refugee communities to reclaim their own cultural knowledge and strengths and to create effective and sustainable programs, with the potential for significant public health impact. As such, psychologists can play a critical role in transforming social systems over time and actively working to dismantle racism. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring cumulative identity-based discrimination, distress, and traumatic exposure among Muslims living in the United States.

OBJECTIVE: Muslims living in the United States (MLUS), a highly heterogeneous group, experience high rates of discrimination that may cumulatively contribute to traumatic stress. This study explored whether identity-based discrimination (i.e., due to religion, gender, race) was individually and cumulatively associated with psychological distress and exposure to trauma among MLUS. METHOD: Fifty-nine MLUS completed the survey at two time points (~1 year apart). We administered measures of discrimination (at Time 1), distress (at Times 1 and 2), and trauma exposure (at Time 2). Multiple linear regressions determined whether discrimination at Time 1 was associated with traumatic exposure or distress at Time 2, after controlling for covariates. Mediation analyses determined whether the relationship between cumulative discrimination and distress at Time 2 occurred via distress at Time 1. RESULTS: MLUS who reported experiencing both religious and racial discrimination also reported greater exposure to traumatic events, after controlling for covariates. All three forms of identity-based discrimination (religion, race, gender) were individually and cumulatively (i.e., experiencing all three) associated with distress at Time 1, but not Time 2. However, the relationships between cumulative discrimination at Time 1 and distress at Time 2 were mediated by distress at Time 1. U.S.-born Muslims were particularly at risk for experiencing discrimination, distress, and traumatic exposure. CONCLUSION: Experiences of discrimination may have a cumulative impact on trauma and psychological distress among MLUS. This study underscores the need for targeted interventions that assess MLUS clients' discriminatory experiences to develop a more holistic conceptualization, better support systems, and the most effective approaches. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adverse childhood experiences and yoga as "a practice of liberation".

OBJECTIVE: The long-term negative health consequences of adverse childhood experiences (ACEs) pose a significant public health concern. Effective and engaging interventions that simultaneously address physical, mental, and socio-emotional health and mitigate the negative sequelae related to ACEs are needed. Promising evidence points to the impact of yoga and mindfulness on physiological and emotional health outcomes. Yet, little is known about those who have experienced multiple ACEs and their perspectives on the influence of yoga and mindfulness on their lives. The current study examines the phenomenological experiences of adults with high ACEs who engage in yoga practice. METHOD: Twelve adults participated in in-depth, semistructured interviews. These included nine cisgender women, two cisgender men, and one gender nonbinary individual; 66.8% White, 16.6% multiracial, 8.3% Black/African American, and 8.3% Asian American/Pacific Islander. Participants were aged 20-63 years and endorsed four or more ACEs. They practiced yoga at least once a week for at least 6 months. RESULTS: Themes that emerged included: healing from trauma-related symptoms, integration of the whole self in mind-body practice, corrective experiences through yoga and mindfulness, and healing beyond talk therapy. CONCLUSIONS: Individuals with ACEs may experience yoga as a potentially valuable method for promoting healing through an integrative approach. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A structural model of racial discrimination, acculturative stress, and cultural resources among Arab American adolescents.

Despite evidence towards the risk for discrimination and acculturative stress that Arab American adolescents may face, the link between socio-cultural adversities and psychological well-being in this population has not been established. This study examined the role of socio-cultural adversities (discrimination and acculturative stress) and cultural resources (ethnic identity, religious support and religious coping) in terms of their direct impact on psychological distress. Using structural equation modeling, the proposed model was tested with 240 Arab American adolescents. The results indicated a strong positive relationship between socio-cultural adversities and psychological distress. Furthermore, this study supported a promotive model of cultural resources, where a negative association between cultural resources and psychological distress was found. Understanding the manner in which socio-cultural adversities and resources are linked to psychological distress can inform the development of culturally appropriate interventions that can effectively mitigate mental health concerns for understudied and vulnerable populations.

Implications of adverse childhood experiences screening on behavioral health services: A scoping review and systems modeling analysis.

Widespread implementation of adverse childhood experiences (ACEs) screening is occurring in the United States in response to policies and practice recommendations. However, limited research has established how these screening efforts impact the health care system and ultimately health outcomes. This article examines the current knowledge base on screening in medical settings. A scoping review of articles reporting on ACEs screening and prevalence in the United States was conducted. Of the 1,643 unique studies across two decades, 12 articles meeting criteria included nine on routine screening in medical settings and three on population-based surveys. A Monte Carlo simulation model was designed to synthesize evidence, identify key areas of uncertainty, and explore service system implications. Results indicated significant heterogeneity in the proportion of respondents who reported ACEs, with 6% to 64% of patients reporting 1+ ACEs and .01% to 40.7% reporting 4+ ACEs. Gaps in the literature were identified regarding cut-scores for referrals and referral completion rates. Three scenarios, modeled based on these data and past research on behavioral health screenings in pediatric primary care, demonstrated how ACEs screening may differentially impact behavioral health care systems. Priorities for future research were highlighted to refine estimates of the likely impact of ACEs screening on health care delivery. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Promoting Equity and Resilience: Wellness Navigators' Role in Addressing Adverse Childhood Experiences.

