Prevalence of Childhood Trauma in a Community-Based Mental Health Clinic.

A large number of individuals in the US have experienced childhood trauma. However, little is known about the prevalence of trauma in a diverse patient population entering treatment in a community mental health center. To assess early trauma in this population, the Adverse Childhood Experience (ACEs) questionnaire was administered to 856 participants over a nine-month period. 40% reported four or more ACEs. Among high scorers, emotional abuse, physical abuse and emotional neglect were the most prevalent ACE experiences. High mean ACE sum scores were observed among patients with PTSD, depression, impulse disorder and substance use disorder. Having a higher ACE sum score was associated with a greater number of co-occurring psychiatric disorders. Characterizing ACEs by patient sociodemographic attributes and psychiatric diagnoses extracted from the electronic medical records (EMR) can benefit therapeutic interventions. These findings indicate a need for creating more trauma-informed settings with knowledgeable, trained staff.

Predictors of physical intimate partner violence in the lives of young women: victimization, perpetration, and bidirectional violence.

BACKGROUND: Dating violence in young people is highly prevalent, and bidirectional violence characterizes most violent relationships. However, there is limited data on predictors of bidirectional violence in young relationships. PURPOSE: To examine the frequency of victimization, perpetration, and bidirectional physical violence in young women's relationships and compare individual and relationship characteristics across violence profiles. METHODS: Six hundred eighteen young women visiting an urban reproductive health care clinic completed an anonymous survey using the Conflict in Adolescent Dating Relationships Inventory to measure their experience of violence with a partner in the last year. RESULTS: Thirty-four percent of women reported at least one instance of physical violence (3% "victim only" 12% "perpetrator only," 19% "bidirectional"). The frequency of violence in the previous year within the bidirectional profile was significantly higher than both the victim-only and perpetrator-only profiles. In all adjusted models, younger age, childhood sexual abuse, witnessing parental intimate partner violence (IPV), and relationship length remained significant. Black race was predictive of both perpetration and bidirectional violence, but not victimization. Compared to nulliparous women or those with one previous pregnancy, those who had had two or more had twice the odds of both victimization and bidirectional, but no increase in odds of perpetration. CONCLUSIONS: Bidirectional violence was the most common profile and was associated with the highest frequency of violent behaviors. Contrary to expectation, only two variables differed significantly across the three violence profiles. However, as hypothesized, bidirectional relationships were characterized by longer length, lending moderate support for social learning theory as one explanation underlying the occurrence of bidirectional violence.

Mindfulness training for community-based psychotherapists: a feasibility study.

BACKGROUND: While mindfulness training's feasibility has been assessed in many health care settings, the feasibility of teaching mindfulness to psychotherapists of various orientations for both self- and patient-care has not been explored. The objectives of this feasibility assessment were to determine the degree to which clinic psychotherapists were willing to complete a skills-based mindfulness training program; evaluate the acceptability of integrating mindfulness interventions into an urban community mental health clinic; examine the training's influence on both personal mindfulness practice and integration into patient care; and explore the impact of a support group following the training. METHODS: Data on six aspects of feasibility were gathered through quantitative surveys, semi-structured qualitative interviews, and group observation and feedback, analyzed using grounded theory. RESULTS: Sixteen therapists and one administrator attended at least one session of this voluntary program and responded to the associated surveys. At 1-year post-training, 7 participants had attended one or more group support sessions, and 4 more than 50% of sessions. The following factors were identified as contributing to the training's success: significant interest on the part of clinic staff to receive the training; diversity of the teaching staff, buy-in from clinic administration, provision of meditation scripts, role-play exercises, the variety of practices taught, and case presentations. Therapists indicated that the training helped them create a personal mindfulness practice, and several proceeded to integrate mindfulness into client sessions. A bi-weekly support group organized after the training encompassed group practice, discussion, case presentations, and information about trauma-sensitive mindfulness. Clinicians identified the following challenges to integrating mindfulness into sessions: lack of scripts in client languages other than English, the unacceptability of mindfulness to some clients' religious beliefs, the lack of appropriateness for clients facing ongoing psychosocial crises, the lack of interest on the part of some clients, and the time constraints posed by brief therapy sessions. CONCLUSIONS: These findings indicate that such training may be feasible in community mental health settings given support from leadership and the presence of qualified facilitators within the organization. Adaptations to the training based on participant feedback can inform a larger scale trial that compares our protocol with another intervention in the treatment of a psychological disorder or condition identified by the participants as having responded favorably to the program.

