Training Master of Social Work Students in Brief Intervention for Unhealthy Alcohol Use: Results of a Validated Adherence Assessment.

BACKGROUND: Many social workers receive limited training in working with clients engaged in unhealthy substance use. As a result, national organizations and agencies such as the Council on Social Work Education and individual social work programs are beginning to address this need by incorporating training into higher education social work programs. The purpose of this study was to examine Master of Social Work (MSW) students' adherence to a brief intervention protocol for unhealthy alcohol use. METHODS: A total of 91 MSW students consented to the assessment of their digital, audio-recorded class assignment by independent raters. RESULTS: Although 90% of MSW student participants were found to be overall adherent to the protocol, gaps in training quality were also identified. CONCLUSIONS: Lessons learned for addressing the gaps are discussed, along with future directions for teaching and learning in social work related to substance use.

Assessing Polyvictimization in a Family Justice Center: Lessons Learned From a Demonstration Project.

There is a growing interest in developing comprehensive assessments that measure intimate partner violence (IPV) alongside other adverse events that correlate with IPV and compound its effects. One promising line of research in this area has focused on the impact of exposure to multiple types of victimization, i.e., polyvictimization. The purpose of this study is to examine the experience of administration of a polyvictimization tool from staff and client perspectives in order to inform future tool developments and assessment procedures. Qualitative interviews and focus groups with clients and staff from a family justice center who had experience with the assessment tool were used to identify strengths and challenges of the assessment too and inform future tool development. Findings demonstrate that an assessment tool provides the space for clients to talk about trauma and facilitate empowerment, while providing the opportunity for psychoeducation and service referrals. Concerns about the assessment tool included adverse reactions without proper framing and language, as well as shifting the emphasis from screening for adversities toward strengths, coping skills, and resilience. Implications for future measurement development and establishing best practices in polyvictimization assessment are discussed, with an emphasis on the benefits of social service agencies utilizing assessment tools.

Increasing mental health treatment access and equity through trauma-responsive care.

Adverse childhood experiences and other potentially traumatic events have lasting implications for mental health. Evidence-based treatments are available to address trauma-related symptoms, but their impact is hindered because access is limited and unequal. In the U.S., adverse experiences and mental disorders disproportionately affect socioeconomically disadvantaged groups that face treatment access barriers-disparities that are compounded by passive systems of care that wait for clients to seek treatment. This article presents a conceptual argument, backed by empirical evidence, that population health can be improved by implementing trauma-responsive practices, and that greater mental health equity can be achieved if these strategies are used to engage underserved clients. A description is provided of the Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT), a promising protocol that can be used by nonclinical providers to detect trauma-related mental health concerns in adults and help them access therapeutic services. The T-SBIRT protocol has been successfully implemented in diverse settings, and it is currently being piloted in a universal postpartum home visiting program called Family Connects. Prior results from three trials of Family Connects are summarized, including evidence of program impact on maternal mental health. New results are also presented indicating that T-SBIRT is feasible to implement within Family Connects, as denoted by indicators of suitability, tolerability, provider adherence, and referral acceptance. Closing recommendations are offered for reducing mental health disparities by testing and disseminating T-SBIRT through Family Connects and other large-scale programs and systems of care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Influence of race/ethnicity and income on the link between adverse childhood experiences and child flourishing.

BACKGROUND: The impact of early adversity increases the risk of poor outcomes across the life course. Identifying factors that protect against or contribute to deleterious life outcomes represents an important step in resilience promotion among children exposed to adversity. Informed by resilience science, we hypothesized that family resilience mediates the relationship between adverse childhood experiences (ACEs) and child flourishing, and these pathways vary by race/ethnicity and income. METHODS: We conducted a secondary data analysis using the 2016-17 National Survey of Children's Health data reported by parents/guardians for 44,686 children age 6-17 years. A moderated-mediation model estimated direct, indirect, and total effects using a probit link function and stacked group approach with weighted least square parameter estimates. RESULTS: The main variables were related in expected directions. Family resilience partially mediated the ACEs-flourishing association. Although White and socioeconomically advantaged families were more likely to maintain family resilience, their children functioned more poorly at high-risk levels relative to Black and Hispanic children and across income groups. CONCLUSION: Children suffer from cumulative adversity across race/ethnicity and income. Partial mediation of family resilience indicates that additional protective factors are needed to develop comprehensive strategies, while racial/ethnic differences underscore the importance of prevention and intervention programs that are culturally sensitive. IMPACT: The key message of the article reinforces the notion that children suffer from cumulative adversity across race/ethnicity and income, and prevention of ACEs should be the number one charge of public policy, programs, and healthcare. This is the first study to examine family resilience in the National Survey Children's Health (NSCH) data set as mediating ACEs-flourishing by race/ethnicity and family poverty level. Examining an ACEs dose-response effect using population-based data within the context of risk and protective factors can inform a public health response resulting in a greater impact on prevention efforts.