OBJECTIVE: Adverse childhood experiences (ACEs) have demonstrable negative effects on long-term physical and mental health. Racial and ethnic minority children disproportionally experience ACEs due to the impacts of structural inequality and discrimination, which could drive health disparities. Pediatric settings offer an opportune context to address ACEs and improve health equity, and to link families to the necessary resources to promote resilience. Wellness navigators (WNs), who can reflect patients' cultural, linguistic, and other shared characteristics, have the potential to improve patient care and integrated behavioral health services to mitigate the public health impact of ACEs. In the current study, bilingual and bicultural WNs helped to deliver an ACEs screening and response to predominately Latinx patients in a pediatric service setting. METHODS: Quantitative data on referrals made by WNs and qualitative interviews were analyzed to understand the role of WNs in ACEs screening. RESULTS: Among families (infants and caregivers) that screened positive for ACEs, WNs addressed social determinants of health and, based on individual needs assessments, made referrals to community resources in over half of the cases. Insurance, childcare, and housing were the most frequent referral sources. WNs supported caregivers in initiating services with 94% of the referrals that were made. Qualitative interviews with medical providers and caregivers underscored WNs' role in the ACEs screening process. Implications for ACEs screening, trauma-responsive pediatric care, and integrating WNs into an integrated behavioral health team are discussed.

The influence of flood exposure and subsequent stressors on youth social-emotional health.

Most disaster mental health research focuses on the relationship between disaster exposure and distress, often neglecting its influence on social-emotional health, despite implications for resilience and well-being after the disaster. Following multiple floods in Texas, a sample of 486 youth aged 10-19 years old (M = 13.74 years, SD = 2.57; 52.9% male) completed measures of disaster exposure, life stressors since the disaster, and social-emotional health. Using mixture regression modeling, we examined differences in the relationship between life stressors and social-emotional health across latent classes of disaster exposure (high, moderate, community, and low exposure). After accounting for mean levels of life stressors, the mean levels of social-emotional health did not differ across exposure classes; however, the strength of the relationship between life stressors and social-emotional health did. Youth in the high exposure group had the highest mean level of life stressors since the disaster. Thus, each additional life stressor did not result in changes in social-emotional health, suggesting saturated stress levels. For youth in the moderate and community exposure classes, increases in life stressors did lower social-emotional health, perhaps pushing them into stress overload. For the low exposure group, life stressors did not have an influence. This has implications for postdisaster mental health screening and support, tailored by levels of exposure and attuned to ongoing stressors that may impact long-term social-emotional health. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A novel examination of exposure patterns and posttraumatic stress after a university mass murder.

OBJECTIVE: Occurring at an alarming rate in the United States, mass violence has been linked to posttraumatic stress symptoms (PTSS) in both direct victims and community members who are indirectly exposed. Identifying what distinct exposure patterns exist and their relation to later PTSS has important clinical implications. The present study determined classes of exposure to an event of mass violence, and if PTSS differed across classes. METHOD: First- and second-year college students (N = 1,189) participated in a confidential online survey following a mass murder at their university, which assessed event exposure and PTSS 3 months later. Latent class analysis (LCA) was used to empirically determine distinct classes of exposure patterns and links between class membership and PTSS. RESULTS: The final model yielded 4 classes: minimal exposure (55.5% of sample), auditory exposure (29.4% of sample), visual exposure (10% of sample), and interpersonal exposure (5% of sample). More severe direct exposure (i.e., the visual exposure class) was associated with significantly higher levels of PTSS than the auditory exposure or minimal exposure classes, as was the interpersonal exposure class. There were no significant differences in PTSS between the auditory exposure and minimal exposure classes or the visual exposure and interpersonal exposure classes. CONCLUSION: Results point to the differential impact of exposure categories, and provide empirical evidence for distinguishing among auditory, visual, and interpersonal exposures to events of mass violence on college campuses. Clinical implications suggest that visual and interpersonal exposure may warrant targeted efforts following mass violence. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A model of cumulative racial-ethnic trauma among Americans of Middle Eastern and North African (MENA) descent.