Developing culturally relevant educational materials about emergency contraception.

New York City has growing numbers of Mexican and Caribbean born residents, who have been identified as underserved communities for reproductive health care. We conducted exploratory focus groups to develop and test messages about emergency contraception that would be culturally relevant to these communities. Findings reveal lack of knowledge about what emergency contraception is and how it works, concerns about safety, and health care barriers. Multiple messages were tested in Spanish and English, and participants expressed positive attitudes about using emergency contraception once they knew that is was different from an abortion pill.

Con un pie en dos islas: cultural bridges that inform sexual and reproductive health in the Dominican Republic and New York.

Immigrants from the Dominican Republic have grown in number and currently make up a substantial portion of New York City's population. In order to better understand the cultural context of Dominican women's sexual and reproductive health attitudes and practices, focus groups were conducted with Dominican women living in New York City as well as with women living in the Dominican Republic. Analysis found that women in the USA had more economic independence and a greater sense of freedom in regards to sexuality than women in the Dominican Republic. However, those in New York City also hoped to maintain their cultural identity in many ways. Women associated the prevalence of gender-based violence with male unemployment and alcohol abuse. Women in both locales reported limited condom use and saw contraception as a woman's responsibility. Many barriers to using the healthcare system were identified and, in many cases, there exists a preference for herbal treatments and folk remedies. This study provided many important insights that have the potential to increase the quality of sexual and reproductive health care for Dominican women.

Screening for intimate partner violence in reproductive health centers: an evaluation study.

This study compared rates of intimate partner violence reports on a new, empirically-developed screening tool completed by 385 women in 2007 to those from an older tool completed by 420 women in 2006. Data were obtained from randomly selected medical charts across three health center locations, which were part of the same reproductive health care organization. Chi-square analyses were conducted to test associations between demographic characteristics and partner violence reports. Multiple regression analyses were used to compare odds ratios of disclosure by type of screening tool, adjusting for associated demographic factors associated with partner violence reports. Women completing the old and new tools were similar across all demographic characteristics. After adjusting for age and center location, women completing the new screening form were more than 2.5 times as likely to report any partner violence. When analyzed by mutually exclusive violence history categories, women completing the new screening form were over 2.5 times as likely to report past or current violence and over 4 times as likely to report experiencing both past and current violence. Findings suggest that implementing empirically developed brief screening tools for partner violence in reproductive health settings may elicit more disclosures from patients than more traditional tools.

Understanding control in adolescent and young adult relationships.

OBJECTIVES: To describe the receipt of controlling behaviors in young women's dating relationships and the association with physical and sexual relationship violence (RV) and to ascertain whether young women experiencing controlling from partners support RV screening and respond honestly. DESIGN: Anonymous audio computer-assisted self-interview. SETTING: Reproductive health center. PARTICIPANTS: A total of 603 women aged 15 to 24 years seeking reproductive care. MAIN OUTCOME MEASURES: Self-reported victimization (controlling behaviors and physical and sexual aggression) by a partner in the past year. RESULTS: Sixty-eight percent of participants reported receiving 1 or more episodes of controlling behavior by a partner: 38.1% reported experiencing only controlling behaviors; 11.4% and 10.0% reported receiving controlling behaviors plus physical or sexual victimization, respectively; and 8.6% reported all forms of RV. Adjusted Poisson regression found that age 15 to 18 years (relative risk, 1.40), Hispanic ethnicity (1.29), childhood exposure to domestic violence (1.11), ever pregnant (1.21), older partner (1.28), recent physical (1.89) or sexual (1.93) victimization, and uncomfortable asking for condom use (1.39) were significantly associated with increased episodes of controlling behavior by a partner. Younger women and those who reported being victimized by controlling behaviors were more than twice as likely to object to screening by a health care provider, and those who reported receiving these behaviors were 2.5 times more likely to report that they might not honestly disclose RV. CONCLUSIONS: Controlling behaviors are strongly associated with physical and sexual RV. Young women experiencing controlling behaviors are more reticent about screening for RV and may not feel that they can answer honestly.