Translating and Implementing Evidence-Based Mental Health Services in Child Welfare.

Children in the child welfare system with mental health difficulties seldom receive evidence-based treatment (EBT) despite the abundance of validated interventions that exist. This manuscript describes two projects aimed at increasing access to EBTs. The first is a completed field trial of an adapted parent-child interaction therapy intervention with foster-parent child dyads. New findings are presented from variable- and person-centered analyses of impact on diverse symptom profiles. The second is an ongoing statewide initiative that is increasing access to multiple EBTs while navigating implementation barriers. Lessons learned for bridging gaps between children's mental health research, services, and policy are discussed.

Evaluation of a Motivation-Based Intervention to Reduce Health Risk Behaviors among Black Primary Care Patients with Adverse Childhood Experiences.

BACKGROUND: Considerable evidence suggests that greater attention should be paid to the impact of trauma among low-income, racial/ethnic minority patients living in urban communities. The goal of this article is to evaluate a 2-session, motivational intervention designed to motivate a change in health risk behaviors among low-income, self-identified Black/African American patients with adverse childhood experiences (ACEs). METHODS: Qualitative self-reported data described helpful aspects of the intervention and those that could be improved. Eligible participants with 1 or more ACEs being seen in a community-based clinic were interviewed by a mental health clinician researcher for 2 in-person sessions scheduled 1 month apart. Content analysis was performed using a general inductive approach to identify core themes. RESULTS: In total, 36 of 40 participants completed both sessions, with the majority reporting a high rate of satisfaction. Participants emphasized the importance of talking with a trained professional who could listen without judgment, understand patient challenges, clarify patient goals, and facilitate behavior change plans. Suggestions for improvement included modifying structure and content, enhancing clinic environment, improving linkages to behavioral health, and increasing communication and collaboration with clinicians. CONCLUSION: Participant evaluation data gathered for this study suggest that through the practice of asking, listening, and accepting, clinicians can help patients who have been exposed to childhood adversity better understand themselves and promote healthy coping behaviors. This study provides preliminary data on the needs of underserved patients that can be utilized to develop and deliver health promotion interventions using a trauma-informed approach in community-based clinics.

Medical Students' Perspectives on Trauma-Informed Care Training.

INTRODUCTION: Adults exposed to traumatic events during childhood commonly seek medical services, but health care practitioners hesitate to address and assess early trauma despite its known negative health effects. This study examines medical students' perspectives on a brief course that addressed the health care needs of patients exposed to adverse childhood experiences. METHODS: A convenience sample of 20 University of California, Davis medical students from the Summer Institute on Race and Health received 6 hours of trauma-informed care training. The course was delivered in 2-hour modules during the course of 3 days, and included lectures, discussions, and practice. A questionnaire assessing students' perspectives on training benefits, current practice challenges, and necessary resources to provide trauma-informed medical care was distributed posttraining. RESULTS: From the students' perspectives, this course increased their ability to recognize various clinical manifestations of adverse childhood experience exposure in adult patients. Students said they learned how to ask about and respond to adverse childhood experience disclosures and identify necessary resources to responsibly implement trauma-informed care in medical settings. Students identified provision of adequate resources and links to appropriate treatment identified as common challenges in providing health care to trauma-affected patients. CONCLUSION: Study findings illustrate that trauma training can fill a knowledge gap and provide associated benefits for medical students. Initial training may pique students' interest by demonstrating the relevance of trauma knowledge in clinical practice; additional training likely is needed to support skills and confidence.