Americans of Middle Eastern and North African (MENA) descent in the United States have been historically understudied, in part due to limitations of racial classification systems that typically include MENA under the broad umbrella of White. As a result, enormous gaps in knowledge about health and mental health disparities exist, with broad public health significance. In particular, there is an urgent need to attend more specifically to MENA Americans' experiences of cumulative racial-ethnic trauma, which occurs at every level of their social ecologies. This article offers a conceptual model of cumulative racial-ethnic trauma to represent the unique experiences of the MENA American population. Traumatic factors at the macrolevel include historical trauma, pervasive institutional discrimination, and a hostile national context. These factors interact with one another and further impact microlevel traumatic experiences related to interpersonal discrimination and microaggressions, as well as struggles with identity and recognition. The deleterious impacts of these experiences may include a ubiquitous sense of insecurity, hopelessness, and alienation among MENA American individuals, in addition to more specific mental health and physical health concerns. It also compromises the overall well-being of the MENA American population in terms of belonging versus alienation, freedom versus restriction, and opportunities versus disadvantage. We discuss how the model can help to create a foundation for future inquiry and contribute to intervention efforts to find effective ways to support resilience and thriving for the MENA American population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Developing and evaluating a lay health worker delivered implementation intervention to decrease engagement disparities in behavioural parent training: a mixed methods study protocol.

INTRODUCTION: Behavioural parent training (BPT) programmes are effective in preventing and treating early-onset conduct problems and child maltreatment. Unfortunately, pervasive mental health service disparities continue to limit access to and engagement in these interventions. Furthermore, challenges with parental engagement can impede the successful implementation of evidence-based practices (EBPs) in community settings that serve low-income, ethnic minority families. Lay health workers (LHWs)-individuals without formal mental health training-represent an important workforce to increase engagement, as they are members of the communities they serve. However, the mobilisation of LHWs has not been well studied as an implementation strategy to extend the reach or effectiveness of EBPs in the USA. LHW-delivered implementation interventions that specifically support the engagement of Latinx parents in evidence-based BPT programmes have the potential to improve clinical and implementation outcomes. METHODS AND ANALYSIS: A community-partnered approach will use the Quality Implementation Framework (QIF) to tailor and implement an LHW-delivered implementation intervention that aims to promote Latinx parent engagement in BPT programmes. Steps from the QIF will guide study activities to (1) conduct a mixed methods needs assessment to fit the implementation intervention to the local context, (2) adapt LHW-delivered implementation strategies to promote parent access to and engagement in Parent-Child Interaction Therapy and (3) conduct a hybrid effectiveness-implementation pilot trial to examine the feasibility, acceptability and preliminary effectiveness of the LHW implementation intervention at increasing engagement. ETHICS AND DISSEMINATION: Study procedures have been approved by the Institutional Review Board at the University of California, Santa Barbara. Results will be shared with the community-advisory group, at community-based meetings for other stakeholders involved in the pilot project, and submitted for publication in peer-reviewed journals.

Patterns of adversity and pathways to health among White, Black, and Latinx youth.

Research has demonstrated the negative impact of Adverse Childhood Experiences (ACEs) on long-term trajectories of mental and physical health. Yet existing literature on this topic is limited in its understanding of outcomes among youth samples, optimal measurement items and methods, and differences in adverse experiences across race/ethnicity. The current study used a person-centered approach to measure ACEs and their impact on youth health outcomes across three different racial/ethnic groups from a large national database. Patterns of exposure to adverse experiences among Black, Latinx, and White youth (N = 30,668, ages 12-17) were determined empirically using latent class analysis (LCA). Significant differences in class membership by demographic indicators (age, household income, sex) and concurrent health outcomes were identified. Different models emerged for Black (2 classes), Latinx (3 classes), and White youth (3 classes). Older and lower-income youth were more likely to have experienced adversities, but there were no differences in adversity likelihood by sex. Additionally, racial/ethnic minority youth were at greater risk of experiencing higher levels of adversity, poverty, and poor health when compared to their White counterparts. Rather than occuring in meaningful clusters, adverse experiences among youth reflected a cumulative risk model such that classes were defined by the overall intensity of adverse experiences (i.e., low, moderate, high). Findings provide greater knowledge regarding the relationship between ACEs and health and future research directions to inform more targeted and culturally-appropriate screening, prevention, and intervention programs.

Linking profiles of neighborhood elements to health and related outcomes among children across the United States.

The current study explored association of neighborhood elements to children's health and related outcomes. Nationally representative data (N = 49,513,974, ages 6-17, 51.1% Male) was used to empirically define classes of neighborhoods based on presence or absence of various neighborhood elements. Analyses resulted in a three-class model: 1) "High Assets, Low Disorganization" (64.57%), 2) "High Assets, High Disorganization" (13.51%), and 3) "Few Assets, Low Disorganization" (21.91%). Class Membership was differentially associated with health, flourishing, and neighborhood cohesion. Results suggest health interventions should focus on increasing neighborhood assets, decreasing levels of neighborhood violence and poverty, and improving social dynamics of neighborhoods.