Barriers to screening for intimate partner violence: a mixed-methods study of providers in family planning clinics.

CONTEXT: Universal screening for intimate partner violence has been recommended for health care settings. However, provider adherence to this recommendation is low, and little research has explored perspectives on relevant policies and procedures among providers in family planning centers. METHODS: In 2009, a sample of 75 health care staff from a large, urban family planning organization that has a protocol for screening for partner violence participated in focus group discussions about their attitudes toward, perceptions of barriers to and preparedness for such screening; 64 of them also completed a brief survey. Multiple analysis of variance was used to assess differences between licensed practitioners (advanced practice clinicians and social workers) and unlicensed health care assistants; findings were analyzed for congruence with and divergence from the focus group data. RESULTS: Barriers included lack of time, training and referral resources, but were reported less by licensed than by unlicensed providers. Overall, participants rated screening as helpful to clients, but licensed providers had more positive attitudes toward and felt more prepared for it than unlicensed ones. In the focus groups, some providers expressed frustration with clients' responses to referrals, concern about taking too much time away from other health care matters and opinions that it was more appropriate for licensed professionals than for unlicensed practitioners to conduct screening. Both licensed and unlicensed staff wanted more training on responding to disclosures of violence. CONCLUSIONS: Family planning providers who are working under an institutional protocol continue to perceive barriers to screening and may benefit from ongoing professional development.

A randomized trial of screening for relationship violence in young women.

OBJECTIVES: We conducted a randomized controlled trial of three screening approaches to assess relationship violence disclosure among young women as well as patient and provider satisfaction. METHODS: Reproductive healthcare patients (n=699) aged 15 to 24 years completed one of three approaches to violence screening, that is, basic, healthy relationship, and bidirectional. Screening was embedded in a comprehensive health history using an audio-assisted computer interview (ACASI). Afterward, the patient met with the provider, who reviewed screening results. The patient and provider independently completed an assessment of the process. RESULTS: Medical and violence screening took about 8 minutes with those in the basic screening finishing significantly more quickly. We did detect a significant difference by screening approach for recent physical violence victimization, but no other significant differences emerged between screening approaches. Although patients' or providers' satisfaction and comfort with the screening process were positive, no differences were detected. CONCLUSIONS: An approach that frames questioning within a birectional context enhances detection of recent physical victimization, and can be completed in busy reproductive healthcare setting. All screens were equally and highly regarded by participants and adequately rated by providers.

Attitudes about intimate partner violence screening among an ethnically diverse sample of young women.

PURPOSE: This clinic-based study investigated attitudes about intimate partner violence (IPV) screening among an ethnically diverse population of adolescent and young adult women (n = 645). METHODS: A cross-sectional quantitative and qualitative survey assessed experiences with and attitudes toward IPV screening. RESULTS: Almost all participants supported universal IPV screening and over 90% believed that a health care provider was the most appropriate adult to ask them about interpersonal violence. Young women's concerns toward screening varied by age and violence experience; those most likely to mind being screened were younger, had a history of childhood sexual abuse, and were victims of physical violence in the last year. However, even in these groups, over 70% supported IPV screening. Qualitative analyses suggested that provider qualities and confidentiality will affect the amount of disclosure to provider-initiated screening. Women also raised important questions about how to define IPV in relationships. CONCLUSIONS: Young women generally favor universal screening of interpersonal violence, but provider qualities and confidentiality issues affect responses to screening questions.