Educational success and adult health: findings from the Chicago longitudinal study.

Growing evidence indicates that education is associated with health, yet we lack knowledge about the specific educational experiences influencing health trajectories. This study examines the role school factors play in the emergence of poor young adult health outcomes for a low-income, minority sample. The following research questions are addressed. First, what are the education-based predictors of daily tobacco smoking, frequent substance use, depression, and no health insurance coverage? Second, do later-occurring school factors explain the association between earlier school measures and the outcomes and, if so, what pathways account for this mediation effect? Data were derived from the Chicago Longitudinal Study, an investigation of a cohort of 1,539 individuals, born around 1980, who attended kindergarten programs in the Chicago Public Schools. Participants were followed prospectively from early childhood through age 24, and study measures were created from various data sources and multiple assessment waves. Findings from probit hierarchical regressions with controls for early sociodemographic covariates indicated that elementary school socioemotional classroom adjustment and high school completion were significantly and negatively associated with all four study outcomes. Participation in the Chicago Child Parent Center preschool program predicted lower rates of both daily tobacco smoking and no health insurance coverage (p < .05). Middle school reading achievement was inversely related to depression (p < .01), while middle school frustration tolerance was inversely associated with daily tobacco smoking and frequent drug use (p < .05). Also, negatively linked to frequent drug use was a high school measure of students' expectation to attend college (p < .01). In nearly all cases, later-occurring school factors fully mediated significant associations between earlier ones and the outcomes. Patterns of mediation were explored along with implications of results.

Effects of a school-based, early childhood intervention on adult health and well-being: a 19-year follow-up of low-income families.

OBJECTIVE: To determine the effects of an established preventive intervention on the health and well-being of an urban cohort in young adulthood. DESIGN: Follow-up of a nonrandomized alternative-intervention matched-group cohort at age 24 years. SETTING: Chicago, Illinois. PARTICIPANTS: A total of 1539 low-income participants who enrolled in the Child-Parent Center program in 20 sites or in an alternative kindergarten intervention. INTERVENTIONS: The Child-Parent Center program provides school-based educational enrichment and comprehensive family services from preschool to third grade. MAIN OUTCOME MEASURES: Educational attainment, adult arrest and incarceration, health status and behavior, and economic well-being. RESULTS: Relative to the comparison group and adjusted for many covariates, Child-Parent Center preschool participants had higher rates of school completion (63.7% vs 71.4%, respectively; P = .01) and attendance in 4-year colleges as well as more years of education. They were more likely to have health insurance coverage (61.5% vs 70.2%, respectively; P = .005). Preschool graduates relative to the comparison group also had lower rates of felony arrests (16.5% vs 21.1%, respectively; P = .02), convictions, incarceration (20.6% vs 25.6%, respectively; P = .03), depressive symptoms (12.8% vs 17.4%, respectively; P=.06), and out-of-home placement. Participation in both preschool and school-age intervention relative to the comparison group was associated with higher rates of full-time employment (42.7% vs 36.4%, respectively; P = .04), higher levels of educational attainment, lower rates of arrests for violent offenses, and lower rates of disability. CONCLUSIONS: Participation in a school-based intervention beginning in preschool was associated with a wide range of positive outcomes. Findings provide evidence that established early education programs can have enduring effects on general well-being into adulthood.

Paths of effects of early childhood intervention on educational attainment and delinquency: a confirmatory analysis of the Chicago Child-Parent Centers.

This study investigated the contributions of 5 mechanisms to the effects of preschool participation in the Child-Parent Centers for 1,404 low-income children in the Chicago Longitudinal Study. Based on a matched-group design, preschool participation was associated with significantly higher rates of educational attainment and lower rates of juvenile arrest. LISREL analysis revealed that the primary mediators of effects for both outcomes were attendance in high-quality elementary schools and lower mobility (school support hypothesis), literacy skills in kindergarten and avoidance of grade retention (cognitive advantage hypothesis), and parent involvement in school and avoidance of child maltreatment (family support hypothesis). The model accounted for 58% and 79% of the preschool links with school completion and juvenile arrest, respectively. The maintenance early intervention effects are influenced by many alterable factors.